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ObjectId: 202232239349301908 - Submission: 2022-08-11
TIN: 36-2643638
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
20
Open to Public Inspection
Name of the organization
COVENANT HOME ILLINOIS
Employer identification number
36-2643638
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Housing allowance or residence for personal use
Travel for companions
Payments for business use of personal residence
Tax idemnification and gross-up payments
Health or social club dues or initiation fees
Discretionary spending account
Personal services (e.g., maid, chauffeur, chef)
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain
.....
1b
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a?
....
2
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Written employment contract
Independent compensation consultant
Compensation survey or study
Form 990 of other organizations
Approval by the board or compensation committee
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment?
.............
4a
Yes
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization?
....................
5a
No
b
Any related organization?
.......................
5b
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
..................
6a
No
b
Any related organization?
......................
6b
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III
............
7
Yes
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III
..........................
8
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2020
Page 2
Schedule J (Form 990) 2020
Page
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A)
Name and Title
(B)
Breakdown of W-2 and/or 1099-MISC compensation
(C)
Retirement and other deferred compensation
(D)
Nontaxable
benefits
(E)
Total of columns
(B)(i)-(D)
(F)
Compensation in column (B) reported as deferred on prior Form 990
(i)
Base
compensation
(ii)
Bonus & incentive
compensation
(iii)
Other
reportable compensation
1
TERRI S CUNLIFFE
DIRECTOR/CLCS PRESIDENT/CEO
(i)
(ii)
0
-------------
534,767
0
-------------
155,443
0
-------------
445,583
0
-------------
8,550
0
-------------
30,448
0
-------------
1,174,791
0
-------------
347,426
2
JODY HOLT
FORMER CFO/TREASURER/ASST SECRETARY
(i)
(ii)
0
-------------
81,823
0
-------------
117,667
0
-------------
319,231
0
-------------
2,715
0
-------------
26,296
0
-------------
547,732
0
-------------
82,449
3
DAVID G ERICKSON
SR VP & GEN COUNSEL/ASST SECRETARY
(i)
(ii)
0
-------------
286,046
0
-------------
3,000
0
-------------
95,431
0
-------------
50,278
0
-------------
38,468
0
-------------
473,223
0
-------------
47,101
4
WILLIAM RABE
SR VP ENTERPRISE OPS/ASST SECRETARY
(i)
(ii)
0
-------------
243,388
0
-------------
65,304
0
-------------
55,379
0
-------------
36,655
0
-------------
17,039
0
-------------
417,765
0
-------------
0
5
HILDE SAGER
EXECUTIVE DIRECTOR
(i)
(ii)
142,746
-------------
0
25,275
-------------
0
34,968
-------------
0
19,871
-------------
0
22,656
-------------
0
245,516
-------------
0
0
-------------
0
6
CORY STERN - END 7121
INTERIM FINANCE LEAD/TREASURER
(i)
(ii)
0
-------------
139,176
0
-------------
17,785
0
-------------
53,413
0
-------------
20,195
0
-------------
8,858
0
-------------
239,427
0
-------------
11,773
7
JOHN WENRICH
DIRECTOR/EX-OFFICIO
(i)
(ii)
0
-------------
127,768
0
-------------
0
0
-------------
0
0
-------------
25,723
0
-------------
71,708
0
-------------
225,199
0
-------------
0
8
BARBARA BEAKE - END 81420
ASSOCIATE VICE PRESIDENT, OPERATIONS
(i)
(ii)
0
-------------
114,068
0
-------------
13,339
0
-------------
33,425
0
-------------
10,480
0
-------------
21,722
0
-------------
193,034
0
-------------
0
9
MICHELLE PARDUN
ASSOCIATE EXECUTIVE DIRECTOR
(i)
(ii)
139,720
-------------
0
10,068
-------------
0
2,766
-------------
0
5,684
-------------
0
21,507
-------------
0
179,745
-------------
0
0
-------------
0
10
KATHRYN BERG
HEALTHCARE ADMINISTRATOR
(i)
(ii)
111,345
-------------
0
5,543
-------------
0
11,634
-------------
0
3,310
-------------
0
26,060
-------------
0
157,892
-------------
0
3,092
-------------
0
Schedule J (Form 990) 2020
Page 3
Schedule J (Form 990) 2020
Page
3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference
Explanation
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, LINES 4A-B
LINE 4A: JODY HOLT RECEIVED SEVERANCE PAYMENTS TOTALING $169,389 DURING THE TAX YEAR. LINE 4B: EXECUTIVE BENEFIT PLAN COVENANT MINISTRIES OF BENEVOLENCE (CMB), A RELATED ORGANIZATION, 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. THE FOLLOWING ARE PARTICIPANTS IN THE PLAN: KATHRYN BERG HILDE SAGER MICHELLE PARDUN AMY LANE TERRI CUNLIFFE DAVID ERICKSON WILLIAM RABE CORY STERN REBEKAH ERICKSON JEAN JUSTIE AMY LACROIX BARBARA BEAKE IN 2020, THESE INDIVIDUALS VESTED IN THE PLAN IN THE FOLLOWING AMOUNTS: TERRI CUNLIFFE - $374,150 DAVID ERICKSON - $22,000 CORY STERN - $11,773 KATHRYN BERG - $7,761 IN 2020, THESE INDIVIDUALS RECEIVED DISTRIBUTIONS FROM THE PLAN IN THE FOLLOWING AMOUNTS: JODY HOLT - $90,685 DAVID ERICKSON - $25,101
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 COVENANT LIVING AND CMB ARE ELIGIBLE FOR INCENTIVE COMPENSATION AS DETERMINED BY THE EXECUTIVE COMPENSATION COMMITTEE OF EITHER THE COVENANT LIVING OR CMB'S BOARD BASED ON WHERE THESE INDIVIDUALS ARE EMPLOYED. INCENTIVES PAID IN 2020 RELATE TO THE ACHIEVEMENT OF TARGETS FOR THE TWELVE MONTHS ENDED 1/31/2020 AS WELL AS A $3,000 CORONAVIRUS APPRECIATION BONUS. PART II, COLUMN D: NONTAXABLE BENEFITS INCLUDE HEALTH INSURANCE PREMIUMS PAID BY THE EMPLOYER AND EMPLOYEE.
Schedule J (Form 990) 2020
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