2019-10-11T10:19:22-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 943229627 MARTHA & MARY HEALTH SERVICES MART 3607797500 PO BOX 127 POULSBO WA 983700127 LYNETTE LADENBURG CEO 3607797500 2019-09-26 1 KURT BENNION CPA P01469618 4252506100 2019-09-26 67.137.57.251 2019-09-26 21:59:13 PD P 87BD3611550E1D67138C53841B1C9A886D50C97E CB8FE41F7A1541848066F2058C3AF12D9D3FCB15 2018 2020-01-14 16:20:31Z BILL BAIRD PO BOX 127 POULSBO WA 983700127 17782247 0 4103 X WWW.MARTHAANDMARY.ORG X 1995 WA A SKILLED NURSING FACILITY OFFERING REHABILITATION, LONG-TERM CARE, AND RESPITE CARE. 14 14 434 243 0 5863 135552 102643 16949205 17357669 -30461 -111374 302135 307468 17356431 17656406 0 0 0 0 10861233 11176611 0 0 0 6795998 6511094 17657231 17687705 -300800 -31299 11580968 11719071 15790356 16021898 -4209388 -4302827 X MARTHA AND MARY HEALTH SERVICES PROVIDES QUALITY, COMPASSIONATE CARE FOR ADULTS AND SENIORS REGARDLESS OF FAITH, ETHNICITY OR ECONOMIC STATUS. WE DO THIS IN A CHRISTIAN MANNER BY OFFERING THOSE WE SERVE INTERGENERATIONAL EXPERIENCES, A CARING PLACE FOR REHABILITATION, AND AN OPPORTUNITY TO LIVE WITH DIGNITY, HONOR AND INDIVIDUALITY. 0 0 12647180 0 17357669 MARTHA & MARY HEALTH SERVICES (MMHS) AND ITS AFFILIATED ORGANIZATIONSHAVE SERVED SENIORS AND OTHERS IN NEED IN THE WEST SOUND REGION SINCE1954. MMHS IS NOT ONLY ONE OF THE LARGEST SKILLED NURSING PROVIDERS INWASHINGTON, WE CONSISTENTLY RANK AMONG THE TOP THREE TO FOUR PROVIDERSWHEN IT COMES TO ACCESS. IN 2018, 565 INDIVIDUALS (404 ADMISSIONS) WERESERVED, WITH AN AVERAGE AGE OF 82 YEARS. 75% OF THE DAYS OF CAREPROVIDED WERE MEDICAID. MORE THAN $1.2M IN UNDERFUNDED CARE WASPROVIDED IN 2018.MMHS IS COMPRISED OF THREE RESIDENT CARE AREAS: BAY/COURTYARD, MARINAAND GARDEN. ALTHOUGH PROGRAMMING AND SERVICES OVERLAP IN ALL THREEAREAS, EACH HAS ITS SIGNATURE PROGRAMS SPECIFIC TO THE NEEDS OF RESIDENTS SERVED IN THOSE AREAS. BAY/COURTYARD SERVES INDIVIDUALS WITHBOTH MEMORY AND BEHAVIORAL HEALTH CARE NEEDS.THE MARINA CARE AREA SERVES PRIMARILY LONG-TERM CARE RESIDENTS WITH CHRONIC CONDITIONS REQUIRING 24-HOUR CARE AND SUPPORT. FOR MANY OF THESE RESIDENTS, OUR ROBUST QUALITY OF LIFE PROGRAM IS AN IMPORTANT FACTOR TO THEIR OVERALL WELLNESS AND SATISFACTION. PET, MUSIC, HORTICULTURE AND ART THERAPIES ARE AMONG THE ACTIVITIES OFFERED TO THIS RESIDENT GROUP. INTERGENERATIONAL PROGRAMMING IS OFFERED DAILY IN CONJUNCTION WITH OUR CHILDCARE AND EARLY LEARNING PROGRAMS.THE GARDEN CARE AREA SPECIALIZES IN SHORT-STAY REHABILITATION. WE OFFER 24-HOUR RN COVERAGE, 7 DAYS-A-WEEK PHYSICAL AND OCCUPATIONAL THERAPIES AND 6 DAYS-A-WEEK SPEECH LANGUAGE THERAPY. IN 2018, THE AVERAGE REHABILITATION STAY WAS APPROXIMATELY 14 DAYS. MMHS CONTINUES TO DEMONSTRATE QUALITY OUTCOMES AND HIGH PATIENT/FAMILY SATISFACTION WHILE SERVING A VERY DIVERSE PORTFOLIO OF INDIVIDUALS AND NEEDS. 12647180 1 1 0 1 0 0 0 0 1 1 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 49 0 434 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X ROBIN SCHUMAN CFO 3607797500 PO BOX 127 POULSBO WA 983700127 DOUG LOVE PRESIDENT & TRUSTEE 0.30 1.20 X X 0 0 0 JAMIE MITTET TRUSTEE & PRESIDENT 0.30 1.20 X X 0 0 0 MARY POLENSKY VICE PRESIDENT & SECRETARY 0.30 1.20 X X 0 0 0 TOM HAWKS TRUSTEE VICE PRES. (THROUGH SEPTEMBER 2018) 0.30 1.20 X X 0 0 0 MARLENE LEMIRE SECRETARY & TRUSTEE 0.30 1.20 X X 0 0 0 BILL BAIRD TRUSTEE 0.30 1.20 X 0 0 0 ALAN CRAIN TRUSTEE 0.30 1.20 X 0 0 0 KATHRYN DE BRUYN TRUSTEE 0.30 1.20 X 0 0 0 SUSAN EAGAN TRUSTEE 0.30 1.20 X 0 0 0 LISA HECKER TRUSTEE (THROUGH APRIL 2018) 0.30 1.20 X 0 0 0 CAROL HOFFMAN TRUSTEE (THROUGH MARCH 2018) 0.30 1.20 X 0 0 0 DONALD LACHATA TRUSTEE 0.30 1.20 X 0 0 0 BOBBIE MOORE TRUSTEE 0.30 1.20 X 0 0 0 ROBERT NICHOLS TRUSTEE (THROUGH APRIL 2018) 0.30 1.20 X 0 0 0 PHIL ROCKEFELLER TRUSTEE (THROUGH SEPTEMBER 2018) 0.30 1.20 X 0 0 0 AARON SCHIELKE TRUSTEE 0.30 1.20 X 0 0 0 GALEN SCHULER TRUSTEE 0.30 1.20 X 0 0 0 KENT SHANE TRUSTEE 0.30 1.20 X 0 0 0 HELEN STOLL TRUSTEE 0.30 1.20 X 0 0 0 LYNETTE LADENBURG CEO 1.00 39.00 X 165940 0 16181 CHRISTOPHER VERNON-COLE COO 1.00 39.00 X 118151 0 9124 ROBIN SCHUMAN CFO 1.00 39.00 X 108000 0 8970 SHARON CHRISTOR CCO 40.00 0.00 X 99778 0 334 LEAH MEADOWS DNS 40.00 0.00 X 101071 0 0 592940 0 34609 4 0 1 0 CONSONUS REHAB UNIT 12 PO BOX 4800 PORTLAND OR 972084800 REHAB SERVICES 1053719 SODEXO INC AND AFFILIATES DEP 880328 LOS ANGELES CA 900880328 FOOD SERVICES 849899 MARTHA AND MARY LUTHERAN SERVICES PO BOX 127 POULSBO WA 983700127 MANAGEMENT SERVICES 754051 CONSONUS PHARMACY UNIT 12 PO BOX 4800 PORTLAND OR 972084800 PHARMACY SERVICES 357424 4 6100 96543 102643 NURSING HOME REVENUE 623000 17316887 17316887 OTHER PROGRAM REVENUE 900099 40782 40782 17357669 3221 3221 8663 105932 -8663 -105932 -114595 -114595 96581 11246 85335 85335 GROUP RETRO REBATE 900099 149122 149122 OTHER REVENUE 722320 33946 33946 NAC TRAINING REIMBURSEMENT 611710 28382 28382 10683 10683 222133 17656406 17357669 0 196094 491869 491869 8319771 8127558 192213 1447159 1334461 112698 917812 847248 70564 754051 754051 783 783 39404 39404 246 195 51 1530829 1530829 4055 3218 837 78539 65542 12997 277759 6016 271743 841803 351171 490632 28087 20068 8019 784119 1149 782970 136991 9144 127847 UBI TAXES 1231 1231 SUPPLIES/ANCILLARY/FOOD 1620342 1550787 69555 BAD DEBTS 194722 154551 40171 MISCELLANEOUS 117728 96380 21348 100405 79692 20713 17687705 12647180 5040525 0 397 3451 734713 1384159 2202432 1438521 130933 133509 20404200 13541293 6723630 6862907 150773 952422 826176 836441 919575 11580968 11719071 1254932 1337076 15958 20262 13377596 13829379 1141870 835181 15790356 16021898 X -5214918 -5213064 1005530 910237 -4209388 -4302827 11580968 11719071 X -31299 -62140 X 0 1 X 1 1 1 X 139428 227527 1495692 135552 102643 2100842 15463560 15805318 16172667 16949205 17357669 81748419 351164 356209 331528 270219 284768 1593888 15954152 16389054 17999887 17354976 17745080 85443149 84237 84237 0 84237 84237 85358912 1143 8422 10338 5890 3221 29014 1143 8422 10338 5890 3221 29014 63693 63415 46648 39939 33946 247641 16018988 16460891 18056873 17400805 17782247 85719804 0.99580 0.99490 0.00030 0.00030 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE X 0 0 1115 1160 1115 1160 17686590 25065865 17687705 25067025 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 1050 217 355 1160 2782 250000 250000 250000 250000 1000000 1500000 0 1 X 952422 -62140 64106 826176 890930 128992 67500 952422 917502 33426 59998 890930 938162 -4856 15804 917502 898610 62679 12127 11000 938162 0.00000 0.00000 1.00000 0 0 271139 271139 11373316 6099071 5274245 1432731 1362828 69903 7197780 6079394 1118386 129234 129234 6862907 TRUST ASSETS 826176 C 826176 ESCROW DEPOSITS 81196 REPLACEMENT RESERVE 813937 RESIDENT FUNDS HELD IN TRUST 20262 OTHER ASSETS 4180 919575 INTEREST PAYABLE 38856 INTERCOMPANY PAYABLE 796325 835181 X 17736029 157284 157284 17578745 77661 77661 17656406 17804883 117178 117178 17687705 0 17687705 PART IV, LINE 2B: FUNDS ARE RECEIVED FROM RESIDENTS AND DEPOSITED INTO A SEPARATE BANK ACCOUNT ON BEHALF OF THE RESIDENTS. MARTHA AND MARY HEALTH SERVICES, AS CUSTODIAN, DISBURSES THOSE FUNDS AT THE DIRECTION OF THE RESIDENTS OR THEIR REPRESENTATIVES. PART V, LINE 4: THE ORGANIZATION IS BENEFICIARY OF A TERM TRUST. THE PURPOSE OF THE TRUST IS TO ADMINISTER THE WELL-BEING OF SINGLE WOMEN OF INADEQUATE MEANS AT THE HEALTH SERVICES' SKILLED NURSING FACILITY. THE PRINCIPAL IS RESTRICTED FOR 50 YEARS, UNTIL OCTOBER 2058. AFTER THAT DATE, THE TRUSTEE WILL HAVE DISCRETION TO DISTRIBUTE INCOME AND PRINCIPAL. PART X, LINE 2: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED HEALTH SERVICES TO BE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE FINANCIAL STATEMENTS. HEALTH SERVICES IS ALSO EXEMPT FROM CERTAIN STATE BUSINESS AND OCCUPATION TAXES AND CERTAIN COUNTY REAL PROPERTY TAXES. HEALTH SERVICES APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN HEALTH SERVICES' FINANCIAL STATEMENTS. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. HEALTH SERVICES IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THEIR TAX-EXEMPT STATUS. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 11,246. NET ASSETS RELEASED FROM RESTRICTION 40,106. LOSS ON DISPOSAL OF ASSETS 105,932. PART XI, LINE 4B - OTHER ADJUSTMENTS: GRANTS RECEIVED FOR CAPITAL PURCHASES 77,661. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 11,246. LOSS ON DISPOSAL OF ASSETS 105,932. 0 0 0 0 0 0 0 0 0 LYNETTE LADENBURG CEO 165940 0 0 0 0 0 0 0 16181 0 182121 0 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS ESTABLISHED BY MARTHA AND MARY LUTHERAN SERVICES, A RELATED ORGANIZATION. MARTHA AND MARY LUTHERAN SERVICES USES THE FOLLOWING TO ESTABLISH THE CEO'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. COMPENSATION SURVEY OR STUDY 3. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE PRESIDENT, VICE PRESIDENT AND SECRETARY. THE EXECUTIVE COMMITTEE MEETS UPON CALL FOR THE PURPOSE OF PERFORMING BUSINESS THAT CANNOT WAIT FOR THE ACTION OF THE BOARD, AND TO CONSULT WITH OR ASSIST THE CEO AND/OR ADMINISTRATOR IN THE PERFORMANCE OF THEIR RESPECTIVE DUTIES. ANY ACTION OF THE EXECUTIVE COMMITTEE IS REPORTED FOR RATIFICATION AT THE NEXT MEETING OF TRUSTEES AND, IF INDICATED, MAY BE REPORTED SOONER BY MAIL. TWO MEMBERS OF THE COMMITTEE CONSTITUTE A QUORUM. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT FUNCTIONS ARE PERFORMED BY MARTHA AND MARY LUTHERAN SERVICES. FORM 990, PART VI, SECTION A, LINE 6 MARTHA AND MARY HEALTH SERVICES (MMHS) IS A SUBSIDIARY OF MARTHA AND MARY LUTHERAN SERVICES (MMLS). WHILE MMLS IS NOT DEFINED AS A MEMBER OR STOCK HOLDER IN THE ORGANIZATIONAL DOCUMENTS, MMLS "HAS THE RIGHT TO PARTICIPATE" IN THE GOVERNANCE OF MMHS AND AS A RESULT IS CONSIDERED A "MEMBER" FOR PURPOSES OF THIS QUESTION. FORM 990, PART VI, SECTION A, LINE 7A MARTHA AND MARY LUTHERAN SERVICES, AS THE PARENT CORPORATION, ELECTS ALL TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B MARTHA AND MARY HEALTH SERVICES IS A SUBSIDIARY OF MARTHA AND MARY LUTHERAN SERVICES. THERE ARE DEFINED "SUBSTANTIAL ISSUES" THAT MUST BE APPROVED BY THE PARENT CORPORATION. THESE "SUBSTANTIAL ISSUES" INCLUDE: A) ACQUISITION OR SALE OF REAL PROPERTY, B) CORPORATE BORROWING THAT IS OR WILL BE SECURED BY A MORTGAGE, DEED OF TRUST, OR OTHER ENCUMBRANCE ON CORPORATE REAL PROPERTY, C) DISSOLVING THE CORPORATION, OR D) SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS. APPROVED SUBSTANTIAL ISSUES WILL NOT HAVE ANY FORCE OR EFFECT WITHOUT THE PRIOR WRITTEN CONSENT OF HUD. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT REVIEWED THE FORM 990 PRIOR TO THE COMPLETED FORM BEING SUBMITTED TO THE BOARD. A SUBCOMMITTEE OF THE BOARD UNDERTOOK A SPECIFIC REVIEW OF THE 990 AND PROVIDED ITS RECOMMENDATION FOR APPROVAL TO THE ENTIRE BOARD. THE 990 WAS APPROVED BY THE BOARD PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS NOT ESTABLISHED A CONFLICT OF INTEREST POLICY OF ITS OWN. HOWEVER, IT HAS ADOPTED THE CONFLICT OF INTEREST POLICY OF ITS PARENT ORGANIZATION, MARTHA AND MARY LUTHERAN SERVICES (MMLS). THE MMLS CONFLICT OF INTEREST POLICY IS AS FOLLOWS: EACH YEAR AND UPON SELECTION TO THE BOARD, ALL BOARD TRUSTEES AND EMPLOYEE OFFICERS ARE REQUIRED TO COMPLETE A FORM STATING THAT THEY UNDERSTAND THE POLICY AND THAT THERE HAS BEEN NO CONTRAVENTION OF THE POLICY BY THEMSELVES OR FAMILY DURING THE YEAR, OR IF THERE WAS A CONFLICT, IT WAS FULLY DISCLOSED AT THE TIME. IN THE CASE OF A CONFLICT, TRUSTEES WILL RECUSE THEMSELVES. TRUSTEES AND ALL EMPLOYEES, INCLUDING EMPLOYEE OFFICERS, ARE REQUIRED TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST WHENEVER THEY ARISE. THE GOVERNANCE COMMITTEE DETERMINES WHETHER CONFLICTS EXIST AND REVIEWS ACTUAL CONFLICTS OF INTEREST TO DETERMINE APPROPRIATE ACTIONS. ALSO, EACH YEAR PRIOR TO THE PREPARATION OF THE FORM 990, ALL TRUSTEES AND EMPLOYEE OFFICERS WHO SERVED DURING THE YEAR ARE PROVIDED WITH A QUESTIONNAIRE SPECIFICALLY TAILORED TO THE REQUIREMENTS OF FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION DOES NOT PROVIDE A SALARY TO THE CEO. INSTEAD, THE CEO RECEIVES COMPENSATION FROM THE PARENT ORGANIZATION, MARTHA AND MARY LUTHERAN SERVICES (MMLS). THE BOARD PERSONNEL COMMITTEE SETS THE COMPENSATION PACKAGE FOR THE CEO UTILIZING COMPENSATION BENCHMARKS AND ADDITIONAL PARAMETERS RELATED TO THE CONSTRAINTS OF BOARD-APPROVED BUDGET GUIDELINES. MMLS SETS AND PAYS THE COMPENSATION FOR THE CHIEF FINANCIAL OFFICER AND CHIEF OPERATIONS/STRATEGY OFFICER. THE CEO AND HR DIRECTOR USE BENCHMARKS FROM LEADINGAGE WASHINGTON TO ESTABLISH A STARTING WAGE AND DETERMINE A FAIR AND EQUITABLE WAGE RANGE FOR THE CHIEF FINANCIAL OFFICER AND CHIEF OPERATIONS/STRATEGY OFFICER POSITIONS WITHIN MARTHA AND MARY. THE BOARD PRESIDENT REVIEWS AND SIGNS OFF ON ANY ADDITIONAL WAGE INCREASES FOR THE CHIEF FINANCIAL OFFICER AND CHIEF OPERATIONS/STRATEGY OFFICER POSITIONS BEYOND THE STARTING WAGE. THIS PAST YEAR, THE ENTIRE BOARD ALSO REVIEWED THE COMPENSATION AND A ROUGH DRAFT OF PERFORMANCE MANAGEMENT METHODOLOGY FOR ALL KEY POSITIONS INCLUDING THE CHIEF FINANCIAL OFFICER AND CHIEF OPERATIONS/STRATEGY OFFICER. FORM 990, PART VI, SECTION C, LINE 19 OUR FINANCIAL INFORMATION IS PUBLISHED IN OUR ANNUAL REPORT AND IS DISTRIBUTED TO OUR SUPPORTERS AND THE GREATER COMMUNITY. AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT GENERALLY AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF TERM TRUST -62,140. MARTHA AND MARY LUTHERAN SERVICES PO BOX 127 POULSBO WA 98370 910567265 PROVIDE EXECUTIVE MANAGEMENT, FUNDRAISING SERVICES AND ADMIN SUPPORT WA 501(C)(3) LINE 7 N/A 0 MARTHA AND MARY CHILDREN'S SERVICES PO BOX 127 POULSBO WA 98370 911916806 CHILDCARE AND EDUCATION FOR CHILDREN WA 501(C)(3) LINE 10 MARTHA AND MARY LUTHERAN SERVICES 0 MARTHA AND MARY EBENEZER SERVICES PO BOX 127 POULSBO WA 98370 911249343 SENIOR INDEPENDENT HOUSING WA 501(C)(3) LINE 10 MARTHA AND MARY LUTHERAN SERVICES 0 MARTHA AND MARY HOME AND COMMUNITY SERVICES PO BOX 127 POULSBO WA 98370 911293400 COMMUNITY BASED SERVICES FOR SENIORS AND FAMILIES WA 501(C)(3) LINE 10 MARTHA AND MARY LUTHERAN SERVICES 0 VILLAGE GREEN KINGSTON ASSOCIATES LLLP 19160 FRONT ST NE POULSBO WA 98370 263242661 DEVELOPMENT OF LOW INCOME SENIOR HOUSING WA N/A 1 TERM TRUST INVESTMENTS WA COLUMBIA BANK T 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 MARTHA AND MARY LUTHERAN SERVICES PO BOX 127 POULSBO WA 983700127 910567265 X 0 42 42 2198296 2198338 259917 64979 0 0 0 MARTHA AND MARY CHILDREN'S SERVICES PO BOX 127 POULSBO WA 983700127 911916806 X 0 3 3 3654141 3654144 332707 83177 0 0 0 MARTHA AND MARY EBENEZER SERVICES PO BOX 127 POULSBO WA 983700127 911249343 X 0 0 0 152862 152862 30572 7643 0 0 0 MARTHA AND MARY HEALTH SERVICES PO BOX 127 POULSBO WA 983700127 943229627 X 0 1115 1115 17686590 17687705 1000000 250000 0 0 0 MARTHA AND MARY HOME AND COMMUNITY SERVICES PO BOX 127 POULSBO WA 983700127 911293400 0 0 0 1373976 1373976 212398 53100 0 0 0