2024-09-26T15:13:26-05:00 2024-02-29 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-10-01 452508860 MIRABELLA PORTLAND FOUNDATION INC MIRA 8887246424 3550 SW BOND AVENUE PORTLAND OR 97239 SHARON VAN EATON EXECUTIVE DIRECTOR 8887246424 2024-09-24 1 1 KURT BENNION P01469618 4252506100 2024-09-24 2023 2024-08-08 14:25:15Z X LYNN JOHNSON 1 WEST MAIN SUITE 303 MEDFORD OR 97501 189376 0 X WWW.RETIREMENT.ORG X 2011 OR TO ACQUIRE, HOLD AND DISTRIBUTE GIFTS TO MIRABELLA AT SOUTH WATERFRONT, AN EXEMPT ORGANIZATION. X 7 4 0 5 0 0 86581 183963 0 0 46781 5413 0 0 133362 189376 251802 1071374 0 0 0 0 0 0 0 34786 105780 286588 1177154 -153226 -987778 926535 0 35728 0 890807 0 X MIRABELLA PORTLAND FOUNDATION INC.'S PRIMARY EXEMPT PURPOSE IS TO ACQUIRE, HOLD, AND DISTRIBUTE GIFTS TO MIRABELLA AT SOUTH WATERFRONT, AN EXEMPT ORGANIZATION. 0 1 1174647 1071374 0 GRANTS AND ALLOCATIONS / OUTLAYS ACCORDING TO DONORS' SPECIFIC REQUESTS.IN FEBRUARY 2023, MIRABELLA PORTLAND FOUNDATION WAS MERGED INTO MIRABELLA AT SOUTH WATERFRONT (EIN: 71-1016384), INCLUDING ALL ASSETS AND OPERATIONS. 1174647 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 1 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 OR X KATRINA BYWATER 5416463300 1 WEST MAIN SUITE 303 MEDFORD OR 97501 X SHARON VAN EATON VICE CHAIR 1.00 39.00 X X 0 301583 44240 RENEE CHAN SECRETARY/TREASURER 1.00 39.00 X X 0 132032 12724 MEGAN HUSTON DIRECTOR 1.00 39.00 X 0 96366 13006 LYNN JOHNSON CHAIR 1.00 3.00 X X 0 0 0 STANLEY BERMAN RESIDENT DIRECTOR 1.00 0.00 X 0 0 0 LYNN DEVRIES RESIDENT DIRECTOR 1.00 0.00 X 0 0 0 JAMES FITZSIMMONS RESIDENT DIRECTOR 1.00 0.00 X 0 0 0 0 529981 69970 0 0 1 0 0 138539 45424 183963 5413 5413 189376 0 0 5413 1068623 1068623 2751 2751 2507 2507 PROGRAM EXPENSE 103273 103273 1177154 1174647 2507 0 33862 0 0 0 0 0 0 0 0 0 0 892673 0 0 0 0 0 926535 0 35728 0 35728 0 X 424987 0 465820 0 890807 0 926535 0 -987778 96971 0 X X 0 0 0 X 146725 117199 214848 86581 183963 749316 146725 117199 214848 86581 183963 749316 6896 742420 15981 16650 19649 20591 5413 78284 827600 0.89710 0.92170 X PART II, COLUMN E: THE AMOUNTS REPORTED IN PART II, COLUMN E ARE FOR A SHORT YEAR THAT BEGAN ON OCTOBER 1, 2023 AND ENDED ON FEBRUARY 29, 2024. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 MIRABELLA AT SOUTH WATERFRONT 3550 S BOND AVENUE PORTLAND OR 97239 711016384 501(C)(3) 20996 0 RESIDENT ASSISTANCE MIRABELLA AT SOUTH WATERFRONT 3550 S BOND AVENUE PORTLAND OR 97239 711016384 501(C)(3) 52570 995057 FAIR MARKET VALUE PUBLICLY TRADED SECURITIES TRANSFER OF ASSETS UPON MERGER 1 0 PART I, LINE 2: THE USE OF GRANT FUNDS IS MONITORED BY THE BOARD OF DIRECTORS AND IS REVIEWED QUARTERLY FOR PROPRIETY. 0 0 0 0 0 0 0 0 0 SHARON VAN EATON VICE CHAIR 0 258708 0 42875 0 0 0 22500 0 21740 0 345823 0 0 CASH 2024-02-29 52570 CASH 711016384 MIRABELLA AT SOUTH WATERFRONT 3550 S BOND AVENUE PORTLAND OR 97239 501(C)(3) PUBLICLY TRADED SECURITIES 2024-02-29 995057 DAILY TRADING PRICE 711016384 MIRABELLA AT SOUTH WATERFRONT 3550 S BOND AVENUE PORTLAND OR 97239 501(C)(3) 1 1 0 0 1 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: LYNN JOHNSON, RENE CHAN AND MEGAN HUSTON PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: LYNN JOHNSON WAS A BOARD MEMBER OF MIRABELLA AT SOUTH WATERFRONT PRIOR TO ITS MERGER WITH MIRABELLA PORTLAND FOUNDATION AND CONTINUES TO SERVE AS A BOARD MEMBER AFTER THE MERGER.RENEE CHAN AND MEGAN HUSTON WERE EMPLOYEES OF MIRABELLA AT SOUTH WATERFRONT PRIOR TO ITS MERGER WITH MIRABELLA PORTLAND FOUNDATION AND CONTINUE TO WORK THERE AFTER THE MERGER. FORM 990, PART III, LINE 3 IN FEBRUARY 2023, MIRABELLA PORTLAND FOUNDATION WAS MERGED INTO MIRABELLA AT SOUTH WATERFRONT (EIN: 71-1016384), INCLUDING ALL ASSETS AND OPERATIONS. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE FOUNDATION. THE EXECUTIVE COMMITTEE HAS THE POWER TO ACT ONLY ON THOSE MATTERS OF ROUTINE BUSINESS OF THE FOUNDATION FOR ACTION BETWEEN REGULAR BOARD MEETINGS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE REPORTS ITS ACTIONS TO THE BOARD AT THE NEXT REGULAR MEETING OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 MIRABELLA PORTLAND FOUNDATION'S BOARD DELEGATES MANAGEMENT DUTIES TO MIRABELLA AT SOUTH WATERFRONT. FORM 990, PART VI, SECTION A, LINE 4 ARTICLES OF MERGER WERE FILED WITH THE OREGON SECRETARY OF STATE IN FEBRUARY 2023, MERGING MIRABELLA PORTLAND FOUNDATION INTO MIRABELLA AT SOUTH WATERFRONT, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, MIRABELLA AT SOUTH WATERFRONT. FORM 990, PART VI, SECTION A, LINE 7A UP TO THREE BOARD MEMBERS ARE ELECTED BY THE RESIDENTS OF MIRABELLA AT SOUTH WATERFRONT. MIRABELLA AT SOUTH WATERFRONT APPOINTS THE REMAINING BOARD MEMBERS TO MIRABELLA PORTLAND FOUNDATION'S BOARD. FORM 990, PART VI, SECTION A, LINE 7B MIRABELLA AT SOUTH WATERFRONT HOLDS RESERVE POWERS INCLUDING BUT NOT LIMITED TO THE FOLLOWING: (A) TAKING CORRECTIVE ACTIONS IN THE EVENT THE BOARD OF DIRECTORS EMBARKS UPON ACTIONS THAT CONTRADICT THE MISSION OF THE FOUNDATION OR POTENTIALLY ARE IN VIOLATION OF FEDERAL, STATE, OR LOCAL LAW; (B) APPROVING AND REMOVING FOUNDATION DIRECTORS; (C) APPOINTING OUTSIDE AUDITORS; (D) APPROVING POLICIES AND PROCEDURES FOR THE FOUNDATION; AND (E) APPROVING ANY AMENDMENTS OR ALTERATIONS TO, OR REPEAL OF, THE BYLAWS OR ARTICLES OF INCORPORATION OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CORPORATE DIRECTOR OF ACCOUNTING, VICE PRESIDENT OF ACCOUNTING AND CFO. 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 CORPORATE FINANCIAL DATA AND GOVERNANCE INFORMATION IS NOT PUBLIC INFORMATION, AND AS SUCH, IS RELEASED ONLY PURSUANT TO LEGAL REGULATION, COURT ORDER, OR OTHER APPLICABLE LAW, AND AS DIRECTED BY CORPORATE COUNSEL. FORM 990, PART XII, LINE 2C: THE PROCESS AND AUTHORITY FOR SELECTING THE FINANCIAL STATEMENT AUDITOR AND FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT DID NOT CHANGE DURING THE FISCAL YEAR. PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931067253 SUPPORTING ORGANIZATION OR 501(C)(3) LINE 12C, III-FI N/A 0 PACIFIC RETIREMENT SERVICES FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 472352652 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 PACIFIC RETIREMENT SERVICES INC 0 ROGUE VALLEY MANOR 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930453216 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 THE CUMBERLAND REST INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 750891470 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 CASCADE MANOR INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930557803 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931179254 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 HOLLADAY PARK PLAZA 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930513697 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 CAPITOL LAKES INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 391412320 SENIOR HOUSING WI 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 ROGUE VALLEY MANOR FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930712867 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 ROGUE VALLEY MANOR 0 UNIVERSITY RETIREMENT COMMUNITY FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931301816 PUBLIC FOUNDATION CA 501(C)(3) LINE 7 UNIVERSITY RETIREMENT COMMUNITY AT DAVIS INC 0 MIRABELLA WASHINGTON FOUNDATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 450574348 PUBLIC FOUNDATION WA 501(C)(3) LINE 7 MIRABELLA 0 CASCADE MANOR FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 931330100 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CASCADE MANOR INC 0 CAPITOL LAKES FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 383781089 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 CAPITOL LAKES INC 0 MIRABELLA 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 342030255 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA AT SOUTH WATERFRONT 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 711016384 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 COMMUNITY VOLUNTEER NETWORK 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930892261 COMMUNITY SERVICES TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930864466 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM ASHLAND HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 930942933 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM GRANTS PASS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943136037 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM ROSEBURG HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943179782 SENIOR HOUSING WI 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MYRTLE CREEK HOUSING 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