PINE HAVEN INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
PINE HAVEN INC (EIN 41-0944721)
Tax period
2019-10-01 to 2020-09-30
Filed
2021-08-16
IRS object ID
202132289349302723
Schema version
2019v5.2
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

FieldValueIRS element (for citing)
Return2021-08-16T13:01:08-05:00ReturnTs
Tax Period End2020-09-30TaxPeriodEndDt

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 Begin2019-10-01TaxPeriodBeginDt

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)
PersonMARCUS PARENCEPersonNm
Person TitleCEO/ADMINISTRATORPersonTitleTxt
Phone5073568304PhoneNum
Signature2021-08-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL J PETERSON CPAPreparerPersonNm
PTINP01833529PTIN
Phone2187224705PhoneNum
Preparation2021-08-12PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMARCUS PARENCEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 3RD STREET NWAddressLine1Txt
CityPINE ISLANDCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55963ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$8,392,965GrossReceiptsAmt
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 Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee218TotalEmployeeCnt
Total Volunteers80TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$6,495PYContributionsGrantsAmt
CY Contributions Grants$751,511CYContributionsGrantsAmt
PY Program Service Revenue$6,981,446PYProgramServiceRevenueAmt
CY Program Service Revenue$7,607,692CYProgramServiceRevenueAmt
PY Investment Income$803PYInvestmentIncomeAmt
CY Investment Income$1,599CYInvestmentIncomeAmt
PY Other Revenue$5,553PYOtherRevenueAmt
CY Other Revenue$32,163CYOtherRevenueAmt
PY Total Revenue$6,994,297PYTotalRevenueAmt
CY Total Revenue$8,392,965CYTotalRevenueAmt
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$4,109,315PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,763,772CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,768,591PYOtherExpensesAmt
CY Other Expenses$3,457,356CYOtherExpensesAmt
PY Total Expenses$6,877,906PYTotalExpensesAmt
CY Total Expenses$8,221,128CYTotalExpensesAmt
PY Revenues Less Expenses$116,391PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$171,837CYRevenuesLessExpensesAmt
Total Assets BOY$7,280,552TotalAssetsBOYAmt
Total Assets EOY$7,846,455TotalAssetsEOYAmt
Total Liabilities BOY$6,657,420TotalLiabilitiesBOYAmt
Total Liabilities EOY$7,051,486TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$623,132NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$794,969NetAssetsOrFundBalancesEOYAmt
MissionPINE HAVEN COMMUNITY PROVIDES A CONTINUUM OF CARE THROUGH THE BELIEF THAT EVERY PERSON IS UNIQUE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$7,212,322ExpenseAmt
Grant$0GrantAmt
Revenue$7,607,692RevenueAmt
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 23,792 INPATIENT DAYS WERE PROVIDED.Desc
Total Program Service Expenses$7,212,322TotalProgramServiceExpensesAmt
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 StmtYes (1)ConsolidatedAuditFinclStmtInd
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 Document17IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee218EmployeeCnt
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 Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
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
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JESSICA RIVERABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5073568304PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
CRAIG SMITH
ADMINISTRATOR (THRU JAN)40.00Yes (X)$0$0$0
MARCUS PARENCE
CEO/ADMINISTRATOR40.00Yes (X)$0$0$01.00
JESSICA RIVERA
FINANCE DIRECTOR40.00Yes (X)$16,717$0$0
RANDY HOFFARTH
CHAIR1.00Yes (X)$0$0$01.00Yes (X)
JOANNE JUDGE-DIETZ
CHAIR / VICE CHAIR1.00Yes (X)$0$0$0Yes (X)
BRIAN HALE
VICE CHAIR1.00Yes (X)$0$0$01.00Yes (X)
GLEN HEMANN
TREASURER1.00Yes (X)$0$0$01.00Yes (X)
TERESA BUCK
SECRETARY1.00Yes (X)$0$0$0Yes (X)
RON FLEMKE
DIRECTOR1.00$0$0$0Yes (X)
JERRY VETTEL
DIRECTOR1.00$0$0$01.00Yes (X)
WAYNE WELLIK
DIRECTOR1.00$0$0$01.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$16,717TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
AEGIS THERAPIES
PO BOX 936653ATLANTAGA31193THERAPY SERVICES$445,874
PRIME TIME HEALTHCARE
PO BOX 3544OMAHANE68103NURSING POOL STAFF$187,914
SENIOR CARE SOLUTIONS
PO BOX 2283STILLWATERMN55082NURSING INTERIM STAFF$114,593
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$725,557GovernmentGrantsAmt
All Other Contributions$25,954AllOtherContributionsAmt
Total Contributions$751,511TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT SERVICES623000$7,258,865$7,258,865
APARTMENT REVENUE623000$289,827$289,827
MANAGEMENT SERVICES623000$59,000$59,000
FieldValueIRS element (for citing)
Total Program Service Revenue$7,607,692TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,599TotalRevenueColumnAmt
Exclusion$1,599ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$32,163TotalRevenueColumnAmt
Exclusion$32,163ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$32,163OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,392,965TotalRevenueColumnAmt
Related Or Exempt Func Income$7,607,692RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$33,762ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$187,198TotalAmt
Management And General$187,198ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,970,545TotalAmt
Program Services$3,831,994ProgramServicesAmt
Management And General$138,551ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$17,242TotalAmt
Program Services$16,137ProgramServicesAmt
Management And General$1,105ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$306,358TotalAmt
Program Services$282,441ProgramServicesAmt
Management And General$23,917ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$282,429TotalAmt
Program Services$260,322ProgramServicesAmt
Management And General$22,107ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$11,045TotalAmt
Management And General$11,045ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$85,668TotalAmt
Program Services$1,106ProgramServicesAmt
Management And General$84,562ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$994,644TotalAmt
Program Services$916,861ProgramServicesAmt
Management And General$77,783ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$87,075TotalAmt
Management And General$87,075ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$135,834TotalAmt
Program Services$30,909ProgramServicesAmt
Management And General$104,925ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$75,457TotalAmt
Management And General$75,457ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$171,450TotalAmt
Program Services$145,311ProgramServicesAmt
Management And General$26,139ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,520TotalAmt
Program Services$48ProgramServicesAmt
Management And General$1,472ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$47,056TotalAmt
Program Services$2,955ProgramServicesAmt
Management And General$44,101ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$179,500TotalAmt
Program Services$176,891ProgramServicesAmt
Management And General$2,609ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$447,977TotalAmt
Program Services$361,874ProgramServicesAmt
Management And General$86,103ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
NURSING SUPPLIES$439,932$439,932
FOOD EXPENSE$281,766$281,766
NURSING HOME SURCHARGE$197,050$197,050
BAD DEBT EXPENSE$195,843$195,843

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$105,539TotalAmt
Program Services$70,882ProgramServicesAmt
Management And General$34,657ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,221,128TotalAmt
Program Services$7,212,322ProgramServicesAmt
Management And General$1,008,806ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$7,941BOYAmt
EOY$5,791EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$224,556BOYAmt
EOY$960,937EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$614,390BOYAmt
EOY$730,026EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$22,518BOYAmt
EOY$32,371EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,202,888LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$5,095,744LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,407,631BOYAmt
EOY$6,107,144EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

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

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$6,670EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,280,552BOYAmt
EOY$7,846,455EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$715,302BOYAmt
EOY$809,638EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$465,589EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$3,655BOYAmt
EOY$6,548EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$5,847,507BOYAmt
EOY$5,769,711EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$90,956BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,657,420BOYAmt
EOY$7,051,486EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$623,132BOYAmt
EOY$794,969EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$623,132BOYAmt
EOY$794,969EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,280,552BOYAmt
EOY$7,846,455EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$171,837ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
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$232,712CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$151,688CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$40,821CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,495CurrentTaxYearMinus1YearAmt
Current Tax Year$751,511CurrentTaxYearAmt
Total$1,183,227TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,860,358CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,303,897CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,128,723CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,981,446CurrentTaxYearMinus1YearAmt
Current Tax Year$7,607,692CurrentTaxYearAmt
Total$32,882,116TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$12,817CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$575CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$43,874CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,553CurrentTaxYearMinus1YearAmt
Current Tax Year$32,163CurrentTaxYearAmt
Total$94,982TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,105,887CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,456,160CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,213,418CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,993,494CurrentTaxYearMinus1YearAmt
Current Tax Year$8,391,366CurrentTaxYearAmt
Total$34,160,325TotalAmt

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$34,160,325PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$927CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$964CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,159CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$803CurrentTaxYearMinus1YearAmt
Current Tax Year$1,599CurrentTaxYearAmt
Total$5,452TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$927CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$964CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,159CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$803CurrentTaxYearMinus1YearAmt
Current Tax Year$1,599CurrentTaxYearAmt
Total$5,452TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,106,814CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,457,124CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,214,577CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,994,297CurrentTaxYearMinus1YearAmt
Current Tax Year$8,392,965CurrentTaxYearAmt
Total$34,165,777TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99980PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00020InvestmentIncomeCYPct
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$3,886,919DepreciationAmt
Book Value$5,585,125BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,566,029OtherCostOrOtherBasisAmt
Depreciation$1,160,800DepreciationAmt
Book Value$405,229BookValueAmt

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$6,107,144TotalBookValueLandBuildingsAmt

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 (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION CONTRACTED PATHWAY HEALTH FOR THE SERVICES OF CRAIG SMTIH AS THE ADMINISTRATOR FROM JUNE 2019 UNTIL JANUARY 2020.
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 THEN PRESENTS FORM 990 TO THE BOARD OF DIRECTORS FOR APPROVAL 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.
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 11GPHARMACY SERVICES: PROGRAM SERVICE EXPENSES 5,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,930. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 421,059. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 421,059. OTHER HEALTH CARE PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 489,872. MANAGEMENT AND GENERAL EXPENSES 77,783. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 567,655.

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

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