STRATEGY STUDIO / PUBLIC DATA EXPLORER

PILGRIM MANOR INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
PILGRIM MANOR INC (EIN 38-1651383)
Tax period
2016-01-01 to 2016-11-01
Filed
2017-09-12
IRS object ID
201742559349301119
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-09-12T14:50:49-05:00ReturnTs
Tax Period End2016-11-01TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1250 S HIGH STREET SUITE 100AddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN381651383EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PILGRIM MANOR INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPILGBusinessNameControlTxt
Phone6164581133PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 LEONARD NEAddressLine1Txt
CityGRAND RAPIDSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49505ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKAREN MESSICKPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone6164581133PhoneNum
Signature2017-08-23SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAmy Ciminello CPAPreparerPersonNm
PTINP00796388PTIN
Phone6148493000PhoneNum
Preparation2017-08-23PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.59.56.33IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-08-23IPDt
IP Tm16:57:42IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device Id1674A2254C8EB78FFC88BE4D5865C21DF24A8C7CAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Final ReturnYes (X)FinalReturnInd
Principal OfficerKAREN MESSICKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 LEONARD NEAddressLine1Txt
CityGRAND RAPIDSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49505ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$6,500,142GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PILGRIMMANOR.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1963FormationYr
Legal Domicile StateMILegalDomicileStateCd
Activity Or MissionPILGRIM MANOR OPERATES A RETIREMENT HOME WITH SECTIONS FOR INDEPENDENT RESIDENTS, ASSISTED LIVING, AND NURSING CARE.ActivityOrMissionDesc
Contract TerminationYes (X)ContractTerminationInd
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee310TotalEmployeeCnt
Total Volunteers21TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$150,457PYContributionsGrantsAmt
CY Contributions Grants$102,496CYContributionsGrantsAmt
PY Program Service Revenue$7,654,156PYProgramServiceRevenueAmt
CY Program Service Revenue$6,385,342CYProgramServiceRevenueAmt
PY Investment Income$2,359PYInvestmentIncomeAmt
CY Investment Income$148CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$12,156CYOtherRevenueAmt
PY Total Revenue$7,806,972PYTotalRevenueAmt
CY Total Revenue$6,500,142CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$4,584,647PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$3,877,641CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,558,440PYOtherExpensesAmt
CY Other Expenses$3,025,019CYOtherExpensesAmt
PY Total Expenses$8,143,087PYTotalExpensesAmt
CY Total Expenses$6,902,660CYTotalExpensesAmt
PY Revenues Less Expenses-$336,115PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$402,518CYRevenuesLessExpensesAmt
Total Assets BOY$6,773,602TotalAssetsBOYAmt
Total Assets EOY$0TotalAssetsEOYAmt
Total Liabilities BOY$2,351,542TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,422,060NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$0NetAssetsOrFundBalancesEOYAmt
MissionPILGRIM MANOR, A NONPROFIT CORPORATION AFFILIATED WITH THE UNITED CHURCH OF CHRIST, PROVIDES A COMMUNITY FOR OLDER ADULTS THAT ENABLES THEM TO MEET THEIR ON-GOING PHYSICAL, SOCIAL, AND SPIRITUAL NEEDS, AFFIRMING THEIR DIGNITY, MEANING, AND WORTH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$5,765,362ExpenseAmt
Revenue$6,397,498RevenueAmt
DescASSISTED LIVING/INDEPENDENT CARE AND SKILLED NURSING CAREDesc
Total Program Service Expenses$5,765,362TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate OperationsYes (1)TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee310EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org DocumentsYes (1)ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JEANETTE EGGERTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6164581133PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 LEONARD NEAddressLine1Txt
CityGRAND RAPIDSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP495055894ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
MICKI BENZ
CHAIR0.500.50Yes (X)Yes (X)$0$0$0
CARL APPLE
VICE CHAIR0.500.50Yes (X)Yes (X)$0$0$0
CHARLES FERRO
TREASURER0.500.50Yes (X)Yes (X)$0$0$0
GRETCHEN TELLMAN-PARTRIDGE
SECRETARY0.500.50Yes (X)Yes (X)$0$0$0
MARK BRIEVE
DIRECTOR0.500.50Yes (X)$0$0$0
PHILIP BALKEMA
DIRECTOR0.500.50Yes (X)$0$0$0
MARY LOUPEE
DIRECTOR0.500.50Yes (X)$0$0$0
SUE ANN ROBERT
DIRECTOR0.500.50Yes (X)$0$0$0
TAMERA LAAGE
DIRECTOR0.500.50Yes (X)$0$0$0
BRIAN MOORE
DIRECTOR0.500.50Yes (X)$0$0$0
KEN VERMEULEN
DIRECTOR0.500.50Yes (X)$0$0$0
KAREN MESSICK
EXECUTIVE DIRECTOR40.001.00Yes (X)$112,646$0$3,593
FieldValueIRS element (for citing)
Total Reportable Comp From Org$112,646TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$3,593TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
GORDON FOOD SERVICE
4990 CLAY AVE SWGRAND RAPIDSMI49548FOOD SERVICE$353,123
THERAPY MANAGEMENT INC
3000 MONROE AVE NEGRAND RAPIDSMI49505THERAPY SVCS$315,585
SAINT MARYS LTC PHARMACY
360 DIVISION AVE SGRAND RAPIDSMI49503PHARMACY$209,179
QCI HEALTHCARE
32401 8 MILE RDLIVONIAMI48152HEALTHCARE$157,133
MCKESSON MEDICAL-SURGICAL SUPPLY
30881 SCHOOLCRAFT RDLIVONIAMI48150SURGICAL SUPPLY$126,118
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Related Organizations$102,496RelatedOrganizationsAmt
Total Contributions$102,496TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PROGRAM SERVICE REVENU623000$5,967,047$5,967,047
QAAP REVENUE623000$324,432$324,432
ADMISSIONS623000$22,500$22,500
GUEST MEALS623000$14,626$14,626
APPLICATION FEES623000$6,000$6,000

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$50,737TotalRevenueColumnAmt
Related Or Exempt Func Income$50,737RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$6,385,342TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$148TotalRevenueColumnAmt
Exclusion$148ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$12,156RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$12,156RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,156TotalRevenueColumnAmt
Related Or Exempt Func Income$12,156RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,500,142TotalRevenueColumnAmt
Related Or Exempt Func Income$6,397,498RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$148ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$174,913TotalAmt
Management And General$174,913ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,133,660TotalAmt
Program Services$2,669,658ProgramServicesAmt
Management And General$464,002ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$24,595TotalAmt
Program Services$19,787ProgramServicesAmt
Management And General$4,808ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$247,009TotalAmt
Program Services$228,616ProgramServicesAmt
Management And General$18,393ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$297,464TotalAmt
Program Services$203,683ProgramServicesAmt
Management And General$93,781ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,177,476TotalAmt
Program Services$846,902ProgramServicesAmt
Management And General$330,574ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$29,549TotalAmt
Program Services$15,519ProgramServicesAmt
Management And General$14,030ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$269,128TotalAmt
Program Services$269,128ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,851TotalAmt
Program Services$1,851ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$223,211TotalAmt
Program Services$223,211ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$10,265TotalAmt
Management And General$10,265ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$7,553TotalAmt
Management And General$7,553ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$68,877TotalAmt
Program Services$68,877ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$233,346TotalAmt
Program Services$233,346ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
SUPPLIES$623,865$623,865
QAAP$242,985$242,985
PROVISION FOR BAD DEBTS$101,535$101,535
uniforms$2,884$2,884

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$32,494TotalAmt
Program Services$13,515ProgramServicesAmt
Management And General$18,979ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$6,902,660TotalAmt
Program Services$5,765,362ProgramServicesAmt
Management And General$1,137,298ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$895,924BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$16,231BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$499,534BOYAmt
EOY$0EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$64,900BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$0LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$0LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,622,822BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,551,757BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$122,434BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$6,773,602BOYAmt
EOY$0EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$622,376BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,729,166BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,351,542BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,441,443BOYAmt
EOY$0EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$637,528BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$343,089BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,422,060BOYAmt
EOY$0EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,773,602BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$402,518ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$4,019,542OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$471,090CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$217,924CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,071,679CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$150,457CurrentTaxYearMinus1YearAmt
Current Tax Year$102,496CurrentTaxYearAmt
Total$2,013,646TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,479,192CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,031,924CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,905,959CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,654,156CurrentTaxYearMinus1YearAmt
Current Tax Year$6,385,342CurrentTaxYearAmt
Total$37,456,573TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,950,282CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,249,848CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,977,638CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,804,613CurrentTaxYearMinus1YearAmt
Current Tax Year$6,487,838CurrentTaxYearAmt
Total$39,470,219TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$91,990CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$71,679CurrentTaxYearMinus3YearsAmt
Total$163,669TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$91,990CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$71,679CurrentTaxYearMinus3YearsAmt
Total$163,669TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$39,306,550PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,516CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,582CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,503CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,448CurrentTaxYearMinus1YearAmt
Current Tax Year$12,304CurrentTaxYearAmt
Total$27,353TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,516CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,582CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,503CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,448CurrentTaxYearMinus1YearAmt
Current Tax Year$12,304CurrentTaxYearAmt
Total$27,353TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,957,798CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,251,430CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,981,141CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,807,061CurrentTaxYearMinus1YearAmt
Current Tax Year$6,500,142CurrentTaxYearAmt
Total$39,497,572TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99520PublicSupportCY509Pct
Public Support PY5090.99330PublicSupportPY509Pct
Investment Income CY0.00070InvestmentIncomeCYPct
Investment Income PY0.00060InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferencePart III, Short Year Explanation:FormAndLineReferenceDesc
ExplanationTHE CURRENT YEAR ENDS ON 11/01/2016 DUE TO THE ACQUISITION OF THE ORGANIZATION BY UNITED CHURCH HOMES, INC. ON THAT DATE AND SUBSEQUENT INCORPORATION OF THE ORGANIZATION INTO THE UNITED CHURCH HOMES, INC CONSOLIDATED FINANCIAL STATEMENTS.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule N IRS990ScheduleN

Liquidation Of Assets Table LiquidationOfAssetsTableGrp

Liquidation Of Assets Detail LiquidationOfAssetsDetail

FieldValueIRS element (for citing)
Assets Distri Or Expnss PaidEQUIPMENT, LAND, BUILDINGS, ET AL.AssetsDistriOrExpnssPaidDesc
Distribution2016-11-01DistributionDt
Fair Market Value Of Asset$4,019,542FairMarketValueOfAssetAmt
Method Of FMV DeterminationBOOKMethodOfFMVDeterminationTxt
EIN344429276EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UNITED CHURCH HOMESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1170 E Center StAddressLine1Txt
CityMarionCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43301ZIPCd
FieldValueIRS element (for citing)
IRC Section501(C)(3)IRCSectionTxt
FieldValueIRS element (for citing)
Director Of Successor0DirectorOfSuccessorInd
Employee Of Successor0EmployeeOfSuccessorInd
Owner Of Successor0OwnerOfSuccessorInd
Receive Compensation0ReceiveCompensationInd
Assets Distributed0AssetsDistributedInd
Required To Notify AG0RequiredToNotifyAGInd
Attorney General Notified0AttorneyGeneralNotifiedInd
Liabilities Paid0LiabilitiesPaidInd
Bonds Outstanding0BondsOutstandingInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 3:FormAndLineReferenceDesc
ExplanationORGANIZATION WAS ACQUIRED BY UNITED CHURCH HOMES, INC. ON 11/01/2016 AND INCLUDED IN THE UNITED CHURCH HOMES, INC CONSOLIDATED FINANCIAL STATEMENTS FOR THE PERIOD SUBSEQUENT TO 11/01/2016 TO 12/31/2016. THE ORGANIZATION WILL BE ABSORBED INTO UNITED CHURCH HOMES, INC. AND THIS WILL BE THE FINAL 990 THAT THE ORGANIZATION FILES.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 4PILGRIM MANOR INC. WAS ACQUIRED BY UNITED CHURCH HOMES AS OF 11/1/2017. AS A RESULT, THIS WILL BE PILGRIM MANOR INC'S FINAL RETURN.
Form 990, Part VI, Section A, line 6THE ORGANIZATION HAS SHAREHOLDERS IN ACCORDANCE WITH THE BY-LAWS.
Form 990, Part VI, Section A, line 7aSHAREHOLDERS HAVE THE ABILITY TO ELECT BOARD MEMBERS.
Form 990, Part VI, Section B, line 11bNO REVIEW WAS OR WILL BE CONDUCTED. THE RETURN IS PREPARED BY AN INDEPENDENT CPA FIRM. THE RETURN IS THEN REVIEWED BY MANAGEMENT PRIOR TO FILING THE RETURN.
Form 990, Part VI, Section B, line 12cBOARD MEMBERS ARE REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST AND SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. IF A POTENTIAL CONFLICT OF INTEREST ARISES, THE BOARD MEMBER SHALL LEAVE THE BOARD OR EXECUTIVE COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR EXECUTIVE COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS.
Form 990, Part VI, Section B, line 15THE BOARD OF DIRECTORS REVIEW THE EXECUTIVE DIRECTOR'S SALARY ANNUALLY. COMPENSATION FOR OTHER KEY MEMBERS OF MANAGEMENT ARE BASED ON PERFORMANCE AND REVIEW OF OTHER 990S FOR SIMILAR ORGANIZATIONS. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2015.
Form 990, Part VI, Section C, line 19DOCUMENTS ARE AVAILABLE UPON REQUEST.
Form 990, Part IX, line 11gDIET CONTRACTED SERVICES: Program service expenses 2,528. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,528. NURSING ADMIN: Program service expenses 198,024. Management and general expenses 0. Fundraising expenses 0. Total expenses 198,024. MEDICAL RECORDS: Program service expenses 1,106. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,106. SOCIAL SERVICES/PORSTAL CARE: Program service expenses 3,185. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,185. DIVERSIONAL THERAPY: Program service expenses 2,898. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,898. ROUTINE CARE UNIT: Program service expenses 354,723. Management and general expenses 0. Fundraising expenses 0. Total expenses 354,723. ADMINISTRATIVE: Program service expenses 0. Management and general expenses 39,693. Fundraising expenses 0. Total expenses 39,693. MAINTENANCE & REPAIR: Program service expenses 236,915. Management and general expenses 0. Fundraising expenses 0. Total expenses 236,915. OTHER PROFESSIONAL SERVICES: Program service expenses 47,523. Management and general expenses 290,881. Fundraising expenses 0. Total expenses 338,404.
Form 990, Part XI, line 9:TRANSFER OF NET ASSETS DUE TO UNITED CHURCH HOMES MERGER DATED 11/1/16 -4,019,542.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1PILGRIM MANOR FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12000 LEONARD NEAddressLine1Txt
CityGRAND RAPIDSCityNm
State AbbreviationMIStateAbbreviationCd
ZIP495055894ZIPCd
FieldValueIRS element (for citing)
EIN383410416EIN
Primary ActivitiesSUPPORT OF NURSING HOMEPrimaryActivitiesTxt
Legal Domicile StateMILegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity StatusLine 12a, IPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PILGRIM MANOR INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1PILGRIM MANOR FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$102,496InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt