2023-11-16T14:54:27-06:00 2022-12-31 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-01-01 844589118 TAMPA LIFE PLAN VILLAGE INC TAMP 8134379896 12401 N 22ND STREET TAMPA FL 33612 RONALD R SHUCK BOARD CHAIR 8134379896 2023-11-16 1 RONALD SHUCK 999009999 1 AMY BIBBY P00445891 8282542254 2023-11-16 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RONALD R SHUCK 12401 N 22ND STREET TAMPA FL 33612 4690301 0 X N/A X 2020 FL OPERATION OF A SENIOR LIVING COMMUNITY IN TAMPA FLORIDA 3 3 76 0 0 0 0 0 3966544 4297427 2133 53370 546275 339504 4514952 4690301 0 0 0 0 2682550 3211356 0 0 0 10077294 15103946 12759844 18315302 -8244892 -13625001 57175002 52392301 68569769 77668221 -11394767 -25275920 NONE 0 0 7934484 4636931 THE COMMUNITY CONSISTS OF 445INDEPENDENT LIVING APARTMENTS, 46 INDEPENDENT LIVING VILLAGES, AND RELATED COMMON AREAS, SITUATED ON APPROXIMATELY 32 ACRES IN HILLSBOROUGH COUNTY, FLORIDA. 7934484 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 1 76 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 0 0 FL X THE ORGANIZATION 8134379896 12401 N 22ND STREET TAMPA FL 33612 RONALD R SHUCK CHAIRMAN 10.00 X X 0 0 0 KRISTIN KUTAC WARD SECRETARY 2.50 X 0 0 0 MICHELE S WASSERLAUF ASST. SECRETARY 2.50 X 0 0 0 MICHAEL J BROWN JR EXECUTIVE DIRECTOR 40.00 X 190887 0 11955 JANE ELIZABETH FINANCE DIRECTOR 40.00 X 95240 0 17817 286127 0 29772 1 0 1 0 RELIANCE CONSTRUCTION COMPANY LLC 1025 S DIXIE HIGHWAY DELRAY BEACH FL 33483 CONSTRUCTION 3539351 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 CULINARY SERVICES 1712566 CREATING RESULTS INC 14000 CROWN CT 211 WOODBRIDGE VA 22193 SALES & MARKETING CONSULTING 526990 BRP SENIOR HOUSING MGMT LLC 315 SOUTH BEVERLY DR BEVERLY HILLS CA 90212 MANAGEMENT COMPANY 410000 LEBEL LANDSCAPING 12217 GROVEWOOD AVE THONOTASSA FL 33592 LANDSCAPING 137042 6 RESIDENT SERVICE FEES 623990 3627666 3627666 EARNED ENTRANCE FEES 623990 615348 615348 ANCILIARY REVENUE 623990 54413 54413 4297427 53370 53370 339504 0 339504 339504 339504 4690301 4636931 0 53370 X 2507703 1954107 553596 28395 28395 475767 11244 464523 199491 158218 41273 325565 325565 134418 134418 2136045 2111869 24176 9444 9444 666731 336822 329909 778829 163547 615282 1414249 1370382 43867 48913 39733 9180 187102 683 186419 6232867 6232867 2297292 1343222 954070 866912 439078 427834 BAD DEBT 5579 5579 18315302 7934484 10380818 0 345060 210403 14727609 11101216 55665 13581 26472 30886 350065 277350 40455809 3002526 37828669 37453283 3643174 3216854 198288 88728 57175002 52392301 4400206 4819251 1748748 1156881 52782238 53301827 9058577 16539811 580000 710000 0 1140451 68569769 77668221 X -11394767 -25275920 -11394767 -25275920 57175002 52392301 -13625001 -256152 0 X X 0 1 X 1 0 X 0 0 X 2843272 2843272 31891876 1328375 30563501 3417807 786562 2631245 2302854 887589 1415265 37453283 LEASE LIABILITY 1140451 1140451 X 4690301 0 4690301 0 4690301 18315302 0 18315302 0 18315302 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION UNDER CHAPTER 617 OF FLORIDA STATUTES AND IS A CHARITABLE ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION FOR FEDERAL AND STATE INCOME TAXES. MANAGEMENT HAS DETERMINED THAT THE ORGANIZATION DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022. 0 0 0 0 0 0 0 0 0 MICHAEL J BROWN JR EXECUTIVE DIRECTOR 190887 0 0 0 0 0 3529 0 8426 0 202842 0 0 0 A FLORIDA DEVELOPMENT FINANCE CORPORATION 563270584 34016WAL8 2020-07-17 52785000 FDFC SENIOR LIVING REVENUE BONDS, SERIES 2020A 0 0 0 B FLORIDA DEVELOPMENT FINANCE CORPORATION 563270584 34061WCC6 2022-12-28 2538000 FDFC SENIOR LIVING REVENUE BONDS, SERIES 2022A 0 0 0 A 52785000 4545763 930689 47308548 0 0 0 1 B 2538000 218445 49350 2270205 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 0 FORM 990, PART VI, SECTION A, LINE 3 IN CONNECTION WITH THE ACQUISITION OF THE COMMUNITY, THE ORGANIZATION ENTERED INTO MANAGEMENT AND DEVELOPMENT AGREEMENTS WITH BRP SENIOR HOUSING MANAGEMENT, LLC ("BRP") TO DEVELOP, MARKET, AND OPERATE THE COMMUNITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY MANAGEMENT PRIOR TO SUBMITTING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY AND ARE REQUIRED TO NOTIFY THE BOARD OF POTENTIAL CONFLICTS ARISE AS PART OF THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD UTLIZES COMPARIBILITY DATA IN ESTABLISHING THE COMPENSATION OF THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE FOR THE PUBLIC UPON REQUEST. FORM 990 PART VI LN 13 & 14 THE ORGANIZATION WAS IN THE PROCESS OF DEVELOPING ITS POLICIES AND PROCEDURES DURING 2020, HOWEVER THEY WERE NOT FORMALLY IN PLACE BY THE CLOSE OF THE YEAR. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 2,111,869. MANAGEMENT AND GENERAL EXPENSES 23,513. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,135,382. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 663. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 663. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.