2016-11-14T10:42:49-06:00 2015-12-31 461497033 EKS&H LLLP 7979 E TUFTS AVENUE SUITE 400 DENVER CO 802372521 990 2015-01-01 271953892 COLORADO SENIOR RESIDENCES INC COLO 9708798855 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 CHARLES PARSONS CHAIRMAN 9708798855 2016-11-11 1 RYAN C HARRIS P00614618 3037409400 2015 2017-02-10 21:41:12Z CASEY'S POND SENIOR LIVING CHARLES PARSONS 2855 OWL HOOT TRAIL STEAMBOAT SPRINGS CO 80487 10058078 0 X WWW.CASEYSPOND.ORG X 2010 CO TO PROVIDE HOUSING, HEALTHCARE, & OTHER SERVICES TO SENIOR CITIZENS THROUGH A RETIREMENT FACILITY. 10 10 278 80 0 0 7366 1170 9471039 9942075 80968 56293 266008 58540 9825381 10058078 0 0 0 0 6673893 6798480 0 0 0 7540727 8035135 14214620 14833615 -4389239 -4775537 49425743 44509773 50034826 49894393 -609083 -5384620 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 12297446 10000615 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; 42 ASSISTED LIVING UNITS; 26 MEMORY CARE UNITS; 22 INDEPENDENT LIVING UNITS; AND RELATED COMMON AREAS, AMENITIES, AND OTHER IMPROVEMENTS ALL HOUSED WITHIN ONE BUILDING. 12297446 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 81 0 1 278 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 KARL GILLS TREASURER 1.00 X X 0 0 0 BRIAN HARRINGTON MEDICAL DIRECTOR 1.00 X 0 0 0 CHUCK 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 SECRETARY 1.00 X X 0 0 0 PJ WHARTON DIRECTOR 1.00 X 0 0 0 RENEE GILBERTSON DIRECTOR 1.00 X 0 0 0 DANIEL SHIELDS EXECUTIVE DIRECTOR 40.00 X 0 0 0 0 0 0 0 0 0 0 UNIDINE PO BOX 360639 PITTSBURGH PA 152516639 MEALS 1042667 PEARL SENIOR LIVING MANAGEMENT 165 COOK STREET SUITE 200 DENVER CO 80206 MANAGEMENT 721752 INFINITY 25117 SW PARKWAY STE D WILSONVILLE OR 97070 THERAPY 459028 3 1170 1170 RESIDENT/PATIENT SERV. 623000 9942075 9942075 9942075 56293 56293 MOVE-IN FEE & LEASE 532000 33165 33165 TRANSPORT, MEALS & MIS 999999 25375 25375 58540 10058078 10000615 0 56293 5596359 4900141 696218 36373 30268 6105 825825 687226 138599 339923 304439 35484 878062 878062 34297 34297 60622 60622 663630 620140 43490 31827 31827 118072 1027 117045 45892 45892 360716 360641 75 8688 8688 23224 9076 14148 3212406 3212406 1265343 1265343 101313 101313 FOOD & BEVERAGE 417959 410104 7855 SUPPLIES 349131 336402 12729 REPAIRS & MAINTENANCE 131586 131478 108 BAD DEBT EXPENSE 107085 107085 225282 20067 205215 14833615 12297446 2536169 0 16569 29138 83555 128371 674478 488541 11408 12462 17783 203761 42226967 2729916 40609378 39497051 8012572 4150449 49425743 44509773 1140813 781138 133187 93793 44649528 42728557 39195 32603 3500000 3500000 572103 2758302 50034826 49894393 X -609083 -5384620 -609083 -5384620 49425743 44509773 -4775537 0 X 0 1 X 1 0 X 2737485 1614889 245945 7366 1170 4606855 1455199 9737047 10000615 21192861 2737485 1614889 1701144 9744413 10001785 25799716 0 0 0 25799716 34383 80968 56293 171644 34383 80968 56293 171644 2737485 1614889 1735527 9825381 10058078 25971360 X 3777121 3777121 36489138 1973141 34515997 1647113 677979 969134 313595 78796 234799 39497051 DEPOSITS 135500 ASSETS LIMITED AS TO USE 4014949 4150449 DEPOSITS HELD IN ESCROW 135500 SECURITY DEPOSITS 93500 OTHER LONG TERM LIABILITIES 663011 BOND INTEREST PAYABLE 1771208 NOTE INTEREST PAYABLE 95083 2758302 X 10058078 0 10058078 0 10058078 14833615 0 14833615 0 14833615 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, 2015 AND 2014. 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, 2015 AND 2014. TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION INCLUDE 2012 THROUGH THE CURRENT YEAR FOR THE FEDERAL AND STATE RETURNS. 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 PART III LINE 3 THE AMOUNT OF THE PROCEEDS RECEIVED BY THE ORGANIZATION WAS THE ISSUE PRICE OF THE BONDS, REDUCED BY THE ORIGINAL ISSUE DISCOUNT ON THE BONDS OF $497,168 AND THE UNDERWRITER'S DISCOUNT OF $902,200. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OF THE EXECUTIVE DIRECTOR POSITION TO PEARL SENIOR LIVING MANAGEMENT. DANIEL SHIELDS IS THE EXECUTIVE DIRECTOR OF THE ORGANIZATION AND IS AN EMPLOYEE OF PEARL SENIOR LIVING MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 11 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.