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 750891470 THE CUMBERLAND REST INC CUMB 8887246424 1600 TEXAS STREET FORT WORTH TX 761023434 M SCOTT THOMAS EXECUTIVE DIRECTOR 8887246424 2020-08-11 1 KURT BENNION P01469618 4252506100 2020-08-11 67.137.57.251 2020-08-11 23:22:09 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CB8FE41F7A1541848066F2058C3AF12D9D3FCB15 2018 2020-09-23 17:36:50Z TRINITY TERRACE DONALD MILLS 1 WEST MAIN SUITE 303 MEDFORD OR 97501 55654942 0 X WWW.RETIREMENT.ORG X 1943 TX TO PROVIDE COMPREHENSIVE CARE AND HOUSING FOR THE ELDERLY. 13 13 322 177 0 0 343359 1130973 23497263 26106576 5460315 712416 11857627 10458443 41158564 38408408 0 6488 0 0 11638251 12528555 0 0 0 22733186 23293240 34371437 35828283 6787127 2580125 280871600 292469447 198164204 196693928 82707396 95775519 THE CUMBERLAND REST, INC. (DBA: TRINITY TERRACE) IS A NOT-FOR-PROFIT CONTINUING CARE RETIREMENT COMMUNITY PROVIDING EXCEPTIONAL SERVICES AND A SECURE, COMFORTABLE ENVIRONMENT TO ENRICH THE LIVES OF SENIORS. 0 0 29672413 6488 26106576 TRINITY TERRACE 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, MEMORY CARE, AND SKILLED NURSING. 29672413 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 95 0 1 322 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X JOSH BLACKSON 5418577205 1 WEST MAIN SUITE 303 MEDFORD OR 97501 X X DONALD MILLS CHAIR 1.00 0.00 X X 0 0 0 DOUG WILSON VICE CHAIR 1.00 4.00 X X 0 0 0 GRETCHEN SMITH SECRETARY 1.00 1.00 X X 0 0 0 MICHAEL HYATT TREASURER 1.00 0.00 X X 0 0 0 JIM AUSTIN DIRECTOR 1.00 0.00 X 0 0 0 DIONNE BAGSBY DIRECTOR (PASSED DURING FISCAL YEAR) 1.00 0.00 X 0 0 0 ALLAN BARR DIRECTOR 1.00 1.00 X 0 0 0 ROBERT FERNANDEZ DIRECTOR 1.00 0.00 X 0 0 0 MIKE MCMAHON DIRECTOR 1.00 0.00 X 0 0 0 JUDITH STEMPEL DIRECTOR 1.00 0.00 X 0 0 0 ANDY TAFT DIRECTOR 1.00 0.00 X 0 0 0 REV KARL TRAVIS DIRECTOR 1.00 0.00 X 0 0 0 CARLELA VOGEL DIRECTOR 1.00 1.00 X 0 0 0 JIM WHITTON DIRECTOR 1.00 0.00 X 0 0 0 LEE PATTERSON EXECUTIVE DIRECTOR 40.00 0.00 X 276323 0 17445 LINE WILSON ASSISTANT EXECUTIVE DIRECTOR 40.00 0.00 X 174866 0 28210 DAVID HENTON HEALTH SERVICES ADMINISTRATOR 40.00 0.00 X 144489 0 19935 BOBBY DAVIS DIRECTOR OF FACILITY SERVICES 40.00 0.00 X 109299 0 23489 BARBARA HARRINGTON BUSINESS OFFICE MANAGER 40.00 0.00 X 107834 0 24073 JUDE OKEREKE HC LVN 40.00 0.00 X 103409 0 16836 916220 0 129988 6 0 1 0 MANHATTAN CONSTRUCTION COMPANY 6300 NORTH CENTRAL EXPRESSWAY DALLAS TX 75206 CONSTRUCTION SERVICES 6485174 PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 MANAGEMENT SERVICES 2397809 CONSONUS REHAB UNIT 12 PO BOX 4800 PORTLAND OR 97208 THERAPY SERVICES 562472 ANKROM MOISAN 6720 SW MACADAM AVE PORTLAND OR 97219 ARCHITECTURAL SERVICES 216888 MISSION LINEN SUPPLY 1010 AVENUE R GRAND PRAIRIE TX 750501505 LAUNDRY SERVICES 166845 8 862536 268437 1130973 SERVICE FEES 623000 18986481 18986481 ENTRANCE FEES 623000 3551801 3551801 HEALTH CENTER 623000 3121759 3121759 DIETARY 623000 170540 170540 HOME CARE 623000 102138 102138 173857 173857 26106576 795032 795032 112768 112768 10458443 10458443 17051150 17246534 -195384 -195384 -195384 38408408 26106576 0 11170859 6488 6488 481207 481207 8974312 7891403 1082909 302178 236027 66151 2057957 1814151 243806 712901 606637 106264 2220932 2220932 169887 169887 26001 26001 310671 310671 1237919 897172 340747 345850 3431 342419 635241 494790 140451 180350 180350 174000 174000 2922058 2921718 340 179461 45836 133625 50591 16406 34185 4563488 4563488 6807677 6807677 267975 267975 OTHER DIETARY EXPENSE 1513787 1513787 HEALTH CENTER EXPENSE 871484 871484 OTHER FACILITY SERVICE 571434 295509 275925 PROGRAM FUND EXPENSES 244434 244434 35828283 29672413 6155870 0 32105554 34841290 8406377 8045394 1279688 1348326 72088 70702 384639 264071 206341510 59186246 142711485 147155264 39177561 36341833 10 23081 56734198 64379486 280871600 292469447 5209717 4250511 29022749 28928167 97171718 93747414 66760020 69767836 198164204 196693928 X 54430315 63805772 7307165 7632354 20969916 24337393 82707396 95775519 280871600 292469447 X 2580125 596304 9891694 X 0 1 X 1 0 X 12637 183706 239301 343359 1130973 1909976 17032832 16719702 17386710 23497263 26106576 100743083 17045469 16903408 17626011 23840622 27237549 102653059 0 0 0 102653059 5224706 4878960 7099870 11287938 11366243 39857717 5224706 4878960 7099870 11287938 11366243 39857717 22270175 21782368 24725881 35128560 38603792 142510776 0.72030 0.68120 0.27970 0.31880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 35828283 35828283 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 250000 250000 250000 250000 1000000 1500000 0 1 X 1429229 1429229 179811448 53378747 126432701 12308472 5807499 6500973 12792361 12792361 147155264 OIL AND GAS MINERAL RIGHTS 64359649 OTHER NON-CURRENT ASSETS 19837 64379486 SWAP AGREEMENTS 3490356 DUE TO AFFILIATES 277961 ENTRANCE FEES REFUNDABLE UPON REOCCUPANCY 65187039 REFUNDABLE DEPOSITS 812480 69767836 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. 1 EMPLOYEE SCHOLARSHIPS 1 6488 PART I, LINE 2: INDIVIDUAL SCHOLARSHIP FUNDS ARE GIVEN DIRECTLY TO THE SCHOOL TO ENSURE CORRECT USE. 0 0 0 0 0 0 0 1 0 LEE PATTERSON EXECUTIVE DIRECTOR 276323 0 0 0 0 0 6224 0 11221 0 293768 0 0 0 LINE WILSON ASSISTANT EXECUTIVE DIRECTOR 145441 0 29425 0 0 0 12812 0 15398 0 203076 0 0 0 DAVID HENTON HEALTH SERVICES ADMINISTRATOR 131882 0 12607 0 0 0 0 0 19935 0 164424 0 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY THE CUMBERLAND REST, 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 PRS AND IT IS BASED ON THE PERFORMANCE OF THE COMMUNITY FOR THE YEAR. A TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINANCE CORPORATION 043833551 2018-09-14 30930000 FINANCE FACILITY IMPROVEMENTS AND REIMBURSEMENTS 0 0 0 B TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINANCE CORPORATION 043833551 87638TEW9 2014-12-18 86742084 FINANCE BUILDING EXPANSION AND REFUND SERIES 2011 ISSUE 0 0 0 A 30930000 30930000 2017 1 0 1 1 B 21215000 87133227 4400401 4566451 1551212 33871763 42743399 2017 1 0 0 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00100 0.00000 0.00100 0 0 1 A 0 1 1 0 1 1 MORGAN STANLEY CAP SERV INC 24.600000000000 0 0 0 0 1 B 0 1 1 0 0 0 0 0 1 A 1 B 1 PART I, LINE A, COLUMN F: THE LOAN IS A REISSUANCE OF THE 2014 COMPASS LOAN, WHICH WAS ISSUED ON 12/18/14. PART I, LINE B, COLUMN F: THE BONDS REFUNDED A SERIES 2011 ISSUANCE, ISSUED 12/29/11. PART II, LINE 3, COLUMN B: THE AMOUNT LISTED DIFFERS FROM THE ISSUE PRICE LISTED IN PART I, COLUMN E DUE TO INTEREST EARNINGS ON INVESTED PROCEEDS. 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 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, COLUMN A: THE LOAN QUALIFIED FOR THE 6-MONTH EXCEPTION TO THE REBATE REQUIREMENT. PART IV, LINE 2B, COLUMN B: THE CURRENT REFUNDING PORTION OF THE BONDS HAS QUALIFIED FOR THE 6-MONTHS 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 THE STANDING COMMITTEES 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. IT ALSO MAKES RECOMMENDATIONS TO THE BOARD FOR FILLING DIRECTOR AND OFFICER VACANCIES AND IS RESPONSIBLE FOR LONG RANGE PLANNING. IT REPORTS ITS ACTIONS TO THE BOARD AT THE NEXT REGULAR MEETING. FORM 990, PART VI, SECTION A, LINE 3 THE CUMBERLAND REST, INC. (DBA: TRINITY TERRACE) BOARD DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION 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 NOMINEES SELECTED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS ARE RESERVED TO PACIFIC RETIREMENT SERVICES, THE SOLE MEMBER: (1) APPROVAL OF THE FINAL ADOPTION OF ANY AMENDMENT OR RESTATEMENT OF THE ORGANIZATION'S ARTICLES OF INCORPORATION; (2) APPROVAL OF THE FINAL ADOPTION OF ANY AMENDMENT OF THE ORGANIZATION'S BY-LAWS; (3) ELECTION OF THE DIRECTORS OF THE ORGANIZATION FROM NOMINEES SELECTED BY THE BOARD OF DIRECTORS OF THE ORGANIZATION AND INCLUDING THE FILING OF VACANCIES CAUSED BY REMOVAL OR RESIGNATION OF A DIRECTOR. INDIVIDUAL DIRECTORS MAY BE REMOVED BY PACIFIC RETIREMENT SERVICES WITH OR WITHOUT CAUSE; (4) APPROVAL OF THE ELECTION BY THE BOARD OF DIRECTORS OF ALL CORPORATE OFFICERS, INCLUDING BUT NOT LIMITED TO THE CHAIRMAN, CHAIR AND/OR VICE CHAIRMAN OF THE BOARD OF DIRECTORS, WHO SHALL BE SUBJECT TO REMOVAL BY PACIFIC RETIREMENT SERVICES WITH OR WITHOUT CAUSE; (5) APPROVAL OF ANY MERGER, CORPORATE CONSOLIDATION, CHANGE OF CONTROL, AND/OR ALL PARTIAL OR TOTAL DISSOLUTIONS INVOLVING THE ORGANIZATION, AND ALL DONATIONS OR TRANSFERS WITHOUT CONSIDERATION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (6) APPROVAL OF ANY SELLING, LEASING, OR OTHERWISE UNBUDGETED TRANSFERRING OF ANY ASSET (OR COMMITMENT TO DO SO) TO ANY PERSON OR OTHER LEGAL ENTITY (OTHER THAN PACIFIC RETIREMENT SERVICES OR AN AFFILIATE THEREOF) IN EXCESS OF $10,000; (7) APPROVAL OF ANY ACQUISITIONS OR AGREEMENTS TO ACQUIRE (BY PURCHASE, LEASE, CHANGE IN SPONSORSHIP OR OTHERWISE) OF ANY ORGANIZATION OR BUSINESS; (8) APPROVAL (FOLLOWING PREPARATION BY ORGANIZATION MANAGEMENT AND APPROVAL BY THE BOARD OF DIRECTORS) OF THE ORGANIZATION'S ANNUAL OPERATING BUDGET AND THE ANNUAL CAPITAL BUDGET, MANAGEMENT OF PACIFIC RETIREMENT SERVICES WILL ADVISE MANAGEMENT OF THE ORGANIZATION IN THE PREPARATION OF BOTH THE OPERATING BUDGET AND THE CAPITAL BUDGET; (9) APPROVAL OF THE ORGANIZATION TO INCUR ANY DEBT OR ENTER INTO ANY CONTRACT NOT CONTEMPLATED BY THE ANNUAL BUDGET, IF THE DOLLAR AMOUNT EXCEEDS THE SUM OF $100,000; (10) APPROVAL OF THE APPOINTMENT OF ALL PROFESSIONAL ADVISORS, INCLUDING BUT NOT LIMITED TO ACCOUNTANTS, AUDITORS AND LEGAL COUNSEL, FOR THE ORGANIZATION; (11) APPROVAL OF THE ADOPTION OR REVISION OF OPERATING POLICIES AND PROCEDURES OF THE ORGANIZATION, THE CORPORATE MISSION AND LONG-RANGE PLANS; (12) 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; (13) APPROVAL OF THE REMOVAL OR REPLACEMENT OF THE EXECUTIVE DIRECTOR/ ADMINISTRATOR AND ANY OTHER SENIOR MANAGER OF TRINITY TERRACE AND APPROVAL OF A NEW EXECUTIVE DIRECTOR/ADMINISTRATOR AND ANY OTHER SENIOR MANAGER OF TRINITY TERRACE; (14) APPROVAL OF THE CREATION OF ANY SUBSIDIARY (TAXABLE OR TAX-EXEMPT) AND THE INVESTMENT BY THE ORGANIZATION IN ANY JOINT VENTURE, PARTNERSHIP, LIMITED LIABILITIES CORPORATION, SUBCHAPTER C CORPORATION OR SIMILAR ENTITY; (15) APPROVAL OF ANY REVISIONS TO THE FORM, WHETHER NOW EXISTING OR HEREINAFTER CREATED, OF TRINITY TERRACE RESIDENCY CONTRACTS; (16) APPROVAL OF ALL EMPLOYEE BENEFITS AND COMPENSATION PAYABLE TO THE SENIOR MANAGEMENT OF THE ORGANIZATION PRIOR TO CONTRACTING; (17) APPROVAL OF ALL INVESTMENT POLICIES OF THE ORGANIZATION IN EXCESS OF $10,000 AS ADOPTED BY THE BOARD; ALL INVESTMENTS SHALL BE MADE IN ACCORDANCE WITH SUCH BOARD-ADOPTED POLICIES; (18) 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 LEE PATTERSON, LINE WILSON AND DAVID HENTON ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORM SERVICE ON BEHALF OF THE CUMBERLAND REST, INC. PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN THE CUMBERLAND REST, INC. AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, THEIR COMPENSATION IS REIMBURSED BY THE CUMBERLAND REST, INC. COMPENSATION HAS BEEN REPORTED IN PART VII SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY THE CUMBERLAND REST, INC., NOTWITHSTANDING THAT THEY ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF MINERAL ASSETS 7,826,443. CHANGE IN VALUE OF INTEREST RATE CAP/SWAP AGREEMENT -1,413,119. CHANGES IN INTEREST IN NET ASSETS OF TRINITY TERRACE FOUNDATION -16,654. CHANGE IN FAIR VALUE OF SPLIT INTEREST TRUST 127,547. CHANGE IN FAIR VALUE OF PERPETUAL TRUSTS 3,367,477. 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 CASCADE MANOR INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930557803 SENIOR HOUSING OR 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 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 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 1 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 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 0 CAPITOL LAKES FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 383781089 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CAPITOL LAKES INC 0 MIRABELLA 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 342030255 SENIOR HOUSING WA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA PORTLAND FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 452508860 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 MIRABELLA AT SOUTH WATERFRONT 0 MIRABELLA AT SOUTH WATERFRONT 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 711016384 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 COMMUNITY VOLUNTEER NETWORK 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930892261 COMMUNITY SERVICES OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930864466 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM ASHLAND HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930942933 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM GRANTS PASS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943136037 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM ROSEBURG HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943179782 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MYRTLE CREEK HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943162074 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943163349 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM EAGLE POINT HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943191447 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM KLAMATH FALLS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943196455 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MEDFORD II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943212537 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM LIVELY OAKS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943194409 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM REEDSPORT HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943212538 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM YREKA HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943212540 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM EUGENE HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943247154 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM FORT WORTH I HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311520436 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943260016 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM FORT WORTH II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311587415 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MEDFORD III HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311587418 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM ROSEBURG II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311587420 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM GRANTS PASS II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311662259 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM DAVIS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311662208 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MYRTLE CREEK II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311715321 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM PORTLAND HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311780332 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM PORTLAND II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 300037898 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM CENTRAL POINT HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 300315618 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MANSFIELD HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 900292647 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 MIDDLETON GLEN INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 911859494 SENIOR HOUSING WI 501(C)(3) LINE 10 CAPITOL LAKES INC 0 SENIOR HOUSING OF MIDDLETON INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 470825736 SENIOR HOUSING WI 501(C)(3) LINE 10 CAPITOL LAKES INC 0 MIRABELLA AT ASU INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 813784956 SENIOR HOUSING AZ 501(C)(3) LINE 10 PACIFIC 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 0 TRINITY TERRACE FOUNDATION INC C 712321 CASH