2017-11-06T13:38:29-06:00 2017-06-30 391173131 SCHENCK SC 712 RIVERFRONT DRIVE STE 301 SHEBOYGAN WI 53081 990 2016-07-01 390816900 PINE HAVEN CHRISTIAN HOME INC PINE 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 MARTIN HALVERSON OFFICER 9204672401 2017-10-31 1 TERRY T STRITTMATER CPA P00012661 9204580341 74.142.163.66 2017-10-31 12:21:00 CD P 9475B8F64D5A719E781C043AAC9DC26B2B2E8E16 A2332E9BA041B4FC086FC95AEC67015C51811E2D 2016 2018-03-14 21:41:22Z MARTIN HALVERSON 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 17249345 0 X WWW.PINEHAVEN.ORG X 1950 WI PINE HAVEN CHRISTIAN COMMUNITIES WILL PROVIDE THE AGING POPULATION WE SERVE AN ENVIRONMENT THAT IS A CHRIST-CENTERED, SAFE HAVEN OFFERING QUALITY, COMPASSIONATE CARE. 17 17 448 171 0 0 1098178 230821 16611212 16942320 -103492 54394 0 21810 17605898 17249345 0 0 0 0 9547752 9675585 0 0 1000 7587344 7080460 17135096 16756045 470802 493300 43277168 42495160 29836157 28512853 13441011 13982307 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 14686822 16942320 PROVIDING HOUSING, HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS IN A NON-PROFIT NURSING HOME AND ASSISTED LIVING FACILITIES. 14686822 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 58 0 1 448 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 1 1 1 0 WI X MARTIN HALVERSON 9204672401 531 GIDDINGS AVENUE SHEBOYGAN FALLS WI 53085 CHRISTINE TEMPAS PRESIDENT 0.00 X X 0 0 0 GENNY TEN PAS VICE PRESIDENT 0.00 X X 0 0 0 ROBERT DESMIDT SECRETARY 0.00 X X 0 0 0 JACK HOFFMANN TREASURER 0.00 X X 0 0 0 DAVE BRASSER BOARD MEMBER 0.00 X 0 0 0 JANE BUTEYN BOARD MEMBER 0.00 X 0 0 0 GLENN LEMMENES BOARD MEMBER 0.00 X 0 0 0 BETTY MOODY BOARD MEMBER 0.00 X 0 0 0 NORENE HUIBREGTSE BOARD MEMBER 0.00 X 0 0 0 MIKE FOLEY BOARD MEMBER 0.00 X 0 0 0 LARRY LORENZ BOARD MEMBER 0.00 X 0 0 0 WENDY BAACKES BOARD MEMBER 0.00 X 0 0 0 RANDY TEUNISSEN BOARD MEMBER 0.00 X 0 0 0 JEFF BROETZMANN BOARD MEMBER 0.00 X 0 0 0 ROGER BUYZE BOARD MEMBER 0.00 X 0 0 0 KEN KOEHLER BOARD MEMBER 0.00 X 0 0 0 DAN NEERHOFF BOARD MEMBER 0.00 X 0 0 0 BOB NYHUIS BOARD MEMBER 0.00 X 0 0 0 GENE JENTINK BOARD MEMBER 0.00 X 0 0 0 RON WALVOORT CHIEF EXECUTIVE OFFICER 40.00 X 144472 0 20576 MARTIN HALVERSON CHIEF FINANCIAL OFFICER 40.00 X 93992 0 20576 STEVE HENDRIKSE CHIEF OPERATING OFFICER 40.00 X 78552 0 12860 317016 0 54012 1 0 1 0 REHAB CARE GROUP EAST INC PO BOX 503534 SAINT LOUIS MO 631503534 THERAPY 923408 ELITE NURSES INC 1987 SCHEUERING RD 8 DE PERE WI 54115 NURSING SERVICES 235137 LEADERSTAT 1322B MANNING PKWY POWELL OH 43065 PROFESSIONAL AGENCY 121187 3 181160 49661 230821 RESIDENTIAL CENTERS 623000 9893646 9893646 NURSING HOME 623000 5164764 5164764 RESIDENTIAL CARE APMT COMPLEX 623000 1883910 1883910 16942320 54394 54394 MISCELLANEOUS REVENUE 900099 21810 21810 21810 17249345 16942320 0 76204 400310 400310 7580968 6770031 810937 91567 77557 14010 1019095 904616 114479 583645 494351 89294 12646 12646 25050 25050 15564 15564 33124 33124 86794 86794 119779 119779 238240 237545 695 93986 93986 916901 916901 1605963 1605658 305 165372 165372 NURSING AND MEDICAL 1532367 1532367 DIETARY - FOOD 772286 772286 UTILITIES 434761 386944 47817 SUPPLIES 211071 161435 49636 816556 661759 154797 16756045 14686822 2068223 1000 X 4877780 2552280 1126521 873881 11920 10588 34111 110963 44136218 11583902 34126705 32552316 5491772 2209827 890304 903360 43277168 42495160 1971844 1210765 27864313 27302088 29836157 28512853 X 12551606 13081203 889405 901104 13441011 13982307 43277168 42495160 493300 47996 0 X X 0 1 X 1 0 X 14118 19658 4729 1098178 230821 1367504 12978233 13210591 14452767 16611212 16942320 74195123 12992351 13230249 14457496 17709390 17173141 75562627 0 0 0 75562627 42678 30190 13914 26159 54394 167335 42678 30190 13914 26159 54394 167335 11412 8060 7401 21810 48683 13046441 13268499 14478811 17735549 17249345 75778645 0.99710 0.99700 0.00220 0.00250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1345944 1345944 38210922 9292993 28917929 3820075 1876548 1943527 759277 414361 344916 32552316 17288867 47996 7090 55086 17233781 15564 15564 17249345 16747571 7090 7090 16740481 15564 15564 16756045 0 0 0 0 0 0 0 0 0 RON WALVOORT CHIEF EXECUTIVE OFFICER 144472 0 0 0 0 0 0 0 20576 0 165048 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY - SERIES 2014 A 391337855 2014-05-01 10000000 REFINANCE 2009 BONDS 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY - SERIES 2014 B 391337855 2014-05-01 18100000 NEW PROJECT 0 0 0 A 10000000 2015 1 0 1 1 B 18100000 18100000 2015 0 0 1 1 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 A 0 B 0 X 1 49661 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PINE HAVEN CHRISTIAN HOME HAS A BOARD OF DIRECTORS APPROVED EMPLOYEE HANDBOOK CONTAINING A POLICY REGARDING CONFLICTS OF INTEREST. EMPLOYEES SIGN OFF ACKNOWLEDGING RECEIPT OF THE EMPLOYEE HANDBOOK WHEN HIRED. BOARD OF DIRECTORS SIGN OFF ON A CONFLICT OF INTEREST ACKNOWLEDGMENT AT THE TIME OF "NEW" BOARD MEMBER ORIENTATION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE CEO AND OTHER KEY EMPLOYEES 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 CEO 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 AVALIABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART XII, LINE 2C THERE IS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. PINE HAVEN CHRISTIAN HOME FOUNDATION INC 531 GIDDINGS AVE SHEBOYGAN FALLS WI 53085 391963866 RAISE/RECEIVE FUNDS FOR THE GENERAL SUPPORT OF THIS ORGANIZATION WI 501(C)(3) 12 N/A 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 PINE HAVEN CHRISTIAN HOME FOUNDATION INC C 181160 ACTUAL AMOUNT RECEIVED PINE HAVEN CHRISTIAN HOME FOUNDATION INC D 2256 ACTUAL AMOUNT BORROWED PINE HAVEN CHRISTIAN HOME FOUNDATION INC O 7141 ALLOCATION BASED ON HOURS WORKED