2023-06-12T09:19:34-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 362167769 KING-BRUWAERT HOUSE KING 6303232250 6101 SOUTH COUNTY LINE ROAD BURR RIDGE IL 60527 ADRIAN GOETZ CHIEF FINANCIAL OFFICER 6303232250 2023-06-09 1 ADRIAN GOETZ 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-05-26 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z TERRI BOWEN 6101 SOUTH COUNTY LINE ROAD BURR RIDGE IL 60527 16517736 0 X HTTPS://WWW.KINGBRUWAERT.ORG/ X 1929 IL A FULL RANGE LIFE PLAN COMMUNITY. 14 14 184 35 19148 509 870398 859315 8025268 8337475 4105858 2691102 0 121555 13001524 12009447 0 26123 0 0 8123744 8609518 0 0 120011 5261924 5209188 13385668 13844829 -384144 -1835382 65270377 61171811 46356858 49469158 18913519 11702653 X SINCE 1933, KING-BRUWAERT HOUSE HAS PROVIDED A GRACIOUS, CARING, AND UNIQUELY SPECIAL COMMUNITY FOR SENIOR MEN AND WOMEN. WE RESPECT AND BUILD ON THIS TRADITION OF ENHANCING INDIVIDUAL DIGNITY, INDEPENDENCE, AND SELF-ESTEEM.OUR MISSION IS TO PROVIDE UNSURPASSED LEVELS OF SERVICE THAT CATER TO ASSISTED LIVING, MEMORY CARE, SKILLED NURSING, AND INDEPENDENT LIVING. WE WILL MAKE EVERY EFFORT TO MEET THE PHYSICAL, SOCIAL, AND EMOTIONAL NEEDS OF OUR RESIDENTS. 0 0 10682862 26123 8291116 AT KING-BRUWAERT HOUSE, WE OPERATE AND MAINTAIN A LIFE PLAN COMMUNITY LIVING ARRANGEMENT FOR THE LONG-TERM CARE, COMFORT AND MAINTENANCE OF ELDERLY MEN AND WOMEN AT ALL LEVELS OF ABILITY (I.E., INDEPENDENT LIVING, ASSISTED LIVING, MEMORY CARE AND SKILLED CARE). OVER 200 SENIORS CALL KING-BRUWAERT HOUSE HOME. AS PART OF ITS MISSION, KING-BRUWAERT HOUSE PROVIDES CHARITY CARE. OVER THE PAST YEAR WE HAVE PROVIDED OVER 1,921 DAYS OF CHARITY CARE IN ITS ASSISTED LIVING, MEMORY CARE AND SKILLED NURSING UNITS. WE PROVIDE HOUSING, FOOD, NURSING AND MEDICAL CARE, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING AND HAIRCUTS TO OUR CHARITY RESIDENTS; WE ALSO PAY THEIR MEDICAL INSURANCE PREMIUMS AND GIVE EACH OF THEM A MONTHLY CASH STIPEND TO USE AS THEY WISH. ALL KING-BRUWAERT HOUSE RESIDENTS ARE PART OF A VIBRANT COMMUNITY. WE PROVIDE A WIDE RANGE OF CREATIVE PROGRAMMING (SPEAKER SERIES ON A VARIETY OF TOPICS, SOCIAL GATHERINGS, MUSICAL ENTERTAINMENT, ART AND WELLNESS CLASSES, BOOK GROUPS AND RELIGIOUS SERVICES, TO NAME A FEW). WE ALSO PROVIDE TRANSPORTATION (TO MEDICAL APPOINTMENTS, SHOPPING, PERSONAL VISITS, AND CHURCHES), HOUSEKEEPING, LANDSCAPING, AND MAINTENANCE SERVICES. OUR PROGRAMS SUPPORT WELLNESS AND FITNESS, ARTS AND CULTURE, LIFELONG LEARNING, AND INDIVIDUAL AND GROUP ENGAGEMENT. ALL RESIDENTS ENJOY SEVERAL DINING OPTIONS (RESTAURANT-STYLE DINING IN OUR MAIN DINING ROOM, A CAFE OPTION AT OUR BISTRO, AND HOME DELIVERY OF MEALS TO OUR INDEPENDENT RESIDENTS AND OTHERS WHO NEED IT). WE PROVIDE 24-HOUR NURSING AND PERSONAL CARE AT ALL LEVELS ALONG THE CONTINUUM TO RESIDENTS IN OUR ASSISTED LIVING, MEMORY CARE AND SKILLED NURSING UNITS AND IN-HOME NURSING SERVICE TO OUR INDEPENDENT RESIDENTS UPON REQUEST.OVER THE PAST YEAR, KING-BRUWAERT HOUSE HAS COMPLETED PLANS FOR AND BEGUN CONSTRUCTION OF A NEW 28-BED SKILLED AND MEMORY CARE WING WHICH WILL BE COMPLETED IN 2023. THIS NEW BUILDING AND SURROUNDING OUTDOOR GARDENS WILL ENHANCE OUR RESIDENTS' LIVES. 10682862 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 48 0 184 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 1 0 IL X ADRIAN GOETZ 6302309556 6101 SOUTH COUNTY LINE ROAD BURR RIDGE IL 60527 JOHN GRUBE CHAIRMAN 5.00 X X 0 0 0 CATHY KEATING VICE CHAIRMAN 3.00 X X 0 0 0 KATHARINE SYLVESTER SECRETARY 3.00 X X 0 0 0 DEAN BARRETT DIRECTOR 0.50 X 0 0 0 KATHERINE BIRCK DIRECTOR 0.50 X 0 0 0 RICHARD BULGER DIRECTOR 0.50 X 0 0 0 RICHARD BURRIDGE DIRECTOR 1.00 X 0 0 0 J DOUGLAS CLEVELAND DIRECTOR 0.50 X 0 0 0 MARY-BETH DESMOND DIRECTOR (THROUGH 9/21) 0.50 X 0 0 0 CHARLES B LEWIS DIRECTOR 0.50 X 0 0 0 JAMES MCCARTHY DIRECTOR 0.50 X 0 0 0 SHAWN O'CONNOR DIRECTOR 0.50 X 0 0 0 SUZANNE PETREE DIRECTOR 0.50 X 0 0 0 EILEEN L SACHANDA DIRECTOR 0.50 X 0 0 0 JENNIFER TEMPLETON DIRECTOR 0.50 X 0 0 0 TERRI BOWEN CEO 40.00 X 270451 0 20579 ADRIAN GOETZ CFO 40.00 X 196015 0 37650 JEREMY LEONE CONTROLLER 40.00 X 139821 0 24728 KAREN MILLER SR DIR OF RESIDENT SERVICES 40.00 X 118444 0 15091 NICOLE SLIGHTOM SR DIR OF HOSP, WELLNESS, RISK MGMT 40.00 X 143834 0 5555 PAUL STECH SR DIR OF BUILDINGS AND GROUNDS 40.00 X 135809 0 25053 ANDREW BELTZ SR DIR OF MARKETING & EXTERNAL RELATIONS 40.00 X 122301 0 24062 1126675 0 152718 8 0 1 0 PEPPER CONSTRUCTION 643 NORTH ORLEANS STREET CHICAGO IL 60654 CONSTRUCTION SERVICES 2614551 SEQUOIA GEN CONTRACTING CORP 1585 BEVERLY COURT UNIT 109 AURORA IL 60502 CONSTRUCTION SERVICES 1867028 CEW CONSTRUCTION LLC 260 SAINT ANDREWS DRIVE BOLINGBROOK IL 60440 CONSTRUCTION SERVICES 752454 SAS ARCHITECTS & PLANNERS 630 DUNDEE ROAD NO 110 NORTHBROOK IL 60062 ARCHITECTURE SERVICES 387203 MARIANI LANDSCAPING 300 ROCKLAND ROAD LAKE BLUFF IL 60044 LANDSCAPING SERVICES 294038 9 456277 403038 859315 RESIDENT SERVICE REVENUE 623000 8189498 8189498 147977 101618 46359 8337475 607204 607204 6585937 6250 4508289 0 2077648 6250 2083898 2083898 PARTNERSHIP INTEREST INCOME 523000 19148 19148 102407 102407 121555 12009447 8291116 19148 2839868 26123 26123 537852 537852 6421045 5345473 988482 87090 244107 202660 38145 3302 918963 748474 158294 12195 487551 377977 103416 6158 80153 80153 34900 34900 124994 124994 25825 25825 446007 446007 107151 107151 164359 164359 404213 376003 28210 23147 23147 58784 58784 1573341 1436460 136881 389478 389478 MAINTENANCE 469532 469532 WOODS RESIDENT EXPENSE 377691 377691 DIETARY 321813 321813 HEALTHCARE 229979 229979 377821 299268 67287 11266 13844829 10682862 3041956 120011 67628 546373 811149 850963 104801 141767 71519410 43717612 22321438 27801798 41886466 31752015 78895 78895 65270377 61171811 1236876 1686591 918027 1096383 1725233 565077 88691 215171 0 2241835 42388031 43664101 46356858 49469158 X 18289563 11114778 623956 587875 18913519 11702653 65270377 61171811 X -1835382 -5666631 291147 X 0 1 X 1 0 X 217657 253328 1634199 870398 859315 3834897 10536978 10329564 10382064 8025268 8275929 47549803 144805 144805 10754635 10582892 12016263 8895666 9280049 51529505 23200 32499 29200 22826 37955 145680 0 23200 32499 29200 22826 37955 145680 51383825 585876 790887 786442 561542 626352 3351099 0 12670 8238 2766 8373 32047 585876 803557 794680 564308 634725 3383146 11340511 11386449 12810943 9459974 9914774 54912651 0.93570 0.06160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 480302 1000 -38914 26123 416265 419430 0 71303 10430 480303 384958 7086 27386 0 419430 302813 62281 23290 3425 384959 198167 85889 18757 0 302813 0.85000 0.15000 0 0 91467 91467 60978013 40785715 20192298 3661789 2931897 729892 6788141 6788141 27801798 KB NURSING AT HOME, LLC OBLIGATION 89381 REFUNDABLE DEPOSITS 2728860 REFUNDABLE ENTRANCE FEES 40454363 OBLIGATION TO PROVIDE FUTURE SERVICES 391497 43664101 6198741 -5666631 -19081 -5685712 11884453 124994 124994 12009447 13409607 0 13409607 124994 310228 435222 13844829 PART IV, LINE 2B: THE ORGANIZATION HOLDS REFUNDABLE SECURITY DEPOSITS FOR RESIDENTS. PART V, LINE 4: THE ENDOWMENT'S PURPOSE IS TO HOLD DONATED FUNDS IN PERPETUITY, UTILIZING THE EARNED INCOME TO PROVIDE SCHOLARSHIPS FOR EMPLOYEES AND THEIR DEPENDENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS -35,302. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 16,221. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN ESTIMATE OBLIGATION TO PROVIDE FUTURE SERVICES 310,228. 1 SCHOLARSHIPS 10 26123 PART I, LINE 2: A. SCHOLARSHIPS ARE SELECTED BY THE SCHOLARSHIP COMMITTEE BASED ON MERIT FROM THE POOL OF SCHOLARSHIP APPLICATIONS RECEIVED. AFTER THE SCHOLARSHIPS ARE SELECTED, THE PROCESS CONTINUES BY ENSURING PROPER DOCUMENTATION IS RECEIVED AND FUNDS ARE DISBURSED APPROPRIATELY. X X X 0 0 0 0 0 0 0 0 0 TERRI BOWEN CEO 210377 0 55790 0 4284 0 9659 0 10920 0 291030 0 0 0 ADRIAN GOETZ CFO 159707 0 36308 0 0 0 7418 0 30232 0 233665 0 0 0 JEREMY LEONE CONTROLLER 122275 0 15050 0 2496 0 5090 0 19638 0 164549 0 0 0 PAUL STECH SR DIR OF BUILDINGS AND GROUNDS 119233 0 14209 0 2367 0 4953 0 20100 0 160862 0 0 0 A VILLAGE OF BURR RIDGE 362517422 2018-12-21 3500000 CARRINGTON HALL PROJECT 0 0 0 A 1166667 3500000 49534 3450466 2020 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 0 0 1 A 1 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO, CFO, AND CONTROLLER PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY DIRECTOR SHALL BE DISCLOSED TO THE BOARD AND MADE A MATTER OF RECORD. EACH DIRECTOR, SENIOR MANAGEMENT OFFICIAL AND DEPARTMENT HEAD SHALL COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT, WHICH SHALL BE RETAINED IN THE BOOKS AND RECORDS OF THE CORPORATION. WHEN ANY SUCH INTEREST BECOMES RELEVANT TO ANY MATTER REQUIRING BOARD OR COMMITTEE ACTION, THE DIRECTOR SHALL ADVISE THE BOARD OR COMMITTEE OF THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST. THE CEO DETERMINES IF A CONFLICT EXISTS AND REVIEWS ALL ACTUAL CONFLICTS. A DIRECTOR SHALL REFRAIN FROM PARTICIPATION IN DISCUSSION OR VOTE ON ANY MATTER IN WHICH THE DIRECTOR OR MEMBER OF THE DIRECTOR'S IMMEDIATE FAMILY HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, SHALL NOT USE PERSONAL INFLUENCE IN CONNECTION THEREWITH, AND SHALL NOT BE COUNTED IN DETERMINING THE VOTE ON THAT PARTICULAR ISSUE. ANY DIRECTOR WHO IS EXCLUDED FROM VOTING BECAUSE OF SUCH ACTUAL OR POTENTIAL CONFLICT OF INTEREST MAY BRIEFLY ANSWER PERTINENT QUESTIONS FROM OTHER DIRECTORS OR COMMITTEE MEMBERS WHEN THE DIRECTOR'S KNOWLEDGE OF THE MATTER WILL ASSIST THE BOARD OR COMMITTEE. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, AND THAT THE INTERESTED DIRECTOR ABSTAINED FROM DISCUSSION AND VOTING ON THAT PARTICULAR ISSUE. THE VOTE IN THIS INSTANCE SHALL BE A MAJORITY OF DISINTERESTED DIRECTORS. THE PROVISIONS OF THIS SECTION SHALL ALSO APPLY TO ANY PERSON, OTHER THAN A DIRECTOR, WHO IS AT ANY TIME SERVING AS A MEMBER OF ANY COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF DELIBERATION AND DECISION. A SALARY SURVEY IS COMPLETED BY AN OUTSIDE CONSULTANT WITH RESULTS PROVIDED TO THE COMPENSATION COMMITTEE. A REVIEW OF THE CEO IS DONE BY THE BOARD AND ADMINISTERED BY THE CHAIRMAN OF THE BOARD. BASED ON THE REVIEW AND SALARY SURVEY, A COMPENSATION PACKAGE IS ADJUSTED. THE CHAIRMAN OF THE BOARD PROVIDES AN E-MAIL WITH THE DETERMINED COMPENSATION, WHICH IS PRINTED AND STORED IN THE HUMAN RESOURCES FILE. OTHER OFFICERS AND KEY EMPLOYEES ARE ALSO INCLUDED IN THE SALARY SURVEY. THEY ARE REVIEWED BY THEIR MANAGERS WITH FINAL COMPENSATION BEING DETERMINED BY THE CEO WITHIN THE CONFINES OF THE BOARD APPROVED BUDGET. THE DETERMINED COMPENSATION IS DOCUMENTED IN THE HUMAN RESOURCES FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 16,221. NET ASSETS RELEASED FROM RESTRICTIONS -35,302. CHANGE IN ESTIMATE OBLIGATION TO PROVIDE FUTURE SERVICES 310,228. KB NURSING AT HOME LLC 6101 SOUTH COUNTY LINE ROAD BURR RIDGE IL 60527 812781395 NURSING CARE IL -857 26267 KING-BRUWAERT HOUSE THE ORGANIZATION IS TECHNICALLY FILING THEIR RETURN LATE. HOWEVER, THIS IS ULTIMATELY THE CAUSE OF THE IRS DATABASE HAVING A DELAY IN UPDATING TO THE ORGANIZATION'S PROPER STATUS. IN AUGUST OF 2022, THE ORGANIZATION SUBMITTED THE FORM 8940 TO FINALIZE THE TERMINATION OF PRIVATE FOUNDATION STATUS UNDER SECTION 507(B)(1)(B) 60-MONTH PERIOD. AT THE TIME, THE FORM 8940 WAS STILL REQUIRED TO BE PAPER FILED WITH THE IRS AND REQUIRES SEVERAL MONTHS TO BE PROCESSED. THE ORGANIZATION WAS APPROVED FOR PUBLIC CHARITY STATUS PER LETTER CONFIRMATION ON 02/13/2023 TO BE A PUBLIC CHARITY UNDER 509(A)(2) (LETTER#4422; CATALOG NUMBER 5225E). PER THE LETTER THIS STATUS WAS RETROACTIVE TO JULY 1, 2017. IN ANTICIPATION OF THIS ACCEPTANCE, THE ORGANIZATION FILED THE FORM 8868 (EXTENSION) AS A PUBLIC CHARITY ON OCTOBER 23, 2022 (NOT AS A PRIVATE FOUNDATION) AHEAD OF THE NOVEMBER 15, 2022 INITIAL DEADLINE. THE EXTENSION WAS RETURNED ON JANUARY 30, 2023 WITH AN NOTICE INDICATING THAT THE FORM 8868 HAD BEEN SWITCHED BACK TO PRIVATE FOUNDATION STATUS. AS INDICATED IN THE PREVIOUS PARAGRAPH, A SEPARATE LETTER CONFIRMED THE CHANGE IN STATUS LESS THAN TWO WEEKS AFTER THAT. THE ORGANIZATION DOES RELY UPON A PAID PREPARER TO RELEASE VIA E-FILE THE EXTENSIONS AND FINAL RETURNS. ON FEBRUARY 17, 2023 THE PAID PREPARER ATTEMPTED THE FIRST RELEASE OF THE FORM 990 FOR THE YEAR ENDED 06/30/2022 (WITH AN EXTENDED DUE DATE OF MAY 15TH). AFTER A FAILED ATTEMPT, A DELAY TO SEE IF THE DATA BASE WOULD BE REFLECTED TO THE PUBLIC CHARITY STATUS PER THAT LETTER WAS ATTEMPTED. THE NEXT RELEASE WAS ON 03/23/2023 WITH ANOTHER REJECTION. AT THAT TIME THE PAID PREPARER MADE MULTIPLE PHONE CALLS TO THE E-FILE SYSTEM AND IRS TEG PHONE NUMBER AND WAS ABLE TO CONFIRM THAT THE DATABASE DID REQUIRE AN UPDATE. AT THAT TIME, THE SERVICE INFORMED THE PAID PREPARER THAT THE DATABASE SHOULD BE UPDATED WITHIN 6 WEEKS TO REFLECT THE CORRECT INFORMATION. SIX WEEKS FROM 03/23/2023 IS MAY 4, 2023. SEVERAL MORE ATTEMPTS WERE MADE ON MAY 05, 12, AND 15TH TO FILE ON TIME. ATTEMPTS TO CALL THE IRS WERE UNSUCCESSFUL DUE TO CALL VOLUME AND A FOLLOW UP CALL WITH THE E-FILE SERVICE LINE CONFIRMED IT WAS A DATABASE ISSUE AND WAS UNABLE TO HELP. THE ORGANIZATION AND PREPARER HAVE DONE ALL POSSIBLE STEPS TO FILE THE RETURN TIMELY AS SHOWN ABOVE AND ASK THAT ALL FEES, INTEREST AND PENALTIES BE WAIVED, AND THE RETURN BE SHOWN TO BE TIMELY FILED PER THE SERVICE.