2020-09-22T14:31:48-05:00 2019-12-31 431594752 MUELLER PROST LC 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2019-01-01 431114366 PINE VIEW MANOR INC PINE 6607832118 307 N PINEVIEW STREET STANBERRY MO 64489 PAMELA HAILEY ADMINISTRATOR 6607832118 2020-09-16 1 KARYN A NUNN P00096490 3148622070 2020-09-16 47.24.178.82 2020-09-16 15:11:27 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C07DD3AA4395365E7C35FA948EC7F31A8176C973 2019 2021-01-29 14:40:06Z TONY JENNINGS 307 N PINEVIEW STREET STANBERRY MO 64489 4096867 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 9 130 30 0 0 6847 4621 3590178 4058386 18415 28376 5100 5484 3620540 4096867 0 0 0 0 2160428 2409522 0 0 0 1192363 1274197 3352791 3683719 267749 413148 2510755 2985249 227945 289291 2282810 2695958 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 3313862 4063870 PINE VIEW MANOR PROVIDED 24 HOUR SKILLED NURSING CARE TO RESIDENTS. THE TOTAL SKILLED NURSING FACILITY CENSUS FOR 2019 WAS 20,720. PINE VIEW MANOR ALSO PROVIDED 24 HOUR CARE TO RESIDENTS IN THE ASSISTED LIVING UNIT. THE TOTAL ASSISTED LIVING FACILITY CENSUS DAYS FOR 2019 WAS 3,165. IN ADDITION, PINE VIEW MANOR PROVIDED IN-PATIENT AND OUT-PATIENT REHABILITATION SERVICES. 3313862 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 8 0 1 130 0 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 TONYA MCCAMPBELL BOARD MEMBER 0.50 X 0 0 0 MIKE MCQUINN BOARD MEMBER 0.75 X 0 0 0 CRISTI OSBORN BOARD MEMBER 0.50 X 0 0 0 MIRANDA FLOYD 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 50366 0 0 PAMELA HAILEY ADMINISTRATOR 40.00 X 90163 0 6752 140529 0 6752 0 0 0 0 DIANE WILSON 14098 PAISH DRIVE ST JOSEPH MO 64505 PHYSICAL THERAPIST 104449 1 4621 4621 RESIDENT SERVICE REVEN 623000 4020479 4020479 RESIDENT CAFETERIA 722210 17320 17320 RESIDENT BEAUTY SHOP 446199 9276 9276 OTHER RESIDENT CARE RE 623000 6888 6888 RESIDENT TRANSPORTATIO 480000 4423 4423 4058386 28376 28376 5484 0 5484 5484 5484 4096867 4063870 0 28376 147281 48458 98823 56199 56199 1778386 1671555 106831 284082 256801 27281 143574 128439 15135 3540 1770 1770 18720 18720 10330 5165 5165 6603 6603 18276 9138 9138 183045 178600 4445 105 105 80785 79844 941 93175 83353 9822 PURCHASED SERVICES 372236 372236 DIETARY EXPENSE 219058 219058 MEDICAL SUPPLIES 57093 57093 BAD DEBT EXPENSE 53364 0 53364 157867 146153 11714 3683719 3313862 369857 0 50 50 1072926 1576079 383260 351778 19909 20388 29100 31470 3803089 3009934 801391 793155 199767 207634 4352 4695 2510755 2985249 148926 210001 79019 79290 227945 289291 X 2282810 2695958 2282810 2695958 2510755 2985249 413148 0 X 1 X 0 0 0 X 3092 4145 2780 6847 4621 21485 3770428 3583556 3388818 3590178 4058386 18391366 3773520 3587701 3391598 3597025 4063007 18412851 75372 85567 83805 75060 60861 380665 169908 175290 217819 209306 154421 926744 245280 260857 301624 284366 215282 1307409 17105442 7740 11992 13912 23515 33860 91019 7740 11992 13912 23515 33860 91019 3781260 3599693 3405510 3620540 4096867 18503870 0.92440 0.92440 0.00490 0.00360 X 51250 51250 2735497 2223954 511543 397675 337666 60009 618667 448314 170353 793155 DUE TO RESIDENTS 4695 ASSET RETIREMENT OBLIGATION 45385 EMPLOYEE ASSISTANCE FUND 9068 PROVIDER TAX PAYABLE 20142 79290 X 4096867 0 4096867 0 4096867 3683719 0 3683719 0 3683719 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 AN 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, 2019 AND 2018. THE RETURNS OF THE ORGANIZATION FOR 2019, 2018, 2017, 2016, AND 2015 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.