2024-08-10T23:31:36-05:00 2023-09-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-10-01 472352652 PACIFIC RETIREMENT SERVICES FOUNDATION INC PACI 8887246424 1 WEST MAIN STREET 303 MEDFORD OR 97501 ERIC SHOLTY BOARD CHAIR 8887246424 2024-08-06 1 1 KURT BENNION CPA P01469618 4252506100 2024-07-14 2022 2024-08-08 14:25:15Z ERIC SHOLTY 1 WEST MAIN STREET 303 MEDFORD OR 97501 491573 0 X WWW.RETIREMENT.ORG X 2014 OR TO SUPPORT ACTIVITIES OF PACIFIC RETIREMENT SERVICES, INC. AND ITS AFFILIATES. 3 2 0 2 0 0 70484 176201 0 0 30157 50592 -159137 -137999 -58496 88794 0 51218 0 0 0 0 0 0 0 30448 6044 30448 57262 -88944 31532 977991 1092365 8688 35563 969303 1056802 TO SUPPORT ACTIVITIES OF PACIFIC RETIREMENT SERVICES, INC. AND ITS AFFILIATES. 0 0 51296 51218 0 TO SUPPORT ACTIVITIES OF PACIFIC RETIREMENT SERVICES, INC. AND ITS AFFILIATES. 51296 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 3 2 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X KATRINA BYWATER 5416463300 1 WEST MAIN STREET SUITE 303 MEDFORD OR 97501 ERIC SHOLTY CHAIR 1.00 49.00 X X 0 773872 34323 WILLIAM THORNDIKE JR VICE CHAIR 1.00 0.00 X X 0 0 0 CAROLYN LYN HENNION SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 0 773872 34323 0 0 1 0 0 137999 38202 176201 28040 28040 287332 264780 22552 22552 22552 0 137999 137999 -137999 -137999 88794 0 0 -87407 51218 51218 3310 3310 1838 1838 78 78 BANK SERVICE CHARGES 521 521 DUES & SUBSCRIPTIONS 297 297 57262 51296 5966 0 30080 41204 947911 1051161 977991 1092365 8688 35563 8688 35563 X 649019 715573 320284 341229 969303 1056802 977991 1092365 31532 55967 0 X X 0 1 X 1 0 X 268847 19043 142860 70484 176201 677435 268847 19043 142860 70484 176201 677435 14285 663150 17628 16907 20360 25359 28040 108294 785729 0.84400 0.88190 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING EVENT REVENUES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14641 1438 1438 14641 14641 2524 2524 14641 14641 2257 2257 14641 14641 317 317 14641 14641 248 248 14641 0.00000 1.00000 0.00000 0 0 0 DUE TO AFFILIATES 35563 35563 X PART V, LINE 4: EARNINGS FROM THE ENDOWMENT FUNDS ARE USED TO FURTHER THE FOSTER GRANDPARENT PROGRAM. 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, 2023, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. GOLF TOURNAMENT 137999 137999 137999 137999 137999 137999 137999 -137999 1 PACIFIC RETIREMENT SERVICES INC 1 WEST MAIN STREET SUITE 303 MEDFORD OR 97501 931067253 501(C)(3) 30206 0 COMMUNITY SERVICES ROGUE VALLEY MANOR FOUNDATION 1200 MIRA MAR AVENUE MEDFORD OR 97504 930712867 501(C)(3) 15094 0 GENERAL OPERATING SUPPORT HOLLADAY PARK PLAZA 1300 NE 16TH AVENUE PORTLAND OR 97232 930513697 501(C)(3) 10736 0 GENERAL OPERATING SUPPORT 3 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 1 0 ERIC SHOLTY CHAIR 0 674872 0 99000 0 0 0 0 0 34323 0 808195 0 0 PART I, LINE 3 COMPENSATION WAS RECOMMENDED BY PACIFIC RETIREMENT SERVICES, INC.'A LEADERSHIP AND APPROVED BY PACIFIC RETIRMENT SERVICES'S BOARD AS PART OF THE ANNUAL BUDGET PROCESS. PART I, LINE 7 THE ORGANIZATION PAID BONUSES THIS YEAR. THE PROCESS FOR DETERMINING EXECUTIVE BONUSES IS DISCRETIONARY. IT IS DETERMINED BY THE VP OF OPERATIONS FOR PRS AND IT IS BASED ON THE PERFORMANCE OF THE COMMUNITY FOR THE YEAR. FORM 990, PART VI, SECTION A, LINE 3 PACIFIC RETIREMENT SERVICES FOUNDATION'S BOARD DELEGATES MANAGEMENT DUTIES TO PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 6 PACIFIC RETIREMENT SERVICES FOUNDATION, INC. HAS ONE MEMBER, WHICH IS PACIFIC RETIREMENT SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A PACIFIC RETIREMENT SERVICES, INC. HAS THE AUTHORITY TO ELECT DIRECTORS TO THE PACIFIC RETIREMENT SERVICES FOUNDATION, INC. BOARD OF DIRECTORS FROM A LIST OF NOMINEES SELECTED BY THE PACIFIC RETIREMENT SERVICES FOUNDATION, INC. BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS ARE RESERVED TO PACIFIC RETIREMENT SERVICES, INC., THE SOLE MEMBER: (A) ADOPT, AMEND OR RESTATE THE BYLAWS OF THE ORGANIZATION; (B) ADOPT, AMEND OR RESTATE THE ORGANIZATION'S LONG-RANGE PLAN, STRATEGIC PLAN OR MISSION STATEMENT; (C) APPROVE ANY MERGER OR CONSOLIDATION OF THE ORGANIZATION WITH ANOTHER ENTITY, OR ANY PARTIAL OR TOTAL LIQUIDATION OF THE ORGANIZATION'S ASSETS; (D) APPROVE ANY DEBT OR ENTER INTO ANY CONTRACT NOT CONTEMPLATED BY THE ANNUAL BUDGET, IF THE DOLLAR AMOUNT EXCEEDS THE SUM OF $100,000; (E) MAKE ANY GIFTS OR GRATUITOUS TRANSFERS IN EXCESS OF $5,000 IN ANY CALENDAR YEAR; (T) CREATE A TAXABLE OR TAX-EXEMPT SUBSIDIARY OR AFFILIATED ORGANIZATION; (G) ACQUIRE A CONTROLLING INTEREST IN ANOTHER ENTITY; (H) APPOINT OUTSIDE AUDITORS; (I) ELECT OR APPOINT THE ORGANIZATION'S DIRECTORS INCLUDING THE FILLING OF VACANCIES CAUSED BY THE DEATH, REMOVAL OR RESIGNATION OF A DIRECTOR; AND (J) REMOVE ANY OF THE ORGANIZATION'S DIRECTORS AND OFFICERS. 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 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 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 WA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 MIRABELLA PORTLAND FOUNDATION INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 452508860 PUBLIC FOUNDATION OR 501(C)(3) LINE 7 MIRABELLA AT SOUTH WATERFRONT 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 OR 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 OR 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 OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MYRTLE CREEK HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943162074 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943163349 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM EAGLE POINT HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943191447 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM KLAMATH FALLS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943196455 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MEDFORD II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943212537 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM LIVELY OAKS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943194409 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM REEDSPORT HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943212538 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM YREKA HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943212540 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM EUGENE HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943247154 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM FORT WORTH I HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311520436 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM BEND II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 943260016 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM FORT WORTH II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311587415 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MEDFORD III HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311587418 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM ROSEBURG II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311587420 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM GRANTS PASS II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311662259 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM DAVIS HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311662208 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MYRTLE CREEK II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311715321 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM PORTLAND HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 311780332 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM PORTLAND II HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 300037898 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM CENTRAL POINT HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 300315618 SENIOR HOUSING OR 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 RVM MANSFIELD HOUSING CORPORATION 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 900292647 SENIOR HOUSING TX 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 MIDDLETON GLEN INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 911859494 SENIOR HOUSING WI 501(C)(3) LINE 10 CAPITOL LAKES INC 0 SENIOR HOUSING OF MIDDLETON INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 470825736 SENIOR HOUSING WI 501(C)(3) LINE 10 CAPITOL LAKES INC 0 MIRABELLA AT ASU INC 1 WEST MAIN ST SUITE 303 MEDFORD OR 97501 813784956 SENIOR HOUSING AZ 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 BAY AREA SENIOR SERVICES INC 1 BALDWIN AVENUE SAN MATEO CA 94401 943008774 SENIOR HOUSING CA 501(C)(3) LINE 10 PACIFIC RETIREMENT SERVICES INC 0 PRS MANAGEMENT INC 1 WEST MAIN STREET SUITE 303 MEDFORD OR 97501 931328250 MANAGEMENT COMPANY OR N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0