PROVIDENCE PLACE ASSISTED LIVING INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE PLACE ASSISTED LIVING INC (EIN 27-3481562)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-16
- IRS object ID
- 202132289349303823
- Schema version
- 2019v5.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-16T15:56:28-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560571159 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BERNARD ROBINSON & COMPANY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 19608 | AddressLine1Txt |
| City | GREENSBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 274199608 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273481562 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE PLACE ASSISTED LIVING INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PROV | BusinessNameControlTxt |
| Phone | 3368884561 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 WESTCHESTER DRIVE SUITE 400 | AddressLine1Txt |
| City | HIGH POINT | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27262 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERRY MILLER | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 3368884561 | PhoneNum |
| Signature | 2021-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RHONDA F SKILES | PreparerPersonNm |
| PTIN | P00174702 | PTIN |
| Phone | 3362944494 | PhoneNum |
| Preparation | 2021-08-11 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERRY MILLER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 WESTCHESTER DRIVE SUITE 400 | AddressLine1Txt |
| City | HIGH POINT | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27262 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,534,577 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PROVIDENCEPLACENC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO 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 Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 104 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,664,158 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,528,164 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$9,410 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,223 | CYInvestmentIncomeAmt |
| PY Other Revenue | $720 | PYOtherRevenueAmt |
| CY Other Revenue | $1,190 | CYOtherRevenueAmt |
| PY Total Revenue | $4,655,468 | PYTotalRevenueAmt |
| CY Total Revenue | $4,534,577 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,667,693 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,722,145 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,613,146 | PYOtherExpensesAmt |
| CY Other Expenses | $2,679,082 | CYOtherExpensesAmt |
| PY Total Expenses | $4,280,839 | PYTotalExpensesAmt |
| CY Total Expenses | $4,401,227 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $374,629 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $133,350 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,401,668 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,693,921 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,659,368 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,535,514 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$257,700 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $158,407 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,507,693 | ExpenseAmt |
| Revenue | $4,529,354 | RevenueAmt |
| Desc | PROVIDING 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, 2020, 103 RESIDENTS WERE SERVED BY THE ASSISTED LIVING FACILITY. | Desc |
| Total Program Service Expenses | $3,507,693 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 104 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERRY MILLER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3368884560 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 WESTCHESTER DRIVE SUITE 400 | AddressLine1Txt |
| City | HIGH POINT | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27262 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| ED WINSLOW | |||||||
| DIRECTOR | 3.14 | Yes (X) | $0 | $0 | $0 | ||
| TIM FARLOW | |||||||
| DIRECTOR | 3.14 | Yes (X) | $0 | $0 | $0 | ||
| CRAIG DUNN | |||||||
| DIRECTOR | 3.14 | Yes (X) | $0 | $0 | $0 | ||
| KIM JOHNSON | |||||||
| CHAIR | 3.14 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ROGER RICHARDSON | |||||||
| DIRECTOR | 3.14 | Yes (X) | $0 | $0 | $0 | ||
| TERRY MILLER | |||||||
| PRESIDENT/CEO | 4.00 | Yes (X) | $0 | $138,337 | $1,068 | Yes (X) | 12.00 |
| PENNY CATES | |||||||
| SECRETARY/TREASURER | 3.14 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BARRY YATES | |||||||
| CFO | 5.00 | $18,805 | $75,220 | $11,944 | Yes (X) | 20.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $18,805 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $213,557 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $13,012 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULINARY SERVICES GROUP LLC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1135 BUSINESS PARKWAY S 10 | AddressLine1Txt |
| City | WESTMINSTER | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21157 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | FOOD SERVICE | ServicesDesc |
| Compensation | $523,397 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ROOM AND BOARD | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $4,528,164 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,528,164 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,528,164 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,223 | TotalRevenueColumnAmt |
| Exclusion | $5,223 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $1,190 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,190 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,190 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,534,577 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,529,354 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $5,223 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,805 | TotalAmt |
| Management And General | $18,805 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,495,337 | TotalAmt |
| Program Services | $983,798 | ProgramServicesAmt |
| Management And General | $511,539 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,423 | TotalAmt |
| Program Services | $49,296 | ProgramServicesAmt |
| Management And General | $21,127 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,580 | TotalAmt |
| Program Services | $96,306 | ProgramServicesAmt |
| Management And General | $41,274 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,690 | TotalAmt |
| Management And General | $271,690 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,576 | TotalAmt |
| Management And General | $3,576 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,500 | TotalAmt |
| Management And General | $14,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,722 | TotalAmt |
| Program Services | $24,112 | ProgramServicesAmt |
| Management And General | $8,610 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,019 | TotalAmt |
| Program Services | $7,019 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,010 | TotalAmt |
| Program Services | $25,010 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,699 | TotalAmt |
| Program Services | $52,699 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,330 | TotalAmt |
| Program Services | $140,330 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,247 | TotalAmt |
| Program Services | $2,247 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475,552 | TotalAmt |
| Program Services | $475,552 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $337,082 | TotalAmt |
| Program Services | $337,082 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,685 | TotalAmt |
| Program Services | $93,685 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PATIENT EXPENSES | $844,717 | $844,717 |
| MISCELLANOUS | $222,532 | $222,532 |
| REPAIRS AND MAINTENANCE | $125,108 | $125,108 |
| BAD DEBT | $28,200 | $28,200 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,413 | TotalAmt |
| Management And General | $2,413 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,401,227 | TotalAmt |
| Program Services | $3,507,693 | ProgramServicesAmt |
| Management And General | $893,534 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,593 | BOYAmt |
| EOY | $1,005,538 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000 | BOYAmt |
| EOY | $1,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,670 | BOYAmt |
| EOY | $84,126 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,524 | BOYAmt |
| EOY | $21,355 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,534,174 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,036,841 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,817,628 | BOYAmt |
| EOY | $5,497,333 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,821 | BOYAmt |
| EOY | $68,071 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $707,432 | BOYAmt |
| EOY | $16,498 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,401,668 | BOYAmt |
| EOY | $6,693,921 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,494 | BOYAmt |
| EOY | $148,768 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,762 | BOYAmt |
| EOY | $96,791 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,322,631 | BOYAmt |
| EOY | $6,257,532 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,481 | BOYAmt |
| EOY | $32,423 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,659,368 | BOYAmt |
| EOY | $6,535,514 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$257,700 | BOYAmt |
| EOY | $158,407 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$257,700 | BOYAmt |
| EOY | $158,407 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,401,668 | BOYAmt |
| EOY | $6,693,921 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $133,350 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $282,757 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,372,190 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,007,609 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,244,312 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,664,878 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,529,354 | CurrentTaxYearAmt |
| Total | $21,818,343 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,372,190 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,007,609 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,244,312 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,664,878 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,529,354 | CurrentTaxYearAmt |
| Total | $21,818,343 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $21,818,343 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $624 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,125 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,287 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,648 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,223 | CurrentTaxYearAmt |
| Total | $11,907 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $624 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,125 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,287 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,648 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,223 | CurrentTaxYearAmt |
| Total | $11,907 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,372,814 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,009,734 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,245,599 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,667,526 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,534,577 | CurrentTaxYearAmt |
| Total | $21,830,250 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99950 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99970 | PublicSupportPY509Pct |
| Investment Income CY | 0.00050 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00030 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,218,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,218,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,359,050 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,192,733 | DepreciationAmt |
| Book Value | $4,166,317 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $957,124 | OtherCostOrOtherBasisAmt |
| Depreciation | $844,108 | DepreciationAmt |
| Book Value | $113,016 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,497,333 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE PAYABLE | $19,185 |
| FUNDS HELD IN TRUST - RESIDENTS | $13,238 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $32,423 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,817,334 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $282,757 | OtherRevenueAmt |
| Revenue Not Reported | $282,757 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,534,577 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,534,577 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,401,227 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,401,227 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,401,227 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2020 AND 2019. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PPP LOAN FORGIVENESS RECORDED AS REVENUE IN THE FINANCIAL STATEMENTS 282,757. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | CERTAIN MANAGEMENT DUTIES WERE DELEGATED TO A RELATED 501(C)(3) ORGANIZATION: WESLEYAN ARMS, INC. (56-1012908). |
| FORM 990, PART VI, SECTION B, LINE 11B | PROVIDENCE 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 12C | ALL 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 15 | THE 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 19 | THE 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 FOR FINANCIAL STATEMENT PURPOSES 282,757. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| WESLEYAN ARMS INC | ||||||||||
| 1701 WESTCHESTER DRIVE | HIGH POINT | NC | 27262 | 561012908 | ASSISTED LIVING | NC | 501(C)(3) | LINE 10 | N/A | 0 |
| PPRC NURSING HOME INC | ||||||||||
| 1795 WESTCHESTER DRIVE | HIGH POINT | NC | 27262 | 311733046 | NURSING HOME | NC | 501(C)(3) | LINE 10 | N/A | 0 |
| PPRC SENIOR LIVING I INC | ||||||||||
| 1795 WESTCHESTER DRIVE | HIGH POINT | NC | 27262 | 311733044 | INDEPENDENT LIVING | NC | 501(C)(3) | LINE 10 | N/A | 0 |
| PPRC SENIOR LIVING II INC | ||||||||||
| 1727 WESTCHESTER DRIVE | HIGH POINT | NC | 27262 | 300113709 | INDEPENDENT LIVING | NC | 501(C)(3) | LINE 10 | N/A | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTCHESTER CHRISTIAN CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 WESTCHESTER DRIVE | AddressLine1Txt |
| City | HIGH POINT | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27262 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561963673 | EIN |
| Primary Activities | ACQUISITION, IMPROVEMENT, MAINTENANCE, LEASING OF PROPERTY | PrimaryActivitiesTxt |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTCHESTER CHRISTIAN CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | D | TransactionTypeTxt |
| Involved | $208,238 | InvolvedAmt |
| Method Of Amount Determination | CASH PAID | MethodOfAmountDeterminationTxt |