FURP.ORG / PUBLIC DATA EXPLORER

PINE HAVEN INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
PINE HAVEN INC (EIN 41-0944721)
Tax period
2023-10-01 to 2024-09-30
Filed
2025-08-13
IRS object ID
202512259349301446
Schema version
2023v6.0
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)
Return2025-08-13T12:17:20-05:00ReturnTs
Tax Period End2024-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11502 LONDON ROAD SUITE 200AddressLine1Txt
CityDULUTHCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55812ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN410944721EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PINE HAVEN INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPINEBusinessNameControlTxt
Phone5073568304PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 3RD STREET NWAddressLine1Txt
CityPINE ISLANDCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55963ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAMBER THORNPersonNm
Person TitleINTERIM ADMINISTRATORPersonTitleTxt
Phone5073568304PhoneNum
Signature2025-08-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL J PETERSON CPAPreparerPersonNm
PTINP01833529PTIN
Phone2187224705PhoneNum
Preparation2025-08-06PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1PINE HAVEN CARE CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerAMBER THORNPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 3RD STREET NWAddressLine1Txt
CityPINE ISLANDCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55963ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,533,024GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PINEHAVENCOMMUNITY.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1964FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionPROVIDE QUALITY, AFFORDABLE SERVICES FOR OLDER ADULTS AND FAMILIES IN OUR COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee182TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$603,126PYContributionsGrantsAmt
CY Contributions Grants$700,206CYContributionsGrantsAmt
PY Program Service Revenue$7,217,637PYProgramServiceRevenueAmt
CY Program Service Revenue$12,805,132CYProgramServiceRevenueAmt
PY Investment Income$13PYInvestmentIncomeAmt
CY Investment Income$106CYInvestmentIncomeAmt
PY Other Revenue$14,880PYOtherRevenueAmt
CY Other Revenue$27,580CYOtherRevenueAmt
PY Total Revenue$7,835,656PYTotalRevenueAmt
CY Total Revenue$13,533,024CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,380,189PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,791,704CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,522,055PYOtherExpensesAmt
CY Other Expenses$5,412,643CYOtherExpensesAmt
PY Total Expenses$8,902,244PYTotalExpensesAmt
CY Total Expenses$12,204,347CYTotalExpensesAmt
PY Revenues Less Expenses-$1,066,588PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,328,677CYRevenuesLessExpensesAmt
Total Assets BOY$7,098,089TotalAssetsBOYAmt
Total Assets EOY$8,464,386TotalAssetsEOYAmt
Total Liabilities BOY$9,072,041TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,459,455TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$1,973,952NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,931NetAssetsOrFundBalancesEOYAmt
MissionPINE HAVEN COMMUNITY PROVIDES A CONTINUUM OF CARE THROUGH THE BELIEF THAT EVERY PERSON IS UNIQUE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$9,901,061ExpenseAmt
Grant$0GrantAmt
Revenue$12,805,132RevenueAmt
DescPINE 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, APPROXIMATELY 20,800 INPATIENT DAYS WERE PROVIDED.Desc
Total Program Service Expenses$9,901,061TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee182EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MEGAN WATERCOTTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5073568304PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1701 N WASHINGTON AVE STE 500AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55401ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RANDY HOFFARTH
CHAIR (THRU DEC 23)1.001.00Yes (X)Yes (X)$0$0$0
BRIAN HALE
VICE CHAIR1.00Yes (X)Yes (X)$0$0$0
JOANNE JUDGE-DIETZ
VICE CHAIR1.00Yes (X)Yes (X)$0$0$0
GLEN HEMANN
TREASURER1.001.00Yes (X)Yes (X)$0$0$0
TERESA BUCK
SECRETARY (THRU DEC 23)1.00Yes (X)Yes (X)$0$0$0
RON FLEMKE
DIRECTOR (THRU DEC 23)1.00Yes (X)$0$0$0
JERRY VETTEL
DIRECTOR (THRU DEC 23)1.001.00Yes (X)$0$0$0
WAYNE WELLIK
DIRECTOR (THRU DEC 23)1.001.00Yes (X)$0$0$0
AMBER THORN
CEO/INTERIM ADMINISTRATOR40.001.00Yes (X)$0$0$0
ERIC EVERSON
CEO/ADMINISTRATOR (THRU DEC 23)40.001.00Yes (X)$0$0$0
JESSICA RIVERA
FINANCE DIRECTOR40.00Yes (X)$77,471$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$77,471TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K8IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PATHWAY HEALTH SERVICES
11240 STILLWATER BLVDLAKE ELMOMN55042MANAGEMENT SERVICES$1,365,496
PRIME TIME HEALTHCARE
PO BOX 3544OMAHANE68103POOL AGENCY STAFF$387,831
ESHYFT
4547 US HWY 9 SUITE QHOWELLNJ07731POOL AGENCY STAFF$251,063
THE RESOLUTE COMPANIES
4734 WHITE PINE PL NWROCHESTERMN55901POOL AGENCY STAFF$229,722
ALL MEDICAL PERSONNEL
PO BOX 931904ATLANTAGA31193POOL AGENCY STAFF$214,313
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$700,206GovernmentGrantsAmt
Total Contributions$700,206TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT SERVICES623000$12,202,481$12,202,481
APARTMENT REVENUE623000$530,984$530,984
MANAGEMENT SERVICES623000$71,667$71,667
FieldValueIRS element (for citing)
Total Program Service Revenue$12,805,132TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$106TotalRevenueColumnAmt
Exclusion$106ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$27,580TotalRevenueColumnAmt
Exclusion$27,580ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$27,580OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,533,024TotalRevenueColumnAmt
Related Or Exempt Func Income$12,805,132RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$27,686ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$77,471TotalAmt
Management And General$77,471ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,299,741TotalAmt
Program Services$4,125,782ProgramServicesAmt
Management And General$173,959ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,041,047TotalAmt
Program Services$1,923,808ProgramServicesAmt
Management And General$117,239ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$373,445TotalAmt
Program Services$351,994ProgramServicesAmt
Management And General$21,451ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,032,162TotalAmt
Program Services$1,774,871ProgramServicesAmt
Management And General$1,257,291ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$70,604TotalAmt
Management And General$70,604ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$55,940TotalAmt
Management And General$55,940ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$103,128TotalAmt
Management And General$103,128ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$179,852TotalAmt
Program Services$173,108ProgramServicesAmt
Management And General$6,744ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$598TotalAmt
Management And General$598ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,400TotalAmt
Program Services$3,400ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$570,244TotalAmt
Program Services$548,861ProgramServicesAmt
Management And General$21,383ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$352,233TotalAmt
Management And General$352,233ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
NURSING SUPPLIES$557,186$557,186
FOOD EXPENSE$327,621$327,621
REPAIRS & MAINTENANCE$89,599$89,599
DUES & SUBSCRIPTIONS$14,350$14,350

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$55,726TotalAmt
Program Services$24,831ProgramServicesAmt
Management And General$30,895ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,204,347TotalAmt
Program Services$9,901,061ProgramServicesAmt
Management And General$2,303,286ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY-$2,693BOYAmt
EOY$12,148EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,029,913BOYAmt
EOY$1,215,023EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$416,911BOYAmt
EOY$2,358,566EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$247,096BOYAmt
EOY$34,814EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,202,888LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$6,366,223LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,403,346BOYAmt
EOY$4,836,665EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,516BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$7,170EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,098,089BOYAmt
EOY$8,464,386EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,414,276BOYAmt
EOY$3,106,334EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$22,556BOYAmt
EOY$27,557EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$5,625,415BOYAmt
EOY$5,325,564EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,794BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,072,041BOYAmt
EOY$8,459,455EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$1,973,952BOYAmt
EOY$4,931EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$1,973,952BOYAmt
EOY$4,931EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,098,089BOYAmt
EOY$8,464,386EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,328,677ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$650,206OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$751,511CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$699,725CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$498,556CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$603,126CurrentTaxYearMinus1YearAmt
Current Tax Year$700,206CurrentTaxYearAmt
Total$3,253,124TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,607,692CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,160,383CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,113,291CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,217,637CurrentTaxYearMinus1YearAmt
Current Tax Year$12,805,132CurrentTaxYearAmt
Total$42,904,135TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$32,163CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$217,054CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$874,502CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$14,880CurrentTaxYearMinus1YearAmt
Current Tax Year$27,580CurrentTaxYearAmt
Total$1,166,179TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,391,366CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,077,162CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,486,349CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,835,643CurrentTaxYearMinus1YearAmt
Current Tax Year$13,532,918CurrentTaxYearAmt
Total$47,323,438TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$47,323,438PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,599CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,297CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$452CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$13CurrentTaxYearMinus1YearAmt
Current Tax Year$106CurrentTaxYearAmt
Total$4,467TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,599CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,297CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$452CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$13CurrentTaxYearMinus1YearAmt
Current Tax Year$106CurrentTaxYearAmt
Total$4,467TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,392,965CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,079,459CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,486,801CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,835,656CurrentTaxYearMinus1YearAmt
Current Tax Year$13,533,024CurrentTaxYearAmt
Total$47,327,905TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99990PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

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

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,472,044OtherCostOrOtherBasisAmt
Depreciation$4,945,443DepreciationAmt
Book Value$4,526,601BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,566,029OtherCostOrOtherBasisAmt
Depreciation$1,372,755DepreciationAmt
Book Value$193,274BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$48,025OtherCostOrOtherBasisAmt
Depreciation$48,025DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,836,665TotalBookValueLandBuildingsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART IV, LINE 2B:FormAndLineReferenceDesc
ExplanationTHE 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 (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION IS UNDER RECEIVERSHIP - FROM THE MN DEPARTMENT OF HEALTH. AS A PART OF THE PROCESS THEY HAVE ENGAGED PATHWAY HEALTH TO ASSIST WITH ADMINISTRATOR, MANAGEMENT AND FISCAL SERVICES. THIS INCLUDES ERIC EVERSON, DENNIS ANDERSON, DUSTIN BRUGGMAN AND SARA BLAIR. THE TOTAL PAID IS REPORTED ON PART VII, SECTION B.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION IS CURRENTLY IN A RECEIVERSHIP AND THE BOARD OF DIRECTORS ARE NO LONGER INVOLVED WITH DECISION MAKING.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION B, LINE 11BMANAGEMENT OF THE ORGANIZATION REVIEWS FORM 990 PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 15ATHE 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. DURING THIS RECEIVERSHIP, THE BOARD OF DIRECTORS ARE NOT INVOLVED IN THE COMPENSATION DECISION FOR THE ADMINISTRATOR AS THE STATE OF MN HAS APPOINTED A MANAGING AGENT THAT HAS EMPLOYED THEIR OWN ADMINISTRATOR.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GOTHER HEALTH CARE PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 842,911. MANAGEMENT AND GENERAL EXPENSES 1,257,291. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,100,202. NURSING SERVICES: PROGRAM SERVICE EXPENSES 931,960. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 931,960.
FORM 990, PART XI, LINE 9:PRIOR PERIOD ADJUSTMENT 650,206.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1PINE HAVEN FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 3RD STREET NWAddressLine1Txt
CityPINE ISLANDCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55963ZIPCd
FieldValueIRS element (for citing)
EIN411580669EIN
Primary ActivitiesSUPPORT PINE HAVEN, INCPrimaryActivitiesTxt
Legal Domicile StateMNLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 12A, IPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PINE HAVEN INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd