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COTTAGE GROVE PLACE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COTTAGE GROVE PLACE (EIN 42-1412375)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-05-16
IRS object ID
201131369349302798
Schema version
2010v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-16T14:13:23-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1HONKAMP KRUEGER & CO PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 188AddressLine1
CityHIAWATHACity
StateIAState
ZIP Code52233ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421412375EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COTTAGE GROVE PLACEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOTTNameControl
Phone3193632420Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12115 FIRST AVENUE SEAddressLine1
CityCEDAR RAPIDSCity
StateIAState
ZIP Code52402ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMATTHEW CARPENTERName
TitleEXECUTIVE DIRECTORTitle
Phone3193632420Phone
Date Signed2011-05-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDALE J LEIBFRIED CPAName
Phone3193783370Phone
Date Prepared2011-05-16DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMATTHEW CARPENTERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12115 FIRST AVENUE SEAddressLine1
CityCEDAR RAPIDSCity
StateIAState
ZIP Code52402ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10485354GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.COTTAGEGROVEPLACE.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1992YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A RETIREMENT FACILITYActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees269TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10500854ProgramServiceRevenuePriorYear
Program Service Revenue CY10443927ProgramServiceRevenueCY
Investment Income Prior Year64026InvestmentIncomePriorYear
Investment Income Current Year41427InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year10564880TotalRevenuePriorYear
Total Revenue Current Year10485354TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4147789SalariesEtcPriorYear
Salaries Etc Current Year4316121SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6439381OtherExpensePriorYear
Other Expenses Current Year6279109OtherExpensesCurrentYear
Total Expenses Prior Year10587170TotalExpensesPriorYear
Total Expenses Current Year10595230TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-22290RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-109876RevenuesLessExpensesCY
Total Assets BOY31102316TotalAssetsBOY
Total Assets EOY30447580TotalAssetsEOY
Total Liabilities BOY53997156TotalLiabilitiesBOY
Total Liabilities EOY53488375TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-22894840NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-23040795NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A RETIREMENT FACILITYMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense5726203Expense
Revenue10443927Revenue
DescriptionTHE RETIREMENT FACILITIES CONTAIN 166 INDEPENDENT LIVING UNITS, 19 ASSISTED LIVING UNITS, 40 NURSING CARE BEDS, AND 12 MEMORY CARE UNITS FOR ITS RESIDENTS.Description
Total Program Service Expense5726203TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109637NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees269NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GREG OLBEKSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3192975754TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12115 FIRST AVENUE SEAddressLine1
CityCEDAR RAPIDSCity
StateIAState
ZIP Code52402ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
ROBERT A SEDLACEK
TRUSTEE1.20X000
THEODORE F PAULSON
TRUSTEE1.20X000
HAROLD G SCHAEFER
TRUSTEE1.20X000
RUSSELL H ANTHONY
TRUSTEE1.20X000
WILLIAM S ELLIOTT
TRUSTEE1.20X000
JOHN C WAGOR
TRUSTEE1.20X000
CARL E HALLBERG
TRUSTEE1.20X000
PHIL MORRIS
TRUSTEE1.20X000
KATHY TOBORG
TRUSTEE1.20X000
RALPH H PALMER
TRUSTEE1.20X000
TAD COOPER
TRUSTEE1.20X000
MARTIN DWYER
TRUSTEE1.20X000
CRYSTAL USHER
TRUSTEE1.20X000
JAN ALTORFER
TRUSTEE1.20X000
ROBERT SILBER
TRUSTEE1.20X000
JIM BURR
TRUSTEE1.20X000
STEVE KING
TRUSTEE1.20X000
DAVID BEY
TREASURER1.20000X
BILL JACOBSON
CHAIRMAN1.20000X
DICK HEFT
SECRETARY1.20000X
B D COOPER
VICE CHAIRMAN1.20000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LIFE CARE SERVICES LLCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1400 LOCUST STREET SUITE 820AddressLine1
CityDES MOINESCity
StateIAState
ZIP Code50309ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesMANAGEMENT COMPANYDescriptionOfServices
Compensation428817Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT SERVICESDescription
Business Code623000BusinessCode
Total Revenue Column10443927TotalRevenueColumn
Related Or Exempt Function Income10443927RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10443927TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column41427TotalRevenueColumn
Exclusion$41,427ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10485354TotalRevenueColumn
Related Or Exempt Function Income10443927RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$41,427ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total295051Total
Program Services247843ProgramServices
Management And General47208ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3272946Total
Program Services2737395ProgramServices
Management And General535551ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total436638Total
Program Services364422ProgramServices
Management And General72216ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total311486Total
Program Services265918ProgramServices
Management And General45568ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total428817Total
Management And General428817ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total167495Total
Program Services112202ProgramServices
Management And General55293ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total170912Total
Management And General170912ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total632251Total
Program Services589168ProgramServices
Management And General43083ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total75174Total
Program Services54423ProgramServices
Management And General20751ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1740729Total
Management And General1740729ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1046489Total
Management And General1046489ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total256086Total
Program Services95589ProgramServices
Management And General160497ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FOOD524252524252
MEDICAL EXPENSE440056440056
PROPERTY TAXES252277252277
MISCELLANEOUS EXPENSE143841901142940
DEPARTMENT SUPPLIES13070210482225880

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total270028Total
Program Services189212ProgramServices
Management And General80816ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10595230Total
Program Services5726203ProgramServices
Management And General4869027ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY121984BOY
EOY715064EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY895523BOY
EOY264975EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY9383BOY
EOY23060EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY139571BOY
EOY115187EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis36708305LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11965335LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY25075333BOY
EOY24742970EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4860522BOY
EOY4586324EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY31102316BOY
EOY30447580EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2169219BOY
EOY1944612EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY10002991BOY
EOY10071820EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY29876441BOY
EOY29207994EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY11948505BOY
EOY12263949EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY53997156BOY
EOY53488375EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-22894840BOY
EOY-23040795EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-22894840BOY
EOY-23040795EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY31102316BOY
EOY30447580EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-109876ReconcilationRevenueExpenses
Reconcilation Other Changes-36079ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8914154CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9508572CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10421187CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10500854CurrentTaxYearMinus1Year
Current Tax Year10443927CurrentTaxYear
Total49788694Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8914154CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9508572CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10421187CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10500854CurrentTaxYearMinus1Year
Current Tax Year10443927CurrentTaxYear
Total49788694Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50949788694PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years160283CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years203827CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years106849CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year61226CurrentTaxYearMinus1Year
Current Tax Year41427CurrentTaxYear
Total573612Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years160283CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years203827CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years106849CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year61226CurrentTaxYearMinus1Year
Current Tax Year41427CurrentTaxYear
Total573612Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9074437CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9712399CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10528036CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10562080CurrentTaxYearMinus1Year
Current Tax Year10485354CurrentTaxYear
Total50362306Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98860PublicSupportPercentage509
Prior Year Support Percentage0.98640PriorYearSupportPercentage
Investment Income Percentage0.01140InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01360PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4016275OtherCostOrOtherBasis
Book Value4016275BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis27808427OtherCostOrOtherBasis
Depreciation8983682Depreciation
Book Value18824745BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2246205OtherCostOrOtherBasis
Depreciation876089Depreciation
Book Value1370116BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis252771OtherCostOrOtherBasis
Depreciation173745Depreciation
Book Value79026BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2384627OtherCostOrOtherBasis
Depreciation1931819Depreciation
Book Value452808BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24742970TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
ASSETS LIMITED AS TO USE3122743
DEFERRED FINANCING EXPENSES572582
CASH SURRENDER VALUE OF LIFE INSURANCE362090
BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST329441
ORGANIZATIONAL COSTS, NET199468
FieldValueIRS element (for citing)
Total Book Value Other Assets4586324TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
REFUNDABLE ENTRANCE FEES$12,097,178
DEPOSITS$99,931
DUE TO AFFILIATES$1,597
CAPITAL LEASES$65,243
FieldValueIRS element (for citing)
Total Of Amounts12263949TotalOfAmounts

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF CEDAR RAPIDS IOWABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN426004336IssuerEIN
CUSIP Number0150571AJCUSIPNumber
Date Issued2004-03-01DateIssued
Issue Price5310000IssuePrice
Description Of PurposeCOSTS OF 2004 PROJECT-HEALTH CENTERDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds5310000TotalProceeds
Issuance Costs From Proceeds219785IssuanceCostsFromProceeds
Capital Expenditures5090215CapitalExpenditures
Year Of Subst Completion2004YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed1Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate1ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2B D COOPER (VICE CHAIRMAN) IS THE FATHER OF TAD COOPER (TRUSTEE).
FORM 990, PART VI, SECTION A, LINE 3MANAGEMENT DUTIES FOR THE ORGANIZATION ARE HANDLED BY THE MANAGEMENT COMPANY - LIFE CARE SERVICES LLC.
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S FORM 990 IS REVIEWED BY THE BOARD AND THE EXECUTIVE DIRECTOR.
BOARD MEMBERS ARE REQUIRED TO DISCLOSE EVERY YEAR POTENTIAL CONFLICTS WITH BUSINESSES THEY ARE ASSOCIATED WITH.FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:UNREALIZED LOSS ON INVESTMENTS -13,515. INCREASE IN CASH SURRENDER VALUE OF LIFE INSURANCE -22,564. TOTAL TO FORM 990, PART XI, LINE 5: -36,079.FORM 990, PART XI, LINE 5:
AUDIT COMMITTEE PROCEDURESTHERE WERE NO CHANGES IN THE PROCEDURES FOR THE OVERSIGHT OF THE AUDIT.FORM 990, PART XI, LINE 2C