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PENDLETON MANOR INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
PENDLETON MANOR INC (EIN 55-0547603)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-06-18
IRS object ID
201501699349300235
Schema version
2014v5.0
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)
Return2015-06-18T14:24:38-05:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN540504608PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BROWN EDWARDS & COMPANY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1124 NEWMAN AVENUEAddressLine1Txt
CityHARRISONBURGCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22801ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN550547603EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PENDLETON MANOR INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPENDBusinessNameControlTxt
Phone3043582320PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 700AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26807ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGREG BOWERSPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone3043582320PhoneNum
Signature2015-06-04SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJAMES R FRIESPreparerPersonNm
PTINP01320612PTIN
Phone5404346736PhoneNum
Preparation2015-05-20PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGREG BOWERSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 700AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26807ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$8,781,814GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PENDLETONMANOR.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1974FormationYr
Legal Domicile StateWVLegalDomicileStateCd
Activity Or MissionAS A MEMBER OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, OUR MISSION IS TO SHARE GOD'S WORD IN LOVE AND DEED BY PROVIDING SHELTER AND SUPPORTIVE SERVICES TO OLDER PERSONS AND OTHERS IN NEED BELIEVING THAT IN CHRIST'S LOVE, EVERYONE IS SOMEONE.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee187TotalEmployeeCnt
Total Volunteers172TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$69,220PYContributionsGrantsAmt
CY Contributions Grants$73,166CYContributionsGrantsAmt
PY Program Service Revenue$8,552,184PYProgramServiceRevenueAmt
CY Program Service Revenue$8,707,930CYProgramServiceRevenueAmt
PY Investment Income$1,509PYInvestmentIncomeAmt
CY Investment Income-$219CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$8,622,913PYTotalRevenueAmt
CY Total Revenue$8,780,877CYTotalRevenueAmt
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$4,219,400PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,327,167CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,552,776PYOtherExpensesAmt
CY Other Expenses$3,606,653CYOtherExpensesAmt
PY Total Expenses$7,772,176PYTotalExpensesAmt
CY Total Expenses$7,933,820CYTotalExpensesAmt
PY Revenues Less Expenses$850,737PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$847,057CYRevenuesLessExpensesAmt
Total Assets BOY$2,234,109TotalAssetsBOYAmt
Total Assets EOY$2,386,418TotalAssetsEOYAmt
Total Liabilities BOY$486,108TotalLiabilitiesBOYAmt
Total Liabilities EOY$550,989TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,748,001NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,835,429NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS TO BUILD A STRONGER COMMUNITY BY IMPROVING AND ENRICHING THE LIVES OF THOSE WHO HAVE EXCEPTIONAL PHYSICAL, DEVELOPMENTAL OR FINANCIAL CHALLENGES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$6,688,231ExpenseAmt
Revenue$8,656,746RevenueAmt
DescPROVIDE INTERMEDIATE AND SKILLED CARE NURSING SERVICES FOR ELDERLY PATIENTS; 91 BEDS AVAILABLE, 31,807 PATIENT DAYS PROVIDED. PROVIDING HOME HEALTH AND OUTPATIENT THERAPY SERVICES FOR THE COMMUNITY.Desc
Total Program Service Expenses$6,688,231TotalProgramServiceExpensesAmt
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 EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
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 RequiredYes (1)ScheduleJRequiredInd
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 Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document14IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee187EmployeeCnt
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 Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn0AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARILYNN WAGGYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3043582320PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 700AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationWVStateAbbreviationCd
ZIP26807ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
GREG BOWERS
PRESIDENT0.50Yes (X)Yes (X)$0$0$0
WENDY SUESS
VICE PRESIDENT0.50Yes (X)Yes (X)$0$0$0
MARSHALL HARPER
TREASURER0.50Yes (X)Yes (X)$0$0$0
JUDY RADER
SECRETARY0.50Yes (X)Yes (X)$0$0$0
KENNETH HARPER
DIRECTOR0.50Yes (X)$0$0$0
MERL WARNER
DIRECTOR0.50Yes (X)$0$0$0
BYRON BLAND
DIRECTOR0.50Yes (X)$0$0$0
DYER ANDERSON
DIRECTOR0.50Yes (X)$0$0$0
LYNN VANDEVANDER
DIRECTOR0.50Yes (X)$0$0$0
DAVID O'BOYLE
ADMINISTRATOR40.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (1)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
AEGIS THERAPIES INC
PO BOX 8103FT SMITHAR72902THERAPY PROVIDER$855,860
EVANGELICAL LUTHERAN GOOD SAMARITAN SOCI
4800 W 57 STSIOUX FALLSSD57108MANAGEMENT SERVICES$440,626
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
All Other Contributions$73,166AllOtherContributionsAmt
Noncash Contributions$1,178NoncashContributionsAmt
Total Contributions$73,166TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENU623000$5,233,551$5,233,551
ANCILLARY SERVICES623000$2,919,051$2,919,051
SPECIAL CARE SERVICES623000$503,426$503,426

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$51,902TotalRevenueColumnAmt
Related Or Exempt Func Income$51,902RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$8,707,930TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$718TotalRevenueColumnAmt
Related Or Exempt Func Income$718RelatedOrExemptFuncIncomeAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$937OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$937OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$937TotalRevenueColumnAmt
Exclusion-$937ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,780,877TotalRevenueColumnAmt
Related Or Exempt Func Income$8,708,648RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$937ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,570,168TotalAmt
Program Services$3,290,270ProgramServicesAmt
Management And General$279,898ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$127,961TotalAmt
Program Services$117,929ProgramServicesAmt
Management And General$10,032ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$367,972TotalAmt
Program Services$347,138ProgramServicesAmt
Management And General$20,834ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$261,066TotalAmt
Program Services$240,406ProgramServicesAmt
Management And General$20,660ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$504,314TotalAmt
Management And General$504,314ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$6,587TotalAmt
Management And General$6,587ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$22,526TotalAmt
Management And General$22,526ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$923,180TotalAmt
Program Services$915,778ProgramServicesAmt
Management And General$7,402ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$11,541TotalAmt
Program Services$2,857ProgramServicesAmt
Management And General$8,684ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$25,105TotalAmt
Management And General$25,105ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$433,622TotalAmt
Program Services$433,622ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$13,547TotalAmt
Program Services$2,204ProgramServicesAmt
Management And General$11,343ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$96,091TotalAmt
Management And General$96,091ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$215,882TotalAmt
Program Services$95,423ProgramServicesAmt
Management And General$120,459ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$654,762$654,762
TAXES AND LICENSES$425,018$425,018
EQUIPMENT RENTAL & MAIN$78,467$78,467
MISCELLANEOUS$66,867$66,867

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$129,144TotalAmt
Program Services$84,357ProgramServicesAmt
Management And General$44,787ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$7,933,820TotalAmt
Program Services$6,688,231ProgramServicesAmt
Management And General$1,245,589ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$100BOYAmt
EOY$100EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$491,960BOYAmt
EOY$678,929EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,143,505BOYAmt
EOY$1,162,589EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$38,002BOYAmt
EOY$36,666EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$27,291BOYAmt
EOY$38,639EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,551,382LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,082,177LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$532,251BOYAmt
EOY$469,205EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,000BOYAmt
EOY$290EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,234,109BOYAmt
EOY$2,386,418EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$475,732BOYAmt
EOY$537,764EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$10,376BOYAmt
EOY$13,225EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$486,108BOYAmt
EOY$550,989EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,676,275BOYAmt
EOY$1,705,508EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$71,726BOYAmt
EOY$129,921EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,748,001BOYAmt
EOY$1,835,429EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,234,109BOYAmt
EOY$2,386,418EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$847,057ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$759,629OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (1)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
FS Audited0FSAuditedInd
Audit CommitteeYes (1)AuditCommitteeInd
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$7,748CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$38,828CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$45,186CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$69,220CurrentTaxYearMinus1YearAmt
Current Tax Year$73,166CurrentTaxYearAmt
Total$234,148TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,509,606CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,101,915CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,516,959CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,509,169CurrentTaxYearMinus1YearAmt
Current Tax Year$8,656,028CurrentTaxYearAmt
Total$41,293,677TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$46,546CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$52,462CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$43,015CurrentTaxYearMinus1YearAmt
Current Tax Year$51,902CurrentTaxYearAmt
Total$193,925TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,517,354CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,187,289CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,614,607CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,621,404CurrentTaxYearMinus1YearAmt
Current Tax Year$8,781,096CurrentTaxYearAmt
Total$41,721,750TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$41,721,750PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$75CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus2 Years$694CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,517CurrentTaxYearMinus1YearAmt
Current Tax Year$718CurrentTaxYearAmt
Total$3,004TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$75CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus2 Years$694CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,517CurrentTaxYearMinus1YearAmt
Current Tax Year$718CurrentTaxYearAmt
Total$3,004TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,517,429CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,187,289CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,615,301CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,622,921CurrentTaxYearMinus1YearAmt
Current Tax Year$8,781,814CurrentTaxYearAmt
Total$41,724,754TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99990PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

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 D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,428,830OtherCostOrOtherBasisAmt
Depreciation$959,625DepreciationAmt
Book Value$469,205BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$122,552OtherCostOrOtherBasisAmt
Depreciation$122,552DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$469,205TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescRESIDENT TRUST FUNDSDesc
Amt$13,225Amt
FieldValueIRS element (for citing)
Total Liability$13,225TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationN/AExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonDAVID O'BOYLEPersonNm
TitleADMINISTRATORTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$93,404CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$93,404TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART II:FormAndLineReferenceDesc
ExplanationCOMPENSATION FOR DAVID O'BOYLE WAS PAID BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY HAS BEEN HIRED BY PENDLETON MANOR TO PROVIDE MANAGEMENT SERVICES.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR AND THE BOARD OF DIRECTORS, AND THE FINANCIAL DATA ARE VERIFIED BY THE ACCOUNTING DEPARTMENT AND MANAGEMENT.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT-OF-INTEREST POLICY IS REVIEWED PERIODICALLY BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15ATHE WAGE FOR THE ADMINISTRATOR IS SET BY THE MANAGING AGENCY - EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY.
FORM 990, PART VI, SECTION C, LINE 19ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART IX, LINE 11GCONTRACT SERVICES: PROGRAM SERVICE EXPENSES 915,778. MANAGEMENT AND GENERAL EXPENSES 7,402. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 923,180.
FORM 990, PART XI, LINE 9:TRANSFER TO PENDLETON VILLAGE, INC. -359,629. TRANSFER TO THE PENDLETON, INC. -400,000.
FORM 990, PART XII, LINE 2C:THIS PROCESS DID NOT CHANGE FROM PRIOR YEARS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
PENDLETON APARTMENTS INC
PO BOX 700FRANKLINWV26807311130225TO PROVIDE HOUSING TO ELDERLY PERSONSWV501(C)(3)LINE 9PENDLETON VILLAGE INC0
PENDLETON VILLAGE INC
PO BOX 700FRANKLINWV26807261339734ACT AS MANAGEMENT COMPANY FOR THE OTHER ENTITIESWV501(C)(3)LINE 11B, II0N/A
THE PENDLETON INC
PO BOX 700FRANKLINWV26807261339779REAL ESTATE AND EQUIPMENT HOLDING COMPANY FOR RELATED ORGANIZATIONS.WV501(C)(2)PENDLETON VILLAGE INC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
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 OrgYes (1)RentalOfFcltsFromOthOrgInd
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 Line1THE PENDLETON INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeKTransactionTypeTxt
Involved$205,200InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt