2011-05-16T14:13:23-05:00 2010-12-31 HONKAMP KRUEGER & CO PC P O BOX 188 HIAWATHA IA 52233 990 2010-01-01 421412375 COTTAGE GROVE PLACE COTT 3193632420 2115 FIRST AVENUE SE CEDAR RAPIDS IA 52402 MATTHEW CARPENTER 3193632420 2011-05-16 1 DALE J LEIBFRIED CPA 3193783370 2011-05-16 2010 2016-02-24 21:20:13Z MATTHEW CARPENTER 2115 FIRST AVENUE SE CEDAR RAPIDS IA 52402 10485354 0 X WWW.COTTAGEGROVEPLACE.COM X 1992 IA TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A RETIREMENT FACILITY 21 21 269 0 0 0 0 0 10500854 10443927 64026 41427 0 0 10564880 10485354 0 0 0 0 4147789 4316121 0 0 0 6439381 6279109 10587170 10595230 -22290 -109876 31102316 30447580 53997156 53488375 -22894840 -23040795 TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A RETIREMENT FACILITY 0 0 5726203 10443927 THE RETIREMENT FACILITIES CONTAIN 166 INDEPENDENT LIVING UNITS, 19 ASSISTED LIVING UNITS, 40 NURSING CARE BEDS, AND 12 MEMORY CARE UNITS FOR ITS RESIDENTS. 5726203 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 0 0 0 0 0 1 37 0 1 269 1 0 0 0 0 0 0 0 0 0 0 X 21 21 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X GREG OLBEKSON 3192975754 2115 FIRST AVENUE SE CEDAR RAPIDS IA 52402 X ROBERT A SEDLACEK 1.20 X 0 0 0 THEODORE F PAULSON 1.20 X 0 0 0 HAROLD G SCHAEFER 1.20 X 0 0 0 RUSSELL H ANTHONY 1.20 X 0 0 0 WILLIAM S ELLIOTT 1.20 X 0 0 0 JOHN C WAGOR 1.20 X 0 0 0 CARL E HALLBERG 1.20 X 0 0 0 PHIL MORRIS 1.20 X 0 0 0 KATHY TOBORG 1.20 X 0 0 0 RALPH H PALMER 1.20 X 0 0 0 TAD COOPER 1.20 X 0 0 0 MARTIN DWYER 1.20 X 0 0 0 CRYSTAL USHER 1.20 X 0 0 0 JAN ALTORFER 1.20 X 0 0 0 ROBERT SILBER 1.20 X 0 0 0 JIM BURR 1.20 X 0 0 0 STEVE KING 1.20 X 0 0 0 DAVID BEY 1.20 X 0 0 0 BILL JACOBSON 1.20 X 0 0 0 DICK HEFT 1.20 X 0 0 0 B D COOPER 1.20 X 0 0 0 0 0 0 0 0 0 0 LIFE CARE SERVICES LLC 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT COMPANY 428817 1 RESIDENT SERVICES 623000 10443927 10443927 10443927 41427 41427 10485354 10443927 0 41427 295051 247843 47208 3272946 2737395 535551 436638 364422 72216 311486 265918 45568 428817 428817 167495 112202 55293 170912 170912 632251 589168 43083 75174 54423 20751 1740729 1740729 1046489 1046489 256086 95589 160497 FOOD 524252 524252 MEDICAL EXPENSE 440056 440056 PROPERTY TAXES 252277 252277 MISCELLANEOUS EXPENSE 143841 901 142940 DEPARTMENT SUPPLIES 130702 104822 25880 270028 189212 80816 10595230 5726203 4869027 0 121984 715064 895523 264975 9383 23060 139571 115187 36708305 11965335 25075333 24742970 4860522 4586324 31102316 30447580 2169219 1944612 10002991 10071820 29876441 29207994 11948505 12263949 53997156 53488375 X -22894840 -23040795 -22894840 -23040795 31102316 30447580 X -109876 -36079 X X 0 1 1 X 0 X 8914154 9508572 10421187 10500854 10443927 49788694 8914154 9508572 10421187 10500854 10443927 49788694 0 0 0 49788694 160283 203827 106849 61226 41427 573612 160283 203827 106849 61226 41427 573612 9074437 9712399 10528036 10562080 10485354 50362306 0.98860 0.98640 0.01140 0.01360 X 4016275 4016275 27808427 8983682 18824745 2246205 876089 1370116 252771 173745 79026 2384627 1931819 452808 24742970 ASSETS LIMITED AS TO USE 3122743 DEFERRED FINANCING EXPENSES 572582 CASH SURRENDER VALUE OF LIFE INSURANCE 362090 BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 329441 ORGANIZATIONAL COSTS, NET 199468 4586324 REFUNDABLE ENTRANCE FEES 12097178 DEPOSITS 99931 DUE TO AFFILIATES 1597 CAPITAL LEASES 65243 12263949 CITY OF CEDAR RAPIDS IOWA 426004336 0150571AJ 2004-03-01 5310000 COSTS OF 2004 PROJECT-HEALTH CENTER 0 0 0 5310000 219785 5090215 2004 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 FORM 990, PART VI, SECTION A, LINE 2 B D COOPER (VICE CHAIRMAN) IS THE FATHER OF TAD COOPER (TRUSTEE). FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES FOR THE ORGANIZATION ARE HANDLED BY THE MANAGEMENT COMPANY - LIFE CARE SERVICES LLC. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FORM 990 IS REVIEWED BY THE BOARD AND THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE EVERY YEAR POTENTIAL CONFLICTS WITH BUSINESSES THEY ARE ASSOCIATED WITH. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: 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. AUDIT COMMITTEE PROCEDURES FORM 990, PART XI, LINE 2C THERE WERE NO CHANGES IN THE PROCEDURES FOR THE OVERSIGHT OF THE AUDIT.