PINE HAVEN INC: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization
PINE HAVEN INC (EIN 41-0944721)
Tax period
2024-10-01 to 2025-09-30
Filed
2026-09-02
IRS object ID
202632459349300608
Schema version
2024v5.5
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)
Return2026-09-02T07:31:21-05:00ReturnTs
Tax Period End2025-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN393647910PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI ADVISORY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11502 LONDON ROAD SUITE 220AddressLine1Txt
CityDULUTHCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55812ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2024-10-01TaxPeriodBeginDt

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)
PersonRANDY HOFFARTHPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone5073568304PhoneNum
Signature2026-08-28SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL J PETERSON CPAPreparerPersonNm
PTINP01833529PTIN
Phone2187224705PhoneNum
Preparation2026-08-28PreparationDt
FieldValueIRS element (for citing)
Tax2024TaxYr

Form 990 IRS990

FieldValueIRS element (for citing)
Final ReturnYes (X)FinalReturnInd

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1PINE HAVEN CARE CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerAMBER THORNPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 3RD STREET NWAddressLine1Txt
CityPINE ISLANDCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55963ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$25,601,241GrossReceiptsAmt
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
Contract TerminationYes (X)ContractTerminationInd
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee178TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$700,206PYContributionsGrantsAmt
CY Contributions Grants$25CYContributionsGrantsAmt
PY Program Service Revenue$12,805,132PYProgramServiceRevenueAmt
CY Program Service Revenue$25,561,828CYProgramServiceRevenueAmt
PY Investment Income$106PYInvestmentIncomeAmt
CY Investment Income$1,922CYInvestmentIncomeAmt
PY Other Revenue$27,580PYOtherRevenueAmt
CY Other Revenue$37,466CYOtherRevenueAmt
PY Total Revenue$13,533,024PYTotalRevenueAmt
CY Total Revenue$25,601,241CYTotalRevenueAmt
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$6,791,704PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,337,327CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$5,412,643PYOtherExpensesAmt
CY Other Expenses$10,676,467CYOtherExpensesAmt
PY Total Expenses$12,204,347PYTotalExpensesAmt
CY Total Expenses$23,013,794CYTotalExpensesAmt
PY Revenues Less Expenses$1,328,677PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,587,447CYRevenuesLessExpensesAmt
Total Assets BOY$8,464,386TotalAssetsBOYAmt
Total Assets EOY$0TotalAssetsEOYAmt
Total Liabilities BOY$8,459,455TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,931NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$0NetAssetsOrFundBalancesEOYAmt
MissionPINE HAVEN COMMUNITY PROVIDES A CONTINUUM OF CARE THROUGH THE BELIEF THAT EVERY PERSON IS UNIQUE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$17,559,223ExpenseAmt
Grant$0GrantAmt
Revenue$25,561,828RevenueAmt
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, APPROXIMATELY 13,788 INPATIENT DAYS WERE PROVIDED. AT THE END OF THE FISCAL YEAR, THE ORGANIZATION WAS SOLD TO PINE ISLAND OPERATIONS, LLC.Desc
Total Program Service Expenses$17,559,223TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
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 Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
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 OperationsYes (1)TerminateOperationsInd
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 Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee178EmployeeCnt
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 Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
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
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PATHWAY HEALTH SERVICES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6514078699PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line111240 STILLWATER BLVDAddressLine1Txt
CityLAKE ELMOCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55042ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RANDY HOFFARTH
PRESIDENT1.001.00Yes (X)Yes (X)$0$0$0
JOANNE JUDGE-DIETZ
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
GLEN HEMANN
TREASURER1.001.00Yes (X)Yes (X)$0$0$0
TERESA BUCK
SECRETARY1.00Yes (X)Yes (X)$0$0$0
RON FLEMKE
DIRECTOR1.00Yes (X)$0$0$0
JERRY VETTEL
DIRECTOR1.001.00Yes (X)$0$0$0
WAYNE WELLIK
DIRECTOR1.001.00Yes (X)$0$0$0
AMBER THORN
CEO/INTERIM ADMINISTRATOR40.001.00Yes (X)$0$0$0
JESSICA RIVERA
FINANCE DIRECTOR40.00Yes (X)$79,519$0$2
FieldValueIRS element (for citing)
Total Reportable Comp From Org$79,519TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$2TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PATHWAY HEALTH SERVICES INC
11240 STILLWATER BLVDLAKE ELMOMN55042MANAGEMENT SERVICES$1,101,365
THE RESOLUTE COMPANIES
4734 WHITE PINE PL NWROCHESTERMN55901POOL AGENCY STAFF$620,441
PRIME TIME HEALTHCARE
PO BOX 3544OMAHANE68103POOL AGENCY STAFF$353,578
ALL MEDICAL PERSONNEL
PO BOX 931904ATLANTAGA31193POOL AGENCY STAFF$324,864
ESHYFT
4547 US HWY 9 SUITE QHOWELLNJ07731POOL AGENCY STAFF$218,128
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
All Other Contributions$25AllOtherContributionsAmt
Total Contributions$25TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT SERVICES623000$24,452,735$24,452,735
APARTMENT REVENUE623000$927,426$927,426
MANAGEMENT SERVICES623000$181,667$181,667
FieldValueIRS element (for citing)
Total Program Service Revenue$25,561,828TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,922TotalRevenueColumnAmt
Exclusion$1,922ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$37,466TotalRevenueColumnAmt
Exclusion$37,466ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$37,466OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$25,601,241TotalRevenueColumnAmt
Related Or Exempt Func Income$25,561,828RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$39,388ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$79,521TotalAmt
Management And General$79,521ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,750,520TotalAmt
Program Services$8,427,001ProgramServicesAmt
Management And General$323,519ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$9,146TotalAmt
Program Services$9,146ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,735,838TotalAmt
Program Services$2,735,838ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$762,302TotalAmt
Program Services$762,302ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$6,040,737TotalAmt
Program Services$2,667,913ProgramServicesAmt
Management And General$3,372,824ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$71,675TotalAmt
Program Services$834ProgramServicesAmt
Management And General$70,841ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$128,730TotalAmt
Program Services$26,316ProgramServicesAmt
Management And General$102,414ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$158,705TotalAmt
Management And General$158,705ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$342,202TotalAmt
Program Services$342,202ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,554TotalAmt
Program Services$715ProgramServicesAmt
Management And General$839ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,400TotalAmt
Program Services$3,400ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$827,306TotalAmt
Program Services$827,306ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$491,582TotalAmt
Management And General$491,582ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
NURSING SUPPLIES$968,200$968,200
FOOD EXPENSE$568,049$568,049
LICENSES & FEES$547,869$15,293$532,576
BAD DEBT EXPENSE$275,315$275,315

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$251,143TotalAmt
Program Services$204,708ProgramServicesAmt
Management And General$46,435ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$23,013,794TotalAmt
Program Services$17,559,223ProgramServicesAmt
Management And General$5,454,571ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$12,148BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,215,023BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,358,566BOYAmt
EOY$0EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$34,814BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$0LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$0LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,836,665BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$7,170BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,464,386BOYAmt
EOY$0EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,106,334BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$27,557BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$5,325,564BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,459,455BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,931BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,931BOYAmt
EOY$0EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,464,386BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$2,587,447ReconcilationRevenueExpnssAmt
Prior Period Adjustments-$2,738,183PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$145,805OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
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$699,725CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$498,556CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$603,126CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$700,206CurrentTaxYearMinus1YearAmt
Current Tax Year$25CurrentTaxYearAmt
Total$2,501,638TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,160,383CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,113,291CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,217,637CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,805,132CurrentTaxYearMinus1YearAmt
Current Tax Year$25,561,828CurrentTaxYearAmt
Total$60,858,271TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$217,054CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$874,502CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,880CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$27,580CurrentTaxYearMinus1YearAmt
Current Tax Year$37,466CurrentTaxYearAmt
Total$1,171,482TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$9,077,162CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,486,349CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,835,643CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$13,532,918CurrentTaxYearMinus1YearAmt
Current Tax Year$25,599,319CurrentTaxYearAmt
Total$64,531,391TotalAmt

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$64,531,391PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,297CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$452CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$106CurrentTaxYearMinus1YearAmt
Current Tax Year$1,922CurrentTaxYearAmt
Total$4,790TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,297CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$452CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$106CurrentTaxYearMinus1YearAmt
Current Tax Year$1,922CurrentTaxYearAmt
Total$4,790TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$9,079,459CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,486,801CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,835,656CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$13,533,024CurrentTaxYearMinus1YearAmt
Current Tax Year$25,601,241CurrentTaxYearAmt
Total$64,536,181TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99990PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

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 N IRS990ScheduleN

Liquidation Of Assets Table LiquidationOfAssetsTableGrp

Liquidation Of Assets Detail LiquidationOfAssetsDetail

FieldValueIRS element (for citing)
Assets Distri Or Expnss PaidLAND, BUILDING, PROPERTY AND EQUIPMENTAssetsDistriOrExpnssPaidDesc
Distribution2025-09-30DistributionDt
Fair Market Value Of Asset$4,638,753FairMarketValueOfAssetAmt
Method Of FMV DeterminationFAIR MARKET VALUEMethodOfFMVDeterminationTxt
EIN334210658EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PINE ISLAND OPERATIONS LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 AND 220 3RD ST NWAddressLine1Txt
CityPINE ISLANDCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55963ZIPCd
FieldValueIRS element (for citing)
IRC SectionN/AIRCSectionTxt
FieldValueIRS element (for citing)
Director Of Successor0DirectorOfSuccessorInd
Employee Of Successor0EmployeeOfSuccessorInd
Owner Of Successor0OwnerOfSuccessorInd
Receive Compensation0ReceiveCompensationInd
Assets DistributedYes (1)AssetsDistributedInd
Required To Notify AGYes (1)RequiredToNotifyAGInd
Attorney General NotifiedYes (1)AttorneyGeneralNotifiedInd
Liabilities PaidYes (1)LiabilitiesPaidInd
Bonds Outstanding0BondsOutstandingInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 6C:FormAndLineReferenceDesc
ExplanationPINE HAVEN, INC. COMPLETED THE TRANSFER AND SALE OF ITS NURSING FACILITY OPERATIONS AND SUBSTANTIALLY ALL OPERATING ASSETS ASSOCIATED WITH THE FACILITY TO A SUCCESSOR OPERATOR EFFECTIVE SEPTEMBER 1, 2025. AS PART OF THE TRANSACTION, THE SUCCESSOR OPERATOR ACQUIRED THE FACILITY AND CERTAIN OPERATING ASSETS AND CONTRACTUAL RIGHTS NECESSARY TO CONTINUE OPERATIONS. RECEIVABLES AND CERTAIN LIABILITIES REMAINED SUBJECT TO SEPARATE ADMINISTRATION AND RESOLUTION PURSUANT TO THE RECEIVERSHIP AND RELATED TRANSACTION AGREEMENTS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION IS UNDER RECEIVERSHIP - FROM THE MN DEPARTMENT OF HEALTH. AS A PART OF THE PROCESS THEY HAVE ENGAGED PATHWAY HEALTH TO ASSIST WITH ADMINISTRATOR, MANAGEMENT AND FISCAL SERVICES. THE TOTAL PAID IS REPORTED ON PART VII, SECTION B.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION IS CURRENTLY IN A RECEIVERSHIP AND THE BOARD OF DIRECTORS ARE NO LONGER INVOLVED WITH DECISION MAKING.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.
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 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. DURING THIS RECEIVERSHIP, THE BOARD OF DIRECTORS ARE NOT INVOLVED IN THE COMPENSATION DECISION FOR THE ADMINISTRATOR AS THE STATE OF MN HAS APPOINTED A MANAGING AGENT THAT HAS EMPLOYED THEIR OWN ADMINISTRATOR.
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 11GPOOL AGENCY EXPENSES: PROGRAM SERVICE EXPENSES 328,913. MANAGEMENT AND GENERAL EXPENSES 258,224. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 587,137. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 2,288,588. MANAGEMENT AND GENERAL EXPENSES 1,915,430. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,204,018. PRO SERVICES: PROGRAM SERVICE EXPENSES 2,117. MANAGEMENT AND GENERAL EXPENSES 1,199,170. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,201,287. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 48,295. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,295.
FORM 990, PART XI, LINE 9:TRANSFER OF NET ASSETS TO PINE ISLANDS OPERATIONS, LLC 145,805.

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 Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
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

Reasonable Cause Explanation ReasonableCauseExplanation

FieldValueIRS element (for citing)
ExplanationTHE ORGANIZATION RESPECTFULLY REQUESTS RELIEF FROM ANY LATE-FILING PENALTIES ASSOCIATED WITH THIS FINAL FORM 990 FILING. THE DELAY WAS NOT THE RESULT OF WILLFUL NEGLECT OR A FAILURE TO EXERCISE ORDINARY BUSINESS CARE AND PRUDENCE. RATHER, ADDITIONAL TIME WAS REQUIRED TO ENSURE THE ACCURACY AND COMPLETENESS OF THE ORGANIZATION'S FINAL RETURN.DURING THE PREPARATION OF THE RETURN, THE ORGANIZATION AND ITS ADVISORS DEVOTED SIGNIFICANT EFFORT TO GATHERING AND REVIEWING INFORMATION RELATED TO THE ORGANIZATION'S FINAL OPERATIONS, DISSOLUTION ACTIVITIES, AND DISPOSITION OF ASSETS. BECAUSE THIS FILING REPRESENTS THE ORGANIZATION'S FINAL TAX RETURN, IT WAS PARTICULARLY IMPORTANT THAT ALL REPORTING BE COMPLETE, ACCURATE, AND CONSISTENT WITH THE ORGANIZATION'S RECORDS AND GOVERNING ACTIONS.THE ORGANIZATION ACTED IN GOOD FAITH THROUGHOUT THE PROCESS AND WORKED DILIGENTLY WITH ITS ADVISORS TO OBTAIN THE NECESSARY INFORMATION AND DOCUMENTATION REQUIRED FOR PROPER REPORTING. ONCE THE REQUIRED INFORMATION WAS ASSEMBLED AND REVIEWED, THE RETURN WAS COMPLETED AND SUBMITTED AS PROMPTLY AS POSSIBLE.THE ORGANIZATION HAS NOW CEASED OPERATIONS AND THIS FILING REPRESENTS ITS FINAL FEDERAL INFORMATION RETURN. GIVEN THE ORGANIZATION'S GOOD-FAITH EFFORTS TO COMPLY WITH ITS FILING OBLIGATIONS, THE COMPLEXITY ASSOCIATED WITH PROPERLY REPORTING ITS FINAL ACTIVITIES, AND THE ABSENCE OF WILLFUL NEGLECT, THE ORGANIZATION RESPECTFULLY REQUESTS ABATEMENT OF ANY PENALTIES ASSESSED IN CONNECTION WITH THE LATE FILING.ExplanationTxt

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