2024-11-06T16:15:08-06:00 2023-12-31 912011386 JACOBSON JARVIS & CO PLLC 200 1ST AVE W SUITE 200 SEATTLE WA 98119 990 2023-01-01 910950710 CAROLINE KLINE GALLAND HOME CARO 2067258800 7500 SEWARD PARK AVENUE SOUTH SEATTLE WA 98118 JEFFREY COHEN CEO 2067258800 2024-10-23 1 0 JACOB J DEHNE CPA P02534988 2066288990 2024-10-23 2023 2024-10-15 13:58:12Z JEFFREY COHEN 7500 SEWARD PARK AVENUE SOUTH SEATTLE WA 98118 55212016 0 X WWW.KLINEGALLAND.ORG X 1975 WA PROVIDES LONG-TERM AND SHORT-TERM CARE SERVICES TO ADULTS. 25 23 0 60 0 0 989082 3953690 46152652 51197375 -1142 60951 0 0 47140592 55212016 0 0 0 0 36586131 40091429 0 0 0 11144626 11679146 47730757 51770575 -590165 3441441 26249584 30382227 5049341 5571404 21200243 24810823 CAROLINE KLINE GALLAND HOME PROVIDES LONG-TERM AND SHORT-TERM CARE SERVICES TO ADULTS, INCLUDING SKILLED NURSING, REHABILITATION, HOME HEALTH, HOSPICE AND HOME CARE. 0 0 47474931 51197375 CAROLINE KLINE GALLAND HOME PROVIDED MORE THAN 70,000 RESIDENT CARE DAYS OF SKILLED NURSING AND REHABILITATION SERVICES WITH AN AVERAGE DAILY FACILITY CENSUS OF 93%. KLINE GALLAND HOSPICE PROVIDED MORE THAN 39,000 DAYS OF HOSPICE SERVICES. KLINE GALLAND HOME HEALTH MAINTAINED AN AVERAGE DAILY CENSUS OF 210 PATIENTS AND KLINE GALLAND HOME CARE HAS PROVIDED AN AVERAGE DAILY CARE OF APPROXIMATELY 120 HOURS. 47474931 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 48 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 25 23 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X TRACEY GROSCOST 2067258800 7500 SEWARD PARK AVENUE SOUTH SEATTLE WA 98118 IRENE FISHER CHAIR 0.50 3.00 X X 0 0 0 ROBERT SIMON VICE CHAIR 0.50 3.00 X X 0 0 0 BARBARA SULMAN SECRETARY 0.50 3.00 X X 0 0 0 JAY RIFFKIN TREASURER 0.50 3.00 X X 0 0 0 JEANIE ALHADEFF DIRECTOR 0.25 1.75 X 0 0 0 JACK ALMO DIRECTOR 0.50 3.00 X 0 0 0 DAVID BENOLIEL DIRECTOR 0.25 1.75 X 0 0 0 MARC BRIDGE DIRECTOR 0.25 1.75 X 0 0 0 MICHAEL COHEN DIRECTOR 0.25 1.75 X 0 0 0 LYNN DUBEY DIRECTOR 0.25 1.75 X 0 0 0 DAVID FAIN DIRECTOR 0.25 1.75 X 0 0 0 MARK KANE DIRECTOR 0.25 1.75 X 0 0 0 THOMAS LEAVITT DIRECTOR 0.25 1.75 X 0 0 0 ALVIN MARTIN DIRECTOR 0.25 1.75 X 0 0 0 RABBI JAMES MIREL DIRECTOR 0.25 1.75 X 0 0 0 MICHAEL MORGAN DIRECTOR 0.25 1.75 X 0 0 0 JEFF PIHA DIRECTOR 0.25 1.75 X 0 0 0 BRIAN QUINT DIRECTOR 0.25 1.75 X 0 0 0 ARI ROBICSEK DIRECTOR 0.25 1.75 X 0 0 0 DOUGLAS ROSEN DIRECTOR 0.25 1.75 X 0 0 0 STEVEN SCHWARTZ DIRECTOR 0.25 1.75 X 0 0 0 DAVID SHAPIRO DIRECTOR 0.25 1.75 X 0 0 0 ALLAN STEINMAN DIRECTOR 0.25 1.75 X 0 0 0 DOUG WIVIOTT DIRECTOR 0.25 1.75 X 0 0 0 ELANA ZANA DIRECTOR 0.25 1.75 X 0 0 0 JEFF COHEN CHIEF EXECUTIVE OFFICER 26.80 13.20 X 0 795342 63010 CHRISTINE AN CHIEF OPERATING OFFICER 33.10 8.30 X 0 390986 66677 TRACEY GROSCOST CHIEF FINANCIAL OFFICER 26.80 13.20 X 0 327439 10075 RACHELLE RYAN CHIEF HUMAN RESOURCE OFFICER 32.00 8.00 X 0 283728 21553 ERIN SHERIDAN CHIEF COMPLIANCE OFFICER AND GENERAL COUNSEL 26.80 13.20 X 0 182638 10167 LILIYA BABADZHANOVA ADMINISTRATOR 40.00 0.00 X 0 218719 18086 PAMELA SWANBORN ADMINISTRATOR 40.00 0.00 X 0 211990 17709 PETROS TEWOLDE LICENSED PRACTICAL NURSE 77.40 0.00 X 0 222309 9873 KHANG TRAN REGISTERED NURSE 69.90 0.00 X 0 211129 6556 RUTH KIHARA LICENSED PRACTICAL NURSE 70.30 0.00 X 0 203756 10095 ROBERT ALI MEDICAL DOCTOR 32.00 0.00 X 0 204470 9329 FREHIWET NEGASH LICENSED PRACTICAL NURSE 65.20 0.00 X 0 182201 10025 0 3434707 253155 0 0 1 0 GLY 8431 SE 82ND STREET MERCER ISLAND WA 98040 BUILDING CONTRACTOR 2386051 JOHNSON KENDALL AND JOHNSON INC 109 PHEASANT RUN NEWTOWN PA 18940 INSURANCE BROKER 609146 SISADMIN LLC 131 CEDAR AVE SNOHOMISH WA 98290 TECHNOLOGY SERVICES 318525 UMC 19020 33RD AVE W STE 400 LYNNWOOD WA 98036 BUILDING CONTRACTOR 223766 HOPE DRUCKMAN 8431 SE 82ND STREET MERCER ISLAND WA 98040 HOSPICE MEDICAL DIRECTOR 203599 5 2607000 1044791 301899 3953690 RESIDENT SKILLED NURSING SERVICES 623000 51197375 51197375 51197375 60951 60951 55212016 51197375 0 60951 2019492 466504 1552988 32319454 31682283 637171 723372 609661 113711 2132888 1973412 159476 2896223 2738546 157677 174020 174020 374574 374574 1468339 1114256 354083 42736 42736 567181 488540 78641 464259 464259 1264742 1264104 638 213708 169407 44301 73099 56772 16327 1230147 1205544 24603 277400 272191 5209 RESIDENTIAL SUPPLIES 3652792 3652792 FOOD 1188897 1172433 16464 BAD DEBT 304211 304211 COVID 13088 13088 369953 291187 78766 51770575 47474931 4295644 0 1527393 1769050 9889 31256 66000 48000 4149192 6572410 499232 645603 36938633 23426472 11406114 13512161 8591764 7803747 26249584 30382227 4366887 5094185 281405 179659 401049 297560 5049341 5571404 X 15732325 20830101 5467918 3980722 21200243 24810823 26249584 30382227 3441441 169139 0 X 0 1 X 1 0 X 957325 4860679 5975271 989082 3953690 16736047 42893401 39685321 43867509 46152652 51197375 223796258 43850726 44546000 49842780 47141734 55151065 240532305 0 0 0 240532305 51879 45890 35154 60951 193874 51879 45890 35154 60951 193874 43902605 44591890 49877934 47141734 55212016 240726179 0.99920 0.99940 0.00080 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 57413 8129 65542 57413 57413 0.00000 0.87600 0.12400 0 0 1069449 1069449 30532135 19740564 10791571 4976310 3685908 1290402 360739 360739 13512161 BENEFICIAL INTEREST IN TRUSTS 1525288 OPERATING LEASE 216722 DUE FROM AFFILIATES 6061737 7803747 RESIDENT TRUST FUND 16951 HC DEPOSITS 64374 OPERATING LEASE 216235 297560 55381155 169139 169139 55212016 0 55212016 51770575 0 51770575 0 51770575 PART V, LINE 4: CAROLINE KLINE GALLAND HOME IS A MEMBER OF THE GROUP OF RELATED ORGANIZATIONS, THE KLINE GALLAND CENTER AND AFFILIATES, WHICH TOGETHER HAVE VARIOUS PERMANENTLY RESTRICTED ASSETS, THE INCOME OF WHICH MAY BE USED FOR GENERAL OPERATIONS BY ANY OF THE RELATED ORGANIZATIONS. 0 0 0 0 0 0 0 0 0 JEFF COHEN CHIEF EXECUTIVE OFFICER 0 743128 0 43552 0 8662 0 39000 0 24010 0 858352 0 0 CHRISTINE AN CHIEF OPERATING OFFICER 0 376265 0 3158 0 11563 0 55500 0 11177 0 457663 0 0 TRACEY GROSCOST CHIEF FINANCIAL OFFICER 0 324810 0 2629 0 0 0 9744 0 331 0 337514 0 0 RACHELLE RYAN CHIEF HUMAN RESOURCE OFFICER 0 281387 0 2341 0 0 0 14380 0 7173 0 305281 0 0 LILIYA BABADZHANOVA ADMINISTRATOR 0 216903 0 1816 0 0 0 6909 0 11177 0 236805 0 0 PETROS TEWOLDE LICENSED PRACTICAL NURSE 0 222309 0 0 0 0 0 2700 0 7173 0 232182 0 0 PAMELA SWANBORN ADMINISTRATOR 0 210245 0 1745 0 0 0 10557 0 7152 0 229699 0 0 KHANG TRAN REGISTERED NURSE 0 211129 0 0 0 0 0 0 0 6556 0 217685 0 0 RUTH KIHARA LICENSED PRACTICAL NURSE 0 202556 0 1200 0 0 0 2943 0 7152 0 213851 0 0 ROBERT ALI MEDICAL DOCTOR 0 204435 0 35 0 0 0 2177 0 7152 0 213799 0 0 ERIN SHERIDAN CHIEF COMPLIANCE OFFICER AND GENERAL 0 181166 0 1472 0 0 0 3015 0 7152 0 192805 0 0 FREHIWET NEGASH LICENSED PRACTICAL NURSE 0 182161 0 40 0 0 0 2873 0 7152 0 192226 0 0 FORM 990, PART VII, SECTION A, LINE 4: THE COMPENSATION AMOUNTS REPORTED IN PART VII WERE PAID BY KLINE GALLAND PAYROLL COMPANY LLC, WHICH SERVES AS THE MASTER PAYROLL COMPANY FOR THIS ENTITY AND THOSE RELATED ENTITIES LISTED IN SCHEDULE R, PART II. IRV KARL FAMILY 9693 INSURANCE SERVICES 0 MARK KANE OWNER 2359719 CONSTRUCTION SERVICES 0 MIKE MORGAN OWNER 200292 LEGAL SERVICES 0 SCHEDULE L, PART IV: THE ORGANIZATION CONTRACTS WITH SPRAGUE ISRAEL GILES FOR INSURANCE SERVICES. FORMER BOARD MEMBER, IRV KARL, IS THE FATHER OF AN OWNER OF SPRAGUE ISRAEL GILES. AS SUCH, THE TRANSACTIONS HAVE BEEN DISCLOSED IN ACCORDANCE WITH IRS INSTRUCTIONS.THE ORGANIZATION CONTRACTS WITH GLY CONSTRUCTION FOR CONSTRUCTION SERVICES. BOARD MEMBER, MARK KANE, IS AN OWNER OF GLY CONSTRUCTION. AS SUCH, THE TRANSACTIONS HAVE BEEN DISCLOSED IN ACCORDANCE WITH IRS INSTRUCTIONS.THE ORGANIZATION CONTRACTS WITH LANE POWELL FOR LEGAL SERVICES. BOARD MEMBER, MIKE MORGAN, IS AN OWNER OF LANE POWELL. AS SUCH, THE TRANSACTIONS HAVE BEEN DISCLOSED IN ACCORDANCE WITH IRS INSTRUCTIONS. FORM 990, PART VI, SECTION A, LINE 4 FILED ARTICLES OF AMENDMENT AND RESTATED ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION A, LINE 6 THE KLINE GALLAND CENTER IS THE SOLE CORPORATE MEMBER OF THIS ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED FIRST BY THE CFO, AND THEN THE CEO AND ALL MEMBERS OF THE BOARD RECEIVE A DRAFT PRIOR TO THE FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C DESIGNATED COMPLIANCE OFFICER REPORTS TO THE BOARD AND CEO THAT OVERSEES COMPLIANCE AND ADHERENCE TO APPLICABLE LAWS, RULES, AND REGULATIONS. FORM 990, PART VI, SECTION B, LINE 15 A COMMITTEE OF THE BOARD DETERMINES THE CEO'S COMPENSATION BY CONSULTING A NATIONAL SALARY SURVEY. COMPENSATION OF THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE DETERMINED VIA LOCAL SALARY SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY REQUEST. KLINE GALLAND CENTER (KGC) 7500 SEWARD PARK AVE S SEATTLE WA 98118 911154904 SUPPORT WA 501(C)(3) LINE 12A, I 0 THE SUMMIT AT FIRST HILL 7500 SEWARD PARK AVE S SEATTLE WA 98118 911973348 INDEPENDENT AND ASSISTED LIVING WA 501(C)(3) LINE 10 KGC 0 POLACK ADULT DAY CENTER 7500 SEWARD PARK AVE S SEATTLE WA 98118 911154092 ADULT DAY CARE WA 501(C)(3) LINE 10 KGC 0 POLACK FAMILY SUPPORTING FOUNDATION 7500 SEWARD PARK AVE S SEATTLE WA 98118 911289467 SUPPORT WA 501(C)(3) LINE 12A, I KGC 0 CAROLINE KLINE GALLAND TESTAMENTARY TRUST 7500 SEWARD PARK AVE S SEATTLE WA 98118 910567729 SUPPORT WA 501(C)(3) LINE 12A, I KGC 0 KLINE GALLAND CENTER FOUNDATION 7500 SEWARD PARK AVE S SEATTLE WA 98118 911973347 SUPPORT WA 501(C)(3) LINE 12A, I KGC 0 KLINE GALLAND PAYROLL COMPANY LLC 7500 SEWARD PARK AVE S SEATTLE WA 98118 912087012 COMMON PAYMASTER WA KGC C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 KLINE GALLAND CENTER C 2475000 CASH CAROLINE KLINE GALLAND TESTAMENTARY TRUST C 132000 CASH