2022-02-09T17:28:06-06:00 2021-03-31 111986323 MARCUM LLP 9 PARKWAY NORTH SUITE 200 DEERFIELD IL 60015 990 2020-04-01 362030089 THREE CROWNS PARK THRE 8473288700 2323 MCDANIEL AVENUE EVANSTON IL 602012519 JEAN JUSTIE CHIEF FINANCIAL OFFICER 8473288700 2022-02-09 1 JEAN JUSTIE 999009999 ARIANA WARREN P01441395 8472826300 2022-02-15 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JEAN JUSTIE 2323 MCDANIEL AVENUE EVANSTON IL 602012519 18874195 0 X WWW.THREECROWNSPARK.ORG X 1964 IL TO PROVIDE HIGH QUALITY RETIREMENT HOUSING AND HEALTH CARE OPTIONS THAT FOSTER SECURITY, DIGNITY AND INDEPNEDENCE AND PROMOTE PERSONAL GROWTH. 7 6 203 130 0 0 298651 11751 13319907 11528012 101549 339854 0 1409341 13720107 13288958 125818 0 0 0 6417280 7329848 0 0 0 11113094 13584013 17656192 20913861 -3936085 -7624903 59506395 57003328 85831707 88135184 -26325312 -31131856 TO PROVIDE HIGH QUALITY RETIREMENT HOUSING AND HEALTH CARE OPTIONS THAT FOSTER SECURITY, DIGNITY, AND INDEPENDENCE AND PROMOTE PERSONAL GROWTH. 0 0 18433498 11528012 PROVIDE LONG-TERM CARE FOR THE ELDERLY RANGING FROM RESIDENTIAL LIVING TO ASSSISTED LIVING TO PERMANENT HEALTH-CARE. 18433498 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 32 0 203 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 0 0 0 0 1 1 0 IL X DENNIS H TRAUTVETTER 8473288700 2323 MCDANIEL AVENUE EVANSTON IL 60201 NANCY FLOWERS CHAIRPERSON 1.00 X X 0 0 0 DAVID C FEINSTEIN VICE-CHAIRPERSON 1.00 X X 0 0 0 THOMAS J MUSZYNSKI TREASURER 1.00 X X 0 0 0 PHIL HEMMER ASSISTANT SECRETARY AND CEO 35.00 5.00 X X 0 206274 5829 JANET GOELZ HOFFMAN DIRECTOR 1.00 X 0 0 0 PEGGY NELSON DIRECTOR 1.00 X 0 0 0 RONNA HOFFBERG DIRECTOR 1.00 X 0 0 0 DENNIS H TRAUTVETTER CFO 32.00 8.00 X 0 183880 5196 MARY BETH DENTZER HEALTH SERVICES ADMINISTRA 40.00 X 111841 0 9268 LISA DYE INTERIM ED 25.00 15.00 X 120638 0 8888 THOKO MAVUSO DIRECTOR OF NURSING 40.00 X 114391 0 10754 DAISY COLLIER LPN 40.00 X 114061 0 9609 GINA ESHUIS DIRECTOR OF MARKETING 40.00 X 103292 0 2866 564223 390154 52410 5 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DINING & ENVIR. SERV 1821958 HORIZON HEALTHCARE AGENCY 1446 N FOURTH STREET CHILLOCOTHE IL 61523 NURSING SERVICES 636807 VILLA HOLISTIC CAREGIVERS 6100 N ALBANY AVENUE CHICAGO IL 60659 NURSING SERVICES 564079 CUSTOM HOME CARE 2716 PETERSON AVENUE CHICAGO IL 60659 NURSING SERVICES 376829 FREEDOM HOME CARE PO BOX 565 HIGHLAND PARK IL 60035 NURSING SERVICES 339575 5 11751 11751 RESIDENT FEES 623000 9648079 9648079 ENTRANCE FEES 623000 1823521 1823521 OTHER REVENUE 900099 56412 56412 11528012 200091 200091 5725000 5585237 139763 139763 139763 PAYCHECK PROTECTION PR 900099 1379200 1379200 INSURANCE CLAIM 900099 30141 30141 1409341 13288958 11528012 0 1749195 X 389834 343055 46779 6258083 5580190 677893 150784 133731 17053 92638 68783 23855 438509 384948 53561 457247 103326 353921 23855 23855 11016 11016 3145994 2935403 210591 185320 185320 1015304 986863 28441 232978 22147 210831 825285 723866 101419 644 614 30 1773102 1609499 163603 3331045 3023692 307353 1066911 1002069 64842 FOOD 914640 914640 OTHER 449887 449887 LICENSES AND TAXES 112791 112791 ACTIVITIES & ASSOC. 37994 37994 20913861 18433498 2480363 0 224350 1012518 580706 24277 59727 193912 80886287 37206916 46009868 43679371 9045763 8435807 3585981 3657443 59506395 57003328 1448295 1993553 11513348 12096225 34792772 34191304 4376063 33701229 39854102 85831707 88135184 X -26810842 -31635743 485530 503887 -26325312 -31131856 59506395 57003328 X -7624903 86287 2732072 X 0 1 X 1 0 X 247483 413972 328278 298651 11751 1300135 14148986 14052046 13733072 13319907 11528012 66782023 14396469 14466018 14061350 13618558 11539763 68082158 0 0 0 68082158 273320 225310 294082 385797 200091 1378600 273320 225310 294082 385797 200091 1378600 1409341 1409341 14669789 14691328 14355432 14004355 13149195 70870099 0.96070 0.97990 0.01950 0.02010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 485530 18357 503887 480139 14506 9115 485530 477360 13993 11214 480139 481413 11170 15223 477360 482788 12682 14057 481413 1.00000 0 1 1 98810 98810 73409503 31800543 41608960 6356779 4960656 1396123 1021195 445717 575478 43679371 OTHER ASSETS 80638 ASSETS LIMITED AS TO USE 3576805 3657443 SECURITY DEPOSITS 161701 RESIDENT DEPOSITS 328188 BOND PREMIUM - NET OF AMORT. 899091 ENTRANCE FEES 31921030 ESTIMATED OBLIGATION TO PROVIDE FUTURE SERVICES 6544092 39854102 13288958 0 13288958 0 13288958 20913861 0 20913861 0 20913861 PART V, LINE 4: THE ENDOWMENT FUND IS TO BE MAINTAINED INTO PERPETUITY. THE PURPOSE OF THE FUND IS TO SUPPORT RESIDENTS WHO ARE EXPERIENCING FINANCIAL HARDSHIP. X 0 0 0 0 0 0 0 0 0 PHIL HEMMER ASSISTANT SECRETARY AND CEO 0 206274 0 0 0 0 0 5829 0 0 0 212103 0 0 DENNIS H TRAUTVETTER CFO 0 183880 0 0 0 0 0 5196 0 0 0 189076 0 0 A ILLINOIS FINANCE AUTHORITY 861091967 45203HPZ9 2013-04-25 3035000 RENOVATION OF FACILITY 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 45204EUN6 2017-07-25 35316395 REFUND PRIOR ISSUE (8/15/06) 0 0 0 A 3066984 167380 445 60700 2335908 502552 0 0 0 1 B 2081468 35316395 2643782 1264 703328 34611803 1 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 1 1 B 0 0 0 1 0 0 0 0 1 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/10/2018 PART V: THE FILING ORGANIZATION DOES NOT CURRENTLY HAVE ESTABLISHED WRITTEN PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFED AND CORRECTED. THE FILING ORGANIZATION AFFILIATED WITH COVENANT LIVING COMMUNITIES AND SERVICES (CLCS) ON JULY 1, 2021, AND WILL ADOPT THE POLICIES OF CLCS GOING FORWARD. THOSE POLICIES WILL INCLUDE A WRITTEN PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFED AND CORRECTED IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. FORM 990, PART VI, SECTION A, LINE 6 THE TAXPAYER HAS ONE MEMBER/STOCKHOLDER - THREE CROWNS FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THREE CROWNS FOUNDATION, AS THE SOLE MEMBER OF THREE CROWNS PARK, HAS THE RIGHT TO APPROVE THREE CROWNS PARK'S OFFICERS (CHAIR, VICE CHAIR, SECRETARY AND TREASURER). FORM 990, PART VI, SECTION A, LINE 7B THREE CROWNS FOUNDATION, AS THE SOLE MEMBER OF THREE CROWNS PARK, HAS THE RIGHT TO APPROVE THREE CROWNS PARK'S OFFICERS (CHAIR, VICE CHAIR, SECRETARY AND TREASURER). FORM 990, PART VI, SECTION B, LINE 11B A DRAFT FORM 990 IS PROVIDED TO THE BOARD AT A BOARD MEETING AT WHICH THE FORM 990 IS REVIEWED. THE TAX RETURN IS FILED AFTER BOARD ACCEPTANCE AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12 ALTHOUGH THE FILING ORGANIZATION HAS A WRITTEN CONFLICTS OF INTEREST POLICY, THE ANNUAL ATTESTATION REQUIRED BY THE POLICY WAS NOT OBTAINED IN THE PERIOD COVERED BY THIS FORM 990. THE ORGANIZATION AFFILIATED WITH COVENANT LIVING COMMUNITIES AND SERVICES (CLCS) ON JULY 1, 2021, AND WILL ADOPT THE POLICIES OF CLCS GOING FORWARD, WHICH WILL INCLUDE OBTAINING AN ANNUAL ATTESTATION. FORM 990, PART VI, SECTION B, LINE 15 ANNUAL INCREASES ARE MERIT BASED AND ARE COMPARED WITH INDUSTRY STANDARDS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNANCE DOCUMENTS ARE FILED WITH STATE. FINANCIAL STATEMENTS ARE PROVIDED TO PROSPECTIVE RESIDENTS. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC IN THE LIBRARY AT THREE CROWNS PARK. FORM 990, PART VI, SECTION B, LINES 13 AND 14: THE FILING ORGANIZATION DOES NOT HAVE A WRITTEN WHISTLEBLOWER POLICY OR A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. THE FILING ORGANIZATION AFFILIATED WITH COVENANT LIVING COMMUNITIES AND SERVICES (CLCS) ON JULY 1, 2021, AND WILL ADOPT THE POLICIES OF CLCS GOING FORWARD. THOSE POLICIES WILL INCLUDE A WRITTEN WHISTLEBLOWER POLICY AND A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. FORM 990, PART IX, LINE 11G COVID-9 AGENCY FEES: PROGRAM SERVICE EXPENSES 2,376,558. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,376,558. AGENCY FEES - LPNS: PROGRAM SERVICE EXPENSES 528. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 528. AGENCY FEES - CNA'S: PROGRAM SERVICE EXPENSES 4,888. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,888. OTHER PROFESSIONALS: PROGRAM SERVICE EXPENSES 840. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 840. OTHER PROFESSIONALS: PROGRAM SERVICE EXPENSES 15,537. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,537. RELIGIOUS SERVICES: PROGRAM SERVICE EXPENSES 7,013. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,013. CONSULTING FEES: PROGRAM SERVICE EXPENSES 339. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 339. HOUSEKEEPING FEES: PROGRAM SERVICE EXPENSES 2,476. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,476. NON-EMPLOYEE FEES: PROGRAM SERVICE EXPENSES 139,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 139,200. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 500. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 39,870. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,870. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 148,951. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 148,951. OTHER PROFESSIONAL DEVELOPMENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,270. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,270. NON EMPLOYEE FEES: PROGRAM SERVICE EXPENSES 388,024. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 388,024. FORM 990, PART XI, LINE 9: TRANSFER FROM THREE CROWNS FOUNDATION 9,257,807. CHANGE IN OBLIGATION TO PROVIDE FUTURE SERVICES -6,544,092. CHANGE IN VALUE IN PERPETUAL TRUST 18,357. THREE CROWNS FOUNDATION 2323 MCDANIEL AVENUE EVANSTON IL 60201 201060468 SUPPORT IL 501(C)(3) 12(C)(III) N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 1