2013-08-14T16:23:41-05:00 2012-12-31 233022325 ZELENKOFSKE AXELROD LLC 2370 YORK ROAD SUITE A-5 JAMISON PA 18929 990 2012-01-01 251302760 PLEASANT RIDGE MANOR PLEA 8144745521 8300 W RIDGE ROAD GIRARD PA 16417 ROBERT V SMITH 8144745521 2013-08-14 1 DONNA SCAMBY-POWERS P00671750 2159182277 2012 2016-02-24 21:20:13Z ROBERT V SMITH 8300 W RIDGE ROAD GIRARD PA 16417 33802105 0 X WWW.PLEASANTRIDGEMANOR.COM X 1976 PA THE MISSION OF PLEASANT RIDGE MANOR IS TO ASSURE THAT THE MEDICALLY AND FINANCIALLY INDIGENT OF ERIE COUNTY SHALL RECEIVE THE HIGHEST QUALITY MEDICAL AND NURSING HOME CARE IN AN ENVIRONMENT THAT PROMOTES THE PSYCHOLOGICAL, SOCIAL, SPIRITUAL, RECREATIONAL, AND REHABILITATIVE DEVELOPMENT OF THE INDIVIDUAL. 7 7 520 0 0 0 189507 117655 33092436 33222595 5149 18657 609371 443198 33896463 33802105 0 0 0 0 28617102 24453272 0 0 0 5861303 7901112 34478405 32354384 -581942 1447721 12526737 12767214 5141240 4469882 7385497 8297332 X THE MISSION OF PLEASANT RIDGE MANOR IS TO ASSURE THAT THE MEDICALLY AND FINANCIALLY INDIGENT OF ERIE COUNTY SHALL RECEIVE THE HIGHEST QUALITY MEDICAL AND NURSING HOME CARE IN AN ENVIRONMENT THAT PROMOTES THE PSYCHOLOGICAL, SOCIAL, SPIRITUAL, RECREATIONAL, AND REHABILITATIVE DEVELOPMENT OF THE INDIVIDUAL. 0 0 29189619 33684450 PROVIDE LONG TERM CARE SERVICES IN AN APPROXIMATE 390 BED NURSING HOME FACILITY. 29189619 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 1 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 1 0 0 0 1 115 0 1 520 1 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X THE ORGANIZATION 8144745521 8300 W RIDGE ROAD GIRARD PA 16417 BARRY GROSSMAN 1.00 X 0 0 0 JAMES SPARBER 1.00 X 0 0 0 FIORE LEONE 0.50 X 0 0 0 PHIL FATICA 0.50 X 0 0 0 DOUGLAS SMITH 1.00 X 0 0 0 RWHITNEY CLEAVER 1.00 X 0 0 0 EDWARD DIMATTIO JR 0.50 X 0 0 0 KYLE FOUST 0.50 X 0 0 0 JOSEPH GILES 0.50 X 0 0 0 CAROL LOLL 0.50 X 0 0 0 EILEEN AGRESTI 37.50 X 72228 0 0 SHEILA HAMILTON 37.50 X 73154 0 0 MARY VENEZIA 37.50 X 64892 0 0 DAVID POPOWICZ 37.50 X 72750 0 0 ROBERT SMITH 37.50 X 99941 0 0 382965 0 0 0 0 0 0 HIGHMARK INC POBOX 382022 PITTSBURGH PA 15251 HEALTH INSURANCE PROVIDER 5915262 ALLIANCE REHAB 1520 KENSINGTON ROAD OAK BROOK IL 60523 REHAB THERAPY 1281890 MAPLEVALE FARMS INC 2063 ALLEN ST EXT FALCONER NY 14733 FOOD SERVICE 641498 CA CURTZE INC POBOX 797 ERIE PA 16512 FOOD SERVICE 218228 INC PO BOX 931703 ATLANTA GA 31193 SECURITY SERVICES 173824 5 47655 70000 117655 PATIENT FEES/REVENUES 623000 32016486 32016486 1206109 1206109 33222595 18657 18657 PRIOR YEAR REFUNDS 900099 239903 239903 OTHER OPERATING REVENUE 900099 202550 202550 REFUND RESERVE 900099 745 745 443198 33802105 33684450 0 0 15530810 14353131 1177679 1323028 1217186 105842 6429159 5914826 514333 1170275 1076653 93622 171199 162413 8786 45927 45927 29849 29849 128160 128160 2237 2237 158135 119940 38195 30146 30146 890316 712253 178063 6078 3208 2870 7572 841 6731 12383 12383 747780 747780 170322 170322 THERAPY 1845455 1845455 DRUGS - PHARMACY COST 1557729 1557729 FOOD COST 1186118 1186118 MEDICAL SUPPLIES TO NUR 911706 911706 32354384 29189619 3164765 0 260963 1320589 494993 509135 5502923 5344538 302809 251980 63993 82980 30262577 25740596 4769852 4521981 1120834 725641 10370 10370 12526737 12767214 3542271 3526176 548862 495302 650000 0 400107 448404 5141240 4469882 X 2615645 3775351 4769852 4521981 7385497 8297332 12526737 12767214 X 1447721 -535886 X X 0 1 X 1 1 1 X 1 568834 156807 725641 1 150490 150490 19320846 16418005 2902841 556298 441567 114731 9776409 8881024 895385 458534 458534 4521981 RESTRICTED CASH-CLIENT FUNDS 495302 C NET PENSION ASSETS 230339 F 725641 COMPENSATED ABSENCES 448404 448404 33802105 0 33802105 0 33802105 32354384 0 32354384 0 32354384 PART IV, LINE 1B: FUNDS ARE HELD FOR RESIDENTS ON THEIR BEHALF. THE ORGANIZATION ENTRUSTS THE FUNDS FOR RESIDENTS WHO PERSONALLLY CHOOSE TO HAVE THE ORGANIZATION HANDLE THESE FUNDS. THESE FUNDS CANNOT BE USED FOR ANY PURPOSE OTHER THAN AT THE RESIDENT'S DISCRETION. THE FACILITY HOLDS CLIENT FUNDS IN RESTRICTED ESCROW ACCOUNTS. THESE FUNDS ARE ALSO HELD IN RESTRICTION AS AN ASSET. 0 0 0 X 1 0 1 1 PLEASANT RIDGE MANOR

8300 W RIDGE ROAD GIRARD PA 16417

LONG TERM CARE SKILLED NURSING HOME PLEASANT RIDGE MANOR 1 0 0 0 0 0 0 0 0 0 0 0 0 PART III, LINE 4: THE CFO REVIEWS WITH THE ACCOUNTING STAFF THE ACCOUNTS TO BE EVALUATED FOR NON-COLLECTIBILITY. THE ACCOUNTS ARE EVALUATED FOR ALL CUSTOMER BILLING TYPES, AND AMOUNTS TO BE DEEMED AS UNCOLLECTIBLE ARE DETERMINED ON A CASE BY CASE BASIS, PENDING BOARD OF DIRECTORS APPROVAL.THE ORGANIZATION FOLLOWS THE DIRECT WRITE OFF METHOD FOR ACCOUNTING FOR BAD DEBT EXPENSE. THE FIGURE SHOWN IS FOR INFORMATIONAL PURPOSES ONLY. PART III, LINE 8: MEDICAL ASSISTANCE REIMBURSEMENT RESIDENTS ACCOUNT FOR APPROXIMATELY 86% OF PLEASANT RIDGE MANOR'S CENSUS AND APPROXIMATELY 71% OF ITS REVENUE BASE. REVENUE REPORTED ON LINE 5 REPRESENTS THE INPATIENT NET PPS AMOUNT AFTER DEDUCTIBLES AND CO-INSURANCE. PART VI, LINE 2: PLEASANT RIDGE MANOR, FORMERLY THE ERIE COUNTY GERIATRIC CENTER, IS A NON-PROFIT ORGANIZATION, AS DEFINED UNDER SECTION 501 C 3 OF THE INTERNAL REVENUE CODE, ORGANZIED TO PROVIDE PUBLIC, NONSECTARIAN CHARITY, HEALTH AND NURSING CARE TO INDIGENT PERSONS WITHIN ERIE COUNTY, PENNSYLVANIA. UNDER THE TERMS OF THE STATEMENT OF AGREEMENT DATED APRIL 15, 1980 BETWEEN THE COUNTY OF ERIE AND PLEASANT RIDGE MANOR, THE COUNTY HAS THE FULL AND ENTIRE RIGHT OF CONTROL OF THE FINANCIAL AFFAIRS OF PLEASANT RIDGE MANOR. PLEASANT RIDGE MANOR IS RECOGNIZED AS A COUNTY FACILITY. APPROXIMATELY 71% OF ITS REVENUE IS DERIVED FROM SERVICES PROVIDED TO RESIDENTS UNDER THE MEDICAL ASSISTANCE PROGRAM. HOWEVER, NO PURELY CHARITABLE CARE WAS PROVIDED DURING THE PERIOD COVERED BY THIS REPORT (CALENDAR YEAR 2012). FORM 990, PART VI, SECTION B, LINE 11 THE BOARD REVIEWED FORM 990 PRIOR TO ITS FILING. THE FORM 990 WAS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C AS PART OF ITS POLICIES AND PROCEDURES, PLEASANT RIDGE MANOR STRICTLY ENFORCES THE CONFLICT OF INTEREST POLICY WITH ALL EMPLOYEES AND OFFICERS AND HAS SAID POLICY SIGNED OFF ON WITH INDIVIDUALS ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 PLEASANT RIDGE MANOR HAS A BUDGET PROCESS INTEGRATED WITH THE COUNTY OF ERIE. WITHIN THAT PROCESS, THE COMPENSATION OF THE ORGANIZATIONS EXECUTIVE DIRECTOR/CEO AND ALL TOP MANAGEMENT PERSONNEL ARE CAREFULLY BUDGETED AND REVIEWED IN COMPARISON TO OTHERS IN SIMILAR INDUSTRIES BEFORE THOSE SALARY AMOUNTS ARE APPROVED BY THE COUNTY OF ERIE AND THE BOARD OF DIRECTORS OF PLEASANT RIDGE MANOR. FORM 990, PART VI, SECTION C, LINE 18 UPON REQUEST, THE MANAGEMENT OF PLEASANT RIDGE MANOR WILL MAKE THEIR AUDITED FINANCIAL STATEMENTS AND FORM 990 AVAILABLE FOR INSPECTION. THE FORM 990 IS ALSO AVAILABLE FOR INSPECTION ON THE PUBLIC WEBSITE GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE MANAGEMENT OF PLEASANT RIDGE MANOR WILL MAKE THEIR AUDITED FINANCIAL STATEMENTS AND FORM 990 AVAILABLE FOR INSPECTION AND/OR REVIEW. THE FORM 990 IS ALSO AVAILABLE FOR TO INTERESTED PARTIES ON THE PUBLIC WEBSITE GUIDESTAR.ORG CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RESTATEMENT OF NET POSITION -535,886. FORM 990 PART XI LINE 2C ERIE COUNTY COUNCIL SERVES AS THE PLEASANT RIDGE MANOR BOARD OF DIRECTORS WITH COMPLETE OVERSIGHT APPLICABLE TO ALL PLEASANT RIDGE MANOR FUNCTIONS. PLEASANT RIDGE MANOR IS A POLITICAL SUBDIVISION OF THE COUNTY OF ERIE. THIS POLICY HAS NOT CHANGED SINCE THE PRIOR FISCAL YEAR END. PLEASANT RIDGE MANOR FRIENDS FOREVER 8300 W RIDGE ROAD GIRARD PA 16417 251464234 TO ASSIST THE BOARD OF TRUSTEES OF PLEASANT RIDGE MANOR. PA 501(C)(3) 0 COUNTY OF ERIE 140 W 6TH STREET ROOM 505 ERIE PA 16501 ORGANIZATION IS A POLITICAL SUBDIVISION OF ERIE COUNTY PA GOVT UNIT 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 PLEASANT RIDGE MANOR FRIENDS FOREVER L COUNTY OF ERIE C