WILLIAMSPORT HOME: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WILLIAMSPORT HOME (EIN 24-0795507)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202213189349303736
- Schema version
- 2021v4.2
- 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 | 2022-11-14T06:59:38-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 COMMERCE PARK DR | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240795507 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE WILLIAMSPORT HOME | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WILL | BusinessNameControlTxt |
| Phone | 5703238781 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 RAVINE ROAD | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DONALD S POTE | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 5703238781 | PhoneNum |
| Signature | 2022-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DONALD | PersonFirstNm |
| Person Last | POTE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAIME L KUNTZ CPA | PreparerPersonNm |
| PTIN | P01272711 | PTIN |
| Phone | 5703236023 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DONALD S POTE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 RAVINE ROAD | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,949,472 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | THEWILLIAMSPORTHOME.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1873 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 334 | TotalEmployeeCnt |
| Total Volunteers | 42 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,273,900 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,124,768 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,405,539 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,938,015 | CYProgramServiceRevenueAmt |
| PY Investment Income | $833,271 | PYInvestmentIncomeAmt |
| CY Investment Income | -$250,437 | CYInvestmentIncomeAmt |
| PY Other Revenue | $595,291 | PYOtherRevenueAmt |
| CY Other Revenue | $96,478 | CYOtherRevenueAmt |
| PY Total Revenue | $19,108,001 | PYTotalRevenueAmt |
| CY Total Revenue | $17,908,824 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $600 | 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 | $10,961,892 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,340,112 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,393,637 | PYOtherExpensesAmt |
| CY Other Expenses | $7,823,122 | CYOtherExpensesAmt |
| PY Total Expenses | $19,356,129 | PYTotalExpensesAmt |
| CY Total Expenses | $18,163,234 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$248,128 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$254,410 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,027,195 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,816,206 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,466,929 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,217,317 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,560,266 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,598,889 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE THE HIGHEST QUALITY OF CARE TO OUR RESIDENTS WHILE HONORING THEIR INDEPENDENCE AND DIGNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,270,325 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $15,938,015 | RevenueAmt |
| Desc | THE WILLIAMSPORT HOME (THE HOME) OPERATES A 129-BED SKILLED NURSING AND REHABILITATION CENTER, 2 LICENSED PERSONAL CARE PROGRAMS AND 179 INDEPENDENT LIVING APARTMENTS WHICH SERVE MEN AND WOMEN. THE HOME ALSO OPERATES A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) PROVIDING HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO ELDERLY RESIDENTS. THE HOME WAS APPROVED TO PROVIDE CONGREGATE MEALS, TRANSPORTATION AND ASSISTANCE TO APARTMENT RESIDENTS BY THE DEPARTMENT OF HEALTH AS A HOME CARE PROVIDER ON APRIL 1, 2011.DURING 2021, THE HOME PROVIDED 39,208 DAYS OF NURSING SERVICES TO RESIDENTS; 51,288 DAYS OF HOUSING TO RESIDENTS IN INDEPENDENT APARTMENTS; AND 7,936 DAYS IN OUR DHS LICENSED PERSONAL CARE PROGRAMS. CONTINUED ON SCHEDULE OOUR PROGRAMS ARE DESIGNED TO HELP MAINTAIN OUR RESIDENT'S HEALTH, SECURITY AND INDEPENDENCE.THE HOME PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOME DOES NOT PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUES. THE HOME PROVIDED APPROXIMATELY $34,000 OF CHARITY CARE DURING 2021. ADDITIONALLY, THE HOME PROVIDES SERVICES TO MEDICAL ASSISTANCE BENEFICIARIES AND IS REIMBURSED AT RATES DIFFERENT FROM STANDARD ROOM CHARGES. THE TOTAL DIFFERENCES RELATED TO THESE SERVICES WERE APPROXIMATELY$2,500,000 IN 2021.VOLUNTEERING:42 INDIVIDUALS VOLUNTEERED 1,864 HOURS OF SERVICE TO THE WILLIAMSPORT HOME DURING 2021.ADULT VOLUNTEERS PROVIDED 1,050 HOURS TO RESIDENTS IN THE SKILLED NURSING CENTER BY ASSISTING WITH DELIVERY OF RESIDENT MAIL, NEWSPAPERS, READING OR WRITING LETTERS, READING BOOKS. VOLUNTEERS ALSO PACKAGED 3 PLY MASKS IN SANITARY BAGS FOR STAFF AND VISITORS TO ASUUR NON-EXPOSED MASKS WHERE AVAILALBE TO WEAR WHEN VISTING OR WORKING IN BUILDING. IN ADDITION, VOLUNTEERS ASSEMBLED COVID TESTING SUPPLIES IN SANITARY BAGS FOR STAFF COVID TESTING.TEN STUDENTS FROM THE JERSEY SHORE HIGH SCHOOL, FUTURE BUSINESS LEADERS OF AMERICA, PURCHASED AND DONATED TWH RESIDENTS GAMES SUCH AS CARDS, PUZZLES, AND GAMEBOARDS TO OCCUPY RESIDENT TIME. THEY ALSO DONTATED A NOON MEAL TO ALL WORKING STAFF IN THE SKILLED NURSING UNIT. 21 APARTMENT RESIDENTS VOLUNTEERED 423.50 HOURS TO ASSIST WITH SETTING AND CLEARING APARTMENT DINING ROOM TABLES DAILY AND/OR ASSISTED WITH MANAGING APARTMENT STORES IN EACH APARTMENT BUILDING.THE WILLIAMSSPORT HOME IS GOVERNED BY AN ALL VOLUNTEER BOARD WHO, DURING 2021, PROVIDED 390.5 HOURS OF SERVICE TO THE WILLIAMSPORT HOME BY ATTENDING BOARD MEETINGS, BOARD SUBCOMMITTEE MEETINGS OR RESIDENT/STAFF MEETINGS. BOARD MEMBERS DONATED NOT ONLY THEIR TIME BUT ALSO RESOUCRES TO PROVIDE INDIVIDUALLY WRAPPED CANDY, FOOR OR SNACK ITEMS FOR STAFF NURISHMENT DURING BREAKS AND FOR STAFF TO ENJOY WHILE ENTERING/LEAVING BUILDING. | Desc |
| Total Program Service Expenses | $16,270,325 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | 0 | 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 | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | 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 | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 334 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | Yes (1) | 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 |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHLEY BOGART | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703238781 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 RAVINE ROAD | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| SHARON ATHERHOLT | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CANDACE DEWAR | |||||||
| VICE-PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRETTE CONFAIR | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SUSAN EVANS | |||||||
| TREASURER (4/27/21-9/28/21) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MAUREEN CAREY | |||||||
| TREASURER (2/23/21-4/27/21) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TERRY KREZMER | |||||||
| TREASURER (UNTIL 2/23/21) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RENEE LAYCHUR | |||||||
| TREASURER (AS OF 9/28/21) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ELVIRA ANDERSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAURIE BARCLAY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HIEN CONNOLLY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WINONA KREMSER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHLEEN PAGANA | |||||||
| DIRECTOR (AS OF 4/27/21) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CATHERINE PICCOLO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PATRICIA SHIPMAN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BETH STUBLER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHRYN NASSBERG | |||||||
| DIRECTOR (UNTIL 4/2021) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| VERA ANDERSON | |||||||
| DIRECTOR (UNTIL 4/2021) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DONALD S POTE | |||||||
| EXEC. DIRECTOR (NHA 10/1/21-10/31/21) | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMMY SHEEHAN | |||||||
| ASSISTANT DIRECTOR (AS OF 11/1/21) | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER CISNEROS | |||||||
| ASSISTANT DIRECTOR (UNTIL 9/30/21) | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| EVELYN F PARENT | |||||||
| REGISTERED NURSE | 49.10 | $139,999 | $0 | $1,137 | Yes (X) | ||
| SUSAN R HOOKER | |||||||
| REGISTERED NURSE | 65.50 | $151,753 | $0 | $5,311 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $291,752 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $6,448 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,085,764 | GovernmentGrantsAmt |
| All Other Contributions | $39,004 | AllOtherContributionsAmt |
| Total Contributions | $2,124,768 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 623000 | $12,538,906 | $12,538,906 |
| APARTMENT REVENUE | 623000 | $3,399,109 | $3,399,109 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,938,015 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $140,442 | TotalRevenueColumnAmt |
| Exclusion | $140,442 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $649,769 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,040,648 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$390,879 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$390,879 | TotalRevenueColumnAmt |
| Exclusion | -$390,879 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CABLE TV SERVICES FOR RESIDENTS | 517000 | $57,400 | $57,400 |
| BEAUTY/BARBER SHOP REVENUE | 812900 | $6,933 | $6,933 |
| TRANSPORTATION FOR RESIDENTS | 480000 | $5,727 | $5,727 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,418 | TotalRevenueColumnAmt |
| Exclusion | $26,418 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $96,478 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,908,824 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,938,015 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$153,959 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,483,496 | TotalAmt |
| Program Services | $8,058,326 | ProgramServicesAmt |
| Management And General | $425,170 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,663 | TotalAmt |
| Program Services | $53,050 | ProgramServicesAmt |
| Management And General | $3,613 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,201,434 | TotalAmt |
| Program Services | $1,162,514 | ProgramServicesAmt |
| Management And General | $38,920 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,519 | TotalAmt |
| Program Services | $565,235 | ProgramServicesAmt |
| Management And General | $33,284 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $426,589 | TotalAmt |
| Program Services | $28,629 | ProgramServicesAmt |
| Management And General | $397,960 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,081 | TotalAmt |
| Management And General | $16,081 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,620 | TotalAmt |
| Program Services | $100 | ProgramServicesAmt |
| Management And General | $51,520 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,182,211 | TotalAmt |
| Program Services | $1,883,599 | ProgramServicesAmt |
| Management And General | $298,612 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,173 | TotalAmt |
| Program Services | $48,579 | ProgramServicesAmt |
| Management And General | $594 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,597,912 | TotalAmt |
| Program Services | $1,369,287 | ProgramServicesAmt |
| Management And General | $228,625 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $591,003 | TotalAmt |
| Program Services | $591,003 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,517 | TotalAmt |
| Program Services | $39,346 | ProgramServicesAmt |
| Management And General | $14,171 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,023 | TotalAmt |
| Program Services | $73,023 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,259,322 | TotalAmt |
| Program Services | $1,259,322 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $386,932 | TotalAmt |
| Program Services | $138,352 | ProgramServicesAmt |
| Management And General | $248,580 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $251,030 | $251,030 | |
| NURSING HOME ASSESSMENT | $218,405 | $218,405 | |
| REPAIRS & MAINTENANCE | $174,889 | $123,750 | $51,139 |
| BAD DEBT EXPENSE | $109,690 | $109,690 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $381,725 | TotalAmt |
| Program Services | $297,085 | ProgramServicesAmt |
| Management And General | $84,640 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,163,234 | TotalAmt |
| Program Services | $16,270,325 | ProgramServicesAmt |
| Management And General | $1,892,909 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500 | BOYAmt |
| EOY | $500 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,290,827 | BOYAmt |
| EOY | $2,013,250 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,608 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $998,498 | BOYAmt |
| EOY | $1,063,804 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,725 | BOYAmt |
| EOY | $28,232 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,382 | BOYAmt |
| EOY | $78,801 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $35,780,721 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,825,025 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,666,820 | BOYAmt |
| EOY | $9,955,696 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,314,406 | BOYAmt |
| EOY | $8,187,325 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $607,429 | BOYAmt |
| EOY | $488,598 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,027,195 | BOYAmt |
| EOY | $21,816,206 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,940,023 | BOYAmt |
| EOY | $1,490,141 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,176 | BOYAmt |
| EOY | $12,233 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,589,830 | BOYAmt |
| EOY | $2,363,215 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,909,900 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $351,728 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,466,929 | BOYAmt |
| EOY | $4,217,317 | 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 | $16,435,360 | BOYAmt |
| EOY | $17,473,983 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,906 | BOYAmt |
| EOY | $124,906 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,560,266 | BOYAmt |
| EOY | $17,598,889 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,027,195 | BOYAmt |
| EOY | $21,816,206 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$254,410 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,293,033 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $126,428 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $443,662 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $52,157 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,273,900 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,124,768 | CurrentTaxYearAmt |
| Total | $4,020,915 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,110,361 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,276,146 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,599,559 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,918,039 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,938,015 | CurrentTaxYearAmt |
| Total | $84,842,120 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,236,789 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,719,808 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,651,716 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,191,939 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,062,783 | CurrentTaxYearAmt |
| Total | $88,863,035 | 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 | $88,863,035 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $155,135 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $136,462 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $185,653 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $115,653 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $140,442 | CurrentTaxYearAmt |
| Total | $733,345 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $155,135 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $136,462 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $185,653 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $115,653 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $140,442 | CurrentTaxYearAmt |
| Total | $733,345 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $101,231 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $115,439 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $137,193 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $82,791 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $96,478 | CurrentTaxYearAmt |
| Total | $533,132 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,493,155 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,971,709 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,974,562 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,390,383 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,299,703 | CurrentTaxYearAmt |
| Total | $90,129,512 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98590 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98590 | PublicSupportPY509Pct |
| Investment Income CY | 0.00810 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00800 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | EMPLOYEE AND GUEST MEALS - 2017 AMOUNT: $ 6,148. 2018 AMOUNT: $ 5,654. 2019 AMOUNT: $ 6,151. 2020 AMOUNT: $ 1,888. 2021 AMOUNT: $ 735. LAUNDRY SERVICES - 2017 AMOUNT: $ 257. BEAUTY/BARBER SHOP REVENUE - 2017 AMOUNT: $ 33,230. 2018 AMOUNT: $ 32,602. 2019 AMOUNT: $ 29,949. 2020 AMOUNT: $ 6,432. 2021 AMOUNT: $ 6,933. CABLE TV SERVICES FOR RESIDENTS - 2017 AMOUNT: $ 51,870. 2018 AMOUNT: $ 51,689. 2019 AMOUNT: $ 57,646. 2020 AMOUNT: $ 60,620. 2021 AMOUNT: $ 57,400. CONCESSION/VENDING - 2017 AMOUNT: $ -5,867. 2018 AMOUNT: $ 259. 2019 AMOUNT: $ 7. 2020 AMOUNT: $ -5,485. 2021 AMOUNT: $ 1,355. TRANSPORTATION FOR RESIDENTS - 2017 AMOUNT: $ 3,307. 2018 AMOUNT: $ 2,091. 2019 AMOUNT: $ 2,298. 2020 AMOUNT: $ 4,444. 2021 AMOUNT: $ 5,727. OTHER INCOME - 2017 AMOUNT: $ 12,286. 2018 AMOUNT: $ 23,144. 2019 AMOUNT: $ 38,164. 2020 AMOUNT: $ 14,549. 2021 AMOUNT: $ 24,328. PROFESSIONAL WELLNESS - 2019 AMOUNT: $ 2,978. 2020 AMOUNT: $ 343. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $796,206 | OtherCostOrOtherBasisAmt |
| Book Value | $796,206 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,720,502 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,339,496 | DepreciationAmt |
| Book Value | $7,381,006 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,305,547 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,312,337 | DepreciationAmt |
| Book Value | $993,210 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,958,466 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,173,192 | DepreciationAmt |
| Book Value | $785,274 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,955,696 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE LIABILITY | $40,561 |
| DEFERRED GRANT REVENUE | $311,167 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $351,728 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $19,201,857 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,293,033 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $1,293,033 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,908,824 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,908,824 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,163,234 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $18,163,234 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,163,234 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUSAN R HOOKER | PersonNm |
| Title | REGISTERED NURSE | TitleTxt |
| Base Compensation Filing Org | $151,753 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $5,311 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $157,064 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 236760375 | BondIssuerEIN |
| Bond Issued | 2013-04-12 | BondIssuedDt |
| Issue Price | $4,400,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,998,482 | RetiredAmt |
| Total Proceeds | $4,400,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $43,739 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $4,356,261 | CapitalExpendituresAmt |
| Substantial Completion | 2015 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART 1, BOND ISSUES: | FormAndLineReferenceDesc |
| Explanation | (A) ISSUER NAME: LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 (F) DESCRIPTION OF PURPOSE: DESIGN, CONSTRUCTION, AND EQUIPPING OF REHABILITATION UNIT | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOME UTILIZES THE MANAGEMENT SERVICES OF AFFINITY HEALTHCARE SERVICES. AFFINITY EMPLOYS DONALD S. POTE, EXECUTIVE DIRECTOR ($147,957) JENNIFER CISNEROS, ASSISTANT DIRECTOR (UNTIL AUG 2021)($121,546) AND TAMMY SHEEHAN, ASSISTANT DIRECTOR (AS OF NOV 2021) ($8,045). |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FINANCE COMMITEE OF THE WILLIAMSPORT HOME BOARD OF MANAGERS REVIEWED THE FORM 990 IN DETAIL DURING A REGULARLY SCHEDULED FINANCE MEETING. THE FORM 990 WAS ALSO REVIEWED AND OPENED FOR QUESTION/DISCUSSION AT THE GENERAL BOARD MEETING PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS AND MEMBERS OF MANAGEMENT MUST COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. ALL QUESTIONNAIRES ARE REVIEWED BY THE EXECUTIVE DIRECTOR AND MAINTAINED ON FILE. BOARD DIRECTORS WITH POTENTIAL CONFLICTS ARE REQUIRED TO ABSTAIN FROM VOTING ON MATTERS RELATED TO THE CONFLICT AND COULD BE REMOVED FROM THE BOARD IF THE CONFLICT IS SIGNIFICANT. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE EXECUTIVE DIRECTOR AND ALL EMPLOYEES IS CALCULATED BY MANAGEMENT AND THE MANAGEMENT COMPANY, AFFINITY HEALTH SERVICES. MANAGEMENT AND AFFINITY USE DATA FROM LEADING AGE PA AND WAGE/SALARY SURVEYS FROM THE REGION TO COMPARE ORGANIZATIONAL WAGES TO LOCAL AND REGIONAL COMPETITION AS WELL AS OTHER LOCAL MARKETS. THE BOARD OF MANAGERS APPROVES ALL STAFF COMPENSATION (INCLUDING THE EXECUTIVE DIRECTOR AND MANAGEMENT) AT THE TIME THE OPRATING BUDGET IS APROVED. MANAGEMENT DESCRIBES IN DETAIL THE SALARY INCREASES FOR ALL STAFF DURING THE OPERATING BUDGET REVIEW WITH THE BOARD AND THE BOARD APPROVES THE BUDGET AND INCLUDED INCREASES. THE REVIEW AND APPROVAL IS DOCUMENTED VIA BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | THERAPY AND ANCILLARY SERVICES: PROGRAM SERVICE EXPENSES 1,070,613. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,070,613. NURSING: PROGRAM SERVICE EXPENSES 457,596. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 457,596. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 318,227. MANAGEMENT AND GENERAL EXPENSES 2,464. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 320,691. CONSULTANTS: PROGRAM SERVICE EXPENSES 37,163. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,163. CONTRACTORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 296,148. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 296,148. |
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