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CAPITOL LAKES INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
CAPITOL LAKES INC (EIN 39-1412320)
Tax period
2017-10-01 to 2018-09-30
Filed
2019-07-30
IRS object ID
201902119349301600
Schema version
2017v2.3
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)
Return2019-07-30T16:48:46-05:00ReturnTs
Tax Period End2018-09-30TaxPeriodEndDt

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 Begin2017-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391412320EIN

Business Name BusinessName

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

US Address USAddress

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

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTIM CONROYPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone8887246424PhoneNum
Signature2019-07-23SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKURT BENNIONPreparerPersonNm
PTINP01469618PTIN
Phone4252506100PhoneNum
Preparation2019-07-23PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.137.57.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-07-23IPDt
IP Tm07:01:48IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id3C05182BCE949607266F40F8D21D5C2A178D6925AtSubmissionCreationDeviceId
At Submission Filing Device IdC6A37568A41E0AB8BE07FF512B9036924B050377AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSUE CENTERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 WEST MAIN SUITE 303AddressLine1Txt
CityMEDFORDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97501ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$23,616,790GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.RETIREMENT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1990FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROVIDE CARE AND HOUSING FOR THE ELDERLY.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee412TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$153,353PYContributionsGrantsAmt
CY Contributions Grants$208,344CYContributionsGrantsAmt
PY Program Service Revenue$20,867,694PYProgramServiceRevenueAmt
CY Program Service Revenue$21,870,492CYProgramServiceRevenueAmt
PY Investment Income$6,513PYInvestmentIncomeAmt
CY Investment Income$72,411CYInvestmentIncomeAmt
PY Other Revenue$15,256PYOtherRevenueAmt
CY Other Revenue$15,174CYOtherRevenueAmt
PY Total Revenue$21,042,816PYTotalRevenueAmt
CY Total Revenue$22,166,421CYTotalRevenueAmt
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$10,848,471PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$11,781,417CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$12,152,097PYOtherExpensesAmt
CY Other Expenses$12,383,261CYOtherExpensesAmt
PY Total Expenses$23,000,568PYTotalExpensesAmt
CY Total Expenses$24,164,678CYTotalExpensesAmt
PY Revenues Less Expenses-$1,957,752PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,998,257CYRevenuesLessExpensesAmt
Total Assets BOY$46,240,707TotalAssetsBOYAmt
Total Assets EOY$45,660,123TotalAssetsEOYAmt
Total Liabilities BOY$99,278,436TotalLiabilitiesBOYAmt
Total Liabilities EOY$100,767,254TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$53,037,729NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$55,107,131NetAssetsOrFundBalancesEOYAmt
MissionCAPITOL LAKES IS A VIBRANT CONTINUING CARE RETIREMENT COMMUNITY COMMITTED TO THE ENRICHMENT OF RESIDENTS' LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$19,791,654ExpenseAmt
Grant$0GrantAmt
Revenue$21,870,492RevenueAmt
DescCAPITOL LAKES IS A CONTINUING CARE RETIREMENT COMMUNITY, DEDICATED TO ENHANCING OUR RESIDENTS' QUALITY OF LIFE IN A STIMULATING, SECURE ENVIRONMENT. WE PROVIDE HIGH-QUALITY SERVICES INCLUDING HOUSING, NUTRITIOUS MEALS, NURSING, HOUSEKEEPING, MAINTENANCE, AND OTHER SUPPORT TO THOSE WE SERVE. OUR LEVELS OF SERVICE INCLUDE INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING.Desc
Total Program Service Expenses$19,791,654TotalProgramServiceExpensesAmt
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
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
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 Bonds0TaxExemptBondsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document83IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee412EmployeeCnt
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
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 (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
SUE CENTER
CHAIR1.001.00Yes (X)Yes (X)$0$0$0
PAULA BONNER
VICE CHAIR (LEFT IN FISCAL YEAR)1.000.00Yes (X)Yes (X)$0$0$0
CLAY NORRBOM
VICE CHAIR1.000.00Yes (X)Yes (X)$0$0$0
BRIAN PURTELL SECRETARY
TREASURER (LEFT IN FISCAL YEAR)1.000.00Yes (X)Yes (X)$0$0$0
SALLY DREW
SECRETARY/TREASURER1.000.00Yes (X)Yes (X)$0$0$0
CONNIE BAKKER
RESIDENT DIRECTOR1.000.00Yes (X)$0$0$0
HARRY PETERSON
DIRECTOR1.000.00Yes (X)$0$0$0
JANE VOICHICK RESIDENT
DIRECTOR (LEFT IN FISCAL YEAR)1.000.00Yes (X)$0$0$0
TIM CONROY
EXECUTIVE DIRECTOR40.001.00$223,558$0$46,429Yes (X)
KRISTIN VATER
HEALTH CENTER ADMINISTRATOR40.000.00$124,323$0$19,963Yes (X)
ISMAEL FANNY
LPN40.000.00$117,376$0$25,755Yes (X)
STEVEN MELLSTROM
HR DIRECTOR40.000.00$109,075$0$25,171Yes (X)
SHELLY SABOURIN
HC DIRECTOR OF NURSING40.000.00$110,782$0$13,980Yes (X)
KIM KARLIN-KAMIN
NUTRITIONAL SERVICES MANAGER40.000.00$102,545$0$15,815Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$787,659TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$147,113TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
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
CONSONUS REHAB
PO BOX 4800 UNIT 12PORTLANDOR97208THERAPY SERVICES$1,640,674
PACIFIC RETIREMENT SERVICES INC
1 WEST MAIN SUITE 303MEDFORDOR97501MANAGEMENT SERVICES$1,582,149
MCGANN CONSTRUCTION INC
3622 LEXINGTON AVENUEMADISONWI53714CONSTRUCTION SERVICES$195,157
GREAT LAKES ROOFING CORPORATION
W194 N11095 KLEINMANN DRGERMANTOWNWI53022CONSTRUCTION SERVICES$189,086
PRIME CLERK LLC
830 THIRD AVENUE 9TH FLOORNEW YORKNY10022CONSULTING SERVICES$186,695
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt
Related Organizations$84,543RelatedOrganizationsAmt
All Other Contributions$123,801AllOtherContributionsAmt
Total Contributions$208,344TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
HEALTH CENTER623000$10,507,970$10,507,970
SERVICE FEES623000$9,628,784$9,628,784
ENTRANCE FEES623000$969,365$969,365
DIETARY623000$251,442$251,442
GARAGE & CARPORT623000$56,183$56,183

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$456,748TotalRevenueColumnAmt
Related Or Exempt Func Income$456,748RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$21,870,492TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$49,032TotalRevenueColumnAmt
Exclusion$49,032ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$15,174RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$15,174RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,174TotalRevenueColumnAmt
Exclusion$15,174ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,473,748SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,450,369SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$23,379SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$23,379TotalRevenueColumnAmt
Exclusion$23,379ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$22,166,421TotalRevenueColumnAmt
Related Or Exempt Func Income$21,870,492RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$87,585ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$284,165TotalAmt
Management And General$284,165ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,996,604TotalAmt
Program Services$8,193,091ProgramServicesAmt
Management And General$803,513ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$391,684TotalAmt
Program Services$352,589ProgramServicesAmt
Management And General$39,095ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,425,995TotalAmt
Program Services$1,267,107ProgramServicesAmt
Management And General$158,888ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$682,969TotalAmt
Program Services$611,345ProgramServicesAmt
Management And General$71,624ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,704,152TotalAmt
Management And General$1,704,152ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$19,101TotalAmt
Management And General$19,101ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$23,500TotalAmt
Management And General$23,500ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$1,701TotalAmt
Management And General$1,701ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$802,069TotalAmt
Program Services$465,745ProgramServicesAmt
Management And General$336,324ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$307,626TotalAmt
Program Services$100ProgramServicesAmt
Management And General$307,526ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$851,484TotalAmt
Program Services$735,036ProgramServicesAmt
Management And General$116,448ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$149,787TotalAmt
Management And General$149,787ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,319,911TotalAmt
Program Services$1,318,187ProgramServicesAmt
Management And General$1,724ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$118,711TotalAmt
Program Services$42,199ProgramServicesAmt
Management And General$76,512ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$40,543TotalAmt
Program Services$28,938ProgramServicesAmt
Management And General$11,605ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$36,643TotalAmt
Program Services$36,643ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,027,476TotalAmt
Program Services$3,027,476ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$192,508TotalAmt
Program Services$192,508ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
HEALTH CENTER EXPENSE$2,470,684$2,470,684
OTHER DIETARY EXPENSE$958,858$958,858
OTHER FACILITY SERVICE$241,641$91,148$150,493
PROGRAM FUND EXPENSES$116,672$116,672

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$194TotalAmt
Management And General$194ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,164,678TotalAmt
Program Services$19,791,654ProgramServicesAmt
Management And General$4,373,024ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,729,119BOYAmt
EOY$1,924,153EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$194BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,192,282BOYAmt
EOY$1,612,075EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$52,412BOYAmt
EOY$86,788EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$246,867BOYAmt
EOY$329,101EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$66,327,256LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$29,841,806LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$38,764,058BOYAmt
EOY$36,485,450EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,220,536BOYAmt
EOY$4,270,602EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,035,239BOYAmt
EOY$951,954EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$46,240,707BOYAmt
EOY$45,660,123EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,192,894BOYAmt
EOY$1,757,782EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$6,358,610BOYAmt
EOY$8,327,318EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$441,052BOYAmt
EOY$606,890EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$51,782,904BOYAmt
EOY$49,729,327EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$38,502,976BOYAmt
EOY$40,345,937EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$99,278,436BOYAmt
EOY$100,767,254EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$54,061,944BOYAmt
EOY-$56,084,640EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$947,888BOYAmt
EOY$901,182EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$76,327BOYAmt
EOY$76,327EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$53,037,729BOYAmt
EOY-$55,107,131EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$46,240,707BOYAmt
EOY$45,660,123EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$1,998,257ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$17,310NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$53,835OtherChangesInNetAssetsAmt
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$2,948CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$74,655CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,626,110CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$153,353CurrentTaxYearMinus1YearAmt
Current Tax Year$208,344CurrentTaxYearAmt
Total$4,065,410TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,738,492CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,589,111CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$20,773,042CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,867,694CurrentTaxYearMinus1YearAmt
Current Tax Year$21,870,492CurrentTaxYearAmt
Total$102,838,831TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,741,440CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,663,766CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$24,399,152CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21,021,047CurrentTaxYearMinus1YearAmt
Current Tax Year$22,078,836CurrentTaxYearAmt
Total$106,904,241TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$41,383CurrentTaxYearMinus3YearsAmt
Total$41,383TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$41,383CurrentTaxYearMinus3YearsAmt
Total$41,383TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$106,862,858PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$242,661CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$286,356CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$175,326CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$59,231CurrentTaxYearMinus1YearAmt
Current Tax Year$64,206CurrentTaxYearAmt
Total$827,780TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$242,661CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$286,356CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$175,326CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$59,231CurrentTaxYearMinus1YearAmt
Current Tax Year$64,206CurrentTaxYearAmt
Total$827,780TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,984,101CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,950,122CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$24,574,478CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21,080,278CurrentTaxYearMinus1YearAmt
Current Tax Year$22,143,042CurrentTaxYearAmt
Total$107,732,021TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99190PublicSupportCY509Pct
Public Support PY5090.99050PublicSupportPY509Pct
Investment Income CY0.00770InvestmentIncomeCYPct
Investment Income PY0.00910InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Total Grassroots Lobbying TotalGrassrootsLobbyingGrp

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

Total Direct Lobbying TotalDirectLobbyingGrp

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

Total Lobbying Expend TotalLobbyingExpendGrp

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

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$24,164,678FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$24,164,678FilingOrganizationsTotalAmt

Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp

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

Grassroots Nontaxable GrassrootsNontaxableGrp

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

Tot Lbbyng Grassroot Mns Non Tx TotLbbyngGrassrootMnsNonTxGrp

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

Tot Lbby Expend Mns Lbbyng Non Tx TotLbbyExpendMnsLbbyngNonTxGrp

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

Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp

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

Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp

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

Schedule D IRS990ScheduleD

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

Land LandGrp

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

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$53,915,154OtherCostOrOtherBasisAmt
Depreciation$27,542,322DepreciationAmt
Book Value$26,372,832BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,371,038OtherCostOrOtherBasisAmt
Depreciation$2,299,484DepreciationAmt
Book Value$1,071,554BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$503,464OtherCostOrOtherBasisAmt
Book Value$503,464BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$36,485,450TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO AFFILIATES$1,765,926
OTHER CURRENT LIABILITIES$17,932
ENTRANCE FEES REFUNDABLE UPON REOCCUPANCY$38,562,079
FieldValueIRS element (for citing)
Total Liability$40,345,937TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:RESIDENT SECURITY DEPOSITS ARE HELD IN A SEPARATE BANK ACCOUNT. WHEN THE RESIDENT LEAVES THE FACILITY THE SECURITY DEPOSIT, MINUS ANY AMOUNTS RETAINED FOR REPAIRS, IS REFUNDED.
PART X, LINE 2:THE CORPORATION RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE CORPORATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2018 AND 2017, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS.

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonTIM CONROYPersonNm
TitleEXECUTIVE DIRECTORTitleTxt
Base Compensation Filing Org$190,289BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$33,269BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$23,111DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$23,318NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$269,987TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$0TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

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

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3CAPITOL LAKES, INC. DELEGATES MANAGEMENT DUTIES TO PACIFIC RETIREMENT SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7APACIFIC RETIREMENT SERVICES, INC. HAS THE RIGHT TO ELECT THE DIRECTORS OF THE BOARD OF CAPITOL LAKES, INC.
FORM 990, PART VI, SECTION A, LINE 7BTHE AUTHORITY OF THE BOARD OF DIRECTORS TO EXERCISE THE FOLLOWING POWERS IS CONDITIONED UPON THE APPROVAL OF THE CORPORATE MEMBER: (A) MERGER, CONSOLIDATION OR DISSOLUTION OF THE ORGANIZATION; (B) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OF THE ORGANIZATION; (C) SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL THE PROPERTY AND ASSETS OF THE ORGANIZATION; (D) THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY ORGANIZATION; (E) THE ADOPTION OF THE AGGREGATE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION; (F) AGGREGATE BORROWING FOR PERIODS OF ONE (1) YEAR OR LESS FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE MEMBER FROM TIME TO TIME; AND AGGREGATE BORROWING FOR PERIODS OF MORE THAN ONE (1) YEAR FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE MEMBER FROM TIME TO TIME; (G) THE PURCHASE, SALE, LEASE DISPOSITION HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, AND ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE MEMBER FROM TIME TO TIME, NOT PREVIOUSLY INCLUDED IN THE CAPITAL BUDGET; (H) THE APPOINTMENT OF AN INDEPENDENT AUDITOR; (I) GIFTS OR GRATUITOUS TRANSFERS IN EXCESS OF $5,000 IN A CALENDAR YEAR; (J) ADOPTION OR REVISION OF THE MISSION STATEMENT AND LONG RANGE PLANS; AND (K) INCUR ANY DEBT OR ENTER INTO ANY CONTRACT NOT CONTEMPLATED BY THE ANNUAL BUDGET IF THE DOLLAR AMOUNT EXCEEDS THE SUM OF $100,000.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 WAS REVIEWED BY THE CFO, ASSISTANT CONTROLLER AND THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE ARE SENT TO ALL BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY. THERE ARE TWO POLICIES RELATED TO CONFLICTS OF INTEREST: 1) BOARD OF DIRECTORS; 2)KEY EMPLOYEES, WHICH IDENTIFY THE PURPOSE, DEFINITIONS, AND PROCEDURES. IF A CONFLICT IS SELF-IDENTIFIED BY A BOARD MEMBER OR KEY EMPLOYEE IN THE QUESTIONNAIRE AND/OR MEETING, PROCEDURES ARE FOLLOWED AND DOCUMENTED ACCORDING TO THE POLICY.
FORM 990, PART VI, SECTION B, LINE 15AA COMPENSATION COMMITTEE OF THE PRS BOARD EXISTS TO DETERMINE COMPENSATION FOR THE EXECUTIVE DIRECTOR OF EACH COMMUNITY. THIS COMMITTEE IS COMPRISED OF THE OFFICERS OF THE PRS BOARD OF DIRECTORS. THE COMMITTEE HAS A CHARTER THAT OUTLINES ITS DUTIES AND RESPONSIBILITIES. IT ALSO HAS AGENDA ELEMENTS THAT DESCRIBE THE ACTIVITIES THAT THE COMMITTEE UNDERTAKES DURING THE YEAR. THE VP OF HUMAN RESOURCES PROVIDED SALARY STUDIES FROM THE FOLLOWING RESOURCES TO THE COMMITTEE RELATIVE TO EXECUTIVE DIRECTOR COMPENSATION: SALARY.COM, PAYSCALE.COM, 990 REVIEW (LIKE SIZE ORGANIZATIONS), CEMO (CHIEF EXECUTIVE OFFICERS OF MULTI-FACILITY ORGANIZATIONS) SALARY STUDY RESULTS, AND INDUSTRY STATE ASSOCIATION SALARY STUDY RESULTS BASED ON GEOGRAPHICAL LOCATION. THE RECOMMENDATION FOR BASE COMPENSATION AND BONUS ARE PROVIDED BY THE EXECUTIVE DIRECTOR'S DIRECT SUPERVISOR (COO OR VP OF OPERATIONS).
FORM 990, PART VI, SECTION C, LINE 19ALL REQUESTS GO THROUGH CORPORATE COUNSEL.
FORM 990, PART VII, SECTION A:NOTE THAT TIM CONROY IS A LEASED EMPLOYEE OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORMS SERVICES ON BEHALF OF CAPITOL LAKES, INC. PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN CAPITOL LAKES, INC. AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, HIS COMPENSATION IS REIMBURSED BY CAPITOL LAKES, INC. COMPENSATION HAS BEEN REPORTED IN PART VII, SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY CAPITOL LAKES, INC., NOTWITHSTANDING THAT HE IS A LEASED EMPLOYEE OF PACIFIC RETIREMENT SERVICES, INC.
FORM 990, PART XI, LINE 9:CHANGES IN INTEREST IN NET ASSETS OF FOUNDATION -53,835.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (47 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
PACIFIC RETIREMENT SERVICES INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931067253SUPPORTING ORGANIZATIONOR501(C)(3)LINE 12C, III-FIN/A0
PACIFIC RETIREMENT SERVICES FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501472352652PUBLIC FOUNDATIONOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
ROGUE VALLEY MANOR
1 WEST MAIN ST SUITE 303MEDFORDOR97501930453216SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
THE CUMBERLAND REST INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501750891470SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
CASCADE MANOR INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501930557803SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
UNIVERSITY RETIREMENT COMMUNITY AT DAVIS
1 WEST MAIN ST SUITE 303MEDFORDOR97501931179254SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
HOLLADAY PARK PLAZA
1 WEST MAIN ST SUITE 303MEDFORDOR97501930513697SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
ROGUE VALLEY MANOR FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501930712867PUBLIC FOUNDATIONOR501(C)(3)LINE 70ROGUE VALLEY MANOR
UNIVERSITY RETIREMENT COMMUNITY FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931301816PUBLIC FOUNDATIONCA501(C)(3)LINE 70UNIVERSITY RETIREMENT COMMUNITY AT DAVIS
TRINITY TERRACE FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501912162130PUBLIC FOUNDATIONTX501(C)(3)LINE 70THE CUMBERLAND REST INC
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 70MIRABELLA
CASCADE MANOR FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931330100PUBLIC FOUNDATIONOR501(C)(3)LINE 70CASCADE MANOR INC
CAPITOL LAKES FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501383781089PUBLIC FOUNDATIONOR501(C)(3)LINE 7Yes (1)CAPITOL LAKES INC
MIRABELLA
1 WEST MAIN ST SUITE 303MEDFORDOR97501342030255SENIOR HOUSINGWA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
MIRABELLA PORTLAND FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501452508860PUBLIC FOUNDATIONOR501(C)(3)LINE 70MIRABELLA AT SOUTH WATERFRONT
MIRABELLA AT SOUTH WATERFRONT
1 WEST MAIN ST SUITE 303MEDFORDOR97501711016384SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
COMMUNITY VOLUNTEER NETWORK
1 WEST MAIN ST SUITE 303MEDFORDOR97501930892261COMMUNITY SERVICESOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501930864466SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM ASHLAND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501930942933SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM GRANTS PASS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943136037SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM ROSEBURG HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943179782SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MYRTLE CREEK HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943162074SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM BEND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943163349SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM EAGLE POINT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943191447SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM KLAMATH FALLS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943196455SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MEDFORD II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212537SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM LIVELY OAKS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943194409SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM REEDSPORT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212538SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM YREKA HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212540SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM EUGENE HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943247154SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM FORT WORTH I HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311520436SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM BEND II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943260016SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM FORT WORTH II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587415SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MEDFORD III HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587418SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM ROSEBURG II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587420SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM GRANTS PASS II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311662259SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM DAVIS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311662208SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MYRTLE CREEK II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311715321SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM PORTLAND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311780332SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM PORTLAND II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501300037898SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM CENTRAL POINT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501300315618SENIOR HOUSINGOR501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
RVM MANSFIELD HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501900292647SENIOR HOUSINGTX501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
MIDDLETON GLEN INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501911859494SENIOR HOUSINGWI501(C)(3)LINE 10Yes (1)CAPITOL LAKES INC
SENIOR HOUSING OF MIDDLETON INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501470825736SENIOR HOUSINGWI501(C)(3)LINE 10Yes (1)CAPITOL LAKES INC
MIRABELLA AT ASU INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501813784956SENIOR HOUSINGAZ501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC
BAY AREA SENIOR SERVICES INC
1 BALDWIN AVESAN MATEOCA94401943008774SENIOR HOUSINGCA501(C)(3)LINE 100PACIFIC RETIREMENT SERVICES INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (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
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 OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CAPITOL LAKES FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$84,543InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt