BETHANY NURSING HOME AND HEALTH RELATED FACILITY INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
BETHANY NURSING HOME AND HEALTH RELATED FACILITY INC (EIN 51-0191763)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-10-18
IRS object ID
202242919349301079
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-10-18T14:11:14-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN161092347PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MENGEL METZGER BARR & CO LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1333 EAST WATER ST STE 200AddressLine1Txt
CityELMIRACityNm
State AbbreviationNYStateAbbreviationCd
ZIP14901ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN510191763EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BETHANY NURSING HOME AND HEALTH RELATEDBusinessNameLine1Txt
Business Name Line2FACILITY INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlBETHBusinessNameControlTxt
Phone6077344183PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13005 WATKINS ROADAddressLine1Txt
CityHORSEHEADSCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14845ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL KISERPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone6077344183PhoneNum
Signature2022-06-22SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMICHAELPersonFirstNm
Person LastKISERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKRISTA L NILES-UPDYKEPreparerPersonNm
PTINP00958947PTIN
Phone6077344183PhoneNum
Preparation2022-06-22PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMICHAEL KISERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13005 WATKINS ROADAddressLine1Txt
CityHORSEHEADSCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14845ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$10,577,157GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BETHANY-VILLAGE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1975FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionTO PROVIDE REGIONAL LEADERSHIP, SERVICES, ADVOCACY, AND EDUCATION FOR QUALITY SENIOR LIVING, WHILE OPERATING A VIBRANT, LIFE-AFFIRMING RESIDENTIAL COMMUNITY THAT CELEBRATES SPIRITUAL WELL-BEING, ENHANCES INDEPENDENCE AND PROMOTES WELLNESS AS ITS RESIDENTS EVOLVE TOWARD THEIR FULL POTENTIAL.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee205TotalEmployeeCnt
Total Volunteers11TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,212,153PYContributionsGrantsAmt
CY Contributions Grants$1,602,698CYContributionsGrantsAmt
PY Program Service Revenue$10,655,560PYProgramServiceRevenueAmt
CY Program Service Revenue$8,830,357CYProgramServiceRevenueAmt
PY Investment Income$5,189PYInvestmentIncomeAmt
CY Investment Income$9,123CYInvestmentIncomeAmt
PY Other Revenue$415,839PYOtherRevenueAmt
CY Other Revenue$134,979CYOtherRevenueAmt
PY Total Revenue$13,288,741PYTotalRevenueAmt
CY Total Revenue$10,577,157CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,405,620PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,492,073CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,876,895PYOtherExpensesAmt
CY Other Expenses$4,138,376CYOtherExpensesAmt
PY Total Expenses$11,282,515PYTotalExpensesAmt
CY Total Expenses$9,630,449CYTotalExpensesAmt
PY Revenues Less Expenses$2,006,226PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$946,708CYRevenuesLessExpensesAmt
Total Assets BOY$7,348,553TotalAssetsBOYAmt
Total Assets EOY$9,235,158TotalAssetsEOYAmt
Total Liabilities BOY$5,305,093TotalLiabilitiesBOYAmt
Total Liabilities EOY$6,244,990TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,043,460NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,990,168NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE MISSION OF BETHANY VILLAGE IS TO PROVIDE REGIONAL LEADERSHIP, SERVICES, ADVOCACY, AND EDUCATION FOR QUALITY SENIOR LIVING, WHILE OPERATING A VIBRANT, LIFE-AFFIRMING RESIDENTIAL COMMUNITY THAT CELEBRATES SPIRITUAL WELL-BEING, ENHANCES INDEPENDENCE AND PROMOTES WELLNESS AS ITS RESIDENTS EVOLVE TOWARD THEIR FULL POTENTIAL.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,122,449ExpenseAmt
Revenue$8,974,459RevenueAmt
DescOPERATES A SKILLED NURSING FACILITY WHICH PROVIDES HEALTH CARE SERVICES TO THE ELDERLY.Desc
Total Program Service Expenses$8,122,449TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document6IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee205EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MICHAEL KISER CPABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6077398711PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13005 WATKINS ROADAddressLine1Txt
CityHORSEHEADSCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14845ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
RICHARD CARR
TREASURER / SECRETARY2.00Yes (X)Yes (X)$0$0$0
RANDI HEWIT
BOARD MEMBER1.00Yes (X)$0$0$0
ANITA LEWIS
BOARD MEMBER1.00Yes (X)$0$0$0
CAROL LINCOLN
BOARD MEMBER1.00Yes (X)$0$0$0
MARY THERESE OWEN
BOARD MEMBER1.00Yes (X)$0$0$0
JASON PARMENTER
BOARD VICE CHAIR2.00Yes (X)Yes (X)$0$0$0
KIMBERLEE MIDDAUGH
BOARD MEMBER1.00Yes (X)$0$0$0
DAWN BURLEW
BOARD CHAIR2.00Yes (X)Yes (X)$0$0$0
ALISON HUNT
BOARD MEMBER1.00Yes (X)$0$0$0
DAVID HELSING
BOARD MEMBER1.00Yes (X)$0$0$0
JACK BENJAMIN
BOARD VICE CHAIR2.00Yes (X)Yes (X)$0$0$0
MICHAEL KISER
EXECUTIVE DIRECTOR40.00Yes (X)$178,908$0$27,871
LESLEY LATSHAW
ASSOCIATE EXECUTIVE DIRECT40.00Yes (X)$63,140$96,805$43,713
JAMES MARK
ADMINISTRATOR40.00$133,841$0$35,155Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$375,889TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$96,805TotReportableCompRltdOrgAmt
Total Other Compensation$106,739TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PREFERRED PHYSICAL THERAPY SOLUTIONS
850 SILAS DEAVE HIGHWAY 2ND FLOORWAETHERSFIELDCT06109MANAGES AND STAFFS PT/OT/SLP THERAPY PRO$863,605
MORRISON MANAGEMENT SPECIALISTS
PO BOX 102289ATLANTAGA30368DIETARY SERVICES$721,051
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$1,600,198GovernmentGrantsAmt
All Other Contributions$2,500AllOtherContributionsAmt
Total Contributions$1,602,698TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICARE AND MEDICAID623000$7,601,687$7,601,687
PRIVATE PAY623000$1,198,475$1,198,475
ANCILLARY SERVICES623000$30,195$30,195
FieldValueIRS element (for citing)
Total Program Service Revenue$8,830,357TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,123TotalRevenueColumnAmt
Related Or Exempt Func Income$9,123RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SHARED SERVICES/MGMT FEE623000$113,450$113,450
SUNDRY623000$21,529$21,529
FieldValueIRS element (for citing)
Other Revenue Total$134,979OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,577,157TotalRevenueColumnAmt
Related Or Exempt Func Income$8,974,459RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$285,970TotalAmt
Management And General$285,970ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,237,862TotalAmt
Program Services$3,606,097ProgramServicesAmt
Management And General$631,765ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$91,652TotalAmt
Program Services$81,500ProgramServicesAmt
Management And General$10,152ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$521,267TotalAmt
Program Services$433,440ProgramServicesAmt
Management And General$87,827ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$355,322TotalAmt
Program Services$286,811ProgramServicesAmt
Management And General$68,511ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$27,199TotalAmt
Management And General$27,199ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$51,778TotalAmt
Program Services$13,433ProgramServicesAmt
Management And General$38,345ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$916,133TotalAmt
Program Services$914,227ProgramServicesAmt
Management And General$1,906ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$66,547TotalAmt
Program Services$15,675ProgramServicesAmt
Management And General$50,872ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$58,822TotalAmt
Program Services$43,908ProgramServicesAmt
Management And General$14,914ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$163,933TotalAmt
Program Services$160,875ProgramServicesAmt
Management And General$3,058ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$3,554TotalAmt
Program Services$2,012ProgramServicesAmt
Management And General$1,542ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$104,189TotalAmt
Program Services$103,629ProgramServicesAmt
Management And General$560ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$383,101TotalAmt
Program Services$338,508ProgramServicesAmt
Management And General$44,593ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$149,596TotalAmt
Program Services$17,557ProgramServicesAmt
Management And General$132,039ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CONTRACTED SERVICES$1,272,961$1,230,888$42,073
CASH RECEIPTS ASSESSMEN$389,806$389,806
MEDICAL SUPPLIES AND DR$300,928$300,928
GENERAL SUPPLIES AND MA$173,665$128,113$45,552

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$76,164TotalAmt
Program Services$55,042ProgramServicesAmt
Management And General$21,122ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$9,630,449TotalAmt
Program Services$8,122,449ProgramServicesAmt
Management And General$1,508,000ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,300BOYAmt
EOY$1,300EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,061,304BOYAmt
EOY$5,018,156EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,216,319BOYAmt
EOY$970,337EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$34,642BOYAmt
EOY$93,835EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$12,242,050LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,973,137LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,574,305BOYAmt
EOY$1,268,913EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$460,683BOYAmt
EOY$1,882,617EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,348,553BOYAmt
EOY$9,235,158EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,420,075BOYAmt
EOY$916,841EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$105,405BOYAmt
EOY$127,763EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$842,893BOYAmt
EOY$2,878,003EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,936,720BOYAmt
EOY$2,322,383EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,305,093BOYAmt
EOY$6,244,990EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,043,460BOYAmt
EOY$2,990,168EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,043,460BOYAmt
EOY$2,990,168EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,348,553BOYAmt
EOY$9,235,158EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$946,708ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,258CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$61,286CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$207,891CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,388,350CurrentTaxYearMinus1YearAmt
Current Tax Year$1,516,483CurrentTaxYearAmt
Total$3,177,268TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,298,067CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$10,888,582CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,246,463CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$10,655,560CurrentTaxYearMinus1YearAmt
Current Tax Year$8,830,357CurrentTaxYearAmt
Total$52,919,029TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,301,325CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$10,949,868CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,454,354CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,043,910CurrentTaxYearMinus1YearAmt
Current Tax Year$10,346,840CurrentTaxYearAmt
Total$56,096,297TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$56,096,297PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,061CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$655CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$790CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,189CurrentTaxYearMinus1YearAmt
Current Tax Year$9,123CurrentTaxYearAmt
Total$22,818TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,061CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$655CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$790CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,189CurrentTaxYearMinus1YearAmt
Current Tax Year$9,123CurrentTaxYearAmt
Total$22,818TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$419,553CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$588,351CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$43,007CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$415,839CurrentTaxYearMinus1YearAmt
Current Tax Year$134,979CurrentTaxYearAmt
Total$1,601,729TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,727,939CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,538,874CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$11,498,151CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,464,938CurrentTaxYearMinus1YearAmt
Current Tax Year$10,490,942CurrentTaxYearAmt
Total$57,720,844TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.97190PublicSupportCY509Pct
Public Support PY5090.97120PublicSupportPY509Pct
Investment Income CY0.00040InvestmentIncomeCYPct
Investment Income PY0.00020InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,400OtherCostOrOtherBasisAmt
Book Value$24,400BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,408,621OtherCostOrOtherBasisAmt
Depreciation$6,872,614DepreciationAmt
Book Value$536,007BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$275,836OtherCostOrOtherBasisAmt
Depreciation$221,480DepreciationAmt
Book Value$54,356BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,533,193OtherCostOrOtherBasisAmt
Depreciation$3,879,043DepreciationAmt
Book Value$654,150BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,268,913TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDescBook ValueBookValueAmt
DUE FROM MEDICAID$39,379
DUE FROM AFFILIATED ENTITY$11,912
RESTRICTED CASH - RESIDENT DEPOSITS$127,048
RESTRICTED CASH - PROJECT FUNDS$190,295
EMPLOYEE RETENTION CREDIT$1,513,983
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,882,617TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO THIRD PARTIES$267,358
CAP LEASE OBLIG WITH AFFILIATE$1,981,961
DUE TO AFFILIATED ENTITIES$73,064
FieldValueIRS element (for citing)
Total Liability$2,322,383TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$10,577,157TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$10,577,157RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$10,577,157TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$9,630,449TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$9,630,449ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$9,630,449TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:RESIDENT DEPOSITS REPRESENT CASH HELD ON BEHALF OF THE RESIDENTS. SUCH FUNDS REPRESENT LIVING ALLOWANCES RECEIVED FROM THE STATE OF NEW YORK, AS WELL AS OTHER RESIDENT FUNDS DEPOSITED WITH THE FACILITY FOR SAFE KEEPING.
PART X, LINE 2:THE FACILITY IS A NON-PROFIT ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE REGULATIONS. THE FACILITY HAS FILED FOR AND RECEIVED INCOME TAX EXEMPTIONS IN THE VARIOUS JURISDICTIONS WHERE THEY ARE REQUIRED TO DO SO. THE FACILITY FILES FORM 990 TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND IN NEW YORK STATE. WITH FEW EXCEPTIONS, AS OF DECEMBER 31, 2021, THE FACILITY IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE DECEMBER 31, 2018. THE TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2018 THROUGH DECEMBER 31, 2021 ARE STILL SUBJECT TO POTENTIAL AUDIT BY THE IRS AND THE TAXING AUTHORITIES IN NEW YORK STATE. MANAGEMENT OF THE FACILITY BELIEVES IT HAS NO MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, IT HAS NOT RECOGNIZED ANY LIABILITY FOR UNRECOGNIZED TAX BENEFITS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MICHAEL KISER
EXECUTIVE DIRECTOR$178,908$0$0$0$0$0$0$0$27,871$0$206,779$0$0$0
LESLEY LATSHAW
ASSOCIATE EXECUTIVE DIRECT$63,140$96,805$0$0$0$0$0$0$16,051$0$79,191$96,805$0$0
JAMES MARK
ADMINISTRATOR$133,841$0$0$0$0$0$0$0$35,155$0$168,996$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 1BFormAndLineReferenceDesc
ExplanationTHE GOVERNING BOARD REVIEWS AND APPROVES ALL WAGE AND SALARY INCREASES THROUGH THE BUDGET PROCESS FOR THE EXECUTIVE DIRECTOR AND ASSOCIATE EXECUTIVE DIRECTOR.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE FINANCE COMMITTEE MEETS WITH A DESIGNATED BOARD MEMBER WHO HAS BEEN ASSIGNED BY THE OTHER BOARD MEMBERS TO REVIEW THE FORM 990. THE FORM 990 IS PRESENTED TO THE DESIGNATED BOARD MEMBER AND THE FULL EXTENT OF THE FORM AND ITS PREPARATION IS EXPLAINED AT THAT TIME. THE DESIGNATED BOARD EMMBER THEN REVIEWS AND APPROVES THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS WRITTEN CONFLICT OF INTEREST POLICY AT QUARTERLY MEETINGS AND QUALITY ASSURANCE AUDITS.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD REVIEWS AND APPROVES ALL WAGE AND SALARY INCREASES THROUGH THE BUDGET PROCESS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2CTHE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
BETHANY RETIREMENT HOME INC
3005 WATKINS ROADHORSEHEADSNY14845160988865HOUSING ELDERLYNY501(C)(3)LINE 10N/A0
ORCHARD HOMES AT BETHANY VILLAGE INC
3005 WATKINS ROADHORSEHEADSNY14845202019814HOUSING ELDERLYNY501(C)(3)LINE 10N/A0
BETHANY SENIOR CITIZENS' HOUSING INC
3005 WATKINS ROADHORSEHEADSNY14845222238087HOUSING ELDERLYNY501(C)(3)LINE 10N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1BETHANY VILLAGE DEVELOPMENT CORPORATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13005 WATKINS ROADAddressLine1Txt
CityHORSEHEADSCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14845ZIPCd
FieldValueIRS element (for citing)
EIN813458789EIN
Primary ActivitiesPROPERTY INVESTMENTSPrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BETHANY NURSING HOME AND HEALTH RELATED FACILITY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Ownership1.00000OwnershipPct
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
BETHANY SENIOR CITIZEN'S HOUSING INC
L$106,286MANAGEMENT AGREEMENT (CONTRACT)
BETHANY RETIREMENT HOME INC
Q$1,043,563SHARED SERVICE ALLOCATION
ORCHARD HOMES AT BETHANY VILLAGE INC
L$92,349SHARED SERVICE ALLOCATION
BETHANY RETIREMENT HOME INC
K$91,914DIRECT FINANCE LEASE INTEREST
BETHANY RETIREMENT HOME INC
R$304,062DIRECT FINANCE LEASE PRINCIPAL
ORCHARD HOMES AT BETHANY VILLAGE INC
Q$19,120SHARED SERVICE ALLOCATION
BETHANY SENIOR CITIZEN'S HOUSING INC
Q$7,164MANAGEMENT AGREEMENT (CONTRACT)

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