COVENANT HEALTH CARE CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COVENANT HEALTH CARE CENTER INC (EIN 52-1115873)
Tax period
2012-02-01 to 2013-01-31
Filed
2013-12-11
IRS object ID
201313459349301001
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-12-11T13:58:25-06:00Timestamp
Tax Period End Date2013-01-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-02-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN521115873EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Covenant Health Care Centers IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOVENameControl
Phone8474807110Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12155 Pfingsten RoadAddressLine1
CityNorthbrookCity
StateILState
ZIP Code60062ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameElizabeth BuikemaName
TitleSenior VP - Finance/CFOTitle
Phone7738782294Phone
Date Signed2013-12-11DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonElizabeth BuikemaNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1c/o CRC - 5700 Old Orchard RdAddressLine1
CitySkokieCity
StateILState
ZIP Code60077ZIPCode
FieldValueIRS element (for citing)
Gross Receipts25092565GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number2650GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.covenantretirement.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1969YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionCare for senior adults.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers250TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year57362ContributionsGrantsPriorYear
Contributions Grants Current Year196820ContributionsGrantsCurrentYear
Program Service Revenue Prior Year23620982ProgramServiceRevenuePriorYear
Program Service Revenue CY23712015ProgramServiceRevenueCY
Investment Income Prior Year1318340InvestmentIncomePriorYear
Investment Income Current Year1139889InvestmentIncomeCurrentYear
Other Revenue Prior Year39531OtherRevenuePriorYear
Other Revenue Current Year43841OtherRevenueCurrentYear
Total Revenue Prior Year25036215TotalRevenuePriorYear
Total Revenue Current Year25092565TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12675018SalariesEtcPriorYear
Salaries Etc Current Year12629129SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year83900TotalFundrsngExpCurrentYear
Other Expense Prior Year10558476OtherExpensePriorYear
Other Expenses Current Year12489046OtherExpensesCurrentYear
Total Expenses Prior Year23233494TotalExpensesPriorYear
Total Expenses Current Year25118175TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1802721RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-25610RevenuesLessExpensesCY
Total Assets BOY58754224TotalAssetsBOY
Total Assets EOY59904258TotalAssetsEOY
Total Liabilities BOY32640150TotalLiabilitiesBOY
Total Liabilities EOY33797106TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY26114074NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY26107152NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionAs 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)MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense5477479Expense
Revenue6920333Revenue
DescriptionAssisted Living & Assisted Dementia: The number of persons who benefited from the services we provided for the year ended January 31, 2013 were as follows:There were a total of 119 assisted living residents at 01/31/2013 Assisted living residency for the fiscal year totaled 43,852 patient days.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense14980280Expense
Revenue16835523Revenue
DescriptionSkilled Nursing & Skilled Dementia: The number of persons who benefited from the services we provided for the year ended January 31, 2013 were as follows:There were a total of 165 skilled care patients at 01/31/2013.Skilled care residency for the fiscal year totaled 58,536 patient days.Description
FieldValueIRS element (for citing)
Total Program Service Expense20457759TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org1TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address1OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Elizabeth BuikemaBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7738782294TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1C/O CRC 5700 Old Orchard RdAddressLine1
CitySkokieCity
StateILState
ZIP Code60077ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Jon P Aagaard MD
Director1.001.00X000
Curtis B Anderson
Director1.001.00X000
Rev Richard B Berry
Director1.001.00X000
Pamela Christensen
Director1.001.00X000
Wendell Danielson
Director1.001.00X000
Rev Harvey Drake
Director1.001.00X000
Mark C Eastburg
Director1.001.00X000
James Elving
Director1.001.00X000
Marc E Espinosa
Director1.001.00X000
Carol A Findling
Director1.001.00X000
Lorene G Flewellen
Director1.001.00X000
Rhoda Friesen
Director1.001.00X000
Thomas F Heywood
Director1.001.00X000
Donald Hodgkinson
Director1.001.00X000
Jody Holt
Director1.001.00X000
Cletus J Moll
Director1.001.00X000
Joyce Peterson
Director1.001.00X000
Walter Schiller
Director1.001.00X000
Marlene Stante
Director1.001.00X000
Anne Vining
Director1.001.00X000
David A Dwight
Ex-Officio1.0040.00X0581280129403
Rick K Fisk
Ex-Officio/President1.0040.00X059426561092X
Scott MacDonald
Ex-Officio1.001.00X000
Gary Walter
Ex-Officio1.0040.00X0157472117568
Steven P Anderson
Senior VP/Asst Secretary1.0040.0002932512327X
Elizabeth B Buikema
Senior VP/CFO/Treasurer1.0040.00027655662425X
Moraine M Byrne
Senior VP/Asst Secretary1.0040.0007335247422X
Terri S Cunliffe
EVP of Oper/Asst Sec1.0040.00026639887577X
John R Harriff
Senior VP/Asst Secretary1.0040.00023600710277X
David G Erickson
VP/Asst Secretary1.0040.00021031344208X
Kathleen Jenkins
Dir Admin Srvcs/Asst Secretary1.0040.00013285655436X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2557824TotalReportableCompFrmRltdOrgs
Total Other Compensation627735TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions196820AllOtherContributions
Total Contributions196820TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Routine Services6230001604361816043618
Medicare/Medicaid62300041610404161040
Ancillary Services62300034946083494608
Meals6230001274912749
FieldValueIRS element (for citing)
Total Program Service Revenue23712015TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column703786TotalRevenueColumn
Exclusion$703,786ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities436103Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities436103Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column436103TotalRevenueColumn
Exclusion$436,103ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Services to Residents6230001922219222
Support Services6230001186411864

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column12755TotalRevenueColumn
Related Or Exempt Function Income12755RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue43841TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column25092565TotalRevenueColumn
Related Or Exempt Function Income23755856RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,139,889ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9940748Total
Program Services8989807ProgramServices
Management And General929485ManagementAndGeneral
Fundraising21456Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total398418Total
Program Services360154ProgramServices
Management And General37353ManagementAndGeneral
Fundraising911Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1529214Total
Program Services1357734ProgramServices
Management And General164374ManagementAndGeneral
Fundraising7106Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total760749Total
Program Services651492ProgramServices
Management And General107800ManagementAndGeneral
Fundraising1457Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total114940Total
Program Services114940ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total22621Total
Management And General22621ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total3439Total
Management And General3439ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2145700Total
Program Services1932334ProgramServices
Management And General212809ManagementAndGeneral
Fundraising557Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total4535Total
Management And General4535ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1172593Total
Program Services1022291ProgramServices
Management And General150285ManagementAndGeneral
Fundraising17Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total184036Total
Program Services9449ProgramServices
Management And General174587ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total521905Total
Program Services521905ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total35424Total
Program Services33134ProgramServices
Management And General2256ManagementAndGeneral
Fundraising34Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total33944Total
Program Services5253ProgramServices
Management And General28691ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1823826Total
Program Services1179286ProgramServices
Management And General620100ManagementAndGeneral
Fundraising24440Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1877673Total
Program Services1214306ProgramServices
Management And General638409ManagementAndGeneral
Fundraising24958Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total314847Total
Program Services314847ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Admin & General16040011435097168904
Related Party Activity123452758212309812964
Dining Services840183840183
Resident Care386930386930

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total167922Total
Program Services88035ProgramServices
Management And General79887ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total25118175Total
Program Services20457759ProgramServices
Management And General4576516ManagementAndGeneral
Fundraising83900Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY150BOY
EOY150EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY35072BOY
EOY25985EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1882020BOY
EOY2609132EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY31133BOY
EOY23421EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis41627450LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec20712586LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY21660341BOY
EOY20914864EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY10519169BOY
EOY8163933EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3697711BOY
EOY4738405EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY20928628BOY
EOY23428368EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY58754224BOY
EOY59904258EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1403982BOY
EOY1390305EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY31004450BOY
EOY32229468EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY44523BOY
EOY35435EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY187195BOY
EOY141898EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY32640150BOY
EOY33797106EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY26096338BOY
EOY26070729EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY17736BOY
EOY36423EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY26114074BOY
EOY26107152EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY58754224BOY
EOY59904258EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-25610ReconcilationRevenueExpenses
Reconcilation Other Changes18688ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years168263CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years41394CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years174291CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year57362CurrentTaxYearMinus1Year
Current Tax Year196820CurrentTaxYear
Total638130Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21558929CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22256292CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years23096597CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year23620982CurrentTaxYearMinus1Year
Current Tax Year23712015CurrentTaxYear
Total114244815Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years21727192CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22297686CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years23270888CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year23678344CurrentTaxYearMinus1Year
Current Tax Year23908835CurrentTaxYear
Total114882945Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509114882945PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years905986CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1355567CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1295783CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1318340CurrentTaxYearMinus1Year
Current Tax Year1139889CurrentTaxYear
Total6015565Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years905986CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1355567CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1295783CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1318340CurrentTaxYearMinus1Year
Current Tax Year1139889CurrentTaxYear
Total6015565Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22633178CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years23653253CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24566671CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24996684CurrentTaxYearMinus1Year
Current Tax Year25048724CurrentTaxYear
Total120898510Total
FieldValueIRS element (for citing)
Public Support Percentage5090.95020PublicSupportPercentage509
Prior Year Support Percentage0.95030PriorYearSupportPercentage
Investment Income Percentage0.04980InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.04970PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis156030OtherCostOrOtherBasis
Book Value156030BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis37015776OtherCostOrOtherBasis
Depreciation18522909Depreciation
Book Value18492867BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4234250OtherCostOrOtherBasis
Depreciation2155484Depreciation
Book Value2078766BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis221394OtherCostOrOtherBasis
Depreciation34193Depreciation
Book Value187201BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20914864TotalOfBookValueLandBuildings

Other Securities OtherSecurities (6 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Mortgages452936F
Domestic Equity628676F
International Equity999188F
Hedge Funds & Derivatives1652989F
Private Equity742721F
International Real Estate261895F
FieldValueIRS element (for citing)
Total Of Book Value Securities4738405TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Unamortized Debt & Related Expenses488421
Unamortized Original Issue Discount51853
Inter-company Advance Accounts22888094
FieldValueIRS element (for citing)
Total Book Value Other Assets23428368TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Accrued Taxes & Employee Benefits$60,498
Other Liabilities$81,400
FieldValueIRS element (for citing)
Total Of Amounts141898TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Line 2b:Part IV, line 2b: 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: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, 2013, 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 2010."Description of Uncertain Tax Positions Under FIN 48:

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
David A Dwight
Ex-Officio0503155000781250102125027278071068300
Rick K Fisk
Ex-Officio/President0412768091770089727038852022240065535700
Gary Walter
Ex-Officio01574720000028402089166027504000
Elizabeth B Buikema
Senior VP/CFO/Treasurer0212825031980031751035157030947034266000
Terri S Cunliffe
EVP of Oper/Asst Sec0198566032000035832072711017477035658600
John R Harriff
Senior VP/Asst Secretary047175016064017276806320122560248895024946
David G Erickson
VP/Asst Secretary0155845029129025339023153026818026028400
Kathleen Jenkins
Dir Admin Srvcs/Asst Secretary082597075000427590370650210410190962011185

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 3See Schedule O explanation for Form 990 Part VI Section B Line 15 for the methods used to determine CEO compensation.
Part I, Lines 4a-bPart I, Line 4a: John R. Harriff, an officer and Senior Vice President of Covenant Retirement Communities, Inc. (CRC) until February 2012 received $132,525 severance payment from CRC. 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 - $78,482.61 Rick Fisk - $61,269.96 Elizabeth Buikema - $24,608.58 Steven P. Anderson - $19,987.26 John R. Harriff - $11,783.44 Terri Cunliffe - $21,899.90 David Erickson - $21,270.98 Kathleen Jenkins - $10,789.45 Moraine Byrne - $18,560.00
Part I, Line 7Part 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 IIIPart 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 2012 relate to the achievement of targets for the fiscal year ended 1/31/2012. Part II, Column C: Deferred compensation includes an estimate of the contribution made to an employer sponsored defined benefit pension plan. Part II, Column D: Nontaxable benefits include health insurance premiums paid by the employer and employee.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Mission Statement:Form 990 - Part III - Line 1As 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 Health Care Centers, Inc. provided $801,129 free or discounted services to those residents unable to pay all or a portion of their charges, and who meet certain eligibility requirements.
Employees and VendorsForm 990 - Part V - Lines 1a & 2aCovenant Health Care Centers, Inc. (CHCC) is a combination of the assisted living and skilled nursing facilities of two continuing care retirement communities (CCRC), Covenant Home Illinois and The Holmstad, Inc. The W2's of employees and 1099-Misc for vendors that do work for CHCC are reported and issued under the FEIN of each campus. No wages or 1099's are issued under the FEIN of CHCC. There are about 735 employees working in these two campus locations and a combined total of 87 vendors were sent 1099's as of 1/31/13.
Form 990, Part VI, Section A, line 3Covenant Health Care Centers, Inc. delegated control over management duties to Covenant Retirement Communities, Inc. (CRC), its parent organization.
Form 990, Part VI, Section A, line 6The sole member is Covenant Retirement Communities, Inc. (CRC)
Form 990, Part VI, Section A, line 7bS 2.4 of Bylaws include reserved powers to the [invidual] 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 11Management 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 12cCovenant 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.
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 18Form 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 19Form 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.
Contact Info for Directors & OfficersForm 990 - Part VI - Line 9All of the organization's directors and officers can be contacted at this address: Covenant Retirement Communities, Inc. - 5700 Old Orchard Road, Skokie, IL 60077.
Related OrganizationForm 990 - Part VII - Section A Column BOfficers 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.
Changes in Net Assets or Fund Balances:Form 990, Part XI, line 9:Change in Temporarily Restricted Net Assets not included on Income Stmnt 18,688.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Evangelical Covenant Church
8303 West Higgins RoadChicagoIL60631362167730ChurchIL501(c)(3)Line 1N/A0
Swedish Covenant Faculty Group (SCFG)
5145 North California AvenueChicagoIL60625363686216Patient Treatment/EducationIL501(c)(3)Line 11a, I0Swedish Covenant Hospital
Swedish Covenant Hospital
5145 North California AvenueChicagoIL60625362179813HospitalIL501(c)(3)Line 30Covenant Ministries of Benevolence
Swedish Covenant Hospital Foundation (SCHF)
5145 North California AvenueChicagoIL60625205055155Supporting Organization of SCHIL501(c)(3)Line 70Swedish Covenant Hospital
SC Insurance Company
6970 E Chauncey Lane Suite 100PhoenixAZ85054273312053InsuranceAZ501(c)(3)Line 11a, I0Swedish Covenant Hospital

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
Coast Asset Management LLC
2450 Colorado Ave Suite 100 E TowerSanta MonicaCA90404954763400Hedge Fund InvestmentCAN/AN/A00
Covenant Village of Portland LP
420 NE Mason StPortlandOR97211364356838Assisted Living CommunityORN/AN/A00
Swedish Covenant Surgery LLC
5215 N California AvenueChicagoIL60625272485300Outpatient Medical ServicesILN/AN/A00

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryPrimary ActivityPrimaryActivityLegal Domicile Foreign CountryLegalDomicileForeignCountryDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINLegal Domicile StateLegalDomicileStateType Of EntityTypeOfEntity
Covenant International Insurance Company Ltd
Crawford House 50 Cedar AvenueHamiltonBDInsuranceBDN/A0
Covenant Trust Company
Financial ServicesN/A05215 Old Orchard Road Suite 725SkokieIL60077363583163ILC
Swedish Covenant Management Services Inc (SCMS)
Physician Practice ManagementN/A05145 North California AvenueChicagoIL60625364073303ILC
Swedish Covenant Managed Care Alliance (SCMCA)
Physician - Hospital OrganizationN/A02740 West Foster Avenue Suite 409ChicagoIL60625364118659ILC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Covenant Retirement Communities Inc
P2806846
Covenant Retirement Communities Inc
A458726

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