MENNONITE HOME ASSOCIATION INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MENNONITE HOME ASSOCIATION INC (EIN 43-0730924)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-02-08
IRS object ID
201110399349300621
Schema version
2009v1.7
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)
Timestamp2011-02-08T14:29:30-06:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1600 WASHINGTON AVENUE SUITE 1800AddressLine1
CityST LOUISCity
StateMOState
ZIP Code63101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN430730924EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MENNONITE HOME ASSOCIATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMENNNameControl
Phone5732216000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12500 PLEASANT STREETAddressLine1
CityHANNIBALCity
StateMOState
ZIP Code63401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePaul EwertName
Titlechief executive officerTitle
Phone5732216000Phone
Date Signed2011-02-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameALLAN LARSONName
Phone3149254300Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPaul EwertNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12500 PLEASANT STREETAddressLine1
CityHANNIBALCity
StateMOState
ZIP Code63401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6679738GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.bethaven.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1957YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionPROVIDE NURSING AND assisted living SERVICES TO THE ELDERLYActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees230TotalNbrEmployees
Total Nbr Volunteers402TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5453ContributionsGrantsPriorYear
Contributions Grants Current Year3739ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6317381ProgramServiceRevenuePriorYear
Program Service Revenue CY6579056ProgramServiceRevenueCY
Investment Income Prior Year18665InvestmentIncomePriorYear
Investment Income Current Year17243InvestmentIncomeCurrentYear
Other Revenue Prior Year13000OtherRevenuePriorYear
Other Revenue Current Year79700OtherRevenueCurrentYear
Total Revenue Prior Year6354499TotalRevenuePriorYear
Total Revenue Current Year6679738TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3345641SalariesEtcPriorYear
Salaries Etc Current Year3487602SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2893108OtherExpensePriorYear
Other Expenses Current Year3134690OtherExpensesCurrentYear
Total Expenses Prior Year6238749TotalExpensesPriorYear
Total Expenses Current Year6622292TotalExpensesCurrentYear
Revenues Less Expenses Prior Year115750RevenuesLessExpensesPriorYear
Revenues Less Expenses CY57446RevenuesLessExpensesCY
Total Assets BOY7874396TotalAssetsBOY
Total Assets EOY7835251TotalAssetsEOY
Total Liabilities BOY4896561TotalLiabilitiesBOY
Total Liabilities EOY4757339TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2977835NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3077912NetAssetsOrFundBalancesEOY
Mission DescriptionElderly healthcare and housingMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6090062Expense
Revenue6579056Revenue
DescriptionBETH HAVEN NURSING HOME AND assisted living IS A 105 BED SKILLED NURSING FACILITY AND A 38 UNIT assisted living FACILITY PROVIDING NURSING AND assisted living care TO THE ELDERLY.Description
Total Program Service Expense6090062TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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 Bonds0TaxExemptBonds
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 Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109624NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees230NumberOfEmployees
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
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
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 Body1Form990ProvidedToGoverningBody
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
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PAUL EWERTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5732216000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12500 PLEASANT STREETAddressLine1
CityHannibalCity
StateMOState
ZIP Code63401ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
TODD AHRENS
DIRECTOR0.50X000
TIM GOODMAN
DIRECTOR0.50X000
EDITH DANIELS-rice
DIRECTOR0.50X000
BETTY HATHAWAY
DIRECTOR0.50X000
RICHARD GRIFFEN
DIRECTOR0.50X000
ED CLINE
DIRECTOR0.50X000
WENDELL KREIDER
PRESIDENT0.50000X
JEROLD LEE
VICE PRESIdent0.50000X
DIRK SAUER
SECRETARY/TREASURER0.50000X
PAUL EWERT
chief executive officer40.0007920313939X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs79203TotalReportableCompFrmRltdOrgs
Total Other Compensation13939TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BETH HAVEN MANAGEMENT SERVICES
2500 PLEASANT STREEThannibalMO63401MANAGEMENT530272
ONR INC
1101 S CAPITAL OF TEXAS HWY BLDG GaustinTX78746THERAPY SERVICES320741
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
All Other Contributions3739AllOtherContributions
Total Contributions3739TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT SERVICESDescription
Business Code623000BusinessCode
Total Revenue Column6579056TotalRevenueColumn
Related Or Exempt Function Income6579056RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue6579056TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column17243TotalRevenueColumn
Exclusion$17,243ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real13000Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real13000Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column13000TotalRevenueColumn
Exclusion$13,000ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
misc income90009926335$26,335
vending machine45200018435$18,435
meal income72232012205$12,205

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column9725TotalRevenueColumn
Exclusion$9,725ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue66700TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6679738TotalRevenueColumn
Related Or Exempt Function Income6579056RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$96,943ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2933771Total
Program Services2876801ProgramServices
Management And General56970ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total311232Total
Program Services305188ProgramServices
Management And General6044ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total242599Total
Program Services237888ProgramServices
Management And General4711ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total308446Total
Management And General308446ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total8164Total
Management And General8164ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total21870Total
Management And General21870ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total20263Total
Management And General20263ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total935438Total
Program Services902793ProgramServices
Management And General32645ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total244884Total
Program Services239696ProgramServices
Management And General5188ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total3389Total
Program Services3323ProgramServices
Management And General66ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11366Total
Program Services11145ProgramServices
Management And General221ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total235234Total
Program Services230250ProgramServices
Management And General4984ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total290571Total
Program Services284415ProgramServices
Management And General6156ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total144387Total
Program Services141328ProgramServices
Management And General3059ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Rental & Maintenance4673694594807889
NFRA MONTHLY FEE370427370427
Bad Debts2660426604
VENDING MACHINE1462714344283
Dues & subscriptions1299112991

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total18660Total
Program Services12984ProgramServices
Management And General5676ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6622292Total
Program Services6090062ProgramServices
Management And General532230ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY826577BOY
EOY544518EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY628286BOY
EOY942671EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY383172BOY
EOY341420EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY19611BOY
EOY95555EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY21773BOY
EOY23197EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY49734BOY
EOY42912EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9499229LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3841482LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5741325BOY
EOY5657747EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY74729BOY
EOY97004EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY129189BOY
EOY90227EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7874396BOY
EOY7835251EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY432173BOY
EOY432834EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4408421BOY
EOY4262065EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY55967BOY
EOY62440EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4896561BOY
EOY4757339EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2977835BOY
EOY3077912EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2977835BOY
EOY3077912EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7874396BOY
EOY7835251EOY
FieldValueIRS element (for citing)
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 Years3882CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3080CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2500CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5453CurrentTaxYearMinus1Year
Current Tax Year3739CurrentTaxYear
Total18654Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4771084CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4898184CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5920423CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6317381CurrentTaxYearMinus1Year
Current Tax Year6579056CurrentTaxYear
Total28486128Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4774966CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4901264CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5922923CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6322834CurrentTaxYearMinus1Year
Current Tax Year6582795CurrentTaxYear
Total28504782Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50928504782PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years46877CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56926CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years53859CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year36313CurrentTaxYearMinus1Year
Current Tax Year30243CurrentTaxYear
Total224218Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years46877CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56926CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years53859CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year36313CurrentTaxYearMinus1Year
Current Tax Year30243CurrentTaxYear
Total224218Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years53453CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years82950CurrentTaxYearMinus2Years
Current Tax Year66700CurrentTaxYear
Total203103Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4821843CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5011643CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6059732CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6359147CurrentTaxYearMinus1Year
Current Tax Year6679738CurrentTaxYear
Total28932103Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98520PublicSupportPercentage509
Prior Year Support Percentage0.98680PriorYearSupportPercentage
Investment Income Percentage0.00770InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00810PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis103330OtherCostOrOtherBasis
Book Value103330BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8589059OtherCostOrOtherBasis
Depreciation3285260Depreciation
Book Value5303799BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis759213OtherCostOrOtherBasis
Depreciation511715Depreciation
Book Value247498BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis47627OtherCostOrOtherBasis
Depreciation44507Depreciation
Book Value3120BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5657747TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
RESIDENT TRUST FUNDS$26,886
DUE TO AFFILIATES$35,167
DUE TO TERRACE$247
DUE TO GROUP HOMES$140
FieldValueIRS element (for citing)
Total Of Amounts62440TotalOfAmounts
Total Revenue6679738TotalRevenue
Total Expenses6622292TotalExpenses
Excess Or Deficit For Year57446ExcessOrDeficitForYear
Net Unrealized GL On Investments20356NetUnrealizedGLOnInvestments
Other$22,275OtherAmount
Total Adjustments42631TotalAdjustments
Excess Or Deficit Per FS100077ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt6722369TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments20356NetUnrealizedGainsInvestments
Other Revenues22275OtherRevenues
Revenue Not Rptd F99042631RevenueNotRptdF990
Revenue Subtotal6679738RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9906679738TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6622292TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal6622292ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9906622292TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:The Association qualifies as a tax-exempt organization described in Section 501 (c)(3) of the Internal Revenue Code. Accordingly, the Association is not subject to federal income taxes under Section 501 (c)(3) of the Code. The Association is classified as a publicly supported charitable organization under the Code and contributions to the Association qualifies as charitable tax deductions for the contributor. The entity files as a tax-exempt organization. Should that status be challenged in the future, all years since inception could be subject to review by the IRS. The Association's income tax returns for the years 2006 through 2009 are subject to review and examination by the IRS.
Part XI, Line 8 - Other Adjustments:gain on investment in affiliated company: 22275.
Part XII, Line 2d - Other Adjustments:gain from investment in affiliated company: 22275.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Jerold Lee Board of Director
President, Commerce BankLoan and Checking Account0
DIRK Sauer Board of Director
Owner, Martin's True ValuePurchased Supplies0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 3The organization delegates management duties including supervising personnel, operations, and budgeting to Beth Haven Management Services, a management company.
Form 990, Part VI, Section B, line 11The management and board of directors will be provided a draft of the 990 for review prior to being filed. The Board will again review it at the next regular meeting following the filing. Management will review it with the Board where they will receive a summary during the meeting and provided a copy for review on their own.
Form 990, Part VI, Section B, line 12cAnnually, in January the Board of Directors and key management personnel are required to review the conflict of interest policy and sign a conflict of interest statement disclosing any potential conflicts of interest. These potential conflicts of interest are disclosed to the entire Board. During a Board meeting if a potential conflict of interest arises the Board member is to disclose the potential conflict and remove themselves from the Board discussion and voting.
Form 990, Part VI, Section B, line 15Prior to hiring an area wide review of comparable positions is conducted. Annually a survey of Northeast Missouri Nursing homes is conducted to compare similar positions. During the annual review an evaluation of current market conditions, comparable positions, and facility operational forecasts are considered in determining compensation. Salary levels for Officers and key employees are set by the Board of Directors.
Form 990, Part VI, Section C, line 19The Organization makes the conflict of interest policy and the financial statements available to the public upon request.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
BETH HAVEN GROUP HOMES
2518 PLEASANT STHANNIBALMO63401431580486HOME FOR HANDICAPPEDMO501c3509(a)(2)N/A
BETH HAVEN TERRACE
901 CENTRAL AVEHANNIBALMO63401431162094ELDERLY APARTMENTSMO501C3509(a)(2)N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Beth Haven Management ServicesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12500 PleasantAddressLine1
CityHannibalCity
StateMOState
ZIP Code63401ZIPCode
FieldValueIRS element (for citing)
EIN431299897EIN
Primary ActivityHealth Care ManagementPrimaryActivity
Legal Domicile StateMOLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income22275ShareOfTotalIncome
Share Of EOY Assets172626ShareOfEOYAssets
Percentage Ownership0.50000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Beth Haven Managment Services
L246028
BETH HAVEN GROUP HOMES
P90117
Beth Haven Managment Services
N284244
Beth Haven Managment Services
D83888
Beth HAVEN GROUP HOMES
E4262065

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