2020-08-13T19:17:18-05:00 2019-09-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-10-01 930557803 CASCADE MANOR INC CASC 8887246424 65 WEST 30TH AVENUE EUGENE OR 974059931 BRIAN YOUNG EXECUTIVE DIRECTOR 8887246424 2020-08-11 1 KURT BENNION CPA P01469618 4252506100 2020-08-11 67.137.57.251 2020-08-11 19:23:51 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CB8FE41F7A1541848066F2058C3AF12D9D3FCB15 2018 2020-11-06 18:47:13Z DON HIRST 1 WEST MAIN SUITE 303 MEDFORD OR 97501 17986315 0 X WWW.RETIREMENT.ORG X 1967 OR CASCADE MANOR, INC.'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 6 6 186 14 0 0 251462 211932 10391486 11286715 345522 212388 44000 45420 11032470 11756455 0 0 0 0 4907080 5149393 0 0 0 6977348 7499907 11884428 12649300 -851958 -892845 41909835 42062911 60302723 61160812 -18392888 -19097901 CASCADE MANOR, INC.'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 0 0 10164413 0 11286715 CASCADE MANOR, INC. 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, RESIDENTIAL LIVING, AND SKILLED NURSING. 10164413 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 39 0 1 186 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X JOSH BLACKSON 5418577205 1 WEST MAIN SUITE 303 MEDFORD OR 97501 X X DON HIRST PRESIDENT 1.00 0.00 X X 0 0 0 LAURIE BULLARD VICE PRESIDENT 1.00 0.00 X X 0 0 0 THOMAS COCHRAN SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 HUGH JOHNSTON RESIDENT DIRECTOR 1.00 0.00 X 0 0 0 KAY HYDE-PATTON DIRECTOR (THROUGH 7/9/19) 1.00 0.00 X 0 0 0 JOAN LOOMIS DIRECTOR 1.00 0.00 X 0 0 0 BILL VAN VACTOR DIRECTOR 1.00 3.00 X 0 0 0 BRIAN YOUNG EXECUTIVE DIRECTOR 40.00 1.00 X 224238 0 63448 224238 0 63448 1 0 1 0 PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 MANAGEMENT SERVICES 826085 ESSEX GENERAL CONSTRUCTION INC 4284 W 7TH AVENUE EUGENE OR 97402 CONSTRUCTION SERVICES 349707 CONSONUS REHAB PO BOX 4800 UNIT 12 PORTLAND OR 97208 THERAPY SERVICES 279747 IMPERIAL FLOORS P O BOX 10030 EUGENE OR 97440 FLOORING SERVICES 134371 360 HEALTHCARE STAFFING LLC 5401 W KENNEDY BLVD TAMPA FL 33609 MEDICAL SERVICES 127896 6 129892 82040 211932 SERVICE FEES 623000 7652757 7652757 HEALTH CENTER 623000 2276308 2276308 ENTRANCE FEES 623000 974267 974267 HOME CARE / PRIVATE DUTY 623000 148257 148257 DIETARY 623000 66477 66477 168649 168649 11286715 178515 178515 203 203 45420 0 45420 45420 45420 6263530 6229860 33670 33670 33670 11756455 11286715 0 257808 239956 239956 3751197 3237979 513218 155610 107369 48241 703683 602665 101018 298947 248890 50057 844936 844936 4750 4750 20500 20500 13569 13569 767819 649037 118782 148852 148852 255504 196185 59319 128538 128538 730977 730977 60662 21080 39582 23971 12252 11719 728105 728105 2356221 2356221 110762 110762 OTHER DIETARY EXPENSE 576304 576304 HEALTH CENTER EXPENSE 367739 367739 OTHER FACILITY SERVICE 227640 129800 97840 PROGRAM FUND EXPENSES 133058 89048 44010 12649300 10164413 2484887 0 685427 2058696 639846 667582 284229 341343 34161 33383 132595 129852 57684425 26632761 32739702 31051664 7120843 7507582 273032 272809 41909835 42062911 832979 752701 5932010 6023193 20909264 20361604 48000 48000 32580470 33975314 60302723 61160812 X -18671387 -19371817 278499 273916 -18392888 -19097901 41909835 42062911 X -892845 188055 -223 X 0 1 X 1 0 X 245370 233877 290953 251462 211932 1233594 7696531 8389689 10256555 10391486 11286715 48020976 7941901 8623566 10547508 10642948 11498647 49254570 94269 94269 79452 79452 173721 173721 49080849 262654 216758 178457 224724 224138 1106731 262654 216758 178457 224724 224138 1106731 8204555 8840324 10725965 10867672 11722785 50361301 0.97460 0.96330 0.02200 0.02340 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 12649300 12649300 782465 195616 0 0 700922 741098 743767 782465 2968252 4452378 175231 185275 185942 195616 742064 1113096 0 1 X 1700673 1700673 52063994 23824727 28239267 3797859 2808034 989825 121899 121899 31051664 DUE TO AFFILIATES 133366 ASSET RETIREMENT OBLIGATION 54899 REFUNDABLE ENTRANCE FEES 33787049 33975314 X 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, 2019 AND 2018, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. 0 0 0 0 0 0 0 1 0 BRIAN YOUNG EXECUTIVE DIRECTOR 199388 0 24850 0 0 0 42980 0 20468 0 287686 0 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY CASCADE MANOR, INC. BOARD AS PART OF THE ANNUAL BUDGET PROCESS. PART I, LINE 7 THE ORGANIZATION PAID BONUSES THIS YEAR. THE PROCESS FOR DETERMINING EXECUTIVE BONUSES IS DISCRETIONARY. IT IS DETERMINED BY THE VP OF OPERATIONS FOR PACIFIC RETIREMENT SERVICES, INC. AND IT IS BASED ON THE PERFORMANCE OF THE COMMUNITY FOR THE YEAR. A THE HOSPITAL FACILITIES AUTHORITY OF THE CITY OF MEDFORD OREGON 521378932 2014-10-15 33776237 SEE PART VI 0 0 0 A 12969000 33776252 56131 614835 17525286 15580000 2015 1 0 0 1 A 0 1 1 1 0 0.00400 0.00000 0.00400 0 0 1 A 0 1 1 0 1 0 0 0 1 A 1 PART I, LINE A, COLUMN E: THE DIFFERENCE BETWEEN PART I, COLUMN E AND PART II, LINE 3 IS DUE TO INVESTMENT EARNINGS. PART I, LINE A, COLUMN F: PROCEEDS OF THE BONDS WERE ISSUED AS A DRAW DOWN LOAN TO CURRENTLY REFUND THE ISSUER'S SERIES 2010 REFUNDING REVENUE BONDS, ISSUED ON 12/30/2010, FINANCE AND REIMBURSE CAPITAL COSTS, AND PAY COSTS OF ISSUANCE. 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 ORGANIZATOIN 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 2: THE 5TH BOND YEAR HAS NOT OCCURRED, AND THUS NO REBATE COULD BE DUE. ADDITIONALLY, THE REFUNDING PORTION OF THE BONDS HAS SATISFIED THE 6-MONTH EXPENDITURE EXCEPTION TO REBATE. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD, THE CHAIR AND VICE CHAIR OF EACH STANDING COMMITTEE AND SUCH OTHERS AS THE BOARD MAY DESIGNATE. THE EXECUTIVE COMMITTEE CONSIDERS MATTERS RELATING TO ADMISSIONS AND OCCUPANCY, ALL QUESTIONS REFERRED TO IT BY THE BOARD OF DIRECTORS, AND HAS THE POWER TO ACT IN THE PLACE AND STEAD OF THE BOARD OF DIRECTORS ON MATTERS OF BUSINESS REQUIRING IMMEDIATE ACTION BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MAKES RECOMMENDATIONS TO THE BOARD FOR FILLING DIRECTOR AND OFFICER VACANCIES AND IS RESPONSIBLE FOR LONG RANGE PLANNING. THE EXECUTIVE COMMITTEE REPORTS ITS ACTIONS TO THE BOARD AT THE NEXT REGULAR MEETING. FORM 990, PART VI, SECTION A, LINE 3 CASCADE MANOR, INC. DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 6 CASCADE MANOR, INC. HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A PACIFIC RETIREMENT SERVICES, INC. HAS THE AUTHORITY TO ELECT ALL DIRECTORS FROM A LIST OF NOMINEES SELECTED BY THE CASCADE MANOR, INC. BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS ARE RESERVED TO PACIFIC RETIREMENT SERVICES, INC., THE SOLE MEMBER: (A) ENACTMENT, AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION; (B) APPROVAL OF THE ENACTMENT OR AMENDMENT OF THE BY-LAWS AT ANY TIME; (C) THE ELECTION OF ALL DIRECTORS FROM NOMINEES SELECTED BY THE BOARD OF DIRECTORS, INCLUDING FILLING VACANCIES CAUSED BY THE REMOVAL OR RESIGNATION OF A DIRECTOR. INDIVIDUAL DIRECTORS MAY BE REMOVED BY THE MEMBER, WITH OR WITHOUT CAUSE; (D) APPROVAL OF THE ELECTION BY THE BOARD OF DIRECTORS OF ALL OFFICERS WHO SHALL BE SUBJECT TO REMOVAL BY THE MEMBER; (E) APPROVAL OF ANY MERGER, ALL CONSOLIDATIONS, AND/OR ALL PARTIAL OR TOTAL DISSOLUTIONS INVOLVING THE ORGANIZATION; (F) APPROVAL OF ALL DONATIONS OR TRANSFERS WITHOUT CONSIDERATION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (G) THE CREATION OF ANY TAXABLE OR TAX-EXEMPT SUBSIDIARY ORGANIZATION OF THE ORGANIZATION, AND THE INVESTMENT BY THE ORGANIZATION IN ANY JOINT VENTURE, PARTNERSHIP, LIMITED LIABILITY COMPANY, SUBCHAPTER 'C' CORPORATION, OR SIMILAR ENTITY; (H) ANY ACQUISITION OF CONTROLLING INTERESTS IN ORGANIZATIONS OR BUSINESS BY THE ORGANIZATION; (I) APPROVAL OF ALL BUDGETS AND LONG-RANGE PLANS OF THE ORGANIZATION BEFORE AUTHORIZED EXPENDITURES MAY BE MADE THEREFROM; (J) APPROVAL OF ALL NON-BUDGETED CONTRACTS, EXPENDITURES, OR INVESTMENTS IN EXCESS OF $100,000; (K) THE APPOINTMENT OF THE OUTSIDE AUDITORS FOR THE ORGANIZATION; (L) ADOPTION OR REVISION OF THE MISSION STATEMENT AND LONG-RANGE PLANS; (M) APPROVAL OF THE APPOINTMENT OF ALL PROFESSIONAL ADVISORS, INCLUDING BUT NOT LIMITED TO ACCOUNTANTS, AUDITORS, AND LEGAL COUNSEL FOR THE ORGANIZATION; (N) APPROVAL OF THE ADOPTION OR REVISION OF OPERATING POLICIES AND PROCEDURES OF THE ORGANIZATION, THE CORPORATE MISSION AND LONG-RANGE PLANS; (O) APPROVAL OF ANY CHANGE IN ANY MATERIAL RESPECT TO THE NATURE OF THE ORGANIZATION'S BUSINESS OR THE DECISION TO ENTER INTO NEW LINES OF BUSINESS; (P) APPROVAL OF THE REMOVAL OR REPLACEMENT OF THE EXECUTIVE DIRECTOR/ADMINISTRATOR AND ANY OTHER SENIOR MANAGER OF CASCADE MANOR; (Q) APPROVAL OF ANY REVISIONS TO THE FORM, WHETHER NOW EXISTING OR HEREAFTER CREATED, OF CASCADE MANOR RESIDENCE CONTRACTS; (R) APPROVAL OF ANY PLAN OF DISSOLUTION OR LIQUIDATION INVOLVING THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO, ASSISTANT CONTROLLER, VP OF ACCOUNTING, AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE 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 15A A 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 19 ALL REQUESTS GO THROUGH CORPORATE COUNSEL. FORM 990, PART VII, SECTION A: NOTE THAT BRIAN YOUNG IS A LEASED EMPLOYEE OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORMS SERVICES ON BEHALF OF CASCADE MANOR, INC. PURSUANT TO MANAGEMENT SERVICES AGREEMENT BETWEEN CASCADE MANOR, INC. AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, HIS COMPENSATION IS REIMBURSED BY CASCADE MANOR, INC. HIS COMPENSATION HAS BEEN REPORTED IN FORM 990, PART VII, SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY CASCADE MANOR, INC., NOTWITHSTANDING THAT HE IS A LEASED EMPLOYEE OF PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE CAP AGREEMENT -2,648. CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 2,425. PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931067253 SUPPORTING ORGANIZATION OR 501(C)(3) LINE 12C, III-FI N/A 0 PACIFIC RETIREMENT SERVICES FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 472352652 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 ROGUE VALLEY MANOR 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930453216 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 THE CUMBERLAND REST INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 750891470 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931179254 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930513697 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 CAPITOL LAKES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 391412320 SENIOR HOUSING WI 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 ROGUE VALLEY MANOR FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930712867 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 ROGUE VALLEY MANOR 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931301816 PUBLIC FOUNDATION CA 501(C)(3) LINE 7 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 0 TRINITY TERRACE FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 912162130 PUBLIC FOUNDATION TX 501(C)(3) LINE 7 THE CUMBERLAND REST INC 0 HOLLADAY PARK PLAZA FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 264529118 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 HOLLADAY PARK PLAZA INC 0 MIRABELLA WASHINGTON FOUNDATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 450574348 PUBLIC FOUNDATION WA 501(C)(3) LINE 7 MIRABELLA 0 CASCADE MANOR FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931330100 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CASCADE MANOR INC 1 CAPITOL LAKES FOUNDATION INC 1 WEST MAIN ST 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RETIREMENT SERVICES INC 0 BAY AREA SENIOR SERVICES INC 1 BALDWIN AVENUE SAN MATEO CA 94401 943008774 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 931169683 REAL ESTATE OR N/A C 0 PRS MANAGEMENT INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 931328250 MANAGEMENT COMPANY OR N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 CASCADE MANOR FOUNDATION INC C 83381 CASH