2016-12-14T17:23:13-06:00 2016-01-31 990 2015-02-01 521115870 Covenant Village of Florida Inc COVE 9544722860 9215 W Broward Blvd No 100 Plantation FL 33324 Elizabeth Buikema VP of Finance/CFO 7738782294 2016-12-14 2015 2017-02-10 21:41:12Z Elizabeth Buikema c/o CRC - 5700 Old Orchard Rd Skokie IL 60077 18998218 0 2650 X www.covenantretirement.org X 1978 FL Care for senior adults. 21 18 316 118 0 0 534759 223330 16714481 17902989 726939 623757 227599 235579 18203778 18985655 0 0 0 0 6926005 7662118 0 0 197140 12562786 14146114 19488791 21808232 -1285013 -2822577 55590456 53208018 63409903 63912197 -7819447 -10704179 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 8483076 9063119 Residential Living: The number of persons who benefited from the services we provided for the year ended January 31, 2016 were as follows:There were a total of 292 residents, occupying 248 apartments at 01/31/2016. Residency for the fiscal year totaled 101,972 resident days. 1430234 1924766 Assisted Living: The number of persons who benefited from the services we provided for the year ended January 31, 2016 were as follows:There were a total of 35 assisted living residents at 01/31/2016. Assisted living residency for the fiscal year totaled 12,112 patient days. 4960112 7150683 Skilled Nursing: The number of persons who benefited from the services we provided for the year ended January 31, 2016 were as follows:There were a total of 49 skilled care patients at 01/31/2016.Skilled care residency for the fiscal year totaled 18,160 patient days. The organization was involved in various community benefits projectswhich include the following:- Staff members volunteered a total of 26 hours to Hope South Florida and Relay for Life(equivalent to $1,550)- Residents volunteered a total of 1,749 hours to various organizationsor events in the community including Charity Bears, Senior Luncheon, Men's Chorus, Insight for the blind, at local churches,Plantation History Museum, AARP and others. The residents also raised in-kind donations for Operation Christmas Child Shoebox Collection (estimated value of $3,000).- Provided space usage for meetings/events for small (under 35) tolarge groups (75+ people) and Community Events including AARP safe driving class, Alzheimer's Support Group, Girl Scout Troops, BCOA, various arts and music events, H2U Fitness Clas, WSR Lecture, USO Veteran's Dance, Garden Getaway Women's Retreat, Holiday Bazaar, Pastors' Appreciation Brunch, NSU Lifelong Learning, Election Polls and others (equivalent to $966,000)-In-Kind donations to Escarment Foundation, Faith Farm Ministries andImmanuel Baptist Church (estimated value of $16,632) 14873422 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 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 35 0 1 316 1 0 0 0 0 0 1 1 0 0 0 0 X 21 18 0 1 0 0 1 0 1 1 1 1 0 1 1 1 1 1 1 0 0 0 X Elizabeth B Buikema 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 1.00 1.00 X 0 0 0 James Elving Director 1.00 1.00 X 0 0 0 Marc E Espinosa Director 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 1.00 1.00 X 0 0 0 Scott Macdonald 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 1846302 29812 Rick K Fisk Ex-Officio/President 1.00 40.00 X X 0 1037707 19210 Jennifer Larson Ex-Officio 1.00 1.00 X 0 0 0 Gary Walter Ex-Officio 1.00 40.00 X 0 151696 109618 Terri S Cunliffe Ex-Officio/President 1.00 40.00 X X 0 482038 73683 Elizabeth B Buikema Senior VP/CFO/Treasurer 1.00 40.00 X 0 356598 57905 David G Erickson VP/Asst Secretary 1.00 40.00 X 0 285049 52820 Nadia Geigler Dir Admin Srvcs/Asst Secretary 1.00 40.00 X 0 100457 10051 Ian L Brown Executive Director 40.00 0.00 X 138290 0 30057 Theresa Minervini Sales Director 40.00 0.00 X 109785 0 21354 Douglas S Fennema Executive Director 40.00 0.00 X 110323 0 12893 358398 4259847 417403 3 0 1 0 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Dining Services 466664 R&S General Contractors 3325 Griffin Road 113 Fort Lauderdale FL 33312 Apartment Refurbishments 430950 Dubois Construction Servics 1311 W Newport Center Drive Suite Deerfield Beach FL 33442 Apartment Refurbishments 404224 Advanced Fire and Security PO Box 668370 Pompano Beach FL 33066 Fire Alarm Systems 247235 JWR Constructions Services 1311 W Newport Center Drive Suite Deerfield Beach FL 33442 Health Center Refurbishments 234623 5 18690 204640 223330 Routine Services 623000 9838785 9838785 Medicare/Medicaid 623000 2788368 2788368 Entrance Fee 623000 2639449 2639449 Ancillary Services 623000 2494775 2494775 Meals 623000 141612 141612 17902989 484090 484090 123877 15790 0 0 123877 15790 139667 139667 12563 18690 12563 0 Support Services 623000 68184 68184 Services to Resident 623000 16908 16908 150487 150487 235579 18985655 18138568 0 623757 6287791 5025014 1262777 123660 89429 34231 790441 623995 166446 460226 364592 95634 44553 44553 45058 45058 31453 31453 1252746 751841 500905 578561 348 578213 1247556 878643 368913 351647 351647 959614 959614 55849 11857 43992 33508 14231 19277 1978210 1339050 613245 25915 3104684 2103514 962452 38718 342919 342919 Admin & General 1462958 797180 665778 Related Party Activity 1088763 956256 132507 Dining Services 931109 931109 Resident Care 550023 550023 86903 45510 41393 21808232 14873422 6737670 197140 13729 497964 1124694 100574 1122743 996090 2007042 1830375 83113 37778 30583 30645 68345862 34054416 34411265 34291446 14173934 12795022 2382154 2264580 241199 363544 55590456 53208018 958747 762885 9504192 9511469 27615801 24860052 5000 27700 25326163 28750091 63409903 63912197 X -8248514 -11071092 429067 366913 -7819447 -10704179 55590456 53208018 X -2822577 -62155 X 0 1 X 1 0 X 683401 661797 1036135 534759 223330 3139422 14790848 14674726 15923241 16714481 17902989 80006285 15474249 15336523 16959376 17249240 18126319 83145707 0 0 0 83145707 823232 654113 545442 726939 623757 3373483 823232 654113 545442 726939 623757 3373483 16297481 15990636 17504818 17976179 18750076 86519190 0.96100 0.95690 0.03900 0.04310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 565255 565255 53130624 27398622 25732002 11680140 5463084 6217056 2969843 1192710 1777133 34291446 Deferred Revenue Subject to Refund 7299742 Refundable Contract Liabilities 2590680 Accrued Taxes & Employee Benefits 35650 Inter-company Advance Accounts 18455080 Other Liabilities 368939 28750091 17952210 -116717 -116717 18068927 916727 916727 18985654 20774788 -916727 -916727 21691515 116717 116717 21808232 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 XI, Line 2d - Other Adjustments: Contribution related expenses netted against contribution Revenue -132,507. Other non-operating income 15,790. Part XI, Line 4b - Other Adjustments: Dining services revenue 141,612. Loss - Disposal of Fixed Asset 15,790. Loss on Extinguishment of Debt 759,325. Part XII, Line 2d - Other Adjustments: Dining services revenue netted with Dietary expense -141,612. Loss - Disposal of Fixed Asset -15,790. Loss on Extinguishment of Debt -759,325. Part XII, Line 4b - Other Adjustments: Contribution related expenses netted against contribution Revenue 132,507. Other non-operating income -15,790. Benefit Dinner 31253 18690 12563 2521 6221 1000 2821 31253 18690 12563 2521 6221 1000 2821 12563 0 0 1 0 0 0 0 0 1 0 David A Dwight Ex-Officio 0 497736 0 0 0 1348566 0 7950 0 31135 0 1885387 0 0 Rick K Fisk Ex-Officio/President 0 461683 0 222540 0 353484 0 7950 0 18993 0 1064650 0 0 Gary Walter Ex-Officio 0 151696 0 0 0 0 0 22754 0 86864 0 261314 0 0 Terri S Cunliffe Ex-Officio/President 0 341165 0 77220 0 63653 0 54291 0 22034 0 558363 0 0 Elizabeth B Buikema Senior VP/CFO/Treasurer 0 240768 0 75396 0 40434 0 30133 0 31216 0 417947 0 0 David G Erickson VP/Asst Secretary 0 193687 0 41895 0 49467 0 25505 0 31019 0 341573 0 0 Ian L Brown Executive Director 135968 0 0 0 2322 0 11733 0 18818 0 168841 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 - $26,913 Terri Cunliffe - $45,986 David Dwight - $65,253 David Erickson - $24,737 Rick Fisk - $56,068 Nadia Geigler - $7,308 Ian L. Brown - $11,733 The compensation amounts reported for certain individuals in Part II, columns (B)(i) through (iii), include amounts earned over many years of employment under a supplemental nonqualified retirement plan. These amounts were at risk, and would have been forfeited if the reported individual had not satisfied a substantial service requirement. These amounts would be paid out over an individual's years of retirement, like a traditional pension plan benefit, but special laws for tax-exempt organizations require that the entire value be reported, taxed and paid out at one time. The individuals who earned these amounts over many years of service, and the amounts that were paid out in the reported year, are as follows: Rick Fisk: $248,729 David Dwight: $1,215,769 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 2015 relate to the achievement of targets for the fiscal year ended 1/31/2015. 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), Covenant Village of Florida, Inc. provided $344,021 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 Covenant Village of Florida, 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, dispositions and financings, changes to articles and bylaws. Form 990, Part VI, Section B, line 11 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 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 -62,155. Evangelical Covenant Church 5101 North Francisco Avenue Chicago IL 60625 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 11a, 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 11a, 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 1093794 Covenant Retirement Communities Inc P 498581 Covenant Trust Company P 106775