2019-11-14T18:38:46-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 910743702 THE LUTHERAN RETIREMENT HOME OF GREATER SEATTLE LUTH 2065259666 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 JAMES MERTZ CEO 2065259666 2019-11-14 1 KURT BENNION CPA P01469618 4252506100 2019-11-14 67.137.57.251 2019-11-14 11:55:06 PS P A52F513B8D8172ADA5E5426B2D9DBB033DEB48E6 437A48F7A65F248D0909731AA99F0A79285329FF 2018 2020-04-17 16:48:07Z THE HEARTHSTONE JAMES MERTZ 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 19738600 0 9386 X WWW.HEARTHSTONE.ORG X 1961 WA PROMOTE INDEPENDENCE, HEALTH, SECURITY, PURPOSE AND BELONGING IN LIFE FOR ADULTS AGE 62 PLUS. 14 14 255 37 0 0 179768 102866 16531740 17655599 1112423 1264891 220977 -184238 18044908 18839118 101272 104920 0 0 10188061 10054899 0 0 141415 8160572 8651333 18449905 18811152 -404997 27966 62555781 88494166 50902875 79110704 11652906 9383462 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 15507117 104920 17655599 THE HEARTHSTONE OWNS AND OPERATES A LIFE PLAN COMMUNITY LOCATED IN SEATTLE, WASHINGTON, THAT INCLUDES 120 INDEPENDENT LIVING APARTMENTS, A SEPARATE INDEPENDENT LIVING BUILDING WITH 28 APARTMENTS, A 40-BED NURSING CARE FACILITY, A 37-UNIT ASSISTED LIVING AREA, AND 12 MEMORY CARE APARTMENTS.THE HEARTHSTONE IS INVOLVED WITH THE MEDICAL EDUCATION COMMUNITY BY PROVIDING A LEARNING EXPERIENCE TO STUDENTS FROM SHORELINE COMMUNITY COLLEGE SCHOOL OF NURSING TO LEARN PATIENT COMMUNICATION SKILLS AND DISCUSS MEDICATIONS. 15507117 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 83 0 255 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X KIM SPANIER 2065259666 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 JOHN ENGBER CHAIR & PAST CHAIR 1.00 X X 0 0 0 DAVID ASHCOM SECRETARY, CHAIR & PAST CHAIR 1.00 X X 0 0 0 JUDITH CHANEY TRUSTEE, VICE CHAIR & CHAIR 1.00 X X 0 0 0 REV DEANNA WILDERMUTH VICE CHAIR & TRUSTEE 1.00 X X 0 0 0 REV TIM OLESON TRUSTEE & VICE CHAIR 1.00 X X 0 0 0 REV ERNIE LASSMAN TRUSTEE & SECRETARY 1.00 X X 0 0 0 JOHN BYRNE TRUSTEE 1.00 X 0 0 0 LEE COHRS TRUSTEE 1.00 X 0 0 0 KARRIN DANIELS TRUSTEE 1.00 X 0 0 0 TERI HIGBY TRUSTEE 1.00 X 0 0 0 MARK JOHNSON TRUSTEE 1.00 X 0 0 0 KATHLEEN JONES TRUSTEE 1.00 X 0 0 0 BEATRICE PRIEST TRUSTEE (THROUGH FEB 2018) 1.00 X 0 0 0 CAROL REDFIELD TRUSTEE 1.00 X 0 0 0 NANCY WARD TRUSTEE 1.00 X 0 0 0 JAMES MERTZ CEO 40.00 X 286521 0 22937 BART BROSTEN MBA CFO 40.00 X 134770 0 38120 RANDI SAETER HEALTH SERVICES DIRECTOR 40.00 X 131695 0 25357 HAMADI SISAWO DNS 40.00 X 126582 0 15777 JOHN PAULSON CHRO 40.00 X 117550 0 35281 DAVID BALLBACH DIRECTOR OF STEWARDSHIP 40.00 X 116875 0 22502 ANN VEY DIRECTOR OF MARKETING 40.00 X 111542 0 15435 1025535 0 175409 7 0 1 0 ANDERSON CONSTRUCTION GROUP 1900 AIRPORT WAY S 102 SEATTLE WA 98134 CONSTRUCTION 1611476 UNIDINE CORPORATION PO BOX 360639 PITTSBURGH PA 15251 DINING MANAGEMENT 1302620 CONSONUS REHAB UNIT 12 PO BOX 4800 PORTLAND OR 97208 THERAPY SERVICES 778990 CONSONUS PHARMACY SERVICES WA LLC PO BOX 34663 SEATTLE WA 98124 PHARMACY SERVICES 247240 CLIFTONLARSONALLEN LLP PO BOX 31001-2443 PASADENA CA 91110 CONSULTING 217379 7 102866 102866 RESIDENTS' MONTHLY FEES 623000 9424371 9424371 HEALTH CARE SERVICES 623000 4505643 4505643 ENTRANCE FEE AMORTIZATION 623000 3725585 3725585 17655599 1116597 1116597 1047776 884986 14496 162790 -14496 148294 148294 MEAL REVENUES 722210 167114 167114 MISCELLANEOUS INCOME 900099 32786 32786 LOSS ON DEBT REFINANING 900099 -384138 -384138 -184238 18839118 17655599 0 1080653 500 500 104420 104420 482348 482348 7662261 6298913 1248670 114678 234223 215653 12604 5966 888445 749924 130981 7540 787622 643270 137152 7200 749292 749292 15046 15046 83136 83136 142155 142155 1499323 1380989 118271 63 20159 313 18362 1484 10364 8205 2159 844445 672223 172222 22429 7284 14283 862 6396 -511 6382 525 887029 887029 2122997 2122997 135570 135570 FOOD 665526 665526 SUPPLIES 407980 340839 66999 142 MISCELLANEOUS EXPENSES 255852 107943 147863 46 PHARMACY EXPENSE 232200 232200 551434 192743 357941 750 18811152 15507117 3162620 141415 1422773 856123 849212 1431449 51693 66873 145325 136722 70778273 25053374 40862293 45724899 18821749 39930913 402736 347187 62555781 88494166 1534078 3357799 18817327 18693578 18301035 44479634 9476201 12112943 2774234 466750 50902875 79110704 X 11516288 9254898 136618 128564 11652906 9383462 62555781 88494166 X 27966 -2428829 131419 X 0 1 X 1 0 X 115513 80120 104288 179768 102866 582555 14116189 15127753 15559819 16531740 17655599 78991100 65179 60860 71301 171885 167114 536339 14296881 15268733 15735408 16883393 17925579 80109994 0 0 0 80109994 894370 849493 669882 913008 1116597 4443350 894370 849493 669882 913008 1116597 4443350 49092 32786 81878 15191251 16118226 16405290 17845493 19074962 84635222 0.94650 0.94980 0.05250 0.04960 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 1 430 430 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 4477419 4477419 47163523 17134706 30028817 8186499 7918668 267831 10950832 10950832 45724899 LAND PAYABLE - REMEDIATION OBLIGATION 466750 466750 18999231 398634 398634 18600597 142155 96366 238521 18839118 18683493 14496 14496 18668997 142155 142155 18811152 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 2D - OTHER ADJUSTMENTS: LOSS ON DEBT REFINANCING 384,138. LOSS ON DISPOSAL OF FIXED ASSETS 14,496. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 96,366. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 14,496. 1 RESIDENT ASSISTANCE 3 104420 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 0 0 0 0 0 0 0 0 0 JAMES MERTZ CEO 286521 0 0 0 0 0 22937 0 0 0 309458 0 0 0 BART BROSTEN MBA CFO 134770 0 0 0 0 0 31218 0 6902 0 172890 0 0 0 RANDI SAETER HEALTH SERVICES DIRECTOR 131695 0 0 0 0 0 18455 0 6902 0 157052 0 0 0 JOHN PAULSON CHRO 117550 0 0 0 0 0 28379 0 6902 0 152831 0 0 0 PART I, LINE 1A JAMES MERTZ LIVES IN AN APARTMENT AT THE HEARTHSTONE AND RECEIVES A DISCOUNT ON HIS MONTHLY RENT. THE DISCOUNT WAS $450 PER MONTH IN 2018, FOR A TOTAL OF $5,400. 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. 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 45700955 2503125 913030 3732464 18507716 20044620 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 DURING 2018, THE ORGANIZATION UTILIZED UNIDINE TO PROVIDE DINING SERVICES, INCLUDING MANAGEMENT. THE ORGANIZATION ALSO UTILIZED A CONSULTANT FROM SODEXO TO PROVIDE MANAGEMENT SERVICES IN THE MAINTENANCE DEPARTMENT. 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 FORM 990 WAS REVIEWED BY THE CONTROLLER. IT WAS THEN REVIEWED BY THE AUDIT/INVESTMENT COMMITTEE. IT WAS THEN PRESENTED TO THE BOARD FOR FINAL REVIEW PRIOR TO FILING. 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 2018. 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: UNREALIZED GAIN ON SWAP INVESTMENT 131,419.