2023-11-10T17:04:19-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 362382853 REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME REST 7083428100 18601 NORTH CREEK DRIVE TINLEY PARK IL 60477 BARRY VANDERGENUGTEN CFO 7083428100 2023-11-09 1 BARRY VANDERGENUGTEN 999009999 0 DAVID LOWENTHAL P00378651 3122071040 2023-11-09 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z PROVIDENCE LIFE SERVICES RICHARD SCHUTT 18601 NORTH CREEK DRIVE TINLEY PARK IL 60477 83037842 0 X WWW.PROVIDENCELIFESERVICES.COM X 1956 IL REST HAVEN'S PURPOSE IS TO PROVIDE SERVICES FOR THE AGED INCLUDING SKILLED NURSING AND REHAB SERVICES, HOME HEALTH CARE, TOWN HOME LIVING, INDEPENDENT AND ASSISTED LIVING. 16 15 937 120 626955 29383 6552517 2783625 56161018 48837276 1344984 15533466 -35731 -195607 64022788 66958760 0 0 0 0 36729113 28569309 0 0 466277 28964660 28078811 65693773 56648120 -1670985 10310640 77792257 76767096 58712983 43367455 19079274 33399641 X REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME D/B/A PROVIDENCE LIFE SERVICES (REST HAVEN) IS A NOT-FOR-PROFIT ILLINOIS CORPORATION WHOSE PURPOSE IS TO PROVIDE NURSING AND RESIDENTIAL LIVING ARRANGEMENTS FOR THE AGED INCLUDING SKILLED NURSING AND REHABILITATION SERVICES, HOME HEALTH CARE, TOWNHOME LIVING, INDEPENDENT LIVING, AND ASSISTED LIVING. 0 0 47810975 63432706 TO PROVIDE PROPER CARE FOR THE SICK AND ELDERLY. 522 BEDS/UNITS WITH OCCUPANCY OVER 85% ON THE FULL CONTINUUM OF CARE. 47810975 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 105 0 1 937 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 16 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X BARRY VANDERGENUGTEN 7083428100 18601 NORTH CREEK DRIVE TINLEY PARK IL 60477 RICH SCHUTT DIRECTOR & CEO 40.00 5.00 X X 676244 0 25008 PAUL KATS CHAIR 1.00 2.00 X X 0 0 0 ROGER BOEREMA VICE CHAIR 1.00 2.00 X X 0 0 0 JAKE GROENEWOLD SECRETARY/TREASURER 1.00 2.00 X X 0 0 0 KEVIN BOTMA ASST. SECRETARY/TREASURER - PART YEAR 1.00 2.00 X X 0 0 0 HOWARD RYNBERK JR ASST. SECRETARY/TREASURER - PART YEAR 1.00 2.00 X X 0 0 0 PAUL BUIKEMA DIRECTOR 1.00 2.00 X 0 0 0 EDWARD DAMSTRA III DIRECTOR 1.00 2.00 X 0 0 0 TED FEENSTRA DIRECTOR 1.00 2.00 X 0 0 0 SHERYL HAMMER DIRECTOR 1.00 2.00 X 0 0 0 KEN HOVING DIRECTOR 1.00 2.00 X 0 0 0 KAREN HUIZENGA DIRECTOR 1.00 2.00 X 0 0 0 PATTI JABAAY DIRECTOR 1.00 2.00 X 0 0 0 EMILY MCMASTER DIRECTOR 1.00 2.00 X 0 0 0 GARY SMIT DIRECTOR - PART YEAR 1.00 2.00 X 0 0 0 DARREN VAN ESSEN DIRECTOR 1.00 2.00 X 0 0 0 DAVID VOSS DIRECTOR 1.00 2.00 X 0 0 0 KYLE YONKER DIRECTOR 1.00 2.00 X 0 0 0 BILL ZANDSTRA DIRECTOR 1.00 2.00 X 0 0 0 WILLIAM DEYOUNG COO 40.00 5.00 X 456264 0 78925 BARRY VANDERGENUGTEN CFO 40.00 5.00 X 384359 0 31294 SUSAN ENRIGHT VP HOME & COMMUNITY BASED SERVICES 40.00 0.00 X 217931 0 15104 JOHANNA ZANDSTRA VP OF OPERATIONS 40.00 5.00 X 186661 0 26168 MEGAN TENGERSTROM VP OF OPERATIONS 40.00 5.00 X 200774 0 16380 SCOTT STUDEBAKER VP MINISTRY ADVANCEMENT & DEVELOPMENT 40.00 5.00 X 182472 0 19738 LARRY OTTE VP OF FINANCE 40.00 5.00 X 185190 0 26446 2489895 0 239063 36 0 1 0 SYMBRIA REHAB 28100 TORCH PARKWAY WARRENVILLE IL 60555 THERAPY 4920683 PROVIDENCE MGMT & DEVELOPMENT (DBA PROVI 18645 WEST CREEK DRIVE TINLEY PARK IL 60477 IT SERVICES 2199794 GORDON FOOD SERVICE PO BOX 88029 CHICAGO IL 60680 DINING SERVICES 1636694 CREATIVE DINING SERVICES 1 ROYAL PARK DR 3 ZEELAND MI 49464 DINING SERVICES 1084081 NOVASTAFF HEALTHCARE SERVICES INC PO BOX 249 COAL CITY IL 60416 NURSING AND HEALTHCARE SERVICES 655725 26 310242 1248387 1224996 2783625 ROUTINE REVENUE 621610 44154009 44154009 ANCILLARY REVENUE 621610 4683267 4056312 626955 48837276 311057 311057 5137144 25800000 5137120 10577615 24 15222385 15222409 15222385 24 168740 310242 364347 -195607 -195607 66958760 63432706 626955 115474 1652094 1652094 21930068 17411746 4140205 378117 581662 329651 236887 15124 2665209 1989132 630161 45916 1740276 1430393 282763 27120 17552 17552 10500 10500 3122329 2770848 351481 1220481 1220481 1680948 1385934 295014 1722730 1590249 132481 2264069 2177826 86243 2582260 2472275 109985 NURSING EXPENSE 5482200 5482200 FOOD & DIETARY EXPENSE 2382988 2382988 REPAIRS & MAINTENANCE 1185775 1185775 PHARMACY EXPENSE 849790 849790 5557189 5131687 425502 56648120 47810975 8370868 466277 175795 1038773 313333 226837 10197184 4694019 646895 578637 57537665 26573458 38001431 30964207 9170379 12156943 652869 652869 18634371 26454811 77792257 76767096 6947199 4006671 530985 577894 43349113 32795687 7885686 5987203 58712983 43367455 X 18976703 32973350 102571 426291 19079274 33399641 77792257 76767096 X 10310640 -2394 4012121 X 0 1 X 1 1 1 X 3724032 1651685 5887369 6552517 2783625 20599228 80188343 77473126 56204654 56161018 48837276 318864417 83912375 79124811 62092023 62713535 51620901 339463645 96282 142964 155395 202321 319476 916438 0 96282 142964 155395 202321 319476 916438 338547207 338317 543487 483540 364052 311057 2040453 16018 35313 22547 18963 29383 122224 354335 578800 506087 383015 340440 2162677 96282 142964 155395 202321 531030 1127992 84362992 79846575 62753505 63298871 52492371 342754314 0.98770 0.99190 0.00630 0.00630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4947986 4947986 48716031 23855391 24860640 3735953 2652898 1083055 137695 65169 72526 30964207 GROUND LEASE RECEIVABLES 994150 ASSETS LIMITED TO USE 1399632 DUE FROM AFFILIATES 17806357 OTHER ASSETS 296735 LEGAL LIABILITY INS RECOVERIES 3379263 DEFERRED COMP GRANTOR TRUST 492198 INTEREST RATE SWAP VALUE 2086476 26454811 ESTIMATED SELF-INS LIABILITIES 4746963 ASSET RETIREMENT OBLIGATION 61803 RESIDENT NOTES AND DEPOSITS 1008282 ACCRUED INTEREST PAYABLE 49905 CHARITABLE ANNUITY CONTRACTS 120250 5987203 BANQUET 282676 191476 91200 244901 GOLF OUTING 157926 93126 64800 82744 1 38380 25640 12740 36702 478982 310242 168740 364347 364347 -195607 FORM 990, SCHEDULE G, PART II: THE ORGANIZATION HOSTS EVENTS FOR PUBLIC RELATIONS AND FUNDRAISING PURPOSES. THESE EVENTS ARE OFTEN UNDERWRITTEN BY LEADERSHIP SPONSORS OF WHICH THEIR SPONSORSHIPS ARE ALLOCATED AMONGST THE VARIOUS EVENTS. THE COMBINED GROSS RECEIPTS OF THE EVENTS TOTALED $478,982 FOR 2022. THE COMBINED COSTS OF THE EVENTS TOTALED $364,347. THE NET INCOME TO THE ORGANIZATION FOR HOSTING ALL OF THE EVENTS WAS $114,635. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 RICH SCHUTT DIRECTOR & CEO 562185 0 94681 0 19378 0 11200 0 13808 0 701252 0 0 0 WILLIAM DEYOUNG COO 389702 0 52885 0 13677 0 58109 0 20816 0 535189 0 0 0 BARRY VANDERGENUGTEN CFO 318341 0 43668 0 22350 0 11200 0 20094 0 415653 0 0 0 SUSAN ENRIGHT VP HOME & COMMUNITY BASED SERVICES 214636 0 0 0 3295 0 8652 0 6452 0 233035 0 0 0 MEGAN TENGERSTROM VP OF OPERATIONS 180461 0 18439 0 1874 0 7734 0 8646 0 217154 0 0 0 JOHANNA ZANDSTRA VP OF OPERATIONS 167459 0 9643 0 9559 0 6698 0 19470 0 212829 0 0 0 LARRY OTTE VP OF FINANCE 173250 0 0 0 11940 0 6930 0 19516 0 211636 0 0 0 SCOTT STUDEBAKER VP MINISTRY ADVANCEMENT & DEVELOPMEN 172338 0 0 0 10134 0 6894 0 12844 0 202210 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES AN ALLOWANCE FOR UP TO 10 BOARD MEMBERS TO ATTEND THE ANNUAL ASSOCIATION CONVENTION TO PROVIDE MORE IN DEPTH KNOWLEDGE OF THE SENIOR CARE INDUSTRY. THE COST OF TRAVEL FOR SPOUSES IS PERMITTED AS LONG AS THE TOTAL DOES NOT EXCEED THE ESTABLISHED ALLOWANCE AMOUNT. THE BENEFIT OF SPOUSAL TRAVEL IS INCLUDED IN TAXABLE COMPENSATION. DOCUMENTATION OF ATTENDANCE AT THE ANNUAL CONVENTION IS REQUIRED. PART I, LINE 4B REST HAVEN HAS ESTABLISHED A NONQUALIFIED DEFERRED COMPENSATION PLAN IN AN EFFORT TO RETAIN SELECTED OFFICERS ON A LONG TERM BASIS. WILLIAM DEYOUNG PARTICIPATES IN THE PLAN. IN 2022, THERE WERE NO DISTRIBUTIONS FROM OR AMOUNTS VESTED IN THE ACCOUNT. THE PLAN WAS ORIGINALLY SET UP IN 2005 BY THE BOARD OF DIRECTORS TO ESTABLISH A RETENTION INITIATIVE FOR CERTAIN OFFICERS. THIS PLAN RECOGNIZES THE HISTORIC CONTRIBUTION OF THE EXECUTIVES AND ESTABLISHES AN INCENTIVE FOR THEM TO CONTINUE THEIR EMPLOYMENT WITH THE ORGANIZATION UNTIL NORMAL RETIREMENT AGE. AMONG VARIOUS CRITERIA, IN ORDER TO QUALIFY FOR THE BENEFIT, THE EXECUTIVE WILL NEED TO BE CONTINUOUSLY EMPLOYED THRU AND UNTIL A FUTURE DATE. THE ORGANIZATION'S PAYMENTS INTO THE PLAN ARE RECORDED ON THE 990 AS DEFERRED COMPENSATION. HOWEVER, THESE MONIES ARE ONLY ELIGIBLE TO BE RECEIVED BASED UPON THE ACHIEVEMENT OR SATISFACTION OF SOME FUTURE EVENTS. THE PLAN CONTRIBUTIONS ARE NOT UNDER THE CONTROL OF THE EXECUTIVE, THEY REMAIN THE ASSET OF THE ORGANIZATION, AND THE ENTIRE PLAN IS SUBJECT TO A FULL RISK OF FORFEITURE BY THE INDIVIDUAL. PART I, LINE 7 THE EXECUTIVE COMPENSATION PROGRAM HAS TWO MAJOR ELEMENTS, SALARY, OR BASE PAY, AND VARIABLE PAY. THE SALARY REFLECTS THE VALUE OF AN EXECUTIVE'S CAPABILITIES AND EXPERIENCE. THE VARIABLE PAY REFLECTS THE ORGANIZATION'S COMMITMENT TO PAY FOR SPECIFIC PERFORMANCE TOWARDS THE ORGANIZATION'S GOALS. THE VARIABLE PAY IS AWARDED SEMI-ANNUALLY BASED UPON A SPECIFIC REVIEW OF GOALS AND OBJECTIVES (INCLUDING THOSE WHICH RELATE TO MISSION, OPERATIONAL EFFICIENCY, FINANCIAL EFFECTIVENESS, AND STRATEGIC GOALS). THE COMPENSATION COMMITTEE REVIEWS, ASSESSES AND DETERMINES ANY AWARD UNDER THE VARIABLE PAY COMPONENT. EXECUTIVE EMPLOYEES ARE REVIEWED BY THE COMPENSATION COMMITTEE AND OUTSIDE CONSULTANTS TO ENSURE THEY ARE COMPETITIVE AND IN LINE WITH COMMON PRACTICE FOR SIMILAR POSITIONS IN SIMILARLY SIZED AND TYPE ORGANIZATIONS. THE COMMITTEE ROUTINELY RECEIVES AN EXECUTIVE COMPENSATION OPINION NOTING THAT THE ORGANIZATION'S EXECUTIVE COMPENSATION FALLS WITHIN THE RANGE OF COMPARABLE POSITIONS WITHIN THE SAME INDUSTRY AND SCALE OF OPERATIONS. THE REPORT/OPINION ALSO NOTES THAT THE STATED REQUIREMENTS OF ENSURING INDEPENDENCE OF COMPENSATION DELIBERATIONS FOR SENIOR EXECUTIVES ARE MET. LINDA SCHUTT SPOUSE OF CEO 40629 EMPLOYMENT COMPENSATION; MASTERS PREPARED R.N. THAT LEADS THE ORGANIZATION'S EDUCATION. 0 SCH L, PART IV: THE TRANSACTIONS REPORTED ABOVE INVOLVING INTERESTED PERSONS ARE REVIEWED ANNUALLY BY THE BOARD'S COMPENSATION COMMITTEE AND HAVE BEEN DEEMED APPROPRIATE BASED ON THE POSITION EMPLOYED. FORM 990, PART VI, SECTION A, LINE 2 JOHANNA ZANDSTRA (VP OF OPERATIONS) AND BILL ZANDSTRA (SECRETARY/TREASURER) HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 WAS PREPARED AND SENT FOR INITIAL REVIEW BY THE CONTROLLER, CFO AND CEO. UPON REVIEW AND APPROVAL, THE 990 WAS MADE AVAILABLE TO THE ENTIRE BOARD PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST STATEMENT UPON BEGINNING THEIR POSITION. THEREAFTER, THE CONFLICT OF INTEREST STATEMENTS ARE UPDATED ON AN ANNUAL BASIS. ANY POTENTIAL CONFLICTS ARE REVIEWED AND ADDRESSED BY THE BOARD AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION PROGRAM'S PRIMARY OBJECTIVE IS TO PROVIDE COMPETITVE TOTAL PAY OPPORTUNITIES THAT HELP ATTRACT, REWARD AND RETAIN CRITICAL LEADERSHIP TALENT IN ORDER TO ACHIEVE THE ORGANIZATION'S MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECUTIVE COMPENSATION RANGES THROUGH A WRITTEN POLICY AND BY COMPARING ITSELF TO ORGANIZATIONS OF SIMILAR SIZE AND TYPE - USING OBJECTIVE, THIRD-PARTY DATA. A COMPENSATION COMMITTEE OF INDEPENDENT DIRECTORS RECOMMENDS, AND THE BOARD OF DIRECTORS APPROVES, THE SALARY RANGES AND REVIEWS TOTAL COMPENSATION FOR EXECUTIVES ON AN ANNUAL BASIS. THE ORGANIZATION ROUTINELY USES KNOWLEDGEABLE EXTERNAL CONSULTANTS TO ADVISE ON THE PROCESS AND HAS RECEIVED AFFIRMATION OF COMPLIANCE WITH IRS GUIDELINES FOR REASONABLENESS OF EXECUTIVE COMPENSATION IN TAX-EXEMPT ENTITIES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY TO RELATED ENTITIES 345,357. UNREALIZED GAIN ON INTEREST RATE SWAP 3,666,764. 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