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CAPITOL LAKES INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
CAPITOL LAKES INC (EIN 39-1412320)
Tax period
2015-10-01 to 2016-09-30
Filed
2017-08-07
IRS object ID
201702199349300045
Schema version
2015v3.0
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)
Return2017-08-07T18:32:22-05:00ReturnTs
Tax Period End2016-09-30TaxPeriodEndDt

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 Begin2015-10-01TaxPeriodBeginDt

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
Signature2017-08-02SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKURT BENNIONPreparerPersonNm
PTINP01469618PTIN
Phone4252506100PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLARRY BOECKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 WEST MAIN SUITE 303AddressLine1Txt
CityMEDFORDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97501ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$28,781,447GrossReceiptsAmt
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 Employee395TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$74,655PYContributionsGrantsAmt
CY Contributions Grants$3,626,110CYContributionsGrantsAmt
PY Program Service Revenue$20,589,111PYProgramServiceRevenueAmt
CY Program Service Revenue$20,773,042CYProgramServiceRevenueAmt
PY Investment Income$246,225PYInvestmentIncomeAmt
CY Investment Income-$5,630CYInvestmentIncomeAmt
PY Other Revenue$14,260PYOtherRevenueAmt
CY Other Revenue$13,985CYOtherRevenueAmt
PY Total Revenue$20,924,251PYTotalRevenueAmt
CY Total Revenue$24,407,507CYTotalRevenueAmt
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$9,477,016PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,341,445CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$15,672,147PYOtherExpensesAmt
CY Other Expenses$18,975,973CYOtherExpensesAmt
PY Total Expenses$25,149,163PYTotalExpensesAmt
CY Total Expenses$29,317,418CYTotalExpensesAmt
PY Revenues Less Expenses-$4,224,912PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$4,909,911CYRevenuesLessExpensesAmt
Total Assets BOY$58,317,825TotalAssetsBOYAmt
Total Assets EOY$51,639,042TotalAssetsEOYAmt
Total Liabilities BOY$104,157,130TotalLiabilitiesBOYAmt
Total Liabilities EOY$102,774,996TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$45,839,305NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$51,135,954NetAssetsOrFundBalancesEOYAmt
MissionCAPITOL LAKES IS A VIBRANT CONTINUING CARE RETIREMENT COMMUNITY COMMITTED TO THE ENRICHMENT OF RESIDENTS' LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$19,939,950ExpenseAmt
Grant$0GrantAmt
Revenue$20,773,042RevenueAmt
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$19,939,950TotalProgramServiceExpensesAmt
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 SecYes (1)ReportInvestmentsOtherSecInd
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 BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
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 Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document59IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee395EmployeeCnt
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
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SHERI LOYABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5418577644PhoneNum

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 (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
LARRY BOECK
CHAIR1.002.00Yes (X)Yes (X)$0$0$0
PAULA BONNER
VICE CHAIR1.000.00Yes (X)Yes (X)$0$0$0
BRIAN PURTELL
SECRETARY / TREASURER1.000.00Yes (X)Yes (X)$0$0$0
SUE CENTER
DIRECTOR (THROUGH 2/23/16)1.001.00Yes (X)$0$0$0
SALLY DREW
RESIDENT DIRECTOR1.000.00Yes (X)$0$0$0
DENISE GLOEDE
DIRECTOR1.000.00Yes (X)$0$0$0
JOE SILVERBERG
RESIDENT DIRECTOR (THROUGH 6/27/16)1.000.00Yes (X)$0$0$0
TIM CONROY
EXECUTIVE DIRECTOR40.003.00$193,296$0$29,749Yes (X)
TSERING DAMDUL
REGISTERED NURSE40.000.00$110,465$0$18,364Yes (X)
KRISTI VATER
HEALTH CARE ADMINISTRATOR40.001.00$110,166$0$16,525Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$413,927TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$64,638TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CONSONUS REHAB
PO BOX 4800 UNIT 12PORTLANDOR97208THERAPY SERVICES$1,663,552
PACIFIC RETIREMENT SERVICES
1 WEST MAIN SUITE 303MEDFORDOR97501MANAGEMENT SERVICES$1,132,501
MCGANN CONSTRUCTION INC
3622 LEXINGTON AVENUEMADISONWI53714CONSTRUCTION SERVICES$383,658
KVALHEIM KOUNTRY PAINTERS LLC
410 JOYCE COURTSUN PRAIRIEWI53590PAINTING SERVICES$112,083
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Related Organizations$3,543,803RelatedOrganizationsAmt
All Other Contributions$82,307AllOtherContributionsAmt
Total Contributions$3,626,110TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
HEALTH CENTER623000$9,877,014$9,877,014
SERVICE FEES623000$8,933,278$8,933,278
ENTRANCE FEES623000$841,844$841,844
DIETARY623000$208,079$208,079
GARAGE & CARPORT623000$50,407$50,407

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$862,420TotalRevenueColumnAmt
Related Or Exempt Func Income$862,420RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$20,773,042TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$108,634TotalRevenueColumnAmt
Exclusion$108,634ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$52,707TotalRevenueColumnAmt
Exclusion$52,707ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$13,985RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$13,985RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,985TotalRevenueColumnAmt
Exclusion$13,985ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$4,206,269SecuritiesAmt
Other$700OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$4,373,940SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$167,671SecuritiesAmt
Other$700OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$166,971TotalRevenueColumnAmt
Exclusion-$166,971ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,407,507TotalRevenueColumnAmt
Related Or Exempt Func Income$20,773,042RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$8,355ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$244,941TotalAmt
Management And General$244,941ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,928,442TotalAmt
Program Services$7,161,936ProgramServicesAmt
Management And General$766,506ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$388,744TotalAmt
Program Services$339,399ProgramServicesAmt
Management And General$49,345ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,186,902TotalAmt
Program Services$1,032,921ProgramServicesAmt
Management And General$153,981ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$592,416TotalAmt
Program Services$526,512ProgramServicesAmt
Management And General$65,904ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,177,322TotalAmt
Management And General$1,177,322ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,938,092TotalAmt
Management And General$4,938,092ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$64,703TotalAmt
Management And General$64,703ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$14,157TotalAmt
Management And General$14,157ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$747,396TotalAmt
Program Services$430,751ProgramServicesAmt
Management And General$316,645ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$259,933TotalAmt
Management And General$259,933ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$756,222TotalAmt
Program Services$653,655ProgramServicesAmt
Management And General$102,567ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$116,814TotalAmt
Management And General$116,814ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,249,623TotalAmt
Program Services$1,247,942ProgramServicesAmt
Management And General$1,681ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$110,098TotalAmt
Program Services$39,789ProgramServicesAmt
Management And General$70,309ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$39,305TotalAmt
Program Services$30,985ProgramServicesAmt
Management And General$8,320ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,437,117TotalAmt
Program Services$1,437,117ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,387,667TotalAmt
Program Services$3,387,667ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$188,373TotalAmt
Program Services$188,373ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
HEALTH CENTER EXPENSE$2,445,317$2,445,317
OTHER DIETARY EXPENSE$920,349$920,349
BOND FEES WRITE-OFF EXP$877,386$877,386
OTHER FACILITY SERVICE$246,099$97,237$148,862

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$29,317,418TotalAmt
Program Services$19,939,950ProgramServicesAmt
Management And General$9,377,468ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,843,913BOYAmt
EOY$2,457,886EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,088,194BOYAmt
EOY$193EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,546,949BOYAmt
EOY$1,692,408EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$51,909BOYAmt
EOY$59,399EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$710,345BOYAmt
EOY$514,821EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$64,578,339LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$23,971,553LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$42,951,982BOYAmt
EOY$40,606,786EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,331,646BOYAmt
EOY$1,846,890EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$3,466,709EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,792,887BOYAmt
EOY$993,950EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$58,317,825BOYAmt
EOY$51,639,042EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,603,515BOYAmt
EOY$6,183,316EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$5,691,193BOYAmt
EOY$5,833,795EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$46,585,000BOYAmt
EOY$53,566,113EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$755,212BOYAmt
EOY$297,052EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$5,590,000BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$43,932,210BOYAmt
EOY$36,894,720EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$104,157,130BOYAmt
EOY$102,774,996EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$46,762,995BOYAmt
EOY-$52,143,231EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$847,363BOYAmt
EOY$930,950EOYAmt

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-$45,839,305BOYAmt
EOY-$51,135,954EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$58,317,825BOYAmt
EOY$51,639,042EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$4,909,911ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$27,930NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$414,669OtherChangesInNetAssetsAmt
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 Minus2 Years$2,948CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$74,655CurrentTaxYearMinus1YearAmt
Current Tax Year$3,626,110CurrentTaxYearAmt
Total$3,703,713TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,830,608CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,572,205CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$18,738,492CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,589,111CurrentTaxYearMinus1YearAmt
Current Tax Year$20,773,042CurrentTaxYearAmt
Total$96,503,458TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,830,608CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,572,205CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$18,741,440CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,663,766CurrentTaxYearMinus1YearAmt
Current Tax Year$24,399,152CurrentTaxYearAmt
Total$100,207,171TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$41,383CurrentTaxYearMinus1YearAmt
Total$41,383TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,634CurrentTaxYearMinus4YearsAmt
Total$8,634TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,634CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus1 Year$41,383CurrentTaxYearMinus1YearAmt
Total$50,017TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$100,157,154PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$240,532CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$186,015CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$242,661CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$286,356CurrentTaxYearMinus1YearAmt
Current Tax Year$175,326CurrentTaxYearAmt
Total$1,130,890TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$240,532CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$186,015CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$242,661CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$286,356CurrentTaxYearMinus1YearAmt
Current Tax Year$175,326CurrentTaxYearAmt
Total$1,130,890TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,071,140CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,758,220CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$18,984,101CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,950,122CurrentTaxYearMinus1YearAmt
Current Tax Year$24,574,478CurrentTaxYearAmt
Total$101,338,061TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98830PublicSupportCY509Pct
Public Support PY5090.98630PublicSupportPY509Pct
Investment Income CY0.01120InvestmentIncomeCYPct
Investment Income PY0.01240InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$29,317,418FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$29,317,418FilingOrganizationsTotalAmt

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$52,661,384OtherCostOrOtherBasisAmt
Depreciation$22,211,357DepreciationAmt
Book Value$30,450,027BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,029,698OtherCostOrOtherBasisAmt
Depreciation$1,760,196DepreciationAmt
Book Value$1,269,502BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$349,657OtherCostOrOtherBasisAmt
Book Value$349,657BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$40,606,786TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescENRANCE FEE DEPOSIT ESCROW ACCOUNTDesc
Book Value$3,466,709BookValueAmt
Method ValuationCMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$3,466,709TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
DUE TO AFFILIATES$457,742
OTHER CURRENT LIABILITIES$63,205
ASSET RETIREMENT OBLIGATION$1,450
ENTRANCE FEES REFUNDABLE UPON REOCCUPANCY$36,372,323
FieldValueIRS element (for citing)
Total Liability$36,894,720TotalLiabilityAmt
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:CAPITOL LAKES, INC. 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 ORGANIZATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2016 AND 2015, 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$167,696BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$25,600BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$15,011DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$14,738NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$223,045TotalCompensationFilingOrgAmt
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 K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN391337855BondIssuerEIN
CUSIP97710V7V4CUSIPNum
Bond Issued2008-04-01BondIssuedDt
Issue Price$44,590,000IssuePriceAmt
PurposeACQUIRE, CONSTRUCT, RENOVATE AND IMPROVE FACILITIES AND REFUND BONDS.PurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$3,295,000RetiredAmt
Total Proceeds$44,812,994TotalProceedsAmt
In Reserve Fund$155InReserveFundAmt
Capitalized Interest$771,878CapitalizedInterestAmt
Issuance Costs From Proceeds$690,604IssuanceCostsFromProceedsAmt
Credit Enhancement$724,551CreditEnhancementAmt
Capital Expenditures$36,018,638CapitalExpendituresAmt
Other Spent Proceeds$6,607,323OtherSpentProceedsAmt
Substantial Completion2009SubstantialCompletionYr
Current RefundingYes (1)CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease ArrangementsYes (1)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (1)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsYes (1)EngageBondCounselContractsInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00500PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00500TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To RebateYes (1)ExceptionToRebateInd
No Rebate DueYes (1)NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And RecYes (1)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1KBC BANKBusinessNameLine1Txt
FieldValueIRS element (for citing)
Term Of Hedge11.900000000000TermOfHedgePct
Superintegrated Hedge0SuperintegratedHedgeInd
Hedge TerminatedYes (1)HedgeTerminatedInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DATE REBATE COMPUTATION PERFORMEDISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/01/2013
PART I, COLUMN F:THE BONDS REFUND THE ISSUER'S SERIES 1995 REDEVELOPMENT REVENUE BONDS, ISSUED ON 4/25/1995, AND THE ISSUER'S SERIES 1999 REVENUE BONDS, ISSUED ON 8/25/1999.
PART II, LINE 3:THE AMOUNT DIFFERENT FROM PART I, COLUMN E DUE TO INTEREST EARNED 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 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 2B:THE BONDS CONSIST OF BOTH A CURRENT REFUNDING, WHICH HAS MET AN EXCEPTION TO THE REBATE REQUIREMENT, AND A NEW MONEY FINANCING, WHICH HAS NOT MET AN EXCEPTION TO THE REBATE REQUIREMENT.
PART IV, LINE 2E:THE QUALITIFIED HEDGE BETWEEN KBC BANK AND THE ISSUER WAS TERMINATED AS OF FEBRUARY 9, 2016.

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 11THE 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 ANOTE 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:CHANGE IN VALUE OF INTEREST RATE CAP/SWAP AGREEMENT -484,929. CHANGES IN INTEREST IN NET ASSETS OF FOUNDATION 70,260.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (46 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 11C, 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 90PACIFIC RETIREMENT SERVICES INC
THE CUMBERLAND REST INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501750891470SENIOR HOUSINGTX501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
CASCADE MANOR INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501930557803SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
UNIVERSITY RETIREMENT COMMUNITY AT DAVIS INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501931179254SENIOR HOUSINGCA501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
HOLLADAY PARK PLAZA INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501930513697SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC 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 INC
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 INC
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 70PACIFIC RETIREMENT SERVICES INC
MIRABELLA PORTLAND FOUNDATION INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501452508860PUBLIC FOUNDATIONOR501(C)(3)LINE 90MIRABELLA AT SOUTH WATERFRONT
MIRABELLA AT SOUTH WATERFRONT
1 WEST MAIN ST SUITE 303MEDFORDOR97501711016384SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
COMMUNITY VOLUNTEER NETWORK
1 WEST MAIN ST SUITE 303MEDFORDOR97501930892261COMMUNITY SERVICESOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501930864466SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM ASHLAND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501930942933SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM GRANTS PASS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943136037SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM ROSEBURG HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943179782SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM MYRTLE CREEK HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943162074SENIOR HOUSINGOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM BEND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943163349SENIOR HOUSINGOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM EAGLE POINT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943191447SENIOR HOUSINGOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM KLAMATH FALLS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943196455SENIOR HOUSINGOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM MEDFORD II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212537SENIOR HOUSINGOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM LIVELY OAKS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943194409SENIOR HOUSINGOR501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM REEDSPORT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212538SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM YREKA HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943212540SENIOR HOUSINGCA501(C)(3)LINE 70PACIFIC RETIREMENT SERVICES INC
RVM EUGENE HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943247154SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM FORT WORTH I HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311520436SENIOR HOUSINGTX501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM BEND II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501943260016SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM FORT WORTH II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587415SENIOR HOUSINGTX501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM MEDFORD III HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587418SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM ROSEBURG II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311587420SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM GRANTS PASS II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311662259SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM DAVIS HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311662208SENIOR HOUSINGCA501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM MYRTLE CREEK II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311715321SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM PORTLAND HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501311780332SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM PORTLAND II HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501300037898SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM CENTRAL POINT HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501300315618SENIOR HOUSINGOR501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
RVM MANSFIELD HOUSING CORPORATION
1 WEST MAIN ST SUITE 303MEDFORDOR97501900292647SENIOR HOUSINGTX501(C)(3)LINE 90PACIFIC RETIREMENT SERVICES INC
MIDDLETON GLEN INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501911859494SENIOR HOUSINGWI501(C)(3)LINE 9Yes (1)CAPITOL LAKES INC
SENIOR HOUSING OF MIDDLETON INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501470825736SENIOR HOUSINGWI501(C)(3)LINE 9Yes (1)CAPITOL LAKES INC
MIRABELLA AT ASU INC
1 WEST MAIN ST SUITE 303MEDFORDOR97501813784956SENIOR HOUSINGAZ501(C)(3)LINE 90PACIFIC 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