STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

HAVEN PARK CHRISTIAN HOUSING AND: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
HAVEN PARK CHRISTIAN HOUSING AND (EIN 38-3026594)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-15
IRS object ID
201803199349307735
Schema version
2017v2.3
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)
Return2018-11-15T11:48:49-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1LARRY J OTTE CPABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110755 HAWTHORNE DRAddressLine1Txt
CitySAINT JOHNCityNm
State AbbreviationINStateAbbreviationCd
ZIP46373ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN383026594EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HAVEN PARK CHRISTIAN HOUSING ANDBusinessNameLine1Txt
Business Name Line2NURSING ASSOCIATION OF ZEELANDBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlHAVEBusinessNameControlTxt
Phone7083428100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 NORTH CREEK DRIVEAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonVANDERGENUGTEN BARRYPersonNm
Person TitleCFOPersonTitleTxt
Phone7083428100PhoneNum
Signature2018-11-14SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLARRY J OTTEPreparerPersonNm
PTINP01427347PTIN
Phone7083593329PhoneNum
Preparation2018-11-15PreparationDt
Self EmployedYes (X)SelfEmployedInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address199.58.216.254IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-15IPDt
IP Tm11:48:49IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdB59CC9CE2E2088C378F68B0EC4A2186E05531FF1AtSubmissionCreationDeviceId
At Submission Filing Device Id05F5D912F79D4F939E4B956C0FD9A55DB61B7E32AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerVANDERGENUGTEN BARRYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 N CREEK DRAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,017,332GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHAVENPARK.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1991FormationYr
Legal Domicile StateMILegalDomicileStateCd
Activity Or MissionCARE OF THE ELDERLY AND SICKActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee348TotalEmployeeCnt
Total Volunteers25TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$12,553,296PYProgramServiceRevenueAmt
CY Program Service Revenue$12,777,608CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$226,894PYOtherRevenueAmt
CY Other Revenue$239,724CYOtherRevenueAmt
PY Total Revenue$12,780,190PYTotalRevenueAmt
CY Total Revenue$13,017,332CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,095,989PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,482,457CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,504,147PYOtherExpensesAmt
CY Other Expenses$6,548,485CYOtherExpensesAmt
PY Total Expenses$13,600,136PYTotalExpensesAmt
CY Total Expenses$14,030,942CYTotalExpensesAmt
PY Revenues Less Expenses-$819,946PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,013,610CYRevenuesLessExpensesAmt
Total Assets BOY$3,247,315TotalAssetsBOYAmt
Total Assets EOY$3,242,680TotalAssetsEOYAmt
Total Liabilities BOY$1,762,964TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,480,199TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,484,351NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$237,519NetAssetsOrFundBalancesEOYAmt
MissionCARE OF THE ELDERLY AND SICKMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$12,688,387ExpenseAmt
Revenue$13,017,332RevenueAmt
DescTO PROVIDE THE GENERAL PUBLIC LONG-TERM HEALTHCARE FACILITIES AND SERVICES FOR THE SICK, INJURED &/OR AGED.Desc
Total Program Service Expenses$12,688,387TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document8IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee348EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldMIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE LIFE SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7083428100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 NORTH CREEK DRIVEAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
VAN HATTEM RICH
VICE CHAIR1.002.00Yes (X)Yes (X)$0$0$0
KATS JUSTIN
CHAIR1.002.00Yes (X)Yes (X)$0$0$0
VANDYK DON
SEC/TREAS1.002.00Yes (X)Yes (X)$0$0$0
WORKMAN ROBERT
DIRECTOR1.002.00Yes (X)Yes (X)$0$0$0
BAMFORD LUCETTE
DIRECTOR1.002.00Yes (X)$0$0$0
DIEPSTRA AL
DIRECTOR1.002.00Yes (X)$0$0$0
LARSEN DAVE
DIRECTOR1.002.00Yes (X)$0$0$0
SCHUTT RICHARD
CEO5.0050.00Yes (X)$0$551,375$165,951
DEYOUNG WILLLIAM
COO5.0050.00Yes (X)$0$379,845$77,476
VANDERGENUGTEN BARRY
CFO5.0050.00Yes (X)$0$234,273$30,749
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$1,165,493TotReportableCompRltdOrgAmt
Total Other Compensation$274,176TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PROVIDENCE LIFE SERVICES
18601 NORTH CREEK DRTINLEY PARKIL60477MGMT, EDUC MKTG$819,589
PRIORITY HEALTH
3915 MOMEMTUM PLACECHICAGOIL60689HEALTH INS$528,598
PROVINET SOLUTIONS
18601 NORTH CREEK DRTINLEY PARKIL60477IT$410,049
GORDON FOOD SERVICE
520 79TH ST SEGRAND RAPIDSMI49508DIETARY$399,847
MCKESSON MEDICAL SURGICAL
PO BOX 630693CINCINNATIOH45263MEDICAL SUPPLIE$227,033
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHEALTHCAREDesc
Business623000BusinessCd
Total Revenue Column$12,777,608TotalRevenueColumnAmt
Related Or Exempt Func Income$12,777,608RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$12,777,608TotalProgramServiceRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescRENTAL INCOMEDesc
Total Revenue Column$239,724TotalRevenueColumnAmt
Related Or Exempt Func Income$239,724RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$239,724OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,017,332TotalRevenueColumnAmt
Related Or Exempt Func Income$13,017,332RelatedOrExemptFuncIncomeAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,314,604TotalAmt
Program Services$6,314,604ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$114,758TotalAmt
Program Services$114,758ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$585,351TotalAmt
Program Services$585,351ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$467,744TotalAmt
Program Services$467,744ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$982,783TotalAmt
Management And General$982,783ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$12,326TotalAmt
Program Services$12,326ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$75,401TotalAmt
Program Services$75,401ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$27,467TotalAmt
Program Services$27,467ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$201,319TotalAmt
Program Services$201,319ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$359,772TotalAmt
Management And General$359,772ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,573,087TotalAmt
Program Services$1,573,087ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$48,000TotalAmt
Program Services$48,000ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$78,647TotalAmt
Program Services$78,647ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PROVIDER TAXES$927,020$927,020
CONTRACT NURSING$409,015$409,015
DIETARY$391,828$391,828
NURSING SUPPLIES$385,897$385,897

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,075,923TotalAmt
Program Services$1,075,923ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$14,030,942TotalAmt
Program Services$12,688,387ProgramServicesAmt
Management And General$1,342,555ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$620,327BOYAmt
EOY$226,947EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,251,848BOYAmt
EOY$1,742,847EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$11,823BOYAmt
EOY$11,622EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$38,703BOYAmt
EOY$39,250EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,483,254LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$261,240LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,270,014BOYAmt
EOY$1,222,014EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$54,600BOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,247,315BOYAmt
EOY$3,242,680EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,128,804BOYAmt
EOY$1,218,078EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$634,160BOYAmt
EOY$2,262,121EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,762,964BOYAmt
EOY$3,480,199EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,484,351BOYAmt
EOY-$237,519EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,484,351BOYAmt
EOY-$237,519EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,247,315BOYAmt
EOY$3,242,680EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,013,610ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$708,260OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,254,106CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$12,477,083CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,219,238CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,780,190CurrentTaxYearMinus1YearAmt
Current Tax Year$13,017,332CurrentTaxYearAmt
Total$63,747,949TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,254,106CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$12,477,083CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,219,238CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,780,190CurrentTaxYearMinus1YearAmt
Current Tax Year$13,017,332CurrentTaxYearAmt
Total$63,747,949TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$63,747,949PublicSupportTotal509Amt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$13,254,106CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$12,477,083CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,219,238CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,780,190CurrentTaxYearMinus1YearAmt
Current Tax Year$13,017,332CurrentTaxYearAmt
Total$63,747,949TotalAmt
FieldValueIRS element (for citing)
Public Support CY5091.00000PublicSupportCY509Pct
Public Support PY5091.00000PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Investment Income PY0.00000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,483,254OtherCostOrOtherBasisAmt
Depreciation$261,240DepreciationAmt
Book Value$1,222,014BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,222,014TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATESDesc
Amt$2,262,121Amt
FieldValueIRS element (for citing)
Total Liability$2,262,121TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
SCHUTT RICHARD
CEO$475,911$63,464$12,000$139,307$26,644$717,326
DEYOUNG WILLLIAM
COO$327,173$43,946$8,726$43,036$34,440$457,321
VANDERGENUGTEN BARRY
CFO$197,788$26,169$10,316$8,958$21,791$265,022

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART IIIFormAndLineReferenceDesc
ExplanationQUESTION 1A THE ORGANIZATION PROVIDES AN ALLOWANCE FOR UP TO 10 BOARD MEMBERS TO ATTEND THE ANNUAL ASSOCIATION CONVENTION TO PROVIDE MORE IN DEPTH KNOWLEDGE OF THE SENIOR CARE INDUSTRY. THE COST OF TRAVEL FOR SPOUSES IS PERMITTED AS LONG AS THE TOTAL DOES NOT EXCEED THE ESTABLISHED ALLOWANCE AMOUNT. DOCUMENTATION OF ATTENDANCE AT THE ANNUAL CONVENTION IS REQUIRED. THE ORGANIZATION HAS ESTABLISHED A SENIOR EXECUTIVE MANAGEMENT PROGRAM WHICH ALLOWS STATED EMPLOYEES TO JOIN A FITNESS CENTER. ELIGIBLE EMPLOYEES THAT ENROLL ARE REQUIRED TO BE ACTIVELY UTILIZING THE FITNESS CENTER. NO SENIOR EXECUTIVES RECEIVED THIS BENEFIT IN 2017. QUESTION 4B REST HAVEN HAS ESTABLISHED A NONQUALIFIED DEFERRED COMPENSATION PLAN IN AN EFFORT TO RETAIN SELECTED OFFICERS ON A LONG TERM BASIS. THE FOLLOWING IS A SCHEDULE OF THE OFFICERS AND THE ANNUAL CREDIT OR DEBIT TO THE ACCOUNT IN 2017: RICHARD SCHUTT RECEIVED A CREDIT TO THE ACCOUNT OF 128,507 WILLIAM DEYOUNG RECEIEVED A CREDIT TO THE ACCOUNT OF 32,236 IN 2005, THE BOARD OF DIRECTORS ESTABLISHED A RETENTION INCENTIVE PLAN FOR CERTAIN OFFICERS. THIS PLAN RECOGNIZES THE HISTORIC CONTRIBUTION OF THE EXECUTIVES WITH THE ORGANIZATION UNTIL NORMAL RETIREMENT AGE. AMONG VARIOUS CRITERIA, IN ORDER TO QUALIFY FOR THE BENEFIT, THE EXECUTIVE WILL NEED TO BE CONTINOUSLY EMPLOYED THRU AND UNTIL FUTURE DATE. THE ORGANIZATIONS PAYMENTS INTO THE PLAN ARE RECORDED ON THE 990 AS DEFERRED COMPENSATION. HOWEVER, THE EXECUTIVE HAS NOT RECEIVED THESE MONIES AND WILL ONLY BE ELIGIBLE TO RECEIVE THE MONIES BASED UPON ACHIEVEMENT OR SATISFACTION OF SOME FUTURE EVENTS. THE PLAN CONTRIBUTIONS ARE NOT UNDER THE CONTROL OF THE EXECUTIVES, THEY REMAIN THE ASSET OF THE ORGANIZATION, AND THE ENTIRE PLAN IS SUBJECT TO A FULL RISK FORFEITURE BY THE INDIVIDUAL. QUESTIONS 5A AND 6A THE EXECUTIVE COMPENSATION PROGRAM HAS TWO MAJOR ELEMENTS: SALARY, OR BASE PAY, AND VARIABLE PAY. THE SALARY REFLECTS THE VALUE OF AN EXECUTIVE'S CAPABALITIES AND EXPERIENCE. THE VARIABLE PAY REFLECTS THE ORGANIZATIONS COMMITMENT TO PAY FOR SPECIFIC PERFORMANCE TOWARDS THE ORGANIZATIONS GOALS. THE VARIABLE PAY IS AWARDED BASED UPON A SPECIFIC REVIEW OF GOALS AND OBJECTIVES (INCLUDING THOSE WHICH RELATE TO MISSION, OPERATIONAL EFFICIENCY, FINANCIAL EFFECTIVENESS, AND STRATEGIC GOALS). SEMI-ANNUALLY THE COMPENSATION COMMITTEE REVIEWS, ASSESSES AND DETERMINES ANY AWARD UNDER THE VARIABLE PAY COMPONENT. EXECUTIVE EMPLOYEE BENEFITS ARE REVIEWED BY THE COMPENSATION COMMITTEE AND OUTSIDE CONSULTANTS TO INSURE THEY ARE COMPETITIVE AND IN LINE WITH COMMON PRACTICE FOR SIMILAR POSITIONS IN SIMILARLY SIZED AND TYPE ORGANIZATIONS. THE COMMITTEE RECIEVES AN EXECUTIVE COMPENSATION OPINION NOTING THAT THE ORGANIZATIONS EXECUTIVE COMPENSATION FALLS WITHIN THE RANGE OF COMPARABLE POSITIONS WITHIN THE SAME INDUSTRY. THE REPORT/OPINION ALSO NOTES THAT THE STATED REQUIREMENTS OF ENSURING INDEPENDENCE OF COMPENSATION DELIBERATIONS FOR SENIOR EXECUTIVES ARE MET.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
LINDA SCHUTT
SPOUSE OF CEO$97,607EMPLOYMENT COMPfalse
BONNIE HEIRENDT
SISTER OF CEO$57,630EMPLOYMENT COMPfalse
ALLISON OLESHKO
DAUGHTER OF CEO$34,646EMPLOYMENT COMPfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationTHE TRANSACTIONS REPORTED ABOVE INVOLVING INTEREST PERSONS ARE REVIEWED ANNUALLY BY THE BOARDS COMPENSATION COMMITTEE AND HAVE BEEN DEEMED APPROPRIATE BASED ON THE POSITIONS EMPLOYED.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 3RESPONSIBILITIES PAID THROUGH MANAGEMENT FEES TO REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME DBA PROVIDENCE LIFE SERVICES.
FORM 990, PAGE 6, PART VI, LINE 6THE SOLE MEMBER OF THE CORPORATION IS REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME. THE AFFAIRS, BUSINESS AND ALL LEGAL MATTERS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF DIRECTORS.
FORM 990, PAGE 6, PART VI, LINE 7ATHE MEMBER SHALL HAVE AND EXERCISE THE FOLLOWING RESERVE POWERS: (1) TO APPOINT OR REMOVE DIRECTORS; (2) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (3) TO REVIEW ALL ANNUAL BUDGETS AND AUDITED FINANCIAL STATEMENTS AND TO APPROVE ANY DEFICIT BUDGET; (4) TO APPROVE THE CONSTRUCTION OF ANY NEW OR THE ALTERATION OF ANY EXISTING FACILITY INVOLVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESTATE OR SUBSTANTIALLY ALL OF THE OTHER ASSETS OF THE CORPORATION; (6) TO DISSOLVE THE CORPORATION.
FORM 990, PAGE 6, PART VI, LINE 7BTHE MEMBER SHALL HAVE AND EXERCISE THE FOLLOWING RESERVE POWERS: (1)TO APPOINT OR REMOVE DIRECTORS; (2) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (3)TO REVIEW ALL ANNUAL BUDGETS AND AUDITED FINANCIAL STATEMENTS AND TO APPROVE ANY DEFICIT BUDGET; (4) TO APPROVE THE CONSTRUCTION OF ANY NEW OR THE ALTERATION OF ANY EXISTING FACILITY INVOLVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESTATE OR SUBSTANTIALLY ALL OF THE OTHER ASSETS OF THE CORPORATION; (6) TO DISSOLVE THE CORPORATION.
FORM 990, PAGE 6, PART VI, LINE 11BA DRAFT OF THE 990 IS PREPARED AND REVIEWED BY THE CONTROLLER AND THE CFO. UPON THEIR REVIEW AND APPROVAL, THE FINAL DRAFT IS FORWARDED TO THE EXECUTIVE COMMITTEE BEFORE SUBMISSION. A COMPLETED COPY OF THE 990 IS PROVIDED TO THE FULL BOARD AT THE SUBSEQUENT BOARD MEETING, AFTER FILING.
FORM 990, PAGE 6, PART VI, LINE 12CBOARD MEMBERS ANNUALLY REVIEW AND UPDATE THEIR CONFLICT OF INTEREST STATEMENTS.
FORM 990, PAGE 6, PART VI, LINE 15ATHE EXECUTIVE COMPENSATION PROGRAMS PRIMARY OBJECTIVE IS TO PROVIDE COMPETITIVE TOTAL PAY OPPORTUNITIES THAT HELP ATTRACT, REWARD AND RETAIN CRITICAL LEADERSHIP TALENT IN ORDER TO ACHIEVE THE ORGANIZATIONS MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECTUIVE COMPENSATION RANGES THROUGH A WRITTEN POLICY AND BY COMPARING ITSELF TO ORGANIZATIONS OF SIMILAR SIZE AND TYPE - USING OBJECTIVE, THIRD-PARTY DATA. A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS RECOMMENDS, AND THE BOARD OF DIRECTORS APPROVES, THE SALARY RANGES AND REVIEWS TOTAL COMPENSATION FOR EXECUTIVES ON AN ANNUAL BASIS. THE ORGANIZATION ROUTINELY USES KNOWLEDGEABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR REASONABLENESS OF EXECUTIVE COMPENSATION IN TAX-EXEMPT ENTITIES.
FORM 990, PAGE 6, PART VI, LINE 15BTHE EXECUTIVE COMPENSATION PROGRAMS PRIMARY OBJECTIVE IS TO PROVIDE COMPETITIVE TOTAL PAY OPPORTUNITIES THAT HELP ATTRACT, REWARD AND RETAIN CRITICAL LEADERSHIP TALENT IN ORDER TO ACHIEVE THE ORGANIZATIONS MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECTUIVE COMPENSATION RANGES THROUGH A WRITTEN POLICY AND BY COMPARING ITSELF TO ORGANIZATIONS OF SIMILAR SIZE AND TYPE - USING OBJECTIVE, THIRD-PARTY DATA. A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS RECOMMENDS, AND THE BOARD OF DIRECTORS APPROVES, THE SALARY RANGES AND REVIEWS TOTAL COMPENSATION FOR EXECUTIVES ON AN ANNUAL BASIS. THE ORGANIZATION ROUTINELY USES KNOWLEDGEABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR REASONABLENESS OF EXECUTIVE COMPENSATION IN TAX-EXEMPT ENTITIES.
FORM 990, PAGE 6, PART VI, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9AFFILIATE TRANSFERS -708,260

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1RPPII LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 NORTH CREEK DRIVEAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd
FieldValueIRS element (for citing)
Primary ActivitiesRENTALPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd
Total Income$239,724TotalIncomeAmt
End Of Year Assets$1,403,301EndOfYearAssetsAmt
Direct Controlling NAN/ADirectControllingNACd

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1REST HAVEN ILLIANA CHRISTIANBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 N CREEK DRIVEAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd
FieldValueIRS element (for citing)
EIN362382853EIN
Primary ActivitiesHEALTHCAREPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd
Exempt Code Section501C3ExemptCodeSectionTxt
Public Charity Status7PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE MANAGMENT & DEVELOPMENTBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 N CREEK DRAddressLine1Txt
CityTINLEY PARKCityNm
State AbbreviationILStateAbbreviationCd
ZIP60477ZIPCd
FieldValueIRS element (for citing)
EIN363774205EIN
Primary ActivitiesMGMT & ITPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
PROVIDENCE MGMT & DEVELOPMENT
P$359,772FMV
REST HAVEN ILLIANA CHRISTIAN
P$982,783FMV
REST HAVEN ILLIANA CHRISTIAN
K$1,269,000FMV