2017-11-08T10:29:44-06:00 2017-01-31 990 2016-02-01 362835154 The Holmstad Inc HOLM 6308794100 700 W Fabyan Parkway Batavia IL 605101247 Jody Holt VP of Finance/CFO 7738782294 2017-11-08 69.8.120.204 2017-11-08 10:01:58 CS P 475448EDD106694E6004F08D4B312B5174DD2527 475448EDD106694E6004F08D4B312B5174DD2527 2016 2018-03-14 21:41:22Z Jody Holt c/o CRC - 5700 Old Orchard Rd Skokie IL 60077 14807996 0 2650 X www.covenantretirement.org X 1975 IL Care for senior adults. 20 17 483 117 0 0 233304 97821 12313548 12418889 1062195 2031346 302493 244889 13911540 14792945 0 0 0 0 3941592 3903742 0 0 118892 13762904 12114328 17704496 16018070 -3792956 -1225125 71529249 71520525 89528410 90316354 -17999161 -18795829 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 10471788 12663778 Residential and Catered Living:The number of persons who benefited from the services we provided for the year ended January 31, 2017 were as follows:There were a total of 372 residents, occupying 315 apartments at 01/31/2017. Residency for the fiscal year totaled 133,009 resident days. The organization was involved in various community benefits projects that include the following:- Staff volunteered a total of 3 hours to Walk to End Alzheimer's (equivalent to $150)- Residents volunteered a total of 1,095 hours of their time to various activities/events in the community.- Hosted student internship program for students from Midvalley, Chamberlin Nursing Program and WCC Nurses Program (equivalent to $34,875)- Provided space for meetings & events for different groups ranging from under 35 participants to a large group of 75 or more. These include groups from Toast Masters, Cub Scouts, Daisy Scouts, Fox Valley Children's Choir, Rush Memory Study, Batavia United Way, and Batavia Chamber of Commerce (equivalent to $228,448)- Monetary Donation to Swedish Covenant Hospital ($1,146 in total)- In-Kind Donations to Chip-in Batavia School Supply Drive, Goodwill, Kars for Kids and Wayside Cross (estimated value of $3,250)- Host site for "Believe, Inspire and Grow," Heartland Blood Drive, Turkey Trot, elections and early voting (equivalent to $203,619) 10471788 1 1 0 0 0 0 0 0 1 1 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 62 0 1 483 1 0 0 0 0 0 1 1 0 0 0 0 X 20 17 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 0 0 0 X Jody Holt 7738782294 C/O CRC 5700 Old Orchard Rd Skokie IL 60077 X Jon P Aagaard MD 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 Rev Harvey Drake Director 1.00 1.00 X 0 0 0 Mark C Eastburg Director/Chair 1.00 1.00 X 0 0 0 James Elving Director 1.00 1.00 X 0 0 0 Marc E Espinosa Director/Vice Chair 1.00 1.00 X 0 0 0 Carol A Findling Director 1.00 1.00 X 0 0 0 Lorene G Flewellen Director 1.00 1.00 X 0 0 0 Rhoda Friesen Director 1.00 1.00 X 0 0 0 Thomas F Heywood Director 1.00 1.00 X 0 0 0 Donald Hodgkinson Director 1.00 1.00 X 0 0 0 Kathy Holmgren Director 1.00 1.00 X 0 0 0 Jody Holt Director/Secretary 1.00 1.00 X 0 0 0 Scott Macdonald Director 1.00 1.00 X 0 0 0 Matthew 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 Anne Vining Director 1.00 1.00 X 0 0 0 David A Dwight Ex-Officio 1.00 40.00 X 0 629581 22698 Jennifer Larson Ex-Officio 1.00 1.00 X 0 0 0 Gary Walter Ex-Officio 1.00 40.00 X 0 166203 111795 Terri S Cunliffe Ex-Officio/President 1.00 40.00 X X 0 502850 84235 Elizabeth B Buikema Senior VP/CFO/Treasurer 1.00 40.00 X 0 330207 63644 David G Erickson VP/Asst Secretary 1.00 40.00 X 0 278833 52881 Joshua Anderson Assoc VP/Asst Secretary 1.00 40.00 X 0 216126 48796 Marya Jordan Admin-Healthcare 40.00 0.00 X 108841 0 25007 Rick K Fisk Former Ex-Officio/President 0.00 40.00 X 0 547941 259846 108841 2671741 668902 1 1 1 0 Joseph J Duffy Company 4994 North Elston Avenue Chicago IL 60630 Construction Services 1098271 Incredible Builders Inc 13N252 Brier Hill Road Hampshire IL 60140 Construction Services 1095288 HealthPRO Rehabilitation 634 Academy Drive Northbrook IL 60062 Therapeutic Services 779984 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 519211 Brickman Group LTD LLC 1772 North Aurora Road Naperville IL 60563 Landscaping and Snowplowing 239052 5 24319 73502 97821 Routine Services 623000 7935727 7935727 Entrance Fee 623000 4255954 4255954 Ancillary Services 623000 127426 127426 Meals 623000 99782 99782 12418889 1798116 1798116 233230 0 233230 233230 233230 15051 24319 15051 0 Support Services 623000 104197 104197 Services to Residents 623000 24593 24593 116099 116099 244889 14792945 12663778 0 2031346 3168687 2234780 926255 7652 96335 62051 34032 252 403784 283124 120593 67 234936 162218 72133 585 69383 69383 17748 17748 4536 4536 809175 580899 227936 340 276006 582 275424 579237 375098 203746 393 259435 6817 252618 1152181 1152181 30209 25196 5013 32035 3825 28210 2957755 1942358 976059 39338 3393523 2231064 1119863 42596 201993 201993 Related Party Activity 704625 676956 27669 Dining Services 567507 567507 Resident Care 496671 496671 Admin & General 428447 13460 414987 133862 62581 71281 16018070 10471788 5427390 118892 9545 8599 160889 311231 916378 693531 16457 6226 34613 35690 77451999 35440855 43463058 42011144 20610762 21428057 4944309 6271493 1373238 754554 71529249 71520525 607310 630815 14928673 15619021 45057029 44052346 57564 77200 28877834 29936972 89528410 90316354 X -18418258 -19643383 -242907 138340 662004 709214 -17999161 -18795829 71529249 71520525 X -1225125 428457 X 0 1 X 1 0 X 55963 42731 643750 233304 97821 1073569 9768714 10490860 11713496 12313548 12418889 56705507 9824677 10533591 12357246 12546852 12516710 57779076 0 0 0 57779076 1615253 1731136 1431321 1062195 2031346 7871251 1615253 1731136 1431321 1062195 2031346 7871251 11439930 12264727 13788567 13609047 14548056 65650327 0.88010 0.88720 0.11990 0.11280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 662005 47209 709214 559517 179197 -76709 662005 366689 190000 2828 559517 366069 620 366689 354150 11919 366069 1.00000 0 1 1 630376 630376 58595569 24773689 33821880 14855378 8872635 5982743 3370676 1794531 1576145 42011144 Mortgages 42773 F Domestic Equity 1789587 F International Equity 1743861 F Hedge Funds and Derivatives 1998556 F Private Equity 696716 F 6271493 Deferred Revenue Subject to Refund 8546811 Refundable Contract Liabilities 10656950 Accrued Taxes & Employee Benefits 252883 Inter-company Advance Accounts 10383215 Other Liabilities 97113 29936972 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. Part V, Line 4: Earnings will be used for maintaining certain campus property. Benevolent Gala 39370 24319 15051 5313 4215 2500 3023 39370 24319 15051 5313 4215 2500 3023 15051 0 0 1 0 0 0 0 0 1 0 David A Dwight Ex-Officio 0 503437 0 0 0 126144 0 7950 0 25192 0 662723 0 0 Gary Walter Ex-Officio 0 166203 0 0 0 0 0 24931 0 86864 0 277998 0 0 Terri S Cunliffe Ex-Officio/President 0 392000 0 44510 0 66340 0 65703 0 21879 0 590432 0 0 Elizabeth B Buikema Senior VP/CFO/Treasurer 0 248387 0 40586 0 41234 0 36737 0 30576 0 397520 0 0 David G Erickson VP/Asst Secretary 0 217505 0 17861 0 43467 0 27940 0 31264 0 338037 0 0 Joshua Anderson Assoc VP/Asst Secretary 0 164113 0 22680 0 29333 0 22074 0 29767 0 267967 0 0 Rick K Fisk Former Ex-Officio/President 0 286625 0 134971 0 126345 0 254610 0 5508 0 808059 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 - $28,787 Terri Cunliffe - $45,986 David Dwight - $67,225 David Erickson - $27,994 Joshua Anderson - $19,783 Rick Fisk - $18,600 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 2016 relate to the achievement of targets for the fiscal year ended 1/31/2016. Part II, Column D: Nontaxable benefits include health insurance premiums paid by the employer and employee. Form 990 - Part III - Line 1 Mission Statement 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), Holmstad provided $189,679 of 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 IV - Line 24a Tax-Exempt Bonds 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 The Holmstad, 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, disposition 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 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. 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 Information for Directors and 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 381,247. Change in Permanently Restricted Net Assets not included on Income Stmnt 47,210. 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 12a, 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 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 12a, I 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 60623 Covenant Retirement Communities Inc P 306373 Covenant Trust Company P 27668