2021-11-13T11:30:59-06:00 2020-12-31 390859910 BAKER TILLY US LLP 1000 COMMERCE PARK DR WILLIAMSPORT PA 17701 990 2020-01-01 240795507 THE WILLIAMSPORT HOME WILL 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 DONALD S POTE EXECUTIVE DIRECTOR 5703238781 2021-11-12 1 DONALD POTE 999009999 JAIME L KUNTZ CPA P01272711 5703236023 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DONALD S POTE 1900 RAVINE ROAD WILLIAMSPORT PA 17701 21200983 0 X THEWILLIAMSPORTHOME.COM X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 14 14 332 115 0 0 52157 1273900 17092771 16405539 250259 833271 643981 595291 18039168 19108001 832 600 0 0 9982315 10961892 0 0 0 7668354 8393637 17651501 19356129 387667 -248128 21321737 23027195 4488497 6466929 16833240 16560266 X THE WILLIAMSPORT HOME HAS AS ITS MISSION TO PROVIDE ITS RESIDENTS WITH THE HIGHEST QUALITY OF CARE HONORING THEIR INDEPENDENCE AND DIGNITY. CONTINUED ON SCHEDULE "O".WE WILL REMAIN THE CAMPUS OF CHOICE IN OUR COMMUNITY COMPRISED OF DEDICATED STAFF WHO STRIVE TO PROVIDE QUALITY, COMPASSIONATE CARE, AND SERVICES TO OUR RESIDENTS. THE WILLIAMSPORT HOME VALUES ITS TRADITION OF CARING. OUR HIGHLY TRAINED STAFF ARE EMPOWERED TO SERVE RESIDENTS AND FAMILIES WITH PROFESSIONAL SERVICES, DELIVERED ON A CONTINUUM OF CARE CAMPUS WHILE MAINTAINING RESIDENT AND FAMILY SATISFACTION. 0 0 17487259 600 16918039 115 INDIVIDUALS VOLUNTEERED MORE THAN 2,256 HOURS OF SERVICE TO THE WILLIAMSPORT HOME DURING 2020.TWH SKILLED NURSING CENTER PROVIDED VOLUNTEER OPPORTUNITIES TO GROUPS FROM UNITED CHURCHES, THE SUSQUEHANNA CORVETTE CLUB, JERSEY SHORE SCHOOL DISTRICT FUTURE BUSINESS LEADERS OF AMERICA, THERAPY DOGS AND THE SPCA, WHO PROVIDED, PET THERAPY, MUSICAL ENTERTAINMENT AND PROGRAMMING SUPPORT TO SKILLED NURSING RESIDENTS AND EMPLOYEES.CONTINUED ON SCHEDULE O.THE SUSQUEHANNA CORVETTE CLUB COORDINATED A 25 CORVETTE AND OLD CAR DRIVE ESCORTED BY THEY LYCOMING COUNTY SHERRIF'S DEPARTMENT FOR RESIDENTS AND STAFF OF THE WILLIAMSPORT HOME CAMPUS ON THE AFTERNOON OF SUNDAY, MAY 5TH TO SHOW ENCOURAGEMENT, LIFT MORAL, SPIRITS AND SHOW THEIR SUPPORT OF OUR HEALTH CARE HEROES, WORKERS AND RESIDENTS. JUNIOR AND ADULT VOLUNTEERS, PROVIDED 607.75 HOURS TO RESIDENTS IN THE SKILLED NURSING CENTER BY ASSISTING WITH DELIVERY OF RESIDENT MAIL, NEWSPAPERS, READING OR WRITING LETTERS, READING BOOKS, SPENDING 1 ON 1 TIME WITH RESIDENT AND TRANSFERRING RESIDENTS WHO ARE IN WHEELCHAIRS TO THE LOBBY, HOBBY ROOM, AND BEAUTY SHOP.53 APARTMENT RESIDENTS VOLUNTEERED 1,153.50 HOURS TO ASSIST WITH SETTING AND CLEARING THE APARTMENT DINING ROOM TABLES EACH DAY AND ASSIST IN OPERATING THE APARTMENT STORES IN EACH APARTMENT BUILDING.TWELVE (12) MEMBERS OF JERSEY SHORE FUTURE BUSINESS LEADERS OF AMERICA, PACKAGE AND DONATED GIFT BAGS FOR EVERY INDEPENDENT LIVING RESIDENT AND INDIVIDUAL GAMES FOR RESIDENTS IN THE SKILLED NURSING AND REHABILITATION FACILITY. THEY ALSO PAINTED WINDOWS, WITH WORDS OF ENCOURAGMENT AND SUPPORT DURING COVID ISOLATION PERIODS AND DREW INSPIRATIONAL PICTURES OUTSIDE OF RESIDENT ROOMS AND BALCONIES. THEY ALSO DONATED A MEAL TO EVERY STAFF MEMBER ON OCTOBER 29, 2020.DURING 2020, TWH SERVED AS A HOST SITE FOR TWO (2) A42D (FORMERLY EXPERIENCE WORKS) WORKERS. THE A42D PROGRAM IS DESIGNED TO GIVE INCOME QUALIFIED INDIVIDUALS OVER THE AGE OF 60 AN OPPORTUNITY TO BE PLACED IN A WORK SETTING FOR ON THE JOB TRAINING THAT MAY LEAD TO FULL TIME EMPLOYMENT. DURING 2020 WE PROVIDED 83 HOURS AS A HOST SITE.THE WILLIAMSPORT HOME IS GOVERNED BY A 13 MEMBER, ALL VOLUNTEER BOARD WHO, DURING 2020, PROVIDED 245 HOURS OF SERVICE TO THE WILLIAMSPORT HOME BY ATTENDING BOARD MEETINGS, BOARD SUBCOMMITTEE MEETINGS, SPECIAL EVENTS FOR CAMPUS RESIDENTS, FAMILIES, STAFF BASKETS, CANDY BARS, ENERGY FOOD MEALS AND OTHER PRIZES TO ENCOURAGE AND SUPPORT STAFF DURING COVID 19 PERIODS, WHEN THE SNF WAS SHUT DOWN FOR TESTING OR ISOLATION TO SUPPORT RESIDENTS.COMMUNITY SUPPORT:THE WILLIAMSPORT HOME SERVED AS A CLINICAL SITE FOR 6 LPNS FROM PENN COLLEGE OF TECHNOLOGY PROVIDING ON SITE CLINICAL EXPERIENCE OF 42 HOURS PER STUDENT AND 250 TOTAL CLINCIAL TRAINING HOURS. 17487259 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 15 0 332 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 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 TERRY KREZMER TREASURER 1.00 X X 0 0 0 BRETTE CONFAIR SECRETARY 1.00 X X 0 0 0 MAUREEN CAREY DIRECTOR 1.00 X 0 0 0 KATHRYN NASSBERG DIRECTOR 1.00 X 0 0 0 VERA ANDERSON DIRECTOR 1.00 X 0 0 0 WINONA KREMSER 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 LAURIE BARCLAY DIRECTOR 1.00 X 0 0 0 CATHERINE PICCOLO DIRECTOR 1.00 X 0 0 0 HIEN CONNOLLY DIRECTOR 1.00 X 0 0 0 ELVIRA ANDERSON DIRECTOR 1.00 X 0 0 0 LAURIE BURKHOLDER DIRECTOR (UNTIL 04/20) 1.00 X 0 0 0 DONALD S POTE EXECUTIVE DIRECTOR 40.00 X 0 0 0 JENNIFER CISNEROS ASSISTANT DIRECTOR 40.00 X 0 0 0 KENNETH ANGSTADT DIRECTOR OF FINANCE 40.00 X 79057 0 2663 STEPHANIE FRY DIRECTOR OF NURSING 40.00 X 77818 0 26279 SUSAN R HOOKER REGISTERED NURSE 65.50 X 166541 0 13259 323416 0 42201 1 0 1 0 0 1238074 35826 1273900 PATIENT SERVICE REVENUE 623000 12791776 12791776 APARTMENT REVENUE 623000 3613763 3613763 16405539 115653 115653 2810600 2092982 717618 717618 717618 PA NURSING HOME ASSESSMENT 900099 512500 512500 CABLE TV SERVICES FOR RESIDENTS 517000 60620 60620 BEAUTY/BARBER SHOP REVENUE 812900 6432 6432 15739 15739 595291 19108001 16918039 0 916062 X 600 600 9026971 8570591 456380 57540 56648 892 1157848 1119410 38438 719533 685713 33820 418598 28074 390524 30340 30340 14247 109 14138 2032610 1656648 375962 43125 42963 162 1676015 1462378 213637 576760 576760 48155 40514 7641 93504 93504 1408521 1408521 316687 144264 172423 MEDICAL SUPPLIES 818894 818894 NURSING HOME ASSESSMENT 280027 280027 REPAIRS & MAINTENANCE 182865 126255 56610 EQUIPMENT RENTALS 96908 92327 4581 356381 283059 73322 19356129 17487259 1868870 0 500 500 2164728 3290827 6608 1596639 998498 39725 39725 87701 102382 35164001 24497181 11616793 10666820 5399960 7314406 31346 384345 607429 21321737 23027195 1629288 1940023 29164 27176 2830045 2589830 1909900 4488497 6466929 X 16658737 16435360 174503 124906 16833240 16560266 21321737 23027195 -248128 -24846 0 X 0 1 X 1 0 X 216960 126428 443662 52157 1273900 2113107 16710739 17110361 17276146 17599559 16918039 85614844 16927699 17236789 17719808 17651716 18191939 87727951 0 0 0 87727951 121077 155135 136462 185653 115653 713980 121077 155135 136462 185653 115653 713980 108463 101231 115439 137193 82791 545117 17157239 17493155 17971709 17974562 18390383 88987048 0.98590 0.98520 0.00800 0.00820 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: EMPLOYEE AND GUEST MEALS - 2016 AMOUNT: $ 6,246. 2017 AMOUNT: $ 6,148. 2018 AMOUNT: $ 5,654. 2019 AMOUNT: $ 6,151. 2020 AMOUNT: $ 1,888. LAUNDRY SERVICES - 2016 AMOUNT: $ 769. 2017 AMOUNT: $ 257. BEAUTY/BARBER SHOP REVENUE - 2016 AMOUNT: $ 27,489. 2017 AMOUNT: $ 33,230. 2018 AMOUNT: $ 32,602. 2019 AMOUNT: $ 29,949. 2020 AMOUNT: $ 6,432. CABLE TV SERVICES FOR RESIDENTS - 2016 AMOUNT: $ 55,656. 2017 AMOUNT: $ 51,870. 2018 AMOUNT: $ 51,689. 2019 AMOUNT: $ 57,646. 2020 AMOUNT: $ 60,620. CONCESSION/VENDING - 2016 AMOUNT: $ -9,233. 2017 AMOUNT: $ -5,867. 2018 AMOUNT: $ 259. 2019 AMOUNT: $ 7. 2020 AMOUNT: $ -5,485. TRANSPORTATION FOR RESIDENTS - 2016 AMOUNT: $ 8,689. 2017 AMOUNT: $ 3,307. 2018 AMOUNT: $ 2,091. 2019 AMOUNT: $ 2,298. 2020 AMOUNT: $ 4,444. OTHER INCOME - 2016 AMOUNT: $ 18,847. 2017 AMOUNT: $ 12,286. 2018 AMOUNT: $ 23,144. 2019 AMOUNT: $ 38,164. 2020 AMOUNT: $ 14,549. PROFESSIONAL WELLNESS - 2019 AMOUNT: $ 2,978. 2020 AMOUNT: $ 343. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 796206 796206 25289079 17529896 7759183 6057964 5332438 725526 3020752 1634847 1385905 10666820 19083155 -24846 -24846 19108001 0 19108001 19356129 0 19356129 0 19356129 X X 0 0 0 0 0 0 0 0 0 SUSAN R HOOKER REGISTERED NURSE 166541 0 0 0 0 0 2275 0 10984 0 179800 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 1781011 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 ($143,456) AND JENNIFER CISNEROS, ASSISTANT DIRECTOR ($140,973). 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 1,112,421. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,112,421. NURSING: PROGRAM SERVICE EXPENSES 154,466. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,466. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 355,934. MANAGEMENT AND GENERAL EXPENSES 73,015. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 428,949. CONSULTANTS: PROGRAM SERVICE EXPENSES 33,827. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,827. CONTRACTORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 302,947. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 302,947.