2012-08-14T15:40:35-05:00 2011-09-30 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2010-10-01 910666887 PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST PRES 2068262110 715 9TH AVENUE SUITE 400 SEATTLE WA 98104 TAMERYN CAMPBELL 2068262110 2012-08-14 1 SARA ELIZABETH J HYRE 4254544919 2010 2016-02-24 21:20:13Z TAMERYN CAMPBELL 715 9TH AVENUE SUITE 400 SEATTLE WA 98104 47848641 0 X WWW.PRCN.NET X 1956 WA A FAITH-BASED ORGANIZATION SUPPORTING COMMUNITIES AND SERVICES THAT CELEBRATE AND ENRICH LIVES. 17 17 500 17 13999 -6836 0 206906 21983719 31966512 738905 659907 191622 652729 22914246 33486054 1250 3000 0 0 13067562 15346289 0 0 0 29325616 28730858 42394428 44080147 -19480182 -10594093 279527548 264766167 285292345 281339525 -5764797 -16573358 X A FAITH-BASED ORGANIZATION SUPPORTING COMMUNITIES AND SERVICES THAT CELEBRATE AND ENRICH LIVES. 0 0 36171929 32154277 PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST (PRCN) IS A PREMIER NOT-FOR-PROFIT ORGANIZATION COMPRISED OF THREE UNIQUE RESIDENTIAL COMMUNITIES PROVIDING SERVICES FOR A DIVERSE POPULATION OF OLDER ADULTS IN THE PACIFIC NORTHWEST. FOR OVER FIVE DECADES, PARK SHORE AND EXETER HOUSE HAVE BEEN MEETING THE NEEDS OF SENIORS THROUGH OUR HEALTH, WELLNESS AND LIFE ENRICHMENT PROGRAMS. IN THE FALL OF 2012, PRCN WILL BE CELEBRATING THIS MILESTONE ANNIVERSARY WITH OUR RESIDENTS AND TEAM MEMBERS. IN OCTOBER OF 2009, WE OPENED OUR NEWEST RETIREMENT COMMUNITY IN DOWNTOWN SEATTLE, SKYLINE AT FIRST HILL, AND WILL BE COMMEMORATING THEIR THREE YEAR ANNIVERSARY IN OCTOBER 2012. SKYLINE HAS BEEN A TREMENDOUS SUCCESS STORY. TO ACHIEVE OUR OCCUPANCY GOALS WITHIN A 36 MONTH PERIOD HAS BEEN UNPRECEDENTED IN THIS MARKETPLACE. WITH THE ECONOMIC DOWNTURN AND HOUSING MARKET CHALLENGED MANY COMMUNITIES HAVE NOT BEEN AS SUCCESSFUL. WE ATTRIBUTE THIS TO OUR LOW TEAM MEMBER TURNOVER, OUR COHESIVE BOARD OF DIRECTORS AND THE GUIDANCE AND DIRECTION OF STRONG LEADERSHIP. THROUGH OUR CONTINUOUS CARE RETIREMENT COMMUNITIES WE PROVIDE A CONTINUUM OF CARE: INDEPENDENT LIVING, ASSISTED LIVING, MEMORY SUPPORT AND SKILLED NURSING CATERING TO RESIDENTS AND THEIR INDIVIDUAL NEEDS. AS A FAITH BASED ORGANIZATION, WE ARE GUIDED BY OUR MISSION AND VISION TO SUPPORT COMMUNITIES AND SERVICES THAT CELEBRATE AND ENRICH LIVES. 36171929 1 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 121 0 1 500 1 1 1 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WA X EILEEN CHRISTENSON 2068262110 715 9TH AVENUE SUITE 400 SEATTLE WA 98104 X GARY HOULAHAN 5.00 X X 0 0 0 GREG ROBINSON 5.00 X X 0 0 0 ROBERT MITCHELL 4.00 X 0 0 0 CAROLE CONGER 8.00 X 0 0 0 JAMES MELHORN 4.00 X 0 0 0 PAUL COLLINS 2.00 X 0 0 0 HEATHER JAMES 2.00 X 0 0 0 TOM JOHNSTON 3.00 X 0 0 0 DOUG DIEKEMA 1.00 X 0 0 0 BONNIE BRIAN-CALDWELL 1.00 X 0 0 0 LUCILLE KELLEY 1.00 X 0 0 0 JOHN ESHELMAN 5.00 X 0 0 0 RICHARD MATTHEWS 3.00 X 0 0 0 TOM VALSILATOS 3.00 X 0 0 0 DOUG SETO 3.00 X 0 0 0 KAY BROWELEIT 3.00 X 0 0 0 REV SCOTT LUMSDEN 1.00 X 0 0 0 PAM PROSKE 1.00 X 0 0 0 TAMERYN CAMPBELL 65.00 X 99891 0 1018 JEFFREY CRANDALL 40.00 X 130047 0 3858 WESLEY BARD 40.00 X 158977 0 4070 JAMES YAMAMOTO 40.00 X 121930 0 4070 JOHN GREELEY 40.00 X 0 0 0 ALAN FLETCHER 40.00 X 145661 0 7775 ROB LIEBREICH 40.00 X 0 0 0 THOM HOWSON 40.00 X 125580 0 6824 JANET NAHLIN 40.00 X 126327 0 6284 SHELLY PARKS 40.00 X 115196 0 0 SALLY NAFZIGER 40.00 X 112795 0 7651 JOSEPH BOCHNIAK 40.00 X 110953 0 2046 FREDERICK MARSH KELLEGREW 40.00 X 154433 0 0 RACHEL RUGGERI 40.00 X 12953 0 1295 1247357 0 43596 10 0 1 1 SELLEN CONSTRUCTION 227 WESTLAKE AVE N SEATTLE WA 98109 CONTRACTOR 2349716 GREYSTONE DEVELOPMENT 222 W LAS COLINAS BLVD IRVING TX 75039 CONSULTING 895044 ATLAS GLASS AND CONSTRUCTION 5290 SOUTHCENTER BLVD TUKWILA WA 98188 CONSTRUCTION 326632 ZIEGLER LOTSOFF CAPITAL MANAGEMENT LLC 20 N CLARK STREET 34TH FLOOR CHICAGO IL 60602 CAPITAL MANAGEMENT 182341 RICE FERGUSEN 262 4TH STREET BREMERTON WA 98337 ARCHITECT 177469 14 206906 206906 RESIDENCY FEES 623990 18231047 18231047 MEDICAL SERVICES 623000 7983397 7983397 ASSISTED LIVING 623990 5512174 5512174 GUEST SERVICES 900099 164922 164922 OTHER RESIDENT SRVCS 900099 74972 74972 31966512 327744 327744 538016 538016 141913 141913 141913 135713 6200 14156734 14209123 153464 -52389 -153464 -205853 -205853 REFUNDS 900099 337299 337299 GARAGE INCOME 900099 126763 112764 13999 EMPLOYEE MEALS 900099 44483 44483 2271 2271 510816 33486054 32050067 13999 1215082 3000 3000 706413 706413 11815698 9573077 2242621 173808 131769 42039 1362126 971146 390980 1288244 1045847 242397 338935 338935 638908 9156 629752 285878 28015 257863 51300 51300 2474785 2227295 247490 886509 205453 681056 1350645 1164596 186049 198353 198353 1942907 1664134 278773 120180 7333 112847 113761 27516 86245 8891872 8891872 8645639 7781075 864564 650082 650082 RAW FOOD & KITCHEN 1817134 1817134 BAD DEBT 167275 167275 DUES/PERMITS/LICENSE 109935 70541 39394 UNIFORMS 46760 46760 44080147 36171929 7908218 0 2846711 2997508 3115829 6354468 7277555 5950547 397653 460837 247643725 37493408 214305600 210150317 34850754 19771910 12142128 11149985 4591318 7930595 279527548 264766167 3743671 4460991 89627787 117917850 186690000 154165000 5230887 4795684 285292345 281339525 X -5764797 -16573358 -5764797 -16573358 279527548 264766167 X -10594093 -214468 X 0 1 1 X 0 X 126671 13000 14701 206906 361278 16252820 16063743 16481882 22080501 31989355 102868301 164922 164922 16379491 16076743 16496583 22080501 32361183 103394501 0 0 0 103394501 528264 523801 519253 1066106 871960 3509384 528264 523801 519253 1066106 871960 3509384 36468 19367 339571 395406 44483 44483 16907755 16600544 17052304 23165974 33617197 107343774 0.96320 0.96290 0.03270 0.03650 X 1 0 0 0 0 1 831 0 0 0 831 0 13218689 13218689 203924987 29130836 174794151 11541226 6621779 4919447 18958823 1740793 17218030 210150317 DEPOSITS 2970090 ACCRUED MARKETING FEES 1761864 CAPITAL LEASE OBLIGATIONS 63730 4795684 33486054 44080147 -10594093 -420518 300435 -120083 -10714176 33456015 -420518 390479 -30039 33486054 0 33486054 44170191 90044 90044 44080147 0 44080147 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP- FH, LLC 206,046. CHANGE IN NET ASSETS FROM AFFILIATE 94,389. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM AFFILIATES 184,433. CHANGE IN VALUE OF INTEREST RATE SWAP- FH, LLC 206,046. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSE FROM AFFILIATES 90,044. X X X X 0 0 0 0 0 0 0 1 0 WESLEY BARD 158125 0 507 0 345 0 0 0 4070 0 163047 0 0 0 ALAN FLETCHER 145661 0 0 0 0 0 4050 0 3725 0 153436 0 0 0 PART I, LINE 7 FREDERICK MARSH KELLGREW RECEIVED A BONUS AS DETERMINED BY THE BOARD. SUPPLEMENTAL INFORMATION PART III ALAN FLETCHER WAS COMPENSATED BY GREYSTONE COMMUNITIES, AN UNRELATED ORGANIZATION, IN THE AMOUNT OF $153,436 IN WAGES AND OTHER COMPENSATION. WASHINGTON STATE HOUSING FINANCE COMMISSION- SERIES A 911874730 93978LDE3 2007-02-28 204865405 CONSTRUCT A CONTINUING CARE RETIREMENT COMMUNITY 0 0 0 50700405 204865405 15822834 3869728 1358952 169068115 2009 0 0 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 1 1 SOVEREIGN BANK 5.000000000000 0 0 0 0 0 FORM 990, PART I, LINE 6: THERE WERE 17 VOLUNTEER MEMBERS ON THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE PRESIDENT/CEO OF PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST REVIEWS THE FORM 990 PRIOR TO SIGNING. THE AUDIT COMMITTEE WILL ALSO REVIEW THE FORM 990 BEFORE IT IS SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, A CONFLICT OF INTEREST FORM IS DISTRIBUTED TO THE BOARD OF DIRECTORS AND OFFICERS. THE CEO TYPICALLY REVIEWS THE FORMS AND IDENTIFIES ANY CONFLICTS. IF A CONFLICT IS FOUND, THAT BOARD MEMBER REMOVES HIMSELF OR HERSELF FROM VOTING ON OR DISCUSSING THAT MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD USES AN INDEPENDENT COMPENSATION CONSULTANT AND COMPENSATION SURVEY TO ANNUALLY DETERMINE THE CEO AND CFO'S COMPENSATION. THE CEO IS RESPONSIBLE FOR CONDUCTING THE REVIEW OF OTHER OFFICERS' COMPENSATION (EXECUTIVE DIRECTORS). THE LAST REVIEW FOR THE CEO WAS PERFORMED IN DECEMBER 2011. FORM 990, PART VI, SECTION C, LINE 19 PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN (B): THE ESTIMATED AVERAGE HOURS PER WEEK DEVOTED BY THE FOLLOWING INDIVIDUALS TO RELATED ORGANIZATIONS ARE AS LISTED: ROBERT MITCHELL DIRECTOR 0.2 HOURS CAROLE CONGER DIRECTOR 0.0 HOURS JAMES MELHORN DIRECTOR 1.5 HOURS GREG ROBINSON VICE CHAIR 0.5 HOURS GARY HOULAHAN CHAIR 5.0 HOURS PAUL COLLINS DIRECTOR 1.0 HOURS HEATHER JAMES DIRECTOR 2.0 HOURS TOM JOHNSTON DIRECTOR 2.0 HOURS DOUG DIEKEMA DIRECTOR 0.5 HOURS BONNIE BRIAN-CALDWELL DIRECTOR 0.0 HOURS LUCILLE KELLEY DIRECTOR 0.1 HOURS JOHN ESHELMAN DIRECTOR 1.0 HOURS RICHARD MATTHEWS DIRECTOR 2.0 HOURS TOM VALSILATOS DIRECTOR 1.0 HOURS KAY BROWELEIT EX-OFFICIO DIRECTOR 3.0 HOURS REV. SCOTT LUMSDEN EX-OFFICIO DIRECTOR 0.1 HOURS DOUG SETO DIRECTOR 1.0 HOURS TAMERYN CAMPBELL PRESIDENT & CEO 1.0 HOURS FREDERICK MARSH KELLEGREW FORMERPRESIDENT & CEO 1.0 HOURS JEFFREY CRANDALL VICE PRESIDENT 1.0 HOURS PAM PROSKE INTERIM EX-OFFICIO DIRECTOR 0.1 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -420,518. CHANGE IN VALUE OF INTEREST RATE SWAP- FH, LLC 206,046. ROUNDING 4. TOTAL TO FORM 990, PART XI, LINE 5: -214,468. FH LLC 715 9TH AVENUE SUITE 400 SEATTLE WA 98104 910666887 OPERATE RETIREMENT COMMUNITY WA -12288885 225512964 PRCN PRESBYTERIAN RETIREMENT NORTHWEST FOUNDATION 715 9TH AVENUE SUITE 400 SEATTLE WA 98104 911586491 BENEFIT RESIDENTS AND EMPLOYEES WA 501(C)(3) 11-TYPE 1 PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0