2021-08-16T15:56:28-05:00 2020-09-30 560571159 BERNARD ROBINSON & COMPANY LLP PO BOX 19608 GREENSBORO NC 274199608 990 2019-10-01 273481562 PROVIDENCE PLACE ASSISTED LIVING INC PROV 3368884561 1701 WESTCHESTER DRIVE SUITE 400 HIGH POINT NC 27262 TERRY MILLER PRESIDENT/CEO 3368884561 2021-08-12 1 RHONDA F SKILES P00174702 3362944494 2021-08-11 2019 2022-09-23 18:48:47Z TERRY MILLER 1701 WESTCHESTER DRIVE SUITE 400 HIGH POINT NC 27262 4534577 0 X WWW.PROVIDENCEPLACENC.COM X 2010 NC 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. 7 6 104 0 0 0 0 0 4664158 4528164 -9410 5223 720 1190 4655468 4534577 0 0 0 0 1667693 1722145 0 0 0 2613146 2679082 4280839 4401227 374629 133350 7401668 6693921 7659368 6535514 -257700 158407 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. 0 0 3507693 4529354 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. 3507693 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 1 104 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X TERRY MILLER 3368884560 1701 WESTCHESTER DRIVE SUITE 400 HIGH POINT NC 27262 ED WINSLOW DIRECTOR 3.14 X 0 0 0 TIM FARLOW DIRECTOR 3.14 X 0 0 0 CRAIG DUNN DIRECTOR 3.14 X 0 0 0 KIM JOHNSON CHAIR 3.14 X X 0 0 0 ROGER RICHARDSON DIRECTOR 3.14 X 0 0 0 TERRY MILLER PRESIDENT/CEO 4.00 12.00 X X 0 138337 1068 PENNY CATES SECRETARY/TREASURER 3.14 X X 0 0 0 BARRY YATES CFO 5.00 20.00 X 18805 75220 11944 18805 213557 13012 0 0 0 0 CULINARY SERVICES GROUP LLC 1135 BUSINESS PARKWAY S 10 WESTMINSTER MD 21157 FOOD SERVICE 523397 1 ROOM AND BOARD 623000 4528164 4528164 4528164 5223 5223 MISCELLANEOUS 623000 1190 1190 1190 4534577 4529354 0 5223 18805 18805 1495337 983798 511539 70423 49296 21127 137580 96306 41274 271690 271690 3576 3576 14500 14500 32722 24112 8610 7019 7019 25010 25010 52699 52699 140330 140330 2247 2247 475552 475552 337082 337082 93685 93685 PATIENT EXPENSES 844717 844717 MISCELLANOUS 222532 222532 REPAIRS AND MAINTENANCE 125108 125108 BAD DEBT 28200 28200 2413 2413 4401227 3507693 893534 0 699593 1005538 1000 1000 76670 84126 24524 21355 8534174 3036841 5817628 5497333 74821 68071 707432 16498 7401668 6693921 296494 148768 7762 96791 7322631 6257532 32481 32423 7659368 6535514 X -257700 158407 -257700 158407 7401668 6693921 X 133350 282757 X 0 1 X 0 0 X 4372190 4007609 4244312 4664878 4529354 21818343 4372190 4007609 4244312 4664878 4529354 21818343 0 0 0 21818343 624 2125 1287 2648 5223 11907 624 2125 1287 2648 5223 11907 4372814 4009734 4245599 4667526 4534577 21830250 0.99950 0.99970 0.00050 0.00030 X 1218000 1218000 6359050 2192733 4166317 957124 844108 113016 5497333 CAPITAL LEASE PAYABLE 19185 FUNDS HELD IN TRUST - RESIDENTS 13238 32423 X 4817334 282757 282757 4534577 0 4534577 4401227 0 4401227 0 4401227 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. 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. 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 WESTCHESTER CHRISTIAN CENTER INC 1701 WESTCHESTER DRIVE HIGH POINT NC 27262 561963673 ACQUISITION, IMPROVEMENT, MAINTENANCE, LEASING OF PROPERTY NC N/A C 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 WESTCHESTER CHRISTIAN CENTER INC D 208238 CASH PAID