PINE HAVEN INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: PINE HAVEN INC (EIN 41-0944721)
Tax period: 2020-10-01 to 2021-09-30
Filed: 2022-08-15
IRS object ID: 202232279349302938
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-08-15T12:18:48-05:00	ReturnTs
Tax Period End	2021-09-30	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	1502 LONDON ROAD SUITE 200	AddressLine1Txt
City	DULUTH	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55812	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	410944721	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PINE HAVEN INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	PINE	BusinessNameControlTxt
Phone	5073568304	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	210 3RD STREET NW	AddressLine1Txt
City	PINE ISLAND	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55963	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CRAIG SMITH	PersonNm
Person Title	CEO/ADMINISTRATOR	PersonTitleTxt
Phone	5073568304	PhoneNum
Signature	2022-08-15	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	CRAIG	PersonFirstNm
Person Last	SMITH	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MICHAEL J PETERSON CPA	PreparerPersonNm
PTIN	P01833529	PTIN
Phone	2187224705	PhoneNum
Preparation	2022-08-15	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	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	CRAIG SMITH	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	210 3RD STREET NW	AddressLine1Txt
City	PINE ISLAND	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55963	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$9,079,459	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.PINEHAVENCOMMUNITY.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1964	FormationYr
Legal Domicile State	MN	LegalDomicileStateCd
Activity Or Mission	PROVIDE QUALITY, AFFORDABLE SERVICES FOR OLDER ADULTS AND FAMILIES IN OUR COMMUNITY.	ActivityOrMissionDesc
Voting Members Governing Body	7	VotingMembersGoverningBodyCnt
Voting Members Independent	7	VotingMembersIndependentCnt
Total Employee	283	TotalEmployeeCnt
Total Volunteers	80	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$751,511	PYContributionsGrantsAmt
CY Contributions Grants	$699,725	CYContributionsGrantsAmt
PY Program Service Revenue	$7,607,692	PYProgramServiceRevenueAmt
CY Program Service Revenue	$8,160,383	CYProgramServiceRevenueAmt
PY Investment Income	$1,599	PYInvestmentIncomeAmt
CY Investment Income	$2,297	CYInvestmentIncomeAmt
PY Other Revenue	$32,163	PYOtherRevenueAmt
CY Other Revenue	$217,054	CYOtherRevenueAmt
PY Total Revenue	$8,392,965	PYTotalRevenueAmt
CY Total Revenue	$9,079,459	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	$4,763,772	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$5,993,010	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$3,457,356	PYOtherExpensesAmt
CY Other Expenses	$3,198,308	CYOtherExpensesAmt
PY Total Expenses	$8,221,128	PYTotalExpensesAmt
CY Total Expenses	$9,191,318	CYTotalExpensesAmt
PY Revenues Less Expenses	$171,837	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$111,859	CYRevenuesLessExpensesAmt
Total Assets BOY	$7,846,455	TotalAssetsBOYAmt
Total Assets EOY	$7,119,498	TotalAssetsEOYAmt
Total Liabilities BOY	$7,051,486	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$6,439,186	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$794,969	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$680,312	NetAssetsOrFundBalancesEOYAmt
Mission	PINE HAVEN COMMUNITY PROVIDES A CONTINUUM OF CARE THROUGH THE BELIEF THAT EVERY PERSON IS UNIQUE.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$7,986,365	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$8,160,383	RevenueAmt
Desc	PINE HAVEN, INC. (PINE HAVEN COMMUNITY) IS RESPONSIBLE FOR PROVIDING NURSING CARE AND HOUSING FOR THE ELDERLY AND DISABLED, OPERATING A 70 BED LICENSED NURSING FACILITY LOCATED IN PINE ISLAND, MINNESOTA. PROVIDE MANAGEMENT SERVICES TO EVERGREEN PLACE, AN ASSISTED LIVING HOUSING FACILITY OWNED BY THE CITY OF PINE ISLAND, MINNESOTA. DURING THE YEAR 24,209 INPATIENT DAYS WERE PROVIDED.	Desc
Total Program Service Expenses	$7,986,365	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	Yes (1)	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	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	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	0	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
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	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	20	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	283	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
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	7	GoverningBodyVotingMembersCnt
Independent Voting Member	7	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	0	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	0	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	JESSICA RIVERA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	5073568304	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	210 3RD STREET NW	AddressLine1Txt
City	PINE ISLAND	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55963	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt
RANDY HOFFARTH
CHAIR	1.00	1.00	Yes (X)	Yes (X)	$0	$0	$0
JOANNE JUDGE-DIETZ
CHAIR / VICE CHAIR	1.00		Yes (X)	Yes (X)	$0	$0	$0
GLEN HEMANN
TREASURER	1.00	1.00	Yes (X)	Yes (X)	$0	$0	$0
TERESA BUCK
SECRETARY	1.00		Yes (X)	Yes (X)	$0	$0	$0
RON FLEMKE
DIRECTOR	1.00		Yes (X)		$0	$0	$0
JERRY VETTEL
DIRECTOR	1.00	1.00	Yes (X)		$0	$0	$0
WAYNE WELLIK
DIRECTOR	1.00	1.00	Yes (X)		$0	$0	$0
MARCUS PARENCE
CEO/ADMINISTRATOR	40.00	1.00		Yes (X)	$107,434	$0	$1,867
JESSICA RIVERA
FINANCE DIRECTOR	40.00			Yes (X)	$46,646	$0	$90

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$154,080	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,957	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	1	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	0	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
AEGIS THERAPIES
PO BOX 936653	ATLANTA	GA	31193	THERAPY SERVICES	$368,055
PRIME TIME HEALTHCARE
PO BOX 3544	OMAHA	NE	68103	NURSING POOL STAFF	$153,622

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	2	CntrctRcvdGreaterThan100KCnt
Government Grants	$699,608	GovernmentGrantsAmt
All Other Contributions	$117	AllOtherContributionsAmt
Total Contributions	$699,725	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT SERVICES	623000	$7,801,825	$7,801,825
APARTMENT REVENUE	623000	$294,683	$294,683
MANAGEMENT SERVICES	623000	$63,875	$63,875

Field	Value	IRS element (for citing)
Total Program Service Revenue	$8,160,383	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,297	TotalRevenueColumnAmt
Exclusion	$2,297	ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$217,054	TotalRevenueColumnAmt
Exclusion	$217,054	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$217,054	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$9,079,459	TotalRevenueColumnAmt
Related Or Exempt Func Income	$8,160,383	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$219,351	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$163,064	TotalAmt
Management And General	$163,064	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$4,826,277	TotalAmt
Program Services	$4,519,373	ProgramServicesAmt
Management And General	$306,904	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$18,209	TotalAmt
Program Services	$18,209	ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$611,871	TotalAmt
Program Services	$555,037	ProgramServicesAmt
Management And General	$56,834	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$373,589	TotalAmt
Program Services	$338,567	ProgramServicesAmt
Management And General	$35,022	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$53,180	TotalAmt
Management And General	$53,180	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$840,919	TotalAmt
Program Services	$779,581	ProgramServicesAmt
Management And General	$61,338	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$74,190	TotalAmt
Management And General	$74,190	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$58,875	TotalAmt
Program Services	$8,980	ProgramServicesAmt
Management And General	$49,895	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$152,006	TotalAmt
Management And General	$152,006	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$146,228	TotalAmt
Program Services	$140,665	ProgramServicesAmt
Management And General	$5,563	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,535	TotalAmt
Program Services	$976	ProgramServicesAmt
Management And General	$559	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$175,483	TotalAmt
Program Services	$168,903	ProgramServicesAmt
Management And General	$6,580	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$365,340	TotalAmt
Program Services	$351,640	ProgramServicesAmt
Management And General	$13,700	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$63,460	TotalAmt
Management And General	$63,460	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
NURSING SUPPLIES	$656,879	$656,879
FOOD EXPENSE	$225,936	$225,936
NURSING HOME SURCHARGE	$129,021	$129,021
REPAIRS & MAINTENANCE	$43,526	$41,841	$1,685

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$211,730	TotalAmt
Program Services	$50,757	ProgramServicesAmt
Management And General	$160,973	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$9,191,318	TotalAmt
Program Services	$7,986,365	ProgramServicesAmt
Management And General	$1,204,953	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$5,791	BOYAmt
EOY	-$2,047	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$960,937	BOYAmt
EOY	$25,509	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$730,026	BOYAmt
EOY	$1,304,237	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$32,371	BOYAmt
EOY	$50,042	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$11,202,888	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$5,464,647	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$6,107,144	BOYAmt
EOY	$5,738,241	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$3,516	BOYAmt
EOY	$3,516	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$6,670	BOYAmt
EOY	$0	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$7,846,455	BOYAmt
EOY	$7,119,498	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$809,638	BOYAmt
EOY	$734,445	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$465,589	BOYAmt
EOY	$0	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$6,548	BOYAmt
EOY	$12,260	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$5,769,711	BOYAmt
EOY	$5,682,687	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$9,794	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,051,486	BOYAmt
EOY	$6,439,186	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	$794,969	BOYAmt
EOY	$680,312	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$794,969	BOYAmt
EOY	$680,312	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$7,846,455	BOYAmt
EOY	$7,119,498	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$111,859	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$2,798	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	0	FSAuditedInd
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	$151,688	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$40,821	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$6,495	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$751,511	CurrentTaxYearMinus1YearAmt
Current Tax Year	$699,725	CurrentTaxYearAmt
Total	$1,650,240	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$6,303,897	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$7,128,723	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$6,981,446	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$7,607,692	CurrentTaxYearMinus1YearAmt
Current Tax Year	$8,160,383	CurrentTaxYearAmt
Total	$36,182,141	TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$575	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$43,874	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$5,553	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$32,163	CurrentTaxYearMinus1YearAmt
Current Tax Year	$217,054	CurrentTaxYearAmt
Total	$299,219	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$6,456,160	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$7,213,418	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$6,993,494	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$8,391,366	CurrentTaxYearMinus1YearAmt
Current Tax Year	$9,077,162	CurrentTaxYearAmt
Total	$38,131,600	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	$38,131,600	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$964	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$1,159	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$803	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,599	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,297	CurrentTaxYearAmt
Total	$6,822	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$964	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$1,159	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$803	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,599	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,297	CurrentTaxYearAmt
Total	$6,822	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$6,457,124	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$7,214,577	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$6,994,297	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$8,392,965	CurrentTaxYearMinus1YearAmt
Current Tax Year	$9,079,459	CurrentTaxYearAmt
Total	$38,138,422	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.99980	PublicSupportCY509Pct
Public Support PY509	0.99980	PublicSupportPY509Pct
Investment Income CY	0.00020	InvestmentIncomeCYPct
Investment Income PY	0.00020	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

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$116,790	OtherCostOrOtherBasisAmt
Book Value	$116,790	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$9,472,044	OtherCostOrOtherBasisAmt
Depreciation	$4,183,582	DepreciationAmt
Book Value	$5,288,462	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,566,029	OtherCostOrOtherBasisAmt
Depreciation	$1,233,040	DepreciationAmt
Book Value	$332,989	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$48,025	OtherCostOrOtherBasisAmt
Depreciation	$48,025	DepreciationAmt
Book Value	$0	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$5,738,241	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	DUE TO PINE HAVEN FOUNDATION	Desc
Amt	$9,794	Amt

Field	Value	IRS element (for citing)
Total Liability	$9,794	TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART IV, LINE 2B:	FormAndLineReferenceDesc
Explanation	THE ORGANIZATION IS THE TRUSTEE OF VARIOUS RESIDENT FUNDS AND HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION AND DISTRIBUTION OF THESE FUNDS FOR THE RESIDENTS. THESE FUNDS ARE ON DEPOSIT IN A SEPARATE BANK ACCOUNT.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 8B	THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION B, LINE 11B	MANAGEMENT OF THE ORGANIZATION REVIEWS FORM 990 PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF THE CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT EXISTS. UPON DETERMINATION OF THE CONFLICT OF INTEREST, THE INTERESTED PERSON MUST LEAVE THE MEETING DURING THE DISCUSSION AND VOTE UPON THE TRANSACTION AT HAND.
FORM 990, PART VI, SECTION B, LINE 15A	THE BOARD OF DIRECTORS REVIEWS AND DETERMINES COMPENSATION FOR THE ADMINISTRATOR DURING THE ADMINISTRATOR'S ANNUAL PERFORMANCE APPRAISAL. THE BENCHMARK WHICH THE BOARD COMPARES THE SALARY FOR THE ADMINISTRATOR IS PROVIDED BY THE SALARY SURVEY COMPLETED BY LEADINGAGE MINNESOTA. THIS IS THE AGING SERVICES TRADE ORGANIZATION WHICH THE ORGANIZATION BELONGS TO.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	OTHER CHANGES IN NET ASSETS -2,798.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

Field	Value	IRS element (for citing)
Business Name Line1	PINE HAVEN FOUNDATION INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	210 3RD STREET NW	AddressLine1Txt
City	PINE ISLAND	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55963	ZIPCd

Field	Value	IRS element (for citing)
EIN	411580669	EIN
Primary Activities	SUPPORT PINE HAVEN, INC	PrimaryActivitiesTxt
Legal Domicile State	MN	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 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	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	Yes (1)	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	0	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd