Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Porter Place Inc
Employer identification number
84-1553192
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Porter Place Inc
Employer identification number
84-1553192
Identifier
Return Reference
Explanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, Q. 4A
Porter Place, Inc. is a 501(c)(3) nonprofit corporation that provides independent and assisted living housing for seniors. Porter Place, Inc. is located adjacent to Porter Adventist Hospital in Denver, Colorado, and provides a full range of social, cultural, religious and recreational events to enhance the quality of life for its residents. Porter Place, Inc. operates at the lowest feasible cost taking into account cash flow requirements. Its entrance fees and monthly charges are set at rates that are generally affordable in the community, with certain entrance fees being refundable. This pricing structure ensures that Porter Place, Inc. reaches the broadest portion of the community as possible.
DELEGATION OF MANAGEMENT DUTIES
FORM 990, PART VI, Q. 3
PORTER PLACE, INC. HAS CONTRACTED WITH CENTURA HEALTH CORPORATION TO PROVIDE MANAGEMENT SERVICES. SUCH SERVICES INCLUDE THE MANAGEMENT OF DAY-TO-DAY OPERATIONS INCLUDING PERSONNEL MATTERS, PROVISION OF ACCOUNTING SERVICES AND NEGOTIATION OF CONTRACTS WITH VENDORS AND SERVICE PROVIDERS.
MEMBERS/STOCKHOLDERS
FORM 990, PART VI, Q. 6
THERE IS A SINGLE CLASS OF MEMBERS CONSISTING OF THE EXECUTIVE SECRETARY OF MID-AMERICA UNION CONFERENCE OF SEVENTH-DAY ADVENTISTS; SECRETARY/TREASURER OF ROCKY MOUNTAIN CONFERENCE OF SEVENTH-DAY ADVENTISTS; VICE PRESIDENT FOR FINANCE OF UNION COLLEGE, LINCOLN, NEBRASKA; AND PRESIDENT OF PORTERCARE ADVENTIST HEALTH SYSTEM, A COLORADO NON-PROFIT CORPORATION.
ELECTION OF MEMBERS OF GOVERNING BODY
FORM 990, PART VI, Q. 7A
THE MEMBERS HAVE THE POWER TO ELECT ALL MEMBERS OF THE BOARD INCLUDING ALL SUCCESSOR TRUSTEES.
PROCESS THE ORGANIZATION USES TO REVIEW FORM 990
FORM 990, PART VI, Q. 11b
Once the return is prepared, the return is reviewed by the Chief Financial Officer. The Chief Financial Officer provides a copy of the return to the board either at a board meeting or electronically prior to the filing deadline. Subsequent to providing a copy to the board, the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board.
PROCEDURES FOR MONITORING AND ENFORCING THE COI POLICY
FORM 990, PART VI, Q. 12c
THE ORGANIZATION ANNUALLY DISTRIBUTES CONFLICT OF INTEREST STATEMENTS TO ALL INTERESTED PERSONS WHO ARE REQUIRED TO COMPLETE AND RETURN THE STATEMENTS. A REPORT IS COMPILED IDENTIFYING ALL REPORTED POTENTIAL CONFLICTS AND THE REPORT IS SHARED WITH THE BOARD FOR INFORMATION, DISCUSSION, AND POSSIBLE ACTION RELATIVE TO SPECIFIC CONFLICTIVE SITUATIONS. WHEN ANY MATTER COMES BEFORE A MEETING OF THE ORGANIZATION'S BOARD OF TRUSTEES, A BOARD COMMITTEE, MANAGEMENT OR MATERIALS MANAGEMENT/SUPPLY CHAIN THAT POTENTIALLY GIVES RISE TO A CONFLICT OF INTEREST, PROCEDURES ARE UTILIZED TO RESOLVE THE POTENTIAL CONFLICT.
Written Whistleblower Policy
FORM 990, PART VI, Q. 13
Porter Place, Inc. has a Whistleblower policy in place however, it has not been formally adopted by the board of directors as of 6/30/2011.
Document Retention and Destruction Policy
FORM 990, PART VI, Q. 14
Porter Place, Inc. has a document retention and destruction policy in place. however, it has not been formally adopted by the board of directors as of 6/30/2011.
PROCESS FOR DETERMINING COMPENSATION
FORM 990, PART VI, Q. 15a/b
During the tax year ended 6/30/11, no officers, directors or key employees were compensated BY Porter Place, Inc. Any executive compensation paid to officers or directors WAS PAID BY Centura health corporation AND was set by a compensation committee who utilized an independent consultant and comparability studies to determine compensation that was paid in accordance with a written contract.
Public Inspection of Documents
FORM 990, PART VI, Q. 19
PORTER PLACE, INC.'S ORGANIZING AND GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC TO THE EXTENT REQUIRED BY LAW.
Estimate of Hours
Form 990, Part VII
THE TOP MANAGEMENT AND TOP FINANCIAL OFFICIALS OF THE ORGANIZATION WERE PAID BY centura HEALTH CORPORATION ("CHC") IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 60 HOUR-PER-WEEK EMPLOYEES. CHC, an unrelated entity, provided these services to the organization through a management services contract.
RECONCILIATION OF NET ASSETS
FORM 990, PART XII, Q. 5
PRIOR PERIOD ADJUSTMENT $1
Schedule K
Form 990, Schedule K, Part V:
Colorado Health Facilities Authority Part I Line D: Date Issued March 3, 2011 Line E: Issue Price $9,600,000 Line F: Purpose The Borrower has requested the Authority to assist in the refinancing of an interim loan by issuing and selling its Revenue Bond (Porter Place Inc. Project) Series 2011 and loaning the proceeds to the Borrower. The refinancing of the loan will assist the Borrower in providing more adequate assisted living care and health facilities. Part II Line 3: Total Proceeds of issue $9,600,000 Line 4: Gross proceeds in reserve funds $0 Line 6: Proceeds in refunding or defeasance escrows: $0 The Series 2000A Bonds were refinanced with the proceeds of the Series 2011 Revenue Bond (Porter Place Inc. Project) All proceeds of the Series 2011 Bond will be expended to refinance the Centura Loan. Therefore, the Series 2011 bond is not sized larger than is necessary to carry out the purpose for which the Series 2011 Bond is issued. Line 7: Issuance costs from proceeds $0 Line 9: Working capital expenditures from proceeds $0 Line 10: Capital expenditures from proceeds $0 Line 12: Other unspent proceeds $0 Line 13: Year of substantial completion: 2026 Part III Line 1: Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? No Line 2: Are there any lease arrangements with respect to the financed property which may result in private business use? No Line 3 a: Are there any management or service contracts with respect to the financed property which may result in private business use? No Line 3 b: Are there any research agreements with respect to the financed property which may result in private business use? No Line 3 c: Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? Yes No portion of the Facilities will be used pursuant to a lease, sub-lease or other contractual arrangement that results in a private business use unless the Authority, the Corporation and the Initial Purchaser receive an opinion of Bound Counsel that such use or arrangement will not adversely affect the exclusion of interest on the Series 2011 Bond Line 4: Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government 0% Line 5: Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another 501(c)(3) organization or a state or local government 0% Line 6: Total of lines 4 and 5 0% Line 7: Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? Yes PART IV Line 1: Has a form 8308 T Arbitrage Rebate been filed with Respect to the Bond Issue: No, Form 8308 was filed. Line 2: Is the Bond issued at a variable rate? No, The interest rate from and including the Date Dated Through, but not including, March 1, 2021 (The Reset Date) is 4.6% per annum (The Initial Interest Rate). The Interest Rate shall be converted from the Initial Interest Rate to the reset rate on the Reset Date provided certain conditions precedent set forth in the financing agreement. Line 3a: Has the organization of the governmental issuer entered into a qualified hedge with respect to the bond issue: No Line 4: Were gross proceeds invested in GIC? No Line 5: Were any gross proceeds invested beyond an available temporary period? No Porter Place reasonably expects that no proceeds will be invested beyond an available temporary period and that it will meet an available exception to rebate. Line 6: Did the bond issue qualify for an exception to rebate? No The Financing Agreement creates a Reserve Fund. Reserve Fund will not initially be funded with Proceeds of the Series 2011 Bond and will instead be funded with Cash Contributed by the Corporation. To the extent rebate is determined to be owed, The Corporation and Authority may segregate a portion of the Reserve Fund to hold any amounts owing to the IRS (The Rebate Fund).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.