2022-11-15T09:19:10-06:00 2021-12-31 263753134 CBIZ MHM LLC 500 BOYLSTON STREET BOSTON MA 02116 990 2021-01-01 231945075 ELK HAVEN NURSING HOME ASSOCIATION ELKH 8148342618 785 JOHNSONBURG ROAD ST MARYS PA 15857 CHARLETTE GERG VICE PRESIDENT 8148342618 2022-11-10 1 CHARLETTE GERG 999009999 CHARLES N CICCONE P01274937 6177610600 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JUNE SORG 785 JOHNSONBURG ROAD ST MARYS PA 15857 11626212 0 X WWW.ELKHAVENNURSINGHOME.COM X 1967 PA PROVIDING LONG TERM NURSING CARE THROUGH A SKILLED NURSING FACILITY AND PERSONAL CARE UNIT. 5 5 235 47 0 0 1516171 2698564 9661954 8768648 564815 99959 54110 59041 11797050 11626212 0 0 0 0 7871766 7178969 0 0 0 3703785 3655181 11575551 10834150 221499 792062 12547514 11975645 2225894 988946 10321620 10986699 X OUR MISSION IS TO BE THE LEADING PROVIDER OF SPECIALIZED HEALTH CARE PROGRAMS, PRODUCTS AND SERVICES IN THE AREA. WE ARE COMMITTED TO QUALITY, DIGNITY, RESPECT AND HOSPITALITY IN OUR CUSTOMER SERVICE AND ACTIVE PARTICIPATION IN THE COMMUNITIES WE SERVE. EMPOWERED EMPLOYEES DRIVE OUR CUSTOMER RELATIONS AND CREATE AN ATMOSPHERE WHICH ENHANCES PERSONAL GROWTH, EXPANDS RESPONSIBILITY, MAXIMIZES CREATIVITY AND INSTILLS TRUST. WE BELIEVE IN CREATING VALUE FOR OUR CUSTOMERS. MEETING THEIR INDIVIDUAL AND COLLECTIVE NEEDS IS A SHARED RESPONSIBILITY AND THE STANDARD OF CONDUCT BY WHICH EACH OF US IS MEASURED. 0 0 9660915 8768648 ASSOCIATION OPERATES A 120-BED NURSING FACILITY AND A 40-UNIT PERSONAL CARE CENTER, PROVIDING HOUSING, HEALTH CARE AND OTHER RELATED SERVICES FOR THE RESIDENTS OF ELK COUNTY, PENNSYLVANIA. IN PROVIDING SERVICES, CERTAIN INDIVIDUALS ARE NOT DENIED SERVICES IN EXCESS OF THEIR MEANS. THE ESTIMATED COST OF PROVIDING CHARITY CARE IS APPROXIMATELY $889,383 FOR THE YEAR ENDED DECEMBER 31, 2021. 9660915 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 1 0 0 0 1 40 0 1 235 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 PA X X COMPLETE HEALTHCARE RESOURCES-EASTERN INC 2153285723 200 DRYDEN ROAD SUITE 2000 DRESHER PA 19025 ROBERT SCHRIEBER SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 JUNE SORG PRESIDENT 2.00 2.00 X X 0 0 0 FRANK BEIMEL BOARD MEMBER 2.00 2.00 X 0 0 0 CHARLETTE GERG VICE PRESIDENT 2.00 2.00 X X 0 0 0 LOU RADKOWSKI BOARD MEMBER 2.00 2.00 X 0 0 0 MARK JACOB SOLICITOR 2.00 2.00 X 0 0 0 ARLENE ANDERSON ADMINISTRATOR 38.00 2.00 X 116908 0 28392 BONITA STEELE RN 40.00 0.00 X 107284 0 13317 224192 0 41709 2 0 0 0 COMPLETE HEALTHCARE RESOURCES-EASTERN I 200 DRYDEN ROAD SUITE 3100 DRESHER PA 19025 MANAGEMENT SERVICES 588356 SELECT REHABILITATION PO BOX 71985 CHICAGO IL 60694 THERAPY SERVICES 581926 ST MARY'S PHARMACY 4 RAILROAD ST ST MARYS PA 15857 PHARMACY 216703 PENN HIGHLANDS - ELK 763 JOHNSONBURG ROAD SSAINT MARYS PA 15857 LABS 192028 4 124704 1984637 589223 2698564 RESIDENT SERVICE REVENUE 623000 8768648 8768648 8768648 89375 89375 10584 0 10584 10584 10584 FOOD REVENUE 900099 48270 48270 OTHER REVENUE 900099 10771 10771 59041 11626212 8768648 0 159000 145300 145300 5279378 5221679 57699 30811 30811 1332641 1311625 21016 390839 379234 11605 575133 575133 7158 2500 4658 43950 43950 839231 777231 62000 18860 2570 16290 99114 33342 65772 54399 959 53440 232499 232499 266 13 253 475181 431911 43270 140615 140615 SUPPLIES 598158 598158 0 PHYSICIAN FEES 312542 296023 16519 OTHER NURSING SERVICES 76867 74347 2520 OXYGEN 25056 25056 156152 128468 27684 10834150 9660915 1173235 0 2870244 2812543 417487 153049 790562 609569 122805 122123 15433064 10687770 5063490 4745294 3088675 3312862 194251 220205 12547514 11975645 683351 618459 29327 6911 1513216 363576 2225894 988946 X 10321620 10986699 10321620 10986699 12547514 11975645 792062 -126983 0 X 0 1 X 1 0 X 7287 18208 12906 1516171 2698564 4253136 10808697 10464934 10981274 9661954 8768648 50685507 10815984 10483142 10994180 11178125 11467212 54938643 0 0 0 54938643 474819 632287 435037 512985 89375 2144503 474819 632287 435037 512985 89375 2144503 49811 51574 69774 54110 59041 284310 11340614 11167003 11498991 11745220 11615628 57367456 0.95770 0.95070 0.03740 0.04430 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2017 AMOUNT: $ 12,370. 2018 AMOUNT: $ 15,904. 2019 AMOUNT: $ 35,527. 2020 AMOUNT: $ 10,323. 2021 AMOUNT: $ 10,771. FOOD REVENUE - 2017 AMOUNT: $ 37,441. 2018 AMOUNT: $ 35,670. 2019 AMOUNT: $ 34,247. 2020 AMOUNT: $ 43,787. 2021 AMOUNT: $ 48,270. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 44000 44000 11801469 7680492 4120977 263911 248101 15810 3041921 2510031 531890 281763 249146 32617 4745294 THIRD PARTY SETTLEMENTS 363576 363576 X 11412171 -126983 -126983 11539154 87058 87058 11626212 10747092 0 10747092 87058 87058 10834150 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE CODE AND THE COMMONWEALTH ACT OF MAY 5, 1933, KNOWN AS THE NONPROFIT ORGANIZATION LAW AND, ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. THE ORGANIZATION ACCOUNTS FOR THE EFFECT OF ANY UNCERTAIN TAX POSITIONS BASED ON A "MORE LIKELY THAN NOT" THRESHOLD APPLIED TO THE RECOGNITION OF THE TAX POSITIONS BEING SUSTAINED BASED ON THE TECHNICAL MERITS OF THE POSITION UNDER SCRUTINY BY THE APPLICABLE TAXING AUTHORITY. IF A TAX POSITION OR POSITIONS ARE DEEMED TO RESULT IN UNCERTAINTIES OF THOSE POSITIONS, THE UNRECOGNIZED TAX BENEFIT IS ESTIMATED BASED ON A "CUMULATIVE PROBABILITY ASSESSMENT" THAT AGGREGATES THE ESTIMATED TAX LIABILITY FOR ALL UNCERTAIN TAX POSITIONS. INTEREST AND PENALTIES ASSESSED, IF ANY, ARE ACCRUED AS INCOME TAX EXPENSE. THE ORGANIZATION HAS IDENTIFIED ITS TAX STATUS AS A TAX-EXEMPT ENTITY AS A TAX POSITION; HOWEVER, THE ORGANIZATION HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2018. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 87,058. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 87,058. FORM 990, PART VI, SECTION A, LINE 3 ELK HAVEN ENTERED INTO A MANAGEMENT AGREEMENT WITH COMPLETE HEALTHCARE RESOURCES - EASTERN, (CHRE) INC. TO PROVIDE FINANCIAL AND ACCOUNTING SERVICES AND SUPERVISE THE DAY-TO-DAY OPERATIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS SENT TO THE BOARD MEMBERS FOR REVIEW AND SIGNATURE PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE ANNUALLY. THE DISCLOSURES ARE REVIEWED ANNUALLY BY THE BOARD AND AS NEW CONFLICTS ARISE. FORM 990, PART VI, SECTION B, LINE 15A MARKET STUDIES ARE PERFORMED IN THE REGION TO DETERMINE THE APPROPRIATE LEVEL OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS WILL BE MADE AVAILABLE TO THE PUBLIC BASED UPON REQUEST. ELK HAVEN FOUNDATION 785 JOHNSONBURG ROAD ST MARYS PA 16127 841788081 SUPPORTING ORGANIZATION PA 501(C)(3) LINE 12B, II N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0