2011-12-13T17:39:26-06:00 2011-01-31 990 2010-02-01 521115870 Covenant Village of Florida Inc COVE 9544722860 9215 W Broward Blvd No 100 Plantation FL 33324 Elizabeth Buikema 7738782294 2011-12-13 2010 2016-02-24 21:20:13Z Elizabeth Buikema c/o CRC - 5700 Old Orchard Rd Skokie IL 60077 16702224 0 2650 X www.covenantretirement.org X 1978 FL Care for senior adults. 19 15 202 42 0 0 683458 924287 14661376 14752243 1129990 875020 137937 139738 16612761 16691288 0 0 0 0 5569696 5845485 0 0 385451 10669893 12011370 16239589 17856855 373172 -1165567 57058855 54579848 55537300 54594398 1521555 -14550 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 7512496 6936303 Residential Living: The number of persons who benefited from the services we provided for the year ended January 31, 2011 were as follows:There were a total of 262 residents, occupying 211 apartments at 01/31/2011. Residency for the fiscal year totaled 100,639 resident days. 1320111 2128106 Assisted Living: The number of persons who benefited from the services we provided for the year ended January 31, 2011 were as follows:There were a total of 42 assisted living residents at 01/31/2011. Assisted living residency for the fiscal year totaled 15,448 patient days. 4365381 5827572 Skilled Nursing: The number of persons who benefited from the services we provided for the year ended January 31, 2011 were as follows:There were a total of 57 skilled care patients at 01/31/2011.Skilled care residency for the fiscal year totaled 18,435 patient days. The organization was involved in various community benefits projectswhich include the following:- Staff members volunteered a total of 437 hours to various organizations or events in the community including the Alzheimer's Memory Walk, BCOA, Boy Scouts of America, Plantation Chamber of Commerce, Epilepsy Foundation Walk, FAHSA, Relay for Life Survivor Dinner, Rotary Club, Salvation Army, local churches and others (equivalent to $35,038)- Residents volunteered a total of 2322 hours to various organizations or events in the community including the Operation Christmas Child, Salvation Army, Plantation Historical Society, Ronald McDonald House, soup kitchens, local schools, churches and hospitals, mentoring children and others- Provided space usage for meetings/events for small (under 35) tolarge groups (75+ people) including the ESRN Meetings, Broward County Home School Drama Club, Nova Southern University Lifelong Learning Class, Thursdays @ 2 Lecture Series, a church's Senior Ministry Workshop, Holiday Bazaar, Pastor's Appreciation Brunch and LifeConnect Wellness Fair (equivalent to $372,753)- In-Kind donations to the Salvation Army, Relay for Life Survivor Dinner and Operations Christmas Child Boxes (estimated value of $5,200) 13197988 1 1 0 0 0 0 0 1 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 37 0 1 202 1 0 0 0 0 0 1 1 0 0 0 0 X 19 15 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 0 X Elizabeth B Buikema 7738782294 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 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 Beverly A Freeman 1.00 X 0 0 0 Rhoda Friesen 1.00 X 0 0 0 Donald Holt 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 Jean A Stebinger 1.00 X 0 0 0 John C Swanson 1.00 X 0 0 0 Anne Vining 1.00 X 0 0 0 David A Dwight 1.00 X 0 571606 115344 Rick K Fisk 1.00 X X 0 538086 87445 Robert K Johnston 1.00 X 0 0 0 Gary Walter 1.00 X 0 148660 113514 Steven P Anderson 1.00 X 0 192411 58709 Elizabeth B Buikema 1.00 X 0 269952 47324 Moraine M Byrne 1.00 X 0 212629 38590 Terri S Cunliffe 1.00 X 0 215784 45700 John R Harriff 1.00 X 0 197364 44229 David G Erickson 1.00 X 0 201342 28760 Kathleen Jenkins 1.00 X 0 115714 49654 Judith I Johnson 40.00 X 116112 0 41979 Charles W Johnson 40.00 X 117903 0 22121 234015 2663548 693369 2 0 1 0 RehabCare Group Inc PO Box 503534 St Louis MO 63150 Therapy Services 464079 Sodexo Inc & Affiliates PO Box 536922 Atlanta GA 30353 Dining Services 377726 2 24305 300000 599982 924287 Routine Services 623000 9371706 9371706 Entrance Fee 623000 2439144 2439144 Medicare/Medicaid 623000 1838970 1838970 Ancillary Services 623000 1046166 1046166 Meals 623000 56257 56257 14752243 751406 751406 118614 5000 118614 5000 123614 123614 10936 13369 10936 0 Support Services 623000 57793 57793 Services to Resident 623000 29297 29297 52648 52648 139738 16691288 14891981 0 875020 4603965 3717321 858341 28303 89541 72562 16628 351 758210 632193 123914 2103 393769 325541 66010 2218 103194 103106 88 11986 11986 23845 23845 1252196 1114217 137979 217407 383 216921 103 698734 550397 148337 75890 75890 1376531 1376531 21236 4319 12526 4391 22654 2899 19755 2095411 1540546 502899 51966 2570216 1893364 616852 60000 290526 290526 Related Party Payments 1020628 24138 760474 236016 Dining Services 757874 757874 Resident Care 664577 664577 Admin & General 364789 30687 334102 Property Taxes 282157 282157 161519 96807 64712 17856855 13197988 4273416 385451 24444 9517 3754 10068 1563513 1212205 1468434 1273496 200 0 90817 108166 60381206 24529317 37486481 35851889 14347914 13739866 1676093 2007233 397205 367408 57058855 54579848 639514 653221 9441267 9459194 29435182 29098306 95750 91050 15925587 15292627 55537300 54594398 X 759177 -406391 762378 391841 1521555 -14550 57058855 54579848 X -1165567 -370538 X 0 1 1 X 0 X 3142027 251865 5060261 383458 624287 9461898 13335602 13155992 13957697 14661376 14752243 69862910 16477629 13407857 19017958 15044834 15376530 79324808 0 0 0 79324808 890694 891086 707496 1129990 875020 4494286 890694 891086 707496 1129990 875020 4494286 17368323 14298943 19725454 16174824 16251550 83819094 0.94640 0.94190 0.05360 0.05810 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 565255 565255 48922301 20026072 28896229 8194165 3466728 4727437 2699485 1036517 1662968 35851889 Deferred Revenue Subject to Refund 4186684 Refundable Contract Liabilities 2431255 Accrued Taxes & Employee Benefits 39642 Inter-company Advance Accounts 8248580 Other Liabilities 386466 15292627 16691288 17856855 -1165567 -370538 -370538 -1536105 16147556 -254941 -254941 16402497 288791 288791 16691288 17617048 15134 15134 17601914 254941 254941 17856855 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 Village of Florida, Inc. A FIN 48 analysis was completed for Covenant Village of Florida, Inc. 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 -370,538. Part XII, Line 2d - Other Adjustments: Contribution related expenses netted against contribution Revenue -273,484. Other non-operating income 18,543. Part XII, Line 4b - Other Adjustments: Net assets released from restriction for capital purchases 3,925. Net assets transferred for benevolent care support from CRC, Inc. 300,000. Dining services revenue 56,258. Entrance fee assessment charged by Covenant Retirement Communities, Inc. -76,392. Disposal of Fixed Asset 5,000. Part XIII, Line 2d - Other Adjustments: Dining services revenue netted with Dietary expense -56,258. Entrance fee assessment charged by Covenant Retirement Communities, Inc. 76,392. Disposal of Fixed Asset -5,000. Part XIII, Line 4b - Other Adjustments: Contribution related expenses netted against contribution Revenue 273,484. Other non-operating income -18,543. Benefit Dinner 24305 10936 13369 1734 500 5555 2400 3180 24305 10936 13369 1734 500 5555 2400 3180 13369 0 X 1 1 X X X X 0 1 0 0 0 0 0 1 0 David A Dwight 0 510979 0 0 0 60627 0 85776 0 29568 0 686950 0 0 Rick K Fisk 0 370403 0 130023 0 37660 0 71690 0 24115 0 633891 0 9534 Gary Walter 0 148660 0 0 0 0 0 27082 0 86432 0 262174 0 0 Steven P Anderson 0 145268 0 30547 0 16596 0 41797 0 22581 0 256789 0 10259 Elizabeth B Buikema 0 198408 0 39225 0 32319 0 24656 0 24621 0 319229 0 10513 Moraine M Byrne 0 155268 0 35675 0 21686 0 24929 0 15826 0 253384 0 8244 Terri S Cunliffe 0 151562 0 31369 0 32853 0 37247 0 10719 0 263750 0 0 John R Harriff 0 125169 0 34080 0 38115 0 30819 0 18998 0 247181 0 0 David G Erickson 0 142537 0 32865 0 25940 0 9874 0 23996 0 235212 0 0 Kathleen Jenkins 0 71285 0 7500 0 36929 0 33794 0 17549 0 167057 0 4408 Judith I Johnson 102883 0 4851 0 8378 0 24987 0 16992 0 158091 0 0 0 Part I, Line 1a The following is an available benefit and is treated as taxable compensation: - Travel for companions paid for one (1) senior-level employee Part I, Line 4b 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 - $47,991.81 Rick Fisk - $34,207.02 Elizabeth Buikema - $11,583.58 Steven P. Anderson - $13,334.46 John R. Harriff - $13,818.86 Terri Cunliffe - $9,889.30 David Erickson - $12,754.58 Moraine Byrne - $9,796.00 Kathleen Jenkins - $7,046.80 Judith I. Johnson - $16,776.70 Charles Johnson - $7,087.50 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 - $8,596 Rick K. Fisk - $9,273 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 2010 relate to the achievement of targets for the fiscal year ended 1/31/2010. Part II, Column C: Deferred compensation includes and 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. Colorado Health Facilities Authority 840752932 196474Z29 2005-08-25 25317417 See Schedule O 0 0 0 27170862 2162578 413794 24340765 253725 2009 0 0 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 NA 0 NA 0 0 Schedule K Supplental Information Part IV - Question 1: No positive arbitrage was calculated. Part IV - Question 5: Opinion of Bond Counsel was received that disbursement after temporary period would not adversely affect any exemption from federal income taxation to which such interest would otherwise be entitled. Part I Row A, Col F: Bond Issues Description of Purpose Phase I included the renovation, equipping and site development of the campus kitchen facilities and other common areas. Construction of Phase I was completed in 2006. Phase II of this project includes the construction, equipping and site development of a three-story 67,000 square foot Town Center with 34 residential living units on the upper two levels. The Town Center common area space includes a library, media center, creative arts area, fitness/wellness center and outdoor pool, in addition to administrative and marketing offices. Phase II was completed in 2009. Form 990, Part VI, Section A, line 3 Covenant Village of Florida, 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. Form 990, Part VI, Section B, line 15 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. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Change in Temporarily Restricted Net Assets not included on Income Stmnt -370,538. Total to Form 990, Part XI, Line 5: -370,538. 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 Florida, Inc. provided $542,101 free or discounted services to those residents unable to pay all or a portion of their charges, and who meet certain eligibility requirements. 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. Evangelical Covenant Church 5101 North Francisco Avenue Chicago IL 60625 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 LifeConnect LLC 5700 Old Orchard Road Skokie IL 60077 272827919 Wellness Software Developement IL N/A N/A 0 0 Management Services Organization LLC 5700 Old Orchard Road Skokie IL 60077 272827998 Management & Consulting Services IL 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 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Covenant Retirement Communities Inc O 349809 Covenant Retirement Communities Inc C 300000 Covenant Trust Company O 237022 Covenant Retirement Communities Inc P 491812