2012-12-11T10:45:48-06:00 2012-01-31 990 2011-02-01 362643638 Covenant Home Illinois COVE 8474806380 2625 Techny Road Northbrook IL 600625900 Elizabeth Buikema 7738782294 2012-12-11 2011 2016-02-24 21:20:13Z Elizabeth Buikema 10784489 0 2650 X www.covenantretirement.org X 1962 IL Care for senior adults. 21 17 330 220 0 0 684006 330191 8993857 9499818 1712443 670764 248585 206346 11638891 10707119 0 0 0 0 3005367 3298859 0 0 284208 8372102 9337355 11377469 12636214 261422 -1929095 81576177 79578914 67888911 67497892 13687266 12081022 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 8412580 9760540 Residential Living:The number of persons who benefited from the services we provided for the year ended January 31, 2012 were as follows:There were a total of 328 residents, occupying 271 apartments at 01/31/2012. Residency for the fiscal year totaled 118,264 resident days. The organization was involved in various community benefits projectswhich includes the following:- Staff members volunteered 190 hours of their time to local churches,Greater Food Depository and others (equivalent to $17,450)- Residents volunteered 6,559 hours of their time to local churches,local schools, public libraries, food pantries and soup kitchens, hospitals, Chicago Botanic Garden and others- Hosted the student internship program "Paramedic Training and Observations" (equivalent to $1,800)- Provided space usage for small groups (under 35 people) to largegroups (75+ participants) which includes the Community CollegeEmeritus, Northbrook Chamber of Commerce, Parkinsons Support Group, local church service and annual meeting and as a Polling Place (equivalent to $72,000 and about 46 hrs of staff time)- Provided scholarships to individuals ($500 in total)- Monetary Donations to Deerfield Park Foundation, Northfield Township Food Pantry, Swedish Covenant Hospital Foundation, World Vision and others($6,175 in total)- In-Kind Donations to missions in Zaire (bandage rolling ministry), Covenant Passport Program, North Park Friendship Center and Habitat for Humanity (estimated value of $38,860)- Land usage by YMCA and Northbrook Covenant Church (equivalent to $30,000)- Usage of property by Covenant Enabling Residence (equivalent to $6,000)- Hosted medium to large scale community events such as the Free Paper Shredding Progam, Parkinsons Awareness sessions and Covenant Trust Company seminar (equivalent to $116,775 and about 85 staff hours ) 8412580 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 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 0 1 0 1 31 0 1 330 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 7738782295 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 X Jon P Aagaard MD 1.00 X 0 0 0 Curtis B Anderson 1.00 X 0 0 0 Rev Richard B Berry 1.00 X 0 0 0 Wendell Danielson 1.00 X 0 0 0 Rev Harvey Drake 1.00 X 0 0 0 James Elving 1.00 X 0 0 0 Marc E Espinosa 1.00 X 0 0 0 Lorene G Flewellen 1.00 X 0 0 0 Rhoda Friesen 1.00 X 0 0 0 Mary Miller 1.00 X 0 0 0 Cletus J Moll 1.00 X 0 0 0 Joyce Peterson 1.00 X 0 0 0 Norton Richards 1.00 X 0 0 0 Walter Schiller 1.00 X 0 0 0 Marlene Stante 1.00 X 0 0 0 Jean A Stebinger 1.00 X 0 0 0 Robert K Johnston 1.00 X 0 0 0 David A Dwight 1.00 X 0 848677 95681 Rick K Fisk 1.00 X X 0 897465 84268 Scott MacDonald 1.00 X 0 0 0 Gary Walter 1.00 X 0 151985 115788 Steven P Anderson 1.00 X 0 252774 70881 Elizabeth B Buikema 1.00 X 0 358640 55395 Moraine M Byrne 1.00 X 0 202945 47866 Terri S Cunliffe 1.00 X 0 350896 72409 John R Harriff 1.00 X 0 273526 47657 David G Erickson 1.00 X 0 226176 40285 Kathleen Jenkins 1.00 X 0 176448 70348 Neil E Warnygora 40.00 X 226629 0 62420 226629 3739532 762998 1 0 1 0 Advance Rooofing & Woodworking Inc 230 N Hicks Place Palatine IL 60067 Roof Repair/Replacement 702652 Ptak Construction Company 33182 N Island Avenue Wildwood IL 60030 Maintenance Services 658558 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 454210 Comprehensive Therapeutics Ltd 3703 West Lake Avenue Glenview IL 60025 Therapy Services 395564 4 49552 280639 330191 Routine Services 623000 5532164 5532164 Entrance Fee 623000 3573411 3573411 Meals 623000 212123 212123 Ancillary Services 623000 182120 182120 9499818 210860 210860 16020 70397 -54377 -54377 -54377 459904 0 459904 459904 459904 6973 49552 6973 0 Support Services 623000 138500 138500 Services to Residents 623000 12243 12243 109980 109980 260723 10707119 9760541 0 616387 2555773 1884274 657535 13964 84263 63112 20329 822 460366 349974 110174 218 198457 129359 67954 1144 11868 11868 104520 104520 12443 12443 433652 418911 14594 147 384759 345 384081 333 362764 271514 91067 183 99534 2478 96993 63 710127 710127 10358 3609 6749 26423 1750 24673 1444613 958934 447830 37849 2987818 1991807 926223 69788 128941 128941 Related Party Payables 1071594 15 918779 152800 Resident Care 560996 560996 Dining Services 544500 544500 Admin & General 35500 17598 17902 406945 362468 37580 6897 12636214 8412580 3939426 284208 33752 21922 271893 227444 77256 389698 175 945 44774 75904 70751958 23216388 47049137 47535570 23527677 20249675 5521483 8367176 5050030 2710580 81576177 79578914 467171 488983 13585936 14600860 31807577 29352438 231198 210398 21797029 22845213 67888911 67497892 X 13865675 11936581 -178409 144441 13687266 12081022 81576177 79578914 X -1929095 322850 X 0 1 1 X 0 X 247299 559683 337149 684006 330191 2158328 7015051 6968740 8598924 8993857 9499818 41076390 7262350 7528423 8936073 9677863 9830009 43234718 0 0 0 43234718 1882157 -88296 1797876 1712443 670764 5974944 1882157 -88296 1797876 1712443 670764 5974944 9144507 7440127 10733949 11390306 10500773 49209662 0.87860 0.85970 0.12140 0.14030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 450291 450291 52966184 17682129 35284055 9764853 4237421 5527432 7570630 1296838 6273792 47535570 Mortgages 285881 F Domestic Equity 942446 F International Equity 1536214 F Hedge Funds & Derivatives 3926566 F Private Equity 1074760 F International Real Estate 601309 F 8367176 Deferred Revenue Subject to Refund 9684496 Refundable Contract Liabilities 12330216 Other Liabilities 830501 22845213 10707119 12636214 -1929095 322850 322850 -1606245 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: A FIN 48 footnote was not included in the consolidated audited financial statements of Covenant Retirement Communities, Inc. and affiliates. A FIN 48 analysis was completed for Covenant Retirement Communities, Inc. and affiliates and it did not have a material impact on the financial position or results of operations. Part XI, Line 8 - Other Adjustments: Change in Temporarily Restricted Net Assets not included on Income Stmnt 322,850. Benefit Gala 56525 49552 6973 4438 500 2035 56525 49552 6973 4438 500 2035 6973 0 X X 1 1 0 1 0 0 0 0 0 1 0 David A Dwight 0 505032 0 0 0 343645 0 67314 0 28367 0 944358 0 0 Rick K Fisk 0 401500 0 109285 0 386680 0 67384 0 23717 0 988566 0 18009 Gary Walter 0 151985 0 0 0 0 0 27623 0 88165 0 267773 0 0 Steven P Anderson 0 146862 0 21837 0 84075 0 52698 0 24166 0 329638 0 5634 Elizabeth B Buikema 0 213636 0 38071 0 106933 0 34666 0 23948 0 417254 0 10768 Moraine M Byrne 0 160778 0 21538 0 20629 0 33590 0 17108 0 253643 0 8210 Terri S Cunliffe 0 169582 0 29138 0 152176 0 57714 0 17075 0 425685 0 0 John R Harriff 0 128946 0 15355 0 129225 0 37805 0 16193 0 327524 0 0 David G Erickson 0 149595 0 32240 0 44341 0 20060 0 23450 0 269686 0 0 Kathleen Jenkins 0 80036 0 7500 0 88912 0 52257 0 20314 0 249019 0 11125 Neil E Warnygora 135656 0 12404 0 78569 0 44237 0 21855 0 292721 0 5171 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. - Travel for companions 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, 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 - $78,250.81 Rick Fisk - $62,656.27 Elizabeth Buikema - $22,523.08 Steven P. Anderson - $19,775.86 John R. Harriff - $21,225.06 Terri Cunliffe - $18,594.60 David Erickson - $20,085.18 Kathleen Jenkins - $11,814.81 Moraine Byrne - $17,884.00 Neil Warnygora - $16,524.00 Pension Restoration Plan As certain individuals' pension benefits may be limited by tax code maximums on both eligible compensation and benefits, Covenant Ministries of Benevolence (CMB) provides a Pension Restoration Plan which entitles the individuals listed below to a pension benefit based on total cash compensation. David A. Dwight - $6,814 Rick K. Fisk - $25,517 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 2011 relate to the achievement of targets for the fiscal year ended 1/31/2011. Part II, Column B (iii): Other Reportable Compensation - During the 2010 calendar year, Covenant Ministries of Benevolence (CMB) discontinued its sponsorship of a particular deferred benefit program that included employer contributions to split dollar life insurance arrangements for certain employees, including some individuals whose compensation is disclosed on this Form 990 Part VII and in Schedule J. While the sponsorship and employer contributions to the split dollar life insurance arrangements were discontinued in 2010, federal tax law rules prevented CMB from transferring the insurance policies to the affected employees, and fully terminating these arrangements, for 12 months following the Board action to end its sponsorship and contributions. As a result, affected employees were taxed on the value of those split dollar life insurance policies in 2011, when the policies or the value of them was actually transferred to the employees. Although these benefits were earned over many years of employment, the full value of the benefits must be treated as taxable compensation in the year that the employee receives the policy or the benefit. In prior years, the premiums paid for the life insurance arrangements were reported in Part II Column B(iii) as non-taxable benefits in the years they were paid. The portions of reportable compensation that were due to this acceleration treatment are as follows: David Dwight - $283,443.23 Rick Fisk - $274,538.58 Elizabeth Buikema - $75,181.58 Steven P. Anderson - $67,348.01 John R. Harriff - $92,164.41 Terri Cunliffe - $119,770.13 David Erickson - $19,001.89 Kathleen Jenkins - $45,430.60 Neil Warnygora - $62,033.63 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 $57,300 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 Officers and Directors devote less than 1 hour per week to related organizations except for those individuals that are employees of Covenant Retirement Communities, Inc. (CRC). Those that are employed by CRC devote approximately 40 hours per week to CRC. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in Temporarily Restricted Net Assets not included on Income Stmnt 322,850. Total to Form 990, Part XI, Line 5: 322,850. 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 Cardiovascular Performance Group LLC 5145 N California Avenue Chicago IL 60625 203587272 Management Services IL N/A N/A 0 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 Covenant Trust Company 5215 Old Orchard Road Suite 725 Skokie IL 60077 363583163 Financial Services IL N/A C Swedish Covenant Management Services Inc (SCMS) 5145 North California Avenue Chicago IL 60625 364073303 Physician Practice Management IL N/A C 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 1 1 0 0 Covenant Retirement Communities Inc P 2157570 Covenant Retirement Communities Inc O 38962 Covenant Trust Company O 152800