2012-10-10T12:49:22-05:00 2011-12-31 520783935 SMITH ELLIOTT KEARNS & COMPANY LLC 804 WAYNE AVENUE CHAMBERSBURG PA 17201 990 2011-01-01 236276101 MENNO-HAVEN INC MENN 7172621000 2011 SCOTLAND AVENUE CHAMBERSBURG PA 17201 RODNEY E MASON 7172621000 2012-09-25 1 GREGORY P HALL CPA P00156653 7172633910 2011 2016-02-24 21:20:13Z RODNEY E MASON 2011 SCOTLAND AVE CHAMBERSBURG PA 17201 49319524 0 X WWW.MENNOHAVEN.ORG X 1964 PA TO ENHANCE THE QUALITY OF LIFE THROUGH RESPONSIVE CHRISTIAN HUMAN SERVICES IN A CARING COMMUNITY 12 12 688 579 220057 -224022 597467 397916 37734090 40435759 682185 521374 192096 252837 39205838 41607886 0 0 0 0 18974596 19195570 0 0 220260 19096819 19577156 38071415 38772726 1134423 2835160 106027524 107520673 93308822 98210221 12718702 9310452 TO ENHANCE THE QUALITY OF LIFE THROUGH RESPONSIVE CHRISTIAN HUMAN SERVICES IN A CARING COMMUNITY 0 0 15392507 21101408 ORGANIZATION MAINTAINS A LICENSED SKILLED NURSING FACILITY. PROVIDES ROOM & BOARD AND NURSING CARE, MEDICAL AND REHAB SERVICES, SOCIAL SERVICES, AND ACTIVITY PROGRAMS. 311614 11115776 ORGANIZATION MAINTAINS A LICENSED ASSISTED LIVING AND RESIDENTIAL LIVING FACILITY IN TWO LOCATIONS. PROVIDES ROOM & BOARD, LIMITED NURSING CARE, MEDICAL AND REHAB SERIVCES, SOCIAL SERVICES AND ACTIVITY PROGRAMS. 18430065 8218575 ORGANIZATION MAINTAINS INDEPENDENT LIVING UNITS FOR INDIVIDUALS WHO WISH TO MAINTAIN MORE INDEPENDENCE, BUT DESIRE ACCESS TO THE FOLLOWING SUPPORT SERVICES: EMERGENCY NURSE CALL, GROUNDS MAINTENANCE, MEDICAL AND TRANSPORTATION SERVICES. 34134186 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 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 0 0 0 1 1 0 0 0 1 153 0 1 688 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 PA MD X RODNEY E MASON 7172621000 2011 SCOTLAND AVENUE CHAMBERSBURG PA 17201 LLWELLYN MARTIN 0.40 X X 0 0 0 DALE HORST 0.30 X X 0 0 0 MARTHA WALKER 0.30 X X 0 0 0 LYNN ROTZ 0.30 X X 0 0 0 JOSEPH HULOCK 0.30 X X 0 0 0 BRADLEY MARTIN 0.30 X 0 0 0 DARRELL BAER 0.10 X 0 0 0 GLENN WINGERT 0.20 X 0 0 0 WAYNE YEAGER 0.20 X 0 0 0 DALE CLUGSTON 0.30 X 0 0 0 CAROLYN GEORGE 0.40 X 0 0 0 HELEN SKIBA-POWELL 0.20 X 0 0 0 RODNEY MASON 40.00 X 213779 0 22091 JACK PARSON 40.00 X 168499 0 11793 TIMOTHY JOHNSON 40.00 X 128899 0 13135 CHARLES NELSON 40.00 X 136567 0 13657 WENDY COWAN 40.00 X 111003 0 5492 DENNIS TRAVERS 40.00 X 109803 0 9466 DR ZACHARY SIMPSON 40.00 X 170372 0 0 1038922 0 75634 7 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVIES 1842467 CURA HOSPITALITY PO BOX 827276 PHILADELPHIA PA 19182 DIETARY SERVICES 1288601 FEESERS INC 5561 GRAYSON ROAD HARRISBURG PA 17111 FOOD SERVICE DISTRIBUTOR 1070251 MCCONKEY & CO INC 2555 KINGSTON RD STE 100 YORK PA 17402 INSURANCE 612090 CONTINUING CARE RX INC PO BOX 12899 PHILADELPHIA PA 19176 PHARMACY 100356 13 397916 397916 NURSING & PERSONAL CAR 623000 34338830 34338830 OTHER RESIDENT SERVICE 623000 3830902 3830902 LIFE LEASE CONTRACTS 623000 2266027 2266027 40435759 452732 452732 7769516 7700874 68642 68642 68642 43544 10764 32780 32780 PHYSICIAN/FOOD SERVICE 722100 220057 220057 220057 41607886 40435759 220057 554154 944184 889477 54707 14882051 13340898 1455540 85613 274061 190950 76845 6266 1959293 1727988 211318 19987 1135981 972524 154879 8578 1586117 1391946 194091 80 384124 200 383529 395 2698126 2506917 179608 11601 138094 37436 96327 4331 3261477 3261477 67868 35542 32048 278 30450 30450 2331661 2306928 24733 4223306 4109208 114098 330503 160392 170111 DIRECT RESIDENTIAL SERV 4209314 3940567 268747 MISCELLANEOUS 254560 143505 107364 3691 BAD DEBTS 55992 2144 53848 EQUIPMENT RENTAL & MAIN 5564 5564 38772726 34134186 4418280 220260 2300 2300 4261462 2447831 16299 5599 2251745 2619873 235605 248445 1071231 1028927 122089725 50288157 74250666 71801568 21752856 27265842 2185360 2100288 106027524 107520673 3800257 3589563 26775622 26701547 43965000 43195000 3323 1726 12033349 12013320 6731271 12709065 93308822 98210221 X 5714127 2319701 5824289 5878915 1180286 1111836 12718702 9310452 106027524 107520673 X 2835160 -6243410 X X 0 1 1 X 0 X 1374654 656949 480295 597467 397916 3507281 21654174 23212281 24221786 37734090 40435759 147258090 23027 25920 16132 29590 43544 138213 23051855 23895150 24718213 38361147 40877219 150903584 1625 1895 2490 4340 3305 13655 0 1625 1895 2490 4340 3305 13655 150889929 412877 340160 167364 631151 452732 2004284 412877 340160 167364 631151 452732 2004284 23464732 24235310 24885577 38992298 41329951 152907868 0.98680 0.98530 0.01310 0.01370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 6526629 229827 21785 245029 6533212 5814676 319799 739004 346850 6526629 4358246 253953 1280534 78057 5814676 5986053 213400 -1540291 300916 4358246 0.17000 0.83000 1 0 2806265 2806265 90151880 31350339 58801541 23979913 15638597 8341316 5151667 3299221 1852446 71801568 GIFT ANNUITIES 529572 OBLIGATION UNDER INTEREST RATE SWAP 12179493 12709065 41607886 38772726 2835160 -124029 -6119381 -6243410 -3408250 35375240 -124029 -6108617 -6232646 41607886 0 41607886 38783490 10764 10764 38772726 0 38772726 PART IV, LINE 2B: RESIDENT FUNDS ARE MAINTAINED FOR THE BENEFIT OF OUR RESIDENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED TAX BENEFITS WOULD BE CLASSIFIED AS EXPENSES AGAINST OTHER OPERATING REVENUE IN THE STATEMENT OF OPERATIONS. AT DECEMBER 31, 2011 AND 2010 THERE WAS NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS. TAX YEARS SUBSEQUENT TO 2007 ARE OPEN FOR EXAMINATION. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVES -6,050,931. CHANGE IN VALUE OF PERPETUAL TRUST -68,450. TOTAL TO SCHEDULE D, PART XI, LINE 8: -6,119,381. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVES -6,050,931. CHANGE IN VALUE OF PERPETUAL TRUST -68,450. SPECIAL EVENT EXPENSES NETTED AGAINST FUNDRAISING INCOME 10,764. ROUNDING PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED AGAINST FUNDRAISING INCOME 10,764. GOLF TOURNAMENT 43544 43544 1110 2491 3728 2356 1079 43544 43544 1110 2491 3728 2356 1079 10764 32780 X X 0 0 0 0 0 0 0 1 0 RODNEY MASON 202618 0 9850 0 1311 0 5000 0 17091 0 235870 0 0 0 JACK PARSON 158799 0 5938 0 3762 0 2000 0 9793 0 180292 0 0 0 CHARLES NELSON 126491 0 6314 0 3762 0 0 0 13657 0 150224 0 0 0 DR ZACHARY SIMPSON 170372 0 0 0 0 0 0 0 0 0 170372 0 0 0 PART I, LINE 7 CHIEF OFFICERS RECEIVED ADDITIONAL COMPENSATION AT THE REQUEST OF THE BOARD. THEY WERE GIVEN THE OPTION OF CASH OR INVESTMENT IN THEIR 457 PLAN. FRANKLIN COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 232261213 353273AG0 2006-08-15 29250000 CONSTRUCTION, FURNISHING, AND EQUIPMENT 0 0 0 FRANKLIN COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 232261213 353273AH8 2008-01-10 18850000 REFINANCING OF SERIES 2001 AND 2006 PRIOR BONDS 0 0 0 29250000 578675 28671325 2008 0 0 1 0 18850000 13471824 245470 4596180 2011 0 0 1 0 0 1 1 0 0 0.21000 0.26000 0.47000 0 0 1 1 0 0 0.21000 0.26000 0.47000 0 1 1 1 WELLS FARGO 30.000000000000 0 0 0 0 1 1 1 1 WELLS FARGO 30.000000000000 0 0 0 0 1 FORM 990, PART VI, SECTION A, LINE 2 THE MARKETING DIRECTOR IS DISTANTLY RELATED TO A BOARD MEMBER. THERE HAVE BEEN NO ITEMS THAT WOULD BE CONSIDERED A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH A MANAGEMENT COMPANY TO MANAGE AND DIRECT FOOD SERVICES. FORM 990, PART VI, SECTION A, LINE 7B MAJOR DECISIONS OF THE GOVERNING BODY ARE APPROVED AND VOTED ON BY OUR BOARD OF DIRECTORS. WRITTEN MINUTES DOCUMENT OUR BOARD OF DIRECTORS MEETINGS, AS WELL AS, ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE FILING OF THIS FORM. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE REVIEWED BY THE CEO AND ANY DISCLOSED CONFLICTS ARE DISCUSSED WITH THE EXECUTIVE COMMITTEE OR APPROPRIATE OFFICERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIALS IS DETERMINED BY A COMPENSATION SURVEY OR STUDY USING PRIMARILY THE LEADING AGE AGENCY WAGE SURVEY OF SIMILAR SIZE FACILITIES. LEADING AGE IS AN ASSOCIATION OF NONPROFIT SENIOR SERVICES IN THE STATE OF PENNSYLVANIA. THE EXECUTIVE COMMITTEE OF THE BOARD ALSO HAS THE LIBERTY TO UTILIZE OTHER SURVEYS OF SIMILAR OPERATIONS IF THEY CHOOSE TO DO SO. COMPENSATION RANGES FOR OTHER OFFICERS AND KEY EMPLOYEES ARE DETERMINED BY A COMPENSATION SURVEY USING THE LEADING AGE PARENT AGENCY WAGE SURVEY. LEADING AGE IS AN ASSOCIATION OF NONPROFIT SENIOR SERVICES IN THE STATE OF PENNSYLVANIA. DISCRESSION OF WHERE THE FALL IN THAT RANGE IS DETERMINED BY THEIR EXPERIENCE AND KNOWLEDGE AND IS DETERMINED BY THEIR SENIOR MANAGER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGNIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT ITS ADMINISTRATIVE OFFICES LOCATED AT 2011 SCOTLAND AVE., CHAMBERSBURG, PA 17201. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -124,029. CHANGE IN FAIR VALUE OF DERIVATIVES -6,050,931. CHANGE IN VALUE OF PERPETUAL TRUST -68,450. TOTAL TO FORM 990, PART XI, LINE 5: -6,243,410. CONSOLIDATED FINANCIAL STATEMENT AUDIT AND SELECTION OF ACCOUNTANTS FORM 990, PART XI, LINE 2C: THE ORGANIZATION'S FINANCE COMMITTE IS RESPONSIBLE FOR THE OVERSIGHT OF THIS CONSOLIDATED AUDIT AND MAKES RECOMMENDATIONS FOR THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH IS APPRROVED BY THE FULL BOARD OF DIRECTORS. MENNO HAVEN AUXILIARY INC 2075 SCOTLAND AVENUE CHAMBERSBURG PA 17201 251673680 SUPPORT OF THE CAMPUSES OF MENNO HAVEN AND PENN HALL CCRC'S. PA 501 (C)(3) PUBLIC CHARITY MENNO HAVEN AUXILARY INC 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 MENNO HAVEN AUXILIARY INC M 7263 FMV MENNO HAVEN AUXILIARY INC N 9799 FMV MENNO HAVEN AUXILIARY INC C 44719 FMV