2013-12-11T13:58:25-06:00 2013-01-31 990 2012-02-01 362643638 Covenant Home Illinois COVE 8474806380 2625 Techny Road Northbrook IL 600625900 Elizabeth Buikema 7738782294 2013-12-11 2012 2015-11-30 17:44:51Z Elizabeth Buikema 5700 Old Orchard Road Skokie IL 60077 11732932 0 2650 X www.covenantretirement.org X 1962 IL Care for senior adults. 20 16 338 216 0 0 330191 45029 9499818 9824523 670764 1602151 206346 175329 10707119 11647032 0 0 0 0 3298859 3327892 0 0 175231 9337355 9262965 12636214 12590857 -1929095 -943825 79578914 80678784 67497892 69585550 12081022 11093234 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 8169281 10062818 Residential Living: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 337 residents, occupying 274 apartments at 01/31/2013. Residency for the fiscal year totaled 124,081 resident days. The organization was involved in various community benefits projectswhich includes the following:- Staff members volunteered 405.5 hours of their time to Family Promise homeless shelter, Greater Food Depository, Northbrook Chamber of Commerce, United Synagogue Youth, Paramedic Traning and Observation, Glenbrook Hospital and others (equivalent to $51,238)- Residents volunteered 6,544 hours of their time to local churches,local schools, public libraries, food pantries and soup kitchens,hospitals, Chicago Botanic Garden, Field Museum, Glenview Village Cable Station and others. Resident also raised in-kind donations to Operation Christmas Child (estimated value of $950)- Hosted student internship programs such as the Paramedic Training andObservations, NPTS students and NSSED Special Ed work experience program (equivalent to $100,113)- Provided space usage for small groups (under 35 people) to largegroups (75+ participants) which includes the Oakton Community CollegeEmeritus, Parkinsons Support Group, AARAP Safe Driving class, Covenant Care at Home's Hospice Training and Flu Shot Clinic, Diabetic shoe fitting clinic, Harbor Point Ministries, Holy Trinity Guild, YMCA staff, Glenview Senior Center, St. Peter Church and others (equivalent to $154,566 and about 96 staff hours)- Provided scholarships to individuals ($1,700 in total)- Monetary Donations to Northfield Township Food Pantry, Evangelical Covenant Church, Helping Hands Food Drive, Northbrook Police and Fire Department, Northbrook Public Library and World Vision ($13,085in total)- In-Kind Donations to missions in Zaire (bandage rolling ministry),Covenant Passport Program, Helping Hands Food Drive and Habitat forHumanity (estimated value of $24,310)- Land usage by YMCA and Northbrook Covenant Church (equivalent to$30,000)- Usage of property by Covenant Enabling Residence (equivalent to$6,000)- Hosted small to large scale community events for different groups such as Alzheimers and Parkinsons Support Group, Covenant Trust Company and Northbrook Chamber of Commerce (equivalent to $189,425 and about 61 staff hours) 8169281 1 1 0 0 0 0 0 0 1 0 1 1 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 35 0 1 338 1 0 0 0 0 0 1 1 0 0 0 0 X 20 16 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 0 0 0 X Elizabeth Buikema 7738782295 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 X Jon P Aagaard MD 1.00 1.00 X 0 0 0 Curtis B Anderson 1.00 1.00 X 0 0 0 Rev Richard B Berry 1.00 1.00 X 0 0 0 Pamela Christensen 1.00 1.00 X 0 0 0 Wendell Danielson 1.00 1.00 X 0 0 0 Rev Harvey Drake 1.00 1.00 X 0 0 0 Mark C Eastburg 1.00 1.00 X 0 0 0 James Elving 1.00 1.00 X 0 0 0 Marc E Espinosa 1.00 1.00 X 0 0 0 Carol A Findling 1.00 1.00 X 0 0 0 Lorene G Flewellen 1.00 1.00 X 0 0 0 Rhoda Friesen 1.00 1.00 X 0 0 0 Thomas F Heywood 1.00 1.00 X 0 0 0 Donald Hodgkinson 1.00 1.00 X 0 0 0 Jody Holt 1.00 1.00 X 0 0 0 Cletus J Moll 1.00 1.00 X 0 0 0 Joyce Peterson 1.00 1.00 X 0 0 0 Walter Schiller 1.00 1.00 X 0 0 0 Marlene Stante 1.00 1.00 X 0 0 0 Anne Vining 1.00 1.00 X 0 0 0 David A Dwight 1.00 40.00 X 0 581280 129403 Rick K Fisk 1.00 40.00 X X 0 594265 61092 Scott MacDonald 1.00 1.00 X 0 0 0 Gary Walter 1.00 40.00 X 0 157472 117568 Steven P Anderson 1.00 40.00 X 0 29325 12327 Elizabeth B Buikema 1.00 40.00 X 0 276556 62425 Moraine M Byrne 1.00 40.00 X 0 73352 47422 Terri S Cunliffe 1.00 40.00 X 0 266398 87577 John R Harriff 1.00 40.00 X 0 236007 10277 David G Erickson 1.00 40.00 X 0 210313 44208 Kathleen Jenkins 1.00 40.00 X 0 132856 55436 Neil E Warnygora 40.00 0.00 X 163125 0 58461 163125 2557824 686196 1 0 1 0 Ptak Construction Company 33182 N Island Avenue Wildwood IL 60030 Maintenance Services 635145 Comprehensive Therapeutics Ltd 3703 West Lake Avenue Glenview IL 60025 Therapy Services 555375 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 460497 3 55354 -10325 45029 Routine Services 623000 5905956 5905956 Entrance Fee 623000 3462324 3462324 Medicare/Medicaid 623000 243605 243605 Ancillary Services 623000 211754 211754 Meals 623000 884 884 9824523 902348 902348 14413 77379 -62966 -62966 -62966 699803 0 699803 699803 699803 8521 55354 8521 0 Support Services 623000 157219 157219 Services to Residents 623000 15385 15385 65691 65691 238295 11647032 10062818 0 1539185 195171 195171 2378263 1824639 541738 11886 100185 69941 29376 868 472739 357115 115604 20 181534 129909 50715 910 12096 12096 61854 61854 947 947 266367 238836 27421 110 351035 684 349076 1275 414814 309138 105455 221 119882 801 119081 652243 652243 5609 3370 2239 27785 1286 26499 1350286 873095 459097 18094 3228648 2092165 1097740 38743 134749 134749 Related Party Activity 1105144 164 1010177 94803 Resident Care 679860 679860 Dining Services 585882 585882 Admin & General 166463 152795 13668 99301 50513 40487 8301 12590857 8169281 4246345 175231 21922 17596 354300 227444 69471 389698 129956 945 75904 35762 73297777 25347125 47535570 47950652 20249675 19886497 8367176 11034154 2710580 1200396 79578914 80678784 488983 455559 14600860 16392239 29352438 28720046 210398 542200 22845213 23475506 67497892 69585550 X 11936581 10992755 144441 100479 12081022 11093234 79578914 80678784 X -943825 -43963 X 0 1 X 1 0 X 559683 337149 684006 330191 45029 1956058 6968740 8598924 8993857 9499818 9824523 43885862 7528423 8936073 9677863 9830009 9869552 45841920 0 0 0 45841920 -88296 1797876 1712443 670764 1602151 5694938 -88296 1797876 1712443 670764 1602151 5694938 7440127 10733949 11390306 10500773 11471703 51536858 0.88950 0.87860 0.11050 0.12140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 450291 450291 54066315 18857297 35209018 10560782 4853480 5707302 8220389 1636348 6584041 47950652 Mortgages 1054737 F Domestic Equity 1463976 F International Equity 2326774 F Hedge Funds & Derivatives 3849254 F Private Equity 1729547 F International Real Estate 609866 F 11034154 Inter-company Advance Accounts 2189986 Deferred Revenue Subject to Refund 8528048 Refundable Contract Liabilities 12566558 Other Liabilities 190914 23475506 X Part IV, Line 2b: Part IV, line 2b: 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. Description of Uncertain Tax Positions Under FIN 48: 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." Benefit Gala 63875 55354 8521 5735 750 2036 63875 55354 8521 5735 750 2036 8521 0 X 1 1 1 1 0 0 0 0 0 1 0 David A Dwight 0 503155 0 0 0 78125 0 102125 0 27278 0 710683 0 0 Rick K Fisk 0 412768 0 91770 0 89727 0 38852 0 22240 0 655357 0 0 Gary Walter 0 157472 0 0 0 0 0 28402 0 89166 0 275040 0 0 Elizabeth B Buikema 0 212825 0 31980 0 31751 0 35157 0 30947 0 342660 0 0 Terri S Cunliffe 0 198566 0 32000 0 35832 0 72711 0 17477 0 356586 0 0 John R Harriff 0 47175 0 16064 0 172768 0 632 0 12256 0 248895 0 24946 David G Erickson 0 155845 0 29129 0 25339 0 23153 0 26818 0 260284 0 0 Kathleen Jenkins 0 82597 0 7500 0 42759 0 37065 0 21041 0 190962 0 11185 Neil E Warnygora 133748 0 10971 0 18406 0 39641 0 22819 0 225585 0 0 0 Part I, Line 1a The following are available benefits and are treated as taxable compensation: - Health club dues paid for one (1) senior-level employee. 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, Lines 4a-b Part 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 Neil Warnygora - $17,035.58 Part I, Line 7 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. Supplemental Information Part III 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 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. Mission Statement: Form 990 - Part III - Line 1 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 Home provided $184,093 free or discounted services to those residents unable to pay all or a portion of their charges, and who meet certain eligibility requirements. Tax-Exempt Bonds: Form 990 - Part IV - Line 24a 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 Home 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 Communties, 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 Covenant Retirement Communities, Inc. (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. 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 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 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. Contact Information for Directors & Officers Form 990 Part VI - Line 9 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. Related Organization Form 990 Part VII - Section A Column B 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in Temporarily Restricted Net Assets not included on Income Stmnt -43,963. 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 3527937 Covenant Trust Company P 94803