2019-11-14T14:45:50-06:00 2018-12-31 LARRY J OTTE CPA 10755 HAWTHORNE DR SAINT JOHN IN 46373 990 2018-01-01 201834903 PARK PLACE CHRISTIAN COMMUNITY OF ST JOHN INC PARK 7083428100 18601 N CREEK DR TINLEY PARK IL 60477 VANDERGENUGTEN BARRY CFO 7083428100 2019-04-14 LARRY J OTTE P01427347 7083593329 2019-11-14 X 199.58.216.254 2019-11-14 14:45:50 CS P 05F5D912F79D4F939E4B956C0FD9A55DB61B7E32 05F5D912F79D4F939E4B956C0FD9A55DB61B7E32 2018 2020-04-17 16:48:07Z VANDERGENUGTEN BARRY 18601 N CREEK DR TINLEY PARK IL 60477 7572372 false X PROVIDENCELIFESERVICES.COM X 2004 IN TO MAINTAIN RESIDENTIAL AND RELATED FACILITIES AND PROVIDE FOR THE PROPER CARE AND NURTURE OF THE ELDERLY AND INFIRM PEOPLE WHO SEEK COMPASSIONATE SERVICES IN THE LATER YEARS OF THEIR LIFE. 7 7 188 25 0 0 5576726 7572372 0 0 5576726 7572372 0 0 2928502 3531200 0 0 5654985 6947622 8583487 10478822 -3006761 -2906450 37331945 42890224 28024613 36366936 9307332 6523288 TO MAINTAIN RESIDENTIAL AND RELATED FACILITIES AND PROVIDE FOR THE PROPER CARE AND NURTURE OF THE ELDERLY AND INFIRM PEOPLE WHO SEEK COMPASSIONATE SERVICES IN THE LATER YEARS OF THEIR LIFE. false false 9393275 7572372 TO PROVIDE THE GENERAL PUBLIC LONG-TERM HEALTHCARE FACILITIES AND SERVICES FOR THE SICK, INJURED &/OR AGED. 9393275 true false false false false false false false false false true false false false true false false false false false false false false false false false false false false true false false false false false false true false false false false false false true false false false true 0 0 188 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 IN X VANDERGENUGTEN BARRY 7083428100 18601 N CREEK DR TINLEY PARK IL 60477 VAN HATTEM RICHARD CHAIR 1.00 2.00 X X 0 0 0 BOTMA KEVIN DIRECTOR 1.00 2.00 X X 0 0 0 WORKMAN ROBERT VICE CHAIR 1.00 2.00 X 0 0 0 CAVANAUGH JEAN 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 ZANDSTRA WILLIAM DIRECTOR 1.00 2.00 X 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 BURTON TRACEY RN 40.00 X 0 100806 0 1727857 289118 false true true PROVIDENCE LIFE SERVICES 18601 NORTH CREEK DR TINLEY PARK IL 60477 MGMT, EDUC, MKT 915898 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY 775136 SYMBRIA RX SERVICES 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 PHARMACY 492037 NIPSCO PO BOX 13007 MERRILLVILLE IN 46411 UTILITY 361628 GORDON FOOD SERVICE PO BOZ 88029 CHICAGO IL 60680 DIETARY 172268 7 ROUTINE REVENUE 623000 7572372 7572372 7572372 7572372 7572372 2984431 2984431 19423 19423 307700 307700 219646 219646 915898 915898 21461 21461 60024 60024 97321 97321 292283 292283 169649 169649 364241 364241 1032555 1032555 1188673 1188673 221085 221085 THERAPY 707063 707063 PHARMACY 398863 398863 NURSING SUPPLIES 345703 345703 DIETARY 286396 286396 846407 846407 10478822 9393275 1085547 0 1135 66350 830586 829915 22027 32322 43484149 2486383 35542045 40997766 936152 963871 37331945 42890224 218295 1494678 25079324 27252004 2726994 7620254 28024613 36366936 X 9307332 6523288 9307332 6523288 37331945 42890224 X -2906450 122406 X false true X true X 5576726 7572372 13149098 5576726 7572372 13149098 13149098 5576726 7572372 13149098 1.00000 1.00000 0.00000 0.00000 X 1574154 1574154 39527570 1773797 37753773 2382425 712586 1669839 40997766 DUE TO AFFILIATES 7620254 7620254 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 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. 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 RECEIVED A DISTRIBUTION FROM THE ACCOUNT OF 450,000. IN 2005, THE BOARD OF DIRECTORS ESTABLISHED THE RETENTION 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 THE 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 RECIEVE 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 CAPABILITIES AND EXPERIENCE. THE VARIABLE PAY REFLECTS THE ORGANIZATIONS COMMITMENT TO PAY FOR SPECIFIC PERFORMANCE TOWARDS ORGANIZATIONAL 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 POSTIONS IN SIMILARLY SIZED AND TYPE ORGANIZAITONS. THE COMMITTEE RECEIEVES 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. LINDA SCHUTT SPOUSE OF CEO 99401 EMPLOYMENT COMP false BONNIE HEIRENDT SISTER OF CEO 52378 EMPLOYMENT COMP false ALLISON OLESHKO DAUGTHER 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 RESPONSIBILITIES 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 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 REVEIW 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 INVLOVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESTATE 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 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 REVEIW 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 INVLOVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESTATE 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 BOARD MEMBERS ANNUALLY REVIEW AND UPDATE THEIR CONFLICT OF INTEREST STATEMENTS. FORM 990, PAGE 6, PART VI, LINE 15A THE PARENT COMPANY'S 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 EXECUTIVE 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 KNOWLEDGABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR THE REASONABLENESS OF EXECUTIVE COMPENSATION IN TAX-EXEMPT ENTITIES. FORM 990, PAGE 6, PART VI, LINE 15B THE EXECUTIVE COMPENSATION OF THE PARENT (REST HAVEN) COMPANYS EXECUTIVES IS SET BY THE PARENT COMPANYS BOARD OF DIRECTORS THROUGH BOARD OVERSIGHT. THE 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 ORGANIZATIONS MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECUTIVE 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 KNOWLEDGABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR THE 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 AFFILIATE EQUITY TRANSFER 122,406 REST HAVEN ILLIANA CHRISTIAN 18601 N CREEK DRIVE TINLEY PARK IL 60477 362382853 HEALTHCARE IL 501C3 7 NA false PROVIDENCE MANAGMENT & DEVELOPMENT 18601 N CREEK DRIVE TINLEY PARK IL 60477 363774205 IT SERVICE IL NA C CORP 3257098 false false false false false false false false false false false false false false false false true false true false PROVIDENCE MANAGEMENT DEVELOPEMENT P 169649 FMV REST HAVEN ILLIANA CHRISTIAN P 915898 FMV