RESTHAVEN: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
RESTHAVEN (EIN 38-1387113)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-07-16
IRS object ID
201221989349300842
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-07-16T16:13:15-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1750 TRADE CENTRE WAY STE 300AddressLine1
CityPORTAGECity
StateMIState
ZIP Code49002ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN381387113EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1RESTHAVENBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlRESTNameControl
Phone6167963504Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line19 EAST 8TH STREETAddressLine1
CityHOLLANDCity
StateMIState
ZIP Code49423ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCHARLES VANDER BROEKName
TitlePRESIDENT/CEOTitle
Phone6167963504Phone
Date Signed2012-07-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCAROL LALONDE CPAName
PTINP00181637PTIN
Phone2695674500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1RESTHAVEN AT HOMEBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHARLES VANDER BROEKNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line19 EAST 8TH STREETAddressLine1
CityHOLLANDCity
StateMIState
ZIP Code49423ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19188420GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.RESTHAVEN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1945YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionRESTHAVEN'S MISSION IS TO GLORIFY GOD BY PROVIDING A CONTINUUM OF QUALITY CARE AND SERVICES THAT DEMONSTRATES THE LOVE AND COMPASSION OF JESUS CHRIST.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees472TotalNbrEmployees
Total Nbr Volunteers263TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year408978ContributionsGrantsPriorYear
Contributions Grants Current Year662187ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16361702ProgramServiceRevenuePriorYear
Program Service Revenue CY17976675ProgramServiceRevenueCY
Investment Income Prior Year16366InvestmentIncomePriorYear
Investment Income Current Year15257InvestmentIncomeCurrentYear
Other Revenue Prior Year109715OtherRevenuePriorYear
Other Revenue Current Year109289OtherRevenueCurrentYear
Total Revenue Prior Year16896761TotalRevenuePriorYear
Total Revenue Current Year18763408TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10522384SalariesEtcPriorYear
Salaries Etc Current Year11115855SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year100409TotalFundrsngExpCurrentYear
Other Expense Prior Year6113024OtherExpensePriorYear
Other Expenses Current Year6540907OtherExpensesCurrentYear
Total Expenses Prior Year16635408TotalExpensesPriorYear
Total Expenses Current Year17656762TotalExpensesCurrentYear
Revenues Less Expenses Prior Year261353RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1106646RevenuesLessExpensesCY
Total Assets BOY13780653TotalAssetsBOY
Total Assets EOY14804135TotalAssetsEOY
Total Liabilities BOY5979086TotalLiabilitiesBOY
Total Liabilities EOY5886968TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7801567NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8917167NetAssetsOrFundBalancesEOY
Mission DescriptionRESTHAVEN'S MISSION IS TO GLORIFY GOD BY PROVIDING A CONTINUUM OF QUALITY CARE AND SERVICES THAT DEMONSTRATES THE LOVE AND COMPASSION OF JESUS CHRIST.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12142951Expense
Revenue13647160Revenue
DescriptionRESTHAVEN CARE CENTER - PROVIDES MEDICAL REHABILITATION, LONG-TERM CARE SERVICES, AND MEMORY SUPPORT FOR SENIORS IN HOLLAND, MI. SERVING AN AVERAGE OF 136 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 68% 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2190978Expense
Revenue2340017Revenue
DescriptionRESTHAVEN 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.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1935221Expense
Revenue1989498Revenue
DescriptionRESTHAVEN 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense16269150TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109667NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees472NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BEVERLY DONAHUEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6167963504TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line19 EAST 8TH STREETAddressLine1
CityHOLLANDCity
StateMIState
ZIP Code49423ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ILSE K SAEWERT
BOARD CHAIR1.00XX000
JOHN DICE
VICE CHAIR1.00XX000
GREG MCCOY
TREASURER1.00XX000
SUSAN HUTCHINSON
SECRETARY1.00XX000
KAREN BROWN
TRUSTEE1.00X000
DAVID LUTZ
TRUSTEE1.00X000
TRACEY MCKNIGHT
TRUSTEE1.00X000
KAY HUBBARD
TRUSTEE1.00X000
GEORGE ZUIDEMA
TRUSTEE1.00X000
SCOTT PATCHIN
TRUSTEE1.00X000
BILL RYCKBOST
TRUSTEE1.00X000
DARELL SCHREGARDUS
TRUSTEE1.00X000
CHARLES VANDER BROEK
PRESIDENT/CEO40.00XX13798403622
JOHN SCHMIDT
TRUSTEE - THROUGH 4/111.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org137984TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation3622TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AGILITY THERAPY
PO BOX 77000DETROITMI482772000THERAPY PROVIDER932565
CREATIVE DINING SERVICES INC
ONE ROYAL PARK DRIVE ST3ZEELANDMI49464DIETARY SERVICES386257
CC HODGSON ARCHITECTURAL GROUP
23240 CHAGRIN BLVD ST350CLEVELANDOH44122ARCHITECTURAL136450
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants1000GovernmentGrants
All Other Contributions661187AllOtherContributions
Noncash Contributions217454NoncashContributions
Total Contributions662187TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ROOM AND BOARD6243101357139913571399
HOME CARE SERVICES62161022120632212063
ANCILLIARY SERVICES90009921723422172342
OTHER OPERATING INCOME9000992087120871
FieldValueIRS element (for citing)
Total Program Service Revenue17976675TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column29379TotalRevenueColumn
Exclusion$29,379ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real109289Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real109289Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column109289TotalRevenueColumn
Exclusion$109,289ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities410890Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities418775Securities
Other6237Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-7885Securities
Other-6237Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-14122TotalRevenueColumn
Exclusion-$14,122ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18763408TotalRevenueColumn
Related Or Exempt Function Income17976675RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$124,546ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total138281Total
Management And General138281ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8971941Total
Program Services8388422ProgramServices
Management And General509268ManagementAndGeneral
Fundraising74251Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total38107Total
Program Services36213ProgramServices
Management And General1575ManagementAndGeneral
Fundraising319Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1290863Total
Program Services1226709ProgramServices
Management And General53359ManagementAndGeneral
Fundraising10795Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total676663Total
Program Services624184ProgramServices
Management And General47054ManagementAndGeneral
Fundraising5425Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total16054Total
Program Services5384ProgramServices
Management And General10670ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total30500Total
Program Services13000ProgramServices
Management And General17500ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1738Total
Management And General1738ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1630472Total
Program Services1516746ProgramServices
Management And General113101ManagementAndGeneral
Fundraising625Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total56923Total
Management And General56923ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1162323Total
Program Services1068024ProgramServices
Management And General87664ManagementAndGeneral
Fundraising6635Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total60059Total
Program Services53353ProgramServices
Management And General6706ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total420658Total
Program Services411725ProgramServices
Management And General8933ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total19003Total
Program Services9111ProgramServices
Management And General9892ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total49890Total
Program Services34433ProgramServices
Management And General15312ManagementAndGeneral
Fundraising145Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total126331Total
Program Services125191ProgramServices
Management And General1140ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total992528Total
Program Services955935ProgramServices
Management And General35451ManagementAndGeneral
Fundraising1142Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total150476Total
Program Services140ProgramServices
Management And General150336ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
DUES & LICENSES103659810330783345175
FOOD613867605351841799
BAD DEBTS13972712839110538798
RESIDENT SERVICES3369533695

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total65Total
Program Services65ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17656762Total
Program Services16269150ProgramServices
Management And General1287203ManagementAndGeneral
Fundraising100409Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1515BOY
EOY1515EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY778143BOY
EOY2872936EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY80000BOY
EOY166836EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2286704BOY
EOY1443323EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY129265BOY
EOY109770EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY35785BOY
EOY37392EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY206917BOY
EOY224227EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis21196578LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11811321LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8964630BOY
EOY9385257EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1232205BOY
EOY495328EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY65489BOY
EOY67551EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY13780653BOY
EOY14804135EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1031880BOY
EOY1092216EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY504891BOY
EOY660000EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
EOY3112985EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4442315BOY
EOY1021767EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5979086BOY
EOY5886968EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7347772BOY
EOY8636953EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY370085BOY
EOY196504EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY83710BOY
EOY83710EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7801567BOY
EOY8917167EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13780653BOY
EOY14804135EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1106646ReconcilationRevenueExpenses
Reconcilation Other Changes8954ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years293868CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years544958CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years424751CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year408978CurrentTaxYearMinus1Year
Current Tax Year662187CurrentTaxYear
Total2334742Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14894479CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15529441CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16267018CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16402394CurrentTaxYearMinus1Year
Current Tax Year17976675CurrentTaxYear
Total81070007Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15188347CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16074399CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16691769CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16811372CurrentTaxYearMinus1Year
Current Tax Year18638862CurrentTaxYear
Total83404749Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years118875CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years375000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years160426CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year179500CurrentTaxYearMinus1Year
Current Tax Year359750CurrentTaxYear
Total1193551Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years118875CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years375000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years160426CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year179500CurrentTaxYearMinus1Year
Current Tax Year359750CurrentTaxYear
Total1193551Total
FieldValueIRS element (for citing)
Public Support Total50982211198PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years208363CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years171245CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years108275CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year109715CurrentTaxYearMinus1Year
Current Tax Year138668CurrentTaxYear
Total736266Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years208363CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years171245CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years108275CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year109715CurrentTaxYearMinus1Year
Current Tax Year138668CurrentTaxYear
Total736266Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15396710CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16245644CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16800044CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16921087CurrentTaxYearMinus1Year
Current Tax Year18777530CurrentTaxYear
Total84141015Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97710PublicSupportPercentage509
Prior Year Support Percentage0.99030PriorYearSupportPercentage
Investment Income Percentage0.00880InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01000PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis448128OtherCostOrOtherBasis
Book Value448128BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16169312OtherCostOrOtherBasis
Depreciation9504083Depreciation
Book Value6665229BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis691940OtherCostOrOtherBasis
Depreciation388736Depreciation
Book Value303204BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2891698OtherCostOrOtherBasis
Depreciation1918502Depreciation
Book Value973196BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis995500OtherCostOrOtherBasis
Book Value995500BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9385257TotalOfBookValueLandBuildings
Total Revenue18763408TotalRevenue
Total Expenses17656762TotalExpenses
Excess Or Deficit For Year1106646ExcessOrDeficitForYear
Net Unrealized GL On Investments30774NetUnrealizedGLOnInvestments
Other-$21,820OtherAmount
Total Adjustments8954TotalAdjustments
Excess Or Deficit Per FS1115600ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt18772362TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments30774NetUnrealizedGainsInvestments
Other Revenues-21820OtherRevenues
Revenue Not Rptd F9908954RevenueNotRptdF990
Revenue Subtotal18763408RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99018763408TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17656762TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal17656762ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99017656762TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:UNREALIZED LOSS ON INTEREST RATE SWAP -21,820.
PART XII, LINE 2D - OTHER ADJUSTMENTS:UNREALIZED LOSS ON INTEREST RATE SWAP -21,820.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY
38288941759465HCG92006-02-222771588REFINANCE LOAN AT RESTHAVEN CARE CENTER001
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY
38288941759465HDY92006-09-27500633FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY001
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY
38288941759465HEK82007-01-17530045FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY001
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY
38288941759465HEP72007-03-28428376FINANCE CONSTRUCTION OF 10 BED SKILLED NURSING FACILITY001

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
139092277158822170277125820060011
26038500633400550063320070011
27568530045424053004520070011
22280428376342742837620070011

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
010000
010000
010000
010000

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions8NumberOfContributions
Noncash Contribs Rptd F99032454NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionFURNITUREDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990185000NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DOING BUSINESS ASFORM 990, PART I, ITEM CDBA: 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 11THE 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 12CTHE 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 15TOP 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 2011.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 30,774. UNREALIZED LOSS ON INTEREST RATE SWAP -21,820. TOTAL TO FORM 990, PART XI, LINE 5: 8,954.
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.

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