2019-11-14T16:32:11-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2018-01-01 271953892 COLORADO SENIOR RESIDENCES INC COLO 9708798855 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 CHARLES PARSONS PRESIDENT 9708798855 2019-11-13 1 RYAN C HARRIS P00614618 3037409400 2019-11-13 208.42.238.142 2019-11-13 19:30:54 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4FAAE17C086B81945F5E5BD9D8957F2F7DAB692C 2018 2020-03-31 21:24:44Z CASEY'S POND SENIOR LIVING BRAD BOATRIGHT 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 11945627 0 X WWW.CASEYSPOND.ORG X 2010 CO TO PROVIDE HOUSING, HEALTHCARE, & OTHER SERVICES TO SENIOR CITIZENS THROUGH A RETIREMENT FACILITY. 12 12 219 30 0 0 1983 2000 10985854 11818804 20392 51284 71864 73539 11080093 11945627 0 0 0 0 6945185 6526792 0 0 0 8068167 8389478 15013352 14916270 -3933259 -2970643 42325457 42276320 56515250 59436756 -14189793 -17160436 TO BE VIEWED AS A LEADER IN THE SENIOR LIVING CONTINUUM OF SERVICES WITH WARM AND INVITING RESIDENCES, DEDICATED AND VISIONARY LEADERSHIP, PROFESSIONAL MANAGEMENT AND AN ENGAGED STAFF WHO ARE COMMITTED TO AN ENVIRONMENT OF GROWTH AND INDEPENDENCE. 0 0 12558102 11818804 CASEY'S POND WAS FORMED TO DEVELOP, OWN, AND OPERATE A SENIOR LIVING AND LONG-TERM CARE COMMUNITY IN STEAMBOAT SPRINGS, COLORADO. CASEY'S POND CONSISTS OF APPROXIMATELY 66 SKILLED NURSING BEDS; 53 ASSISTED LIVING UNITS; 15 MEMORY CARE UNITS; 22 INDEPENDENT LIVING UNITS; AND RELATED COMMON AREAS, AMENITIES, AND OTHER IMPROVEMENTS ALL HOUSED WITHIN ONE BUILDING. 12558102 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 X 26 0 1 219 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X DEBBIE WILLIAMS 9708798855 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 X CHARLES PARSONS PRESIDENT 1.00 X X 0 0 0 KARL GILLS TREASURER 1.00 X X 0 0 0 MARILYN MCCAULLEY VICE PRESIDENT 1.00 X X 0 0 0 CONNIE BRINKMAN DIRECTOR 1.00 X 0 0 0 KAREN BOMBERG DIRECTOR 1.00 X 0 0 0 MARY JENKINS SECRETARY 1.00 X X 0 0 0 RENEE GILBERSON DIRECTOR 1.00 X 0 0 0 RALPH WALTON DIRECTOR 1.00 X 0 0 0 TRISH O'CONNELL DIRECTOR 1.00 X 0 0 0 MICHAEL LOMAS DIRECTOR 1.00 X 0 0 0 BJ HEUBERGER DIRECTOR 1.00 X 0 0 0 PJ WHARTON DIRECTOR 1.00 X 0 0 0 BRAD BOATRIGHT EXECUTIVE DIRECTOR 40.00 X 0 0 0 SANDRA SPIEGEL REGISTERED NURSE 40.00 X 105249 0 0 105249 0 0 1 0 0 0 MORRISON COMMUNITY LIVING PO BOX 102289 ATLANTA GA 303682289 CULINARY SERVICES 1638146 CAPPELLA LIVING SOLUTIONS 9570 S LINGSTONG CT STE 300 ENGLEWOOD CO 80112 MANAGEMENT 818451 PREMERE REHAB LLC 25117 SW PARKWAY STE D WILSONVILLE OR 97070 THERAPY 350756 3 2000 2000 RESIDENT/PATIENT SERV. 623000 11818804 11818804 11818804 51284 51284 MOVE-IN FEE & LEASE 532000 58000 58000 TRANSPORT, MEALS & MIS 999999 15539 15539 73539 11945627 11892343 0 51284 5621655 4967833 653822 22911 20246 2665 548998 463119 85879 333228 299233 33995 763954 763954 24537 24537 56040 56040 977888 943340 34548 60519 60519 64456 33515 30941 127734 6775 120959 337795 337795 6321 6321 15195 1923 13272 3287768 3239997 47771 1245120 1227029 18091 130898 130898 FOOD & BEVERAGE 592631 590366 2265 SUPPLIES 312041 298604 13437 REPAIRS & MAINTENANCE 113650 97963 15687 EQUIPMENT RENTAL & PURC 89720 16519 73201 183211 7524 175687 14916270 12558102 2358168 0 126913 630954 975446 632088 637098 613482 18778 18778 20753 26297 42442616 6503762 37004382 35938854 3542087 4415867 42325457 42276320 623744 893010 183327 206719 42854378 42917289 18084 10056 3500000 3500000 9335717 11909682 56515250 59436756 X -14189793 -17160436 -14189793 -17160436 42325457 42276320 -2970643 0 X 0 1 X 1 0 X 7366 1170 1762 1983 2000 14281 9737047 10000615 10122387 11057718 11892343 52810110 9744413 10001785 10124149 11059701 11894343 52824391 0 0 0 52824391 80968 56293 30027 8826 51284 227398 80968 56293 30027 8826 51284 227398 9825381 10058078 10154176 11068527 11945627 53051789 0.99570 0.99510 0.00430 0.00490 X 3777121 3777121 36479290 4769172 31710118 1872610 1653917 218693 313595 80673 232922 35938854 DEPOSITS 57223 ASSETS LIMITED AS TO USE 4358644 4415867 DEPOSITS HELD IN ESCROW 46646 SECURITY DEPOSITS 56500 OTHER LONG TERM LIABILITIES 693358 BOND INTEREST PAYABLE 10210236 NOTE INTEREST PAYABLE 479042 REFUNDABLE LIFE CARE ENTRY FEES 423900 11909682 X 11945627 0 11945627 0 11945627 14916270 0 14916270 0 14916270 PART X, LINE 2: CASEY'S POND IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM TAX UNDER THE PROVISIONS OF THE INTERNAL REVENUE CODE SECTION 501(C)(3). A COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AYC3 2012-05-03 45110000 CONSTRUCTION OF FACILITY 0 0 0 A 43710632 3586747 892257 39231628 2013 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 PART IV, LINE 2C THE REBATE COMPUTATION WAS PERFORMED IN 2017. FORM 990, PART V, LINE 2B: CASEY'S POND USES A PEO, WHICH FILES FORMS W-2 ON BEHALF OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OF THE EXECUTIVE DIRECTOR POSITION TO CAPPELLA LIVING SOLUTIONS. BRAD BOATRIGHT IS THE EXECUTIVE DIRECTOR OF THE ORGANIZATION AND IS AN EMPLOYEE OF CAPPELLA LIVING SOLUTIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND THEN PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH RESPONSIBLE PERSON HAS A CONTINUING OBLIGATION TO (I) SCRUTINIZE HIS OR HER INTERESTS, RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES, BOTH DIRECT AND INDIRECT, TO IDENTIFY ANY APPARENT OR ACTUAL CONFLICTS OF INTEREST, AND (II) DISCLOSE THE CONFLICT OF INTEREST AS SOON AS IT IS KNOWN. DISCLOSURE IS REQUIRED ANNUALLY, AND WHENEVER A RESPONSIBLE PERSON BECOMES AWARE OF AN ACTUAL OR APPARENT CONFLICT OF INTEREST THAT HAS NOT PREVIOUSLY BEEN DISCLOSED. IN CASES WHERE A RESPONSIBLE PERSON FEELS A CONFLICT ARISES THAT IS NOT PART OF THE ANNUAL DISCLOSURE, HE/SHE SHALL REPORT THE CIRCUMSTANCE TO THE CHAIR OF THE BOARD. IF A CONFLICT OF INTEREST EXISTS, THE RESPONSIBLE PERSON MUST EXCUSE HIMSELF OR HERSELF FROM DISCUSSION, DELIBERATION AND DEBATE ON THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION B THE ORANIZATION PAID THE EXECUTIVE DIRECTOR THROUGH A MANAGEMENT COMPANY. THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF CAPPELLA LIVING SOLUTIONS, AN UNRELATED ENTITY. BRAD BOATRIGHT WAS PAID THROUGH CAPPELLA LIVING SOLUTIONS. BRAD'S WAGES WERE $162,942 AND HIS NONTAXABLE BENEFITS WERE $10,440.