2017-11-06T13:03:44-06:00 2016-12-31 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2016-01-01 240795507 The Williamsport Home WILL 5703238781 1900 Ravine Road Williamsport PA 17701 Donald S Pote Executive Director 5703238781 2017-10-30 1 Julius C Green CPA P00350393 2159720701 96.89.178.154 2017-10-30 11:26:46 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9D0D8DD59390B7764A3ECE0F40BBFE3618018605 2016 2021-01-29 14:40:06Z Donald S Pote 1900 Ravine Road Williamsport PA 17701 20028288 0 X thewilliamsporthome.com X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 14 14 286 150 0 0 272754 216960 15599598 16208845 147653 589897 388023 610357 16408028 17626059 1337 2183 0 0 8360008 8748981 0 0 0 7497799 7914939 15859144 16666103 548884 959956 19472894 19749171 5378164 4890382 14094730 14858789 X The Williamsport Home has as its mission to provide its residents with the highest quality of care honoring their independence and dignity. 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 15188098 2183 16710739 Provided 45,543 days of nursing services to residents; 64,922 days of housing to residents in independent apartments; and 11,266 days of housing and assistance in living services to residents on our Assistance in Living program licensed by the DPW as personal care. 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 and four (4) Independent Living residents in our DPW licensed personal care programs totaling approximately $95,723. 15188098 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 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 14 0 1 286 1 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 KENNETH ANGSTADT 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 Beth Stubler 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 LAURIE BARCLAY DIRECTOR 1.00 X 0 0 0 Tricia Shipman DIRECTOR 1.00 X 0 0 0 Vera Anderson DIRECTOR 1.00 X 0 0 0 Winnie kREMSER DIRECTOR 1.00 X 0 0 0 SHARON ATHERHOLT DIRECTOR 1.00 X 0 0 0 CANDY DEWAR DIRECTOR 1.00 X 0 0 0 HALLE NIKLAUS DIRECTOR 1.00 X 0 0 0 CLAUDIA SACAVAGE Secretary (until 6/2016) 1.00 X X 0 0 0 JOANNE LUDWIKOWSKI DirECTOR (until 10/2016) 1.00 X 0 0 0 marGARET CHAPMAN DIRECTOR (until 9/2016) 1.00 X 0 0 0 Mary CAMP DIRECTOR (until 9/2016) 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 92564 0 780 KENNETH ANGSTADT DIRECTOR OF FINANCE 40.00 X 64471 0 23720 susan getz Registered Nurse 77.50 X 138300 0 22222 susan hooker Registered Nurse 70.30 X 128364 0 20635 423699 0 67357 2 0 1 0 FUNCTIONAL PATHWAYS OF TENNESSEE PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 1223739 SODEXHO INC & AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE DIETARY 879787 AFFINITY HEALTH SERVICES INC 942 PHILADELPHIA ST INDIANA PA 15701 MANAGEMENT SERVICES 734602 TURNKEY CONSTRUCTION INC 2440 Lycoming Creek Rd WillIAMSPORT PA 17701 CONTRACTOR 430095 DIXON AC & R 3983 WEST FOURTH ST WILLIAMSPORT PA 17701 CONTRACTOR 346564 6 216960 216960 PATIENT SERVICE REVENUE 623000 12629150 12629150 APARTMENT REVENUE 623000 3579695 3579695 16208845 121077 121077 2871049 2402229 468820 468820 468820 PA Nursing Home Assessment 900099 501894 501894 CABLE TV SERVICES FOR RESIDENTS 517000 55656 55656 BEAUTY/BARBER SHOP SERVICES FOR R 812900 27489 27489 25318 25318 610357 17626059 16710739 0 698360 X 2183 2183 7008437 6639005 369432 46800 42231 4569 1144357 1063521 80836 549387 507598 41789 635546 276982 358564 28021 28021 48596 851 47745 256 256 1809987 1809987 79339 77254 2085 1850847 1679758 171089 632026 632026 60533 46346 14187 112064 112064 1272649 1272649 401381 210238 191143 EQUIPMENT RENTAL AND RE 529580 499491 30089 PA NURSING HOME ASSESSM 277086 277086 BAD DEBTS 59360 59360 CABLE TV 41159 41159 76509 50373 26136 16666103 15188098 1478005 0 124447 500 1416604 1096753 1381848 1968895 40417 39469 160963 107366 30564949 19340474 10995236 11224475 5080492 5035996 40094 37907 232793 237810 19472894 19749171 1133075 1458732 13683 4653 4208628 3426997 22778 0 5378164 4890382 X 13920227 14684286 99951 99951 74552 74552 14094730 14858789 19472894 19749171 959956 -195897 0 X 0 1 X 1 0 X 169386 86782 198970 272754 216960 944852 13956301 14268808 14712482 15876408 16710739 75524738 14125687 14355590 14911452 16149162 16927699 76469590 0 0 0 76469590 101848 107514 106543 115670 121077 552652 101848 107514 106543 115670 121077 552652 107383 108336 161478 111213 108463 596873 14334918 14571440 15179473 16376045 17157239 77619115 0.98520 0.98470 0.00710 0.00700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 256 256 0 Part II-B, Line 1: The Williamsport Home pays dues to LeadingAge. A portion of the dues are considered to be lobbying expenses. 170814 170814 22520719 14041047 8479672 5745689 4276948 1468741 2127727 1022479 1105248 11224475 X 17430162 -195897 -195897 17626059 0 17626059 16666103 0 16666103 0 16666103 Part X, Line 2: The Home accounts for uncertainty in income taxes using a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold is met. Management determined there were no tax uncertainties that met the recognition threshold in 2016 and 2015. X X 0 0 0 0 0 0 0 0 0 susan getz Registered Nurse 138300 0 0 0 0 0 758 0 21464 0 160522 0 0 0 A LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 236760375 2013-04-12 4400000 DESIGN, CONSTRUCTION, AND EQUIPPING OF REHABILITATION UNIT 0 0 0 A 973003 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 Form 990, Part III, Line 4a Residents received 24,331 medical assistance days of service in the Skilled Nursing and Rehabilitation Center during 2016. Volunteering: THE TOTAL NUMBER OF VOLUNTEER HOURS PROVIDED TO THE WILLIAMSPORT HOME FROM COMMUNITY SERVICE VOLUNTEERS IN 2016 INCLUDED MORE THAN 2323 HOURS. 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 AND, WHO PROVIDED 242.75 HOURS OF MUSICAL AND ENTERTAINMENT PROGRAMMING AND SUPPORT TO SKILLED NURSING RESIDENTS. JUNIOR AND ADULT VOLUNTEERS PROVIDED 2225 HOURS TO RESIDENTS IN THE SKILLED NURSING CENTER BY ASSISTING TO DELIVER RESIDENT MAIL, NEWPAPERS, READ OR WRITE LETTERS, BOOKS, SPENDING 1/1 TIME WITH RESIDENT AND TRANSFERRING RESIDENTS IN CHAIRS TO THE LOBBY, HOBBY ROOM AND BEAUTY SHOP. 42 APARTMENT RESIDENTS VOLUNTEERED 3906.45 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 2016, TWH SERVED AS S HOST SITE FOR FOUR 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 2016 WE PROVIDED 2262.50 HOURS AS A HOST SITE. THE WILLIAMSPORT HOME WAS GOVERNED BY A 14 MEMBER ALL VOLUNTEER BOARD DURING 2016 WHO PROVIDED 468 HOURS OF SERVICE TO THE WILLIAMSPORT HOME ATTENDING, BOARD MEETINGS, BOARD SUBCOMMITTEE MEETINGS, SPECIAL EVENTS FOR CAMPUS RESIDENTS, DONORS AND FORMER BOARD MEMBERS. COMMUNITY SUPPORT: THE WILLIAMSPORT HOME SERVED AS A HOST SITE FOR TWO INTERNS FROM LYCOMING COLLEGE, TOTALING 182.5 Hours. IN ADDITION, THE WILLIAMSPORT HOME SERVED AS A CLINICAL SITE FOR 12 LPN'S PROVIDING ON SITE CLINICAL EXPERINCE OF 72 HOURS PER STUDENT AND FOR 20 ASSOICATE DEGREE RN'S PROVIDING ON SITE CLINICAL EXPERIENCE OF 48 HOURS PER STUDENT. DURING 2016, THE WILLIAMSPORT HOME CONTRIBUTED $41,068.00 TO THE CITY OF WILLIAMSPORT TO HELP PAVE A PUBLIC SECTION OF RAVINE ROAD OWNED BY THE CITY AND LOYALSOCK TOWNSHIP LEADING TO THE WILLIAMSPORT HOME CAMPUS WHICH STRETCHED FROM THE CITY OF WILLIAMSPORT INTO LOYALSOCK TOWNSHIP UP RAVINE ROAD TO OUR MAIN ENTRANCE. THE WILLIAMSPORT HOME RECEIVED A GRANT FROM THE WILLIAMSPORT ROTARY CLUB AND HOSTED A ALZHEIMER'S CAREGIVER SESSION FOR 30 CAREGIVERS FROM LCYOMING COUNTY TO ATTEND A FREE EDUCATIONAL SESSION ON ALZHEIMERS' DISEASE WHICH INCLUDED A MEDICAL UPDATE BY THE DR. FINNEY, CHIEF OF NEUROLOGY FROM GEISINGER MEDICAL CENTER, LEGAL ADVICE FROM MARSHAL PARKER AND WEBER, CAREGIVER SUPPORT BY BOB MEACHUM LICENSED PYSCHOLOGIST AND RUNDY PURDY, AUTHOR OF "THE SEA IS WIDE" - MEMOIRS OF A CAREGIVER, FOR 30 MEMBERS OF OUR COMMUNITY. IN ADDITION, TWH DONATED SPACE DURING 2016 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 DIAGNOSED WITH DEMENTIA. TWH ALSO SUPPORTED AND RAISED OVER $6,000 FOR THE ALZHEIMER'S MEMORY WALK IN 2016. FINALLY, TWH PARTICIPATED IN SUPPORTING THE LYCOMING COUNTY SALVATION ARMY FESTIVAL OF TREES BY RAISING $1680 AND SUPPLYING CLERICAL SUPPORT BY ONE OF OUR STAFF VOLUNTEERING. Form 990, Part VI, Section A, line 3 THE HOME UTILIZES THE MANAGEMENT SERVICES OF AFFINITY HEALTHCARE SERVICES. AFFINITY EMPLOYS DONALD POTE, EXECUTIVE DIRECTOR ($108,055) AND JENNIFER CISNEROS, ASST. EXECUTIVE DIRECTOR ($102,816). 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 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 DIETARY: Program service expenses 242,815. Management and general expenses 0. Fundraising expenses 0. Total expenses 242,815. THERAPY AND ANCILLARY SERVICES: Program service expenses 1,255,548. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,255,548. NURSING: Program service expenses 202,007. Management and general expenses 0. Fundraising expenses 0. Total expenses 202,007. LAUNDRY AND HOUSEKEEPING: Program service expenses 91,980. Management and general expenses 0. Fundraising expenses 0. Total expenses 91,980. CONSULTANTS & OTHER PROFESSIONAL SERVICES: Program service expenses 17,637. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,637.