2012-12-06T11:17:37-06:00 2012-01-31 990 2011-02-01 841084331 Covenant Village of Colorado Inc COVE 3034244828 9153 Yarrow Street Westminster CO 800214563 Elizabeth B Buikema 7738782294 2012-12-06 2011 2016-02-24 21:20:13Z Elizabeth Buikema c/o CRC - 5700 Old Orchard Rd Skokie IL 60077 14920674 0 2650 X www.covenantretirement.org X 1988 CO Care for senior adults. 21 17 253 170 0 0 334944 106826 15773325 14305846 840792 241012 238514 257206 17187575 14910890 0 0 0 0 6530171 6835908 0 0 22816 10324742 10880225 16854913 17716133 332662 -2805243 59432316 55486349 67727758 66589955 -8295442 -11103606 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 6438509 6448676 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 272 residents occupying 191 apartments at 01/31/12. Residency for the fiscal year totaled 100,873 resident days. 1750462 2155920 Assisted Living:The number of persons who benefited from the services we provided for the year ended January 31, 2012 were as follows:There were total of 44 assisted living residents at 01/31/12. Assisted living residency for the the fiscal year totaled 14,859 resident days. 5413892 5958457 Skilled Nursing & Skilled Dementia: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 51 skilled and long term residents at 01/31/12. Skilled and long term residency for the fiscal year totaled 19,354 resident days. The organization was involved in various community benefits projectswhich include the following:- Staff members volunteered a total of 275 hours of their time to various activities/events in the community including the Feed the Homeless project, helping in various ministries of the Arvad Covenant Church, helping out at other assisted living and nursing care facilities, making church banners for the Denver Women's Correctional Center and others (equivalent to $18,600)- Residents volunteered a total of 5,612 hours at local hospitals and clinics, police departments, churches, schools & libraries, Feed the Homeless project, knitting and sewing projects to benefit the homeless and other missions, Habitat of Humanity, and others. Residents also raised fund through the Creative Arts project and made monetary donations to various groups such as the Arvada Food Bank, Denver Rescue Mission, Hope House, Have-A-Heart and Family Tree ($5,000 in total)- Sponsored various student internship programs which includes seminary and nursing students (equivalent to $3,750)- Provided space usage for meeetings and events for various groupsranging from under 35 people to 75+ people such as Standley Lake HighSchool Link Leaders Traning, CCAH Hospice Volunteer Training and others(equivalent to $25,500)- Monetary Donations to Colorado Alzheimer's Walk, Denver Rescue Mission, Urban Peak (homeless shelter for youth), Hannah's Pantry, Covenant Heights Conference Center (Bible camp) and Westminster Public Safety Recognition Foundation ($8,479 in total)- In-Kind Donations to Feed the Homeless project, food bank calledHannah's Pantry, "Packs of Hope" project (backpacks with clothing and other items for children placed in foster homes), Good Will, Habitat for Humanity, ARC Thrift Store and Whispering Pines Church ($9,702 estimated value)- Host site for small to large scale community events (from under 35participant to 75+) such as the Arthritis Foundation Aquatic Program, seminars/sessions on several topics/issues called "Wednesdays at 2" throughout the year, Christmas Tea for the American Association of University Women, Health Faire, Relay for Life (co-sponsoredwith the American Cancer Society), and CRC Sunday special presentations (equivalent to $516,615) 13602863 1 1 0 0 0 0 0 0 1 0 1 0 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 45 0 1 253 1 0 0 0 0 0 1 1 0 0 0 0 X 21 17 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 0 0 0 X Elizabeth Buikema 7738782294 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 X Jon P Aagaard MD 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 William H Lange 40.00 X 161682 0 21616 Kathy J Dilger 40.00 X 102207 0 22972 263889 3739532 745166 2 0 1 0 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 323427 Rehab Care Group Inc Contract Therapy Division - PO Box St Louis MO 63150 Therapy Services 208257 Teery's Healthcare 7951 East Maplewood Avenue 327 Greenwood Village CO 80111 Healthcare Services 136526 3 34095 72731 106826 Routine Services 623000 9235631 9235631 Entrance Fee 623000 1886409 1886409 Medicare/Medicaid 623000 1705664 1705664 Ancillary Services 623000 1336994 1336994 Meals 623000 141148 141148 14305846 223088 223088 12606 5318 0 0 12606 5318 17924 17924 9784 34095 9784 0 Support Services 623000 187719 187719 Services to Residents 623000 39686 39686 29801 29801 257206 14910890 14563052 0 241012 5230878 4414074 800916 15888 136314 111212 24687 415 1056123 873861 182197 65 412593 318901 92477 1215 96893 96893 15814 15814 27632 27632 1114416 904031 210223 162 359145 359145 617162 510526 105544 1092 171341 171341 757959 757959 30114 5720 24394 40475 6098 34377 2528676 1921794 606882 2073551 1575899 497652 218312 218312 Related Party Payments 778487 150 777305 1032 Admin & General 741205 608126 133079 Dining Services 634573 634573 Resident Care 404123 404123 270347 240611 26789 2947 17716133 13602863 4090454 22816 99458 109193 436867 498244 111234 109204 1220398 847722 33859 45491 73864 55066 64920775 19137306 46929127 45783469 8360911 6025649 1181983 1266672 984615 745639 59432316 55486349 471472 616720 12443374 12175252 41532040 40739096 94586 84571 13186286 12974316 67727758 66589955 X -8418825 -11224067 123383 120461 -8295442 -11103606 59432316 55486349 X -2805243 -2921 X 0 1 1 X 0 X 79237 111802 142237 334944 106826 775046 14003884 14501377 15492461 15773325 14305846 74076893 14083121 14613179 15634698 16108269 14412672 74851939 0 0 0 74851939 785788 -335122 1237180 840792 241012 2769650 785788 -335122 1237180 840792 241012 2769650 14868909 14278057 16871878 16949061 14653684 77621589 0.96430 0.95630 0.03570 0.04370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 2161208 2161208 59037820 17074178 41963642 3419474 1919850 1499624 302273 143278 158995 45783469 Deferred Revenue Subject to Refund 3926445 Refundable Contract Liabilities 5451671 Inter-company Advance Accounts 2940176 Other Liabilities 656024 12974316 14910890 17716133 -2805243 -2921 -2921 -2808164 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. 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 -2,921. Benefit Gala 43879 34095 9784 3395 1500 4889 43879 34095 9784 3395 1500 4889 9784 0 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 William H Lange 98719 0 7421 0 55542 0 15149 0 12324 0 189155 0 13502 0 Part I, Line 1a Part I, Line 1a: The following is an available benefit and is treated as taxable compensation: - Health club dues paid for two (2) senior-level employees. 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 William Lange - $18,452.76 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 William Lange - $27,725.33 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 Village of Colorado, Inc. provided $75,151 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 Village of Colordo, Inc. delegated control over management duties to Covenant Retirement Communities, Inc. (CRC), its parent organization. Form 990, Part VI, Section A, line 6 The sole member is Covenant Retirement Communities, Inc. (CRC) Form 990, Part VI, Section A, line 7b S 2.4 of Bylaws include reserved powers to the [individual] members such as appointment of president of CRC, changes to mission and strategic plan, approval of certain acquisitions, dispositions and financings, changes to articles and bylaws. Form 990, Part VI, Section B, line 11 Management Review: The draft Form 990 was reviewed by multiple levels of management including the President of CRC, the Vice President of Finance/CFO and the Vice President of Legal Affairs. Board Review: Prior to filing, key provisions of the Form were discussed with the Board of Directors at the Board meeting and the final Form 990 was provided to each Board member. Form 990, Part VI, Section B, line 12c Covenant Retirement Communities, Inc. (CRC) has an Administrative Policy on conflict of interest, identifying the parameters of a conflict of interest and the requirement to disclose any such conflict of interest. Each January, the CRC policy is distributed to CRC board members and officers. They are asked to sign acknowledging receipt of the policy and to disclose if they have any conflict of interests. If someone is absent from the meeting or fails to return the acknowledgment, there is a follow-up with the individual until the signed acknowledgment is provided. In addition to the above, a separate and more comprehensive questionnaire is sent to the board members, officers, key employees and other interested persons. The completed questionnaires are reviewed by CRC's legal counsel to determine if any actual or potential conflicts exist. If a person becomes an interested person, he or she may be considered in determining whether a quorum is present. The interested person may make a short statement relating to the transaction or arrangement in question, but shall not be present during the discussion and shall not vote on the motion addressing the actual or potential conflict. 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 Info 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 -2,921. Total to Form 990, Part XI, Line 5: -2,921. 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 Covenant Retirement Communities Inc O 1802425