2017-06-29T17:11:28-05:00 2016-12-31 420794029 Denman & Company LLP 1601 22nd Street Suite 400 West Des Moines IA 502661453 990 2016-01-01 421068850 Lifespace Communities Inc LIFE 5152885805 4201 Corporate Drive West Des Moines IA 50266 LARRY M SMITH Senior VP, CFO & Treasurer 5152885805 2017-06-23 1 Bruce Cahill P00546325 5152258400 167.142.53.102 2017-06-23 16:19:42 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 0E1B973726001D6F901B89741ACBB070236FD491 2016 2021-01-29 14:40:06Z X M SLOAN BENTLEY 4201 Corporate Drive West Des Moines IA 50266 506303089 0 X WWW.LIFESPACECOMMUNITIES.COM X 1976 IA 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. 10 9 3060 3704 0 0 131002 87325 235884554 243366546 2131472 59838 0 0 238147028 243513709 1258781 1620326 0 0 107088727 107629127 0 0 0 131847729 133042734 240195237 242292187 -2048209 1221522 725739982 801738215 788910354 858233455 -63170372 -56495240 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 210531502 1620326 239592181 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 TO THE PROPERTY. 210531502 1 1 0 0 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 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 765 0 3060 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 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 PAULA J SHIVES DIRECTOR 2.00 2.50 X 35500 0 0 DONALD W BOURNE DIRECTOR 2.00 2.50 X 35500 0 0 RITA M DRAGONETTE DIRECTOR & VICE-CHAIR 2.00 2.50 X 20500 0 0 ANN A WAGNER-HAUSER DIRECTOR 2.00 2.50 X 35500 0 0 ROBERT C KEHM Director 2.00 2.50 X 35500 0 0 Neal Yanofsky Director 2.00 2.50 X 15000 0 0 Ana Dutra Director 2.00 2.50 X 15000 0 0 Patrick Spangler Director 2.00 2.50 X 15000 0 0 JOHN J KADUCE DIRECTOR 2.00 2.50 X 35500 0 0 E LAVERNE EPP DIRECTOR & CHAIR 6.00 6.50 X 44250 0 0 M SLOAN BENTLEY PRESIDENT, CEO & DIRECTOR 40.00 2.50 X X 713237 0 26992 LARRY M SMITH Senior VP, CFO & Treasurer 40.00 2.50 X 361678 0 33457 JODI HIRSCH Senior VP & GENERAL Counsel 40.00 2.50 X 294401 0 9759 DAVID RANDAZZO Regional Operations Director 40.00 0.00 X 209237 0 13224 AMY E LACROIX Regional Operations Director 40.00 2.00 X 208991 0 13379 Ann Walsh Senior Vice President - Operations 40.00 2.00 X 236378 0 8069 Jodi Bleier Vice President - Financial Oper & Strat Growth 40.00 2.00 X 182503 0 2064 JOEILYNN LEONHARDT VICE PRESIDENT - HR 40.00 2.00 X 245948 0 30081 Joe Chambers Vice President - Marketing 40.00 2.00 X 199554 0 19913 SARA E HAMM VICE PRESIDENT - CLINICAL Sales 40.00 2.00 X 219447 0 19157 John Couture Vice President - IT 40.00 2.00 X 176828 0 28330 Blaire Goldstein Executive Director 40.00 0.00 X 184753 0 19842 David Miller Executive Director 40.00 0.00 X 180879 0 24968 Brian Devlin Director of Construction, Design & Redevelopment 40.00 0.00 X 163975 0 24530 JOHN SPOONER Regional Operations Director 40.00 0.00 X 149118 0 13969 Heidi Leavengood Controller 40.00 0.00 X 149278 0 12543 4163455 0 300277 44 0 1 0 Plaza Construction Group FL LLC 120 NE 27th Street Miami FL 33137 CONTRACTOR 9779446 US FOODS INC 15838 Collection Ctr Dr Chicago IL 606935838 FOOD & BEVERAGE 9767172 WALSH CONTRUCTION CO LLC 929 WEST ADAMS STREET CHICAGO IL 60607 CONTRACTOR 7780477 REHABCARE GROUP EAST INC PO BOX 503534 ST LOUIS MO 631503534 HEALTH CENTER 6392995 GLYNN DEVINS ADVERTISING 11230 COLLEGE BLVD OVERLAND PARK KS 66210 MARKETING 3944591 147 87325 87325 APARTMENT FEES 531110 138883951 138883951 SKILLED NURSING 623000 75912397 75912397 ENTRANCE FEES 531110 28570198 28570198 243366546 3854601 3854601 258992117 2500 259012515 3776865 -20398 -3774365 -3794763 -3774365 -20398 243513709 239592181 0 3834203 269196 269196 1351130 1351130 3950319 790064 3160255 81841803 65473442 16368361 1000449 800359 200090 12801985 10241588 2560397 8034571 6427657 1606914 14273791 13560102 713689 719142 719142 166918 166918 247154 247154 4923654 3938923 984731 4773805 4773805 37919802 36023812 1895990 3523305 3452839 70466 MEDICAL & OTHER RESIDEN 18945821 18945821 DIETARY 15997008 15997008 PLANT OPERATIONS 11991028 11991028 OTHER GENERAL & ADMINIS 8094669 6475735 1618934 11466637 10018993 1447644 242292187 210531502 31760685 0 9570784 11766680 2259317 1718946 21134884 19931162 11486800 20803613 1261253 1240101 2643840 3297113 804212568 369290830 417417954 434921738 143916119 128215857 831332 831332 3237710 2932525 111979989 176079148 725739982 801738215 37874464 39777418 5056488 4482159 141370764 209044331 4855000 4951831 21392825 1775832 578360813 598201884 788910354 858233455 X -63170372 -56495240 -63170372 -56495240 725739982 801738215 1221522 5453610 0 X X 0 1 X 1 0 X 506432 401776 578009 131002 87325 1704544 210118367 210646816 219904385 235884554 243366546 1119920668 210624799 211048592 220482394 236015556 243453871 1121625212 506432 336877 576257 131002 87325 1637893 0 506432 336877 576257 131002 87325 1637893 1119987319 2935383 3293887 2844106 3348921 3854601 16276898 2935383 3293887 2844106 3348921 3854601 16276898 213560182 214342479 223326500 239364477 247308472 1137902110 0.98430 0.98370 0.01430 0.01430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32877499 32877499 737000389 346016225 390984164 318099 78016 240083 34016581 23196589 10819992 434921738 ASSETS WHOSE USE IS LIMITED: OPERATING RESERVE FUND 17118213 ASSETS WHOSE USE IS LIMITED: DEBT SERVICE RESERVE FUND 17971012 ASSETS WHOSE USE IS LIMITED: PRINCIPAL & INTEREST FUND 66586650 ASSETS WHOSE USE IS LIMITED: WAIT LIST RESERVE FUND 3910759 ASSETS WHOSE USE IS LIMITED: ENTRANCE FEE DEPOSITS 3110842 ASSETS WHOSE USE IS LIMITED: ASSET REPLACEMENT FUND 10516934 DEFERRED EXPENSES 4041480 GOODWILL 52823258 176079148 DEFERRED ENTRANCE FEES, REFUNDABLE ENTRANCE & MEMBERSHIP FEES 583895439 UNAMORTIZED BOND PREMIUM 14281366 Capital Lease Obligations 25079 598201884 X Part X, Line 2: LIFESPACE COMMUNITIES, DEERFIELD, AND THE LIFESPACE FOUNDATION HAVE BEEN GRANTED EXEMPTIONS FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAVE BEEN DESIGNATED AS PUBLICLY SUPPORTED ORGANIZATIONS (RATHER THAN PRIVATE FOUNDATIONS). LIFESPACE DG, LLC, D/B/A OAK TRACE SHARES THE SAME EXEMPTIONS AS LIFESPACE BY VIRTUE OF LIFESPACE BEING THE SOLE MEMBER OF OAK TRACE. 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, 2016 AND 2015, 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, 2013 THROUGH DECEMBER 31, 2015. 1 THE LIFESPACE FOUNDATION 4201 Corporate Drive West Des Moines IA 50266 421370848 501(C)(3) 269196 REIMBURSE FOR ADMINISTRATIVE EXPENSES AND PAYMENT OF CAPITAL CONTRIBUTION 1 0 HARDSHIP ASSISTANCE - REDUCTION OF FEES 48 1351130 FAIR MARKET VALUE OF REDUCTION OF 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 BOARD APPROVED CRITERIA TO DETERMINE WHETHER THE RESIDENT IS A CANDIDATE 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. THE GRANT TO THE LIFESPACE FOUNDATION IS A REIMBURSEMENT OF DOCUMENTED ADMINISTRATIVE EXPENSES OF THE FOUNDATION AND AN ADDITIONAL CAPITAL CONTRIBUTION TO THE FOUNDATION. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 M SLOAN BENTLEY PRESIDENT, CEO & DIRECTOR 447354 0 223178 0 42705 0 9252 0 17740 0 740229 0 0 0 LARRY M SMITH Senior VP, CFO & Treasurer 297568 0 49949 0 14161 0 9473 0 23984 0 395135 0 0 0 JODI HIRSCH Senior VP & GENERAL Counsel 240472 0 42378 0 11551 0 8483 0 1276 0 304160 0 0 0 DAVID RANDAZZO Regional Operations Director 184758 0 7701 0 16778 0 5199 0 8025 0 222461 0 0 0 AMY E LACROIX Regional Operations Director 173863 0 18800 0 16328 0 5239 0 8140 0 222370 0 0 0 Ann Walsh Senior Vice President - Operations 189582 0 40150 0 6646 0 0 0 8069 0 244447 0 0 0 Jodi Bleier Vice President - Financial Oper & St 176673 0 150 0 5680 0 0 0 2064 0 184567 0 0 0 JOEILYNN LEONHARDT VICE PRESIDENT - HR 196309 0 32566 0 17073 0 7259 0 22822 0 276029 0 0 0 Joe Chambers Vice President - Marketing 193646 0 150 0 5758 0 0 0 19913 0 219467 0 0 0 SARA E HAMM VICE PRESIDENT - CLINICAL Sales 177077 0 34350 0 8020 0 3734 0 15423 0 238604 0 0 0 John Couture Vice President - IT 151589 0 19195 0 6044 0 3224 0 25106 0 205158 0 0 0 Blaire Goldstein Executive Director 150914 0 23315 0 10524 0 5414 0 14428 0 204595 0 0 0 David Miller Executive Director 152601 0 16802 0 11476 0 5287 0 19681 0 205847 0 0 0 Brian Devlin Director of Construction, Design & R 163771 0 150 0 54 0 0 0 24530 0 188505 0 0 0 JOHN SPOONER Regional Operations Director 90890 0 19315 0 38913 0 4349 0 9620 0 163087 0 0 0 Heidi Leavengood Controller 133175 0 11850 0 4253 0 4418 0 8125 0 161821 0 0 0 Part I, Line 1a COUNTRY CLUB MEMBERSHIP DUES FOR M. SLOAN BENTLEY (OFFICER & DIRECTOR) ARE REIMBURSED BY LIFESPACE COMMUNITIES, INC. AND ARE INCLUDED IN HER W-2 AS TAXABLE WAGES. A PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297506 696507UA8 2015-03-25 47992621 REFUND PRIOR ISSUES (11/28/07 & 2/20/13) 0 0 0 B PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY 521297505 696507RV6 2004-12-22 5465000 ACQUISITION, CONSTRUCTION AND EQUIPPING FACILITY 0 0 0 C ILLINOIS FINANCE AUTHORITY 861091967 45200BMX3 2005-04-21 12165166 REFUND BONDS (4/29/1997) 0 0 0 D ILLINOIS FINANCE AUTHORITY 861091967 45203HT28 2015-03-25 38167219 CONSTRUCTION OF FACILITY & REFUND PRIOR ISSUES (5/19/99 10/22/03 & 2/20/13) 0 0 0 A 1425000 48538306 1300532 70475 24978315 858282 21436902 1 1 1 1 B 1210000 5467835 356377 109300 7211 4994947 2005 0 0 1 1 C 6755000 12165166 1032921 241856 279578 11643732 2005 1 0 1 1 D 1600000 38274171 2447602 687038 18737148 16830399 2016 1 0 1 1 A 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 B 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 C 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 D 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 A 0 1 1 0 0 0 0 0 1 B 0 0 1 1 1 0 0 0 1 C 0 0 1 1 1 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: PALM BEACH COUNTY HEALTH FACILITIES AUTHORITY Date the Rebate Computation was Performed: 12/22/2014 Issuer Name: ILLINOIS FINANCE AUTHORITY Date the Rebate Computation was Performed: 04/21/2015 Issuer Name: HOSPITAL AUTHORITY NO.1 OF LANCASTER COUNTY, NEBRASKA Date the Rebate Computation was Performed: 03/05/2005 Issuer Name: HOSPITAL AUTHORITY NO.1 OF LANCASTER COUNTY, NEBRASKA Date the Rebate Computation was Performed: 12/05/2008 Issuer Name: KANSAS DEVELOPMENT FINANCE AUTHORITY Date the Rebate Computation was Performed: 10/31/2015 Issuer Name: KANSAS DEVELOPMENT FINANCE AUTHORITY Date the Rebate Computation was Performed: 09/03/2014 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 I, ROW A, COLUMN (E) DUE TO INVESTMENT EARNINGS. ENTITY 1, SCHEDULE K, PART II, COLUMN A, 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 B, LINE 3, TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN ENTITY 1, SCHEDULE K, PART I, ROW B, COLUMN (E) DUE TO INVESTMENT EARNINGS. 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 D, COLUMN (E) DUE TO INVESTMENT EARNINGS / MARKET VALUE FLUCTUATION. 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. 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. 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 C, COLUMN (E) DUE TO INVESTMENT EARNINGS / MARKET VALUE FLUCTUATION. ENTITY 2, 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 WERE NECESSARY. ENTITY 2, 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 FURTHER REBATE CALCULATIONS WERE NECESSARY. ENTITY 2, SCHEDULE K, PART IV, COLUMN D, LINE 2, REBATE COMPUTATION: NOTE REGARDING THE REBATE COMPUTATION 9/3/2014: 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 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 / MARKET VALUE FLUCTUATION. 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. A HOSPITAL AUTHORITY NO1 OF LANCASTER COUNTY NEBRASKA 470721900 2003-03-05 9700000 CONSTRUCTION OF FACILITY 0 0 0 B HOSPITAL AUTHORITY NO1 OF LANCASTER COUNTY NEBRASKA 470721900 2005-12-05 13050000 CONSTRUCTION OF FACILITY 0 0 0 C KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 485429BX1 2010-11-18 25526524 CONSTRUCTION OF FACILITY AND REFUND A TAXABLE LOAN (7/1/2009) 0 0 0 D KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 2014-08-13 5485000 REFUND PRIOR ISSUE (8/28/2003) 0 0 0 A 2959832 9777788 9777788 2004 0 0 1 1 B 2511000 13603719 200000 13403719 2007 0 0 1 1 C 25935638 2660403 431072 19922450 2921714 2012 1 0 1 1 D 1793028 5485000 5485000 2003 1 0 1 1 A 0 1 0 0 0.00100 0.00000 0.00100 0 0 1 B 0 1 0 0 0.00100 0.00000 0.00100 0 0 1 C 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 D 0 1 0 0 0.00300 0.00000 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 0 1 1 0 0 0 0 1 D 0 0 1 1 1 0 0 0 1 A 1 B 1 C 1 D 1 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 A 52462589 4190321 1052101 4517332 42702835 0 0 0 1 B 24462650 1960089 490963 1473204 20538395 0 0 0 1 A 0 1 0 0 0.00300 0.00000 0.00300 0 0 1 B 0 1 0 0 0.00300 0.00000 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 DEERFIELD RETIREMENT COMMUNITY INC RELATED CHARITABLE ORGANIZATION TAXABLE AND TAX-EXEMPT BONDS FOR CONSTRUCTION AND OPERATION OF COMMUNITY X 17214760 17214760 0 1 1 DEERFIELD RETIREMENT COMMUNITY INC RELATED CHARITABLE ORGANIZATION NOTES PAYABLE FOR Operations X 3588853 3588853 0 1 1 20803613 Form 990, Part VI, Section B, line 11b MANAGEMENT PERFORMS A THOROUGH REVIEW OF THE FORM 990. THE RISK MANAGEMENT & AUDIT COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE FORM 990 PRIOR TO FILING. ANY CONCERNS OR SUGGESTIONS IDENTIFIED BY THE RISK MANAGEMENT & AUDIT COMMITTEE ARE REPORTED TO THE FULL BOARD OF DIRECTORS. 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 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 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 & 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 OFFICERS AND DIRECTORS IS REVIEWED BY THE COMPENSATION COMMITTEE ANNUALLY. AN OUTSIDE CONSULTANT IS USED EVERY OTHER YEAR TO DETERMINE THE REASONABLENESS OF OFFICER AND DIRECTOR COMPENSATION. A REPORT IS PROVIDED TO THE BOARD OF DIRECTORS BY THE CONSULTANT. IN YEARS WHEN AN OUTSIDE CONSULTANT IS NOT USED, THE COMPENSATION COMMITTEE REVIEWS SURVEY INFORMATION TO DETERMINE THE REASONABLENESS OF OFFICER AND DIRECTOR COMPENSATION. THE BOARD OF DIRECTORS APPROVES THE ANNUAL COMPENSATION BASED ON THESE REVIEWS. OFFICERS FOR WHICH THIS PROCESS IS USED ARE THE CEO AND CFO. 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 XII, LINE 2C: THE PROCESS OF OVERSEEING THE AUDIT AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. LIFESPACE DG LLC dba OAK TRACE 4201 Corporate Drive West Des Moines IA 50266 452672674 OPERATION OF RETIREMENT COMMUNITY IA 22487000 110057000 DEERFIELD RETIREMENT COMMUNITY INC 4201 Corporate Drive West Des Moines IA 50266 421508960 OPERATION OF RETIREMENT COMMUNITY IA 501(c)(3) Line 10 1 THE LIFESPACE FOUNDATION 4201 Corporate Drive West Des Moines IA 50266 421370848 SUPPORT OF RETIREMENT COMMUNITIES IA 501(c)(3) Line 12a, I 1 LIFESPACE INC 4201 Corporate Drive West Des Moines IA 50266 273270337 OWNERSHIP & ADMINISTRATION OF RETIREMENT COMMUNITY PROPERTY IA 501(c)(3) Line 12b, II 1 LIFESPACE MANAGEMENT INC 4201 Corporate Drive West Des Moines IA 50266 273271283 MANAGEMENT OF RETIREMENT COMMUNITIES IA 501(c)(3) Line 12b, II 1 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 1 PRAIRIE VIEW CLUB OF KANSAS 8101 MISSION RD PRAIRIE VILLAGE KS 66208 481159378 RESIDENT ENTERTAINMENT SERVICES KS C 63170 11769 1.00000 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 DEERFIELD RETIREMENT COMMUNITY INC A 73739 THE LIFESPACE FOUNDATION B 269196 DEERFIELD RETIREMENT COMMUNITY INC C 18685 THE LIFESPACE FOUNDATION C 1973 DEERFIELD RETIREMENT COMMUNITY INC D 9316813 THE LIFESPACE FOUNDATION O 179059 DEERFIELD RETIREMENT COMMUNITY INC Q 904961 THE LIFESPACE FOUNDATION Q 66667