2013-11-08T16:09:49-06:00 2012-12-31 431594752 MUELLER PROST PC 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2012-01-01 431114366 PINE VIEW MANOR INC PINE 6607832118 307 N PINEVIEW STREET STANBERRY MO 64489 PAMELA HAILEY 6607832118 2013-11-07 1 JEANETTE BAX-KURTZ P00096490 3148622070 2013-11-03 2012 2016-02-24 21:20:13Z BARB SHUPE 307 N PINEVIEW STREET STANBERRY MO 64489 2735212 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. 10 10 114 24 0 0 1276 20609 2531530 2700552 1641 670 4125 13381 2538572 2735212 0 0 0 0 1534973 1584869 0 0 0 959823 1058712 2494796 2643581 43776 91631 1106843 1065898 666376 533800 440467 532098 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 2431015 2713933 PINE VIEW MANOR PROVIDED 24 HOUR SKILLED NURSING CARE TO RESIDENTS. THE TOTAL SKILLED NURSING FACILITY CENSUS FOR 2012 WAS 15,106. PINE VIEW MANOR ALSO PROVIDED 24 HOUR CARE TO RESIDENTS IN THE ASSISTED LIVING UNIT. THE TOTAL ASSISTED LIVING FACILITY CENSUS DAYS FOR 2012 WAS 2,096. IN ADDITION, PINE VIEW MANOR PROVIDED IN-PATIENT AND OUT-PATIENT REHABILITATION SERVICES. 2431015 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 1 1 1 0 0 0 0 0 0 0 0 0 1 9 0 1 114 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X PAMELA HAILEY 6607832118 307 N PINEVIEW ST STANBERRY MO 64489 BARB SHUPE 1.00 X X 0 0 0 KENT PETERSON 1.00 X X 0 0 0 SANDY JOHNSON 0.50 X 0 0 0 MIKE MCQUINN 1.00 X 0 0 0 BRUCE JOHNSON 0.00 X 0 0 0 LATON ALLISON 1.00 X 0 0 0 ELDON LONG 0.50 X 0 0 0 KATIE DIAS 0.50 X 0 0 0 DAVE HIBBS 0.50 X X 0 0 0 NORMA HILL 0.50 X 0 0 0 JERRY DOERHOFF 40.00 X 43846 0 0 43846 0 0 0 0 0 0 0 20609 16103 20609 RESIDENT SERVICE REVEN 623000 2634347 2634347 OTHER RESIDENT CARE RE 623000 35691 35691 RESIDENT TRANSPORTATIO 480000 14354 14354 RESIDENT CAFETERIA 722210 9470 9470 RESIDENT BEAUTY SHOP 446199 6690 6690 2700552 670 670 13381 0 13381 13381 13381 2735212 2713933 0 670 43846 21923 21923 1326341 1243328 83013 114732 106651 8081 99950 93694 6256 12380 12380 5203 2602 2601 4549 4549 32744 16372 16372 172826 169347 3479 8009 7508 501 73859 72404 1455 89836 86348 3488 PURCHASED SERVICES 255901 255901 DIETARY EXPENSE 133854 133854 PHARMACY EXPENSE 76052 76052 MEDICAL SUPPLIES EXPENS 40196 40196 153303 104835 48468 2643581 2431015 212566 0 83561 60996 243225 255771 12916 16523 44317 48771 3302336 2620225 720486 682111 2338 1726 1106843 1065898 541124 285823 86555 158468 38697 89509 666376 533800 X 440467 532098 440467 532098 1106843 1065898 91631 0 X X 1 X 0 1 0 X 1140 1192 1722 1276 20609 25939 2196611 2491442 2533122 2531530 2700552 12453257 2197751 2492634 2534844 2532806 2721161 12479196 63839 49357 113196 165291 223754 260157 306775 955977 165291 223754 323996 356132 1069173 11410023 15103 10531 7537 5766 14051 52988 15103 10531 7537 5766 14051 52988 27226 27940 34403 89569 2240080 2531105 2576784 2538572 2735212 12621753 0.90400 0.92710 0.00420 0.00420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 51250 51250 2454002 1887047 566955 387895 368803 19092 409189 364375 44814 682111 DUE TO RESIDENTS 1726 ASSET RETIREMENT OBLIGATION 32732 EMPLOYEE ASSISTANCE FUND 5186 PROVIDER TAX 49865 89509 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ACCOUNTING STANDARD ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THAT GUIDANCE, THE MANOR MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS INCLUDE THE TAX-EXEMPT STATUS OF THE MANOR AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. THE MANOR'S INFORMATION RETURNS, FOR THE YEARS ENDING 2012, 2011, 2010 AND 2009 ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR 3 YEARS AFTER THEY WERE FILED. BARB SHUPE PRESIDENT OF PINE VIEW BARB SHUPE IS A DIRECTOR OF GRAND RIVER AMBULANCE 245 PINE VIEW MANOR USES GRAND RIVER AMBULANCE TO TRANSPORT RESIDENTS TO AND FROM THE HOSPITALS. 0 MIKE MCQUINN BOARD MEMBER MIKE MCQUINN OWNS FAMILY HEALTH PHARMACY 53227 PINE VIEW MANOR USES FAMILY HEALTH PHARMACY TO SUPPLY MEDICATIONS TO RESIDENTS AND ALSO TO SET UP BUBBLE PACKS FOR MED DISTRIBUTION. 0 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 11 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 C, LINE 19 THE ORGANIZATIONS GOVERNING DOCUMENTS AND ANNUAL FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATIONS FINANCIAL STATEMENT REVIEW OVERSIGHT PROCESS AND ACCOUNTING FIRM SELECTION PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.