2011-10-03T15:04:29-05:00 2010-12-31 MONSON & BASS INC PS 3500 188TH SW SUITE 234 LYNNWOOD WA 980374716 990 2010-01-01 910573114 FOSS HOME & VILLAGE FOSS 2063641300 13023 GREENWOOD AVE N SEATTLE WA 981337397 DAVID CROUCH 2063641300 2011-09-12 STEVEN B BASS CPA 4257785232 2011-09-12 2010 2016-03-07 17:11:31Z DAVID CROUCH 13023 GREENWOOD AVE N SEATTLE WA 981337397 18496877 0 X WWW.FOSSCARE.ORG X 1929 WA NURSING HOME & ASSISTED LIVING FACILITY 11 11 376 162 0 0 131773 200000 18705425 18198386 39024 41491 35860 9290 18912082 18449167 0 0 0 0 13460933 13744323 0 0 0 4587061 4401040 18047994 18145363 864088 303804 11401711 11338239 7892410 7465352 3509301 3872887 NURSING HOME AND ASSISTED LIVING FACILITY. 0 0 16058698 18198386 NURSING HOME AND ASSISTED LIVING CARE, INCLUDING A SUBSTANTIAL NUMBER OF MEDICARE & MEDICAID SUPPORTED RESIDENTS/PATIENTS. 52% OF REVENUE IS FROM MEDICARE/MEDICAID AND THE REMAINDER IS FROM PRIVATE PAY RESIDENTS. RATES ARE SET BASED ON MARKET RATES IN THE SEATTLE AREA, AND ARE NECESSARY TO MAKE THE ORGANIZATION VIABLE. 16058698 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 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 0 1 47 0 1 376 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X PATRICIA UPDEGRAFF 2063641300 13023 GREENWOOD AVE N SEATTLE WA 981337397 ART BATT 2.00 X 0 0 0 ARLENE VANDERKLOMP 2.00 X X 0 0 0 KELLIE HESSLER DE'ARTURET 2.00 X 0 0 0 MARYANN JOHNSTON 2.00 X X 0 0 0 DAWNELL LAMB 2.00 X 0 0 0 CARLOS GUANGORENA 2.00 X 0 0 0 PAUL WOLD 2.00 X 0 0 0 MARK CHURCHILL 2.00 X X 0 0 0 NORMA BEERWEILER 2.00 X 0 0 0 REVEREND MARVIN JONASEN 2.00 X 0 0 0 JANE JONES 2.00 X 0 0 0 DAVID CROUCH 40.00 X 181674 0 77720 PATRICIA L UPDEGRAFF 40.00 X 109212 0 43465 GAIL M BARTHOLD 40.00 X 101304 0 31585 JOHN F HENRY JR 40.00 X 106782 0 22438 498972 0 175208 4 0 1 0 JEM PROFESSIONAL SERVICES 17912 25TH DRIVE SE BOTHELL WA 98012 CONTRACT THERAPIST 234345 1 200000 200000 RESIDENT FEES 623000 18045676 18045676 152710 152710 18198386 41491 41491 57000 47710 9290 9290 9290 18449167 18198386 0 50781 412071 412071 10384947 9394733 990214 314575 281945 32630 1522617 1441426 81191 1110113 976899 133214 43680 43680 19098 19098 49855 49855 119102 119102 83813 73755 10058 755084 664474 90610 36866 36866 118175 103994 14181 521307 458750 62557 SUPPLIES 748137 658361 89776 FOOD 734708 734708 PURCHASED SERVICES 597273 525600 71673 PHARMACY 333286 333286 240656 211119 29537 18145363 16058698 2086665 0 801190 948698 1896381 1860259 60168 55878 269099 290021 17919062 11288784 6891874 6630278 1282493 428397 954695 200506 170013 11401711 11338239 2252566 2205248 5480000 5090000 159844 170104 7892410 7465352 X 3509301 3872887 3509301 3872887 11401711 11338239 X 303804 59782 X X 0 1 1 X 0 X 287348 268971 757977 131773 200000 1646069 17466249 18371846 18235508 18705425 18198386 90977414 -7972 1253 -2186 4193 57000 52288 17745625 18642070 18991299 18841391 18455386 92675771 0 0 0 92675771 168027 139477 56248 39024 41491 444267 168027 139477 56248 39024 41491 444267 35860 9290 45150 17913652 18781547 19083407 18889705 18496877 93165188 0.99470 0.99440 0.00480 0.00560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 676973 1454155 2131128 938516 8110332 5473933 3574915 5651783 4918722 733061 1087303 896129 191174 6630278 WELLESLEY INCOME FUND 448215 F WELLINGTON FUND ADMIRAL 506480 F 954695 RESIDENT TRUST ACCTS 14346 DEPOSITS 155758 170104 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS REPORT THERE ARE NO MATTERS THAT WOULD CREATE UNRELATED BUSINESS INCOME TAX OR CALL INTO QUESTION ITS EXEMPT STATUS. X X X 0 1 0 0 0 0 0 0 0 DAVID CROUCH 181674 0 0 0 0 0 52645 0 25075 0 259394 0 0 0 PATRICIA L UPDEGRAFF 109212 0 0 0 0 0 28163 0 15302 0 152677 0 0 0 PART I, LINE 4B DAVID CROUCH 49,012 FORM 990, PART VI, SECTION B, LINE 11 DRAFT TAX RETURN DISTRIBUTED AT BOARD MEETING FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED AT THE BOARD MEETING AND MEMBERS ARE REQUIRED TO COMPLETE AND SIGN THE FORM FOR PROPER DISCLOSURE. MEMBERS ARE DIRECTED TO NOTIFY THE BOARD DURING THE YEAR IF A CONFLICT OF INTEREST DEVELOPS. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF DIRECTORS REVIEWS DATA ON SALARY FROM SALARY SURVEY COMPILED BY HOPSITAL ASSOCIATION, REVIEWS FROM 990'S OF COMPARABLE ORGANIZAITONS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 59,782. AUDIT COMMITTEE RESPONSIBILITY FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE HAS OVERSIGHT RESPONSIBILITY FOR THE FINANCIAL STATEMENTS, AND THE SELECTION OF THE INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FOSS FOUNDATION 13023 GREENWOOD AVE N SEATTLE WA 981337397 911640102 FUNDRAISING ACTIVITIES TO RAISE FUNDS TO PROVIDE GRANTS TO FOSS HOME & VILLA WA 501(C)(3) SEC 170(B)(1)(A)(I) N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FOSS FOUNDATION C 200000 CASH