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RECEiVED

~ Property ~Tax

5"S~ I)
Car

DATE

Petition to Local Board of Review
.-----Petition# Parcel # For lise by board of review only

-_R~e~gLu~la~r~S~e~s~s~io~

This petition must be filed or mailed to your city or county assessor from April 16 through May 5. It must be postmarked no later than May 5. Iowa assessors' addresses can be found at the Iowa State Association of Assessors Web site. To the Board of Review of the County/City Theundeffiigned, _C_a_re_l_n_iti_at_iv_e_s of Johnson

-=If.~

cJ?-

30. '3 S I, ooa,Iowa

ClassC~(",.

12
_

as owner or aggrieved taxpayer of the following described real estate: with the street address 2200 Oakdale Road, Coralville, Iowa 52241

Com 392.81' N & N 68 Deg W 1220.19',

et al.

and as such, liable for the payment of taxes thereon, does hereby respectfully object to the assessment made against said real estate as of January 1, 2011 In the sum of $_4;....,3_6_4,'-0_00 _ for the following reasons, and upon the following grounds: (Complete all grounds that apply)

1. That said assessment is not equitable as compared with assessments of other like property in the county or city. (Give
legal description and assessment of representative number of comparable properties.) Assessed at:

2. That said property is assessed for more than the value authorized by law
said over-assessment is $ ( Land

------------------------------------------------------$_-------------------------------------------------------------------------$---------------------------------------------------------------------------$---------------------------------------------------------------------------$----------------------------------------------------------------------------$----------------------(Section 441.21, Code of Iowa);

that the amount of

; and that $
Building

is its actual value ) and is a fair assessment.

$

$ ________________

3. That said property is not assessable, is exempt from taxes or is misclassified for the following reason:
4. That there is an error in the assessment as follows:

_ Propertyshould be classifiedas residentialunder Iowa Code 441.21 (11)_ Please see attachedcorrespondenceand documentation. _

5. That there is fraud in the assessment as follows: 6. That there has been a change downward in the value since the last assessment
(Section 441.35, Code of Iowa): _

The undersigned respectfully requests that the assessment made against said real estate be reduced to an amount that is fair, equitable, and just, or canceled if property is not assessable. I hereby state that the facts in this petition are true and correct. Mailing Address: 215 10tl1 Street, Suite 1300, Des Moines, IA 50309 An oral hearing is requested: Tele # Home 515-288-2500 Signature ~

DYES ~NO

N\ (2;(A._!l_

Bus. or Cell 515-288-2500 -----o-at-e

-sl-q-I-;-I--

(owner or duly authorized agent)

FOR USE BY BOARD OF REVIEW ONLY Action Taken: Date: _
56-064a (07/29/09)

0730351002
ADMINISTRATIVE
PARCEL NUMBER 0730351002 Parent Parcel Number

CARE INITIATIVES
INFORMATION OWNERSHIP

2200 OAKDALE RD
Printed 05/05/2011
TRANSFER
Date 04/15/2002 02/28/2001 GRELL, MOLLOY, WAYNE DAVID D & DENISE
&

412
Card No.

1

CARE INITIATIVES 1611 WEST LAKES PKWY WEST DES MOINES IA 50266
COM 392.81' N & N 68 DEG W 1220.19' OF S 1/4 COR THENCE N 16 DEG E 371.04'; 9 DEG W 770.5'; S 235.1'8 68 DEG E 702.42' TO BEG

of

OF OWNERSHIP

2

-_._.._-_--Bk/Pg: $325000 Bk/Pg: $150000 Bk/Pg: $0 Bk/Pg: $1750 3272, 3039, 396, 505 336 338

Property Address 2200 OAKDALE RD Neighborhood 50017 OAKDALE AREA COMMERCIAL hms

JOAN

OS/21/1973

SCHNOEBELEN,

F.W.

Property Class 412 Hospitals/Nurs TAXING DISTRICT

INFORMATION 52 001 CVI

Jurisdiction Area District Section Routing & Plat Number

COMMERCIAL
Assessment Reason Year

09/30/1969

339, 40

VALUATION
03/17/2005
Reassess L B T

RECORD
04/04/2008 _~~_~C Compl 04/04/2009 Reassess 03/20/2010 Reassess 03/16/2011
Reassess

03/30/2006
Reassess

04/04/2007 NC Compl

308006 07-3

for Change

VALUATION 0 Site Description

22250 0 22250

22250 0 22250

445000 2444100 2889100

445000 3919000 4364000

445000 3919000 4364000

445000 3919000 4364000

445000 3919000 4364000

Topography: Public Street Utilities: or Road: Rating Soil ID Measured Acreage Table

LAND DATA AND CALCULATIONS
-or~orProd. Factor -Or150 Depth Factor E1'1'ectiITe -orSquare Feet Depth 1. 00

Neighborhood: Land Zoning: Legal Acres: 4.4500 1 Primary Type Land

Actual Frontage

Effective Frontage 4.4500

Base

Rate 100000.00

Adjusted Rate 100000.00

Extended Value 445000

Influence Factor

Value 445000

Commercial/lndust

DBA: LANTERN PARK NURSING & REHAB FACILITY NC06 60% COMPLETE NC07 COMPLETE PREV Previous info. from cards 1998 Annexed to CV ( $4,500 } - 0.07Ac Correct./SurITey ( - $170 02' Survey 44-63 4/16/02 PRMT: 05/11/06 #06-0153 NEvi COMM $6,250,000

Supplemental TRUE
TAX

Cards 445000

VALUe;

'l.'O'l'AI.

Supplemental Cards LAND VALUE

445000

0730351002

Property 2200 OAKDALE RD

Class:

412

IMPROVEMENT

DATA
Item Description

PHYSICAL
ROOFING

CHARACTERISTICS

Units

Cost

Total

WALLS
B

2

U

Frame Brick Metal Guard FRAMING
B

66.3

1 s Fr --Slab
1 2
U

@

21

FINISH UF SF FO

FD

HEATING AND AIR CONDITIONING B 1 2 U

(LCN:

lOO.OO}

SPECIAL
Description

FEATURES
Value
ID

SUMMARY
Use LAUNDRY Stry Hgt 0.00 Canst Type Grade 4 Year Canst 2006 Eff Year Cond 2006

OF IMPROVEMENTS
Base Rate 0.00 Features
N

Adj Rate

Size or Area

Computed Value

PhysObsolMarket Depr Depr Adj

% Camp 100

Value 102000

C

0.00

1200

o

a

SV

Data VANG

collector/Date

Appraiser/Date

Neighborhood Neigh 50017 AV

Supplemental Cards TOTAL IMPROVEMENT VALm;

102000

11/06/2007

5 12.9 41.7 54.00 o o SV Data VANG Collector/Date Appraiser/Date Neighborhood Neigh 50017 AV 11/06/2007 Supplemental Cards TOTAL IMPROVEMENT VALUE 3747600 .3 61.3 54.6 39.6 7 12.7 54.00J SPECIAL Description PAVING FENCECL MIse FEATURES Value SUMMARY 10 Use NURSHOME Stry Hgt 0.3 20.3 12.00 Const Type Grade Year Const 2006 Eff Year Cond 2006 OF IMPROVEMENTS Base Rate 0.0730351002 Property 2200 OAKDALE RD Class: 412 IMPROVEMENT PHYSICAL ROOFING Built-up DATA CHARACTERISTICS @!J §]§] 61.6 20.6 12.6 27 7 @V 49 5 36.6 B I'/ALLS 1 2 U Frame Brick Metal Guard FRAMING B FINISH UF 44339 44339 SF 0 0 FO 0 0 FO 0 1 2 U 27 7 44 23.7 1s ~~~ Fr Slab 1 Total HEATING AND AIR CONDITIONING B Heat PLUMBING 0 I 44339 2 0 Commercial ° 5 36.6 36.6 U 0 Residential Full Baths Half Baths Fixtures Extra TOTAL # TF # 66 TF 132 5 137 0 ~ 27 (LCN: 100.00 Features N Adj Rate Size or Area 42097 Computed Value Phys ObsolMarket Depr Depr Adj %- Comp 100 Value 3747600 oe o o 3 0.3 27 7 36.6 36.4 7 39.7 61.

00) SPECIAL Description FEATURES Value ID C SUMMARY Use LAUNDRY Stry Hgt 0.0730351002 Property 2200 OAKDALE RD Class: 412 IMPROVEMENT DATA Item Description PHYSICAL ROOFING CHARACTERISTICS Units Cost Total ~IALLS B Frame Brick Metal Guard FRAMING B FINISH UF SF FO FD 1 2 U 1 2 U 66.3 ~~- 1 s Fr Slab 21 @ HEATING AND AIR CONDITIONING B 1 2 U (LCM: 100.00 Feat~ ures N Adj Rate Size or Area Computed Value PhysObsolMarket Depr Depr Adj % Comp 100 Value 102000 0.00 Const Type Grade 4 Year Const 2006 Eff Year Cond 2006 4 OF IMPROVEMENTS Base Rate 0.00 1200 o a SV Data VANG Collector/Date 11/06/2007 Appraiser/Date Neighborhood Neigh 50017 AV Supplemental Cards TOTAL IMPROVEMENT VALUE 102000 .

Ramsay Thomas E. Dubuque Iowa City. Wi1liam R. This appeal relates solely to a requested change in classification from commercial to residential under Iowa Code Section 441.. Robert. 2011 Johnson County Johnson County Johnson County 913 S. Iowa Code Section 441. Jr. M. Talcott Eli za beth R. Greffenius Dennis D. Happe Scott M. Hall John S. Nwasike Christopher E. Herink Robert 1. if you have any questions relating to this request. Pawlosky Richard E. Koehn Stephen M. Watkins ]osoph A. Care Initiatives is not requesting an oral hearing on this matter because the request is based purely on this legal issue.21 (11). Harris B. Walz GaryM. Knutson Julie Johnson McLean RE: Property Tax Appeal for Care Initiatives Dear Members of the Board of Review: This letter is submitted on behalf of Care Initiatives. Crane Intellectual Property Kent A. Jr. Beverly Evans Margaret Van Houten Thomas E. The Evangelical Lutheran Good Samaritan Society v. Brown Denise R. Meyer Michele L Warnock Sarah E.r. La Suer Deborah M. Thomas A. Landwehr John C. Boatwright Thomas J. Care Initiatives fits squarely within this statutory provision and so is seeking residential classification. Henigan Debra Rectenbeugh Pettit Matthew E. Board of #1978250 DAVIS BROWN KOEHN SHORS & ROBERTS P. J.. Pursuant to this statutory provision. Mark D. Wittmack Courtney Srrutt Todd Kelly A. and (2) a copy of its IRS Form 990. Shere Stepbcn W. However. Morain Joseph M. Robert A. Freed Jason M. Carroll Bruce I. who is filing herewith a protest to the classification of its property. Care Initiatives' protest is also supported by an appellate court decision. Herink Emily E. Iowa Board of Review Assessor's Office Administration Building St. Wickham Christopher S.AW FIRM John D." 0 esser Jo Elten Whitney Becky S. Holz. Kulik Franil J. Carleton Frederici A. Suite 205 52240 Steven L. VanSickel Gene R. Jeoncs Sharon K Malheiro Kris Ho lub Tilley William A." K. Brennan william E. Harris Of Counsel Jeffrey A. Boker Donald J.21(11) provides that land and buildings that are used primarily for human habitation and are (l) owned and operated by organizations that have received tax exempt status under Section 501(c)(3) and (2) the rental income from the property is not taxed an unrelated business income. Wilson REPLY TO DES MorNES OFFrCE May 4. L)'l1" Boc< William P. Thamish Kent A. Stone Amy M. Care Initiatives provides the following information in support of its protest: (1) a copy of its 501(c)(3) determination letter from the Internal Revenue Service. Ross Jason M. J. which shows that Care Initiatives does not have any unrelated business income.C. please do not hesitate to contact me. Nelson David B. Stanberry Christopher P. Deters Nichole Miras Mordini Krystle L. Erickson Lori Torger. Gamble Michael G. James Robert W. Thompson David M.-= Stanley J.. Campa Sar. King Robert F. Miller Jodie Clark McDougal Jeffrey D.. Arthur Davis 1928·1997 . Ewoldt TaraZ. can be classified as residential for property tax purposes. Laughlin Judith R. Franklin Victoria P. Dixon Mark D. Houser Kendall R. Douglas.. Claron C. Salsbery Neal Smith William D. Pietila EmilyE. Long Charles N. Campbell Jonathan C. Jerde William 1. Kelly Susan J.

Iowa law allows the Care Initiatives property to be classified as residential property under Iowa Code 441. satisfied the statutory requirements of Iowa Code Section 441. the Department of Revenue issued Technical Bulletin 99-1 0-29( 1) which provides: "Further. DAVIS. they are not eligible for the residential classification. Care Initiatives does not file a Form 990-T.May 4.2d 482 (Iowa Ct. Thamish Enclosures . like the Care Initiatives property at issue here. please do not hesitate to contact me. 668 N. If the rental income is taxed as unrelated business income.21(11) and the holding by the Iowa Court of Appeals in The Evangelical Lutheran Good Samaritan Society v. As shown by the Form 990 produced herewith. BROWN. Board of Review of Montgomery County.W. 2004). KOEHN. all land and buildings owned and operated by 50 1(c)(3) organizations that are used primarily for human habitation shall be classed residential if the rental income from the property is not taxed as unrelated business income. In the Good Samaritan case. Finally. The Board of Review should change the classification of the Care Initiatives property from commercial to residential based on both the statutory provision and the Good Samaritan case.21(11). If I can provide any additional information. If the organization files a Form 990. Deborah M.T. App." The Technical Bulletin then provides that an assessor may look to whether the entity files an IRS Form 990-T.C. Care Initiatives requests that this classification change be made. the court found that even though a nursing home facility did not qualify for full tax exempt status.2011 Page 2 Review of Montgomery County. P. it was still entitled to be classified as a residential property because it. residential classification shall not apply. Sincerely. SHORS & ROBERTS.

INTERNAL REVENUE SERVICE DISTRICT DIRECTOR 1100 COMMERCE STREET D.ALLAS, TX 75242-0000
Date:

DEPARTMENT OF THE TREASURY

JUl 18 1SS6
iNC·~

Employer Identification Number:
·7E.-02S2402 Case Num1:ier: 75E.199000

W DES MOINES, IA 50256

::'915 VISTA

C/O MICHAEL MGDANIEL

CARE INITIATIVES;

Contact Persan~
ANNE:TTE sr'lITH

Conte.ct Telephone

Number ~

{214) 767-6023 Our'L2tt~r Daied: Addendum Ap~!ies:
No .March 31 1S89 .

Deal- Applicant; This modifies OUl- letter Qf the' above I:!.ate irl :~hich ~'lould be tn=ated as an organization tha.t is riot a. proivate e:~pind:.ian·of your advance Tuiing per i cd .

we

stated

foundation

that you until t he

Your s~smpt status under sect foil 50L (a.) 0';:' the Inter.i1E.l RevenuE[ode .as ail orgaFlizatic:m desqribed in sed ion 501 (c) (3) is sun in effect •. Based on the' inf.ormatii::m YOL-l._ su.bmit ted, we have deten111ned that yaw. are not- a private . fQI • .tndatioh ~·lithin t.he meaning of section 50S{,3.) t\f the Gode be~aU5e you are an ; org·anizaticn "of the type d,-::scribed .in section 509(.a)·{2l·. - Grantors and ccnt r Ibut or-s may relY on this det!3rminatibn unless the Internal 'Hevenue Service publishe=; notice to the·ccmt;-al-·i" However', .if you lase your section 509'(2,) (2) status·. a tn-ante. cr ccnt r Ibut.cr may nat n!,lY orr this detc:~l·minat ian if he or' she in "part resQor.)sib Ie- +er , or was ·.a~an; of ~ . t.he act or failure to act, or the SUbstantial 01- ma"t.En-ial .chariqe en the' pal-t of ... the 0l-ga'r1izat ion ttlat n~sl..\l ted in you:r less of siJ.~.h stab~s ~ if he: or she a.=q'..tlred kmlwledge that the. Illt5~l-nai Revenue Set-vice had given notice _that 'IOU woul·c( ri'o loog'!;lrbe .·cl.a.E·s1 fi'ed as' a· 'secll,oo :509~aHE")· ·orgat-1"iiaH.6h·.·.'

ItJas

0,-

,
,J

If ~<j.e have indicate# in the j-(eading·of this a.ppl~e~~t~e·addEndut1l·entlased is.·an integn~l·pa\-t Because this fO!..illdat ian :=;tatus

latlsH- thar an addendum of this letter.

l

letter could help resolve anv, qUEs·t·ions a~out 'your-?rl"Vate~~'lease ki'!~p it in your permanemt recol~d-s • contact the per-son whoSiit name and

. If you havs:'"any 'q·r..le·stions, please telephone number al~e snol.oJn abo.Vla.- .

'Bobby' E. Scott District Director

Lrt ter

1050 (DO/Cj3)

99-10-29 (#1) - LAND AND BUILDINGS OF 499A AND 501(C)(3)ORGANIZATIONS
Section 441.21 (11) of the Iowa Code states that "residential property" includes all land and buildings of multiple housing cooperatives organized under chapter 499A and includes land and buildings used primarily for human habitation which land and buildings are owned and operated by organizations that have received tax -exempt status under section 501 (c)(3) of the Internal Revenue Code and rental income from the property is not taxed as unrelated business income under section 422.33, subsection lA. Translation: AU land and buildings owned by multiple housing cooperatives organized under chapter 499A should be classed residential. Further, all land and buildings owned and operated by 50 1(c)(3) organizations that are used primarily for human habitation shall be classed residential if the rental income from the property is not taxed as unrelated business income. If the rental income is taxed as unrelated business income, residential classification shall not apply. How do you know if rental income is taxed as unrelated business income? According to IRS Publication 598, an exempt organization subject to the tax on unrelated business income must file Form 990- T, Exempt Organization Business Income Tax Return, with the Internal Revenue Service. Thus, if the organization files a Form 990- T, they are not eligible for the residential classification.

99-10-29 (#2) - CONDOMINIUMS
Iowa Administrative Code 71.1(4) and 71.1(5) Revenue {70l} reiterate the residential classification of property of 499 A and 501 (c)(3) organizations and also address the classification of condominiums. The rules state that regardless of the number of separate living quarters, condominiums not used as commercial ventures shall be considered residential real estate. The rules have been further amended to include the following: 71.1(4) Effective January 1,2000, property shall be classified as residential real estate if a majority of the condominiums are or will be used for residential purposes and have been sold, are available for sale, or are being rented, but the primary intent of the owner is to sell the units. For example, a building containing 25 condominiums of which 22 have been sold, are available for sale, or are being rented, but the primary intent of the owner is to sell the units, shall be classified as residential real estate. If more than one building is included in the horizontal property regime, the number of condominiums shall be combined to determine the majority use. 71.1(5) Effective January 1,2000, property shall be classified as commercial real estate if a majority of the condominiums are being used as a business or used for residential purposes and not sold, not available for sale, or are rented and the primary intent of the owner is to continue renting rather than sell the units. For example, a building containing 25 condominiums of which 22 are being used as businesses or used for residential purposes and not sold, not available for sale, or are rented and the primary intent of the owner is to continue renting rather than sell the units, is to be classified as commercial real estate. If more than one building is included in the

#1979018

horizontal property regime, the number of condominiums shall be combined to determine the majority use. House File 769, which amends Iowa Code section 499B.11 effective July 1, 1999, permits those condominiums included in a horizontal property regime for which a declaration was recorded prior to January 1, 1999, and which are or will be used for human habitation to be classified as residential real estate through the assessment year beginning January 1,2004. An interim committee was also established to study the issue of the classification and taxation of condominiums and to report any recommendations to the General Assembly by January 15, 2000.

. __ .•....567........ 515. __ cUrrent Year .... IA 50309-2354 (\cl.T. and 11e) .1llalnla...._7..... _••• T44 ......... and street (or p..... T4":1........-3) 14 6enefits paid to or for members (part IX. -••••• +~.450.....'992............... ....-45.558.. _ ........ .47.... _ . column (Al.......... ..742.......11 ~ (i...4 - =oyocI)..DiftheorgaqizationCllsCOlllil:lueditao~or:$posedOfrnore1han..retum to satisfy state reportfng requirements. ....... 90.. '1 /f........ OMS :::-~~ S Chod<1J ""pbblo: A For1be 2D09 calendar year or tax year beg!lVIing 0-.. 0 IL Year offormaJion: 19891 M StaIBoftegal domicile: TX " 0:: CD <I> j cd m <I> E......•... _ . '" '-.. .. 714~ ~ 1""5"3 . Total fundralslng expenses (Part IX.... 12 Total ravenu~·adt! linas8through 11 (must eouaJPartVill. ...... 111·240 •..• 90'1 z... -... .....385'.... ~ .... ••• ...... rilles ..... employee benefits (part 1X..•_...' 7..._ ....._ .. n ••••••• •••••• ~ _------------ Y'O_ ••••••••• ...... 146'....... or 4947(aHll 2009 '.. - 18 from line 12 ..~onaD_~ ~ BloC.. ~O?... Other expenses (Part IX.297...... and 7d) .. _.. fine 11e) .... 629...153.. nu.' attach a list.G.......•... -----_.......... column (A).~ 14............3 ... No..d Beginning of Current Year 179 .... II>- of the Internal Revenue Code (except black lung benefit trustor private foundation) Th~ IlI9l!nization may. (see instruCtions)" . 11 other revenue (Part VIII.... other compensation....... column (A). column (Al..... theseparate~. . 5 6 Total numbet of volunteers (estimate if necessEIIY)......... columo (11.} L J 4947fal(11 or l ]"527 I Tax-exempt status: l.... _....8 ...... fines 11a·11d... " Professional fundraising fees (part IX. .~. column (A)... STE 640 DES MOINES... _........... ~ ~=s ~ ~~ 0018 ~ MIKE MCDANIELi lypeorPTInEnameanijm~ SR VP/c:I!O ...MILESKING C ABOVE DES MOINES......535.... ~8..... ~'Dl~~~ .... ~_ . 22 Net assets orfund balances. ~611 WEST LAKES PKWY WEST ortown."47....n. 'II 3 3 Numberot voting members of the goVerning body {part VI..llnes 3.boX II>..._9_:II_tIIos....lo<Ig&aodbolief. _ . .···DyeS [XJNo for affiliates? ... 883................ Gne34 ....line 1b) .•...:558-66.......... 29.. one 2a} _...416... t:Jv:*aJl ~~ IRS discuss this ~ with the PTeParBl'shown above? (sea instructions} 9:!200102--04-1O lHA ForPI'ivKVActandPap~ReductI.... column (C)...... 9 Program SBlVice revenue (Part VOI.... _.....4J. ~".... .......-5"54• Total exPenSes.....:' .. .. _ 145... 15 Salaries.• £nd of Year . ... 982 f.•.... .. H(a) Is this a group retUm ............... ... . '. column (A)... _.."4-8-8'....+ •••• ~...tine 2g) 2... mission or most slgnfflcant activities: ~'l'ABLE a 45 ..... 10 Investment income (Pan VIII.... _.... . u ..-471. :4... . .... 99.."b.... ·.u .. line 12 7a 7b b NetUl1related business taxable income from Form99Q. ~ ........... ". l<Ibboatcf"'l'Io:tI ...•. '..' ......... 26. ine 4) _ ............•....... ~............H(b] Are aRaffiliates iIlCIUded?DVes No If 'No.... 1lnes5........ szr..44·2 ....."...v Lf ~j~"'.............r_d&8.1......-........ 6(f.. _... 2 NURSING BOMES.......... ~. .. ·FOnn99()(2009} . ~ ..... 7·:il1..._..... 145 ~....~ r~~l I~II tift) employed em .......: .. ine 1a} 4 4 Numberof independent voting members of the goVerning body (parlVl........~. ana ZIP + 4 .... .....~ n...... .....903...""01J2"...._-_ .....co~ __ ~h. ORG K Form 01 organizalkln: LXJ Corporation L J l'rust t J Association L J Olllerll>1 9riefty describe the olgBnizalion's SAME AS 50266-8212 address of principal officer. ~Signature Undu __ ~~__~.. '.. o~ "~ Stibbac:t line ...........~85...• 146 ~515 . ~~ ..0041 C Name of organization • and ending o EmplQyer"idenlification llumbeI' PRE Number City INITIATIVES..........' ..24""1 .•..~' Here hid Preparel'c I Use Only '"'''''H'''' <J" Z9.9""3T........ rme 25) . __......... SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION· . INC • Doln!! Buslness As . Oltial turn D!l::l'1n~IHI ~. INC....' .... -. F Name and l'Pi...... 147. column (A)... 515-224~4442 ..-b1""2 •-Z-ZIT • -178.......... CAREDUTIATlVES....•..... -SlL""5"77'..have to use a copy of thiS....... line 12\ ... .....••.............197.: NON-PROFIT.."1:132....... _. ~ ..' '. ~.. INDEPENDENT' LIVING . .... ~. .. .._ ~....QI:! ... tina 25) . l!I$ primCl tjIpB... 1545.. u .. ~nsel'tl1O. ' .)...107. ~_ . Sp-oc:ifie D~ PIII\dlftII _ .. Add nneS 13-17 (must equal Part IX........... 6'·2..... _...k oIpotjory.. _. 8 ContnDutiI)AS aild gmnts (Part VIII.255.00...o..... 54....• ....... bDX if mati is not derNered to street address) Roomlsuite state I 76-0262402 E Telephone number G --pts$ .8...... Prior Year ITl". H{c} Grouo examotlon number .....•.. 40 0 LOCUST ST....37 ':..._· .ass_ets.... 0·...........370..•••_.... .802"..' .XJ 501 Ce} ( 3 J Website: ..••• ~ . Plloneno ... .14 __ I __ od_fIlU!JI....... J......• 6:~7..... 6 7a Total gross unrelated business ravenue from Part VUI..' '._... fine 16} 21 Tcrtalliabilitles (Part X..onActNotiee.l.....Return of Organization Exempt From Income Tax Under section 501(c)...... Sc....... 8 ASSISTED LIVING FACILITIES. 16a b 17 18 19 82 .. " ......708..... _ ..!tt It Summary ...... ~•••••• u~ .... lines 5-10) .............. _ ... ps..IXJ"yes ·1 'JRO ~ ....... _ ...... ~ 62..... column (D).. column 00. . .... IA or counby.25%-of1tsne ................ 4. 5 Total number of employees (Part V.. Una25) . 1Oc... ... _ ....go O:=....... .. 246. 805 ..........157... Chec::k1his. '. ~ ...... " ReVenue less exnonses......see !l::l!!Xthe HCGLADR1iIY.......... 9 ~-----."" ~ """ IP~nn Sign 20 total aaaels (part X........ 9b..:'..... _ ••••••• __ . -= CD ~ < 0:: ! !'l £ ... 13 Grants and sllTlllar amounts paid (part IX....: ..760w 881..........--..... line 1h) 143.). .. Subtract rille 21"from line 20 ...

000 WAS CONTRIBUTED TO ALZHEIMER'S ASSOCIATION. IN 2009.. $ 134 ... Describe the exempt purpose achievements for each of the organization's three largest program services by expenses. (Descl1be in Schedule 0..QUAL.O..I. or make significant changes in how it conducts.. TO SUPPORT CHARITABLE AND BENEVOLENT CAUSES. ) 4b DURING 2009 CARE PROVIDED SERVICl. 00 No If 'Yes.... INF~RM AND FI~ANCIALLY LIMITED INDIVIDUALS WITH A COMEORTABLE. . THERE WERE 24 WALKS. 76-0262402 Page 2 Briefly describe the organization's mission: SEE SCHEDULE 0 FOR CONTINUATION TO PROVIPE FOR THE HEALTH AND CONVALESCENT CARE OF THE ELDERLY IN LOCAL COMMUNITIES THROUGH PL'EASANT.. CARE IS THE STATEWIDE PRESENTING SPONSOR FOR THE ALZHEIMER'S MEMORY WALKS. GENERATING $951. OF THIS $100..654 • 2 } (Revenue $ Form 990 (2009) .m~a._AT.760 IN CHARITABLE CONTRIBUT~ONS WERE MADE TO SUPPORT CHARITABLE ORGANIZATIONS THAT FURTHER CARE'S EXEMPT MISSION. if any.611.. $147.ITYHEALTH . ASSISTANCE WITH PERSONAL HYGIENE WHERE ~EDED. CARE P~OVIDED RESIDENTS WHICH ARE COMPRISED OF ELDERLY. ) (Revenue $ ...tpl Statement 1 For'm990 (2'009) of Program Service Accomplishments CARE INITIATIVES.000 IN CONTRIBUTIONS TO THE ALZHEIMER'S ASSOCIATION. 8 ASSISTED LIVING FACILITIES AND 4 INDEPENDENT LIVING FACILITIES..!:S 2.HIGH . any program services?..PHERE.. SERVICES PROVIDED INCLUDE ROOM AND BOARD.MQS.. INC. 4a (Code: ) (Expenses $ 134.437.. HOME.. includinggrantsof$ SEE SCHEDULE 0 FOR CONTINUATION(S) )(Revenue$ 145. SECURE AND HOMELIKE HEALTH CARE FACILITIES STAFFED BY PROFESSIONALLY TRAINED AND CARING P·ERSONNEL. inCluding grants of $ 147. ADDITIONAL SERVICES INCLUDE OCCUPATIONAL.t:r. . for each program service reported. I 4c (Code:' ) (Expenses $ including grants of $ ) (Revenue $ 4d 4e Other program servicee.76 CARE IS AN IOWA LEADER IN DIRECT CONTRIBUTIONS TO THE COMMUNITY.." describe these changes on Schedule O. WHICH IMPROVE THE QUALITY Did the organization undertake any significant program services during the year which were not listed on the priorFonn 990 or 990·EZ? If 'Yes. .to report the amount of grants and allocations to others.· CLEAN.L. PHYSICAL AND SOCIAL ACTIVITIES TO MAINTAIN THE HIGHEST PHYSICAL AND MENTAL QUALITY OF LIFE AT~AINABLE.:l.. PROVISION FOR DIETARY REQUIREMENTS. the total expenses.292 . CARE.KE.144. [X]Yes DYes DNo' 2 3 4 Did the organization cease conducting.685 RESIDENTS OPERl':iTINGIN 44 TO IOWA NURSING HOMES.' describe these new services on Schedule O. FREE OF AS MANY RESTRAINTS AND PSYCHOTROPIC MEDICATIONS AS IS PRUDENT FOR THEIR SAFETY AND THE SAFETY OF OTHER RESIDENTS AT THE LOWEST POSSIBLE COST.. (Code: ) (Expenses $ 147 ... IN 2009. CARE ALSO PROVIDED HOSPICE CARE THROUGH 6 HOSPICE AGENCIES LOCATED THROUGHOUT IOWA.894.) (Expenses $ including grants of $ Total program service expenses . and revenue. Section 501 (c)(3) and 501 (c)(4) organizations and section 4947(a}(1) trusts are required ...76 O..

................•. or historic structures? collections of worl<$ of If ·Yes....... 14b 148 Did the organization b Did the organization and program 15 service have aggregate or expenses of more than $10...•. VII..... or other similar assets? X X X X .. a related organization. • complete Schedule D.... activities? subject 4 5 Section Section reporting 501(c){3) 501{c)(4)... independent under AN 48? If 'Yes... Part funds or any similar funds in such funds including (If ...••.. Part 11 '" to the section 6033(e) _ and 501(c)(6) any donor organizations........ VIII.. _. .... ........... line 9a1 If "Yes.. Part I organizations..' complete Schedule C.•..•... Schedule fl. independent audited financial statements 12A Was the organization If 'Yes. Part X auorted financial for the tax year? If ·Yes. included in consolidated.••...••. or quasi-endowments? c.. equipment in Part X...... line 12 that is 5% or more of its total in Part X.•...•.. XII....Parts XI......." complete Schedule E of the United States? from grantmaking......•.••••••••••••..••••.•... fine • • 16? If "Yes..._.. Parts VI.. • complete far the tax year? 12 0....... • complete PartVl. Part 11/ •.......... historical If 'Yes......• comptete Schedule F....'J INC...' 13 Is the organization completing Schedule D. employees............. • complete Schedule C...•_ .... Part V __ Is the organization's answer to any of the'foUoWing _ questions _ _ ....•....... Part I _ _. Parts XI....• _....•........... _... line 25? If ''res....•....000 total of fundraising event gross income and contributions on Part VlU... ..... Part I "_' ...••.... If "res.. B....... "...... Is the organization notice and requirement advice and proxy tax? If 'Yes..•...000 Schedule F. line 3.....•••• 1---"5'-1----'-ir-6 7 8 6 7 Did the organization provide Did the organization ltle environment......... column to individuals the United States? If "Yes.....•..' complete Schedule D.. Part VJIl..•. or provide or debt negotiation services? If "Yes. .... or indirect on behalf of or in opposition If "Yes.... .. Did the organization report more than $15.....000 of aggregate af expenses for profeSSional _.......... Part II (A).. complete Schedule D. • complete Schedule D......._. report an amount report... to candidates _ for . :... _ _.......... on Part VIII... 17 18 (A).... an amount for land. _ business.. . Of X as app/ioable • Did the organization report :..... line 21..... IX........................... Schedule H 9320~3 02-04-10 3 ....._ 2 3 required engage to complete in direct Schedule _..•. permanent.Part lI treasures...· complete Schedule D.•.. • complete Schedule D..•... Part VJJ....... Part til the _ _ _ _..•. _ _................ - "Yes"? If so........••....... nne 161 If 'Yes...' ...•...•... _ .. Did the organization engage "'""_ in lobbying .' complete Schedule F.' complete Schedule A ...000 __ _ of gross income from gaming activities _ . If "Yes... column States? (A)... hald assets in term. line 13 that is 5% or more of its tota! reported in in Part X....... buildings.... Part X statements for the tax year include statements a footnote that addresses or consolidated fiabifrty for Uncertain tax positions obtain separate........ line 16? If "Yes. and XIII is optional a school maintain activities report on described in section revenues 170(b)(1)(A)(lI)? or agents States? an office... 15 X X X X X Did the organization located outside report on Part IX. outside the United outside __. lines 6 and 11 e? If 'Yes......... • complete Schedule D..... Part IV 9 10 Did the organization.ather securities in Part X..•............... Part for other assets IX financial in Part X...•••••• fundraising services _. line 3... _ _. and for investments ""'" ...... Part II 19 Did the organization report more than $15..•. 501(c)(5)... Schedule D. • complete Schedule G.. _ Did the organization report an amount in Part X.. • complete _... • complete open space.....000 If ·Yes..._ •........•.X maintain art........ an amount separate • Did the organization Part X.. Part I of grants or assistance to any organization X .. " la complete SchedUle G.. line 15 that is 5% or more of its total assets Did the organization Did the orgaflization's the organization's Did the organization Schedule for other liab~ities in Part X. Xli. and XJU....". fine 10? If "Yes....' maintain complete SChedule C......••••. Part 1/1 ••.......• Did the organizatian assets • reported report an amount ... /f 'Yes.. "camp/ete more than $5..000 IX....•• __. debt management.•.. lines 1c and Sa? If • Yes...... Schedule D.. __ _ . grants or assistance _ _.•... .... Schedule of Contn"butors? activities political campaign _ _..... on Part 16 17 Did the organizatioo column report a total of more than $15.•.........' complete Schedfl/e D. It ·Yes...... ....... or entity located 16 outside the United If •Yes......•... X or hold a conservation easements to preserve a 9 10 11 historic land areas.... Did the organization advised or accounts or accounts? where donors have the right to on the distnbution receive or investment of amounts easement...•••••••••...... 76-0262402 1 Is the organization Is the organization Did the organization public office? descnbed in section 501(c}(3) or 4947(a)(1) (other than a private foundation)? If "Yes. serve as a custodian credit counseling..• complete Schedule D........•..•.•. report Did the organization assets reported an amount for investments· program related in Part X.•••••••••••••. complete Schedule G.•••••••••••••• _•••••• _•...... _ . _ _...... _..... Did the organization Part IX... _....... _ _ """ fundraising. directly or through credit repair. more than $5. _ for amounts nat listed in Part X..

in Schedule 0 for Part VI. director. or direct or indirect owner? If 'Yes..... 2002? If 'Yes.... e Did the organization maintain an escrow account other than a refunding escrow at any time during the year to detease 24a 24b 24c 24d 25a X X X X X anytax·exempt bonds? d Did the organization act as an "on behalf of' issuer for bonds outstanding at any time during the year? 25a Section 501(c)(3) and 501(c)(4) organizations......... trustee.........l:Ialified person outstanding contributor........::~ ::' ~~. directors... Did the organization engage in an excess benefit transaction disqualified person during the year? If 'Yes. .....•.......... If "No".. " C<)mpiete fjlchedule L........ • complete 29 30 31 32 33 Schedule L... PartJ under RegUlations 33 34 34 35 36 37 38 If "Yes..... or key employee of the organization an officer.......•.... of art..•••..•.....000 of grants and other assistance to individuals column (A).. that was issued after December 31. rme 1? If "Yes............ . trustees. ill.. and highest compensated employees? If "res... have a tax-exempt bond' issue with an outstanding .. line 2 .... highly compef'\sated· employee. or qualified conservation 30 31 If 'Yes........... cclumn (A)..•..7701·2 and 301.•... a A current or former officer........... ........000 in non-cash oontributions? Did the organization receiva contributions contributions? If 'Yes..•••• 22 21 Page 4 Yes No report more than $5........ • answer lines 24b through Schedule K. Part /I "... Did the organization answer "Yes" to Part VII.....:' ~......• .....•. b Is the organization aware that it engaged in an excess benefit transaction with a disqualified that the transaction Schedule ~...•. with one of the following parties..... and has not been reported on any of the organization's prior Forms 990 or 990·EZ? If ·Yes.•••••..... ......... trustee.... • complete Schedule N... .............. " complete Schedule I.... Part V. " complete c An entity of which a current or former officer. or transfer more than 25% of its net assets?/f SchedUle N.. .. director. (see Schedule L............... 76-0262402 and organizations in the .................•.........•..••.. in the United States on Part IX.•• .... ' complete Schedule R......•.•...•... or other similar assets....... Zl 28 Was the organization a party to' a business transaction instructions for applicable fiUng thresholds. Did the organization own 10()Dh of an entity disregarded as separate from the organization sections 301.. 'Yes.•..... Part IV (or a family rnerncen was 28b 28c 29 ........ "complete Schedule M Did the organization liquidate. or to a person related to such an individual? /f "Yes. Parts J eaa 1/ X X Did the organi:.•.....•.. Dne 1 :..................•...•..... dispose of..... Part I ........000 of grants and other assistance to governments Schedule J.... 4..•.. Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If 'Yes.." complete Schedule R.. principal amount of more than $1 00. exchange... 932004 02-Q4-10 4 . line 2 Section 501(c)(3} organi~tions..•...... and exceptions): !..... key employee...... ..... Part VI.. .......... historical treasures... ....••...... 25b 26 X X as of the end of the organization's tax year? If 'Yes.............. . line 2? If ·Yes.. •.. ·key employee. Schedu/eL..•....•..... or dissolve and cease operations? If "Yes.......... Is any related organization a controlled entity within the meaning of section S12(b}(13)? If 'Yes..... Part Ii" Did the organization provide a grant or other assistance to an officer.. trustee. terminate....•..•..•..... go to line 25 b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . director.•." complete Schedule L......•..·:..... ' complete ·26 27 L....000 as of the 24d and C<)mpJete X last day of the year...•.•......•.• with a person in a prior year. director........• ••........ trustee.. III.... lines 11 and 197 •................7701-3? If 'Yes. X X X b A family member of a current or former officer............. oonditiohs... substantial or a grant selection committee member............•........ or 5 about compensation of the organization's current and former officers....••••• •••••• •••••••• ••.. 36 37 38 Form Schedule R.. trustee.•.....•........ key employees. •..... Did the organization If ·Yes.... Part I ....... or dise.. Part i . Parts II..... complete Fo~ 990 (2009) "........ .. •... " complete Part IV ........ director..... Section A........... or key employee? If 'Yes... and 11................. x: X 990 (2009) Did the organization complete Schedule 0 and provide explanations Note. All Form 990 tilers are required to complete Schedule O.. or key employee? If ·Yes..• Was'a' loan to or-by a current or-former officer.. Part IV Schedule I..•... Schedule X X X X X X X X X Did the organization receive more than $25.... Parts I and 11/ ••••...... _..............•. ~~~L:.. Part V..... One 3.•.... trustee..............·d 28a ... " complete 23 243 J Did the organization Schedule _............... director.. " complete M ........ Did the organization sell..... ..... • complete Schedule R.• complete 35 make any transfers to an exempt non-charitable related organization? ..:ation report more than $5..... ~~~j!!511!~ Checklist of Required Schedules (continued) 21 22 23 Did the organization United States on Part IX....' CARE INITIATIVES I INC.. " complete Part III .. Part IV Schedule L................•....... ••••••••.•..........•.." complete 32 . ' complete Schedule Was the organization related to any tax-exempt or taxable entity? R.........

•...000 or... did the organization file Fonn BBBS·T.•.. directly or indirectly... ....... provided to the Pay<Jr? .' to line 5a or 5b. fine 12........• """" ............ line 12 b Gross receipts..~ ...•.......•.lnfonnation Returns. boats........ TURKS/CAl CDS ISL.. or a signature or other authority over.... .. did the organization have an interest in...... a financ!al account in a forelgn country (such as a bank account....... '1f!... ........... _ ...................·'·'".. Enter ·0·if not applicable ...... a Did the organization make any taxable Ol$tnbutions under section 4966? ....•........... did the organization file all required federal employment 107 LL'"-·'·.. ~I. or a donor advised fund maintained by a sponsoring organization.. exchange.....•.......... ......•...... (see instructions) 3a Did the organization have unrelated business gross income of $1 . for public use of club faci~ties 11 Section 501(0)(12) organizations. or otherwise dispose of tangible personal property for which it was required ........... ... during the year.....!.......... 5a Was the organization a party to a prOhibited tax shelter transaction at any time during the tax year? b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? c If 'Yes. Enter: a Initiation fees and capital contributions included on Part VIII. Organizations that may receive deductible contributions under section 170(c).. included on Form 990..•..•........•.... and did the .?:: .. donor advisor...e~rganjzati()FIf!le a Form 1098:Casrequired? .......if not applicable ....................... securities account....•.•.....•.../........ Section 4947(a}{1) non-exempt charitable trusts..........did tt-. ~~h~r--.' did the organ~ion 7 include with every solicitation an express statement that such contributions or gifts were not tax deductible? ................. have excess business holdings 9 at any time during the year? SpollSOl'"ing organi~tions maintaining donor advised funds.000.the organization notify the donor of the value of the goods or services provided? c Did the organization sell.............. Did the supporting organization..•....... 2a Enter the number of employees reported on Form W·3........more during the year covered by this return? b If "Yes: has it filed a Form 990·T for this yea(11f "No..Form 990 76-0262402 1a Enter the number reported in Box 3 of Form 1096... 9 For all contributions of qualified intellectual property....•. pay premiums. If the sum of fines 1a and 2a is greater than 250..........................."" .. an(j ()tlle~ vehic....... directly or indirectly....•............... to file Form 8282? d If 'Yes: indicate the number of Forms 8282 filed during the year ... 473 . or other financial account)? b If ·Yes: enter the name of the foreig~ country: . b Enter the number of Forms W·2G included in line 1a...... receive any funds..... c Did the organization comply with backup Withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ...1.......... 6a x a Did the Organization receive a payment in excess of $75 made pa-:tly as a contribution and partly for goods and services ..organization solicit any contributions that were not tax deductible? b If 'Yes.•...... to pay premiums on a personal f benefit contract? _ Did the organization......... filed for the calendar year ending with or within the year covered by this return b If at least one is reported on line2a.................. Jil..?'!: ..........•.•...... Enter: a Gross...•.......... e Did the organ~ion.............. ..•.:les.?'!: ...•.... b Gross income from other sources (Do not net amounts due or paid to other sources against '1f!.... on a personal benefit contract? ... or related person? 10 Section 501(c}(7) organizations....... Financial Accounts.... b Did the organization make a distribution to a donor.......~..•................. Ji/..incomefrom members or shareholders . tax returns? Note. amounts due or receivetl from them.' did.. Disclosure by Tax·Exempt Entity Regarding Prohibited Tax Shelter·TransactioFl? 6a Does the organization have annual gross receipts that are normally greater than $100......•......... . airplanes. 8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations.......... .......• b If 'Yes.......... 5c x See the instructions for exceptions and filing requirements for Form TO F 90-22... ......." provide an explanatidn in Schedule 0 4a At any time during the calendar year..... you may be required to e-file this return......•. Enter -0.••.. ...••.. ...) """' ....... ..... Part Vln.............•..•...... did the organization file Form 8899 as required? h For contnbutlons of cars.. during the year. Annual Summary and Transmittal of U-S.......... Transmittal of Wage and Tax Statements..... Report of Foreign Bank and ------~~--------------~----------------.......... Is the organ~ion finng Form 990 in lieu of 932005 02-04-10 5 ..................

Check all that apply.. 17 18 Ust the states with which a copy afthis Fonn 990 is required to be filed Section 6104 requires an organization to make its Fonns 1023 (or 1024 if applicable).: Did the organization make any significant changes to its organizational documents since the prior Form 990 was filed? Did the organization become aware during the year of a material di'lersion of the organization's assets? .' does the organizatfon have written policies and procedures governing the activities of SUch chapters. Management. how).515-224~4442 1611 WEST LaKESPKWY.. or key employee? Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers. and taken steps to safeguard the organization's . Form 990 (2009) ab..-t--I-::.: .. director. used by the organization to review this Form 990. [XJ OWn website 19 20 0 Another's website [Xl Upon request makes its governing documents. affiBates. directors or trustees. or changes in Schedule O.. 12a Does the organization have a written conflict of interest policy? If 'No.. or affiliates? "" ~ b If -Yes. -----. ~ •••• -. ' describe ----. . 5 6 Does the organgation have members or stockholders? : 7a Does the organization hava members. and Disclosure CARE INITIATIVES. contnbute assets to. or key employee listed in Part VII. or top management official bOther officers-or key employees of the organization If 'Yes' to fine 15a or 15b.~_. MIKE MCDANIEL . 16a Did the organization invest in. . 2 Did any officer. if any. WEST DES MOINES. processes.. . or other persons? 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? b Each committee with authority to act on behalf of the governing body? 9 Is there any officer. and key employees required to disclose annually interests that could give rise to conflicts? in Schedule 0 how this is done 13 14 15 •• ~~ •••••••• ~ _ ••• . . Executive Director. who cannot be reached at the . and 990-T {501 (c)(3)s only) available for public inspection.. .. or partiCipate in a joint venture or Similar arrangement with a taxable entity dvring the year? b If ·Yes.. -.· has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in pint venture arrangements under applicable federal tax law. describe the process in Schedule O. (See instructions. Section A. .. and financial _ Describe in Schedule 0 whether (and If so. 990. G to line Ba.~_. describe the circumstances. See instructions. LA state the name. branches. and telephone number of the person who possesses the books and records of the organization: ~ 50266-8212 Form990 (2009) 932006 02·D<!-10 6 .. and fora 'No" response or 10b below. 76-0262402 Page 6 1a Enter the number of voting members of-the governing body : . or key employees to a management company or other person? .~{~Movernance. For each •Yes" response toUnes 2 through 7b below.) . Indicate how you make these available. e Does the organization regularly and consistently monitor and enforce compliance with the poflcy? If 'Yes. trustee.. . directors or trustees. trustee. .b Are any decisions of the governing body subject to approval by members. __ ••• __ "_ •• -. 'I---'::. conflict of interest 'poficy.. . trustee. .•••• _ " ~ "" . b Enterthe number of voting members that are independent '" . director.. 10a Does the organization have local chapters. -. Does the organiZation have a written document retention and destruction policy? Did the process for determining compensation of the following persons include a review and approval by independent persons. . or key employee have a family relationship or a business relationship with any other 3 4 officer. •••• ro •• .. • go to line 13 b Are officers. physical address. comparabilfty data.l. INC.~.. 11A Describe in Schedule 0 the process._ •• • _ Does the organization have a written whistleblower policY? : __ .. stockholders.b\i. . 11 and branches to ensure their operations are consistent with those of the organization? Has the qrganiZation provided a copy of this Form 990 to all members of its governing body before' filing the form? " . the organ~tion statements available to the public. ". stockholders... director. . __ . and contemporaneous substantiation of the deliberation and decision? : a The organization's CEO. or other persons who may elect one or more members of the governing body? .

174. ·from the organization (W·2I1099·MI$C) .783. 274. 7 Form 990 (2009) . 9.0·0 40. Enter ·0·in columns (0). institutional and fonner such persons. 9.420.466.00 40. trustees. more than $10. and Highest Compensated Employees CARE INITIATIVES 1 INC.. or trustee.00 X 4.141. O.694. IS (A) NameandTttle (8) Average hoUl'S per week (C) Position (check all that apply) [E} Reportable compensation from related organizatlor. See instructions for definition of "key employee. 28.=0 j =.200. Use Schedule J·2 if additional space is needed. O.056. O.. 28. 411. ~ ~ .00 40. 170. • Ust all of the organization's former officers.000 of reportable compensation from the organization and any List persons in the following order. 159.021256.00 40. officers. O.00 X 3. O.. related organizations. 18. Trustees.000 from the organization and any related organizations.00 X . O. • Ust all of the organization's current key employees.s (W·211099·MISC) (F) Estimated amount of Reportable compensation .217. (O) o Check t hl box if the organl4ation di d not compensa te an curren t 0ffireer.195. Directors. o. Report compensation for the calendar year ending with or within the organization's tax year. individual trustees or directors.tt~F:".. Key Employees.672. 76-0262402 Page 7 1a Complete this table for all persons required to be listed.00 40. 5.202.' • List the organization's five current highest compensated employees (other than an officer. and highest reportable compensation from the organization and any related organizatiollS. O.00 40. 28 200. Trustees. 19.200.662. trustees (whether individuals or organizations). (E).200. and ·Independent Contractors Officers. 163. O. ". 591.. O. Form 990 (2009) of Officers. O.·00 X 40. ~. highest compensated employees. O. and (F) if no compensation was paid. 188. or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Fonm 1099-M1SC) of more than $1 00. O.00 X 40. S< RON NORTHUP DIRECTOR KENT KAPLAN DIRECTOR RICHARD THORNTON DIRECTOR RONALD HARMOND DIRECTOR JOHN K •.412.00 40. • list all of the organization's farmer directars or trustees that received. regardless of amount of compensation.593.00 X 4. compensated employees who received more than $100.783. • Ust all of the organization's current officers.000 of in the capacity as a former director or trustee of the organization. key employees. 23.SMITH DIRECTOR MILES KING P~ESIDENT/CEO HULON WALKER DIRECTOR/FORMER PRES/CEO MIKE MCDANIEL SR VP/CFO ROBERT CONLON VP/DIR OF OPERATIONS ROBERT HAYDEN VP DIR OF MEDICARE CHARLEEN SCHLEPP VPDIR OF QUALITY DAVID nIXON DIRECTOR OF FINANCE JERAMY KUHN COMPLIANCE OFFICER WILLIAM HAVEKOST VP/DIR OF HOSPICE LANNY "" ~E! 5. O. ~ "". 29. O. Directors.(il other compensation from the organization and related organizations ~ ~ . Key Employees. 4:. director.200. 28.¥ltlCompensation Section A.00 X X X X O. 28. d'irector.§l i a _t ~~ . !.200. trustee.. key employees. 21.924.00 X 4. directors. 1 o.5! "2 .575. O. 21. 28. . x X X X DIVISIONAL WARD DIRECTOR o. X O..394. Highest Compensated Employees. O.

.... CARE J... . director or trustee.000 .· IA} Name and title IB) Average hours per week IF) Estimated amount of other compensation ..... 207 702.. in reportable U 157 581. 929. Did any person listed on nne 1a receive or accrue compensation from any unrelated organi:z:ationfor services rendered to the orQani:z:ation? "Yes.000 3 4 5 Did the organi2:atlon fist any former officer. 5 X Section 8. 2 0:59. or highest compensated employee on line 1a? If "Yes.and Highest ...." complete Schedule J for such individual : :....... ~~ 4 ~ X ~~ ~:N~i~ ~l~~~ . 932006 02·04-10 8 ... nffi........ ..... Trustees...0001 If • Yes.2f1 099·MISe) (E) Reportable compensation from related organizations (W·211099-MISC) PageS ... INC. Form 990 6(009) Section A.·. key employee. 27 Yes No Total number of individuals Qncluding but not limited to those fisted above) who received more than $100.• complete Schedu/eJ for sucn p6fS()n If ........ from the organization and related organizations Position (check all that apply) ~ ! i I~t ~ j 1b Total 2 compensation from the oraani2:ation . • complete Schedule J for such indMduaJ For any individual listed on line 1a..1·IATIVES. ... Key ... {e} Ie.829.. lndependent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100..... 176 980.~J.. is the sum of reportable compensation and other compensation from the organi:z:ation and related organi:z:ations greater than $150... the (A) Name and business address' fB) Description of services (C) Compen'sation of compensation from 526.. 76-0262402 (0) Reportable corrpensatlon from the organi:z:ation (W..

....:.... ".:..... less returns and allowances Less: cost of goods sold _...:::f=""""===.. 9 ... 6 a Gross Rents c Rental income or (loss) b Less:rental expenses ....~::.... r=....... .•.•..:.•..*~.....wi.INC..:..•.....•. and similar amounts not included above e d NURSING HOME SERVICES ASSISTED LIVING SERVIC PHARMACY SERVICES HOSPICE SERVICES LIVING e INDEPENDENT f All other program service revenue ....•. 8 a Gross income from fund raising events (not including $ Part IV..•.. Total revellue..•.:..........~_...... .... d Net rental income or ~oss) 7 a Gross amount from sales of assets other than inventOly b Less: cost or other basis and sales expenses .. ....•....... c Fundraising events ...........•.............:....:..... Add lines 11a-11d 12 02-04-10 ".•.... r::.... grants.......0"'=~="'""".._~+s...••...._" ........ Seeinstructions. 3 4 5 Royalties .. line 18 b Less: direct expenses C r===. b Less: direct expenses C Net income or (loss) r----L_ from gaming activities ...::====T=~...•...:__=--+ 31_ _ 10 a Gross sales of inventory.. ..........•_.. fine 19 ."tli~~~~t:)jlQ~t...= c Gain or Ooss) ...•...... interest...... See Net income or (loss) from fundi'aising events Gross income from gaming activities.. _ ... ..•........•..... (A) Total revenue (B) Related or exempt function 76-0262402 (C) Unrelated 9 b Membership dues ~ ..... and other similar amounts} . b 1-- c d Atl other revenue e Total.. See a b 9a Part IV. d Net gain or (loss) ......c~i7i~it....:==..•..:........ Investment income Qncluding dividends.•... gifts...• : d' Related organizations e Government grants (contributions) f All other conlrlbufions....~ of a 1-----b L_ contnbutions reported on fine 1c).....:::..

Chea<here..-:''''''-+-------n ... All other organ~tions must complete column (A) but are not requir-ed to complete columns (8).:..:...•. to disqualified persons (as defined under section 4958(1)(1» and persons described in section 4958(c)(3)(B) ..!.....:_.~. Ex:pehses INC.:..::.~~.i~F-=+--__. linea 15 and 16 .H-------........rstatemeritof Functional 1 2 3 Fo'rm 990 (2009) CARE INITIATIVES.-rrll---:.....0..:4:...."...:.•..... Grants and other assistance to individuals in the U...."..!.•.""'-+-.. 76-0262402 Page10 Section 501(c)(3) and 501(c)(4) organizations must complete all columns.. 26 Joint costs. See Part IV... line 21 •...IT-T....) . Other employeebenefits Payrol11axes .. and individuals outside the U..... .+Compensation not included above. iffollowiog SOP98-~ Completethis line only if the organization reported in column (B) joint costs from a combined educational Form 990 (2009) S32G10 02·04-10 10 .-. Compensation of currerit officers.~. ..:~~~~~------- and promotion .'I"-:n:r-t-""n-r7Pn-"'..'7"i'F'. -t-_=.... line 22 ....S...rll--_... See Part IV...:.:....-~.. ...:..-___.r-------+--..~""'. Benefits paid to or for members .. 1--------+------.. .~_i:...=..5. 7'''''''..:..... Grants and ottler assetance to govemments and orgalliza1~ns ill the U. t-~--... Office expenses Information technology Royalties Occupancy Travel Payments of travel Of entertainment expenses for any federal.-:...=.---:~7-!~~-=+------..Itemizeexpensesnot covered above... and meetings Interest Payments to affifiates Depreciation... e Professional fundraising services. 9 Other 12 Advertising 13 14 15 16 17 f-------~~ t-..:.._:....... ..•.~~. line 17 Investment management fees . organizations.~-+-'-..~~ir-T."""''l"t-I'''---. -...~+- _ 7 8 9 10 Pension plan coritributions (include section 401(1() arld section 403(b) employer contributions) ... depletion. Other salaries and wages ..!.::....s... 7b....•.... conventions... or local publlc officials 1B 19 20 21 22 Conferences. (Expenses groupedtogether and labeled miscellaneous may not exceed5% of total expensesshown on line 25 below.8:. Grants and other assistance to governments.:.s..I-_i:.. and (D)...7.. 23 24 a MISCELLANEOUS b TRAINING c DUES d TC LLC LOSS Insurance Other expenses..------ I-~...._ 4 5 6 +- _ trustees..:1::..!-. Do not include amounts reported on lines 6b. See Part IV.. Sb.. ancll<ey employees 1-~1::..::.. t-" ... 147 760. ... Rt*~..............-II-----r.... 9b. .!:... (e).:... See PartN.....". and amortization . directors. and 10b of Part VIII.::. state.. . 11 Fees for SeMCes (non·employees): a Management b Legal c Accounting d Lobbying f r--.

20 ill III 21 22 'il CII B :i . line 11 Total Accounts payable and accrued expenses Grants payable Deferred revenue Tax-exempt bond liabilities Escrow or custodial account "ability. 14 15 16 17 18 19 .'TI7!]W~F~q~~8f:~~~ 4958(f)(1}}and persons described in section~8(c)(3)(B). directors.=-. .::... 24 25 .. INITIATIVES INC. .. highest compensated employees... buildings. net Receivables from current and former officers.. accumulated income.... net Accounts receivable.. trustees.-r""""'ii'"'7. key employees.::.. endowment.:_.. or other funds Total net assets or fund balances i :z 32 33 932t111 02-ll4-1a 11 .. Hne11 Intangible assets Other assets.. .. . key employees. Complete Part II of Schedule L 23 Secured mortgages and notes payable to unrelated third parties Unsecured notes and loans payable to unrelated third parties Other liabilities.t--:=-+-_::.~:.::.. See·Part IV. and lines 33 and 34Unrestricted net assets Temporarily restricted net assets Permanently restricted net assets Organizations that do not foRow SFAS 117.. check here complete lines 30 through 34 • Capital stock or ... Complete Part X of Schedule D Organizations that follow SFAS 117...!. and highest compensated employees. See Part IV..:.. $ III ill 7 8 '" < Prepaid expenses and deferred charges 10a Land. . and disquarlfied persons. Complete Part II ...::.....~y.. .. . Complete Part 11 of Schedule L Notes and loans receivable... or land.::.... III 1: ca: "tI III zr 28 29 lines Zl through 29.. line 11 Investmeflts ..".::.-n:.:.""""--... III . Beginning of year 76-0262402 (Al (B) End of year 11 1 casn..... .. directors...--.. .::. trustees. and equipment cost or other basis. ......<-7..Inventories for sale or use 1--------4..c.... -e i .. building. . .non-lnterest-bearinq Savings and temporary cash investments Pledges and grants receivable... ." c :s u....:.-!-=-t-.. 30 31 0 ."} ...:. check here ~ and complete _ 9 ~~j--:::.~~~~·(~~·d~ii~~·d·~~~·~~~~i~~ ttIT0S8~§... 1-. or current funds _ Paid-in or capital surplus. .. Complete Part VI of Schedule 0 b Less: accumulated depreciation 11 12 ·13 Investments· pOblicly traded securities Investments· other securities. or equipment fund Retained earnings.=.-. .... .=:-+-'-------. and ... trust principal... ... net .. o ... program-related. Complete Part IV of Schedule D Payables to current and former officers. .. ....fi~·.. 2 3 4 5 I-_:::. 6 ~f=::~~:~O~·~th~~·~~~~i.!~_. See Part IV....~~w.!-.. . ..-. ..._:..

-c If .. or both: . was the organization required to undergo an audit or audits as set forth in the Single Allifrt: Act and OMB Circular A-133? b ______ .-+ __ 1-'.. or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year.---':. _. 1-'=-. review. INC.z:ation's financial statements audited by an independent accountant? . d [f 'Yes" to line 2a or 2b.. separate basis. I-'=-t--t-X- o Separate basis [Xl COflSOlidated basis D Both consolidated and separate basis 932012 02-()4-10 12 . does the organization have a committee that assumes re~ponsibility for oversight of the audit."+-_.'.·Yes· to line 2a or 2b.. . ---.... 2a Were the organization's financial statements cornpued or reviewed by an independent accountant? b Were the organi. explain in Schedule O.'''' . explain in Schedule O. .'..' 76-0262402 Other K 1 Accounting method used to prepare the form 990: 0 Cash 00Accrual 0 If the organization changed its method of accounting from a prior year or checked "Other.. check a box below to indicate whether the financial statements for the year we~e issued on a consolidated basis.__ 3a As a result of a federal award.

_ . 1975. OMS No_ \54.. convention of churches.• . Type I b e f 0 a0 0 Type II cD Type JII. membership fees.Type II. • • A fallllly member of a person described in (i) above? (ii) h (iii) A35% controlled entity of a person described in (i) or (ii) above? Provide the fonowing information about . .. or to carry out the purposes of one or more publicly supported organizations descrioed in section 509(a){1) or section 509(a)(2)_See section 509(a)(3).. has the organization accepted any gift or contnbution from any of the follOwing persons? (i) A person who directly or indirectly controls. in section 170(b}(1)(A){ii). Check the box that descnbes the type of supporting organization and complete lines 11e through 11h.2006. See separate instructions. Enter the hospital's name.) A community trust described in section 170(b}(1)(A)(IIi). to perform the functions of. (Attach Schedule Eo) A hospital or a cooperative hospital service organization described in section 17O(b){1){A)(iii}. see the Instructions Form 990 or 99O-EZ 932021 02008-10 for Schedule A (Form 990 or 99O-EZ) 2009 13 . or local government or governmental unit described in section 17O{b)(1)(A)(v). check this box .tionorganized and operated exclusively for the benefit of. .•• • . A medical research organization operated in conjunction with a hospital described in section 17O(b){1)(A)(iii). • . or assoctanon of churches described in section 170(b)[1)(A)(i}. . . . state. • . See section 509(a){2).. ••_ _ _ __ Yes _ 11g{il _ 11g(ii) _ 11g(ni\ _ 0 ·No 9 Since August 17.govemmental unit described in section 170(b){1){A)(iv). Icertify that the organiZation is not controlled directly or indirectly by one or more disqualified persons other than . . An organization that normally receives a substantial part of its support from a governmental unit orfrom the general public described in section 17O(b)(1)(A){vi).• • • • •__ .._. (Complete Part II.5-0047 The organization is not a private foundation because it is: (For lines 1 through 11. _. (Complete Part II.esupported Qrgal)izatiqn(s)•. Functionally integrated d D Type 111. and (2) no more than_33 113% of its support from gross investment income and unrelated-businesstaxableincome (less seotion511 tax)-from-businesses acquired byttie organization after June 30. . Attach to Form 990 or Form 99O-EZ.. ._. As! O1ganiza.Other By checking this box. (Complete Part ilL) D 10 11 0 0 An organization organized and operated exclusively to test for public safety.•_.) A federal. _ (i) Name of supported organization (ii)EIN (vii) Amount of support lilA For Privacy Act and Paperwork Reduction Act Notice. and gross receipts from actiVities related to its exempt functions ._. .. See section 509<a){4). • . .subject to certain exceptions. SCHEDULE A Public Charity Status and Public Support Complete if the organization is a section 501(c)(3) organization or a section 4947(a){1) nonexempt charitable trust. c~tand~t~ __ As! organization operated for the benefit of a college or university' owned or operated by a . either alone or toqether with persons described in (ii) and (ui) below.. If the organization received a Wlitten determination from the IRS that it is a Type I. oTType III supporting organization._.foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). th. the governing body of the supported organization? ••__ • . (Complete Part ILl An organization that normally receives: (1) more than 33 1/3% of its support from contributions. check only one box) 30 40 -5 6 7 8 9 20 A school described 0 0 0 [Xl 10 A church.

1f the organization did not check the box on line 13. 5 The portion of total contributions Amounts from llne 4 Gross income from interest. The organization qualifies as a publicly supported organization . 2 Tax revenues levied for the organ· ization's benefit and either paid to or expended on its behalf .. Explain in Part IV how the organization meets the 'facts-and-circumstances' test. third.. check this box and stop here... Acidlilies? through 10 . grants. .. .. Do not include gain 12 se~." Other income...•.G"1fts.facts-and-circumstances test . Pub6c support percentage for 2009 (fine 6.. Part II.. 9 Net income from unrelated business activities. 16a. 17a 10% ·fucts-and-circumstances test· 2009. column (f) divided by line 11. b 10010 .. royalties and income from similar soorces '" ... line 14 .. or17b. and line 15 is 331/3% or more. or 16b. second.1f the organization did not check a box on line 13.. diyidends. 3 The value of services or facilities fumished by a govemmental unit to the organization without charge _. and if the organization meets the "facts·and-circumstances" organization meets the "facts'and-Circumstances' 18 Privatefoundation.2009. and membership fees received. 1ab. and line 14 is 10"/0 or more. and if"the organization meets the 'facts-anoorcumstances' test. or fifth tax year as a section 501 (c)(3) ··m m m ~ . did not check a box on line 13.D A (Form 990 or 99O-EZ) 200"9 932022 02-08--10 14 .. fotnh. Schedule n .. (Do not include any 'unusual grants. check this box and see instructions . 16a 33 1/3"10 support test . The organization b 331/3"10 quafifles as a publicly supported organization . 4 Total. check this box and here. check thiS box and stDP here.ided on line 1 that exceeds 2% of the .g. column (f)) ••. rents. If the Fonn 990 is for the organization's first.') .lftheoTsanization test. 1&.. check this box .. and line 15 is 10% or more...lfthe organization did not check a box online 13. The organi<:ation quanfies as a pubUcly supported organization :. Add lines 1 through 3 by each person (other than a governmental unitor publicly supported organization) inch. The organization qualifies as a publicly supported organization .. __ ..ceiitage·········· 14 stop 13 First five years.. and Rne 14 is 33 1/3% or more.2OO8. payments received on securities loans.) __ 11 Total support. i 6a. support test . and stop here..2008. 178. whether or not the business is regularly carried on 10 or loss from the'sale !)f capital assets (Explain in Part IV. contributions. •• . % % '15 Public support percentage from 2008 Schedule A. or 17a. ... 0 .lfthe organization did not check a box on line 13 or 16a.. Explain in Part IV how the test.r~ticb~~~t::r:: ofP~bG~S~pport·pe·j...168.

759. 0 99:0 or 0 99O--EZ) 2009 15 ._..415 111.107.742. 145.. 697...967 228. column (f) divided by line 13...-----.... second.296. ~. _.811 1 240. {less section511 taxes}from businesses acquiredafter June 30. ""d 12. 2.. ·'1 (Fonn 990 or 99[).181. -------------. stop here m •• _ •••• m • • • __ . 1...207.. 2. fourth. 143..447....158. rnerchandise sold or services performed. 1'9a 331/3"10 support tests- 20..643. If the organization did notoheck a boX on line 14.. 13 Total support . or faClTmesfurnished in any activity that is related to the organization's tax-exempt purpose Gross receipts from activities that ere not an unrelated trade or business under section 513 ~...Private foundation. (a) 2005 13~..2~8. Part 111..726.355... 146. payments received on securities loans.496.793.3:n. 140.) First five years. BID... ~ 4 Tax revenues levied for the organ" ization's benefit and either paid to or expended on its behalf u _____ . : . r .. check this box andstop here."!ved from oll1er than disqualified exceed . Add lines 1 through 5 .09.714. . Schedule A (Fonn ..506.~ ' tor CARE INITIATIVES .____________ [X] more than 33 1J30.388.. 17 _ _ _••_ _..606. O• : ~" Add lines 7a and 7b 8 Public support .. o. checkthis box and see instnlctions __ . 19. 1975 ....228.arnolintonliP"e't3fortheyear C persons thaI the grea.. 146. 3.._. If the organiZation did not check a box on line 14 or line 19a. 6 Total. .. check this box and.44'1.759.044.212.606.870.532..000 or 1% of the •. 131..870. Part III... 7a Amounts included on lines 1.. lfthe ol'Qanization did not check the box Oil line 14.. 143 629 471 145...... 908. 143.577 338 137...158..326...44 1 •.2008. and Une18 is not more than 33 1J3<'/o. rents.741. . 1. ..187. (c}2007 (dI200S' 139 )!O'I.506. 1.385.. (fl Total 697.1 Support Calendar year (or fiscal yearbeginning in)'" 9 Amounts from line 6 10a Gross income from interest..... assets (Explain in Part IV.753..149 139. or fifth tax year as a section 501{c}(3} organization...388. . 01 $5.. Public . 714.omnll!tI\ Oillyif you checkedthe box on line 9 of Part L) (d)20()8 (e) 2009 (f! Total . and 3 received from disqualified persons b Am<>IUlts included en lines 2 and 3 '".. b Unrelatedbusinesstaxableincome • __________ r. Computation of Public Support Percentage 15 Public support percentage for 2009 {line S..326.143..ine 17 __ l _ _. third.. and line 16is more than 33113%. 11 cAdd lines 1Da and 10b .-••••• R . .. 693..108.. • 76 . 11.._ Section C.. 2.714. and membership fees received.--_ .. In . 2.. 47~~"92. royalties and income from similar sources . dividends.._ .. The organization qualifies as a pubflcly supported organization b 331/3% support tests . grants. 10.._.. Net income from unrelated business activities not included in Jine 10b.187._ 98.741.. 2 635 926. 131 442 366 136.907._ 2 Gross receipts from admissions.558. 28... If the Form 990 is for the organization's first. ... The organization quafrfies as a publicly supported organization 20 .810. ___ .955.143..0262402 Paqe3 (r.. Total ~" . column {f)} 16 Public su rt rcen e from 2008 Schedule A.. (bl2006 137.321..496..n _____ ._ . 2.. (Do not include any 'unusual grants_") .. check this box andstop here.788. 137.. 3.984.. 143. 709...... 54. Do not include galn or loss from the sale of capital .224._..907. 53.973..450.) ---..973. .377.377 697.810..149..450.174.. line 15 . (a) 2005 Ib)2006 .. . and line 17 is not _. and line 15 is more than 33113%. u O... _____ .• .268.036.4 6· 1 • 43 % % % % 18 Investment income percentage for 2009 (6ne toe.. or 19b. 14 (Add Unes 9. 10c. 3 5 The value of services or facilities furnished by a governmental unit to the organi4ation without charge .070. contnbutions. oolumn (f)} Investment inoome percentage from 2008 Schedule A. hn!-ll~lf?' (c12007 Calendar year (or fiscal year beginningin)'" 1 Gifts.. 695.928. 1. 42...41 98. 10.. whether or not the business is regularly carried on 12 Other income. 132.A. INC u" ~alll"'''''''''''''' .. 89.224. column (f) divided by line 13.246.361.070.643. ~ (e}2009 145.. B.EZ)2009 Sup_£ort A..----'ImmllnH.

' CARE INITIAT'IVES Infonnation. fine 10.472 $28..LINE 12: $42.212 SUBPART F INCOME SUBPART F INCOME SUBPART F INCOME LIABILITY INSURANCE REIMBURSEMENT 2005 2006 2007 2007 $600. Provide any other addi~jona[ infonnation. and Part 1II...238 $89. Part 'II.o 16 Schedule A {Form 990 or 99O-EZ) 2009 . 76-0262402 4 Complete this part to provide the explanations required by Part II.line 12.928 $93. INC. See instructions.000 2008 2009 $54.108 SUBPART F INCOME SUBPART F INCOME 932024 02·Q8. line 17a or 17b.' \ . PART III .

or on line 2 of its Form 99(}PF. fine 2 of its Form 990. purposes. or educational purposes.000 toruse exclusively for relIgious."} Schedule B (FQfm 990. or 99O-PF). a contnbution of the greater of (1) $5. o For a section 501 (c)(7). charitable. [X) For an organization filing FOfI1l990.. II. 99(}EZ. contnbutions for use exclusively for religious... during the year. T"". and 111. scientific. line 1. 99o-EZ.EZ that met the 33 1/~1o support test of the regulations under sections 509(a)(1} and 17O(b}(1)(A)(vi). literary.EZ that received from anyone contributor..EZ. o For a section 501 (c)(7) .. or990-PF) Department of th. but it must answer ·No· on Part IV. 99O-EZ. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990. chaiitable. during the year. 990-EZ.. If this box is checked. during the year. UiA For Privacy Act and Paperwork for Form 990. OMS No. enter here the tota! contributions that were received during the year for an exclusively refigious. Complete Parts I and U._ _. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious. 99o-EZ. _ ... Part Vln.. See instructions.. to certify that it does not meet the flUng requirements of Schedule B (Form 990. 76-0262402 00 501 (c)( 3) (enter number) organization Fonn99O-PF o o o D 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization 501 (e)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated 501 (el(S) taxable private foundation as a private foundation D Checl< if your organization is covered by the General Rule or a Special Rule .. during the year.. purpose. ._ . $5. or check the box on fine H of its Form 99O. ete. or 990-PF) (2'009) 99O-PF. aggregate contributions of more than $1. 923451 02-01-10 . etc. etc. ..___ . Complete Parts I and II. line 1h or (ii) Fonn 990-EZ.and received from anyone contributor.000 or more (in money or property) from any <me contributor. contributions of $5.000 or more during the year. C8}. 99O-EZ.. 154~0047 2009 Employer identification number Name of the organi2:atkln CARE INITIATIVES. or the prevention of cruelty to children or animals. see the Instructions Schedule B (Form 99D. Complete Parts I. or g90-PF). 0( Reduction Act Notice. or 990-PF that received. Organization Filers of: Fonn 990 or 990·EZ type (check one): Section: INC. _ Caution. or (1-0) organization filing Form 990 or 9go:..(8). .or (10) organization filing Fonn 990 or 99(}EZ that received from anyone contributor. Special Rules o For a section 501 (c}(3) organization fi6ng Fonn 990 or 99Q..000 or (2) 2% of the amount on (il Form 990. {8}. $ . . but these contributions did not aggregate to more than $1. .. or (10) organization General Rule can check boXes tor both the General Rule and a Special Rule. Note.. charitable. Only a section 501(c)(7)...SIJ'Y Internal Revenu& service Schedule of Contributors ~ Attaeh 10 Form 990. charitable.000. 99O-EZ.. or 99Q-PF.

and ZIP + 4 {el Aggregate contrlbutions (d) Type of contribution Person Payroll Noncash --s 0 0 0 (Complete Part II if there is a noncash cnntribution..) (a) No.o1.~:?J)itJ·.. 990·g or 990-PFf(2009) . (h) Name.] (a) No. and ZIP + 4 (c) Aggregate contributions (d) Type of contribution Person Payroll Noncash --s 0 D 0 (Complete Part.~'.. 0 0 0 (Complete Part II if there..) (a) No. (b) Name.fn Contributors {see instructions) (dl Type of . and ZIP + 4 (e) Aggregate contributions (d) Type of contribution Person Payroll Noncash --$ . . (b) Name. and ZIP + 4 (cl Aggregate contributions (dj Type of contribution Person Payroll Noncash --$ 0 D 0 (Complete Part II if there is a noncash contribution. 1of 1ofPartf Page Name {If organization Employeridentification number CARE INITIATIVES. Id) Type of contribution Person Name.$ 923452 Q2.. a~ess. addre~ and ZIP + 4 --. Schodul. B (fotm 990. or 990-Pf) {2009) 18 .::ontribution Person Payroll Noncash {a} No.(. and ZIP + 4 (c) Aggregate contributions 76-0262402 ~~~f~ ·~j.) Schedule B (Form 990! 99!)....) (a) No. address. (b) Name..EZ.1Q O· 0 0 Payroll Noncash (Complete Part II If there is a noncash contribution. (b) Name. is a noncash contribution. address.:.. INC.) (b) (e) Aggfega"te contributions (a) No. address.1I if there is a noncash contribution.000. 0 (Complete Part II jf there is a noncash contribution. 1 --$ I:XI 0 5. address.

... _ .•. enter ..lf additional space is needed...• _ • _...... such as a separate segregated fund or a political action committee (PAC).. _ - -.. Add lines 1 and 2........ If the organization answered ''Yes..... . ...... ..• _ _ ....•. . or Form 99O-EZ.__ Enter the amount of any exclse tax incurred by organization managers' under section 4955 •..." to Form 990.. Also enter the amount of political contributions received that were promptly and directly defivered to a separate political organization.. _.. .. _ __ ~ _ _ __ _.•_.......•_ _ .•....•..except section 501 (c)(3)....•.0Yes DYes 4a Was a correction made? _ •...• _.....· describe hi Part IV. Do not complete Part I-C.. For each organization listed.." to Form 990. line .$ : l1li.... If the organization • Section 501 answered "Yes.... amount of any.•..... or Form 99O-EZ. see the Instructions utA for Form 990 or 99O-EZ.. Yes No 5 Enterthe names......__ __ .............. _.. enter -0-...__ .....Do not complete Part II·A..... 1 Enter the amount directly expended by the flUng organization for section 527 exempt function activities ..... 2 Political e)(penditUres ......---..•.... Part IV.••.&aSUIl' Internal Ra'looue Service Political Campaign and Lobbying Activities For Organizations Exempt From Income Tax: Under section SOl{c) and section 527 is described beloW. SChedule C (Form 990 or 99O-EZ) 2009 93~041 O~...........--._.SCHeDULEC (FOrm goo or 99O~E2:H Department of the T. _. If none. 0 No D No Complete if the organization is exempt under section 501(e).._ .excise tax incun-edby the organization.......•....._ .._..._ : --------------_ $ $ _. provide information in Part IV.. then 1 Provide a description of the organization's direct and indirect political campaign activities in Part IV. line 4.•. delivered to a separate . Part VI. ..()-.." to Form 990. line 46 (Political.... Do not complete Part I·B.•.. Enter here and on Form 112O-POL.Complete if the organization 990 OMS Nn. ..•. ......•...•.. ~ $ --7"--..... • Section 501 (c)(3) organizations that have NOT filed Form 5768 (election under section 501(h»: Complete Part 1I·B..... _. _ __ 3 Total exempt function expenditures. __ 4 Did the filing organization file Form ll20-POLforthis year? _ _...•....... fme 17b . 0 -..-- a section 4955 tax..... _.....Campaign Activities). Complete if the organization is ex~mpt under section 2 3 If the organization incurred 501(e)(3). ~ $ 2 Enter the amount of the flfing organization's funds contribtrtedto other organization·s for section 527 exempt function activities _ .line 5 (proxy Tax).---....•. then • Section 501 (cj(S) organizations that have filed Form 5768 {election under section 501 (h}}: COmplete Part II·A. Part IV..... If none......... then • Section 501 (c)(3) organizations: Complete Parts I·Aand 8. • Section 501 (c) (other than section 501 (c)(3))organizations: Complete Parts I·A and C below... line 47 (Lobbying Activities)._.... • Section 527 organizations: Complete Part I·A only._...... {a) Name (b}Address (c) EIN (d) Amount paid from (e) Amount of pofltical contiibutions receiiieoarid filing organization'S· promptly and directly funds......•_ ....... addresses and employer identification number (BN) of all section 527 political organizations to which payments were made.. 1 Enmr the....••.. enterthe amount paid from the filing organization's funds.....• _ . Do not complete Part II·B.•.... _ b If ·Yes..... political organizatiQn.•....._. 1545·0047 If the organization answered "Yes...._.•._ ...... ._. Part IV.. Part VI...•........ __ 0 For Privacy Act and Paperwork Reduction Act Notice..•.... $ _ 3 Volunteer hours •..... ___ .under section 4955 _........•. did it file Form 4720 for this year? _ ___...•....Q4-10 19 .......

..........but The lobbying nontaxable amount is: 20% of the amount on line 1e. DYes DNo If there is an amount other than zero on either reporting section 4911 tax for this year? Dne 1h or litte'1 i..000........500....000..000.500...000 Ius 15% of the excess over $500.·Oor tess....000....Ius 5% of the excess 'over $1.......... column (a) or (b) is: Not over $500......000.1 Lobbying....in) (a) 2006 During 4-Year Averaging Period (b) 2007 (c) 2008 (d}2009 (e) Total 2009 20 .000 OVer $5OO...... 'If zero 1a If zero or less.000 $1 000.......... erIC!the organization file Form 4720 4-Year Averaging Period Under Section 501(h} (Some organizations that made a section 501(hl election do not have to complete all of the five columns below.000 Over $1.... .............. Ius 10% of the excess over $1 .. Enter the amount from the followin H1he amount on line 1e.... l-----. ....000 ....-~+--.ExpencfJtures Calendar year (or1iscaJ year beginning..._--_...... $225.} la) Aling organization's totals . Over: $17.......OOObut not over $17. table in both columns: (b) Affiliated group totals D 1a Total lobbying expenditures to influence publlc b Total lobbying expenditures {grass roots lobbying) to influence a legislative body (direct lobbying) c Total lobbying expenditures {add lines 1a and 1b} d Other exempt purpose expenditures e Total exempt purpose expenditures (add fines 1c and 1d) f Lobb in nontaxable amount... $100....... h SubtracUne1gfrom....000' ......000....... 2 A Check SCheck 0 (election under section 501 (h». enter-o- ...... See the instructions for lines 2a through 2f on page 4.000... if1he filing organization belongs to a~ affiliated group..000 $175....000 g Grassroots nontaxable amoUnt (enter 25% of line 11) .line SUbtract line H from line to.OCiO not over $1 ..'_ .enter.....000 Over $1~OO........000..000 but not over $1... .. if the Umits on lobbying EJ!:penditures [The term "exp'enditures" means amounts paid or incurred. ...

what portion of "the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? c _. _. . government officials.. . . or the public? e Publications. line 3 is answered II 1 2. ..__ _ . a Current year b Carryover from last year _ __ . Dues._. including any attempt to influence public opinion on a legislative matter or referendum.. state or local legislation.-.. PART II-E._ . __ . ..._.. .ACTIVITIES: HAD NO DIRECT EXPENSES FOR LOB13Y:tNG WAS NOTIFIED BY IOWA HEALTlI CARE DURING 2009. _ .. Add lines lcthrough 1i in Part IV _ __ __ ..... OTHER LOBB~ING._ r-----+-~~.any taxincurred·by·orgaRi:z:ation maFiagers-undersecOOn 4912 . or any simiJai means? i Other activities? If "Yes..line 1l. lines 1 and 2 are answered "No" OR if Part Ill-A.. their staffs. . complete this part for any additional information. .' enter the amount of. INITIATIVES PAID DUES TO IHCA O~ $185..__ . Also. . or 501(c){6) if BOTH Part III-A.' enter the amount of any tax incurred under section 4912 c If 'Y-es.__ _ _ .. 1 During the year. national. assessments and similar amounts from members _ Section 162(e) nondeductible lobbying and political expend"ltUres (do not include amounts of political expenses for which the section 527(1) tax was paid).. -r._----------- 2a Oid the activities in line 1 cause the organization to be not described in section 501(c)(3}? b If "Yes.._ .. _ 9 Direct contact with legislators. and Part 11·8..AND OTHER 162 (E) (1). speeches..2% OF DUES WOULD BE SPENT ON LOBBYING . .. • . or published or broadcast statements? f Grants to other organizations for lobbying purposes? .. . _ .. did the filing organization attempt to influence foreign._.--. . Taxab=le~~~~~~~~~~~~==================::::::::::::::::::::::::==================== Complete this part to provide the descriptions required for Part I·A..· describe j Total.·. _.. Part J·C. or a legislative body? ._. . through the use ot a Volunteers? c MediaadVertisements? ._t------- If notices were sent and -the amount on line 20 exceeds the amount on line 3. _ __ ..-------.__ . _.. Part 1·8.. h Rallies._. CARE INITIATIVES CARE INITIATIVES ASSOCIATION THAT 14. ACTIVITIES. lectures. _..line 5.. Schedule C (Form 990 or 99O-EZ) 2009 932043 OZ-04-10 21 .-Aggregate amount reported in section 6033(e)(1}(Ai notices of nondeductible section 162(e) dues _. ~ne 1. seminars. . . . .931. . _ _ - .. demonstrations... . line 4. conventions. legislators. LINE 1(1). . DURING 2009.. c Total 3 4 -. _ .b Paid staff or management (include compensation in expenses reported on llnes 1c through 1~? •__ d Mailings to members. CARE EXPENDITURES SUBJECT TO CODE SEC. ..

_..Preser-vationofQpeRspace 2 day of the tax year. the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. transferred. Held attbe End of the Tax Year 2a 2b 2c 2d ~~ Number of conservation' easements modified.pal1mentof the Treasury lntemal Revenue Servk. ..... historical treasures. line 6. Part vin. and balance sheet.. handling of violations. 10. flOe 1 b Assets included in Form 990. provide. 0 No _'------D No and section 170(h)(4)(B)Q~? Yes In Part XIV.'..a Supplemental Financial Statements . or other slmllar assets held for pUblic exhibition. and enforcing conservation easements during the year ~ $ Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h){4)(B}(~ DVes 0 .. or 12. as permittf)d under SFAS 116.... and include... Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last ~~ a Total flumber of conservation easements b Total acreage restricted by conservation easements .. or other similar assets held for publlc exhibition. education. provide the following amounts relating to these items: II) Revenues included in Fonn 990... .... """ . ot other similar assets for financial gain....•._ Staff and volunteer hours devoted to monitoring.. Schedule 0 (Form990) O. _ LHA For Privacy Act and Paperwork Reduction Act Notice.... ""'" . o o o PreseNation of land for public use (e..... (b) Funds and other accounts Aggregate value at end of year . as permitted under SFAS 116. . inspection. education.. !~ Organizations Maintaining Collections of Art. historical treasures. b If the organization elected.. and donor advisors in writing that grant funds can be used only for charitable purposes and not for tile benefrt of the donor or donor advisor. historical treasures. Complete if the organization answered "Yes' to Form 990.. Attach to Form 990. '.... Name of the organi~tion organization answered "Yas· to Fonn 990. $ $ _ _ If the organization rec'eived or held waW. recreation or pleasure) Protection of natural habitat D.g..s of art....· to Form 990. or research in furtherance of public service. (a) Donor advised funds 1 2 3 4 5 Total number at end of year Aggregate contributions to (during year) Aggregate glaMs from (during year) . Part IV.. line 8. ~ See separate instructions. or for any other purpose conferring DYes 6 Dves 1 Purpose(s) of conservation easements held by the organization (check all that apply). 9. S.•. or reeearch in furtherance of pub6c service.. Part IV. Complete if the o[ganization answered "Ves. see the Instructions 932051 02·01-10 Schedule 0 (Form 990) 2009 22 .•.. line 6.. inspecting. line 1 (ii) Assets included in Form 990... extingUished. .. inspecting. the text of the footnote to its "financial statements that describes these items. and enforcement of the conservation easements it holds? .. of an historically important land area of a certified historic structure . c Number of conservation easements on a certified historic stnrcture included in (a) d Number of conservation easements included in {c} acquired after 8/17/06 3 4 5 6 7 8 9 ... to report in its revenue statement and balance sheet works of art. Historical Treasures.. Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property.. Part VIII. donors... 1a If the organization elected. Part X $ _ $ for 'Form 990.7. . not to report in its revenue statement and balance sheet works of art. . subject to the organization's exclusive legal control? Did the organization inform all grantees.•. or Other Similar Assets.. in Part XIV.. descnbe how the organization reports conservation easements in itS revenue and expense statement.. . 11. D Preservation D Preservation .. if app6cable. Amount of expenses incurred in monitoring... and enforcing conservation easements during the year ... Part IV.. provide the following amounts required to be reported under SFAS 116 relating to these items: a Revenues included in FoI1Tl 990. Part X 2 _ ..•. or terminated by Ul"eorganization during the tax Number of states where property subject to conservation easement is located'" _ Does the organization have a written poticy regarding the periodic monitoring... released.

=_ Schedule D (Form 1il9O) 2009 932052 02·D1-tD 23 ..._ ...•..• _ .. _...... ...... or Other Similar Assets (continuer1) Using the organization's acquisition..................•.•......... _ ..•..•....•. _..•..•.......•..... __ ...._............. e Other expenditures for facmties f 1-'-------+----'--- and programs ....•.... _ ........•.~~~-T:~+--......=-.....•....•.•......•. c Net investment earnings.!... gains......••........••....•.."~l D Yes [X] Yes Amount DNo Complete if organiZation answered ·Yes" to Form 990.. _..-.. : .•.. _ .••........ did the organization soDcit or receive donations of art..•............•...• _ ...•..•.... b Permanent endowment..•...............•.. fine 21..665. are the related organizatiOns listed as required on Schedule R? (d) Book value 1a Land _ •...... 2.... trustee.....•. 76-0262402 Page2 Organizations Maintaining Collections of Art.._.....•.... Part X.............761..•.... 0 Loan or exchange programs 0 Other _ Provide a description of the organiZation's collections and explain how they further the organization's exempt purpose in Part XJV._.•......... .._.•..•..... line 9..... . 3a(ii) Sb No Iii} li1 r3a=li.. _ 1. and losses d Grants or scholarships __. 296._ U Yes 1a Beginning of year balance b Contnoutions __ _ .....OI1Ianizations related organizations _.._..••. historical treasures..i:. _ _ _ ........•....__ •........•..1 ·f Wf§l.......-.. reported an amount on Form 9oo..- b BUIldings ..•.........••..•......~~mi.•...•..•...•..•... _ ......- }---------J--'-..607..... check any of the following that are a significant use of its collection items (check all that apply): D Public exhibition D Scholarty research d e D Preservation for future generations Escrow and Custodial Arrangements...•...•... _.....•.•_ _..• e Distributions during !he year .••........••.... Did the organization include an amount on Form 990. Part X....•••.. ............-+'-.350..•.. Atlministrative expenses ...' explain the armngement in Part XJVand complete the follOWingtable: c Beginning balance .. _ _ f 2a Ending balance •...•.•.......•.. custodian or other intermediary for contributions or other assets not included on Form 990..JIJ 3 a b c 4 5 Schedule o (Form 990) 2009 CARE INITIATIVES. % 3a Are there endowment funds not in the possession of the organization that are held and administered _ _ : for the organization yes Ufl~l~t~d.................} _. .....•. Part X? ..586. __ _..•.....• : _ _• _ _ . 2....•._....•.. accession... Historical Treasures..........•........'..... ... _...........~~~~~. ....•.....••..........••........ _ _.•. or other similar assets to be sold to raise funds rather than to be maintained as art of the or nization's collection? _ _ ~W.... --•.... _ .......... -1---'as: % % _ 9 End of year batance •..•. line 211 _..•. _ _ ....... INC..........•...... _ b If "Yes....•.•._ .... _.........._ __ c Leasehold improvements d Equipment -•...................... or 1a Is the organization an agent............._... _ _.........i~+. 2 Provide the estimated percentage of the year end a Board designated or quasi-endowment .••.....• . 1c 1d 1e 1f d Additions during the year ..... During the year.....•.....•.•.......... _ ...••.. 274... c Term endowment by: .....••.•.••..._ b If "Yes" to 3a{ii).......••. DNo _ .•.•. ._....... and other records...•..•. Part IV...076.....

§tibM 02-01·10 24 Schedule 0 (Form 990) 2009 .76-0262402 (o) Method of valuation: Cost or end-of·year market value 3 (a) Description of investment iype (b) Book value -(e) Method of valuation: Cost or end-of. In Part XlV. FIN 48 Footnote.year market value 2. provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48.

__ .. line 4..~-----: . column for the year. .•. but not on line 1: . _ " . and other support per audited financial statements . Part III.__ " ..:..' TO FEDERAL AND STATE INCOME TAXES TO THE INCOME.•••. " ". __ . TO THE FINANCIAL 932054 02-II1-tC Schedule D (Form 990) 2009 25 ._. ... Part IV.) (net).....:..c_. " . ]--'=-. Part IX. b Donated services c Recoveries d Other (Describe 3 4 of prior year grants in Part XIV.. and 9.' . line 12: a Net unrealized gains on investments and use of facilities _ .lded bOther (Descnlle in Part XlV. fme 2.-. . included on line 1 but not on Form 990.. 12._:... ... Part VIII.. Part XlI. Excess or (deficit) line 2 from rme 1..i:--. lines 2d and 4b.) e Add1ines2athrough2d 3 4 a b c Subtract Amounts Investment line 2e from line 1 included expenses not included . Part information.and 4b . __ .. . lines 1band this part to provide any additional 2b. : <-. . ... Part IX.... Subtract fine 2e from line 1 on Form 990. "" . . Part V...' Total expenses and losses per audited and use of facilities financial statements . Subtract (A).) . . !-=~I- _ on Form 990.. line 25: . .IN INCOME TAXES EYALUATED THEIR MATERIAL TAX POSITIION$ INCOME TAX EFFECTS WITH RESPECT MANAGEMENTHAS AND DETERMINED THAT THERE ARE NO STATEMENTS.. .'. .. __ . Part VI1I. .. .. .1 _ a c Donated b Prior year acfJI... fines 1 a and 4.. 5. Also complete CARE INITIATIVES IS SUBJEC'l.. . Part VIII. IN ACCORDANCE WITH THE I EXTENT IT HAS UNRELATED BUSINESS ACCOUNTING GUIDANCE FOR UNCERTAINTY .-- '--_ Other (Describe Total adjustments 8 I----'~I-----~.. .. Add lines 4 through I-~. Part IX.. . Complete this part to proVide the descriptions required for Part II._ ..line 25) ... " . services expenses adjustments in Part XIV. but not on Une 1: on Form 990.) 990. . 4 5 6 7 8 9 Net unrealized Donated Investment Prior period gains Oosses) on investments and use offacifrt:ies ' .•.... """ Add fines 4a ..: . . .J-----_-=-:. line 8. '..:. line on·Form a 'lnvestment'expensesnotincll.. _ . .:::::::... 2 Amounts gains..:... fine 7b .. line :?5. j-:... Part ViII.~ _ e Add nnes 2athrough2d Amounts included .--'- Total revenue. ..Istments Otherlosses .column (A)..:-... Part VIII.. Part XI..) . lines 3.. . . .. lines 2d and 4b..._. . and Part XIII.... line 7b . . t-==-. _ ..' Other (Describe in Part XIV. d Other {Describe in Part XIV. 2 Amounts included services on line 1 but not on Form 990.Total revenue Total expenses (Rmn 990.. ine 12) (Fonn 990. X.

the grantees' eflgibility for the grants or assistance. describe speCific type of service(s) in region 0 Yes 0 No Describe in Part IV the organization's procedures ror monitoring the use of"grant funds outside the United States. asu. see the Instructions for Form 990. 16• ..(Form 990) Department Schedule F of the T. and 1he selection criteria used to award the grants or assistance? 2 For grantmakers. 76-0262402 Complete if the organization answered ·Yes· General Information on Activities Outside the United States.5S0... AttaCh to Form 990. Complete if the organiz<rtion answered "Yes" to Form 990.. See separate instructions.y lmemal Rev"" ue SeN. Statement of Activities Outside the United States . 932()71 02.. 3 If) Total expencfltures for regiOn CEN'l'RAla AMElUCA I< THE CARIBBEAN o ~6.. Does the organization maintain records to substantiate the amount of the grants or assistance. grants to recipients located in the region) (e) If activity listed in {d) is a program service. line 14b. Part IV. .e. Une 14b..-01-10 26 . 15. to Form 990. Schedule F (Form 990) 2OOIJ. INC."" or Name of the organization Employer identification number INITIATIVES 1 For grantmakers. Activities (a) Region (b] Number of offices in the region (e) Number of· employees or agents in region (d) Activities conducted in reglon (by type) (l. Part IV. lHA For Privacy Act and Paperwork Reduction Act Notice. progtam services. fund raising..

INC. " by . Complete If the organlUltlon 0 (0) Region non-cash assistance 2 3 Enter total number of recipient organizations Enter total number of other organizations listed above that are recognized as charities by the foreign country. for any ~ (f) Manner of (9) Amount of (h) Descliptlon of non.cash assistance OutsidE! the United States.000.000 (d) Purpose of grant (e) Amount of cash grant . 76-0262402 answered "Yes' to Form 990. Check this box If no one recipient received more than $5. .. Part IV. Sohedule lhe IRS... line 15.. recognlzed as tax-exempt letter _. or for which the grantee or counsel has provided a section 501 (c)(3) equivalency or entities F (Form 990) 2009 27 . Grants and Other Assistance rec!'pientwho to Organizations or Entities received more than $5.

FMV. United States.INC. (e) Number of (b) Region (a) Type of grant or asslstimce recipients (d) Amount of cash grant (e) Mannar of cash disbursement 76-0262402 (f) Amount of [g) Description of non-cash assistance (h) Method of valuation (book. Grants and Other Assistance Use SchedUle F·1 (Form 990 If additional space is needed. other) to Individuals Outside the. non-cash asslstanoe . appraisal. Complete If the organization answered "Yes" to Form 990. Part IV. Schedule F (Form 990) 2009 28 . line 16.

O. PENERAL SUPPORT 2 Enter total number of section 501 (0)(3) and government orqanlzatlons . IA 50316 IOWA GA. O.S 14 21 sotrra BELL AMES....000. line 21. line 21 or 22. 3 Enter total number of other organizations . Use Part iVand Schedule 1·1(Form 990) If additional space is needed . O. and Individuals In the United States Complete It the organization answered "Yes" on Form 990..1 Does the organization maintain records to substannate criteria used to award the grants or assistance? Grants and Other Assistance to Governments 00 Yes ONo In the United States. Name of the organization INC. the grantees' eligibility for the grants or assistance.. see tlie Instructions for Form 990.CI r o 1 (a) Name and address of organization (b) EIN (c)IRC section (dl Amount of (e) Amount of (g) Desorlption of (h) Purpose of grant valuation (book.. asslstanoe other) . " "".. ." : " LHA For Prlvaoy Ac:t and Paperwork· Reduotlon Act Notice.000.. Attach to Form 990. Complete If the organiZation answered "Yes" to Form 990. . pENERAL SUPPORT 42-1177880 ~Ol(C}(3) 10.mal R.. Sonedule I (Form 990)2009 5• 29 . or government If applicable cash grant non-cash non-cash assistance or ass Istance FMV..260.. the amount oftha grants or assistance.000. ~ENERAL SUPPORT 30-00369 83 ~Ol(C) (3) 5. ".000.Ml1. . Governments. IA 50266 FOOD BANK OF IOWA EAST 17TH STREET DES MOINES.venuo Service Grants and Other Assistance to Organizations. and th!'i selection " and Organizations . Part IV. :.. Check this box It no one recipient received more than $5. .ENERAL SUPPORT 42-1218326 501(C}(3) 10. 42~1520582 ~Ol(C) (3) 100. . O..000.. for any reCipient that received more than $5.SCHEDULE' I (Form 990) Oepartment of lhe Treasury Int. appraisal. O. 0.1~IIV!~tn~. ~ENERAL SUPPORT 42~06a0425 sOl(C) (3) 7. IA 50309 CHEROKEE COMMUNITY FOUNDATION 416 WEST MAIN STREET CHEROKEE.000. IA 50010 UNITED WAY OF CENTRAL IA "1111 9TH ST DES MOINES. IA 51012 .. Part IV. 0 ALZHEIMERS ASSOCIATION 1730 28TH STREET WEST DBS MOINES.

this part to provide the I required in Part t. DURING 2009..J any other .. (Jammer. Part 22. .. . appraisal. . ALL CONTRIBUTIONS WERE MADE TOCijARITABLE 932102 02-02-10 30 Schedule I (Fotm 990) 2009 .. (f) Descrlptloh of han-cash assistance (al Type of"grant or asslstance (b) Numbe{of recipients (e) Amount of cash grant (d) Amount of noncash assistance (e~Method afvaluatlon (boo • FMV.... ORGANIZATIONS. line 2.--.:".. other) <:.. ORGANIZATIONS ARE SELECTED BASED UPON RELATEDNESS TO CARE INITIATIVES EXEMPT MISSION.76-0262402 to Form 990.." .

First·claSs or charter travel Travel for companions and g·ross·up payments Discretionary spending account o 2 DTax indemnification 0 Housing allowance or residence for personal use D payments for business use of personal residence 0 Health or social club dues or initiation fees maid. line ta. Part VII...•" . line 130did the organization payor accrue any compensation contingent on the net earnings of: _ : : _ ... describe in Part III....... Section A. that was subject to the 7 8 9 X initial contract exception described in Regs. e For persons listed in Form 990.•• _.. trustees..". -.4958-4(a)(3l1 It "Yes: describe in Part III . see the lilsb"Uctions for FOrm 990...... __ a Receive a severance payment or chanqe-of-control payment? b Participate in. 1a Check the appropriate box(es) if the organization provided any of the foUowing to or for a person listed in Form 990. Check all that apply.... did the organization follow a written policy regard"1f'G payment or .•...:. to a contract Forpersons listed in Form 990.. or receive payment froin..:: ..•.. Section A.. or recelve payment from.. with respect to the filing organi2:ation or a related organization: . •" ..•.. .'1 sCHEO'ULEJ (FOrm gOO) Oopartment of tho Tre3Sllry Internal Ravenue Son...... 00 Compensation committee [XJ Written EX] DO Form 990 of other organizations Independent compensation consultant 00 Compensatlon [X] Approval employment contract SUNey or study . che!) D Personal services (e.. fine ta.•. line ta.i"" Compensation Information For certain OffICers..: .... an equity~based compensation arrangement? If 'Yes' to any of lines 4a-c.. Part VII. Complete iUhe organitation answered "Yes" to Form 990... Part VII....••" . Part IV. Section A. line 23.. Section A. _ _ __ .. Complete Part III to provide any relevant infurmation regarding these items.. did the orgariaation provide any non·fixed payments not descnbed ihlines5 and 61 If "Yes.. if any...-.... reirnbursement-or provision of all of the expenses described abOVe? If "No: complete Part III to explain .. o o Part VII. 1545·0047 Name cif the organi2:ation CARE INITIATIVES..g.:ganizatlon? _ b Any rel?<tedorgal'li. OMB No..._ ~ •..... Key Employees...::::..' describe in Part III Were any amounts reported in Form 990.. directors. .... Part VII.... Directors.. For persons liSteti in Form 990... a supplemental nonllualified retirement plan? c Participate in.. paid or accrued pursuant :... If 'Yes' to line 8._.. did the organization payor accrue any compensation _.. did any person listed in Form 990.~ion1 If 'Yes' to line 5a or 5b..... Part VII...aare Checked...... " : a The o-.. _ . b If any of the boxes on nne 1..•. INC.... SChedule J (Form 990) 2009 932111 02-G1Z-10 31 .. chauffeur.. of the following the organization uses to estabrl$h the compensation of the organizatiOn's ·GEOlExeclrtive Director..... . Section A. _. and Highest Compensated Employees ... a ltIe organization? b Any related organization? If 'Yes" to line 6a or 6b. describe in Part 7 8 9 m.... regarding the items checked in tine 1a? 3 Indicate which...:. ..... Trustees. .•__ Didthe organization require substantiation prior to reimbursing or allowing expenses incurred by all officers... did ttie organization also fonow the rebuttable presumption procedure de:scl'ibed in X UiA For Privacy Act and Paperwork Reduction Act Notice.. . lis!:the persons and provide the applicable amounts for each item in Part III.....:.. section ~.... Only section 501{cH3) and 501(c}{4) organizations 5 contingent on the revenues of: must complete rmes 5-9... line 1a.. by the board or compensation committee 4 During the year. and the CEOJExecutive Director. ..: ...

023. O.325. 16. I nil (I) 303. .680.7. IIlI {I] (iI) (I) IIlI .1. at columns (B)(~'(IIQmust equal the appllcabls column (D) or column (E) amounts on Form 990. 18.(111 (i) fill (i) LANNY WARD O.833. O. '. O. 157.082. O.760. 292.680. O. 16. O. O.902. 164. fill [I) ~_96. O. O. 131.1It1 (I) IliIl (I) 55. O. o. 900.044. 26. 871. O. O. The sum must be reported In Schedule J. 2.. O. 191.961117. 277. O.680. O. o. .760. 430. 173. O. O. O. O. 131.634. line 1a. -0. 125. 11. 3.605.21. 17.987. O. .573. O.. O. O. Part VII. (B) Breakdown of W·2 and/or 1099·M ISC compensation (0) Retirement and other deferred compensation (0) Nontaxable benefits (El Totelotcclurnns (B)(I)·{D) (Al Name' (i) Base compensation (Ill Bonus & Incentive compensation (III) Other reportable compensation (F) Compensation reported in prior Form 990 or Form 990·EZ MILES KING MIKE MCDANIEL ROBERT CONLON ROBERT HAYDEN CHARLEEN SCHLEPP (I) 442.495. 14. O.. JERAMY KUHN WILLIAM HAVEKOST (1) 7.157.412. O. 6.I . O.080. O. 3. O.861. described In the Instructions.177.208.945. 2. 183. O. O. O. 204. O.165. 198. 614. 18.000. report compensation from the organization on row and from related organizations. O. O.680.041.980. ' O. O.. Part VII.002. 1.416.135. O.. O.822.For each Individual whose compensation' Note.993.732. I fin llil (t) . 3. O. O. O. o.992.435. 33. O. ' 3. O. O. 46115.. Iml DAV!D DIXON lun I lin (il (i) (i) 124.465. 17.0. O. O. . O. O.'497. 36. O. O. O. • Do not list any Individuals that are not listed on Form 990. -614. 37.923. O. 4. O. O. O. 1 !:.376. O. 932112 U2-02·10 I till (i) (i) 11111 32 Sohedule J (Form 990) 2009 . O. O. on row (Ii).-G9-3. 17. 17.2. 90. 40.924. O. O.000. O. .985.477. O. O. 58. O. O. . O. O. _760.

4_~7 .+=nn". Yes No Yes Were the bongs issued as p.9. I>J_(]_ A B IOWA FINANCli: AU ... " 1• allnformetlon on Tax-exempt ~onds I OMsNo. ~~~I~J:.'li!.'J_'... ._srt f a current .... line ~4a. 1.~r~~~._. k~~1~/9~~IOR BONDS PUR r..1:Je_en macje1 Has the fillal'" I of Doss the '" ~'" """._ B C 0 E ....-t . 'see the Instructions X for Fcaia 990. .!..~. ZOO!!.07:J.t<. 399 616.. 990.o~. SU...lonallnfOrmEitlon on Schedule O. Total Gross : of issue In reserve funds 1 2 3 4 5 6 7 8 9 J!1 refund ina or Other unspent proueecrs lssuance cQstsJrclfll_ Working capital Oapltal excenottureefrom '(ear of: ursa from .._ .."' ._. X X No Y_e_s No Yes No 10 11 X X X X X I X 12 . Part IV. C D No Yes No Yes No 1 Was the organization a partner In a partnershlp.545·U047 '. 742 942. maintain "..811 2.fQr_m INC CARE INITIJI. See In".. X respect to the financed ~~"_'!' LHA orooertv wi)loh_ll1aYJasult In crlvate buslnsss ~e?_ For Privac y Act and Pa p erwork Reduction Act Notice.(FQrm 990).... SCHEDULE K g~f..-tin'1 issue? o Were the bonds Issued as part of an advance refUnding IssUl~?_ . nenta with .' .W~ "Yas" to Form 990...259 650..711. Ves No 20.~.....!.0.UCT / C 0 E .....:'1Y Nama of the organization Bond Issues (0) lssuer name (Form 990). ..O:J!:!. Schedule K Form 990 2009 ....t..968 869. ~....v._. Provide descriptions... which owned property financed by tax-exempt bonds? Yes No Yes' No Yes 2 020310 Are there lease" "'"!. ..649 502.!!~SE/ X X X X IOWA FINANCE AUTHORITY 20 00...69 Q.. or a member of an LLC.94.. Complete If the ~'''..w::. .-" ._----------_ .--- ... .:'''~M''W'' ~... .. . u"""tITY 52-169988_§ 462466AV5 S2-169988§ 462466BP7 08/02/06 11/_15/06 . .lpp_ort_the final Private Business Use I of . escrows I' 56.. 55. A 2 O.. expianau 1:~~:ddlt.Sl.: Attaoh .. .. 000 ~EN:vvATE FACILITY L:U..'l:'IVE~ (b) Issuer EIN (e) CUSIP # (d) Date Issued (e) Issue price (f) Description of purpose rEt"7'61_~'O'2"6\~r40'2' number (g) Defeased Yes No (hI On behalf of issuer ~ _. books and records '_'_'.

"""".... ....u...Schedule K(Form990) 2009 _PJiI/!Itll_ ~ CARE INITIATIVES. No Yes No Has the organization or the governmental Issuer Identified a hedge with respect to the bond Issue on Its books and records? ""...... ". Use (Continued) INC. "" ( Yes X No Yes 2 3a Is the bond Issue a variable rate Issue? X X X X No Yas No '(~s..... X ..~IM'''.. % X B . Arbitrage Rebate. .. . ...... .. % ..... . ...".00 • 00 % % % % % 'Yo_ % % 1 Has a Form a038·T...00 % % % % 5 Enter the peroentage of financed property used In a private buslneas use as a result of unrelated trade or business aotlvlty carried on by your organization. " 4 .management practices and prooedures to ensure the post-lssuance compliance of Its :bnnd . ...". '" X Enter the percentage of financed property used In a private buslnass use by entities other than a sectlon 501 (0)(3) I or a state or local . 5 6 Were any gross proceeds Invested 'beyond an available • period? Old the bond issue auallfv for an I to X X X X Schedule K Form 990 2009 rebate? Q~~O'~. .or a state or local % 6 7 Total of lines 4 and 5 Has the organIZation adopted. A B No Yes No Yes 76-0262'402 c Yes No Yes PaQe2 0 No Yes E No 3a Are there any management or service contracts with respect to-the flnanoed property whloh may result In private business use? . X o Term of hedge 4a)Veregross b Name of provider invested In a G1C? X c Tarm of GIQ_ " d Was the regulatory safe harbor for establishing the fair market valUe of the GIG .. been flied with respect to the bond Issue? .." X X b Are there any research "14' '"'' "C>'" 'D with respect to the flna-nced orocertv whioh may result in private n. "."".... ..1D ...b Name of provider .." .. . .. e Does the organization routlnaly engage bond counselor other outside counsel to review any management or service contracts or research agreements relating to the flnancad ... another section 501(0)(3) . Yield Reduction and Penalty In Lieu of Arbitrage Rebata.'" .. use? ... ..

CARE HAS INIT"IATED A PROGRAM OF RESTORATIVE RESIDENT'S OPPORTUNITY CARE TO HASTEN TO RETURN TO THEIR HOMES. THOSE RESIDENTS l. OF ORGANIZATION MISSION: FORM 990. o!1l>e T. WHO PAY PRIVATELY BECOME UNABLE TO PAY FULL J:lRIVATE. PART III. IS THE LARGEST NURSING HOME.430 RESIDENTS PART1CIPATED IN THE MEDICAID TO $13. LINE 1. CARE.easUT)' m Name of the organization CARE INITIATIVES INC. PART III.oVIDER. see the Instructions ~2211 02·03-10 . PART III. AND ASSISTED INDEPENDENT LIVING APARTMENTS SEVERAL LOCATIONS LIVING IN EIGHT LOCATIONS. QUALITY CARE TO THOSE COPING WITH OR LIFE-LIMITING ILLNESS AND TO THEIR FAMILIES. PART It LINE i. SER'iTICEFi~.SCHEDULE 0 (Form990} Department Internal Supplemental Information to Form 990 COmplete to provide information for responses to specific questions on Form or to provide any additional information.000 LESS THAN COST). NURSING I~ ADDI~ION.017 AND PROGRAM WHICH REIMBURSED LESS THAN CHARGES AMOUNTING ($12J 349. Schedule 0 {FOTm 990) 2009 35 . OUTPATIENT CARE IN ALL CARE CENTERS. LINE 2. IN 2009 TO SERVE RESIDENTS' CARE ALSO OPENED A PHARMACY FACILITY NEEDS..OR MEDIcAID F RESIDENTS IN IOWA.FOR for Form 990.. THERAPY.ROVIDING HOSPICE AGENCIES TERMINAL TO PROVIDE. NEW PROGRAM SERVICES: SERVICES THROUGH 6 HOSPICE DURING 2009.DESCRIPTION OF LIFE OF THE ELDERLY OF ORGANIZATION MISSION: ARE tNTHE. 1.. FACILITIES. PHARMACEUTIC_AL FORM 990. SKILLED AT. FORM 990. COMMUNI~IIES IN wHICH OUR FACILITIES LOCATED.. 6 HOSPICE PHARMACY. RATES BUT DID NOT QUALIFY· . COMPASSIONA'l'E. PROGRAM SPEECH AND PHYSICAL NURSING SERVICE. CARE BEGAN P. DESCRIPTION LOCATIONS.HA ·For Privacy Act and Paperwork Reduction Act Notice.~CCOMPLISHMENTS: THERAPY SERVICES.Attach to Form 990.142. FORM 990. . LINE 4A.

6 HOURS TO HELP 'I'HE . CEl'JTER THAT H1}.TION 7 FACILITIES: SINCE CARE HAS INVES~ED MORE THAN $82 MILLION TO MODERNIZE ITS SPRINKLERS.LACmml¢!' EVERY C~. SCHEDULED (Form 990) O. CARE ~ACILITIES.CARE DOES NOT USE COLLEGTION AGENCIES OR THE. 932211 02-l)3-1~ ' Schedule 0 (Form 990) 2009 36 . CARE HAS INVESTED MORE THAN $72 M1LLION IN TEN NEW REPLACEMENT CENTER BUILDINGS THROUGHOUT IOWA. CARE TO FINANCIALLY OPEN .~t~lh&T~my Internal Revenue Service . SUPPLY OR THERAPY. .INABILITY TO PAY. WITHOUT SCREENING. CARE • S .NURSING PAY. Supplemental Information to Form 990 Complete to provide information for responses to specific questions on Form 990 or to provide any additional information. see the InStructions for Form 990. LARGEST EMPLOYER AND THEIR FAMILIES \" THE LARGEST STUDENT POPULATION FOR . .ITS IN IDrnY OF ITS COMMUNITIES BY PAYING COMMUNITIES. CEN'J.+"SDUE.AND ELECTRItAi.STORY OF MODERNIZATION AND REPLACEMENT OF NURSING INCEP.SNOT YET BEEN REPLACED WITH A l'JEW REPLACEMEN:T HAS HAD EXTENSIVE RENOVATIONS. . Name 6f the organization CARE INC. NO RESIDENT OF CARE . BUILDING OF HVAC . $INCE INCEPTION.ELDERLY. CONCERNS.TC) THE . HI.PARKING LOTS'. IN THE CASE OF BAD DEB.THE LOCAL SCHOOL DISTRICT.IS DENIED A REGARDLESS OF THEIR ABILITY TO MEDICAL OR. FINANCIAL MEDICATION. SYS'l'EMS. IMPROVEMEN'l'S INCLUDE AIR CONDITIONING. FIRE AND 'pAVED . IN 2009.. Attach to Form 990. PRACTICE GOVERNMENT ASSISTANCE OF NOT DENYING.COURTS.CONTINUUM OF CARE LHA .WERE A GATHERING PLACE FORCOMMDNITY VOLUNTEERS WHQ PROVIDED 51. EDUCATIONAL OR ENVIRONMENTAL CARE CONTRIBUTED TO. REP.06. IN THE COMMUNITIES IT SERVES BY NEEDS A1ID EMPLOYMENT. CARE IS THE BASE PROPERTY TAX..For Privacy Act and Paperwork Reduction Act Notice..ADMISSION POLICY CARE HAS AN 24 HOURS PER DAY AND 7 DAYS PER WEEK. CARE PROMO~ES ECONOMIC DEVELOP~ ADDRESSING HOUSING. WERE NOT DISCHARGED IN FOLLOWING CARE'S LIMITED INDIVIDUALS'..'ERS. . OF $3 MILLION...

A. LINE 12C: THE BOARD OF DIRECTORS OFFICERS ARE REQUIRED TO READ THE CORPORATE AND CONFLICT OF INTEREST POLICY AND BY THE COMPLETE AN ANNUAL SIGNED CgRTIFICATE. LIVING FACILITY THAT CORPORATION.BUS~NESS PRACTICES CONFLICT OF INTEREST. ADDITIONALLY.. ALONG WITH ALL BOARD MEMBERS. PART VI. AGAIN UNDER THE St1PERVISION OF. TRAINING.REGULARLY SUBSEQUEN~ BOARD ~ERS. THE FILED FORM 990 IS PUBLISHED ON THE FORM 990. Name of the organization CARE'INIT INC. EDUCATIONAL PROGRAMS. AND IDENTIFY POTENTIAL OF INTEREST SI'I'UATIONS Schedule 0 (FCirm 990) 2009 SERVES. SECTION A.'. . TllE COMPLIANCE OFFICER. PUBLIC WEBSITE.SERVICES AND PUBLIC AWARENESS MEALS FOR COUNTY . THE COMPLIANCE OFFICER ALSO ATTENDS EACH BOARD MEETING AND.1 '} SCHEDULE 0 (Fcrm990) O~nt of thoTreaslJl}' SBfVice Supplemental Information to Form 990 Complete to proVide infonnation for responses to specific questions on Form 990 or to provide any additional information. LINE 11: A DRAFT OF THE ANNUAL FORM 990 IS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CFO WITH THE EXTERNAL BY THE FULL BOAnD IN ACCOUNTANT.JAILS. FORM 990. CONDUCTED NO BUSINESS WITH CARE INITIATIVES. THE . PART VI. IT SERVES BY PROVIDING REDUCED OR NO-FEE EXTENDED INTO THE COMMUNITIES SERVICES SUCH AS MEALS-ON-WHEELS. FORM 990. SECTION B. SECTION B. A FINAL COPY OF THE FORM 990 IS MADE AVAILAB~E ADDITIONALLY. CORPORATION'S A COPY OF THE FINAL FORM 990 IS REVIEWED SCHEDULED BOARD MEETING PRIOR TO FILING WITH THE IRS. DIRECTOR HULON WALKER AND DIRECTOR JOHN K. THAT OWNED AND OPERATED ONE ASSISTED IN THE SAME IN INC. CONFLICT OF INTEREST EVENTS. TO RECOGNIZE CONFLICT 37 IDENTIFIED .ANNUAL COMPLIANCE IN~LUDING . LINE 2: DURING 2009.BOARD AND OFF-ICERS RECEIVE AND REQUIRED . PART VI. ~ Attach to Fonn 990.. TO THE TO FILING. SMITH EACH HELD A ONE QUARTER INTEREST TEXAS CORPORATION TEXAS. CORPORATE: COMPLIANCE THIS PROCESS IS ADMINISTERED OFF'ICER.

BY A 2008 REPORT BY A QUALIFIED COMPENSATION. .tenue SONi". ALONG WITH PERFORMANCE ALL TO.. CFO AND VICE AS DISQUALIFIED BY· INDEPENDENT OF OPERATIONS COMPENSATION FOR THESE POSITIONS COMMITTEE PROVIDED IS DETERMINED OF.. DIRECTORS B.AND FORMAL ·PERFORMliliCEEVALUATIONS PROCESS ARE CONTAINED DOCUMENTATIOllIS OF EACH STEP COMPENSATION COMMITTEE IS IN THE DELIBERATION COMMITTEE SUPPORTED CONSULTANTS COMPENSATION MEETING REPORTS. Department'" t~e T1"6aSury Internal Ro.. Name of the organization CARE INITIATIVES ARE DOCUMENTED INC. AND DELIBERATIONS FORM 990. DATA AND COMPETITIVE COMPEl'lSATION· CHANGES FACTORS. SCHEDULE 0 [Form990} . PERSONS..AND VICE ARE REVIEWED. LINE 15: CARE INITIATIvES HAVE BEEN IDENTIFIED CEO.. IN FORMAL BOARD OF DIRECTOR MINUTES. ES·TABLISH AND RETAINED BY PRESIDENT /DIRECTOR OF OPERATIONS EVALUATIONS... IN RETAINED THE DETERMINATION OF THE COMPENSATION INDEPENDENT DATA.TO LONG STANDING Sc:hedule 0 (Form 990) 2009 POLICIES ADMINISTERED BY THE CORPORAT.RGANIZATION.ION'S HUMAN RESOURCES for Form 990. COMPENSATION INFLATION LEVELS.COMPENSA~ION· WITHOUT THE AFFECTED PARTIES.PART VI. BEING OR PRESENT AND IS SUBSEQUENTLY APPROVAL.THE. . OF THE USING .. TO THE FULL BOARD FOR THEIR ACTION . Attach to Form 990.THE EVALUATION COMPENSATION IS DETERMINED BY THE PRESIDENT COMMITTEE AND AND WITH THE MEMBERS THE REPORTS OF THE COMPENSAT10N OF COMPENSATION CONSULTANTS UTILIZED IN OF COMPENSATION LEVELS FOR THE CEO. Jl:MPLOYEES COMPENSATION PERSONNEL 932211 02-03-10 IS DETERMINED ACCORDING . ARE DOCUMENTED THE CORPORATIONS'S HUMAN RESOURCE DEPARTMENT. LHA For Piivacy Act and Pa"pei"Work Reduction Act Notice.. SECTION PRESIDENT/DIRECTOR. .APPROPRIATE COMPARABILITY COMMITTEE THE. OTHER KEY. .. see the lnsbucticins 38 . .D1RECTORS. DELIBERATIONS RECORDED AND BOARD ARE CONTEMPORANEOUSLY BY THE O. CFO . IN FORMAL MINUTES THAT· ARE RETAINED OTHER LOWER LEVEL OFFICER CEO IN CONSULTATION BOARD OF. Supplemental Information to Form 990 Complete to provide infonnation for responses to specific questions·on Fonn 990 or to provide :any additional information.

. .. PUBLIC WEBSITE. LINE 19: THE ORGANIZATION 990 ON THE ORGANIZATION'S ITS GOVERNING DOCUMENTS.AND SELECTION OF AN ·OVERSIGHT OF THE AUDIT OF ITS FINANCIAL INDEP~ENT ACCOUNTANT. see the tnstructlons Schedule 0 (Form 990) 2009 02-03-10 39 .SCHEDULE 0 (Form 990) Oepartm. 2Q09. COSTS . DEPARTMENT • FORM 990.000. SCHEDULE ISSUANCE ISSUANCE K. 2B.. SECTION C.IBILITY FOR STATEMENTS .. Attach to Form 990. CALCULATED VOLUNTEERS MAINLY PROVIDE ENTERTAINMENT for Form 990. THE AVERAGE ONE HOUR PER WEEK RESULTING· IN A. PROVIDES ITS FORM THE ORGANIZATION DOES NOT MAKE FINANCIAL STATEMENT. PART XI.SSUMES. THE dRGANlZATION THAT A CONSOLIDATED THE HAS AN AUDIT OF BOARD OF DIRECTORS l. PART VI. VOLUNTEERS: CARE INITIATIVES VOLUNTEER HAD 51. FORM 990.. LINE 5. PART II.'$349 . CREDIT ENHANCEMENT FEE .$50. LINE 6:. LHA For Privacy Act and Paperwork Reduction Act Notice. LINES 2A. . on Name of the organization CARE INIT INC.COLUMN B COSTS FROM PROCEEDS. PART I. OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.nt of tho TrOOSlJ'Y Supplemental Information to Form 990 Complete to provide information for responses to specific questions Form 990 or to provide any additional information..\. 2C: CONSOLIDATED AUDIT OF FINANCIAL FINANCIAL STATEMENTS: THE ORGANIZATION'S ACCOUNTANT COMMITTEE ON STATEMENTS ARE AUDITED BY AN INDEPENDENT BASIS. NUMBER OF VOLUNTEERS 932211 OF 982. RESPONS.066 WORKS RECORDED VOLUNTEER HOURS IN.616 FORM 990.

Ol%·MANAGIN~ MEMBER IN FOUR LIMITED LIABILITY THESE ENTITIES OWN HOMES PROVIDING ASSISTED THAT ARE ATTACHED LIvING SERVICES. . TO THE PRQP·ERTY APPLICABLE IN 2009. see the Jnstructions for Form 990. SCHEDULE K I PART III...oasUIY Sorviee Name of the organization CARE INITIATIVES INC....OW-INCOME HOUSING TAX CREDITS CODE OF 1986. TH. INCLUDES AND OF THE ENTITI·ES IN ITS FINANCIAL STATEMENTS FORM FORM 990 DISCLOSuRE: DURING 2009. SERVICES AND PERMANENT pROVIDE FOR CARE INITIATIVES TO. IN THE AGREEMENT.iLe 0 .E AN AUDIT OF CARE'S OF AND 2006 IRS CJ. Attach to Form 990. Schedule 0 (Form 990) 2009 .PURCHASE THE 99..99% INVESTOR PERIOD AS A THE INTEREST AT THE END OF THE lS-YR TAX CREDIT COMPLIANCE FOR AN AMOUINT BASED ON A PROCESS AS SPECIFIED RESULT OF ITS CONTROLLING NET INCOME/LOSS 990. WOULD ENGAGE BOND COUNSEL IF A REVIEW WAS APPLICABLE.OS... AS AMENDED.: BOND COUNSEL REVIEW NO MANAGEMENT/SERVICE FINANCED CONTRACTS OR RESEARCH AGREE~TS THE ORGANIZATION RELATED. SCHEDl. (FOfIT1990) Oepartmont Intern'" cf the T. Supplemental Information to Form 990 Complete to provide information for responses to specific questions on Form 990 or to provide any additional information. DAILY THE AND UNDER REVENUE WERE PLACED IN. FOR AND CONVERSE WITH RESIDENTS. .ED !TS EXAMINATION 40 THE 2005 . 2005 932211 02-(13--10 THE INTERNAL REVENUE SERVICE COMPLETED FORM 990. LINE 3. SCHEDULE R: THE CORPORATION COMPANIES BUILDINGS MID IS THE O. OPERATIONAL AGREEMENTS MEMBER MANAGEMENT CARE INIT1ATIVESPROVIDES FINANCING.AND LHA For Privacy Act and Paperwork Reduction Act Notice. CARE INTEREST IN THE ENTITIES. SERVICE IN 2007. TO THE CORPORATION'S RELATED NUR~ING THEY QUALIFY FOR AN ALLOCATION SECTION 42 OF TaEINTERNAL OF· t.

see tile Instructions for Form 990..SCHEDULE 0 (Form990t Department of the Treasury Se<Vie<o Supplemental Information to Form 990 Complete to provide information for responses to specific questions on Form 990 or to provide any additional infonnation. Name of the organ~tion CARE INITIATIVES. 932211 112-03-10 Schedule 0 (Form 990) 2009 41 . 2006 RETURN WITH NO CHANGES.. LHA For Prhracy Act and Paperwork R¢(iuction Act Notice. INC. . Attach to Form 990.

Sohedule R (Form 990) 2.. line 33.HEDUl. Part IV.. Reduction Act Nottoe.1i*mw. Part IV. Exempt Code Section Public charity status (If section 501 (c){3) LHA For Privacy Aot and Paperwork.~09 42 .36.'p. Name of· the organization Identification . 33.35..ER (Form 990) Related Organlzattons ~Complete and Unrelated PartnershIps or 31.SC.) (b) Primary aotlvity (e) Legal domicile (state or foreign country) (d) Total income (e) End·of·year assets (f) Direct controlling entity Name.) (a) Organizations (Complete if the organization (b) Primary aotivlty answered "Yes" to Form 990. address.. ''''''''~~~ Identlfloation organizations of Related Tax·Exempt during the tax year. If the organization !!!. and EIN of related organization Legal domiolle (state or foreign country) .34.AteIn.·trl1l~tIDns. and EIN of disregarded entity o. if the organization answered 'Yes" to Form 990. see the Instruotlons 932161 02·04-10 for Form 990. See "''''11AY. CARE IN'ITIATIVE of Disregarded (a) Entitles (Complete INC. answered' Attaoh to Form 990. line 34 because It had one or more related tax-exempt (0) (d) (e) (f) Direct controlling entity Name. "Ves" to Form 990. Part IV. address.

7B. NE 68154 LAMONI ASSISTED LIVING·. Part IV. X M/A Pt. S corp. NE 68154 tJ~iIif. 100. OMAHA. line (e) Type of entity (C corp. OMAHA. NE 68154 DUNLA~ ASSISTED LIVING. LLC . exc udedfrom tax under sections 512-514) "Yss" IdantlflootTon of Retated Organizations Taxable as a Partnership organizations treated· as a partnership during the tax year. 13520 CALU'ORNIA ST. - 99'.l'i'i.800. LLC 20-3738210. address. X N/A ~ LOW INCOME HOUSING NE !'jfA ~ELATED -3.716. 13520 . X N/A X ~ow INCOME BOUSING NE til/A RELATED answered (d) Direct controlling entit:y CARE' -8. . 119. 1.108. 13520' CALIFORNIA ST. OMAHA.CAL!FORNIA s~.l\ Identification r~.~APTlVE INSURANCE NITIA'l'IVES :::AICOS18 NC l'URKS « c: CORP 28. 13520 CALIFORNIA ST. SUITE 250. Part IV.1 domloliG (stale-or foreign country)· (I) (J) Share of total Income General or CodeV·UBI m~naglng file alloe~Uoh07 amount In box 20 of Schedule ~~ Yes No K-1 (Form 1065) !ves No ODEBOLT ASSISTED LIVING. line 34 because It had ona or more related (f) (9) Share of end-of-year assets (h) DI'propOl1lon· Page 2 (al Name. OMAltA. LLC 20-3738239. (b) Primary actiVity INC. and EIN of related organization (h) Percenta~e ownerShp Share of total Income end-of-year assets Share of I(lWA INDEMNITY COM~AN¥.) or Trust (Complete If the organization (b) Primary activity (c) Logal domlcl19 Islat. and EIN of related organization (0) Lag.) tb Form 76-0262402 990. SUITE 250. 1o'»D 76-0262402 BOX 5GO BEATRICE 8UTTERrIELD BUILDING PROVIDENCIALBS.'l!N organizations . TURKS' « CAICOS IS. (Complete II the organization (d) Direct controlling entity answered (e) Predominant income ~related.Schedule R (Form 990) 2009: . address. ~ow INCOMB HOUSING NE ~/A IIELATeD -6.20-3738090. or trust) 34 because (f) it had one or more related (g) (a) Name. SUITE 25O.i. lOS.00% -" . ~OW INCOME HOUSING I NE filA ~BLATED -7. " 43 Schedule R (Form g90) 2009 .unrelated. or foreign OOUhtry) ·Yes~' to Form 990. NB 68154 PANORA ASSISTED LIVING. X N/A ~ of Related Organizations Taxable as a Corporation treated as a oorporatlon or trust during the tax year.':ifi!. SUITE 250.. CAREl INITIATIVES. LLC 20-3738136.

920.000. equipment.. . . .. . LLC PANORA ASSISTED LIVING. line 34.04·10 I LLC 44 D D (~PANORA.920. . or IV of this schedule.ASSISTED LIVING. grant. or other assets to other organ lzatlon(s) or other assets front other organlzatlon(s) . Inc Iu dIngcovere d re Iat Ions hiIpS an d transact IS r (a) Name of other organli:atJon(s) (b) Transaction type (a·r) (1) (2)'. or 36. Transactions CARE INITIATIVES. on t hres h01ds. LLC A 10. . grant. . . (e) Amount Involved 2 h If t h e answer to any of tea bove . W0 a Reoeipt of (i) Interest (iiI annuities (ill) royalties or (iv) rent from a oontrolled entity b Gift. with one or more related organizations listed In Parts II·IV? .Sohedule R (Form 990) 2009 ~...te !lne 1 If any entity Is listed In Parts II. 1 Dur!ng the tax year. . .. . : p Reimbursement . . Part IV. Sehedul e R (Fer m9 9) 02009 A A A ..920. 200. . k Performance of services or rnsmbsrshlp or fundralslng solicitations for other organlzatlon(s) of services or membership or fundralslng solloltatlons by other organlzatlon(s) m Sharing of faoililles. I Performance . 200. INC. . equIpment. LLC (5)ODEBOLT ASSISTED LIVING 932163 02. LtC . LtC MlLAMONI ASSISTED LIVING. answered "Ves" to Form 990.000.920. .. 10. 11(. : " : : . equIpment.. .' Sale of assets to other organllatlon(s) 9 Purchase of assets from other organization(s) h Exohange·of assets Lease of facilities. n Sharing of paid' employees o Reimbursement mallJng lists. t! Other transfer of cash or property to other organlzatlon(s) . "Yas. : for expenses for expenses ~ .. did the organization engage In any of the folloWing transactions ~ .. . or capital contrlbutlon to other orQanization(s) c Gift. 10. : . .. .. or other assels paid to other organization paid by other organization ..) 76-0262402 P~ge3 With Related OrganizatIons (Complete If the organizatIon Note. . . . . . ~IDUNLAP ASSISTED LIVING.. 35. or capital contribution e Loans or loan guarantees from other organizatlon(s) d Loans or loan guarantees to or for other organlzatlon(s) by other organizatlon(s) : . 10. " see the instructlons for lnformat on on IS e ins rue or In h mus complete t h' me. ODEBOLT ASSISTED LIVING. Compla. Lease of faailitles. .

.._-. line 37.nl . -. answered 'Yes" to Form 990.. (a) Name.. aU partners (o) Legal domicile (state or foreign country) (e) Share of end-ofyear assets (f) tlonal. Part IV. Sohedule R (Form 990) 2009 CARE INITIATIVES Taxable I INC.? Yes No Ves No Yes No Schedule 932164 R (Form 990) 2009 02-04-10 45 .'-"~~-. See Instructions regarding exclusion for certain Investment partnerships.~ • . address.. '_ •• •__ " __ . tlon.) 76-0262402 Page 4 Organizations as a Partnershlp (Complete [f the organlzatlon Provide the following Information for each entity taxed as a partnership through which the organization oonducted that was not a related organization... • _. allocatlons1 Dtspropor- (9) CodeV·UBI amount In box 20 of Sohedule K·1 (Form 1065) (h) General or managing partner? e_ollon S01(oK3 D(g._~ • ~~ c_~ ._ m[~t~ Unrelated .--~-- . and EIN of entity (b) Primary activity more than live percent of its activities (measured by total assets or gross revenue) (d) Iv.

LAMONI ASSISTED LIVING. INC • ContinuatIon bfTransaotions With Related OrganIzations (Sohedule R (Form 990).. Une2} (a) Name of other organization Transaction type (a-r) (b) Amount Involved (e) (71 (81· (9) DUNLAP ASSISTED LIVING. CARE .000. 200.Sohedule R-1 (Form920) 2009. LLC D D 200. LLC 1101· (111 (121 (13) (14)· (151 (16) (17) (18) (19) (20) (21) {22] {23] {24] Schedule R-1 (Form 990)2009 932226 02-02-10 46· . INITIATIVES. Part V.000. ~.

Fi1er's1llxyearbeginning D Person(s) on whose behalftllis JAN 1 IA 50266-8212 . BOX 560 BEATRICE BUTTERFIELD BUILDING PROVIDENCIALES.oasury ~ntemal Revenue Sen/ioe sectilin898j{seeinstroctions)begillningJAN 1 .0. • Number. dollars unless otherwise indicated. 2009. 1a Name·and·addr~s·of·foreign corporation· b· Employer ideAtifieation·numlier. Persons With Respect To Certain Foreign Corporations IiIoSee separate instructions.sj (ot 1". TURKS & CAICOS ISLA TURKS. an<l room or sultana. . INC • iI mall is nol ~ivered to sll"'" a<ld"".any d Date of incorporation IOWA INDEMNITY COMPANY. if.2009.s. All information - .. 1545-0704 (Rev.person filing tllis return numb er CARE INITIATIVES. 1 (repealed) C Enter the total percentage 76-0262402 Check applicable box(es)): 1611 WEST LAKES PKWY City or town. state. Information Return of U.S. Information furnished for tlle foreign corporation's annual accounting period (1llx year required by OMS No. LHA For PapelWO"Ik Reduction Act Notice. must be In English. d Name and address (including corporate department.streot.'ACTUARIE'S' LTD BOX 560 BEATRICE BUTTERFIELD BLDG PROVIDENCIALES TURKS & CAICOS IS. GLOBAL INS MANAGERS&.andending A Identifying DEC 31. LTD. form 5411 (Rev. f Principal business activity code number c Countryllnder whose laws incorporated IS.andending return is flied' (2) Address you owned attlle end of its annual accounting DEC 31 ..2009 (3) Identifying number 100. & CAlCeS IS. 2005 Attachment Sequence 121 No. II different a GLOBAL INS MANAGERS & ACTUARIES LTD BOX 5qO BEATRICE BUTTERFIELD BLDG PROVIDENCIALES &: CAlCOS IS.S. (a) Description of each class of stock ". if applicable) of person (or persons) with custody of the books and records of the foreign corporation. boxnumbor B Category of filer (See instructions..00 information (1) Name (4) Check applicable. AIl amounts must be stated in U. 12-2007) 912:J01 04-24-09 47 . December 2007) Depar1rtlent of the T. INSnn " "TeE U.lU"U" 9 Principal business actIVity 524140 (i) Taxable income or (loss) (ii) u. box( es) Shateholder N/A . and the location €If such bOOksnd records.] Form 5471 . see instruc1ions. Officer Director Important RU in all applicable Ones and schedules •. Name of . income tax paid (after all credits) c Name and address of foreign corporation's in country of incorporation statutory or resident agent . and ZIP code 20 3D 400 voting stock 500 % of the foreign corporation's period WEST DES MOINES.

S.. DollarS column... I---'~I. . {a) Name. . ~E XNITIATIVES...'!'IATlVESr 1611 WEST LAKES PARKWAY WEST DES MOINES IA 50266 76-0262402 1.."'""'.000 100U. .~.~..000. GAAP.tions for special rules for DASTM corporations...:... U.~~ Ond of annual accounting period ..llUIUt:I. ... ~ +__---.~~~:~.. .__ . report each amount in U..-. . §.. address. and full proviSion for income. prior period adjustments..O{}_l. 76-0262402' Page 2 :.... .. and excess prafrtstiJi:es) _ $~~ $.t---'------t-----. 13 Depreciation not deduc:ledelsewhere _ 14 Depletion 15 Taxes (exclude provision for income.:. war prolits...--..:.D1l. see inStrtJr.l.. and excess prafris taxes (subtract line 17 from Une9) 19 Exlraorilinary items and prior period adjustments 20 Provisio'n for income.-:.~"""". "' ...'!'~*.--:.... ....-.. 1-:-:--1-----------+-------...~ .~ $. . and excess profits taxes) 16 Other Ikductions (attach schedule ~exclude provision for income..~.nnn 18 Net income or (loss) befOre extraordinary items.. . However.. f..S ot I of shareholder . COl Q... coinj:>Ieteonfy the U. 12-2007) ..~-:o:-- .N=:'rc. .. J Gl 1a Gross receipts.. dollar.l 100 ..... " ....S.Wrnsand allowances 1: Subtract line 1 ~ from line 1a 2 Cost'of goods sold 3 Gross prolit (subtract nile 21rom line tc) 4 Dividends 5 Interest 6a Gross rents b Gross royalties and license fees 7 Net gain or (loss) on sale of capital assets 8 Other income (attach schedule) 9 Total iMome 10 Compensation not deducted elsewhere 11a Rents b Royalties and license fees 12 Interest : ~ .~ Total lines lf11Inm. war: profits..."..~':~~onal Cu~CY in accordance With U.. (b) OescripUon ~f each class of $Ieck held by shani>holder.-~----------+--_. and identifying number Fonn 5471 (Rev.~~ beginning accQunting i~.. if tMfunctiona/ culTency is the U. war profits... dollars translated from functional currency (using GAAP trcu1s1ation rules)...:.....UO% ~p::. CARE l. Also.. INC.S.:S.e) Pro rata share of subpart F income (enter as a percentage) ""Iurnn (a~ annual of period INC..~. t-::-'.. NOte:This ~pUon should match lha eorrespgndlng descriptioo entered in Schedule A.... or sales b Rr.. .~. 21 48 Form .~~*. war profits. and excess profits taxes 4 ~~---- ----I- ---.S..

=........ ~ ..~. .......:...... and c " 12 Other assets (attach schedule) ...:...... za b 3 4 5 6 7 8a b t---:=---ii----'-~-----~l-------'-f-.. Liabilities and Shareholders' Equity .J---=--!....==-.... ... . 13 Total assets b Organization't:ostS p..... . .. ... trademarks... : Less accumulated depletion : land (net of anyarnortization) Intangible assets: r--:-:+-....... _ lnvestmenlin subsidlaries (attach schedule) _ Otherilwestments (attach schedule) Bu~dings and oilier depreciable assets : Less accumulated depreciation ....!....=-=.:.......~~~~~'r .. ....................yl... a 'Soodwlll _ c Patents. ---''-'----''--l----''----- 9a b 10 11 t-=:.... . Trade notes and accoums receivable less allowance for bad debts _ '" ·Inventotles ~ .:=..... ........!.. ....=...... ..... 448 • ~'~2' 04-24-09 49 . ..:....22 Total flabflities and shareholders' 22 1 738........ Other current assets (attach schedule) '"'''' : "'''''''''''''' loans r? shareholders and Oilier related persons ..............:.. ' Depletableassets ••_ : ..... and other intangible assets d Less accumulated amortization for lines 11a..... ........ Assets Cash ..~S...............:--:P-------~P_------'--__..=-!.....!.. ..........::... .... b...

.__ -:. . did the foreign corporation own an interestin any !rust? •__ : 3 During tlJe tax year... -------.. 7 B 7 8 • Dividends received (translated at spot rate 011payme~ date under section 989(b){1}) on a distribution of taxed lncome .. Worksheet C in the instructions) __ : __ __ __ . INC....+_-..".. 912331 04-24-09 tax·~~~·.-=.(line 17.s. . Net Additions Net Subtractions a Capital gains or losses b ·Deprec~tion·and-amortiz:ation r--------+---~-. c Combine lines Sa and 5b __ __ .. f Inventoty adjustments : .. :. __ __ . Yes No Was any income of the foreign corporation blocked? • Did any such income become unblocked during the If the answer to either.. 28. . Worksheet A in the instructions) 2 3 __ __ __ __ .S. 76-0262402 Page 4 Yes No During 1I1etax year.....50 .(~~~·~~~ii~·~·964(b))?·-·:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 0 lXl Form 5471 (Rev. _... question is "Yes/ attach an explanation.. directly or indirectly........'!'A?. 12-2007) D [Xl . Enter here and on your income tax return . 12-2007) CARE INITIATIVES. 0 .". [XJ [!] D 0 0 tax 0 00 00 2 Net adjustments made to line 1 to determille curtent earnings and profrts according to U. 11 Current earnings and profits in U. __ If "Yes: you are generally required to attach Form 8858 for each entity (see instructions).S.-f 4 Total net subtractions Sa Current earnings and profits (line 1 plus line 3 minus line 4) .'. 0 00.. Worksheet 0 lnthe instructions) _ __ __ __ __ Factoringincome __ __ __ ----- _ 5 6 : .~'J' ~ 1--__ .... -- __ __ 1-5_1-- _ Total oflines 1 through 5..-=-'--=""""' .. did tne foreign corporation own any foreign entities that were disregarded as entities separate from Iheir owners under Regulations sections 301.-:.__ Previously excluded export trade income withdrawn from investment in export trade assets (1ine 7b._...:II Other(attachschedule) __ S. finanCial and tax accounting standards (see instructions): _ : .._. 3 Total net additions _ L--~~-... II Taxes _ I. F~~m5471 (Rev. property.~.. 28 1 08.._-- c Depletion " __ . __ __ __ . . was the foreign corporation a participant ill any cost sharing arrangement? ''''''' 5· During the course of the year. e Charges to statutory reserves __ ____ . did the foreign corporation become a participant in any cost sharing arrangement? . did the foreign corporation own at least a 10% interest. t-4_1"- 28 108... Worksheet B in the instructions) __ Previously excluded subpar! F income withdrawn from Quarlfied investments (line 6b.n01-3? __ .. __ b DASTM gain or (loss) for foreign corporations that use DASTM __ __ . . 4 During the tax y~. .7701-2 and 301._:_..--. dollars (line 5c translated at the appropriate exchange rate as defined in section 989{b) and the related regulations) 5d Subpart F income (line 38b... . in any foreign partllership? : __ __ : If "Yes. 4 Earnirigs invested in U. see tbe instructions for required attachment 2 Duringthe tax year.. d Investment or incentive allowance . __ __ __ __ .108.---.. .

Oecember 2005) Accumulated Earnings and Profits (E&P) of Controlled Foreign Corporation ~ Attach to Form 5471_ OMB No. INC. minus line Sa Balance of previously taxed E&P at end 7 Balance at end of (i) Earnings Invested in U. Important Enter amounts in functiOnal currency. ~r Form 5471_ 51 Schedule J (Form 5471) (Rev.v"""" Service Name of person filing Form 5471 loenlifying number CARE INITIATIVES. and (cn 2a b 3 4 Sa b Sa b 912421/C4--24-09 LHA For Paperwork Reduction Act Notice.S. Property (d) Total Section 964{a) E&P .'J 'J SCHEDuLEJ (For. 76-0262402 IOWA INDEMNITY COMPANY LTD. 12-2605) . 1545-0704 Department 01tile Tre ""t>'Y Internal R. (a} Post-1986 Undistributed Earnings (post-86 section 959(c)(3) balance) (b) Pre-19B7 E&P Not Previously Taxed (pre-87 section 959(c){3) balance) b' 3 Current year deficit in E&P line 2a or line 1 minus line Total current and accumulated E&P not previously Amounts included 4 under section or reclassified under section in current year 5a Actual'distributions b Actual distributions reclassifications of previoUsly taxed E&P of nonprevious!y taxed E&P line 4.m 5471) (Rev. (b). minus line 5a) 3 minus line 4. see the Instructions . {combine columns (a).

..._ ...see instr......... LTD..... All amounts must be stated in U.s.. 5 Cost sharing payments received •••.... trademarks....... man'agertat engineering. (a)r". 12 Add lines 1 through 1L . .. Important Complete a separate Schedule M for each C()ntro/Jed foreign corporation..... Enter the relevant functional currency and the exchange rate used throughout this schedule" U... ... 1545-0704 fl. and license fees paid 183.) ...... ~ .... . -_ .. 25 Amounts borrowed (enter the maximum loan balance during the year) ... See instructions. 19 Commissions paid ..•.... fo!aign (e) 10% or more u.......... "~~. __ .... -. SCHEDULEM (Form 5471) (Rev. ~...-~---..action that occurred during and the persons listed in columns (b) through (I)...•... ~..............-~-.. 11 Cost sharing payments paid ~ ... u ... 912371/04-24-09 lHA For Paperwolt Redaction Act Notice. ccritrolled by foreign COIPoraijon foreign corporation u... 6 Oornpensatlon received for technicat manageria~ engineering.......nsaction& eorporation or padnersl>ip colj)om1Ion orpannersllip ~) us. 26 Amounts loaned (enter the maximum Ioail balance during the ye·ar)~see irlStr..... construction... see the Instructions for Form 5471...... 21 Dividends paid 22 Interest paid ... Name of foreign corporation INC.. pesscn sharellolder of controlled controlled by of n9 this return ._ .. or like servlees ~ ......... ~. ........•.. etc. or like selVices .r<ng this retu". Add lines 13 through 23 ...... '~"_"PO •• n ••••• • ...........DOLLAR (c) Any d............to Form 5471. 76-0262402 IOWA INDEMNITY the annual accounting COMPANY... ~ •• rOft ••••• ~......•.ven~·e SeN..._-_.... OMS No..... 20 Rents.. etc. 1 Commissions received .......•.....•. ...... 1 Sales of stock in trade (inventory) ....S...... _-_ .... ~ .. Attach. person U..... ~ 18 Compensation paid for technical. royalties......•........ _ .) .. •• n .... ~ 3 Sales of property rights (patents. trademarks....o" Name of person filing Form 5471 Iclentifyillllllumber CARE INITIATIVES. 2 Sales of tangible property other than stDck in trade ~-..-L~••••••••• ~. _-_ . 4 Buy-ln payments received '...•... royalties.. 11 Premiums received for insurance or reinsurance _ . ~' . 1:2-2007) ..-.. ... r... ~etSon filing Ihis teluro) sharliholdarof ally corporation conlrQlling lI>e foreign ............ c:otpDtal:ion (f) 10% or more us...... _-_ . 13 Purchases of stock in trade (inventory) 14 Purchases ot tangible property other than stock in trade 15 Pllrchases of property rights (patents........omesfic (d) Any 011> . I 52 Schedule M (Form 5471)(Rev........ period between the foreign corporation dollars translated from functional Enter the totals for each type of ttarn........... :!3 Premiums paid for insurance or reinsurance 183 000...... _ ..~~......•.• 16 Buy-in payments paid . December 2007) Department Intomol of the Treostny Transactions Between Controlled Foreign Corporation and Shareholders or Other Related Persons ....S...... .. CUJTeocyat the avetage exchange rate for the foreign corporation's taxyear..... ~ ..._---_ . and license fees received ......... . construction.. ~. S • . ··_···_··_ •• • ••• ··_ ......_...p"""'" (other than the U.• 9 Dividends received (exclude deemed distributions under subpart F and distributions of previously taxed income) 10 Interest received -._-_ . filing this ratum .s.. 8 Rents.s.. 24.....000 •...

PAGE END OF ANNUAL ACCOUNTING PERIOD 11. STATEMENT 3 DESCRIPTION DUE TO/FROM PARENT RESTRICTED CAPITAL PREPAID COSTS TOTAL TO 5471.186.S. OF ANNUAL ACCOUNTING PERIOD DEPOSIT 3.· 4. 8" (). DOLLAR 17. 53 STATEMENT(S) 1.093. 2. 66. 152.386. SCHEDULE C.232.580. 3 . 7. 171.l·G·.000.250.333.S. 167. LINE 16 CtIRRENCY U. 24. FORM 5471 OTHER ASSETS BEG. 190. 12.800. FORM 5471· INC. LINE 12 -22.CARE I~ITIATIVES.517. SCHEDULE F.897.250.775. LINE 8 U. 7. TO 5471. -41. DOLLAR -41.696.287. SCHEDULE FORM 5471 OTHER DEDUCTIONS FUNCTIONAL EXCHANGE RATE STATEMENT 2 DESCRIPTION MANAGEMENT FEES ADMINISTRATIVE & CONSULTING LICENS-E-S& F-EES ACTURIAL COSTS AUDITING· COSTS TOTAL TO 5471. OTHER INCOME FUNCTIONAL CURRENCY EXCHANGE RATE 76-0262402 STATEMENT 1 DESCRIPTION CHANGE TOTAL IN UNPAID LOSS RESERVE C.

.250.VE TOTAL TO 5471. DESCRIPTION PREMI-tJM. LINE 2H ADDITIONS 66.116.500.11. 8.. . PAGE 4. 10. CARE lli!ITIATlVES. INC..• 282.6. SCHEDULE H. 5 . SCHEDULE ·769. LINE 15 717. J:NGOME/-DEPOS·IT LJ:ABILIT-Y LOSS EXPENSES/DEPOSIT LIABILTTY CHANGE IN LOSS RESE!R.545. .421.921. FORM 5471 OTHER NET ADJUSTMENTS NET STATEMENT NET 5.830..580.295. 726. 107. TOTAL TO 5471. SUBTRACTIONS 282. PAGE 3. OF ANNUAL ACCOuNTING PERIOD STATEMENT END 4 DESCRIPTION RESERVE OF ANNUAL ACCOUNTING PERIOD 758..750. ACCRUED OTHER FOR UNPAID LOSSES F. 76-0262402 FORM 5471 OTHER CURRENT LIABILITIES BEG. 41. ·54 STATEMENT(S) 4.