2012-08-15T13:30:57-05:00 2011-09-30 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2010-10-01 931067253 PACIFIC RETIREMENT SERVICES INC PACI 8887246424 965 ELLENDALE DRIVE MEDFORD OR 97504 BRIAN MCLEMORE 8887246424 2012-08-13 1 TRACY S PAGLIA 2099556100 2010 2016-02-24 21:20:13Z X WILLIAM THORNDIKE JR 965 ELLENDALE DRIVE MEDFORD OR 97504 11431403 0 X WWW.RETIREMENT.ORG X 1990 OR PACIFIC RETIREMENT SERVICES PROVIDES LEADERSHIP FOR ITS AFFILIATE ORGANIZATIONS AND CREATES AND ENHANCES LIFESTYLE OPPORTUNITIES FOR SENIORS. 8 8 150 1 61682 60682 0 0 12803299 10990560 538982 440843 82360 0 13424641 11431403 0 0 0 0 8506988 6001595 0 0 0 2903828 2225834 11410816 8227429 2013825 3203974 43956831 45001490 7602912 5512232 36353919 39489258 PACIFIC RETIREMENT SERVICES PROVIDES LEADERSHIP FOR ITS AFFILIATE ORGANIZATIONS AND CREATES AND ENHANCES LIFESTYLE OPPORTUNITIES FOR SENIORS. 0 0 7680963 0 10928878 PACIFIC RETIREMENT SERVICES, INC. PROVIDES STRATEGIES, FINANCIAL PLANNING AND ADMINISTRATIVE SERVICES FOR SEVERAL RELATED 501(C)(3) ORGANIZATIONS, INCLUDING SEVERAL THAT PROVIDE HOUSING FOR SENIOR CITIZENS. 7680963 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 1 0 0 0 0 1 1 1 1 0 0 1 69 0 1 150 1 1 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA OR WI X SHERI DRESSLER 5418577644 965 ELLENDALE DRIVE MEDFORD OR 97504 X WILLIAM THORNDIKE JR 1.00 X X 4000 0 0 WILLIAM L LEEVER 1.00 X X 4000 0 0 EDWARD JOLLY 1.00 X X 4000 0 0 HARRY E KNIGHT 1.00 X X 3000 0 0 LYNN C JOHNSON 1.00 X 0 0 0 MARC BAYLISS 1.00 X 4000 0 0 TODD MARTIN 1.00 X 4000 0 0 DOUG SCHMOR 1.00 X 1000 0 0 CAROLYN HENNION 1.00 X X 4000 0 0 JERRY SCHOEGGL 50.00 X 277341 0 33945 BRIAN MCLEMORE 60.00 X 247211 0 78799 JILL COLLINS 50.00 X 289535 0 70833 THOMAS BROWN 50.00 X 217271 0 68141 MICHAEL MORRIS 40.00 X 164657 0 43548 PAUL RIEPMA III 50.00 X 175991 0 21678 DEBBIE RAYBURN 50.00 X 178650 0 31293 JOHN LARSON 40.00 X 159984 0 32916 THOMAS R BECKER 60.00 X 2469033 0 112629 4207673 0 493782 30 1 1 0 MILLER NASH LLP PO BOX 3585 PORTLAND OR 97208 LEGAL 151734 DELOITTE & TOUCHE LLP PO BOX 6000 SAN FRANCISCO CA 94160 AUDITING 148527 2 MANAGEMENT FEE REVENUE 561000 8002850 7941168 61682 ACCOUNTING FEES 561000 1224075 1224075 SERVICE FEES 561000 941604 941604 DEVELOPMENT FEE REVENU 561000 470669 470669 MEDIA & ADVERTISING 541800 71496 71496 279866 279866 10990560 386740 386740 54103 54103 54103 54103 11431403 10928878 61682 440843 789752 789752 3354013 3354013 652038 652038 715205 715205 490587 490587 361365 361365 69782 69782 6256 6256 155340 155340 94199 94199 215481 168348 47133 213041 213041 144425 144425 160314 160314 77868 77868 473675 473675 51397 51397 EDUCATION 62532 62532 HOUSING PROGRAM 49631 49631 BOARD EXPENSE 38770 38770 DUES AND SUBSCRIPTIONS 24908 24908 ASSET DISPOSALS 23160 23160 3690 3690 8227429 7680963 546466 0 3677960 1285769 4321025 444107 27756 24115 0 6463 1440 96117 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DEBT ISSUE COSTS & LOAN FEES 13371 OTHER NONCURRENT ASSETS 342277 35490824 OTHER LONG TERM LIABILITIES 342277 342277 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION 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, 2011, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 JERRY SCHOEGGL 277341 0 0 0 0 0 33799 0 146 0 311286 0 0 0 BRIAN MCLEMORE 247211 0 0 0 0 0 59652 0 19147 0 326010 0 0 0 JILL COLLINS 289535 0 0 0 0 0 66114 0 4719 0 360368 0 0 0 THOMAS BROWN 217271 0 0 0 0 0 47805 0 20336 0 285412 0 0 0 MICHAEL MORRIS 164657 0 0 0 0 0 26983 0 16565 0 208205 0 0 0 PAUL RIEPMA III 175991 0 0 0 0 0 15573 0 6105 0 197669 0 0 0 DEBBIE RAYBURN 178650 0 0 0 0 0 11817 0 19476 0 209943 0 0 0 JOHN LARSON 159984 0 0 0 0 0 20257 0 12659 0 192900 0 0 0 THOMAS R BECKER 315371 0 0 0 2153662 0 95867 0 16762 0 2581662 0 1221435 0 PART I, LINE 1A TRAVEL FOR COMPANIONS - THOMAS BECKER, PRESIDENT AND CEO, RECEIVED REIMBURSEMENT FOR TWO COMPANION TRIPS TO THE AAHSA ANNUAL MEETING IN THE FALL AND THE AAHSA SPRING MEETING OR IAHSA CONFERENCE. THE BENEFIT WAS NOT TAXABLE. HEALTH AND SOCIAL CLUBS - THOMAS BECKER, PRESIDENT AND CEO, HAD MEMBERSHIPS AT THE FOLLOWING CLUBS; ROGUE VALLEY COUNTRY CLUB, UNIVERSITY CLUB, AND ARLINGTON CLUB. PACIFIC RETIREMENT SERVICES, INC PAYS THE CLUB DUES, AS WELL AS ANY BUSINESS RELATED EXPENDITURES. ALL PERSONAL EXPENSES WERE PAID FOR BY THOMAS BECKER. PART I, LINES 4A-B THE CORPORATION HAD TWO SERPS DURING THE YEAR. SELECTIVE EXECUTIVE EMPLOYEES OF THE CORPORATION WERE ENTITLED TO PLAN BENEFITS. CONTRIBUTIONS AND EARNINGS WERE HELD IN A TRUST. THE FOLLOWING INDIVIDUALS HAD SERP CONTRIBUTIONS DURING 2010 - THOMAS BECKER - $59,438; JERRY SCHOEGGL - $24,000. THOMAS BECKER'S EMPLOYMENT ENDED 7/5/10 AND HE RECEIVED A SEVERANCE PAYMENT, ALONG WITH DISTRIBUTIONS FROM THE AFOREMENTIONED SERP PLAN. THE PARTIES ENTERED INTO A SETTLEMENT AGREEMENT AND MUTUAL GENERAL RELEASES (THE "AGREEMENT"). THE AGREEMENT PROVIDES FOR CERTAIN PAYMENTS TO MR. BECKER, IMPOSES AND CLARIFIES CERTAIN OBLIGATIONS ON MR. BECKER, CONTAINS MUTUAL RELEASES OF ALL CLAIMS BETWEEN THE PARTIES, AND IMPOSES MUTUAL CONFIDENTIALITY OBLIGATIONS. THE HOSPITAL FACILITIES AUTHORITY OF THE CITY OF MEDFORD OR 521378932 2005-03-31 2094750 CONSTRUCTION OF OFFICE BUILDING 0 0 0 2094750 2094750 2006 0 0 1 1 1 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 CARING COMMUNITIES INSURANCE COMPANY THOMAS BECKER/BOARD MEMBER 1076484 INSURANCE PREMIUMS 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINAL FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH INFORMATION PROVIDED BY THE PACIFIC RETIREMENT SERVICES, INC ACCOUNTING DEPARTMENT. THE FORM 990 IS THEN REVIEWED BY MANAGEMENT AND PROVIDED TO THE BOARD BEFORE FILING WITH THE IRS. 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 15 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 STAFF COMPENSATION: SALARY.COM, PAYSCALE.COM, 990 REVIEW (LIKE SIZE ORGANIZATIONS), CEMO (CHIEF EXECUTIVE OFFICERS OF MULTI-FACILITY ORGANIZATIONS) SALARY STUDY RESULTS. RECOMMENDATION FOR BASE COMPENSATION AND INCENTIVE ARE PROVIDED BY IMMEDIATE SUPERVISOR, BASED ON STUDY FINDINGS AND PERFORMANCE FACTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL AND STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: PART VII, SECTION A: WILLIAM L. LEEVER DEVOTES TIME TO RELATED ORGANIZATIONS AS FOLLOWS: ROGUE VALLEY MANOR 1 HOUR UNIVERSITY RETIREMENT COMMUNITY AT DAVIS, INC. 1 HOUR EDWARD JOLLY DEVOTES TIME TO RELATED ORGANIZATIONS AS FOLLOWS: ROGUE VALLEY MANOR 1 HOUR HARRY E. KNIGHT DEVOTES TIME TO RELATED ORGANIZATIONS AS FOLLOWS: ROGUE VALLEY MANOR 1 HOUR TRINITY TERRACE 1 HOUR UNIVERSITY RETIREMENT COMMUNITY AT DAVIS, INC. 1 HOUR MARC BAYLISS DEVOTES TIME TO RELATED ORGANIZATIONS AS FOLLOWS: ROGUE VALLEY MANOR FOUNDATION 1 HOUR TODD MARTIN DEVOTES TIME TO RELATED ORGANIZATIONS AS FOLLOWS: HOLLADAY PARK PLAZA, INC. 1 HOUR MIRABELLA AT SOUTH WATERFRONT 1 HOUR MIRABELLA 1 HOUR MIRABELLA PORTLAND FOUNDATION 1 HOUR MICHAEL MORRIS IS AN EMPLOYEE OF PACIFIC RETIREMENT SERVICES, AND DEVOTES 100% OF HIS TIME PROVIDING MANAGEMENT SERVICES TO UNIVERSITY RETIREMENT COMMUNITY AT DAVIS, INC., A RELATED ORGANIZATION. JOHN LARSON IS AN EMPLOYEE OF PACIFIC RETIREMENT SERVICES, AND DEVOTES 100% OF HIS TIME PROVIDING MANAGEMENT SERVICES TO HOLLADAY PARK PLAZA, INC., A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -68,635. 965 ELLENDALE DRIVE LLC 965 ELLENDALE DRIVE MEDFORD OR 97504 931067253 OFFICE BLDG. OR 539500 1846891 N/A CORBINTON LLC 965 ELLENDALE DRIVE MEDFORD OR 97504 931067253 CCRC DEVELOPMENT OR 0 0 N/A 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 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 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ASHLAND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 930942933 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM GRANTS PASS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943136037 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM ROSEBURG HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943179782 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM MYRTLE CREEK HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943162074 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943163349 SENIOR HOUSING 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 FORT WORTH I HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311520436 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND II HOUSING CORPORATION 965 ELLENDALE 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LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931169683 HOTEL OR N/A C 2892135 13920055 1.00000 RETIREMENT SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931328250 MGMT COMPANY OR N/A C 5632817 18159173 1.00000 PRS SCHOOL OF AGING SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 262477424 SCHOOL OR N/A C 1.00000 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 ROGUE VALLEY MANOR K 2650392 PERCENTAGE OF REVENUES THE CUMBERLAND REST INC K 1238137 PERCENTAGE OF REVENUES CASCADE MANOR INC K 514719 PERCENTAGE OF REVENUES UNIVERSITY RETIREMENT COMMUNITY AT DAVIS K 1251984 PERCENTAGE OF REVENUES HOLLADAY PARK PLAZA K 864010 PERCENTAGE OF REVENUES CAPITOL LAKES INC K 948717 PERCENTAGE OF REVENUES MIRABELLA INC K 688999 PERCENTAGE OF REVENUES MIRABELLA AT SOUTH WATERFRONT K 458452 PERCENTAGE OF REVENUES RVM EUGENE HOUSING CORPORATION K 55625 PERCENTAGE OF REVENUES ROGUE VALLEY MANOR P 662064 FMV THE CUMBERLAND REST INC P 183091 FMV CASCADE MANOR INC P 87076 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