2011-11-15T15:07:00-06:00 2010-12-31 ZELENKOFSKE AXELROD LLC 2370 YORK ROAD SUITE A-5 JAMISON PA 18929 990 2010-01-01 251302760 PLEASANT RIDGE MANOR PLEA 8144745521 8300 W RIDGE ROAD GIRARD PA 16417 ROBERT V SMITH 8144745521 2011-11-15 1 DONNA SCAMBY-POWERS 2159182277 2010 2016-03-07 17:11:31Z ROBERT V SMITH 8300 W RIDGE ROAD GIRARD PA 16417 32683259 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 7 543 0 0 0 35100 52703 31879197 32194358 13310 9469 302309 241351 32229916 32497881 0 0 0 0 24567669 27899683 0 0 0 8779396 5563148 33347065 33462831 -1117149 -964950 15156603 13382545 6224214 5415106 8932389 7967439 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 25713964 32497881 PROVIDE LONG TERM CARE SERVICES IN AN APPROXIMATE 390 BED NURSING HOME FACILITY. 25713964 1 0 0 0 0 0 0 1 0 1 0 0 0 1 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 0 0 0 0 1 58 0 543 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 PHIL FATICA 0.50 X 0 0 0 CAROL LOLL 0.50 X 0 0 0 JOSEPH GILES 0.50 X 0 0 0 EBERT BEEMAN 0.50 X 0 0 0 EILEEN AGRESTI 37.50 X 75014 0 0 TIMOTHY DOMMERMUTH 37.50 X 90969 0 0 SANDRA NELSON 37.50 X 80540 0 0 DAVID POPOWICZ 37.50 X 75436 0 0 ROBERT SMITH 37.50 X 103819 0 0 KYLE W FOUST 0.50 X 0 0 0 RON CLEAVER 1.00 X 0 0 0 DOUGLAS SMITH 1.00 X 0 0 0 FIORE LEONE 0.50 X 0 0 0 425778 0 0 1 0 0 0 HIGHMARK INC POBOX 382022 PITTSBURGH PA 15251 HEALTH INSURANCE PROVIDER 6951453 ALLIANCE 1520 KENSINGTON ROAD SUITE 110 OAK BROOK IL 60523 CONTRACTED SECURITY SERVICE 1066679 VILLA MEDICAL SUPPLY 1460 W 38TH STREET ERIE PA 16508 MEDICAL GOODS/EQUIPMENT 173784 PELICAN INSURANCE POBOX 60769 HARRISBURG PA 17104 CONTRACTED SECURITY SERVICE 166663 ERIE PSYCHIATRIC ASSOCIATES 150 E 8TH STREET ERIE PA 16501 CONTRACTED SECURITY SERVICE 127640 5 18993 33710 52703 PATIENT FEES/REVENUES 623000 31616883 31616883 577475 577475 32194358 9469 9469 185378 185378 0 0 OTHER OPERATING REVENU 900099 241351 241351 241351 32497881 32445178 0 0 17077416 13205431 3871985 1824540 1459632 364908 7784144 6275358 1508786 1213583 938426 275157 14989 14989 49119 49119 12509 12509 265084 265084 4806 4806 177721 90012 87709 8661 8661 637166 509733 127433 5848 3525 2323 218576 218576 991563 991563 210343 210343 FOOD COST 1358181 1358181 DRUGS - PHARMACY COST 981154 981154 MEDICAL SUPPLIES TO NUR 627428 627428 33462831 25713964 7748867 0 3698933 2826698 468311 477842 3654859 3871300 326093 299875 290676 73514 29378390 24205970 5918816 5172420 767659 643019 31256 17877 15156603 13382545 3262305 3061675 1950633 1446575 644257 521104 367019 385752 6224214 5415106 X 3174827 2751392 5757562 5216047 8932389 7967439 15156603 13382545 -964950 0 X X 0 1 1 X 0 X 1 644257 1238 643019 1 150490 150490 19195385 15498500 3696885 556298 382444 173854 9429661 8325026 1104635 46556 46556 5172420 COMPENSATED ABSENCES 385752 385752 32497881 33462831 -964950 0 -964950 32497881 0 32497881 0 32497881 33462831 0 33462831 0 33462831 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 2009). 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 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 1 0 0 0 0 0 0 0 PLEASANT RIDGE MANOR FRIENDS FOREVER K COUNTY OF ERIE C