2013-08-13T08:16:32-05:00 2012-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2012-01-01 381387113 RESTHAVEN REST 6167963504 9 EAST 8TH STREET HOLLAND MI 49423 CHARLES VANDER BROEK 6167963504 2013-08-12 1 CAROL LALONDE CPA P00181637 2695674500 2012 2016-02-24 21:20:13Z RESTHAVEN AT HOME CHARLES VANDER BROEK 9 EAST 8TH STREET HOLLAND MI 49423 19904866 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. 12 11 475 265 0 0 662187 696076 17976675 18148943 15257 18628 109289 119486 18763408 18983133 0 0 0 0 11115855 11593929 0 0 123771 6540907 6461274 17656762 18055203 1106646 927930 14804135 17717322 5886968 7832406 8917167 9884916 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 11617443 12793929 RESTHAVEN CARE CENTER - PROVIDES MEDICAL REHABILITATION, LONG-TERM CARE SERVICES, AND MEMORY SUPPORT FOR SENIORS IN HOLLAND, MI. SERVING AN AVERAGE OF 137 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 72% 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. 1957934 1943903 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. 1851603 1945966 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 11% 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. 1221442 1465145 OTHER SERVICES 1221442 1465145 16648422 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 1 0 0 0 0 0 0 0 0 1 54 0 1 475 1 0 0 0 0 0 0 0 0 0 0 X 12 11 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 K SAEWERT 1.00 X X 0 0 0 JOHN DICE 1.00 X 0 0 0 GREY MCCOY 1.00 X 0 0 0 SUSAN HUTCHINSON 1.00 X 0 0 0 KAREN BROWN 1.00 X X 0 0 0 DAVID LUTZ 1.00 X X 0 0 0 TRACEY MCKNIGHT 1.00 X 0 0 0 KAY HUBBARD 1.00 X 0 0 0 GEORGE ZUIDEMA 1.00 X 0 0 0 SCOTT PATCHIN 1.00 X X 0 0 0 BILL RYCKBOST 1.00 X 0 0 0 DARELL SCHREGARDUS 1.00 X 0 0 0 CHARLES VANDER BROEK 40.00 X 143168 0 19689 143168 0 19689 1 0 1 0 AGILITY THERAPY 607 DEWEY AVE NW GRAND RAPIDS MI 49504 THERAPY PROVIDER 802484 CREATIVE DINING SERVICES INC ONE ROYAL PARK DRIVE ST3 ZEELAND MI 49464 CONTRACT DINING 387657 2 696076 51799 696076 ROOM AND BOARD 624310 14108279 14108279 HOME CARE SERVICES 621610 2170352 2170352 ANCILLIARY SERVICES 900099 1859492 1859492 OTHER OPERATING INCOME 900099 10820 10820 18148943 33947 33947 119486 0 119486 119486 119486 906414 902914 18819 3500 -18819 -15319 -15319 18983133 18148943 0 138114 165191 165191 9283733 8677795 515616 90322 42377 40395 1570 412 1420892 1354427 52652 13813 681736 629842 45415 6479 22637 3864 18773 35000 9100 25900 906 906 1470357 1395490 73892 975 47651 47651 1178202 1078091 90470 9641 73403 70548 2855 422819 417879 4940 12941 5265 7676 69073 50538 18180 355 117379 117269 110 1074257 1033064 40326 867 152305 140 152165 DUES & LICENSES 1041748 1037963 3785 FOOD 632579 623559 8770 250 BAD DEBTS 80318 73494 6167 657 RESIDENT SERVICES 29699 29699 18055203 16648422 1283010 123771 1515 1490 2872936 2942163 166836 488983 1443323 1484164 109770 5407 37392 36319 224227 95808 24555874 12476982 9385257 12078892 495328 523693 67551 60403 14804135 17717322 1092216 1515789 660000 660000 3112985 2950649 1021767 2705968 5886968 7832406 X 8636953 9513622 196504 287584 83710 83710 8917167 9884916 14804135 17717322 X 927930 34237 5582 X X 0 1 X 1 0 X 544958 424751 408978 662187 696076 2736950 15529441 16267018 16402394 17976675 18148943 84324471 16074399 16691769 16811372 18638862 18845019 87061421 375000 97483 179500 354750 256163 1262896 0 375000 97483 179500 354750 256163 1262896 85798525 171245 108275 109715 138668 153433 681336 171245 108275 109715 138668 153433 681336 16245644 16800044 16921087 18777530 18998452 87742757 0.97780 0.97710 0.00780 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 448128 448128 18216556 10259001 7957555 759601 409393 350208 2850043 1808588 1041455 2281546 2281546 12078892 X 19022952 34237 5582 39819 18983133 0 18983133 18055203 0 18055203 0 18055203 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2012, 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, 2009 ARE NO LONGER SUBJECT TO EXAMINATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN ON INTEREST RATE SWAP 5,582. X X X X X X 0 1 0 0 0 0 0 0 0 CHARLES VANDER BROEK 138535 0 100 0 4533 0 16500 0 3189 0 162857 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 0 0 1 B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HDY9 2006-09-27 500633 FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY 0 0 1 C MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HEK8 2007-01-17 530045 FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY 0 0 1 D MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HEP7 2007-03-28 428376 FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY 0 0 1 A 139092 2771588 22170 2771258 2006 0 0 1 1 B 26038 500633 4005 500633 2007 0 0 1 1 C 27568 530045 4240 530045 2007 0 0 1 1 D 22280 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 ANDREW MULDER MEMBER OF BOARD OF TRUSTEES 15437 A FAMILY MEMBER IS EMPLOYED BY RESTHAVEN 0 X 2 9076 SELLING PRICE X FURNITURE 1 15993 MARKET VALUE X TECHNICAL EQUIPMENT 5 26730 MARKET VALUE 0 0 0 DOING BUSINESS AS FORM 990, PART I, ITEM C DBA: RESTHAVEN CARE COMMUNITY DBA: RESTHAVEN MAPLE WOODS DBA: RESTHAVEN CARE CENTER DBA: THE WARM FRIEND DBA: RESTHAVEN CARE COMMUNITY DBA: VERN AND LOIS BOERSMA COTTAGE DBA: GOOD SHERPHERD HOME, MEMORY SUPPORT DBA: RESTHAVEN REHABILITATION DBA: RESTHAVEN 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 2012. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UNREALIZED GAIN ON INTEREST RATE SWAP 5,582. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.