2021-12-16T14:31:05-06:00 2021-03-31 381357951 PLANTE MORAN 10 S RIVERSIDE PLAZA CHICAGO IL 60606 990 2020-04-01 471545753 PRESBYTERIAN HOMES PRES 8479793902 8707 SKOKIE BOULEVARD NO 400 SKOKIE IL 60077 TODD F SWORTZEL CHIEF EXECUTIVE OFFICER 8479793902 2021-12-13 1 TODD SWORTZEL 999009999 DAVID LOWENTHAL P00378651 3122071040 2021-12-13 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TODD F SWORTZEL 8707 SKOKIE BOULEVARD NO 400 SKOKIE IL 60077 143489229 0 X WWW.PRESBYTERIANHOMES.ORG X 2014 IL PRESBYTERIAN HOMES, A FAITH BASED NOT FOR PROFIT, CREATES VIBRANT COMMUNITIES FOR OLDER ADULTS THAT INSPIRE WELLNESS, INDEPENDENCE, JOY, AND SECURITY - ENRICHING THE LIVES OF RESIDENTS AND THEIR FAMILIES. 15 15 877 210 0 0 2170057 5895285 73199933 73335487 9068605 6644714 3672909 6753169 88111504 92628655 0 0 0 0 36676883 36611681 0 0 0 46277716 46940191 82954599 83551872 5156905 9076783 435486176 450344403 363453136 346876082 72033040 103468321 X PRESBYTERIAN HOMES, A FAITH BASED NOT FOR PROFIT, CREATES VIBRANT COMMUNITIES FOR OLDER ADULTS THAT INSPIRE WELLNESS, INDEPENDENCE, JOY, AND SECURITY - ENRICHING THE LIVES OF RESIDENTS AND THEIR FAMILIES. 0 0 32415529 38877989 LAKE FOREST PLACE AND THE MOORINGS OF ARLINGTON HEIGHTS ("THE MOORINGS") ARE NOT-FOR-PROFIT INDEPENDENT LIVING, LIFE PLAN COMMUNITIES (FORMERLY KNOWN AS CONTINUING CARE RETIREMENT COMMUNITIES). INDEPENDENT LIVING FACILITIES AT LAKE FOREST PLACE AND THE MOORINGS CONSIST A TOTAL OF 546 APARTMENTS, VILLAS AND COTTAGES. AVAILABLE RESIDENTIAL SERVICES INCLUDE FLEXIBLE DINING OPTIONS, HOUSEKEEPING AND COMPLETE MAINTENANCE SERVICES, TRANSPORTATION AS WELL AS PLANNED SOCIAL AND EDUCATIONAL ACTIVITIES AND PROGRAMS. TEN TWENTY GROVE IS AN INDEPENDENT LIVING FACILITY CONSISTING OF 47 APARTMENTS. DURING THE FILING YEAR, THE THREE INDEPENDENT LIVING FACILITIES SERVED A TOTAL OF 706 INDEPENDENT LIVING RESIDENTS DURING THE FILING YEAR. 14662119 14579295 ASSISTED FACILITIES AT LAKE FOREST PLACE AND THE MOORINGS CONSIST OF 144 UNITS. THE PROGRAM PROVIDES CARE TO OLDER ADULTS WHO NEED ASSISTANCE WITH PERSONAL CARE AND DAILY ACTIVITIES. BOTH FACILITIES SERVED A TOTAL OF 184 ASSISTED LIVING RESIDENTS DURING THE FILING YEAR. 22719520 19858707 LAKE FOREST PLACE AND THE MOORINGS HEALTH CARE CENTERS PROVIDE INTERMEDIATE AND SKILLED NURSING FOR BOTH SHORT AND LONG TERM STAYS. RESPITE, REHABILITATION, AND PROGRAMS TO CARE FOR THOSE WITH ALZHEIMER'S DISEASE AND OTHER COGNITIVE IMPAIRMENTS ARE ALSO AVAILABLE. LAKE FOREST PLACE HEALTH CARE CENTER CONSISTS OF 50 SKILLED, MEDICARE-CERTIFIED NURSING BEDS. THE MOORINGS HEALTH CARE CENTER CONSISTS OF 57 SKILLED, MEDICARE-CERTIFIED NURSING BEDS AND 39 INTERMEDIATE AND MEMORY CARE BEDS. THE TWO HEALTH CARE CENTERS SERVED A TOTAL OF 466 RESIDENTS DURING THE FILING YEAR. 3296228 REVENUE IS RELATED TO PROCEEDS FROM INSURANCE CLAIMS, INCOME FROM EMPLOYEE MEALS AND OTHER PROGRAM ACTIVITIES. 3296228 69797168 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 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 1 1 1 1 0 0 1 X 63 0 1 877 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X MARK HAVRILKA 8479793904 8707 SKOKIE BOULEVARD SUITE 400 SKOKIE IL 60077 PAULA NOBLE BOARD CHAIR 1.00 2.00 X X 0 0 0 MICHAEL KIRBY SECRETARY 1.00 2.00 X X 0 0 0 NEELE STEARNS TREASURER 1.00 2.00 X X 0 0 0 TERRI BRADY DIRECTOR 1.00 2.00 X 0 0 0 CHARLIE DENISON DIRECTOR 1.00 2.00 X 0 0 0 DAVID DONNERSBERGER DIRECTOR 1.00 2.00 X 0 0 0 MONICA HEENAN DIRECTOR 1.00 2.00 X 0 0 0 ELINOR HITE DIRECTOR 1.00 2.00 X 0 0 0 LEE HUTCHINSON DIRECTOR 1.00 2.00 X 0 0 0 VINCE KELLY DIRECTOR 1.00 2.00 X 0 0 0 DENNIS MARX DIRECTOR 1.00 2.00 X 0 0 0 THOMAS MCAFEE DIRECTOR 1.00 2.00 X 0 0 0 MARSHALL PECK DIRECTOR 1.00 2.00 X 0 0 0 HARLAN STANLEY DIRECTOR 1.00 2.00 X 0 0 0 MARK TOLEDO DIRECTOR 1.00 2.00 X 0 0 0 TODD F SWORTZEL CHIEF EXECUTIVE OFFICER 15.00 22.50 X 824512 0 199674 NADIM M ABI-ANTOUN CHIEF OPERATING OFFICER 24.50 13.00 X 497553 0 98397 MARK HAVRILKA CHIEF FINANCIAL OFFICER 24.50 13.00 X 449106 0 94383 LISA J VANDERMARK EXEC. DIR. THE MOORINGS 37.50 0.00 X 291806 0 56573 NANCY TOLAN VP, FACILITY MANAGEMENT 20.50 17.00 X 279191 0 68676 MIRIAM A WALLACE VP, HUMAN RESOURCES 24.50 13.00 X 263949 0 42492 GLENN B BRICHACEK EXEC. DIR. LAKE FOREST PLACE 37.50 0.00 X 233180 0 56437 ROBERT A WERDAN VP, MARKETING & PUBLIC RELATIONS 25.50 12.00 X 291037 0 55331 DANIEL M WEINBERGER VP, INFORMATION TECHNOLOGY 24.50 13.00 X 191584 0 50372 ALPANA A PATEL VP, CLINICAL SERVICES 24.50 13.00 X 182086 0 29220 VINCENT CONNOLLY DIR. ENVIRONMENTAL SVCS, THE MOORINGS 37.50 0.00 X 178781 0 15967 LINDSEY M AUMICK DIRECTOR OF FINANCE 24.50 13.00 X 160121 0 10766 ANDREW T WISSEL DIRECTOR, HUMAN RESOURCES 24.50 13.00 X 143265 0 32889 3986171 0 811177 33 1 1 0 UNIDINE CORPORATION 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 DINING/FOOD SERVICES 4360553 HEALTHPRO HERITAGE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY MGMT AND CONSULTING SERVICES 2220432 A-1 ROOFING COMPANY 1425 CHASE AVE ELK GROVE VILLAGE IL 60007 COMMERCIAL ROOFING CONTRACTOR 2179811 SKENDER CONSTRUCTION LLC 1330 W FULTON ST STE 200 CHICAGO IL 60607 CONSTRUCTION 2022159 POWER CONSTRUCTION COMPANY 8750 W BRYN MAWR AVENUE SUITE 500 CHICAGO IL 60631 CONSTRUCTION 1518426 27 4413710 1481575 5895285 INDEPENDENT LIVING FEES 623311 25409973 25409973 HEALTH CARE FEES 623311 19858707 19858707 ASSISTED LIVING FEES 623311 14579295 14579295 DEFERRED ENTRANCE FEE INCOME 623311 13468016 13468016 19496 19496 73335487 3061708 3061708 34200 0 34200 34200 34200 54286000 50702994 3583006 3583006 3583006 186437 157580 28857 28857 MANAGEMENT FEES 561000 3413380 3413380 NET PROCEEDS FROM INSURANCE CLAIM 525100 3276732 3276732 6690112 92628655 76612219 0 10121151 2906848 2906848 25661871 21572625 4089246 1005919 879251 126668 5133644 4671299 462345 1903399 1644266 259133 338801 338801 191326 191326 106593 106593 6946137 6301280 644857 1535116 1535116 239332 141587 97745 896802 621368 275434 367045 49860 317185 2590 62 2528 4238881 3667656 571225 20033329 19708189 325140 1103008 1043509 59499 BUILDING SERVICES AND U 3925179 3863143 62036 FOOD COSTS AND DINING S 2288155 2288155 REAL ESTATE AND PROVIDE 1957332 1956997 335 IT ALLOCATION 0 -756200 756200 2770565 2144121 626444 83551872 69797168 13754704 0 21782936 19633677 12516455 19741556 3817037 1392307 1168926 1491186 460547526 182206358 285284118 278341168 103417044 125572349 7499660 4172160 435486176 450344403 16631212 14620682 87541590 83009344 151210976 145841361 108069358 103404695 363453136 346876082 X 72033040 103468321 72033040 103468321 435486176 450344403 X 9076783 20842407 1516091 X X 0 1 X 1 1 0 X 6657868 2063672 1992062 2170057 5895285 18778944 62730926 64507905 69110341 73199933 76612219 346161324 444606 483720 499392 471368 186437 2085523 69833400 67055297 71601795 75841358 82693941 367025791 6657868 2063672 1992062 2170057 4413710 17297369 0 6657868 2063672 1992062 2170057 4413710 17297369 349728422 2476445 3498853 4561268 3880887 2989315 17406768 2476445 3498853 4561268 3880887 2989315 17406768 3409496 3249501 3432140 3592879 3413380 17097396 75719341 73803651 79595203 83315124 89096636 401529955 0.87100 0.04340 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MANAGEMENT FEE - 2016 AMOUNT: $ 3,409,496. 2017 AMOUNT: $ 3,249,501. 2018 AMOUNT: $ 3,432,140. 2019 AMOUNT: $ 3,592,879. 2020 AMOUNT: $ 3,413,380. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19642758 19642758 394578723 156028652 238550071 620451 171497 448954 45278604 26006209 19272395 426990 426990 278341168 SAFEKEEPING 590541 DEPOSITS - ENTRANCE FEES 1408761 REFUNDABLE ENTRANCE FEES 96492134 OTHER LIABILITIES 2526150 INTEREST RATE SWAP 1692297 DEFERRED COMPENSATION 694812 103404695 X PART X, LINE 2: THE PARENT, WESTMINSTER PLACE, AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND ARE EXEMPT FROM TAX UNDER THE PROVISIONS OF INTERNAL REVENUE CODE SECTION 501(C)(3). LAKE FOREST PLACE, THE MOORINGS, TEN TWENTY GROVE, PH MANAGER, AND PH OUTPATIENT REHABILITATION ARE SINGLE-MEMBER LIMITED LIABILITY COMPANIES AND, THEREFORE, ARE CONSIDERED TO BE DISREGARDED ENTITIES FOR TAX PURPOSES. ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE PARENT, WESTMINSTER PLACE, AND THE FOUNDATION FOLLOW THE ACCOUNTING STANDARDS FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THE PARENT, WESTMINSTER PLACE, AND THE FOUNDATION FILE INFORMATIONAL RETURNS AS TAX-EXEMPT ORGANIZATIONS. THE INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 TODD F SWORTZEL CHIEF EXECUTIVE OFFICER 519889 0 118033 0 186590 0 176126 0 23548 0 1024186 0 159026 0 NADIM M ABI-ANTOUN CHIEF OPERATING OFFICER 374983 0 86084 0 36486 0 75091 0 23306 0 595950 0 16956 0 MARK HAVRILKA CHIEF FINANCIAL OFFICER 331048 0 76530 0 41528 0 68655 0 25728 0 543489 0 24224 0 LISA J VANDERMARK EXEC. DIR. THE MOORINGS 192514 0 20204 0 79088 0 34037 0 22536 0 348379 0 67211 0 NANCY TOLAN VP, FACILITY MANAGEMENT 203097 0 51158 0 24936 0 37973 0 30703 0 347867 0 15471 0 ROBERT A WERDAN VP, MARKETING & PUBLIC RELATIONS 206484 0 54934 0 29619 0 36821 0 18510 0 346368 0 18449 0 MIRIAM A WALLACE VP, HUMAN RESOURCES 232054 0 29702 0 2193 0 28528 0 13964 0 306441 0 0 0 GLENN B BRICHACEK EXEC. DIR. LAKE FOREST PLACE 187727 0 13432 0 32021 0 26465 0 29972 0 289617 0 20048 0 DANIEL M WEINBERGER VP, INFORMATION TECHNOLOGY 157533 0 33708 0 343 0 28791 0 21581 0 241956 0 0 0 ALPANA A PATEL VP, CLINICAL SERVICES 146797 0 34989 0 300 0 25390 0 3830 0 211306 0 0 0 VINCENT CONNOLLY DIR. ENVIRONMENTAL SVCS, THE MOORING 107373 0 13597 0 57811 0 6938 0 9029 0 194748 0 0 0 ANDREW T WISSEL DIRECTOR, HUMAN RESOURCES 121413 0 0 0 21852 0 8035 0 24854 0 176154 0 15577 0 LINDSEY M AUMICK DIRECTOR OF FINANCE 159843 0 0 0 278 0 9590 0 1176 0 170887 0 0 0 PART I, LINE 1A TODD F. SWORTZEL, CEO, RECEIVES A $24,000 TAXABLE HOUSING ALLOWANCE WHICH IS INCLUDED IN W-2 WAGES. PART I, LINE 4B PRESBYTERIAN HOMES HAS ESTABLISHED A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. THE ORGANIZATION'S PAYMENTS ACCURALS INTO THE PLAN ARE RECORDED ON THE 990 AS DEFERRED COMPENSATION. HOWEVER, THESE MONIES VEST OVER A FIVE-YEAR PERIOD AND ARE ONLY ELIGIBLE TO BE RECEIVED BASED UPON THE ACHIEVEMENT OR SATISFACTION OF SOME FUTURE EVENT. THE PLAN CONTRIBUTIONS ARE NOT UNDER THE CONTROL OF THE EXECUTIVE, THEY REMAIN THE ASSET OF THE ORGANIZATION, AND THE ENTIRE PLAN IS SUBJECT TO A FULL RISK OF FORFEITURE BY THE INDIVIDUAL. DURING THE YEAR THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN: TODD SWORTZEL, MARK HAVRILKA, NADIM ABI-ANTOUN, NANCY TOLAN, ROBERT WERDAN, ANDREW WISSEL, MIRIAM WALLACE, ALPANA PATEL, GLEN BRICHACEK, LISA VANDERMARK AND DANIEL WEINBERGER. DURING THE YEAR TODD SWORTZEL RECEIVED PAYMENTS TOTALING $159,026 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR NADIM ABI-ANTOUN RECEIVED PAYMENTS TOTALING $16,956 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR MARK HAVRILKA RECEIVED PAYMENTS TOTALING $24,224 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR GLEN BRICHACEK RECEIVED PAYMENTS TOTALING $20,048 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR NANCY TOLAN RECEIVED PAYMENTS TOTALING $15,471 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR LISA VANDERMARK RECEIVED PAYMENTS TOTALING $67,211 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR ANDREW WISSEL RECEIVED PAYMENTS TOTALING $15,577 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. DURING THE YEAR ROBERT WERDAN RECEIVED PAYMENTS TOTALING $18,449 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. PART I, LINE 7 AS INDICATED IN SCHEDULE J, PART II, THE OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION RECEIVED A BONUS BASED ON PERFORMANCE, QUALITY AND CENSUS METRICS AND THE FINANCIAL RESULTS OF THE ORGANIZATION. THIS BONUS WAS APPROVED BY BOARD OF DIRECTORS UPON THE RECOMMENDATION OF THE GOVERNANCE COMMITTEE. A ILLINOIS FINANCE AUTHORITY 861091967 45204EBD9 2016-04-27 114484316 TO REFUND THE SERIES 1996A, 2001, 2006 AND 2007 BONDS 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 2016-09-30 69615000 TO FUND CAMPUS EXPANSION AT THE MOORINGS OF ARLINGTON HEIGHTS 0 0 0 C ILLINOIS FINANCE AUTHORITY 861091967 45204FHL2 2021-03-31 70917301 TO REFUND SERIES 2016B BONDS & FUND COSTS OF CERTAIN WESTMINSTER FACILITIES 0 0 0 A 43224552 100253916 1586771 8252145 90415000 2016 1 0 1 1 B 3286985 69615000 400000 69215000 2018 0 0 1 1 C 29423520 525420 28898100 1 0 1 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 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 1 0 0 1 1 THE HUNTINGTON NATIONAL BANK 7.400000000000 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/19/2021 SCHEDULE K, PART I AND II, LINE 3, BOND A: THE 2016 BOND WAS ISSUED FOR THE BENEFIT OF LAKE FOREST PLACE, LLC (A DISREGARDED ENTITY OF PRESBYTERIAN HOMES). TOTAL PROCEEDS FOR THE BOND IS $114,484,316. $100,253,916 OF THE TOTAL PROCEEDS IS ALLOCABLE TO PRESBYTERIAN HOMES. THE REMAINING PROCEEDS OF $14,230,400 ARE REPORTED ON THE FORM 990, SCHEDULE K OF WESTMINSTER PLACE. SCHEDULE K, PART II, LINE 7, BOND A: TOTAL ISSUANCE COST FOR THE BOND IS $1,817,171. $1,586,771 OF THE TOTAL COST IS ALLOCABLE TO PRESBYTERIAN HOMES. THE REMAINING COST OF $230,400 IS REPORTED ON THE FORM 990, SCHEDULE K OF WESTMINSTER PLACE. SCHEDULE K, PART I AND II, LINE 3, BOND C: THE 2021 BOND WAS ISSUED FOR THE BENEFIT OF LAKE FOREST PLACE, LLC (A DISREGARDED ENTITY OF PRESBYTERIAN HOMES). TOTAL PROCEEDS FOR THE BOND IS $ $70,917,301. $29,423,520 OF THE TOTAL PROCEEDS IS ALLOCABLE TO PRESBYTERIAN HOMES. THE REMAINING PROCEEDS OF $41,493,781 ARE REPORTED ON THE FORM 990, SCHEDULE K OF WESTMINSTER PLACE. SCHEDULE K, PART II, LINE 7, BOND C: TOTAL ISSUANCE COST FOR THE BOND IS $1,002,040. $525,420 OF THE TOTAL COST IS ALLOCABLE TO PRESBYTERIAN HOMES. THE REMAINING COST OF $476,620 IS REPORTED ON THE FORM 990, SCHEDULE K OF WESTMINSTER PLACE. FORM 990, PART VI, SECTION A, LINE 1: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR, THE VICE CHAIR, THE SECRETARY, THE TREASURER, AND SUCH ADDITIONAL MEMBERS OF THE BOARD AS FROM TIME TO TIME MAY BE DETERMINED BY THE BOARD OF DIRECTORS. THE PRESIDENT/CEO SHALL BE A NON-VOTING ATTENDEE AT ALL MEETINGS OF THE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF DIRECTORS IN EMERGENCIES WHEN CONVENING THE FULL BOARD IS NOT PRACTICABLE AND SHALL REPORT ITS ACTIONS TO THE BOARD AT THE EARLIEST OPPORTUNITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND IS THEN PRESENTED TO THE AUDIT COMMITTEE, WHICH ACTS AS A REPRESENTATIVE OF THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. THIS IS ACCOMPLISHED PRIOR TO THE FILING OF THE FORM 990. THE AUDIT COMMITTEE FORWARDS ITS RECOMMENDATION FOR ACCEPTANCE OF THE FORM 990 TO THE BOARD OF DIRECTORS. COPIES OF THE FORM 990 ARE ALSO FORWARDED TO THE ENTIRE BOARD FOR THEIR REVIEW AND COMMENT PERIOD. THE BOARD THEN ACTS ON THE RECOMMENDATION OF THE AUDIT COMMITTEE PRIOR TO THE 990'S BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AN EXTENSIVE CONFLICT OF INTEREST POLICY WAS ADOPTED IN APRIL 2001 AND MOST RECENTLY REVISED IN 2019. THE POLICY DEFINES COVERED FIDUCIARIES AS PERSONS TO WHOM THIS POLICY APPLIES, AND INCLUDES ALL DIRECTORS, OFFICERS, IDENTIFIED KEY EMPLOYEES AND AGENTS OF PRESBYTERIAN HOMES. AN ANNUAL DISCLOSURE FORM IS PROVIDED TO ALL IDENTIFIED COVERED FIDUCIARIES FOR COMPLETION AND RETURN. PRESBYTERIAN HOMES ALSO ASKS ALL COVERED FIDUCIARIES TO PROVIDE DISCLOSURE WHENEVER CONFLICTS OR DUALITIES OF INTEREST ARISE OR ARE SUSPECTED. IN ADDITION, THE BOARD OR BOARD COMMITTEE CHAIR SHALL REMIND DIRECTORS AT ALL MEETINGS OF THE BOARD OR BOARD COMMITTEE TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OR DUALITIES AS ONE OF THEIR ONGOING DUTIES UNDER THE POLICY. COVERED FIDUCIARIES ARE REQUIRED TO DISCLOSE ANY FACTS OR CIRCUMSTANCES THAT MIGHT GIVE RISE TO POTENTIAL CONFLICTS OR DUALITIES. THE PRESIDENT/CEO OR HIS/HER DESIGNEE REVIEWS THE ANNUAL DISCLOSURE STATEMENTS SUBMITTED BY COVERED FIDUCIARIES AND DETERMINE SPECIFICALLY ANY ACTUAL OR POTENTIAL CONFLICTS OR DUALITIES OF INTEREST. THE PRESIDENT/CEO/DESIGNEE SHALL ADVISE THE APPROPRIATE BOARD OR BOARD COMMITTEE CHAIR AND THE AFFECTED COVERED FIDUCIARY(IES) ON THOSE MATTERS FOR WHICH CERTAIN COVERED FIDUCIARIES SHOULD NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNANCE COMMITTEE OF PRESBYTERIAN HOMES IS RESPONSIBLE FOR ALL COMPENSATION AND BENEFIT MATTERS FOR SENIOR MANAGEMENT AND KEY EMPLOYEES. PRESBYTERIAN HOMES ANNUALLY PARTICIPATES IN AN INDUSTRY SPECIFIC EXECUTIVE COMPENSATION SURVEY. THE RESULTS OF THIS SURVEY ARE REVIEWED BY MANAGEMENT AND SHARED WITH THE COMMITTEE AS NECESSARY. IN ADDITION THE COMMITTEE REGULARLY ENGAGES AN EXTERNAL COMPENSATION CONSULTING FIRM TO ASSIST IN ITS REVIEW OF THE LEVEL OF COMPENSATION, INCENTIVES AND BENEFITS FOR SENIOR EXECUTIVES AND KEY EMPLOYEES EVERY THREE YEARS. THE COMPENSATION CONSULTANTS ACCUMULATE AND PRESENT TO THE GOVERNANCE COMMITTEE MARKET INFORMATION FOR EACH SENIOR EXECUTIVE POSITION, SUMMARIZE INDIVIDUAL EXECUTIVE COMPENSATION, INCENTIVE AND BENEFITS PACKAGES AND BENCHMARK THAT INFORMATION TO THE INDUSTRY DATA THEY HAVE ACCUMULATED. ANNUALLY, THE ORGANIZATION'S STAFF AND/OR THE BOARD OF DIRECTORS PREPARES PERFORMANCE REVIEWS FOR ALL SENIOR MANAGERS AND KEY EMPLOYEES AND MAKES A RECOMMENDATION TO THE GOVERNANCE COMMITTEE REGARDING COMPENSATION, INCENTIVES AND BENEFITS ADJUSTMENTS. THE GOVERNANCE COMMITTEE CONSIDERS THE PERFORMANCE RECOMMENDATION, COMPARISONS OF TOTAL COMPENSATION BY EXECUTIVE TO MARKET COMPENSATION PERCENTILE FOR INDUSTRY EXECUTIVES WITH SIMILAR JOB TITLES AND/OR SKILL SETS, AND ORGANIZATIONAL NEEDS IN TERMS OF MEETING THE CHALLENGES OF THE UNIQUE BUSINESS OF PROVIDING SENIOR CARE SERVICES. THE GOVERNANCE COMMITTEE MAKES A RECOMMENDATION REGARDING COMPENSATION AND BENEFITS CHANGES FOR SENIOR MANAGEMENT WHICH IS APPROVED ANNUALLY BY THE FULL BOARD OF DIRECTORS WITHIN THE BUDGET PROCESS. THE GOVERNANCE COMMITTEE PROCEEDINGS ARE CONTEMPORANEOUSLY DOCUMENTED AND MINUTES ARE MAINTAINED AND ON FILE AT THE CORPORATE OFFICE. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST TO THE PUBLIC. FOR THE INFORMATION CONTACT THE CHIEF FINANCIAL OFFICER, MARK HAVRILKA AT PRESBYTERIAN HOMES, 8707 SKOKIE BOULEVARD, SUITE 400, SKOKIE, IL 60077. THE FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ILLINOIS ATTORNEY GENERAL'S OFFICE. FORM 990, PART XI, LINE 9: CHANGE IN MARKET VALUE OF SWAP 1,516,091. FORM 990, PART XII, LINE 3B: THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT BEEN COMPLETED YET FOR FUNDS RECEIVED DURING FISCAL YEAR ENDING MARCH 31, 2021, BUT PLANS TO BE COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN THE RELEVANT OMB GUIDANCE. LAKE FOREST PLACE LLC 1100 PEMBRIDGE DRIVE LAKE FOREST IL 60045 472210722 LIFE PLAN COMMUNITY (FKA CONTINUING CARE RETIREMENT COMMUNITY) IL 43566718 244977477 PRESBYTERIAN HOMES TEN TWENTY GROVE 1020 GROVE STREET EVANSTON IL 60201 472216648 INDEPENDENT LIVING IL 632118 5500715 PRESBYTERIAN HOMES THE MOORINGS OF ARLINGTON HEIGHTS LLC 811 E CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 472235160 LIFE PLAN COMMUNITY (FKA CONTINUING CARE RETIREMENT COMMUNITY) IL 42568656 154075329 PRESBYTERIAN HOMES PRESBYTERIAN HOMES MANAGER LLC 8707 SKOKIE BOULEVARD SUITE 400 SKOKIE IL 60077 472195328 MANAGEMENT SERVICES IL 5050907 51966081 PRESBYTERIAN HOMES PRESBYTERIAN HOMES OUTPATIENT REHAB AGENCY LLC 3200 GRANT STREET EVANSTON IL 60201 611748512 OUTPATIENT REHABILITATION IL 703663 178436 PRESBYTERIAN HOMES MANAGER LLC GENEVA FOUNDATION 8707 SKOKIE BOULEVARD SUITE 400 SKOKIE IL 60077 710945228 LIFE PLAN COMMUNITIES IL 501(C) (3) LINE 12A, I PRESBYTERIAN HOMES 1 WESTMINSTER PLACE 3200 GRANT STREET EVANSTON IL 60201 362167832 LIFE PLAN COMMUNITIES IL 501(C) (3) LINE 10 PRESBYTERIAN HOMES 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 GENEVA FOUNDATION OF PRESBYTERIAN HOMES C 4413710 CASH RECEIVED GENEVA FOUNDATION OF PRESBYTERIAN HOMES O 381428 CASH RECEIVED GENEVA FOUNDATION OF PRESBYTERIAN HOMES O 229385 CASH RECEIVED WESTMINSTER PLACE O 3183994 CASH RECEIVED WESTMINSTER PLACE O 60000 CASH PROVIDED