PINE HAVEN CHRISTIAN HOME INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PINE HAVEN CHRISTIAN HOME INC (EIN 39-0816900)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2012-11-13
- IRS object ID
- 201233189349302348
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T12:28:59-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391173131 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHENCK SC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 712 RIVERFRONT DRIVE STE 301 | AddressLine1 |
| City | SHEBOYGAN | City |
| State | WI | State |
| ZIP Code | 53081 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390816900 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINE HAVEN CHRISTIAN HOME INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PINE | NameControl |
| Phone | 9204672401 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1 |
| City | SHEBOYGAN FALLS | City |
| State | WI | State |
| ZIP Code | 53085 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RON WALVOORT | Name |
| Title | OFFICER | Title |
| Phone | 9204672401 | Phone |
| Date Signed | 2012-09-20 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRY T STRITTMATER CPA | Name |
| PTIN | P00012661 | PTIN |
| Phone | 9204580341 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RON WALVOORT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1 |
| City | SHEBOYGAN FALLS | City |
| State | WI | State |
| ZIP Code | 53085 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12262082 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PINEHAVEN.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1950 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | PINE HAVEN CHRISTIAN HOME PROVIDES NURSING AND ASSISTED LIVING HOUSING AND SERVICES TO SENIORS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 18 | NbrIndependentVotingMembers |
| Total Nbr Employees | 284 | TotalNbrEmployees |
| Total Nbr Volunteers | 90 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 6065 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 22829 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 10800366 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12168630 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 60130 | InvestmentIncomePriorYear |
| Investment Income Current Year | 61035 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 10438 | OtherRevenuePriorYear |
| Other Revenue Current Year | 9588 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10876999 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12262082 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6388261 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6709342 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1000 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3601014 | OtherExpensePriorYear |
| Other Expenses Current Year | 4142407 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9989275 | TotalExpensesPriorYear |
| Total Expenses Current Year | 10851749 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 887724 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1410333 | RevenuesLessExpensesCY |
| Total Assets BOY | 19942727 | TotalAssetsBOY |
| Total Assets EOY | 21511235 | TotalAssetsEOY |
| Total Liabilities BOY | 12630161 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 12773906 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7312566 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8737329 | NetAssetsOrFundBalancesEOY |
| Mission Description | PINE HAVEN CHRISTIAN HOME PROVIDES SKILLED NURSING AND ASSISTED LIVING HOUSING AND SERVICES TO SENIORS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 9577366 | Expense |
| Revenue | 12168630 | Revenue |
| Description | PROVIDING HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN A NON-PROFIT NURSING HOME AND ASSISTED LIVING FACILITIES. | Description |
| Total Program Service Expense | 9577366 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 45 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 284 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 18 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RON WALVOORT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9204672401 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVENUE | AddressLine1 |
| City | SHEBOYGAN FALLS | City |
| State | WI | State |
| ZIP Code | 53085 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| DIRK ZYLMAN | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| WENDY BAACKES | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| DAVE BRASSER | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| JANE BUTEYN | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| JERITH BUTEYN-GIER | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| JOHN DAANE | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| PAUL DAMKOT | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| DON DEMASTER | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| DARRELL HAUSE | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| CARL HUENINK | ||||||
| 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 | |
| CARL JOOSSE | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| DAN NEERHOFF | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| JEFF RISSEEUW | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| BOB VANDER PUY | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| NANCY VERSTRATE | ||||||
| BOARD MEMBER | 0.00 | X | 0 | 0 | 0 | |
| CAROL DULMES | ||||||
| PRESIDENT | 0.00 | 0 | 0 | 0 | X | |
| RICH DAANE | ||||||
| VICE PRESIDENT | 0.00 | 0 | 0 | 0 | X | |
| JOHN ACKERMANN | ||||||
| SECRETARY | 0.00 | 0 | 0 | 0 | X | |
| VIRGIL NAVIS | ||||||
| TREASURER | 0.00 | 0 | 0 | 0 | X | |
| RON WALVOORT | ||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 88725 | 0 | 28158 | X | |
| CATHY KELLING | ||||||
| CHIEF OPERATING OFFICER | 40.00 | 100773 | 0 | 6529 | X | |
| ROGER LEYS | ||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 107221 | 0 | 3418 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 296719 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 38105 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| REHAB CARE GROUP EAST INC | |||||
| PO BOX 503534 | ST LOUIS | MO | 631503534 | THERAPY | 376047 |
| ELITE NURSES INC | |||||
| 225B LINDEN COURT | LOMIRA | WI | 53048 | NURSING STAFF | 259387 |
| O&W COMMUNICATIONS | |||||
| 2040 NORTH AVENUE | SHEBOYGAN | WI | 53083 | ELECTRONICS/TECHNICIANS | 202268 |
| SHORELAND BUILDERS | |||||
| W1591 DE MASTER ROAD | OOSTBURG | WI | 53070 | REMODEL BUILDING | 184483 |
| STAFFING PARTNERS INC | |||||
| PO BOX 88247 | MILWAUKEE | WI | 532880247 | NURSING STAFF | 106471 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 22829 | AllOtherContributions |
| Noncash Contributions | 5820 | NoncashContributions |
| Total Contributions | 22829 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| RES CENTER RESIDENT FE | 623000 | 6478551 | 6478551 |
| NURSING HOME RES. FEES | 623000 | 4253831 | 4253831 |
| RES CARE APARTMENT COM | 623000 | 1436248 | 1436248 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12168630 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 61035 | TotalRevenueColumn |
| Exclusion | $61,035 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 9588 | TotalRevenueColumn |
| Exclusion | $9,588 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 9588 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12262082 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12168630 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $70,623 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296719 | Total |
| Management And General | 296719 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5299163 | Total |
| Program Services | 4898641 | ProgramServices |
| Management And General | 400190 | ManagementAndGeneral |
| Fundraising | 332 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59857 | Total |
| Program Services | 51710 | ProgramServices |
| Management And General | 8147 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 612814 | Total |
| Program Services | 534875 | ProgramServices |
| Management And General | 77868 | ManagementAndGeneral |
| Fundraising | 71 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440789 | Total |
| Program Services | 380788 | ProgramServices |
| Management And General | 59990 | ManagementAndGeneral |
| Fundraising | 11 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 928 | Total |
| Management And General | 928 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31798 | Total |
| Management And General | 31731 | ManagementAndGeneral |
| Fundraising | 67 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36891 | Total |
| Management And General | 36891 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125763 | Total |
| Management And General | 125763 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 322988 | Total |
| Program Services | 322988 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28739 | Total |
| Management And General | 28739 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 387257 | Total |
| Program Services | 387257 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 714783 | Total |
| Program Services | 714770 | ProgramServices |
| Fundraising | 13 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145674 | Total |
| Program Services | 145601 | ProgramServices |
| Fundraising | 73 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| NURSING AND MEDICAL | 673082 | 673082 | ||
| DIETARY - FOOD | 452071 | 452071 | ||
| UTILITIES | 330834 | 329731 | 1072 | 31 |
| SUPPLIES | 260028 | 212807 | 47152 | 69 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 631571 | Total |
| Program Services | 473045 | ProgramServices |
| Management And General | 158193 | ManagementAndGeneral |
| Fundraising | 333 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10851749 | Total |
| Program Services | 9577366 | ProgramServices |
| Management And General | 1273383 | ManagementAndGeneral |
| Fundraising | 1000 | Fundraising |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Joint Costs | X | JointCosts |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1813143 | BOY |
| EOY | 2934118 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 408665 | BOY |
| EOY | 444805 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13850 | BOY |
| EOY | 15567 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87068 | BOY |
| EOY | 200942 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 21753683 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7169189 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14414378 | BOY |
| EOY | 14584494 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 291392 | BOY |
| EOY | 299056 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2649259 | BOY |
| EOY | 2435803 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 264972 | BOY |
| EOY | 596450 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19942727 | BOY |
| EOY | 21511235 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 830161 | BOY |
| EOY | 1133906 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11800000 | BOY |
| EOY | 11640000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12630161 | BOY |
| EOY | 12773906 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7312566 | BOY |
| EOY | 8737329 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7312566 | BOY |
| EOY | 8737329 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19942727 | BOY |
| EOY | 21511235 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1410333 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 14430 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 68379 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 71418 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 163946 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6065 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22829 | CurrentTaxYear |
| Total | 332637 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8958396 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 9893073 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9481663 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10800365 | CurrentTaxYearMinus1Year |
| Current Tax Year | 12168630 | CurrentTaxYear |
| Total | 51302127 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9026775 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 9964491 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9645609 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10806430 | CurrentTaxYearMinus1Year |
| Current Tax Year | 12191459 | CurrentTaxYear |
| Total | 51634764 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 51634764 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 90796 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus1 Year | 60130 | CurrentTaxYearMinus1Year |
| Current Tax Year | 61035 | CurrentTaxYear |
| Total | 211961 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 90796 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus1 Year | 60130 | CurrentTaxYearMinus1Year |
| Current Tax Year | 61035 | CurrentTaxYear |
| Total | 211961 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 19415 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 38196 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus1 Year | 10438 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9587 | CurrentTaxYear |
| Total | 77636 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9136986 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 10002687 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9645609 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10876998 | CurrentTaxYearMinus1Year |
| Current Tax Year | 12262081 | CurrentTaxYear |
| Total | 51924361 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99440 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99390 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00410 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00440 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 1 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 0 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART IV, SUPPLEMENTAL INFORMATION: | Identifier |
| Explanation | 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. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1741822 | OtherCostOrOtherBasis |
| Book Value | 1741822 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18101359 | OtherCostOrOtherBasis |
| Depreciation | 5897228 | Depreciation |
| Book Value | 12204131 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1910502 | OtherCostOrOtherBasis |
| Depreciation | 1271961 | Depreciation |
| Book Value | 638541 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14584494 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CERTIFICATES OF DEPOSIT-CURRENT ASSETS | 1512786 | C |
| LONG-TERM INVESTMENTS | 923017 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 2435803 | TotalOfBookValueSecurities |
| Total Revenue | 12262082 | TotalRevenue |
| Total Expenses | 10851749 | TotalExpenses |
| Excess Or Deficit For Year | 1410333 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 14430 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 14430 | TotalAdjustments |
| Excess Or Deficit Per FS | 1424763 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 12276512 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 14430 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 14430 | RevenueNotRptdF990 |
| Revenue Subtotal | 12262082 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12262082 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 10851749 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 10851749 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 10851749 | TotalExpensesPerForm990 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. THE ADMINISTRATOR HAS TAUGHT THIS CLASS FOR TWO YEARS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION FOR THE CEO AND OTHER KEY EMPLOYEES IS COMPARED TO INDUSTRY DATA COMPILED BY THE WISCONSIN ASSOCIATION OF HOMES AND SERVICES FOR THE AGED. 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 XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 14,430. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THERE IS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINE HAVEN CHRISTIAN HOME FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 531 GIDDINGS AVE | AddressLine1 |
| City | SHEBOYGAN FALLS | City |
| State | WI | State |
| ZIP Code | 53085 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391963866 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | WI | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| PINE HAVEN CHRISTIAN HOME FOUNDATION INC | ||
| C | 17009 | ACTUAL AMOUNT RECEIVED |
| PINE HAVEN CHRISTIAN HOME FOUNDATION INC | ||
| D | 36411 | ACTUAL AMOUNT BORROWED |
| PINE HAVEN CHRISTIAN HOME FOUNDATION INC | ||
| N | 8929 | ALLOCATION BASED ON HOURS WORKED |
| PINE HAVEN CHRISTIAN HOME FOUNDATION INC | ||
| P | 20618 | ACTUAL EXPENSE INCURRED |