2013-08-15T18:41:46-05:00 2012-09-30 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2011-10-01 930712867 ROGUE VALLEY MANOR MEMORIAL FOUNDATION ROGU 8887246424 1200 MIRA MAR AVENUE MEDFORD OR 97504 MARC BAYLISS 8887246424 2013-08-15 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-02-24 21:20:13Z MARC BAYLISS 965 ELLENDALE DRIVE MEDFORD OR 97504 1227035 0 X WWW.RETIREMENT.ORG X 1977 OR ACQUIRE, HOLD, AND DISTRIBUTE GIFTS TO ROGUE VALLEY MANOR AND COMMUNITY ORGANIZATIONS. 7 7 0 700 0 0 1015028 668538 0 0 2479472 84486 -85256 82037 3409244 835061 396413 657384 0 0 155007 187288 0 0 0 567422 782106 1118842 1626778 2290402 -791717 10789601 11104805 185114 267454 10604487 10837351 THE MISSION OF THE ROGUE VALLEY MANOR FOUNDATION IS TO ENRICH THE QUALITY OF LIFE FOR MANOR RESIDENTS, FOR SENIORS SERVED BY AFFILIATE ORGANIZATIONS, AND FOR OTHERS IN THE COMMUNITY 0 0 1385578 657384 0 GRANTS AND ALLOCATIONS / OUTLAYS ACCORDING TO DONORS SPECIFIED PURPOSES. 0 0 0 0 0 0 0 0 0 1385578 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 5 0 1 0 0 0 0 0 0 1 1 1 3 0 0 1 0 X 7 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X SHERI DRESSLER 5418577644 965 ELLENDALE DRIVE MEDFORD OR 97504 X PHYLLIS SKINNER 1.00 X 0 0 0 RON MCCUNE 1.00 X X 0 0 0 JASON BROESDER 1.00 X 0 0 0 FAYE HUTCHINGS 1.00 X X 0 0 0 MARC BAYLISS 1.00 X X 0 4000 0 ESTHER KENNEDY 1.00 X 0 0 0 ELLEN WALDMAN 1.00 X 0 0 0 TIM BROPHY 1.00 X 0 0 0 JOSEPH PEDROJETTI 1.00 X X 0 0 0 0 4000 0 0 0 0 0 0 300709 367829 144299 668538 271196 271196 93000 279710 -186710 -186710 -186710 194301 300709 112264 82037 82037 835061 0 0 166523 586402 586402 70982 70982 156529 156529 13380 13380 6105 6105 11274 11274 1550 1550 33019 33019 3059 3059 1323 1323 695 695 4349 4349 2409 2409 PROGRAM FUND EXPENSES 721436 721436 FACILITY SERVICE EXPENS 14266 14266 1626778 1385578 241200 0 1280600 452419 507357 321297 217777 55228 2135 3631 14300 17775 30962 17501 17810 13461 8749622 10240994 10789601 11104805 62600 223964 122514 43490 185114 267454 X 4593283 5525935 4644692 3944714 1366512 1366702 10604487 10837351 10789601 11104805 X -791717 1024581 X 0 1 1 X 0 X 774306 1361977 1214017 1015028 668538 5033866 774306 1361977 1214017 1015028 668538 5033866 436383 4597483 344163 68059 218677 236376 271196 1138471 373387 140150 346785 180204 194301 1234827 7407164 0.62070 0.59250 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SPECIAL EVENT RECEIPTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1366512 50 140 1366702 1373663 -4648 2503 1366512 1382813 610 -9760 1373663 1341325 85710 -44222 1382813 0.00000 1.00000 0.00000 1 0 30962 17501 13461 13461 DUE TO AFFILIATES 43490 43490 835061 1626778 -791717 1187130 -162549 1024581 232864 1826624 1187130 1187130 639494 33018 162549 195567 835061 1593760 0 1593760 33018 33018 1626778 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION'S ENDOWMENT CONSISTS OF VARIOUS INDIVIDUAL FUNDS ESTABLISH FOR VARIOUS PURPOSES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION 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 FOUNDATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2012 AND 2011, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: ACTUARIAL CHANGE ON GIFT ANNUTIES RECEIVABLE -162,549. PART XII, LINE 4B - OTHER ADJUSTMENTS: ACTUARIAL CHANGE ON GIFT ANNUITIES RECEIVABLE 162,549. GOLF TOURNAMENT 150972 128691 22281 33967 BIG SALE AUCTION 288601 144300 144301 78190 1 55437 27718 27719 107 495010 300709 194301 112264 112264 82037 1 ROGUE VALLEY MANOR INC 965 ELLENDALE DRIVE MEDFORD OR 97501 930453216 501(C)(3) 249449 336953 PURCHASE PRICE PROPERTY AND EQUIPMENT RESIDENT PROGRAM SUPPORT 1 0 SCHOLARSHIPS 51 70982 X 144299 APPRAISED VALUE 0 0 1 1 THIRD PARTY USE: PART I, LINE 32B: RVM FOUNDATION USED VOLUNTEERS TO SELL NON-CASH CONTRIBUTIONS ON CRAIGSLIST AND/OR EBAY. THE RVM FOUNDATION ALSO OCCASIONALLY USED CONSIGNMENT AND PROFESSIONAL HELP WITH AUTO SALES. FORM 990, PART VI, SECTION A, LINE 3 ROGUE VALLEY MANOR MEMORIAL FOUNDATION DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A PACIFIC RETIREMENT SERVICES HAS THE RIGHT TO ELECT FOUNDATION DIRECTORS FROM NOMINEES SELECTED BY THE FOUNDATION BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE BOARD ARE SUBJECT TO APROVAL BY PACIFIC RETIREMENT SERVICES AS DESCRIBED IN ARTICLE I, SECTION 4 OF THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS CURRENTLY BEING REVIEWED BY THE CFO, ASSISTANT CONTROLLER AND THE BOARD OF DIRECTORS. 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 C, LINE 19 ALL REQUESTS GO THROUGH THE CORPORATE COUNSEL. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: PART VII, SECTION A: MARC BAYLISS DEVOTES 1 HOUR PER WEEK TO PACIFIC RETIREMENT SERVICES, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,187,130. ACTUARIAL CHANGE ON GIFT ANNUTIES RECEIVABLE -162,549. TOTAL TO FORM 990, PART XI, LINE 5: 1,024,581. PACIFIC RETIREMENT SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931067253 SUPPORTING ORGANIZATION OR 501(C)(3) LINE 11C, III-FI N/A 0 ROGUE VALLEY MANOR 965 ELLENDALE DRIVE MEDFORD OR 97504 930453216 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 THE CUMBERLAND REST INC 965 ELLENDALE DRIVE MEDFORD OR 97504 750891470 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CASCADE MANOR INC 965 ELLENDALE DRIVE MEDFORD OR 97504 930557803 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 965 ELLENDALE DRIVE MEDFORD OR 97504 931179254 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA 965 ELLENDALE DRIVE MEDFORD OR 97504 930513697 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA ENDOWMENT FUND 965 ELLENDALE DRIVE MEDFORD OR 97504 930776291 ASSISTANCE TRUST OR 501(C)(3) LINE 7 HOLLADAY PARK PLAZA 0 CAPITOL LAKES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 391412320 SENIOR HOUSING WI 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 931301816 PUBLIC FOUNDATION CA 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 TRINITY TERRACE FOUNDATION INC 965 ELLENDALE DRIVE MEDFORD OR 97504 912162130 PUBLIC FOUNDATION TX 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 264529118 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA WASHINGTON FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 450574348 PUBLIC FOUNDATION WA 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 CASCADE MANOR FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 931330100 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 CAPITOL LAKES FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 383781089 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CAPITOL LAKES INC 0 MIRABELLA 965 ELLENDALE DRIVE MEDFORD OR 97504 342030255 SENIOR HOUSING WA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA PORTLAND FOUNDATION 965 ELLENDALE DRIVE MEDFORD OR 97504 452508860 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA AT SOUTH WATERFRONT 965 ELLENDALE DRIVE MEDFORD OR 97504 711016384 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA SAN FRANCISCO BAY 965 ELLENDALE DRIVE MEDFORD OR 97504 200428927 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM COMMUNITY SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 930892261 COMM SRVCS OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 930864466 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM ASHLAND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 930942933 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM GRANTS PASS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943136037 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM ROSEBURG HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943179782 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MYRTLE CREEK HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943162074 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM BEND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943163349 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM EAGLE POINT HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943191447 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM KLAMATH FALLS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943196455 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM MEDFORD II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943212537 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM LIVELY OAKS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943194409 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM REEDSPORT HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943212538 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM YREKA HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943212540 SENIOR HOUSING CA 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM EUGENE HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943247154 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM FORT WORTH I HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311520436 SENIOR HOUSING TX 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM BEND II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 943260016 SENIOR HOUSING OR 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 RVM FORT WORTH II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311587415 SENIOR HOUSING TX 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MEDFORD III HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311587418 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM ROSEBURG II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311587420 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM GRANTS PASS II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311662259 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM DAVIS HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311662208 SENIOR HOUSING CA 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MYRTLE CREEK II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311715321 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM PORTLAND HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 311780332 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM PORTLAND II HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 300037898 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM CENTRAL POINT HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 300315618 SENIOR HOUSING OR 501(C)(3) LINE 9 ROGUE VALLEY MANOR 0 RVM MANSFIELD HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 900292647 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CORBINTON RETIREMENT 965 ELLENDALE DRIVE MEDFORD OR 97504 262987036 SENIOR HOUSING NC 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA AT MORRISON 965 ELLENDALE DRIVE MEDFORD OR 97504 271016196 SENIOR HOUSING NC 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK 965 ELLENDALE DRIVE MEDFORD OR 97504 931169683 HOTEL OR N/A C RETIREMENT SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931328250 MANAGEMENT COMPANY OR N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0