2018-09-11T09:16:22-05:00 2017-12-31 540504608 BROWN EDWARDS & COMPANY LLP 124 NEWMAN AVENUE HARRISONBURG VA 22801 990 2017-01-01 550547603 PENDLETON MANOR INC PEND 3043582320 PO BOX 700 FRANKLIN WV 26807 GREG BOWERS PRESIDENT 3043582320 2018-08-28 1 JAMES R FRIES P01320612 5404346736 2018-08-21 206.248.228.130 2018-08-28 14:03:00 ED P CE530EA759AC3AF6BB0EECEF8950573E07121913 C6B7EFC27ADC1D591699B7D67A64703C90C79A72 2017 2018-06-14 16:35:46Z GREG BOWERS PO BOX 700 FRANKLIN WV 26807 8981913 0 X WWW.GOOD-SAM.COM/LOCATIONS/PENDLETON-MANOR X 1974 WV 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. 10 10 183 200 0 0 53193 55895 8627974 8923746 175 2272 0 0 8681342 8981913 0 0 0 0 4845155 4873752 0 0 2063 3383610 3730474 8228765 8604226 452577 377687 2489925 2239764 780747 609929 1709178 1629835 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 7174351 8923746 PROVIDE INTERMEDIATE AND SKILLED CARE NURSING SERVICES FOR ELDERLY PATIENTS; 91 BEDS AVAILABLE, 31,057 PATIENT DAYS PROVIDED. PROVIDING HOME HEALTH AND OUTPATIENT THERAPY SERVICES FOR THE COMMUNITY. 7174351 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 0 0 1 0 0 0 1 10 0 1 183 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 PRESIDENT 0.50 X X 0 0 0 WENDY SUESS VICE PRESIDENT 0.50 X X 0 0 0 MARSHALL HARPER TREASURER 0.50 X X 0 0 0 JUDY RADER SECRETARY 0.50 X X 0 0 0 KENNETH HARPER DIRECTOR 0.50 X 0 0 0 LYNN VANDEVANDER DIRECTOR 0.50 X 0 0 0 BYRON BLAND DIRECTOR 0.50 X 0 0 0 DYER ANDERSON DIRECTOR 0.50 X 0 0 0 GENE MCCONNELL DIRECTOR 0.50 X 0 0 0 CARA MITCHELL DIRECTOR 0.50 X 0 0 0 DAVID O'BOYLE ADMINISTRATOR 40.00 X 0 0 0 0 0 0 0 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FT SMITH AR 72902 THERAPY PROVIDER 864101 LANTZ CONSTRUCTION 539 S MAIN STREET BROADWAY VA 22815 CONTRACTOR SERVICES FOR WING REBUILD 700762 EVANGELICAL LUTHERAN GOOD SAMARITAN SOCI 4800 W 57 ST SIOUX FALLS SD 57108 MANAGEMENT SERVICES 399209 3 55895 55895 PATIENT SERVICE REVENU 623000 7626596 7626596 ANCILLARY SERVICES 623000 772738 772738 SPECIAL CARE SERVICES 623000 458583 458583 65829 65829 8923746 2272 2272 8981913 8923746 0 2272 X 3934181 3572307 361874 160265 147367 12898 490088 431596 58492 289218 263767 25451 461274 461274 140 140 21248 21248 1195367 1065715 129652 13914 443 11415 2056 48292 48292 438393 438393 12880 1503 11377 87030 87030 129996 129996 SUPPLIES 675660 665094 10566 TAXES AND LICENSES 321259 320134 1125 EQUIPMENT RENTAL & MAIN 113891 83344 30547 SERVICE CENTER SERVICES 59280 59280 151850 97658 54185 7 8604226 7174351 1427812 2063 100 100 630184 643159 1329204 1120688 34955 36620 36134 26426 1546389 1133908 446799 412481 12549 290 2489925 2239764 774155 600709 6592 9220 780747 609929 X 1696562 1611334 12616 18501 1709178 1629835 2489925 2239764 X 377687 -457030 X X 1 X 0 1 0 X 69220 73166 57620 53194 55895 309095 8509169 8656028 8810266 8567585 8857916 43400964 43015 51902 53405 60389 65829 274540 8621404 8781096 8921291 8681168 8979640 43984599 0 0 0 43984599 1517 718 2328 814 2273 7650 1517 718 2328 814 2273 7650 8622921 8781814 8923619 8681982 8981913 43992249 0.99980 0.99990 0.00020 0.00010 X 1412105 1007190 404915 134284 126718 7566 412481 RESIDENT TRUST FUNDS 9220 9220 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 11B 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. 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. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,065,715. MANAGEMENT AND GENERAL EXPENSES 129,652. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,195,367. FORM 990, PART XI, LINE 9: TRANSFER FROM PENDLETON VILLAGE, INC. -139,369. TRANSFER FROM THE PENDLETON, INC. -317,661. ROUNDING FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PENDLETON APARTMENTS INC PO BOX 700 FRANKLIN WV 26807 311130225 TO PROVIDE HOUSING TO ELDERLY PERSONS WV 501(C)(3) LINE 10 PENDLETON VILLAGE INC 0 PENDLETON VILLAGE INC PO BOX 700 FRANKLIN WV 26807 261339734 ACT AS MANAGEMENT COMPANY FOR THE OTHER ENTITIES WV 501(C)(3) LINE 12B, 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 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 THE PENDLETON INC K 217665 CASH THE PENDLETON INC B 317661 CASH