2013-08-15T18:45:00-05:00 2012-09-30 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2011-10-01 931179254 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS UNIV 8887246424 1515 SHASTA DRIVE DAVIS CA 95616 MATT NEAL 8887246424 2013-08-15 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-02-25 16:41:14Z JACQUE BARTHOLOMEW 965 ELLENDALE DRIVE MEDFORD OR 97504 23173690 0 X WWW.RETIREMENT.ORG X 1995 CA TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 6 6 247 10 0 0 0 0 18453933 19634762 4266429 269786 30747 30579 22751109 19935127 0 0 0 0 6919675 7259053 0 0 0 10365018 11447751 17284693 18706804 5466416 1228323 76790490 74120414 73684578 70007742 3105912 4112672 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS PROVIDES CONTINUING CARE, QUALITY SERVICES, AND DIVERSE OPPORTUNITIES THAT ENHANCE THE LIVES OF OUR RESIDENTS. 0 0 15501894 0 19634762 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 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. 15501894 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 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 0 0 0 0 1 46 0 1 247 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X SHERI DRESSLER 5418577644 965 ELLENDALE DRIVE MEDFORD OR 97504 X WILLIAM L LEEVER 1.00 X 0 4000 0 JACQUE BARTHOLOMEW 1.00 X X 0 0 0 JAY T GERBER 1.00 X X 0 0 0 PAUL HART 1.00 X X 0 0 0 DENNIS LINDSAY 1.00 X X 0 0 0 WAYNE SCRADER 1.00 X 0 0 0 MICHAEL A MORRIS 40.00 X 175752 0 46604 ALIKA CASTILLO 40.00 X 119615 0 27484 295367 4000 74088 1 0 1 0 A P THOMAS CONSTRUCTION INC 2330 BUTANO DRIVE SACRAMENTO CA 95825 CONSTRUCTION 6671064 PACIFIC RETIREMENT SERVICES 965 ELLENDALE DRIVE MEDFORD OR 97504 MANAGEMENT SERVICES 1106006 CNL CONSTRUCTION INC 895 EMBARCADERO DRIVE 206 EL DORADO HILLS CA 95762 CONSTRUCTION 960607 CONSONUS REHAB PO BOX 4800 PORTLAND OR 97208 THERAPY SERVICES 548766 KAISER FOUNDATION HEALTH PLAN INC P O BOX 60000 SAN FRANCISCO CA 94160 EMPLOYEE BENEFITS 233374 17 SERVICE FEES 623000 10553510 10553510 HEALTH CENTER REVENUE 623000 4802497 4802497 ENTRANCE FEES 623000 3698291 3698291 DINING REVENUE 623000 177922 177922 GARAGE & CARPORT REVEN 623000 57997 57997 344545 344545 19634762 306163 306163 2186 2186 30579 0 30579 30579 30579 3200000 3238563 -38563 -38563 -38563 19935127 19634762 0 300365 156632 156632 5583431 5039732 543699 260679 224318 36361 800138 694716 105422 458173 404472 53701 1311986 1311986 20152 20152 57527 57527 36442 36442 9558 9558 284128 8071 276057 261404 202837 58567 47483 47483 1507189 1506976 213 72219 21237 50982 22894 13966 8928 1897581 1897581 2762082 2762082 137663 137663 DIETARY EXPENSE 997537 997537 HEALTH CENTER EXPENSE 933675 933675 CONTRACT SERVICES 428220 319378 108842 FACILITY SERVICES 423006 337653 85353 237005 237005 18706804 15501894 3204910 0 3768735 3746928 9952983 9263324 527702 368486 36611 39331 197395 221478 79467023 27426080 53147954 52040943 8080590 7419911 1078520 1020013 76790490 74120414 2917932 1392345 25739084 27409453 38665000 34375000 6362562 6830944 73684578 70007742 X 3073239 4089352 32673 23320 3105912 4112672 76790490 74120414 X 1228323 -221563 X 0 1 1 X 0 X 16612210 17444093 17710533 18453933 19634762 89855531 16612210 17444093 17710533 18453933 19634762 89855531 0 12781 21709 34490 12781 21709 34490 89821041 1169418 860620 701071 383338 338928 3453375 1169418 860620 701071 383338 338928 3453375 2055 2055 17781628 18304713 18411604 18839326 19973690 93310961 0.96260 0.95020 0.03700 0.04940 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME 0 0 18706804 18706804 1000000 250000 0 0 1000000 1000000 2000000 3000000 0 250000 250000 500000 750000 2250000 2250000 68811342 21924268 46887074 4404076 2564870 1839206 4001605 2936942 1064663 52040943 REFUNDABLE DEPOSITS 226000 SWAP AGREEMENT 6452724 DUE TO AFFILIATES 152220 6830944 19935127 18706804 1228323 511125 -732688 -221563 1006760 19677122 511125 511125 19165997 36442 732688 769130 19935127 18670362 0 18670362 36442 36442 18706804 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 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, 2012 AND 2011, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: SWAP AGREEMENT LOSS -723,335. CHANGE IN INTEREST IN NET ASSETS OF URC FOUNDATION -9,353. TOTAL TO SCHEDULE D, PART XI, LINE 8: -732,688. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 723,335. CHANGE IN INTEREST IN NET ASSETS OF URCADF 9,353. 0 0 0 0 0 0 0 0 0 MICHAEL A MORRIS 147152 0 28600 0 0 0 29022 0 17582 0 222356 0 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC. AND APPROVED BY UNIVERSITY RETIREMENT COMMUNITY AT DAVIS BOARD AS PART OF THE ANNUAL BUDGET PROCESS. CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2010-09-15 29970000 REFUND BORROWER'S SERIES 2003 BONDS 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 130795SS7 2008-07-07 15000000 CONSTRUCTION, EXPANSION, IMPROVEMENT OF RETIREMENT FACILITIES 0 0 0 1645000 29970000 2112584 29970000 2000 1 0 1 1 8980000 15303536 256139 111849 9800952 5131358 2010 0 0 1 1 0 1 1 1 0 0.00100 0.00000 0.00100 1 0 1 0 0 0 1 0 1 0 0 0 0 X FORM 990, PART VI, SECTION A, LINE 3 URCAD DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 URCAD 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. 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 II, SECTION 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 THE CORPORATE COUNSEL. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: PART VII, SECTION A: WILLIAM L. LEEVER DEVOTES 1 HOUR PER WEEK TO EACH OF THE FOLLOWING ENTITIES: PACIFIC RETIREMENT SERVICES ROGUE VALLEY MANOR JAY T. GERBER, MATT NEAL AND PAUL HART EACH DEVOTE 1 HOUR PER WEEK TO UNIVERSITY RETIREMENT COMMUNITY FOUNDATION, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 511,125. SWAP AGREEMENT LOSS -723,335. CHANGE IN INTEREST IN NET ASSETS OF URC FOUNDATION -9,353. TOTAL TO FORM 990, PART XI, LINE 5: -221,563. 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 HOLLADAY PARK PLAZA 965 ELLENDALE DRIVE MEDFORD OR 97504 930513697 SENIOR HOUSING OR 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 0 CAPITOL LAKES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 391412320 SENIOR HOUSING WI 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 ROGUE VALLEY MANOR FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 930712867 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 931301816 PUBLIC FOUNDATION CA 501(C)(3) LINE 7 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 CAPITOL LAKES FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 383781089 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CAPITOL LAKES INC 0 MIRABELLA 965 ELLENDALE DRIVE MEDFORD OR 97504 342030255 SENIOR HOUSING WA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA PORTLAND FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 452508860 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 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 MIRABELLA SAN FRANCISCO BAY 965 ELLENDALE DRIVE MEDFORD OR 97504 200428927 SENIOR HOUSING CA 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 HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 930864466 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM ASHLAND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 930942933 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM GRANTS PASS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943136037 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM ROSEBURG HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943179782 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MYRTLE CREEK HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943162074 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM BEND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943163349 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 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 FORT WORTH I HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311520436 SENIOR HOUSING TX 501(C)(3) LINE 9 ROGUE VALLEY MANOR 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 FORT WORTH II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311587415 SENIOR HOUSING TX 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MEDFORD III HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311587418 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM ROSEBURG II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311587420 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM GRANTS PASS II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311662259 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM DAVIS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311662208 SENIOR HOUSING CA 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MYRTLE CREEK II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311715321 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM PORTLAND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311780332 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM PORTLAND II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 300037898 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM CENTRAL POINT HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 300315618 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 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 CORBINTON RETIREMENT 965 ELLENDALE DRIVE MEDFORD OR 97504 262987036 SENIOR HOUSING NC 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA AT MORRISON 965 ELLENDALE DRIVE MEDFORD OR 97504 271016196 SENIOR HOUSING NC 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK 965 ELLENDALE DRIVE MEDFORD OR 97504 931169683 HOTEL OR N/A C 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 1 0 0 1 0 0 0