2025-08-14T13:57:03-05:00 2024-09-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-10-01 383781089 CAPITOL LAKES FOUNDATION INC CAPI 8887246424 333 WEST MAIN STREET MADISON WI 53703 DIANE FARSETTA BOARD CHAIR 8887246424 2025-08-13 1 1 KURT BENNION CPA P01469618 4252506100 2025-08-11 2023 2025-03-06 01:10:19Z DIANE FARSETTA 1 WEST MAIN SUITE 303 MEDFORD OR 97501 351636 0 X WWW.RETIREMENT.ORG X 2008 WI TO ACQUIRE, HOLD, AND DISTRIBUTE GIFTS TO CAPITOL LAKES, INC. 14 11 0 11 0 0 263442 304462 0 0 86640 47174 0 0 350082 351636 119414 102674 0 0 74623 78222 0 0 0 46657 63541 240694 244437 109388 107199 1814921 2349045 31068 44805 1783853 2304240 THE CAPITOL LAKES FOUNDATION SEEKS TO SERVE OUR COMMUNITY BY ENRICHING THE QUALITY OF LIFE OF OUR RESIDENTS, PROVIDING PEACE OF MIND TO THEIR FAMILIES, SUPPORTING AND NURTURING OUR STAFF, AND REACHING OUT TO OUR NEIGHBORS AS LEADERS AND ADVOCATES ON ISSUES RELATED TO AGING. 0 0 159290 102674 0 GRANTS AND ALLOCATIONS/OUTLAYS ACCORDING TO DONORS' SPECIFIC REQUESTS. 159290 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 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 0 0 X 14 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X KATRINA BYWATER 5416463300 1 WEST MAIN SUITE 303 MEDFORD OR 97501 TIM CONROY ADMINISTRATIVE DIRECTOR 1.00 39.00 X 0 305512 50245 KRISTIN VATER SECRETARY 1.00 39.00 X X 0 174284 19225 NATASHA KILLIAN ADMINISTRATIVE DIRECTOR 1.00 39.00 X 0 92714 26154 CONNIE BAKKER CHAIR 1.00 0.00 X X 0 0 0 DR DIANE FARSETTA VICE CHAIR 1.00 0.00 X X 0 0 0 PATRICK CARROLL TREASURER 1.00 0.00 X X 0 0 0 BETSY ABRAMSON DIRECTOR 1.00 0.00 X 0 0 0 JACK BOLZ DIRECTOR 1.00 0.00 X 0 0 0 DR BARBARA BOWERS DIRECTOR 1.00 0.00 X 0 0 0 SHERRY LEPAGE DIRECTOR 1.00 0.00 X 0 0 0 NORMA MADSEN DIRECTOR 1.00 0.00 X 0 0 0 JIM POPE DIRECTOR 1.00 0.00 X 0 0 0 DR TRACEY SCHROEPFER DIRECTOR 1.00 0.00 X 0 0 0 CAROL TOUSSAINT DIRECTOR 1.00 0.00 X 0 0 0 0 572510 95624 0 0 1 0 0 304462 304462 47174 47174 351636 0 0 47174 102674 102674 68457 6098 62359 1950 1950 2530 2502 28 5285 471 4814 1 1 2952 2952 1890 1890 2203 2203 4284 4284 21 21 176 176 PROGRAM FUND EXPENSES 47545 47545 OTHER FACILITY SERVICE 4469 4469 244437 159290 85147 0 132775 114041 6254 6254 0 0 1682146 2235004 1814921 2349045 1269 30273 29799 14532 31068 44805 X 1012480 1583232 771373 721008 1783853 2304240 1814921 2349045 107199 413188 0 X X 0 1 X 1 0 X 148793 246575 286872 263442 304462 1250144 148793 246575 286872 263442 304462 1250144 139466 1110678 28148 22061 33121 31803 47174 162307 1412451 0.78630 0.82570 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 76327 76327 76327 76327 76327 76327 76327 76327 76327 76327 0.00000 1.00000 0.00000 0 0 6254 6254 0 0 DUE TO AFFILIATES 14532 14532 X PART V, LINE 4: THE FOUNDATION'S ENDOWMENT CONSISTS OF VARIOUS INDIVIDUAL FUNDS ESTABLISHED FOR VARIOUS PURPOSES. PART X, LINE 2: 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, 2024 AND 2023, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. 1 CAPITOL LAKES INC 333 WEST MAIN STREET MADISON WI 53703 391412320 501(C)(3) 102674 0 RESIDENT ASSISTANCE AND IPACE 1 0 PART I, LINE 2: CAPITOL LAKES FOUNDATION, INC. ONLY MAKES TRANSFERS TO CAPITOL LAKES, INC. APPROPRIATE USE OF FUNDS IS ENSURED THROUGH COMMON MANAGEMENT AND OVERSIGHT BY ADMINISTRATIVE STAFF, EXECUTIVES AND THE BOARDS OF DIRECTORS. 0 0 0 0 0 0 0 0 0 TIM CONROY ADMINISTRATIVE DIRECTOR 0 262424 0 43088 0 0 0 28192 0 22053 0 355757 0 0 KRISTIN VATER SECRETARY 0 161743 0 12541 0 0 0 12164 0 7061 0 193509 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE THAT CONSISTS OF ALL THE OFFICERS OF THE BOARD AND HAS THE POWER TO ACT ONLY ON THOSE MATTERS OF ROUTINE BUSINESS OF THE FOUNDATION FOR ACTION BETWEEN REGULAR MEETINGS OF THE BOARD. 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 CAPITOL LAKES FOUNDATION'S BOARD DELEGATES MANAGEMENT TO CAPITOL LAKES. FORM 990, PART VI, SECTION A, LINE 6 CAPITOL LAKES FOUNDATION, INC. HAS TWO CLASSES OF MEMBERS. THE SOLE CLASS A MEMBER IS CAPITOL LAKES, INC. THE CLASS B MEMBERS CONSIST OF ALL RESIDENTS OF THE CONTINUING CARE RETIREMENT COMMUNITY OPERATED BY CAPITOL LAKES, INC. WHO HAVE PAID ALL AMOUNTS DUE UNDER THEIR RESIDENCE AND CARE AGREEMENT AND ARE NOT IN DEFAULT THEREUNDER. FORM 990, PART VI, SECTION A, LINE 7A THE CLASS A MEMBER, CAPITOL LAKES, INC., ELECTS THE ADMINISTRATIVE REPRESENTATIVE TO THE FOUNDATION'S BOARD OF DIRECTORS AND HAS THE RIGHT TO APPROVE AND REMOVE ALL FOUNDATION DIRECTORS. THE CLASS B MEMBERS ELECT THE RESIDENT REPRESENTATIVE TO THE FOUNDATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CAPITOL LAKES, INC.'S APPROVAL IS REQUIRED BEFORE THE FOUNDATION MAY TAKE ANY OF THE FOLLOWING ACTIONS: (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, CFO, 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 CORPORATE FINANCIAL DATA AND GOVERNANCE INFORMATION IS NOT PUBIC 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 MIRABELLA 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 342030255 SENIOR HOUSING WA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA AT SOUTH WATERFRONT 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 711016384 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