2022-05-13T14:52:51-05:00 2021-06-30 263753134 CBIZ MHM LLC 500 BOYLSTON STREET BOSTON MA 02116 990 2020-07-01 231352250 OLD MAN'S HOME OF PHILADELPHIA D/B/A SAUNDERS HOUSE OLDM 6106585100 100 LANCASTER AVENUE WYNNEWOOD PA 19096 KEVIN ROSS PRESIDENT & CEO 6105258300 2022-05-13 1 KEVIN ROSS XXX-XX-XXXX BRENDA L BOOTH P01342395 6177610600 2022-05-13 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SAUNDERS HOUSE KEVIN ROSS 100 LANCASTER AVENUE WYNNEWOOD PA 19096 18058034 0 X WWW.SAUNDERSHOUSE.ORG X 1864 PA PROVIDED SKILLED NURSING AND REHABILIATION SERVICES. 15 14 309 20 0 0 1385992 1284081 16933203 13290761 31815 897768 11036 238639 18362046 15711249 0 0 0 0 11148769 11133445 0 0 0 6909731 5151977 18058500 16285422 303546 -574173 26277588 28896647 5781200 7335167 20496388 21561480 PROVIDED SKILLED NURSING AND REHABILIATION SERVICES. 0 0 14732643 13529400 OUR MISSION TO BE A PREMIER SKILLED NURSING HOME OF CHOICE FOR SHORT-TERM REHABILITATION AND LONG-TERM CARE ON THE MAIN LINE.AS A NOT-FOR-PROFIT PROVIDER, OUR PURPOSE IS TO SERVE THE COMMUNITY BY PROVIDING QUALITY CARE AND SERVICES AND TO USE OUR RESOURCES IN A COST-EFFECTIVE AND COMMUNITY-RESPONSIVE MANNER. WE STRIVE TO ACCOMPLISH THIS IN AN ENVIRONMENT THAT IS RESPECTFUL OF RESIDENTS AND STAFF. 14732643 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 1 0 0 0 1 12 0 1 309 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 PA X MAIN LINE SENIOR CARE 6106585100 100 E LANCASTER AVENUE WYNNEWOOD PA 19096 KEVIN ROSS PRESIDENT & CEO 10.00 30.00 X X 0 364884 25481 BOB BERGEN SECRETARY 1.00 2.00 X X 0 0 0 GORDON MOTT CHAIRMAN 1.00 2.00 X X 0 0 0 A LOUIS DENTON VICE CHAIRMAN 1.00 2.00 X X 0 0 0 PAUL BOSTON BOARD MEMBER 1.00 2.00 X 0 0 0 CHARLES F BREISH MD BOARD MEMBER 1.00 2.00 X 0 0 0 DAVID R DUGERY TREASURER 1.00 2.00 X X 0 0 0 ROSELLA HARVEY BOARD MEMBER 1.00 2.00 X 0 0 0 DAVIS PEARSON BOARD MEMBER 1.00 2.00 X 0 0 0 PHIL ROBINSON BOARD MEMBER 1.00 2.00 X 0 0 0 LIZ ROGAN BOARD MEMBER 1.00 2.00 X 0 0 0 TIM RUBIN BOARD MEMBER 1.00 2.00 X 0 0 0 SARA SENIOR BOARD MEMBER 1.00 2.00 X 0 0 0 MARY ANNE STETZER BOARD MEMBER 1.00 2.00 X 0 0 0 JENNIFER NAM CFO 10.00 30.00 X 0 173380 7152 LORI MARKUSFELD DIRECTOR OF FUNDRAISING 40.00 0.00 X 137847 0 1396 CHARLYANNE NESTER DIRECTOR OF CLINCAL REIMBURSEMENT 40.00 0.00 X 122266 0 7077 CURTIS HAMMOND DIRECTOR OF NURSING 40.00 0.00 X 127856 0 7078 MARK S MASON DIRECTOR, HUMAN RESOURCES 40.00 0.00 X 119940 0 7719 STACY HOUSEKNECHT EMPLOYEE 40.00 0.00 X 123077 0 0 630986 538264 55903 6 0 1 0 SELECT REHABILITATION INC PO BOX 71985 CHICAGO IL 606941985 THERAPY SVCS - RESIDENTS 975683 P1 FINANCE PO BOX 922025 NORCROSS GA 300102025 FINANCIAL SERVICES 903212 US FOODS INC PO BOX 33101 NEWARK NJ 07188 FOOD - RESIDENTS 389409 MCKESSON MEDICAL-SURGICAL PO BOX 630693 CINCINNATI OH 45263 MEDICAL SUPPIES 365255 CONTRACT PHARMACY SERVICES 125 TITUS AVENUE WARRINGTON PA 18976 PHARMACY - RESIDENTS 340462 14 856548 427533 1284081 RESIDENT CARE/ADMIN FEES 623000 13290761 13290761 13290761 133322 133322 3111231 2346785 764446 764446 764446 OTHER INCOME 623000 238639 238639 238639 15711249 13529400 0 897768 9590094 8953564 636530 879609 805335 74274 663742 614953 48789 710176 710176 16575 16575 578633 576886 1747 51646 1846 49800 213087 213087 45319 45319 52236 52236 507134 507134 730577 730577 MEDICAL/ANCILLARY SERV 966043 966043 UTILITIES/PLANT OPS 635920 635920 FOOD/SUPPLEMENT 411450 411450 SUPPLIES 148330 134964 13366 84851 83329 1522 16285422 14732643 1552779 0 4025069 4712825 398704 0 1912384 1544120 87084 84398 811968 327940 26216301 19183997 7298207 7032304 7742888 9975292 1122873 1363818 2878411 3855950 26277588 28896647 1308561 1717305 426376 24980 1551051 875964 2233 0 2492979 4716918 5781200 7335167 X 19373515 20197662 1122873 1363818 20496388 21561480 26277588 28896647 X -574173 1398320 240945 X 0 1 X 1 0 X 331427 441733 392521 1385992 1284081 3835754 19458818 19192021 19091709 16933203 13290761 87966512 19790245 19633754 19484230 18319195 14574842 91802266 5800 7600 6515 6625 3900 30440 0 5800 7600 6515 6625 3900 30440 91771826 257962 207616 293861 247088 133322 1139849 257962 207616 293861 247088 133322 1139849 27298 23283 10630 11036 238639 310886 20075505 19864653 19788721 18577319 14946803 93253001 0.98410 0.98640 0.01220 0.01250 X SCHEDULE A, PART III, SECTION B., #12 MISCELLANEOUS REVENUES 2016: 27,298 2017: 23,283 2018: 10,630 2019: 11,036 2020: 238,639 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8866115 2572869 43028 11395956 8700243 205130 39258 8866115 8377749 341119 18625 8700243 7749615 663342 35208 8377749 6562437 500000 723333 36166 7749615 0.88000 0.12000 1 0 1600000 1600000 14461454 9169806 5291648 412947 355693 57254 9741900 9658498 83402 7032304 DUE FROM RELATED PARTY 3855950 3855950 UNCLAIMED PROPERTY 75858 ESTIMATED THIRD PARTY SETTLEMENTS 325050 PPP LOAN 4316010 4716918 X 17333939 1398320 240945 1639265 15694674 16575 16575 15711249 16268847 0 16268847 16575 16575 16285422 PART V, LINE 4: UNDER THE TERMS OF PERPETUAL TRUSTS HELD AND ADMINISTERED BY A THIRD-PARTY, THE ORGANIZATION IS THE BENEFICIARY OF INCOME EARNED BY THOSE TRUSTS' ASSETS IN PERPETUITY. THE ORGANIZATION RECORDS ANY INCOME RECEIVED FROM THE TRUSTS IN THE PERIOD AS UNRESTRICTED. BOARD DESIGNATED FUNDS CONSIST OF AN ENDOWMENT OF FUNDS HELD IN AN INVESTMENT PROGRAM WHICH PRIMARILY INVESTS IN MUTUAL FUND SECURITIES. THE ORGANIZATION MAY SPEND THE ACCUMULATED INVESTMENT INCOME REINVESTED FOR ENDOWMENT PURPOSES AT THE DISCRETION OF THE BOARD OF DIRECTORS. PART X, LINE 2: THE ORGANIZATION IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS AMENDED, AND FROM STATE INCOME TAXES UNDER THE NOT-FOR-PROFIT ORGANIZATION LAWS OF THE COMMONWEALTH OF PENNSYLVANIA. ACCORDINGLY, NO PROVISION FOR INCOME TAXES FOR THE ORGANIZATION HAS BEEN PROVIDED. THE ORGANIZATION ACCOUNTS FOR THE EFFECT OF ANY UNCERTAIN TAX POSITIONS BASED ON A "MORE LIKELY THAN NOT" THRESHOLD APPLIED TO THE RECOGNITION OF THE TAX POSITIONS BEING SUSTAINED BASED ON THE TECHNICAL MERITS OF THE POSITION UNDER SCRUTINY BY THE APPLICABLE TAXING AUTHORITY. IF A TAX POSITION OR POSITIONS ARE DEEMED TO RESULT IN UNCERTAINTIES OF THOSE POSITIONS, THE UNRECOGNIZED TAX BENEFIT IS ESTIMATED BASED ON A "CUMULATIVE PROBABILITY ASSESSMENT" THAT AGGREGATES THE ESTIMATED TAX LIABILITY FOR ALL UNCERTAIN TAX POSITIONS. INTEREST AND PENALTIES ASSESSED, IF ANY, ARE ACCRUED AS INCOME TAX EXPENSE. THE ORGANIZATION HAS IDENTIFIED ITS TAX STATUS, AS A TAX-EXEMPT ENTITY, AS A TAX POSITION. THE ORGANIZATION HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON BENEFICIAL INTEREST IN PERPETUAL TRUSTS 240,945. X X X 0 0 0 0 0 0 0 1 0 KEVIN ROSS PRESIDENT & CEO 0 332384 0 25000 0 7500 0 752 0 24729 0 390365 0 0 JENNIFER NAM CFO 0 173380 0 0 0 0 0 1315 0 5837 0 180532 0 0 PART I, LINE 3 THE ORGANIZATION USED CONVERGE, AN INDEPENDENT CONTRACTOR, TO CONDUCT A REVIEW OF KEY EMPLOYEE COMPENSATION WITH ASSISTANCE FROM COMPENSATION CONSULTING ALTERNATIVES, INC. THEY COMPILE AND ANALYZE DATA FROM SEVERAL HEALTHCARE SURVEY SOURCES. THIS DATA WAS PROVIDED TO THE BOARD CHAIR WHO REVIEWED IT, ASKED QUESTIONS, MADE A DECISION AND REVIEWED THAT DECISION WITH THE BOARD MEMBERS. PART I, LINE 7 KEVIN ROSS RECEIVED A DISCRETIONARY BONUS IN 2020 THAT IS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(II). FORM 990, PART VI, SECTION A, LINE 3 MAIN LINE SENIOR CARE, A NOT-FOR-PROFIT CORPORATION, IS THE CONTROLLING ENTITY OF OLD MAN'S HOME OF PHILADELPHIA DBA SAUNDERS HOUSE AND PROVIDES MANAGEMENT AND OVERSIGHT SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS DISTRIBUTED AND REVIEWED BY ALL BOARD MEMBERS PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY EACH BOARD MEMBER. THE BOARD MEMBERS ARE EXPECTED TO IDENTIFY ANY CONFLICTS OR POTENTIAL CONFLICTS AND MUST SIGN THE CONFLICT OF INTEREST DOCUMENT. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION USED CONVERGE, AN INDEPENDENT CONTRACTOR, TO CONDUCT A REVIEW OF THE KEY EMPLOYEE COMPENSATION WITH ASSISTANCE FROM COMPENSATION CONSULTATING ALTERNATIVES, INC. THEY COMPILE AND ANALYZE THE DATA FROM SEVERAL HEALTHCARE SURVEY SOURCES. THIS DATA WAS PROVIDED TO THE BOARD CHAIR WHO REVEIWED IT, MADE A DECISION AND REVIEWED THE DECISION WITH THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE, UPON IN-PERSON, VERBAL OR WRITTEN REQUEST, DOCUMENTS RELATING TO THE GOVERNANCE, CONFLICTS OF INTEREST AND FINANCIAL STATEMENTS TO THE PUBLIC. FORM 990, PART XI, LINE 9: GAIN ON BENEFICIAL INTEREST IN PERPETUAL TRUSTS 240,945. BRYN MAWR TERRACE 773 E HAVERFORD ROAD BRYN MAWR PA 19010 208411287 NURSING HOME PA 501(C)(3) LINE 10 MAIN LINE SENIOR CARE 1 MAIN LINE SENIOR CARE 100 LANCASTER AVENUE WYNNEWOOD PA 19096 455110022 MANAGEMENT SERVICES PA 501(C)(3) LINE 12A, I 0 CHAPIN HOME FOR AGED BLIND C/O LEWIS NEILSON JR 7926 QUEEN STR WYNDMOOR PA 19038 231365201 SUPPORTING ORGANIZATION PA 501(C)(3) LINE 12A, I 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0