2020-11-16T10:49:17-06:00 2019-12-31 LARRY J OTTE CPA 10755 HAWTHORNE DR SAINT JOHN IN 46373 990 2019-01-01 201835089 TIMOTHY PLACE NFP TIMO 7083428100 18601 NORTH CREEK DRIVE TINLEY PARK IL 60477 VANDERGENUGTEN BARRY CFO 7083428100 2020-11-16 LARRY J OTTE P01427347 7083593329 2020-11-16 X 199.58.216.254 2020-11-16 10:49:17 CS P 05F5D912F79D4F939E4B956C0FD9A55DB61B7E32 05F5D912F79D4F939E4B956C0FD9A55DB61B7E32 2019 2021-01-29 14:40:06Z PARK PLACE CHRISTIAN COMM ELMHURST VANDERGENUGTEN BARRY 18601 N CREEK DR TINLEY PARK IL 60477 20811497 false X PROVIDENCELIFESERVICES.COM X 2004 IL TO PROVIDE HOUSING AND THE FULL CONTINUUM OF CARE FOR SENIORS. 7 7 374 25 0 102165 140049 19800526 20384088 268370 287360 0 20171061 20811497 0 0 7698109 8207452 0 0 18508721 18729873 26206830 26937325 -6035769 -6125828 140488578 134977939 240684032 234072751 -100195454 -99094812 TO PROVIDE HOUSING AND THE FULL CONTINUUM OF CARE FOR SENIORS. false false 26087108 TO PROVIDE HOUSING AND CARE FOR THE ELDERLY AND SICK. 26087108 true true false false false false false false false false true false false true true false true false false false false false false false false false false false false true true false false false false false false false false true false false false false false false true false false false true 39 0 true 374 true false false false false false false false false X 7 7 false true false false true true true true true false false true true true true true true true true false IL X PROVIDENCE LIFE SERVICES 7083428100 18601 NORTH CREEK DR TINLEY PARK IL 60477 SCHUTT RICHARD CEO 5.00 45.00 X 0 1995413 26022 DEYOUNG WILLIAM COO 5.00 45.00 X 0 372252 70380 VANDERGENUGTEN BARRY CFO 5.00 45.00 X 0 285879 30526 ENGELSMAN DONALD ADMINISTRATO 40.00 X 168841 0 19308 SMITH SHELLY HEALTHCARE D 40.00 X 153215 0 25958 MARY BETH FRITZ MARKETING DI 40.00 X 123241 0 8308 OPELARIO-ARROYO ARLENE DIRECTOR OF 40.00 X 118386 0 2980 CARRASQUILLA GEORGE DIRECTOR RES 40.00 X 100811 0 14092 DIEPSTRA AL VICE CHAIR 1.00 X X 0 0 0 KOLDENHOVEN ARNIE DIRECTOR 1.00 X 0 0 0 TAMELING CAL ASST SECT/TR 1.00 X X 0 0 0 VAN DYK DON SECT/TREASUR 1.00 X X 0 0 0 HOVING KEN DIRECTOR 1.00 X 0 0 0 VAN HATTEM RICH CHAIR 1.00 X X 0 0 0 BREEMS TIM DIRECTOR 1.00 X 0 0 0 664494 2653544 197574 5 false true true SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY 809967 GORDON FOOD SERVICE PO BOX 88029 CHICAGO IL 60680 DIETARY 679647 PROVINET SOLUTIONS 18645 WEST CREEK DR TINLEY PARK IL 60477 IT SERVICES 490217 AEP ENERGY DEPT CH 19346 PALATINE IL 60055 UTILITY 449479 SYMBRIA RX SERVICES 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 PHARMACY 382660 16 140049 140049 ROUTINE REVENUE 623000 20016048 20016048 ANCILLARY REVENUE 623000 368040 368040 20384088 287360 287360 20811497 20384088 287360 6825855 6825855 94595 94595 789107 789107 497895 497895 360000 360000 17518 17518 97750 97750 37436 37436 230905 230905 91525 91525 490217 490217 874446 874446 7955682 7955682 3771675 3771675 534450 534450 DIETARY SERVICES 837368 837368 THERAPY 758177 758177 MAINTENANCE & REPAIR 579584 579584 PHARMACY 381511 381511 1711629 1711629 26937325 26087108 850217 0 2986888 3114851 1783803 1562778 18632 499523 163589 138523373 25948424 115358044 112574949 2684707 2470389 17156981 15091383 140488578 134977939 3805832 3985237 81061134 81339548 141106642 141106642 14710424 7641324 240684032 234072751 X -100195454 -99094812 -100195454 -99094812 140488578 134977939 X -6125828 24112 -40551 7242909 X false true X true false X 2950 2100 78123 102165 140049 325387 15192394 16843184 19376787 19800526 20384088 91596979 15195344 16845284 19454910 19902691 20524137 91922366 91922366 114526 30095 62349 268370 287360 762700 114526 30095 62349 268370 287360 762700 15309870 16875379 19517259 20171061 20811497 92685066 0.99180 0.99270 0.01000 0.01000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14600000 14600000 121125255 24001030 97124225 2725955 1899529 826426 112550651 ASSETS LIMITED TO USE 15091383 15091383 OBLIGATION TO PROVIDE FUTURE SERVICE 9042554 RESIDENT DEPOSITS 271145 ORIGINAL ISSUE DISCOUNT -1672375 7641324 20811497 20811497 20811497 26937325 26937325 26937325 X true true X X X X X false true false false false false false true false SCHUTT RICHARD CEO 500649 25186 1469578 11200 14822 2021435 1372554 DEYOUNG WILLIAM COO 348691 14755 8806 48557 21823 442632 VANDERGENUGTEN BARRY CFO 261580 11427 12872 10463 20063 316405 ENGELSMAN DONALD ADMINISTRATOR 158587 10254 6343 12965 188149 SMITH SHELLY HEALTHCARE DIRECTOR 148579 3750 886 5943 20015 179173 SCHEDULE J, PART III 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. RICHARD SCHUTT AND WILLIAM DEYOUNG PARTICIPATE IN THE PLAN. IN 2019, RICHARD SCHUTT RECIEVED A DISTRIBUTION FROM THE ACCOUNT OF 1,450,030; HAVING ACHIEVED NORMAL RETIREMENT AGE AND OVER 40 YEARS OF EMPLOYMENT WITH REST HAVEN. IN 2005, THE PLAN WAS SET UP BY THE BOARD OF DIRECTORS TO ESTABLISH A RETENTION INCENTIVE PLAN 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 CONTINOUSLY 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 ACHIEVEMENT OR SATISFACTION OF SOME FUTURE EVENTS. THE PLAN CONTRIBUTIONS ARE NOT UNDER THE CONTROL OF THE EXECUTIVES, THEY REMAIN THE ASSET OF THE ORGANIZATION, AND THE ENTIRE PLAN IS SUBJECT TO A FULL RISK 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 CAPABALITIES 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 INSURE THEY ARE COMPETITIVE AND IN LINE WITH COMMON PRACTICE FOR SIMILAR POSITIONS IN SIMILARLY SIZED AND TYPE ORGANIZATIONS. THE COMMITTEE ROUTNINELY RECIEVES AN EXECUTIVE COMPENSATION OPINION NOTING THAT THE ORGANIZATION'S EXECUTIVE COMPENSATION FALLS WITHIN THE RANGE OF COMPARABLE POSITIONS WITHIN THE SAME INDUSTRY, AND SCOPE OF OPERATIONS. THE REPORT/OPINION ALSO NOTES THAT THE STATED REQUIREMENTS OF ENSURING INDEPENDENCE OF COMPENSATION DELIBERATIONS FOR SENIOR EXECUTIVES ARE MET. A ILLINOIS FINANCE AUTHORITY 861091967 45203H7D8 2016-04-01 10710000 DEBT REFINANCING false false false B ILLINOIS FINANCE AUTHORITY 861091967 45203H7E6 2016-04-01 15801500 DEBT REFINANCING false false false C ILLINOIS FINANCE AUTHORITY 861091967 45203H7F3 2016-04-01 34310250 DEBT REFINANCING false false false D ILLINOIS FINANCE AUTHORITY 861091967 45203H7G1 2016-04-01 42869750 DEBT REFINANCING false false false A 10710000 146646 10710000 true false false true B 15801500 216268 15801500 true false false true C 34310250 469747 34310250 true false false true D 42869750 586983 42869750 true false false true A false false false false false false false B false false false false false false false C false false false false false false false D false false false false false false false A false false false false false false false false true B false false false false false false false false true C false false false false false false false false true D false false false false false false false false true A true B true C true D true PURPOSE OF ISSUE DESCRIPTION ILLINOIS FINANCE AUTHORITY DEBT REFINANCING PURPOSE OF ISSUE DESCRIPTION ILLINOIS FINANCE AUTHORITY DEBT REFINANCING PURPOSE OF ISSUE DESCRIPTION ILLINOIS FINANCE AUTHORITY DEBT REFINANCING PURPOSE OF ISSUE DESCRIPTION ILLINOIS FINANCE AUTHORITY DEBT REFINANCING A ILLINOIS FINANCE AUTHORITY 861091967 45203H7H9 2016-04-01 20514750 DEBT REFINANCING false false false B ILLINOIS FINANCE AUTHORITY 861091967 45203H7J5 2016-04-01 21918750 DEBT REFINANCING false false false A 5018358 20514750 280888 20514750 true false false true B 21918750 300094 21918750 true false false true A false false false false false false false B false false false false false false false A false false false false false false false false true B false false false false false false false false true A true B true PURPOSE OF ISSUE DESCRIPTION ILLINOIS FINANCE AUTHORITY DEBT REFINANCING PURPOSE OF ISSUE DESCRIPTION ILLINOIS FINANCE AUTHORITY DEBT REFINANCING LINDA SCHUTT SPOUSE OF CEO 104843 EMPLOYMENT COMP false BONNIE HEIRENDT SISTER OF CEO 14130 EMPLOYMENT COMP false SCHEDULE L, PART V SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: LINDA SCHUTT (D) DESCRIPTION OF TRANSACTION: EMPLOYMENT COMPENSATION; MASTERS PREPARED R.N. THAT LEADS THE ORGANIZATION'S EDUCATION. (A) NAME OF PERSON: BONNIE HEIRENDT (D) DESCRIPTION OF TRANSACTION: EMPLOYMENT COMPENSATION 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 POSTION EMPLOYED. FORM 990, PAGE 6, PART VI, LINE 3 RESPONSIBILITES PAID THROUGH MANAGEMENT FEES TO REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME DBA PROVIDENCE LIFE SERVICES. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME. THE AFFAIRS, BUSINESS AND ALL LEGAL MATTERS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 7A THE MEMBER SHALL HAVE AND EXERCISE THE FOLLOWING RESERVE POWERS: (1) TO APPOINT OR REMOVE DIRECTORS; (2) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (3) TO REVIEW ALL ANNUAL BUDGETS AND AUDITED FINANCIAL STATEMENTS AND TO APPROVE ANY DEFICIT BUDGET; (4) TO APPROVE THE CONSTRUCTION OF ANY NEW OR THE ALTERATION OF ANY EXISTING FACILITY INVOLVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESATE OR SUBSTANTIALLY ALL OF THE OTHER ASSETS OF THE CORPORATION; (6) TO DISSOLVE THE CORPORATION. FORM 990, PAGE 6, PART VI, LINE 7B THE MEMBER SHALL HAVE AND EXERCISE THE THE FOLLOWING RESERVE POWERS: (1) TO APPOINT OR REMOVE DIRECTORS; (2) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (3) TO REVIEW ALL ANNUAL BUDGETS AND AUDITED FINANCIAL STATEMENTS AND TO APPROVE ANY DEFICIT BUDGET; (4) TO APPROVE THE CONSTRUCTION OF ANY NEW OR THE ALTERATION OF ANY EXISTING FACILITY INVOLVING AN EXPENDITURE OF 500,000 OR MORE; (5) TO SELL, MORTGAGE, PLEDGE OR ALIENATE ALL OR ANY PART OF THE REAL ESATE OR SUBSTANTIALLY ALL OF THE OTHER ASSETS OF THE CORPORATION; (6) TO DISSOLVE THE CORPORATION. FORM 990, PAGE 6, PART VI, 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 FILING. FORM 990, PAGE 6, PART VI, LINE 12C THE OFFICERS AND DIRECTORS/TRUSTEES 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, PAGE 6, PART VI, LINE 15A THE PARENT COMPANY'S EXECUTIVE COMPENSATION PROGRAM'S PRIMARY OBJECTIVE IS TO PROVIDE COMPETITIVE 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, PAGE 6, PART VI, LINE 15B THE EXCECUTIVE COMPENSATION OF THE PARENT (REST HAVEN) COMPANYS EXECUTIVES IS SET BY THE PARENT COMPANYS BOARD OF DIRECTORS THROUGH BOARD OVERSIGHT. THE EXECUTIVE COMPENSATION PROGRAMS PRIMARY OBJECTIVE IS TO PROVIDE COMPETITIVE TOTAL PAY OPPORTUNITIES THAT HELP ATTRACT, REWARD AND RETAIN CRITICAL LEADERSHIP TALENT IN ORDER TO ACHIEVE THE ORGANIZATIONS MISSION AND STRATEGIC INITIATIVES. REST HAVEN ESTABLISHES ITS EXECTUIVE 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, PAGE 6, PART VI, 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 DEBT RELEIF - AFFILIATE 5,000,000 CHANGE IN FSO OBLIGATION 2,242,909 TOTAL 7,242,909 REST HAVEN ILLIANA CHRISTIAN REST HAVEN ILLIANA CHRISTIAN 18601 N CREEK DRIVE TINLEY PARK IL 60477 362382853 HEALTHCARE IL 501C3 7 N/A false CHRISTIAN HEALTHCARE FOUNDATION CHRISTIAN HEALTHCARE FOUNDATION 18601 N CREEK DRIVE TINLEY PARK IL 60477 200722359 RESEARCH IL 501C3 7 N/A false PROVIDENCE MANAGEMENT & DEVELOPMENT PROVIDENCE MANAGEMENT & DEVELOPMENT 18601 N CREEK DR TINLEY PARK IL 60477 363774205 IT SERVICE IL N/A false false false false false false false false false false false false false false false true true false false false REST HAVEN ILLIANA CHRISTIAN P 360000 FMV PROVIDENCE MANAGEMENT P 490217 FMV