2016-11-07T07:42:12-06:00 2015-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2015-01-01 240795507 THE WILLIAMSPORT HOME WILL 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 DONALD S POTE EXECUTIVE DIRECTOR 5703238781 2016-11-04 1 JULIUS C GREEN CPA P00350393 2159720701 2015 2017-02-10 21:41:12Z DONALD S POTE 1900 RAVINE ROAD WILLIAMSPORT PA 17701 17132732 0 X THEWILLIAMSPORTHOME.COM X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 15 15 320 150 0 0 198970 272754 14421262 15599598 327414 147653 452698 388023 15400344 16408028 1518 1337 0 0 7959253 8360008 0 0 0 7242711 7497799 15203482 15859144 196862 548884 19385582 19472894 5610030 5378164 13775552 14094730 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 14443227 1337 15876408 PROVIDED 44,152 DAYS OF NURSING SERVICES TO RESIDENTS; 63,550 DAYS OF HOUSING TO RESIDENTS IN INDEPENDENT APARTMENTS; AND 11,003 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 THREE (3) INDEPENDENT LIVING RESIDENTS IN OUR DPW LICENSED PERSONAL CARE PROGRAMS TOTALLING APPROXIMATELY $99,000. 99 RESIDENTS RECEIVED 22,925 MEDICAL ASSISTANCE DAYS OF SERVICE IN THE SKILLED NURSING AND REHABILITATION CENTER DURING 2015.VOLUNTEERING:THE TOTAL NUMBER OF VOLUNTEER HOURS PROVIDED TO THE WILLIAMSPORT HOME FROM COMMUNITY SERVICE VOLUNTEERS IN 2015 INCLUDED MORE THAN 1750 HOURS.TWH SKILLIED NURSING CENTER PROVIDED VOLUNTEER OPPORTUNITIES TO GROUPS FROM LOCAL CHURCHES, 4H, THERAPY DOGS, SPCA, MEMBERS OF THE KIWANIS CIRCLE K AND KEY CLUBS AND SOUTHER CARE HOSPICE, WHO PROVIDED 303 HOURS OF MUSICAL AND ENTERTAINMENT PROGRAMMING AND SUPPORT TO SKILLED NURSING RESIDENTS. JUNIOR AND ADULT VOLUNTEERS PROVIDED 1321 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 3741 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 2015, TWH SERVED AS S HOST SITE FOR FIVE 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. TWH SERVED AS A HOST SITE FOR THE ELEVENTH YEAR AND WE PROVIDED 2197 HOURS AS A HOST SITE.THE WILLIAMSPORT HOME ALSO SERVED AS A CLINICAL SITE FOR 21 PENN COLLEGESCHOOL OF TECHNOLOGY NURSING STUDENTS WHO WERE RNROLLED IN THE LPN (5), RN (11) AND BSN (5) NURSING PROGRAMS AND RECEIVED CLINICAL SUPPORT AT THE WILLIAMSPORT HOME FOR 202 HOURS.EACH MONTH TWH RECEIVES ONGOING SUPPORT FROM THE FOLLOWING GROUPS; THE SPCA (SPONSORS PET VISITS), AND CIRCLE K AND WILLIAMSPORT HIGH SCHOOL KEY CLUB PROVIDED A CAROLING GROUP FOR THE ANNUAL CHRISTMAS TREE LIGHTING.COMMUNITY SUPPORT:TWH DONATED SPACE DURING 2015 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 2015. THE WILLIAMSPORT HOME ALSO SERVED AS HOST SITE FOR THE PEER TRAINING AND QUARTERLY MEETINGS OF THE CLINTON-LYCOMING BI-COUNTY OFFICE ON AGING. FINALLY, TWH PARTICIPATED IN SUPPORTING THE LYCOMING COUNTY SALVATION ARMY FESTIVAL OF TREES BY RAISING OVER $1500 AND SUPPLYING CLERICAL SUPPORT BY ONE OF OUR STAFF VOLUNTEERING. 14443227 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 1 12 0 1 320 1 0 0 0 0 0 0 0 0 0 0 X 15 15 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 VERA ANDERSON PRESIDENT 1.00 X X 0 0 0 LAURIE BURKHOLDER VICE-PRESIDENT 1.00 X X 0 0 0 MAUREEN CAREY TREASURER 1.00 X X 0 0 0 CLAUDIA SACAVAGE SECRETARY 1.00 X X 0 0 0 MARY CAMP DIRECTOR 1.00 X 0 0 0 MARGARET CHAPMAN DIRECTOR 1.00 X 0 0 0 BRETTE CONFAIR 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 KATHRYN NASSBERG 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 JOANNE LUDWIKOWSKI DIRECTOR 1.00 X 0 0 0 DONALD S POTE EXECUTIVE DIRECTOR 45.00 X 0 0 0 JENNIFER CISNEROS ASST. EXECUTIVE DIRECTOR 40.00 X 0 0 0 TAMMY COLEMAN DIRECTOR OF NURSING 40.00 X 83821 0 0 KENNETH ANGSTADT DIRECTOR OF FINANCE 40.00 X 61423 0 18305 SUSAN GETZ REGISTERED NURSE 66.00 X 132840 0 16913 SUSAN HOOKER REGISTERED NURSE 66.00 X 128608 0 16301 406692 0 51519 2 0 0 0 FUNCTIONAL PATHWAYS OF TENNESSEE PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 1122704 SODEXHO INC & AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE DIETARY 837840 AFFINITY HEALTH SERVICES INC 942 PHILADELPHIA ST INDIANA PA 15701 MANAGEMENT SERVICES 668502 DIXON AC & R 3983 WEST FOURTH ST WILLIAMSPORT PA 17701 CONTRACTOR 385979 OMNICARE INC PO BOX 415276 COLUMBUS OH 432715276 RESIDENT MEDICATIONS 314882 7 272754 272754 PATIENT SERVICE REVENUE 623000 12032487 12032487 APARTMENT REVENUE 623000 3567111 3567111 15599598 115670 115670 756687 724704 31983 31983 31983 PA NURSING HOME ASSESSMENT 900099 276810 276810 CABLE TV SERVICES FOR RESIDENTS 517000 56632 56632 BEAUTY/BARBER SHOP SERVICES FOR R 812900 22352 22352 32229 32229 388023 16408028 15876408 0 258866 X 1337 1337 163550 154614 8936 6508532 6152914 355618 55339 45445 9894 1074593 993196 81397 557994 516715 41279 550534 244707 305827 20552 20552 45652 851 44801 1719706 1719706 68853 68567 286 1655654 1492744 162910 659508 659508 39452 29873 9579 132828 132828 1282517 1282517 400823 216751 184072 EQUIP RENTAL AND REPAIR 495460 466795 28665 PA NURSING HOME ASSESSM 276810 276810 BAD DEBTS 40350 40350 CABLE TV 37423 37423 71677 42404 29273 15859144 14443227 1415917 0 201491 124447 1575201 1416604 1251942 1381848 39133 40417 140467 160963 29140263 18145027 11275766 10995236 4618550 5080492 42281 40094 240751 232793 19385582 19472894 1175820 1133075 16704 13683 4373362 4208628 44144 22778 5610030 5378164 X 13601049 13920227 99951 99951 74552 74552 13775552 14094730 19385582 19472894 548884 -229706 0 X 0 1 X 1 0 X 110831 169386 86782 198970 272754 838723 14278101 13956301 14268808 14712482 15876408 73092100 14388932 14125687 14355590 14911452 16149162 73930823 0 0 0 73930823 94490 101848 107514 106543 115670 526065 94490 101848 107514 106543 115670 526065 130752 107383 108336 161478 111213 619162 14614174 14334918 14571440 15179473 16376045 75076050 0.98470 0.98440 0.00700 0.00680 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 170814 170814 21982459 13208273 8774186 5366153 4040054 1326099 1620837 896700 724137 10995236 CAPITAL LEASE OBLIGATION 22778 22778 X 16178322 -229706 -229706 16408028 0 16408028 15859144 0 15859144 0 15859144 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 2015 AND 2014. THE HOME'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR YEARS ENDED PRIOR TO 2012 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 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 191372 4400000 43739 4155270 200991 0 0 0 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 VI, SECTION A, LINE 3 THE HOME UTILIZES THE MANAGEMENT SERVICES OF AFFINITY HEALTHCARE SERVICES. AFFINITY EMPLOYS DONALD POTE, EXECUTIVE DIRECTOR ($101,107) AND JENNIFER CISNEROS, ASST. EXECUTIVE DIRECTOR ($53,666). FORM 990, PART VI, SECTION B, LINE 11 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 USES 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 252,081. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 252,081. THERAPY AND ANCILLARY SERVICES: PROGRAM SERVICE EXPENSES 1,176,884. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,176,884. NURSING: PROGRAM SERVICE EXPENSES 189,252. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189,252. LAUNDRY AND HOUSEKEEPING: PROGRAM SERVICE EXPENSES 75,896. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,896. TRUSTEE FEES: PROGRAM SERVICE EXPENSES 4,650. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,650. CONSULTANTS & OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 20,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,943.