2020-11-13T08:46:29-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-01-01 201203479 BARTON CREEK SENIOR LIVING CENTER INC BART 5152885805 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 NICK HARSHFIELD SVP, CFO & TREASURER 5152885805 2020-11-12 1 JED CHENEY P01587750 6123764500 2020-11-12 66.188.188.148 2020-11-12 11:57:08 CS P 3CD4913DF4E17C37ADE879CAF2747CF9DBB73520 8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4C 2019 2021-01-29 14:40:06Z X QUERENCIA AT BARTON CREEK JESSE JANTZEN 4201 CORPORATE DRIVE WEST DES MOINES IA 50266 23739541 0 X WWW.QUERENCIABARTONCREEK.COM X 2003 TX TO PROVIDE THE HIGHEST QUALITY RESIDENTIAL LIVING ENVIRONMENT FOR SENIOR CITIZENS, FEATURING PERSONAL SERVICES, INDEPENDENT AND ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING. 3 0 347 10 0 0 0 0 20057803 22854631 768569 866524 124419 0 20950791 23721155 0 1021711 0 0 9994209 10230218 0 0 0 14382838 16413479 24377047 27665408 -3426256 -3944253 111176849 123990141 156582772 125158134 -45405923 -1167993 TO PROVIDE THE HIGHEST QUALITY RESIDENTIAL LIVING ENVIRONMENT FOR SENIOR CITIZENS, FEATURING PERSONAL SERVICES, INDEPENDENT AND ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING. 0 0 22849234 1021711 22854631 A CONTINUING CARE RETIREMENT COMMUNITY LIFE CARE COMMUNITY FEATURING INDEPENDENT LIVING, ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING. 22849234 1 0 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 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 74 0 1 347 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 1 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 LARRY SMITH INTERIM PRESIDENT & CEO, & CFO 2.00 40.00 X X 0 603909 36186 THOMAS BROD SVP OF BUSINESS DEVELOPMEN 2.00 40.00 X 0 316775 21237 CHRIS HUTFLESS INTERIM SVP & GENERAL COUNSEL 2.00 40.00 X X 0 220672 14364 NATE WEYAND EXECUTIVE DIRECTOR 40.00 X 195005 0 28464 TIMOTHY STUTEVILLE ASSISTANT EXECUTIVE DIRECTOR 40.00 X 152929 0 9901 SCOTT COLLIER CHAIRMAN (THRU JUNE) 1.00 5.00 X 0 173324 0 JOAN FORD DIRECTOR OF SALES & MARKET 40.00 X 147094 0 11325 DAVID GOBBLE SECRETARY/TREASURER (THRU JUNE) 1.00 2.00 X 0 18000 0 JAN VAN SANT DIRECTOR (THRU JUNE) 1.00 2.00 X 0 18000 0 SUSAN CARTER DIRECTOR (THRU MAY) 1.00 5.00 X 0 15000 0 495028 1365680 121477 3 0 1 0 SENORITY INC 15601 DALLAS PARKWAY SUITE 200 ADDISON TX 75001 MANAGEMENT SERVICES 1707992 THOMAS MANAGEMENT LLC E FRANKLIN RD MERIDIAN ID 83642 CULINARY SERVICES 522217 GDK REMODELING 2501 MONARCH DR AUSTIN TX 78748 REMODELING SERVICES 474818 GLYNN DEVINS INC 8880 WARD PARKWAY SUITE 400 KANSAS CITY MO 64114 MARKETING 311865 HEALTHPRO MANAGEMENT SERVICES PO BOX 69268 BALTIMORE MD 21264 THERAPY SERVICES 209688 14 INDEPENDENT LIVING 531110 11489436 11489436 SKILLED NURSING 623000 10184300 10184300 ENTRNACE FEES 531110 1180895 1180895 22854631 596221 596221 288689 12786 5600 275903 -5600 270303 270303 23721155 22854631 0 866524 2500 2500 1019211 1019211 7976982 6381586 1595396 26768 21414 5354 1520798 1216638 304160 705670 564536 141134 1919616 1823635 95981 259434 259434 23088 23088 1821271 1821271 289321 231457 57864 224579 224579 789115 789115 61373 49098 12275 2311909 2311909 4769833 4531341 238492 267082 261740 5342 DIETARY 1228160 1228160 PLANT OPERATIONS 962217 962217 MEDICAL AND OTHER RESID 603919 603919 OTHER GENERAL AND ADMIN 519455 519455 363107 331303 31804 27665408 22849234 4816174 0 2431457 4284115 1904796 0 1260332 391319 67997 42328 424934 408617 75352435 1698590 83029402 73653845 6789213 17841583 14374644 17473264 894074 9895070 111176849 123990141 2946809 1842140 6458354 47318122 46015000 850000 1625605 266355 99009487 75409034 156582772 125158134 X -45405923 -1167993 -45405923 -1167993 111176849 123990141 X -3944253 2170372 -54076 46065887 X X 0 1 X 1 0 X 5553 3796 9349 19309287 19098227 20110368 20057803 22854631 101430316 19309287 19103780 20114164 20057803 22854631 101439665 0 0 0 101439665 321510 436467 528821 768569 596221 2651588 321510 436467 528821 768569 596221 2651588 105352 108605 232166 124419 570542 19736149 19648852 20875151 20950791 23450852 104661795 0.96920 0.96920 0.02530 0.02420 X 0 1 X 5000000 5000000 67603752 1459167 66144585 2748245 239423 2508822 438 438 73653845 MARKETING COMMISSIONS 29734 NONCURRENT ASSETS LIMITED AS TO USE 6067101 ASSETS LIMITED AS TO USE 3548221 INTERCOMPANY RECEIVABLES 250014 9895070 INTERCOMPANY PAYABLES 201026 DEFERRED & REFUNDABLE ENTRANCE FEES 75208008 75409034 X 24879000 2170372 2170372 22708628 1012527 1012527 23721155 26653000 0 26653000 1012408 1012408 27665408 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, 2019 AND 2018, 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, 2016 THROUGH DECEMBER 31, 2018. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE NETTED WITH EXPENSES 1,013,611. ROUNDING ON AUDITED FINANCIAL STATEMENTS -1,084. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUES NETTED WITH EXPENSES 1,013,611. ROUNDING ON AUDITED FINANCIAL STATEMENTS -1,203. 1 HARDSHIP ASSISTANCE - REDUCTION OF FEES 14 1019211 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 LARRY SMITH INTERIM PRESIDENT & CEO, & CFO 0 493787 0 81248 0 28874 0 8400 0 27786 0 640095 0 0 THOMAS BROD SVP OF BUSINESS DEVELOPMEN 0 279513 0 30000 0 7262 0 8088 0 13149 0 338012 0 0 CHRIS HUTFLESS INTERIM SVP & GENERAL COUNSEL 0 157927 0 58665 0 4080 0 6509 0 7855 0 235036 0 0 NATE WEYAND EXECUTIVE DIRECTOR 167635 0 27200 0 170 0 3350 0 25114 0 223469 0 0 0 TIMOTHY STUTEVILLE ASSISTANT EXECUTIVE DIRECTOR 125066 0 25800 0 2063 0 867 0 9034 0 162830 0 0 0 SCOTT COLLIER CHAIRMAN (THRU JUNE) 0 173324 0 0 0 0 0 0 0 0 0 173324 0 0 JOAN FORD DIRECTOR OF SALES & MARKET 89590 0 53975 0 3529 0 3009 0 8316 0 158419 0 0 0 FORM 990, SCHEDULE J, PART II COMPENSATION OF THE EXECUTIVE DIRECTOR THE EXECUTIVE DIRECTOR, ASSISTANT EXECUTIVE DIRECTOR AND HEALTH DIRECTOR WAS PAID THROUGH A RELATED SUPPORTING ORGANIZATION, SENIORITY INC. (EIN: 94-3287180), A FOR PROFIT MANAGEMENT COMPANY WHOLLY OWNED BY SQLC. BEGINNING SEPTEMBER 2019, 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 REFUNDING OF 2005 SERIES, COMMUNITY RENOVATION 0 0 0 A 4675000 52689627 3701247 126715 1040388 10823354 37079732 3004495 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 1 0 0 1 A 1 SCHEDULE K, 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 4 QUERENCIA'S ARTICLES OF INCORPORATION AND THE BYLAWS WERE UPDATED AS A RESULT OF BEING ACQUIRED BY LIFESPACE COMMUNITIES, INC. IN 2019 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: EQUITY CLOSED OUT DUE TO ACQUISTION 46,066,000. ROUNDING ON AUDITED FINANICAL STATEMENTS -113. FORM 990, PART XII, LINE 2C: DUE TO THE SOLE MEMBER OF THE COMPANY CHANGING TO LIFESPACE COMMUNITIES, INC. DURING 2019, THE PROCESS OF SELECTING AN INDEPENDENT ACCOUNTANT IS NOW DETERMINED BY LIFESPACE COMMUNITIES, INC. AND ITS BOARD OF DIRECTORS. 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 BUCKINGHAM SENIOR LIVING COMMUNITY INC 8580 WOODWAY HOUSTON TX 77063 300097872 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 N/A 0 SQLC CHARITABLE FOUNDATION 8523 THACKERY ST DALLAS TX 75225 262474373 SUPPORT OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 12A, I N/A 0 MAYFLOWER COMMUNITIES INC 5415 BEARBERRY LANE INDIANAPOLIS IN 46268 261446350 OPERATION OF RETIREMENT COMMUNITIES IN 501(C)(3) LINE 10 BHI SENIOR LIVING INC 0 SQLC SENIOR LIVING CENTER AT CORPUS CHRISTI 1440 LAKE FRONT CIRCLE SUITE 140 THE WOODLANDS TX 77380 261778912 OPERATION OF RETIREMENT COMMUNITIES TX 501(C)(3) LINE 10 METHODIST RETIREMENT 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 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1