2014-10-14T08:45:42-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 600 3RD AVE SE STE 300 CEDAR RAPIDS IA 52401 990 2013-01-01 420698245 FRIENDSHIP HAVEN INC FRIE 5155732121 420 KENYON ROAD FORT DODGE IA 50501 JULIE THORSON PRESIDENT/CEO 5155732121 2014-09-26 1 JEFF VRIEZE P01273590 3193632697 2013 2015-11-30 17:44:51Z JULIE THORSON 420 KENYON ROAD FORT DODGE IA 50501 22948851 0 X WWW.FRIENDSHIPHAVEN.ORG X 1946 IA OFFERING INNOVATIVE AND RESPONSIVE SERVICES TO OLDER ADULTS. 11 11 419 137 0 0 2930596 1306522 17004468 15131688 795066 608880 13317 371165 20743447 17418255 0 0 0 0 10358031 9862059 1898 0 80330 7855244 7781353 18215173 17643412 2528274 -225157 53061536 62483138 39012969 49622873 14048567 12860265 OFFERING INNOVATIVE AND RESPONSIVE SERVICES TO OLDER ADULTS. 0 0 15926439 0 15131688 OPERATING A CONTINUING CARE RETIREMENT COMMUNITY THAT SERVES ELDERLY INDIVIDUALS. IT PROVIDES HEALTH CARE, HOUSING AND SERVICES IN A SKILLED NURSING FACILITY WITH 155 LICENSED BEDS (INCLUDING 30 BEDS LICENSED FOR CCDI), AN ASSISTED LIVING FACILITY WITH 112 CERTIFICED BEDS, AND 108 INDEPENDENT LIVING APARTMENTS. THE ADULT DAY PROGRAM PROVIDES SERVICES TO 20-30 INDIVIDUALS ON A DAILY BASIS. THE ORGANIZATION PROVIDED $886,152 IN CHARITY AND BENEVOLENT CARE TO INDIVIDUALS WHO COULD NOT AFFORD TO PAY FULL FEES FOR HOUSING AND SERVICES. 15926439 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 32 0 1 419 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X KALLEEN ENGELS 5155736018 420 KENYON ROAD FORT DODGE IA 50501 BRUCE VANDAGRIFF CHAIR 1.00 1.00 X X 0 0 0 DOUG SPENCER VICE CHAIR 1.00 1.00 X X 0 0 0 PHIL GUNDERSON SECRETARY 1.00 1.00 X X 0 0 0 AL HABHAB DIRECTOR 1.00 1.00 X 0 0 0 DAVID GIDEL DIRECTOR 1.00 1.00 X 0 0 0 DOUG STANEK DIRECTOR 1.00 1.00 X 0 0 0 JIM PATTON DIRECTOR 1.00 1.00 X 0 0 0 JULIE LARSON DIRECTOR 1.00 1.00 X 0 0 0 L J HARTLEY DIRECTOR 1.00 1.00 X 0 0 0 MARK THOMPSON DIRECTOR 1.00 1.00 X 0 0 0 RAEANNE FREY MARNER DIRECTOR 1.00 1.00 X 0 0 0 BRUCE SHIMKAT CHAIR THRU JULY 1.00 1.00 X X 0 0 0 RAMONA WEINS DIRECTOR THRU JULY 1.00 1.00 X 0 0 0 GARY LEVALLEY DIRECTOR THRU JULY 1.00 1.00 X 0 0 0 JULIE THORSON CEO 39.00 1.00 X 139384 0 18375 DEBORAH RUSSELL CFO 39.00 1.00 X 111373 0 14184 NICOLE CONRAD PHARMACIST 40.00 0.00 X 117975 0 2583 368732 0 35142 3 0 0 0 JENSEN BUILDERS LTD 1175 SOUTH 32ND ST FORT DODGE IA 50501 CONSTRUCTION 9080007 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 434265 2 13900 1138442 154180 1306522 NURSING FACILITY 623000 7030029 7030029 ASSISTED LIVING 623000 4333348 4333348 INDEPENDENT LIVING 623000 2385202 2385202 PHARMACY 623000 910147 910147 ADULT DAY CARE 623000 413238 413238 59724 59724 15131688 251675 251675 15356 15356 5811952 1500 5471603 0 340349 1500 341849 341849 24385 13900 8141 16244 16244 63773 50852 12921 12921 MEAL REVENUE 722210 63899 63899 BEAUTY SALON 812900 62215 62215 TELEPHONE 517000 58859 58859 157027 157027 342000 17418255 15131688 0 980045 283316 283316 7735425 7157176 578249 65587 51437 14150 1184144 1076844 107300 593587 519228 74359 12240 12240 27786 27786 82534 82534 13665 13665 636490 516953 119537 160475 160475 648432 593434 54998 14438 14438 970666 970666 41237 31609 9628 743310 743310 2164798 2164798 157746 157746 DRUGS 640431 640431 FOOD 616306 616306 MEDICAL SUPPLIES 284874 284874 DEMOLITION COSTS 278502 278502 287423 123125 83968 80330 17643412 15926439 1636643 80330 2890837 4183842 353629 347537 743107 731027 229885 231043 208235 184497 73894556 24163850 26726062 49730706 5043500 2789022 16866281 4285464 53061536 62483138 3389730 1840619 11231816 14872608 24372001 32311710 19422 597936 39012969 49622873 X 14048567 10171717 2688548 14048567 12860265 53061536 62483138 -225157 -129147 -833998 0 X 0 1 X 1 0 X 408025 436416 1266686 2943913 1306522 6361562 16142517 17119013 17336674 15999749 15131688 81729641 1195475 1250110 1317890 1471206 5234681 17746017 18805539 19921250 20414868 16438210 93325884 83512 106450 110393 71417 371772 0 83512 106450 110393 71417 371772 92954112 474534 435310 510072 328579 267031 2015526 474534 435310 510072 328579 267031 2015526 342000 342000 18220551 19240849 20431322 20743447 17047241 95683410 0.97150 0.97260 0.02110 0.02350 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MEAL REVENUE - 2013 AMOUNT: $ 63,899. BEAUTY SHOP - 2013 AMOUNT: $ 62,215. TELEPHONE REVENUE - 2013 AMOUNT: $ 58,859. TRANSPORTATION REVENUE - 2013 AMOUNT: $ 55,345. GARAGE/PARKING REVENUE - 2013 AMOUNT: $ 43,773. MISCELLANEOUS - 2013 AMOUNT: $ 28,506. INTERNET REVENUE - 2013 AMOUNT: $ 16,973. FITNESS CENTER - 2013 AMOUNT: $ 8,970. HOSPITALITY REVENUE - 2013 AMOUNT: $ 2,360. APPLICATION REVENUE - 2013 AMOUNT: $ 1,100. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 421384 421384 64642405 18888212 45754193 8283693 5275638 3008055 547074 547074 49730706 INTEREST IN GEORGE MURPHY TRUST 2688548 DUE FROM RELATED PARTY 364064 BOND FUNDS 780300 DEFERRED COSTS (NET OF ACCUMULATED AMORTIZATION) 452552 4285464 CHARITABLE GIFT ANNUITIES 52936 ASBESTOS ABATEMENT 545000 597936 X PART X, LINE 2: FRIENDSHIP HAVEN, INC. IS EXEMPT UNDER CODE SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FRIENDSHIP HAVEN HOME CARE, L.L.C. HAS BEEN ORGANIZED AS A LIMITED LIABILITY COMPANY AND IS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE BASED ON ITS SOLE MEMBER. THE ORGANIZATION'S INCOME TAX RETURN IS SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2010 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. LEGENDS 38285 13900 24385 100 638 182 2286 1500 3435 38285 13900 24385 100 638 182 2286 1500 3435 8141 16244 A IOWA FINANCE AUTHORITY 521699886 2011-10-14 14000000 TO REFINANCE SERIES 2004 BONDS 0 0 0 B IOWA FINANCE AUTHORITY 521699886 2011-10-14 6000000 TO FINANCE CONSTRUCTION AND CAMPUS RENOVATION 0 0 0 C IOWA FINANCE AUTHORITY 521699886 2011-10-14 14000000 TO FINANCE CONSTRUCTION AND CAMPUS RENOVATION 0 0 0 A 709821 14000000 14000000 2005 1 0 1 1 B 11798 6000000 5988202 11798 2013 0 0 0 1 C 966671 14000000 415337 13033329 966671 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS MADE UP OF THE BOARD CHAIR, VICE CHAIR, AND SECRETARY OF THE BOARD OF DIRECTORS. THIS COMMITTEE IS CONCERNED WITH THE GENERAL BUSINESS OPERATIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE POLICY OF THE ORGANIZATION IS TO PROVIDE A DRAFT OF THE 990, INCLUDING SIGNIFICANT SCHEDULES, TO EACH MEMBER OF THE BOARD OF DIRECTORS PRIOR TO SUBMISSION OF THE FORM TO THE IRS, ALLOWING A REASONABLE PERIOD OF TIME FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL UPON APPOINTMENT AND ANNUALLY THEREAFTER SIGN A STATEMENT REGARDING CONFLICT OF INTEREST THAT AFFIRMS THE PERSON HAS RECEIVED THE CONFLICT OF INTEREST POLICY, READ AND UNDERSTANDS THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY. THE REQUIRED DISCLOSURES ARE REVIEWED BY THE CORPORATE INTEGRITY OFFICER AND IF ANY POTENTIAL OR ACTUAL CONFLICTS ARE IDENTIFIED, HE WOULD REPORT THEM TO THE ORGANIZATION'S INTEGRITY COMMITTEE FOR RESOLUTION. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. PROCEDURES FOR CONFLICT OF INTEREST RESOLUTION: (A) AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, THE INTERESTED PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. (B) THE PERSON CHAIRING THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. (C) AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER FRIENDSHIP HAVEN CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. (D) IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN FRIENDSHIP HAVEN'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE A DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. VIOLATIONS OF THE CONFLICT OF INTEREST POLICY: (A) IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. (B) IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. RECORDS OF PROCEEDINGS: THE MINUTES OF THE GOVERNING BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN: (A) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN EXISTING OR POTENTIAL TRANSACTION OR ARRANGEMENT, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE GOVERNING BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST EXISTED. (B) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD CHAIR AND BOARD EXECUTIVE COMMITTEE DETERMINE AND APPROVE COMPENSATION OF THE PRESIDENT/CEO USING DATA FROM COMPARABLE ORGANIZATIONS. THE CEO AND EXECUTIVE TEAM DETERMINE AND APPROVE COMPENSATION OF KEY EMPLOYEES OF THE ORGANIZATION USING DATA FROM COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS ALSO MADE AVAILABLE ON ANOTHER'S WEBSITE, SPECIFICALLY WWW.FOUNDATIONCENTER.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FRIENDSHIP HAVEN HOME CARE LLC 420 KENYON ROAD FORT DODGE IA 50501 200577731 HOME HEALTH CARE IA 59945 12404 FRIENDSHIP HAVEN INC FRIENDHSIP HAVEN MEMORIAL FOUNDATION 420 KENYON ROAD FORT DODGE IA 50501 426065344 TO PROVIDE CHARITABLE SUPPORT TO FRIENDSHIP HAVEN, INC. IA 501(C)(3) LINE 11B, II N/A 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FRIENDSHIP HAVEN MEMORIAL FOUNDATION C 1138442 CASH