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MIRA BELLA: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
MIRA BELLA (EIN 34-2030255)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-15
IRS object ID
202202279349303820
Schema version
2020v4.2
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)
Return2022-08-15T15:10:45-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

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 Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN342030255EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MIRABELLABusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMIRABusinessNameControlTxt
Phone8887246424PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1116 FAIRVIEW AVENUE NORTHAddressLine1Txt
CitySEATTLECityNm
State AbbreviationWAStateAbbreviationCd
ZIP98109ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTRAVIS DUNCANPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone8887246424PhoneNum
Signature2022-08-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTRAVISPersonFirstNm
Person LastDUNCANPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKURT BENNIONPreparerPersonNm
PTINP01469618PTIN
Phone4252506100PhoneNum
Preparation2022-08-11PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCHRISTOPHER WOODPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 WEST MAIN SUITE 303AddressLine1Txt
CityMEDFORDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97501ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$33,819,648GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.RETIREMENT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2005FormationYr
Legal Domicile StateWALegalDomicileStateCd
Activity Or MissionTO PROVIDE COMPREHENSIVE CARE AND HOUSING FOR THE ELDERLY.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee417TotalEmployeeCnt
Total Volunteers80TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$399,558PYContributionsGrantsAmt
CY Contributions Grants$398,553CYContributionsGrantsAmt
PY Program Service Revenue$31,101,562PYProgramServiceRevenueAmt
CY Program Service Revenue$30,183,414CYProgramServiceRevenueAmt
PY Investment Income$507,156PYInvestmentIncomeAmt
CY Investment Income$539,781CYInvestmentIncomeAmt
PY Other Revenue$146,029PYOtherRevenueAmt
CY Other Revenue$209,859CYOtherRevenueAmt
PY Total Revenue$32,154,305PYTotalRevenueAmt
CY Total Revenue$31,331,607CYTotalRevenueAmt
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$15,288,834PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$14,843,555CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$21,843,045PYOtherExpensesAmt
CY Other Expenses$18,858,707CYOtherExpensesAmt
PY Total Expenses$37,131,879PYTotalExpensesAmt
CY Total Expenses$33,702,262CYTotalExpensesAmt
PY Revenues Less Expenses-$4,977,574PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,370,655CYRevenuesLessExpensesAmt
Total Assets BOY$207,800,101TotalAssetsBOYAmt
Total Assets EOY$187,904,464TotalAssetsEOYAmt
Total Liabilities BOY$330,276,768TotalLiabilitiesBOYAmt
Total Liabilities EOY$312,948,086TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$122,476,667NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$125,043,622NetAssetsOrFundBalancesEOYAmt
MissionNONEMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$30,530,952ExpenseAmt
Grant$0GrantAmt
Revenue$30,183,414RevenueAmt
DescMIRABELLA 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$30,530,952TotalProgramServiceExpensesAmt
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 Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document66IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee417EmployeeCnt
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 Line1JOSH BLACKSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5418577205PhoneNum

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 (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerInd
JESAN FRAZIER
DIRECTOR NURSING SERVICES40.000.00Yes (X)$129,408$0$22,588
GAIL CARTER-LINDBERG
HUMAN RESOURCES DIRECTOR40.000.00Yes (X)$123,311$0$15,233
DANA EMMATRICE
MDS COORDINATOR40.000.00Yes (X)$110,994$0$22,558
TRAVIS DUNCAN
EXECUTIVE DIRECTOR40.000.00$228,454$0$28,974Yes (X)
ALLAN AGUFA RN
NURSE40.000.00Yes (X)$106,762$0$20,861
MICHELLE YUSIM
HEALTHCARE ADMINISTRATOR40.000.00Yes (X)$116,010$0$49,956
CHRISTOPHER WOOD
CHAIR/PRESIDENT1.000.00$0$0$0Yes (X)Yes (X)
WILLIAM POOLE
VICE CHAIR1.000.00$0$0$0Yes (X)Yes (X)
LEE BURNSIDE
SECRETARY / TREASURER1.000.00$0$0$0Yes (X)Yes (X)
RUTH BENFIELD
RESIDENT DIRECTOR1.000.00$0$0$0Yes (X)
MARITE BUTNERS
DIRECTOR1.000.00$0$0$0Yes (X)
OLEG ZASLAVSKY
DIRECTOR1.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$814,939TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$160,170TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
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
JTM CONSTRUCTION INC
800 MAYNARD AVE SOUTH STE 1010SEATTLEWA98134CONSTRUCTION$2,283,375
PACIFIC RETIREMENT SERVICES INC
1 WEST MAIN SUITE 303MEDFORDOR97501MANAGEMENT SERVICES$1,693,868
CONSONUS REHAB
PO BOX 4800 UNIT 12PORTLANDOR97208THERAPY SERVICES$396,785
CONVERGINT TECHNOLOGIES
450 SHATTUCK AVENUE S 100RENTONWA98057SECURITY SYSTEM SERVICES$317,977
F&M CONSTRUCTION & REMODELING LLC
13737 SE 26TH STREETBELLEVUEWA98005GENERAL CONTRACTOR$221,223
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt
All Other Contributions$398,553AllOtherContributionsAmt
Total Contributions$398,553TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SERVICE FEES623000$20,903,975$20,903,975
HEALTH CENTER623000$4,275,218$4,275,218
ENTRANCE FEES623000$2,458,044$2,458,044
HOME CARE/PRIVATE DUTY623000$1,551,150$1,551,150
OTHER PROGRAM REVENUE623000$673,027$673,027

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$322,000TotalRevenueColumnAmt
Related Or Exempt Func Income$322,000RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$30,183,414TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$107,243TotalRevenueColumnAmt
Exclusion$107,243ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$261,655TotalRevenueColumnAmt
Exclusion$261,655ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$209,859RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$209,859RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$209,859TotalRevenueColumnAmt
Exclusion$209,859ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$2,658,924SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,429,165SecuritiesAmt
Other$58,876OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$229,759SecuritiesAmt
Other-$58,876OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$170,883TotalRevenueColumnAmt
Exclusion$170,883ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,331,607TotalRevenueColumnAmt
Related Or Exempt Func Income$30,183,414RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$749,640ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$241,902TotalAmt
Management And General$241,902ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,519,301TotalAmt
Program Services$10,719,681ProgramServicesAmt
Management And General$799,620ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$445,445TotalAmt
Program Services$390,574ProgramServicesAmt
Management And General$54,871ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,747,274TotalAmt
Program Services$1,543,108ProgramServicesAmt
Management And General$204,166ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$889,633TotalAmt
Program Services$816,634ProgramServicesAmt
Management And General$72,999ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,752,329TotalAmt
Management And General$1,752,329ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$62,188TotalAmt
Management And General$62,188ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$24,357TotalAmt
Management And General$24,357ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$51,247TotalAmt
Management And General$51,247ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,040,715TotalAmt
Program Services$751,450ProgramServicesAmt
Management And General$289,265ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$306,507TotalAmt
Management And General$306,507ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$875,411TotalAmt
Program Services$810,791ProgramServicesAmt
Management And General$64,620ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$232,763TotalAmt
Management And General$232,763ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,015,112TotalAmt
Program Services$2,015,112ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$50,221TotalAmt
Program Services$4,942ProgramServicesAmt
Management And General$45,279ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$32,128TotalAmt
Program Services$25,007ProgramServicesAmt
Management And General$7,121ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$4,067,644TotalAmt
Program Services$4,067,644ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,998,821TotalAmt
Program Services$5,998,821ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$402,070TotalAmt
Program Services$402,070ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
OTHER DIETARY EXPENSE$1,615,003$1,615,003
HEALTH CENTER EXPENSE$772,460$772,460
OTHER FACILITY SERVICE$471,145$205,835$265,310
PROGRAM FUND EXPENSES$391,820$391,820

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total-$1,303,234TotalAmt
Management And General-$1,303,234ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$33,702,262TotalAmt
Program Services$30,530,952ProgramServicesAmt
Management And General$3,171,310ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$4,044,865BOYAmt
EOY$3,032,771EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$18,709,915BOYAmt
EOY$81,692EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$780,149BOYAmt
EOY$740,217EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$312,140BOYAmt
EOY$258,036EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$291,142BOYAmt
EOY$703,077EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$249,222,776LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$75,783,314LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$177,552,118BOYAmt
EOY$173,439,462EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$5,618,434BOYAmt
EOY$9,105,708EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$491,338BOYAmt
EOY$543,501EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$207,800,101BOYAmt
EOY$187,904,464EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,349,061BOYAmt
EOY$3,069,562EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$15,529,447BOYAmt
EOY$16,092,060EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$105,446,460BOYAmt
EOY$93,085,046EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$684,139BOYAmt
EOY$961,049EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$201,267,661BOYAmt
EOY$199,740,369EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$330,276,768BOYAmt
EOY$312,948,086EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$123,018,256BOYAmt
EOY-$125,643,111EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$541,589BOYAmt
EOY$599,489EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$122,476,667BOYAmt
EOY-$125,043,622EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$207,800,101BOYAmt
EOY$187,904,464EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,370,655ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$248,465NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$52,165OtherChangesInNetAssetsAmt
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$329,855CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$263,152CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$452,335CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$399,558CurrentTaxYearMinus1YearAmt
Current Tax Year$398,553CurrentTaxYearAmt
Total$1,843,453TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$27,660,066CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$29,475,888CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$30,620,866CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$31,101,562CurrentTaxYearMinus1YearAmt
Current Tax Year$30,183,414CurrentTaxYearAmt
Total$149,041,796TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$27,989,921CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$29,739,040CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$31,073,201CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$31,501,120CurrentTaxYearMinus1YearAmt
Current Tax Year$30,581,967CurrentTaxYearAmt
Total$150,885,249TotalAmt

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$150,885,249PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$419,167CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$583,769CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$733,012CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$665,501CurrentTaxYearMinus1YearAmt
Current Tax Year$578,757CurrentTaxYearAmt
Total$2,980,206TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$419,167CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$583,769CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$733,012CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$665,501CurrentTaxYearMinus1YearAmt
Current Tax Year$578,757CurrentTaxYearAmt
Total$2,980,206TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$28,409,088CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$30,322,809CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$31,806,213CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$32,166,621CurrentTaxYearMinus1YearAmt
Current Tax Year$31,160,724CurrentTaxYearAmt
Total$153,865,455TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98060PublicSupportCY509Pct
Public Support PY5090.97880PublicSupportPY509Pct
Investment Income CY0.01940InvestmentIncomeCYPct
Investment Income PY0.02120InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

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$33,702,262FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$33,702,262FilingOrganizationsTotalAmt

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$21,194,646OtherCostOrOtherBasisAmt
Book Value$21,194,646BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$213,465,177OtherCostOrOtherBasisAmt
Depreciation$67,891,832DepreciationAmt
Book Value$145,573,345BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,328,415OtherCostOrOtherBasisAmt
Depreciation$7,891,482DepreciationAmt
Book Value$3,436,933BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,234,538OtherCostOrOtherBasisAmt
Book Value$3,234,538BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$173,439,462TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
REFUNDABLE ENTRANCE FEES$179,699,392
DUE TO AFFILIATES$18,050,977
PPP LOAN$1,990,000
FieldValueIRS element (for citing)
Total Liability$199,740,369TotalLiabilityAmt
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 ORGANIZATION 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 ORGANIZATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2021 AND 2020, 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 Payments0AnyNonFixedPaymentsInd
Initial Contract ExceptionYes (1)InitialContractExceptionInd
Rebuttable Presumption Proc0RebuttablePresumptionProcInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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
TRAVIS DUNCAN
EXECUTIVE DIRECTOR$190,815$0$37,639$0$0$0$18,245$0$10,729$0$257,428$0$0$0
MICHELLE YUSIM
HEALTHCARE ADMINISTRATOR$104,113$0$11,897$0$0$0$19,500$0$30,456$0$165,966$0$0$0
JESAN FRAZIER
DIRECTOR NURSING SERVICES$122,981$0$6,427$0$0$0$5,322$0$17,266$0$151,996$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY THE MIRABELLA BOARD AS PART OF THE ANNUAL BUDGET PROCESS.
PART I, LINE 8THE 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 Line1WASHINGTON STATE HOUSING FINANCE COMMISSIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN911874730BondIssuerEIN
Bond Issued2021-03-29BondIssuedDt
Issue Price$20,950,000IssuePriceAmt
PurposeCURRENT REFUND 2006 AR BONDS ISSUED ON DECEMBER 27, 2012PurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$150,000RetiredAmt
Total Proceeds$20,950,000TotalProceedsAmt
Other Spent Proceeds$20,950,000OtherSpentProceedsAmt
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 Others0.01000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.01000TotalPrivateBusinessUsePct
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 E:THE BONDS WERE ISSUED CONTEMPORANEOUSLY WITH $40,000,000 IN AGGREGATE PRINCIPAL AMOUNT OF THE OREGON FACILITIES AUTHORITY REFUNDING REVENUE BONDS (PRS PACIFIC NORTHWEST OBLIGATION GROUP PROJECTS), 2021 SERIES A (THE OREGON BONDS")
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 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 TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE.
PART IV, LINE 2B:THE BONDS HAVE SATISFIED THE 6-MONTH EXPENDITURE EXCEPTION TO REBATE.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3MIRABELLA'S BOARD 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 VOTE ON THE ELECTION OF DIRECTORS FOR THE BOARD OF MIRABELLA.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING ACTIONS ARE RESERVED TO PACIFIC RETIREMENT SERVICES, INC., THE SOLE MEMBER: (A) AMEND, RESTATE OR REPEAL THE BYLAWS, OR ADOPT NEW BYLAWS; (B) COORDINATE THE ACTIVITIES OF THE ORGANIZATION, AND ENGAGE IN THE OVERALL PLANNING, POLICY DEVELOPMENT, BUDGETING, AND RESOURCE ALLOCATION FOR THE ORGANIZATION; (C) APPOINT OUTSIDE AUDITORS FOR THE ORGANIZATION; (D) ELECT OR APPOINT THE ORGANIZATION'S DIRECTORS, INCLUDING THE RESIDENT DIRECTOR AND THE PRS REPRESENTATIVE DIRECTOR, AND FILL VACANCIES CAUSED BY THE DEATH, REMOVAL OR RESIGNATION OF A DIRECTOR; AND (E) REMOVE ANY OF THE ORGANIZATION'S DIRECTORS OR OFFICERS. THE PRIOR APPROVAL OF THE MEMBER IS REQUIRED BEFORE THE BOARD OF DIRECTORS MAY (A) APPROVE ANY MERGER OR CONSOLIDATION OF THE ORGANIZATION WITH ANOTHER ENTITY, OR ANY PARTIAL OR TOTAL LIQUIDATION OF THE ORGANIZATION'S ASSETS; (B) INCUR ANY DEBT, OR ENTER INTO ANY CONTRACT, NOT CONTEMPLATED BY THE ANNUAL BUDGET IF THE DOLLAR AMOUNT EXCEEDS THE SUM OF $100,000; (C) MAKE ANY GIFT OR GRATUITOUS TRANSFER IN EXCESS OF $15,000 IN ANY CALENDAR YEAR; (D) CREATE A TAXABLE OR TAX-EXEMPT SUBSIDIARY OR AFFILIATED ORGANIZATION; (E) ACQUIRE A CONTROLLING INTEREST IN ANOTHER ENTITY; OR (F) APPROVE ANY AMENDMENT, REPEAL, OR RESTATE OF THE ORGANIZATION'S ARTICLES OF INCORPORATION, OR ADOPT ANY NEW ARTICLES OF INCORPORATION.
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 TRAVIS DUNCAN AND MICHELLE YUSIM ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORM SERVICES ON BEHALF OF MIRABELLA PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN MIRABELLA AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, THEIR COMPENSATION IS REIMBURSED BY MIRABELLA. COMPENSATION HAS BEEN REPORTED IN FORM 990, PART VII, SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY MIRABELLA, 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 52,165.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (46 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
CAPITOL LAKES INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501391412320SENIOR HOUSINGWI501(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
HOLLADAY PARK PLAZA FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501264529118PUBLIC FOUNDATIONOR501(C)(3)LINE 70HOLLADAY PARK PLAZA
MIRABELLA WASHINGTON FOUNDATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501450574348PUBLIC FOUNDATIONWA501(C)(3)LINE 7Yes (1)MIRABELLA
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 70CAPITOL LAKES 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 100CAPITOL LAKES INC
SENIOR HOUSING OF MIDDLETON INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501470825736SENIOR HOUSINGWI501(C)(3)LINE 100CAPITOL 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 AVENUESAN MATEOCA94401943008774SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
CREST PARK INC
1 WEST MAIN SUITE 303MEDFORDOR97501931169683REAL ESTATEORN/AC0
PRS MANAGEMENT INC
1 WEST MAIN SUITE 303MEDFORDOR97501931328250MANAGEMENT COMPANYORN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
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 Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd