2011-10-06T10:56:15-05:00 2010-12-31 MOSS ADAMS LLP 1301 A STREET SUITE 600 TACOMA WA 984024205 990 2010-01-01 910570870 JOSEPHINE SUNSET HOME JOSE 3606292126 9901 272ND PLACE NW STANWOOD WA 98292 TERRY ROBERTSON 3606292126 2011-10-06 1 NANCY J SCHAUER 2535724100 2010 2016-03-07 17:11:31Z TERRY ROBERTSON 9901 272ND PLACE NW STANWOOD WA 98292 15366746 0 X WWW.JOSEPHINENET.COM X 1925 WA A SOCIAL SERVICE MINISTRY OF THE ELCA PROVIDING ACUTE REHABILITATION, SKILLED NURSING CARE, ASSISTED LIVING, CHILDCARE AND EARLY LEARNING SERVICES. 15 15 337 125 0 0 343881 322043 14913089 14973059 38546 52607 1236 -637 15296752 15347072 10500 12500 0 0 9310925 9325941 0 0 27916 4945523 4977424 14266948 14315865 1029804 1031207 13936513 14640744 7718448 7379467 6218065 7261277 X SEE SCHEDULE O. 0 0 10381673 7500 12347306 SKILLED NURSING -MEDICAL AND THERAPEUTIC 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. 1417322 1500 1689188 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. 985398 3500 778219 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. 43310 0 158346 CARE TEAM MINISTRY, ADULT DAY SERVICES & NAC TRAINING REIMBURSEMENT -CARE TEAM MINISTRY RESPONDS FREE OF CHARGE, TO THE NON-MEDICAL "QUALITY OF LIFE" NEEDS OF INDIVIDUALS NOT ROUTINELY PROVIDED BY EXISTING SOCIAL SERVICE PROGRAMS. CARE TEAMS, STAFFED BY LAY VOLUNTEERS FROM AREA CHURCHES, PROVIDE RESPITE CARE FOR OVERBURDENED HOME CARE GIVERS AND SOCIALIZATION. CHORES FOR FRAIL ELDERLY LIVING AT HOME AND INDIVIDUALIZED SUPPORT FOR ANYONE WITH SPECIAL NEEDS ARE ALSO PROVIDED. THROUGH JOSEPHINE, CARE TEAMS RECEIVE COMPREHENSIVE ORIENTATIONS, AND CLIENT SPECIFIC TRAINING DEALING WITH TOPICS SUCH 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 MINISTRY FURTHERS JOSEPHINE'S MISSION BY PROVIDING INNOVATIVE, INDIVIDUALIZED CARE THAT COMPLEMENTS EXISTING SOCIAL SERVICE, ENSURING THAT THE NEEDS OF THE WHOLE PERSON - BODY, MIND AND SPIRIT - ARE BEING MET. 43310 158346 12827703 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 36 0 1 337 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X TERRY ROBERTSON EXECUTIVE DIRECTOR 3606292126 9901 272ND PLACE NW STANWOOD WA 98292 HARVEY WOLDEN 1.00 X 0 0 0 SUZANNE KNAUS 1.00 X 0 0 0 VICTOR LESHER 1.00 X 0 0 0 KIMBERLY GEARIETY 1.00 X 0 0 0 BILL SHULER 1.00 X 0 0 0 JERRY VAN VLIET 1.00 X 0 0 0 JIM NEHER 1.00 X 0 0 0 LANA HANSON 2.00 X 0 0 0 CARL GABRIELSON 2.00 X 0 0 0 MILLIE FOSBERG 2.00 X 0 0 0 BEN RICHARDS 2.00 X 0 0 0 SCOTT BRENTS 2.00 X 0 0 0 NANCY SLIND 2.00 X 0 0 0 TERRY ROBERTSON 40.00 X X 127171 0 4863 127171 0 4863 1 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 PHYSICAL, SPEECH & OCCUPATIONAL THERAPIE 1089213 1 4795 232211 85037 322043 NURSING HOME REVENUE 623000 12347306 12347306 BOARDING HOME REVENUE 623000 1689188 1689188 CHILD CARE REVENUE 624410 778219 778219 OTHER PROGRAM REVENUE 623000 153306 153306 ADULT DAY CARE REVENUE 623000 5040 5040 14973059 52607 52607 1800 1246 554 554 554 4320 4795 10415 -6095 -6095 12917 8013 4904 4904 15347072 14973059 0 51970 12500 12500 131846 131846 7425951 6993670 410184 22097 89129 82320 6809 779603 737217 39936 2450 899412 856242 41090 2080 15911 15911 106144 106144 1199024 1184415 14609 44174 585 43589 1293706 1065442 228259 5 76084 76084 558752 516315 42437 59548 31442 28106 29948 16953 12995 341965 331078 10887 614207 540995 71928 1284 82129 5286 76843 MEDICARE/HMO ANCILLARY 400151 400151 MISCELLANEOUS 129830 53092 76738 AGING SERVICES L&I RETR 25851 25851 14315865 12827703 1460246 27916 1739835 2093875 2555424 3470533 1351748 1084177 50865 40495 105758 117276 17905404 10331594 7874277 7573810 45117 50612 51447 58267 162042 151699 13936513 14640744 1083322 934335 31582 6612188 6394188 22938 19362 7718448 7379467 X 5743294 6768151 52350 46950 422421 446176 6218065 7261277 13936513 14640744 X 1031207 12005 X 0 1 1 X 0 X 48870 318900 699279 343881 322043 1732973 11589920 13051844 13639752 14931142 14973059 68185717 11638790 13370744 14339031 15275023 15295102 69918690 0 0 0 69918690 83373 79492 66367 40346 54407 323985 83373 79492 66367 40346 54407 323985 11722163 13450236 14405398 15315369 15349509 70242675 0.99540 0.99500 0.00460 0.00500 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 432129 23755 12721 8507 526 459572 362708 60111 9746 353 83 432129 5000 357370 353 15 362708 1.00000 1 0 468554 468554 8915142 5512372 3402770 5835923 2992676 2843247 2414305 1650710 763595 271480 175836 95644 7573810 DEPOSITS 2020 FUNDS HELD FOR RESIDENTS 17342 19362 15347072 14315865 1031207 12005 12005 1043212 15348318 1246 1246 15347072 0 15347072 14317111 1246 1246 14315865 0 14315865 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. EXEMPTION HAS ALSO BEEN GIVEN BY SNOHOMISH 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. REAL PROPERTY TAX IS PAID ON LAND HELD FOR INVESTMENT. IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(L)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). THE ORGANIZATION ADOPTED THE PROVISIONS OF FASB ACCOUNTING STANDARDS CODIFICATION ("ASC") 740-10, INCOME TAXES, RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS ON JANUARY 1, 2009, WHICH HAD NO FINANCIAL STATEMENT IMPACT TO THE ORGANIZATION. THE ORGANIZATION RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,246. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,246. 1 EDUCATIONAL SCHOLARSHIP 12 12500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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). WASHINGTON STATE HOUSING FINANCE COMMISSION 911874730 2005-08-04 7293188 SEE SCHEDULE O 0 0 0 7293188 143000 7150188 2006 1 0 1 1 0 0 0 0 1 0 0 0 0 0 0 DESCRIPTION OF ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 JOSEPHINE IS A CHRISTIAN COMMUNITY WELCOMING PEOPLE OF ALL FAITHS. WE OFFER CARE FOR THE WHOLE PERSON - BODY, MIND, AND SPIRIT. THROUGH INNOVATIVE RESIDENTIAL AND NON-RESIDENTIAL HEALTH AND LONG TERM CARE SERVICES, COMPREHENSIVE CHILD SERVICES, AND OUR SPECIAL FOCUS ON INTEGRATED PROGRAMS, WE STRIVE TO BE A RESOURCE TO THE INDIVIDUALS AND COMMUNITIES WE SERVE. 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 BEGINNING IN 2009. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 12,005. BOND ISSUES- DESCRIPTION OF PURPOSE SCHEDULE K, PART I, COLUMN F REMODEL/EXPANSION; REFUND OF PRIOR BOND - 1995 LOW INCOME HOUSING ASSISTANCE REVENUE BOND ISSUED BY HOUSING AUTHORITY OF SNOHOMISH COUNTY.