2018-12-15T20:04:54-06:00 2018-01-31 990 2017-02-01 131740015 Covenant Home Inc Connecticut COVE 8606352690 52 Missionary Road Cromwell CT 06416 Jody Holt Vice President/CFO 7738782294 2018-12-15 99.179.150.174 2018-12-15 20:01:26 CS P CD71869BFC494223FABD92E93AB0669CE7B22062 943C2B779621AE68CF3E0BED5C235FDF89DF7949 2017 2019-02-21 02:37:17Z Jody Holt c/o CRC - 5700 Old Orchard Rd Skokie IL 60077 21138789 0 2650 X www.covenantretirement.org X 1962 CT Care for Senior Adults 17 13 311 22 0 0 214654 1461088 17536233 18403576 639909 334986 832866 855466 19223662 21055116 0 0 0 0 8835672 8939317 0 0 249702 11569691 11719015 20405363 20658332 -1181701 396784 43195903 44521319 39955951 40622560 3239952 3898759 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 6091078 8767121 Residential Living: The number of persons who benefited from the services we provided for the year ended January 31, 2018 were as follows:There were a total of 253 residents, occupying 199 apartments at 01/31/2018. Residency for the fiscal year totaled 92,449 resident days. 2761701 3016760 Assisted Living: The number of persons who benefited from the services we provided for the year ended January 31, 2018 were as follows:There were a total of 50 assisted living residents at 01/31/2018. Assisted living residency for the fiscal year totaled 15,409 patient days. 5678129 7459900 Skilled Nursing: The number of persons who benefited from the services we provided for the year ended January 31, 2018 were as follows:There were a total of 57 skilled care patients at 01/31/2018.Skilled care residency for the fiscal year totaled 20,066 patient days. 14530908 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 1 0 1 61 0 1 311 1 0 0 0 0 0 1 1 0 0 0 0 X 17 13 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 0 1 0 X Jody Holt 7738782295 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 X Jon P Aagaard MD Director 1.00 1.00 X 0 0 0 Sarah Bentley Director 1.00 1.00 X 0 0 0 Pamela Christensen Director 1.00 1.00 X 0 0 0 Kara E Davis MD Director 1.00 1.00 X 0 0 0 Mark C Eastburg Director/Chair 1.00 1.00 X 0 0 0 Marc E Espinosa Director/Vice Chair 1.00 1.00 X 0 0 0 Donald Hodgkinson Director 1.00 1.00 X 0 0 0 Scott Macdonald Director 1.00 1.00 X 0 0 0 Mathew Manlove Director 1.00 1.00 X 0 0 0 Dale Glen Rinard Director 1.00 1.00 X 0 0 0 Marlene Stante Director 1.00 1.00 X 0 0 0 Andrew Vanover Director 1.00 1.00 X 0 0 0 Anne E Vining Director 1.00 1.00 X 0 0 0 Richard P Nelson Ex-Officio 1.00 1.00 X 0 0 0 Gary Walter Ex-Officio 1.00 1.00 X 0 0 0 David A Dwight former Ex-Officio/President 1.00 40.00 X 0 512941 43574 Roger Oxendale Ex-Officio 1.00 40.00 X 0 183226 37485 Terri S Cunliffe President/Asst Secretary 1.00 40.00 X X 0 544189 86739 Jody Holt Senior VP/CFO/Treasurer/Asst Secretary 1.00 40.00 X X 0 175758 29300 David G Erickson Senior VP/General Councel/Asst Secretary 1.00 40.00 X 0 289791 55484 Rebekah Erickson Asst Secretary 1.00 40.00 X 0 23693 2318 Elizabeth B Buikema Senior VP/CFP/Treasurer 1.00 40.00 X 0 291162 19281 Pamela B Klapproth Executive Director 40.00 0.00 X 162866 0 35546 Erin Hall Director of Sales 40.00 0.00 X 114120 0 3423 276986 2020760 313150 2 1 1 0 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 481428 CarpetWorks LLC 672 Tolland Street East Hartford CT 06128 Construction Services 248080 Karl E Lindroth PO Box 463 Hebron CT 06248 Construction Services 195626 Orlando's Ornamentals and Landscp 153 West Street Cromwell CT 06416 Landscaping Services 168930 United Cabnets 128 Day Street Newington CT 06111 Construction Services 112338 7 30075 1431013 1461088 Routine Services 623000 11786882 11786882 Medicare/Medicaid 623000 2706959 2706959 Entrance Fee 623000 2365702 2365702 Ancillary 623000 1451711 1451711 Meals 623000 92322 92322 18403576 591376 591376 83014 67756 15258 15258 15258 -256390 -256390 -256390 15917 30075 15917 0 Support Services 623000 788230 788230 Services to Residents 623000 19848 19848 32130 32130 840208 21055116 19243783 0 350244 193141 193141 7065581 5972786 1023995 68800 227010 181881 42378 2751 899779 779784 117753 2242 553806 419632 129016 5158 130395 130395 152159 152159 8376 8376 1833032 1392433 427803 12796 62570 691 61879 669438 512044 155185 2209 560359 560359 1245858 1245858 46454 13491 32963 37510 7908 29602 880856 614045 255448 11363 2834053 1976968 821875 35210 232261 232261 Related Party Activity 1170468 -14075 1078248 106295 Admin & General 751403 8892 742511 Dining Services 567300 567300 Resident Care 394110 394110 142413 94504 45031 2878 20658332 14530908 5877722 249702 7262 7766 76074 106875 542410 1241234 1251330 1129563 320024 336478 54352016 24703870 30129820 29648146 6841216 6964798 2931614 4006660 1096153 1079799 43195903 44521319 729673 34377 11382416 11039430 80935 291562 27762927 29257191 39955951 40622560 X 2672342 3581904 567610 316855 3239952 3898759 43195903 44521319 X 396784 -250756 X 0 1 X 1 0 X 336407 405459 169579 214654 1461088 2587187 15932157 16157587 17284259 17536233 18403576 85313812 16268564 16563046 17453838 17750887 19864664 87900999 0 0 0 87900999 607397 456316 374590 639909 847766 2925978 607397 456316 374590 639909 847766 2925978 16875961 17019362 17828428 18390796 20712430 90826977 0.96780 0.96940 0.03220 0.03060 X 0 1 X 195000 195000 39741454 18803309 20938145 11578973 5352924 6226049 2836589 547637 2288952 29648146 Mortgages 19204 F Domestic Equity 1104308 F International Equity 1545066 F Hedge Funds & Derivatives 731444 F Private Equity 328233 F Fixed Income 196216 F Strategic Income Derivatives 82189 F 4006660 Deferred Revenue Subject to Refund 4289186 Refundable Contract Liabilities 3209308 Inter-company Advance Accounts 21629560 Other Liabilities 129137 29257191 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. 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. Benefit Gala 45992 30075 15917 10626 1400 3891 45992 30075 15917 10626 1400 3891 15917 0 0 1 0 0 1 1 1 1 0 David A Dwight former Ex-Officio/President 0 230697 0 0 0 282244 0 30657 0 15193 0 558791 0 0 Roger Oxendale Ex-Officio 0 100353 0 15000 0 67873 0 14648 0 22981 0 220855 0 0 Terri S Cunliffe President/Asst Secretary 0 455990 0 23520 0 64679 0 65450 0 25139 0 634778 0 0 Jody Holt Senior VP/CFO/Treasurer/Asst Secreta 0 158132 0 0 0 17626 0 17910 0 17901 0 211569 0 0 David G Erickson Senior VP/General Councel/Asst Secre 0 239455 0 0 0 50336 0 28904 0 35396 0 354091 0 0 Elizabeth B Buikema Senior VP/CFP/Treasurer 0 19574 0 25947 0 245641 0 9158 0 10246 0 310566 0 0 Pamela B Klapproth Executive Director 138546 0 0 0 24320 0 18187 0 17826 0 198879 0 0 0 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. The review and approval process is designed to satisfy and qualify for the rebuttable presumption of reasonableness under the Internal Revenue Code Section 4958. 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 Executive Compensation Committee of CMB's Board ("Committee") 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 Committee has determined that total compensation for each such executive is reasonable. Contributions were made to the deferred compensation plan for the following participants: Elizabeth Buikema - $5,766 Terri Cunliffe - $60,601 David Dwight - $22,395 David Erickson - $29,318 Rebekah Erickson - $2,133 Jody Holt- $22,773 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 (of CMB's board) follows a prescribed method for calculating incentive compensation awards. 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 or on factors that will assure that final incentive compensation awards are in the best interest of the organization and appropriately reflect the performance of the organization. Refer to additional information on the Committee included in Schedule O. Part II, Column B (ii): Bonus and incentive compensation - Certain key persons employed by CRC and CMB are eligible for incentive compensation as determined by the Executive Compensation Committee of either the CRC or CMB's Board based on where these individuals are employed. Incentives paid in 2017 relate to the achievement of targets for the fiscal year ended 1/31/2017. Part II, Column D: Nontaxable benefits include health insurance premiums paid by the employer and employee. 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, Inc. provided $564,327 free or discounted services to those residents unable to pay all or a portion of their charges, and who meet certain eligibility requirements. Form 990, Part VI, Section A, line 3 Covenant Home, 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 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 11b Management Review: The draft Form 990 was reviewed by multiple levels of management including the Vice President of Finance/CFO and the Vice President of Legal Affairs. Board Review: Prior to filing, the 990 process was reviewed 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 15b 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 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 The governing documents, conflict of interest policy and financial statements are available upon request by contacting the CRC accounting department at 773-878-5744. Form 990 - Part VI - Line 9 Contact Info for Directors & Officers 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. Form 990 - Part VII - Section A Column B Related Organization Officers and Directors devote approximately 1 hour per week to related organizations except for those individuals that are employees of these related organizations; those individuals devote approximately 40 hours to the organizations at which they are employed. Form 990, Part XI, line 9: Change in Temporarily Restricted Net Assets not included on Income Stmnt -250,756. 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 12b, II 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 Support of Swedish Covenant Hospital 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 12b, II Swedish Covenant Hospital 0 Covenant Village of Portland LP 420 NE Mason St Portland OR 97211 364356838 Assisted Living Community OR N/A N/A 0 0 Covenant International Insurance Company Ltd Crawford House 50 Cedar Avenue Hamilton BD Insurance BD N/A C 0 Covenant Trust Company 8303 West Higgins Road 6th Floor Chicago IL 60631 363583163 Financial Services IL N/A C 0 Swedish Covenant Management Services Inc (SCMS) 5145 North California Avenue Chicago IL 60625 364073303 Physician Practice Management IL N/A C 0 Swedish Covenant Managed Care Alliance (SCMCA) 2740 West Foster Avenue Suite 409 Chicago IL 60625 364118659 Physician - Hospital Organization IL N/A C 0 St Francis Health Care Ltd 2740 West Foster Avenue Suite 002 Chicago IL 60625 363208131 Independent Group of Physicians IL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Covenant Retirement Communities Inc Q 58137 Covenant Retirement Communities Inc P 637090 Covenant Trust Company P 96776