PINE HAVEN CHRISTIAN HOME INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PINE HAVEN CHRISTIAN HOME INC (EIN 39-0816900)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-04-20
- IRS object ID
- 202211109349301636
- Schema version
- 2020v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-04-20T16:00:36-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 170 NORTH RADNOR-CHESTER ROAD SUITE | AddressLine1Txt |
| Address Line2 | 200 | AddressLine2Txt |
| City | RADNOR | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19087 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390816900 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINE HAVEN CHRISTIAN HOME INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PINE | BusinessNameControlTxt |
| Phone | 9204672401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1Txt |
| City | SHEBOYGAN FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53085 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LINDA EVRAETS | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 9204672401 | PhoneNum |
| Signature | 2022-03-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LINDA | PersonFirstNm |
| Person Last | EVRAETS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SOLOMON MARDAKHAEV | PreparerPersonNm |
| PTIN | P01806552 | PTIN |
| Phone | 6105653930 | PhoneNum |
| Preparation | 2022-03-28 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RONALD WALVOORT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1Txt |
| City | SHEBOYGAN FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53085 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,580,922 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PINEHAVEN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1950 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | PINE HAVEN CHRISTIAN HOME, INC. (PINE HAVEN CHRISTIAN COMMUNITIES) WILL PROVIDE THE AGING POPULATION WE SERVE AN ENVIRONMENT THAT IS A CHRIST-CENTERED, SAFE HAVEN OFFERING QUALITY, COMPASSIONATE CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 538 | TotalEmployeeCnt |
| Total Volunteers | 76 | TotalVolunteersCnt |
| Total Gross UBI | $77,279 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $266,001 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,880,254 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,794,613 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,225,478 | CYProgramServiceRevenueAmt |
| PY Investment Income | $145,134 | PYInvestmentIncomeAmt |
| CY Investment Income | $126,241 | CYInvestmentIncomeAmt |
| PY Other Revenue | $83,228 | PYOtherRevenueAmt |
| CY Other Revenue | $87,818 | CYOtherRevenueAmt |
| PY Total Revenue | $18,288,976 | PYTotalRevenueAmt |
| CY Total Revenue | $19,319,791 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,140,723 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,936,430 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $9,542 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,240,237 | PYOtherExpensesAmt |
| CY Other Expenses | $8,655,273 | CYOtherExpensesAmt |
| PY Total Expenses | $18,380,960 | PYTotalExpensesAmt |
| CY Total Expenses | $18,591,703 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$91,984 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $728,088 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $43,487,731 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,878,229 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,748,958 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,084,219 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,738,773 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,794,010 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PINE HAVEN CHRISTIAN COMMUNITIES WILL PROVIDE THE AGING POPULATION WE SERVE AN ENVIRONMENT THAT IS A CHRIST-CENTERED, SAFE HAVEN OFFERING QUALITY, COMPASSIONATE CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,087,797 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $16,225,478 | RevenueAmt |
| Desc | PINE HAVEN CHRISTIAN HOME, INC. PROVIDES HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN A NURSING HOME, ASSISTED LIVING FACILITIES, AND SENIOR HOUSING FACILITIES. PINE HAVEN CHRISTIAN HOME, INC. OPERATES A SKILLED NURSING FACILITY, AN ASSISTED LIVING COMMUNITY BASED RESIDENTIAL FACILITY (CBRF) INCLUDING MEMORY CARE AND AN ASSISTED LIVING RESIDENTIAL CARE APARTMENT COMPLEX (RCAC) AT ITS HAVEN DRIVE LOCATION; A CBRF INCLUDING MEMORY CARE AT ITS GIDDINGS AVE. LOCATION; AND A CBRF AND SENIOR HOUSING UNITS AT ITS OOSTBURG LOCATION. | Desc |
| Total Program Service Expenses | $17,087,797 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 63 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 538 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LINDA EVRAETS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204672401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1Txt |
| City | SHEBOYGAN FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53085 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| RONALD WALVOORT | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 1.00 | Yes (X) | $168,105 | $0 | $31,602 | |
| STANLEY KAYMEN | |||||||
| CHIEF FINANCIAL OFFICER (THRU MARCH) | 40.00 | 1.00 | Yes (X) | $128,342 | $0 | $3,836 | |
| SHANNON OTTEN | |||||||
| CHIEF OPERATING OFFICER | 40.00 | 1.00 | Yes (X) | $100,848 | $0 | $25,933 | |
| LINDA EVRAETS | |||||||
| CHIEF FINANCIAL OFFICER (BEG. MARCH) | 40.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JERITH BUTEYN-GIER | |||||||
| PRESIDENT (THRU SEPTEMBER)/DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DENNIS BEACH | |||||||
| PRESIDENT (BEG. SEPTEMBER) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DARRELL HAUSE | |||||||
| VICE PRESIDENT (BEG. SEPTEMBER) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| KEVIN VELDHORST | |||||||
| SECRETARY (BEG. SEPTEMBER) | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JACK HOFFMAN | |||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JEFF BROETZMANN | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ROGER BUYZE | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| TIM GORTER | |||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| DR CURTIS HANCOCK | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DARRYL HARMELINK | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MARY HUENINK | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| NORENE HUIBREGTSE | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GLENN LEMMENES | |||||||
| DIRECTOR (THRU SEPTEMBER) | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| BETTY MOODY | |||||||
| DIRECTOR (THRU SEPTEMBER) | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| VIRGIL NAVIS | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ROBERT NYHUIS | |||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| JEWEL RAUWERDINK | |||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $397,295 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $61,371 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GREENFIELD REHABILITATION AGENCY INC | |||||
| 19395 WEST CAPITAL DRIVE SUITE 200 | BROOKFIELD | WI | 53005 | THERAPY SERVICES | $803,630 |
| STAT NURSING SOLUTIONS LLC | |||||
| 1117 SOUTH 16TH STREET | SHEBOYGAN | WI | 53081 | STAFFING SERVICES | $451,985 |
| ALLIANCE SERVICES INC | |||||
| 910 SOUTH MAIN STREET | WEST BEND | WI | 53095 | STAFFING SERVICES | $227,541 |
| AYA HEALTHCARE INC | |||||
| 5930 CORNERSTONE COURT WEST SUITE | SAN DIEGO | CA | 92121 | STAFFING SERVICES | $153,484 |
| ELITE NURSES INC | |||||
| 808 BAYLAND COURT | GREEN BAY | WI | 54304 | STAFFING SERVICES | $150,336 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $186,640 | RelatedOrganizationsAmt |
| Government Grants | $2,693,614 | GovernmentGrantsAmt |
| Total Contributions | $2,880,254 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CBRF REVENUE | 623000 | $9,544,676 | $9,544,676 |
| NURSING HOME REVENUE | 623000 | $4,747,073 | $4,747,073 |
| RESIDENTIAL CARE REVENUE | 623000 | $1,758,544 | $1,758,544 |
| INDEPENDENT LIVING REVENUE | 623000 | $175,185 | $175,185 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,225,478 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $171,039 | TotalRevenueColumnAmt |
| Exclusion | $171,039 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,216,333 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,241,376 | SecuritiesAmt |
| Other | $19,755 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$25,043 | SecuritiesAmt |
| Other | -$19,755 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$44,798 | TotalRevenueColumnAmt |
| Exclusion | -$44,798 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MANAGEMENT SERVICES REVENUE | Desc |
| Business | 541610 | BusinessCd |
| Total Revenue Column | $77,279 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $77,279 | UnrelatedBusinessRevenueAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,539 | TotalRevenueColumnAmt |
| Exclusion | $10,539 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $87,818 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,319,791 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,225,478 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $77,279 | UnrelatedBusinessRevenueAmt |
| Exclusion | $136,780 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $501,788 | TotalAmt |
| Management And General | $501,788 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,882,770 | TotalAmt |
| Program Services | $7,183,804 | ProgramServicesAmt |
| Management And General | $692,545 | ManagementAndGeneralAmt |
| Fundraising | $6,421 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,943 | TotalAmt |
| Program Services | $94,943 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $826,561 | TotalAmt |
| Program Services | $824,376 | ProgramServicesAmt |
| Management And General | $1,746 | ManagementAndGeneralAmt |
| Fundraising | $439 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $630,368 | TotalAmt |
| Program Services | $539,002 | ProgramServicesAmt |
| Management And General | $91,366 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,771 | TotalAmt |
| Management And General | $49,771 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,000 | TotalAmt |
| Management And General | $30,000 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,774 | TotalAmt |
| Management And General | $26,774 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,927,260 | TotalAmt |
| Program Services | $2,926,798 | ProgramServicesAmt |
| Fundraising | $462 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,561 | TotalAmt |
| Program Services | $104,561 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,754 | TotalAmt |
| Program Services | $32,321 | ProgramServicesAmt |
| Management And General | $56,433 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,342 | TotalAmt |
| Program Services | $181,342 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $791,039 | TotalAmt |
| Program Services | $783,253 | ProgramServicesAmt |
| Management And General | $7,786 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,880 | TotalAmt |
| Program Services | $14,880 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $847,917 | TotalAmt |
| Program Services | $836,266 | ProgramServicesAmt |
| Management And General | $11,651 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,755,340 | TotalAmt |
| Program Services | $1,730,836 | ProgramServicesAmt |
| Management And General | $24,504 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,599 | TotalAmt |
| Program Services | $173,599 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| FOOD EXPENSES | $762,235 | $762,235 |
| MEDICAL SUPPLIES | $431,820 | $431,820 |
| MAINTENANCE & REPAIRS | $156,954 | $156,954 |
| PROVISION FOR BAD DEBTS | $5,600 | $5,600 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $307,427 | TotalAmt |
| Program Services | $305,207 | ProgramServicesAmt |
| Fundraising | $2,220 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,591,703 | TotalAmt |
| Program Services | $17,087,797 | ProgramServicesAmt |
| Management And General | $1,494,364 | ManagementAndGeneralAmt |
| Fundraising | $9,542 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $583,244 | BOYAmt |
| EOY | $395,916 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $566,232 | BOYAmt |
| EOY | $754,471 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $647,311 | BOYAmt |
| EOY | $862,366 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,722 | BOYAmt |
| EOY | $135,156 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $49,394,200 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,490,097 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,167,722 | BOYAmt |
| EOY | $31,904,103 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,403,262 | BOYAmt |
| EOY | $12,826,217 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,238 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,487,731 | BOYAmt |
| EOY | $46,878,229 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,281,591 | BOYAmt |
| EOY | $1,190,699 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $277,764 | BOYAmt |
| EOY | $201,169 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,272,503 | BOYAmt |
| EOY | $25,692,351 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,917,100 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,748,958 | BOYAmt |
| EOY | $27,084,219 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,738,773 | BOYAmt |
| EOY | $19,782,821 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $11,189 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,738,773 | BOYAmt |
| EOY | $19,794,010 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,487,731 | BOYAmt |
| EOY | $46,878,229 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $728,088 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $48,958 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $4,278,191 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $230,821 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $189,886 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $246,929 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $266,001 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,880,254 | CurrentTaxYearAmt |
| Total | $3,813,891 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,942,320 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,895,865 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,518,688 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17,794,613 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $16,225,478 | CurrentTaxYearAmt |
| Total | $86,376,964 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $21,810 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $21,201 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,476 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,774 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,539 | CurrentTaxYearAmt |
| Total | $84,800 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,194,951 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $18,106,952 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,786,093 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,071,388 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,116,271 | CurrentTaxYearAmt |
| Total | $90,275,655 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $90,275,655 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $54,394 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $75,276 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $121,539 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $140,920 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $171,039 | CurrentTaxYearAmt |
| Total | $563,168 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $1,132 | CurrentTaxYearMinus1YearAmt |
| Total | $1,132 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $54,394 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $75,276 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $121,539 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $142,052 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $171,039 | CurrentTaxYearAmt |
| Total | $564,300 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,249,345 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $18,182,228 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,907,632 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,213,440 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,287,310 | CurrentTaxYearAmt |
| Total | $90,839,955 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99380 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99530 | PublicSupportPY509Pct |
| Investment Income CY | 0.00620 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00470 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,345,944 | OtherCostOrOtherBasisAmt |
| Book Value | $1,345,944 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,318,785 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,870,147 | DepreciationAmt |
| Book Value | $28,448,638 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,363,061 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,619,950 | DepreciationAmt |
| Book Value | $1,743,111 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $366,410 | OtherCostOrOtherBasisAmt |
| Book Value | $366,410 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $31,904,103 | TotalBookValueLandBuildingsAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RONALD WALVOORT | PersonNm |
| Title | CHIEF EXECUTIVE OFFICER | TitleTxt |
| Base Compensation Filing Org | $163,571 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $1,460 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $3,074 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $4,748 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $26,854 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $199,707 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | |||||||
| A | 391337855 | 2014-05-01 | $10,000,000 | ADJUSTABLE RATE REFUNDING REVENUE BONDS, SERIES 2014A | 0 | 0 | 0 |
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | |||||||
| B | 391337855 | 2014-05-01 | $19,100,000 | NEW PROJECT, SERIES 2014B | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|
| A | $2,166,273 | $10,000,000 | $10,000,000 | 2006 | Yes (1) | 0 | Yes (1) | Yes (1) | |
| B | $2,060,757 | $19,100,000 | $1,000,000 | 2015 | 0 | 0 | Yes (1) | Yes (1) | $18,100,000 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/13/2021 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS HAVE BEEN UPDATED TO REFLECT THE MERGER WITH PINE HAVEN CHRISTIAN FOUNDATION HOME, INC. THE OUTREACH COMMITTEE WAS CREATED TO FUNCTION ON BEHALF OF THE BOARD OF DIRECTORS AND CARRY ON THE ACTIVITIES FORMALLY PERFORMED BY THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | PINE HAVEN CHRISTIAN HOME, INC. HAS ONE CLASS OF MEMBERS. A PERSON WILL BE ADMITTED TO MEMBERSHIP OF PINE HAVEN CHRISTIAN HOME, INC. UPON THE CONDITIONS THAT (I) THE INDIVIDUAL BE A MEMBER OF GOOD STANDING IN ANY CONGREGATION, AND (II) SUCH INDIVIDUAL CONSENTS TO BEING A MEMBER OF PINE HAVEN CHRISTIAN HOME, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS ELECT THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | 1. THE PERSONS COVERED BY THE CONFLICT OF INTEREST POLICY ARE DIRECTORS AND OFFICERS. 2. DETERMINATIONS OF WHETHER A CONFLICT EXISTS ARE MADE BY THE BOARD OF DIRECTORS. 3. ACTUAL CONFLICTS ARE REVIEWED AT THE BOARD OF DIRECTORS LEVEL. 4. IF A CONFLICT EXISTS, THE BOARD'S OPTIONS INCLUDE BUT ARE NOT LIMITED TO I) PROHIBITING THE AFFECTED DIRECTOR OR OFFICER FROM PARTICIPATING IN ANY PINE HAVEN DISCUSSION OR DECISIONS INVOLVING THE CONFLICT OF INTEREST; II) MODIFYING OR REDEFINING THE DUTIES AND RESPONSIBILITIES OF THE AFFECTED DIRECTOR OR OFFICER; III) REQUIRING THE RESIGNATION OF THE AFFECTED DIRECTOR OR OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND OTHER OFFICERS IS COMPARED TO INDUSTRY DATA COMPILED BY LEADING AGE WISCONSIN. THE SURVEY COMPARES COMPENSATION BASED ON THREE CRITERIA: GROSS REVENUES, GEOGRAPHIC AREA AND TOTAL BED RESPONSIBILITIES. THE CHIEF EXECUTIVE OFFICER HAS AN ANNUAL REVIEW COMPLETED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| FORM 990, PART IX, LINE 11G | CNA PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 767,989. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 767,989. LPN PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 587,406. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 587,406. RN PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 363,454. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 363,454. THERAPY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 731,216. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 731,216. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 476,733. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 462. TOTAL EXPENSES 477,195. |
| FORM 990, PART XI, LINE 9: | TRANSFER DUE TO MERGER OF PINE HAVEN CHRISTIAN HOME FOUNDATION, INC. 4,278,191. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINE HAVEN CHRISTIAN HOME FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1Txt |
| City | SHEBOYGAN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53085 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391963866 | EIN |
| Primary Activities | TO SUPPORT PINE HAVEN CHRISTIAN HOME, INC. | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINE HAVEN CHIRSTIAN HOME INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINE HAVEN CHRISTIAN HOME FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $186,640 | InvolvedAmt |
| Method Of Amount Determination | FAIR MARKET VALUE | MethodOfAmountDeterminationTxt |