SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Pilgrims Senior Citizen HSG Corp
CO California Lutheran Homes
Employer identification number

95-2459415
Return Reference Explanation
Form 990, Part VI, SECTION A, Line 6 Members or Stockholders: California Lutheran Homes is the sole corporate member of the organization. Form 990, Part VI, SECTION A, Line 7a and 7b POWER TO APPOINT MEMBERS OF THE GOVERNING BODY: California Lutheran Homes has the power to appoint members of the organization's governing body and make governance decisions. Form 990, Part VI, SECTION B, Line 11b 990 Review Process: The Organization's governing body has delegated this function to the CEO. The return was duly reviewed before filing.
Form 990, Part VI, SECTION C, Line 19 Organization Documents Publicly Available: THE ORGANIZATION'S CEO IS THE CUSTODIAN OF GOVERNING DOCUMENTS AND FINANCIAL RECORDS AND UPON REQUEST CAN MAKE THEM AVAILABLE TO THE PUBLIC. THE ORGANIZATION FOLLOWS THE CONFLICT OF INTEREST POLICY OF ITS SOLE MEMBER WHO FOLLOWS ALL PUBLIC INSPECTION REQUIREMENTS.
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE BOARD MEMBERS ARE RESPONSIBLE FOR LETTING THE BOARD KNOW WHEN THERE MAY BE A CONFLICT. THE BOARD THEN TAKES APPROPRIATE MEASURES TO ENSURE THE CONFLICT OF INTEREST POLICY IS ADHERED TO.
FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: TRANSFER TO CALIFORNIA LUTHERAN HOMES ($996,568)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


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