STRATEGY STUDIO / PUBLIC DATA EXPLORER

REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME (EIN 36-2382853)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201213209349308226
Schema version
2011v1.3
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)
Timestamp2012-11-15T15:59:47-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1191 West Nationwide Blvd Ste 500AddressLine1
CityColumbusCity
StateOHState
ZIP Code432152568ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362382853EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Rest Haven Illiana ChristianBusinessNameLine1
Business Name Line2Convalescent HomeBusinessNameLine2
FieldValueIRS element (for citing)
In Care Of Name% WILLIAM DEYOUNGInCareOfName
Name ControlRESTNameControl
Phone7083428100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line118601 NORTH CREEK DRIVEAddressLine1
CityTINLEY PARKCity
StateILState
ZIP Code60477ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWILLIAM DEYOUNGName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6142492300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE LIFE SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonRichard SchuttNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line118601 North Creek DriveAddressLine1
CityTinley ParkCity
StateILState
ZIP Code60477ZIPCode
FieldValueIRS element (for citing)
Gross Receipts75478482GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PROVIDENCELIFESERVICES.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionREST HAVEN'S PURPOSE IS TO PROVIDE NURSING AND RESIDENTIAL LIVING FOR THE AGED INCLUDING SKILLED NURSING AND REHABILITATION SERVICES, HOME HEALTH CARE, TOWN HOME LIVING, INDEPENDENT AND ASSISTED LIVING.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees1553TotalNbrEmployees
Total Nbr Volunteers350TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1843841ContributionsGrantsPriorYear
Contributions Grants Current Year1657909ContributionsGrantsCurrentYear
Program Service Revenue Prior Year70618626ProgramServiceRevenuePriorYear
Program Service Revenue CY73255482ProgramServiceRevenueCY
Investment Income Prior Year1590950InvestmentIncomePriorYear
Investment Income Current Year432311InvestmentIncomeCurrentYear
Other Revenue Prior Year-179731OtherRevenuePriorYear
Other Revenue Current Year-94397OtherRevenueCurrentYear
Total Revenue Prior Year73873686TotalRevenuePriorYear
Total Revenue Current Year75251305TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2524GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2069GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year33697428SalariesEtcPriorYear
Salaries Etc Current Year35161270SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year38143817OtherExpensePriorYear
Other Expenses Current Year38579526OtherExpensesCurrentYear
Total Expenses Prior Year71843769TotalExpensesPriorYear
Total Expenses Current Year73742865TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2029917RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1508440RevenuesLessExpensesCY
Total Assets BOY84982962TotalAssetsBOY
Total Assets EOY88158307TotalAssetsEOY
Total Liabilities BOY66371783TotalLiabilitiesBOY
Total Liabilities EOY69007027TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18611179NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY19151280NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense69085633Expense
Grants2069Grants
Revenue73255482Revenue
DescriptionTO PROVIDE PROPER CARE FOR THE SICK AND ELDERLY. 1,033 BEDS/UNITS WITH OCCUPANCY OVER 80% ON THE FULL CONTINUUM OF CARE.Description
Total Program Service Expense69085633TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109669NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1553NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledMIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonWILLIAM DEYOUNGNamePerson
Telephone Number7083428139TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line118601 NORTH CREEK DRIVEAddressLine1
CityTINLEY PARKCity
StateILState
ZIP Code60477ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
PAT BILTHOUSE
DIRECTOR2.0X
KURT NELSON
DIRECTOR2.0X
ROBERT WORKMAN
SECRETARY/TREASURER2.0XX
RON PORTER
DIRECTOR2.0X
ARNOLD KOLDENHOVEN
DIRECTOR2.0X
JANICE DEBOER
DIRECTOR2.0X
CATHY LARSEN
ASST. SEC./TREAS.2.0XX
GEORGE VANDE WERKEN
DIRECTOR2.0X
NORM AARDEMA
DIRECTOR2.0X
DR DAVE BEEZHOLD
DIRECTOR2.0X
HAL BROWN
DIRECTOR2.0X
SHARON CLOUSING
DIRECTOR2.0X
GARY ELLENS
DIRECTOR2.0X
HOWARD HOFF
DIRECTOR2.0X
RICH VAN HATTEM
PRESIDENT2.0XX
RICHARD SCHUTT
CEO60.0X0452204119315
WILLIAM DEYOUNG
CFO60.0X026435049550
DAN HOLWERDA
COO60.0X027264539334
Timothy Abbring
ADMINISTRATOR40.0012932031036X
Mary Kay Kacmarek
Corp. Clinical Nurse Mgr.40.0012806329455X
Leeona Campbell
VP of Marketing40.0012638930334X
Mercedita Defante
Registered Nurse40.0011438622877X
Richard Nolden
ADMINISTRATOR40.0011282522565X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1600182TotalReportableCompFrmRltdOrgs
Total Other Compensation344466TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALLIANCE PHARMACY SERVICES
PO BOX 66973CHICAGOIL60666PHARMACY SERVICES3826616
PROVIDENCE MGMT DEV
18601 N CREEK DRIVETINLEY PARKIL60477MANAGEMENT SERVICES4519088
GORDON FOOD SERVICE
333 50th St SWGRAND RAPIDSMI49501Dietary services2310046
LIBERTY MUTUAL INSURANCE
PO BOX 0569CAROL STREAMIL60132WORKMANS COMP INS1144651
Healthcare Serv Corp
PO Box 1186CHICAGOIL60690Health insurance3408064
FieldValueIRS element (for citing)
Number Of Contractors GT100 K20NumberOfContractorsGT100K
Fundraising Events213402FundraisingEvents
All Other Contributions1444507AllOtherContributions
Total Contributions1657909TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ROUTINE REVENUE6216107014057770140577
ANCILLARY REVENUE62161031149053114905
FieldValueIRS element (for citing)
Total Program Service Revenue73255482TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column432311TotalRevenueColumn
Exclusion$432,311ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events132780GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events213402CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses227177FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-94397TotalRevenueColumn
Exclusion-$94,397ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column75251305TotalRevenueColumn
Related Or Exempt Function Income73255482RelatedOrExemptFunctionIncome
Exclusion$337,914ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2069Total
Program Services2069ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total989199Total
Program Services989199ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total28684880Total
Program Services28684880ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total584136Total
Program Services584136ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2719737Total
Program Services2719737ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2183318Total
Program Services2183318ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total4657232Total
Management And General4657232ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7779362Total
Program Services7779362ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total508020Total
Program Services508020ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1912794Total
Program Services1912794ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total165113Total
Program Services165113ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total2067166Total
Program Services2067166ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3401932Total
Program Services3401932ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2910984Total
Program Services2910984ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
NURSING65218466521846
FOOD AND DIETARY38505723850572
REPAIRS AND MAINTENANCE18836671883667
REAL ESTATE TAX527391527391

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2393447Total
Program Services2393447ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total73742865Total
Program Services69085633ProgramServices
Management And General4657232ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1165534BOY
EOY1597477EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3557374BOY
EOY2845310EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY653393BOY
EOY653393EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY12848190BOY
EOY11579380EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY176130BOY
EOY481376EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis115359554LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec64838065LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY51789245BOY
EOY50521489EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6873802BOY
EOY6774826EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1257617BOY
EOY1305417EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY6661677BOY
EOY12399639EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY84982962BOY
EOY88158307EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11744480BOY
EOY14954420EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY3153849BOY
EOY3149044EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY17895000BOY
EOY17535000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY32012240BOY
EOY31269611EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1566214BOY
EOY2098952EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY66371783BOY
EOY69007027EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17531848BOY
EOY17867290EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1079331BOY
EOY1283990EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18611179BOY
EOY19151280EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY84982962BOY
EOY88158307EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1508440ReconcilationRevenueExpenses
Reconcilation Other Changes-968339ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years761897CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years794151CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years853703CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1843841CurrentTaxYearMinus1Year
Current Tax Year1657909CurrentTaxYear
Total5911501Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years68144834CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years72001336CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years70984500CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year70618626CurrentTaxYearMinus1Year
Current Tax Year73255481CurrentTaxYear
Total355004777Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years68906731CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years72795487CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years71838203CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year72462467CurrentTaxYearMinus1Year
Current Tax Year74913390CurrentTaxYear
Total360916278Total
FieldValueIRS element (for citing)
Public Support Total509360916278PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1160230CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years550529CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years299821CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year740596CurrentTaxYearMinus1Year
Current Tax Year181696CurrentTaxYear
Total2932872Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1160230CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years550529CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years299821CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year740596CurrentTaxYearMinus1Year
Current Tax Year181696CurrentTaxYear
Total2932872Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25935CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total25935Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years70066961CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years73371951CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years72138024CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year73203063CurrentTaxYearMinus1Year
Current Tax Year75095086CurrentTaxYear
Total363875085Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99187PublicSupportPercentage509
Prior Year Support Percentage0.98000PriorYearSupportPercentage
Investment Income Percentage0.00806InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00920PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6453725OtherCostOrOtherBasis
Book Value6453725BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis74908940OtherCostOrOtherBasis
Depreciation40637394Depreciation
Book Value34271546BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4442385OtherCostOrOtherBasis
Depreciation3407898Depreciation
Book Value1034487BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis23229118OtherCostOrOtherBasis
Depreciation20792774Depreciation
Book Value2436344BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6325386OtherCostOrOtherBasis
Book Value6325386BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings50521488TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
GROUND LEASE RECEIVABLES4789839
INTERDIVISIONAL3517745
LEGAL LIAB INS RECOVERIES2885407
DEFERRED FINANCING COSTS, NET1206648
FieldValueIRS element (for citing)
Total Book Value Other Assets12399639TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
OTHER LONG-TERM LIABILITIES$1,633,233
CHARITABLE ANNUITY CONTRACTS$198,437
ACCRUED INTEREST PAYABLE$134,117
RESIDENT NOTES AND DEPOSITS$133,165
FieldValueIRS element (for citing)
Total Of Amounts2098952TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierASC 740 FOOTNOTEIdentifier
ExplanationTHE CORPORATIONS ACCOUNT FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC SUBTOPIC 740-10, INCOME TAXES - OVERALL, WHICH ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, THE CORPORATIONS MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST, AND PENALTIES ON INCOME TAXES AND ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. AS OF DECEMBER 31, 2011 AND 2010, THE CORPORATIONS DO NOT HAVE A LIABILITY FOR ANY UNRECOGNIZED TAX BENEFITS.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1BANQUETNameOfEvent1
Gross Receipts Event1184765GrossReceiptsEvent1
Charitable Contributions Event1110965CharitableContributionsEvent1
Gross Revenue Event173800GrossRevenueEvent1
Other Direct Expenses Event1167627OtherDirectExpensesEvent1
Name Of Event2GOLF OUTINGNameOfEvent2
Gross Receipts Event2129154GrossReceiptsEvent2
Charitable Contributions Event287034CharitableContributionsEvent2
Gross Revenue Event242120GrossRevenueEvent2
Other Direct Expenses Event243367OtherDirectExpensesEvent2
Total Number Of Other Events3TotalNumberOfOtherEvents
Gross Receipts Other Events32263GrossReceiptsOtherEvents
Charitable Contrib Other Events15403CharitableContribOtherEvents
Gross Revenue Other Events16860GrossRevenueOtherEvents
Other Direct Expenses Other Events16183OtherDirectExpensesOtherEvents
Gross Receipts Total346182GrossReceiptsTotal
Charitable Contributions Total213402CharitableContributionsTotal
Gross Revenue Total Events132780GrossRevenueTotalEvents
Other Direct Expenses Total Events227177OtherDirectExpensesTotalEvents
Direct Expense Summary Events227177DirectExpenseSummaryEvents
Net Income Summary-94397NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierFUNDRAISING OR GAMING ACTIVITIESIdentifier
Return ReferenceFORM 990, SCHEDULE G, PART IIReturnReference
ExplanationThe organization hosts events for public relations and fundraising purposes. These events are often underwritten by leadership sponsors of which their sponsorships are allocated amongst the various events. The combined gross receipts of the events totaled $346,182 for 2011. The combined costs of the events totaled $227,177. The net income to the organization for hosting all of the events was $119,005.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RICHARD SCHUTT
03915870519600865708237503694005715190524077
WILLIAM DEYOUNG
021927603443801063601950603004403139000315138
DAN HOLWERDA
0236930031250044650980002953403119790260935
Timothy Abbring
0121120082000005172025864016035600
Mary Kay Kacmarek
0128063000003842025613015751800
Leeona Campbell
0963890300000005056025278015672300

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPart IIIIdentifier
Return ReferenceQuestion 1aReturnReference
ExplanationThe 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. 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 $ 82,375 William DeYoung $ 19,506 In 2005, the Board of Directors established a Retention Incentive Plan for certain officers. This plan recognizes the historic contribution of the executives and establishes an incentive for them to continue their employment with the organization until normal retirement age. Among various criteria, in order to qualify for the benefit, the executive will need to be continuously employed thru and until a future date. The organization's 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 them based upon the achievement or satisfaction of some future events. The plan contributions are not under the control of the executive, they remain the asset of the organization, and the entire plan is subject to a full risk of forfeiture by the individual. For calendar year 2011, a portion of the Retention Incentive Plan includes a retro-calculated catch-up provision as if the plan had been established upon assuming their current positions, as opposed to many years after the fact. That reality affects the current year's contribution level. This plan was developed by an outside professional compensation expert who practices significantly in non-profit, faith-based, aging services organizations. 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 capabilities and experience. The Variable pay reflects the organization's commitment to pay for specific performance towards the organization's 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 RECEIVES AN EXECUTIVE COMPENSATION OPINION NOTING THAT THE ORGANIZATION'S 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.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MICHIGAN STRATEGIC FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN521417332IssuerEIN
CUSIP Number59469YAF2CUSIPNumber
Date Issued2004-11-18DateIssued
Issue Price9585000IssuePrice
Description Of PurposeMICHIGAN STRATEGIC FUNDDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired1205000AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds9585000TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds191700IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures166000CapitalExpenditures
Other Spent Proceeds0OtherSpentProceeds
Amount Unspent0AmountUnspent
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Prcntge Prvt Business Use By Others0PrcntgePrvtBusinessUseByOthers
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatefalseExceptionToRebate
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ILLINOIS FINANCE AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN861091967IssuerEIN
CUSIP Number45200BGF9CUSIPNumber
Date Issued2004-11-01DateIssued
Issue Price33170000IssuePrice
Description Of PurposeILLINOIS DEVELOPMENT FINANCEDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired24015000AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds33170000TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds663400IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures6933000CapitalExpenditures
Other Spent Proceeds0OtherSpentProceeds
Amount Unspent0AmountUnspent
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Prcntge Prvt Business Use By Others0PrcntgePrvtBusinessUseByOthers
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatefalseExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSIONREST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME D/B/A PROVIDENCE LIFE SERVICES (REST HAVEN) IS A NOT-FOR-PROFIT ILLINOIS CORPORATION WHOSE PURPOSE IS TO PROVIDE NURSING AND RESIDENTIAL LIVING ARRANGEMENTS FOR THE AGED INCLUDING SKILLED NURSING AND REHABILITATION SERVICES, HOME HEALTH CARE, TOWNHOME LIVING, INDEPENDENT LIVING, AND ASSISTED LIVING.
GOVERNANCE, MANAGEMENT, AND DISCLOSUREQUESTION 3: All management activities for Rest Haven are performed and supervised by Rest Haven's wholly-owned corporation, Providence Management and Development Company.FORM 990 PART VI, SECTION A
GOVERNANCE, MANAGEMENT, AND DISCLOSUREQUESTION 11B: A draft of the 990 was prepared and sent for initial review by the controllers, CFO and CEO. Upon 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 PART VI, SECTION A
GOVERNANCE, MANAGEMENT, AND DISCLOSUREQUESTION 12C: The officers, directors/trustees and key employees are required to submit a conflict of interest statement upon beginning their position. Thereafter, the conflict of interest statements are updated on an annual basis. Any potential conflicts are reviewed and addressed by the board as necessary.FORM 990 PART VI, SECTION B
COMPENSATION OF KEY EMPLOYEESQUESTIONS 15A & 15B: The Executive Compensation Program's primary objective is to provide competitive total pay opportunities that help attract, reward and retain critical leadership talent in order to achieve the organization's mission and strategic initiatives. Rest Haven establishes its executive 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 PART VI, SECTION B
GOVERNANCE, MANAGEMENT, AND DISCLOSUREQUESTION 19: The governing documents, conflict of interest policy, and financial statements are available to the public upon request.FORM 990 PART VI, SECTION C
Reconciliation of Net Assetsprior period adjustment (717,612) unrealized losses (250,727) --------- (968,339) =========Form 990, Part XI, Line 5

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodePrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
PROVIDENCE DEVELOPMENT GROUP
18601 N CREEK DRIVETINLEY PARKIL60477DEVELOPMENTIL07726040NA
PARK PLACE REALTY GROUP LLC
18601 N CREEK DRIVETINLEY PARKIL60477REAL ESTATEIL1670276943NA

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStatePublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
CHRISTIAN HEALTHCARE FOUNDATION
18601 N CREEK DRIVETINLEY PARKIL60477200722359RESEARCHIL9false
CHRISTIAN LIVING CAMPUS
18601 N CREEK DRIVETINLEY PARKIL60477200226221SENIOR LIVINGIL9false
HAVEN PARK
18601 N CREEK DRIVETINLEY PARKIL60477383026594HEALTHCAREMI9false
TIMOTHY PLACE
18601 N CREEK DRIVETINLEY PARKIL60477201835089SENIOR LIVINGIL9false
PARK PLACE OF ST JOHN
18601 N CREEK DRIVETINLEY PARKIL60477201834903SENIOR LIVINGIL9false
HUDSONVILLE PARK PLACE
18601 N CREEK DRIVETINLeY PARKIL60477201834667SENIOR LIVINGIL9false

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
PROVIDENCE MGMT & DEVELOPMENT
18601 N CREEK DRIVETINLEY PARKIL60477363774205MGMT & ITILNAC CORP-63198332265261.00000
HOME AIDE HEALTH NETWORK
18601 N CREEK DRIVETINLEY PARKIL60477364167569HOME CAREMIPROV MGMT & DEVC CORP-376294932091.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
PROVIDENCE MANAGEMENT DEVELOPMENT COMPANY
1O4519088FMV
HOME AIDE HEALTH NETWORK
1P21504FMV
HOME AIDE HEALTH NETWORK
1O223659FMV