2012-11-13T12:28:59-06:00 2012-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2011-07-01 390816900 PINE HAVEN CHRISTIAN HOME INC PINE 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 RON WALVOORT 9204672401 2012-09-20 1 TERRY T STRITTMATER CPA P00012661 9204580341 2011 2016-02-24 21:20:13Z RON WALVOORT 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 12262082 0 X WWW.PINEHAVEN.ORG X 1950 WI PINE HAVEN CHRISTIAN HOME PROVIDES NURSING AND ASSISTED LIVING HOUSING AND SERVICES TO SENIORS. 18 18 284 90 0 0 6065 22829 10800366 12168630 60130 61035 10438 9588 10876999 12262082 0 0 0 0 6388261 6709342 0 0 1000 3601014 4142407 9989275 10851749 887724 1410333 19942727 21511235 12630161 12773906 7312566 8737329 PINE HAVEN CHRISTIAN HOME PROVIDES SKILLED NURSING AND ASSISTED LIVING HOUSING AND SERVICES TO SENIORS. 0 0 9577366 12168630 PROVIDING HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN A NON-PROFIT NURSING HOME AND ASSISTED LIVING FACILITIES. 9577366 1 0 0 1 0 0 0 0 0 0 1 1 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 0 1 45 0 1 284 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 DIRK ZYLMAN 0.00 X 0 0 0 WENDY BAACKES 0.00 X 0 0 0 DAVE BRASSER 0.00 X 0 0 0 JANE BUTEYN 0.00 X 0 0 0 JERITH BUTEYN-GIER 0.00 X 0 0 0 JOHN DAANE 0.00 X 0 0 0 PAUL DAMKOT 0.00 X 0 0 0 DON DEMASTER 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 DAN NEERHOFF 0.00 X 0 0 0 JEFF RISSEEUW 0.00 X 0 0 0 BOB VANDER PUY 0.00 X 0 0 0 NANCY VERSTRATE 0.00 X 0 0 0 CAROL DULMES 0.00 X 0 0 0 RICH DAANE 0.00 X 0 0 0 JOHN ACKERMANN 0.00 X 0 0 0 VIRGIL NAVIS 0.00 X 0 0 0 RON WALVOORT 40.00 X 88725 0 28158 CATHY KELLING 40.00 X 100773 0 6529 ROGER LEYS 40.00 X 107221 0 3418 296719 0 38105 2 0 0 0 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 5 22829 5820 22829 RES CENTER RESIDENT FE 623000 6478551 6478551 NURSING HOME RES. FEES 623000 4253831 4253831 RES CARE APARTMENT COM 623000 1436248 1436248 12168630 61035 61035 MISCELLANEOUS REVENUE 900099 9588 9588 9588 12262082 12168630 0 70623 296719 296719 5299163 4898641 400190 332 59857 51710 8147 612814 534875 77868 71 440789 380788 59990 11 928 928 31798 31731 67 36891 36891 125763 125763 322988 322988 28739 28739 387257 387257 714783 714770 13 145674 145601 73 NURSING AND MEDICAL 673082 673082 DIETARY - FOOD 452071 452071 UTILITIES 330834 329731 1072 31 SUPPLIES 260028 212807 47152 69 631571 473045 158193 333 10851749 9577366 1273383 1000 X 1813143 2934118 408665 444805 13850 15567 87068 200942 21753683 7169189 14414378 14584494 291392 299056 2649259 2435803 264972 596450 19942727 21511235 830161 1133906 11800000 11640000 12630161 12773906 X 7312566 8737329 7312566 8737329 19942727 21511235 X 1410333 14430 X X 0 1 1 X 0 X 68379 71418 163946 6065 22829 332637 8958396 9893073 9481663 10800365 12168630 51302127 9026775 9964491 9645609 10806430 12191459 51634764 0 0 0 51634764 90796 60130 61035 211961 90796 60130 61035 211961 19415 38196 10438 9587 77636 9136986 10002687 9645609 10876998 12262081 51924361 0.99440 0.99390 0.00410 0.00440 X 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. 1741822 1741822 18101359 5897228 12204131 1910502 1271961 638541 14584494 CERTIFICATES OF DEPOSIT-CURRENT ASSETS 1512786 C LONG-TERM INVESTMENTS 923017 C 2435803 12262082 10851749 1410333 14430 14430 1424763 12276512 14430 14430 12262082 0 12262082 10851749 0 10851749 0 10851749 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 14,430. 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 1 0 1 0 0 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