2025-10-29T11:45:15-05:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2024-01-01 391209707 BETHEL HOME INC BETH 9202325238 225 N EAGLE STREET OSHKOSH WI 54902 THERESA BERTRAM PRESIDENT/CEO/CFO 9202325238 2025-10-28 1 1 KRISTEN DONLEVY P01670215 4144761880 2025-10-28 2024 2025-03-06 01:10:19Z THERESA BERTRAM 225 N EAGLE STREET OSHKOSH WI 54902 10552606 0 9386 X WWW.MIRAVIDALIVING.COM X 1966 WI BETHEL HOME IS PART OF A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS COMMITTED TO PROVIDING QUALITY CARE AND LIFE-ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 9 9 183 9 0 0 3416 38860 9968414 10423127 6967 23567 662846 67052 10641643 10552606 0 0 0 0 6633169 6854116 0 0 0 3520942 3183919 10154111 10038035 487532 514571 7037264 7478527 3833657 3760349 3203607 3718178 BETHEL HOME IS PART OF A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS COMMITTED TO PROVIDING QUALITY CARE AND LIFE-ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 8862283 10423127 BETHEL HOME, INC., OPERATES A 100-BED NURSING HOME PROVIDING SKILLED AND INTERMEDIATE NURSING CARE FOR THE AGED AND DISABLED OF OSHKOSH AND THE SURROUNDING AREA. THE HOME ALSO OPERATES A 12-BED DEMENTIA-SPECIFIC COMMUNITY-BASED RESIDENTIAL FACILITY. 8862283 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 183 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KIM MAKI 9202325238 225 N EAGLE STREET OSHKOSH WI 54902 MARK BEECHER CHAIR 0.20 1.40 X X 0 0 0 NATE OLSON VICE CHAIR 0.20 1.40 X X 0 0 0 JIM STAPEL BOARD MEMBER 0.20 1.40 X 0 0 0 STEW RIECKMAN BOARD MEMBER 0.20 1.40 X 0 0 0 MARK BOETTCHER BOARD MEMBER 0.20 1.40 X 0 0 0 DIANE LANGDON BOARD MEMBER 0.20 1.40 X 0 0 0 JASON LOWE BOARD MEMBER 0.20 1.40 X 0 0 0 DR PAULA MCNIEL BOARD MEMBER 0.20 1.40 X 0 0 0 JAMIE BONELL SECRETARY 0.20 1.40 X 0 0 0 THERESA BERTRAM PRESIDENT/CEO/CFO 4.00 34.00 X 0 363150 0 KELLY FITZPATRICK ADMINISTRATOR 40.00 0.00 X 133009 0 0 133009 363150 0 1 0 1 0 SHIFTKEY PO BOX 735913 DALLAS TX 753735913 STAFFING SERVICES 734569 KELSTAR PARTNERSHIP GROUP N8874 CHURCH ST FOREST JUNCTION WI 54123 STAFFING SERVICES 692863 MARTIN BROS DISTRIBUTING CO PO BOX 69 CEDAR FALLS IA 50613 FOOD SUPPLIER 377971 FUNCTIONAL PATHWAYS LLC 10133 SHERRILL BLVD KNOXVILLE TN 379323347 THERAPY SERVICES 226546 ELIM PREFERRED SERVICES 3500 HOLLY LANE SUITE 30 PLYMOUTH MN 55447 THERAPY SERVICES 108290 5 38860 38860 RESIDENT REVENUE 623000 10395627 10395627 PHARMACY RENT 623000 27500 27500 10423127 23567 23567 TRANSPORTATION REVENUE 900099 28721 28721 MEAL REVENUE 900099 15976 15976 OBRA SCREENING 900099 11660 11660 10695 10695 67052 10552606 10423127 0 90619 6292399 5998295 294104 45120 43011 2109 210868 201012 9856 305729 291439 14290 585000 585000 29878 29878 73634 3975 69659 356309 346642 9667 4913 4913 74229 18707 55522 70362 70362 447520 444055 3465 3604 3604 287325 287325 151737 151737 FOOD 377527 377527 MEDICAL SUPPLIES 318391 318391 BED ASSESSMENT 204000 204000 MISCELLANEOUS EXPENSE 72535 72535 126955 100028 26927 10038035 8862283 1175752 0 2012 1036802 713483 1541101 1937974 41546 29313 27591 23141 17612201 15961514 1840999 1650687 237634 367583 2309579 2756346 7037264 7478527 749071 759409 69055 55310 3015531 2945630 3833657 3760349 X 3203607 3718178 3203607 3718178 7037264 7478527 514571 0 X 0 1 X 1 1 1 X 700213 1975576 315484 3416 38860 3033549 8078208 8361449 8504293 9968414 10434487 45346851 8778421 10337025 8819777 9971830 10473347 48380400 0 149023 385398 1416162 1438166 1857278 5246027 149023 385398 1416162 1438166 1857278 5246027 43134373 27036 10036 -2343 5967 23567 64263 27036 10036 -2343 5967 23567 64263 44080 38422 24310 662846 120747 890405 8849537 10385483 8841744 10640643 10617661 49335068 0.87430 0.91030 0.00130 0.00130 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: TRAINING REVENUE - MEAL REVENUE - 2020 AMOUNT: $ 22,126. 2021 AMOUNT: $ 15,340. 2022 AMOUNT: $ 11,533. 2023 AMOUNT: $ 8,197. 2024 AMOUNT: $ 15,976. MISCELLANEOUS INCOME - 2020 AMOUNT: $ 7,023. 2021 AMOUNT: $ 8,885. 2022 AMOUNT: $ 2,175. 2023 AMOUNT: $ 634,931. 2024 AMOUNT: $ 75,851. TRANSPORTATION INCOME - 2020 AMOUNT: $ 40. 2021 AMOUNT: $ 138. 2022 AMOUNT: $ 140. 2023 AMOUNT: $ 9,453. 2024 AMOUNT: $ 28,721. OTHER INCOME - 2020 AMOUNT: $ 3,240. 2021 AMOUNT: $ 3,990. 2022 AMOUNT: $ 2,970. 2023 AMOUNT: $ 4,194. 2024 AMOUNT: $ 199. VACCINE INCOME - 2020 AMOUNT: $ 11,651. 2021 AMOUNT: $ 10,069. 2022 AMOUNT: $ 7,492. 2023 AMOUNT: $ 6,071. 2024 AMOUNT: $ 0. 0 1 X 26261 26261 8599294 8082135 517159 636235 541293 94942 8276713 7338086 938627 73698 73698 1650687 DUE FROM AFFILIATES 2663330 RESIDENTS' CUSTODIAL ACCOUNTS 9239 SECURITY DEPOSITS 83777 2756346 ASSET RETIREMENT OBLIGATIONS 157837 DUE/TO FROM AFFILIATES 2787793 2945630 X PART IV, LINE 2B: RESIDENT'S CUSTODIAL ACCOUNTS CONSIST OF AMOUNTS ON DEPOSIT WITH BETHEL HOME BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY RESIDENTS. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE INCOME TAX STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATOIN FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT/CEO/CFO 0 363150 0 0 0 0 0 0 0 0 0 363150 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, MIRAVIDA LIVING, INC. THE FOLLOWING METHODS WERE USED BY MIRAVIDA LIVING, INC. TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND VOTING MEMBERSHIP MEETINGS. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES. FORM 990, PART VI, SECTION A, LINE 6 MIRAVIDA LIVING, INC., IS THE SOLE MEMBER OF BETHEL HOME, INC. THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND VOTING MEMBERSHIP MEETINGS. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF BETHEL HOME, INC. ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION A, LINE 7B MAJOR STANDARD OPERATING PROCEDURES, MAJOR POLICIES, AND PROGRAMS OF BETHEL HOME, INC. ARE SUBMITTED TO THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC., FOR APPROVAL AND IMPLEMENTATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION B, LINE 11B BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE CEO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FORM TO EACH MEMBER OF THE BOARD OF DIRECTORS AND VARIOUS COMMITTEE MEMBERS NOT ON THE BOARD THAT REQUIRES EACH TO IDENTIFY POTENTIAL CONFLICTS OR OTHER RELATED PARTY INTERESTS. THE REPORTS ARE REVIEWED BY THE SECRETARY AND CEO AND ANY CONFLICTS ARE BROUGHT TO THE BOARD'S ATTENTION. A MEMBER OF THE BOARD WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON ANY SUCH ISSUE BEFORE THE BOARD. ANY QUESTION OF WHETHER THERE IS A CONFLICT IS RESOLVED BY THE BOARD OF DIRECTORS. IF THE BOARD OF DIRECTORS DETERMINES THAT A DIRECTOR HAS COMMITTED A SUBSTANTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL IS REMOVED FROM THE OFFICE OF DIRECTOR. IN ADDITION, ALL MANAGEMENT AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATION'S POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. MIRAVIDA LIVING INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 10 N/A 0 CARMEL RESIDENCE INC 220 NORTH WESTFIELD STREET OSHKOSH WI 59402 391448325 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 GABRIEL'S VILLA INC 215 NORTH WESTFIELD STREET OSHKOSH WI 59402 391857036 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA APARTMENTS INC 155 NORTH EAGLE STREET OSHKOSH WI 59402 237148097 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391238670 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391270056 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 MIRAVIDA LIVING FOUNDATION INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 010938793 FUNDRAISING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 0 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC 3151 EDEN COURT OSHKOSH WI 54904 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0