2016-11-11T15:20:39-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2015-01-01 391209707 BETHEL HOME INC BETH 9202354653 225 NORTH EAGLE STREET OSHKOSH WI 54902 THERESA M BERTRAM PRESIDENT & CEO 9202325238 2016-11-10 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2016-09-15 2015 2017-02-10 21:41:12Z THERESA M BERTRAM 225 NORTH EAGLE STREET OSHKOSH WI 54902 10810637 0 9386 X WWW.LUTHERANHOMES.COM X 1966 WI TO PROVIDE NURSING CARE FOR AGING PERSONS. 10 10 256 36 0 0 386924 137638 10022581 10576232 2779 1935 122462 94832 10534746 10810637 0 0 0 0 6854596 6605225 0 0 0 4006872 3958338 10861468 10563563 -326722 247074 6025780 5924826 1649481 1301453 4376299 4623373 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 8982384 0 10576232 BETHEL HOME, INC., OPERATES A 128-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. 8982384 1 1 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 26 0 1 256 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X KIM MAKI 9202325238 225 NORTH EAGLE STREET OSHKOSH WI 54902 MARK BEECHER CHAIR 0.20 1.40 X X 0 0 0 KATHLEEN BELLAIRE VICE CHAIR 0.20 1.40 X X 0 0 0 THOMAS DUNHAM SECRETARY 0.20 1.40 X X 0 0 0 KAREN JACOBSON BOARD MEMBER 0.20 1.40 X 0 0 0 DR ROGER HEROLD BOARD MEMBER 0.20 1.40 X 0 0 0 MARY MURKEN BOARD MEMBER 0.20 1.40 X 0 0 0 REV KAREN JEWELL BOARD MEMBER 0.20 1.40 X 0 0 0 DR SUZANNE MARNOCHA BOARD MEMBER 0.20 1.40 X 0 0 0 WAYNE MUELLER BOARD MEMBER 0.20 1.40 X 0 0 0 JIM STAPEL BOARD MEMBER 0.20 1.40 X 0 0 0 THERESA BERTRAM PRESIDENT & CEO 4.50 36.00 X 0 237487 2835 JULIE VANDENBERG CORPORATE SECRETARY 4.50 36.00 X 0 73156 254 GERARD BODALSKI VP HEALTHCARE SERVICES 40.00 X 162045 0 1742 162045 310643 4831 1 0 1 0 GREENFIELD REHABILITATION AGENCY 7517 W COLDSPRING RD GREENFIELD WI 53220 THERAPY SERVICES 762472 REINHART FOOD SERVICE LLC 2655 EAST RICHMOND ST SHAWANO WI 54166 FOOD SUPPLIER 319046 WI DEPARTMENT OF HEALTH SERVICES PO BOX 093594 MILWAUKEE WI 53293 HEALTH SERVICES 273020 MCKESSON MEDICAL SURGICAL PO BOX 630693 CINCINNATI OH 45274 MEDICAL SUPPLIES 131061 4 42452 95186 137638 RESIDENT REVENUE 623000 10576232 10576232 10576232 1935 1935 18217 0 18217 18217 18217 MEAL REVENUE 900099 58234 58234 OBRA SCREENING 900099 2460 2460 TRANSPORTATION REVENUE 900099 22 22 15899 15899 76615 10810637 10576232 0 96767 5524881 5248238 276643 106893 101541 5352 571561 542942 28619 401890 381766 20124 669648 669648 583 583 45079 2200 42879 796473 794691 1782 28309 28309 960790 912926 47864 27394 27394 380262 375176 5086 7614 4289 3325 2788 2788 408142 408142 144132 144132 BED ASSESSMENT 273020 273020 BAD DEBT EXPENSE 120000 120000 EQUIPMENT AND REPAIRS 35801 35801 MISCELLANEOUS 18022 18022 40281 24852 15429 10563563 8982384 1581179 0 23715 18694 774099 1432274 549421 327447 48255 51781 73200 23730 15102653 12531325 2802794 2571328 114262 0 92699 92699 1547335 1406873 6025780 5924826 1185865 997030 77748 102829 41944 27724 245000 70000 98924 103870 1649481 1301453 X 4283600 4530674 92699 92699 4376299 4623373 6025780 5924826 247074 0 X X 0 1 X 1 0 X 72431 83147 258336 386924 137638 938476 10988783 10698668 10484131 10022581 10576232 52770395 11061214 10781815 10742467 10409505 10713870 53708871 0 0 0 53708871 29326 20895 15341 14779 20152 100493 29326 20895 15341 14779 20152 100493 184298 573943 178113 110462 76615 1123431 11274838 11376653 10935921 10534746 10810637 54932795 0.97770 0.97640 0.00180 0.00220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 26261 26261 8302063 6914510 1387553 452968 394252 58716 6164388 5222563 941825 156973 156973 2571328 DUE FROM AFFILIATES 1300776 RESIDENTS' CUSTODIAL ACCOUNTS 106097 1406873 ASSET RETIREMENT OBLIGATIONS 103870 103870 X PART IV, LINE 2B: RESIDENTS' 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'S NINE NONPROFIT CORPORATIONS ARE EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE ENTITES ARE NOT PRIVATE FOUNDATIONS, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. 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 0 198087 0 39400 0 0 0 0 0 2835 0 240322 0 0 GERARD BODALSKI VP HEALTHCARE SERVICES 159295 0 2750 0 0 0 0 0 1742 0 163787 0 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, LUTHERAN HOMES OF OSHKOSH, INC. THE FOLLOWING METHODS WERE USED BY LUTHERAN HOMES OF OSHKOSH, 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 1 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 LUTHERAN HOMES OF OSHKOSH, INC., IS THE SOLE MEMBER OF BETHEL HOME, INC. 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, LUTHERAN HOMES OF OSHKOSH, 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, LUTHERAN HOMES OF OSHKOSH, 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, LUTHERAN HOMES OF OSHKOSH, INC. FORM 990, PART VI, SECTION B, LINE 11 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 CORPORATE 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 B, LINE 15 CEO COMPENSATION IS DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE CONSIDERS COMPARABLE DATA AND ECONOMIC CONDITIONS. THE DELIBERATIONS ARE RECORDED. OTHER OFFICER AND SENIOR MANAGEMENT SALARIES ARE DETERMINED BY THE CEO, WITHOUT CONFLICT, IN CONJUNCTION WITH THE HUMAN RESOURCES MANAGER AND ARE BASED ON COMPARABLE DATA, PERFORMANCE MEASURES, AND OTHER ECONOMIC CONDITIONS. THIS PROCESS LAST OCCURRED IN 2015 FOR THE CEO AND FOR ALL OTHER OFFICERS AND SENIOR MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG. THE ORGANIZATION'S FORM 1023 IS ALSO AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S PROCESSES HAVE NOT CHANGED FROM PRIOR YEARS. LUTHERAN HOMES OF OSHKOSH INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 9 N/A 0 CARMEL RESIDENCE INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391448325 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 GABRIEL'S VILLA INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391857036 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA APARTMENTS INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 237148097 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391238670 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 391270056 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 BETHEL FOUNDATION OF OSHKOSH INC 225 NORTH EAGLE STREET OSHKOSH WI 59402 010938793 FUNDRAISING WI 501(C)(3) LINE 11A, I LUTHERAN HOMES OF OSHKOSH INC 0 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC 3151 EDEN COURT OSHKOSH WI 54902 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 0 0