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  5. WELLS NURSING HOME, INC.

WELLS NURSING HOME, INC.

Company Details

Name: WELLS NURSING HOME, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 18 Dec 1967 (57 years ago)
Entity Number: 217357
ZIP code: 12095
County: Fulton
Place of Formation: New York
Address: 201 W MADISON AVENUE, JOHNSTOWN, NY, United States, 12095

Contact Details

Phone +1 518-762-4546

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
V72BLZDT1VX6 2025-04-01 201 W MADISON AVE, JOHNSTOWN, NY, 12095, 2806, USA 201 W MADISON AVE, JOHNSTOWN, NY, 12095, 2806, USA

Business Information
Doing Business As WELLS NURSING HOME INC
Congressional District 21
State/Country of Incorporation NY, USA
Activation Date 2024-04-02
Initial Registration Date 2003-11-07
Entity Start Date 1970-12-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 623110

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MICHELE DYGERT
Address 201 W. MADISON AVE., JOHNSTOWN, NY, 12095, 2806, USA
Government Business
Title PRIMARY POC
Name MICHELE DYGERT
Address 201 W MADISON AVENUE, JOHNSTOWN, NY, 12095, USA
Past Performance
Title PRIMARY POC
Name NEAL E VANSLYKE
Address 201 W MADISON AVE, JOHNSTOWN, NY, 12095, USA
Title ALTERNATE POC
Name MOLLY J HAYES
Address 1433 MILL ROAD, ST. JOHNSVILLE, NY, 13452, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WELLS NURSING HOME PROFIT SHARING AND 401(K) PLAN 2023 141507009 2024-06-18 WELLS NURSING HOME 109
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5187624546
Plan sponsor’s address 201 W. MADISON AVENUE, JOHNSTOWN, NY, 12095

Signature of
Role Plan administrator
Date 2024-06-18
Name of individual signing MICHELE DYGERT

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 201 W MADISON AVENUE, JOHNSTOWN, NY, United States, 12095

Agent

Name Role Address
N/ATHE CORP Agent WEST MADISON AVE., JOHNSTOWN, NY, 12095

Filings

Filing Number Date Filed Type Effective Date
980813000325 1998-08-13 CERTIFICATE OF AMENDMENT 1998-08-13
C222975-4 1995-05-16 ASSUMED NAME CORP INITIAL FILING 1995-05-16
863424-3 1970-10-15 CERTIFICATE OF AMENDMENT 1970-10-15
753595-5 1969-04-30 CERTIFICATE OF AMENDMENT 1969-04-30
726806-5 1969-01-03 CERTIFICATE OF AMENDMENT 1969-01-03
654610-9 1967-12-18 CERTIFICATE OF INCORPORATION 1967-12-18

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
345955553 0213100 2022-05-12 201 WEST MADISON AVE., JOHNSTOWN, NY, 12095
Inspection Type FollowUp
Scope Partial
Safety/Health Health
Close Conference 2022-05-12
Emphasis N: COVID-19
Case Closed 2022-06-07

Related Activity
Type Inspection
Activity Nr 1558404
Health Yes
345584049 0213100 2021-10-18 201 WEST MADISON AVE., JOHNSTOWN, NY, 12095
Inspection Type Fat/Cat
Scope Partial
Safety/Health Health
Close Conference 2021-12-20
Emphasis N: COVID-19
Case Closed 2024-03-25

Related Activity
Type Accident
Activity Nr 1824110

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19100134 F02
Issuance Date 2021-12-20
Abatement Due Date 2022-01-31
Current Penalty 7987.2
Initial Penalty 12288.0
Final Order 2022-01-10
Nr Instances 1
Nr Exposed 5
Gravity 10
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.134(f)(2): The employer did not ensure that employees using tight fitting face piece respirators pass an appropriate qualitative or quantitative fit test prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter. (a) Wells Nursing Home, Inc. 201 West Madison Ave. Johnstown, N.Y.: On or about 9/01/2021 and thereafter, the employer did not provide a fit test to all employees provided with and required to wear an N-95 respirator. The employer required Registered Nurses, Certified Nursing Assistants, and Licensed Practical Nurses to wear an N-95 respirator while providing direct care to suspected and confirmed positive COVID-19 residents.
Citation ID 01001B
Citaton Type Serious
Standard Cited 19100502 F02 I
Issuance Date 2021-12-20
Abatement Due Date 2022-01-07
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2022-01-10
Nr Instances 1
Nr Exposed 5
Gravity 10
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.502(f)(2)(i): The employer did not ensure that a respirator was used in accordance with 29 CFR � 1910.134 when employees have exposure to a person with suspected or confirmed COVID-19: (a) Wells Nursing Home, Inc. 201 West Madison Ave. Johnstown, N.Y.: On or about 9/01/2021 and thereafter, the employer did not provide a fit test to all employees provided with and required to wear an N-95 respirator. The employer required Registered Nurses, Certified Nursing Assistants, and Licensed Practical Nurses to wear a N-95 respirator while providing direct care to suspected and confirmed positive COVID-19 residents.
339158628 0213100 2013-07-02 201 WEST MADISON AVE., JOHNSTOWN, NY, 12095
Inspection Type Planned
Scope Records
Safety/Health Safety
Close Conference 2013-07-02
Emphasis N: NURSING, P: NURSING
Case Closed 2013-10-31

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100151 C
Issuance Date 2013-09-18
Abatement Due Date 2013-10-04
Current Penalty 3150.0
Initial Penalty 6300.0
Final Order 2013-09-27
Nr Instances 4
Nr Exposed 10
Gravity 10
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.151(c): Where employees were exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body were not provided within the work area for immediate emergency use: a) Kitchen - On or about August 29, 2013, employees who work around corrosives in the kitchen area were exposed to low water pressure along with the water coming out orange in color in the eyewash station making the eyewash station not readily available for immediate emergency use. b) Washer Room - On or about August 29, 2013, employees who work around corrosives in the washer room were exposed to low water pressure in the eyewash station making the eyewash station not readily available for immediate emergency use. c) 1st Floor - On or about August 29, 2013, there was no emergency eyewash station readily available for employees who clean with corrosive materials on the 1st Floor. d) 2nd Floor - On or about August 29, 2013, there was no emergency eyewash station readily available for employees who clean with corrosive materials on the 2nd Floor.

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
14-1507009 Corporation Unconditional Exemption 201 W MADISON AVE, JOHNSTOWN, NY, 12095-2806 1969-04
In Care of Name % WILLIAM MCCOSKI
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-12
Asset 1,000,000 to 4,999,999
Income 5,000,000 to 9,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 1985177
Income Amount 9897956
Form 990 Revenue Amount 9897806
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201812
Filing Type P
Return Type 990T
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201812
Filing Type P
Return Type 990T
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name WELLS NURSING HOME INC
EIN 14-1507009
Tax Period 201512
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9872487203 2020-04-28 0248 PPP 201 WEST MADISON AVE, JOHNSTOWN, NY, 12095
Loan Status Date 2021-05-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 887200
Loan Approval Amount (current) 887200
Undisbursed Amount 0
Franchise Name -
Lender Location ID 434162
Servicing Lender Name Citizens Bank, National Association
Servicing Lender Address 1 Citizens Plaza, PROVIDENCE, RI, 02903-1344
Rural or Urban Indicator R
Hubzone N
LMI Y
Business Age Description Existing or more than 2 years old
Project Address JOHNSTOWN, FULTON, NY, 12095-0001
Project Congressional District NY-21
Number of Employees 160
NAICS code 623110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 434162
Originating Lender Name Citizens Bank, National Association
Originating Lender Address PROVIDENCE, RI
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 895294.18
Forgiveness Paid Date 2021-03-31

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N/ATHE CORP

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Related by address

No related companies by address

Date of last update: 18 Mar 2025

Sources: New York Secretary of State

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