2017-11-08T10:29:44-06:00 2017-01-31 990 2016-02-01 410841150 Colonial Acres Home Inc COLO 6125466125 5800 St Croix Ave Minneapolis MN 55422 Jody Holt VP of Finance/CFO 7738782294 2017-11-08 69.8.120.204 2017-11-08 09:28:20 CS P 475448EDD106694E6004F08D4B312B5174DD2527 475448EDD106694E6004F08D4B312B5174DD2527 2016 2018-03-14 21:41:22Z Jody Holt 5700 Old Orchard Road Skokie IL 60077 19414709 0 2650 X www.covenantretirement.org X 1959 MN Care for senior adults. 20 17 376 276 0 0 363481 166690 18240948 18253406 393128 443950 249858 224759 19247415 19088805 0 0 0 0 9470313 9575301 0 0 74514 12077301 13126250 21547614 22701551 -2300199 -3612746 43688151 43438721 66075971 69443309 -22387820 -26004588 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 6296295 6941319 Residential 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 230 residents, occupying 178 apartments at 01/31/2017. Residency for the fiscal year totaled 80,243 resident days. 2623463 3182191 Assisted 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 50 assisted living residents at 01/31/2017. Assisted living residency for the fiscal year totaled 19,873 patient days. 7645856 8365944 Skilled Nursing: 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 74 skilled care patients at 01/31/2017.Skilled care residency for the fiscal year totaled 26,180 patient days. The organization was involved in various community benefits projects that include the following:- Staff members volunteered a total of 31 hours of their time to various activities/events in the community (equivalent to $1,663)- Residents volunteered a total of 3,500 hours to the community by serving in local churches, schools, library, food drives and feeding programs, tutoring programs, sewing and knitting projects for various ministries and others. - Provided space usage for small (under 35 people) to large groups (75+ people) for various community events such Clergy Appreciation Breakfast, Halloween Event, Jazz Piano concert, various presentations/topics and others (equivalent to $366,845)- Monetary Donations to various individuals and organizations including the Alzheimer's Association, PRISM, local churches and others ($6,347 in total)- In-kind Donation to various individuals and organizations including the local food pantries, local churches, Salvation Army and others ($930 in estimated value) 16565614 1 1 0 0 0 0 0 0 1 0 1 0 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 63 0 1 376 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 MN X Jody Holt 7738782294 C/O CRC 5700 Old Orchard Road 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 Thomas Freudenstein Sales Director 40.00 0.00 X 108814 0 0 Todd Carsen Admin-Healthcare 40.00 0.00 X 108856 0 10119 Rick K Fisk Former Ex-Officio/President 0.00 40.00 X 0 547941 259846 217670 2671741 654014 2 1 1 0 AJW Contracting Inc 11428 293rd Avenue Princeton MN 55371 Flooring and Cabinets 848996 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 429622 Seitz Bros Inc 8608 Xylon Avenue North Brooklyn Park MN 55445 Plumbing 293765 Nordic Services Inc 11965 Larc Industrial Blvd Suite 6 Burnsville MN 55337 A/C and Heating 255392 Mary Nell Zellner 522 Hackmore Drive St Paul MN 55123 Consullting Services 215488 5 56966 109724 166690 Routine Services 623000 13614779 13614779 Entrance Fee 623000 1982806 1982806 Ancillary Services 623000 1887610 1887610 Medicare/Medicaid 623000 679613 679613 Meals 623000 88598 88598 18253406 730870 730870 11040 22329 -11289 -11289 -11289 2790 0 289710 2790 -289710 -286920 -286920 13865 56966 13865 0 Support Services 623000 138703 138703 Services to Residents 623000 15253 15253 82092 82092 236048 19088805 18489454 0 432661 7845892 6729731 1113262 2899 219960 177659 42012 289 915821 779520 136200 101 593628 509122 84284 222 112210 112210 38742 38742 9288 9288 1684635 1200468 484131 36 342951 592 342359 875240 720825 154025 390 817134 817134 875676 875676 41598 16396 25202 33389 6901 26488 2252816 1615945 608260 28611 2842095 2039248 767366 35481 254532 254532 Related Party Activity 1065972 1059538 6434 Dining Services 780840 780840 Resident Care 555633 555633 Admin & General 265197 25662 239535 278302 164654 113597 51 22701551 16565614 6061423 74514 114471 5908 135859 81006 251149 264936 1854248 2297297 59092 100299 63320996 33033307 31189255 30287689 7610552 8224679 1820570 2100697 652955 76210 43688151 43438721 1070921 1021140 8019155 8336063 32338650 31729207 57976 52865 24589269 28304034 66075971 69443309 X -22612966 -26225712 225146 221124 -22387820 -26004588 43688151 43438721 X -3612746 -4022 X 0 1 X 1 0 X 581692 223512 299736 363481 166690 1635111 15696836 16502268 17168341 18240948 18253406 85861799 16278528 16725780 17468077 18604429 18420096 87496910 0 0 0 87496910 620495 622648 236238 393128 443950 2316459 620495 622648 236238 393128 443950 2316459 16899023 17348428 17704315 18997557 18864046 89813369 0.97420 0.97270 0.02580 0.02730 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 551033 551033 48942753 27078861 21863892 13191730 5704835 7486895 635480 249611 385869 30287689 Deferred Revenue Subject to Refund 4379628 Refundable Contract Liabilities 4844171 Accrued Taxes & Employee Benefits 56867 Inter-company Advance Accounts 18930795 Other Liabilities 92573 28304034 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 at the Skilled Nursing Facility: Per state regulations, an account is made available to SNF residents wishing to deposit personal needs funds that they can access as needed. Interest is paid on any balance exceeding $49. Annual Benefit Event 35364 22253 13111 650 3891 1603 6967 Benevolent Care Matching Fund Drive 35467 34713 754 754 70831 56966 13865 650 3891 1603 7721 13865 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 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), Colonial Acres Home, Inc. provided $2,051,762 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 issue 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 Colonial Acres Home, Inc. delegated control over management duties to Covenant Retirement Communities, Inc. (CRC). 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 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 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 Related Organizations 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 -4,022. 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Covenant Retirement Communities Inc Q 1614816 Covenant Retirement Communities Inc P 532255 Covenant Retirement Communities Inc A 900 Covenant Trust Company P 6434