2022-08-24T16:36:32-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 818 SECOND STREET SOUTH SUITE 320 WAITE PARK MN 56387 990 2021-01-01 411305200 PINE RIVER GROUP HOME INC PINE 2185874888 PO BOX 96 PINE RIVER MN 56474 DANIEL FRANK BOARD CHAIRPERSON 2185874888 2022-08-22 1 DANIEL FRANK 999009999 JASON R NEUMANN CPA P01690179 3202035500 2022-08-22 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DANIEL FRANK PO BOX 96 PINE RIVER MN 56474 3385550 0 X N/A X 1977 MN SUPPORTING PERSONS WITH DISABILITIES THROUGH A PERSON CENTERED APPROACH. 9 9 78 9 0 0 59753 0 3278502 3244867 17029 -17537 3713 38342 3358997 3265672 0 0 0 0 2308527 2300990 0 0 0 583844 613871 2892371 2914861 466626 350811 3395305 3699608 286896 237508 3108409 3462100 SUPPORTING PERSONS WITH DISABILITIES THROUGH A PERSON CENTERED APPROACH. 0 0 2474837 3283209 PINE RIVER GROUP HOME, INC. CURRENTLY SUPPORTS 26 PERSONS WITH DEVELOPMENTAL AND OTHER DISABILITIES IN FIVE RESIDENTIAL HOMES AND FOUR APARTMENTS AND 20-25 INDIVIDUALS IN THEIR OWN HOMES IN THE PINE RIVER AREA. 2474837 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 78 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X CARRIE GUIDA 2185874888 PO BOX 96 PINE RIVER MN 56474 CARRIE GUIDA EXECUTIVE DIRECTOR 46.80 X 98596 0 2976 DAN FRANK CHAIRPERSON 0.50 X X 0 0 0 FRED FEY VICE CHAIRPERSON 0.30 X X 0 0 0 JANET RILEY TREASURER 0.30 X X 0 0 0 PENNY OLSON SECRETARY 0.50 X X 0 0 0 ADRIS ANDERBERG DIRECTOR 0.30 X 0 0 0 CRAIG ANDERSON DIRECTOR 0.30 X 0 0 0 CHARLIE MINION DIRECTOR 0.30 X 0 0 0 DAN PFLUGSHAUPT DIRECTOR 0.30 X 0 0 0 BEVERLY WIGNES DIRECTOR 0.30 X 0 0 0 98596 0 2976 0 0 0 0 0 RESIDENTS 624100 3244867 3244867 3244867 13067 13067 89274 116982 2896 -27708 -2896 -30604 -30604 MISCELLANEOUS 900099 38342 38342 38342 3265672 3283209 0 -17537 101572 101572 2020984 1973270 47714 30180 30180 148254 114899 33355 21718 21718 3088 3088 11590 11590 1902 1902 24670 24670 45279 41127 4152 23786 23497 289 52690 47421 5269 129397 36294 93103 REPAIRS AND MAINTENANCE 150565 105019 45546 FOOD 68415 68415 AFFORDABLE CARE ACT PEN 27501 27501 RESIDENT PROGRAMS 23125 23125 30145 30145 2914861 2474837 440024 0 799809 1111536 750424 751352 260757 226201 15979 13302 1717464 782798 889614 934666 678722 662551 3395305 3699608 161994 123505 38400 86502 114003 286896 237508 X 3108409 3462100 3108409 3462100 3395305 3699608 350811 2880 0 X 0 1 X 1 0 X 576 710 547 59753 61586 2829084 2830836 2970404 3278502 3244867 15153693 2829660 2831546 2970951 3338255 3244867 15215279 0 0 0 15215279 12629 12180 14481 13562 13067 65919 12629 12180 14481 13562 13067 65919 22247 -5275 30333 7180 7738 62223 2864536 2838451 3015765 3358997 3265672 15343421 0.99160 0.99160 0.00430 0.00410 X 118948 118948 1300092 555456 744636 63302 38871 24431 235122 188471 46651 934666 ACCRUED ACA PENALTY 114003 114003 X 3265464 2880 2880 3262584 3088 3088 3265672 2911773 0 2911773 3088 3088 2914861 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX CODES, AND THERFORE, THE FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES. CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS A CHARITABLE TAX DEDUCTION BY THE CONTRIBUTOR. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION WOULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION A, LINE 3 BOARD SOMETIMES DELEGATES TASKS TO A SUBCOMMITTEE, SOMETIMES WITH POWER TO ACT, AND SOMETIMES JUST TO BRING RECOMMENDATION TO FULL BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD WILL REVIEW, APPROVE AND SIGN FORM 990 AND ALL SCHEDULES BEFORE SUBMISSION. THIS ACTION WILL BE DOCUMENTED IN MINUTES. FORM 990, PART VI, SECTION B, LINE 12C ANNNUAL WRITTEN CONFLICT OF INTEREST (COI) FORMS ARE SUBMITTED AND REVIEWED. PERSONS WITH KNOWN OR DOCUMENTED COI ARE EXCUSED FROM OR ABSTAIN FROM DECISIONS OR ACTIONS PERTAINING TO THAT COI. FORM 990, PART VI, SECTION B, LINE 15 BOARD HAS PROCESS FOR ANNUAL PERFORMANCE EVALUATION OF ED AND DETERMINING WAGE INCREASE, OR NOT. SUBCOMMITTEE MEETS WITH ED, AND SEPARATELY WITH OTHER EMPLOYEES, CHOSEN BY THE BOARD, TO GATHER INPUT DURING THIS PROCESS. SUBCOMMITTEE TAKES SUMMARY AND RECOMMENDATION TO FULL BOARD FOR ACTION. THIS PROCESS IS DOCUMENTED IN MINUTES. THIS PROCESS MAY INCLUDE COMPARING MARKET DATA OR SIMILAR ORGANIZATIONS. THE BOARD REVIEWS WAGE AND YEARS OF SERVICE INFORMATION PRESENTED BY ED ALONG WITH FINANCIAL STATEMENTS TO DETERMINE WHAT BUDGET WILL SUPPORT. OTHER RELEVANT INFORMATION IS PROVIDED, IF ANY, SUCH AS MARKET DATA FROM DEED, DHS, ARRM, ANCOR OR OTHERS. ALL DECISIONS DOCUMENTED IN MINUTES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.