2011-01-28T15:00:38-06:00 2010-06-30 RYUN GIVENS & COMPANY PLC 2900 100TH STREET SUITE 301 URBANDALE IA 50322 990 2009-07-01 421308032 On With Life Inc ONWI 5159651339 715 Southwest Ankeny Road Ankeny IA 50023 JULIE FIDLER DIXON 5159651339 2010-11-08 1 STEVE D GIVENS CPA 5152253141 2009 2016-02-24 21:20:13Z JULIE FIDLER DIXON 715 Southwest Ankeny Road Ankeny IA 50023 7401827 0 X ON-WITH-LIFE.ORG X 1987 IA JOINING HANDS, HEARTS, AND MINDS TO HELP PERSONS LIVING WITH BRAIN INJURY GET ON WITH LIFE. 16 16 174 75 26083 -12 28350 13131 6702068 7186763 90853 77163 0 6821271 7277057 0 0 5123316 5420455 0 0 1583332 1502889 6706648 6923344 114623 353713 7209395 8028933 3691526 4105565 3517869 3923368 JOINING HANDS, HEARTS, AND MINDS TO HELP PERSONS LIVING WITH BRAIN INJURY GET ON WITH LIFE. 0 0 5086503 7064004 FUNCTIONAL EXPENSES WERE INCURRED IN PROVIDING 9,087 DAYS OF SPECIALIZED CARE AND REHABILITATION SERVICES TO INDIVIDUALS WHO HAVE SUSTAINED A TRAUMATIC BRAIN INJURY OR OTHER NEUROLOGICAL DISABILITY. 5086503 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 35 0 174 1 1 1 0 0 0 0 0 0 0 0 16 16 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X JULIE FIDLER DIXON 5159651339 715 SOUTHWEST ANKENY ROAD ANKENY IA 50023 thomas j FRIEDMAN 2.00 X X 0 0 0 VILIA TARVYDAS 2.00 X X 0 0 0 KAY HINES 2.00 X X 0 0 0 DONNA WALTER 2.00 X X 0 0 0 GAIL BOLIVER 2.00 X 0 0 0 BETTY BUITENWERF 2.00 X 0 0 0 THOMAS CARLSTROM MD 2.00 X 0 0 0 R JERRY CARSPECKEN 2.00 X 0 0 0 CHARLES DENHART MD 2.00 X 0 0 0 ARTHER FILEAN 2.00 X 0 0 0 CARL HARRIS 2.00 X 0 0 0 MARC HARDING 2.00 X 0 0 0 JEFFREY LAMBERTI 2.00 X 0 0 0 DAVE OLSON 2.00 X 0 0 0 MIKKI STIER 2.00 X 0 0 0 ELI WIRTZ 2.00 X 0 0 0 JULIE FIDLER DIXON 40.00 X 103983 0 8794 CYNTHIA EWALD 40.00 X 74969 0 5658 DAVID DEMAREST 40.00 X 105282 0 6403 284234 0 20855 2 0 0 0 0 13131 13131 PATIENT SERVICES 623000 3859934 3859934 MEDICARE/MEDICAID PAYM 623000 3197171 3197171 DIETARY/COBRA/MISC 900099 96676 96676 DIETARY CONSULTING 541900 26083 26083 SUPPORTIVE HOUSING 623990 6899 6899 7186763 76933 76933 125000 122990 1780 2010 -1780 230 230 7277057 7064004 26083 173839 302117 302117 4265345 3397038 868307 101237 80625 20612 395183 295904 99279 356573 267163 89410 14765 189 14576 27341 10850 16491 86966 7153 79813 161989 161989 4904 4904 128446 38257 90189 85300 59015 26285 32328 12346 19982 142387 142387 259724 233752 25972 SUPPLIES, MEDICAL SUPPL 320677 320677 EQUIPMENT RENTAL AND MA 130603 130603 SERVICE FEES 125493 30455 95038 FOOD AND DIETARY 124645 123257 1388 WORKERS COMPENSATION 65209 15930 49279 -207888 63289 -271177 6923344 5086503 1836841 0 1107 1205 907408 566652 887479 1466286 46800 38345 20314 1620 5484271 2515396 2976746 2968875 1132134 1288709 1237407 1697241 7209395 8028933 542519 795546 2830000 2660000 319007 650019 3691526 4105565 X 3517869 3923368 3517869 3923368 7209395 8028933 X 0 1 1 X 0 X 9615 13000 129300 28350 13131 193396 5847415 6233428 5949675 6671005 7064004 31765527 96676 96676 5857030 6246428 6078975 6699355 7173811 32055599 0 0 0 32055599 105338 106514 86962 91359 76933 467106 105338 106514 86962 91359 76933 467106 3479 3479 5962368 6352942 6169416 6790714 7250744 32526184 0.98550 0.98540 0.01440 0.01450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 154240 154240 4095964 1815351 2280613 403128 172039 231089 830939 528006 302933 2968875 CASEY'S GENERAL STORES, INC. 6919 F VANGUARD GROUP - PRIME MONEY MARKET 5975 F VANGUARD GROUP - INFLATION PRO 102995 F VANGUARD GROUP - GNMA 510439 F VANGUARD GROUP - SHORT TERM 662381 F 1288709 BOND ISSUANCE COSTS (NET OF AMORTIZATION) 69220 BOND FUND 1994 206810 DEBT SERVICE RESERVE 1994 165465 DUE FROM COMMUNITY SERVICES 620481 DUE FROM CORPORATE DIVISION 29538 DUE FROM GLENWOOD 14319 PROJECT FUND 13130 LOAN TO GLENWOOD 397647 PROJECT ACCOUNT - POOL 5000 CONSTRUCTION IN PROCESS 175631 1697241 DUE TO ANKENY DIVISION 595303 DUE TO CORPORATE 54716 650019 7277057 6923344 353713 51786 51786 405499 7328613 51786 51786 7276827 230 230 7277057 6923114 -230 -230 6923344 0 6923344 Part XI, Line 8 - Other Adjustments: UNREALIZED GAIN/LOSS ON INVESTMENTS: 51786. Part XII, Line 4b - Other Adjustments: GAIN ON SALE OF ASSET: 230. Part XIII, Line 2d - Other Adjustments: REVENUE OFFSET AGAINST EXPENSE ON F/S: 0. GAIN ON SALE OF ASSET: -230. CITY OF ANKENY IOWA - SERIES 2004A 426004235 035362AZ5 2004-07-29 2840000 REFUNDING SERIES 1994 BONDS 0 0 CITY OF ANKENY IOWA - SERIES 2004B 426004235 035362AY8 2004-07-29 600000 EXPANDING AND MAKING IMPROVEMENTS ON HEALTH CARE FACILITY 0 0 2840000 159325 2616538 64137 2004 0 1 1 1 600000 600000 2004 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Form 990, Part VI, Section A, line 2 BUSINESS RELATIONSHIP BETWEEN JEFFREY LAMBERTI WHO IS ON THE BOARD OF DIRECTORS OF CASEY'S GENERAL STORES, INC. AND ELI WIRTZ WHO IS EMPLOYED AS A VICE PRESIDENT OF CORPORATE COUNCIL AT CASEY'S GENERAL STORES, INC. Form 990, Part VI, Section B, line 11 THE BOARD OF DIRECTORS WILL BE GIVEN A COPY OF FORM 990 TO BE APPROVED BEFORE BEING FILED. THE BOARD WILL BE PROVIDED WITH A CHECKLIST FROM THE FIRM'S FORM 990 PREPARER TO HELP REVIEW FORM 990. Form 990, Part VI, Section B, line 12c ALL SENIOR STAFF AND DIRECTORS ANNUALLY SUBMIT A DISCLOSURE OF INTEREST STATEMENT. THE DISCLOSURE STATEMENT IS THEN REVIEWED BY THE EXECUTIVE DIRECTOR AND THE BOARD AFFAIRS COMMITTEE ANNUALLY FOR ANY POTENTIAL CONFLICTS OF INTEREST. Form 990, Part VI, Section B, line 15 THE BOARD APPROVES SALARIES FOR THE EXECUTIVE DIRECTOR, OFFICERS, AND KEY EMPLOYEES BASED ON RECOMENDATIONS BY THE HUMAN RESOURCE COMMITTEE. HUMAN RESOURCE COMMITTEE COMPILES WAGE SURVEYS AND OTHER INFORMATION TO BASE WAGE RECOMMENDATIONS TO THE BOARD. Form 990, Part VI, Section C, line 18 FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S BUSINESS OFFICE. Form 990, Part VI, Section C, line 19 ALL GOVERNING DOCUMENTS INCLUDING THE ARTICLES OF INCORPORATION, BYLAWS, FORM 501(C)(3), FINANCIAL STATEMENTS, AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE BUSINESS OFFICE. THE CONFLICT OF INTEREST POLICY IS CURRENTLY NOT AVAILABLE TO THE PUBLIC. FORM 990. PART XI, LINE 2C OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT AUDITORS THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF INDEPENDENT AUDITORS AND ARE ALSO RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS HAS REMAINED UNCHANGED FROM THE PRIOR YEARS. ON WITH LIFE EXTENDED SERVICES LTD 715 SW ANKENY RD ANKENY IA 50023 421521198 PROVIDE SKILLED CARE AND REHAB SERVICES FOR INDIVIDUALS WITH BRAIN INJURIES IA 501(C)(3) 9 ON WITH LIFE FOUNDATION 715 SW ANKENY RD ANKENY IA 50023 421399777 TO SUPPORT ON WITH LIFE, INC. AND ON WITH LIFE EXTENDED SERVICES, LTD. IA 501(C)(3) 11B 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 ON WITH LIFE FOUNDATION C 13131 ON WITH LIFE EXTENDED SERVICES LTD D 50540 ON WITH LIFE FOUNDATION M 24000 ON WITH LIFE FOUNDATION N 11700 ON WITH LIFE EXTENDED SERVICES LTD N 38443 ON WITH LIFE EXTENDED SERVICES LTD P 27820