2022-11-14T11:14:13-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2021-01-01 390979908 FAIRHAVEN CORPORATION FAIR 2624732140 435 STARIN ROAD WHITEWATER WI 53190 PAUL KUENNING EXECUTIVE DIRECTOR 2624732140 2022-11-08 1 PAUL KUENNING 999009999 KIMBERLY ANDERSON P00188889 6086628600 2022-11-08 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z PAUL KUENNING 435 STARIN ROAD WHITEWATER WI 53190 10385766 0 X WWW.FAIRHAVEN.ORG X 1962 WI TO PROVIDE HOUSING AND SERVICES, INCLUDING SKILLED NURSING AND REHAB TO SENIOR ADULTS. 18 16 268 15 0 0 358866 1742095 11605565 8148305 158113 3562 644428 485911 12766972 10379873 2600 0 0 0 7016677 5491418 0 0 64403 5289942 4903501 12309219 10394919 457753 -15046 33350451 31820625 18890702 17144478 14459749 14676147 X TO PROVIDE HOUSING AND SERVICES WHICH PROMOTE DIGNITY AND WELL-BEING WITH SPIRITUAL, INTELLECTUAL, CULTURAL AND RECREATIONAL VITALITY. 0 0 9542127 0 8623579 SERVING RESIDENTS SINCE 1962, FAIRHAVEN CORPORATION (FAIRHAVEN OR THE CORPORATION) IS A NONPROFIT LIFE PLAN COMMUNITY RELATED TO THE WISCONSIN CONFERENCE OF THE UNITED CHURCH OF CHRIST, LOCATED IN WHITEWATER, WISCONSIN. FAIRHAVEN'S MAIN CAMPUS INCLUDES INDEPENDENT APARTMENTS, ASSISTED LIVING, SUPPORTIVE LIVING, MEMORY CARE, AND THE HEALTH AND REHABILITATION CENTER OFFERING SKILLED NURSING CARE. THE CORPORATION OFFERS LIFE LEASE ENTRANCE FEE AND MONTHLY FEE AGREEMENTS. THE CORPORATION HOLDS A COMMUNITY BASED RESIDENTIAL FACILITY (CBRF) LICENSE FOR 150 BEDS AVAILABLE IN 105 APARTMENTS AND 23 ASSISTED LIVING UNITS. IT ALSO HOLDS LICENSES FOR AN 82-BED SKILLED NURSING FACILITY AND A 24-BED CBRF MEMORY CARE RESIDENCE CALLED HEARTHSTONE. PRAIRIE VILLAGE IS AN INDEPENDENT PATIO HOME COMMUNITY FOR THOSE 55 AND OLDER LOCATED ONE MILE FROM THE MAIN CAMPUS. FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, 65 DUPLEX UNITS WERE IN USE, RESPECTIVELY. 9542127 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 1 0 0 0 1 46 0 268 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 16 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X PAUL KUENNING 2624732140 435 STARIN ROAD WHITEWATER WI 53190 JAMES CALDWELL PRESIDENT 1.00 1.00 X X 0 0 0 DR FRED WILEMAN VICE PRESIDENT 1.00 1.00 X X 0 0 0 GARY KINCAID SECRETARY/TREASURER 1.00 X X 0 0 0 ANN HERDENDORF DIRECTOR 1.00 X 0 0 0 DR RICHARD HANEY DIRECTOR 1.00 X 0 0 0 MARLEEN LIPPERT DIRECTOR 1.00 X 0 0 0 SHARON MCCULLOUGH DIRECTOR 1.00 X 0 0 0 MARK OLM EXECUTIVE COMMITTEE 1.00 X X 0 0 0 REV MAX RIGERT EXECUTIVE COMMITTEE 1.00 1.00 X X 0 0 0 MICHAEL WALLACE DIRECTOR 1.00 X 0 0 0 REV MARGARET SHEPHERD DIRECTOR 1.00 X 0 0 0 DR RICHARD TELFER DIRECTOR 1.00 X 0 0 0 REV JERALD WENDT DIRECTOR 1.00 X 0 0 0 PAUL KUENNING EXECUTIVE DIRECTOR 40.00 1.00 X X 145014 0 20262 DR GERALD THEUNE DIRECTOR 1.00 X 0 0 0 DR ROBERTA WEDL DIRECTOR 1.00 X 0 0 0 REV FRANZ RIGERT EX-OFFICIO 1.00 X 0 0 0 DR KENNETH KIDD DIRECTOR 1.00 X 0 0 0 145014 0 20262 2 0 1 0 DEMPSEY BUILDERS N9116 ADAMS ROAD EAST TROY WI 53120 CONSTRUCTION 450678 GREENFIELD REHABILITATION AGENCY 19395 W CAPITOL DR SUITE 200 BROOKFIELD WI 53045 THERAPY SERVICES 418589 SYSCO PO BOX 90 BARABOO WI 53190 FOOD 337628 HOME LUMBER COMPANY PO BOX 370 WHITEWATER WI 53190 CONSTRUCTION 311309 UNITED METHODIST HEALTHCARE 1415 W FOSTER AVE CHICAGO IL 60640 HEALTHCARE 266115 5 1734580 7515 1742095 PRIVATE PAY 623000 5860944 5860944 MEDICAID/MEDICARE 623000 2287361 2287361 8148305 3562 3562 16530 5893 10637 10637 10637 ENTRY FEES 623000 475274 475274 475274 10379873 8623579 0 14199 158632 140632 17404 596 4139511 3672458 451480 15573 171157 150666 19855 636 711554 626368 82543 2643 310564 273384 36027 1153 6084 5869 215 83484 83484 841960 836939 5021 177373 173139 4234 119011 20749 97596 666 913500 911749 1751 9783 9744 39 12865 12465 400 88293 88073 220 1445153 1445153 144350 139690 4660 SUPPLIES 839170 819356 19814 NURSING BED ASSESSMENT 167280 161358 5922 DUES AND SUBSCRIPTIONS 18706 18044 662 36489 36291 198 10394919 9542127 788389 64403 3261805 1379516 683605 867966 680225 458214 48619 78240 51988999 24688855 27270302 27300144 1405895 1736545 33350451 31820625 2430050 1016287 12258548 13226508 1951683 1547328 132000 132000 2118421 1222355 18890702 17144478 X 14459749 14676147 14459749 14676147 33350451 31820625 X -15046 514972 -306020 22492 X 0 1 X 1 1 1 X 87002 68290 18537 358866 1742095 2274790 11920561 12213176 11620125 11605565 8148305 55507732 12007563 12281466 11638662 11964431 9890400 57782522 75000 75000 11891 17801 425148 454840 75000 11891 17801 425148 529840 57252682 18883 23209 26999 23605 20092 112788 18883 23209 26999 23605 20092 112788 738205 765453 513540 633759 475274 3126231 12764651 13070128 12179201 12621795 10385766 61021541 0.93820 0.94280 0.00180 0.00180 X X 1384624 114437 211398 -6548 1717007 1170167 105801 109596 940 1384624 1839405 158649 172113 1000000 1170167 2391010 143921 4474 700000 1839405 2017185 228249 145576 2391010 1.00000 0.00000 0.00000 0 0 985126 3480407 4465533 36559559 17779265 18780294 9133465 6909590 2223875 1830442 1830442 27300144 REQUIRED DONOR ANNUITY RESERVE 60155 ASSET RETIREMENT OBLIGATION 51779 DUE TO FAIRHAVEN FOUNDATION 1110421 1222355 X PART X, LINE 2: THE CORPORATION AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM WISCONSIN FRANCHISE AND INCOME TAX. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. X X X 0 0 0 0 0 0 0 0 0 PAUL KUENNING EXECUTIVE DIRECTOR 145014 0 0 0 0 0 0 0 20262 0 165276 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPRISED OF THE BOARD CHAIR, THE PRESIDENT/CEO AND FOUR OTHER DIRECTORS FROM THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE FULL AUTHORITY OF THE BOARD OF DIRECTORS BETWEEN MEETINGS OF THE FULL BOARD. FORM 990, PART VI, SECTION A, LINE 2 REV. MAX RIGERT, EXECUTIVE COMMITTEE, AND REV. FRANZ RIGERT, EX-OFFICO, ARE FATHER AND SON. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE ORGANIZATION'S MANAGEMENT AND WAS PRESENTED TO THE FULL BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER OR DIRECTOR OF FAIRHAVEN CORPORATION CURRENTLY IN OFFICE IS EXPECTED TO COMPLETE, SIGN AND RETURN TO THE CORPORATION A DISCLOSURE STATEMENT ANNUALLY REPORTING DIRECT AND INDIRECT PERSONAL OR FINANCIAL INTERESTS WITH CONFLICTING BUSINESSES AND ORGANIZATIONS. DETERMINATIONS ARE MADE BY THE REMAINING BOARD MEMBERS OR COMMITTEE MEMBERS. INDIVIDUALS WITH A CONFLICT ABSTAIN BOTH FROM DISCUSSION AND VOTING ON THE ISSUE BEFORE THE BOARD OF DIRECTORS. ALL PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S FINANCE AND PERSONNEL COMMITTEE APPROVES THE ANNUAL BUDGET WHICH INCLUDES GENERAL INCREASES FOR ALL EMPLOYEES. THE GENERAL INCREASES FOR ALL EMPLOYEES ARE DETERMINED UTILIZING INFORMATION FROM THE LEADING AGE WISCONSIN ANNUAL WAGE SURVEY AND PERFORMANCE AT THE ORGANIZATIONAL AND INDIVIDUAL LEVELS. THIS PROCESS WAS LAST UNDERTAKEN IN 2019 FOR THE EXECUTIVE DIRECTOR, PAUL KUENNING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN DONOR ANNUITIES -3,766. REVERSAL OF ALLOWANCE 26,258. FAIRHAVEN FOUNDATION 435 STARIN ROAD WHITEWATER WI 53190 391797563 TO SUPPORT FAIRHAVEN CORPORATION WI 501(C)(3) LINE 12A, I FAIRHAVEN CORPORATION 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0