2016-05-03T15:17:00-05:00 2015-09-30 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2014-10-01 931067253 PACIFIC RETIREMENT SERVICES INC PACI 8887246424 1 WEST MAIN SUITE 303 MEDFORD OR 97501 DOUG SCHMOR CHAIR 8887246424 2016-04-19 1 TRACY S PAGLIA P00366884 2099556100 2016-04-19 2014 2016-08-17 19:52:53Z DOUG SCHMOR 1 WEST MAIN SUITE 303 MEDFORD OR 97501 20690363 0 X WWW.RETIREMENT.ORG X 1990 OR PACIFIC RETIREMENT SERVICES PROVIDES EXCEPTIONAL LEADERSHIP TO OUR FAMILY OF ORGANIZATIONS, WORKING TOGETHER TO ENHANCE THE AGING EXPERIENCE. 14 14 128 14 70394 14435 0 0 12671940 15898419 144503 -16984 199134 20440 13015577 15901875 0 0 0 0 7645199 7939913 0 0 0 2255946 2902246 9901145 10842159 3114432 5059716 51092012 53925960 3568411 1364888 47523601 52561072 PACIFIC RETIREMENT SERVICES PROVIDES EXCEPTIONAL LEADERSHIP TO OUR FAMILY OF ORGANIZATIONS, WORKING TOGETHER TO ENHANCE THE AGING EXPERIENCE. 0 0 10543102 15898419 PACIFIC RETIREMENT SERVICES, INC.'S VISION IS THAT EVERY PERSON DESERVES STABLE RETIREMENT EXPERIENCE. WE PURSUE THIS VISION BY CREATING COMMUNITIES TO PROVIDE EACH RESIDENT WITH LIFESTYLE OPPORTUNITIES THAT FACILITATE HEALTHY AGING, AND SUPPORTIVE SERVICES TO ENSURE STABILITY AND SECURITY AS RESIDENTS AGE. 10543102 1 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 83 0 1 128 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 CA OR WI X SHERI LOYA 5418577644 1 WEST MAIN SUITE 303 MEDFORD OR 97501 DOUG SCHMOR CHAIR 1.00 X X 0 0 0 LARRY BOECK VICE CHAIR 1.00 1.00 X X 0 0 0 DOUG SPANI SECRETARY 1.00 X X 0 0 0 CAROLYN HENNION ASSISTANT SECRETARY 1.00 X X 0 0 0 LYNN JOHNSON TREASURER 1.00 2.00 X X 0 0 0 DOUG WILSON DIRECTOR 1.00 2.00 X 0 0 0 MARC BAYLISS DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM LEEVER DIRECTOR 1.00 X 0 0 0 EDWARD JOLLY DIRECTOR 1.00 X 0 0 0 BILL VAN VACTOR DIRECTOR 1.00 2.00 X 0 0 0 CHRISTOPHER WOOD DIRECTOR 1.00 2.00 X 0 0 0 BOB MAYERS DIRECTOR 1.00 1.00 X 0 0 0 JACQUE BARTHOLOMEW DIRECTOR 1.00 1.00 X 0 0 0 C TODD MARTIN DIRECTOR 1.00 4.00 X 0 0 0 BRIAN MCLEMORE PRESIDENT/CEO 38.00 12.00 X 0 488573 48279 MARY SCHOEGGL CFO 38.00 12.00 X 0 313814 48279 MICHAEL MORRIS COO 38.00 12.00 X 0 326823 47287 DEBBIE RAYBURN CHIEF HEALTHCARE OFFICER 38.00 12.00 X 0 263159 38769 PAUL RIEPMA II SENIOR VP OF MARKETING 38.00 12.00 X 0 222199 30931 STEPHEN EICHEN CHIEF INFORMATION OFFICER 38.00 12.00 X 0 226539 29463 STEVEN RINKLE GENERAL COUNSEL 38.00 12.00 X 0 233248 38317 TAMARA NORDIN SENIOR VP OF HUMAN RESOURCES 38.00 12.00 X 0 200696 49173 0 2275051 330498 0 0 1 0 PRS MANAGEMENT INC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 MANAGEMENT SERVICES 8139253 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 AUDIT AND TAX SERVICES 130979 2 MANAGEMENT FEE REVENUE 561000 10163379 10163379 DEVELOPMENT FEES REVENUE 561000 2350416 2350416 ACCOUNTING FEES 561000 1134029 1134029 INFO TECH SVC FEES 561000 1088794 1088794 ADMINISTRATIVE REVENUE 561000 954609 954609 207192 157238 49954 15898419 20071 20071 20440 0 20440 20440 20440 4751433 4774295 14193 -22862 -14193 -37055 -37055 15901875 15848465 70394 -16984 1254118 1254118 6636873 6636873 41175 41175 7556 7556 191 191 76182 455 75727 102416 102416 3178 3178 431350 431350 56875 56875 244824 244824 400460 400460 336523 336523 329824 329824 77188 77188 40017 40017 351858 351858 52322 52322 OTHER FACILITY SERVICE 384828 278223 106605 INCOME TAXES 11131 11131 HEALTH CENTER EXPENSE 3270 3270 10842159 10543102 299057 0 3055449 3536808 3959511 1422391 54168 104833 5846335 5271195 7192 20185 313194 371512 6124574 3787142 1959775 2337432 3722027 3122027 1325840 7623830 30848521 30115747 51092012 53925960 1692232 1063455 1559523 0 316656 301433 3568411 1364888 X 47523601 52561072 47523601 52561072 51092012 53925960 5059716 -22245 0 X 0 1 X 1 0 X X 34 CAPITOL LAKES INC 391412320 9 1 0 0 CASCADE MANOR INC 930557803 9 1 0 0 HOLLADAY PARK PLAZA 930513697 9 1 0 0 MIRABELLA 342030255 9 1 0 0 MIRABELLA AT SOUTH WATERFRONT 711016384 9 1 0 0 ROGUE VALLEY MANOR 930453216 9 1 0 0 ROGUE VALLEY MANOR ASHLAND HOUSING CORPORATION 930942933 9 1 0 0 ROGUE VALLEY MANOR BEND HOUSING CORPORATION 943163349 9 1 97 0 ROGUE VALLEY MANOR BEND II HOUSING CORPORATION 943260016 9 1 45 0 ROGUE VALLEY MANOR CENTRAL POINT HOUSING CORPORATION 300315618 9 1 713 0 ROGUE VALLEY MANOR DAVIS HOUSING CORPORATION 311662208 9 1 125 0 ROGUE VALLEY MANOR EAGLE POINT HOUSING CORPORATION 943191447 9 1 24 0 ROGUE VALLEY MANOR EUGENE HOUSING CORPORATION 943247154 9 1 564 0 ROGUE VALLEY MANOR FORT WORTH HOUSING CORPORATION 311520436 9 1 0 0 ROGUE VALLEY MANOR FORT WORTH II HOUSING CORPORATION 311587415 9 1 0 0 ROGUE VALLEY MANOR GRANTS PASS HOUSING CORPORATION 943136037 9 1 0 0 ROGUE VALLEY MANOR GRANTS PASS II HOUSING CORPORATION 311662259 9 1 0 0 ROGUE VALLEY MANOR HOUSING CORPORATION 930864466 9 1 0 0 ROGUE VALLEY MANOR KLAMATH FALLS HOUSING CORPORATION 943196455 9 1 0 0 ROGUE VALLEY MANOR LIVELY OAKS HOUSING CORPORATION 943194409 9 1 446 0 ROGUE VALLEY MANOR MANSFIELD HOUSING CORPORATION 900292647 9 1 0 0 ROGUE VALLEY MANOR MEDFORD II HOUSING CORPORATION 943212537 9 1 550 0 ROGUE VALLEY MANOR MEDFORD III HOUSING CORPORATION 311587418 9 1 1309 0 ROGUE VALLEY MANOR MYRTLE CREEK HOUSING CORPORATION 943162074 9 1 558 0 ROGUE VALLEY MANOR MYRTLE CREEK II HOUSING CORPORATION 311715321 9 1 314 0 ROGUE VALLEY MANOR PORTLAND HOUSING CORPORATION 311780332 9 1 240 0 ROGUE VALLEY MANOR PORTLAND II HOUSING CORPORATION 300037898 9 1 252 0 ROGUE VALLEY MANOR REEDSPORT HOUSING CORPORATION 943212538 9 1 50 0 ROGUE VALLEY MANOR ROSEBURG HOUSING CORPORATION 943179782 9 1 0 0 ROGUE VALLEY MANOR ROSEBURG II HOUSING CORPORATION 311587420 9 1 0 0 ROGUE VALLEY MANOR YREKA HOUSING CORPORATION 943212540 9 1 0 0 THE CUMBERLAND REST INC 750891470 9 1 0 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 931179254 9 1 0 0 COMMUNITY VOLUNTEER NETWORK 930892261 9 0 0 0 34 5287 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV SECTION D QUESTION 3 THE SUPPORTED ORGANIZATIONS OF PRS HAD A SIGNIFICANT VOICE IN THE PRS INVESTMENT POLICIES AND IN DIRECTING THE USE OF PRS' INCOME OR ASSETS AT ALL TIMES DURING THE TAX YEAR. EACH SUPPORTED ORGANIZATION HAS AT LEAST ONE DIRECTOR WHO ALSO SERVES ON THE PRS BOARD OF DIRECTORS (SOME ALSO SERVE AS OFFICERS OF PRS) AS SET FORTH IN 26 CFR 1.509(A)4(I)(3)(II)(B), AS WELL AS REPRESENTATION ON THE PRS INVESTMENT SUBCOMMITTEE, AND AS SUCH CONTROLS THE INVESTMENT POLICIES OF PRS AND DETERMINE HOW THE INCOME AND ASSETS OF PRS ARE TO BE USED. PART IV SECTION E QUESTION 3A THE BYLAWS OF EACH OF THE PRS SUPPORTED ORGANIZATIONS PROVIDES THAT A MAJORITY OF THE SUPPORTED ORGANIZATION'S OFFICERS AND/OR DIRECTORS ARE ELECTED OR APPOINTED BY PRS ACTING THROUGH ITS GOVERNING BODY. PART IV SECTION E QUESTION 3B PRS EXERCISED A SUBSTANTIAL DEGREE OF DIRECTION OVER THE POLICIES, PROGRAMS AND ACTIVITIES OF EACH OF ITS SUPPORTED ORGANIZATIONS. PRS EXERCISES AUTHORITY FOR REVIEWING AND APPROVING THE BUDGETS, STRATEGIC PLANS, UNBUDGETED CONTRACTS IN EXCESS OF STATED DOLLAR AMOUNTS, CHANGES TO GOVERNING DOCUMENTS, ETC. OF THE SUPPORTED ORGANIZATIONS. PRS ALSO PROVIDES MANAGEMENT SERVICES TO THE SUPPORTED ORGANIZATIONS. PART IV SECTION A QUESTION 1 COMMUNITY VOLUNTEER NETWORK (CVN) IS THE ONLY SUPPORTED ORGANIZATION NOT LISTED IN PRS' GOVERNING DOCUMENTS AS OF SEPTEMBER 30, 2015. CVN WAS ADDED TO PRS' ARTICLES OF INCORPORATION AS A SUPPORTED ORGANIZATION ON FEBRUARY 11, 2016. PRS AND CVN HAVE HAD A HISTORIC AND CONTINUING RELATIONSHIP. PRS PROVIDED AN ANNUAL SUPPORT NOTIFICATION LETTER TO CVN AND PROVIDES ALL ACCOUNTING, IT AND MANAGEMENT SERVICES FOR CVN, AS WELL AS FREE USE OF OFFICE SPACE. PRS IS THE SOLE MEMBER OF CVN AND HAS THE POWER TO APPOINT CVN'S BOARD MEMBERS. 10842159 10842159 692108 173027 0 0 586066 620109 645057 692108 2543340 3815010 146517 155027 161264 173027 635835 953753 400000 400000 2228336 1139500 1088836 3423193 2612473 810720 73045 35169 37876 2337432 3122027 F 3122027 INVESTMENT IN AFFILIATES-AFFORD. HOUS. 784031 F CCIC CAPITAL INVESTMENT 1139799 F INVESTMENT IN PRS MANAGEMENT, INC. 5700000 F 7623830 DUE FROM AFFILIATES 28794150 OTHER NONCURRENT ASSETS 301433 LINE OF CREDIT & GUARANTEES 1020164 30115747 OTHER LONG TERM LIABILITIES 301433 301433 X PART X, LINE 2: 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, 2015, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. X X X X 0 0 0 0 0 0 0 1 0 BRIAN MCLEMORE PRESIDENT/CEO 0 452573 0 36000 0 0 0 34500 0 13779 0 536852 0 0 MARY SCHOEGGL CFO 0 288814 0 25000 0 0 0 34500 0 13779 0 362093 0 0 MICHAEL MORRIS COO 0 299823 0 27000 0 0 0 33508 0 13779 0 374110 0 0 DEBBIE RAYBURN CHIEF HEALTHCARE OFFICER 0 241159 0 22000 0 0 0 24990 0 13779 0 301928 0 0 PAUL RIEPMA II SENIOR VP OF MARKETING 0 202199 0 20000 0 0 0 23839 0 7092 0 253130 0 0 STEPHEN EICHEN CHIEF INFORMATION OFFICER 0 207539 0 19000 0 0 0 15684 0 13779 0 256002 0 0 STEVEN RINKLE GENERAL COUNSEL 0 213248 0 20000 0 0 0 24538 0 13779 0 271565 0 0 TAMARA NORDIN SENIOR VP OF HUMAN RESOURCES 0 183696 0 17000 0 0 0 37685 0 11488 0 249869 0 0 PART I, LINE 7 THE VP OF HUMAN RESOURCES PROVIDED SALARY STUDIES FROM THE FOLLOWING RESOURCES TO THE COMPENSATION COMMITTEE (A COMMITTEE OF THE PRS BOARD OF DIRECTORS) 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 THE IMMEDIATE SUPERVISOR, BASED ON STUDY FINDINGS AND PERFORMANCE FACTORS. FORM 990, PART VI, SECTION A, LINE 4 THE FOLLOWING ARE THE SIGNIFICANT CHANGES MADE TO THE FORMER 11/14/11 PRS BYLAWS: AMEND SECTION 1.15.5 TO INCLUDE THAT THE AUDIT COMMITTEE MAY CONSIST OF MEMBERS WHO ARE NOT MEMBERS OF THE BOARD OF DIRECTORS. 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 ALL REQUESTS GO THROUGH CORPORATE COUNSEL. 965 ELLENDALE DRIVE LLC 1 WEST MAIN SUITE 303 MEDFORD OR 97501 931067253 OFFICE BLDG. OR 88982 1617750 PACIFIC RETIREMENT SERVICES INC PACIFIC RETIREMENT SERVICES FOUNDATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 472352652 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 1 ROGUE VALLEY MANOR 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930453216 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 CASCADE MANOR INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930557803 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931179254 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 HOLLADAY PARK PLAZA 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930513697 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 CAPITOL LAKES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 391412320 SENIOR HOUSING WI 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 ROGUE VALLEY MANOR FOUNDATIONINC 1 WEST MAIN ST SUITE 303 MEDFORD 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