2019-07-30T16:48:47-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-10-01 930513697 HOLLADAY PARK PLAZA HOLL 8887246424 1300 NE 16TH AVENUE PORTLAND OR 972321467 SUSAN PLATTE EXECUTIVE DIRECTOR 8887246424 2019-07-23 1 KURT BENNION P01469618 4252506100 2019-07-23 67.137.57.251 2019-07-23 05:43:42 PD P 3C05182BCE949607266F40F8D21D5C2A178D6925 C6A37568A41E0AB8BE07FF512B9036924B050377 2017 2019-02-21 02:37:17Z JOHN HUBBARD 1 WEST MAIN SUITE 303 MEDFORD OR 97501 29720009 0 X WWW.RETIREMENT.ORG X 1967 OR TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 9 9 326 12 0 0 385077 324499 17339684 19087008 422333 1233652 67344 67595 18214438 20712754 0 0 0 0 7367753 7652695 0 0 0 9685064 10445172 17052817 18097867 1161621 2614887 70999549 75645840 48193562 50975619 22805987 24670221 X THE MISSION OF HOLLADAY PARK PLAZA IS TO CREATE AND MAINTAIN A NON-PROFIT RETIREMENT COMMUNITY WHERE THE LIVES OF RESIDENTS ARE CONTINUALLY ENRICHED. (CONTINUED IN SCHEDULE O)AWARE OF THE EVER CHANGING NEEDS OF RETIREES, WE ENCOURAGE AN ACTIVE LIFESTYLE AND SPIRITUAL AND SOCIAL OPPORTUNITIES. WE ARE COMMITTED TO EXCELLENCE IN OUR INDUSTRY THROUGH THE WORK OF EXPERIENCED AND EDUCATED STAFF AND DIRECTORS, ENHANCED BY RESIDENT INVOLVEMENT. WE HONOR OUR CHRISTIAN HERITAGE AND WELCOME THE DIVERSE RELIGIOUS TRADITIONS OF OUR RESIDENTS BY MAINTAINING A POSITIVE OUTLOOK, EMBRACING NEW IDEAS TO PROVIDE PROGRAMS AND SERVICES THAT SUPPORT OUR VISION. WE ARE DEDICATED TO PROVIDING HIGH QUALITY SERVICES INCLUDING HOUSING, NUTRITIOUS MEALS, NURSING, HOUSEKEEPING, MAINTENANCE, AND OTHER SUPPORT TO THOSE WE SERVE. WE ARE COMMITTED TO BEING GOOD FINANCIAL STEWARDS, PROVIDING SUPPORT AND SPONSORSHIP FOR RESIDENTS WHEN APPROPRIATE, WHILE KEEPING COSTS COMMENSURATE WITH SERVICES PROVIDED. 0 0 14814425 0 19087008 HOLLADAY PARK PLAZA 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. 14814425 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 63 0 1 326 1 0 0 0 0 0 0 0 0 0 0 X 9 9 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 JOHN HUBBARD PRESIDENT 1.00 2.00 X X 0 0 0 TOM FULLER VICE PRESIDENT 1.00 1.00 X X 0 0 0 STEVEN THOMSON SECRETARY (THROUGH OCT 2017) 1.00 0.00 X X 0 0 0 JENNIFER MACNICHOL SECRETARY 1.00 0.00 X X 0 0 0 JOE OPSAHL TREASURER (THROUGH OCT 2017) 1.00 0.00 X X 0 0 0 LYNN JOHNSON TREASURER 1.00 3.00 X X 0 0 0 AARON BRAUN DIRECTOR 1.00 0.00 X 0 0 0 DAVID DOUTHWAITE DIRECTOR 1.00 0.00 X 0 0 0 KATHLEEN MCLAUGHLIN DIRECTOR 1.00 0.00 X 0 0 0 MICHELLE NEAL DIRECTOR 1.00 0.00 X 0 0 0 GREG NEEL DIRECTOR (RESIGNED IN FISCAL YEAR) 1.00 0.00 X 0 0 0 RON SHERWOOD RESIDENT DIRECTOR 1.00 0.00 X 0 0 0 SUSAN PLATTE EXECUTIVE DIRECTOR 40.00 0.00 X 188960 0 23656 THERESA TERRILL HR DIRECTOR 40.00 0.00 X 104173 20271 27490 JEFFREY HERINCKX HC ADMINISTRATOR 40.00 0.00 X 101289 0 28066 TERRI OGAN MARKETING DIRECTOR 40.00 0.00 X 100862 0 24234 IRENE MATHEWS HC DIRECTOR OF NURSING 40.00 0.00 X 101455 0 20753 596739 20271 124199 5 0 1 0 TURNER CONSTRUCTION COMPANY 1200 NW NAITO PARKWAY STE 300 PORTLAND OR 97209 CONSTRUCTION SERVICES 7710159 PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN STE 303 MEDFORD OR 97501 MANAGEMENT SERVICES 1218415 CONSONUS REHAB PO BOX 4800 UNIT 12 PORTLAND OR 97208 THERAPY SERVICES 723305 CONSONUS PHARMACY SERVICES PO BOX 4500 PORTLAND OR 97208 PHARMACY SERVICES 269807 HMS COMMERCIAL SERVICE INC PO BOX 50245 BELLEVUE WA 98015 HVAC SERVICE 235655 11 238928 85571 324499 SERVICE FEES 623000 9158802 9158802 HEALTH CENTER 623000 6248456 6248456 ENTRANCE FEES 623000 3131694 3131694 LEVEL OF CARE 623000 164299 164299 DIETARY 623000 142388 142388 241369 241369 19087008 347204 347204 51 51 75790 8195 67595 67595 67595 9883657 1800 8999060 0 884597 1800 886397 886397 20712754 19087008 0 1301247 232923 232923 5746256 5179812 566444 309552 241655 67897 912579 751581 160998 451385 396989 54396 1337935 1337935 2515 2515 21500 21500 23296 23296 654846 459479 195367 52185 52185 465824 371507 94317 126556 126556 1603673 1603673 63626 25798 37828 41725 26475 15250 622633 622633 2618085 2618085 179555 179555 HEALTH CENTER EXPENSE 1230999 1230999 OTHER DIETARY EXPENSE 1004120 1004120 OTHER FACILITY SERVICE 252122 102064 150058 PROGRAM FUND EXPENSES 143977 143977 18097867 14814425 3283442 0 584334 2020079 41564 51024 1147675 961964 52327 56996 146526 215837 79143013 26666008 48223626 52477005 17768087 16802239 3035410 3060696 70999549 75645840 2575884 1972685 22592671 26654181 22166311 21647283 583022 344535 275674 356935 48193562 50975619 X 20783641 22624379 1426889 1450385 595457 595457 22805987 24670221 70999549 75645840 X 2614887 -775939 25286 X 0 1 X 1 0 X 125192 222042 364222 385077 324499 1421032 15525867 17438351 17795516 17339684 19087008 87186426 15651059 17660393 18159738 17724761 19411507 88607458 97961 164893 262854 7444 7444 97961 172337 270298 88337160 450288 732688 558809 466013 423045 2630843 450288 732688 558809 466013 423045 2630843 16101347 18393081 18718547 18190774 19834552 91238301 0.96820 0.96480 0.02880 0.02990 X 0 0 0 18049314 18049314 1000000 250000 0 0 991055 1000000 1000000 1000000 3991055 5986583 247764 250000 250000 250000 997764 1496646 0 1 X 3071888 3071888 69007903 21991322 47016581 6917973 4674686 2243287 145249 145249 52477005 DUE TO AFFILIATES 163020 OTHER CURRENT LIABILITIES 1297 ASSET RETIREMENT OBLIGATION 80526 ENTRANCE FEES REFUNDABLE UPON REOCCUPANCY 105201 SWAP AGREEMENTS 6891 356935 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, 2018 AND 2017, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. 0 0 0 0 0 0 0 1 0 SUSAN PLATTE EXECUTIVE DIRECTOR 162270 0 26690 0 0 0 16826 0 6830 0 212616 0 0 0 THERESA TERRILL HR DIRECTOR 98223 20271 5950 0 0 0 21444 0 6046 0 131663 20271 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY HOLLADAY PARK PLAZA'S 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 THE HOSPITAL FACILITIES AUTHORITY OF MULTNOMAH COUNTY OREGON 931266280 2010-12-23 14445540 REFUND ISSUER'S SERIES 2003 BONDS (ISSUED ON 12/4/2003) 0 0 0 B THE HOSPITAL FACILITIES AUTHORITY OF MULTNOMAH COUNTY OREGON 931266280 2013-10-31 14067310 EXPANSION TO RETIREMENT COMMUNITY AND RENOVATIONS TO EXISTING BUILDING 0 0 0 A 2280000 14445540 280485 14165055 1 0 1 1 B 4100000 14067386 113908 234214 13719264 2015 0 0 0 1 A 0 1 1 1 0 0.00200 0.00000 0.00200 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 A 1 B 1 PART II, LINE 3, COLUMN B: THE DIFFERENCE BETWEEN PART I, COLUMN E AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON BOND 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 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 2C, COLUMN A: THE ISSUE QUALIFIED FOR A SPENDING EXCEPTION TO REBATE. NO REBATE CALCULATION HAS BEEN OR WILL EVER BE MADE, BEFORE OR AFTER THE DUE DATE OF A FORM 8038-T. PART IV, LINE 2C, COLUMN B: THE 5TH BOND YEAR HAS NOT OCCURRED, AND THUS NO REBATE COULD BE DUE. ADDITIONALLY, THE ISSUE QUALIFIED FOR A SPENDING EXCEPTION TO REBATE. NO REBATE CALCULATE HAS BEEN OR EVER WILL BE MADE BEFORE OR AFTER THE DUE DATE OF A FORM 8038-T. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE THAT CONSISTS OF THE OFFICERS OF THE BOARD AND SUCH OTHERS AS THE BOARD MAY DELEGATE. 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 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 HOLLADAY PARK PLAZA DELEGATES MANAGEMENT DUTIES 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 THE ORGANIZATION'S DIRECTORS, WHICH ARE NOMINATED BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER HAS THE FOLLOWING RESPONSIBILITIES: (1) THE ORGANIZATION'S MANAGEMENT STAFF WILL PREPARE THE ANNUAL BUDGET WITH THE ADVICE OF THE MEMBER. THE BUDGET WILL BE SUBMITTED TO THE ORGANIZATION'S BOARD OF DIRECTORS FOR REVIEW AND RECOMMENDATION TO THE MEMBER'S BOARD FOR APPROVAL PRIOR TO FINAL ADOPTION BY THE MEMBER; (2) APPROVAL OF ALL NON-BUDGETED EXPENDITURES AND CONTRACTS IN EXCESS OF $100,000; (3) APPOINTMENT OF THE OUTSIDE AUDITORS FOR THE ORGANIZATION; (4) REVIEW AND APPROVAL OF ANY CHANGES IN MATERIAL OPERATING POLICIES, MAJOR PROCEDURES, ORGANIZATION MISSION, AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE ORGANIZATION WHICH THE ORGANIZATION'S BOARD MAY FROM TIME TO TIME RECOMMEND; (5) APPROVAL OF ANY MERGER, ALL CONSOLIDATIONS, 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) CREATION OF ANY TAXABLE OR TAX-EXEMPT SUBSIDIARY ORGANIZATION TO THE ORGANIZATION; AND (7) APPROVAL OF ANY ACQUISITIONS OF CONTROLLING INTERESTS IN ORGANIZATIONS OF BUSINESSES BY THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO, ASSISTANT CONTROLLER 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 SUSAN PLATTE IS A LEASED EMPLOYEE OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORMS SERVICES ON BEHALF OF HOLLADAY PARK PLAZA PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN HOLLADAY PARK PLAZA AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, HER COMPENSATION IS REIMBURSED BY HOLLADAY PARK PLAZA. COMPENSATION HAS BEEN REPORTED IN FORM 990, PART VII, SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY HOLLADAY PARK PLAZA, NOTWITHSTANDING THAT SHE IS A LEASED EMPLOYEE OF PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE CAP/SWAP AGREEMENT -3,734. CHANGES IN INTEREST IN NET ASSETS OF FOUNDATION 29,020. PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931067253 SUPPORTING ORGANIZATION OR 501(C)(3) LINE 12D, III-O 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 11 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 11 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 11 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 11 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 11 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 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 1 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 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 11 PACIFIC RETIREMENT SERVICES INC 0 BAY AREA SENIOR SERVICES INC 1 BALDWIN AVENUE SAN MATEO CA 97501 943008774 SENIOR HOUSING CA 501(C)(3) LINE 11 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 931169683 REAL STATE 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 1 0 0 HOLLADAY PARK PLAZA FOUNDATION INC C 148026 CASH