2014-08-12T18:58:04-05:00 2013-09-30 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 100 STOCKTON CA 952192303 990 2012-10-01 711016384 MIRABELLA AT SOUTH WATERFRONT MIRA 8887246424 3550 SW BOND PORTLAND OR 97239 ANTHONY SABATINI 5418577854 2014-08-10 1 TRACY S PAGLIA P00366884 2099556100 2012 2015-11-30 17:44:51Z C TODD MARTIN 965 ELLENDALE DRIVE MEDFORD OR 97504 22980475 0 X RETIREMENT.ORG X 2006 OR TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 8 8 371 109 0 0 0 4751 17787772 22789788 157417 154416 0 31520 17945189 22980475 0 0 0 0 6478906 6974395 0 0 0 20914053 20599823 27392959 27574218 -9447770 -4593743 206273568 196538348 249672068 242468014 -43398500 -45929666 MIRABELLA AT SOUTH WATERFRONT'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE CARE AND HOUSING FOR THE ELDERLY. 0 0 24339714 22789788 MIRABELLA AT SOUTH WATERFRONT IS A CONTINUING CARE RETIREMENT COMMUNITY, DEDICATED TO ENHANCING OUR RESIDENTS QUALITY OF LIFE IN A STIMULATING, SECURE ENVIRONMENT. WE PROVIDE HIGH-QUALITY SERVICES INCLUDING HOUSING, NUTRITIOUS MEALS, NURSING, HOUSEKEEPING, MAINTENANCE, AND OTHER SUPPORT TO THOSE WE SERVE. OUR LEVELS OF SERVICE INCLUDE INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING. 24339714 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 0 1 1 0 0 0 1 96 0 1 371 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X SHERI LOYA 5418577644 965 ELLENDALE DRIVE MEDFORD OR 97504 X STEWART ANKROM 1.00 X 0 0 0 LINDA DINAN 1.00 X 0 0 0 ERIC DISHMAN 1.00 X 0 0 0 WALTER GREBE 1.00 X 0 0 0 RICK HAWKINS 1.00 X X 0 0 0 LYNN JOHNSON 1.00 3.00 X X 0 0 0 C TODD MARTIN 1.00 2.00 X X 0 0 0 JIM RUDOLF 1.00 X 0 0 0 STEWART ANKROM 1.00 X 0 0 0 ANTHONY SABATINI 40.00 1.00 X 175714 0 24451 MARK DAGOSTINO 40.00 X 109775 0 42536 285489 0 66987 2 0 1 0 CONSONUS REHAB SERVICES P O BOX 4800 UNIT 12 PORTLAND OR 97208 THERAPY SERVICES 1412312 PACIFIC RETIREMENT SERVICES 965 ELLENDALE DRIVE MEDFORD OR 97504 MANAGEMENT SERVICES 1230830 TRI MET 4012 SE 12TH AVENUE PORTLAND OR 97202 TRANSPORTATION SERVICES 149537 3 4751 4751 RESIDENT SERVICE FEES 623000 11565653 11565653 HEALTH CENTER REVENUE 623000 5965822 5965822 ENTRANCE FEES EARNED 623000 4382090 4382090 DIETARY 623000 356053 356053 GARAGE & CARPORT 623000 185857 185857 334313 334313 22789788 15837 15837 138579 138579 OTHER RENTAL REVENUE 900099 31520 31520 31520 22980475 22789788 0 185936 211086 211086 5173128 4723309 449819 160561 120562 39999 1040858 783275 257583 388762 343641 45121 1393106 1393106 87831 87831 60608 60608 10863 10863 467935 338053 129882 126157 126157 498779 394580 104199 52052 52052 1724509 1724509 50973 9498 41475 24017 16501 7516 6764630 6764630 5624193 5624193 425195 325473 99722 HEALTH CENTER EXPENSE 1941721 1941721 DIETARY EXPENSE 981812 981812 FACILITY SERVICE EXPENS 325651 212203 113448 ASSET DISPOSAL 35754 35754 4037 4037 27574218 24339714 3234504 0 5208644 8181981 18621897 13371409 2276002 1452031 73070 77035 755404 1190311 187153167 17127538 176378861 170025629 2959690 2239952 206273568 196538348 4590779 1543823 112440442 130968468 112630000 94595000 20010847 15360723 249672068 242468014 X -43398500 -45930377 711 -43398500 -45929666 206273568 196538348 X -4593743 -93649 2156226 X 0 1 X 1 0 X 4751 4751 89474 9855362 17787772 22789788 50522396 89474 9855362 17787772 22794539 50527147 0 837 36633 37470 837 36633 37470 50489677 298346 210216 154416 662978 298346 210216 154416 662978 31520 31520 89474 10153708 17997988 22980475 51221645 0.98570 0.98070 0.01290 0.01800 X 27574218 27574218 1000000 250000 0 0 1000000 1000000 1000000 3000000 4500000 250000 250000 250000 750000 1125000 11236081 11236081 170061471 14840768 155220703 2561978 1277867 1284111 3293637 1008903 2284734 170025629 REFUNDABLE DEPOSITS 446410 DUE TO AFFILIATES 10955682 SWAP AGREEMENT 3958631 15360723 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE CORPORATION 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 CORPORATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2013 AND 2012, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. 0 0 0 0 0 0 0 0 0 ANTHONY SABATINI 145068 0 28000 0 2646 0 7376 0 17075 0 200165 0 0 0 MARK DAGOSTINO 105873 0 3902 0 0 0 18687 0 23849 0 152311 0 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES,INC. AND APPROVED BY MIRABELLA AT SOUTH WATERFRONT BOARD AS PART OF THE ANNUAL BUDGET PROCESS. A HOSPITAL FACILITIES AUTHORITY OF MULTNOMAH COUNTY OREGON 931266280 62551PBK2 2008-08-26 212165000 IMPROVEMENT AND EQUIPPING OF FACILITY; REFUND PRIOR OBLIGATIONS. 0 0 0 A 117570000 217946480 4713725 16384226 3114586 22482323 6502394 144038977 20633449 76800 2011 1 0 0 1 A 0 1 1 1 0 0.00800 0.00000 0.00800 0 0 1 A 0 0 1 1 1 1 MORGAN STANLEY CAP SERV INC 6.800000000000 0 0 0 1 1 A 1 DIFFERENCE BETWEEN ISSUE PRICE IN PART I(E) AND TOTAL PROCEEDS OF ISSUE IN PART II, LINE 3 IS DUE TO INVESTMENT EARNINGS. PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(8), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART ILL, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART ILL, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2B: THE BONDS CONSIST OF BOTH A CURRENT REFUNDING, WHICH HAS MET AN EXCEPTION TO THE REBATE REQUIREMENT, AND A NEW MONEY FINANCING, WHICH WILL NOT MEET AN EXCEPTION TO THE REBATE REQUIREMENT. PART IV, LINE 2C: THE FIFTH YEAR REBATE COMPUTATION WAS PERFORMED AS OF OCTOBER 1, 2012. PART II, QUESTION 11 INCLUDES PROCEEDS USED TO REFUND A TAX-EXEMPT NOTE DATED JULY 2, 2007 AND A TAXABLE PROMISSORY NOTE DATED DECEMBER 26, 2007. FORM 990, PART VI, SECTION A, LINE 3 MIRABELLA AT SOUTH WATERFRONT'S BOARD DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC., AN OREGON NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A PACIFIC RETIREMENT SERVICES HAS THE RIGHT TO VOTE ON THE ELECTION OF DIRECTORS FOR THE BOARD OF MIRABELLA AT SOUTH WATERFRONT. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY PACIFIC RETIREMENT SERVICES, AS OUTLINED IN ARTICLE IV SECTION 9 OF THE 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 B, LINE 15A 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 DIRECTOR COMPENSATION: SALARY.COM, PAYSCALE.COM, 990 REVIEW (LIKE SIZE ORGANIZATIONS), CEMO (CHIEF EXECUTIVE OFFICERS OF MULTI-FACILITY ORGANIZATIONS) SALARY STUDY RESULTS, AND INDUSTRY STATE ASSOCIATION SALARY STUDY RESULTS BASED ON GEOGRAPHICAL LOCATION. THE RECOMMENDATION FOR BASE COMPENSATION AND BONUS ARE PROVIDED BY THE ED'S DIRECT SUPERVISOR (COO OR VP OF OPERATIONS). FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS GO THROUGH CORPORATE COUNSEL. FORM 990, PART VII, SECTION A: NOTE THAT ANTHONY SABATINI IS AN EMPLOYEE OF RETIREMENT SERVICES, INC. AND PERFORMS SERVICES ON BEHALF OF MIRABELLA AT SOUTH WATERFRONT PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN MIRABELLA AT SOUTH WATERFRONT AND PACIFIC RETIREMENT SERVICES. UNDER THE MANAGEMENT SERVICES AGREEMENT, HIS COMPENSATION IS REIMBURSED BY MIRABELLA AT SOUTH WATERFRONT. HIS COMPENSATION IS REPORTED IN PART VII SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY MIRABELLA AT SOUTH WATERFRONT, NOTWITHSTANDING THAT HE IS EMPLOYED BY RETIREMENT SERVICES, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 2,156,226. 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 CAPITOL LAKES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 391412320 SENIOR HOUSING WI 501(C)(3) LINE 9 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 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 MIRABELLA AT SOUTH WATERFRONT 1 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 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 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 MANSFIELD HOUSING CORPORATION 965 ELLENDALE DRIVE MEDFORD OR 97504 900292647 SENIOR HOUSING TX 501(C)(3) LINE 9 PACIFIC RETIREMENT SERVICES INC 0 CREST PARK 965 ELLENDALE DRIVE MEDFORD OR 97504 931169683 HOTEL OR N/A C 0 RETIREMENT SERVICES INC 965 ELLENDALE DRIVE MEDFORD OR 97504 931328250 MANAGEMENT COMPANY OR N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0