2011-02-08T14:29:30-06:00 2010-09-30 LARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2009-10-01 430730924 MENNONITE HOME ASSOCIATION INC MENN 5732216000 2500 PLEASANT STREET HANNIBAL MO 63401 Paul Ewert 5732216000 2011-02-07 1 ALLAN LARSON 3149254300 2009 2016-02-24 21:20:13Z Paul Ewert 2500 PLEASANT STREET HANNIBAL MO 63401 6679738 0 X www.bethaven.org X 1957 MO PROVIDE NURSING AND assisted living SERVICES TO THE ELDERLY 9 9 230 402 0 0 5453 3739 6317381 6579056 18665 17243 13000 79700 6354499 6679738 0 0 3345641 3487602 0 0 2893108 3134690 6238749 6622292 115750 57446 7874396 7835251 4896561 4757339 2977835 3077912 Elderly healthcare and housing 0 0 6090062 6579056 BETH 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. 6090062 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 24 0 1 230 1 0 0 0 0 0 0 0 0 0 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PAUL EWERT 5732216000 2500 PLEASANT STREET Hannibal MO 63401 X TODD AHRENS 0.50 X 0 0 0 TIM GOODMAN 0.50 X 0 0 0 EDITH DANIELS-rice 0.50 X 0 0 0 BETTY HATHAWAY 0.50 X 0 0 0 RICHARD GRIFFEN 0.50 X 0 0 0 ED CLINE 0.50 X 0 0 0 WENDELL KREIDER 0.50 X 0 0 0 JEROLD LEE 0.50 X 0 0 0 DIRK SAUER 0.50 X 0 0 0 PAUL EWERT 40.00 X 0 79203 13939 0 79203 13939 0 0 0 0 BETH HAVEN MANAGEMENT SERVICES 2500 PLEASANT STREET hannibal MO 63401 MANAGEMENT 530272 ONR INC 1101 S CAPITAL OF TEXAS HWY BLDG G austin TX 78746 THERAPY SERVICES 320741 2 3739 3739 RESIDENT SERVICES 623000 6579056 6579056 6579056 17243 17243 13000 13000 13000 13000 misc income 900099 26335 26335 vending machine 452000 18435 18435 meal income 722320 12205 12205 9725 9725 66700 6679738 6579056 0 96943 2933771 2876801 56970 311232 305188 6044 242599 237888 4711 308446 308446 8164 8164 21870 21870 20263 20263 935438 902793 32645 244884 239696 5188 3389 3323 66 11366 11145 221 235234 230250 4984 290571 284415 6156 144387 141328 3059 Rental & Maintenance 467369 459480 7889 NFRA MONTHLY FEE 370427 370427 Bad Debts 26604 26604 VENDING MACHINE 14627 14344 283 Dues & subscriptions 12991 12991 18660 12984 5676 6622292 6090062 532230 0 826577 544518 628286 942671 383172 341420 19611 95555 21773 23197 49734 42912 9499229 3841482 5741325 5657747 74729 97004 129189 90227 7874396 7835251 432173 432834 4408421 4262065 55967 62440 4896561 4757339 X 2977835 3077912 2977835 3077912 7874396 7835251 X 0 1 1 X 0 X 3882 3080 2500 5453 3739 18654 4771084 4898184 5920423 6317381 6579056 28486128 4774966 4901264 5922923 6322834 6582795 28504782 0 0 0 28504782 46877 56926 53859 36313 30243 224218 46877 56926 53859 36313 30243 224218 53453 82950 66700 203103 4821843 5011643 6059732 6359147 6679738 28932103 0.98520 0.98680 0.00770 0.00810 X 103330 103330 8589059 3285260 5303799 759213 511715 247498 47627 44507 3120 5657747 RESIDENT TRUST FUNDS 26886 DUE TO AFFILIATES 35167 DUE TO TERRACE 247 DUE TO GROUP HOMES 140 62440 6679738 6622292 57446 20356 22275 42631 100077 6722369 20356 22275 42631 6679738 0 6679738 6622292 0 6622292 0 6622292 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. Jerold Lee Board of Director President, Commerce Bank Loan and Checking Account 0 DIRK Sauer Board of Director Owner, Martin's True Value Purchased Supplies 0 Form 990, Part VI, Section A, line 3 The 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 11 The 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 12c Annually, 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 15 Prior 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 19 The Organization makes the conflict of interest policy and the financial statements available to the public upon request. BETH HAVEN GROUP HOMES 2518 PLEASANT ST HANNIBAL MO 63401 431580486 HOME FOR HANDICAPPED MO 501c3 509(a)(2) N/A BETH HAVEN TERRACE 901 CENTRAL AVE HANNIBAL MO 63401 431162094 ELDERLY APARTMENTS MO 501C3 509(a)(2) N/A Beth Haven Management Services 2500 Pleasant Hannibal MO 63401 431299897 Health Care Management MO N/A C 22275 172626 0.50000 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 0 0 Beth Haven Managment Services L 246028 BETH HAVEN GROUP HOMES P 90117 Beth Haven Managment Services N 284244 Beth Haven Managment Services D 83888 Beth HAVEN GROUP HOMES E 4262065