2021-11-15T09:51:13-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 201203479 BARTON CREEK SENIOR LIVING CENTER INC BART 5152885805 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 NICK HARSHFIELD CFO & TREASURER 5152885805 2021-11-15 1 NICK HARSHFIELD 999009999 JED CHENEY P01587750 6123764500 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z QUERENCIA AT BARTON CREEK JESSE JANTZEN 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 55005648 0 X WWW.QUERENCIABARTONCREEK.COM X 2003 TX CREATE COMMUNITIES CELEBRATING THE LIVES OF SENIORS 3 0 342 0 0 0 0 644224 22854631 22382896 866524 3439718 0 0 23721155 26466838 1021711 1048258 0 0 10230218 10158986 0 0 0 16413479 23007988 27665408 34215232 -3944253 -7748394 123990141 124389534 125158134 134454228 -1167993 -10064694 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 28251124 1048258 22382896 TO PROVIDE APARTMENTS AND HEALTH CARE FOR RETIRED PERSONS. RESIDENTS PAY AN INITIAL ENTRANCE FEE AND MONTHLY FEES THEREAFTER WHICH ENTITLE THEM TO USE OF THE COMMUNITY FOR LIFE AND UNLIMITED USE OF THE HEALTH CENTER. RESIDENTS DO NOT ACQUIRE TITLE TO THE PROPERTY. 28251124 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 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 0 0 0 1 62 0 1 342 1 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TIM NEVINS 5152885805 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 JESSE JANTZEN PRESIDENT & CEO & DIRECTOR 2.00 40.50 X X 0 618707 7341 LARRY SMITH INTERIM PRES, CEO & CFO (THRU JUNE) 2.00 40.50 X X 0 390244 18352 THOMAS BROD SVP OF BUSINESS DEVELOPMEN (THRU JUNE) 40.00 2.00 X X 0 331888 22155 NATHAN WAYAND EXECUTIVE DIRECTOR 40.00 0.00 X 244403 0 22159 NICK HARSHFIELD CFO & TREASURER 2.00 40.50 X X 0 231603 5087 CHRIS HUTFLESS INTERIM SVP & GENERAL COUNSEL (THRU JULY) 2.00 40.50 X X 0 209963 5973 ABDUL SHAKOOR DEPUTY GENERAL COUNSEL AND DIRECTOR (JUL-OCT) 2.00 40.50 X 0 146559 11192 TIFFANY TELLO ADMINISTRATOR 40.00 0.00 X 144541 0 10226 AMBER SUMMERS DIRECTOR OF NURSING 40.00 0.00 X 144881 0 0 AMY JANAK DIRECTOR OF SALES 40.00 0.00 X 114286 0 2483 EDDIE FENOGLIO COO AND SECRETARY 2.00 40.50 X X 0 90163 1796 648111 2019127 106764 4 0 1 0 THOMAS MANAGEMENT LLC 700 E FRANKLIN ROAD MERIDIAN ID 83642 CULINARY SERVICES 335224 GLYNN DEVINS INC 8880 WARD PARKWAY KANSAS CITY MO 64114 MARKETING CONSULTING 315505 TEAM SERVICES 2201 PATTERSON INDUSTRIAL DR PFLUGERVILLE TX 78660 MAINTENANCE SERVICES 186190 SECURITAS SECURITY SERVICES USA INC 12672 COLLECTIONS CENTER DR CHICAGO IL 60693 SECURITY STAFFING 161472 OMNICARE PO BOX 78000 DETROIT MI 48278 HEALTH CENTER SERVICES 152569 8 644224 644224 INDEPENDENT LIVING 531110 11727256 11727256 SKILLED NURSING 623000 9714793 9714793 ENTRANCE FEES 531110 940847 940847 22382896 538025 538025 31440503 28493120 45690 2947383 -45690 2901693 2901693 26466838 22382896 0 3439718 23671 23671 1024587 1024587 7590474 6072379 1518095 43708 34966 8742 1828863 1463090 365773 695941 556753 139188 1448121 1375715 72406 11325 11325 13626 13626 18000 18000 2871583 2871583 261622 209298 52324 231043 231043 617961 617961 33697 26958 6739 2283763 2283763 12432020 11810419 621601 196330 192403 3927 MEDICAL AND OTHER RESID 1020458 1020458 PLANT OPERATIONS 865154 865154 OTHER GENERAL AND ADMIN 329963 329963 REAL ESTATE TAXES 297364 267628 29736 75958 75958 34215232 28251124 5964108 0 4284115 3685351 391319 671713 42328 113128 408617 255560 74021656 1918305 73653845 72103351 17841583 21112769 17473264 15214909 9895070 11232753 123990141 124389534 1842140 1496760 46015000 44690000 1625605 760000 266355 205797 75409034 87301671 125158134 134454228 X -1167993 -10064694 -1167993 -10064694 123990141 124389534 X -7748394 -1149267 960 X 0 1 X 1 0 X 5553 3796 644224 653573 19098227 20110368 20057803 22854631 22382896 104503925 19103780 20114164 20057803 22854631 23027120 105157498 0 0 0 105157498 436467 528821 768569 596221 520025 2850103 436467 528821 768569 596221 520025 2850103 108605 232166 124419 465190 19648852 20875151 20950791 23450852 23547145 108472791 0.96940 0.96920 0.02630 0.02530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 5000000 5000000 70399479 1873538 67169209 -1385506 44767 -73541 7683 7683 72103351 MARKETING COMMISSIONS 51713 NONCURRENT ASSETS LIMITED AS TO USE 7029107 ASSETS LIMITED AS TO USE 3742055 INTERCOMPANY RECEIVABLES 405381 TEAM MEMBER APPRECIATION FUNDS 4497 11232753 INTERCOMPANY PAYABLES 161242 DEFERRED & REFUNDABLE ENTRANCE FEES 87140429 87301671 X 24181000 -1149267 -1149267 25330267 1136571 1136571 26466838 33054000 -23671 -23671 33077671 1137561 1137561 34215232 PART IV, LINE 2B: ESCROW AND CUSTODIAL ARRANGEMENTS THE ORGANIZATION REQUIRES FUTURE RESIDENTS WISHING TO RESERVE SPACE AT THE COMMUNITY TO PAY A DEPOSIT OF $15,000 OF THE ADVANCE FEE WHICH WILL BE REQUIRED UPON RESIDENCY. THE DEPOSITS ARE HELD IN AN INTEREST-BEARING ACCOUNT UNTIL RESIDENCY IS ESTABLISHED AT WHICH TIME THE RESIDENT PAYS THE BALANCE OF THE REQUIRED ENTRANCE FEE. THE RESIDENT'S DEPOSIT IS RESTRICTED BY THE TEXAS DEPARTMENT OF INSURANCE UNTIL THE RESIDENT TAKES OCCUPANCY OF AN APARTMENT. PART X, LINE 2: QUERENCIA HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS BEEN DESIGNATED AS A PUBLICLY SUPPORTED ORGANIZATION (RATHER THAN A PRIVATE FOUNDATION). QUERENCIA 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 A TAX BENEFIT OR EXPENSE IN THE CURRENT YEAR. FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, QUERENCIA HAS NOT RECORDED ANY SUCH TAX BENEFIT OR EXPENSE IN THE ACCOMPANYING FINANCIAL STATEMENTS. NO EXAMINATIONS ARE IN PROGRESS OR ANTICIPATED AT THIS TIME. QUERENCIA'S FEDERAL INCOME TAX RETURNS ARE OPEN TO EXAMINATION FOR THE YEARS ENDED DECEMBER 31, 2017 THROUGH DECEMBER 31, 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE NETTED WITH EXPENSES 1,137,871. ROUNDING ON AUDITED FINANCIAL STATEMENTS -1,300. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONTRIBUTIONS TO LIFESPACE COMMUNITIES -23,671. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUES NETTED WITH EXPENSES 1,137,871. ROUNDING ON AUDITED FINANCIAL STATEMENTS -310. 1 LIFESPACE COMMUNITIES INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 421068850 501(C)(3) 23671 N/A N/A CAPITAL CONTRIBUTIONS HARDSHIP ASSISTANCE - REDUCTION OF FEES 14 1024587 FMV 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 RESIDENT WOULD OWE IF THE HARDSHIP ASSISTANCE WAS NOT GRANTED. 0 0 0 0 0 0 0 0 0 JESSE JANTZEN PRESIDENT & CEO & DIRECTOR 0 467654 0 150000 0 1053 0 0 0 7341 0 626048 0 0 LARRY SMITH INTERIM PRES, CEO & CFO (THRU JUNE) 0 281420 0 87961 0 20863 0 8550 0 9802 0 408596 0 0 THOMAS BROD SVP OF BUSINESS DEVELOPMEN (THRU JUN 0 184123 0 84876 0 62889 0 14038 0 8117 0 354043 0 0 NATHAN WAYAND EXECUTIVE DIRECTOR 190627 0 46560 0 7216 0 6264 0 15895 0 266562 0 0 0 NICK HARSHFIELD CFO & TREASURER 0 181096 0 50000 0 507 0 0 0 5087 0 236690 0 0 CHRIS HUTFLESS INTERIM SVP & GENERAL COUNSEL (THRU 0 97744 0 76564 0 35655 0 0 0 5973 0 215936 0 0 ABDUL SHAKOOR DEPUTY GENERAL COUNSEL AND DIRECTOR 0 132462 0 10950 0 3147 0 3815 0 7377 0 157751 0 0 TIFFANY TELLO ADMINISTRATOR 133580 0 10961 0 0 0 0 0 10226 0 154767 0 0 0 FORM 990, SCHEDULE J, PART II COMPENSATION OF THE EXECUTIVE DIRECTOR THE EXECUTIVE DIRECTOR, ADMINISTRATOR, DIRECTOR OF NURSING, AND DIRECTOR OF SALES WAS PAID THROUGH A RELATED SUPPORTING ORGANIZATION. THE PAYROLL WAS PAID THROUGH A DIFFERENT RELATED NON-PROFIT ORGANIZATION, LIFESPACE COMMUNITIES, INC. (EIN: 42-1068850). A TARRANT COUNTY CULT ED FACILITIES FINANCE CORP 043833551 87638RFP7 2015-10-29 52019415 REFUND PRIOR ISSUE (9/29/05) 0 0 0 A 6000000 52670118 3620596 87819 1040388 10858672 37079732 3069216 2019 1 0 0 1 A 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 A 0 0 1 1 0 0 0 1 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: TARRANT COUNTY CULT. ED. FACILITIES FINANCE CORP DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2020 PART II, LINE 3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART II, LINE 3 THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4 -12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4 FORM 990, PART VI, SECTION A, LINE 1 THE BYLAWS OF THE ORGANIZATION PROVIDE FOR AN EXECUTIVE COMMITTEE, BUT AT THIS TIME THE COMMITTEE IS NOT ACTIVE. IF THE COMMITTEE DOES COMMENCE MEETINGS, IT WILL CONTEMPORANEOUSLY DOCUMENT MEETINGS HELD AND WRITTEN ACTIONS UNDERTAKEN DURING THE YEAR CONSISTENT WITH EXISTING PRACTICES OF THE BOARD OF DIRECTORS. 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 LIFESPACE COMMUNITIES, INC. IS THE SOLE MEMBER OF BARTON CREEK SENIOR LIVING CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A LIFESPACE COMMUNITIES, INC. HAS THE AUTHORITY TO ELECT THE MEMBERS OF THE GOVERNING BODY OF BARTON CREEK SENIOR LIVING CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF LIFESPACE COMMUNITIES, INC. HAS RESERVED POWERS OVER CERTAIN GOVERNANCE DECISIONS. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PERFORMS A THOROUGH REVIEW OF THE FORM 990. A COPY OF THE FORM 990 WILL BE DISTRIBUTED TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO FILING. MEMBERS OF THE BOARD OF DIRECTORS DIRECT 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 BARTON CREEK SENIOR LIVING, 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 OF 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 AND NOMINATING COMMITTEE TO DETERMINE IF ANY CONFLICTS OF INTEREST EXIST PRIOR TO REAPPOINTMENT TO THE BOARD AND OFFICER POSITIONS. ANY DIRECTORS 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 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 THE 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 960. FORM 990, PART IV, LINE 24B: INVESTMENT OF TAX-EXEMPT BOND PROCEEDS THE INVESTMENT YIELD DID NOT EXCEED THE YIELD ON THE BONDS, AND THEREFORE, NO REBATE OF ANY ARBITRAGE IS DUE. LIFESPACE COMMUNITIES INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 421068850 OPERATION OF RETIREMENT COMMUNITIES IA 501(C)(3) LINE 10 LIFESPACE INC 0 THE LIFESPACE FOUNDATION 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 421370848 SUPPORT OF RETIREMENT COMMUNITIES IA 501(C)(3) LINE 12A, I LIFESPACE INC 0 LIFESPACE INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 273270337 OWNERSHIP & ADMINISTRATION OF RETIREMENT COMMUNITY PROPERTY IA 501(C)(3) LINE 12B, II N/A 0 LIFESPACE MANAGEMENT INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 273271283 MANAGEMENT OF RETIREMENT COMMUNITIES IA 501(C)(3) LINE 12B, II LIFESPACE INC 0 LIFESPACE SERVICES INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 273271147 HEALTH SERVICES AND PROGRAMS FOR RETIREMENT COMMUNITIES IA 501(C)(3) LINE 10 LIFESPACE INC 0 DEERFIELD RETIREMENT COMMUNITY INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 421508960 OPERATION OF RETIREMENT COMMUNITIES IA 501(C)(3) LINE 10 LIFESPACE COMMUNITIES INC 0 NORTHWEST SENIOR HOUSING CORPORATION 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 752771278 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 LIFESPACE COMMUNITIES INC 0 SENIOR QUALITY LIFESTYLES CORPORATION 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 364502669 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 LIFESPACE COMMUNITIES INC 0 TARRANT COUNTY SENIOR LIVING CENTER INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 208068602 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 LIFESPACE COMMUNITIES INC 0 SENIORITY INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 943287180 OPERATION OF RETIREMENT COMMUNITIES TX SENIOR QUALITY LIFESTYLE CORPORATION C 0 PRAIRIE VIEW CLUB OF KANSAS 8101 MISSION RD PRAIRIE VILLAGE KS 66208 481159378 RESIDENT ENTERTAINMENT SERVICES KS LIFESPACE COMMUNITIES INC C 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1