WILLIAMSPORT HOME: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- WILLIAMSPORT HOME (EIN 24-0795507)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-06
- IRS object ID
- 202033119349300003
- Schema version
- 2019v5.1
- 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 | 2020-11-06T06:21:49-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | 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 | 2019-01-01 | 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 | 2020-10-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAIME L KUNTZ CPA | PreparerPersonNm |
| PTIN | P01272711 | PTIN |
| Phone | 5703236023 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 142.202.249.55 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-27 | IPDt |
| IP Tm | 14:11:35 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | AE0C272A69DD34E2EDF3B6A185DE1CF90EACE8A4 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | 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 | $18,156,292 | 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 | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 331 | TotalEmployeeCnt |
| Total Volunteers | 117 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $443,662 | PYContributionsGrantsAmt |
| CY Contributions Grants | $52,157 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,779,764 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,092,771 | CYProgramServiceRevenueAmt |
| PY Investment Income | $233,747 | PYInvestmentIncomeAmt |
| CY Investment Income | $250,259 | CYInvestmentIncomeAmt |
| PY Other Revenue | $611,821 | PYOtherRevenueAmt |
| CY Other Revenue | $643,981 | CYOtherRevenueAmt |
| PY Total Revenue | $18,068,994 | PYTotalRevenueAmt |
| CY Total Revenue | $18,039,168 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,994 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $832 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,562,889 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,982,315 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,868,571 | PYOtherExpensesAmt |
| CY Other Expenses | $7,668,354 | CYOtherExpensesAmt |
| PY Total Expenses | $17,434,454 | PYTotalExpensesAmt |
| CY Total Expenses | $17,651,501 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $634,540 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $387,667 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,119,214 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,321,737 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,467,382 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,488,497 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,651,832 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,833,240 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,917,782 | ExpenseAmt |
| Grant | $832 | GrantAmt |
| Revenue | $17,599,559 | RevenueAmt |
| Desc | PROVIDED 45,508 DAYS OF NURSING SERVICES TO RESIDENTS; 59,765 DAYS OF HOUSING TO RESIDENTS IN INDEPENDENT APARTMENTS; AND 9,887 DAYS IN OUR DHS LICENSED PERSONAL CARE PROGRAMS. APPROXIMATELY 54% OF OUR RESIDENTS ARE LOW INCOME RESIDENTS AND ARE PROVIDED SERVICES AT A REDUCED REIMBURSEMENT RATE THROUGH MEDICAID. OUR PROGRAMS ARE DESIGNED TO HELP MAINTAIN OUR RESIDENT'S HEALTH, SECURITY AND INDEPENDENCE. THE WILLIAMSPORT HOME ("TWH") PROVIDED BENEVOLENT CARE FOR TWO (2) APARTMENT RESIDENTS IN OUR DHS LICENSED PERSONAL CARE PROGRAMS TOTALING APPROXIMATELY $71,718.CONTINUED ON SCHEDULE ORESIDENTS RECEIVED 24,469 MEDICAL ASSISTANCE DAYS OF SERVICE IN THE SKILLED NURSING AND REHABILITATION CENTER DURING 2019.VOLUNTEERING: 117 INDIVIDUALS VOLUNTEERED MORE THAN 7323.75 HOURS OF SERVICE TO THE WILLIAMSPORT HOME DURING 2019.IN ADDITION, TWH SKILLED NURSING CENTER PROVIDED VOLUNTEER OPPORTUNITIES TO GROUPS FROM UNITED CHURCHES, 4H, THERAPY DOGS, SPCA, WHO PROVIDED, PET THERAPY, MUSICAL ENTERTAINMENT AND PROGRAMMING SUPPORT TO SKILLED NURSING RESIDENTS.JUNIOR AND ADULT VOLUNTEERS, PROVIDED 1045.67 HOURS TO RESIDENTS IN THE SKILLED NURSING CENTER BY ASSISTING WITH DELIVER 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.61 APARTMENT RESIDENTS VOLUNTEERED 3,259 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.DURING 2019, TWH SERVED AS A HOST SITE FOR TWO EXPERIENCE WORKS WORKERS. THE EXPERIENCE WORKS PROGRAM IS DESIGNED TO GIVE INCOME QUALIFIED INDIVIDUALS OVER THE AGE OF 60 AN OPPORTUNITY TO BE PLACED IN A WORK SETTING FOR UP TO 20 HOURS A WEEK OF ON THE JOB TRAINING THAT MAY LEAD TO FULL TIME EMPLOYMENT. DURING 2019 WE PROVIDED 2347.50 HOURS AS A HOST SITE.THE WILLIAMSPORT HOME IS GOVERNED BY A 15 MEMBER ALL VOLUNTEER BOARD WHO DURING 2019 PROVIDED 208 HOURS OF SERVICE TO THE WILLIAMSPORT HOME ATTENDING, BOARD MEETINGS, BOARD SUBCOMMITTEE MEETINGS, SPECIAL EVENTS FOR CAMPUS RESIDENTS, FAMILIES, DONORS AND FORMER BOARD MEMBERS.COMMUNITY SUPPORT:THE WILLIAMSPORT HOME SERVED AS A CLINICAL SITE FOR 14 LPNS FROM PENN COLLEGE OF TECHNOLOGY PROVIDING ON SITE CLINICAL EXPERIENCE OF 48 HOURS PER STUDENT AND 672 TOTAL CLINCIAL TRAINING HOURS.TWH DONATED SPACE DURING 2019 TO SPONSOR A MONTHLY FACILITATED ALZHEIMER'S SUPPORT GROUP TO HELP FAMILY AND MEMBERS OF OUR LOCAL COMMUNITY COPE WITH UNDERSTANDING AND CARING FOR PERSONS WITH DEMENTIA RELATED DIAGNOSIS. | Desc |
| Total Program Service Expenses | $15,917,782 | 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 | 0 | 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 | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 331 | 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KENNETH ANGSTADT DIRECTOR OF FINAN | PersonNm |
| 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 (20 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 |
|---|---|---|---|---|---|---|---|
| MAUREEN CAREY | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHARON ATHERHOLT | |||||||
| VICE-PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CANDACE DEWAR | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TERRY KREZMER | |||||||
| ACTING TREASURER (AS OF 10/19) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HALLE NIKLAUS | |||||||
| TREASURER (UNTIL 10/19) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LAURIE BURKHOLDER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ELVIRA ANDERSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRETTE CONFAIR | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WINONA KREMSER | |||||||
| DIRECTOR | 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 | ||
| LAURIE BARCLAY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHRYN NASSBERG | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HIEN CONNOLLY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DONALD S POTE | |||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER CISNEROS | |||||||
| NURSING HOME ADMINISTRATOR | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| KENNETH ANGSTADT | |||||||
| DIRECTOR OF FINANCE | 40.00 | Yes (X) | $75,390 | $0 | $4,565 | ||
| SUSAN R HOOKER | |||||||
| REGISTERED NURSE | 65.50 | $173,564 | $0 | $17,347 | Yes (X) | ||
| EVELYN F PARENT | |||||||
| REGISTERED NURSE | 49.10 | $106,431 | $0 | $23,103 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $355,385 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $45,015 | 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 |
| All Other Contributions | $52,157 | AllOtherContributionsAmt |
| Total Contributions | $52,157 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 623000 | $13,520,038 | $13,520,038 |
| APARTMENT REVENUE | 623000 | $3,572,733 | $3,572,733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,092,771 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $185,653 | TotalRevenueColumnAmt |
| Exclusion | $185,653 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $181,730 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $117,124 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $64,606 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,606 | TotalRevenueColumnAmt |
| Exclusion | $64,606 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PA NURSING HOME ASSESSMENT | 900099 | $506,788 | $506,788 | |
| CABLE TV SERVICES FOR RESIDENTS | 517000 | $57,646 | $57,646 | |
| MISCELLANEOUS | 900099 | $38,164 | $38,164 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,383 | TotalRevenueColumnAmt |
| Exclusion | $41,383 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $643,981 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,039,168 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,599,559 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $387,452 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $832 | TotalAmt |
| Program Services | $832 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,116 | TotalAmt |
| Program Services | $155,076 | ProgramServicesAmt |
| Management And General | $8,040 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,023,247 | TotalAmt |
| Program Services | $7,627,758 | ProgramServicesAmt |
| Management And General | $395,489 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,342 | TotalAmt |
| Program Services | $37,902 | ProgramServicesAmt |
| Management And General | $440 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,130,579 | TotalAmt |
| Program Services | $1,086,216 | ProgramServicesAmt |
| Management And General | $44,363 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $627,031 | TotalAmt |
| Program Services | $596,968 | ProgramServicesAmt |
| Management And General | $30,063 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409,285 | TotalAmt |
| Program Services | $27,853 | ProgramServicesAmt |
| Management And General | $381,432 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,853 | TotalAmt |
| Management And General | $42,853 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,840 | TotalAmt |
| Program Services | $851 | ProgramServicesAmt |
| Management And General | $41,989 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,951,333 | TotalAmt |
| Program Services | $1,656,713 | ProgramServicesAmt |
| Management And General | $294,620 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,841 | TotalAmt |
| Program Services | $71,201 | ProgramServicesAmt |
| Management And General | $1,640 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,644,642 | TotalAmt |
| Program Services | $1,457,473 | ProgramServicesAmt |
| Management And General | $187,169 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $601,637 | TotalAmt |
| Program Services | $601,637 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,613 | TotalAmt |
| Program Services | $40,708 | ProgramServicesAmt |
| Management And General | $21,905 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,911 | TotalAmt |
| Program Services | $86,911 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,385,434 | TotalAmt |
| Program Services | $1,385,434 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,308 | TotalAmt |
| Program Services | $144,743 | ProgramServicesAmt |
| Management And General | $159,565 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NURSING HOME ASSESSMENT | $276,624 | $276,624 | |
| REPAIRS & MAINTENANCE | $188,481 | $136,233 | $52,248 |
| MEDICAL SUPPLIES | $160,199 | $160,199 | |
| BAD DEBT EXPENSE | $115,363 | $115,363 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $322,990 | TotalAmt |
| Program Services | $251,087 | ProgramServicesAmt |
| Management And General | $71,903 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,651,501 | TotalAmt |
| Program Services | $15,917,782 | ProgramServicesAmt |
| Management And General | $1,733,719 | 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 | $1,645,502 | BOYAmt |
| EOY | $2,164,728 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,940,622 | BOYAmt |
| EOY | $1,596,639 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,898 | BOYAmt |
| EOY | $39,725 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,070 | BOYAmt |
| EOY | $87,701 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $34,707,640 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $23,090,847 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,542,111 | BOYAmt |
| EOY | $11,616,793 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,471,791 | BOYAmt |
| EOY | $5,399,960 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,533 | BOYAmt |
| EOY | $31,346 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $336,187 | BOYAmt |
| EOY | $384,345 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,119,214 | BOYAmt |
| EOY | $21,321,737 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,413,292 | BOYAmt |
| EOY | $1,629,288 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,128 | BOYAmt |
| EOY | $29,164 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,034,962 | BOYAmt |
| EOY | $2,830,045 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,467,382 | BOYAmt |
| EOY | $4,488,497 | 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 | $15,477,329 | BOYAmt |
| EOY | $16,658,737 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $174,503 | BOYAmt |
| EOY | $174,503 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,651,832 | BOYAmt |
| EOY | $16,833,240 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,119,214 | BOYAmt |
| EOY | $21,321,737 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $387,667 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $793,741 | 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 | $272,754 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $216,960 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $126,428 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $443,662 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $52,157 | CurrentTaxYearAmt |
| Total | $1,111,961 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,876,408 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $16,710,739 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,110,361 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17,276,146 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $17,599,559 | CurrentTaxYearAmt |
| Total | $84,573,213 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,149,162 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $16,927,699 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,236,789 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17,719,808 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $17,651,716 | CurrentTaxYearAmt |
| Total | $85,685,174 | 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 | $85,685,174 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $115,670 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $121,077 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $155,135 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $136,462 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $185,653 | CurrentTaxYearAmt |
| Total | $713,997 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $115,670 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $121,077 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $155,135 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $136,462 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $185,653 | CurrentTaxYearAmt |
| Total | $713,997 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $109,942 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $108,463 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $101,231 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $115,439 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $137,193 | CurrentTaxYearAmt |
| Total | $572,268 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,374,774 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,157,239 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,493,155 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17,971,709 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $17,974,562 | CurrentTaxYearAmt |
| Total | $86,971,439 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98520 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98540 | PublicSupportPY509Pct |
| Investment Income CY | 0.00820 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00750 | 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 - 2015 AMOUNT: $ 9,418. 2016 AMOUNT: $ 6,246. 2017 AMOUNT: $ 6,148. 2018 AMOUNT: $ 5,654. 2019 AMOUNT: $ 6,151. LAUNDRY SERVICES - 2016 AMOUNT: $ 769. 2017 AMOUNT: $ 257. BEAUTY/BARBER SHOP REVENUE - 2015 AMOUNT: $ 22,352. 2016 AMOUNT: $ 27,489. 2017 AMOUNT: $ 33,230. 2018 AMOUNT: $ 32,602. 2019 AMOUNT: $ 29,949. CABLE TV SERVICES FOR RESIDENTS - 2015 AMOUNT: $ 56,632. 2016 AMOUNT: $ 55,656. 2017 AMOUNT: $ 51,870. 2018 AMOUNT: $ 51,689. 2019 AMOUNT: $ 57,646. CONCESSION/VENDING - 2015 AMOUNT: $ -4,181. 2016 AMOUNT: $ -9,233. 2017 AMOUNT: $ -5,867. 2018 AMOUNT: $ 259. 2019 AMOUNT: $ 7. TRANSPORTATION FOR RESIDENTS - 2015 AMOUNT: $ 8,446. 2016 AMOUNT: $ 8,689. 2017 AMOUNT: $ 3,307. 2018 AMOUNT: $ 2,091. 2019 AMOUNT: $ 2,298. OTHER INCOME - 2015 AMOUNT: $ 17,275. 2016 AMOUNT: $ 18,847. 2017 AMOUNT: $ 12,286. 2018 AMOUNT: $ 23,144. 2019 AMOUNT: $ 38,164. BAD DEBT RECOVERY - PROFESSIONAL WELLNESS - 2019 AMOUNT: $ 2,978. | 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 | $25,137,153 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,627,593 | DepreciationAmt |
| Book Value | $8,509,560 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,310,560 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,041,366 | DepreciationAmt |
| Book Value | $1,269,194 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,463,721 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,421,888 | DepreciationAmt |
| Book Value | $1,041,833 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,616,793 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $18,832,909 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $793,741 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $793,741 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,039,168 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,039,168 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,651,501 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,651,501 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,651,501 | 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 | $173,564 | 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 | $3,900 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $13,447 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $190,911 | 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 | $1,569,955 | 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 ($117,612) AND JENNIFER CISNEROS, NURSING HOME ADMINISTRATOR ($111,448). |
| 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 1,190,420. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,190,420. NURSING: PROGRAM SERVICE EXPENSES 132,080. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,080. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 301,831. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 301,831. CONSULTANTS: PROGRAM SERVICE EXPENSES 32,382. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,382. CONTRACTORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 294,620. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 294,620. |
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