2023-11-15T18:05:26-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 20 E THOMAS RD STE 2300 PHOENIX AZ 85012 990 2022-01-01 237458267 LIFESTREAM COMPLETE SENIOR LIVING INC LIFE 6239333333 11555 WEST PEORIA AVENUE YOUNGTOWN AZ 85363 NATHAN MERRILL CFO 7194815481 2023-11-15 1 NATHAN MERRILL 999009999 1 CHAD D KUNZE CPA P00639380 6022662248 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NATHAN MERRILL 15475 GLENEAGLE DRIVE COLORADO SPRINGS CO 80921 11385197 0 X WWWW.LIFESTREAMLIVING.COM X 1975 AZ SERVING SENIORS BY ENRICHING THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL HEALTH IN A CLOSE-KNIT COMMUNITY 8 8 146 13 0 0 3639710 1593267 11603079 9081851 805519 665100 22178 44979 16070486 11385197 0 0 0 0 7976725 7161717 0 0 0 5720831 6326498 13697556 13488215 2372930 -2103018 29507597 26335164 21048170 20224354 8459427 6110810 X OUR MISSION IS TO SERVE SENIORS BY ENRICHING THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL HEALTH IN A CLOSE-KNIT COMMUNITY. 0 0 7790797 0 3471634 THE ORGANIZATION PROVIDES HEALTH CARE SERVICES TO A MAXIMUM OF 102 SENIOR RESIDENTS AT A REASONABLE COST. NEARLY 83% OF OUR RESIDENTS WERE MEDICAID, 6% MEDICARE AND 11% PRIVATE PAY. ONE WING OF OUR SKILLED NURSING CENTER IS DEVOTED TO SENIORS WITH WANDERING DEMENTIA. OUR MISSION IS ACTED OUT BY NEARLY 141 ASSOCIATES. WE HAVE FULL-TIME CHAPLAINS THAT ATTEND TO THE SPIRITUAL AND EMOTIONAL NEEDS OF OUR RESIDENTS. THE CHALLENGES OUR CHAPLAINS FACE EXTEND FROM SENIOR'S FEARS AND FRUSTRATIONS TO ILLNESSES AND THE LOSS OF LOVED ONES. ON A DAILY BASIS OUR CHAPLAINS AND ASSOCIATES HELP RESIDENTS MAKE THE TRANSITION FROM DISCOMFORT TO CONTENTMENT AND FROM APPREHENSION TO ASSURANCE FROM UNCERTAINTY. 4433717 0 5610217 THE ORGANIZATION PROVIDED QUALITY AFFORDABLE HOUSING AND SERVICES TO APPROXIMATELY 177 SENIOR RESIDENTS AT A REASONABLE COST. ON AVERAGE, 143 WERE IN INDEPENDENT LIVING AND 34 WERE IN ASSISTED LIVING. OUR MISSION IS ACTED OUT IN OUR SENIOR HOUSING PROGRAM THE SAME AS IT IS IN OUR NURSING CARE PROGRAM AS DESCRIBED ABOVE. LIFESTREAM AT YOUNGTOWN OPERATES A 47-ACRE RETIREMENT CAMPUS IN YOUNGTOWN, ARIZONA. THE CAMPUS INCLUDES COOK HEALTH CARE CENTER ("COOK"), A 102-BED SKILLED NURSING FACILITY, THREE GREEN HOUSE ASSISTED LIVING HOMES TOTALING 30 BEDS, JT'S PLACE- A 24 BED ASSISTED LIVING CENTER, AND 161 INDEPENDENT LIVING UNITS. THIRTY OF OUR ASSISTED LIVING ROOMS ARE IN THREE "GREEN HOUSES" WHICH IS A CONCEPT THAT MOVES ASSISTED LIVING FROM A HOSPITAL MODEL TO A HOME-LIKE SETTING. EACH HOUSE HAS A COMMON GREAT ROOM, DINING ROOM WHERE FAMILY-STYLE MEALS ARE SHARED BETWEEN SENIORS AND CAREGIVERS, AND A LOVELY PATIO WHERE RESIDENTS CAN ENJOY THE OUTDOORS AS WELL AS A VARIETY OF SOCIAL ACTIVITIES. SERVICES SUCH AS MEDICATION MANAGEMENT, WELL-BEING CHECKS, PET CARE, TRANSPORTATION TO MEALS, COMPANION SERVICE AND A HOST OF OTHER SERVICES ARE AVAILABLE TO OUR SENIOR HOUSING RESIDENTS. WE HAVE FULL-TIME CHAPLAINS THAT ATTEND TO THE SPIRITUAL AND EMOTIONAL NEEDS OF OUR RESIDENTS. 12224514 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 43 0 146 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X NATHAN MERRILL 7194815481 15475 GLENEAGLE DRIVE COLORADO SPRINGS CO 80921 DARWYN HARP BOARD MEMBER THRU 3/22 0.40 0.60 X 0 0 0 DICK DICKSON CHAIRMAN - THRU 3/22 0.40 0.60 X X 0 0 0 JODI SHEAHAN VICE CHAIR - THRU 3/22 0.40 0.60 X X 0 0 0 KENNETH KORTMAN BOARD MEMBER THRU 3/22 0.40 0.60 X 0 0 0 TAMI WISELY BOARD MEMBER THRU 3/22 0.40 0.60 X 0 0 0 JENNY KENNEDY BOARD MEMBER 0.40 3.60 X 0 0 0 DANA RASIC BOARD CHAIR / CEO 5.00 50.00 X X 0 0 0 NATHAN MERRILL TREASURER / CFO 5.00 50.00 X X 0 0 0 DAN VAGLE BOARD MEMBER 0.40 3.60 X 0 0 0 RICK SUMMERS BOARD MEMBER / COO 5.00 50.00 X X 0 0 0 DALE TURNER BOARD MEMBER 0.40 3.60 X 0 0 0 DON MORGAN BOARD MEMBER 0.40 3.60 X 0 0 0 LARRY SMITH BOARD MEMBER 0.40 3.60 X 0 0 0 RONALD E ESTES END 322 PRESIDENT/CEO/CFO 22.00 18.00 X 358240 0 9412 DONNA TAYLOR END 622 EXECUTIVE VICE PRESIDENT/COO 22.00 18.00 X 343680 0 10591 JULIE HOFFMAN CONTROLLER 22.00 18.00 X 118835 0 5084 LISA D SISCO EXECUTIVE DIRECTOR 0.00 40.00 X 103101 0 19388 923856 0 44475 4 0 1 0 RIDGE VIEW CONSTRUCTION 12075 SILVER CONCHO TR ELBERT CO 80106 CONSTRUCTION CONTRACTOR 157730 MORRISON LIVING 5801 PEACHTREE DUNWOODY ROAD ATLANTA GA 30342 HEALTH AGENCY STAFFING 154038 SONORAN LANDSCAPE MAINTENANCE PO BOX 8681 PHOENIX AZ 85066 LANDSCAPING/GROUNDS KEEPING 153360 COVENANT ALLIANCE REHAB 28100 TORCH PARKWAY - SUITE 600 WARRENVILLE IL 60555 THERAPY SERVICES 101083 4 1552194 41073 57640 1593267 LIFE TENANCY 623990 5610217 5610217 NURSING CARE 623000 3383423 3383423 SENIOR HOUSING 623990 88211 88211 9081851 71571 71571 593529 0 593529 593529 593529 OTHER PERSONAL SERVICES FOR RESID 812900 27330 27330 MISCELLANEOUS REVENUE 623000 10399 10399 CATERING SERVICES 722320 7250 7250 44979 11385197 9081851 0 710079 6063145 5461706 601439 639403 599698 39705 459169 412198 46971 21700 10639 11061 76006 1700 74306 579519 579519 944840 803434 141406 36848 36848 466956 441203 25753 149991 139495 10496 907975 886336 21639 18782 9791 8991 8257 6709 1548 447625 380759 66866 834152 793175 40977 415705 282194 133511 RESIDENT RELATED SUPPLI 858263 856202 2061 MAINTENANCE AND REPAIRS 228286 225590 2696 BAD DEBT 184721 184721 DUES AND SUBSCRIPTIONS 92390 68854 23536 54482 43743 10739 13488215 12224514 1263701 0 6103465 2640364 703444 740676 3078948 1998093 62457 67434 406027 68228 27519214 16941662 10740339 10577552 2256332 2187397 623441 535261 5533144 7520159 29507597 26335164 1068028 574514 15167 10078 6492288 6115240 36188 9190 2044168 1604254 11392331 11911078 21048170 20224354 X 6646550 4740104 1812877 1370706 8459427 6110810 29507597 26335164 X -2103018 -157419 -88180 X X 0 1 X 1 0 X 622983 447291 3037015 3639710 1593627 9340626 12995268 13961987 14266385 11603079 9081851 61908570 13618251 14409278 17303400 15242789 10675478 71249196 18058 20706 38506 16154 93424 0 18058 20706 38506 16154 93424 71155772 4626 10050 3234 5243 71571 94724 4626 10050 3234 5243 71571 94724 83284 80125 50419 22178 44979 280985 13706161 14499453 17357053 15270210 10792028 71624905 0.99350 0.99300 0.00130 0.00040 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2018 AMOUNT: $ 13,795. 2019 AMOUNT: $ 17,542. 2020 AMOUNT: $ 22,494. 2021 AMOUNT: $ 7,030. 2022 AMOUNT: $ 10,399. BEAUTY/BARBER SERVICES - CATERING SERVICES - 2018 AMOUNT: $ 35,411. 2019 AMOUNT: $ 32,160. 2020 AMOUNT: $ 13,621. 2021 AMOUNT: $ 9,198. 2022 AMOUNT: $ 7,250. OTHER PERSONAL SERVICES FOR RESIDENTS - 2018 AMOUNT: $ 20,070. 2019 AMOUNT: $ 16,036. 2020 AMOUNT: $ 9,316. 2021 AMOUNT: $ 5,124. 2022 AMOUNT: $ 27,330. OFFICE LEASE INCOME - EMPLOYEE GUEST MEALS - 2018 AMOUNT: $ 14,008. 2019 AMOUNT: $ 14,387. 2020 AMOUNT: $ 4,988. 2021 AMOUNT: $ 826. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2104139 -131135 1973004 1760498 377425 33784 2104139 1639142 148356 27000 1760498 1337674 301468 1639142 1366978 -29304 1337674 1 0 3853842 3853842 19713182 14388199 5324983 3766424 2553463 1212961 185766 185766 10577552 DUE FROM AFFILIATES 7520159 7520159 SECURITY DEPOSITS 109803 REFUNDABLE LIFE TENANCY CONTRACTS 573007 DUE TO AFFILIATES 11228268 11911078 X PART IV, LINE 2B: THE ORGANIZATION MAINTAINS ESCROW ACCOUNTS ON BEHALF OF ITS RESIDENTS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED TO SUPPORT RETIRED PASTORS AND MISSIONARIES, SUPPORT CHAPLAINS, PROVIDE EMERGENCY ASSISTANCE TO EMPLOYEES, PROVIDE HEALTHCARE SERVICES, AND PURCHASE NEEDED EQUIPMENT. PART X, LINE 2: THE ORGANIZATION APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. X X X X 1 0 0 0 0 0 0 0 0 RONALD E ESTES END 322 PRESIDENT/CEO/CFO 127327 0 0 0 230913 0 404 0 9008 0 367652 0 0 0 DONNA TAYLOR END 622 EXECUTIVE VICE PRESIDENT/COO 73106 0 0 0 270574 0 0 0 10591 0 354271 0 0 0 PART I, LINE 4A RONALD ESTES, PRESIDENT / CEO / CFO, DONNA TAYLOR, EXECUTIVE VP / COO, AND JULIE HOFFMANN, CONTROLLER, ALL RECEIVED SEVERANCE PAYMENTS. A IDA OF THE CITY OF PEORIA AZ 521767454 F1284MBG3 2012-12-20 5969957 REFUNDED PRIOR ISSUE DATED 11/20/03 0 0 0 A 5969957 322203 119399 5528355 2013 1 0 1 1 A 0 1 0 0 0.00010 0.00000 0.00010 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: IDA OF THE CITY OF PEORIA, AZ DATE THE REBATE COMPUTATION WAS PERFORMED: 12/01/2022 X 1 57640 COVID PPE - GLOVES 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 LIFESTREAM COMPLETE SENIOR LIVING, INC. AND ITS AFFILIATED ORGANIZATIONS, LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE, INC., LIFESTREAM COMPLETE SENIOR LIVING AT THUNDERBIRD, INC., AND LIFESTREAM COMPLETE SENIOR LIVING AT NORTHEAST PHOENIX, INC. (COLLECTIVELY LIFESTREAM), ENTERED INTO A TRANSITION AGREEMENT WITH BETHESDA FOUNDATION DBA BETHESDA SENIOR LIVING COMMUNITIES (BETHESDA) ON DECEMBER 15, 2021, THAT PROVIDED FOR BETHESDA, SUBJECT TO THE COMPLETION OF THE DUE DILIGENCE, TO ACQUIRE GOVERNANCE CONTROL OF LIFESTREAM ON APRIL 1, 2022. THE GOVERNANCE CONTROL WAS EFFECTED THROUGH ACTION BY LIFESTREAM'S BOARD OF DIRECTORS ON MARCH 17, 2022. BETHESDA BOARD MEMBERS WERE ELECTED TO SERVE AS LIFESTREAM BOARD MEMBERS EFFECTIVE APRIL 1, 2022, AND LIFESTREAM'S EXISTING BOARD MEMBERS TENDERED THEIR RESIGNATION EFFECTIVE MARCH 31, 2022. THIS TRANSACTION AND AGREEMENT DID NOT IMPACT LIFESTREAM'S CORPORATE STRUCTURE. FORM 990, PART VI, SECTION B, LINE 11B TAX RETURNS ARE PROVIDED TO THE BOARD MEMBERS PRIOR TO THE FILING OF THE RETURN. BOARD MEMBERS ARE AFFORDED THE OPPORTUNITY TO PROPOSE APPROPRIATE CHANGES TO THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY AND FORMS ARE DISTRIBUTED AND DISCUSSED AT THE ANNUAL MEETING OF THE BOARD. EACH BOARD DIRECTOR, COMMITTEE MEMBER AND OFFICER WITH BOARD DELEGATED POWERS WHETHER THEY BE DIRECT OR INDIRECT MUST READ AND SIGN INDICATING TO HAVE READ AND UNDERSTOOD THE CONFLICT POLICY AND AGREE TO COMPLY. EACH PERSON, ACCORDING TO THE POLICY, HAS THE DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST BY DISCLOSING THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS SHALL CONTAIN - THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED, THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. FORM 990, PART VI, SECTION B, LINE 15A ANNUALLY, THE COMPENSATION COMMITTEE (COMPRISED OF THE CHAIRMAN AND VICE-CHAIRMAN OF THE BOARD PLUS ONE OTHER MEMBER OF THE BOARD OF DIRECTORS) REVIEWS THE FOLLOWING INFORMATION TO SET AND APPROVE EXECUTIVE COMPENSATION: INDEPENDENT SALARY SURVEY INFORMATION; PERFORMANCE REVIEW FOR CEO BASED ON MISSION, QUALITY, FINANCIAL AND STAFF LEADERSHIP; PERFORMANCE FEEDBACK ON OTHER EXECUTIVES PROVIDED BY CEO; BACKGROUND, SKILLS, QUALIFICATIONS FOR EACH EXECUTIVE. THE COMPENSATION COMMITTEE MEETS AND MAKES RECOMMENDATIONS TO THE FULL BOARD OF DIRECTORS DURING EXECUTIVE SESSION. MINUTES ARE TAKEN AT EACH MEETING AND MADE PART OF THE CORPORATE RECORD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CSPRGC CHANGE -88,180. FORM 990, PAGE 12, PART XII, LINE 2C THERE HAS BEEN NO CHANGE IN EITHER THE OVERSIGHT PROCESS OR THE SELECTION PROCESS DURING THE TAX YEAR. LIFESTREAM COMPLETE SENIOR LIVING AT NORTHEAST PHOENIX INC 11555 WEST PEORIA AVENUE YOUNGTOWN AZ 85363 860682800 SENIOR APARTMENTS AZ 501(C)(3) LINE 10 LIFESTREAM COMPLETE SENIOR LIVING INC 1 LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC 11555 WEST PEORIA AVENUE YOUNGTOWN AZ 85363 860712529 SKILLED NURSING AZ 501(C)(3) LINE 10 LIFESTREAM COMPLETE SENIOR LIVING INC 1 LIFESTREAM COMPLETE SENIOR LIVING AT THUNDERBIRD INC 11555 WEST PEORIA AVENUE YOUNGTOWN AZ 85363 860739097 SENIOR APARTMENTS AZ 501(C)(3) LINE 10 LIFESTREAM COMPLETE SENIOR LIVING INC 1 BETHESDA SENIOR LIVING COMMUNITIES 15475 GLENEAGLE DR COLORADO SPRINGS CO 80921 470497753 DEVELOPMENT AND OPERATION OF SENIOR LIVING FACILITIES CO 501(C)(3) LINE 10 N/A 0 CHARITABLE TRUST (1) INVESTMENTS AZ LIFESTREAM COMPLETE SENIOR LIVING INC T 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0