2013-07-15T14:17:29-05:00 2012-12-31 411690382 Malloy Montague Karnowski Radosevich 5353 Wayzata Blvd Ste 410 Minneapolis MN 55416 990 2012-01-01 860906621 Northern Arizona Senior Living Community LLC NORT 9523618000 1107 Hazeltine Blvd No 200 Chaska MN 55318 Dan R Peterka 9523618000 2013-05-10 1 Thomas M Montague P00089901 9525450424 2013-05-10 2012 2016-02-24 21:20:13Z Dan R Peterka 1107 Hazeltine Blvd No 200 Chaska MN 55318 13157427 0 X www.thepeaks.org X 1997 MN The Corporation was formed to develop and operate a senior living and mentoring facility. 6 6 247 28 0 0 0 0 13195855 12805695 356778 344083 0 0 13552633 13149778 0 0 0 0 4660606 4680576 0 0 0 8660343 8602712 13320949 13283288 231684 -133510 35149518 34452393 37905829 37342214 -2756311 -2889821 X To develop and operate a senior living and mentoring facility. 0 0 11636189 12805695 The Peaks, Flagstaff, Arizona, is unlike any senior community in the county because it shares strong ties with the Museum of Northern Arizona. The Peaks also provides its residents, as well as children in the area, with unique intergenerational activities that benefit the older adults and the children alike. Two of The Peaks residents and The Lodge executive director are docents of the museum, providing education on local history, and discoveries of the Colorado Plateau to area schools, associations, the public and Peaks residents. The Peaks also provides assisted living, progressive memory care, rehabilitation, long-term care, and skilled nursing. The Peaks offers the opportunity for residents to "age in place," which encourages the resident to remain in their apartment homes receiving assistance with activities of daily living through personalized levels of care. Northern Arizona Senior Living Community, LLC is a comprehensive senior living and healthcare campus consisting of 58 skilled nursing beds, 96 assisted living units, and 39 bungalows. 11636189 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 60 0 1 247 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 AZ X The Goodman Group LLC 9523618000 1107 Hazeltine Blvd Chaska MN 55318 X Lisa Brugh 1.00 X 0 0 0 Denise Gustafson 1.00 X 0 0 0 Christopher Bavasi 1.00 X 0 0 0 Mark Wilson 1.00 X 0 0 0 Robert Breunig 1.00 X 0 0 0 Dan R Peterka 1.00 X 0 0 0 Irwin Bloom 1.00 X 0 0 0 0 0 0 0 0 0 0 Synertx 7540 North 19th Avenue Suite 200 Phoenix AZ 85021 Therapy 1524636 The Goodman Group LLC 1107 Hazeltine Blvd 200 Chaska MN 55318 Management and Accounting Services, info 818478 John B Goodman Limited Partnership 1107 Hazeltine Blvd 200 Chaska MN 55318 Construction Management & Development 566314 Pharmerica Corporation of America PO Box 409251 Atlanta GA 30384 Pharmacy 526457 4 Resident Services 623000 8505179 8505179 Ancillary Services 623000 4220130 4220130 Other operating revenue 623000 80386 80386 12805695 351732 351732 7649 -7649 -7649 -7649 13149778 12805695 0 344083 4291449 3951883 339566 39955 39955 349172 319089 30083 834582 834582 26158 26158 116262 116262 67598 67598 1068944 1068944 310160 310160 78625 415 78210 2142413 2142413 990718 990718 494212 276466 217746 Contracted Services 1861822 1861822 Dietary Food 453105 453105 Equipment rental & main 91248 91248 Miscellaneous 62373 62373 4492 4492 13283288 11636189 1647099 0 1834696 1441721 123025 124196 861352 829138 45281 56052 95185 93157 27969365 9258227 18791483 18711138 13398496 13196991 35149518 34452393 910220 801666 35985000 35540000 1010609 1000548 37905829 37342214 X -2756311 -2889821 -2756311 -2889821 35149518 34452393 -133510 0 X X 0 1 X 1 0 X 11616636 12429084 12239655 13186802 12798046 62270223 11616636 12429084 12239655 13186802 12798046 62270223 0 0 0 62270223 1095759 375568 375515 365831 351732 2564405 1095759 375568 375515 365831 351732 2564405 12712395 12804652 12615170 13552633 13149778 64834628 0.96040 0.95420 0.03960 0.04580 X 660000 660000 21775297 6285103 15490194 2430150 1367969 1062181 3101276 1605155 1496121 2642 2642 18711138 Accrued interest receivable 111477 Debt service reserve 2043438 Bond fund 1786149 Net amortized loan costs 1553513 Reserve for replacement 982410 Insurance escrow 101603 Advance refunding escrow 6618401 13196991 Security Deposits 13500 Patient Funds 2298 Accrued Interest 984750 1000548 X 13157427 0 13157427 -7649 -7649 13149778 13290937 0 13290937 -7649 -7649 13283288 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Company is exempt from federal and state income taxes under Internal Revenue Code 501(c)(3). The Company is subject to tax on income from any unrelated business. On January 1, 2010, the Company adopted the recognition requirements for uncertain income tax positions as required by the FASB ASC 740-10 (formerly known as FASB Interpretation No. 48, Accounting for Uncertainty in Income Taxes), with no cumulative effect adjustment required. Income tax benefits are recognized for income tax positions taken or expected to be taken in a tax return, only when it is determined that the income tax position will more-likely-than-not be sustained upon examination by taxing authorities. The Company has analyzed tax positions taken for filing with the Internal Revenue Service and state jurisdiction where it operates. The Company believes that income tax filing positions will be sustained upon examination and does not anticipate any adjustments that would result in a material adverse effect on the Company's financial condition, results of operations, or cash flows. Accordingly, the Company has not recorded any reserves, or related accruals for interest and penalties for uncertain income tax positions at December 31, 2012. Part XI, Line 4b - Other Adjustments: Loss on disposal of property and equipment -7,649. Part XII, Line 4b - Other Adjustments: Loss on disposal of property and equipment -7,649. A The Industrial Development Authority of the City of Flagstaff Arizona 521293802 338448AG8 2007-08-01 30650000 Refinance real estate used by organization 0 0 0 B The Industrial Development Authority of the City of Flagstaff Arizona 521293802 338448AD5 2003-02-27 7000000 Construction additions 1 0 0 A 1525000 30650000 2050428 6866968 610673 797387 20324544 2007 0 1 1 1 B 585000 6415000 7086053 587938 501000 225000 25000 5747115 2003 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 1 1 0 0 0 0 B 1 1 0 0 0 0 Form 990, Part VI, Section A, line 6 Members Form 990, Part VI, Section A, line 7a Members can elect members of the governing body. Form 990, Part VI, Section A, line 7b Decisions of the governing body are subject to approval by members. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by an independent certified public accounting firm. It is then reviewed by the controller of the management company who is a CPA. The Form 990 is given to each board member in advance of a scheduled meeting of the board for their review. There is a discussion of the Form 990 at the board meeting with the preparers and the management company's representative prior to board approval of the Form 990. Form 990, Part VI, Section B, line 12c Each member of the governing board completes a disclosure of conflict of interest questionnaire annually. Form 990, Part VI, Section B, line 15 Compensation is based on experience and market salary surveys. Form 990, Part VI, Section C, line 19 The organization makes it governing documents, conflict of interest policy and financial statements available to the public upon request. Contact Addresses for Officers, Directors, Etc Form 990, Part VII Irwin Bloom - 1200 North Beaver Street, Flagstaff, AZ 86001. Lisa Brugh - 1200 N. Beaver Street, Flagstaff, AZ 86001. Denise Gustafson - 3386 Pilot Knob Road, Eagan, MN 55121. Christopher Bavasi - Flagstaff Medical Center, PO Box 891, Flagstaff, AZ 86002. Mark Wilson - 220 South 6th Street, Suite 1800, Minneapolis, MN 55402. Robert Breunig - 3101 North Fort Valley Road, Flagstaff, AZ 86001. Financial statement preperation FORM 990, PART XII, LINE 2C: The financial statements are prepared by an independent accounting firm. The statements are reviewed and approved by the board before being issued. This process is the same as last year. RELATED ORGANIZATION COMPENSATION: Made an effort to obtain information on compensation, if any were paid from a related organization. No responses received and no transactions noted. Program Service Accomplishments Form 990, Part III, Line 4a The community was developed through a nonprofit partnership between Intergenerational Living and Health Care, the Museum of Northern Arizona and Northern Arizona Healthcare. For the fiscal year ended December 31, 2012, The Peaks participated in various charitable initiatives such as the provision of discounted care through participation in the Arizona State Medicaid program. We average 18 Medicaid patients in our skilled nursing facility on a daily basis and discounted their care by $264,016 during the 2012 year. In our lodge we averaged 27 residents on a daily basis and discounted their care by $44,165 during 2012. We have a partnership with the Museum of Northern Arizona (MNA) that consists of supporting an art collection within The Peaks and three museum docent programs. We believe this art enriches the lives of our residents and the community as a whole. Each month we support the museum with an $825 monthly fee. (Value $9,900). We currently have a $7,500 endowment at Northern Arizona University within the Behavioral and Social Science Department for scholarships to students who plan careers that would support seniors. In addition, an endowment in the amount of $15,000 was established with The Northern Arizona Universitys Foundation to be used for scholarships for degree advancement for registered nurses who aspire to earn a bachelors degree in nursing. The Peaks also gave a donation to the Northland Hospice by sponsoring a golf hole for $5,000 during their annual fund raising golf tournament. A gift of $4,250 was presented to the Poore Clinic, a local clinic that provides free services for the underserved in Flagstaff. As well, in 2012, a gift of $5,000 was given to Camp Colton. Camp Colton is owned and operated by Flagstaff Unified School District (FUSD) and has been in operation since 1971. Over this time, 38,000 children have attended Camp Colton. As its core purpose, Camp Colton educates children about the natural sciences and elevates their understanding and appreciation for the environment through meaningful outdoor experiences. Non-voting member FORM 990, PART VI, LINE 1A: Robert Breunig is a non-voting board member and is not included in the total for voting members. Refunding Escrow Schedule K The entity has an outstanding refunding escrow that is both an asset and liability on the books. Therefore it is not included on the Schedule K. Bond issued at a premium Form 990, Schedule K, Part II, Column B, Line 3 The total proceeds received is greater than the bond issuance price as the bond was issued at a premium.