2017-08-22T16:45:18-05:00 2016-12-31 461497033 EKS&H LLLP 8181 E TUFTS AVENUE SUITE 600 DENVER CO 802372579 990 2016-01-01 271953892 COLORADO SENIOR RESIDENCES INC COLO 9708798855 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 CHARLES PARSONS CHAIRMAN 9708798855 2017-08-22 1 DORI J EGGETT P00645252 3037409400 208.42.238.132 2017-08-22 16:44:20 MD P 0CA5F0488340EA7121183073BB99320ACB41854D 2CD2F342D9A56895E935F8A0E7A9027FDFDBA7CB 2016 2021-01-29 14:40:06Z CASEY'S POND SENIOR LIVING CHARLES PARSONS 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 10154176 0 X WWW.CASEYSPOND.ORG X 2010 CO TO PROVIDE HOUSING, HEALTHCARE, & OTHER SERVICES TO SENIOR CITIZENS THROUGH A RETIREMENT FACILITY. 10 10 251 80 0 0 1170 1762 9942075 10054017 56293 30027 58540 68370 10058078 10154176 0 0 0 0 6798480 7029152 0 0 0 8035135 7996938 14833615 15026090 -4775537 -4871914 44509773 43051806 49894393 53308340 -5384620 -10256534 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 12596231 10054017 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; 47 ASSISTED LIVING UNITS; 26 MEMORY CARE UNITS; 22 INDEPENDENT LIVING UNITS; AND RELATED COMMON AREAS, AMENITIES, AND OTHER IMPROVEMENTS ALL HOUSED WITHIN ONE BUILDING. 12596231 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 64 0 1 251 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 KARL GILLS SECRETARY/TREASURER 1.00 X X 0 0 0 BRIAN HARRINGTON MD DIRECTOR 1.00 X 0 0 0 CHARLES PARSONS CHAIRMAN 1.00 X 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 MARILYN MCCAULLEY VICE-CHAIRMAN 1.00 X 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 DANIEL SHIELDS - TERM END 0216 EXECUTIVE DIRECTOR 40.00 X 0 0 0 BRAD BOATRIGHT - TERM BEG 0316 EXECUTIVE DIRECTOR 40.00 X 0 0 0 0 0 0 0 0 0 0 UNIDINE PO BOX 360639 PITTSBURGH PA 152516639 CULINARY SERVICES 1775416 INFINITY 25117 SW PARKWAY STE D WILSONVILLE OR 97070 THERAPY 398350 CAPELLA LIVING SOLUTIONS 7000 E BELLEVIEW AVE STE 150 GREENWOOD VILLAGE CO 80111 SENIOR MANAGEMENT 132968 PEARL SENIOR LIVING MANAGEMENT 165 COOK STREET SUITE 200 DENVER CO 80206 MANAGEMENT 131634 4 1762 1762 RESIDENT/PATIENT SERV. 623000 10054017 10054017 10054017 30027 30027 MOVE-IN FEE & LEASE 532000 55000 55000 TRANSPORT, MEALS & MIS 999999 13370 13370 68370 10154176 10122387 0 30027 5895970 5169468 726502 35435 29470 5965 773772 643516 130256 323975 288542 35433 658410 658410 36025 36025 49632 49632 583229 544857 38372 110636 110636 77842 47742 30100 49093 1620 47473 301530 301530 5232 5232 32767 1171 31596 3261153 3214683 46470 1299645 1279847 19798 109343 109343 FOOD & BEVERAGE 613134 609766 3368 SUPPLIES 334407 313660 20747 REPAIRS & MAINTENANCE 139707 123334 16373 EQUIPMENT RENTAL & PURC 75667 12950 62717 259486 8843 250643 15026090 12596231 2429859 0 29138 128371 820099 488541 498983 12462 12462 203761 211161 42218274 4029561 39497051 38188713 4150449 3320388 44509773 43051806 781138 933286 93793 129816 42728557 42791468 32603 25575 3500000 3500000 2758302 5928195 49894393 53308340 X -5384620 -10256534 -5384620 -10256534 44509773 43051806 -4871914 0 X 0 1 X 1 0 X 1614889 245945 7366 1170 1762 1871132 1455199 9737047 10000615 10122387 31315248 1614889 1701144 9744413 10001785 10124149 33186380 0 0 0 33186380 34383 80968 56293 30027 201671 34383 80968 56293 30027 201671 1614889 1735527 9825381 10058078 10154176 33388051 0.99400 0.00600 X 3777121 3777121 33331262 2907322 30423940 3134525 3134525 1661771 1071566 590205 313595 50673 262922 38188713 DEPOSITS 105022 ASSETS LIMITED AS TO USE 3215366 3320388 DEPOSITS HELD IN ESCROW 97241 SECURITY DEPOSITS 75000 OTHER LONG TERM LIABILITIES 693358 BOND INTEREST PAYABLE 4844396 NOTE INTEREST PAYABLE 218200 5928195 X 10154176 0 10154176 0 10154176 15026090 0 15026090 0 15026090 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, 2016 AND 2015. 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 31,2016 AND 2015. 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 A MANAGEMENT COMPANY. IN FEBRUARY, THE ORGANIZATION CHANGED MANAGEMENT COMPANIES. DANIEL SHIELDS WAS THE EXECUTIVE DIRECTOR OF THE ORGANIZATION THROUGH FEBRUARY AND WAS AN EMPLOYEE OF PEARL SENIOR LIVING MANAGEMENT. BRAD BOATRIGHT IS THE CURRENT EXECUTIVE DIRECTOR OF THE ORGANIZATION AND IS AN EMPLOYEE OF CAPELLA 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 THE MANAGEMENT COMPANY, AN UNRELATED ENTITY. THROUGH FEBRUARY, DAN SHIELDS WAS PAID $26,656 THROUGH PEARL SENIOR LIVING SOLUTIONS. THE REMAINDER OF THE YEAR, BRAD BOATRIGHT WAS PAID THROUGH CAPELLA LIVING SOLUTIONS. BRAD'S WAGES WERE $126,893 AND HIS NONTAXABLE BENEFITS WERE $6,076.