2024-10-28T14:14:37-05:00 2024-06-30 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2023-07-01 390816900 PINE HAVEN CHRISTIAN HOME INC PINE 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 LINDA EVRAETS CHIEF FINANCIAL OFFICER 9204672401 2024-10-28 1 1 SOLOMON MARDAKHAEV P01806552 6105653930 2023 2024-10-15 13:58:12Z RONALD WALVOORT 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 20307875 0 X WWW.PINEHAVEN.ORG X 1950 WI PINE HAVEN CHRISTIAN HOME, INC. (PINE HAVEN CHRISTIAN COMMUNITIES) WILL PROVIDE THE AGING POPULATION WE SERVE AN ENVIRONMENT THAT IS A CHRIST-CENTERED, SAFE HAVEN OFFERING QUALITY, COMPASSIONATE CARE. 14 14 425 106 91890 0 199954 101682 16714541 17227527 -282902 154055 107038 110342 16738631 17593606 0 0 0 0 11718670 11032166 0 0 10946 8153068 7770546 19871738 18802712 -3133107 -1209106 39492198 38166756 25348171 24467714 14144027 13699042 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 16502389 0 17227527 PINE HAVEN CHRISTIAN HOME, INC. PROVIDES HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN ASSISTED LIVING FACILITIES AND SENIOR HOUSING FACILITIES. PINE HAVEN CHRISTIAN HOME, INC. OPERATES AN ASSISTED LIVING COMMUNITY BASED RESIDENTIAL FACILITY (CBRF) INCLUDING MEMORY CARE AND AN ASSISTED LIVING RESIDENTIAL CARE APARTMENT COMPLEX (RCAC) AT ITS HAVEN DRIVE LOCATION; A CBRF INCLUDING MEMORY CARE AT ITS GIDDINGS AVENUE LOCATION; AND A CBRF AND SENIOR HOUSING UNITS AT ITS OOSTBURG LOCATION. 16502389 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 33 0 425 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X LINDA EVRAETS 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 DARRELL HAUSE PRESIDENT 1.00 X X 0 0 0 DENNIS BEACH VICE PRESIDENT 1.00 X X 0 0 0 FLOYD LEO TREASURER 1.00 X X 0 0 0 KEVIN VELDHORST SECRETARY 1.00 X X 0 0 0 JOHN ACKERMANN DIRECTOR 1.00 X 0 0 0 SANDY BAATZ DIRECTOR 1.00 X 0 0 0 JANE BUTEYN DIRECTOR 1.00 X 0 0 0 BOB CALJOUW DIRECTOR 1.00 X 0 0 0 JERI GESCH DIRECTOR 1.00 X 0 0 0 TIM GORTER DIRECTOR (THRU SEP 2023) 1.00 X 0 0 0 JON GROSSHUESCH DIRECTOR 1.00 X 0 0 0 DR CURTIS HANCOCK DIRECTOR (THRU SEP 2023) 1.00 X 0 0 0 MARY HUENINK DIRECTOR 1.00 X 0 0 0 BRENDA LAMMERS DIRECTOR (THRU JAN 2024) 1.00 X 0 0 0 RON LORIER DIRECTOR 1.00 X 0 0 0 JEWEL RAUWERDINK DIRECTOR 1.00 X 0 0 0 VICKI SOERENS DIRECTOR 1.00 X 0 0 0 RONALD WALVOORT CHIEF EXECUTIVE OFFICER 40.00 X 195795 0 22329 LINDA EVRAETS CHIEF FINANCIAL OFFICER 40.00 X 129418 0 11683 325213 0 34012 2 0 1 0 STAT NURSING SOLUTIONS LLC 1117 SOUTH 16TH STREET SHEBOYGAN WI 53081 STAFFING SERVICES 672316 AYA HEALTHCARE INC 5930 CORNERSTONE COURT W SUITE 300 SAN DIEGO CA 92121 STAFFING SERVICES 318584 ELITE NURSES PO BOX 100173 FORTH WORTH TX 76185 STAFFING SERVICES 187441 GREENFIELD REHABILITATION AGENCY INC 19395 W CAPITAL DR SUITE 200 BROOKFIELD WI 53005 THERAPY SERVICES 165458 4 101682 101682 CBRF REVENUE 623000 14990125 14990125 RESIDENTIAL CARE REVENUE 623000 2015765 2015765 INDEPENDENT LIVING REVENUE 623000 221637 221637 17227527 300155 300155 2568169 2712801 1468 -144632 -1468 -146100 -146100 MANAGEMENT SERVICES REVENUE 541610 91890 91890 18452 18452 110342 17593606 17227527 91890 172507 X 366673 366673 8957507 7270422 1679589 7496 116439 116439 893524 867007 25169 1348 698023 655603 42420 53532 53532 23307 23307 28914 28914 2273947 2273947 105823 105823 84014 58708 25306 178520 178520 789520 780452 9068 10191 10191 757044 746476 10568 1778755 1753924 24831 246883 246883 FOOD EXPENSES 878508 878508 MAINTENANCE & REPAIRS 174445 174445 MEDICAL SUPPLIES 126711 126711 PROVISION FOR BAD DEBTS 2443 2443 257989 255887 2102 18802712 16502389 2289377 10946 768152 60017 168718 1103852 682974 768146 147895 197500 50449526 22666556 29345646 27782970 8378813 8254271 39492198 38166756 1236826 1375768 97980 13079 24013365 23078867 25348171 24467714 X 14122723 13671215 21304 27827 14144027 13699042 39492198 38166756 -1209106 764121 0 X 0 1 X 1 0 X 266001 2880254 1179175 199954 101682 4627066 17794613 16225478 17090546 16714541 17227527 85052705 18060614 19105732 18269721 16914495 17329209 89679771 10000 10000 0 10000 10000 89669771 140920 171039 333790 264811 300155 1210715 1132 1132 142052 171039 333790 264811 300155 1211847 10774 10539 3579 17796 18452 61140 18213440 19287310 18607090 17197102 17647816 90952758 0.98590 0.98860 0.01330 0.01130 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1345944 1345944 43781927 19011462 24770465 4954332 3655094 1299238 367323 367323 27782970 18328813 764121 764121 17564692 28914 28914 17593606 18773798 0 18773798 28914 28914 18802712 X X 0 0 0 0 0 0 0 0 0 RONALD WALVOORT CHIEF EXECUTIVE OFFICER 195795 0 0 0 0 0 5974 0 16355 0 218124 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-05-01 10000000 ADJUSTABLE RATE REFUNDING REVENUE BONDS, SERIES 2014A 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-05-01 19100000 NEW PROJECT, SERIES 2014B 0 0 0 A 534212 10000000 10000000 2006 1 0 1 1 B 263561 19100000 18100000 1000000 2015 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/13/2021 FORM 990, PART VI, SECTION A, LINE 6 PINE HAVEN CHRISTIAN HOME, INC. HAS ONE CLASS OF MEMBERS. A PERSON WILL BE ADMITTED TO MEMBERSHIP OF PINE HAVEN CHRISTIAN HOME, INC. UPON THE CONDITIONS THAT (I) THE INDIVIDUAL BE A MEMBER OF GOOD STANDING IN ANY CONGREGATION, AND (II) SUCH INDIVIDUAL CONSENTS TO BEING A MEMBER OF PINE HAVEN CHRISTIAN HOME, INC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C 1. THE PERSONS COVERED BY THE CONFLICT OF INTEREST POLICY ARE DIRECTORS AND OFFICERS. 2. DETERMINATIONS OF WHETHER A CONFLICT EXISTS ARE MADE BY THE BOARD OF DIRECTORS. 3. ACTUAL CONFLICTS ARE REVIEWED AT THE BOARD OF DIRECTORS LEVEL. 4. IF A CONFLICT EXISTS, THE BOARD'S OPTIONS INCLUDE BUT ARE NOT LIMITED TO I) PROHIBITING THE AFFECTED DIRECTOR OR OFFICER FROM PARTICIPATING IN ANY PINE HAVEN DISCUSSION OR DECISIONS INVOLVING THE CONFLICT OF INTEREST; II) MODIFYING OR REDEFINING THE DUTIES AND RESPONSIBILITIES OF THE AFFECTED DIRECTOR OR OFFICER; III) REQUIRING THE RESIGNATION OF THE AFFECTED DIRECTOR OR OFFICER. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND OTHER OFFICERS 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. THE CHIEF EXECUTIVE OFFICER HAS AN ANNUAL REVIEW COMPLETED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. 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 AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART IX, LINE 11G CNA PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,042,870. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,042,870. LPN PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 929,593. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 929,593. RN PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 43,698. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,698. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 217,677. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 217,677. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 40,109. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,109.