2021-10-18T16:11:30-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 421068850 LIFESPACE COMMUNITIES INC LIFE 5152885805 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 NICK HARSHFIELD SENIOR VICE PRESIDENT & CFO 5152885805 2021-10-12 1 NICK HARSHFIELD 999009999 JED CHENEY P01587750 6123764500 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JESSE JANTZEN 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 667595140 0 X WWW.LIFESPACECOMMUNITIES.COM X 1976 IA CREATE COMMUNITIES CELEBRATING THE LIVES OF SENIORS. 12 11 3920 1206 0 0 314729 8579418 238199146 249893244 8062323 16375388 1635409 6688734 248211607 281536784 3370005 3335415 0 0 120593962 124907399 0 0 0 139435612 154091917 263399579 282334731 -15187972 -797947 1074258846 1067045251 1135882304 1123996107 -61623458 -56950856 X CREATING COMMUNITIES CELEBRATING THE LIVES OF SENIORS. LIFESPACE RECOGNIZES THAT ITS MISSION CAN ONLY BE FULFILLED THROUGH THE DEDICATED EFFORTS OF ITS EMPLOYEES, THEREFORE INCLUDED IN OUR MISSION IS THE ABILITY TO PROVIDE DISASTER RELIEF FUNDS TO EMPLOYEES WHO ENCOUNTER CIRCUMSTANCES RECOGNIZED BY FEDERAL AND STATE AGENCIES AS QUALIFYING FOR EMERGENCY DISASTER RELIEF. 0 0 243839862 3335415 249951234 LIFESPACE COMMUNITIES, INC. OWNS ELEVEN DIFFERENT COMMUNITIES (5 IN FL, 2 IN IL, 1 IN MN, KS, PA AND NE) WHICH PROVIDE APARTMENTS AND HEALTH CARE FOR RETIRED PERSONS. RESIDENTS PAY AN INITIAL ENTRANCE FEE AND MONTHLY FEES THEREAFTER WHICH ENTITLE THEM TO THE USE OF THE COMMUNITY FOR LIFE AND UNLIMITED USE OF THE HEALTH CENTER. RESIDENTS DO NOT ACQUIRE TITLE OF THE PROPERTY. 243839862 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 474 0 1 3920 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 FL IL KS MN PA X TIM NEVINS 5152885805 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 JESSE JANTZEN PRESIDENT & CEO & DIRECTOR 40.00 2.00 X X 618707 0 7341 LARRY SMITH INTERIM PRES, CEO, & CFO (THRU JUNE) 40.00 2.00 X 390244 0 18352 RUSSELL MAUK VP OF DEVELOP/DESIGN/CONST 40.00 2.00 X 344562 0 27667 JOHN ROBERTSON REGIONAL DIRECTOR OF SALES AND MARKETING 40.00 2.00 X 330242 0 32808 THOMAS BROD SVP OF BUSINESS DEVELOPMEN (THRU JUNE) 40.00 2.00 X 331888 0 22155 ANN WALSH SVP - OPERATIONS (THRU JUNE) 40.00 2.00 X 322200 0 14512 JOHN COUTURE VICE PRESIDENT - IT 40.00 2.00 X 302684 0 30455 SARA E HAMM CHEIF CLINICAL AND PUBLIC HEALTH OFFICER 40.00 2.00 X 319390 0 12923 GREG SIEMAN CHIEF REVENUE & COMMUNICATIONS OFFICER 40.00 2.00 X 292347 0 2507 NICK HARSHIELD SVP & CFO 40.00 2.00 X 231603 0 5087 CHRIS HUTFLESS INTERIM SVP & GENERAL COUNSEL (THRU JULY) 40.00 2.00 X 209963 0 5973 PAULA J SHIVES DIRECTOR & CHAIR 2.00 2.50 X 45000 0 0 ANA DUTRA DIRECTOR 2.00 2.50 X 36000 0 0 E LAVERNE EPP DIRECTOR 2.00 2.50 X 36000 0 0 VENITA FIELDS DIRECTOR 2.00 2.50 X 36000 0 0 ROBERT C KEHM DIRECTOR 2.00 2.50 X 36000 0 0 PATRICK SPANGLER DIRECTOR 2.00 2.50 X 36000 0 0 NEAL YANOFSKY DIRECTOR & VICE CHAIR 2.00 2.50 X 31500 0 0 SCOTT COLLIER DIRECTOR 2.00 2.50 X 30000 0 0 JOYCE DARKEY-HRINYA DIRECTOR 2.00 2.50 X 30000 0 0 LAURIE DOTTER DIRECTOR 2.00 2.50 X 30000 0 0 WILLIAM RICH DIRECTOR 2.00 2.50 X 30000 0 0 4070330 0 179780 129 0 1 0 KRAUS-ANDERSON CONSTRUCTION COMPANY 501 SOUTH 8 STREET MINNEAPOLIS MN 55404 CONTRACTOR 31834338 BRASFIELD & GORRIE LLC 941 W MORSE BLVD WINTER PARK FL 32789 CONSTRUCTION SERVICES 25241923 THOMAS MANAGEMENT LLC 700 E FRANKLIN ROAD MERIDIAN ID 83642 CULINARY SERVICES 22791956 REHABCARE GROUP EAST INC PO BOX 503534 ST LOUIS MO 631503534 HEALTH CENTER 6643373 GLYNNDEVINS 8880 WARD PARKWAY KANSAS CITY MO 64114 MARKETING CONSULTANT 5584840 143 337681 8241737 8579418 APARTMENT FEES 531110 122785211 122785211 SKILLED NURSING 623000 71321958 71321958 ENTRANCE FEES 531110 30765673 30765673 ASSISTED LIVING 623000 13763462 13763462 HOME HEALTH 621610 11256940 11256940 249893244 5870016 5870016 396563728 385461716 596640 11102012 -596640 10505372 10505372 87862 0 87862 87862 MANAGEMENT FEES 623000 6443236 6443236 EMPLOYEE MEALS 623990 157636 157636 6600872 281536784 249893244 0 23064122 1952405 1952405 1383010 1383010 4342068 868414 3473654 97921031 78336825 19584206 1532602 1226082 306520 16180729 12944583 3236146 4930969 3944775 986194 841127 841127 309566 309566 274985 274985 27005763 25655474 1350289 7137150 5709720 1427430 2609921 2087937 521984 3570022 2856018 714004 19328506 19328506 887740 710192 177548 13258693 13258693 52412201 49791591 2620610 1661194 1627970 33224 MISCELLANEOUS EXPENSES 6221251 4977001 1244250 PLANT OPERATIONS 5745509 5745509 MEDICAL SUPPLIES/DRUGS 5362518 5362518 RECRUITING 2835928 2268742 567186 4629843 3803897 825946 282334731 243839862 38494869 0 20678325 21554536 5032191 12878708 9300487 12621104 1030591 1034990 3884071 3647852 1161940088 497922760 599812334 664017328 110624533 121199272 1031332 1052582 50295432 45013106 272569550 184025773 1074258846 1067045251 37867093 46885986 14559218 13379829 478817860 471164228 4532030 7849625 2675317 4125317 597430786 580591122 1135882304 1123996107 X -61623458 -56950856 -61623458 -56950856 1074258846 1067045251 X -797947 5470539 10 X X 0 1 X 1 1 0 X 87325 258784 485813 314729 8579418 9726069 243366546 235414554 241524884 238199146 249893244 1208398374 1504476 1534885 1635409 9586389 14261159 243453871 237177814 243545582 240149284 268059051 1232385602 87325 258784 485813 314729 245076 1391727 0 87325 258784 485813 314729 245076 1391727 1230993875 3854601 4589785 5302031 8029090 5870016 27645523 3854601 4589785 5302031 8029090 5870016 27645523 247308472 241767599 248847613 248178374 273929067 1260031125 0.97700 0.97850 0.02190 0.02050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 33777498 33777498 1043622518 447518498 596104020 84540072 50404262 34135810 664017328 ASSETS WHOSE USE IS LIMITED: OPERATING RESERVE FUND 21927088 ASSETS WHOSE USE IS LIMITED: DEBT SERVICE RESERVE FUND 34408809 ASSETS WHOSE USE IS LIMITED: PRINCIPAL & INTEREST FUND 61359640 ASSETS WHOSE USE IS LIMITED: WAIT LIST RESERVE FUND 2038824 ASSETS WHOSE USE IS LIMITED: ENTRANCE FEE DEPOSITS 14682906 ASSETS WHOSE USE IS LIMITED: ASSET REPLACEMENT FUND 12427535 DEFERRED EXPENSES 1133824 DUE FROM RELATED PARTY 36047147 184025773 DEFERRED ENTRANCE FEES, REFUNDABLE ENTRANCE & MEMBERSHIP FEES 579630455 DUE TO RELATED PARTY 960667 580591122 X PART X, LINE 2: LIFESPACE EVALUATES TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN THE COURSE OF PREPARING ITS TAX RETURNS TO DETERMINE WHETHER IT IS "MORE LIKELY THAN NOT" THAT EACH TAX POSITION WOULD BE SUSTAINED UPON EXAMINATION BY A TAXING AUTHORITY BASED ON THE TECHNICAL MERITS OF THE POSITION. TAX POSITIONS NOT DEEMED TO MEET THE MORE-LIKELY-THAN-NOT THRESHOLD WOULD BE RECORDED AS TAX BENEFIT OR EXPENSE IN THE CURRENT YEAR. AS OF OR DURING THE YEARS ENDED DECEMBER 31, 2020 AND 2019, LIFESPACE HAS NOT RECORDED ANY SUCH TAX BENEFIT OR EXPENSE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. NO EXAMINATIONS ARE IN PROGRESS OR ANTICIPATED AT THIS TIME. LIFESPACE'S FEDERAL INCOME TAX RETURNS ARE OPEN TO EXAMINATION FOR THE YEARS ENDED DECEMBER 31, 2017 THROUGH DECEMBER 31, 2019. 1 THE LIFESPACE FOUNDATION 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 421370848 501(C)(3) 75418 N/A N/A TO SUPPORT GENERAL OPERATIONS DEERFIELD RETIREMENT COMMUNITY 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 421508960 501(C)(3) 1876987 N/A N/A GUARANTEE OF DEBT PAYMENTS 2 0 HARDSHIP ASSISTANCE - REDUCTION OF FEES 47 1383010 FAIR MARKET VALUE OF REDUCTION FEES RESIDENTS DO FROM TIME TO TIME SEEK FINANCIAL ASSISTANCE BY REQUESTING ASSISTANCE WITH THE MONTHLY FEE. SINCE THESE RESIDENTS HAVE SIGNED A LIFE CARE CONTRACT, THE ORGANIZATION IS OBLIGATED TO LET THEM CONTINUE TO LIVE IN THE COMMUNITY. MANAGEMENT SHALL REVIEW CRITERIA TO DETERMINE WHETHER THE RESIDENT IS A CANDIDIATE TO RECEIVE A HARDSHIP DISCOUNT. IF THE RESIDENT QUALIFIES FOR A HARDSHIP DISCOUNT, THE DISCOUNT WILL BEGIN TO BE DEDUCTED FROM THE MONTHLY FEES. PART I, LINE 2: THE ORGANIZATION CAN EASILY MONITOR THE USE OF THE GRANTS TO INDIVIDUALS BECAUSE THE GRANTS ARE SIMPLY REDUCTIONS OF THE MONTHLY FEES AND ENTRANCE FEES THAT THE RESIDENTS WOULD OWE IF THE HARDSHIP ASSISTANCE WAS NOT GRANTED. THE GRANT TO THE LIFESPACE FOUNDATION IS A TRANSFER TO A RELATED AFFILIATE. THE USE OF FUNDS ARE MONITORED DURING THE FINANCIAL REPORTING PROCESS AS BOTH AFFILIATES SHARE A COMMON BOARD OF DIRECTORS AND MANAGEMENT TEAM. X X X X X 1 0 0 0 0 0 0 0 0 JESSE JANTZEN PRESIDENT & CEO & DIRECTOR 467654 0 150000 0 1053 0 0 0 7341 0 626048 0 0 0 LARRY SMITH INTERIM PRES, CEO, & CFO (THRU JUNE) 281420 0 87961 0 20863 0 8550 0 9802 0 408596 0 0 0 RUSSELL MAUK VP OF DEVELOP/DESIGN/CONST 284550 0 39750 0 20262 0 7042 0 20625 0 372229 0 0 0 JOHN ROBERTSON REGIONAL DIRECTOR OF SALES AND MARKE 152761 0 171710 0 5771 0 7910 0 24898 0 363050 0 0 0 THOMAS BROD SVP OF BUSINESS DEVELOPMEN (THRU JUN 184123 0 84876 0 62889 0 14038 0 8117 0 354043 0 0 0 ANN WALSH SVP - OPERATIONS (THRU JUNE) 201524 0 52464 0 68212 0 7066 0 7446 0 336712 0 0 0 JOHN COUTURE VICE PRESIDENT - IT 206119 0 25881 0 70684 0 7213 0 23242 0 333139 0 0 0 SARA E HAMM CHEIF CLINICAL AND PUBLIC HEALTH OFF 252834 0 47631 0 18925 0 4620 0 8303 0 332313 0 0 0 GREG SIEMAN CHIEF REVENUE & COMMUNICATIONS OFFIC 241962 0 50000 0 385 0 0 0 2507 0 294854 0 0 0 NICK HARSHIELD SVP & CFO 181096 0 50000 0 507 0 0 0 5087 0 236690 0 0 0 CHRIS HUTFLESS INTERIM SVP & GENERAL COUNSEL (THRU 97744 0 76564 0 35655 0 0 0 5973 0 215936 0 0 0 PART I, LINE 4A ANN WALSH, SVP - OPERATIONS, RECEIVED A SEVERANCE PAY OF $128,243 AFTER SHE LEFT LIFESPACE COMMUNITIES IN JUNE, 2020. THOMAS BROD, SVP OF BUSINESS DEVELOPMENT, RECEIVED A SEVERANCE PAY OF $111,590 AFTER HE LEFT LIFESPACE COMMUNITIES IN JUNE, 2020. A KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 485429BX1 2010-11-18 25526524 CONSTRUCTION OF FACILITY AND REFUND A TAXABLE LOAN (7/1/2009) 0 0 0 B KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 2014-08-13 5485000 REFUND PRIOR ISSUE (8/23/13) 0 0 0 C ILLINOIS FINANCE AUTHORITY 861091967 45203HT28 2015-03-25 38167219 CONSTRUCTION OF FACILITY & REFUND PRIOR ISSUES (5/19/99 10/23/03 & 2/20/13) 0 0 0 D PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297506 696507UA8 2015-03-25 47992621 REFUND PRIOR ISSUES (11/28/07 & 2/20/13) 0 0 0 A 25903314 2638079 431072 19922450 2921714 2012 1 0 1 1 B 4158028 5485000 5485000 2003 1 0 1 1 C 8455000 38257660 2431091 687038 18737148 16830399 2016 1 0 1 1 D 7570000 48775367 3524562 70475 858282 46624107 2017 1 1 1 1 A 0 1 0 0 0.00300 0.00300 0 0 1 B 0 1 0 0 0.00300 0.00300 0 0 1 C 0 1 0 0 0.00300 0.00300 0 0 1 D 0 1 0 0 0.00300 0.00300 0 0 1 A 0 0 1 1 0 0 0 0 1 B 0 0 1 1 1 0 0 0 1 C 0 1 1 0 0 0 0 0 1 D 0 1 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: KANSAS DEVELOPMENT FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 10/31/2020 ISSUER NAME: KANSAS DEVELOPMENT FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 09/03/2014 ISSUER NAME: PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/22/2019 ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/21/2020 ISSUER NAME: HOSPITAL AUTH NO. 1 OF LANCASTER CO, NE DATE THE REBATE COMPUTATION WAS PERFORMED: 03/05/2005 ISSUER NAME: HOSPITAL AUTH NO. 1 OF LANCASTER CO, NE DATE THE REBATE COMPUTATION WAS PERFORMED: 12/05/2008 ENTITY 1, SCHEDULE K, PART II, COLUMN A, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 1, SCHEDULE K, PART 1, ROW C, COLUMN (E) DUE TO INVESTMENT EARNINGS/MARKET VALUE FLUCTUATION. ENTITY 1, SCHEDULE K, PART IV, COLUMN B, LINE 2, REBATE COMPUTATION NOTE REGARDING THE REBATE COMPUTATION 9/30/14: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. ENTITY 1, SCHEDULE K, PART II, COLUMN C, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE ENTITY 1, SCHEDULE K, PART 1 ROW D, COLUMN (E) DUE TO INVESTMENT EARNINGS/MARKET VALUE FLUCTUATION. ENTITY 1, SCHEDULE K, PART II, COLUMN C, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. ENTITY 1, SCHEDULE K, PART II, COLUMN D, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 1, SCHEDULE K, PART I, ROW A, COLUMN (E) DUE TO INVESTMENT EARNINGS. ENTITY 1, SCHEDULE K, PART II, COLUMN D, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. ENTITY 2, SCHEDULE K, PART II, COLUMN A, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 2, SCHEDULE K, PART I, ROW A, COLUMN (E) DUE TO INVESTMENT EARNINGS/MARKET VALUE FLUCTUATION. ENTITY 2, SCHEDULE K, PART II, COLUMN B, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 2, SCHEDULE K, PART I, ROW B, COLUMN (E) DUE TO INVESTMENT EARNINGS/MARKET VALUE FLUCTUATION. ENTITY 2, SCHEDULE K, PART II, COLUMN C, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 2, SCHEDULE K, PART I, ROW B, COLUMN (E) DUE TO INVESTMENT EARNINGS. ENTITY 2, SCHEDULE K, PART II, COLUMN D, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS OF ISSUE DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. ENTITY 3, SCHEDULE K, PART II, COLUMN A, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 3, SCHEDULE K, PART I, ROW A, COLUMN (E) DUE TO INVESTMENT EARNINGS. ENTITY 3, SCHEDULE K, PART IV, COLUMN A, LINE 2, REBATE COMPUTATION NOTE REGARDING THE 03/05/2005 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS. NO FURTHER REBATE CALCULATIONS ARE NECESSARY. ENTITY 3, SCHEDULE K, PART II, COLUMN B, LINE 3, TOTAL PROCEEDS OF ISSUE THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 3, SCHEDULE K, PART I, ROW B, COLUMN (E) DUE TO INVESTMENT EARNINGS/MARKET VALUE FLUCTUATION. ENTITY 3, SCHEDULE K, PART IV, COLUMN B, LINE 2, REBATE COMPUTATION NOTE REGARDING THE 12/05/2008 REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS NO FUTHER REBATE CALCULATIONS WERE NECESSARY. A IOWA FINANCE AUTHORITY 521699886 46246K3P5 2016-11-22 52715703 RENOVATE FACILITIES 0 0 0 B PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297506 696507UD2 2016-11-22 24609426 RENOVATE FACILITIES 0 0 0 C PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297505 696507RV6 2004-12-22 5465000 ACQUISITION, CONSTRUCTION AND EQUIPPING FACILITY 0 0 0 D ILLINOIS FINANCE AUTHORITY 861091967 45200BMX3 2005-04-21 12165166 REFUND BONDS (4/29/1997) 0 0 0 A 53626055 4288475 4802507 1052101 43482972 0 0 1 1 B 25338688 2007069 2235506 490963 20605150 0 0 1 1 C 1825000 5472483 361025 109300 7211 4994947 2005 0 0 1 1 D 10200000 12165166 1021363 241856 279578 11643732 2005 1 0 1 1 A 0 1 0 0 0.00300 0.00300 0 0 1 B 0 1 0 0 0.00300 0.00300 0 0 1 C 0 1 0 0 0.00300 0.00300 0 0 1 D 0 1 0 0 0.00300 0.00300 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 0 1 1 1 0 0 0 1 D 0 0 1 1 1 0 0 0 1 A 1 B 1 C 1 D 1 A HOSPITAL AUTH NO 1 OF LANCASTER CO NE 470721900 2003-03-05 9700000 CONSTRUCTION OF FACILITY 0 0 0 B HOSPITAL AUTH NO 1 OF LANCASTER CO NE 470721900 2005-12-05 13050000 CONSTRUCTION OF FACILITY 0 0 0 C IOWA FINANCE AUTHORITY 521699886 46246K4T6 2018-08-28 141806310 RENOVATE FACILITIES 0 0 0 D PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297506 696507UN0 2018-08-28 32281188 RENOVATE FACILITIES 0 0 0 A 4346741 9777788 9777788 2004 0 0 1 1 B 3981600 13603719 200000 13403719 2007 0 0 1 1 C 145713525 13441037 12151898 2662656 114480708 2977226 0 0 0 1 D 33365994 3155802 2620185 645624 26817892 126492 0 0 0 1 A 0 1 0 0 0.00100 0.00100 0 0 1 B 0 1 0 0 0.00100 0.00100 0 0 1 C 0 1 0 0 0.00300 0.00300 0 0 1 D 0 1 0 0 0.00300 0.00300 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A IOWA FINANCE AUTHORITY 521699886 46246K6Y3 2019-11-20 54891394 RENOVATE FACILITIES 0 0 0 B PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297506 696507US9 2019-11-20 55279646 RENOVATE FACILITIES 0 0 0 A 55520626 1955594 876925 18768708 33919399 0 0 0 1 B 55886707 2324658 959659 32248194 20324195 0 0 0 1 A 0 1 0 0 0.00300 0.00300 0 0 1 B 0 1 0 0 0.00300 0.00300 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR OF THE BOARD, THE VICE CHAIR OF THE BOARD, THE IMMEDIATE PAST CHAIR OF THE BOARD, THE CHAIR OF THE GOVERNANCE AND NOMINATING COMMITTEE AND, AS AN EX-OFFICIO MEMBER, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. EXCEPT AS LIMITED HEREIN, AND EXCEPT FOR RESPONSIBILITIES DELEGATED TO ANOTHER COMMITTEE, THE EXECUTIVE COMMITTEE SHALL POSSESS AND MAY EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS IN THE OVERSIGHT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, EXCEPT AS HEREIN PROVIDED. THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE POWERS OF THE BOARD OF DIRECTORS WITH RESPECT TO AUTHORIZING DISTRIBUTIONS; APPROVING DISSOLUTION, MERGER, OR THE SALE, PLEDGE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; ELECTING, APPOINTING, OR REMOVING DIRECTORS OR FILLING VACANCIES ON THE BOARD OF DIRECTORS OR ON ANY OF ITS COMMITTEES; OR ADOPTING, AMENDING, REPEALING THE ARTICLES OF INCORPORATION OR THE BYLAWS, OR THE APPOINTMENT OR REMOVAL OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. THE PRIMARY PURPOSE OF THE COMMITTEE IS TO ENABLE THE BOARD OF DIRECTORS TO ACT WHERE AN ASSEMBLY OF A QUORUM OF THE BOARD WOULD BE IMPRACTICABLE OR IMPOSSIBLE. THE COMMITTEE ALSO SHALL SERVE AS AN ADVISOR TO THE PRESIDENT AND CEO, PROVIDING CONSULTATION, SUPPORT AND GUIDANCE ON AN INFORMAL BASIS AS REQUESTED FROM TIME TO TIME, AND REVIEW AND APPROVE BOARD MEETING AGENDAS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION SHALL BE LIFESPACE, INC. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PERFORMED A THOROUGH REVIEW OF THE FORM 990. THE RISK MANAGEMENT & AUDIT COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE FORM 990 PRIOR TO FILING. ANY CONCERNS OR SUGGESTIONS IDENTIFIED BY THE RISK MANAGEMENT & AUDIT COMMITTEE WERE REPORTED TO THE FULL BOARD OF DIRECTORS. A COPY OF THE FORM 990 WAS DISTRIBUTED TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO FILING. MEMBERS OF THE BOARD OF DIRECTORS DIRECTED ANY QUESTIONS OR CONCERNS TO THE CHIEF FINANCIAL OFFICER TO BE RESOLVED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS OF LIFESPACE COMMUNITIES, INC. AND ALL RELATED ORGANIZATIONS MUST CONDUCT THEIR PERSONAL AFFAIRS IN SUCH A MANNER AS TO AVOID ANY POSSIBLE CONFLICTS OF INTEREST WITH DUTIES AND RESPONSIBILITIES AS OFFICERS AND MEMBERS OF THE BOARD OR DIRECTORS. ALL NEW BOARD MEMBERS AND OFFICERS ARE REQUIRED TO COMPLETE A CONFLICTS OF INTEREST STATEMENT. THIS IS REVIEWED BY THE GOVERNANCE & NOMINATING COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS ANNUALLY ARE REQUIRED TO COMPLETE A CONFLICTS OF INTEREST STATEMENT. THESE STATEMENTS ARE REVIEWED BY THE GOVERNANCE & NOMINATING COMMITTEE TO DETERMINE IF ANY CONFLICTS OF INTEREST EXIST PRIOR TO REAPPOINTMENT TO THE BOARD AND OFFICER POSITIONS. ANY DIRECTOR HAVING A CONFLICT OF INTEREST SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR DIRECTORS (INCLUDING THE OFFICER-DIRECTOR POSITIONS OF CHAIR AND VICE-CHAIR) IS REVIEWED ANNUALLY BY THE GOVERNANCE AND NOMINATING COMMITTEE. GENERALLY, AN OUTSIDE CONSULTANT IS RETAINED EVERY YEAR TO DETERMINE THE REASONABLENESS OF DIRECTOR COMPENSATION. A REPORT IS PROVIDED TO THE BOARD OF DIRECTORS BY THE CONSULTANT. THE BOARD OF DIRECTORS APPROVES THE ANNUAL COMPENSATION BASED ON THESE REVIEWS. COMPENSATION FOR EMPLOYEES WHO ARE DISQUALIFIED PERSONS UNDER INTERMEDIATE SANCTIONS REGULATION IS REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE DISQUALIFIED PERSONS INCLUDE THE CEO, THE CFO, THE SVP OF OPERATIONS, AND THE SVP OF SUCCESSFUL AGING AND HEALTH SERVICES. THE COMPENSATION COMMITTEE USES AN OUTSIDE, INDEPENDENT COMPENSATION CONSULTANT AT LEAST EVERY OTHER YEAR TO DETERMINE THE REASONABLENESS OF THE DISQUALIFIED PERSONS' COMPENSATION. THE COMPENSATION CONSULTANT PROVIDES A REPORT TO THE COMPENSATION COMMITTEE OF ITS MARKET COMPETITIVENESS REVIEW, FINDINGS, AND RECOMMENDATIONS, AND A LETTER STATING ITS ASSESSMENT OF THE REASONABLENESS OF COMPENSATION. IN YEARS WHEN THE COMPENSATION COMMITTEE DOES NOT USE AN OUTSIDE CONSULTANT, IT REVIEWS SURVEY INFORMATION TO DETERMINE THE REASONABLENESS OF COMPENSATION. THE COMPENSATION COMMITTEE RECOMMENDS TO THE BOARDS, AND THE BOARD OF DIRECTORS APPROVES THE ANNUAL COMPENSATION CHANGES BASED ON THE RECOMMENDATION OF THE COMPENSATION COMMITTEE. THE SALARIES AND BENEFITS LISTED CONTAIN THE TOTAL SALARIES AND BENEFITS PAID TO EACH INDIVIDUAL THROUGH LIFESPACE COMMUNITIES, INC. AND ALL RELATED ENTITIES. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FROM THIRD PARTIES FOR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE REFERRED TO THE CHIEF FINANCIAL OFFICER. ANNUAL RETURNS AND THE APPLICATION FOR EXEMPTION ARE MADE AVAILABLE FOR PUBLIC INSPECTION AND ARE PROVIDED TO INDIVIDUALS WHO REQUEST THEM. COPIES ARE PROVIDED WITHIN 30 DAYS OF A WRITTEN REQUEST OR THE SAME DAY IF REQUESTED IN PERSON. FORM 990, PART XI, LINE 9: FINANCIAL STATEMENT ROUNDING ADJUSTMENT 10. FORM 990, PART XII, LINE 2C: THE PROCESS OF OVERSEEING THE AUDIT AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 3B: FEDERAL GRANTS RECEIVED AND RECOGNIZED AS REVENUE THROUGH THE CARES ACT EXCEEDED THE MAJOR PROGRAM AUDIT THRESHOLD OF $750K. DUE TO THE FINAL SUPPLEMENT AND GUIDANCE OF THESE AUDITS NOT HAVING BEEN RELEASED BY THE FEDERAL GOVERNMENT, THE AUDIT HAS NOT BEEN COMPLETED AS OF FILING. AUDIT WILL BE PERFORMED WHEN SUPPLEMENT AND GUIDANCE IS RELEASED. 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