2018-11-08T13:17:42-06:00 2017-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 191037341 990 2017-01-01 240795507 THE WILLIAMSPORT HOME WILL 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 DONALD S POTE EXECUTIVE DIRECTOR 5703238781 2018-10-26 1 JULIUS C GREEN CPA P00350393 2159720701 96.89.178.154 2018-10-26 10:06:14 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9D0D8DD59390B7764A3ECE0F40BBFE3618018605 2017 2018-06-14 16:35:46Z DONALD S POTE 1900 RAVINE ROAD WILLIAMSPORT PA 17701 17814699 0 X THEWILLIAMSPORTHOME.COM X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 16 16 312 90 0 0 216960 126428 16208845 16598908 589897 259866 610357 612684 17626059 17597886 2183 2636 0 0 8748981 9105542 0 0 0 7914939 8120737 16666103 17228915 959956 368971 19749171 20235494 4890382 4647564 14858789 15587930 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 15550699 2636 17110361 PROVIDED 45,989 DAYS OF NURSING SERVICES TO RESIDENTS; 64,503 DAYS OF HOUSING TO RESIDENTS IN INDEPENDENT APARTMENTS; AND 11,260 DAYS IN OUR DHS LICENSED PERSONAL CARE PROGRAMS. APPROXIMATELY 53.4% 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 ONE (1) APARTMENT RESIDENTS AND THREE (3) INDEPENDENT LIVING RESIDENTS IN OUR DHS LICENSED PERSONAL CARE PROGRAMS TOTALING APPROXIMATELY $64,189. CONTINUED ON SCHEDULE "O"RESIDENTS RECEIVED 24,552 MEDICAL ASSISTANCE DAYS OF SERVICE IN THE SKILLED NURSING AND REHABILITATION CENTER DURING 2017.VOLUNTEERING:75 INDIVIDUALS VOLUNTEERED MORE THAN 6,000 HOURS OF SERVICE TO THE WILLIAMSPORT HOME DURING 2017.TWH SKILLIED NURSING CENTER PROVIDED VOLUNTEER OPPORTUNITIES TO GROUPS FROM UNITED CHURCHES, 4H, THERAPY DOGS, SPCA, MEMBERS OF THE KIWANIS CIRCLE K AND KEY CLUBS, WHO PROVIDED 120.50 HOURS OF MUSICAL ENTERTAINMENT AND PROGRAMMING SUPPORT TO SKILLED NURSING RESIDENTS.18 JUNIOR AND ADULT VOLUNTEERS PROVIDED 2519.50 HOURS TO RESIDENTS IN THE SKILLED NURSING CENTER BY ASSISTING WITH DELIVER OF RESIDENT MAIL, NEWPAPERS, 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.42 APARTMENT RESIDENTS VOLUNTEERED 2994 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 2017, TWH SERVED AS S 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 EMPLOYEMENT. DURING 2017 WE PROVIDED 1608 HOURS AS A HOST SITE.THE WILLIAMSPORT HOME WAS GOVERNED BY A 15 MEMBER ALL VOLUNTEER BOARD DURING 2017 WHO PROVIDED 494.75 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 HOST SITE FOR ONE INTERN FROMLOCK HAVEN UNIVERSITY, TOTALING 300 HOURS.IN ADDITION, THE WILLIAMSPORT HOME SERVED AS A CLINICAL SITE FOR 12 LPNS FROM PENN COLLEGE OF TECHNOLOGY PROVIDING ON SITE CLINICAL EXPERINCE OF 30 HOURS PER STUDENT.TWH DONATED SPACE DURING 2017 TO SPONSOR A MONTHLY ALZHEIMER'S SUPPORT GROUP MEETING FACILITATED BY BOB MEACHAM,CONSULTANT PHYCHOLOGIST TO HELP FAMILY MEMBERS COPE WITH UNDERSTANDING AND CARING FOR PERSONS WITH DEMENTIA RELATED DIAGNOSIS.DURING 2017 THE WILLIAMSPORT HOME HELD SEVERAL BASKET RAFFLES TO BENEFIT NON-PROFIT ORGANIZATIONS SUCH AS THE SPCA, SALVATION ARMY AND ALZHEIMER'S ASSOICATION. 15550699 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 1 312 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X KENNETH ANGSTADT DIRECTOR OF FINAN 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 LAURIE BURKHOLDER PRESIDENT 1.00 X X 0 0 0 MAUREEN CAREY VICE-PRESIDENT 1.00 X X 0 0 0 KATHRYN NASSBERG TREASURER 1.00 X X 0 0 0 BRETTE CONFAIR SECRETARY 1.00 X X 0 0 0 SHARON ATHERHOLT DIRECTOR 1.00 X 0 0 0 VERA ANDERSON DIRECTOR 1.00 X 0 0 0 CANDY DEWAR DIRECTOR 1.00 X 0 0 0 WINNIE KREMSER DIRECTOR 1.00 X 0 0 0 DAWN LINN DIRECTOR 1.00 X 0 0 0 JUDY SARETT DIRECTOR 1.00 X 0 0 0 TRICIA 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 HALLE NIKLAUS DIRECTOR 1.00 X 0 0 0 TERRY KREZMER DIRECTOR 1.00 X 0 0 0 CATHY PICCOLO DIRECTOR 1.00 X 0 0 0 DONALD S POTE EXECUTIVE DIRECTOR 40.00 X 0 0 0 JENNIFER CISNEROS ASST. EXECUTIVE DIRECTOR 40.00 X 0 0 0 TAMMY COLEMAN DIRECTOR OF NURSING 40.00 X 0 0 0 KENNETH ANGSTADT DIRECTOR OF FINANCE 40.00 X 69864 0 2256 SUSAN R HOOKER REGISTERED NURSE 67.80 X 158515 0 22788 SUSAN GETZ REGISTERED NURSE 65.30 X 158437 0 24819 CONNIE S FULLER REGISTERED NURSE 44.30 X 100770 0 29813 487586 0 79676 3 0 1 0 FUNCTIONAL PATHWAYS OF TENNESSEE PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 1262194 SODEXHO INC & AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE DIETARY 888041 AFFINITY HEALTH SERVICES INC 942 PHILADELPHIA ST INDIANA PA 15701 MANAGEMENT SERVICES 739968 DIXON AC & R 3983 WEST FOURTH ST WILLIAMSPORT PA 17701 CONTRACTOR 238965 TURNKEY CONSTRUCTION INC 2440 LYCOMING CREEK RD WILLIAMSPORT PA 17701 CONTRACTOR 172638 7 126428 126428 PATIENT SERVICE REVENUE 623000 12964588 12964588 APARTMENT REVENUE 623000 3634320 3634320 16598908 155135 155135 321544 216813 104731 104731 104731 PA NURSING HOME ASSESSMENT 900099 511453 511453 CABLE TV SERVICES FOR RESIDENTS 517000 51870 51870 BEAUTY/BARBER SHOP REVENUE 812900 33230 33230 16131 16131 612684 17597886 17110361 0 361097 X 2636 2636 72121 68333 3788 7234232 6854269 379963 39794 36901 2893 1200562 1141644 58918 558833 528995 29838 400970 27922 373048 4471 4471 46804 851 45953 2277177 1998649 278528 43971 43837 134 1749573 1582897 166676 652522 652522 76112 63862 12250 101305 101305 1302462 1302462 359619 182647 176972 NURSING HOME ASSESSMENT 276810 276810 REPAIRS & MAINTENANCE 264182 193707 70475 MEDICAL SUPPLIES 160357 160357 BAD DEBT EXPENSE 87502 87502 316900 242591 74309 17228915 15550699 1678216 0 500 500 1096753 1143785 1968895 1998807 39469 35840 107366 152648 31973670 20548718 11224475 11424952 5035996 5184553 37907 35720 237810 258689 19749171 20235494 1458732 1379275 4653 34382 3426997 3233907 4890382 4647564 X 14684286 15413427 99951 99951 74552 74552 14858789 15587930 19749171 20235494 368971 360170 0 X 0 1 X 1 0 X 86782 198970 272754 216960 126428 901894 14268808 14712482 15876408 16710739 17110361 78678798 14355590 14911452 16149162 16927699 17236789 79580692 0 0 0 79580692 107514 106543 115670 121077 155135 605939 107514 106543 115670 121077 155135 605939 108336 161478 111213 108463 101231 590721 14571440 15179473 16376045 17157239 17493155 80777352 0.98520 0.98520 0.00750 0.00710 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2013 AMOUNT: $ 108,336. 2014 AMOUNT: $ 161,478. 2015 AMOUNT: $ 111,213. 2016 AMOUNT: $ 108,463. 2017 AMOUNT: $ 101,231. 796206 796206 23570878 14882551 8688327 5833436 4507370 1326066 1773150 1158797 614353 11424952 17958056 360170 360170 17597886 0 17597886 17228915 0 17228915 0 17228915 X X 0 0 0 0 0 0 0 0 0 SUSAN R HOOKER REGISTERED NURSE 158515 0 0 0 0 0 2275 0 20513 0 181303 0 0 0 SUSAN GETZ REGISTERED NURSE 158437 0 0 0 0 0 758 0 24061 0 183256 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 1166093 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 I, 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 POTE, EXECUTIVE DIRECTOR ($106,963) AND JENNIFER CISNEROS, ASST. EXECUTIVE DIRECTOR ($102,711). FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITEE OF THE WILLIAMSPORT HOME BOARD OF MANAGERS REVIEWED THE 990 IN DETAIL DURING A REGULARLY SCHEDULED FINANCE MEETING. THE 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 1,325,746. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,325,746. NURSING: PROGRAM SERVICE EXPENSES 351,501. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 351,501. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 292,485. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 292,485. CONSULTANTS: PROGRAM SERVICE EXPENSES 28,817. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,817. TRUSTEE FEES: PROGRAM SERVICE EXPENSES 100. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100. CONTRACTORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 278,528. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 278,528.