2022-11-15T15:51:53-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-01-01 910743702 THE LUTHERAN RETIREMENT HOME OF GREATER SEATTLE LUTH 2065259666 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 JACK MCKITTRICK CFO 2065259666 2022-11-15 1 JACK MCKITTRICK 999009999 KURT BENNION CPA P01469618 4252506100 2022-11-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z THE HEARTHSTONE REGGIE MULLIS 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 22530543 0 9386 X WWW.HEARTHSTONE.ORG X 1961 WA PROMOTE INDEPENDENCE, HEALTH, SECURITY, PURPOSE AND BELONGING IN LIFE FOR ADULTS AGE 62 PLUS. 10 10 236 13 0 0 569618 1741115 19599023 18084095 1475326 2015646 125417 151807 21769384 21992663 347378 243206 0 0 10875116 11006348 0 0 72703 10774506 11418523 21997000 22668077 -227616 -675414 86008190 84207346 75741664 74942411 10266526 9264935 X SEE SCHEDULE OTHE HEARTHSTONE, A LIFE PLAN COMMUNITY, A SEATTLE LANDMARK SINCE 1966, IS WELL REGARDED FOR COMFORT, HEALTH AND SENIOR WELLNESS. OUR GOAL IS TO PROVIDE A FULL RANGE OF OPTIONS WITH 120 INDEPENDENT LIVING APARTMENTS, 37 ASSISTED LIVING APARTMENTS, 12 MEMORY CARE APARTMENTS, AND CAN ACCOMODATE 40 RESIDENTS IN OUR HEALTH CARE CENTER WITH 24-HOUR NURSING CARE. THE HEARTHSTONE ALSO PROVIDES DAILY ACTIVITIES, THREE MEALS A DAY, REHABILITATION SERVICES FOR WELLNESS TO RECOVERY, AND HOSPICE SERVICES. THE CHAPEL IS OPEN FOR WEEKLY VESPER SERVICES, MUSIC RECITALS BY LOCAL STUDENTS, AND BOARD MEETINGS FOR OTHER NOT-FOR-PROFIT BUSINESSES. THROUGH DONATIONS, THE HEARTHSTONE PROVIDES FINANCIAL ASSISTANCE TO RESIDENTS WHO HAVE OUTLIVED THEIR ASSETS WHILE LIVING INDEPENDENTLY OR IN ASSISTED LIVING. THE HEARTHSTONE'S HEALTH CARE CENTER IS ALSO AVAILABLE FOR NON-HEARTHSTONE RESIDENTS AGE 62 AND OVER NEEDING SHORT-TERM REHABILITATION SERVICES. 0 0 19205435 243206 18084095 THE HEARTHSTONE OWNS AND OPERATES A LIFE PLAN COMMUNITY ("LAKESIDE") LOCATED IN SEATTLE, WASHINGTON, THAT INCLUDES 113 INDEPENDENT LIVING APARTMENTS, A SECOND FACILITY ("COVE WEST") THAT INCLUDES 27 INDEPENDENT LIVING APARTMENTS, AND A THIRD FACILITY ("COVE EAST") WITH 22 INDEPENDENT LIVING APARTMENTS. LAKESIDE ALSO INCLUDES A 40-BED NURSING CARE FACILITY, A 38-UNIT ASSISTED LIVING AREA, AND 12 MEMORY CARE APARTMENTS. 19205435 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 51 0 236 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X X JACK MCKITTRICK 2065259666 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 JAMES MERTZ CEO (THROUGH MARCH 2021) 40.00 X 240194 0 6349 AIJA STAPARS COO, CHRO & INTERIM CEO 40.00 X 191567 0 29672 EMILIANA CUPAT DIRECTOR OF NURSING SERVICES 40.00 X 145167 0 10056 JEREMIAS RAMIREZ REGISTERED NURSE 40.00 X 118515 0 9406 ANTHONY BAE LICENSED PRACTICAL NURSE 40.00 X 114492 0 6840 ELLIOTT WESTERMAN CFO (THROUGH MAY 2021) 40.00 X 98024 0 10177 NIDA MOUSER MDS COORDINATOR 40.00 X 107425 0 0 REGGIE MULLIS CEO (AS OF NOV 2021) 40.00 X 63833 0 1180 JACK MCKITTRICK CFO (AS OF NOV 2021) 40.00 X 0 0 0 REV ERNIE LASSMAN CHAIR (THROUGH FEB 2021) 1.00 X X 0 0 0 LEE COHRS VICE CHAIR & CHAIR 1.00 X X 0 0 0 CAITLIN GRANT CPA SECRETARY & VICE CHAIR 1.00 X X 0 0 0 HARRY EDMON TRUSTEE & SECRETARY 1.00 X X 0 0 0 LAUREN BLEDSOE TRUSTEE 1.00 X 0 0 0 KARRIN DANIELS TRUSTEE 1.00 X 0 0 0 TERI HIGBY CPA TRUSTEE 1.00 X 0 0 0 MARK JOHNSON TRUSTEE 1.00 X 0 0 0 DR ANN MELVIN TRUSTEE 1.00 X 0 0 0 CAROL REDFIELD TRUSTEE 1.00 X 0 0 0 REV ELISE SCOTT TRUSTEE 1.00 X 0 0 0 1079217 0 73680 6 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 303682289 DINING MANAGEMENT 1801618 ANDERSON CONSTRUCTION GROUP 1900 AIRPORT WAY S 102 SEATTLE WA 98134 CONSTRUCTION 1347333 LUTHERAN SERVICES IN THE NORTHWEST PO BOX 6 MUKILTEO WA 982750025 BEHAVIORAL HEALTH SERVICES 1115674 ANDERSEN CONSTRUCTION COMPANY OF WA LLC 5601 6TH AVE S 550 SEATTLE WA 98108 CONSTRUCTION 669600 MACDONALD-MILLER FACILITY SOLUTIONS 17930 INTERNATIONAL BLVD STE 120 SEATAC WA 98188 CONSTRUCTION 456524 10 1686620 54495 1741115 RESIDENTS' MONTHLY FEES 623000 9846253 9846253 HEALTH CARE SERVICES 623000 4403667 4403667 ENTRANCE FEE AMORTIZATION 623000 3834175 3834175 18084095 1219209 1219209 1334317 537880 796437 796437 796437 MEAL REVENUES 722210 138105 138105 MISCELLANEOUS INCOME 900099 13702 13702 151807 21992663 18084095 0 2167453 243206 243206 575983 575983 7535872 6718954 765409 51509 226765 218023 6991 1751 1922304 1610705 299330 12269 745424 620963 119701 4760 920734 920734 75896 75896 196934 196934 110903 110903 1756944 1353865 402473 606 14216 13007 1209 41697 38150 3547 1060223 970031 90192 82687 75653 7034 3158 2889 269 1739252 1575505 163223 524 3806138 3445309 360829 234283 144461 89822 SUPPLIES 745337 681932 63405 FOOD 606426 554838 51588 BAD DEBTS 204477 204477 EQUIPMENT MAINTENANCE 204200 186829 17371 -384982 -374096 -12170 1284 22668077 19205435 3389939 72703 2662205 2315940 879630 640320 113265 132828 159066 334941 93411859 34291416 60890431 59120443 21303593 21662874 86008190 84207346 2768583 2182105 23378724 25614753 36435195 35054422 10678661 10685131 2480501 1406000 75741664 74942411 X 10266526 9212640 52295 10266526 9264935 86008190 84207346 X -675414 485847 -812024 X 0 1 X 1 0 X 179768 102866 83550 569618 1741115 2676917 16531740 17655599 16978145 19599023 18084095 88848602 171885 167114 178483 120108 138105 775695 16883393 17925579 17240178 20288749 19963315 92301214 0 0 0 92301214 913008 1116597 944389 787690 1219209 4980893 913008 1116597 944389 787690 1219209 4980893 49092 32786 44639 5309 13702 145528 17845493 19074962 18229206 21081748 21196226 97427635 0.94740 0.95070 0.05110 0.04780 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 492 492 0 PART II-B, LINE 1: THE HEARTHSTONE PAYS MEMBERSHIP DUES TO LEADINGAGE NATIONAL AND LEADINGAGE WASHINGTON, A PORTION OF WHICH ARE USED FOR LOBBYING. 0 1 X 8023820 8023820 73028466 24796788 48231678 12057267 9494628 2562639 302306 302306 59120443 LAND PAYABLE - REMEDIATION OBLIGATION 1406000 1406000 21624988 0 21624988 110903 256772 367675 21992663 22352697 0 22352697 110903 204477 315380 22668077 PART IV, LINE 2B: THE ORGANIZATION HOLDS WAIT LIST DEPOSITS FOR INDIVIDUALS WHO WANT TO ACCESS FUTURE ENTRANCE TO THE FACILITY. THE DEPOSITS ARE RETURNED TO INDIVIDUALS WHO WISH TO REMOVE THEMSELVES FROM THE WAIT LIST. WHILE BEING HELD, THE FUNDS ARE INVESTED. THE ORGANIZATION HOLDS PARTIALLY REFUNDABLE DEPOSITS FOR RESIDENTS LIVING IN OUR FACILITY. AN INDIVIDUAL CAN RECEIVE A PARTIAL REFUND OF THEIR DEPOSIT IF THEY LEAVE THE FACILITY WITHIN FOUR YEARS OF ENTRANCE. WHILE BEING HELD, FUNDS ARE INVESTED. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 52,295. BAD DEBT EXPENSE 204,477. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 204,477. 1 RESIDENT ASSISTANCE 6 243206 PART I, LINE 2: THE ORGANIZATION PROVIDES SERVICES TO RESIDENTS WHO HAVE EXHAUSTED THEIR FINANCIAL RESOURCES. ASSISTANCE IS PROVIDED TO HELP COVER ROOM AND BOARD, MEDICAL CARE, AND PRESCRIPTIONS. THE AMOUNT REPORTED AS GRANTS CONSTITUTES THE VALUE OF THESE SERVICES. X 0 1 X X X X 1 1 0 0 0 0 0 0 0 JAMES MERTZ CEO (THROUGH MARCH 2021) 177721 0 970 0 61503 0 6349 0 0 0 246543 0 0 0 AIJA STAPARS COO, CHRO & INTERIM CEO 142732 0 48835 0 0 0 23184 0 6488 0 221239 0 0 0 EMILIANA CUPAT DIRECTOR OF NURSING SERVICES 136584 0 8583 0 0 0 3250 0 6806 0 155223 0 0 0 PART I, LINE 1A THROUGH FEBRUARY 2021, JAMES MERTZ LIVED IN AN APARTMENT AT THE HEARTHSTONE AND RECEIVED A DISCOUNT ON HIS MONTHLY RENT. THE DISCOUNT WAS $750 PER MONTH IN 2021, FOR A TOTAL OF $1,500. THIS AMOUNT WAS INCLUDED IN HIS TAXABLE COMPENSATION. PART I, LINE 1B THE HOUSING PROVIDED TO THE CEO WAS APPROVED BY THE BOARD OF DIRECTORS PRIOR TO INITIATION OF THE ARRANGEMENT. PART I, LINES 4A-B DURING 2021, JAMES MERTZ RECEIVED SEVERANCE PAYMENTS OF $61,503. JIM MERTZ, CEO, PARTICIPATES IN A 457(F) PLAN. DURING 2021, $3,175 WAS CONTRIBUTED TO THE PLAN AND $115,196 WAS DISTRIBUTED FROM THE PLAN. A WASHINGTON STATE HOUSING FINANCE COMMISSION 911874730 939783WS1 2018-06-28 45700955 REFUND SERIES 2013 BONDS; DEVELOP, CONSTRUCT AND EQUIP FACILITIES 0 0 0 A 1385000 45700955 1072000 20487000 24219464 2019 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 DURING 2021, THE ORGANIZATION UTILIZED UNIDINE TO PROVIDE DINING SERVICES, INCLUDING MANAGEMENT. THE ORGANIZATION ALSO UTILIZED A CONSULTANT FROM SODEXHO TO PROVIDE MANAGEMENT SERVICES IN THE MAINTENANCE DEPARTMENT. FINALLY, THE ORGANIZATION UTILIZED A CONSULTANT FROM EXPERIENCE ON DEMAND FOR CONTRACT CFO SERVICES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S MEMBERSHIP IS MADE UP OF BETWEEN EIGHT AND FIFTEEN CONGREGATIONS FROM THE NORTHWEST WASHINGTON SYNOD OF THE EVANGELICAL LUTHERAN CHURCH OF AMERICA AND THE NORTHWEST DISTRICT, LUTHERAN CHURCH - MISSOURI SYNOD (COLLECTIVELY, THE "JURISDICTIONAL UNITS"). CONGREGATIONS, AT LEAST TWO OF WHICH SHALL COME FROM EACH OF THE JURISDICTIONAL UNITS, ARE ADMITTED TO MEMBERSHIP UPON APPLICATION APPROVED BY A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS ELECT ALL FULL-TERM BOARD POSITIONS. FORM 990, PART VI, SECTION B, LINE 11B THE HEARTHSTONE'S CONTROLLER AND CFO REVIEWED THE FORM 990 PRIOR TO FILING. THE FORM WILL BE REVIEWED BY THE BOARD OF DIRECTORS AFTER THE DEADLINE. IF ANY MODIFICATIONS ARE NEEDED, THE FORM 990 WILL BE AMENDED ACCORDINGLY. FORM 990, PART VI, SECTION B, LINE 12C KEY MANAGERS AND BOARD MEMBERS ARE REQUIRED TO SIGN STATEMENTS ANNUALLY. BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS IMMEDIATELY AS THEY ARISE. BOTH MANAGEMENT AND THE BOARD ARE SENSITIVE TO THIS ISSUE AND ARE EXPECTED TO CONTINUOUSLY MONITOR SITUATIONS FOR POSSIBLE CONFLICTS. AN INDIVIDUAL WITH A CONFLICT OF INTEREST IS ALLOWED TO ANSWER QUESTIONS BUT IS NOT PERMITTED TO VOTE ON THE MATTER. THE STATEMENTS ARE REVIEWED EACH YEAR AS PART OF CORPORATE COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15A THE CHIEF HUMAN RESOURCES OFFICER PROVIDES A REPORT TO THE CHAIR OF THE BOARD OF TRUSTEES USING DATA FROM COMPENSATION SURVEYS, AS WELL AS THE CPI FOR THE SEATTLE AREA, TO DETERMINE AN APPROPRIATE SALARY RANGE FOR THE CEO. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS THE REPORT AND MAKES A RECOMMENDATION TO THE FULL BOARD. THE BOARD COMPARES SALARIES WITH SIMILAR ORGANIZATIONS AND MAKES THE FINAL DECISION ON CEO COMPENSATION. ANNUAL INCREASES ARE DETERMINED BY THE BOARD BASED ON ANNUAL PERFORMANCE EVALUATIONS. THE CHIEF HUMAN RESOURCES OFFICER PROVIDES A REPORT USING DATA FROM COMPENSATION SURVEYS, AS WELL AS THE CPI FOR THE SEATTLE AREA, TO DETERMINE AN APPROPRIATE SALARY RANGE FOR THE OTHER OFFICERS AND KEY EMPLOYEES. THE REPORT IS REVIEWED AND DISCUSSED BY THE ADMINISTRATOR, CFO AND CEO. THE CEO MAKES THE FINAL DECISION FOR COMPENSATION AMOUNTS. ANNUAL INCREASES ARE BASED ON ANNUAL PERFORMANCE EVALUATIONS. THESE PROCESSES WERE LAST COMPLETED IN 2021. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S BUSINESS OFFICE. FORM 990, PART XI, LINE 9: CHANGE IN LAND REMEDIATION PAYABLE ESTIMATE -812,024.