2018-10-04T09:07:36-05:00 2017-12-31 461497033 EKS&H LLLP 8181 E TUFTS AVENUE SUITE 600 DENVER CO 802372579 990 2017-01-01 271953892 COLORADO SENIOR RESIDENCES INC COLO 9708798855 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 CHARLES PARSONS CHAIRMAN 9708798855 2018-09-17 1 DORI J EGGETT P00645252 3037409400 208.42.238.142 2018-10-04 09:04:52 MD P C038BB18E12FD8461CEE2CCF1B4EB0E681B4B3A7 BBC6FF48F749624228983DC5C77016F783C914CC 2017 2018-06-14 16:35:46Z CASEY'S POND SENIOR LIVING CHARLES PARSONS 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 11080093 0 X WWW.CASEYSPOND.ORG X 2010 CO TO PROVIDE HOUSING, HEALTHCARE, & OTHER SERVICES TO SENIOR CITIZENS THROUGH A RETIREMENT FACILITY. 14 14 227 40 0 0 1762 1983 10054017 10985854 30027 20392 68370 71864 10154176 11080093 0 0 0 0 7029152 6945185 0 0 0 7996938 8068167 15026090 15013352 -4871914 -3933259 43051806 42325457 53308340 56515250 -10256534 -14189793 TO BE VIEWED AS A LEADER IN THE SENIOR LIVING CONTINUUM OF SERVICES WITH WARM AND INVITING RESIDENCES, DEDICATED AND VISIONARY LEADERSHIP, PROFESSIONAL MANAGEMENT AND AN ENGAGED STAFF WHO ARE COMMITTED TO AN ENVIRONMENT OF GROWTH AND INDEPENDENCE. 0 0 12764298 10985854 CASEY'S POND WAS FORMED TO DEVELOP, OWN, AND OPERATE A SENIOR LIVING AND LONG-TERM CARE COMMUNITY IN STEAMBOAT SPRINGS, COLORADO. CASEY'S POND CONSISTS OF APPROXIMATELY 66 SKILLED NURSING BEDS; 53 ASSISTED LIVING UNITS; 15 MEMORY CARE UNITS; 22 INDEPENDENT LIVING UNITS; AND RELATED COMMON AREAS, AMENITIES, AND OTHER IMPROVEMENTS ALL HOUSED WITHIN ONE BUILDING. 12764298 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 24 0 1 227 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X DEBBIE WILLIAMS 9708798855 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 X X CHARLES PARSONS CHAIRMAN 1.00 X X 0 0 0 KARL GILLS SECRETARY/TREASURER 1.00 X X 0 0 0 MARILYN MCCAULLEY VICE-CHAIRMAN 1.00 X X 0 0 0 BRIAN HARRINGTON MD DIRECTOR 1.00 X 0 0 0 CONNIE BRINKMAN DIRECTOR 1.00 X 0 0 0 KAREN BOMBERG DIRECTOR 1.00 X 0 0 0 LOUI ANTONUCCI DIRECTOR 1.00 X 0 0 0 MARY JENKINS DIRECTOR 1.00 X 0 0 0 PJ WHARTON DIRECTOR 1.00 X 0 0 0 RENEE GILBERTSON DIRECTOR 1.00 X 0 0 0 RALPH WALTON DIRECTOR 1.00 X 0 0 0 TRISH O'CONNELL DIRECTOR 1.00 X 0 0 0 MIKE LOMAS DIRECTOR 1.00 X 0 0 0 BJ HEUBERGER DIRECTOR 1.00 X 0 0 0 BRAD BOATRIGHT EXECUTIVE DIRECTOR 40.00 X 0 0 0 0 0 0 0 0 0 0 UNIDINE PO BOX 360639 PITTSBURGH PA 152516639 CULINARY SERVICES 1629502 CAPPELLA LIVING SOLUTIONS 7000 E BELLEVIEW AVE STE 150 GREENWOOD VILLAGE CO 80111 SENIOR MANAGEMENT 755034 INFINITY 25117 SW PARKWAY STE D WILSONVILLE OR 97070 THERAPY 416493 MORRISON PO BOX 102289 ATLANTA GA 303682289 CULINARY SERVICES 240238 4 1983 1983 RESIDENT/PATIENT SERV. 623000 10985854 10985854 10985854 8826 8826 11566 0 11566 11566 11566 MOVE-IN FEE & LEASE 532000 44500 44500 TRANSPORT, MEALS & MIS 999999 27364 27364 71864 11080093 11057718 0 20392 5908831 5303288 605543 701217 607983 93234 335137 303929 31208 552542 552542 17863 17863 59295 59295 611358 582640 28718 225735 225735 67047 30701 36346 61232 4900 56332 335217 335217 6590 6590 23859 2001 21858 3284473 3237664 46809 1264660 1245371 19289 106434 106434 FOOD & BEVERAGE 617632 616601 1031 SUPPLIES 362748 347833 14915 REPAIRS & MAINTENANCE 123735 104478 19257 BAD DEBT EXPENSE 105147 105147 242600 35102 207498 15013352 12764298 2249054 0 0 126913 820099 975446 498983 637098 12462 18778 211161 20753 42263026 5258644 38188713 37004382 3320388 3542087 43051806 42325457 933286 623744 129816 183327 42791468 42854378 25575 18084 3500000 3500000 5928195 9335717 53308340 56515250 X -10256534 -14189793 -10256534 -14189793 43051806 42325457 -3933259 0 X 0 1 X 1 0 X 245945 7366 1170 1762 1983 258226 1455199 9737047 10000615 10122387 11057718 42372966 1701144 9744413 10001785 10124149 11059701 42631192 0 0 0 42631192 34383 80968 56293 30027 8826 210497 34383 80968 56293 30027 8826 210497 1735527 9825381 10058078 10154176 11068527 42841689 0.99510 0.99400 0.00490 0.00600 X 3777121 3777121 33331262 3472007 29859255 3137611 365712 2771899 1703437 1355252 348185 313595 65673 247922 37004382 DEPOSITS 100477 ASSETS LIMITED AS TO USE 3441610 3542087 DEPOSITS HELD IN ESCROW 91876 SECURITY DEPOSITS 59000 OTHER LONG TERM LIABILITIES 693358 BOND INTEREST PAYABLE 7936316 NOTE INTEREST PAYABLE 346367 REFUNDABLE LIFE CARE ENTRY FEES 208800 9335717 X 11080093 0 11080093 0 11080093 15013352 0 15013352 0 15013352 PART X, LINE 2: CASEY'S POND APPLIES A MORE-LIKELY-THAN-NOT MEASUREMENT METHODOLOGY TO REFLECT THE FINANCIAL STATEMENT IMPACT OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. AFTER EVALUATING THE TAX POSITIONS TAKEN, NONE ARE CONSIDERED TO BE UNCERTAIN; THEREFORE, NO AMOUNTS HAVE BEEN RECOGNIZED AS OF DECEMBER 31, 2017 AND 2016. IF INCURRED, INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS ARE RECORDED IN THE PERIOD ASSESSED AS GENERAL AND ADMINISTRATIVE EXPENSE. NO INTEREST OR PENALTIES HAVE BEEN ASSESSED AS OF DECEMBER 31, 2017 AND 2016. A COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AYC3 2012-05-03 45110000 CONSTRUCTION OF FACILITY 0 0 0 A 43710632 3499231 892257 39319144 2013 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OF THE EXECUTIVE DIRECTOR POSITION TO CAPPELLA LIVING SOLUTIONS. BRAD BOATRIGHT IS THE EXECUTIVE DIRECTOR OF THE ORGANIZATION AND IS AN EMPLOYEE OF CAPPELLA LIVING SOLUTIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND THEN PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH RESPONSIBLE PERSON HAS A CONTINUING OBLIGATION TO (I) SCRUTINIZE HIS OR HER INTERESTS, RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES, BOTH DIRECT AND INDIRECT, TO IDENTIFY ANY APPARENT OR ACTUAL CONFLICTS OF INTEREST, AND (II) DISCLOSE THE CONFLICT OF INTEREST AS SOON AS IT IS KNOWN. DISCLOSURE IS REQUIRED ANNUALLY, AND WHENEVER A RESPONSIBLE PERSON BECOMES AWARE OF AN ACTUAL OR APPARENT CONFLICT OF INTEREST THAT HAS NOT PREVIOUSLY BEEN DISCLOSED. IN CASES WHERE A RESPONSIBLE PERSON FEELS A CONFLICT ARISES THAT IS NOT PART OF THE ANNUAL DISCLOSURE, HE/SHE SHALL REPORT THE CIRCUMSTANCE TO THE CHAIR OF THE BOARD. IF A CONFLICT OF INTEREST EXISTS, THE RESPONSIBLE PERSON MUST EXCUSE HIMSELF OR HERSELF FROM DISCUSSION, DELIBERATION AND DEBATE ON THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION B THE ORGANIZATION PAID THE EXECUTIVE DIRECTOR THROUGH A MANAGEMENT COMPANY. THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF CAPPELLA LIVING SOLUTIONS, AN UNRELATED ENTITY. BRAD BOATRIGHT WAS PAID THROUGH CAPPELLA LIVING SOLUTIONS. BRAD'S WAGES WERE $158,488 AND HIS NONTAXABLE BENEFITS WERE $18,999.