2014-06-30T14:41:35-05:00 2013-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2013-01-01 381387113 RESTHAVEN REST 6167963504 9 EAST 8TH STREET HOLLAND MI 49423 CHARLES VANDER BROEK PRESIDENT/CEO 6167963504 2014-06-16 1 CAROL LALONDE CPA P00181637 2695674500 2013 2015-11-30 17:44:51Z RESTHAVEN CARE COMMUNITY CHARLES VANDER BROEK 9 EAST 8TH STREET HOLLAND MI 49423 20333774 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 10 481 249 0 0 696076 280635 18148943 19115730 18628 30835 119486 131337 18983133 19558537 0 0 0 0 11593929 11881815 0 0 114811 6461274 7195275 18055203 19077090 927930 481447 17717322 17822140 7832406 7453740 9884916 10368400 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 12651366 13619626 RESTHAVEN CARE CENTER - PROVIDES MEDICAL REHABILITATION, LONG-TERM CARE SERVICES, AND MEMORY SUPPORT FOR SENIORS IN HOLLAND, MI. SERVING AN AVERAGE OF 141 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 71.6% 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. 1967792 2011048 RESTHAVEN AT HOME - 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. 1886872 1981467 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 9% 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. 1231884 1503589 OTHER SERVICES 1231884 1503589 17737914 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 66 0 1 481 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 ILSE SAEWERT JD TRUSTEE 1.00 X 0 0 0 JOHN DICE TRUSTEE 1.00 X 0 0 0 MATT AHEARN TRUSTEE 1.00 X 0 0 0 DAVID DEVISSER MD TRUSTEE 1.00 X 0 0 0 KAREN BROWN BOARD SECRETARY 1.00 X X 0 0 0 DAVID LUTZ BOARD TREASURER 1.00 X X 0 0 0 ANDY MULDER TRUSTEE 1.00 X 0 0 0 KAY HUBBARD BOARD VICE CHAIR 1.00 X X 0 0 0 SCOTT PATCHIN BOARD CHAIR 1.00 X X 0 0 0 WILLIAM RYCKBOST TRUSTEE 1.00 X 0 0 0 DARELL SCHREGARDUS PHD TRUSTEE 1.00 X 0 0 0 TRACEY MCKNIGHT PART-YEAR TRUSTEE 1.00 X 0 0 0 SUSAN HUTCHINSON PART-YEAR TRUSTEE 1.00 X 0 0 0 CHARLES VANDER BROEK PRESIDENT/CEO 40.00 X 149037 0 20021 149037 0 20021 1 0 1 0 AGILITY THERAPY 607 DEWEY AVE NW GRAND RAPIDS MI 49504 THERAPY PROVIDER 1024713 CREATIVE DINING SERVICES INC ONE ROYAL PARK DRIVE ST3 ZEELAND MI 49464 CONTRACT DINING 322918 2 280635 9475 280635 ROOM AND BOARD 624310 14942604 14942604 ANCILLIARY SERVICES 900099 2245202 2245202 HOME CARE SERVICES 621610 1856532 1856532 OTHER OPERATING INCOME 900099 71392 71392 19115730 33225 33225 131337 0 131337 131337 131337 772847 772847 2390 0 -2390 -2390 -2390 19558537 19115730 0 162172 X 169058 169058 9516079 8932449 493368 90262 45330 44225 899 206 1443122 1407942 28618 6562 708226 654975 46706 6545 19572 436 19136 36685 10000 26685 1868 1868 1929468 1843359 84782 1327 44855 44855 1115029 1035419 71615 7995 84257 80499 3758 474159 470125 4034 10814 6247 4567 52372 38506 13811 55 163402 163402 1324561 1284309 39481 771 159030 140 158890 DUES & LICENSES 1084121 1081306 2565 250 FOOD 637098 628371 8068 659 RESIDENT SERVICES 33051 33051 BAD DEBTS 24933 23153 1601 179 19077090 17737914 1224365 114811 1490 1515 2942163 3656248 488983 297367 1484164 1567760 5407 5323 36319 40270 95808 232286 25074765 13656483 12078892 11418282 523693 521614 60403 81475 17717322 17822140 1515789 1176505 660000 660000 2950649 5014576 2705968 602659 7832406 7453740 X 9513622 10045367 287584 239323 83710 83710 9884916 10368400 17717322 17822140 X 481447 -2201 4238 X X 0 1 X 1 0 X 424751 408978 662187 696076 280635 2472627 16267018 16402394 17976675 18148943 19115730 87910760 16691769 16811372 18638862 18845019 19396365 90383387 97483 179500 354750 256163 125200 1013096 0 97483 179500 354750 256163 125200 1013096 89370291 108275 109715 138668 153433 164562 674653 108275 109715 138668 153433 164562 674653 16800044 16921087 18777530 18998452 19560927 91058040 0.98150 0.97780 0.00740 0.00780 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 448128 448128 20693180 11211229 9481951 866280 469737 396543 3067177 1975517 1091660 11418282 X 19560574 -2201 4238 2037 19558537 0 19558537 19077090 0 19077090 0 19077090 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, 2013, 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, 2010 ARE NO LONGER SUBJECT TO EXAMINATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN ON INTEREST RATE SWAP 4,238. X X X X X X 0 1 0 0 0 0 0 0 0 CHARLES VANDER BROEK PRESIDENT/CEO 142429 0 0 0 6608 0 16500 0 3521 0 169058 0 0 0 PART I, LINE 4B CHARLES VANDERBROEK RECEIVED $16,500 TOWARDS A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. A MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HCG9 2006-02-22 2771588 REFINANCE LOAN AT RESTHAVEN CARE CENTER 1 0 1 B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HDY9 2006-09-27 500633 FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY 1 0 1 C MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HEK8 2007-01-17 530045 FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY 1 0 1 D MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HEP7 2007-03-28 428376 FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY 1 0 1 A 1854557 2771588 22170 2771258 2006 0 0 1 1 B 358029 500633 4005 500633 2007 0 0 1 1 C 379064 530045 4240 530045 2007 0 0 1 1 D 306355 428376 3427 428376 2007 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 D 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 D 0 A MICHIGAN STRATEGIC FUND SERIES 2013 521417332 2013-07-09 5100000 REFINANCE LOAN AND CONSTRUCTION OF 16 BED SNF 0 0 0 A 87500 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 0 ANDREW MULDER MEMBER OF BOARD OF TRUSTEES 16309 A 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 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 2013. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G FEES FOR CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,843,359. MANAGEMENT AND GENERAL EXPENSES 84,782. FUNDRAISING EXPENSES 1,327. TOTAL EXPENSES 1,929,468. FORM 990, PART XI, LINE 9: UNREALIZED GAIN ON INTEREST RATE SWAP 4,238. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.