2014-08-15T17:03:51-05:00 2013-09-30 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192303 990 2012-10-01 930513697 HOLLADAY PARK PLAZA HOLL 8887246424 1300 NE 16TH AVE PORTLAND OR 972321467 GEORGE WHEELER 8887246424 2014-08-11 1 TRACY S PAGLIA P00366884 2099556100 2012 2015-11-30 17:44:51Z DONNA MUEHLECK 965 ELLENDALE DRIVE MEDFORD OR 97504 15248209 0 X WWW.RETIREMENT.ORG X 1967 OR TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 9 9 277 95 0 0 206541 202894 13255954 14481484 257451 450662 75135 92709 13795081 15227749 0 0 0 0 5833912 6092617 0 0 0 7470890 7961499 13304802 14054116 490279 1173633 42874851 46396869 29666593 31920738 13208258 14476131 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.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 WHICH SUPPORT OUR VISION. WE ARE DEDICATED TO PROVIDING HIGH QUALITY SERVICES INCLUDING HOUSING, NUTRITIOUS MEALS, NURSING, 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 11509833 14481484 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. 11509833 1 1 0 1 0 0 0 0 0 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 53 0 1 277 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 SHERI LOYA 5418577644 965 ELLENDALE DRIVE MEDFORD OR 97504 X DONNA MUEHLECK 1.00 2.00 X X 0 0 0 STEPHEN SCHNEIDER 1.00 1.00 X X 0 0 0 INGRID BRYDOLF 1.00 1.00 X X 0 0 0 CHRISTOPHER TIFF WOOD 1.00 4.00 X X 0 0 0 NANCY JOHNS 1.00 1.00 X 0 0 0 MARIAN HODGES 1.00 1.00 X 0 0 0 JOE OPSAHL 1.00 1.00 X 0 0 0 STEVEN THOMSON 1.00 1.00 X 0 0 0 KERRY TYMCHUK 1.00 1.00 X 0 0 0 JOHN A HUBBARD 1.00 3.00 X X 0 0 0 MARK HALVORSEN 1.00 1.00 X 0 0 0 NANCY HALES 1.00 3.00 X 0 0 0 GEORGE WHEELER 40.00 X 113497 0 26095 JOHN LARSON 0.00 40.00 X 61203 169004 49304 174700 169004 75399 1 1 0 0 WALSH CONSTRUCTION CO OR 2905 SW FIRST AVE PORTLAND OR 97201 CONSTRUCTION 1843310 PACIFIC RETIREMENT SERVICES 965 ELLENDALE DRIVE MEDFORD OR 97504 MANAGEMENT SERVICES 943555 CONSONUS REHAB PO BOX 4800 UNIT 12 PORTLAND OR 97208 THERAPY SERVICES 626344 PC ELECTRIC PO BOX 517 NEWBERG OR 97132 ELECTRICAL 221344 GENERAL BUILDERS SUPPLY INC 510 STRANDER BLVD TUKWILA WA 98188 CONSTRUCTION 142645 11 202894 18990 202894 SERVICE FEES 623000 5949732 5949732 HEALTH SERVICE REVENUE 623000 5242392 5242392 ENTRANCE FEES 623000 2565048 2565048 DIETARY 623000 163329 163329 LEVEL OF CARE SVCS 623000 100590 100590 460393 460393 14481484 268092 268092 1 1 113169 20460 92709 92709 92709 182569 0 182569 182569 182569 15227749 14481484 0 543371 4731644 4121468 610176 183543 151242 32301 837599 676939 160660 339831 296153 43678 1067981 1067981 12335 12335 53905 53905 33584 33584 238347 158406 79941 125725 125725 360927 308883 52044 45126 45126 1329590 1308036 21554 47786 12644 35142 13858 5160 8698 233467 233467 2215713 2215713 139376 65747 73629 HEALTH CENTER EXPENSE 1107567 1107567 DIETARY EXPENSE 738551 738551 FACILITY SERVICE EXPENS 161306 73502 87804 ASSET DISPOSAL 21465 21465 14890 14890 14054116 11509833 2544283 0 2908240 3402734 10208734 13397561 610328 716310 39686 58173 154884 139667 48713385 20759668 28423867 27953717 529112 728707 42874851 46396869 1385928 1120369 13638779 16193387 14180000 13875000 461886 731982 29666593 31920738 X 13089843 14302569 36495 41642 81920 131920 13208258 14476131 42874851 46396869 X 1173633 39093 55147 X 0 1 X 1 0 X 158573 3276 10000 206541 202894 581284 13469940 13349343 13527850 13255954 14481484 68084571 13628513 13352619 13537850 13462495 14684378 68665855 56048 110175 166223 191357 7912 12525 101614 72174 385582 191357 7912 12525 157662 182349 551805 68114050 290797 349444 402147 417883 381262 1841533 290797 349444 402147 417883 381262 1841533 13919310 13702063 13939997 13880378 15065640 70507388 0.96610 0.96410 0.02610 0.02790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14054116 14054116 852706 213177 0 0 773556 815240 852706 2441502 3662253 193389 203810 213177 610376 915564 2944799 2944799 37979211 16583177 21396034 6231583 4176491 2055092 1557792 1557792 27953717 REFUNDABLE DEPOSITS 514450 DUE TO AFFILIATES 109088 OTHER NONCURRENT LIABILITIES 108444 731982 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013 AND 2012, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. 0 0 0 0 0 0 0 0 0 JOHN LARSON 61203 128515 0 36707 0 3782 0 23658 8571 17075 69774 209737 0 12535 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY HOLLADAY PARK PLAZA BOARD AS PART OF THE ANNUAL BUDGET PROCESS. A HOSPITAL FACILITIES AUTHORITY OF MULTNOMAH COUNTY OREGON 931266280 2010-12-23 14445540 REFUND ISSUER'S SERIES 2003 BONDS 0 0 0 A 585000 14445540 280485 14165055 2010 1 0 1 1 A 0 1 1 1 0 0.00300 0.00000 0.00300 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 PAR 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 2(C): THE ISSUE QUALIFIED FOR A SPENDING EXCEPTION TO REBATE. NO REBATE CALCULATION HAS BEEN OR WILL BE EVER MADE, BEFORE OR AFTER THE DUE DATE OF AN 8038-T. FORM 990, PART VI, SECTION A, LINE 3 HOLLADAY PARK PLAZA DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 HOLLADAY PARK PLAZA 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 SOME DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY PACIFIC RETIREMENT SERVICES, AS OUTLINED IN ARTICLE III, SECTION 3.2 OF THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS CURRENTLY BEING 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 GEORGE WHEELER AND JOHN LARSON ARE EMPLOYEES OF RETIREMENT SERVICES, INC. AND PERFORM SERVICES ON BEHALF OF HOLLADAY PARK PLAZA PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN HOLLADAY PARK PLAZA AND PACIFIC RETIREMENT SERVICES. UNDER THE MANAGEMENT SERVICES AGREEMENT, THEIR COMPENSATION IS REIMBURSED BY HOLLADAY PARK PLAZA. THEIR COMPENSATION IS REPORTED IN PART VII SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY HOLLADAY PARK PLAZA, NOTWITHSTANDING THAT THEY ARE EMPLOYED BY RETIREMENT SERVICES, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN HOLLADAY PARK PLAZA FOUNDATION 55,147. PACIFIC RETIREMENT SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931067253 SUPPORTING ORGANIZATION OR 501(C)(3) LINE 11C, III-FI N/A 0 ROGUE VALLEY MANOR 965 ELLENDALE DRIVE MEDFORD OR 97504 930453216 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 THE CUMBERLAND REST INC 965 ELLENDALE DRIVE MEDFORD OR 97504 750891470 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CASCADE MANOR INC 965 ELLENDALE DRIVE MEDFORD OR 97504 930557803 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 965 ELLENDALE DRIVE MEDFORD OR 97504 931179254 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA ENDOWMENT FUND 965 ELLENDALE DRIVE MEDFORD OR 97504 930776291 ASSISTANCE TRUST OR 501(C)(3) LINE 7 HOLLADAY PARK PLAZA 1 CAPITOL LAKES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 391412320 SENIOR HOUSING WI 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 TRINITY TERRACE FOUNDATION INC 965 ELLENDALE DRIVE MEDFORD OR 97504 912162130 PUBLIC FOUNDATION TX 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 264529118 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA WASHINGTON FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 450574348 PUBLIC FOUNDATION WA 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 CASCADE MANOR FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 931330100 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA 965 ELLENDALE DRIVE MEDFORD OR 97504 342030255 SENIOR HOUSING WA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA AT SOUTH WATERFRONT 965 ELLENDALE DRIVE MEDFORD OR 97504 711016384 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM COMMUNITY SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 930892261 COMM SRVCS OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM EAGLE POINT HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943191447 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM KLAMATH FALLS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943196455 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM MEDFORD II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943212537 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM LIVELY OAKS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943194409 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM REEDSPORT HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943212538 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM YREKA HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943212540 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM EUGENE HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943247154 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943260016 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM MANSFIELD HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 900292647 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK 965 ELLENDALE DRIVE MEDFORD OR 97504 931169683 HOTEL OR N/A C 0 RETIREMENT SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931328250 MANAGEMENT COMPANY OR N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 HOLLADAY PARK PLAZA ENDOWMENT Q 183904 CASH