2021-11-11T11:28:53-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-01-01 910743702 THE LUTHERAN RETIREMENT HOME OF GREATER SEATTLE LUTH 2065259666 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 JACK MCKITTRICK CFO 2065259666 2021-11-09 1 JACK MCKITTRICK 999009999 KURT BENNION CPA P01469618 4252506100 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z THE HEARTHSTONE JAMES MERTZ 6720 EAST GREEN LAKE WAY NORTH SEATTLE WA 98103 23650388 0 9386 X WWW.HEARTHSTONE.ORG X 1961 WA PROMOTE INDEPENDENCE, HEALTH, SECURITY, PURPOSE AND BELONGING IN LIFE FOR ADULTS AGE 62 PLUS. 11 11 218 26 0 0 83550 569618 16978145 19599023 1575599 1475326 223122 125417 18860416 21769384 390335 347378 0 0 10925994 10875116 0 0 71837 9266751 10774506 20583080 21997000 -1722664 -227616 89533959 86008190 79889790 75741664 9644169 10266526 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 18800923 347378 19599023 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.THROUGH MARCH 2020, THE HEARTHSTONE WAS 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. THIS PROGRAM WAS TEMPORARILY SUSPENDED BECAUSE OF COVID-19. 18800923 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 69 0 218 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 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 40.00 X 266114 0 31194 ELLIOTT WESTERMAN CFO 40.00 X 224470 0 26712 JOHN PAULSON CHRO 40.00 X 135481 0 33212 ANN VEY DIRECTOR OF MARKETING 40.00 X 132754 0 20034 JEREMIAS RAMIREZ REGISTERED NURSE 40.00 X 115709 0 11715 RONDA KRIZ SALES COUNSELOR 40.00 X 107888 0 13263 JUDITH CHANEY CHAIR (THROUGH FEBRUARY 2020) 1.00 X X 0 0 0 REV ERNIE LASSMAN SECRETARY & CHAIR 1.00 X X 0 0 0 LEE COHRS VICE CHAIR 1.00 X X 0 0 0 CAITLIN GRANT TRUSTEE & SECRETARY 1.00 X X 0 0 0 JOHN BYRNE TRUSTEE (THROUGH FEBRUARY 2020) 1.00 X 0 0 0 KARRIN DANIELS TRUSTEE 1.00 X 0 0 0 HARRY EDMON 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 DR ANN MELVIN TRUSTEE 1.00 X 0 0 0 REV TIM OLESON TRUSTEE (THROUGH JUNE 2020) 1.00 X 0 0 0 CAROL REDFIELD TRUSTEE 1.00 X 0 0 0 NANCY WARD TRUSTEE 1.00 X 0 0 0 REV DEANNA WILDERMUTH TRUSTEE (THROUGH FEBRUARY 2020) 1.00 X 0 0 0 982416 0 136130 6 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 303682289 DINING MANAGEMENT 1712370 ANDERSON CONSTRUCTION GROUP 1900 AIRPORT WAY S 102 SEATTLE WA 98134 CONSTRUCTION 1259161 LUTHERAN SERVICES IN THE NORTHWEST PO BOX 6 MUKILTEO WA 982750025 BEHAVIORAL HEALTH SERVICES 1211822 ANDERSEN CONSTRUCTION COMPANY OF WA LLC 5601 6TH AVE S 550 SEATTLE WA 98108 CONSTRUCTION 716065 CONSONUS REHAB UNIT 12 PO BOX 4800 PORTLAND OR 97208 THERAPY SERVICES 455659 18 479375 90243 569618 RESIDENTS' MONTHLY FEES 623000 10014209 10014209 ENTRANCE FEE AMORTIZATION 623000 5677599 5677599 HEALTH CARE SERVICES 623000 3907215 3907215 19599023 787690 787690 2568640 1881004 687636 687636 687636 MEAL REVENUES 722210 120108 120108 MISCELLANEOUS INCOME 900099 5309 5309 125417 21769384 19599023 0 1600743 347378 347378 548489 548489 8069107 7130500 883943 54664 199017 164059 33621 1337 1304767 1136880 159251 8636 753736 627886 121036 4814 878386 878386 38387 38387 71220 71220 114024 114024 1927334 1369091 557644 599 17798 16381 1417 45908 42252 3656 1077321 991536 85785 7525 6926 599 1796 1653 143 1845322 1556720 288084 518 3404229 3404229 197898 109147 88751 SUPPLIES 747227 687727 59500 FOOD 670524 617131 53393 EQUIPMENT MAINTENANCE 162194 149279 12915 LICENSES 148753 136908 11845 -581340 -573146 -9463 1269 21997000 18800923 3124240 71837 2075178 2662205 1779173 879630 79567 113265 148718 159066 91375707 30485276 60090022 60890431 25361301 21303593 89533959 86008190 3891741 2768583 19300223 23378724 44283347 36435195 12238914 10678661 175565 2480501 79889790 75741664 X 9520914 10266526 123255 0 9644169 10266526 89533959 86008190 X -227616 1559528 -709555 X 0 1 X 1 0 X 104288 179768 102866 83550 569618 1040090 15559819 16531740 17655599 16978145 19599023 86324326 71301 171885 167114 178483 120108 708891 15735408 16883393 17925579 17240178 20288749 88073307 0 0 0 88073307 669882 913008 1116597 944389 787690 4431566 669882 913008 1116597 944389 787690 4431566 49092 32786 44639 5309 131826 16405290 17845493 19074962 18229206 21081748 92636699 0.95070 0.94730 0.04780 0.05130 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 1 515 515 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 69520127 21626762 47893365 11925866 8858514 3067352 1905894 1905894 60890431 LAND PAYABLE - REMEDIATION OBLIGATION 823242 REFUNDABLE ADVANCE - PPP 1657259 2480501 21684028 116411 116411 21567617 114024 87743 201767 21769384 21999387 116411 116411 21882976 114024 114024 21997000 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: BAD DEBT EXPENSE 116,411. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 87,743. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 116,411. 1 RESIDENT ASSISTANCE 5 347378 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 1 0 0 0 0 0 0 0 JAMES MERTZ CEO 247021 0 11328 0 7765 0 31194 0 0 0 297308 0 0 0 ELLIOTT WESTERMAN CFO 223280 0 1190 0 0 0 19500 0 7212 0 251182 0 0 0 JOHN PAULSON CHRO 134351 0 1130 0 0 0 26000 0 7212 0 168693 0 0 0 ANN VEY DIRECTOR OF MARKETING 131564 0 1190 0 0 0 12822 0 7212 0 152788 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 $750 PER MONTH IN 2020, FOR A TOTAL OF $9,000. 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, LINE 4B JIM MERTZ, CEO, PARTICIPATES IN A 457(F) 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 8175000 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 2020, 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. 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 2020. 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 -709,555.