2016-11-18T13:56:17-06:00 2016-03-31 410746749 CLIFTONLARSONALLEN LLP 1301 W 22ND ST STE 1100 OAK BROOK IL 60523 990 2015-04-01 471545753 PRESBYTERIAN HOMES PRES 8474924859 3200 GRANT STREET EVANSTON IL 60201 TODD F SWORTZEL CHIEF EXECUTIVE OFFICER 8474924859 2016-11-15 1 GREGORY S ADAMS P00095597 6305738600 2015 2017-02-10 21:41:12Z TODD F SWORTZEL 3200 GRANT STREET EVANSTON IL 60201 45221411 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 0 252 0 0 0 343158 0 19606749 0 4461644 0 1276166 0 25687717 0 0 0 0 0 10379130 0 0 0 0 10895377 0 21274507 0 4413210 0 327060072 0 281167633 0 45892439 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 7887526 10398024 LAKE FOREST PLACE, THE MOORINGS, AND TEN TWENTY GROVE ARE NOT-FOR-PROFIT INDEPENDENT LIVING, CONTINUING CARE RETIREMENT COMMUNITIES CURRENTLY SERVE 695 INDEPENDENT LIVING RESIDENTS. 1394373 1885254 ASSISTED LIVING FACILITIES AT LAKE FOREST PLACE AND THE MOORINGS PROVIDE CARE TO OLDER ADULTS WHO NEED ASSISTENCE WITH PERSONAL CARE AND DAILY ACTIVITIES. THE FACILITIES CURRENTLY SERVE A TOTAL OF 71 ASSISTED LIVING RESIDENTS. 6994804 7323471 HEALTH CARE CENTERS AT LAKE FOREST PLACE AND THE MOORINGS 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. THE HEALTH CARE CENTERS ARE CURRENTLY SERVING A TOTAL OF 146 RESIDENTS. 16276703 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 0 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 8474924859 3200 GRANT STREET EVANSTON IL 60201 SARAH BUTTER DIRECTOR 1.00 2.00 X 0 0 0 CHARLES DENISON DIRECTOR 1.00 2.00 X 0 0 0 GEORGE DROST DIRECTOR 1.00 2.00 X 0 0 0 GREG HUMMEL DIRECTOR 1.00 2.00 X 0 0 0 LEE HUTCHINSON CHAIR 1.00 2.00 X X 0 0 0 DENNIS MARX DIRECTOR 1.00 2.00 X 0 0 0 BETSY NICHOLS DIRECTOR 1.00 2.00 X 0 0 0 MONICA HEENAN DIRECTOR 1.00 2.00 X 0 0 0 PAULA NOBLE DIRECTOR 1.00 2.00 X 0 0 0 MARSHALL PECK TREASURER 1.00 2.00 X X 0 0 0 HARLAN STANLEY DIRECTOR 1.00 2.00 X 0 0 0 NEELE STEARNS SECRETARY 1.00 2.00 X X 0 0 0 MARK TOLEDO DIRECTOR 1.00 2.00 X 0 0 0 JANE WESTERN DIRECTOR 1.00 2.00 X 0 0 0 DENNIS MURPHY DIRECTOR 1.00 2.00 X 0 0 0 TODD F SWORTZEL CEO 0.00 37.50 X 0 613191 25210 MARK HAVRILKA CFO 0.00 37.50 X 0 287732 28355 JOHN BURNS COO UNTIL 8/29/15 0.00 37.50 X 0 274577 24057 NADIM M ABI-ANTOUN VP OF INFORMATION SYSTEMS 0.00 37.50 X 0 224251 18153 KEITH STOHLGREN VP/EXEC. DIR. WESTMINSTER PLACE 0.00 37.50 X 0 294287 27023 DAVID L BENNI VP/EXEC. DIR. THE MOORINGS 0.00 37.50 X 0 226304 11837 PETER L JAGGARD MEDICAL DIRECTOR 0.00 37.50 X 0 222887 13346 ROBERT A WERDAN VP MARKETING 0.00 37.50 X 0 203587 25272 RICHARD B BERLIN EXEC. DIR. LFP 0.00 37.50 X 0 198396 21659 ANDREW T WISSEL VP HUMAN RESOURCES 0.00 37.50 X 0 177305 17217 NANCY TOLAN VP FACILITIES MANAGEMENT 0.00 37.50 X 0 164203 22481 MICHAEL DEBARI DIRECTOR OF PHARMACY 0.00 37.50 X 0 177719 13489 LINDA L DOTSON DIR. HEALTHCARE-WESTMINSTER 0.00 37.50 X 0 155980 15644 MARY ANN ANICHINI VP QUALITY IMPROVEMENT 0.00 37.50 X 0 135705 7734 JOHN DENKERT DIR. HEALTHCARE-THE MOORINGS 0.00 37.50 X 0 134213 14743 DAVE T DIER MANAGER OF FINANCIAL REPORTING 0.00 37.50 X 0 133255 16406 0 3623592 302626 0 0 1 0 GREAT HAVEN BUILDERS PO BOX 3076 BARRINGTON IL 60010 CONSTRUCTION 4638846 POWER CONSTRUCTION COMPANY 8750 W BRYN MAWR AVENUE SUITE 500 CHICAGO IL 60631 CONSTRUCTION 2183138 GREENLEAF CABINETS INC 1100 FLORENCE EVANSTON IL 60202 CONSTRUCTION 1916664 MORRISON COMMUNITY LIVING PO BOX 102289 ATLANTA GA 30368 DINING/FOOD SERVICES 1327878 RLPS ARCHITECTS 250 VALLEYBROOK DRIVE LANCASTER PA 17601 ARCHITECTS/INTERIOR DESIGNING 884395 19 343158 343158 HEALTHCARE FEES 621990 7323471 7323471 INDEPENDENT LIVING FEES 623990 6861043 6861043 DEFERRED ENTRANCE FEE INCOME 900099 3344937 3344937 ASSISTED LIVING FEES 623990 1885254 1885254 OTHER 900099 163945 163945 28099 28099 19606749 843756 843756 23490 0 23490 23490 23490 23025448 19407560 3617888 3617888 3617888 194281 126134 68147 68147 MANAGEMENT FEES 561000 1184529 1184529 1184529 25687717 19606749 0 5737810 764461 764461 7340720 6041312 1299408 442217 226790 215427 1244799 1080484 164315 586933 454837 132096 1951529 1951529 410637 410637 17041 17041 536387 363059 173328 288331 74 288257 58160 13724 44436 264301 264301 52120 52120 17060 12714 4346 793328 793328 3510751 3493334 17417 151625 47590 104035 UTLITIES & TELEPHONE 865694 814099 51595 SETTLEMENT ON DEFINED B 654423 654423 DRUGS & MED SUPPLIES 464668 458588 6080 ENVIRONMENTAL SERVICES 366414 365756 658 492908 159485 333423 21274507 16276703 4997804 0 12052259 24589189 1717042 732904 302058341 103493111 0 198565230 82484676 0 6918772 0 327060072 10963009 76722355 90415000 0 103067269 0 281167633 X 45892439 0 45892439 0 327060072 X 4413210 -4142198 45621427 X X 0 1 X 1 0 X 343158 343158 19606749 19606749 19949907 19949907 343158 343158 0 343158 343158 19606749 894048 894048 894048 894048 1184529 1184529 22028484 22028484 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MANAGEMENT FEE - 2015 AMOUNT: $ 1,184,529. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25019335 25019335 242994506 89879910 153114596 21563228 13613201 7950027 12481272 12481272 198565230 SAFEKEEPING 345229 DEPOSITS - ENTRANCE FEES 4930902 REFUNDABLE ENTRANCE FEES 94546903 ACCRUED PENSION 2654716 OTHER 589519 103067269 X PART X, LINE 2: PRESBYTERIAN HOMES IS A NOT-FOR-PROFIT CORPORATION EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE(IRC). LAKE FOREST PLACE, LLC, THE MOORINGS LLC, TEN TWENTY GROVE, LLC, PH MANAGER, LLC, AND PH OUTPATIENT REHABILITATION, LLC ARE SINGLE MEMBER LIMITED LIABILITY COMPANIES AND THEREFORE ARE CONSIDERED DISREGARDED ENTITIES FOR TAX PURPOSES. PRESBYTERIAN HOMES FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. PREBYTERIAN HOMES FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. THE INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 TODD F SWORTZEL CEO 0 433080 0 153789 0 26322 0 15900 0 9310 0 638401 0 0 MARK HAVRILKA CFO 0 254204 0 32299 0 1229 0 15900 0 12455 0 316087 0 0 JOHN BURNS COO UNTIL 8/29/15 0 200033 0 35652 0 38892 0 15664 0 8393 0 298634 0 0 NADIM M ABI-ANTOUN VP OF INFORMATION SYSTEMS 0 201283 0 22608 0 360 0 11755 0 6398 0 242404 0 0 KEITH STOHLGREN VP/EXEC. DIR. WESTMINSTER PLACE 0 258001 0 33964 0 2322 0 14838 0 12185 0 321310 0 0 DAVID L BENNI VP/EXEC. DIR. THE MOORINGS 0 192189 0 12701 0 21414 0 11837 0 0 0 238141 0 0 PETER L JAGGARD MEDICAL DIRECTOR 0 222887 0 0 0 0 0 13346 0 0 0 236233 0 0 ROBERT A WERDAN VP MARKETING 0 177354 0 24598 0 1635 0 12817 0 12455 0 228859 0 0 RICHARD B BERLIN EXEC. DIR. LFP 0 169252 0 28333 0 811 0 9294 0 12365 0 220055 0 0 ANDREW T WISSEL VP HUMAN RESOURCES 0 155809 0 20769 0 727 0 10819 0 6398 0 194522 0 0 NANCY TOLAN VP FACILITIES MANAGEMENT 0 148259 0 15471 0 473 0 10296 0 12185 0 186684 0 0 MICHAEL DEBARI DIRECTOR OF PHARMACY 0 176115 0 250 0 1354 0 10325 0 3164 0 191208 0 0 LINDA L DOTSON DIR. HEALTHCARE-WESTMINSTER 0 135784 0 18248 0 1948 0 9383 0 6261 0 171624 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 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, KEITH STOHLGREN, RICHARD BERLIN AND DAVID BENNI. DURING THE YEAR DAVID L BENNI RECEIVED PAYMENTS TOTALING $19,052 FROM A NON-QUALIFIED SECTION 457(F) DEFERRED COMPENSATION PLAN. A ILLINOIS FINANCE AUTHORITY 861091967 45200BF94 2006-08-17 27135000 REFUND THE FY 1996 B BONDS 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 45200B6V5 2007-07-25 28000000 REFUND THE FY 1996 B BONDS 0 0 0 A 11420000 27135000 459000 26676000 2006 1 0 1 1 B 900000 28000000 225155 1718155 26056690 2007 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 1 COUNTER PARTY CO 17.000000000000 0 0 0 0 0 B 0 0 1 0 1 1 COUNTER PARTY CO 24.000000000000 0 0 0 0 1 A 0 B 0 FORM 990, PART I, LINE 1 ON DECEMBER 1, 2015, THE ENTITY FORMERLY KNOWN AS PRESBYTERIAN HOMES (EIN 36-2167832), AN ILLINOIS 501(C)(3) NOT-FOR-PROFIT CORPORATION, WAS RENAMED WESTMINSTER PLACE AS PART OF A SIGNIFICANT CORPORATE REORGANIZATION. IN THE REORGANIZATION, PRESBYTERIAN HOMES (EIN 47-1545753), A NEWLY FORMED ILLINOIS 501(C)(3) NOT-FOR-PROFIT CORPORATION, FORMERLY NAMED PH TRANSITION NFP, BECAME THE MEMBER OF OR OBTAINED RESERVE CORPORATE POWERS OVER SIX SUBSIDIARIES WHICH TOGETHER PROVIDE RESIDENTIAL AND HEALTH CARE PROGRAMS FOR OLDER ADULTS IN ILLINOIS. PRESBYTERIAN HOMES (EIN 47-1545753) IS THE MEMBER OF GENEVA FOUNDATION OF PRESBYTERIAN HOMES AND WAS ADDED AS A SUPPORTED ORGANIZATION OF GENEVA FOUNDATION OF PRESBYTERIAN HOMES. 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 11 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 PRESBYTERIAN HOMES EMPLOY MULTIPLE PRACTICES TO ENSURE SENIOR STAFF AND MEMBERS OF THE BOARD OF DIRECTORS FOLLOW BEST GOVERNANCE PRACTICES. AN EXTENSIVE CONFLICTS OF INTEREST POLICY WAS ADOPTED IN APRIL 2001, REVISED IN APRIL 2004 AND FURTHER REVISED IN 2011. ALL DIRECTORS AND SENIOR STAFF ARE REQUIRED TO FILE AN ANNUAL STATEMENT RELATED TO CONFLICTS OF INTEREST. IN ACCORDANCE WITH PRESBYTERIAN HOME'S ACCREDITATION BY THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES-CONTINUING CARE ACCREDITATION COMMISSION (CARF-CCAC), A CODE OF ETHICS WAS ADOPTED IN APRIL 2007 AND ALL DIRECTORS ARE REQUIRED TO FILE AN ANNUAL STATEMENT CONFIRMING THEIR ACCEPTANCE OF THE CODE. FINALLY, PRESBYTERIAN HOMES ADMINISTERS THE IRS RELATIONSHIP SURVEY TO ALL DIRECTORS AND KEY EMPLOYEES ANNUALLY. 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 IS 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. CONTACT FOR THE INFORMATION IS THE CHIEF FINANCIAL OFFICER, MARK HAVRILKA AT PRESBYTERIAN HOMES, 3200 GRANT STREET, EVANSTON, IL 60201. THE FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ILLINOIS ATTORNEY GENERAL'S OFFICE. FORM 990, PART XI, LINE 9: CHANGE IN MARKET VALUE OF SWAP 583,225. NET ASSETS TRANSFERRED UPON REORGANIZATION 28,449,124. NET ASSETS TRANSFERRED FROM AFFILIATE 15,774,000. CHANGE IN PENSION LIABILITY 815,078. FORM 990, PART XII, LINE 2C THE CONSOLIDATED FINANCIAL STATEMENTS OF PRESBYTERIAN HOMES AND AFFILIATES ARE AUDITED BY AN INDEPENDENT AUDITOR. THERE HAS BEEN NO CHANGE TO THE PROCESS WHEN COMPARED TO THE PRIOR YEAR. LAKE FOREST PLACE LLC 1100 PEMBRIDGE DRIVE LAKE FOREST IL 60045 472210722 CONTINUING CARE RETIREMENT COMMUNITY IL 10418515 214507505 PRESBYTERIAN HOMES TEN TWENTY GROVE LLC 1020 GROVE STREET EVANSTON IL 60201 472216648 CONTINUING CARE RETIREMENT COMMUNITY IL 426247 4988677 PRESBYTERIAN HOMES THE MOORINGS OF ARLINGTON HEIGHTS LLC 811 E CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 472235160 CONTINUING CARE RETIREMENT COMMUNITY IL 9577181 81065965 PRESBYTERIAN HOMES PRESBYTERIAN HOMES MANAGER LLC 3200 GRANT STREET EVANSTON IL 60201 472195328 CONTINUING CARE RETIREMENT COMMUNITY IL 5265774 26483586 PRESBYTERIAN HOMES PRESBYTERIAN HOMES OUTPATIENT REHAB AGENCY LLC 3200 GRANT STREET EVANSTON IL 60201 611748512 OUTPATIENT REHABILITATION IL 0 14399 PRESBYTERIAN HOMES MANAGER LLC GENEVA FOUNDATION 3200 GRANT STREET EVANSTON IL 60201 710945228 SUPPORTING ORGANIZATION IL 501(C)(3) LINE 11A, I PRESBYTERIAN HOMES 1 WESTMINSTER PLACE 3200 GRANT STREET EVANSTON ID 60201 362167832 CONTINUING CARE RETIREMENT COMMUNITY IL 501(C)(3) LINE 9 PRESBYTERIAN HOMES 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 GENEVA FOUNDATION C 343158 CASH RECEIVED GENEVA FOUNDATION O 84630 CASH RECEIVED GENEVA FOUNDATION N 62500 CASH RECEIVED WESTMINSTER PLACE N 1122029 CASH RECEIVED WESTMINSTER PLACE N 52120 CASH PROVIDED WESTMINSTER PLACE O 2691938 CASH PROVIDED WESTMINSTER PLACE S 44223123 BOOK VALUE