2013-10-25T14:49:24-05:00 2013-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2012-07-01 390816900 PINE HAVEN CHRISTIAN HOME INC PINE 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 RON WALVOORT 9204672401 2013-10-01 1 TERRY T STRITTMATER CPA P00012661 9204580341 2012 2016-03-07 17:11:31Z RON WALVOORT 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 13046441 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 18 294 140 0 0 22829 14118 12168630 12978233 61035 42678 9588 11412 12262082 13046441 0 0 0 0 6709342 6959806 0 0 1000 4142407 4366322 10851749 11326128 1410333 1720313 21511235 22827994 12773906 12327748 8737329 10500246 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 9902852 12978233 PROVIDING HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN A NON-PROFIT NURSING HOME AND ASSISTED LIVING FACILITIES. 9902852 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 40 0 1 294 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 X RON WALVOORT 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 DAVE BRASSER 0.00 X 0 0 0 JANE BUTEYN 0.00 X 0 0 0 PAUL DAMKOT 0.00 X 0 0 0 DON DEMASTER 0.00 X 0 0 0 ROBERT DESMIDT 0.00 X 0 0 0 CAROL DULMES 0.00 X 0 0 0 DARRELL HAUSE 0.00 X 0 0 0 CARL HUENINK 0.00 X 0 0 0 NORENE HUIBREGTSE 0.00 X 0 0 0 MIKE FOLEY 0.00 X 0 0 0 CARL JOOSSE 0.00 X 0 0 0 LARRY LORENZ 0.00 X 0 0 0 DAN NEERHOFF 0.00 X 0 0 0 LOIS OOSTDYKE 0.00 X 0 0 0 JEFF RISSEEUW 0.00 X 0 0 0 CHRISTINE TEMPAS 0.00 X 0 0 0 RANDY TEUNISSEN 0.00 X 0 0 0 BOB VANDER PUY 0.00 X 0 0 0 NANCY VERSTRATE 0.00 X 0 0 0 RICH DAANE 0.00 X 0 0 0 VIRGIL NAVIS 0.00 X 0 0 0 JOHN ACKERMANN 0.00 X 0 0 0 WENDY BAACKES 0.00 X 0 0 0 RON WALVOORT 40.00 X 102533 0 26723 ROGER LEYS 40.00 X 120223 0 10251 222756 0 36974 2 0 0 0 REHAB CARE GROUP EAST INC PO BOX 503534 ST LOUIS MO 631503534 THERAPY 406089 1 14118 6020 14118 RES CENTER RES. FEES 623000 7011735 7011735 NURSING HOME RES. FEES 623000 4314153 4314153 RES CARE APARTMENT COMPLEX 623000 1652345 1652345 12978233 42678 42678 MISCELLANEOUS REVENUE 900099 11412 11412 11412 13046441 12978233 0 54090 222756 222756 5727670 5171438 555881 351 58885 51006 7879 498253 417861 80325 67 452242 391723 60509 10 8109 8109 34945 34750 195 80901 80901 122817 122727 90 261348 261348 35751 35749 2 372697 372697 796547 796533 14 148697 148661 36 NURSING AND MEDICAL 707539 707539 DIETARY - FOOD 500433 500433 UTILITIES 392610 391355 1224 31 SUPPLIES 303944 249928 53946 70 599984 442330 157520 134 11326128 9902852 1422276 1000 X 2934118 5828941 444805 550331 15567 18115 200942 17252 23021627 7952286 14584494 15069341 299056 347455 2435803 725391 596450 271168 21511235 22827994 1133906 1267748 11640000 11060000 12773906 12327748 X 8737329 10500246 8737329 10500246 21511235 22827994 1720313 42604 0 X X 0 1 X 1 0 X 71418 163946 6065 22829 14118 278376 9893073 9481663 10800365 12168630 12978233 55321964 9964491 9645609 10806430 12191459 12992351 55600340 0 0 0 55600340 60130 61035 42678 163843 60130 61035 42678 163843 38196 10438 9587 11412 69633 10002687 9645609 10876998 12262081 13046441 55833816 0.99580 0.99440 0.00290 0.00410 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 0 0 0 0 PART IV, SUPPLEMENTAL INFORMATION: EXPENSES INCURRED IN CONTACTING GOVERNMENT REPRESENTATIVES CONSISTED SOLEY OF TIME EXPENDED BY SALARIED EMPLOYEES TO COMMUNICATE EITHER VERBALLY OR IN WRITING FOR AN APPROXIMATE TIME OF FOUR HOURS. 1892727 1892727 19163241 6551103 12612138 1965659 1401183 564476 15069341 13089045 42604 42604 13046441 0 13046441 11326128 0 11326128 0 11326128 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 FUNDRAISING WI 501(C)(3) 11 N/A 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 PINE HAVEN CHRISTIAN HOME FOUNDATION INC C 8098 ACTUAL AMOUNT RECEIVED PINE HAVEN CHRISTIAN HOME FOUNDATION INC D 21140 ACTUAL AMOUNT BORROWED PINE HAVEN CHRISTIAN HOME FOUNDATION INC O 9122 ALLOCATION BASED ON HOURS WORKED PINE HAVEN CHRISTIAN HOME FOUNDATION INC Q 36411 ACTUAL EXPENSE INCURRED