2016-02-15T00:00:00-06:00 2015-09-30 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2014-10-01 750891470 THE CUMBERLAND REST INC CUMB 8887246424 1600 TEXAS ST FORT WORTH TX 761023434 LEE PATTERSON EXECUTIVE DIRECTOR 8887246424 2016-02-15 1 TRACY S PAGLIA P00366884 2099556100 2016-02-15 2014 2016-08-17 19:52:53Z TRINITY TERRACE DOUG WILSON 1 WEST MAIN SUITE 303 MEDFORD OR 97501 46549926 0 X WWW.RETIREMENT.ORG X 1943 TX TO PROVIDE COMPREHENSIVE CARE AND HOUSING FOR THE ELDERLY. 13 13 204 81 0 0 29090 12637 17079171 17032831 1599424 1876024 4337714 5444440 23045399 24365932 0 0 0 0 6916685 7452124 0 0 0 12690876 15164817 19607561 22616941 3437838 1748991 140494607 192822123 102802164 160077303 37692443 32744820 TRINITY TERRACE IS A NOT-FOR-PROFIT CONTINUING CARE RETIREMENT COMMUNITY PROVIDING EXCEPTIONAL SERVICES AND A SECURE, COMFORTABLE ENVIRONMENT TO ENRICH THE LIVES OF SENIORS. 0 0 17613952 17032831 CUMBERLAND REST, INC. 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. 17613952 1 0 0 1 0 0 0 0 0 0 1 0 0 1 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 0 0 0 1 98 0 1 204 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X SHERI LOYA 5418577644 1 WEST MAIN SUITE 303 MEDFORD OR 97501 X X DOUG WILSON CHAIR 1.00 2.00 X X 0 0 0 JIM WHITTON DIRECTOR 1.00 X 0 0 0 GRETCHEN SMITH SECRETARY 1.00 1.00 X X 0 0 0 MICHAEL HYATT TREASURER 1.00 X X 0 0 0 ALLAN BARR VICE CHAIR 1.00 1.00 X X 0 0 0 JIM AUSTIN DIRECTOR 1.00 X 0 0 0 DONALD MILLS DIRECTOR 1.00 X 0 0 0 CARLELA VOGEL DIRECTOR 1.00 1.00 X 0 0 0 REV KARL TRAVIS DIRECTOR 1.00 X 0 0 0 MICK MCMAHON DIRECTOR 1.00 X 0 0 0 DIONNE BAGSBY DIRECTOR (THROUGH 10/15) 1.00 X 0 0 0 ROBERT FERNANDEZ DIRECTOR 1.00 X 0 0 0 ANDY TAFT DIRECTOR 1.00 X 0 0 0 LEE PATTERSON EXECUTIVE DIRECTOR 40.00 X 193952 0 30064 BRYON SCHIFFER HEALTH SERVICES ADMINISTRA 40.00 X 112476 0 24777 ESTHER RASHAD DIRECTOR OF NURSING 40.00 X 104311 0 15812 LINE WILSON REGIONAL SALES DIRECTOR 30.00 10.00 X 125410 0 16421 536149 0 87074 4 0 1 0 LONE STAR CLASSIC CONSTRUCTION 3750 KELLY ROAD ALEDO TX 76008 CONSTRUCTION 2977445 PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 MANAGEMENT SERVICES 2904116 ANKROM MOISAN 6720 SW MACADAM AVE PORTLAND OR 97219 ARCHITECTS 1934035 CONSONUS REHAB UNIT 12 PO BOX 4800 PORTLAND OR 97208 THERAPY 537683 OTIS ELEVATOR COMPANY INC PO BOX 730400 DALLAS TX 75753 ELEVATOR REPAIRS & MAINTENANCE 213982 9 12637 12637 SERVICE FEES 623000 11241825 11241825 HEALTH SERVICE REVENUE 623000 3272044 3272044 ENTRANCE FEES 623000 2155270 2155270 DIETARY 623000 190688 190688 LEVEL OF CARE SVCS 623000 85678 85678 87326 87326 17032831 1862338 1862338 1 1 5444440 5444440 22197179 500 22183994 0 13185 500 13685 13685 24365932 17032831 0 7320464 250690 250690 5527528 4712220 815308 159780 138106 21674 1095643 946350 149293 418483 348655 69828 1481221 1481221 4403 4403 57028 57028 401159 401159 750162 601413 148749 255561 255561 440103 320111 119992 87174 87174 84215 84215 1804138 1804116 22 86179 32030 54149 26065 14042 12023 2312683 2312683 4025238 4025238 162716 162716 DIETARY EXPENSES 965566 965566 BOND FEES WRITE-OFF EXP 962050 962050 HEALTH CENTER EXPENSES 702075 702075 FACILITY SERVICE EXPENS 305482 192817 112665 251599 251599 22616941 17613952 5002989 0 1202718 3550892 4705239 12484616 423048 432857 38220 56333 245613 240286 110675675 43720465 53665964 66955210 42237435 71328016 37976370 37773913 140494607 192822123 3784544 8215613 50897033 52235421 42165000 92186652 5955587 7439617 102802164 160077303 X -7412643 12562014 33501420 5225279 11603666 14957527 37692443 32744820 140494607 192822123 X 1748991 -2707431 -3989183 X 0 1 X 1 0 X 7789 33761 16895 29090 12637 100172 17444437 17513263 16726156 17079171 17032832 85795859 17452226 17547024 16743051 17108261 17045469 85896031 0 48382 48382 48382 48382 85847649 805097 747383 3644952 5405605 7306779 17909816 805097 747383 3644952 5405605 7306779 17909816 18257323 18294407 20388003 22513866 24352248 103805847 0.82700 0.88320 0.17250 0.11630 X 22615941 22615941 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 250000 250000 250000 250000 1000000 1500000 703022 703022 98724692 37859148 60865544 10558655 5373890 5184765 689306 487427 201879 66955210 BOND ISSUE COSTS 2303116 INTEREST IN NET ASSETS OF TRINITY TERRACE FOUNDATION 21757 OIL AND GAS MINERAL RIGHTS 35449040 37773913 REFUNDABLE DEPOSITS 3331109 SWAP AGREEMENT 4044219 DUE TO AFFILIATES 64289 7439617 X 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 EXPENSE. AT SEPTEMBER 30, 2015 AND 2014, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. 0 0 0 0 0 0 0 1 0 LEE PATTERSON EXECUTIVE DIRECTOR 165123 0 28829 0 0 0 16285 0 13779 0 224016 0 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY THE CUMBERLAND REST, INC. BOARD AS PART OF THE ANNUAL BUDGET PROCESS. PART I, LINE 7 THE ORGANIZATION PAID BONUSES THIS YEAR. THE PROCESS FOR DETERMINING EXECUTIVE BONUSES IS DISCRETIONARY, IT IS DETERMINED BY THE VP OF OPERATIONS FOR PRS AND IT IS BASED ON THE PERFORMANCE OF THE COMMUNITY FOR THE YEAR. A TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINANCE CORPORATION 043833551 2014-12-18 44932530 FINANCE FACILITY IMPROVEMENTS AND REIMBURSEMENTS 0 0 0 B TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINANCE CORPORATION 043833551 87638TEW9 2014-12-18 86742084 FINANCE BUILDING EXPANSION & REFUND SERIES 2011 ISSUE 0 0 0 A 44935674 1898143 25791 751250 2860622 39399869 0 0 0 1 B 86822490 4900244 427271 1551208 2335699 42189411 35418656 1 0 0 1 A 0 1 1 1 0 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00100 0.00100 0 0 1 A 0 1 0 0 1 1 MORGAN STANLEY CAPITAL SERVICE 24.600000000000 0 0 0 0 1 B 0 1 1 0 0 0 0 0 1 A 1 B 1 SCHEDULE K, PART II, LINE 3 AMOUNT LISTED DIFFERS FROM THE ISSUE PRICE LISTED IN PART I (E) DUE TO INTEREST EARNINGS ON INVESTED PROCEEDS. SCHEDULE K, 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. BOND A, PART I (E),PART II,LINE 3 LOAN IS A DRAW-DOWN LOAN, AND THE ISSUE PRICE, AMOUNT OF PROCEEDS AND USES OF PROCEEDS ASSUME ALL EXPECTED DRAWS TO BE MADE. BOND B SCHEDULE K, PART I (F) THE BONDS REFUNDED A SERIES 2011 ISSUANCE, ISSUED 12/29/11. BOND B SCHEDULE K, PART IV,LINE 2B THE CURRENT REFUNDING PORTION OF THE BONDS HAS QUALIFIED FOR THE 6- MONTHS EXCEPTION TO REBATE. FORM 990, PART VI, SECTION A, LINE 3 THE CUMBERLAND REST, INC. (AKA TRINITY TERRACE) BOARD DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 6 THE CUMBERLAND REST, INC. (AKA TRINITY TERRACE) HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A PACIFIC RETIREMENT SERVICES, INC. HAS THE AUTHORITY TO ELECT ALL DIRECTORS FROM NOMINEES SELECTED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY PACIFIC RETIREMENT SERVICES, INC. AS OUTLINED IN ARTICLE III, SECTION 2 OF THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS 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 ED'S DIRECT SUPERVISOR (COO OR VP OF OPERATIONS). FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS GO THROUGH CORPORATE COUNSEL. FORM 990, PART VII, SECTION A: NOTE THAT LEE PATTERSON AND BRYON SCHIFFER ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORM SERVICES ON BEHALF OF THE CUMBERLAND REST, INC. PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN THE CUMBERLAND REST, INC. AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, THEIR COMPENSATION IS REIMBURSED BY THE CUMBERLAND REST, INC. COMPENSATION HAS BEEN REPORTED IN PART VII SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY THE CUMBERLAND REST, INC., NOTWITHSTANDING THAT THEY ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART XI, LINE 9: SWAP GAIN -955,999. CHANGE IN INTEREST IN NET ASSETS OF TRINITY TERRACE FOUNDATION -2,441. CHANGE IN FAIR VALUE OF ASSETS -3,030,743. PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931067253 SUPPORTING ORGANIZATION OR 501(C)(3) LINE 11C, III-FI N/A 0 PACIFIC RETIREMENT SERVICES FOUNDATION 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 9 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 9 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 9 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930513697 SENIOR HOUSING OR 501(C)(3) LINE 9 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 9 PACIFIC RETIREMENT SERVICES INC 0 ROGUE VALLEY MANOR FOUNDATIONINC 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 AT DAVIS FOUNDATIONINC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931301816 PUBLIC FOUNDATION CA 501(C)(3) LINE 7 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 0 TRINITY TERRACE FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 912162130 PUBLIC FOUNDATION TX 501(C)(3) LINE 7 THE CUMBERLAND REST INC 1 HOLLADAY PARK PLAZA FOUNDATIONINC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 264529118 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 HOLLADAY PARK PLAZA 0 MIRABELLA WASHINGTON FOUNDATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 450574348 PUBLIC FOUNDATION WA 501(C)(3) LINE 7 MIRABELLA 0 CASCADE MANOR FOUNDATIONINC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931330100 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CASCADE MANOR INC 0 CAPITOL LAKES FOUNDATIONINC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 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