2022-11-15T13:25:16-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-01-01 421508960 DEERFIELD RETIREMENT COMMUNITY INC DEER 5152885805 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 NICK HARSHFIELD SENIOR VICE PRESIDENT AND CFO 5152885805 2022-11-15 1 NICK HARSHFIELD 999009999 JED CHENEY P01587750 6123764500 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JESSE JANTZEN 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 126206266 0 X N/A X 2000 IA TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO THE ELDERLY IN A RETIREMENT COMMUNITY. X 12 11 203 24 0 0 2167002 36678833 13249786 7994813 16345 28806741 0 0 15433133 73480387 80063 53900 0 0 6132257 3523182 0 0 0 11538888 7595685 17751208 11172767 -2318075 62307620 56997118 33475 119283279 3255 -62286161 30220 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 9439556 53900 7994813 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. 9439556 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 38 0 1 203 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 0 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 911488 15857 NICK HARSHIELD SVP & CFO 2.00 40.50 X 0 462933 15653 SANDRA PARKER GENERAL COUNSEL & SECRETARY (JUL-DEC) 2.00 40.50 X X 0 286586 2387 JAMES ROBINSON EXECUTIVE DIRECTOR 40.00 X 279192 0 24621 NEAL YANOFSKY DIRECTOR & CHAIR 2.00 2.50 X X 0 40000 0 LAVERNE EPP DIRECTOR 2.00 2.50 X 0 36000 0 ROBERT KEHM DIRECTOR 2.00 2.50 X 0 36000 0 ANA DUTRA DIRECTOR 2.00 2.50 X 0 36000 0 PATRICK SPANGLER DIRECTOR 2.00 2.50 X 0 36000 0 VENITA FIELDS DIRECTOR 2.00 2.50 X 0 36000 0 PAULA J SHIVES DIRECTOR 2.00 2.50 X X 0 35000 0 JOYCE DARKEY-HRINYA DIRECTOR 2.00 2.50 X 0 30000 0 LAURIE DOTTER DIRECTOR 2.00 2.50 X 0 30000 0 SCOTT COLLIER DIRECTOR 2.00 2.50 X 0 30000 0 SUE DELVAUX DIRECTOR 2.00 2.50 X 0 22500 0 WILLIAM RICH DIRECTOR (THRU APRIL) 2.00 2.50 X 0 15000 0 279192 2043507 58518 1 0 1 0 THOMAS MANAGEMENT LLC 700 E FRANKLIN RAOD MERIDIAN ID 83642 CULINARY SERVICES 676426 SELECT REHABILITATION LLC PO BOX 71985 CHICAGO IL 60694 MEDICAL SERVICES 280798 ASPEN RENOVATIONS 220 32ND STREET SE ALTOONA IA 50009 CONSTRUCTION SERVICES 254518 BAKER GROUP 1600 SE CORPORATE WOODS DR ANKENY IA 50021 CONSTRUCTION SERVICES 220377 BRILLIANT BORDERS PO BOX 71368 CLIVE IA 50325 LANDSCAPING SERVICES 127883 6 36517399 161434 36678833 INDEPENDENT LIVING 531110 4084957 4084957 SKILLED NURSING 623000 3039360 3039360 ENTRANCE FEES 531110 870496 870496 7994813 2482 2482 79012 81451126 70257 52655622 8755 28795504 28804259 28804259 73480387 7994813 0 28806741 28000 28000 25900 25900 3074200 2459360 614840 43047 34438 8609 179266 143413 35853 226669 181335 45334 610731 580194 30537 9175 9175 3905 3905 698136 698136 258493 206794 51699 77883 62306 15577 321971 321971 23173 18538 4635 1920832 1920832 2110651 2005118 105533 110151 107948 2203 REAL ESTATE TAXES 436708 414873 21835 OTHER GENERAL & ADMINIS 426702 341362 85340 PLANT OPERATIONS 409769 409769 MEDICAL & OTHER RESIDEN 137010 137010 40395 40395 11172767 9439556 1733211 0 1006527 32784 910 545589 43863 56360 0 54187768 173291 982810 691 56997118 33475 2424692 3255 27224252 64142 10526291 79043902 0 119283279 3255 X -62286161 30220 -62286161 30220 56997118 33475 X 62307620 9990 -1229 X X 1 X 0 1 1 1 X 1907146 2458796 2167002 40378833 46911777 10835858 12547087 13313201 13249786 7994813 57940745 10835858 14454233 15771997 15416788 48373646 104852522 1907146 2458796 1898994 40217399 46482335 0 1907146 2458796 1898994 40217399 46482335 58370187 5497 18585 21719 6332 2482 54615 5497 18585 21719 6332 2482 54615 10841355 14472818 15793716 15423120 48376128 104907137 0.55640 0.90450 0.00050 0.00080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X PART X, LINE 2: DEERFIELD 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). DEERFIELD 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, 2021 AND 2020, DEERFIELD HAS NOT RECORDED ANY SUCH TAX BENEFIT OR EXPENSE IN THE ACCOMPANYING FINANCIAL STATEMENTS. NO EXAMINATIONS ARE IN PROGRESS OR ANTICIPATED AT THIS TIME. DEERFIELD'S FEDERAL INCOME TAX RETURNS ARE OPEN TO EXAMINATION FOR THE YEARS ENDED DECEMBER 31, 2018 THROUGH DECEMBER 31, 2020 1 LIFESPACE COMMUNITIES INC 4201 CORPORATE DRIVE WEST DES MOINES IA IA 50266 421068850 501(C)(3) 28000 0 N/A N/A CAPITAL CONTRIBUTION HARDSHIP ASSISTANCE - REDUCTION OF FEES 2 25900 N/A N/A PART I, LINE 2: THE GRANT TO LIFESPACE COMMUNITIES, INC. IS AN ADDITIONAL CAPITAL CONTRIBUTION. 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 648173 0 216143 0 47172 0 7810 0 8047 0 927345 0 0 NICK HARSHIELD SVP & CFO 0 377264 0 58079 0 27590 0 5940 0 9713 0 478586 0 0 SANDRA PARKER GENERAL COUNSEL & SECRETARY (JUL-DEC 0 167308 0 118268 0 1010 0 0 0 2387 0 288973 0 0 JAMES ROBINSON EXECUTIVE DIRECTOR 88198 0 79793 0 111201 0 6568 0 18053 0 303813 0 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT AND CEO IS DETERMINED AND PAID BY LIFESPACE COMMUNITIES, INC., A RELATED AFFILIATE. LIFESPACE COMMUNITIES, INC. USED THE FOLLOWING METHODS WHEN DETERMINING COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT CONSULTANT, 3) FORM 990 OF OTHER ORGANIZATIONS, 4) COMPENSATION SURVEY OR STUDY, AND 5) APPROVAL OF THE BOARD OR COMPENSATION COMMITTEE. ASSETS OF THE ORGANIZATION 2021-08-01 27883481 ASSET VALUATION 470733774 IMMANUEL 1044 N 115TH ST SUITE 500 OMAHA NE 68154 501(C)3 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A 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 DEERFIELD RETIREMENT COMMUNITY, INC. FORM 990, PART VI, SECTION A, LINE 7A LIFESPACE COMMUNITIES, INC. HAS THE AUTHORITY TO ELECT THE MEMBERS OF THE GOVERNING BODY OF DEERFIELD RETIREMENT COMMUNITY, INC. PRESENTLY, THE BOARDS OF BOTH ORGANIZATIONS ARE IDENTICAL. 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 DEERFIELD RETIREMENT COMMUNITY, 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: ROUNDING VARIANCE -1,229. 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 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 BARTON CREEK SENIOR LIVING CENTER INC 2500 BARTON CREEK BOULEVARD AUSTIN TX 78735 201203479 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 LIFESPACE COMMUNITIES INC 0 NORTHWEST SENIOR HOUSING CORPORATION 8526 THACKERY STREET DALLAS TX 75225 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 2501 MUSEUM WAY FORT WORTH TX 76107 208068602 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 LIFESPACE COMMUNITIES INC 0 PRAIRIE VIEW CLUB OF KANSAS 8101 MISSION RD PRAIRIE VILLAGE KS 66208 481159378 RESIDENT ENTERTAINMENT SERVICES KS N/A C 0 SENIORITY INC 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 943287180 OPERATIONS OF RETIRMENT COMMUNITIES TX N/A C 0 0 0 1 0 1 0 0 0 0 0 0 1 1 1 1 1 0 0 0