2023-11-14T16:12:36-06:00 2022-12-31 390859910 BAKER TILLY US LLP 1000 COMMERCE PARK DR WILLIAMSPORT PA 17701 990 2022-01-01 240795507 THE WILLIAMSPORT HOME WILL 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 DONALD S POTE EXECUTIVE DIRECTOR 5703238781 2023-11-14 1 DONALD POTE 999009999 0 JAIME L KUNTZ CPA P01272711 5703236023 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DONALD S POTE 1900 RAVINE ROAD WILLIAMSPORT PA 17701 17020149 0 X THEWILLIAMSPORTHOME.COM X 1873 PA PROVIDE NURSING SERVICES IN A 129 BED SKILLED NURSING FACILITY AND HOUSING FOR THE ELDERLY. 13 13 288 18 0 0 2124768 574574 15938015 15014547 -250437 -209600 96478 96853 17908824 15476374 0 0 0 0 10340112 9362854 0 0 0 7823122 8375365 18163234 17738219 -254410 -2261845 21816206 18816006 4217317 4388522 17598889 14427484 X TO PROVIDE THE HIGHEST QUALITY OF CARE TO OUR RESIDENTS WHILE HONORING THEIR INDEPENDENCE AND DIGNITY. 0 0 15802030 15014547 THE WILLIAMSPORT HOME (THE HOME) OPERATES A 129-BED SKILLED NURSING AND REHABILITATION CENTER, 2 LICENSED PERSONAL CARE PROGRAMS AND 185 INDEPENDENT LIVING APARTMENTS WHICH SERVE MEN AND WOMEN. THE HOME ALSO OPERATES A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) PROVIDING HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO ELDERLY RESIDENTS. THE HOME WAS APPROVED TO PROVIDE CONGREGATE MEALS, TRANSPORTATION AND ASSISTANCE TO APARTMENT RESIDENTS BY THE DEPARTMENT OF HEALTH AS A HOME CARE PROVIDER ON APRIL 1, 2011.CONTINUED ON SCHEDULE ODURING 2022, THE HOME PROVIDED 36,877 DAYS OF NURSING SERVICES TO RESIDENTS; 50,595 DAYS OF HOUSING TO RESIDENTS IN INDEPENDENT APARTMENTS; AND 6,888 DAYS IN OUR DHS LICENSED PERSONAL CARE PROGRAMS. OUR PROGRAMS ARE DESIGNED TO HELP MAINTAIN OUR RESIDENT'S HEALTH, SECURITY AND INDEPENDENCE.THE HOME PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOME DOES NOT PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUES. THE HOME PROVIDED APPROXIMATELY $7,425 OF CHARITY CARE DURING 2022. ADDITIONALLY, THE HOME PROVIDES SERVICES TO MEDICAL ASSISTANCE BENEFICIARIES AND IS REIMBURSED AT RATES DIFFERENT FROM STANDARD ROOM CHARGES. THE TOTAL DIFFERENCES RELATED TO THESE SERVICES WERE APPROXIMATELY $2,500,000 IN 2022.VOLUNTEERING:10 COMMUNITY VOLUNTEERS PROVIDED 1,132.75 HOURS IN SKILLED NURSING CENTER 26 APARTMENT RESIDENTS VOLUNTEERED 1,353HOURS IN THE APARTMENTS DINING ROOM AND STORES. 13 BOARD MEMBERS VOLUNTEERED 308 HOURS TO TWH CAMPUS 15802030 1 0 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 37 0 288 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X GARET WESTON 5703238781 1900 RAVINE ROAD WILLIAMSPORT PA 17701 CANDACE DEWAR PRESIDENT 1.00 X X 0 0 0 SUSAN EVANS VICE-PRESIDENT 1.00 X X 0 0 0 BRETTE CONFAIR SECRETARY 1.00 X X 0 0 0 RENEE LAYCHUR TREASURER 1.00 X X 0 0 0 SHARON ATHERHOLT DIRECTOR 1.00 X 0 0 0 MAUREEN CAREY DIRECTOR 1.00 X 0 0 0 WINONA KREMSER DIRECTOR 1.00 X 0 0 0 PATRICIA 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 CATHERINE PICCOLO DIRECTOR 1.00 X 0 0 0 KATHLEEN PAGANA DIRECTOR 1.00 X 0 0 0 HIEN CONNOLLY DIRECTOR 1.00 X 0 0 0 DONALD S POTE EXEC. DIRECTOR 40.00 X 0 0 0 TAMMY SHEEHAN ASSISTANT DIRECTOR 40.00 X 0 0 0 ASHLEY BOGART DIRECTOR OF FINANCE 40.00 X 58203 0 10518 OLGA JACKSON CNA 42.60 X 165326 0 21826 SUSAN R HOOKER REGISTERED NURSE 65.50 X 167892 0 10518 391421 0 42862 2 0 1 0 FUNCTIONAL PATHWAYS 10133 SHERRIL BLVD STE 200 KNOXVILLE TN 37932 THERAPY SERVICES 932025 SODEXO INC & AFFILIATES BOX 360170 PITTSBURGH PA 15251 FOOD SERVICES 734587 AFFINITY HEALTH SERVICES 942 PHILADELPHIA ST INDIANA PA 15701 MANAGEMENT SERVICES 701566 GENERAL HEALTHCARE RESOURCES 2250 HICKORY RD STE 240 PLYMOUTH MEETING PA 19462 STAFFING 375802 DEDICATED NURSING ASSOCIATES INC 6536 WILLIAM PENN HIGHWAY STATE RTE DELMONT PA 15626 STAFFING 265422 13 517691 56883 574574 PATIENT SERVICE REVENUE 623000 11800324 11800324 APARTMENT REVENUE 623000 3214223 3214223 15014547 187483 187483 1146692 1543775 -397083 -397083 -397083 CABLE TV SERVICES FOR RESIDENTS 517000 55638 55638 BEAUTY/BARBER SHOP REVENUE 812900 15686 15686 TRANSPORTATION FOR RESIDENTS 480000 3568 3568 21961 21961 96853 15476374 15014547 0 -112747 X 7886634 7462258 424376 76258 75162 1096 830088 812473 17615 569874 539169 30705 417955 29995 387960 13686 13686 62635 109 62526 2879438 2545014 334424 48605 48205 400 1626644 1346206 280438 646208 646208 56731 35793 20938 55155 55155 1136988 1136988 436023 163195 272828 MEDICAL SUPPLIES 223045 223045 NURSING HOME ASSESSMENT 213121 213121 REPAIRS & MAINTENANCE 193495 151710 41785 LEASE EXPENSE 77469 77469 288167 240755 47412 17738219 15802030 1936189 0 500 500 2013250 625618 1063804 1098870 28232 26152 78801 59038 36738301 26889116 9955696 9849185 8187325 6625301 488598 531342 21816206 18816006 1490141 1698014 12233 10811 2363215 2118363 400049 351728 161285 4217317 4388522 X 17473983 14302578 124906 124906 17598889 14427484 21816206 18816006 -2261845 -909560 0 X 0 1 X 1 0 X 443662 52157 1273900 2124768 574574 4469061 17276146 17599559 16918039 15938015 15014547 82746306 17719808 17651716 18191939 18062783 15589121 87215367 0 0 0 87215367 136462 185653 115653 140442 187483 765693 136462 185653 115653 140442 187483 765693 115439 137193 82791 96478 96853 528754 17971709 17974562 18390383 18299703 15873457 88509814 0.98540 0.98590 0.00870 0.00810 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: EMPLOYEE AND GUEST MEALS - 2018 AMOUNT: $ 5,654. 2019 AMOUNT: $ 6,151. 2020 AMOUNT: $ 1,888. 2021 AMOUNT: $ 735. 2022 AMOUNT: $ 973. BEAUTY/BARBER SHOP REVENUE - 2018 AMOUNT: $ 32,602. 2019 AMOUNT: $ 29,949. 2020 AMOUNT: $ 6,432. 2021 AMOUNT: $ 6,933. 2022 AMOUNT: $ 15,686. CABLE TV SERVICES FOR RESIDENTS - 2018 AMOUNT: $ 51,689. 2019 AMOUNT: $ 57,646. 2020 AMOUNT: $ 60,620. 2021 AMOUNT: $ 57,400. 2022 AMOUNT: $ 55,638. CONCESSION/VENDING - 2018 AMOUNT: $ 259. 2019 AMOUNT: $ 7. 2020 AMOUNT: $ -5,485. 2021 AMOUNT: $ 1,355. 2022 AMOUNT: $ 8,746. TRANSPORTATION FOR RESIDENTS - 2018 AMOUNT: $ 2,091. 2019 AMOUNT: $ 2,298. 2020 AMOUNT: $ 4,444. 2021 AMOUNT: $ 5,727. 2022 AMOUNT: $ 3,568. OTHER INCOME - 2018 AMOUNT: $ 23,144. 2019 AMOUNT: $ 38,164. 2020 AMOUNT: $ 14,549. 2021 AMOUNT: $ 24,328. 2022 AMOUNT: $ 11,804. PROFESSIONAL WELLNESS - 2019 AMOUNT: $ 2,978. 2020 AMOUNT: $ 343. 2022 AMOUNT: $ 438. 796206 796206 26340577 19152320 7188257 6426856 5433903 992953 3174662 2302893 871769 9849185 FINANCE LEASE OBLIGATIONS 161285 161285 X 14566814 -909560 -909560 15476374 0 15476374 17738219 0 17738219 0 17738219 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 HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2022 AND 2021. X X 0 0 0 0 0 0 0 0 0 OLGA JACKSON CNA 165326 0 0 0 0 0 0 0 21826 0 187152 0 0 0 SUSAN R HOOKER REGISTERED NURSE 167892 0 0 0 0 0 0 0 10518 0 178410 0 0 0 A LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 236760375 2013-04-12 4400000 SEE PART VI 0 0 0 A 2245465 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 SCHEDULE K, PART 1, BOND ISSUES: (A) ISSUER NAME: LYCOMING COUNTY AUTHORITY HEALTHCARE REVENUE NOTE SERIES A OF 2013 (F) DESCRIPTION OF PURPOSE: DESIGN, CONSTRUCTION, AND EQUIPPING OF REHABILITATION UNIT FORM 990, PART VI, SECTION A, LINE 3 THE HOME UTILIZES THE MANAGEMENT SERVICES OF AFFINITY HEALTHCARE SERVICES. AFFINITY EMPLOYS DONALD S. POTE, EXECUTIVE DIRECTOR ($123,165) AND TAMMY SHEEHAN, ASSISTANT DIRECTOR ($125,712). FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO AND REVIEWED BY ALL BOARD MEMBERS 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 THERAPY AND ANCILLARY SERVICES: PROGRAM SERVICE EXPENSES 932,945. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 932,945. NURSING: PROGRAM SERVICE EXPENSES 1,048,236. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,048,236. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 527,261. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 527,261. CONSULTANTS: PROGRAM SERVICE EXPENSES 36,572. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,572. CONTRACTORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 334,424. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 334,424.