2014-08-15T16:33:00-05:00 2013-09-30 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2012-10-01 931067253 PACIFIC RETIREMENT SERVICES INC PACI 8887246424 965 ELLENDALE DRIVE MEDFORD OR 97504 DOUG SCHMOR 8887246424 2014-08-14 1 TRACY S PAGLIA P00366884 2099556100 2012 2015-11-30 17:44:51Z DOUG SCHMOR 965 ELLENDALE DRIVE MEDFORD OR 97504 11973635 0 X WWW.RETIREMENT.ORG X 1990 OR PACIFIC RETIREMENT SERVICES PROVIDES PROVIDES EXCEPTIONAL LEADERSHIP TO OUR FAMILY OF ORGANIZATIONS, WORKING TOGETHER TO ENHANCE THE AGING EXPERIENCE. 13 13 117 1 246111 32707 0 0 11038149 11668914 46466 89237 14807 215484 11099422 11973635 0 0 0 0 6485957 6843893 0 0 0 2235372 2558279 8721329 9402172 2378093 2571463 46922982 48744530 5050225 4305566 41872757 44438964 PACIFIC RETIREMENT SERVICES PROVIDES PROVIDES EXCEPTIONAL LEADERSHIP TO OUR FAMILY OF ORGANIZATIONS, WORKING TOGETHER TO ENHANCE THE AGING EXPERIENCE. 0 0 8596028 0 11668914 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. 8596028 1 0 0 1 0 0 0 0 0 0 1 1 0 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 65 0 1 117 1 1 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 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 965 ELLENDALE DRIVE MEDFORD OR 97504 WILLIAM THORNDIKE JR 1.00 1.00 X 4000 0 0 WILLIAM L LEEVER 1.00 4.00 X X 4000 0 0 EDWARD JOLLY 1.00 2.00 X X 4000 0 0 LYNN C JOHNSON 1.00 3.00 X X 4000 0 0 MARC BAYLISS 1.00 2.00 X 4000 0 0 CHRISTOPHER TIFF WOOD 1.00 4.00 X 0 0 0 DOUG SCHMOR 1.00 1.00 X X 4000 0 0 CAROLYN HENNION 1.00 1.00 X X 4000 0 0 DOUG SPANI 1.00 1.00 X 4000 0 0 LARRY BOECK 1.00 4.00 X 4000 0 0 JOHN A HUBBARD 1.00 3.00 X 3000 0 0 DOUG WILSON 1.00 4.00 X 4000 0 0 BILL VAN VACTOR 1.00 3.00 X 0 0 0 BOB MAYERS 1.00 2.00 X 0 0 0 BRIAN MCLEMORE 38.00 12.00 X 291424 78463 68913 MARY SCHOEGGL 38.00 12.00 X 155165 51049 64294 JILL COLLINS 40.00 X 272772 0 4487 MICHAEL MORRIS 38.00 12.00 X 149127 136879 61350 DEBBIE RAYBURN 40.00 X 174546 48467 37611 STEVEN RINKLE 40.00 X 143171 40386 34474 STEPHEN L EICHEN 40.00 X 142747 49479 28669 TAMARA NORDIN 40.00 X 116998 34184 47733 PAUL RIEPMA 40.00 X 160203 43389 27025 1649153 482296 374556 16 0 1 0 MOSS ADAMS ADVISORY SERVICES PO BOX 748369 LOS ANGELES CA 900748369 AUDITING/ACCOUNTING SERVICES 408103 DAVIS WRIGHT TREMAINE LLP 1300 SW FIFTH AVE PORTLAND OR 972015610 LEGAL SERVICES 338030 EN POINTE TECHNOLOGIES SALES INC PO BOX 514429 LOS ANGELES CA 900514429 IT SERVICES 241690 ERNST & YOUNG LLP 950 MAIN AVE SUITE 1800 CLEVELAND OH 441137214 AUDITING/ACCOUNTING SERVICES 240493 DIXON HUGHES GOODMAN LLC PO BOX 602828 CHARLOTTE NC 282602828 CONSULTING/ACCOUNTING SERVICES 238069 21 MANAGEMENT FEE REVENUE 561000 9343055 9343055 ACCOUNTING FEES 561000 1049381 1049381 INFO TECH SVC FEES 561000 967538 967538 MEDIA & ADVERTISING 541800 269346 269346 ADMINISTRATIVE REVENUE 561000 14962 14962 24632 24632 11668914 89162 43066 46096 75 0 75 75 75 RENTAL INCOME FROM RSI 900003 203045 203045 TAX REFUND 900099 12439 12439 215484 11973635 11668914 246111 58610 1341320 1341320 5428242 5428242 61513 61513 12818 12818 643051 643051 77127 77127 181833 181833 49367 49367 183625 183625 322845 322845 175826 175826 203732 203732 84308 84308 318191 318191 56806 56806 HOUSING PRGM/EDU 113339 113339 BOARD EXPENSE 85966 85966 ADMINISTRATIVE EXPENSE 43461 43461 DUES AND SUBSCRIPTIONS 18802 18802 9402172 8596028 806144 0 1961538 5091859 453606 453394 17795 173490 5258345 1097 29490 197549 312011 5370218 3244316 2302509 2125902 3722027 3722027 1325840 1325840 36941021 30252172 46922982 48744530 2932000 2392594 1687693 1624500 430532 288472 5050225 4305566 X 41872757 44438964 41872757 44438964 46922982 48744530 2571463 -5256 0 X 0 1 X 1 0 X X X 0 0 0 CAPITOL LAKES INC 391412320 LINE 9 1 1 1 0 CASCADE MANOR INC 930557803 LINE 9 1 1 1 0 HOLLADAY 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1 1 356 ROGUE VALLEY MANOR HOUSING CORPORATION 930864466 LINE 9 1 1 1 0 ROGUE VALLEY MANOR KLAMATH FALLS HOUSING CORPORATION 943196455 LINE 9 1 1 1 0 ROGUE VALLEY MANOR LIVELY OAKS HOUSING CORPORATION 943194409 LINE 9 1 1 1 962 ROGUE VALLEY MANOR MANSFIELD HOUSING CORPORATION 900292647 LINE 9 1 1 1 0 ROGUE VALLEY MANOR MEDFORD II HOUSING CORPORATION 943212537 LINE 9 1 1 1 2184 ROGUE VALLEY MANOR MEDFORD III HOUSING CORPORATION 311587418 LINE 9 1 1 1 2398 ROGUE VALLEY MANOR MYRTLE CREEK HOUSING CORPORATION 943162074 LINE 9 1 1 1 2421 ROGUE VALLEY MANOR MYRTLE CREEK II HOUSING CORPORATION 311715321 LINE 9 1 1 1 1363 ROGUE VALLEY MANOR PORTLAND HOUSING CORPORATION 311780332 LINE 9 1 1 1 1209 ROGUE VALLEY MANOR PORTLAND II HOUSING CORPORATION 300037898 LINE 9 1 1 1 2112 ROGUE VALLEY MANOR REEDSPORT HOUSING CORPORATION 943212538 LINE 9 1 1 1 268 ROGUE VALLEY MANOR ROSEBURG HOUSING CORPORATION 943179782 LINE 9 1 1 1 293 ROGUE VALLEY MANOR ROSEBURG II HOUSING CORPORATION 311587420 LINE 9 1 1 1 248 ROGUE VALLEY MANOR YREKA HOUSING CORPORATION 943212540 LINE 9 1 1 1 132 THE CUMBERLAND REST INC 750891470 LINE 9 1 1 1 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 931179254 LINE 9 1 1 1 0 CAPITOL LAKES FOUNDATION 383781089 LINE 7 1 1 1 0 CASCADE MANOR FOUNDATION 931330100 LINE 7 1 1 1 0 HOLLADAY PARK PLAZA FOUNDATION 264529118 LINE 7 1 1 1 0 MIRABELLA PORTLAND FOUNDATION 452508860 LINE 7 1 1 1 0 MIRABELLA SAN FRANCISCO BAY 200428927 LINE 9 1 1 1 0 MIRABELLA WASHINGTON FOUNDATION 450574348 LINE 7 1 1 1 0 ROGUE VALLEY MANOR COMMUNITY SERVICES INC 930892261 LINE 9 1 1 1 0 ROGUE VALLEY MANOR FOUNDATION 930712867 LINE 7 1 1 1 0 TRINITY TERRACE FOUNDATION INC 912162130 LINE 7 1 1 1 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS FOUNDATION 931301816 LINE 7 1 1 1 0 43 523311 9402172 9402172 620109 155027 0 0 561371 586066 620109 1767546 2651319 140343 146517 155027 441887 662831 400000 400000 2233042 961074 1271968 29647 29127 520 2356532 2064212 292320 350997 189903 161094 2125902 3722027 F 3722027 DUE FROM AFFILIATES 29952465 DEBT ISSUE COSTS & LOAN FEES 9035 OTHER NONCURRENT ASSETS 290672 30252172 OTHER LONG TERM LIABILITIES 288472 288472 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. X X X X 1 0 0 0 0 0 0 1 0 BRIAN MCLEMORE 237079 78463 30864 0 23481 0 52187 0 16726 0 360337 78463 0 0 MARY SCHOEGGL 134615 51049 17500 0 3050 0 47568 0 16726 0 219459 51049 0 0 JILL COLLINS 71042 0 0 0 201730 0 4119 0 368 0 277259 0 0 0 MICHAEL MORRIS 80958 136879 23000 0 45169 0 44624 0 16726 0 210477 136879 0 0 DEBBIE RAYBURN 149683 48467 20000 0 4863 0 20537 0 17074 0 212157 48467 0 0 STEVEN RINKLE 127120 36348 16051 4038 0 0 17748 0 16726 0 177645 40386 0 0 STEPHEN L EICHEN 123873 49479 15751 0 3123 0 11944 0 16725 0 171416 49479 0 0 TAMARA NORDIN 100857 34184 13309 0 2832 0 35370 0 12363 0 164731 34184 0 0 PAUL RIEPMA 137747 43389 17566 0 4890 0 21043 0 5982 0 187228 43389 0 0 PART I, LINE 4A JILL COLLIN'S EMPLOYMENT ENDED 1/2/2012 AND SHE RECEIVED A SEVERANCE PAYMENT. THE PARTIES ENTERED INTO A SETTLEMENT AGREEMENT AND MUTUAL GENERAL RELEASE (THE "AGREEMENT"). THE AGREEMENT PROVIDES FOR A CERTAIN PAYMENT TO MS. COLLINS, IMPOSES AND CLARIFIES CERTAIN OBLIGATIONS ON MS. COLLINS, AND CONTAINS MUTUAL RELEASES OF ALL CLAIMS BETWEEN THE PARTIES. 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 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 965 ELLENDALE DRIVE MEDFORD OR 97504 931067253 OFFICE BLDG. OR 203045 1664028 N/A ROGUE VALLEY MANOR 965 ELLENDALE DRIVE MEDFORD OR 97504 930453216 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 THE CUMBERLAND REST INC 965 ELLENDALE DRIVE MEDFORD OR 97504 750891470 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 CASCADE MANOR INC 965 ELLENDALE DRIVE MEDFORD OR 97504 930557803 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 965 ELLENDALE DRIVE MEDFORD OR 97504 931179254 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 HOLLADAY PARK PLAZA 965 ELLENDALE DRIVE MEDFORD OR 97504 930513697 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 HOLLADAY PARK PLAZA ENDOWMENT FUND 965 ELLENDALE DRIVE MEDFORD OR 97504 930776291 ASSISTANCE TRUST OR 501(C)(3) LINE 7 HOLLADAY PARK PLAZA 1 CAPITOL LAKES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 391412320 SENIOR HOUSING WI 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 1 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