2021-11-12T09:34:21-06:00 2020-12-31 263753134 CBIZ MHM LLC 500 BOYLSTON STREET BOSTON MA 02116 990 2020-01-01 231945075 ELK HAVEN NURSING HOME ASSOCIATION ELKH 8148342618 785 JOHNSONBURG ROAD ST MARYS PA 15857 JUNE SORG PRESIDENT 8148342618 2021-11-10 1 JUNE SORG 999009999 CHARLES N CICCONE P00734640 6177600600 2021-11-10 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JUNE SORG 785 JOHNSONBURG ROAD ST MARYS PA 15857 11797050 0 X WWW.ELKHAVENNURSINGHOME.COM X 1967 PA PROVIDING LONG TERM NURSING CARE THROUGH A SKILLED NURSING FACILITY AND PERSONAL CARE UNIT. X 5 5 256 50 0 0 12906 1516171 10981274 9661954 432027 564815 69774 54110 11495981 11797050 0 0 0 0 7238454 7871766 0 0 0 3644706 3703785 10883160 11575551 612821 221499 28660055 12547514 1025578 2225894 27634477 10321620 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 10341210 9661954 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 $1,524,000 FOR THE YEAR ENDED DECEMBER 31, 2020. 10341210 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 1 0 1 0 0 0 1 34 0 1 256 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 126213 0 11798 126213 0 11798 1 0 0 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 REHABILIATION SERVICES 737802 COMPLETE HEALTHCARE RESOURCES-EASTERN I 200 DRYDEN ROAD SUITE 3100 DRESHER PA 19025 MANAGEMENT SERVICES 584610 PENN HIGHLANDS - ELK 763 JOHNSONBURG ROAD SSAINT MARYS PA 15857 LABS/COVID TESTING 204896 ST MARY'S PHARMACY 4 RAILROAD ST ST MARYS PA 15857 PHARMACY 186147 4 1493954 22217 1516171 RESIDENT SERVICE REVENUE 623000 9661954 9661954 9661954 512985 512985 51830 0 51830 51830 51830 FOOD REVENUE 900099 43787 43787 OTHER REVENUE 900099 10323 10323 54110 11797050 9661954 0 618925 138011 138011 5811761 5713757 98004 34029 34029 1442063 1415844 26219 445902 432505 13397 548925 548925 19165 19165 39500 39500 1023000 963195 59805 16578 1064 15514 140106 34798 105308 47290 47290 197645 197622 23 738 511 227 492768 449498 43270 136811 136811 PHYSICIAN FEES 570524 570524 SUPPLIES 294240 277344 16896 OTHER NURSING SERVICES 67891 64932 2959 OXYGEN 27888 27888 80716 53717 26999 11575551 10341210 1234341 0 1749551 2870244 2524560 417487 809428 790562 123454 122805 15276079 10212589 5408933 5063490 17874765 3088675 169364 194251 28660055 12547514 961158 683351 7796 29327 56624 1513216 1025578 2225894 X 27634477 10321620 27634477 10321620 28660055 12547514 X 221499 673365 -18207721 X 0 1 X 1 0 X 9558 7287 18208 12906 1516171 1564130 10953140 10808697 10464934 10981274 9661954 52869999 10962698 10815984 10483142 10994180 11178125 54434129 0 0 0 54434129 483353 474819 632287 435037 512985 2538481 483353 474819 632287 435037 512985 2538481 57833 49811 51574 69774 54110 283102 11503884 11340614 11167003 11498991 11745220 57255712 0.95070 0.95120 0.04430 0.04340 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2016 AMOUNT: $ 15,658. 2017 AMOUNT: $ 12,370. 2018 AMOUNT: $ 15,904. 2019 AMOUNT: $ 35,527. 2020 AMOUNT: $ 10,323. FOOD REVENUE - 2016 AMOUNT: $ 42,175. 2017 AMOUNT: $ 37,441. 2018 AMOUNT: $ 35,670. 2019 AMOUNT: $ 34,247. 2020 AMOUNT: $ 43,787. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 44000 44000 11772838 7347283 4425555 263911 237622 26289 2935980 2391990 543990 259350 235694 23656 5063490 THIRD PARTY SETTLEMENTS 336646 PAYCHECK PROTECTION PROGRAM LOAN 1176570 1513216 X 12443282 673365 673365 11769917 27133 27133 11797050 11548418 0 11548418 27133 27133 11575551 PART X, LINE 2: THE ASSOCIATION IS A NOT-FOR-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE 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 ASSOCIATION 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 ASSOCIATION HAS IDENTIFIED ITS TAX STATUS AS TAX-EXEMPT ENTITY AS A TAX POSITION; HOWEVER, THE ASSOCIATION HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. THE ASSOCIATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2017. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 27,133. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 27,133. CASH & CASH EQIVALENTS 2020-10-15 113911 BOOK VALUE 841788081 ELK HAVEN FOUNDATION 785 JOHNSONBURG ROAD ST MARYS PA 16127 501(C)(3) MORTGAGED BACKED SECURITY 2020-10-15 192735 BOOK VALUE 841788081 ELK HAVEN FOUNDATION 785 JOHNSONBURG ROAD ST MARYS PA 16127 501(C)(3) CORPORATE BONDS & NOTES 2020-10-15 15983731 BOOK VALUE 841788081 ELK HAVEN FOUNDATION 785 JOHNSONBURG ROAD ST MARYS PA 16127 501(C)(3) CERTIFICATES OF DEPOSIT 2020-10-15 1746832 BOOK VALUE 841788081 ELK HAVEN FOUNDATION 785 JOHNSONBURG ROAD ST MARYS PA 16127 501(C)(3) 1 0 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: JUNE H. SORG, PRESIDENTCHARLETTE GERG, VICE PRESIDENTSCHWABENBAUER JOHNSONBURG, SECRETARY /TREASURERSCHREIBER, JR., BOARD MEMBERLOU RADOWSKI, BOARD MEMBER PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: THE INITIAL BOARD MEMBERSHIP OF ELK HAVEN FOUNDATION CONSISTS OF THE FIVE MEMBERS OF THE BOARD OF ELK HAVEN NURSING HOME ASSOCIATION WITH SIMILAR OFFICERS. 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. FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY TO RELATED PARTY -18,207,721. 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