2022-11-14T06:59:38-06:00 2021-12-31 390859910 BAKER TILLY US LLP 1000 COMMERCE PARK DR WILLIAMSPORT PA 17701 990 2021-01-01 240795507 THE WILLIAMSPORT HOME WILL 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 DONALD S POTE EXECUTIVE DIRECTOR 5703238781 2022-11-10 1 DONALD POTE 999009999 JAIME L KUNTZ CPA P01272711 5703236023 X 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DONALD S POTE 1900 RAVINE ROAD WILLIAMSPORT PA 17701 18949472 0 X THEWILLIAMSPORTHOME.COM X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 13 13 334 42 0 0 1273900 2124768 16405539 15938015 833271 -250437 595291 96478 19108001 17908824 600 0 0 0 10961892 10340112 0 0 0 8393637 7823122 19356129 18163234 -248128 -254410 23027195 21816206 6466929 4217317 16560266 17598889 X TO PROVIDE THE HIGHEST QUALITY OF CARE TO OUR RESIDENTS WHILE HONORING THEIR INDEPENDENCE AND DIGNITY. 0 0 16270325 0 15938015 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. 16270325 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 16 0 334 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X ASHLEY BOGART 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 SHARON ATHERHOLT PRESIDENT 1.00 X X 0 0 0 CANDACE DEWAR VICE-PRESIDENT 1.00 X X 0 0 0 BRETTE CONFAIR SECRETARY 1.00 X X 0 0 0 SUSAN EVANS TREASURER (4/27/21-9/28/21) 1.00 X X 0 0 0 MAUREEN CAREY TREASURER (2/23/21-4/27/21) 1.00 X 0 0 0 TERRY KREZMER TREASURER (UNTIL 2/23/21) 1.00 X X 0 0 0 RENEE LAYCHUR TREASURER (AS OF 9/28/21) 1.00 X X 0 0 0 ELVIRA ANDERSON DIRECTOR 1.00 X 0 0 0 LAURIE BARCLAY DIRECTOR 1.00 X 0 0 0 HIEN CONNOLLY DIRECTOR 1.00 X 0 0 0 WINONA KREMSER DIRECTOR 1.00 X 0 0 0 KATHLEEN PAGANA DIRECTOR (AS OF 4/27/21) 1.00 X 0 0 0 CATHERINE PICCOLO DIRECTOR 1.00 X 0 0 0 PATRICIA SHIPMAN DIRECTOR 1.00 X 0 0 0 BETH STUBLER DIRECTOR 1.00 X 0 0 0 KATHRYN NASSBERG DIRECTOR (UNTIL 4/2021) 1.00 X 0 0 0 VERA ANDERSON DIRECTOR (UNTIL 4/2021) 1.00 X 0 0 0 DONALD S POTE EXEC. DIRECTOR (NHA 10/1/21-10/31/21) 40.00 X 0 0 0 TAMMY SHEEHAN ASSISTANT DIRECTOR (AS OF 11/1/21) 40.00 X 0 0 0 JENNIFER CISNEROS ASSISTANT DIRECTOR (UNTIL 9/30/21) 40.00 X 0 0 0 EVELYN F PARENT REGISTERED NURSE 49.10 X 139999 0 1137 SUSAN R HOOKER REGISTERED NURSE 65.50 X 151753 0 5311 291752 0 6448 2 0 1 0 0 2085764 39004 2124768 PATIENT SERVICE REVENUE 623000 12538906 12538906 APARTMENT REVENUE 623000 3399109 3399109 15938015 140442 140442 649769 1040648 -390879 -390879 -390879 CABLE TV SERVICES FOR RESIDENTS 517000 57400 57400 BEAUTY/BARBER SHOP REVENUE 812900 6933 6933 TRANSPORTATION FOR RESIDENTS 480000 5727 5727 26418 26418 96478 17908824 15938015 0 -153959 X 8483496 8058326 425170 56663 53050 3613 1201434 1162514 38920 598519 565235 33284 426589 28629 397960 16081 16081 51620 100 51520 2182211 1883599 298612 49173 48579 594 1597912 1369287 228625 591003 591003 53517 39346 14171 73023 73023 1259322 1259322 386932 138352 248580 MEDICAL SUPPLIES 251030 251030 NURSING HOME ASSESSMENT 218405 218405 REPAIRS & MAINTENANCE 174889 123750 51139 BAD DEBT EXPENSE 109690 109690 381725 297085 84640 18163234 16270325 1892909 0 500 500 3290827 2013250 6608 0 998498 1063804 39725 28232 102382 78801 35780721 25825025 10666820 9955696 7314406 8187325 607429 488598 23027195 21816206 1940023 1490141 27176 12233 2589830 2363215 1909900 0 0 351728 6466929 4217317 X 16435360 17473983 124906 124906 16560266 17598889 23027195 21816206 -254410 1293033 0 X 0 1 X 1 0 X 126428 443662 52157 1273900 2124768 4020915 17110361 17276146 17599559 16918039 15938015 84842120 17236789 17719808 17651716 18191939 18062783 88863035 0 0 0 88863035 155135 136462 185653 115653 140442 733345 155135 136462 185653 115653 140442 733345 101231 115439 137193 82791 96478 533132 17493155 17971709 17974562 18390383 18299703 90129512 0.98590 0.98590 0.00810 0.00800 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 796206 796206 25720502 18339496 7381006 6305547 5312337 993210 2958466 2173192 785274 9955696 CAPITAL LEASE LIABILITY 40561 DEFERRED GRANT REVENUE 311167 351728 19201857 1293033 1293033 17908824 0 17908824 18163234 0 18163234 0 18163234 X X 0 0 0 0 0 0 0 0 0 SUSAN R HOOKER REGISTERED NURSE 151753 0 0 0 0 0 5311 0 0 0 157064 0 0 0 A LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 236760375 2013-04-12 4400000 SEE PART VI 0 0 0 A 1998482 4400000 43739 4356261 2015 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 SCHEDULE K, PART 1, BOND ISSUES: (A) ISSUER NAME: LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 (F) DESCRIPTION OF PURPOSE: DESIGN, CONSTRUCTION, AND EQUIPPING OF REHABILITATION UNIT 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.