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CAPITOL LAKES INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
CAPITOL LAKES INC (EIN 39-1412320)
Tax period
2021-10-01 to 2022-09-30
Filed
2023-08-11
IRS object ID
202322239349302282
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-08-11T16:16:48-05:00ReturnTs
Tax Period End2022-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110700 NORTHUP WAY SUITE 200AddressLine1Txt
CityBELLEVUECityNm
State AbbreviationWAStateAbbreviationCd
ZIP98004ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391412320EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CAPITOL LAKES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCAPIBusinessNameControlTxt
Phone8887246424PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1333 WEST MAIN STREETAddressLine1Txt
CityMADISONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53703ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTIM CONROYPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone8887246424PhoneNum
Signature2023-08-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTIMPersonFirstNm
Person LastCONROYPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKURT BENNIONPreparerPersonNm
PTINP01469618PTIN
Phone4252506100PhoneNum
Preparation2023-08-10PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSUE CENTERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 WEST MAIN SUITE 303AddressLine1Txt
CityMEDFORDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97501ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$33,924,740GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.RETIREMENT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1990FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROVIDE CARE AND HOUSING FOR THE ELDERLY.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee437TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$234,440PYContributionsGrantsAmt
CY Contributions Grants$2,392,786CYContributionsGrantsAmt
PY Program Service Revenue$21,732,097PYProgramServiceRevenueAmt
CY Program Service Revenue$21,524,631CYProgramServiceRevenueAmt
PY Investment Income$71,805PYInvestmentIncomeAmt
CY Investment Income$58,041CYInvestmentIncomeAmt
PY Other Revenue$16,658PYOtherRevenueAmt
CY Other Revenue$9,914,307CYOtherRevenueAmt
PY Total Revenue$22,055,000PYTotalRevenueAmt
CY Total Revenue$33,889,765CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$11,384,875PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,365,530CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,518,904PYOtherExpensesAmt
CY Other Expenses$12,619,062CYOtherExpensesAmt
PY Total Expenses$22,903,779PYTotalExpensesAmt
CY Total Expenses$24,984,592CYTotalExpensesAmt
PY Revenues Less Expenses-$848,779PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$8,905,173CYRevenuesLessExpensesAmt
Total Assets BOY$43,454,270TotalAssetsBOYAmt
Total Assets EOY$43,546,740TotalAssetsEOYAmt
Total Liabilities BOY$101,839,342TotalLiabilitiesBOYAmt
Total Liabilities EOY$93,765,208TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$58,385,072NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$50,218,468NetAssetsOrFundBalancesEOYAmt
MissionCAPITOL LAKES IS A VIBRANT CONTINUING CARE RETIREMENT COMMUNITY COMMITTED TO THE ENRICHMENT OF RESIDENTS' LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$20,019,635ExpenseAmt
Grant$0GrantAmt
Revenue$21,524,631RevenueAmt
DescCAPITOL LAKES IS A CONTINUING CARE RETIREMENT COMMUNITY, DEDICATED TO ENHANCING OUR RESIDENTS' QUALITY OF LIFE IN A STIMULATING, SECURE ENVIRONMENT. WE PROVIDE HIGH-QUALITY SERVICES INCLUDING HOUSING, NUTRITIOUS MEALS, NURSING, HOUSEKEEPING, MAINTENANCE, AND OTHER SUPPORT TO THOSE WE SERVE. OUR LEVELS OF SERVICE INCLUDE INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING.Desc
Total Program Service Expenses$20,019,635TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document44IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee437EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KATRINA BYWATERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5416463300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 WEST MAIN SUITE 303AddressLine1Txt
CityMEDFORDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97501ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtKey EmployeeKeyEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerInd
TIM CONROY
EXECUTIVE DIRECTOR40.001.00Yes (X)$256,859$0$43,313
KRISTIN VATER
HEALTH CENTER ADMINISTRATOR40.001.00$152,109$0$17,302Yes (X)
STEVEN MELLSTROM
HR DIRECTOR40.000.00$116,291$0$26,361Yes (X)
DAYLE TESSNER
DIRECTOR OF NURSING40.000.00$129,725$0$10,618Yes (X)
TSERING DAMDUL
REGISTERED NURSE40.000.00$106,324$0$25,179Yes (X)
SUE CENTER
CHAIR1.002.00$0$0$0Yes (X)Yes (X)
CLAY NORRBOM
VICE CHAIR1.000.00$0$0$0Yes (X)Yes (X)
SALLY DREW
SECRETARY/TREASURER1.000.00$0$0$0Yes (X)Yes (X)
STEVE JOHANNSEN
DIRECTOR1.001.00$0$0$0Yes (X)
HARRY PETERSON
DIRECTOR1.000.00$0$0$0Yes (X)
PETE TAYLOR
RESIDENT DIRECTOR1.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$761,308TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$122,773TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K5IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PACIFIC RETIREMENT SERVICES INC
1 WEST MAIN SUITE 303MEDFORDOR97501MANAGEMENT SERVICES$1,663,299
CONSONUS REHAB
PO BOX 4800 UNIT 12PORTLANDOR97208THERAPY SERVICES$1,112,499
MCGANN CONSTRUCTION INC
3622 LEXINGTON AVENUEMADISONWI53714CONSTRUCTION SERVICES$595,360
HOMETOWN LONG-TERM CARE PHARMACY LLC
1571 IVORY DRIVESUN PRAIRIEWI53590PHARMACY SERVICES$508,013
SENIOR CARE SOLUTIONS
2131 OAK GLEN TRAILSTILLWATERMN55082STAFFING SERVICES$151,596
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Related Organizations$67,200RelatedOrganizationsAmt
Government Grants$2,159,805GovernmentGrantsAmt
All Other Contributions$165,781AllOtherContributionsAmt
Total Contributions$2,392,786TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SERVICE FEES623000$11,773,958$11,773,958
HEALTH CENTER623000$7,337,131$7,337,131
ENTRANCE FEES623000$1,552,260$1,552,260
HOME CARE623000$281,811$281,811
DIETARY623000$178,939$178,939

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$400,532TotalRevenueColumnAmt
Related Or Exempt Func Income$400,532RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$21,524,631TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$93,013TotalRevenueColumnAmt
Exclusion$93,013ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$3TotalRevenueColumnAmt
Exclusion$3ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$17,158RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$17,158RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,158TotalRevenueColumnAmt
Exclusion$17,158ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$29,581SecuritiesAmt
Other$5,394OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$29,581SecuritiesAmt
Other-$5,394OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$34,975TotalRevenueColumnAmt
Exclusion-$34,975ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescGAIN ON REFINANCINGDesc
Business900099BusinessCd
Total Revenue Column$9,897,149TotalRevenueColumnAmt
Exclusion$9,897,149ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$9,897,149OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,889,765TotalRevenueColumnAmt
Related Or Exempt Func Income$21,524,631RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$9,972,348ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$291,902TotalAmt
Management And General$291,902ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,887,704TotalAmt
Program Services$8,874,226ProgramServicesAmt
Management And General$1,013,478ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$409,896TotalAmt
Program Services$346,409ProgramServicesAmt
Management And General$63,487ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,011,414TotalAmt
Program Services$900,031ProgramServicesAmt
Management And General$111,383ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$764,614TotalAmt
Program Services$672,498ProgramServicesAmt
Management And General$92,116ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,826,082TotalAmt
Management And General$1,826,082ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$8,057TotalAmt
Management And General$8,057ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$24,107TotalAmt
Management And General$24,107ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$5,471TotalAmt
Management And General$5,471ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,166,991TotalAmt
Program Services$667,602ProgramServicesAmt
Management And General$499,389ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$186,456TotalAmt
Management And General$186,456ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$886,474TotalAmt
Program Services$772,915ProgramServicesAmt
Management And General$113,559ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$240,701TotalAmt
Management And General$240,701ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,587,798TotalAmt
Program Services$1,585,003ProgramServicesAmt
Management And General$2,795ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$105,926TotalAmt
Program Services$34,399ProgramServicesAmt
Management And General$71,527ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$59,738TotalAmt
Program Services$40,523ProgramServicesAmt
Management And General$19,215ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$673,806TotalAmt
Program Services$673,806ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,477,824TotalAmt
Program Services$2,477,824ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$205,004TotalAmt
Program Services$205,004ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
HEALTH CENTER EXPENSE$1,542,576$1,542,576
OTHER DIETARY EXPENSE$938,931$938,931
OTHER FACILITY SERVICE$494,320$99,088$395,232
PROGRAM FUND EXPENSES$188,800$188,800

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,984,592TotalAmt
Program Services$20,019,635ProgramServicesAmt
Management And General$4,964,957ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$5,175,147BOYAmt
EOY$5,566,464EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$608,196EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,677,292BOYAmt
EOY$862,169EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$112,619BOYAmt
EOY$115,297EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$380,767BOYAmt
EOY$542,172EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$71,024,690LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$40,289,016LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$32,510,784BOYAmt
EOY$30,735,674EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,764,650BOYAmt
EOY$4,362,204EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$833,011BOYAmt
EOY$754,564EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$43,454,270BOYAmt
EOY$43,546,740EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,350,862BOYAmt
EOY$2,751,256EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$9,547,129BOYAmt
EOY$10,074,113EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
EOY$32,945,386EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$637,132BOYAmt
EOY$625,075EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$43,912,946BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$45,391,273BOYAmt
EOY$47,369,378EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$101,839,342BOYAmt
EOY$93,765,208EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$59,278,106BOYAmt
EOY-$51,008,170EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$893,034BOYAmt
EOY$789,702EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$58,385,072BOYAmt
EOY-$50,218,468EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$43,454,270BOYAmt
EOY$43,546,740EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$8,905,173ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$659,926NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$78,643OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$208,344CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$207,383CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$258,965CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$234,440CurrentTaxYearMinus1YearAmt
Current Tax Year$2,392,786CurrentTaxYearAmt
Total$3,301,918TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,870,492CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,577,973CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,500,974CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21,732,097CurrentTaxYearMinus1YearAmt
Current Tax Year$21,524,631CurrentTaxYearAmt
Total$109,206,167TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,078,836CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,785,356CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,759,939CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21,966,537CurrentTaxYearMinus1YearAmt
Current Tax Year$23,917,417CurrentTaxYearAmt
Total$112,508,085TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$112,508,085PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$64,206CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$97,996CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$73,154CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$72,645CurrentTaxYearMinus1YearAmt
Current Tax Year$110,174CurrentTaxYearAmt
Total$418,175TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$64,206CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$97,996CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$73,154CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$72,645CurrentTaxYearMinus1YearAmt
Current Tax Year$110,174CurrentTaxYearAmt
Total$418,175TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year$9,897,149CurrentTaxYearAmt
Total$9,897,149TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,143,042CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,883,352CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,833,093CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$22,039,182CurrentTaxYearMinus1YearAmt
Current Tax Year$33,924,740CurrentTaxYearAmt
Total$122,823,409TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.91600PublicSupportCY509Pct
Public Support PY5090.99670PublicSupportPY509Pct
Investment Income CY0.00340InvestmentIncomeCYPct
Investment Income PY0.00330InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationGAIN ON REFINANCINGExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

Total Grassroots Lobbying TotalGrassrootsLobbyingGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt

Total Direct Lobbying TotalDirectLobbyingGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt

Total Lobbying Expend TotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$24,984,592FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$24,984,592FilingOrganizationsTotalAmt

Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Filing Organizations Total$1,000,000FilingOrganizationsTotalAmt

Grassroots Nontaxable GrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Filing Organizations Total$250,000FilingOrganizationsTotalAmt

Tot Lbbyng Grassroot Mns Non Tx TotLbbyngGrassrootMnsNonTxGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt

Tot Lbby Expend Mns Lbbyng Non Tx TotLbbyExpendMnsLbbyngNonTxGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt

Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Current Year Minus3$1,000,000CurrentYearMinus3Amt
Current Year Minus2$1,000,000CurrentYearMinus2Amt
Current Year Minus1$1,000,000CurrentYearMinus1Amt
Current Year$1,000,000CurrentYearAmt
Total$4,000,000TotalAmt
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmt

Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Current Year Minus3$250,000CurrentYearMinus3Amt
Current Year Minus2$250,000CurrentYearMinus2Amt
Current Year Minus1$250,000CurrentYearMinus1Amt
Current Year$250,000CurrentYearAmt
Total$1,000,000TotalAmt
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,537,600OtherCostOrOtherBasisAmt
Book Value$8,537,600BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$57,983,279OtherCostOrOtherBasisAmt
Depreciation$37,147,397DepreciationAmt
Book Value$20,835,882BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,203,247OtherCostOrOtherBasisAmt
Depreciation$3,141,619DepreciationAmt
Book Value$1,061,628BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$300,564OtherCostOrOtherBasisAmt
Book Value$300,564BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$30,735,674TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO AFFILIATES$4,313,628
OTHER CURRENT LIABILITIES$12,348
ENTRANCE FEES REFUNDABLE UPON REOCCUPANCY$43,043,402
FieldValueIRS element (for citing)
Total Liability$47,369,378TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:RESIDENT SECURITY DEPOSITS ARE HELD IN A SEPARATE BANK ACCOUNT. WHEN THE RESIDENT LEAVES THE FACILITY THE SECURITY DEPOSIT, MINUS ANY AMOUNTS RETAINED FOR REPAIRS, IS REFUNDED.
PART X, LINE 2:THE CORPORATION RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS 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. THE CORPORATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2022 AND 2021, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
TIM CONROY
EXECUTIVE DIRECTOR$217,393$0$39,466$0$0$0$10,949$0$32,364$0$300,172$0$0$0
KRISTIN VATER
HEALTH CENTER ADMINISTRATOR$139,346$0$12,763$0$0$0$6,072$0$11,230$0$169,411$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3COMPENSATION WAS DETERMINED BY PACIFIC RETIREMENT SERVICES, INC., A RELATED ORGANIZATION, THAT USED ONE OR MORE OF THE METHODS DESCRIBED ON LINE 3 TO ESTABLISH COMPENSATION.
PART I, LINE 7THE ORGANIZATION PAID BONUSES THIS YEAR. THE PROCESS FOR DETERMINING EXECUTIVE BONUSES IS DISCRETIONARY. IT IS DETERMINED BY THE VP OF OPERATIONS FOR PRS AND IT IS BASED ON THE PERFORMANCE OF THE COMMUNITY FOR THE YEAR.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN391337855BondIssuerEIN
CUSIP97712JFS7CUSIPNum
Bond Issued2022-05-26BondIssuedDt
Issue Price$33,880,000IssuePriceAmt
PurposeSEE PART VIPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds$33,880,000TotalProceedsAmt
Issuance Costs From Proceeds$659,600IssuanceCostsFromProceedsAmt
Other Spent Proceeds$18,000OtherSpentProceedsAmt
Unspent$465UnspentAmt
Refunding Tax Exempt BondsYes (1)RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation Made0FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease ArrangementsYes (1)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (1)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsYes (1)EngageBondCounselContractsInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.01800PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.01800TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due YetYes (1)RebateNotDueYetInd
Exception To RebateYes (1)ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, COLUMN F:BOND PROCEEDS WERE ISSUED TO REFUND A PRIOR LOAN ISSUED ON NOVEMBER 30, 2016.
PART II, LINE 13:BECAUSE THE BONDS WERE ISSUED FOR A CURRENT REFUNDING PURPOSE, A SUBSTANTIAL COMPLETION DATE IS NOT APPLICABLE.
PART III, LINE 7:AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE SECURITY OR PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY OR PAYMENT TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3CAPITOL LAKES, INC. DELEGATES MANAGEMENT DUTIES TO PACIFIC RETIREMENT SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7APACIFIC RETIREMENT SERVICES, INC. HAS THE RIGHT TO ELECT THE DIRECTORS OF THE BOARD OF CAPITOL LAKES, INC.
FORM 990, PART VI, SECTION A, LINE 7BTHE AUTHORITY OF THE BOARD OF DIRECTORS TO EXERCISE THE FOLLOWING POWERS IS CONDITIONED UPON THE APPROVAL OF THE CORPORATE MEMBER: (A) MERGER, CONSOLIDATION OR DISSOLUTION OF THE ORGANIZATION; (B) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OF THE ORGANIZATION; (C) SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL THE PROPERTY AND ASSETS OF THE ORGANIZATION; (D) THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY ORGANIZATION; (E) THE ADOPTION OF THE AGGREGATE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION; (F) AGGREGATE BORROWING FOR PERIODS OF ONE (1) YEAR OR LESS FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE MEMBER FROM TIME TO TIME; AND AGGREGATE BORROWING FOR PERIODS OF MORE THAN ONE (1) YEAR FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE MEMBER FROM TIME TO TIME; (G) THE PURCHASE, SALE, LEASE DISPOSITION HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, AND ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE MEMBER FROM TIME TO TIME, NOT PREVIOUSLY INCLUDED IN THE CAPITAL BUDGET; (H) THE APPOINTMENT OF AN INDEPENDENT AUDITOR; (I) GIFTS OR GRATUITOUS TRANSFERS IN EXCESS OF $5,000 IN A CALENDAR YEAR; (J) ADOPTION OR REVISION OF THE MISSION STATEMENT AND LONG RANGE PLANS; AND (K) INCUR ANY DEBT OR ENTER INTO ANY CONTRACT NOT CONTEMPLATED BY THE ANNUAL BUDGET IF THE DOLLAR AMOUNT EXCEEDS THE SUM OF $100,000.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 WAS REVIEWED BY THE DIRECTOR OF FINANCE, CFO AND THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE ARE SENT TO ALL BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY. THERE ARE TWO POLICIES RELATED TO CONFLICTS OF INTEREST: 1) BOARD OF DIRECTORS; 2)KEY EMPLOYEES, WHICH IDENTIFY THE PURPOSE, DEFINITIONS, AND PROCEDURES. IF A CONFLICT IS SELF-IDENTIFIED BY A BOARD MEMBER OR KEY EMPLOYEE IN THE QUESTIONNAIRE AND/OR MEETING, PROCEDURES ARE FOLLOWED AND DOCUMENTED ACCORDING TO THE POLICY.
FORM 990, PART VI, SECTION B, LINE 15AA COMPENSATION COMMITTEE OF THE PRS BOARD EXISTS TO DETERMINE COMPENSATION FOR THE EXECUTIVE DIRECTOR OF EACH COMMUNITY. THIS COMMITTEE IS COMPRISED OF THE OFFICERS OF THE PRS BOARD OF DIRECTORS. THE COMMITTEE HAS A CHARTER THAT OUTLINES ITS DUTIES AND RESPONSIBILITIES. IT ALSO HAS AGENDA ELEMENTS THAT DESCRIBE THE ACTIVITIES THAT THE COMMITTEE UNDERTAKES DURING THE YEAR. THE VP OF HUMAN RESOURCES PROVIDED SALARY STUDIES FROM THE FOLLOWING RESOURCES TO THE COMMITTEE RELATIVE TO EXECUTIVE DIRECTOR COMPENSATION: SALARY.COM, PAYSCALE.COM, 990 REVIEW (LIKE SIZE ORGANIZATIONS), CEMO (CHIEF EXECUTIVE OFFICERS OF MULTI-FACILITY ORGANIZATIONS) SALARY STUDY RESULTS, AND INDUSTRY STATE ASSOCIATION SALARY STUDY RESULTS BASED ON GEOGRAPHICAL LOCATION. THE RECOMMENDATION FOR BASE COMPENSATION AND BONUS ARE PROVIDED BY THE EXECUTIVE DIRECTOR'S DIRECT SUPERVISOR (COO OR VP OF OPERATIONS).
FORM 990, PART VI, SECTION C, LINE 19ALL REQUESTS GO THROUGH CORPORATE COUNSEL.
FORM 990, PART VII, SECTION A:NOTE THAT TIM CONROY AND KRISTIN VATER ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORM SERVICES ON BEHALF OF CAPITOL LAKES, INC. PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN CAPITOL LAKES, INC. AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, THEIR COMPENSATION IS REIMBURSED BY CAPITOL LAKES, INC. COMPENSATION HAS BEEN REPORTED IN PART VII, SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY CAPITOL LAKES, INC., NOTWITHSTANDING THAT THEY ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC.
FORM 990, PART XI, LINE 9:CHANGES IN INTEREST IN NET ASSETS OF FOUNDATION -78,447. NON OPERATING - MANAGEMENT FEES -196.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (45 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
PACIFIC RETIREMENT SERVICES INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931067253SUPPORTING ORGANIZATIONOR501(C)(3)LINE 12C, III-FIN/A0
PACIFIC RETIREMENT SERVICES FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501472352652PUBLIC FOUNDATIONOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
ROGUE VALLEY MANOR
1 WEST MAIN ST SUITE 303MEDFORDOR97501930453216SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
THE CUMBERLAND REST INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501750891470SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
CASCADE MANOR INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501930557803SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
UNIVERSITY RETIREMENT COMMUNITY AT DAVIS
1 WEST MAIN ST SUITE 303MEDFORDOR97501931179254SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
HOLLADAY PARK PLAZA
1 WEST MAIN ST SUITE 303MEDFORDOR97501930513697SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
ROGUE VALLEY MANOR FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501930712867PUBLIC FOUNDATIONOR501(C)(3)LINE 70ROGUE VALLEY MANOR
UNIVERSITY RETIREMENT COMMUNITY FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931301816PUBLIC FOUNDATIONCA501(C)(3)LINE 70UNIVERSITY RETIREMENT COMMUNITY AT DAVIS
MIRABELLA WASHINGTON FOUNDATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501450574348PUBLIC FOUNDATIONWA501(C)(3)LINE 70MIRABELLA
CASCADE MANOR FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931330100PUBLIC FOUNDATIONOR501(C)(3)LINE 70CASCADE MANOR INC
CAPITOL LAKES FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501383781089PUBLIC FOUNDATIONOR501(C)(3)LINE 7Yes (1)CAPITOL LAKES INC
MIRABELLA
1 WEST MAIN ST SUITE 303MEDFORDOR97501342030255SENIOR HOUSINGWA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
MIRABELLA PORTLAND FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501452508860PUBLIC FOUNDATIONOR501(C)(3)LINE 70MIRABELLA AT SOUTH WATERFRONT
MIRABELLA AT SOUTH WATERFRONT
1 WEST MAIN ST SUITE 303MEDFORDOR97501711016384SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
COMMUNITY VOLUNTEER NETWORK
1 WEST MAIN ST SUITE 303MEDFORDOR97501930892261COMMUNITY SERVICESOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501930864466SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM ASHLAND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501930942933SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM GRANTS PASS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943136037SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM ROSEBURG HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943179782SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MYRTLE CREEK HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943162074SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM BEND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943163349SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM EAGLE POINT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943191447SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM KLAMATH FALLS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943196455SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MEDFORD II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212537SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM LIVELY OAKS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943194409SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM REEDSPORT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212538SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM YREKA HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212540SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM EUGENE HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943247154SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM FORT WORTH I HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311520436SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM BEND II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943260016SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM FORT WORTH II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587415SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MEDFORD III HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587418SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM ROSEBURG II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587420SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM GRANTS PASS II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311662259SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM DAVIS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311662208SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MYRTLE CREEK II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311715321SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM PORTLAND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311780332SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM PORTLAND II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501300037898SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM CENTRAL POINT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501300315618SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MANSFIELD HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501900292647SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
MIDDLETON GLEN INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501911859494SENIOR HOUSINGWI501(C)(3)LINE 10Yes (1)CAPITOL LAKES INC
SENIOR HOUSING OF MIDDLETON INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501470825736SENIOR HOUSINGWI501(C)(3)LINE 10Yes (1)CAPITOL LAKES INC
MIRABELLA AT ASU INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501813784956SENIOR HOUSINGAZ501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
BAY AREA SENIOR SERVICES INC
1 BALDWIN AVESAN MATEOCA94401943008774SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1PRS MANAGEMENTBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 WEST MAIN SUITE 303AddressLine1Txt
CityMEDFORDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97501ZIPCd
FieldValueIRS element (for citing)
EIN931328250EIN
Primary ActivitiesMANAGEMENT COMPANYPrimaryActivitiesTxt
Legal Domicile StateORLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CAPITOL LAKES FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$67,200InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt