Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 5 | 239,301 | 343,359 | 1,130,973 | 328,822 | 2,042,460 |
| 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 | 16,719,702 | 17,386,710 | 23,497,263 | 26,106,576 | 27,920,562 | 111,630,813 |
| 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 | 16,719,707 | 17,626,011 | 23,840,622 | 27,237,549 | 28,249,384 | 113,673,273 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 113,673,273 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 16,719,707 | 17,626,011 | 23,840,622 | 27,237,549 | 28,249,384 | 113,673,273 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 4,878,960 | 7,099,870 | 11,287,938 | 11,366,243 | 3,622,754 | 38,255,765 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 4,878,960 | 7,099,870 | 11,287,938 | 11,366,243 | 3,622,754 | 38,255,765 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 21,598,667 | 24,725,881 | 35,128,560 | 38,603,792 | 31,872,138 | 151,929,038 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD, THE CHAIR AND VICE CHAIR OF THE STANDING COMMITTEES AND SUCH OTHERS AS THE BOARD MAY DESIGNATE. THE EXECUTIVE COMMITTEE CONSIDERS MATTERS RELATING TO ADMISSIONS AND OCCUPANCY, ALL QUESTIONS REFERRED TO IT BY THE BOARD OF DIRECTORS, AND HAS THE POWER TO ACT IN THE PLACE AND STEAD OF THE BOARD OF DIRECTORS ON MATTERS OF BUSINESS REQUIRING IMMEDIATE ACTION BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS. IT ALSO MAKES RECOMMENDATIONS TO THE BOARD FOR FILLING DIRECTOR AND OFFICER VACANCIES AND IS RESPONSIBLE FOR LONG RANGE PLANNING. IT REPORTS ITS ACTIONS TO THE BOARD AT THE NEXT REGULAR MEETING. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE CUMBERLAND REST, INC. (DBA: TRINITY TERRACE) BOARD DELEGATES MANAGEMENT TO PACIFIC RETIREMENT SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE MEMBER, PACIFIC RETIREMENT SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | PACIFIC RETIREMENT SERVICES, INC. HAS THE AUTHORITY TO ELECT ALL DIRECTORS FROM NOMINEES SELECTED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS ARE RESERVED TO PACIFIC RETIREMENT SERVICES, THE SOLE MEMBER: (1) APPROVAL OF THE FINAL ADOPTION OF ANY AMENDMENT OR RESTATEMENT OF THE ORGANIZATION'S ARTICLES OF INCORPORATION; (2) APPROVAL OF THE FINAL ADOPTION OF ANY AMENDMENT OF THE ORGANIZATION'S BY-LAWS; (3) ELECTION OF THE DIRECTORS OF THE ORGANIZATION FROM NOMINEES SELECTED BY THE BOARD OF DIRECTORS OF THE ORGANIZATION AND INCLUDING THE FILING OF VACANCIES CAUSED BY REMOVAL OR RESIGNATION OF A DIRECTOR. INDIVIDUAL DIRECTORS MAY BE REMOVED BY PACIFIC RETIREMENT SERVICES WITH OR WITHOUT CAUSE; (4) APPROVAL OF THE ELECTION BY THE BOARD OF DIRECTORS OF ALL CORPORATE OFFICERS, INCLUDING BUT NOT LIMITED TO THE CHAIRMAN, CHAIR AND/OR VICE CHAIRMAN OF THE BOARD OF DIRECTORS, WHO SHALL BE SUBJECT TO REMOVAL BY PACIFIC RETIREMENT SERVICES WITH OR WITHOUT CAUSE; (5) APPROVAL OF ANY MERGER, CORPORATE CONSOLIDATION, CHANGE OF CONTROL, AND/OR ALL PARTIAL OR TOTAL DISSOLUTIONS INVOLVING THE ORGANIZATION, AND ALL DONATIONS OR TRANSFERS WITHOUT CONSIDERATION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (6) APPROVAL OF ANY SELLING, LEASING, OR OTHERWISE UNBUDGETED TRANSFERRING OF ANY ASSET (OR COMMITMENT TO DO SO) TO ANY PERSON OR OTHER LEGAL ENTITY (OTHER THAN PACIFIC RETIREMENT SERVICES OR AN AFFILIATE THEREOF) IN EXCESS OF $10,000; (7) APPROVAL OF ANY ACQUISITIONS OR AGREEMENTS TO ACQUIRE (BY PURCHASE, LEASE, CHANGE IN SPONSORSHIP OR OTHERWISE) OF ANY ORGANIZATION OR BUSINESS; (8) APPROVAL (FOLLOWING PREPARATION BY ORGANIZATION MANAGEMENT AND APPROVAL BY THE BOARD OF DIRECTORS) OF THE ORGANIZATION'S ANNUAL OPERATING BUDGET AND THE ANNUAL CAPITAL BUDGET, MANAGEMENT OF PACIFIC RETIREMENT SERVICES WILL ADVISE MANAGEMENT OF THE ORGANIZATION IN THE PREPARATION OF BOTH THE OPERATING BUDGET AND THE CAPITAL BUDGET; (9) APPROVAL OF THE ORGANIZATION TO INCUR ANY DEBT OR ENTER INTO ANY CONTRACT NOT CONTEMPLATED BY THE ANNUAL BUDGET, IF THE DOLLAR AMOUNT EXCEEDS THE SUM OF $100,000; (10) APPROVAL OF THE APPOINTMENT OF ALL PROFESSIONAL ADVISORS, INCLUDING BUT NOT LIMITED TO ACCOUNTANTS, AUDITORS AND LEGAL COUNSEL, FOR THE ORGANIZATION; (11) APPROVAL OF THE ADOPTION OR REVISION OF OPERATING POLICIES AND PROCEDURES OF THE ORGANIZATION, THE CORPORATE MISSION AND LONG-RANGE PLANS; (12) APPROVAL OF ANY CHANGE, IN ANY MATERIAL RESPECT, TO THE NATURE OF THE ORGANIZATION'S BUSINESS OR THE DECISION TO ENTER INTO NEW LINES OF BUSINESS; (13) APPROVAL OF THE REMOVAL OR REPLACEMENT OF THE EXECUTIVE DIRECTOR/ ADMINISTRATOR AND ANY OTHER SENIOR MANAGER OF TRINITY TERRACE AND APPROVAL OF A NEW EXECUTIVE DIRECTOR/ADMINISTRATOR AND ANY OTHER SENIOR MANAGER OF TRINITY TERRACE; (14) APPROVAL OF THE CREATION OF ANY SUBSIDIARY (TAXABLE OR TAX-EXEMPT) AND THE INVESTMENT BY THE ORGANIZATION IN ANY JOINT VENTURE, PARTNERSHIP, LIMITED LIABILITIES CORPORATION, SUBCHAPTER C CORPORATION OR SIMILAR ENTITY; (15) APPROVAL OF ANY REVISIONS TO THE FORM, WHETHER NOW EXISTING OR HEREINAFTER CREATED, OF TRINITY TERRACE RESIDENCY CONTRACTS; (16) APPROVAL OF ALL EMPLOYEE BENEFITS AND COMPENSATION PAYABLE TO THE SENIOR MANAGEMENT OF THE ORGANIZATION PRIOR TO CONTRACTING; (17) APPROVAL OF ALL INVESTMENT POLICIES OF THE ORGANIZATION IN EXCESS OF $10,000 AS ADOPTED BY THE BOARD; ALL INVESTMENTS SHALL BE MADE IN ACCORDANCE WITH SUCH BOARD-ADOPTED POLICIES; (18) APPROVAL OF ANY PLAN OF DISSOLUTION OR LIQUIDATION INVOLVING THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BY THE DIRECTOR OF FINANCE, 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 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 EXECUTIVE DIRECTOR'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 MICHAEL (SCOTT) THOMAS, LINE WILSON AND DAVID HENTON ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. AND PERFORM SERVICE ON BEHALF OF THE CUMBERLAND REST, INC. PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN THE CUMBERLAND REST, INC. AND PACIFIC RETIREMENT SERVICES, INC. UNDER THE MANAGEMENT SERVICES AGREEMENT, THEIR COMPENSATION IS REIMBURSED BY THE CUMBERLAND REST, INC. COMPENSATION HAS BEEN REPORTED IN PART VII SECTION A IN ORDER TO HIGHLIGHT AMOUNTS PAID BY THE CUMBERLAND REST, INC., NOTWITHSTANDING THAT THEY ARE LEASED EMPLOYEES OF PACIFIC RETIREMENT SERVICES, INC. |
| FORM 990, PART XI, LINE 9: | CHANGE IN FAIR VALUE OF MINERAL ASSETS -32,450,964. CHANGE IN VALUE OF INTEREST RATE CAP/SWAP AGREEMENT -770,416. CHANGES IN VALUE OF GIFT ANNUITIES 593. |
| Software ID: | |
| Software Version: |