2011-04-30T13:40:31-05:00 2010-09-30 990 2009-10-01 750891470 THE CUMBERLAND REST INC CUMB 5418577854 1200 MIRA MAR AVE MEDFORD OR 97504 BRIAN MCLEMORE 5418577854 2011-05-06 2009 2016-02-24 21:20:13Z BRIAN MCLEMORE 1200 mira mar ave medford OR 97504 17209991 0 X RETIREMENT.ORG X 1990 TX THE PRIMARY EXEMPT PURPOSE OF THE CUMBERLAND REST IS TO PROVIDE COMPREHENSIVE CARE AND HOUSING FOR RETIRED INDIVIDUALS 13 13 198 0 0 0 2016 0 14372299 16572145 226262 335610 0 14600577 16907755 0 0 5519373 5626363 0 0 14379919 12021400 19899292 17647763 -5298715 -740008 87741358 95337346 92434954 95850841 -4693596 -513495 THE PRIMARY EXEMPT PURPOSE OF THE CUMBERLAND REST IS TO PROVIDE COMPREHENSIVE CARE AND HOUSING FOR RETIRED INDIVIDUALS 0 0 3437704 3558206 HEALTH CARE CENTER HAS BEEN ESTABLISHED TO CARE FOR THE NEEDS OF ALL RESIDENTS OF TRINITY TERRACE 2083358 246626 A FOOD SERVICE PROGRAM HAD BEEN ESTABLISHED TO PROVIDE QUALITY AND NUTRITIONAL MEALS FOR ALL RESIDENTS OF TRINITY TERRACE 3079367 20113 RESIDENTIAL COMMUNAL CARE FOR ALL RESIDENTS OF TRINITY TERRACE. THIS INCLUDES PLANNED RECREATIONAL AND OTHER ACTIVITIES 8600429 1 0 0 0 0 0 0 0 0 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 1 0 0 0 1 81 0 1 198 0 0 0 0 0 0 0 0 0 0 0 13 13 1 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 TX X TRINITY TERRACE 5418577854 1200 MIRA MAR AVE MEDFORD OR 97504 X ALLAN BARR 1.00 X X 0 0 0 GRETCHEN SMITH 1.00 X X 0 0 0 MICHAEL HYATT 1.00 X X 0 0 0 Rev Karl Travis 1.00 X 0 0 0 JIM AUSTIN 1.00 X 0 0 0 LARRY ANFIN 1.00 X 0 0 0 HARRY KNIGHT 1.00 X 0 0 0 DONALD MILLS 1.00 X 0 0 0 JIM WHITToN 1.00 X X 0 0 0 DOUG WILSON 1.00 X X 0 0 0 FREDDY JONES 1.00 X 0 0 0 CARLELA VOGEL 1.00 X 0 0 0 0 0 0 0 0 0 0 Lone Star Classic Construction 3750 Kelly Road ALEDO TX 76008 reNOVATIONS 1392952 SYSCO FOOD SERVICES PO BOX 560700 LEWISVILLE TX 97056 FOOD SUPPLIER 440947 HBCC Funding LLC 02-1 PO BOX 4500 PORTLAND OR 97208 PHYSICAL THERAPY 324842 V TECH MECHANICAL PO BOX 737 LILLIAN TX 76061 RENOVATIONS 176046 Glenview Prof Pharmacy II 7640 Glenveiw Drive FORT WORTH TX 76118 RENOVATIONS 116780 6 MONTHLY SERVICE FEES 531110 9563819 9563819 HEALTH CENTER REVENUE 531110 3558206 3558206 ENTRANCE FEES 531110 3068557 3068557 OTHER REVENUE 531110 381563 381563 16572145 637846 637846 302236 -302236 -302236 -302236 16907755 16269909 0 637846 4429454 3762172 667282 107755 83325 24430 734441 618611 115830 354713 302603 52110 1090397 1090397 26310 26310 167914 167914 235643 235643 17216 4572 12644 40937 1116 39821 433528 432947 581 31491 7531 23960 2562800 2562800 3514621 3514621 UTILITIES 1175805 1175805 CONTRACT SERVICES 798024 687659 110365 OTHER DIETARY EXPENSE 759263 759263 OTHER HEALTH EXPENSE 385549 385549 INSURANCE 265014 265014 516888 379276 137612 17647763 8600429 9047334 0 3938626 2823215 16154288 23964956 380182 389479 42068 39730 170133 143474 87935797 29780315 59977928 58155482 3477047 987844 3601086 8833166 87741358 95337346 1088505 1841857 36659774 40542532 50000000 47610000 4686675 5856452 92434954 95850841 X -7883988 -9014530 1383123 4850179 1807269 3650856 -4693596 -513495 87741358 95337346 X 0 1 1 X 0 X 4328 1960 3270 2016 11574 11822548 11957794 23205876 15034337 16571501 78592056 11826876 11959754 23209146 15036353 16571501 78603630 0 0 0 78603630 78768 442322 593179 254467 489216 1857952 78768 442322 593179 254467 489216 1857952 1762264 1285113 1913924 -662041 298994 4598254 13667908 13687189 25716249 14628779 17359711 85059836 0.92410 0.91440 0.02180 0.01850 X 87935797 29780315 58155482 58155482 ASSETS RESTRICTED UNDER BOND INDENTURE AGREEMENT 7479863 BOND ISSUE COST, NET 1169623 OTHER NONCURRENT ASSETS 163600 INTEREST IN NET ASSETS OF TRINITY TERRACE FOUNDATION 20080 8833166 REFUNDABLE DEPOSITS 437670 SWAP AGREEMENT 5353194 DUE TO FROM AFFILIATES 65588 5856452 16907755 17647763 -740008 3437476 1482633 4920109 4180101 17209991 0 17209991 -302236 -302236 16907755 17949999 302236 302236 17647763 0 17647763 Part XI, Line 8 - Other Adjustments: UNREALIZED GAIN ON INVESTMENT SECURITIES: 647556. SWAP AGREEMENT LOSS: -1478501. UNREALIZED GAIN ON ASSETS HELD IN TRUST: 52322. CHANGE IN TEMPORARILY RESTRICITED ASSTS: 17976. CHANGE IN TINTEREST IN TRINITY TERRACE FAOUNDATION: 20080. CHANGE IN FMV OF SPLIT INTEREST TRUST: 2223200. DISPOSAL OF ASSETS TARRANT COUNTY HEALTH FACILITES DEVELOPMENT CORPORATION 751881060 87638LCJ3 2006-12-07 55000000 FINANCE CONSTRUCTION OF NEW BUILDING 0 0 55000000 1490560 53509440 2009 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 Form 990, Part VI, Section A, line 2 THE EXECUATIVE ADMINSITRATOR, MIKE MORRIS, IS RELATED BY MARRIAGE TO TOM BECKER, PACIFIC RETIREMENT SERVICES PRESIDENT Form 990, Part VI, Section A, line 3 TRINITY TERRACE BOARD DELEGATES DAY TO DAY MANAGEMENT TO PACIFIC RETIREMENT SERVICES Form 990, Part VI, Section A, line 7a PACIFIC RETIREMENT SERVCES CAN APPOINT BOARD MEMBERS TO THE TRINITY TERRACE BOARD Form 990, Part VI, Section A, line 7b SOME DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY PACIFIC RETIREMENT SERVICES Form 990, Part VI, Section B, line 11 THE FORM 990 IS CURRENTLY BEING REVEIWED BY CONTROLLER AND THE BOARD OF DIRECTORS Form 990, Part VI, Section B, line 12c CORPORATE COUNSEL ISSUES POLICY ANNUALLY TO KEY EMPLOYEES AND BOARD MEMBERS ORGANIZATION'S BOARD REVEIWS AND APPROVES ANNUAL BUDGET Form 990, Part VI, Section C, line 18 ALL REQUESTS GO THROUGH THE CORPORATE COUNSEL Form 990, Part VI, Section C, line 19 ALL REQUESTS GO THROUGH THE CORPORATE COUNSEL FORM 990 PART XI LINE 2C PACIFIC RETIREMENT SERVICE'S AUDIT COMMITTEE SELECTS AUDITORS Pacific Retirement Services 1200 Mira Mar Ave Medford OR 97504 Supporting Org OR 501(c)(3) 13 Pacific Retirement Services PRS 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services RVM 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Trinity 1200 Mira Mar Ave Medford OR 97504 Senior Housing TX 501(c)(3) 9 Pacific Retirement Services Cascade Manor 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services URCAD 1200 Mira Mar Ave Medford OR 97504 Senior Housing CA 501(c)(3) 9 Pacific Retirement Services Holladay Park Plaza 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Capitol Lakes 1200 Mira Mar Ave Medford OR 97504 Senior Housing WI 501(c)(3) 9 Pacific Retirement Services RVM Foundation 1200 Mira Mar Ave Medford OR 97504 Public Foundation OR 501(c)(3) 9 Pacific Retirement Services URCAD Foundation 1200 Mira Mar Ave Medford OR 97504 Public Foundation CA 501(c)(3) 9 Pacific Retirement Services Trinity Terrace Foundation 1200 Mira Mar Ave Medford OR 97504 Public Foundation TX 501(c)(3) 9 Pacific Retirement Services HPP Foundation 1200 Mira Mar Ave Medford OR 97504 Public Foundation OR 501(c)(3) 9 Pacific Retirement Services Mirabella Washington Foundation 1200 Mira Mar Ave Medford OR 97504 Public Foundation WA 501(c)(3) 9 Pacific Retirement Services Cascade Manor Foundation Inc 1200 Mira Mar Ave Medford OR 97504 Public Foundation OR 501(c)(3) 9 Pacific Retirement Services Capitol Lakes Foundation 1200 Mira Mar Ave Medford OR 97504 Public Foundation OR 501(c)(3) 9 Pacific Retirement Services Mira Bella 1200 Mira Mar Ave Medford OR 97504 Senior Housing WA 501(c)(3) 9 Pacific Retirement Services Mira Bella South Waterfront 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Mira Bella San Francisco Bay 1200 Mira Mar Ave Medford OR 97504 Senior Housing CA 501(c)(3) 9 Pacific Retirement Services FGP RVM Comm SvcsAP 1200 Mira Mar Ave Medford OR 97504 Community Services OR 501(c)(3) 9 Pacific Retirement Services RSVP 1200 Mira Mar Ave Medford OR 97504 Community Services OR 501(c)(3) 9 Pacific Retirement Services Ross Knotts 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Don Lewis 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Foothill 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Oak Grove 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Valley ViewMyrtle Creek 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Pilot Butte 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Royal Loto 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Klamath View 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Larson Creek 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Lively OaksGlenridge Terrace 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Timber RidgeRVM Reedsport Housing Co 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Sierra Vista 1200 Mira Mar Ave Medford OR 97504 Senior Housing CA 501(c)(3) 9 Pacific Retirement Services Kingsley Court 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Silverstone 1200 Mira Mar Ave Medford OR 97504 Senior Housing TX 501(c)(3) 9 Pacific Retirement Services Pilot Butte II 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Fairview Fort Worth II Housing Corp 1200 Mira Mar Ave Medford OR 97504 Senior Housing TX 501(c)(3) 9 Pacific Retirement Services Quail Ridge 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Meadow Creek RVM Roseburg II 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Foothill II 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Shasta Point 1200 Mira Mar Ave Medford OR 97504 Senior Housing CA 501(c)(3) 9 Pacific Retirement Services Valley View II RVM Myrtle Creek II (Plaza) 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Columbia TerraceRVM Portland 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Woodland Heights 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Central Point 1200 Mira Mar Ave Medford OR 97504 Senior Housing OR 501(c)(3) 9 Pacific Retirement Services Magnolia Heights 1200 Mira Mar Ave Medford OR 97504 Senior Housing TX 501(c)(3) 9 Pacific Retirement Services Middleton Glen Inc 1200 Mira Mar Ave Medford OR 97504 Senior Housing WI 501(c)(3) 9 Pacific Retirement Services Senior Housing of Middleton Inc 1200 Mira Mar Ave Medford OR 97504 Senior Housing WI 501(c)(3) 9 Pacific Retirement Services PRS School of Aging Services Inc 1200 Mira Mar Ave Medford OR 97504 School OR 501(c)(3) 9 Pacific Retirement Services Corbinton Retirement 1200 Mira Mar Ave Medford OR 97504 Senior Housing NC 501(c)(3) 9 Pacific Retirement Services Mirabella Marin 1200 Mira Mar Ave Medford OR 97504 Senior Housing CA 501(c)(3) 9 Pacific Retirement Services Crest Park 1200 Mira Mar Ave Medford OR 97504 931169683 Hotel OR Pacific Retirement Services C 1.00000 RS INC 1200 Mira Mar Ave Medford OR 97504 931328250 Management Co OR Pacific Retirement Services C 1.00000 Centennial Inc 1200 Mira Mar Ave Medford OR 97504 510554651 Golf Course OR Pacific Retirement Services C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 PACIFIC RETIREMENT SEERVICES L 1243348 PACIFIC RETIREMENT SEERVICES O 63658