2013-08-09T08:12:17-05:00 2012-12-31 540504608 BROWN EDWARDS & COMPANY LLP 124 NEWMAN AVENUE HARRISONBURG VA 22801 990 2012-01-01 550547603 PENDLETON MANOR INC PEND 3043582320 PO BOX 700 FRANKLIN WV 26807 GREG BOWERS 3043582320 2013-08-08 1 JAMES R FRIES P01320612 5404346736 2013-08-02 2012 2016-02-24 21:20:13Z GREG BOWERS PO BOX 700 FRANKLIN WV 26807 8615301 0 X N/A X 1974 WV THE MISSION OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 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. 9 9 192 150 0 0 38828 45186 8145461 8569421 289 -11092 0 0 8184578 8603515 0 0 0 0 4249096 4189631 0 0 0 3185152 3671176 7434248 7860807 750330 742708 2792511 2602007 469566 536629 2322945 2065378 OUR MISSION IS TO BUILD A STRONGER COMMUNITY BY IMPROVING AND ENRICHING THE LIVES OF THOSE WHO HAVE EXCEPTIONAL PHYSICAL, DEVELOPMENTAL OR FINANCIAL CHALLENGES. 0 0 6600909 8517653 PROVIDE INTERMEDIATE CARE NURSING SERVICES FOR ELDERLY PATIENTS; 91 BEDS AVAILABLE, 30,882 PATIENT DAYS PROVIDED. PROVIDING HOME HEALTH AND OUTPATIENT THERAPY SERVICES FOR THE COMMUNITY. 6600909 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 192 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 1 1 0 0 X MARILYNN WAGGY 3043582320 PO BOX 700 FRANKLIN WV 26807 X GREG BOWERS 0.50 X X 0 0 0 WENDY SUESS 0.50 X X 0 0 0 MARSHALL HARPER 0.50 X X 0 0 0 JUDY RADER 0.50 X X 0 0 0 KENNETH HARPER 0.50 X 0 0 0 MERL WARNER 0.50 X 0 0 0 BYRON BLAND 0.50 X 0 0 0 DYER ANDERSON 0.50 X 0 0 0 LYNN VANDEVANDER 0.50 X 0 0 0 DAVID O'BOYLE 40.00 X 0 0 0 0 0 0 0 0 0 1 AEGIS THERAPIES INC PO BOX 8103 FT SMITH AR 72902 THERAPY PROVIDER 726798 EVANGELICAL LUTHERAN GOOD SAMARITAN SOCI 4800 W 57 ST SIOUX FALLS SD 57108 MANAGEMENT SERVICES 432515 2 45186 455 45186 PATIENT SERVICE REVENU 623000 5597071 5597071 ANCILLARY SERVICES 623000 2533842 2533842 SPECIAL CARE SERVICES 623000 386046 386046 52462 52462 8569421 694 694 11786 -11786 -11786 -11786 8603515 8517653 0 40676 X 3509095 3228215 280880 126569 116438 10131 293219 274740 18479 260748 240064 20684 511314 511314 781 781 19255 19255 864984 821864 43120 19060 3327 15733 34277 34277 419145 419145 27525 16204 11321 109722 109722 270987 166252 104735 SUPPLIES 782546 768822 13724 TAXES AND LICENSES 418668 417644 1024 EQUIPMENT RENTAL & MAIN 69515 67963 1552 STAFF DEVELOPMENT 26266 11281 14985 97131 48950 48181 7860807 6600909 1259898 0 100 100 1170420 836450 929345 1097327 38787 34445 47370 39822 1552276 961528 602121 590748 4368 3115 2792511 2602007 461769 527490 7797 9139 469566 536629 X 2312089 2059434 10856 5944 2322945 2065378 2792511 2602007 X 742708 -1000275 X 0 1 X 1 0 X 39546 6288 7748 38828 45186 137596 6434899 6793615 7509606 8101915 8516959 37356994 46546 52462 99008 6474445 6799903 7517354 8187289 8614607 37593598 0 0 0 37593598 223406 2104 75 694 226279 223406 2104 75 694 226279 6697851 6802007 7517429 8187289 8615301 37819877 0.99400 0.98660 0.00600 0.01340 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1429724 838976 590748 122552 122552 0 590748 RESIDENT TRUST FUNDS 9139 9139 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: N/A 0 0 0 0 0 0 0 0 0 DAVID O'BOYLE 0 88024 0 0 0 0 0 0 0 0 0 88024 0 0 SUPPLEMENTAL INFORMATION PART III COMPENSATION FOR DAVID O'BOYLE WAS PAID BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. FORM 990, PART VI, SECTION A, LINE 3 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY HAS BEEN HIRED BY PENDLETON MANOR TO PROVIDE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR AND THE BOARD OF DIRECTORS, AND THE FINANCIAL DATA ARE VERIFIED BY THE ACCOUNTING DEPARTMENT AND MANAGEMENT, AS WELL AS BEING AUDITED BY AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT-OF-INTEREST POLICY IS REVIEWED PERIODICALLY BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15A THE WAGE FOR THE ADMINISTRATOR IS SET BY THE MANAGING AGENCY - EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 821,864. MANAGEMENT AND GENERAL EXPENSES 43,120. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 864,984. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER TO PENDLETON VILLAGE, INC. -1,000,275. PENDLETON APARTMENTS INC PO BOX 700 FRANKLIN WV 26807 311130225 TO PROVIDE HOUSING TO ELDERLY PERSONS WV 501(C)(3) LINE 9 PENDLETON VILLAGE INC 1 PENDLETON VILLAGE INC PO BOX 700 FRANKLIN WV 26807 261339734 ACT AS MANAGEMENT COMPANY FOR THE OTHER ENTITIES WV 501(C)(3) LINE 11B, II N/A 0 THE PENDLETON INC PO BOX 700 FRANKLIN WV 26807 261339779 REAL ESTATE AND EQUIPMENT HOLDING COMPANY FOR RELATED ORGANIZATIONS. WV 501(C)(2) PENDLETON VILLAGE INC 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 THE PENDLETON INC K 197200 CASH