2024-07-29T09:05:50-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-10-01 391948898 BETHANY SHADOW WOODS INC BETH 7152585521 1226 BERLIN STREET WAUPACA WI 54981 GREG REICHENBACH CEO 7152585521 2024-07-25 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-07-17 2022 2024-08-08 14:25:15Z GREG REICHENBACH 1226 BERLIN STREET WAUPACA WI 54981 779524 0 X WWW.BETHANYOFWAUPACA.COM X 1961 WI BETHANY SHADOW WOOD, INC.'S (THE "CORPORATION") PRIMARY ACTIVITY IS PROVIDING INDEPENDENT RETIREMENT LIVING FACILITIES AND SERVICES TO INDIVIDUAL'S AND/OR COUPLES WHO MEET CERTAIN AGE CRITERIA SET BY THE CORPORATION'S BOARD OF DIRECTORS. 9 9 0 12 7898 2917 0 0 614921 689123 -35520 43 21198 4176 600599 693342 0 0 0 0 0 0 0 0 0 478583 465772 478583 465772 122016 227570 2606223 2539902 2372067 2078176 234156 461726 X BETHANY SHADOW WOOD, INC.'S (THE "CORPORATION") PRIMARY ACTIVITY IS PROVIDING INDEPENDENT RETIREMENT LIVING FACILITIES AND SERVICES TO INDIVIDUAL'S AND/OR COUPLES WHO MEET CERTAIN AGE CRITERIA SET BY THE CORPORATION'S BOARD OF DIRECTORS. 0 0 319106 0 689123 BETHANY SHADOW WOODS, INC. (THE "CORPORATION") OPERATES A COMPLEX CURRENTLY MADE UP OF 20 DUPLEXES, BUILT TO MEET THE NEEDS OF RESIDENTS. THE DUPLEXES ARE LOCATED WITHIN THE CITY LIMITS OF WAUPACA, WISCONSIN, ABOUT ONE BLOCK FROM BETHANY HOME, INC., A SKILLED NURSING FACILITY. THE CORPORATION'S RETIREMENT DUPLEXES OFFER APPROXIMATELY 1,050 SQUARE FEET OF LIVING SPACE ON THE MAIN FLOOR AND HAVE TWO BEDROOMS; A PATIO AREA; AND A SINGLE CAR GARAGE WITH SIDE STORAGE AREA IN ONE UNIT MODEL (34 TOTAL UNITS), AND 1,450 SQUARE FEET OF LIVING SPACE ON THE MAIN FLOOR WITH TWO BEDROOMS, TWO BATHROOMS, A PATIO AREA AND A DOUBLE CAR GARAGE IN THE SECOND UNIT MODEL (6 TOTAL UNITS). IN ADDITION, BETHANY SHADOW WOODS, INC OPERATES A SINGLE FAMILY HOME ON 139 SHADOW LAKE DRIVE WHICH FUNCTIONS THE SAME AS THE DUPLEXES WITH THE SAME CRITERIA. FINALLY, 150 SHADOW LAKE DRIVE OPERATES AS A SHORT-TERM RENTAL UNIT FOR RESIDENT/ FAMILY GATHERINGS AND OTHER SUPPORTIVE GROUPS. THE CORPORATION'S UNITS ARE DESIGNED WITH ALL ESSENTIAL SERVICES ON THE MAIN FLOOR SO THAT PEOPLE WITH IMPAIRED MOBILITY DO NOT HAVE TO USE THE STAIRS. THE STAIRWAYS TO THE LOWER LEVELS OF THE UNITS ARE EQUIPPED WITH HAND RAILS ON BOTH SIDES TO MAKE IT EASIER AND SAFER FOR RESIDENTS TO TRAVEL THEM. THE ENTRANCES OF THE UNITS ARE ALSO DESIGNED WITH NO STEPS MAKING IT EASY FOR INDIVIDUALS WITH LIMITED MOBILITY TO ACCESS THEIR HOMES. FOR AN ADDITIONAL FEE, THE CORPORATION PROVIDES MEALS AND HOUSEKEEPING. A COMPLIMENTARY SHOPPING AND ERRANDS PROGRAM IS AVAILABLE ON A "AS-NEEDED" BASIS. IN ADDITION, SOCIAL WORK, CLINICAL ASSESSMENTS, AND LIMITED PREVENTATIVE SCREENINGS ARE AVAILABLE FOR NO CHARGE.THE CORPORATION PROVIDES "CARE-FREE LIVING". THE CORPORATION'S LIFE LEASE RESIDENTS PAY A MINIMUM MONTHLY SERVICE FEE, AND THIS FEE COVERS THE COSTS OF LAWN CARE, SNOW REMOVAL, GARBAGE SERVICE, WATER AND SEWER FEES, CABLE TELEVISION SERVICE, ALL EXTERIOR MAINTENANCE, MAINTENANCE ON ALL SUPPLIED APPLIANCES, CARETAKER SERVICES DURING TIMES THAT RESIDENTS ARE AWAY ON VACATION AND ALSO INCLUDES INSURANCE ON THE BUILDINGS. INDIVIDUALS WHO RENT OR LEASE ONE OF THE CORPORATION'S UNITS ALSO RECEIVE THE BENEFIT OF PRIORITY ADMISSION TO BETHANY PINES, AN ASSISTED LIVING FACILITY AND BETHANY HOME, INC., A SKILLED NURSING FACILITY LOCATED CLOSE TO THE CORPORATION'S COMPLEX. THIS BENEFIT HELPS THE CORPORATION'S RESIDENTS FEEL MORE SECURE, KNOWING THAT HEALTH CARE SERVICES ARE AVAILABLE A SHORT DISTANCE AWAY FROM THEIR CURRENT RESIDENCE. 319106 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 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 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 WI X MICHELE MAZEMKE 7159421430 1226 BERLIN STREET WAUPACA WI 54981 JOE JONES PRESIDENT 0.10 0.40 X X 0 0 0 BARB CONRADT VICE PRESIDENT 0.10 0.40 X X 0 0 0 VICKI GROTH SECRETARY/TREASURER 0.10 0.40 X X 0 0 0 SUE ABRAHAMSON DIRECTOR 0.10 0.40 X 0 0 0 LORI CARLSON DIRECTOR 0.10 0.40 X 0 0 0 MIKE JACQUARDT DIRECTOR 0.10 0.40 X 0 0 0 VICKI NATZKE DIRECTOR 0.10 0.40 X 0 0 0 ERINN TUBBS DIRECTOR 0.10 0.40 X 0 0 0 DALE WILSON DIRECTOR 0.10 0.40 X 0 0 0 SHELLY SONTAG ADMINISTRATOR/CEO 5.00 35.00 X 0 173947 26582 CINDY ZARDA FINANCE DIRECTOR 5.00 35.00 X 0 34194 2750 MICHELE MAZEMKE HUMAN RESOURCE DIRECTOR 5.00 35.00 X 0 75736 5619 0 283877 34951 0 0 1 0 BETHANY HOME INC 1226 BERLIN STREET WAUPACA WI 54981 ADMINISTRATIVE AND MAINTENANCE SERVICES 128245 1 RETIREMENT LIVING 623990 689123 689123 689123 43 43 82846 86182 -3336 -3336 7898 -11234 7512 7512 7512 693342 689123 7898 -3679 112849 112849 2500 2500 14361 10225 4136 258 258 29334 29334 91051 91051 71825 71825 113255 106173 7082 10240 10240 MUNICIPAL SERVICE FEES 20099 20099 465772 319106 146666 0 449094 581280 2890 2370 5990208 4277633 1760157 1712575 394082 243677 2606223 2539902 83692 109195 46355 13417 153244 79755 2088776 1875809 2372067 2078176 X 234156 461726 234156 461726 2606223 2539902 227570 0 X 0 1 X 1 0 X 557606 572998 592989 621223 689123 3033939 557606 572998 592989 621223 689123 3033939 0 286292 267509 283115 304018 338416 1479350 286292 267509 283115 304018 338416 1479350 1554589 15768 12057 23559 26438 22558 100380 6650 13845 7898 28393 15768 12057 30209 40283 30456 128773 573374 585055 623198 661506 719579 3162712 0.49150 0.48860 0.04070 0.03680 X 0 1 X 549270 549270 4661773 3705470 956303 434336 371270 63066 344829 200893 143936 1712575 DUE FROM BETHANY HOME 243677 243677 PART IV, LINE 2B: THE ORGANIZATION HOLDS SECURITY DEPOSITS UNDER LEASE AGREEMENTS WHICH ARE REFUNDABLE BACK TO THE TENANTS AT LEAST TERMINATION. 0 0 0 0 0 0 0 0 0 SHELLY SONTAG ADMINISTRATOR/CEO 0 173947 0 0 0 0 0 6310 0 20272 0 200529 0 0 FORM 990, PART VI, SECTION A, LINE 3 EMPLOYEES OF BETHANY HOME, INC., A 501(C)(3) ORGANIZATION, (RELATED ORGANIZATION ON SCHEDULE R) PERFORM ALL ADMINISTRATION AND MAINTENANCE DUTIES FOR BETHANY SHADOW WOODS. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE REVIEWS THE FORM 990 BEFORE BRINGING IT TO THE BOARD OF DIRECTORS FOR APPROVAL TO FILE. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS DIRECTED NOT ONLY TO DIRECTORS AND OFFICERS, BUT TO ALL EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF BETHANY SHADOW WOODS, INC. THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL, AND ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING BETHANY SHADOW WOODS, INC. IT IS ASSUMED THAT THE DIRECTORS, OFFICERS, AND MANAGEMENT EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTERESTS DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARD, OFFICERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND IMMEDIATELY MAKE SUCH DISCLOSURES. DISCLOSURE IN THE ORGANIZATION SHOULD BE MADE TO THE ADMINISTRATOR/CEO (IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE BOARD. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE BOARD CHAIR (IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD VICE-CHAIR) WHO SHALL BRING THESE MATTERS TO THE BOARD. THE BOARD SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO BETHANY SHADOW WOODS, INC. THE DECISION OF THE BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION, AND THEIR CONCERN MUST BE WITH THE WELFARE OF BETHANY SHADOW WOODS, INC. AND THE ADVANCEMENT OF ITS PURPOSE. FORM 990, PART VI, SECTION C, LINE 19 BETHANY SHADOW WOODS, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. BETHANY HOME INC 1226 BERLIN STREET WAUPACA WI 54981 390868849 NURSING HOME WI 501(C)3 LINE 11 N/A 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0