2015-11-09T12:11:11-06:00 2015-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2014-07-01 390816900 PINE HAVEN CHRISTIAN HOME INC PINE 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 MARTIN HALVERSON OFFICER 9204672401 2015-11-04 1 TERRY T STRITTMATER CPA P00012661 9204580341 2014 2016-03-07 17:11:31Z MARTIN HALVERSON 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 14478811 0 X WWW.PINEHAVEN.ORG X 1950 WI PINE HAVEN CHRISTIAN COMMUNITIES WILL PROVIDE THE AGING POPULATION WE SERVE AN ENVIRONMENT THAT IS A CHRIST-CENTERED, SAFE HAVEN OFFERING QUALITY, COMPASSIONATE CARE. 18 18 355 175 0 0 19658 4729 13210591 14452767 37190 13914 8060 7401 13275499 14478811 0 0 0 0 7404233 8250112 0 0 1000 4732051 5029498 12136284 13279610 1139215 1199201 24016490 40715121 12317394 27798061 11699096 12917060 PINE HAVEN CHRISTIAN COMMUNITIES WILL PROVIDE THE AGING POPULATION WE SERVE AN ENVIRONMENT THAT IS A CHRIST-CENTERED, SAFE HAVEN OFFERING QUALITY, COMPASSIONATE CARE. 0 0 11429255 14452767 PROVIDING HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN A NON-PROFIT NURSING HOME AND ASSISTED LIVING FACILITIES. A CMS RECOGNIZED OVERALL 5-STAR NURSING HOME. 11429255 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 39 0 1 355 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 1 1 0 X MARTIN HALVERSON 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 RICH DAANE PRESIDENT 0.00 X X 0 0 0 CHRISTINE TEMPAS VICE PRESIDENT 0.00 X X 0 0 0 DAN NEERHOFF SECRETARY 0.00 X X 0 0 0 WENDY BAACKES TREASURER 0.00 X X 0 0 0 DAVE BRASSER BOARD MEMBER 0.00 X 0 0 0 JANE BUTEYN BOARD MEMBER 0.00 X 0 0 0 PAUL DAMKOT BOARD MEMBER 0.00 X 0 0 0 JACK HOFFMANN BOARD MEMBER 0.00 X 0 0 0 ROBERT DESMIDT BOARD MEMBER 0.00 X 0 0 0 GLENN LEMMENES BOARD MEMBER 0.00 X 0 0 0 BETTY MOODY BOARD MEMBER 0.00 X 0 0 0 GENNY TEN PAS BOARD MEMBER 0.00 X 0 0 0 NORENE HUIBREGTSE BOARD MEMBER 0.00 X 0 0 0 MIKE FOLEY BOARD MEMBER 0.00 X 0 0 0 LARRY LORENZ BOARD MEMBER 0.00 X 0 0 0 LOIS OOSTDYKE BOARD MEMBER 0.00 X 0 0 0 JEFF RISSEEUW BOARD MEMBER 0.00 X 0 0 0 RANDY TEUNISSEN BOARD MEMBER 0.00 X 0 0 0 CAROL DULMES BOARD MEMBER 0.00 X 0 0 0 JOHN ACKERMANN BOARD MEMBER 0.00 X 0 0 0 VIRGIL NAVIS BOARD MEMBER 0.00 X 0 0 0 BOB VANDER PUY BOARD MEMBER 0.00 X 0 0 0 RON WALVOORT CHIEF EXECUTIVE OFFICER 40.00 X 107418 0 23969 ROGER LEYS CHIEF EXECUTIVE OFFICER 40.00 X 132789 0 3314 MICHELE OOSTDYK ADMINISTRATOR 40.00 X 105997 0 23969 MARTIN HALVERSON CHIEF FINANCIAL OFFICER 40.00 X 50901 0 13982 397105 0 65234 3 0 0 0 REHAB CARE GROUP EAST INC 680 SOUTH FOURTH STREET LOUISVILLE KY 40202 THERAPY 645968 1 4729 4729 RES CENTER RES. FEES 623000 7903953 7903953 NURSING HOME RES. FEES 623000 4736695 4736695 RES CARE APARTMENT COMPLEX 623000 1812119 1812119 14452767 13914 13914 MISCELLANEOUS REVENUE 900099 7401 7401 7401 14478811 14452767 0 21315 521934 521934 6388483 5801715 586768 81868 68962 12906 735214 617011 118203 522613 438894 83719 3324 3324 23880 23880 34681 34681 139581 139581 205722 205027 695 65294 65294 329127 329127 820880 820575 305 155460 155460 NURSING AND MEDICAL 1150376 1150376 DIETARY - FOOD 615541 615541 UTILITIES 398790 397680 1110 SUPPLIES 315615 260855 54760 771227 568032 203195 13279610 11429255 1849355 1000 X 5733663 5758180 624902 1063507 18055 25646 73111 61607 42267477 9485864 16513592 32781613 407090 425852 207116 208674 438961 390042 24016490 40715121 1350678 2218222 10966716 25579839 12317394 27798061 X 11699096 12917060 11699096 12917060 24016490 40715121 1199201 18763 0 X X 0 1 X 1 0 X 6065 22829 14118 19658 4729 67399 10800365 12168630 12978233 13210591 14452767 63610586 10806430 12191459 12992351 13230249 14457496 63677985 0 0 0 63677985 60130 61035 42678 30190 13914 207947 60130 61035 42678 30190 13914 207947 10438 9587 11412 8060 7401 46898 10876998 12262081 13046441 13268499 14478811 63932830 0.99600 0.99600 0.00330 0.00330 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2010 AMOUNT: $ 10,438. 2011 AMOUNT: $ 9,587. 2012 AMOUNT: $ 11,412. 2013 AMOUNT: $ 8,060. 2014 AMOUNT: $ 7,401. 1920734 1920734 19730508 7891085 11839423 2098997 1594779 504218 18517238 18517238 32781613 X 14504084 18763 6510 25273 14478811 0 14478811 13286120 6510 6510 13279610 0 13279610 PART X, LINE 2: THE ORGANIZATION FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES WHICH IS PART OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THIS GUIDANCE INCREASES THE RELEVANCY AND COMPARABILITY OF FINANCIAL REPORTING BY CLARIFYING THE WAY ORGANIZATIONS ACCOUNT FOR UNCERTAINTIES IN INCOME TAXES FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN. IT MAKES RECOGNITION AND MEASUREMENT MORE CONSISTENT AS WELL AS OFFERING CLEAR CRITERIA FOR SUBSEQUENTLY RECOGNIZING, DERECOGNIZING AND MEASURING SUCH TAX POSITIONS FOR FINANCIAL STATEMENT PURPOSES. PENALTIES AND INTEREST ASSESSED BY INCOME TAXING AUTHORITIES ARE INCLUDED IN MANAGEMENT AND GENERAL EXPENSES, IF APPLICABLE. THE ORGANIZATION HAD NO INTEREST AND PENALTIES RELATED TO INCOME TAXES FOR THE YEARS ENDED JUNE 30, 2015 AND 2014. THE ORGANIZATION'S FEDERAL RETURNS ARE SUBJECT TO EXAMINATION GENERALLY FOR THREE YEARS AFTER THEY ARE FILED AND ITS STATE RETURNS GENERALLY FOR FOUR YEARS AFTER THEY ARE FILED. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY - SERIES 2014 A 391337855 2014-05-01 10000000 REFINANCE 2009 BONDS 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY - SERIES 2014 B 391337855 2014-05-01 1000000 REFINANCE 2009 BONDS 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY - SERIES 2014 B 391337855 2014-05-01 18100000 NEW PROJECT 0 0 0 A 10000000 2015 1 0 0 1 B 439880 1000000 2015 1 0 0 1 C 15019719 206522 14813197 2015 0 0 0 1 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 SCHEDULE K, PART II, LINE 3, COLUMN C: AS OF JUNE 30, 2015, $15,019,719 OF THE $18,100,000 AVAILABLE HAS BEEN DRAWN. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE BOARD OF TRUSTEES FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PINE HAVEN CHRISTIAN HOME HAS A BOARD OF DIRECTOR'S APPROVED "CODE OF ETHICS" DOCUMENT. THE CODE OF ETHICS INCLUDES A SECTION COVERING "CONFLICT OF INTEREST". IT PROVIDES A DEFINITION AND ALL EMPLOYEES ARE REQUIRED TO SIGN A STATEMENT EACH YEAR THAT THEY DO NOT HAVE A "CONFLICT OF INTEREST" OR THEY DECLARE ANY EXISTING CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE CEO AND OTHER KEY EMPLOYEES IS COMPARED TO INDUSTRY DATA COMPILED BY LEADING AGE WISCONSIN. THE SURVEY COMPARES COMPENSATION BASED ON THREE CRITERIA: GROSS REVENUES, GEOGRAPHIC AREA AND TOTAL BED RESPONSIBILITIES. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVALIABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART XII, LINE 2C THERE IS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. PINE HAVEN CHRISTIAN HOME FOUNDATION INC 531 GIDDINGS AVE SHEBOYGAN FALLS WI 53085 391963866 RAISE/RECEIVE FUNDS FOR THE GENERAL SUPPORT OF THIS ORGANIZATION WI 501(C)(3) 11 N/A 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 PINE HAVEN CHRISTIAN HOME FOUNDATION INC C 4729 ACTUAL AMOUNT RECEIVED PINE HAVEN CHRISTIAN HOME FOUNDATION INC D 680 ACTUAL AMOUNT BORROWED PINE HAVEN CHRISTIAN HOME FOUNDATION INC O 8034 ALLOCATION BASED ON HOURS WORKED