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PENN YAN MANOR NURSING HOME, INC.

Company Details

Name: PENN YAN MANOR NURSING HOME, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 13 May 1969 (56 years ago)
Entity Number: 276719
County: Yates
Place of Formation: New York

Contact Details

Phone +1 315-536-2311

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2023 611799794 2024-06-03 PENN YAN MANOR NURSING HOME, INC. 78
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2024-06-03
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2024-06-03
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2022 160967993 2023-04-11 PENN YAN MANOR NURSING HOME, INC. 74
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2023-04-11
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2023-04-11
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2021 160967993 2022-06-02 PENN YAN MANOR NURSING HOME, INC. 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2022-06-02
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2022-06-02
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2020 160967993 2021-03-15 PENN YAN MANOR NURSING HOME, INC. 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 N. LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2021-03-15
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2021-03-15
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2019 160967993 2020-03-06 PENN YAN MANOR NURSING HOME, INC. 75
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 N. LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2020-03-06
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2020-03-06
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2018 160967993 2019-03-06 PENN YAN MANOR NURSING HOME, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 N. LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2019-03-06
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2019-03-06
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2017 160967993 2018-02-22 PENN YAN MANOR NURSING HOME, INC. 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 N. LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2018-02-22
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2018-02-22
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. 401(K) PROFIT SHARING PLAN 2016 160967993 2017-07-05 PENN YAN MANOR NURSING HOME, INC. 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 N. LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2017-07-05
Name of individual signing JESSICA FISH
Role Employer/plan sponsor
Date 2017-07-05
Name of individual signing JESSICA FISH
PENN YAN MANOR NURSING HOME, INC. PROFIT SHARING PLAN AND TRUST 2015 160967993 2016-06-24 PENN YAN MANOR NURSING HOME, INC. 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2016-06-24
Name of individual signing COLIN MAHER
PENN YAN MANOR NURSING HOME, INC. PROFIT SHARING PLAN AND TRUST 2014 160967993 2015-09-08 PENN YAN MANOR NURSING HOME, INC. 74
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 623000
Sponsor’s telephone number 3155362311
Plan sponsor’s address 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527

Signature of
Role Plan administrator
Date 2015-09-08
Name of individual signing COLIN MAHER

Agent

Name Role Address
PENN YAN MANOR NURSING HOME, INC. Agent 655 LIBERTY ST., PENN YAN, NY, 14527

Filings

Filing Number Date Filed Type Effective Date
C306327-2 2001-08-24 ASSUMED NAME CORP INITIAL FILING 2001-08-24
864550-3 1970-10-21 CERTIFICATE OF AMENDMENT 1970-10-21
818994-9 1970-03-04 CERTIFICATE OF AMENDMENT 1970-03-04
818995-6 1970-03-04 CERTIFICATE OF AMENDMENT 1970-03-04
756371-7 1969-05-13 CERTIFICATE OF INCORPORATION 1969-05-13

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
339102790 0215800 2013-06-06 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527
Inspection Type FollowUp
Scope Complete
Safety/Health Health
Close Conference 2013-06-06
Emphasis N: NURSING
Case Closed 2013-08-08

Related Activity
Type Inspection
Activity Nr 625818
Health Yes

Violation Items
Citation ID 01001
Citaton Type Repeat
Standard Cited 19101030 G02 VII I
Issuance Date 2013-07-01
Abatement Due Date 2013-08-04
Current Penalty 280.0
Initial Penalty 280.0
Final Order 2013-07-30
Nr Instances 1
Nr Exposed 65
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1030(g)(2)(vii)(I): The bloodborne pathogens training program did not contain information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, or the fact that the vaccination will be offered free of charge: a) Throughout the facility, on or about 6/6/13: Required training on the hepatitis B vaccination series did not include information on the administration of hepatitis B surface antigen testing, 1-2 months following the third in the three vaccination hepatitis B series. Abatement documentation must be submitted for this item Penn Yan Manor Nursing Home was previously cited for a violation of this occupational safety and health standard, which was contained in OSHA inspection number 625818 citation number 1, item number 1c and was affirmed as a final order on 11/23/12, with respect to a workplace located at 655 North Liberty Street.
Citation ID 02001
Citaton Type Other
Standard Cited 19101030 G02 IV
Issuance Date 2013-07-01
Abatement Due Date 2013-08-04
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2013-07-30
Nr Instances 1
Nr Exposed 52
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1030(g)(2)(iv): Annual training for employees with occupational exposure was not provided within one year of their previous training: a) Throughout the facility, on or about 6/6/13: Annual training on bloodborne pathogens was not provided for employees. Last training was performed on 3/7/12. Abatement certification must be submitted for this item.
Citation ID 02002
Citaton Type Other
Standard Cited 19101030 H02 I
Issuance Date 2013-07-01
Abatement Due Date 2013-08-04
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2013-07-30
Nr Instances 2
Nr Exposed 52
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1030(h)(2)(i): The employer's records for annual bloodborne pathogen training did not include all of the elements required by (h)(2)(i)(A)-(D) of 29 CFR 1910.1030: a) Throughout the facility, on or about 6/6/13: Training records for bloodborne pathogens performed on 3/7/12 did not include the contents or summary of training session; names and qualifications of trainers; and job titles of employees attending the sesssions. b) Throughout the facility, on or about 6/6/13: Training records for bloodborne pathogens on 1/10 through 1/11 in 2013 did not include the contents or summary of the sessions; names and qualifications of trainers; and job titles of employees attending the sessions. Abatement certification must be submitted for this item.
336258181 0215800 2012-09-11 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 2012-09-11
Emphasis P: NURSING, N: NURSING
Case Closed 2012-12-20

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19101030 C01 II B
Issuance Date 2012-10-29
Abatement Due Date 2012-11-28
Current Penalty 2450.0
Initial Penalty 3500.0
Final Order 2012-11-23
Nr Instances 1
Nr Exposed 65
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1030(c)(1)(ii)(B): The employer's Exposure Control Plan did not include the schedule and method of implementation for 29 CFR 1910.1030(f), Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up: a) Throughout the facility, on or about 9/11/12: The company's exposure control plan did not document the method of implementation for administering the hepatitis B surface antigen testing 1 - 2 months following the third vaccination in the three vaccination hepatitis B series. Abatement certification must be submitted for this item.
Citation ID 01001B
Citaton Type Serious
Standard Cited 19101030 F01 II D
Issuance Date 2012-10-29
Abatement Due Date 2012-11-28
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2012-11-23
Nr Instances 1
Nr Exposed 1
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1030(f)(1)(ii)(D): The employer did not ensure that all medical evaluations or procedures including the hepatitis B vaccine, vaccination series, post-exposure evaluation, or follow-up, including prophylaxis, were provided according to recommendations of the US. Public Health Service current at the time these evaluations and procedure took place: a) Throughout the facility, on or about 9/11/12: A certified nurses aide completeing the hepatitis B series on 5/20/12 was not provided with hepatitis B surface antigen testing, 1 - 2 months following the third vaccination in the three vaccination hepatitis B series. Abatement certification must be submitted with this item.
Citation ID 01001C
Citaton Type Serious
Standard Cited 19101030 G02 VII I
Issuance Date 2012-10-29
Abatement Due Date 2012-11-28
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2012-11-23
Nr Instances 1
Nr Exposed 65
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1030(g)(2)(vii)(I): The bloodborne pathogens training program did not contain information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, or the fact that the vaccination will be offered free of charge: a) Throughout the facility, on or about 9/11/12: Required training on the hepatitis B vaccination did not include information on the administration of hepatitis B surface antigen testing, 1 - 2 months following the third vaccination in the three vaccination hepatitis B series. Abatement certification must be submitted for this item.
Citation ID 02001A
Citaton Type Other
Standard Cited 19040029 B01
Issuance Date 2012-10-29
Abatement Due Date 2012-11-08
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2012-11-23
Nr Instances 1
Nr Exposed 1
FTA Current Penalty 0.0
Citation text line 29 CFR 1904.29(b)(1): A one or two line description for each recordable injury or illness was not entered on the OSHA 300 log: a) Throughout the facility, on or about 9/11/12: The OSHA 300 log for 2012 did not include a one or two line description of the recordable injury or illness including but not limited to the injury incurred on 6/12/12. The descriptions did not include the body parts injured. Abatement certification must be submitted for this item.
310749874 0215800 2007-07-12 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527
Inspection Type Planned
Scope Complete
Safety/Health Safety
Close Conference 2007-08-02
Emphasis N: SSTARG07
Case Closed 2007-09-04

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100037 A04
Issuance Date 2007-08-24
Abatement Due Date 2007-08-29
Current Penalty 435.0
Initial Penalty 675.0
Nr Instances 3
Nr Exposed 1
Gravity 01
Citation ID 01002
Citaton Type Serious
Standard Cited 19100101 B
Issuance Date 2007-08-24
Abatement Due Date 2007-08-29
Current Penalty 435.0
Initial Penalty 675.0
Nr Instances 1
Nr Exposed 1
Gravity 01
Citation ID 02001
Citaton Type Other
Standard Cited 19100147 C04 IIB
Issuance Date 2007-08-24
Abatement Due Date 2007-08-29
Nr Instances 1
Nr Exposed 1
Gravity 01
310749882 0215800 2007-07-12 655 NORTH LIBERTY STREET, PENN YAN, NY, 14527
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 2007-08-02
Emphasis N: SSTARG07
Case Closed 2007-09-04

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100151 C
Issuance Date 2007-08-24
Abatement Due Date 2007-08-29
Current Penalty 780.0
Initial Penalty 1200.0
Nr Instances 2
Nr Exposed 1
Gravity 02
Citation ID 02001
Citaton Type Repeat
Standard Cited 19101030 C02 I
Issuance Date 2007-08-24
Abatement Due Date 2007-09-26
Current Penalty 1950.0
Initial Penalty 3000.0
Nr Instances 1
Nr Exposed 1
Gravity 03
307688150 0215800 2004-12-21 655 LIBERTY ST., PENN YAN, NY, 14527
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 2004-12-21
Emphasis N: SSTARG04
Case Closed 2005-10-25

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19101030 C01 IIB
Issuance Date 2005-01-20
Abatement Due Date 2005-02-22
Current Penalty 567.0
Initial Penalty 875.0
Nr Instances 1
Nr Exposed 40
Gravity 03
Citation ID 01001B
Citaton Type Serious
Standard Cited 19101030 C02 I
Issuance Date 2005-01-20
Abatement Due Date 2005-02-22
Nr Instances 1
Nr Exposed 40
Gravity 03
Citation ID 01002
Citaton Type Serious
Standard Cited 19101030 F01 IID
Issuance Date 2005-01-20
Abatement Due Date 2005-02-22
Current Penalty 567.0
Initial Penalty 875.0
Nr Instances 1
Nr Exposed 1
Gravity 03
Citation ID 01003
Citaton Type Serious
Standard Cited 19101030 F02 I
Issuance Date 2005-01-20
Abatement Due Date 2005-01-28
Current Penalty 566.0
Initial Penalty 875.0
Nr Instances 2
Nr Exposed 2
Gravity 03
Citation ID 02001
Citaton Type Other
Standard Cited 19101020 G01 III
Issuance Date 2005-01-20
Abatement Due Date 2005-02-02
Nr Instances 1
Nr Exposed 40
Gravity 01
Citation ID 02002
Citaton Type Other
Standard Cited 19101030 H02 IB
Issuance Date 2005-01-20
Abatement Due Date 2005-02-22
Nr Instances 1
Nr Exposed 33
Gravity 01
307688168 0215800 2004-12-21 655 LIBERTY ST., PENN YAN, NY, 14527
Inspection Type Planned
Scope Complete
Safety/Health Safety
Close Conference 2004-12-21
Emphasis N: SSTARG04
Case Closed 2005-10-25

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100133 A01
Issuance Date 2005-01-20
Abatement Due Date 2005-01-28
Current Penalty 450.0
Initial Penalty 700.0
Nr Instances 1
Nr Exposed 7
Gravity 02
Citation ID 01002A
Citaton Type Serious
Standard Cited 19101200 G01
Issuance Date 2005-01-20
Abatement Due Date 2005-01-28
Current Penalty 450.0
Initial Penalty 700.0
Nr Instances 1
Nr Exposed 7
Gravity 02
Citation ID 01002B
Citaton Type Serious
Standard Cited 19101200 H01
Issuance Date 2005-01-20
Abatement Due Date 2005-02-02
Nr Instances 1
Nr Exposed 7
Gravity 02
Citation ID 02001
Citaton Type Other
Standard Cited 19100132 D01
Issuance Date 2005-01-20
Abatement Due Date 2005-02-02
Nr Instances 1
Nr Exposed 35
Gravity 01
Citation ID 02002
Citaton Type Other
Standard Cited 19100304 F05 V
Issuance Date 2005-01-20
Abatement Due Date 2005-01-28
Nr Instances 1
Nr Exposed 40
Gravity 01

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
16-0967993 Corporation Unconditional Exemption 655 LIBERTY ST, PENN YAN, NY, 14527-1086 1970-02
In Care of Name -
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 Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-12
Asset 1,000,000 to 4,999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 3563293
Income Amount 4986049
Form 990 Revenue Amount 4440676
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 PENN YAN MANOR NURSING HOME INC
EIN 16-0967993
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name PENN YAN MANOR NURSING HOME INC
EIN 16-0967993
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name PENN YAN MANOR NURSING HOME INC
EIN 16-0967993
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name PENN YAN MANOR NURSING HOME INC
EIN 16-0967993
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name PENN YAN MANOR NURSING HOME INC
EIN 16-0967993
Tax Period 201712
Filing Type P
Return Type 990
File View File
Organization Name PENN YAN MANOR NURSING HOME INC
EIN 16-0967993
Tax Period 201612
Filing Type P
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5331078204 2020-08-07 0219 PPP 655 LIBERTY ST, PENN YAN, NY, 14527-1048
Loan Status Date 2020-11-20
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 150000
Loan Approval Amount (current) 150000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 47407
Servicing Lender Name The Lyons National Bank
Servicing Lender Address 35 William St, LYONS, NY, 14489-1544
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address PENN YAN, YATES, NY, 14527-1048
Project Congressional District NY-24
Number of Employees 56
NAICS code 623110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 47407
Originating Lender Name The Lyons National Bank
Originating Lender Address LYONS, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 150328.77
Forgiveness Paid Date 2020-11-03

Related by officers

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Date of last update: 18 Mar 2025

Sources: New York Secretary of State

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