2019-05-15T14:12:12-05:00 2018-12-31 431594752 MUELLER PROST LC 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2018-01-01 431114366 PINE VIEW MANOR INC PINE 6607832118 307 N PINEVIEW STREET STANBERRY MO 64489 PAMELA HAILEY ADMINISTRATOR 6607832118 2019-05-13 1 JEANETTE BAX-KURTZ P00096490 3148622070 2019-05-06 71.91.236.98 2019-05-13 13:41:58 CD P B07FDA97AAC7713492025A2A90B7F2A504042AC6 6D85247E04EA61121E269186BA3C39495FC2638A 2018 2019-02-21 02:37:17Z TONY JENNINGS 307 N PINEVIEW STREET STANBERRY MO 64489 3620540 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 9 140 25 0 0 2780 6847 3388818 3590178 9050 18415 4862 5100 3405510 3620540 0 0 0 0 2116633 2160428 0 0 0 1203730 1192363 3320363 3352791 85147 267749 2232987 2510755 217926 227945 2015061 2282810 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 3067008 3595278 PINE VIEW MANOR PROVIDED 24 HOUR SKILLED NURSING CARE TO RESIDENTS. THE TOTAL SKILLED NURSING FACILITY CENSUS FOR 2018 WAS 19,342. PINE VIEW MANOR ALSO PROVIDED 24 HOUR CARE TO RESIDENTS IN THE ASSISTED LIVING UNIT. THE TOTAL ASSISTED LIVING FACILITY CENSUS DAYS FOR 2018 WAS 3,085. IN ADDITION, PINE VIEW MANOR PROVIDED IN-PATIENT AND OUT-PATIENT REHABILITATION SERVICES. 3067008 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 1 140 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 BOARD MEMBER 3.00 X 0 0 0 TONYA MCCAMPBELL BOARD MEMBER 2.00 X 0 0 0 MIKE MCQUINN BOARD MEMBER 3.00 X 0 0 0 CRISTI OSBORN BOARD MEMBER 2.00 X 0 0 0 MIRANDA FLOYD BOARD MEMBER 2.00 X 0 0 0 KATIE DIAS FORMER PRESIDENT, CURRENT VICE PRESIDENT 3.00 X X 0 0 0 TONY JENNINGS PRESIDENT 3.00 X X 0 0 0 EARL SCHWEBACH BOARD MEMBER 2.00 X 0 0 0 JOHN GROOMER BOARD MEMBER 2.00 X 0 0 0 TERESA STUART SECRETARY/TREASURER 40.00 X 48136 0 0 PAMELA HAILEY ADMINISTRATOR 40.00 X 62483 0 6259 110619 0 6259 0 0 0 0 0 6847 6847 RESIDENT SERVICE REVEN 623000 3547546 3547546 RESIDENT CAFETERIA 722210 20848 20848 RESIDENT BEAUTY SHOP 446199 7929 7929 OTHER RESIDENT CARE RE 623000 7004 7004 RESIDENT TRANSPORTATIO 480000 6851 6851 3590178 18415 18415 5100 0 5100 5100 5100 3620540 3595278 0 18415 116879 34371 82508 48564 48564 1611420 1548250 63170 254455 231146 23309 129110 116080 13030 4411 2205 2206 26642 26642 11679 5839 5840 5577 5577 17357 8678 8679 182953 178201 4752 6 6 87058 85738 1320 90477 81346 9131 PURCHASED SERVICES 369668 369668 DIETARY EXPENSE 191959 191959 MEDICAL SUPPLIES 45525 45525 HOUSEKEEPING EXPENSE 27624 27624 131427 91814 39613 3352791 3067008 285783 0 50 50 1000066 1272693 374339 383260 19422 19909 28659 29100 3755792 2954401 807051 801391 3400 4352 2232987 2510755 143648 148926 74278 79019 217926 227945 X 2015061 2282810 2015061 2282810 2232987 2510755 267749 0 X 1 X 0 0 0 X 1854 3092 4145 2780 6847 18718 3617525 3770428 3583556 3388818 3590178 17950505 3619379 3773520 3587701 3391598 3597025 17969223 90599 75372 85567 83805 75060 410403 114163 169908 175290 217819 209306 886486 204762 245280 260857 301624 284366 1296889 16672334 8494 7740 11992 13912 23515 65653 8494 7740 11992 13912 23515 65653 3627873 3781260 3599693 3405510 3620540 18034876 0.92440 0.93320 0.00360 0.00270 X 51250 51250 2694953 2194609 500344 408243 328294 79949 601346 431498 169848 801391 DUE TO RESIDENTS 4352 ASSET RETIREMENT OBLIGATION 43490 EMPLOYEE ASSISTANCE FUND 9601 PROVIDER TAX 21576 79019 X 3639342 18802 18802 3620540 0 3620540 3371593 18802 18802 3352791 0 3352791 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, 2018 AND 2017. THE RETURNS OF THE ORGANIZATION FOR 2018, 2017, 2016, AND 2015 ARE SUBJECT TO EXAMINATION BY THE RESPECTIVE TAXING AUTHORITIES GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS RECOVERY PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS RECOVERY 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.