2024-11-15T15:59:29-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-01-01 910573114 FOSS HOME & VILLAGE FOSS 2063641300 13023 GREENWOOD AVENUE NORTH SEATTLE WA 981337397 R KEVIN MCFEELY PRESIDENT/CEO 2063641300 2024-11-14 1 1 KURT BENNION CPA P01469618 4252506100 2024-11-12 2023 2024-10-15 13:58:12Z R KEVIN MCFEELY 13023 GREENWOOD AVENUE NORTH SEATTLE WA 981337397 27576030 0 X WWW.FOSSCARE.ORG X 1929 WA NURSING HOME AND ASSISTED LIVING FACILITY. 6 6 295 65 0 0 294489 1708346 17502492 22956414 11807 2691021 159476 29241 17968264 27385022 0 0 0 0 13206618 16462903 0 0 159629 9017927 10778755 22224545 27241658 -4256281 143364 11552384 11477442 5570489 5329520 5981895 6147922 X NURSING HOME AND ASSISTED LIVING FACILITY. 0 0 20389859 0 22956414 SINCE 1929 FOSS HOME AND VILLAGE HAS PROVIDED CARE FOR THE COMMUNITY IN A NURSING HOME AND ASSISTED LIVING SETTING. FOSS SERVES A POPULATION WITH A SUBSTANTIAL NUMBER OF MEDICAID AND MEDICARE SUPPORTED RESIDENTS AND PATIENTS, WITH 70% OF ITS SERVICE REVENUE FROM MEDICAID/MEDICARE. IN ADDITION TO PROVIDING CARE, FOSS STRIVES TO BE ACTIVE IN THE COMMUNITY BY PARTNERING WITH THE UNIVERSITY OF WASHINGTON, SHORELINE COMMUNITY COLLEGE AND OTHER COLLEGES AND UNIVERSITIES. FOSS PROVIDES A LEARNING ENVIRONMENT FOR INTERNSHIPS BASED IN THE FIELDS OF DENTISTRY, PHARMACY, RESTORATIVE THERAPY, NURSING, AND NURSING ASSISTANT TRAINING. FOSS ALSO HAS AN ACTIVE VOLUNTEER PROGRAM THAT ENCOURAGES HIGH SCHOOL AND COLLEGE STUDENTS. FOSS SERVED 499 NURSING HOME CLIENTS AND 39 ASSISTED LIVING CLIENTS, (CONTINUED IN SCHEDULE O)WITH THE AVERAGE LENGTH OF STAY FOR SHORT-STAY RESIDENTS, DEFINED BY THOSE WHO STAYED 100 DAYS OR LESS, OF APPROXIMATELY 22 DAYS. RATES ARE SET BASED ON THE MARKET IN THE SEATTLE AREA, WHICH ARE NECESSARY TO MAKE THE ORGANIZATION VIABLE. 20389859 1 1 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 42 0 295 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X R KEVIN MCFEELY 2063641300 13023 GREENWOOD AVENUE NORTH SEATTLE WA 981337397 R KEVIN MCFEELY PRESIDENT/CEO 22.50 27.50 X 0 493378 40001 BANAFSHEH BAHARLOO RN NURSE 40.00 0.00 X 218215 0 15236 AYENEW AEMERO LPN NURSE 40.00 0.00 X 211148 0 19196 GEBRU TEZERA LPN NURSE 40.00 0.00 X 185337 0 12171 SOLOMON G-KIDANE LPN NURSE 40.00 0.00 X 177906 0 12024 LAURA MOLZAHN EXECUTIVE DIRECTOR 40.00 0.00 X 141591 0 46275 MILAGROS ALMAZAN NURSE 40.00 0.00 X 161681 0 16600 TODD M HEGERMAN DIRECTOR OF FINANCIAL SERVICES 40.00 0.00 X 88221 0 0 JEFFREY WEST RN CHAIR 0.50 2.00 X X 0 0 0 JUDY WILDES VICE CHAIR (THROUGH APRIL 2023) 0.50 2.00 X X 0 0 0 JULIE YARI DIRECTOR & VICE CHAIR 0.50 2.00 X X 0 0 0 BEVERLY ROACH SECRETARY 0.50 2.00 X X 0 0 0 KRISTEN CHICK TREASURER 0.50 2.00 X X 0 0 0 BRIAN BRUCE BOARD MEMBER 0.50 0.00 X 0 0 0 KRIS JOHANSSEN BOARD MEMBER 0.50 0.00 X 0 0 0 1184099 493378 161503 8 0 1 0 STURDY MEDICAL STAFFING LLC PO BOX 64885 UNIVERSITY PLACE WA 98464 STAFFING AGENCY 2086207 A KIND HEART INC 23005 76TH AVE W EDMONDS WA 98026 STAFFING AGENCY 887684 CONSONUS REHAB 4560 SE INTERNATIONAL WAY SUITE 100 MILWAUKIE OR 97222 THERAPY 862092 EASTGATE STAFFING AGENCY 4957 LAKEMONT BLVD SE STE C4-103 BELLEVUE WA 98006 STAFFING AGENCY 559584 COC CONSULTING LLC 6 COMSTOCK CIRCLE CARSON CITY NV 89703 LAB SERVICES 152511 5 1550000 158346 1708346 RESIDENT FEES 623000 22956414 22956414 22956414 -959 -959 202609 187651 14958 14958 14958 2691980 0 2691980 2691980 2691980 17308 3357 13951 13951 MISCELLANEOUS INCOME 900099 332 332 332 27385022 22956414 0 2720262 X 276087 276087 13449959 10428063 2949433 72463 335449 255712 77960 1777 1109145 880775 222250 6120 1292263 985090 300328 6845 98328 98328 19241 19241 5271566 4130980 1130471 10115 79784 79192 592 478294 254854 162028 61412 175937 140750 35187 618151 384999 233152 5564 5564 201947 201947 519101 493146 25955 341029 272823 68206 MEDICAL SUPPLIES 1076098 1075869 229 FOOD 832793 832793 ALLOCATED EXPENSES 618128 618128 BAD DEBT EXPENSE 245866 245866 196928 8139 188484 305 27241658 20389859 6692170 159629 292794 -1130820 2303655 3698119 154039 346027 305489 94431 25919536 17460101 8483004 8459435 4514 4514 8889 5736 11552384 11477442 2656711 2497489 129486 137431 8889 5736 2775403 2688864 5570489 5329520 X 5981895 6147922 5981895 6147922 11552384 11477442 143364 22663 0 X 0 0 0 X 351078 1660130 5766978 294489 1708346 9781021 20638829 16588783 14477342 17502492 22956414 92163860 59524 19589 13866 15435 17308 125722 21049431 18268502 20258186 17812416 24682068 102070603 1923 1923 0 1923 1923 102068680 280969 363425 370622 281682 201650 1498348 280969 363425 370622 281682 201650 1498348 230959 210695 131610 74571 332 648167 21561359 18842622 20760418 18168669 24884050 104217118 0.97940 0.97630 0.01440 0.01580 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 3528000 3528000 13335132 9555224 3779908 1410032 1184275 225757 7646372 6720602 925770 8459435 PART IV, LINE 2B: THE ORGANIZATION HOLDS TRUST ACCOUNTS FOR RESIDENTS WHO REQUEST THAT WE DO SO AND FOR ANY RESIDENTS OF WHICH THE ORGANIZATION IS REPRESENTATIVE PAYEE FOR SOCIAL SECURITY PURPOSES. THE MONEY IS HELD IN AN INTEREST-BEARING CHECKING ACCOUNT. RESIDENTS CAN OBTAIN THEIR MONEY UPON REQUEST. THE ORGANIZATION HOLDS SECURITY DEPOSITS FOR ASSISTED LIVING RESIDENTS AND OTHER RENTAL TENANTS. SECURITY DEPOSITS ARE HELD IN NON-INTEREST BEARING ACCOUNTS. SECURITY DEPOSITS ARE RETURNED TO TENANTS WHEN THE LEASE IS TERMINATED, LESS ANY AMOUNTS FOR DAMAGES. 0 0 0 0 0 0 0 0 0 R KEVIN MCFEELY PRESIDENT/CEO 0 493378 0 0 0 0 0 0 0 40001 0 533379 0 0 BANAFSHEH BAHARLOO RN NURSE 218215 0 0 0 0 0 0 0 15236 0 233451 0 0 0 AYENEW AEMERO LPN NURSE 211148 0 0 0 0 0 0 0 19196 0 230344 0 0 0 GEBRU TEZERA LPN NURSE 185337 0 0 0 0 0 0 0 12171 0 197508 0 0 0 SOLOMON G-KIDANE LPN NURSE 177906 0 0 0 0 0 0 0 12024 0 189930 0 0 0 LAURA MOLZAHN EXECUTIVE DIRECTOR 141591 0 0 0 0 0 0 0 46275 0 187866 0 0 0 MILAGROS ALMAZAN NURSE 161681 0 0 0 0 0 0 0 16600 0 178281 0 0 0 PART I, LINE 3 THE PRESIDENT/CEO'S COMPENSATION IS SET BY THE BOARD OF DIRECTORS OF ELISEO, A RELATED ORGANIZATION. ELISEO USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE PRESIDENT/CEO: 1. COMPENSATION COMMITTEE 2. FORM 990 OF OTHER ORGANIZATIONS 3. COMPENSATION SURVEY OR STUDY 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1A THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. IT HAS GENERAL MANAGEMENT OVER THE FACILITIES OF FOSS, SUBJECT TO INSTRUCTIONS OF THE BOARD, AND HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS BETWEEN REGULAR BOARD MEETINGS SUBJECT TO ANY LIMITATIONS PLACED ON IT BY THE BOARD. IT FORMULATES POLICIES FOR THE ORGANIZATION'S INTERNAL MANAGEMENT SUBJECT TO APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN APRIL 2023 TO IDENTIFY FUTURA AGE, A WASHINGTON NONPROFIT ORGANIZATION, AS THE SOLE MEMBER OF FOSS HOME & VILLAGE, AND TO GIVE FUTURA AGE THE FOLLOWING RIGHTS AS THE SOLE MEMBER: A. APPROVAL OF THE NOMINATION, ELECTION AND REMOVAL OF DIRECTORS; B. APPROVAL OF THE ANNUAL CAPITAL AND OPERATING BUDGETS; C. SELECTION, EMPLOYMENT AND TERMINATION OF THE CHIEF EXECUTIVE OFFICER; D. APPROVAL OF ANY SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS OUTSIDE OF THE NORMAL COURSE OF BUSINESS, OR ANY ACQUISITION OF, OR MERGER OR CONSOLIDATION; E. APPROVAL OF ANY AMENDMENT OR MODIFICATION TO THE ARTICLES OF INCORPORATION OR BYLAWS; F. APPROVAL OF THE ORGANIZATION'S PROPOSED VOLUNTARY DISSOLUTION, LIQUIDATION OR WINDING-UP; G. APPROVAL OF THE DECLARATION OF ANY EVENT OF BANKRUPTCY, INSOLVENCY OR OTHER APPLICATION FOR JUDICIAL RELIEF FROM CREDITORS; H. APPROVAL OF ANY ACTION THAT MIGHT JEOPARDIZE THE ORGANIZATION'S TAX-EXEMPT STATUS; AND I. APPROVAL OF THE CREATION OF AND ORGANIZATIONAL DOCUMENTS (AND AMENDMENTS THERETO) FOR ANY SUBSIDIARY OR AFFILIATED ENTITY, JOINT VENTURE, AFFILIATION OR SIMILAR ARRANGEMENT. ADDITIONALLY, THE BYLAWS WERE AMENDED TO IDENTIFY THE PRESIDENT/CEO AND IMMEDIATE PAST CHAIRS AS OFFICERS OF THE BOARD AND TO IDENTIFY THE POWERS AND AUTHORITY OF THOSE POSITIONS; AND TO CREATE VARIOUS STANDING COMMITTEES OF THE BOARD, INCLUDING AN EXECUTIVE COMMITTEE, AN AUDIT AND FINANCE COMMITTEE, AND A GOVERNANCE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 AS OF APRIL 2023, FUTURA AGE IS THE SOLE MEMBER OF FOSS HOME & VILLAGE. FORM 990, PART VI, SECTION A, LINE 7A AS OF APRIL 2023, FUTURA AGE, HAS THE RIGHT TO APPROVE THE NOMINATION, ELECTION AND REMOVAL OF ALL MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B AS OF APRIL 2023, FUTURA AGE, HAS THE FOLLOWING RIGHTS AS THE SOLE MEMBER: A. APPROVAL OF THE ANNUAL CAPITAL AND OPERATING BUDGETS; B. SELECTION, EMPLOYMENT AND TERMINATION OF THE CHIEF EXECUTIVE OFFICER; C. APPROVAL OF ANY SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS OUTSIDE OF THE NORMAL COURSE OF BUSINESS, OR ANY ACQUISITION OF, OR MERGER OR CONSOLIDATION; D. APPROVAL OF ANY AMENDMENT OR MODIFICATION TO THE ARTICLES OF INCORPORATION OR BYLAWS; E. APPROVAL OF THE ORGANIZATION'S PROPOSED VOLUNTARY DISSOLUTION, LIQUIDATION OR WINDING-UP; F. APPROVAL OF THE DECLARATION OF ANY EVENT OF BANKRUPTCY, INSOLVENCY OR OTHER APPLICATION FOR JUDICIAL RELIEF FROM CREDITORS; G. APPROVAL OF ANY ACTION THAT MIGHT JEOPARDIZE THE ORGANIZATION'S TAX-EXEMPT STATUS; AND H. APPROVAL OF THE CREATION OF AND ORGANIZATIONAL DOCUMENTS (AND AMENDMENTS THERETO) FOR ANY SUBSIDIARY OR AFFILIATED ENTITY, JOINT VENTURE, AFFILIATION OR SIMILAR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, A DRAFT OF THE FORM 990 WAS REVIEWED BY THE PRESIDENT/CEO AND CFO OF FUTURA AGE, THEN SUBMITTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR 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 15A THROUGH APRIL 2023, THE BOARD OF DIRECTORS REVIEWED SALARY DATA FROM A SALARY SURVEY COMPILED BY LEADINGAGE WASHINGTON AND FROM REVIEWING THE FORMS 990 OF COMPARABLE ORGANIZATIONS. THE CEO REVIEWED SALARY DATA IN A SIMILAR MANNER FOR THE OTHER OFFICERS. AS OF APRIL 2023, THE PRESIDENT/CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS OF ELISEO, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 4,130,980. MANAGEMENT AND GENERAL EXPENSES 1,130,471. FUNDRAISING EXPENSES 10,115. TOTAL EXPENSES 5,271,566. FUTURA AGE 1301 N HIGHLANDS PARKWAY TACOMA WA 98406 882748740 MANAGEMENT SERVICES WA 501(C)(3) LINE 12C, III-FI N/A 0 ELISEO 1301 N HIGHLANDS PARKWAY TACOMA WA 98406 910963214 LIFE PLAN COMMUNITY WA 501(C)(3) LINE 10 FUTURA AGE 0 ELISEO FOUNDATION 1301 N HIGHLANDS PARKWAY TACOMA WA 98406 943031579 FUNDRAISING WA 501(C)(3) LINE 12A, I ELISEO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0