2022-11-15T13:13:03-06:00 2021-12-31 390758449 WIPFLI LLP 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2021-01-01 431114366 PINE VIEW MANOR INC PINE 6607832118 307 N PINEVIEW STREET STANBERRY MO 64489 PAMELA HAILEY ADMINISTRATOR 6607832118 2022-11-09 1 PAMELA HAILEY 999009999 KARYN A NUNN P00096490 3148622070 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TONY JENNINGS 307 N PINEVIEW STREET STANBERRY MO 64489 4818056 0 X WWW.PINEVIEWSTANBERRY.COM X 1978 MO DEDICATION TO HIGHEST QUALITY OF CARE AND SERVICE TO OUR RESIDENTS DELIVERED WITH SPIRITUAL COMPASSION, PERSONAL PRIDE, AND PROFESSIONALISM. 9 9 111 0 0 0 689701 846859 3565930 3923562 37868 36455 2286 6956 4295785 4813832 0 0 0 0 2599724 2635886 0 0 0 1322856 1350748 3922580 3986634 373205 827198 3642276 4206805 573113 310444 3069163 3896361 THE MISSION OF PINE VIEW MANOR, INC. IS DEDICATION TO THE HIGHEST QUALITY OF TOTAL CARE AND SERVICE TO OUR RESIDENTS DELIVERED WITH SPIRITUAL COMPASSION, PERSONAL PRIDE, AND PROFESSIONALISM. 0 0 3547364 3930500 PINE VIEW MANOR PROVIDED 24 HOUR SKILLED NURSING CARE TO RESIDENTS. THE TOTAL SKILLED NURSING FACILITY CENSUS FOR 2021 WAS 18,753. PINE VIEW MANOR ALSO PROVIDED 24 HOUR CARE TO RESIDENTS IN THE ASSISTED LIVING UNIT. THE TOTAL ASSISTED LIVING FACILITY CENSUS DAYS FOR 2021 WAS 2,961. IN ADDITION, PINE VIEW MANOR PROVIDED IN-PATIENT AND OUT-PATIENT REHABILITATION SERVICES. 3547364 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 4 0 1 111 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X PAMELA HAILEY 6607832118 307 N PINEVIEW ST STANBERRY MO 64489 KENT PETERSON VICE PRESIDENT 0.75 X X 0 0 0 LILLY PARSONS BOARD MEMBER 0.50 X 0 0 0 MIKE MCQUINN BOARD MEMBER 0.75 X 0 0 0 TONYA MCCAMPBELL BOARD MEMBER 0.50 X 0 0 0 CHRIS HENGGELER BOARD MEMBER 0.50 X 0 0 0 KATIE DIAS BOARD MEMBER 0.50 X 0 0 0 TONY JENNINGS PRESIDENT 0.50 X X 0 0 0 EARL SCHWEBACH BOARD MEMBER 0.50 X 0 0 0 JOHN GROOMER BOARD MEMBER 0.50 X 0 0 0 TERESA STUART SECRETARY/TREASURER 40.00 X 54157 0 0 PAMELA HAILEY ADMINISTRATOR 40.00 X 107220 0 8528 161377 0 8528 1 0 0 0 0 843093 3766 846859 RESIDENT SERVICE REVEN 623000 3836858 3836858 OTHER RESIDENT CARE RE 623000 55875 55875 RESIDENT CAFETERIA 722210 11468 11468 RESIDENT BEAUTY SHOP 446199 10192 10192 RESIDENT TRANSPORTATIO 480000 9169 9169 3923562 36473 36473 6956 0 6956 6956 6956 4206 4224 -18 -18 -18 4813832 3930500 0 36473 169905 57874 112031 42372 42372 1978914 1816072 162842 285653 257573 28080 159042 139250 19792 459 229 230 26572 26572 10163 5081 5082 6099 6099 31678 15839 15839 195229 192250 2979 96129 95708 421 102902 90097 12805 PROVIDER TAX - MEDICAID 251802 251802 DIETARY EXPENSE 221980 221980 PURCHASED SERVICES 115337 115337 MEDICAL SUPPLIES 68952 68952 223446 176948 46498 3986634 3547364 439270 0 50 50 2485617 3009423 263572 343411 35794 26870 31410 33072 3970412 3186093 816173 784319 9660 9660 3642276 4206805 290330 227099 282783 83345 573113 310444 X 3069163 3895695 0 666 3069163 3896361 3642276 4206805 827198 0 X X 1 X 0 1 0 X 2780 6847 4621 689701 846859 1550808 3388818 3590178 4058386 3565930 3923562 18526874 3391598 3597025 4063007 4255631 4770421 20077682 83805 75060 60861 61508 7040 288274 217819 209306 154421 143959 114822 840327 301624 284366 215282 205467 121862 1128601 18949081 13912 23515 33860 40154 43429 154870 13912 23515 33860 40154 43429 154870 301624 284366 215282 61508 7040 869820 3707134 3904906 4312149 4357293 4820890 21102372 0.89800 0.87520 0.00730 0.00610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 51250 51250 2777994 2316626 461368 459597 380876 78721 681571 488591 192980 784319 DUE TO RESIDENTS 9660 ASSET RETIREMENT OBLIGATION 50779 EMPLOYEE ASSISTANCE FUND 6664 PROVIDER TAX PAYABLE 16242 83345 X PART X, LINE 2: THE MANOR IS A QUALIFIED NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 509(A) OF THE INTERNAL REVENUE CODE AND IS, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. HOWEVER, THE MANOR IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE MANOR HAS ASSESSED THEIR FEDERAL AND STATE TAX POSITIONS AND DETERMINED THAT THERE WERE NO UNRELATED BUSINESS INCOME TAXES AND NO UNCERTAINTIES OR POSSIBLE RELATED EFFECTS THAT NEED TO BE RECORDED AS OF OR FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020. THE RETURNS OF THE ORGANIZATION FOR 2021 (WHEN FILED), 2020, 2019, AND 2018 ARE SUBJECT TO EXAMINATION BY THE RESPECTIVE TAXING AUTHORITIES GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS THAT CAN VOTE TO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS MEMBERS THAT CAN VOTE TO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE FORM 990 IS REVIEWED BY ALL PINE VIEW MANOR OFFICERS AND GOVERNING BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL DISCLOSURE STATEMENT IS CIRCULATED TO OFFICERS AND CERTAIN IDENTIFIED AGENTS AND EMPLOYEES TO ASSIST THEM IN CONSIDERING ANY CONFLICTS OF INTEREST, BUT DISCLOSURE IS APPROPRIATE AND REQUIRED WHENEVER CONFLICTS OF INTEREST MAY OCCUR. THE WRITTEN NOTICES OF DISCLOSURES ARE THEN FILED WITH THE ADMINISTRATOR OR SUCH OTHER PERSON DESIGNATED BY THE ADMINISTRATOR TO RECEIVE SUCH NOTIFICATIONS. AT THE MEETING OF THE BOARD OF DIRECTORS, ALL DISCLOSURES OF REAL OR APPARENT CONFLICTS OF INTEREST ARE NOTED FOR THE RECORD IN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS DELIBERATED AND DECIDED UPON BY THE BOARD OF DIRECTORS ANNUALLY. COMPARABILITY DATA AND COMPENSATION REPORTS ARE UTILITIZED IN THE COMPENSATION DELIBERATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS GOVERNING DOCUMENTS AND ANNUAL FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.