2026-09-02T07:31:21-05:00 2025-09-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 220 DULUTH MN 55812 990 2024-10-01 410944721 PINE HAVEN INC PINE 5073568304 210 3RD STREET NW PINE ISLAND MN 55963 RANDY HOFFARTH PRESIDENT 5073568304 2026-08-28 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-08-28 2024 X PINE HAVEN CARE CENTER AMBER THORN 210 3RD STREET NW PINE ISLAND MN 55963 25601241 0 X WWW.PINEHAVENCOMMUNITY.ORG X 1964 MN PROVIDE QUALITY, AFFORDABLE SERVICES FOR OLDER ADULTS AND FAMILIES IN OUR COMMUNITY. X 7 7 178 7 0 0 700206 25 12805132 25561828 106 1922 27580 37466 13533024 25601241 0 0 0 0 6791704 12337327 0 0 0 5412643 10676467 12204347 23013794 1328677 2587447 8464386 0 8459455 0 4931 0 PINE HAVEN COMMUNITY PROVIDES A CONTINUUM OF CARE THROUGH THE BELIEF THAT EVERY PERSON IS UNIQUE. 0 0 17559223 0 25561828 PINE 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. 17559223 1 0 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 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 0 0 178 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 1 1 1 0 0 0 0 1 1 1 1 1 1 0 0 X PATHWAY HEALTH SERVICES INC 6514078699 11240 STILLWATER BLVD LAKE ELMO MN 55042 RANDY HOFFARTH PRESIDENT 1.00 1.00 X X 0 0 0 JOANNE JUDGE-DIETZ VICE PRESIDENT 1.00 X X 0 0 0 GLEN HEMANN TREASURER 1.00 1.00 X X 0 0 0 TERESA BUCK SECRETARY 1.00 X X 0 0 0 RON FLEMKE DIRECTOR 1.00 X 0 0 0 JERRY VETTEL DIRECTOR 1.00 1.00 X 0 0 0 WAYNE WELLIK DIRECTOR 1.00 1.00 X 0 0 0 AMBER THORN CEO/INTERIM ADMINISTRATOR 40.00 1.00 X 0 0 0 JESSICA RIVERA FINANCE DIRECTOR 40.00 X 79519 0 2 79519 0 2 0 0 0 0 PATHWAY HEALTH SERVICES INC 11240 STILLWATER BLVD LAKE ELMO MN 55042 MANAGEMENT SERVICES 1101365 THE RESOLUTE COMPANIES 4734 WHITE PINE PL NW ROCHESTER MN 55901 POOL AGENCY STAFF 620441 PRIME TIME HEALTHCARE PO BOX 3544 OMAHA NE 68103 POOL AGENCY STAFF 353578 ALL MEDICAL PERSONNEL PO BOX 931904 ATLANTA GA 31193 POOL AGENCY STAFF 324864 ESHYFT 4547 US HWY 9 SUITE Q HOWELL NJ 07731 POOL AGENCY STAFF 218128 5 25 25 RESIDENT SERVICES 623000 24452735 24452735 APARTMENT REVENUE 623000 927426 927426 MANAGEMENT SERVICES 623000 181667 181667 25561828 1922 1922 37466 37466 37466 25601241 25561828 0 39388 X 79521 79521 8750520 8427001 323519 9146 9146 2735838 2735838 762302 762302 6040737 2667913 3372824 71675 834 70841 128730 26316 102414 158705 158705 342202 342202 1554 715 839 3400 3400 827306 827306 491582 491582 NURSING SUPPLIES 968200 968200 FOOD EXPENSE 568049 568049 LICENSES & FEES 547869 15293 532576 BAD DEBT EXPENSE 275315 275315 251143 204708 46435 23013794 17559223 5454571 0 12148 0 1215023 0 0 2358566 0 0 0 0 0 34814 0 0 0 4836665 0 0 0 0 0 7170 0 8464386 0 3106334 0 27557 0 5325564 0 8459455 0 X 4931 0 4931 0 8464386 0 X 2587447 -2738183 145805 X 0 0 0 X 699725 498556 603126 700206 25 2501638 8160383 7113291 7217637 12805132 25561828 60858271 217054 874502 14880 27580 37466 1171482 9077162 8486349 7835643 13532918 25599319 64531391 0 0 0 64531391 2297 452 13 106 1922 4790 2297 452 13 106 1922 4790 9079459 8486801 7835656 13533024 25601241 64536181 0.99990 0.99990 0.00010 0.00010 X 0 1 X 0 PART IV, LINE 2B: THE 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. LAND, BUILDING, PROPERTY AND EQUIPMENT 2025-09-30 4638753 FAIR MARKET VALUE 334210658 PINE ISLAND OPERATIONS LLC 210 AND 220 3RD ST NW PINE ISLAND MN 55963 N/A 0 0 0 0 1 1 1 1 0 PART I, LINE 6C: PINE 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. FORM 990, PART VI, SECTION A, LINE 3 THE 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 7A THE 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 7B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT OF THE ORGANIZATION REVIEWS FORM 990 PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE 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 15A THE 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G POOL 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. PINE HAVEN FOUNDATION INC 210 3RD STREET NW PINE ISLAND MN 55963 411580669 SUPPORT PINE HAVEN, INC MN 501(C)(3) LINE 12A, I PINE HAVEN INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 THE 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.