2012-11-15T15:40:17-06:00 2011-12-31 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2011-01-01 371127787 PROVENA SENIOR SERVICES % PATRICK QUINN PROV 7084787900 19065 HICKORY CREEK DRIVE MOKENA IL 60448 John A Orsini 2012-11-15 true KPMG LLP 6142492300 2011 2016-02-24 21:20:13Z CONNIE MARCH-CURTIS 19065 HICKORY CREEK DRIVE Mokena IL 60448 92499794 false X http://www.provena.org/seniors X 1997 IL PROVENA SENIOR SERVICES PROVIDES CARE TO THE ELDERLY in communities primarily in Northern and Central Illinois through long-term care and senior residential properties it owns and operates. 14 12 2444 110 132400 70434 977833 1025624 84007773 87821832 352631 143545 3308070 2451611 88646307 91442612 0 0 0 0 57926500 59026248 0 0 51603 28258693 27197480 86185193 86223728 2461114 5218884 89614158 85363679 15258542 14244402 74355616 71119277 PROVIDES CARE TO THE ELDERLY AND OWNS AND OPERATES 10 NURSING HOMES, FOUR INDEPENDENT LIVING FACILITIES, TWO ASSISTED LIVING FACILITIES, FOUR ADULT DAYCARE CENTERS, TWO COMMUNITY SERVICE FACILITIES, AND ONE OUTPATIENT PHARMACY IN NORTHERN AND CENTRAL ILLINOIS AND INDIANA. false false 75260174 73041576 PROVENA SENIOR SERVICES PROVIDES NURSING CARE FOR LONG-TERM RESIDENTS WHO NEED ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. 5435354 6705380 PROVENA SENIOR SERVICES OPERATES 17 LONG-TERM CARE SENIOR RESIDENTIAL AND COMMUNITY-BASED SERVICE CAMPUSES. FACILITIES ARE LOCATED IN NORTHERN ILLINOIS WITH ONE LOCATION IN INDIANA. 3249827 5971881 PROVENA SENIOR SERVICES OPERATES A PHARMACY IN KANKAKEE, IL THAT IS ONLY AVAILABLE TO ITS RESIDENTS. 1906016 1370349 85851371 true true false false false false false false false true false false false true true false true false false false false false false true false false false false true false false false false false false false false false false false false true true false false false false true 246 0 2444 true true true false false false false false false false false false false false false X 14 12 false false true false false true true true true false true true true true true true true true true true false IL X X PATRICK QUINN 8158062328 9223 WEST ST FRANCIS ROAD Frankfort IL 604238334 DENNIS SONNENBERG 1.0 X X 0 0 0 CHERYL L LOWNEY 1.0 X X 0 0 0 TIM PHILLIPpE 1.0 X X 0 0 0 PATRICIA GOMEZ 1.0 X 0 0 0 CONNIE S MARCH 1.0 X X 0 374873 52485 THERESA KWIATKOWSKI 1.0 X 0 0 0 TERRY SOLEM 1.0 X 0 381290 41332 Nancy T Dowd 1.0 X 0 0 0 Florida Freeman 1.0 X 0 0 0 Sr Marie Mason 1.0 X 0 0 0 Sallie Miller 1.0 X X 0 0 0 Phyllis Nichols 1.0 X 0 0 0 Thomas E Smith 1.0 X 0 0 0 James C Hagen 1.0 X 0 0 0 CRAIG CULVER 40.0 X 141773 0 26714 DAVID HOWARD 40.0 X 252861 0 15093 KATHY DENNIS 40.0 X 159583 0 18543 WENDELL PROVOST 40.0 X 194300 0 22120 mike gordon 1.0 X 0 233173 33617 Susan Enright 40.0 X 162456 0 23722 Marge Gleason 1.0 X 0 370900 20348 NANCY GARCIA 40.0 X 124284 0 12710 Meghan Kieffer 40.0 X 462355 54263 MICHAEL BORN 40.0 X 152182 0 26239 CRAIG PROKUPEK 40.0 X 128770 0 18167 lynda olinski 40.0 X 114859 0 7005 Ann Dodge 40.0 X 123970 0 14953 Delicia Rucker 40.0 X 112826 14323 1667864 1822591 401634 24 false true false Select Rehabilitation INC 550 Frontage Road Suite 2415 NORTHFIELD IL 60093 Therapy Services 8852232 Shawnee Construction Engineering 7701 Opportunity Drive FORT WAYNE IN 46825 Construction 1217421 SCRIPTFLEET GREAT LAKES PO BOX 2513 ORLANDO FL 32802 Delivery Services 250988 BLDD ARCHITECTS INC 100 Merchant Street DECATUR IL 62523 Architechture Srvc 173193 Alverno Clinical Laboratories 2434 Interstate Plaza Drive HAMMOND IN 46324 LAB services 169727 7 1025624 1025624 NET PATIENT REV. 900099 26206770 26206770 MEDICARE/MEDICAID PAYMENTS 900099 61615062 61615062 87821832 251756 251756 0 0 897368 1005579 -108211 -108211 0 0 -108211 128497 51603 76894 76894 0 0 MANAGEMENT SERVICE 541610 105277 132400 -27123 CHILD CARE 900099 601456 601456 PURCHASE REBATES 900099 17320 17320 1650664 1650664 2374717 91442612 87821832 132400 2462756 0 0 0 0 1154159 1154159 0 46043462 45994480 48982 1698227 1694395 3832 6395125 6406027 -10902 3735275 3733819 1456 428025 427079 946 57410 57082 328 52001 50558 1443 0 0 0 0 0 0 0 0 4101608 4095501 6107 0 0 0 2854221 2854221 2936916 2936916 4107707 4106865 842 1148390 1148390 ILLINOIS/INDIANA BED TAX 890329 890329 REAL ESTATE TAXES 629222 629222 SUPPLIES & DRUGS 3662899 3661267 1632 PROVISION FOR BAD DEBT 732645 476756 255889 5596107 5534305 10199 51603 86223728 85851371 320754 51603 0 0 13137926 10199518 0 0 11368039 14237955 0 0 0 0 0 0 704078 788723 214949 202376 108222695 58282719 55659833 49939976 7577039 7767990 0 0 0 0 0 0 952294 2227141 89614158 85363679 11120835 10330629 0 0 347243 330093 0 0 0 0 0 0 1164939 1094537 0 0 2625525 2489143 15258542 14244402 X 72596758 69941648 1515594 934365 243264 243264 74355616 71119277 89614158 85363679 X 5218884 -8455223 X false true true X false X false false false 0.33061 1621364 1609410 3398988 977833 1025624 8633219 81825251 87422313 89935403 84294929 87821832 431299728 89152 1446991 794261 684138 678350 3692892 83535767 90478714 94128652 85956900 89525806 443625839 443625839 1089676 433325 278232 361048 251756 2414037 83384 65134 43561 73477 57825 323381 1173060 498459 321793 434525 309581 2737418 1699322 1204250 2186245 2185302 1667984 8943103 86408149 92181423 96636690 88576727 91503371 455306360 0.97435 0.00000 0.00601 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 4046124 4046124 0 82592586 44642274 37950312 0 1981308 1544198 437110 0 19392931 12096247 7296684 0 209746 209746 49939976 0 RESIDENT DEPOSITS 462787 DUE TO AFFILIATES 983226 DEFERRED COMPENSATION 396894 OTHER CURRENT LIABILITIES 207492 CONDITIONAL ASSET RETIREMENT 438744 2489143 Supplemental Information On January 1, 2008, Provena adopted ASC Subtopic 740-10 Income Taxes- Overall, which addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, Provena may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. At the date of adoption, and as of December 31, 2011, Provena does not have any liabilities for any unrecognized tax benefits. DANCING W/STARS 45644 45644 17713 GOLF OUTING 62497 62497 28611 3 20356 20356 5279 128497 128497 51603 51603 76894 X X X X X X false false false false false false false false false CONNIE S MARCH 0 249768 0 27375 0 97730 0 31670 0 20815 0 427358 0 18069 TERRY SOLEM 0 286154 0 13968 0 81168 0 26060 0 16110 0 423460 0 26923 CRAIG CULVER 120866 0 25351 0 -4444 0 9388 0 17326 0 168487 0 0 0 DAVID HOWARD 167461 0 81836 0 3564 0 14783 0 310 0 267954 0 0 0 KATHY DENNIS 132073 0 25238 0 2272 0 11713 0 6830 0 178126 0 0 0 WENDELL PROVOST 157037 0 30395 0 6868 0 12693 0 9427 0 216420 0 0 0 mike gordon 0 187832 0 0 0 45341 0 15257 0 19106 0 267536 0 0 Susan Enright 135660 0 26090 0 706 0 10135 0 13587 0 186178 0 0 0 Marge Gleason 0 114356 0 90499 0 166045 0 4723 0 16242 0 391865 0 43604 MICHAEL BORN 132115 0 17446 0 2621 0 8913 0 17326 0 178421 0 0 0 Meghan Kieffer 293204 0 169151 37857 17320 517532 16890 FORM 990 PART VI SECTION A, QUESTION 4 ON NOVEMBER 1, 2011, PROVENA HEALTH AND ITs AFFILIATES ("PROVENA") AND RESURRECTION HEALTH ("RHC") COMPLETED A SYSTEM MERGER TO FORM PROVENA-RESURRECTION HEALTH NETWORK (D/B/A PRESENCE HEALTH). PURSUANT TO THE MERGER, THE TWO SPONSORING CONGREGATIONS OF RHC AND THE THREE SPONSORING CONGREGATIONS OF PROVENA AGREED TO JOINTLY SPONSOR A NEW SYSTEM COMPOSED OF ALL ENTITIES COMPRISING BOTH SYSTEMS, including Provena Senior Services. THE SYSTEM MERGER WAS ACCOMPLISHED THROUGH THE ESTABLISHMENT OF A NEW SYSTEM PARENT CORPORATION AS THE SOLE MEMBER OF THE FORMER PARENT CORPORATIONS OF EACH SYSTEM (I.E., RESURRECTION HEALTH CARE CORPORATION AND PROVENA HEALTH, RESPECTIVELY). THE PARENT CORPORATION OF THE NEWLY MERGED HEALTH CARE SYSTEM, PROVENA-RESURRECTION HEALTH NETWORK (D/B/A PRESENCE HEALTH) (REFERRED TO AS PRESENCE HEALTH, HEREIN), IS A NOT_FOR_PROFIT, TAX_EXEMPT CORPORATION. THE MERGER WAS EFFECTED TO PRESERVE AND STRENGTHEN CATHOLIC HEALTH CARE, FURTHERING PROVENA'S AND RHC'S CHARITABLE MISSIONS. PRESENCE HEALTH CREATED THE LARGEST CATHOLIC HEALTHCARE NETWORK IN THE STATE OF ILLINOIS, SPANNING 12 HOSPITALS, 28 LONG_TERM CARE AND SENIOR RESIDENTIAL FACILITIES, MORE THAN 50 PRIMARY AND SPECIALTY CARE CLINICS, AND 6 HOME HEALTH AGENCIES. THE COMBINED HEALTH SYSTEM HAS HOSPITAL OPERATIONS THROUGHOUT CHICAGO, DES PLAINES, EVANSTON, AURORA, ELGIN, JOLIET, KANKAKEE, URBANA, AND DANVILLE. FORM 990 PART VI SECTION A, QUESTIONS 7A & 7B PROVENA SENIOR SERVICES' PARENT ORGANIZATION, PROVENA HEALTH, APPOINTS THE MEMBER BODY OF PROVENA SENIOR SERVICES. FORM 990 PART VI SECTION A, QUESTION 11B THE DATA AND INFORMATION NECESSARY TO PREPARE THE FORM 990 WAS COMPILED BY PROVENA SENIOR SERVICES. KPMG, AS EXTERNAL TAX PREPARERS, USED THIS INFORMATION TO PREPARE THE FORM 990. THE FINAL FORM 990 IS PROVIDED TO THE CORPORATION'S BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990 PART VI SECTION B, QUESTIONS 12A, 12B, & 12C THE ORGANIZATION HAS ADOPTED A POLICY THAT REQUIRES BOARD MEMBERS TO COMPLETE A STATEMENT THAT DISCLOSES ALL ACTIVITIES AND PROHIBITS VOTING ON ANY MATTERS INVOLVING ANY CONFLICTS. EVERY AGENDA HAS A STATEMENT THAT PROHIBITS VOTING ON AGENDA ITEMS WHERE BOARD MEMBERS HAVE CONFLICTS. VENDOR FILES ARE MATCHED WITH COMPANIES THAT BOARD MEMBERS HAVE AFFILIATIONS WITH TO DETERMINE IF CONFLICTS EXIST. FORM 990 PART VI SECTION B, QUESTIONS 15A & 15B AN INDEPENDENT HUMAN RESOURCES COMPANY REVIEWS SALARY SURVEYS FOR CEO'S AND KEY EMPLOYEES DURING THE YEAR AND MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS or a designated board committee. FORM 990 PART VI SECTION C, QUESTION 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND ARE ON THE ORGANIZATION'S WEBSITE. Form 990 Part XI, Line 5 Change in net assets Transfers to Affiliates (8,169,570) Unrealized Gain (208,758) Net Fundraising Income (76,894) ------------ Total Changes in Net Assets (8,455,222) RESURRECTION HEALTH CARE CORPORATION 7435 WEST TALCOTT AVENUE CHICAGO IL 60631 362235165 SENIOR LIVING IL 501(C) (3) 3 na false RESURRECTION MEDICAL CENTER 7435 WEST TALCOTT AVENUE CHICAGO IL 60631 363330926 HEALTH CARE IL 501(C) (3) 3 NA false OUR LADY OF THE RESURRECTION MEDICAL CTR 5645 WEST ADDISON STREET CHICAGO IL 60634 362644178 HEALTH CARE IL 501(C) (3) 3 NA false Provena-Resurrection Health Network 7435 WEST TALCOTT AVENUE CHICAGO IL 60631 361649520 HEALTH CARE IL 501 (c )(3) 3 NA false SAINT FRANCIS HOSPITAL 355 RIDGE AVENUE EVANSTON IL 60202 362167800 HEALTH CARE IL 501(C) (3) 3 NA false SAINTS MARY AND ELIZABETH MEDICAL CENTER 2233 WEST DIVISION STREET CHICAGO IL 60622 362171079 HEALTH CARE IL 501(C) (3) 3 NA HOLY FAMILY MEDICAL CENTER 100 n RIVER ROAD DES PLAINES IL 60016 362439318 HEALTH CARE IL 501(C) (3) 3 NA Holy Family Health Care System Inc 100 N River Road Des Plaines IL 60016 363495969 health care IL 501 (c )(3) 3 NA Saint Joseph Hospital 2900 North Lake Shore Drive chicago IL 60657 363200170 health care IL 501 (c )(3) 3 NA Resurrection University 7435 West Talcott Avenue chicago IL 60631 362182170 health care IL 501 (c )(3) 3 NA Resurrection Ambulatory Services 7435 West Talcott Avenue Chicago IL 60631 364286236 health care IL 501 (c )(3) 3 NA Resurrection Senior Services 7435 West Talcott Avenue chicago IL 60631 237061646 senior living IL 501 (c )(3) 3 na Resurrection Services 7447 West Talcott Avenue chicago IL 60631 363330928 health care IL 501 (c )(3) 3 na Proviso Family Services 1820 South 25th Avenue broadview IL 60155 362709982 health care IL 501 (c )(3) 3 na Resurrection Home Health Services 5747 West Dempster morton grove IL 60053 362893936 home care IL 501 (c )(3) 3 Resur Health Resurrection Development Foundation 150 N River Road des plaines IL 60016 363330929 fundraising IL 501 (c )(3) 7 Resur Health Resurrection Ministries of New York 90 N Main Street castelton NY 12033 141720818 parent corp NY 501 (c )(3) 3 Resur Health Resurrection Nursing Home Inc 90 N Main Street castelton NY 12033 141348691 senior living NY 501 (c )(3) 3 Resur Min NY Mount Loretto Nursing Home Inc 302 Swart Hill Road amsterdam NY 12010 141363014 senior living NY 501 (c )(3) 3 Resur Min NY Resurrection Medical Center Auxiliary 7435 West Talcott Avenue chicago IL 60631 366109825 fundraising IL 501 (c )(3) 7 Resur MedCtr Saint Francis Hospital Auxiliary 355 Ridge Avenue evanston IL 60202 366143349 fundraising IL 501 (c )(3) 7 St Fran Hosp provena hospitals 9223 w st francis road frankfort IL 60423 364195126 healthcare IL 501(c)(3) 3 prov health Provena Health 9223 W St Francis Road Frankfort IL 60423 363366652 Support Org IL 501(c)(3) 11A NA provena care home 19065 hickory creek drive mokena IL 60448 460483587 healthcare IL 501(c)(3) 9 prov health provena home health inc 19065 hickory creek drive mokena IL 60448 460483581 healthcare IL 501(c)(3) 9 prov health provena self-insurance trust 9223 west st st francis road frankfort IL 60423 362987310 healthcare IL 501(c)(3) 9 prov health provena laverna terrace 19065 hickory creek drive mokena IL 60448 363438977 healthcare IL 501(c)(3) 9 prov health PROVENA VENTURES 9223 WEST ST FRANCIS ROAD FRANKFORT IL 60423 371168085 MEDICAL IL Provena Health C CORP 1.00000 PROVENA SERVICE CORPORATION 9223 WEST ST FRANCIS ROAD FRANKFORT IL 60423 364314354 MEDICAL IL PROVENA HOSPITA C CORP PROVENA PROPERTIES 9223 WEST ST FRANCIS ROAD FRANKFORT IL 60423 363520630 MEDICAL IL Provena Health C CORP 1.00000 PROVENA ASSURANCE CORPORATION 9223 WEST ST FRANCIS ROAD FRANKFORT IL 60423 980420054 MEDICAL IL Provena Health C CORP 1.00000 L Gilbraith Insurance SPC LTD 68 West Bay Road PO Box 1109 FRANKFORT IL 60423 980420054 Medical IL NA C Corp Resurrection Health care Preferred 100 N River Road Des Plaines IL 60016 363974620 MGD Care Contract IL RHCC false false false false false false false false false false false false false true true false true false