2013-05-15T10:10:00-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-10-01 416045816 HAVEN HOMES INC HAVE 7634791993 1520 WYMAN AVE MAPLE PLAIN MN 55329 DON STICKNEY 7634791993 2013-05-01 1 CORY RUTLEDGE P01329381 6123764500 2011 2016-02-24 21:20:13Z DON STICKNEY 1520 WYMAN AVE MAPLE PLAIN MN 55329 4457813 0 X WWW.HAVENHOMESINC.COM X 1965 MN TO PROVIDE HOUSING AND OTHER MEDICAL SERVICES TO AGING ADULTS. 4 4 126 10 0 0 0 0 4947844 4185913 13288 10016 25184 92931 4986316 4288860 1500 0 0 0 3143640 3021886 0 0 0 1874499 1924058 5019639 4945944 -33323 -657084 4523476 3757873 4114939 4009207 408537 -251334 TO PROVIDE COMFORTABLE, SAFE, & HEALTHY ACCOMMODATIONS, AND RELATED MEDICAL SERVICES TO MEET THE VARYING HEALTH NEEDS OF AGING ADULTS, PHYSICALLY, MENTALLY, EMOTIONALLY AND SPIRITUALLY, IN AN ATMOSPHERE OF CHRISTIAN DIGNITY. 0 0 4079967 0 3711505 NURSING CARE FOR RESIDENTS:HAVEN HOMES PROVIDES SERVICES TO MEET THE VARYING HEALTH NEEDS OF AGING ADULTS, PHYSICALLY, MENTALLY, EMOTIONALLY AND SPIRITUALLY, IN AN ATMOSPHERE OF CHRISTIAN DIGNITY.THERE WERE 67 BEDS DURING THE YEAR ENDED 9/30/2012. OCCUPANCY FOR THE YEAR ENDED 9/30/2012 WAS 69.7%. 483191 0 474408 PROFESSIONAL CARE FOR RESIDENTS:BRYANT HOUSE PROVIDES AN ASSISTED LIVING ENVIRONMENT THAT IS INNOVATIVE AND APPROPRIATELY MEETS THE NEEDS OF THE RESIDENTS:INDEPENDENCE, DIGNITY, COMMUNITY ATMOSPHERE, SENSE OF BELONGING. THE PROVISIONS OF THESE SERVICES ARE CARRIED OUT BY PERSONNEL WHO POSSESS A POSITIVE ATTITUDE AND ARE COMMITTED TO EXCELLENCE.THERE WERE 21 UNITS DURING THE YEAR ENDED 9/30/2012.OCCUPANCY FOR THE YEAR ENDED 9/30/2012 WAS 67%. 4563158 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 14 0 0 126 1 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X BECKY JOBE 7634791993 1520 WYMAN AVE MAPLE PLAIN MN 55359 DON R STICKNEY 1.00 X X 1350 0 0 CURTIS OLSON 1.00 X X 750 0 0 DAVID K MEIER 1.00 X 1350 0 0 JOEL D MOORE 1.00 X 1050 0 0 ROBERT MUELLER 40.00 X 123235 0 20168 127735 0 20168 1 0 0 0 AEGIS THERAPIES 1000 FIANNA WAY FORT SMITH AZ 72919 THERAPY SERVICES 341134 A'VIANDS LLC 1751 COUNTY ROAD B WEST ROSEVILLE MN 55113 DIETARY SERVICES 268319 2 RESIDENT SERVICES 623000 3711505 3711505 APARTMENT SERVICES 623990 474408 474408 4185913 7426 7426 15600 0 15600 15600 15600 171543 168953 2590 2590 2590 MEAL REVENUE 900099 59932 59932 MISCELLANEOUS 900099 17399 17399 77331 4288860 4185913 0 102947 135932 65716 70216 2432263 2419047 13216 238957 230768 8189 214734 207754 6980 622 622 130 130 27533 27533 44746 42249 2497 15506 15506 126842 87664 39178 32735 32735 120909 111652 9257 26964 26964 2415 2415 217931 196232 21699 170760 153758 17002 32323 29105 3218 THERAPY SERVICES 422870 422870 FOOD EXPENSE 306215 306215 LICENSES & PERMITS 188605 188605 MEDICAL SUPPLIES 101523 101523 85429 85429 4945944 4563158 382786 0 940215 569981 387947 218327 613812 555479 23918 26179 5946752 4138833 1949313 1807919 608271 579988 4523476 3757873 331492 363339 3715000 3580000 13228 13297 55219 52571 4114939 4009207 X 408537 -251334 408537 -251334 4523476 3757873 X -657084 -2787 X 0 1 1 X 0 X 4756991 5152638 5074220 4947844 4185913 24117606 4756991 5152638 5074220 4947844 4185913 24117606 0 1076274 1145472 1116604 1100901 1581190 6020441 1076274 1145472 1116604 1100901 1581190 6020441 18097165 59223 31585 45926 28888 23026 188648 59223 31585 45926 28888 23026 188648 5265 7752 9622 9584 77331 109554 4821479 5191975 5129768 4986316 4286270 24415808 0.74120 0.77940 0.00770 0.00860 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME MEAL REVENUE 0 1 147245 147245 3699081 2290575 1408506 163110 147815 15295 1937316 1700443 236873 1807919 BOND FUND 88091 RESERVE FUND 363601 UNAMORTIZED FINANCING COSTS 119700 RESIDENT TRUST 8319 SPECIAL BOND FUND 277 579988 ACCRUED INTEREST 52571 52571 4288860 4945944 -657084 -2787 -2787 -659871 4226141 -2787 -2787 4228928 59932 59932 4288860 4886012 0 4886012 59932 59932 4945944 PART IV, LINE 1B: THE ORGANIZATION IS THE TRUSTEE OF VARIOUS RESIDENT FUNDS AND HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION AND DISTRIBUTION OF THESE FUNDS FOR THE RESIDENTS. THESE FUNDS ARE ON DEPOSIT IN A SEPERATE BANK ACCOUNT. THEREFORE, THE ORGANIZATION HOLDS THE LIABILITY ON THEIR BOOKS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TAX FOOTNOTE: THE CORPORATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER INTERNAL REVENUE CODE 501(C)(3) AND APPLICABLE STATE STATUTES. THE CORPORATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE CORPORATION IS ALSO NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE INFORMATION TAX RETURNS FOR THE FISCAL YEARS ENDED 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. THE CORPORATION FOLLOWS THE INCOME TAX STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE CORPORATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THE IMPLEMENTATION OF THE ACCOUNTING STANDARDS REGARDING UNCERTAIN TAX PROVISIONS HAD NO IMPACT ON THE CORPORATION'S FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: MEAL REVENUE 59,932. PART XIII, LINE 4B - OTHER ADJUSTMENTS: MEAL REVENUE 59,932. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION MAY HAVE UP TO 25 MEMBERS. THE CURRENT MEMBERS ARE THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION A, LINE 7A MEMBERS MAY ELECT THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS MEETS REGULARLY TO REVIEW RESULTS OF OPERATIONS AND PROVIDE STRATEGIC AND MISSION ORIENTED DIRECTION. THE CHAIRMAN OF THE BOARD OF DIRECTORS IS INVOLVED IN THE SUPERVISION OF MANAGEMENT, OPERATING RESULTS, AND PROVIDES INPUT AND DIRECTION ON MATTERS DURING THE INTERVALS BETWEEN BOARD OF DIRECTORS' MEETINGS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT AND THE BOARD CHAIRMAN REVIEW AND APPROVE THE FORM 990. A COPY OF THE FORM 990 IS DISTRIBUTED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER SHALL ANNUALLY COMPLETE A DISCLOSURE FORM IDENTIFYING ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES IN WHICH THE BOARD MEMBER IS INVOLVED THAT HE OR SHE BELIEVES COULD CONTRIBUTE TO A CONFLICT OF INTEREST ARISING. THIS POLICY SHALL BE REVIEWED ANNUALLY BY EACH MEMBER OF THE BOARD OF DIRECTORS. IF A CONFLICT EXISTS THE BOARD MEMBER WITH THE CONFLICT CANNOT BE PRESENT DURING THE BOARD'S DISCUSSION ON THE MATTER AND CANNOT VOTE ON THE MATTER. THE BOARD MEMBER WITH THE CONFLICT WILL ALSO NOT BE COUNTED IN DETERMINING THE PRESENCE OF A QUOROM FOR PURPOSES OF THE VOTE. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS REVIEWED THE COMPENSATION OF THE ADMINISTRATOR AND ENTERED INTO AN AGREEMENT RELATED TO COMPENSATION AND JOB FUNCTION. THE BOARD REVIEWED COMPARATIVE INFORMATION AND SITUATIONS AS PART OF THIS REVIEW. THE BOARD OF DIRECTORS AS PART OF THE CORPORATION'S ANNUAL BUDGET PROCESS REVIEWS DEPARTMENTAL DIRECTOR'S COMPENSATION AND THE WAGE SCALES FOR THE OTHER EMPLOYEES. THE BOARD APPROVES THE COMPENSATION LEVELS AS PART OF THE BUDGET PROCESS. THE MOST RECENT REVIEW OF DIRECTOR'S COMPENSATION TOOK PLACE IN 2008, AS THEY HAVE HAD A WAGE FREEZE SINCE THEN FOR THE POSITION. FOR ALL OTHER EMPLOYEE'S, THE LAST REVIEW TOOK PLACE AS PART OF THE BUDGET APPROVAL IN SEPTEMBER OF 2011. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,787.