2013-11-15T16:00:23-06:00 2012-12-31 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2012-01-01 362382853 Rest Haven Illiana Christian Convalescent Home % WILLIAM DEYOUNG REST 7083428100 18601 NORTH CREEK DRIVE Suite TINLEY PARK IL 60477 William DeYoung 7083428100 2013-11-15 true 6142492300 2012 2016-03-07 17:11:31Z PROVIDENCE LIFE SERVICES Richard Schutt 18601 North Creek Drive Tinley Park IL 60477 75256774 false X WWW.PROVIDENCELIFESERVICES.COM X 1956 IL REST HAVEN'S PURPOSE IS TO PROVIDE NURSING AND RESIDENTIAL LIVING FOR THE AGED INCLUDING SKILLED NURSING AND REHABILITATION SERVICES, HOME HEALTH CARE, TOWN HOME LIVING, INDEPENDENT AND ASSISTED LIVING. 15 15 1583 350 0 1657909 1027968 73255482 73371513 432311 732973 -94397 -107552 75251305 75024902 2069 354 0 0 35161270 35566954 0 0 0 38579526 38719635 73742865 74286943 1508440 737959 88158307 91164013 69007027 70610688 19151280 20553325 X SEE SCHEDULE O false false 69364582 354 73371513 TO PROVIDE PROPER CARE FOR THE SICK AND ELDERLY. 1,020 BEDS/UNITS WITH OCCUPANCY OVER 82% ON THE FULL CONTINUUM OF CARE. 69364582 true true false false false false false false false false true false false true true true false true false false false false false false true false false false false true true false false false false false false false false false false false false false false true true false false false false true 63 0 true 1583 true false false false false false true true false false false false X 15 15 false true false false false false false true true false false false true true true true true true true false IL IN MI X WILLIAM DEYOUNG 7083428139 18601 NORTH CREEK DRIVE TINLEY PARK IL 60477 KURT NELSON 2.0 X 0 0 0 RON PORTER 2.0 X 0 0 0 ARNOLD KOLDENHOVEN 2.0 X 0 0 0 NORM AARDEMA 2.0 X 0 0 0 DR DAVE BEEZHOLD 2.0 X 0 0 0 HAL BROWN 2.0 X 0 0 0 SHARON CLOUSING 2.0 X X 0 0 0 GARY ELLENS 2.0 X 0 0 0 HOWARD HOFF 2.0 X 0 0 0 LUCETTE BAMFORD 2.0 X 0 0 0 TIM BREEMS 2.0 X 0 0 0 JUSTIN KATS 2.0 X 0 0 0 KEN SCHOON 2.0 X 0 0 0 CAL TAMELING 2.0 X X 0 0 0 DON VAN DYK 2.0 X 0 0 0 RICHARD SCHUTT 60.0 X 0 462937 128057 WILLIAM DEYOUNG 60.0 X 0 307246 58342 Timothy Abbring 40.0 X 0 125109 14582 Mary Kay Kacmarek 40.0 X 0 131124 22514 Leeona Campbell 40.0 X 0 111597 32151 Linda Carrigan 40.0 X 0 104513 9328 Jacquelyn Terpstra 40.0 X 0 107724 32730 0 1350250 297704 11 false true false PROVIDENCE MGMT DEV 18601 N CREEK DRIVE TINLEY PARK IL 60477 MANAGEMENT SERVICES 4693825 ALLIANCE PHARMACY SERVICES 1520 KENSINGTON ROAD SUITE 105 OAK BROOK IL 60523 PHARMACY SERVICES 3669137 GORDON FOOD SERVICE INC PAYMENT PROCESSING CENTER DEPT CH PALATINE IL 600550490 DIETARY SERVICES 2218720 INGALLS REHABILITATION INGALLS MEMORIAL HOSPITAL ACCT DEP HARVEY IL 60426 THERAPY SERVICES 1890141 CREATIVE DINING SERVICES ONE ROYAL PARK DRIVE STE 3 ZEELAND MI 49464 DIETARY SERVICES 811807 47 286738 741230 1027968 ROUTINE REVENUE 621610 70121421 70121421 ANCILLARY REVENUE 621610 3250092 3250092 73371513 732973 732973 0 0 0 0 0 0 124320 286738 231872 -107552 0 0 0 75024902 73371513 732973 0 354 354 0 0 767183 767183 0 29387240 29387240 422929 422929 2818065 2818065 2171537 2171537 4922361 4922361 0 0 0 0 0 7909730 7909730 0 475452 475452 0 0 1817512 1817512 193896 193896 0 0 2061528 2061528 0 3306625 3306625 2613950 2613950 NURSING 6257867 6257867 FOOD AND DIETARY 3812569 3812569 REPAIRS AND MAINTENANCE 1765214 1765214 PROVISION FOR BAD DEBT 1004900 1004900 2578031 2578031 74286943 69364582 4922361 0 1597477 1328950 2845310 1935633 653393 168782 11579380 11671512 0 0 0 0 0 0 0 0 481376 689165 116857834 68144690 50521489 48713144 6774826 11879427 1305417 1533947 0 0 0 0 12399639 13243453 88158307 91164013 14954420 11813313 0 0 3149044 2960262 17535000 17155000 0 0 0 0 31269611 33312382 0 0 2098952 5369731 69007027 70610688 X 17867290 20214760 1283990 338565 0 0 19151280 20553325 88158307 91164013 737959 611702 52384 X false true X true false X 794151 853703 1843841 1657909 741230 5890834 72001336 70984500 70618626 73255481 73371512 360231455 0 0 0 72795487 71838203 72462467 74913390 74112742 366122289 0 0 0 366122289 550529 299821 740596 181696 1344675 3117317 0 550529 299821 740596 181696 1344675 3117317 25935 0 0 0 0 25935 0 73371951 72138024 73203063 75095086 75457417 369265541 0.99149 0.99187 0.00844 0.00806 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6107179 6107179 75747974 43093889 32654085 23462923 21457173 2005750 11539758 3593628 7946130 48713144 GROUND LEASE RECEIVABLES 4984008 INTERDIVISIONAL 4687950 LEGAL LIAB INS RECOVERIES 1894998 DEFERRED FINANCING COSTS, NET 1250386 OTHER ASSETS 426111 13243453 0 OTHER LONG-TERM LIABILITIES 1504724 CHARITABLE ANNUITY CONTRACTS 217437 ACCRUED INTEREST PAYABLE 119017 RESIDENT NOTES AND DEPOSITS 96628 ESTIMATED SELF-INS LIABILITIES 2656905 NONCURRENT LIABILITIES OF DISCONT 254305 CURRENT LIABILITIES OF DISCONT OPS 520715 5369731 X ASC 740 FOOTNOTE THE CORPORATIONS ACCOUNT FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ASC SUBTOPIC 740-10, INCOME TAXES - OVERALL, WHICH ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, THE CORPORATIONS MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST, AND PENALTIES ON INCOME TAXES AND ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. AS OF DECEMBER 31, 2012 AND 2011, THE CORPORATIONS DO NOT HAVE A LIABILITY FOR ANY UNRECOGNIZED TAX BENEFITS. BANQUET 216057 150717 65340 155093 GOLF OUTING 144810 102690 42120 49986 3 50191 33331 16860 26793 411058 286738 124320 231872 231872 -107552 FUNDRAISING OR GAMING ACTIVITIES FORM 990, SCHEDULE G, PART II The organization hosts events for public relations and fundraising purposes. These events are often underwritten by leadership sponsors of which their sponsorships are allocated amongst the various events. The combined gross receipts of the events totaled $411,058 for 2012. The combined costs of the events totaled $231,872. The net income to the organization for hosting all of the events was $179,186. X X true true X X X X X false true false false false false false false false RICHARD SCHUTT 0 400453 0 53780 0 8704 0 87475 0 40582 0 590994 0 0 WILLIAM DEYOUNG 0 260551 0 35861 0 10834 0 24606 0 33736 0 365588 0 0 Mary Kay Kacmarek 0 131124 0 0 0 0 0 3938 0 18576 0 153638 0 0 Part III Question 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. Documentation of attendance at the annual convention is required. The organization has established a senior executive management program which allows stated employees to join a fitness center. Eligible employees that enroll are required to be actively utilizing the fitness center. Question 4b Rest Haven has established a nonqualified deferred compensation plan in an effort to retain selected officers on a long term basis. The following is a schedule of the officers and the annual contribution to the plan: Richard Schutt $ 87,475 William DeYoung $ 24,606 In 2005, the Board of Directors established 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 continuously employed thru and until a future date. The organization's payments into the plan are recorded on the 990 as deferred compensation. However, the executive has not received these monies and will only be eligible to receive them based upon the achievement or satisfaction of some future events. The plan contributions are not under the control of the executive, they remain the asset of the organization, and the entire plan is subject to a full risk of forfeiture by the individual. For calendar year 2012, a portion of the Retention Incentive Plan includes a retro-calculated catch-up provision as if the plan had been established upon assuming their current positions, as opposed to many years after the fact. That reality affects the current year's contribution level. This plan was developed by an outside professional compensation expert who practices significantly in non-profit, faith-based, aging services organizations. Questions 5a and 6a The Executive Compensation Program has two major elements: Salary, or base pay, and variable pay. The salary reflects the value of an executive's capabilities 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 based upon a specific review of goals and objectives (including those which relate to Mission, Operational efficiency, financial effectiveness, and Strategic goals). Semi-annually the compensation committee reviews, assesses and determines any award under the variable pay component. Executive employee benefits 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 RECEIVES AN EXECUTIVE COMPENSATION OPINION NOTING THAT THE ORGANIZATION'S EXECUTIVE COMPENSATION FALLS WITHIN THE RANGE OF COMPARABLE POSITIONS WITHIN THE SAME INDUSTRY. THE REPORT/OPINION ALSO NOTES THAT THE STATED REQUIREMENTS OF ENSURING INDEPENDENCE OF COMPENSATION DELIBERATIONS FOR SENIOR EXECUTIVES ARE MET. A MICHIGAN STRATEGIC FUND 521417332 59469YAF2 2004-11-18 9585000 MICHIGAN STRATEGIC FUND false false false A 1420000 0 9585000 0 0 0 191700 0 0 166000 0 0 true false true true A false false false false 0 false false false false A false false false true false false 0 false false false 0 false false A true Michigan Strategic Fund Schedule K, Part IV, Line 2c The rebate computation was performed on May 18, 2006, for the Michigan Strategic Fund Weekly Adjustable Rate Revenue Bonds, Series 2004A. A ILLINOIS FINANCE AUTHORITY 861091967 45200BGF9 2004-11-01 33170000 ILLINOIS DEVELOPMENT FINANCE false false false A 24180000 0 33170000 0 0 0 663400 0 0 6933000 0 0 true false true true A false false false false 0 false false false false A false false false true false false 0 false false false 0 false false A true Illinois Finance Authority Schedule K, Part IV, Line 2c FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME D/B/A PROVIDENCE LIFE SERVICES (REST HAVEN) IS A NOT-FOR-PROFIT ILLINOIS CORPORATION WHOSE PURPOSE IS TO PROVIDE NURSING AND RESIDENTIAL LIVING ARRANGEMENTS FOR THE AGED INCLUDING SKILLED NURSING AND REHABILITATION SERVICES, HOME HEALTH CARE, TOWNHOME LIVING, INDEPENDENT LIVING, AND ASSISTED LIVING. GOVERNANCE, MANAGEMENT, AND DISCLOSURE FORM 990 PART VI, SECTION A QUESTION 3: All management activities for Rest Haven are performed and supervised by Rest Haven's wholly-owned corporation, Providence Management and Development Company. GOVERNANCE, MANAGEMENT, AND DISCLOSURE FORM 990 PART VI, SECTION A QUESTION 11B: A draft of the 990 was prepared and sent for initial review by the controllers, CFO and CEO. Upon review and approval, the final draft is forwarded to the executive committee before submission. A completed copy of the 990 is provided to the full board at the subsequent board meeting, after filing. GOVERNANCE, MANAGEMENT, AND DISCLOSURE FORM 990 PART VI, SECTION B QUESTION 12C: The officers, directors/trustees and key employees 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. COMPENSATION OF KEY EMPLOYEES FORM 990 PART VI, SECTION B QUESTIONS 15A & 15B: The 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. GOVERNANCE, MANAGEMENT, AND DISCLOSURE FORM 990 PART VI, SECTION C QUESTION 19: The governing documents, conflict of interest policy, and financial statements are available to the public upon request. FEES FOR SERVICES - OTHER FORM 990, PART IX, LINE 11g - OTHER PROFESSIONAL FEES OTHER MISCELLANEOUS PROFESSIONAL FEES 7,909,730 PROVIDENCE DEVELOPMENT GROUP 18601 N CREEK DRIVE TINLEY PARK IL 60477 DEVELOPMENT IL 99387 9891953 REST HAVEN PARK PLACE REALTY GROUP LLC 18601 N CREEK DRIVE TINLEY PARK IL 60477 REAL ESTATE IL 25085 102028 NA CHRISTIAN HEALTHCARE FOUNDATION 18601 N CREEK DRIVE TINLEY PARK IL 60477 200722359 RESEARCH IL 501(C)(3) 9 REST HAVEN false CHRISTIAN LIVING CAMPUS 18601 N CREEK DRIVE TINLEY PARK IL 60477 200226221 SENIOR LIVING IL 501(C)(3) 9 REST HAVEN false HAVEN PARK 18601 N CREEK DRIVE TINLEY PARK IL 60477 383026594 HEALTHCARE MI 501(C)(3) 9 REST HAVEN false TIMOTHY PLACE 18601 N CREEK DRIVE TINLEY PARK IL 60477 201835089 SENIOR LIVING IL 501(C)(3) 9 REST HAVEN false PARK PLACE OF ST JOHN 18601 N CREEK DRIVE TINLEY PARK IL 60477 201834903 SENIOR LIVING IL 501(C)(3) 9 REST HAVEN false HUDSONVILLE PARK PLACE 18601 N CREEK DRIVE TINLeY PARK IL 60477 201834667 SENIOR LIVING IL 501(C)(3) 9 REST HAVEN false PROVIDENCE MGMT & DEVELOPMENT 18601 N CREEK DRIVE TINLEY PARK IL 60477 363774205 MGMT & IT IL NA C CORP 827638 3764431 1.00000 true HOME AIDE HEALTH NETWORK 18601 N CREEK DRIVE TINLEY PARK IL 60477 364167569 HOME CARE MI PROV MGMT & DEV C CORP 0 71126 1.00000 true PROVIDENCE HOUSING CORPORATION 18601 N CREEK DRIVE TINLEY PARK IL 60477 461379112 HOUSING SERVICES IL REST HAVEN C CORP 0 0 1.00000 true true false false false false false false false false true false false true true true true false false PROVIDENCE MANAGEMENT DEVELOPMENT COMPANY 1O 4693825 FMV