STRATEGY STUDIO / PUBLIC DATA EXPLORER

HAVEN PARK CHRISTIAN HOUSING AND: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
HAVEN PARK CHRISTIAN HOUSING AND (EIN 38-3026594)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-15
IRS object ID
201713199349311326
Schema version
2016v3.0
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)
Return2017-11-15T13:30:44-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

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
Signature2017-11-14SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLARRY J OTTEPreparerPersonNm
PTINP01427347PTIN
Preparation2017-11-14PreparationDt

Filing Security Information FilingSecurityInformation

FieldValueIRS element (for citing)
At Submission Creation Device IdB59CC9CE2E2088C378F68B0EC4A2186E05531FF1AtSubmissionCreationDeviceId
At Submission Filing Device IdB59CC9CE2E2088C378F68B0EC4A2186E05531FF1AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

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$12,780,190GrossReceiptsAmt
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 Employee330TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$11,998,394PYProgramServiceRevenueAmt
CY Program Service Revenue$12,553,296CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$220,844PYOtherRevenueAmt
CY Other Revenue$226,894CYOtherRevenueAmt
PY Total Revenue$12,219,238PYTotalRevenueAmt
CY Total Revenue$12,780,190CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,760,801PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,095,989CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,097,652PYOtherExpensesAmt
CY Other Expenses$6,504,147CYOtherExpensesAmt
PY Total Expenses$12,858,453PYTotalExpensesAmt
CY Total Expenses$13,600,136CYTotalExpensesAmt
PY Revenues Less Expenses-$639,215PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$819,946CYRevenuesLessExpensesAmt
Total Assets BOY$2,526,226TotalAssetsBOYAmt
Total Assets EOY$3,247,315TotalAssetsEOYAmt
Total Liabilities BOY$3,085,189TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,762,964TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$558,963NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,484,351NetAssetsOrFundBalancesEOYAmt
MissionCARE OF THE ELDERLY AND SICKMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$12,024,057ExpenseAmt
Revenue$12,553,296RevenueAmt
DescTO PROVIDE THE GENERAL PUBLIC LONG-TERM HEALTHCARE FACILITIES AND SERVICES FOR THE SICK, INJURED &/OR AGED.Desc
Total Program Service Expenses$12,024,057TotalProgramServiceExpensesAmt
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 Document9IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee330EmployeeCnt
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
ASST SECY/TR1.002.00Yes (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
CEO5.0045.00Yes (X)$0$503,058$155,746
DEYOUNG WILLLIAM
COO5.0045.00Yes (X)$0$339,415$73,581
VANDERGENUGTEN BARRY
CFO5.0045.00Yes (X)$0$188,426$28,271
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$1,030,899TotReportableCompRltdOrgAmt
Total Other Compensation$257,598TotalOtherCompensationAmt
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
REST HAVEN ILLIANA CHRISTIAN
18601 NORTH CREEK DRTINLEY PARKIL60477MGMT, EDUC MKTG$1,114,152
PRIORITY HEALTH
3915 MOMEMTUM PLACECHICAGOIL60689HEALTH INS$512,006
PROVINET SOLUTIONS
18601 NORTH CREEK DRTINLEY PARKIL60477IT$391,700
GORDON FOOD SERVICE
520 79TH ST SEGRAND RAPIDSMI49508DIETARY$390,825
AGILITY HEALTH LLC
PO BOX 5509CAROL STREAMIL60197THERAPY$236,220
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K8CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHEALTHCAREDesc
Business623000BusinessCd
Total Revenue Column$12,553,296TotalRevenueColumnAmt
Related Or Exempt Func Income$12,553,296RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$12,553,296TotalProgramServiceRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescRENTAL INCOMEDesc
Total Revenue Column$226,894TotalRevenueColumnAmt
Related Or Exempt Func Income$226,894RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$226,894OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,780,190TotalRevenueColumnAmt
Related Or Exempt Func Income$12,780,190RelatedOrExemptFuncIncomeAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,106,129TotalAmt
Program Services$6,106,129ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$69,600TotalAmt
Program Services$69,600ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$476,074TotalAmt
Program Services$476,074ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$444,186TotalAmt
Program Services$444,186ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,114,152TotalAmt
Management And General$1,114,152ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$28,900TotalAmt
Program Services$28,900ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$52,754TotalAmt
Program Services$52,754ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$22,329TotalAmt
Program Services$22,329ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$243,249TotalAmt
Program Services$243,249ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$461,927TotalAmt
Management And General$461,927ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,610,969TotalAmt
Program Services$1,610,969ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

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

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$69,783TotalAmt
Program Services$69,783ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PROVIDER TAXES$917,668$917,668
NURSING SUPPLIES$412,377$412,377
DIETARY$367,288$367,288
MAINTENANCE & REPAIR$268,600$268,600

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$886,151TotalAmt
Program Services$886,151ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$13,600,136TotalAmt
Program Services$12,024,057ProgramServicesAmt
Management And General$1,576,079ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$223,972BOYAmt
EOY$620,327EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$913,446BOYAmt
EOY$1,251,848EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$10,436BOYAmt
EOY$11,823EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$50,738BOYAmt
EOY$38,703EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,483,254LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$213,240LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,273,034BOYAmt
EOY$1,270,014EOYAmt

Other Assets Total OtherAssetsTotalGrp

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

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,526,226BOYAmt
EOY$3,247,315EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,085,189BOYAmt
EOY$1,128,804EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
EOY$634,160EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,085,189BOYAmt
EOY$1,762,964EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$558,963BOYAmt
EOY$1,484,351EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$558,963BOYAmt
EOY$1,484,351EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,526,226BOYAmt
EOY$3,247,315EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$819,946ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$2,863,260OtherChangesInNetAssetsAmt
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

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,100CurrentTaxYearMinus4YearsAmt
Total$3,100TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,632,780CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,254,106CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,477,083CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,219,238CurrentTaxYearMinus1YearAmt
Current Tax Year$12,780,190CurrentTaxYearAmt
Total$62,363,397TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,635,880CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,254,106CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,477,083CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,219,238CurrentTaxYearMinus1YearAmt
Current Tax Year$12,780,190CurrentTaxYearAmt
Total$62,366,497TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$62,366,497PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$67CurrentTaxYearMinus4YearsAmt
Total$67TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$67CurrentTaxYearMinus4YearsAmt
Total$67TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$11,635,947CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,254,106CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,477,083CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,219,238CurrentTaxYearMinus1YearAmt
Current Tax Year$12,780,190CurrentTaxYearAmt
Total$62,366,564TotalAmt
FieldValueIRS element (for citing)
Public Support CY5091.00000PublicSupportCY509Pct
Public Support PY5090.99940PublicSupportPY509Pct
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$213,240DepreciationAmt
Book Value$1,270,014BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,270,014TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATESDesc
Amt$634,160Amt
FieldValueIRS element (for citing)
Total Liability$634,160TotalLiabilityAmt

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$457,293$34,568$11,197$130,142$25,604$658,804
DEYOUNG WILLLIAM
COO$312,166$15,176$12,073$40,672$32,909$412,996
VANDERGENUGTEN BARRY
CFO$174,277$3,500$10,649$7,111$21,160$216,697

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 ORGANIZATIN 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. 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 CONTRIBUTION TO THE PLAN: RICHARD SCHUTT 119,542 WILLIAM DEYOUNG 30,072 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$93,619EMPLOYMENT COMPfalse
BONNIE HEIRENDT
DAUGHTER OF CEO$55,050EMPLOYMENT COMPfalse
ALLISON OLESHKO
SISTER OF CEO$55,946EMPLOYMENT 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 CORRECTION 2,863,260

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$226,894TotalIncomeAmt
End Of Year Assets$1,790,223EndOfYearAssetsAmt
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$461,927FMV
REST HAVEN ILLIANA CHRISTIAN
P$1,114,152FMV
REST HAVEN ILLIANA CHRISTIAN
K$1,310,633FMV