2012-03-28T09:21:14-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-10-01 416045816 HAVEN HOMES INC HAVE 7634791993 1520 WYMAN AVE MAPLE PLAIN MN 55329 DON STICKNEY 7634791993 2012-03-07 1 6123764500 2010 2016-02-24 21:20:13Z DON STICKNEY 1520 WYMAN AVE MAPLE PLAIN MN 55329 4986316 0 X WWW.HAVENHOMESINC.COM X 1965 MN THE PURPOSE OF THIS CORPORATION IS TO OWN, RENT, OPERATE, AND SPONSOR NURSING HOMES, REST HOMES, RETIREMENT HOMES FOR THE ELDERLY, TO SPONSOR SCHOOLS FOR THE HANDICAPPED, AND TO GIVE FINANCIAL SUPPORT TO CHRISTIAN EDUCATIONAL INSTITUTIONS, AND FOR ALL OTHER RELATED PURPOSES. 4 4 144 14 0 0 0 0 5074220 4947844 30326 13288 25222 25184 5129768 4986316 0 1500 0 0 3166487 3143640 0 0 0 1819797 1874499 4986284 5019639 143484 -33323 4728732 4523476 4257232 4114939 471500 408537 TO PROVIDE ACCOMODATIONS AND RELATED SERVICES TO MEET THE VARYING HEALTH NEEDS OF AGING ADULTS, PHYSICALLY, MENTALLY, EMOTIONALLY AND SPIRITUALLY, IN AN ATOMOSPHERE OF CHRISTIAN DIGNITY. 0 0 4155402 1500 4412897 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 9/30/2011. OCCUPANCY FOR THE YEAR ENDED 9/30/2011 WAS 81%. 491671 534947 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 9/30/2011.OCCUPANCY FOR THE YEAR ENDED 9/30/2011 WAS 76%. 4647073 1 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 12 0 1 144 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 600 0 0 CURTIS OLSON 1.00 X X 450 0 0 DAVID K MEIER 1.00 X 600 0 0 JOEL D MOORE 1.00 X 450 0 0 ROBERT MUELLER 40.00 X 121347 0 14238 123447 0 14238 1 0 0 0 AEGIS THERAPIES 1000 FIANNA WAY FORT SMITH AZ 72919 THERAPY SERVICES 312950 A'VIANDS LLC 1751 COUNTY ROAD B WEST ROSEVILLE MN 55113 DIETARY SERVICES 242064 2 RESIDENT SERVICES 623000 4412897 4412897 APARTMENT SERVICES 623990 534947 534947 4947844 13288 13288 15600 15600 15600 15600 MISCELLANEOUS 900099 9584 9584 9584 4986316 4947844 0 38472 1500 1500 137686 67793 69893 2570655 2551437 19218 236040 227779 8261 199259 192699 6560 455 455 29383 29383 37724 34805 2919 9584 9584 240368 197564 42804 24851 24851 125548 114888 10660 2844 2844 3008 3008 224850 202462 22388 175254 157804 17450 38850 34982 3868 THERAPY SERVICES 440062 440062 FOOD EXPENSE 234693 234693 LICENSES & PERMITS 188605 188605 BAD DEBTS 69665 69665 MISCELLANEOUS 28755 28755 5019639 4647073 372566 0 860089 940215 546161 387947 643814 613812 24525 23918 5924567 3975254 2043306 1949313 610837 608271 4728732 4523476 340987 331492 3840000 3715000 19609 13228 56636 55219 4257232 4114939 X 471500 408537 471500 408537 4728732 4523476 X -33323 -29640 X 0 1 1 X 0 X 500 500 4934585 4756991 5152638 5074220 4947844 24866278 4935085 4756991 5152638 5074220 4947844 24866778 0 998149 1076274 1093552 1065306 1051038 5284319 998149 1076274 1093552 1065306 1051038 5284319 19582459 49389 59223 31585 45926 28888 215011 49389 59223 31585 45926 28888 215011 9735 5265 7752 9622 9584 41958 4994209 4821479 5191975 5129768 4986316 25123747 0.77940 0.78480 0.00860 0.00920 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 0 1 147245 147245 3692796 2204384 1488412 163110 143937 19173 1921416 1626933 294483 1949313 BOND FUND 104409 RESERVE FUND 366164 UNAMORTIZED FINANCING COSTS 126882 RESIDENT TRUST 10539 SPECIAL BOND FUND 277 608271 ACCRUED INTEREST 55219 55219 4986316 5019639 -33323 -29640 -29640 -62963 4986316 0 4986316 0 4986316 5019639 0 5019639 0 5019639 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TAX FOOTNOTE: 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 2007 TO 2010 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. 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 MEET 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 990. A COPY OF THE FORM 990 IS DISTRIBUTED TO ALL BOARD MEMBERS BEFORE FILING. 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 TOOK PLACE 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: PRIOR PERIOD ADJUSTMENTS: -29,640.