2016-08-08T15:05:13-05:00 2015-12-31 420794029 Denman & Company LLP 1601 22nd Street Suite 400 West Des Moines IA 502661453 990 2015-01-01 421068850 Lifespace Communities Inc LIFE 5152885805 100 East Grand Avenue No 200 Des Moines IA 50309 LARRY M SMITH VICE PRESIDENT & CFO 5152885805 2016-08-05 1 Bruce Cahill P00546325 5152258400 2015 2016-12-15 16:53:06Z M SLOAN BENTLEY 100 East Grand Avenue No 200 Des Moines IA 50309 378837141 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. 8 7 3444 2549 0 0 578009 131002 220473455 235884554 3297826 2131472 0 0 224349290 238147028 11839848 1258781 0 0 100330438 107088727 0 0 0 120499904 131847729 232670190 240195237 -8320900 -2048209 714593285 725739982 771089685 788910354 -56496400 -63170372 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 209579745 1258781 234933493 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. 209579745 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 1010 0 3444 1 0 0 0 0 0 0 0 0 0 0 X 8 7 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 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 JOHN J KADUCE DIRECTOR 2.00 2.50 X 32000 0 0 ANN A WAGNER-HAUSER DIRECTOR 2.00 2.50 X 34000 0 0 DONALD W BOURNE DIRECTOR 2.00 2.50 X 34000 0 0 WILLIAM R COOK PRIOR DIRECTOR 2.00 2.50 X 8500 0 0 PAULA J SHIVES DIRECTOR 2.00 2.50 X 32000 0 0 RITA M DRAGONETTE DIRECTOR & VICE-CHAIR 2.00 2.50 X 34000 0 0 E LAVERNE EPP DIRECTOR & CHAIR 6.00 6.50 X 40500 0 0 ROBERT C KEHM DIRECTOR & PRIOR CHAIR 2.00 2.50 X 35500 0 0 M SLOAN BENTLEY PRESIDENT/CEO/DIRECTOR 40.00 2.50 X X 688183 0 11901 LARRY M SMITH VICE PRES/CFO & TREASURER 40.00 2.50 X 328003 0 23098 JOEILYNN LEONHARDT VICE PRESIDENT - HR 40.00 2.50 X 218840 0 20412 KIMBERLY HULETT VICE PRESIDENT - MARKETING 40.00 2.50 X 277635 0 12827 SYDNEY J CODER CORPORATE SECRETARY 2.00 2.50 X 14877 0 0 JODI HIRSCH VICE PRESIDENT & GENERAL COUNSEL 40.00 2.50 X 241495 0 1421 SARA E HAMM VICE PRESIDENT - CLINICAL SALES 40.00 2.50 X 159311 0 7078 DAVID RANDAZZO REGIONAL OPERATIONS DIRECTOR 40.00 X 231203 0 10275 AMY E LACROIX REGIONAL OPERATIONS DIRECTOR 25.00 15.00 X 163785 0 4861 JOHN J SPOONER REGIONAL OPERATIONS DIRECTOR 40.00 X 165346 0 15279 BOBBI JO HADEN EXECUTIVE DIRECTOR 40.00 X 299415 0 8204 HAROLD KAVAN RISK MANAGER 40.00 X 194713 0 9860 ANSLEY HOLT EXECUTIVE DIRECTOR 40.00 X 169239 0 8120 SEAN NEALON EXECUTIVE DIRECTOR 40.00 X 196401 0 12125 RICHARD D'AMICO DIRECTOR OF DESIGN & CONSTRUCTION 40.00 X 169462 0 8250 SCOTT M HARRISON FORMER PRESIDENT & CEO 0.00 0.00 X 406250 0 0 4174658 0 153711 62 1 1 0 WALSH CONTRUCTION CO INC 929 WEST ADAMS STREET CHICAGO IL 60607 CONTRACTOR 8867385 US FOODS INC PO BOX 281838 ATLANTA GA 303841838 FOOD & BEVERAGE 7891024 REHABCARE GROUP EAST INC PO BOX 503534 ST LOUIS MO 631503534 HEALTH CENTER 6893689 KRAUS-ANDERSON CONSTRUCTION CO 525 SOUTH EIGHTH STREET MINNEAPOLIS MN 55404 CONTRACTOR 5545402 GLYNN DEVINS ADVERTISING 11230 COLLEGE BLVD OVERLAND PARK KS 66210 MARKETING 3732720 144 131002 131002 APARTMENT FEES 531110 136101238 136101238 SKILLED NURSING 623000 72116427 72116427 ENTRANCE FEES 531110 27666889 27666889 235884554 3348921 3348921 139465764 6900 139732152 957961 -266388 -951061 -1217449 -951061 -266388 238147028 234933493 0 3082533 86979 86979 1171802 1171802 2846330 569266 2277064 406250 406250 82580881 66064705 16516176 1008129 806503 201626 12796518 10237214 2559304 7450619 5960495 1490124 11510471 10934948 575523 321108 321108 186538 186538 306404 306404 5132053 4105642 1026411 4365025 4365025 34921485 33175411 1746074 5337453 5230704 106749 MEDICAL & OTHER RESIDEN 19340636 19340636 DIETARY 14536525 14536525 PLANT OPERATIONS 11796551 11796551 OTHER GENERAL & ADMINIS 7453953 5963163 1490790 16639527 15234176 1405351 240195237 209579745 30615492 0 5791951 9570784 2496092 2259317 39560413 21134884 4787359 11486800 948576 1261253 5849592 2643840 764537631 347119677 399780055 417417954 146429636 143916119 831332 831332 3542896 3237710 104575383 111979989 714593285 725739982 34660472 37874464 5327662 5056488 148930583 141370764 4700000 4855000 20000000 21392825 557470968 578360813 771089685 788910354 X -56496400 -63170372 -56496400 -63170372 714593285 725739982 -2048209 -4625763 0 X X 0 1 X 1 0 X 666440 506432 401776 578009 131002 2283659 192164208 210118367 210646816 219904385 235884554 1068718330 192830648 210624799 211048592 220482394 236015556 1071001989 643990 506432 336877 576257 131002 2194558 0 643990 506432 336877 576257 131002 2194558 1068807431 3125752 2935383 3293887 2844106 3348921 15548049 3125752 2935383 3293887 2844106 3348921 15548049 195956400 213560182 214342479 223326500 239364477 1086550038 0.98370 0.98190 0.01430 0.01470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32877499 32877499 698574462 325031923 373542539 147248 58382 88866 32938422 22029372 10909050 417417954 ASSETS WHOSE USE IS LIMITED: OPERATING RESERVE FUND 16235146 ASSETS WHOSE USE IS LIMITED: DEBT SERVICE RESERVE FUND 12698987 ASSETS WHOSE USE IS LIMITED: PRINCIPAL & INTEREST FUND 11293071 ASSETS WHOSE USE IS LIMITED: WAIT LIST RESERVE FUND 3895483 ASSETS WHOSE USE IS LIMITED: ENTRANCE FEE DEPOSITS 2106279 ASSETS WHOSE USE IS LIMITED: ASSET REPLACEMENT FUND 10026066 DEFERRED EXPENSES 2901699 GOODWILL 52823258 111979989 DEFERRED ENTRANCE FEES, REFUNDABLE ENTRANCE & MEMBERSHIP FEES 571273587 UNAMORTIZED BOND PREMIUM 7087226 578360813 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, 2015 AND 2014, 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, 2012 THROUGH DECEMBER 31, 2014. 1 THE LIFESPACE FOUNDATION 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 421370848 501(C)(3) 86979 REIMBURSE FOR ADMINISTRATIVE EXPENSES 1 0 HARDSHIP ASSISTANCE - REDUCTION OF FEES 40 1171802 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. X 1 1 X X X X 1 0 0 0 0 0 0 0 0 M SLOAN BENTLEY PRESIDENT/CEO/DIRECTOR 454018 0 234027 0 138 0 2622 0 9279 0 700084 0 0 0 LARRY M SMITH VICE PRES/CFO & TREASURER 269747 0 57998 0 258 0 9193 0 13905 0 351101 0 0 0 JOEILYNN LEONHARDT VICE PRESIDENT - HR 177670 0 41080 0 90 0 6507 0 13905 0 239252 0 0 0 KIMBERLY HULETT VICE PRESIDENT - MARKETING 127779 0 63349 0 86507 0 4815 0 8012 0 290462 0 0 0 JODI HIRSCH VICE PRESIDENT & GENERAL COUNSEL 227032 0 14325 0 138 0 1421 0 0 0 242916 0 0 0 SARA E HAMM VICE PRESIDENT - CLINICAL SALES 129060 0 30150 0 101 0 0 0 7078 0 166389 0 0 0 DAVID RANDAZZO REGIONAL OPERATIONS DIRECTOR 176454 0 54689 0 60 0 5414 0 4861 0 241478 0 0 0 AMY E LACROIX REGIONAL OPERATIONS DIRECTOR 163581 0 150 0 54 0 0 0 4861 0 168646 0 0 0 JOHN J SPOONER REGIONAL OPERATIONS DIRECTOR 165142 0 150 0 54 0 1374 0 13905 0 180625 0 0 0 BOBBI JO HADEN EXECUTIVE DIRECTOR 182185 0 117113 0 117 0 4162 0 4042 0 307619 0 0 0 HAROLD KAVAN RISK MANAGER 95945 0 47636 0 51132 0 3026 0 6834 0 204573 0 0 0 ANSLEY HOLT EXECUTIVE DIRECTOR 143636 0 25359 0 244 0 4822 0 3298 0 177359 0 0 0 SEAN NEALON EXECUTIVE DIRECTOR 119346 0 77011 0 44 0 4275 0 7850 0 208526 0 0 0 RICHARD D'AMICO DIRECTOR OF DESIGN & CONSTRUCTION 91111 0 51383 0 26968 0 0 0 8250 0 177712 0 0 0 SCOTT M HARRISON FORMER PRESIDENT & CEO 0 0 0 0 406250 0 0 0 0 0 406250 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. Part I, Line 4a SCOTT M. HARRISON (FORMER OFFICER & DIRECTOR) RECEIVED SEVERANCE PAYMENTS TOTALING $406,250 FROM LIFESPACE COMMUNITIES, INC. DURING 2015. ADDITIONAL PAYMENTS TOTALING $93,750 WILL BE MADE DURING 2016 IN ACCORDANCE WITH THE SEPARATION AGREEMENT. KIMBERLY HULETT (OFFICER) RECEIVED SEVERANCE PAYMENTS TOTALING $86,452 FROM LIFESPACE COMMUNITIES, INC. DURING 2015. HAROLD KAVAN (HIGHLY COMPENSATED EMPLOYEE) RECEIVED SEVERANCE PAYMENTS TOTALING $51,058 FROM LIFESPACE COMMUNITIES, INC. DURING 2015. RICHARD D'AMICO (HIGHLY COMPENSATED EMPLOYEE) RECEIVED SEVERANCE PAYMENTS TOTALING $26,923 FROM LIFESPACE COMMUNITIES, INC. DURING 2015. 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 48200582 1232878 26716774 787834 19443917 70347 1 1 1 1 B 1075000 5528486 424239 109300 4994947 2005 0 0 1 1 C 5995000 12165166 1039156 241856 279578 11643732 2005 1 0 1 1 D 38184513 2447461 687044 8408061 16830399 10239564 1 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 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. 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. 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. 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 2649097 9777788 9777788 2004 0 0 1 1 B 2186400 13603719 200000 13403719 2007 0 0 1 1 C 26081481 2806246 431072 19922450 2921714 2012 1 0 1 1 D 1268028 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 DEERFIELD RETIREMENT COMMUNITY INC RELATED CHARITABLE ORGANIZATION TAXABLE AND TAX-EXEMPT BONDS FOR CONSTRUCTION AND OPERATION OF COMMUNITY X 9023139 9023139 0 1 1 DEERFIELD RETIREMENT COMMUNITY INC RELATED CHARITABLE ORGANIZATION NOTES PAYABLE FOR ENTRANCE FEES REFUNDED AS PART OF OPERATION OF COMMUNITY X 2463661 2463661 0 1 1 11486800 Form 990, Part VI, Section B, line 11 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 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 452672674 OPERATION OF RETIREMENT COMMUNITY IA -1377000 80621000 DEERFIELD RETIREMENT COMMUNITY INC 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 421508960 OPERATION OF RETIREMENT COMMUNITY IA 501(c)(3) Line 9 1 THE LIFESPACE FOUNDATION 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 421370848 SUPPORT OF RETIREMENT COMMUNITIES IA 501(c)(3) Line 11a, I 1 LIFESPACE INC 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 273270337 OWNERSHIP & ADMINISTRATION OF RETIREMENT COMMUNITY PROPERTY IA 501(c)(3) Line 11b, II 1 LIFESPACE MANAGEMENT INC 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 273271283 MANAGEMENT OF RETIREMENT COMMUNITIES IA 501(c)(3) Line 11b, II 1 LIFESPACE SERVICES INC 100 EAST GRAND AVENUE SUITE 200 DES MOINES IA 50309 273271147 HEALTH SERVICES AND PROGRAMS FOR RETIREMENT COMMUNITIES IA 501(c)(3) Line 9 1 PRAIRIE VIEW CLUB OF KANSAS 8101 MISSION RD PRAIRIE VILLAGE KS 66208 481159378 RESIDENT ENTERTAINMENT SERVICES KS C -1652 12305 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 116792 THE LIFESPACE FOUNDATION B 86979 DEERFIELD RETIREMENT COMMUNITY INC C 11490 THE LIFESPACE FOUNDATION C 119512 DEERFIELD RETIREMENT COMMUNITY INC D 6699441 THE LIFESPACE FOUNDATION O 99578 DEERFIELD RETIREMENT COMMUNITY INC Q 777193 THE LIFESPACE FOUNDATION Q 61385