2014-10-07T17:51:12-05:00 2013-12-31 910189318 MOSS ADAMS LLP 1301 A STREET SUITE 600 TACOMA WA 984024205 990 2013-01-01 910570870 JOSEPHINE SUNSET HOME JOSE 3606292126 9901 272ND PLACE NW STANWOOD WA 98292 TERRY ROBERTSON CHIEF EXECUTIVE OFFICER 3606292126 2014-10-07 1 NANCY J SCHAUER P01326437 2535724100 2013 2015-11-30 17:44:51Z JOSEPHINE TERRY ROBERTSON 9901 272ND PLACE NW STANWOOD WA 98292 19989110 0 X WWW.JOSEPHINENET.COM X 1925 WA A SOCIAL SERVICE MINISTRY OF THE ELCA PROVIDING AFTER-HOSPITAL REHAB, LOVING LONG-TERM CARE, ASSISTED LIVING, CHILDCAREAND EARLY LEARNING SERVICES. 10 10 369 100 0 0 284611 296079 17161187 17052104 48894 20550 4082 2141 17498774 17370874 9000 16326 0 0 10471610 10577361 0 0 27573 5829680 5965078 16310290 16558765 1188484 812109 16720286 17508105 7008497 6923431 9711789 10584674 X OUR MISSION: JOSEPHINE IS A CAREGIVING COMMUNITY FOR ALL GENERATIONS.OUR VISION: TO BE THE COMMUNITY OF CHOICE WHERE NO ONE IS LEFT UNCARED FOR.OUR VALUES: JOSEPHINE, ROOTED IN GOD'S LOVE BELIEVES IN:1)EXCELLENCE OF CAREALL PEOPLE ARE WORTHY OF EXCEPTIONAL AND COMPASSIONATE CARE IN MIND, BODY, AND SPIRIT.2)A PIONEERING SPIRIT AND COURAGEHONORING OUR PAST WHILE RESPONDING TO CHANGING NEEDS AND MOVING INTO THE FUTURE.3)RESPONSIBLE STEWARDSHIPBEING PROACTIVE STEWARDS OF ALL POSSIBLE RESOURCES, LEVERAGING THEM TO ENSURE A SUSTAINABLE FUTURE. 0 0 12063130 12826 14300832 *BETTER BUSINESS ACCREDITED CHARITY *LISTED IN US NEWS & WORLD REPORT AS A BEST NURSING HOME *LISTED AS A TOP 30 NON PROFIT IN SNOHOMISH COUNTY BY THE EVERETT HERALD *RECOGNIZED WITH SENATE RESOLUTION 8741 BY THE WASHINGTON STATE SENATE FOR PROVIDING OVER 100 YEARS OF CARE FOR THE ELDERLY AND CHILDREN. *VOTED BEST RETIREMENT FACILITY* BY THE STANWOOD-CAMANO NEWS POLL FOUR YEARS IN A ROW *RECEIVED THE HIGHEST RATING FOR A NURSING HOME BY THE FEDERAL GOVERNMENT WITH A 5 STAR RATING.SKILLED NURSING - AFTER-HOSPITAL REHABILITATION:IN OUR MEDICARE CERTIFIED REHABILITATION UNIT WE OFFER NURSING AND THERAPY TREATMENT PLANS WHICH RETURN OUR PATIENTS HOME SAFE AND AS QUICKLY AS POSSIBLE AFTER THEIR HOSPITAL STAY. WE OFFER INTENSIVE PHYSICAL,OCCUPATIONAL AND SPEECH THERAPY IN CONJUNCTION WITH REGISTERED NURSE MEDICAL TREATMENT UNDER PHYSICIAN SUPERVISION.LONG-TERM CARE:IN THE NURSING HOME, WE FOCUS ON MEANINGFUL DAYS. BINGO,FOOT MASSAGES AND QUILTING ARE A FEW OF THE ONSITE ACTIVITIES. OUTINGS TO A LOCAL BEACH OR DINING IN A PREFERRED RESTAURANT ARE REGULARLY SCHEDULED. MEALS ARE THOUGHTFULLY PREPARED AND SERVED WITH A HOME COOKED FLAIR. LARGE AND SMALL WORSHIP SERVICES ARE AVAILABLE THROUGHOUT THE WEEK.JOSEPHINE IS UNIQUE AMONG NURSING HOMES FOR ITS INTERGENERATIONAL EMPHASIS. CHILD CARE AND PRESCHOOL TAKE PLACE THROUGHOUT OUR 160 BED NURSING HOME. DAILY INTERACTION BRINGS ENRICHMENT TO THE LIVES OF BOTH RESIDENTS AND CHILDREN. 1341656 0 1678816 THE "SUITES" VIBRANT ASSISTED LIVING -RESIDENTS OF JOSEPHINE'S 57 ASSISTED LIVING APARTMENTS RECEIVE COMPREHENSIVE INDIVIDUAL RESIDENTIAL CARE INCLUDING MEALS, HOUSEKEEPING, LAUNDRY SERVICES, ACTIVITIES AND OUTINGS. CERTIFIED NURSING ASSISTANTS ARE STAFFED 24 HOURS A DAY TO PROVIDE PERSONAL CARE ASSISTANCE AS NEEDED. A REGISTERED NURSE IS ALSO AVAILABLE 24 HOURS PER DAY. WE STRIVE TO CREATE AN ENVIRONMENT THAT MEETS THE UNIQUE NEEDS OF EACH INDIVIDUAL, IN A SAFE AND RESPECTFUL MANNER. 1001184 3500 767378 CHILDCARE AND EARLY LEARNING -JOSEPHINE PROVIDES CHILD CARE, PRESCHOOL AND AFTER SCHOOL PROGRAMS FOR MORE THAN 250 INFANT TO SCHOOL AGE CHILDREN. THIRTY SIX CHILDREN ARE ENROLLED IN THE EARLY CHILDHOOD EDUCATION & ASSISTANCE PROGRAM (ECEAP) FOR UNDERPRIVILEGED CHILDREN. MONTESSORI KINDERGARTEN AND PRESCHOOL CLASSES ARE ALSO OFFERED. OUR CHILD CARE PROGRAMS ARE INTEGRATED THROUGHOUT JOSEPHINE'S FACILITY - GIVING CHILDREN AND NURSING HOME RESIDENTS DAILY OPPORTUNITIES FOR INTERGENERATIONAL ACTIVITIES AND LEARNING. 75344 0 305078 CARE TEAM MINISTRYCARE TEAM MINISTRY RESPONDS FREE OF CHARGE, TO THE NON-MEDICAL "QUALITY OF LIFE" NEEDS OF INDIVIDUALS NOTROUTINELY PROVIDED BY EXISTING SOCIAL SERVICE PROGRAMS. CARE TEAMS, STAFFED BY LAY VOLUNTEERS FROM AREACHURCHES, PROVIDE RESPITE CARE FOR OVERBURDENED HOME CARE GIVERS AND SOCIALIZATION. CHORES FOR FRAIL ELDERLYLIVING AT HOME AND INDIVIDUALIZED SUPPORT FOR ANYONE WITH SPECIAL NEEDS ARE ALSO PROVIDED. THROUGHJOSEPHINE, CARE TEAMS RECEIVE COMPREHENSIVE ORIENTATIONS, AND CLIENT SPECIFIC TRAINING DEALING WITH TOPICSSUCH AS ALZHEIMER'S DISEASE, STROKE, AGING, GRIEF, AND LOSS. IN ADDITION, JOSEPHINE WORKS CLOSELY WITH TEAM LEADERS TO PROVIDE THEM WITH THE TOOLS THEY NEED TO MANAGE THEIR TEAMS EFFECTIVELY. CARE TEAM MINISTRYFURTHERS JOSEPHINE'S MISSION BY PROVIDING INNOVATIVE, INDIVIDUALIZED CARE THAT COMPLEMENTS EXISTING SOCIALSERVICE, ENSURING THAT THE NEEDS OF THE WHOLE PERSON - BODY, MIND AND SPIRIT - ARE BEING MET. 75344 305078 14481314 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 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 43 0 1 369 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X TERRY ROBERTSON CHIEF EXECUTIVE OFFICER 3606292126 9901 272ND PLACE NW STANWOOD WA 98292 HARVEY WOLDEN BOARD MEMBER 1.00 X 0 0 0 KIMBERLY GEARIETY BOARD MEMBER 1.00 X 0 0 0 JERRY VAN VLIET BOARD MEMBER 1.00 X 0 0 0 THOR MCILRATH BOARD MEMBER 2/1 - 7/31 1.00 X 0 0 0 LANA HANSON BOARD MEMBER 4/1 - 5/31 1.00 X 0 0 0 CARL GABRIELSON PRESIDENT 2.00 X X 0 0 0 TOM LUCAS BOARD MEMBER 2/1 - 12/31 1.00 X 0 0 0 BEN RICHARDS TREASURER 2.00 X X 0 0 0 SCOTT BRENTS VICE PRESIDENT 2.00 X X 0 0 0 NANCY SLIND SECRETARY 2.00 X X 0 0 0 ANN STILES BOARD MEMBER 1/1 - 4/30 1.00 X 0 0 0 DONN HOLLENBECK BOARD MEMBER 1.00 X 0 0 0 STEVE HOAG BOARD MEMBER 10/1 - 12/31 1.00 X 0 0 0 TERRY ROBERTSON CHIEF EXECUTIVE OFFICER 40.00 X 155046 0 41320 KAREN JACOBSON DIRECTOR OF NURSING 40.00 X 108168 0 3242 GRETCHEN PIGOTT CONTROLLER 40.00 X 120296 0 12187 TERI LINDGREN NURSING HOME ADMINISTRATOR 40.00 X 103387 0 7381 486897 0 64130 4 0 1 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 PHYSICAL, SPEECH & OCCUPATIONAL THERAPIE 1216107 SNF SOLUTIONS 10506 420TH AVE SE NORTH BEND WA 98045 BILLING SERVICES - SKILLED NURSING FACIL 179549 2 241453 54626 296079 NURSING HOME-MEDICAID 623000 7505664 7505664 NURSING HOME-MEDICARE 623000 4950922 4950922 NURSING HOME-PRIVATE 623000 1844246 1844246 ASSISTED LIVING REVENUE 623000 1678816 1678816 CHILD CARE REVENUE 624410 767378 767378 305078 305078 17052104 39285 39285 2300 2448 -148 -148 -148 2586517 2586517 18735 0 -18735 -18735 -18735 12825 10536 2289 2289 17370874 17091389 0 -16594 X 16326 16326 197317 197317 8586668 8006779 559790 20099 97851 84000 13851 756339 716428 37509 2402 939186 882348 54791 2047 14267 14267 254790 254790 1428998 1371380 57618 59038 59038 429472 159722 268196 1554 122909 122909 455760 438235 17525 68025 45258 22767 64703 28761 35842 100 307916 295400 12516 673920 615221 57328 1371 81078 4715 76363 FOOD AND SUPPLEMENTS 510648 510648 MEDICARE/HMO ANCILLARY 455062 455062 MEDICAL SUPPLIES AND SM 419692 419692 MISCELLANEOUS 199000 65218 133782 419800 366121 53679 16558765 14481314 2049878 27573 2038359 921356 4127483 2489508 2441217 2472579 67103 56447 124743 130589 19248199 11555499 7270283 7692700 433456 677622 86629 348880 131013 2718424 16720286 17508105 1023006 1013871 49742 87894 5921188 5665188 14561 156478 7008497 6923431 X 9222728 10084109 40330 51674 448731 448891 9711789 10584674 16720286 17508105 812109 60776 0 X 0 1 X 1 0 X 343881 322043 317853 284611 296079 1564467 14931142 14973059 16493738 17161187 17052104 80611230 15275023 15295102 16811591 17445798 17348183 82175697 0 0 0 82175697 40346 54407 50450 50738 41585 237526 40346 54407 50450 50738 41585 237526 15315369 15349509 16862041 17496536 17389768 82413223 0.99710 0.99670 0.00290 0.00330 X 1 1 0 0 0 0 1 1100 1 1200 0 2300 0 PART II-B, LINE 1 MET WITH LEGISLATORS TO EDUCATE THEM ON OUTCOMES OF PENDING BILLS AND FUNDING. STAFF, BOARD MEMBERS, VOLUNTEERS ATTEND LEGISLATIVE DAYS IN OLYMPIA. 460129 160 15331 897 474723 452122 12478 3649 822 460129 459572 50 -564 6211 725 452122 432129 23755 12721 8507 526 459572 362708 60111 9746 353 83 432129 0.00000 0.94600 0.05400 1 0 468554 468554 8844131 6153211 2690920 6716704 3344260 3372443 3098518 2058028 1040490 120293 7692700 LOAN ISSUANCE FEES, NET 120670 LAND HELD FOR FUTURE DEVELOPMENT 2597754 2718424 FUNDS HELD FOR RESIDENTS 17602 CAPITAL LEASE 138876 156478 X 17373322 2448 2448 17370874 0 17370874 16561213 2448 2448 16558765 0 16558765 PART V, LINE 4: THE ENDOWMENT FUND WAS ESTABLISHED TO SUPPORT AND FURTHER THE MISSION AND MINISTRY OF THE HOME. DISTRIBUTIONS FROM THE ENDOWMENT FUND SHALL BE TO SUPPORT CAPITAL IMPROVEMENTS WITHIN THE PROPERTY, GROUNDS, BUILDINGS AND PROGRAMS OF JOSEPHINE. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. EXEMPTION HAS ALSO BEEN GIVEN BY SNOHOMISH COUNTY (THE COUNTY) FROM ALL PERSONAL PROPERTY TAXES. IN ADDITION, THE COUNTY HAS GRANTED EXEMPTION FOR REAL PROPERTY ASSOCIATED WITH THE NURSING HOME, BOARDING HOME, AND CHILD CARE PROGRAMS. IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND WAS REASONABLY ESTIMABLE. AS OF DECEMBER, 31, 2013, THE ORGANIZATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,448. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,448. 1 EDUCATIONAL SCHOLARSHIPS 18 16326 PART I, LINE 2: JOSEPHINE HAS A SCHOLARSHIP FUND THAT SUPPORTS STAFF MEMBERS IN PURSUING EDUCATION IN THE FIELD OF HUMAN SERVICES. ANY JOSEPHINE EMPLOYEE, IN GOOD STANDING, WISHING TO FURTHER THEIR EDUCATION IN A FIELD WHICH BENEFITS JOSEPHINE, AND HAS WORKED AT JOSEPHINE FOR AT LEAST 1 YEAR BY THE START DATE OF THE QUARTER FOR WHICH THEY ARE APPLYING FOR A SCHOLARSHIP, MAY APPLY FOR A SCHOLARSHIP. THE SCHOLARSHIP COMMITTEE CONSIDERS THE FOLLOWING CRITERIA IN AWARDING EDUCATION SCHOLARSHIPS: APPLICANT'S CAREER GOALS, ACCREDITATION OF INSTITUTION, COURSE OF STUDY, FULL OR PART-TIME STATUS, REFERENCES AND GRADES. IF EMPLOYMENT IS TERMINATED PRIOR TO COMPLETION OF COURSE WORK, OR IF EMPLOYMENT IS TERMINATED PRIOR TO ONE YEAR FROM THE SCHOLARSHIP AWARD DATE, THE FULL AMOUNT OF THE SCHOLARSHIP FUNDS AWARDED MAY BE DEDUCTED FROM THE EMPLOYEE'S PAYCHECK(S). X X X X X 0 1 0 0 0 0 0 0 0 TERRY ROBERTSON CHIEF EXECUTIVE OFFICER 150745 0 101 0 4200 0 33839 0 7481 0 196366 0 0 0 PART I, LINE 4B A NON-QUALIFIED DEFERRED COMPENSATION PLAN (TOP HAT PLAN) HAS BEEN ESTABLISHED FOR JOSEPHINE'S CEO TERRY ROBERTSON. CEO TERRY ROBERTSON ELECTED ON 12/27/2012 TO MAKE VOLUNTARY SALARY DEFERRAL PAYMENTS DURING 2013 TOTALING OF $27,752. ENTIRE ACCRUED BENEFIT IS SUBJECT TO VESTING SCHEDULE: AGE 62 20% AGE 63 40% AGE 64 60% AGE 65 80% AGE 66 100% EXCEPTION: 100% IF SEPARATION FROM SERVICE RESULTED FROM DEATH OR DISABILITY. A WASHINGTON STATE HOUSING FINANCE COMMISSION 911874730 2005-08-04 7293188 SEE SCHEDULE O 0 0 0 A 143000 7150188 2006 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION BOND ISSUES - DESCRIPTION OF PURPOSE REMODEL/EXPANSION; REFUND OF PRIOR BOND - 1995 LOW INCOME HOUSING ASSISTANCE REVENUE BOND ISSUED BY HOUSING AUTHORITY OF SNOHOMISH COUNTY. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP SHALL BE OPEN TO EACH CHURCH CONGREGATION IN SNOHOMISH, ISLAND, SKAGIT AND WHATCOM COUNTIES WHO HAVE EXPRESSED A COMMITMENT TO THE MISSION OF JOSEPHINE SUNSET HOME AND WHOSE APPLICATION HAS BEEN APPROVED BY THE BOARD OF DIRECTORS OF JOSEPHINE SUNSET HOME. AT ALL TIMES THE MAJORITY OF CONGREGATIONS HOLDING CORPORATE MEMBERSHIP SHALL BE LUTHERAN. BYLAW 5.0.1-ANY CONGREGATION DESCRIBED IN ARTICLE V MAY, ACCORDING TO ITS CONSTITUTION AND BYLAWS WITH THE APPROVAL OF ANY HIGHER DISCIPLINE TO WHICH IT MAY BE RESPONSIBLE, ELECT TO APPLY FOR MEMBERSHIP IN THE CORPORATION. BYLAW 5.0.2-SUCH CONGREGATIONS SHALL SEND A FORMAL LETTER OF APPLICATION TO THE BOARD OF DIRECTORS OF JOSEPHINE SUNSET HOME. A DULY ENDORSED COVENANT STATEMENT OF THE CONGREGATION'S COMMITMENT TO THE MISSION OF JOSEPHINE SUNSET HOME SHALL ACCOMPANY THE LETTER OF APPLICATION. BYLAW 5.0.3-THE COVENANT STATEMENT SHALL BE RENEWED ANNUALLY AS A REQUISITE TO CONTINUED MEMBERSHIP IN THE CORPORATION. BYLAW 5.0.4-UPON APPROVAL OF THE APPLICATION FOR MEMBERSHIP BY THE BOARD OF DIRECTORS OF JOSEPHINE SUNSET HOME, THE MEMBERSHIP OF ANY SUCH CONGREGATION SHALL BE ESTABLISHED AND THE NAME OF THE CORPORATION ENTERED UPON THE ROLLS OF JOSEPHINE SUNSET HOME AS A VOTING MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A 6.1-MEMBER CONGREGATIONS WILL BE REPRESENTED BY DELEGATES AT REGULAR AND SPECIAL MEETINGS OF THE CORPORATION. 6.2-THE NUMBER OF DELEGATES PER MEMBER SHALL BE SET FORTH IN THE BYLAWS. BYLAW 6.2.1-IN ADDITION TO A PASTOR OF THE MEMBER CONGREGATION, EACH CONGREGATION SHALL DESIGNATE ANNUALLY TWO (2) DELEGATES TO REPRESENT THE CONGREGATION IN THE CORPORATION. BYLAW 6.2.2-IN THE EVENT A PASTOR OF THE MEMBER CONGREGATION CANNOT OR CHOOSES NOT TO BE A DELEGATE, THE MEMBER CONGREGATION MAY ELECT AN ALTERNATE DELEGATE. 6.3-DELEGATES WILL EXERCISE THE VOTING RIGHTS OF THE MEMBER AND REPORT PERTINENT INFORMATION TO THE MEMBER. BYLAW 6.3.1-IN THE EVENT THAT A MEMBER CONGREGATION MUST SEND A PROXY VOTER TO THE ANNUAL CORPORATION MEETING SUCH PERSON OR PERSONS MUST BE IDENTIFIED TO THE SECRETARY OF JOSEPHINE SUNSET HOME PRIOR TO THE BEGINNING OF THE MEETING. 6.4-ELECTION OR APPOINTMENT OF DELEGATES WILL BE DETERMINED BY EACH MEMBER CONGREGATION. BYLAW 6.4.1-EACH MEMBER CONGREGATION SHALL FORWARD ITS LIST OF DELEGATES WITH ADDRESSES AND TELEPHONE NUMBERS TO THE SECRETARY OF THE CORPORATION BY FEBRUARY 15TH EACH YEAR TO PROVIDE SUFFICIENT TIME FOR CORRESPONDENCE PRIOR TO THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11 PRESENTED TO BOARD FROM GOVERNANCE COMMITTEE WITH MOTION TO ACCEPT/DECLINE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST ISSUES BROUGHT TO A BOARD MEMBER ARE REVIEWED BY THE BOARD FOR RESOLUTION TO DETERMINE IF PENDING/PRIOR ACTION IS MATERIAL/IMMATERIAL AND IF/WHAT MANNER OF RECUSAL IS TO BE TAKEN BY BOARD MEMBER OR KEY EMPLOYEE. FORM 990, PART VI, SECTION B, LINE 15 BOARD REVIEWED COMPARATIVE DATA FOR SIMILAR ORGANIZATIONS AND KEY POSITIONS COMPILED FROM: AMERICAN ASSOCIATION OF HOMES FOR THE AGING-NURSING HOME SALARY & BENEFITS REPORT; AGING SERVICES OF WASHINGTON LONG TERM CARE & SENIOR HOUSING EMPLOYEE COMPENSATION SURVEY AND GUIDESTAR. COMPENSATION OFFERED TO CEO, EXECUTIVE DIRECTOR AND OTHER TOP MANAGEMENT PERSONNEL WAS NO MORE THAN THE 75TH PERCENTILE FOR SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS. OFFICERS (BOARD MEMBERS) ARE UNPAID. KEY EMPLOYEES - BOARD REVIEWED COMPARATIVE DATA FOR SIMILAR ORGANIZATIONS AND KEY POSITIONS COMPILED FROM: AMERICAN ASSOCIATION OF HOMES FOR THE AGING-NURSING HOME SALARY & BENEFITS REPORT; AGING SERVICES OF WASHINGTON LONG TERM CARE & SENIOR HOUSING EMPLOYEE COMPENSATION SURVEY & GUIDESTAR. COMPENSATION OFFERED TO KEY EMPLOYEES WAS NO MORE THAN THE 75TH PERCENTILE FOR SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS AVAILABLE UPON REQUEST AND TO BE FILED WITH STATE OF WASHINGTON CHARITIES PROGRAM. THE FORM 1023 IS NOT AVAILABLE BECAUSE OF A GROUP EXEMPTION THROUGH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING/ORGANIZING DOCUMENTS ARE AVAILABLE ON REQUEST FROM THE EXECUTIVE DIRECTOR. CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, PUBLISHED IN THE ANNUAL REPORT, AND DISTRIBUTED AT THE ANNUAL MEETING. FORM 990, PART IX, LINE 24E REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 154,859. MANAGEMENT AND GENERAL EXPENSES 30,272. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 185,131. DIETARY/HOUSEKEEPING/LAUNDRY SUPPLIES: PROGRAM SERVICE EXPENSES 68,508. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,508. CHILD PROGRAM SUPPLIES: PROGRAM SERVICE EXPENSES 62,124. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,124. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 33,746. MANAGEMENT AND GENERAL EXPENSES 23,407. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,153. SAFETY NET ASSESSMENT: PROGRAM SERVICE EXPENSES 46,884. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,884.