2016-05-12T15:23:01-05:00 2015-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2015-01-01 381387113 RESTHAVEN REST 6167963504 9 EAST 8TH STREET HOLLAND MI 49423 CHARLES VANDER BROEK PRESIDENT/CEO 6167963504 2016-05-12 1 CAROL LALONDE CPA P00181637 2695674500 2015 2016-09-27 15:27:22Z RESTHAVEN CARE COMMUNITY CHARLES VANDER BROEK 9 EAST 8TH STREET HOLLAND MI 49423 20577239 0 X WWW.RESTHAVEN.ORG X 1945 MI RESTHAVEN'S MISSION IS TO GLORIFY GOD BY PROVIDING A CONTINUUM OF QUALITY CARE AND SERVICES THAT DEMONSTRATES THE LOVE AND COMPASSION OF JESUS CHRIST. 11 10 496 353 0 0 283961 407856 19421594 19596108 14946 26627 132483 134884 19852984 20165475 0 0 0 0 12183787 12457241 0 5300 131997 7475460 7239908 19659247 19702449 193737 463026 17860506 18010961 7301659 7010826 10558847 11000135 X RESTHAVEN'S MISSION IS TO GLORIFY GOD BY PROVIDING A CONTINUUM OF QUALITY CARE AND SERVICES THAT DEMONSTRATES THE LOVE AND COMPASSION OF JESUS CHRIST. 0 0 12992575 13945457 RESTHAVEN CARE CENTER - PROVIDES MEDICAL REHABILITATION, LONG-TERM CARE SERVICES, AND MEMORY SUPPORT FOR SENIORS IN HOLLAND, MI. SERVING AN AVERAGE OF 138 RESIDENTS PER DAY. THE CARE AND SERVICES ARE PROVIDED IN A COMFORTABLE, HOME-LIKE SURROUNDING, INCLUDING A SMALL HOUSE MODEL OF 10 RESIDENTS. THE INDIVIDUAL'S PHYSICAL, SPIRITUAL, AND SOCIAL NEEDS ARE SUPPORTED. RESTHAVEN CARE CENTER PROVIDES SERVICES TO THOSE WHO HAVE EXHAUSTED THEIR FINANCIAL RESOURCES. MEDICAID ELIGIBLE RESIDENTS ACCOUNT FOR APPROXIMATELY 66.8 % OF THE CENSUS. THE ORGANIZATION PROVIDES UNCOMPENSATED COST OF PRIVATE ROOMS TO MANY OF THOSE ON MEDICAID AND A HIGHER STAFFING RATIO OF CAREGIVERS THAN MANDATED BY MEDICAID TO PROMOTE PERSON-CENTERED CARE FOR RESIDENTS. 1839671 1797128 RESTHAVEN HOME CARE - PROVIDES SKILLED MEDICAL SERVICES TO IN-HOME RESIDENTS TO HELP THEM REMAIN AS INDEPENDENT AS POSSIBLE FOLLOWING AN ILLNESS, SURGERY OR OTHER MEDICAL ISSUE. RESTHAVEN PROVIDES CARE MANAGEMENT SERVICES IN THE COMMUNITY TO HELP TRANSITIONS IN THE LIFE OF SENIORS. THE AGENCY PROVIDES CASE COORDINATION AND REFERRAL SERVICES TO ALL AGENCIES AND SERVICES IN THE COMMUNITY TO BEST MEET THE NEEDS OF THE SENIORS IN THE GREATER HOLLAND AREA. 2118809 2239945 RESTHAVEN MAPLE WOODS - AN AFFORDABLE ASSISTED LIVING FACILITY THAT PROVIDES SENIORS WITH 3 MEALS PER DAY, SOCIAL OPPORTUNITIES AND A SUPERVISED ENVIRONMENT TO PROMOTE THEIR HIGHEST LEVEL OF INDEPENDENCE, WHILE PROVIDING SUPPORTS NEEDED TO HELP THEM REMAIN IN THE COMMUNITY. MAPLE WOODS PROVIDES UNCOMPENSATED SERVICES TO THOSE ON MEDICAID AND THOSE RECEIVING SUPPLEMENTAL SOCIAL SECURITY INCOME, APPROXIMATELY 16.5% OF RESIDENTS AT THIS TIME. BY KEEPING RENTAL RATES LOW, RESIDENTS AT 50% AMI FOR THE AREA ARE ABLE TO AFFORD TO LIVE AT MAPLE WOODS. 1368813 1613578 OTHER SERVICES 1368813 1613578 18319868 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 59 0 1 496 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MI X BEVERLY DONAHUE 6167963504 9 EAST 8TH STREET HOLLAND MI 49423 WILLIAM RYCKBOST BOARD CHAIR 1.00 0.00 X X 0 0 0 MATT AHEARN BOARD VICE CHAIR 1.00 0.00 X X 0 0 0 DAVID LUTZ BOARD TREASURER 1.00 0.00 X X 0 0 0 SCOTT PATCHIN BOARD SECRETARY 1.00 0.00 X X 0 0 0 ANDY MULDER TRUSTEE 1.00 0.00 X 0 0 0 VICTOR OROZCO TRUSTEE 1.00 0.00 X 0 0 0 SAM MARTIN TRUSTEE 1.00 0.00 X 0 0 0 MOLLY TRUTTMAN TRUSTEE 1.00 0.00 X 0 0 0 RICK ZWEERING TRUSTEE 1.00 0.00 X 0 0 0 MARIANNE BOUWENS TRUSTEE 1.00 0.00 X 0 0 0 CRAIG JANUSZ TRUSTEE 1.00 0.00 X 0 0 0 KAY HUBBARD TRUSTEE - PART YEAR 1.00 0.00 X 0 0 0 KAREN BROWN TRUSTEE - PART YEAR 1.00 0.00 X 0 0 0 DAVID DEVISSER MD TRUSTEE - PART YEAR 1.00 0.00 X 0 0 0 DARELL SCHREGARDUS PHD TRUSTEE - PART YEAR 1.00 0.00 X 0 0 0 CHARLES VANDER BROEK PRESIDENT/CEO 40.00 0.00 X 157034 0 23066 157034 0 23066 1 0 1 0 AGILITY THERAPY DEPT CH 19549 PALATINE IL 600559549 THERAPY SERVICES 813615 CREATIVE DINING SERVICES INC ONE ROYAL PARK DRIVE SUITE 3 ZEELAND MI 49464 CONTRACT DINING SERVICES 397443 2 407856 2111 407856 ROOM AND BOARD 624310 16239056 16239056 ANCILLIARY SERVICES 900099 1925616 1925616 HOME CARE SERVICES 621610 1289759 1289759 OTHER OPERATING INCOME 900099 141677 141677 19596108 32823 32823 134884 0 134884 134884 134884 405568 399568 12196 6000 -12196 -6196 -6196 20165475 19596108 0 161511 180100 180100 9938640 9358254 490459 89927 117740 114882 2267 591 1490950 1454762 28702 7486 729811 675543 47812 6456 17942 2176 15766 33959 4200 29759 5300 5300 2174 2174 1899594 1758389 137705 3500 27103 27103 1128920 1047027 64586 17307 146610 144685 1925 452729 448000 4729 5542 3154 2388 71996 64298 7593 105 167891 167891 1226971 1205311 21443 217 171255 140 171115 DUES & LICENSES 1145274 1142181 2793 300 FOOD 638203 629991 7870 342 BAD DEBTS 65631 60870 4295 466 RESIDENT SERVICES 38114 38114 19702449 18319868 1250584 131997 1515 1525 3773368 4061893 118176 234966 1545382 1759274 3916 2540 41898 40056 228033 204746 26751603 15745717 11415623 11005886 437418 427391 222603 209010 72574 63674 17860506 18010961 1260238 1212043 660000 660000 4800000 4581500 581421 557283 7301659 7010826 X 10372394 10714167 102743 202258 83710 83710 10558847 11000135 17860506 18010961 463026 -21738 0 X X 0 1 X 1 0 X 662187 696076 280635 283961 407856 2330715 17976675 18148943 19115730 19421594 19596108 94259050 18638862 18845019 19396365 19705555 20003964 96589765 0 0 0 96589765 138668 153433 164562 157640 167707 782010 138668 153433 164562 157640 167707 782010 18777530 18998452 19560927 19863195 20171671 97371775 0.99200 0.99230 0.00800 0.00770 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 629561 629561 21650451 12938905 8711546 1035519 596148 439371 3340226 2210664 1129562 95846 95846 11005886 X 20143737 -21738 -21738 20165475 0 20165475 19702449 0 19702449 0 19702449 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE ORGANIZATIONS COMPRISING THE OBLIGATED GROUP ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS NOT CURRENTLY UNDER EXAMINATION BY THE INTERNAL REVENUE SERVICE OR ANY STATE OR LOCAL TAX AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2012 ARE NO LONGER SUBJECT TO EXAMINATION. X X X X X 0 1 0 0 0 0 0 0 0 CHARLES VANDER BROEK PRESIDENT/CEO 151439 0 0 0 5595 0 18000 0 5066 0 180100 0 0 0 PART I, LINE 4B CHARLES VANDER BROEK RECEIVED $18,000 TOWARDS A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. A MICHIGAN STRATEGIC FUND SERIES 2013 521417332 2013-07-09 5100000 REFINANCE LOAN AND CONSTRUCTION OF 16 BED SNF 0 0 0 A 518500 5100000 5100000 2013 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 1 ALISTER PEEL DAUGHTER OF ANDY MULDER, TRUSTEE 11124 FAMILY MEMBER IS EMPLOYED BY RESTHAVEN 0 FORM 990, PART I, ITEM C DBA: RESTHAVEN AT HOME DBA: RESTHAVEN MAPLE WOODS DBA: RESTHAVEN CARE CENTER DBA: THE WARM FRIEND DBA: VERN AND LOIS BOERSMA COTTAGE DBA: GOOD SHEPHERD HOME DBA: RESTHAVEN REHABILITATION DBA: HOME CARE BY RESTHAVEN DBA: MEMORY SUPPORT DBA: RESTHAVEN HOME CARE FORM 990, PART VI, SECTION B, LINE 11 THE ACCOUNTING FIRM PROVIDES THE ORGANIZATION WITH A DRAFT COPY OF THE 990 FORM. THE FINANCE COMMITTEE, WHO IS APPROVED BY THE GOVERNING BOARD TO MAKE ALL FINANCIAL DECISIONS REGARDING THE ORGANIZATION, REVIEWS THE FORM AND MAKES ANY CORRECTIONS OR SUGGESTIONS AS NEEDED. THE ACCOUNTING FIRM THEN REVISES THE FORM AND FILES IT ELECTRONICALLY. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY APPLIES TO ALL DIRECTORS, TRUSTEES, OFFICERS, ADVISORY MEMBERS AND EXECUTIVE STAFF. ALL ACTUAL AND POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE PRESIDENT/CEO AND CHAIRPERSON OF THE BOARD. BOARD MEMBERS ARE REQUIRED TO SIGN A NEW CONFLICT OF INTEREST POLICY ANNUALLY. IF A CONFLICT ARISES, THE BOARD MEMBER MUST LEAVE THE ROOM DURING DISCUSSION AND ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 TOP OFFICIALS ARE RATED ON A SCALE AND EVALUATED ON SEVERAL PERFORMANCE FACTORS. IT IS THE ORGANIZATION'S POLICY TO MAINTAIN FAIR AND COMPETITIVE SALARY RANGES CONSISTENT WITH THE ECONOMIC REQUIREMENTS OF THE ORGANIZATION AND COMMENSURATE WITH THOSE OF THE COMMUNITY IN WHICH IT OPERATES. LASTLY, THE BOARD OF DIRECTORS DELIBERATES AND DETERMINES WHAT IS AN APPROPRIATE COMPENSATION PACKAGE FOR TOP OFFICIALS. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2014. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.