2015-11-09T13:19:02-06:00 2014-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-01-01 240795507 THE WILLIAMSPORT HOME WILL 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 DON POTE EXECUTIVE DIRECTOR 5703238781 2015-11-09 1 JULIUS C GREEN CPA JD P00350393 2159720701 2015-11-09 2014 2016-04-25 22:37:26Z DON POTE 1900 RAVINE ROAD WILLIAMSPORT PA 17701 15400344 0 X THEWILLIAMSPORTHOME.COM X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 16 16 299 150 0 0 86782 198970 14268808 14421262 137942 327414 108336 452698 14601868 15400344 1100 1518 0 0 7634495 7959253 0 0 0 6523537 7242711 14159132 15203482 442736 196862 18076183 19385582 4370415 5610030 13705768 13775552 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 13924677 1518 14712482 PROVIDED 43,284 DAYS OF NURSING SERVICES TO RESIDENTS; 63,671 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 $53,000. 105 RESIDENTS RECEIVED 23,417 MEDICAL ASSISTANCE DAYS OF SERVICE IN THE SKILLED NURSING AND REHABILITATION CENTER DURING 2014.VOLUNTEERING:THE TOTAL NUMBER OF VOLUNTEER HOURS PROVIDED TO THE WILLIAMSPORT HOME FROM COMMUNITY SERVICE VOLUNTEERS IN 2014 EXCEEDED 9900 HOURS.TWH SKILLED NURSING CENTER PROVIDED VOLUNTEER OPPORTUNITIES TO GROUPS FROM LOCAL CHURCHES, 4 -H, THERAPY DOGS, S.P.C.A., MEMBERS OF THE KIWANIS CIRCLE K AND KEY CLUB AND SOUTHERN CARE HOSPICE WHO PROVIDED 315 HOURS OF MUSICAL AND ENTERTAINMENT PROGRAMMING AND SUPPORT TO SKILLED NURSING RESIDENTS. JUNIOR AND ADULT VOLUNTEERS PROVIDED 1090.75 HOURS TO RESIDENTS IN THE SKILLED NURSING CENTER BY ASSISTING TO DELIVER RESIDENT MAIL, NEWSPAPERS, READ OR WRITE LETTERS, BOOKS, SPENDING 1/1 TIME WITH RESIDENTS AND TRANSFERRING RESIDENTS IN WHEEL CHAIRS TO THE LOBBY, BEAUTY SHOP. 45 APARTMENT RESIDENTS VOLUNTEERED 3329 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 2014, TWH SERVED AS A 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 EMPLOYMENT. TWH SERVED AS A HOST SITE FOR THE TENTH YEAR AND WE PROVIDED 3140.50 HOURS AS A HOST SITETHE WILLIAMSPORT HOME ALSO SERVED AS A CLINICAL SITE FOR 1 PENN COLLEGE SCHOOL OF TECHNOLOGY NURSING STUDENTS WHO WERE ENROLLED IN THE LPN, RN AND BSN NURSING PROGRAMS AND RECEIVED CLINICAL SUPPORT AT THE WILLIAMSPORT HOME FOR 1632 HOURS.IN ADDITION, TWH SERVED AS A HOST CLINICAL SITE FOR SEVERAL STUDENTS FROM LYCOMING COLLEGE, MCCANN BUSINESS SCHOOL AND PENN COLLEGE SCHOOL OF TECHNOLOGY DURING 2014 THAT PROVIDED 430.25 INTERNSHIP HOURSEACH MONTH TWH RECEIVES ONGOING SUPPORT THE FOLLOWING GROUPS, THE S.P.C.A. SPONSORS PET VISITS, 4-H MEMBERS VOLUNTEERED TIME FOR A FASHION SHOW, CIRCLE K CHORUS GROUP AND COMMUNITY SUPPORT:TWH DONATED SPACE DURING 2014 TO SPONSOR A MONTHLY ALZHEIMER'S SUPPORT GROUP MEETING FACILITATED BY BOB MEACHAM, CONSULTANT PSYCHOLOGIST TO HELP FAMILY MEMBERS COPE WITH UNDERSTANDING AND CARING FOR A PERSON DIAGNOSED WITH DEMENTIA. TWH ALSO SUPPORTED AND/OR RAISED OVER $6,000 THE ALZHEIMER'S MEMORY WALK IN 2014. 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 TREE CELEBRATION RISING OVER $1,000. 13924677 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 13 0 1 299 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 KEN 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 KATE ANDERSON DIRECTOR 1.00 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 LISA LARSON 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 LISA LOGUE 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 DONALD S POTE EXECUTIVE DIRECTOR 45.00 X 0 0 0 DENISE BOWER ASST. EXECUTIVE DIRECTOR 40.00 X 0 0 0 KEN ANGSTADT DIRECTOR OF FINANCE 40.00 X 54477 0 18829 TAMMY COLEMAN DIRECTOR OF NURSING 40.00 X 80359 0 0 SUSAN GETZ RN 66.00 X 131600 0 18733 SUSAN HOOKER RN 62.00 X 129191 0 15976 BARBARA KLINE RN 52.20 X 100203 0 8255 495830 0 61793 3 0 1 0 FUNCTIONAL PATHWAYS OF TENNESSEE PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 873308 SODEXHO INC & AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE DIETARY 844792 AFFINITY HEALTH SERVICES INC 942 PHILADELPHIA ST INDIANA PA 15701 MANAGEMENT SERVICES 622518 OMNICARE INC PO BOX 415276 COLUMBUS OH 432715276 RESIDENT MEDICATIONS 348164 DIXON AC & R 3983 WEST FOURTH ST WILLIAMSPORT PA 17701 CONTRACTOR 303220 7 198970 198970 PATIENT SERVICE REVENUE 623000 11023968 11023968 APARTMENT REVENUE 623000 3397294 3397294 14421262 106542 106542 220872 0 220872 220872 220872 PA NURSING HOME ASSESSMENT 900099 291220 291220 CABLE TV SERVICES FOR RESIDENTS 517000 58007 58007 BAD DEBTS RECOVERED 900099 44099 44099 59372 59372 452698 15400344 14712482 0 488892 X 1518 1518 6360736 6001222 359514 48889 42946 5943 993690 926771 66919 555938 514600 41338 568212 248038 320174 43530 43530 42540 810 41730 1551128 1551128 102806 99860 2946 1632403 1483174 149229 646668 646668 13552 5681 7871 35608 35608 1231513 1231513 360945 180147 180798 EQUIP RENTAL AND REPAIR 608568 580829 27739 MA NURSING HOME ASSESSM 291220 291220 CABLE TV 33023 33023 DUES AND SUBSCRIPTIONS 24865 2017 22848 56130 47904 8226 15203482 13924677 1278805 0 500 201491 1229142 1575201 1647835 1251942 35171 39133 127151 140467 28199548 16923782 10399405 11275766 4354605 4618550 43739 42281 238635 240751 18076183 19385582 1874905 1175820 32267 16704 2463243 4373362 0 44144 4370415 5610030 X 13631216 13601049 99951 74552 74552 13705768 13775552 18076183 19385582 X 196862 -145590 18512 X 0 1 X 1 0 X 79054 110831 169386 86782 198970 645023 13347178 14278101 13956301 14268808 14712482 70562870 13426232 14388932 14125687 14355590 14911452 71207893 0 0 0 71207893 81992 94490 101848 107514 106543 492387 81992 94490 101848 107514 106543 492387 129366 130752 107383 108336 161478 637315 13637590 14614174 14334918 14571440 15179473 72337595 0.98440 0.98480 0.00680 0.00660 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 170814 170814 21386607 12364888 9021719 5073855 3787369 1286486 1568272 771525 796747 11275766 CAPITAL LEASE OBLIGATION 44144 44144 X 15229167 -145590 18512 -127078 15356245 44099 44099 15400344 15159383 -44099 -44099 15203482 0 15203482 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 2014 AND 2013. THE HOME'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR YEARS ENDED PRIOR TO 2011 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST IN NET ASSETS HELD BY OTHERS 18,512. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS RECOVERED 44,099. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS RECOVERED -44,099. X X 0 0 0 0 0 0 0 0 0 SUSAN GETZ RN 131600 0 0 0 0 0 758 0 17975 0 150333 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 4400000 43739 4155270 200991 0 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 SCHEDULE K PART III LINE 9, PART IV LINE 7, AND PART V: THE WILLIAMSPORT HOME IS IN THE PROCESS OF FINALIZING WRITTEN BOND POLICIES WHICH WILL ADDRESS THESE ISSUES. FORM 990, PART VI, SECTION A, LINE 3 THE HOME UTILIZES THE MANAGEMENT SERVICES OF AFFINITY HEALTHCARE SERVICES. AFFINITY EMPLOYS DONALD POTE, EXECUTIVE DIRECTOR ($93,833) AND DENISE BOWER, ASST. EXECUTIVE DIRECTOR ($76,207). 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 265,561. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 265,561. THERAPY AND ANCILLARY SERVICES: PROGRAM SERVICE EXPENSES 933,175. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 933,175. NURSING: PROGRAM SERVICE EXPENSES 261,688. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 261,688. LAUNDRY AND HOUSEKEEPING: PROGRAM SERVICE EXPENSES 90,704. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,704. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST IN NET ASSETS HELD BY OTHERS 18,512.