2014-12-11T13:02:40-06:00 2014-01-31 990 2013-02-01 841084331 Covenant Village of Colorado Inc COVE 3034244828 9153 Yarrow Street Westminster CO 800214563 Elizabeth B Buikema VP of Finance/CFO 7738782294 2014-12-11 2013 2015-11-30 17:44:51Z Elizabeth Buikema c/o CRC - 5700 Old Orchard Rd Skokie IL 60077 16684486 0 2650 X www.covenantretirement.org X 1988 CO Care for senior adults. 21 17 294 157 0 0 293230 97708 15038774 15304660 809514 846150 286750 427278 16428268 16675796 0 0 0 0 7431369 7319694 0 0 158495 10148769 10171160 17580138 17490854 -1151870 -815058 57024497 62178873 69199654 75238671 -12175157 -13059798 X As a ministry of the Evangelical Covenant Church, Covenant Retirement Communities celebrates God's gift of life in Christian community. We follow the Great Commandment to love and serve God and one another as taught by Jesus Christ. (SEE SCHEDULE O) 0 0 6205834 7213370 Residential Living:The number of persons who benefited from the services we provided for the year ended January 31, 2014 were as follows:There were a total of 282 residents occupying 202 apartments at 01/31/14. Residency for the fiscal year totaled 97,503 resident days. 1485612 2198922 Assisted Living:The number of persons who benefited from the services we provided for the year ended January 31, 2014 were as follows:There were total of 43 assisted living residents at 01/31/14. Assisted living residency for the the fiscal year totaled 14,395 resident days. 5219306 6319646 Skilled Nursing & Skilled Dementia:The number of persons who benefited from the services we provided for the year ended January 31, 2014 were as follows:There were a total of 50 skilled and long term residents at 01/31/14. Skilled and long term residency for the fiscal year totaled 19,276 resident days. The organization was involved in various community benefits projectswhich include the following:- Staff members volunteered a total of 89 hours of their time tovarious activities/events in the community including the feeding thehomeless, helping in various ministries of local churches and Clown Visit at The Retreat AL (equivalent to $4,550)- Residents volunteered a total of 4,701 hours at local hospitals andclinics, police departments, churches, schools & libraries, food pantries/banks, knitting and sewing projects for different organizations, teaching, tutoring and mentoring projects, Meals for the Homeless project, and others. Residents also raised funds through the Creative Arts project and made monetary donations to various groups such as the Arvada Food Bank, Denver Rescue Mission, Family Tree, Have a Heart Foundation, Hope House, St. Francis Center, Mennonite Disaster Service, Jeffco Action Center, Westminster Food Bank, Salvation Army, and Covenant Heights Conference Center ($11,293 in total). In addition, residents gave in-kind donations to Longmont Flood Relief and Hannah's Pantry ($6,954 estimated value)- Hosted student internship program for Regis University Nursing students (equivalent to $2,000)- Provided space usage for meeetings and events for various groupsranging from under 35 people to 75+ people such as AARAP Driving School,Genealogy Expo, Relay for Life for the American Cancer Society and Standley Lake High School Link Leaders Training (equivalent to $32,000)- Monetary Donations to Covenant World Relief, St. Francis Center, Westminster Legacy Foundation and Westminster Public Safety Recognition Foundation ($1,932 in total)- In-Kind Donations to a food bank called Hannah's Pantry, Good Will, Westminster Police Department and Westminster Fire-Rescue Station ($5,485 estimated value)- Host site for small to large scale community events (from under 35 participant to 75+) such as Arthritis Foundation Aquacize, seminars/sessions on several topics/issues called "Wednesdays at 2" throughout the year and Health Faire (equivalent to $375,000) 12910752 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 30 0 1 294 1 0 0 0 0 0 1 1 0 0 0 0 X 21 17 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 0 0 0 X Elizabeth Buikema 7738782294 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 X Jon P Aagaard MD Director 1.00 1.00 X 0 0 0 Rev Richard B Berry Director 1.00 1.00 X 0 0 0 Pamela Christensen Director 1.00 1.00 X 0 0 0 Kara E Davis MD Director 1.00 1.00 X 0 0 0 Rev Harvey Drake Director 1.00 1.00 X 0 0 0 Mark C Eastburg Director 1.00 1.00 X 0 0 0 James Elving Director 1.00 1.00 X 0 0 0 Marc E Espinosa Director 1.00 1.00 X 0 0 0 Carol A Findling Director 1.00 1.00 X 0 0 0 Lorene G Flewellen Director 1.00 1.00 X 0 0 0 Rhoda Friesen Director 1.00 1.00 X 0 0 0 Thomas F Heywood Director 1.00 1.00 X 0 0 0 Donald Hodgkinson Director 1.00 1.00 X 0 0 0 Kathy Holmgren Director 1.00 1.00 X 0 0 0 Jody Holt Director 1.00 1.00 X 0 0 0 Cletus J Moll Director 1.00 1.00 X 0 0 0 Marlene Stante Director 1.00 1.00 X 0 0 0 Anne Vining Director 1.00 1.00 X 0 0 0 David A Dwight Ex-Officio 1.00 40.00 X 0 829154 35518 Rick K Fisk Ex-Officio/President 1.00 40.00 X X 0 591314 20510 Scott Macdonald Ex-Officio 1.00 1.00 X 0 0 0 Gary Walter Ex-Officio 1.00 40.00 X 0 148198 108038 Terri S Cunliffe EVP of Oper/Asst Sec 1.00 40.00 X 0 291900 46580 Elizabeth B Buikema Senior VP/CFO/Treasurer 1.00 40.00 X 0 286641 51818 David G Erickson VP/Asst Secretary 1.00 40.00 X 0 216079 44087 Kathleen Jenkins Dir Admin Srvcs/Asst Secretary 1.00 40.00 X 0 139833 16572 Brenda Hancock Admin-Healthcare 40.00 0.00 X 112084 0 3462 Mark D Osweiler Executive Director 40.00 0.00 X 134065 0 20580 246149 2503119 347165 2 0 1 0 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 452497 1 28965 68743 97708 Routine Services 623000 9530067 9530067 Entrance Fee 623000 2400880 2400880 Medicare/Medicaid 623000 1869953 1869953 Ancillary Services 623000 1396210 1396210 Meals 623000 107550 107550 15304660 442735 442735 400416 2999 0 0 400416 2999 403415 403415 8690 28965 8690 0 Support Services 623000 118638 118638 Services to Residents 623000 81103 81103 227537 227537 427278 16675796 15731938 0 846150 5623988 4610649 987133 26206 127955 95487 32216 252 1122195 955112 167023 60 445556 336974 106581 2001 99823 99823 35219 35219 10834 10834 1139825 668335 471213 277 103801 691 103110 703430 589778 112254 1398 235684 425 235259 765598 765598 33868 15738 18130 20341 4178 16163 2450313 1807106 612578 30629 2177122 1605926 544281 26915 232189 232189 Related Party Activity 916629 845872 70757 Dining Services 580844 580844 Resident Care 324346 324346 Admin & General 143160 20865 122295 198134 196688 1446 17490854 12910752 4421607 158495 8833 13063 515321 515175 250203 113955 1744475 3291418 36568 42386 70668662 22832396 45660431 47836266 6936061 8186144 1230703 1511467 641902 668999 57024497 62178873 898701 657627 11329649 11111147 41014096 44497381 59352 61323 15897856 18911193 69199654 75238671 X -12375938 -13190995 200781 131197 -12175157 -13059798 57024497 62178873 X -815058 -69584 X 0 1 X 1 0 X 142237 334944 106826 293230 97708 974945 15492461 15773325 14305846 15038774 15304660 75915066 15634698 16108269 14412672 15332004 15402368 76890011 0 0 0 76890011 1237180 840792 241012 809514 846150 3974648 1237180 840792 241012 809514 846150 3974648 16871878 16949061 14653684 16141518 16248518 80864659 0.95080 0.96460 0.04920 0.03540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2161208 2161208 60300180 20224494 40075686 5326796 2426471 2900325 2880478 181431 2699047 47836266 Deferred Revenue Subject to Refund 8008132 Refundable Contract Liabilities 6313803 Inter-company Advance Accounts 3880317 Other Liabilities 708941 18911193 X Part IV, Line 2b: Explanation: Resident Trust Fund Account: Per state regulations, an account is made available to Skilled Nursing Facility residents wishing to deposit personal needs funds that they can access as needed. Interest is paid based on the interest received from the bank for those deposited funds and allocated among the individual trust fund accounts based on average balances. Resident Entrance Fee Account: Prospective residents pay an application fee deposit which is carried in an escrow account. At move in, the deposit is applied against the total entrance fee amount and the remainder of the money is collected and put in this account. At the end of the month the resident has moved in, all money is transferred out of the escrow account. Part X, Line 2: A FIN 48 footnote was included in the consolidated audited financial statements of Covenant Retirement Communities, Inc. and affiliates which states: "Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by the Retirement Communities and recognize a tax liability if the Retirement Communities have taken an uncertain position that more likely than not would not be sustained upon examination by the IRS or other applicable taxing authorities. Management has analyzed the tax positions taken by the Retirement Communities and has concluded that as of January 31, 2014, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the consolidated financial statements. The Retirement communities are subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The Retirement Communities believe they are no longer subject to U.S. federal, state, and local, or non-U.S. income tax examinations by tax authorities for years before 2011." Benefit Gala 37655 28965 8690 3400 750 4540 37655 28965 8690 3400 750 4540 8690 0 0 1 0 0 0 0 0 1 0 David A Dwight Ex-Officio 0 515357 0 0 0 313797 0 7650 0 27868 0 864672 0 13274 Rick K Fisk Ex-Officio/President 0 432480 0 56263 0 102571 0 9286 0 21145 0 621745 0 0 Gary Walter Ex-Officio 0 148198 0 0 0 0 0 22230 0 85808 0 256236 0 0 Terri S Cunliffe EVP of Oper/Asst Sec 0 229480 0 17400 0 45020 0 29700 0 19309 0 340909 0 0 Elizabeth B Buikema Senior VP/CFO/Treasurer 0 228915 0 23750 0 33976 0 28600 0 26551 0 341792 0 0 David G Erickson VP/Asst Secretary 0 167268 0 21600 0 27211 0 21569 0 27995 0 265643 0 0 Kathleen Jenkins Dir Admin Srvcs/Asst Secretary 0 87263 0 7500 0 45070 0 3447 0 15636 0 158916 0 13817 Mark D Osweiler Executive Director 123320 0 2959 0 7786 0 12368 0 9234 0 155667 0 0 0 Part I, Line 3 See Schedule O explanation for Form 990 Part VI Section B Line 15 for the methods used to determine CEO compensation. Part I, Line 4b Executive Benefit Plan Covenant Ministries of Benevolence (CMB) provides certain supplemental retirement benefits to its officers and key employees. These benefits are provided through a nonqualified deferred compensation plan, under which a portion of the benefits being earned are subject to a "substantial risk of forfeiture." The supplemental retirement benefits are structured to provide a retention incentive that has been determined by the Compensation Committee of CMB's Board to be of substantial value to the organization. The Committee approves all retirement benefits, together with all other forms of compensation and benefits for these and other executives, in a manner intended to qualify for the rebuttable presumption of reasonableness under the intermediate sanctions rules of federal income tax law. The following listed individuals participated in the Executive Benefit Plan: David Dwight - $64,611 Rick Fisk - $54,257 Terri Cunliffe - $25,682 Elizabeth Buikema - $25,464 David Erickson - $21,995 Kathleen Jenkins - $ 9,837 Mark Osweiler - $10,400 Part I, Line 7 The following applies to certain individuals listed on Part VII whose compensation is paid from related organizations: The Executive Compensation Committee (the "Committee") follows a prescribed method for calculating bonuses. The calculation is based on measurable targets determined at the beginning of the year. The Committee has the ability to adjust the dollar value of the calculated awards by up to 10%. The adjustment can be an upward or downward adjustment based on various performance factors. Refer to additional information on the Committee included in Schedule O. Part II, Column B (i): Base compensation for certain individuals may include payments from deferred compensation plans. Part II, Column B (ii): Bonus and incentive compensation - Certain key persons employed by CRC are eligible for incentive compensation as determined by the CRC Board Compensation Committee. Incentives paid in 2013 relate to the achievement of targets for the fiscal year ended 1/31/2013. Part II, Column D: Nontaxable benefits include health insurance premiums paid by the employer and employee. Form 990 - Part III - Line 1 Mission Statement As a ministry of the Evangelical Covenant Church, Covenant Retirement Communities celebrate God's gift of life in Christian community. We follow the Great Commandment to love and serve God and one another as taught by Jesus Christ. That compels us to affirm the dignity of each person and to pursue excellence and financial integrity in all that we do. As we provide a broad range of resources, services and programs to enhance individual and community wellness, we collaborate with residents and families to achieve the best possible results. While seeking to foster independence, we respond to each individual's evolving needs in order to provide the security that assures peace of mind. In living out the mission, the community provides a complete continuum of care from residential living through skilled nursing. Such services are guided by a series of values and goals addressing resident needs, privacy, safety and dignity, including appropriate access to services. In carrying out the mission statement of Covenant Retirement Communities (CRC), Covenant Village of Colorado, Inc. provided $176,827 free or discounted services to those residents unable to pay all or a portion of their charges, and who meet certain eligibility requirements. Form 990 - Part IV - Line 24a Tax-Exempt Bonds The organization has tax-exempt bonds issued after December 31, 2002 with an outstanding principal of more than $100,000. The bonds are reported on Schedule K of the parent organization. Form 990, Part VI, Section A, line 3 Covenant Village of Colordo, Inc. delegated control over management duties to Covenant Retirement Communities, Inc. (CRC), its parent organization. Form 990, Part VI, Section A, line 6 The sole member is Covenant Retirement Communities, Inc. (CRC) Form 990, Part VI, Section A, line 7b S 2.4 of Bylaws include reserved powers to the [individual] members such as appointment of president of CRC, changes to mission and strategic plan, approval of certain acquisitions, dispositions and financings, changes to articles and bylaws. Form 990, Part VI, Section B, line 11 Management Review: The draft Form 990 was reviewed by multiple levels of management including the President of CRC, the Vice President of Finance/CFO and the Vice President of Legal Affairs. Board Review: Prior to filing, key provisions of the Form were discussed with the Board of Directors at the Board meeting and the final Form 990 was provided to each Board member. Form 990, Part VI, Section B, line 12c Covenant Retirement Communities, Inc. (CRC) has an Administrative Policy on conflict of interest, identifying the parameters of a conflict of interest and the requirement to disclose any such conflict of interest. Each January, the CRC policy is distributed to CRC board members and officers. They are asked to sign acknowledging receipt of the policy and to disclose if they have any conflict of interests. If someone is absent from the meeting or fails to return the acknowledgment, there is a follow-up with the individual until the signed acknowledgment is provided. In addition to the above, a separate and more comprehensive questionnaire is sent to the board members, officers, key employees and other interested persons. The completed questionnaires are reviewed by CRC's legal counsel to determine if any actual or potential conflicts exist. If a person becomes an interested person, he or she may be considered in determining whether a quorum is present. The interested person may make a short statement relating to the transaction or arrangement in question, but shall not be present during the discussion and shall not vote on the motion addressing the actual or potential conflict. Form 990, Part VI, Section B, line 15 Covenant Retirement Communities' (CRC) Board of Directors has duly appointed an Executive Compensation Committee (the "Committee"), which is responsible for the review and approval of all compensation and benefits provided to CRC's executive management. The Committee has adopted a written Executive Compensation Philosophy Statement and an Executive Compensation Committee Charter governing the work and review process of the Committee. The Committee follows the procedures described in the Philosophy Statement and the Charter when it reviews and approves the compensation and employee benefits provided to the CRC's senior management. The Committee's review analyzes every element of compensation, including current and deferred compensation, and benefits, including qualified and non-qualified benefits. The Committee conducts its review and approval process at least annually, and approves compensation and benefits only to the extent that the Committee has concluded that the compensation and benefits constitute no more than reasonable compensation for each executive. The Committee consists entirely of disinterested members of the Board, and the Committee works with an independent compensation consultant to prepare and review in advance comprehensive data showing the compensation provided by similarly situated organizations for functionally similar positions. The Committee also prepares a timely and thorough written record of its deliberations and conclusions. As a result, the Committee's review process is designed to satisfy the procedural criteria necessary to qualify for the rebuttable presumption of reasonableness under the federal income tax law intermediate sanctions rules. The resources utilized by the compensation Committee include: 1) independent compensation consultant; 2) written employment contract; 3) compensation survey or study; 4) approval by the board or compensation committee. Form 990, Part VI, Section C, line 18 A copy of the organization's Form 990 is available upon request by contacting the CRC accounting department at 773-878-5744. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available upon request by contacting the CRC accounting department at 773-878-5744. Form 990 - Part VI - Line 9 Contact Info for Directors & Officers All of the organization's directors and officers can be contacted at this address: Covenant Retirement Communities, Inc. - 5700 Old Orchard Road, Skokie, IL 60077. Form 990 - Part VII - Section A Column B Related Organization Officers and Directors devote approximately 1 hour per week to related organizations except for those individuals that are employees of these related organizations; those individuals devote approximately 40 hours to the organizations at which they are employed. Form 990, Part XI, line 9: Change in Temporarily Restricted Net Assets not included on Income Stmnt -69,584. Evangelical Covenant Church 8303 West Higgins Road Chicago IL 60631 362167730 Church IL 501(c)(3) Line 1 N/A 0 Swedish Covenant Faculty Group (SCFG) 5145 North California Avenue Chicago IL 60625 363686216 Patient Treatment/Education IL 501(c)(3) Line 11a, I Swedish Covenant Hospital 0 Swedish Covenant Hospital 5145 North California Avenue Chicago IL 60625 362179813 Hospital IL 501(c)(3) Line 3 Covenant Ministries of Benevolence 0 Swedish Covenant Hospital Foundation (SCHF) 5145 North California Avenue Chicago IL 60625 205055155 Supporting Organization of SCH IL 501(c)(3) Line 7 Swedish Covenant Hospital 0 SC Insurance Company 6970 E Chauncey Lane Suite 100 Phoenix AZ 85054 273312053 Insurance AZ 501(c)(3) Line 11a, I Swedish Covenant Hospital 0 Coast Asset Management LLC 2450 Colorado Ave Suite 100 E Tower Santa Monica CA 90404 954763400 Hedge Fund Investment CA N/A N/A 0 0 Covenant Village of Portland LP 420 NE Mason St Portland OR 97211 364356838 Assisted Living Community OR N/A N/A 0 0 Swedish Covenant Surgery LLC 5215 N California Avenue Chicago IL 60625 272485300 Outpatient Medical Services IL N/A N/A 0 0 Covenant International Insurance Company Ltd Crawford House 50 Cedar Avenue Hamilton BD Insurance BD N/A 0 Covenant Trust Company 5215 Old Orchard Road Suite 725 Skokie IL 60077 363583163 Financial Services IL N/A C 0 Swedish Covenant Management Services Inc (SCMS) 5145 North California Avenue Chicago IL 60625 364073303 Physician Practice Management IL N/A C 0 Swedish Covenant Managed Care Alliance (SCMCA) 2740 West Foster Avenue Suite 409 Chicago IL 60625 364118659 Physician - Hospital Organization IL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Covenant Retirement Communities Inc Q 753473 Covenant Trust Company P 70756