FURP.ORG / PUBLIC DATA EXPLORER

PROVIDENCE PLACE ASSISTED LIVING INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
PROVIDENCE PLACE ASSISTED LIVING INC (EIN 27-3481562)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-15
IRS object ID
202242279349303769
Schema version
2020v4.2
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)
Return2022-08-15T15:15:51-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN560571159PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BERNARD ROBINSON & COMPANY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 19608AddressLine1Txt
CityGREENSBOROCityNm
State AbbreviationNCStateAbbreviationCd
ZIP274199608ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN273481562EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PROVIDENCE PLACE ASSISTED LIVING INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPROVBusinessNameControlTxt
Phone3368884561PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11701 WESTCHESTER DRIVE SUITE 400AddressLine1Txt
CityHIGH POINTCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27262ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTERRY MILLERPersonNm
Person TitlePRESIDENT/CEOPersonTitleTxt
Phone3368884561PhoneNum
Signature2022-08-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTERRYPersonFirstNm
Person LastMILLERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRHONDA F SKILESPreparerPersonNm
PTINP00174702PTIN
Phone3362944494PhoneNum
Preparation2022-08-12PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTERRY MILLERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11701 WESTCHESTER DRIVE SUITE 400AddressLine1Txt
CityHIGH POINTCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27262ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$5,053,381GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PROVIDENCEPLACENC.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2010FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PASSIONATELY SERVE THE HOUSING AND CARE NEEDS OF SENIOR ADULTS WITH INNOVATIVE PROGRAMS AND SERVICES DELIVERED AT AN EXCEPTIONAL VALUE WHILE ENCOURAGING PERSONAL AND SPIRTUAL GROWTH AND DEVELOPMENT.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee104TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$282,757CYContributionsGrantsAmt
PY Program Service Revenue$4,528,164PYProgramServiceRevenueAmt
CY Program Service Revenue$3,989,004CYProgramServiceRevenueAmt
PY Investment Income$5,223PYInvestmentIncomeAmt
CY Investment Income$1,485CYInvestmentIncomeAmt
PY Other Revenue$1,190PYOtherRevenueAmt
CY Other Revenue$780,135CYOtherRevenueAmt
PY Total Revenue$4,534,577PYTotalRevenueAmt
CY Total Revenue$5,053,381CYTotalRevenueAmt
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$1,722,145PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,886,393CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,679,082PYOtherExpensesAmt
CY Other Expenses$2,463,701CYOtherExpensesAmt
PY Total Expenses$4,401,227PYTotalExpensesAmt
CY Total Expenses$4,350,094CYTotalExpensesAmt
PY Revenues Less Expenses$133,350PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$703,287CYRevenuesLessExpensesAmt
Total Assets BOY$6,693,921TotalAssetsBOYAmt
Total Assets EOY$7,070,859TotalAssetsEOYAmt
Total Liabilities BOY$6,535,514TotalLiabilitiesBOYAmt
Total Liabilities EOY$6,491,922TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$158,407NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$578,937NetAssetsOrFundBalancesEOYAmt
MissionTO PASSIONATELY SERVE THE HOUSING AND CARE NEEDS OF SENIOR ADULTS WITH INNOVATIVE PROGRAMS AND SERVICES DELIVERED AT AN EXCEPTIONAL VALUE WHILE ENCOURAGING PERSONAL AND SPIRTUAL GROWTH AND DEVELOPMENT.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$3,396,989ExpenseAmt
Revenue$4,769,139RevenueAmt
DescPROVIDING HOUSING AND SENIOR SERVICES THROUGH INNOVATIVE MODELS AND STATE OF THE ART CARE SYSTEMS THAT MAXIMIZE FUNCTIONAL ABILITIES AND SPIRITUAL DEVELOPMENT OF THE RESIDENTS AND PROGRAM PARTICIPANTS IN A CHRISTIAN ENVIRONMENT. THE PRIMARY SERVICES PROVIDED ARE ASSISTED LIVING SERVICES AND MEMORY CARE. 55,170 SQ. FT. OF LIVING SPACE, MEMORY CARE CENTER PROVIDING THERAPEUTIC CARE FOR ALZHEIMER'S/DEMENTIA RESIDENTS, PRIVATE AND SEMI-PRIVATE ROOMS AND ON SITE PHYSICAL THERAPY. DURING THE YEAR ENDED SEPTEMBER 30, 2021, 96 RESIDENTS WERE SERVED BY THE ASSISTED LIVING FACILITY.Desc
Total Program Service Expenses$3,396,989TotalProgramServiceExpensesAmt
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
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
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 With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
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 Document22IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee104EmployeeCnt
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
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
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 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
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TERRY MILLERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3368884560PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11701 WESTCHESTER DRIVE SUITE 400AddressLine1Txt
CityHIGH POINTCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27262ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
BARRY YATES
CFO5.0020.00Yes (X)$0$92,912$11,140
TERRY MILLER
PRESIDENT/CEO4.0012.00Yes (X)$0$32,533$406Yes (X)
PENNY CATES
CHAIRMAN3.14Yes (X)$0$0$0Yes (X)
ED WINSLOW
SECRETARY3.14Yes (X)$0$0$0Yes (X)
CRAIG DUNN
DIRECTOR3.14$0$0$0Yes (X)
THOMAS NEILL
DIRECTOR3.14$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$125,445TotReportableCompRltdOrgAmt
Total Other Compensation$11,546TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CULINARY SERVICES GROUP LLCBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line11135 BUSINESS PARKWAY S 10AddressLine1Txt
CityWESTMINSTERCityNm
State AbbreviationMDStateAbbreviationCd
ZIP21157ZIPCd
FieldValueIRS element (for citing)
ServicesFOOD SERVICEServicesDesc
Compensation$523,397CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$282,757GovernmentGrantsAmt
Total Contributions$282,757TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescROOM AND BOARDDesc
Business623000BusinessCd
Total Revenue Column$3,989,004TotalRevenueColumnAmt
Related Or Exempt Func Income$3,989,004RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$3,989,004TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,485TotalRevenueColumnAmt
Exclusion$1,485ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business623000BusinessCd
Total Revenue Column$780,135TotalRevenueColumnAmt
Related Or Exempt Func Income$780,135RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$780,135OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,053,381TotalRevenueColumnAmt
Related Or Exempt Func Income$4,769,139RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,485ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$28,771TotalAmt
Management And General$28,771ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,598,363TotalAmt
Program Services$1,057,610ProgramServicesAmt
Management And General$540,753ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$113,659TotalAmt
Program Services$79,561ProgramServicesAmt
Management And General$34,098ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$145,600TotalAmt
Program Services$101,920ProgramServicesAmt
Management And General$43,680ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$239,340TotalAmt
Management And General$239,340ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$2,037TotalAmt
Management And General$2,037ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$57,478TotalAmt
Management And General$57,478ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$24,438TotalAmt
Program Services$19,757ProgramServicesAmt
Management And General$4,681ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$14,895TotalAmt
Program Services$14,895ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$25,118TotalAmt
Program Services$25,118ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$45,687TotalAmt
Program Services$45,687ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$139,155TotalAmt
Program Services$139,155ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,803TotalAmt
Program Services$1,803ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$428,374TotalAmt
Program Services$428,374ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$294,912TotalAmt
Program Services$294,912ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$106,638TotalAmt
Program Services$106,638ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PATIENT EXPENSES$811,975$811,975
REPAIRS AND MAINTENANCE$159,627$159,627
MISCELLANOUS$109,319$109,319
ADMINISTRATIVE EXPENSES$2,267$2,267

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$638TotalAmt
Program Services$638ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$4,350,094TotalAmt
Program Services$3,396,989ProgramServicesAmt
Management And General$953,105ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,005,538BOYAmt
EOY$746,655EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

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

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$84,126BOYAmt
EOY$865,153EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$21,355BOYAmt
EOY$26,673EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$8,550,074LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,325,002LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,497,333BOYAmt
EOY$5,225,072EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$68,071BOYAmt
EOY$61,319EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$16,498BOYAmt
EOY$144,987EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$6,693,921BOYAmt
EOY$7,070,859EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$148,768BOYAmt
EOY$231,662EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$96,791BOYAmt
EOY$213,171EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$6,257,532BOYAmt
EOY$6,024,006EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$32,423BOYAmt
EOY$23,083EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,535,514BOYAmt
EOY$6,491,922EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$158,407BOYAmt
EOY$578,937EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$158,407BOYAmt
EOY$578,937EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,693,921BOYAmt
EOY$7,070,859EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$703,287ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$282,757OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit Committee0AuditCommitteeInd
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$282,757CurrentTaxYearAmt
Total$282,757TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,007,609CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,244,312CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,664,878CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,529,354CurrentTaxYearMinus1YearAmt
Current Tax Year$4,769,139CurrentTaxYearAmt
Total$22,215,292TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,007,609CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,244,312CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,664,878CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,529,354CurrentTaxYearMinus1YearAmt
Current Tax Year$5,051,896CurrentTaxYearAmt
Total$22,498,049TotalAmt

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$22,498,049PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,125CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,287CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,648CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,223CurrentTaxYearMinus1YearAmt
Current Tax Year$1,485CurrentTaxYearAmt
Total$12,768TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,125CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,287CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,648CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,223CurrentTaxYearMinus1YearAmt
Current Tax Year$1,485CurrentTaxYearAmt
Total$12,768TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,009,734CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,245,599CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,667,526CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,534,577CurrentTaxYearMinus1YearAmt
Current Tax Year$5,053,381CurrentTaxYearAmt
Total$22,510,817TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99940PublicSupportCY509Pct
Public Support PY5090.99950PublicSupportPY509Pct
Investment Income CY0.00060InvestmentIncomeCYPct
Investment Income PY0.00050InvestmentIncomePYPct
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

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,218,000OtherCostOrOtherBasisAmt
Book Value$1,218,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,374,951OtherCostOrOtherBasisAmt
Depreciation$2,414,530DepreciationAmt
Book Value$3,960,421BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$957,123OtherCostOrOtherBasisAmt
Depreciation$910,472DepreciationAmt
Book Value$46,651BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,225,072TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
CAPITAL LEASE PAYABLE$13,628
FUNDS HELD IN TRUST - RESIDENTS$9,455
FieldValueIRS element (for citing)
Total Liability$23,083TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$4,770,624TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$4,770,624RevenueSubtotalAmt
Other Revenues Not Included$282,757OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$282,757RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$5,053,381TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$4,350,094TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$4,350,094ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$4,350,094TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS NOT CLASSIFIED AS A PRIVATE FOUNDATION. IT IS THE ORGANIZATION'S POLICY TO EVALUATE ALL TAX POSITIONS TO IDENTIFY ANY THAT MAY BE CONSIDERED UNCERTAIN. ALL IDENTIFIED MATERIAL TAX POSITIONS ARE ASSESSED AND MEASURED BY A "MORE-LIKELY-THAN-NOT" THRESHOLD TO DETERMINE IF THE TAX POSITION IS UNCERTAIN AND WHAT, IF ANY, THE EFFECT OF THE UNCERTAIN TAX POSITION MAY HAVE ON THE FINANCIAL STATEMENTS. NO MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED FOR 2021 AND 2020.
PART XI, LINE 4B - OTHER ADJUSTMENTS:PPP LOAN FORGIVENESS PROCEEDS RECORDED ON THE PRIOR YEAR FINANCIAL STATEMENT 282,757.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3CERTAIN MANAGEMENT DUTIES WERE DELEGATED TO A RELATED 501(C)(3) ORGANIZATION: WESLEYAN ARMS, INC. (56-1012908).
FORM 990, PART VI, SECTION B, LINE 11BPROVIDENCE PLACE ASSISTED LIVING, INC. DOES NOT PROVIDE ITS FORM 990 TO THE BOARD FOR REVIEW PRIOR TO FILING THE 990 RETURN. THE FINANCIAL STATEMENTS ARE REVIEWED ON A MONTHLY BASIS BY THE BOARD.
FORM 990, PART VI, SECTION B, LINE 12CALL BOARD MEMBERS ARE ASKED TO DISCLOSE ALL POTENTIAL CONFLICTS OF INTEREST AND IN THE EVENT OF A CONFLICT OF INTEREST THAT MEMBER IS ASKED TO ABSTAIN FROM VOTING.
FORM 990, PART VI, SECTION B, LINE 15THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO AND CERTAIN TOP EMPLOYEES IS DETERMINED BY AN INDEPENDENT BOARD OF DIRECTORS. THE DIRECTORS ARE ALL LOCAL BUSINESS EXECUTIVES AND PROFESSIONALS. THE REVIEW AND ANALYSIS IS CONDUCTED IN A CLOSED SESSION WHERE THE INDIVIDUAL WHO IS THE SUBJECT OF THE REVIEW IS EXCLUDED FROM THE DISCUSSIONS SO AS TO ENCOURAGE FRANK AND FORTHRIGHT DEBATE. DURING THE DISCUSSIONS, COMPARABILITY DATA IS OFTEN IDENTIFIED. FOR EXAMPLE, ONE OF THE DIRECTORS IS A HEALTHCARE ATTORNEY AND IS AWARE OF EXECUTIVE SALARIES AT A NUMBER OF SIMILAR LONG TERM CARE ORGANIZATIONS THROUGHOUT THE STATE. NOTES AND MINUTES ARE TAKEN OF THE DISCUSSION AND THE DECISION AND THEN THE CONCLUSIONS OF THE BOARD ARE THEN PUT INTO PLACE.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST BY ANY INTERESTED PARTY.
FORM 990, PART XI, LINE 9:PPP LOAN FORGIVENESS RECORDED AS REVENUE ON PRIOR YEAR FINANCIAL STATEMENTS -282,757.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
WESLEYAN ARMS INC
1701 WESTCHESTER DRIVEHIGH POINTNC27262561012908ASSISTED LIVINGNC501(C)(3)LINE 10N/A0
PPRC NURSING HOME INC
1795 WESTCHESTER DRIVEHIGH POINTNC27262311733046NURSING HOMENC501(C)(3)LINE 10N/A0
PPRC SENIOR LIVING I INC
1795 WESTCHESTER DRIVEHIGH POINTNC27262311733044INDEPENDENT LIVINGNC501(C)(3)LINE 10N/A0
PPRC SENIOR LIVING II INC
1727 WESTCHESTER DRIVEHIGH POINTNC27262300113709INDEPENDENT LIVINGNC501(C)(3)LINE 10N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1WESTCHESTER CHRISTIAN CENTER INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11701 WESTCHESTER DRIVEAddressLine1Txt
CityHIGH POINTCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27262ZIPCd
FieldValueIRS element (for citing)
EIN561963673EIN
Primary ActivitiesACQUISITION, IMPROVEMENT, MAINTENANCE, LEASING OF PROPERTYPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
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 OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
WESTCHESTER CHRISTIAN CENTER INC
D$140,000CASH PAID
WESLYAN ARMS INC
M$239,340CASH PAID