2019-11-14T14:46:19-06:00 2018-12-31 LARRY J OTTE CPA 10755 HAWTHORNE DR SAINT JOHN IN 46373 990 2018-01-01 201835089 TIMOTHY PLACE NFP TIMO 7083428100 18601 NORTH CREEK DRIVE TINLEY PARK IL 60477 VANDERGENUGTEN BARRY CFO 7083428100 2019-11-14 LARRY J OTTE P01427347 7083593329 2019-11-14 X 199.58.216.254 2019-11-14 14:46:19 CS P 05F5D912F79D4F939E4B956C0FD9A55DB61B7E32 05F5D912F79D4F939E4B956C0FD9A55DB61B7E32 2018 2020-03-31 21:24:44Z PARK PLACE CHRISTIAN COMM ELMHURST VANDERGENUGTEN BARRY 18601 N CREEK DR TINLEY PARK IL 60477 20171061 false X PROVIDENCELIFESERVICES.COM X 2004 IL TO PROVIDE HOUSING AND THE FULL CONTINUUM OF CARE FOR SENIORS. 7 7 391 25 0 78123 102165 19376787 19800526 62349 268370 0 19517259 20171061 0 0 7346105 7698109 0 0 19611781 18508721 26957886 26206830 -7440627 -6035769 151485730 140488578 243650190 240684032 -92164460 -100195454 TO PROVIDE HOUSING AND THE FULL CONTINUUM OF CARE FOR SENIORS. false false 25846830 TO PROVIDE HOUSING AND CARE FOR THE ELDERLY AND SICK. 25846830 true false false false false false false false false false true false false true true false true false false false false false false false false false false false false true true false false false false false false false false true false false false false false false true false false false true 31 0 true 391 true false false false false false false false false X 7 7 false true false false true true true true true false false false true true true true true true true false IL X PROVIDENCE LIFE SERVICES 7083428100 18601 NORTH CREEK DR TINLEY PARK IL 60477 VAN HATTEM RICH CHAIR 1.00 2.00 X X 0 0 0 ZANDSTRA WILLIAM DIRECTOR 1.00 2.00 X X 0 0 0 CAVANAUGH JEAN DIRECTOR 1.00 2.00 X X 0 0 0 WORKMAN ROBERT VICE CHAIR 1.00 2.00 X X 0 0 0 BOTMA KEVIN DIRECTOR 1.00 2.00 X 0 0 0 DIEPSTRA AL DIRECTOR 1.00 2.00 X 0 0 0 LARSEN DAVE SECRETARY/TR 1.00 2.00 X 0 0 0 SCHUTT RICHARD CEO 5.00 50.00 X 0 988853 175074 DEYOUNG WILLIAM COO 5.00 50.00 X 0 373815 78752 VANDERGENUGTEN BARRY CFO 5.00 50.00 X 0 264383 35292 MARY BETH FRITZ MARKETING DI 40.00 X 192090 0 17654 ENGELSMAN DONALD ADMINISTRATO 40.00 X 165307 0 39056 SMITH SHELLY HEALTHCARE D 40.00 X 151209 0 39372 KATHLEEN LORENZ SR LIVING CO 40.00 X 134032 0 15760 OPELARIO-ARROYO ARLENE DIRECTOR OF 40.00 X 119949 0 2135 762587 1627051 403095 5 false true true GORDON FOOD SERVICE PO BOX 88029 CHICAGO IL 60680 DIETARY 617238 AEP ENERGY DEPT CH 19346 PALATINE IL 60055 UTILITY 477619 SYMBRIA RX SERVICES 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 PHARMACY 395306 PROVIDENCE LIFE SERVICES 18601 NORTH CREEK DR TINLEY PARK IL 60477 MANAGEMENT 360000 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY 311555 10 102165 102165 ROUTINE REVENUE 623000 19449469 19449469 ANCILLARY REVENUE 623000 351057 351057 19800526 268370 268370 20171061 19800526 268370 6563217 6563217 80442 80442 581263 581263 473187 473187 360000 360000 7500 7500 64015 64015 37858 37858 350576 350576 89128 89128 920340 920340 7970490 7970490 3478005 3478005 644619 644619 DIETARY SERVICES 869638 869638 THERAPY 743197 743197 MAINTENANCE & REPAIR 497035 497035 PHARMACY 382439 382439 2093881 2093881 26206830 25846830 360000 0 3947246 2986888 3704584 1783803 18414 18632 138518 499523 137880421 22522377 118268949 115358044 7277383 2684707 18130636 17156981 151485730 140488578 3284664 3805832 80389456 81061134 143023642 141106642 16952428 14710424 243650190 240684032 X -92164460 -100195454 -92164460 -100195454 151485730 140488578 X -6035769 -1995225 X true true X true false X 4905 2950 2100 78123 102165 190243 12809868 15192394 16843184 19376787 19800526 84022759 12814773 15195344 16845284 19454910 19902691 84213002 84213002 145695 114526 30095 62349 268370 621035 145695 114526 30095 62349 268370 621035 12960468 15309870 16875379 19517259 20171061 84834037 0.99270 0.99060 0.01000 0.01000 X 14600000 14600000 120571671 20883678 99687993 2708750 1638699 1070051 115358044 ASSETS LIMITED TO USE 17156981 17156981 OBLIGATION TO PROVIDE FUTURE SERVICE 11285463 LOAN FROM AFFILIATE 5000000 RESIDENT DEPOSITS 228645 ORIGINAL ISSUE DISCOUNT -1803684 14710424 20171061 20171061 20171061 26235336 28506 28506 26206830 26206830 SCHEDULE D, PAGE 4, PART XII, LINE 2D BOOK / TAX DEPRECIATION DIFFERENCE 28,506 X X true true X X X X X false false false false true false false false false SCHUTT RICHARD CEO 486067 38241 464545 149145 25929 1163927 450000 DEYOUNG WILLIAM COO 338534 23848 11433 45752 33000 452567 VANDERGENUGTEN BARRY CFO 236387 16717 11279 9456 25836 299675 MARY BETH FRITZ MARKETING DIRECTOR 155928 35400 762 6175 11479 209744 ENGELSMAN DONALD ADMINISTRATOR 154731 10576 6189 32867 204363 SMITH SHELLY HEALTHCARE DIRECTOR 144965 5000 1244 5799 33573 190581 SCHEDULE J, PART III LINE 1A THE ORGANIZATION PROVIDES AN ALLOWANCE FOR UP TO 10 BOARD MEMBERS TO ATTEND THE ANNUAL ASSOCIATION CONVENTION TO PROVIDE MORE IN DEPTH KNOWLEDGE OF THE SENIOR CARE INDUSTRY. THE COST OF TRAVEL FOR SPOUSES IS PERMITTED AS LONG AS THE TOTAL DOES NOT EXCEED THE ESTABLISHED ALLOWANCE AMOUNT. DOCUMENTATION OF ATTENDANCE AT THE ANNUAL CONVENTION IS REQUIRED. THE ORGANIZATION HAS ESTABLISHED A SENIOR EXECUTIVE MANAGEMENT PROGRAM WHICH ALLOWS STATED EMPLOYEES TO JOIN A FITNESS CENTER. ELIGIBLE EMPLOYEES THAT ENROLL ARE REQUIRED TO BE ACTIVELY UTILIZING THE FITNESS CENTER. NO SENIOR EXECUTIVES RECEIVED THIS BENEFIT IN 2018. LINE 4B REST HAVEN HAS ESTABLISHED A NONQUALIFIED DEFERRED COMPENSATION PLAN IN AN EFFORT TO RETAIN SELECTED OFFICERS ON A LONG TERM BASIS. RICHARD SCHUTT AND WILLIAM DEYOUNG PARTICIPATE IN THE PLAN. IN 2018, RICHARD SCHUTT RECIEVED A DISTRIBUTION FROM THE ACCOUNT OF 450,000. IN 2005, THE BOARD OF DIRECTORS ESTABLISHED A RETENTION INCENTIVE PLAN FOR CERTAIN OFFICERS. THIS PLAN RECOGNIZES THE HISTORIC CONTRIBUTION OF THE EXECUTIVES WITH THE ORGANIZATION UNTIL NORMAL RETIREMENT AGE. AMONG VARIOUS CRITERIA, IN ORDER TO QUALIFY FOR THE BENEFIT, THE EXECUTIVE WILL NEED TO BE CONTINOUSLY EMPLOYED THRU AND UNTIL FUTURE DATE. THE ORGANIZATIONS PAYMENTS INTO THE PLAN ARE RECORDED ON THE 990 AS DEFERRED COMPENSATION. HOWEVER, THE EXECUTIVE HAS NOT RECEIVED THESE MONIES AND WILL ONLY BE ELIGIBLE TO RECEIVE THE MONIES BASED UPON ACHIEVEMENT OR SATISFACTION OF SOME FUTURE EVENTS. THE PLAN CONTRIBUTIONS ARE NOT UNDER THE CONTROL OF THE EXECUTIVES, THEY REMAIN THE ASSET OF THE ORGANIZATION, AND THE ENTIRE PLAN IS SUBJECT TO A FULL RISK FORFEITURE BY THE INDIVIDUAL. LINE 5 THE PARENT COMPANYS EXECUTIVE COMPENSATION PROGRAM HAS TWO MAJOR ELEMENTS: SALARY, OR BASE PAY, AND VARIABLE PAY. THE SALARY REFLECTS THE VALUE OF AN EXECUTIVE'S CAPABALITIES AND EXPERIENCE. THE VARIABLE PAY REFLECTS THE ORGANIZATIONS COMMITMENT TO PAY FOR SPECIFIC PERFORMANCE TOWARDS THE ORGANIZATIONS GOALS. THE VARIABLE PAY IS AWARDED BASED UPON A SPECIFIC REVIEW OF GOALS AND OBJECTIVES (INCLUDING THOSE WHICH RELATE TO MISSION, OPERATIONAL EFFICIENCY, FINANCIAL EFFECTIVENESS, AND STRATEGIC GOALS). SEMI-ANNUALLY THE COMPENSATION COMMITTEE REVIEWS, ASSESSES AND DETERMINES ANY AWARD UNDER THE VARIABLE PAY COMPONENT. EXECUTIVE EMPLOYEE BENEFITS ARE REVIEWED BY THE COMPENSATION COMMITTEE AND OUTSIDE CONSULTANTS TO INSURE THEY ARE COMPETITIVE AND IN LINE WITH COMMON PRACTICE FOR SIMILAR POSITIONS IN SIMILARLY SIZED AND TYPE ORGANIZATIONS. THE COMMITTEE RECIEVES AN EXECUTIVE COMPENSATION OPINION NOTING THAT THE ORGANIZATIONS EXECUTIVE COMPENSATION FALLS WITHIN THE RANGE OF COMPARABLE POSITIONS WITHIN THE SAME INDUSTRY. THE REPORT/OPINION ALSO NOTES THAT THE STATED REQUIREMENTS OF ENSURING INDEPENDENCE OF COMPENSATION DELIBERATIONS FOR SENIOR EXECUTIVES ARE MET. A ILLINOIS FINANCE AUTHORITY 861091967 45203H7D8 2016-04-01 10710000 DEBT RESTRUCTURIING false false false B ILLINOIS FINANCE AUTHORITY 861091967 45203H7E6 2016-04-01 15801500 DEBT REFINANCING false false false C ILLINOIS FINANCE AUTHORITY 861091967 45203H7G1 2016-04-01 42869750 DEBT REFINANCING false false false D ILLINOIS FINANCE AUTHORITY 861091967 45203H7H9 2016-04-01 20514750 DEBT REFINANCING false false false A 10710000 146646 10710000 true false false true B 15801500 216268 15801500 true false false true C 42869750 586983 42869750 true false false true D 5018358 20514750 280888 20514750 true false false true A false false false false false false false B false false false false false false false C false false false false false false false D false false false false false false false A false false false false false false false false true B false false false false false false false false true C false false false false false false false false true D false false false false false false false false true A true B true C true D true LINDA SCHUTT SPOUSE OF CEO 99401 EMPLOYMENT COMP false BONNIE HEIRENDT SISTER OF CEO 52378 EMPLOYMENT COMP false ALLISON OLESHKO DAUGHTER OF CEO 19578 EMPLOYMENT COMP false SCHEDULE L, PART V THE TRANSACTIONS REPORTED ABOVE INVOLVING INTERESTED PERSONS ARE REVIEWED ANNUALLY BY THE PARENT COMPANY'S COMPENSATION COMMITTEE AND HAVE BEEN DEEMED APPROPRIATE BASED ON THE POSITIONS EMPLOYED. FORM 990, PAGE 6, PART VI, LINE 3 RESPONSIBILITES PAID THROUGH MANAGEMENT FEES TO REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME DBA PROVIDENCE LIFE SERVICES. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME. THE AFFAIRS, BUSINESS AND ALL LEGAL MATTERS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 7A THE MEMBER SHALL HAVE AND EXERCISE THE THE FOLLOWING RESERVE POWERS:(1)TO APPOINT OR REMOVE DIRECTORS; (2) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (3) TO REVIEW ALL ANNUAL BUDGETS AND AUDITED FINANCIAL STATEMENTS AND TO APPROVE ANY DEFICIT BUDGET; (4) TO APPROVE THE CONSTRUCTION OF ANY NEW OR THE ALTERATION OF ANY EXISTING FACILITY INVOLVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESATE OR SUBSTANTIALLY ALL OF THE OTHER ASSETS OF THE CORPORATION; (6) TO DISSOLVE THE CORPORATION. FORM 990, PAGE 6, PART VI, LINE 7B THE MEMBER SHALL HAVE AND EXERCISE THE THE FOLLOWING RESERVE POWERS:(1)TO APPOINT OR REMOVE DIRECTORS; (2) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (3) TO REVIEW ALL ANNUAL BUDGETS AND AUDITED FINANCIAL STATEMENTS AND TO APPROVE ANY DEFICIT BUDGET; (4) TO APPROVE THE CONSTRUCTION OF ANY NEW OR THE ALTERATION OF ANY EXISTING FACILITY INVOLVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESATE OR SUBSTANTIALLY ALL OF THE OTHER ASSETS OF THE CORPORATION; (6) TO DISSOLVE THE CORPORATION. FORM 990, PAGE 6, PART VI, LINE 11B A DRAFT OF THE 990 WAS PREPARED AND SENT FOR INITIAL REVIEW BY THE CONTROLLER, CFO AND CEO. A COMPLETED COPY OF THE 990 IS PROVIDED TO THE FULL BOARD PRIOR TO SUBMISSION. FORM 990, PAGE 6, PART VI, LINE 12C THE OFFICERS AND DIRECTORS/TRUSTEES ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST STATEMENT UPON BEGINNING THEIR POSITION. THEREAFTER, THE CONFLICT OF INTEREST STATEMENTS ARE UPDATED ON AN ANNUAL BASIS AND REVIEWED BY THE BOARD. ANY POTENTIAL CONFLICTS ARE REVIEWED AND ADDRESSED AS NECESSARY. FORM 990, PAGE 6, PART VI, LINE 15A THE PARENT COMPANY'S EXECUTIVE COMPENSATION PROGRAM'S PRIMARY OBJECTIVE IS TO PROVIDE COMPETITIVE TOTAL PAY OPPORTUNITIES THAT HELP ATTRACT, REWARD AND RETAIN CRITICAL LEADERSHIP TALENT IN ORDER TO ACHIEVE THE ORGANIZATION'S MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECTUIVE COMPENSATION RANGES THROUGH A WRITTEN POLICY AND BY COMPARING ITSELF TO ORGANIZATIONS OF SIMILAR SIZE AND TYPE - USING OBJECTIVE, THIRD- PARTY DATA. A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS RECOMMENDS, AND THE BOARD OF DIRECTORS APPROVES, THE SALARY RANGES AND REVIEWS TOTAL COMPENSATION FOR EXECUTIVES ON AN ANNUAL BASIS. THE ORGANIZATION ROUTINELY USES KNOWLEDGEABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR REASONABLENESS OF EXECUTIVE COMPENSATION IN TAX-EXEMPT ENTITIES. FORM 990, PAGE 6, PART VI, LINE 15B THE EXCECUTIVE COMPENSATION OF THE PARENT (REST HAVEN) COMPANYS EXECUTIVES IS SET BY THE PARENT COMPANYS BOARD OF DIRECTORS THROUGH BOARD OVERSIGHT. THE EXECUTIVE COMPENSATION PROGRAMS PRIMARY OBJECTIVE IS TO PROVIDE COMPETITIVE TOTAL PAY OPPORTUNITIES THAT HELP ATTRACT, REWARD AND RETAIN CRITICAL LEADERSHIP TALENT IN ORDER TO ACHIEVE THE ORGANIZATIONS MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECTUIVE COMPENSATION RANGES THROUGH A WRITTEN POLICY AND BY COMPARING ITSELF TO ORGANIZATIONS OF SIMILAR SIZE AND TYPE - USING OBJECTIVE, THIRD-PARTY DATA. A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS RECOMMENDS, AND THE BOARD OF DIRECTORS APPROVES, THE SALARY RANGES AND REVIEWS TOTAL COMPENSATION FOR EXECUTIVES ON AN ANNUAL BASIS. THE ORGANIZATION ROUTINELY USES KNOWLEDGEABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR REASONABLENESS OF EXECUTIVE COMPENSATION IN TAX-EXEMPT ENTITIES. FORM 990, PAGE 6, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 CHANGE IN FSO OBLIGATION 2,383,312 ASC 606 ADOPTION -4,378,537 TOTAL -1,995,225 REST HAVEN ILLIANA CHRISTIAN REST HAVEN ILLIANA CHRISTIAN 18601 N CREEK DRIVE TINLEY PARK IL 60477 362382853 HEALTHCARE IL 501C3 7 N/A false CHRISTIAN HEALTHCARE FOUNDATION CHRISTIAN HEALTHCARE FOUNDATION 18601 N CREEK DRIVE TINLEY PARK IL 60477 200722359 RESEARCH IL 501C3 7 N/A false PROVIDENCE MANAGEMENT & DEVELOPMENT PROVIDENCE MANAGEMENT & DEVELOPMENT 18601 N CREEK DR TINLEY PARK IL 60477 363774205 IT SERVICE IL N/A false false false false false false false false false false false false false false false true true false false false REST HAVEN ILLIANA CHRISTIAN P 360000 FMV PROVIDENCE MANAGEMENT P 249538 FMV