2017-11-13T12:16:13-06:00 2016-12-31 311543240 CBIZ MHM LLC 401 PLYMOUTH ROAD SUITE 200 PLYMOUTH MEETING PA 19462 990 2016-01-01 231945075 ELK HAVEN NURSING HOME ASSOCIATION ELKH 8148342618 785 JOHNSONBURG ROAD ST MARYS PA 15857 CAROLE HARSHBARGER PRESIDENT 8148342618 2017-11-10 1 Joseph G Sullivan P00360476 6108622249 96.90.32.117 2017-11-10 09:43:27 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 20087036E5B3FD96C17AC6BE1EF3A98CB42C38E1 2016 2018-03-14 21:41:22Z CAROLE HARSHBARGER 785 JOHNSONBURG ROAD ST MARYS PA 15857 13724164 0 X www.elkhavennursinghome.com X 1967 PA providing long term nursing care through a skilled nursing facility and personal care unit. 5 5 217 22 0 0 0 9558 11317161 10953140 378169 476625 0 57833 11695330 11497156 0 0 0 0 6832640 7174278 0 0 0 3731657 3667783 10564297 10842061 1131033 655095 27467564 26860637 1992856 891626 25474708 25969011 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 9711939 10953140 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. 9711939 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 26 0 1 217 1 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 1 0 PA X X COMPLETE HEALTHCARE RESOURCES-EASTERN INC 2153285723 200 DRYDEN ROAD SUITE 2000 DRESHER PA 19025 Carole Harshbarger president 2.00 X X 0 0 0 June Sorg Vice President 2.00 X X 0 0 0 Sandra Schwabenbauer Secretary/Treasurer 2.00 X X 0 0 0 charlette gerg Board Member 2.00 X 0 0 0 LOU RADKOWSKI Board Member 2.00 X 0 0 0 Mark Jacob Attorney Solicitor 2.00 X 0 0 0 Tom Davido Administrator 40.00 X 179867 0 24917 Nancy Votano DON 40.00 X 154049 0 8864 333916 0 33781 2 0 1 0 REHABCARE GROUP INC PO BOX 503534 SAINT LOUIS MO 63150 rehabilitation services 1162181 SYSCO FOOD SERVICES - PITTBURGH 1 WHITNEY DRIVE PO BOX 1000 HARMONY PA 16037 FOOD SERVICES 383672 COMPLETE HEALTHCARE RESOURCES 200 DRYDEN RD STE 3100 DRESHER PA 19025 MANAGEMENT SERVICES 270666 HALLSTROM CONSTRUCTION PO Box 648 101 East Long Ave DUBOIS PA 15801 CONSTRUCTION 247358 Omnicare Inc Dept 781668 Detroit MI 48278 pharmacy 219024 6 9558 9558 RESIDENT SERVICE REVENUE 623000 10953140 10953140 10953140 483353 483353 2220280 2227008 -6728 -6728 -6728 food ervenue 900099 42175 42175 other revenue 900099 15658 15658 57833 11497156 10953140 0 534458 X 204784 204784 5195526 5053329 142197 35118 35118 1328040 1297862 30178 410810 399566 11244 241692 241692 2891 2891 47802 47802 1134376 1098968 35408 2079 2079 97400 1364 96036 43061 405 42656 273079 245771 27308 9013 1684 7329 550 550 456413 410771 45642 110726 110726 food 395777 395777 Supplies 262812 253287 9525 Physician fees 245529 245529 Other Nursing Services 149741 149741 194842 157885 36957 10842061 9711939 1130122 0 1924050 1756641 1127911 1055017 193329 112884 14093227 8399730 5690581 5693497 14613034 15974700 2709832 2117102 1015090 24213 0 169524 150796 27467564 26860637 802706 838259 1173266 0 16884 13891 0 39476 1992856 891626 X 25474708 25969011 25474708 25969011 27467564 26860637 655095 -160792 0 X X 0 1 X 1 0 X 9558 9558 10367333 10642340 10956455 11317160 10953140 54236428 10367333 10642340 10956455 11317160 10962698 54245986 0 0 0 54245986 621236 460090 482583 463728 483353 2510990 621236 460090 482583 463728 483353 2510990 57833 57833 10988569 11102430 11439038 11780888 11503884 56814809 0.95480 0.95380 0.04420 0.04620 X 1 1 X 44000 44000 10806671 6131150 4675521 246530 165425 81105 2807217 1922433 884784 188809 180722 8087 5693497 CERTIFICATES OF DEPOSIT 2117102 F 2117102 THIRD PARTY SETTLEMENTS 39476 39476 X 11336364 -160792 -160792 11497156 0 11497156 10842061 0 10842061 0 10842061 Part IV, Line 2b: THE ESCROW LIABILITY OFFSETS THE RESIDENT TRUST FUND ESTABLISHED ON BEHALF OF THE FACILITY'S RESIDENTS. Part X, Line 2: THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION 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, 2013. X 0 0 0 0 0 0 0 0 0 Tom Davido Administrator 149909 0 29958 0 0 0 0 0 24917 0 204784 0 0 0 Nancy Votano DON 129109 0 24940 0 0 0 0 0 8864 0 162913 0 0 0 Part I, Line 3 Market studies are performed in the region to determine the appropriate level of compensation. Form 990, Part VI, Section A, line 3 Elk Haven entered into a management agreement with Complete Healthcare Resources - Eastern, 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 15 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 IX, line 11g other professional fees: Program service expenses 1,098,968. Management and general expenses 35,408. Fundraising expenses 0. Total expenses 1,134,376. form 990, part xii, line 2c THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR IN HOW THE ASSOCIATION OVERSEES THE AUDIT OR IN ITS SELECTION OF INDEPENDENT ACCOUNTANTS.