GLEN HAVEN HOME INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
GLEN HAVEN HOME INC (EIN 42-1088300)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-07-16
IRS object ID
201101979349300500
Schema version
2010v3.2
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)
Timestamp2011-07-16T12:03:07-07:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PELZER ACCOUNTING LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line132805 GASTON AVEAddressLine1
CityMALVERNCity
StateIAState
ZIP Code51551ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421088300EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GLEN HAVEN HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGLENNameControl
Phone7125273101Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1302 6TH STREETAddressLine1
CityGLENWOODCity
StateIAState
ZIP Code51534ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMATT ROSSName
TitleADMINISTRATORTitle
Phone7125273101Phone
Date Signed2011-05-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameJAMIE L PELZERName
Phone7126248369Phone
Date Prepared2011-07-16DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1MATT ROSSBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1302 6TH STREETAddressLine1
CityGLENWOODCity
StateIAState
ZIP Code51534ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4597864GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.glenhavenhome.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionNursing Home & Assisted Living Care for the ElderlyActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees151TotalNbrEmployees
Total Nbr Volunteers20TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year15754ContributionsGrantsPriorYear
Contributions Grants Current Year7681ContributionsGrantsCurrentYear
Program Service Revenue Prior Year4217585ProgramServiceRevenuePriorYear
Program Service Revenue CY4588563ProgramServiceRevenueCY
Investment Income Prior Year22InvestmentIncomePriorYear
Investment Income Current Year7InvestmentIncomeCurrentYear
Other Revenue Prior Year1050OtherRevenuePriorYear
Other Revenue Current Year1613OtherRevenueCurrentYear
Total Revenue Prior Year4234411TotalRevenuePriorYear
Total Revenue Current Year4597864TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2734000SalariesEtcPriorYear
Salaries Etc Current Year2905603SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1470341OtherExpensePriorYear
Other Expenses Current Year1626319OtherExpensesCurrentYear
Total Expenses Prior Year4204341TotalExpensesPriorYear
Total Expenses Current Year4531922TotalExpensesCurrentYear
Revenues Less Expenses Prior Year30070RevenuesLessExpensesPriorYear
Revenues Less Expenses CY65942RevenuesLessExpensesCY
Total Assets BOY3125536TotalAssetsBOY
Total Assets EOY2911842TotalAssetsEOY
Total Liabilities BOY3069796TotalLiabilitiesBOY
Total Liabilities EOY2790160TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY55740NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY121682NetAssetsOrFundBalancesEOY
Mission DescriptionNursing Home & Assisted Living Care for the ElderlyMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense2819892Expense
Revenue4837733Revenue
DescriptionPROVIDE NURSING CARE AND ASSITED LIVING FOR THE ELDERLY -INCLUDES NURSING, LAUNDRY, DIETARY, ACTIVITIES, AND SOCIAL SERVICESDescription
Total Program Service Expense2819892TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees151NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HHS SOLUTIONSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7125273101TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1302 6TH STREETAddressLine1
CityGLENWOODCity
StateIAState
ZIP Code51534ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
RON ROSS
President2.00XX000
ROGER PETRIK
Vice President2.00XX000
MATT ROSS
Treasurer40.00XX000
LARRY RAABE
Secretary0.50X000
GEORGANNE WILLIAMS
Board Member0.50X000
FieldValueIRS element (for citing)
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HHS SOLUTIONS
6649 FLINT RIDGE RDLINCOLNNE68506Management217588
ENDURACARE
PO BOX 53064PHOENIXAZ85072Therapy189375
OMNICARE
PO BOX 715268COLUMBUSOH43271Pharmacy102797
PEGLER-SYSCO
PO BOX 82605LINCOLNNE68501Food262526
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Fundraising Events7681FundraisingEvents
Total Contributions7681TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionProgram ServiceDescription
Business Code623000BusinessCode
Total Revenue Column4588563TotalRevenueColumn
FieldValueIRS element (for citing)
Total Program Service Revenue4588563TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7TotalRevenueColumn
Exclusion$7ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionRental IncomeDescription
Business Code623000BusinessCode
Total Revenue Column1613TotalRevenueColumn
Exclusion$1,613ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1613TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4597864TotalRevenueColumn
Related Or Exempt Function Income4588563RelatedOrExemptFunctionIncome
Exclusion$1,620ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2379917Total
Program Services2011570ProgramServices
Management And General368347ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total170235Total
Program Services3815ProgramServices
Management And General166420ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total355451Total
Program Services0ProgramServices
Management And General355451ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total171218Total
Program Services84025ProgramServices
Management And General87193ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total3105Total
Program Services0ProgramServices
Management And General3105ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total81853Total
Program Services29636ProgramServices
Management And General52217ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total11964Total
Program Services1568ProgramServices
Management And General10396ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total24757Total
Program Services0ProgramServices
Management And General24757ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total4170Total
Program Services0ProgramServices
Management And General4170ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total84630Total
Program Services0ProgramServices
Management And General84630ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total139154Total
Program Services0ProgramServices
Management And General139154ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total118517Total
Program Services0ProgramServices
Management And General118517ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Auto Expense29302930
Dues172900172900
Bank Charges2520025200
Equipment Rental6636066360

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total960212Total
Program Services689278ProgramServices
Management And General270934ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4531922Total
Program Services2819892ProgramServices
Management And General1712030ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY105764BOY
EOY111955EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY500187BOY
EOY389595EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY450EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY14071BOY
EOY14071EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY46620BOY
EOY54606EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4648552LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2316658LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2451881BOY
EOY2331894EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY2BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7011BOY
EOY9271EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3125536BOY
EOY2911842EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY503589BOY
EOY420530EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2559196BOY
EOY2369630EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7011BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3069796BOY
EOY2790160EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY55740BOY
EOY121682EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY55740BOY
EOY121682EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3125536BOY
EOY2911842EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses65942ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis19352OtherCostOrOtherBasis
Book Value19352BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3385758OtherCostOrOtherBasis
Depreciation1245665Depreciation
Book Value2140093BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis571480OtherCostOrOtherBasis
Depreciation430026Depreciation
Book Value141454BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis533556OtherCostOrOtherBasis
Depreciation509111Depreciation
Book Value24445BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis138406OtherCostOrOtherBasis
Depreciation131856Depreciation
Book Value6550BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2331894TotalOfBookValueLandBuildings

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonHHS SOLUTIONSNamePerson
FieldValueIRS element (for citing)
RelationshipPresidentRelationship
Amount Of Transaction217588AmountOfTransaction
Description Of TransactionManagement ServicesDescriptionOfTransaction
Sharing Of RevenuestrueSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanation
Pt VI-A, Line 2Ron D Ross, President & Matt Ross, Secretary (Father & Son); Ron D Ross, President & Roger Petrik, Vice President (Brothers)
Pt VI-A, Line 3Management was delegated to HHS Solutions and Matt Ross was then authorized as administrator.
Pt VI-A, Line 7aThe board members and directors are authorized to elect any other board members.
Pt VI-A, Line 7bAll decisions of the governing body are subject to approval by the members and directors.
Pt VI-C, Line 19All governing documents, conflict of interest policies, and financial statements are available to the public upon request made at the office.
Pt VI-B, Line 11aA copy of the return is made available to the administrator.
Form 990, Part IX, Line 24fSUPPLIES 246836. 174389. 72447. GENERAL/OTHER 118. 22. 96. UTILITIES 120955. 120955. DONATIONS 842. 842. FOOD COSTS 280271. 280271. REPAIRS 31134. 2209. 28925. REAL ESTATE TAXES 46649. 46649. SPECIAL EVENTS 1251. 1251. THERAPY/OXYGEN/BEAUTY 670. 670. TAXES 184. 184. DRUG TESTING/EDUCATION 2290. 2124. 166. TRANSPORTATION 38369. 38369. POOL AIDES 178894. 178894. THERAPY 1809. 1809. OXYGEN 9940. 9940.

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