2019-10-11T13:03:34-05:00 2018-12-31 FAIRVIEW HEALTH SVCS 2450 RIVERSIDE AVE S DEPT C-207 LE MINNEAPOLIS MN 554541450 990 2018-01-01 412012560 EBENEZER LAKES ASSISTED LIVING EBEN 6128743460 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 JONATHAN LUNDBERG EB PRES/SECRETARY 6128743460 2019-08-29 2019-10-11 162.96.9.40 2019-10-11 13:03:34 CD P 9A7795162CD8FED1DB572D6341B886463E8B285F 9A7795162CD8FED1DB572D6341B886463E8B285F 2018 2019-02-21 02:37:17Z MEADOWS ON FAIRVIEW JONATHAN LUNDBERG 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 4941303 false X WWW.FAIRVIEWEBENEZER.ORG X 2001 MN PROVIDE ASSISTED LIVING SERVICES TO IMPROVE THE QUALITY OF LIFE FOR THE ELDERLY AND DISABLED. 12 9 0 0 33671 10072 4538063 4892455 621 1203 18420 37573 4590775 4941303 0 0 2639017 2876993 0 0 2363643 2185698 5002660 5062691 -411885 -121388 7693370 7377618 10188995 9994631 -2495625 -2617013 X EBENEZER LAKES ASSISTED LIVING IS PART OF EBENEZER SOCIETY. EBENEZER SOCIETY HELPS OLDER ADULTS AND OTHERS MAKE THEIR LIVES MORE INDEPENDENT, HEALTHFUL, MEANINGFUL AND SECURE. BUILDING ON OUR LUTHERAN HERITAGE, WE RESPOND TO PHYSICAL, PSYCHOLOGICAL, SOCIAL AND SPIRITUAL DIMENSIONS OF THE WHOLE PERSON. WE WELCOME PERSONS OF DIVERSE CULTURES AND FAITH TRADITIONS. WE PRACTICE RESPONSIBLE STEWARDSHIP OF HUMANS, PROPERTY, AND FINANCIAL RESOURCES AND ENCOURAGE CONTINUAL LEARNING AND INNOVATION TO STRIVE FOR EXCELLENCE. false false 2090858 2579255 TO PROVIDE ASSISTED LIVING FOR THE ELDERLY AND DISABLED THROUGH A HUD SPONSORED PROGRAM. THE FACILITY HAS 61 UNITS AND WELCOMES PERSONS OF DIVERSE CULTURES AND FAITH TRADITIONS. WE PRACTICE RESPONSIBLE STEWARDSHIP OF HUMANS, PROPERTY AND FINANCIAL RESOURCES AND ENCOURAGE CONTINUAL LEARNING AND INNOVATION TO STRIVE FOR EXCELLENCE. 1891310 2313200 TO PROVIDE TRANSITIONAL CARE FOR THE ELDERLY AND DISABLED THROUGH A HUD SPONSORED PROGRAM. THE TCU HAS 14 UNITS FOR THE BENEFIT OF INDIVIDUALS LEAVING THE HOSPITAL UNTIL THEY ARE STRONG ENOUGH TO GO HOME. 3982168 true true false false false false false false true false true false false false true true true false false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true X 0 0 0 false false false false false false false false false false false false X 12 9 false true false false true true true true true false false true true true true true true true true false MN X TODD WILLETT 6128743460 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 JAMES HEREFORD FHS PRESIDEN 1.00 40.00 X X 0 1780267 84827 LAURA REED RN DIRECTOR, EN 1.00 40.00 X X 0 638399 85201 CAROLYN JACOBSON DIRECTOR,BEG 1.00 40.00 X X 0 573211 144163 MARK THOMAS EB CEO, END 2.00 40.00 X X 0 441102 149271 JONATHAN LUNDBERG EB PRES/SECR 2.00 40.00 X X 0 384352 72369 LINDA COLLINS DIRECTOR 0.25 2.00 X 0 0 0 GINA DINGMAN DIRECTOR 0.25 2.00 X 0 0 0 KENT EKLUND VICE CHAIR 0.25 2.00 X X 0 0 0 ROBB GRUMAN DIRECTOR 0.25 2.00 X 0 0 0 THOMAS HOKR DIRECTOR 0.25 2.00 X 0 0 0 RICHARD HOWARD CHAIR 0.25 2.00 X X 0 0 0 SHARY MULHERE SECRETARY, E 0.25 2.00 X X 0 0 0 JEANNIE RIPLEY DIRECTOR 0.25 2.00 X 0 0 0 CARL RUNCK DIRECTOR 0.25 2.00 X 0 0 0 JOHN SELSTAD 1ST CHAIR, E 0.25 2.00 X X 0 0 0 SCOTT WORDELMAN DIRECTOR 0.25 2.00 X 0 0 0 TODD WILLETT EBENEZER CFO 2.00 40.00 X 0 249370 19989 4066701 555820 false true false 10072 10072 NURSING REVENUE 3231815 3231815 RENT REVENUE 1660640 1660640 4892455 553 553 650 650 650 650 MISCELLANEOUS 27977 27977 MEAL INCOME 9596 9596 37573 4941303 4892455 38776 X 2416135 2296707 119428 19073 15943 3130 261422 241430 19992 180363 166966 13397 76051 19880 56171 576410 482785 93625 26285 26285 68101 23945 44156 301886 137885 164001 6031 3304 2727 13736 6445 7291 188763 188763 285443 285443 SUPPLIES 512724 505028 7696 LICENSES AND PERMITS 56208 40382 15826 BAD DEBT EXPENSE 49182 20935 28247 UTILITIES, REPAIR & MANT. 13989 12365 1624 10889 8168 2721 5062691 3982168 1080523 0 423300 454767 577990 422389 454092 472989 137181 115170 8939662 3091940 6040800 5847722 60007 64581 7693370 7377618 370311 268412 3108 10897 58891 57080 5780731 5634230 3975954 4024012 10188995 9994631 X -2495625 -2617013 -2495625 -2617013 7693370 7377618 -121388 X false true X true true true X 22419 11434 34956 33671 10072 112552 2169836 3649006 4195925 4538063 4892455 19445285 2192255 3660440 4230881 4571734 4902527 19557837 19557837 346 209 355 621 553 2084 346 209 355 621 553 2084 8940 9091 20028 18420 37573 94052 2201541 3669740 4251264 4590775 4940653 19653973 0.99510 0.99190 0.00000 0.00000 X PART III, LINE 12 MISCELLANEOUS & NONPATIENT MEALS 94,052 false true X 29265 29265 8391913 2803400 5588513 340609 221743 118866 177875 66797 111078 5847722 RELATED PARTY PAYABLE 4024012 4024012 X 4941303 4941303 4941303 5062691 5062691 5062691 SCHEDULE D, PAGE 2, PART IV, LINE 2B EBENEZER LAKES ASSISTED LIVING HOLDS IN TRUST DEPOSIT AMOUNTS RECEIVED BY TENANTS UPON MOVE-IN. THE TENANT DEPOSITS ARE MAINTAINED IN AN INTEREST- BEARING ACCOUNT SEPARATE FROM EBENEZER LAKES ASSISTED LIVING'S ACCOUNTS. DEPOSITS ARE REFUNDED, MINUS ANY AMOUNTS FOR REPAIRS, WHEN THE TENANT LEAVES THE FACILITY. SCHEDULE D, PAGE 3, PART X EBENEZER LAKES ASSISTED LIVING IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE MINNESOTA STATUTES. CONSEQUENTLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. THE ORGANIZATION'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR OTHER EXCISE TAXES. false true false false false false false false false JAMES HEREFORD FHS PRESIDENT/CEO 1340912 439355 42546 42281 1865094 LAURA REED RN DIRECTOR, END 8-18 599498 38901 43000 42201 723600 CAROLYN JACOBSON DIRECTOR,BEGAN 12-18 452681 120530 101962 42201 717374 MARK THOMAS EB CEO, END 8-18 253405 138403 49294 87681 61590 590373 JONATHAN LUNDBERG EB PRES/SECRETARY 319335 62990 2027 24500 47869 456721 TODD WILLETT EBENEZER CFO 249370 18500 1489 269359 SCHEDULE J, PAGE 1, PART I, LINE 4 JAMES HEREFORD 0 125,102 0 LAURA REED, RN 0 10,582 0 CAROLYN JACOBSON 0 58,962 0 MARK THOMAS 0 44,681 0 FORM 990, PAGE 1, ITEM C MEADOWS ON FAIRVIEW FORM 990 - ORGANIZATION'S MISSION EBENEZER LAKES ASSISTED LIVING IS PART OF EBENEZER SOCIETY. EBENEZER SOCIETY HELPS OLDER ADULTS AND OTHERS MAKE THEIR LIVES MORE INDEPENDENT, HEALTHFUL, MEANINGFUL AND SECURE. BUILDING ON OUR LUTHERAN HERITAGE, WE RESPOND TO PHYSICAL, PSYCHOLOGICAL, SOCIAL AND SPIRITUAL DIMENSIONS OF THE WHOLE PERSON. WE WELCOME PERSONS OF DIVERSE CULTURES AND FAITH TRADITIONS. WE PRACTICE RESPONSIBLE STEWARDSHIP OF HUMANS, PROPERTY, AND FINANCIAL RESOURCES AND ENCOURAGE CONTINUAL LEARNING AND INNOVATION TO STRIVE FOR EXCELLENCE. FORM 990, PART V LINE 1A: ALL CASH DISBURSEMENTS ARE CENTRALIZED THROUGH A RELATED ORGANIZATION, EBENEZER SOCIETY. THEREFORE THE RELATED ORGANIZATION, EBENEZER SOCIETY, MAKES THE PAYMENT AND FILES THE RELATED FORM 1099'S AND FORM 1096 INSTEAD OF THIS ORGANIZATION. LINE 2A: EBENEZER LAKES ASSISTED LIVING LEASES EMPLOYEES FROM A RELATED ORGANIZATION, EBENEZER SOCIETY, A 501(C)(3) TAX-EXEMPT, NON-PROFIT ORGANIZATION. THEREFORE, EBENEZER SOCIETY FILES THE APPROPRIATE W-3 AND RELATED W-2 TAX FORMS FOR THESE INDIVIDUALS INSTEAD OF EBENEZER LAKES ASSISTED LIVING. ACCORDING TO THE FORM 990 INSTRUCTIONS FOR PART VII, WE REFLECT THE LEASED EMPLOYEE'S COMPENSATION ON THE EBENEZER LAKES ASSISTED LIVING FORM 990, PART VII AND SCHEDULE J, AS IF EBENEZER LAKES ASSISTED LIVING COMPENSATES THESE INDIVIDUALS. FORM 990, PAGE 6, PART VI, LINE 3 EBENEZER LAKES ASSISTED LIVING IS MANAGED BY EBENEZER SOCIETY EMPLOYEES. FORM 990, PAGE 6, PART VI, LINE 6 EBENEZER SOCIETY, A MINNESOTA NONPROFIT ORGANIZATION, IS THE SOLE MEMBER OF EBENEZER LAKES ASSISTED LIVING. FORM 990, PAGE 6, PART VI, LINE 7A EBENEZER SOCIETY, THE SOLE MEMBER, APPOINTS ALL DIRECTORS. FORM 990, PAGE 6, PART VI, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY EBENEZER SOCIETY, THE SOLE MEMBER: (A) ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS; (B) ALL CAPITAL BUDGETS OF THE ORGANIZATION AND ALL OTHER ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS ORGANIZATION, AND ALL MAJOR CAPITAL EXPENDITURES BEFORE FUNDS ARE EXPENDED THEREFOR; (C) ALL OPERATING BUDGETS OF THIS ORGANIZAITON AND ALL OTHER ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS ORGANIZATION, BEFORE AUTHORIZED EXPENDITURES MAY BE MADE THEREFROM; (D) STRATEGIC PLANS OF THIS ORGANIZATION AND ALL OTHER ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS ORGANIZATION; (E) THE INCURRING OF ANY LONG TERM DEBT OF THIS ORGANIZATION AND ALL OTHER ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS ORGANIZATION, OTHER THAN INTRA-SYSTEM OF REFINANCING DEBT; (F) ALL HUMAN RESOURCES AND BENEFIT POLICIES; (G) ANY MAJOR RISK CONTRACTING AGREEMENTS, WHICH FOR THESE PURPOSES MEANS ANY CONTRACT THAT DEALS WITH CAPITATION OR A SIMILAR RISK BEARING CONCEPT; (H) ANY MERGER, CONSOLIDATION, OR TOTAL OR PARTIAL DISSOLUTION; (I) THE NUMBER OF DIRECTORS; AND (J) ANY GOVERNANCE AND ACTION OF THE TYPE SET FORTH IN SUBPARAGRAPHS (A) AND (F) THROUGH (I) ABOVE AS PROPOSED BY THE BOARD OF DIRECTORS OF ANY ENTITY DIRECTLY CONTROLLED BY THIS ORGANIZATION TO THE EXTENT THAT THE GOVERNING DOCUMENTS OF SUCH ENTITY GIVE THIS ORGANIZATION OR THE BOARD A RIGHT TO APPROVAL OVER SUCH GOVERNANCE ACTION. FORM 990, PAGE 6, PART VI, LINE 11B THE TAX DEPARTMENT CONDUCTS A DETAILED REVIEW OF THE COMPLETED RETURN. THE RETURN IS ALSO REVIEWED BY THE PRESIDENT AND CFO. THE FORM 990 IS SUBSEQUENTLY PRESENTED TO THE BOARD OF DIRECTORS. UPON APPROVAL FROM THE BOARD OF DIRECTORS, THE FORM 990 IS FILED. FORM 990, PAGE 6, PART VI, LINE 12C MANAGERS, DIRECTORS AND SENIOR MANAGEMENT ARE REQUIRED TO ANNUALLY COMPLETE A DUTY OF LOYALTY AND CONFLICT OF INTEREST STATEMENT IN COMPLIANCE WITH FAIRVIEW'S SYSTEM CONFLICT OF INTEREST POLICY. DISCLOSURES ARE REVIEWED BY THE COMPLIANCE DEPARTMENT. ANY CONFLICTS OF INTEREST BY BOARD MEMBERS ARE BROUGHT TO THE BOARD FOR REVIEW. FORM 990, PAGE 6, PART VI, LINE 15A THE DETERMINATION OF EXECUTIVE COMPENSATION OF THE ORGANIZATION IS PROCESSED BY THE FAIRVIEW SYSTEM HUMAN RESOURCES COMMITTEE AND INCLUDES A REVIEW OF COMPARABILITY DATA, REVIEW BY INDEPENDENT EXPERTS AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION PROCESS. FORM 990, PAGE 6, PART VI, LINE 15B THE DETERMINATION OF EXECUTIVE COMPENSATION OF THE ORGANIZATION IS PROCESSED BY THE FAIRVIEW SYSTEM HUMAN RESOURCES COMMITTEE AND INCLUDES A REVIEW OF COMPARABILITY DATA, REVIEW BY INDEPENDENT EXPERTS AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION PROCESS. FORM 990, PAGE 6, PART VI, LINE 19 THIS ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AND INSPECTION OF THE DOCUMENTS IS AVAILABLE AT THE CORPORATE FINANCE DEPARTMENT. FORM 990, PART IX, LINE 11G PURCHASED SERVICES 38,038 35,395 0 PHYSICAL THERAPY SERVICES 400,836 0 0 CORPORATE SERVICES 0 30,985 0 LAUNDRY SERVICES 21,311 1,290 0 LAB SERVICES 22,600 1,695 0 AUDIT FEES 0 24,260 0 TOTAL 482,785 93,625 0 FAIRVIEW HEALTH SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 410991680 HOSPITAL MN 501C3 3 N/A false EBENEZER SOCIETY 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 410706141 NURSING MN 501C3 10 N/A true EBENEZER RIDGES ASSISTED LIVING 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 411964691 ASSISTED MN 501C3 10 N/A true EBENEZER RIDGES 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 411287792 NURSING MN 501C3 10 N/A true EBENEZER SOCIETY FOUNDATION 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 411356565 SUPPORT MN 501C3 12A N/A true EBENEZER RIDGE POINT APARTMENTS 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 411769727 HOUSING MN 501C3 10 N/A true EBENEZER TOWERS 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 237005359 HOUSING MN 501C3 10 N/A true EBENEZER PARK APARTMENTS 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 411378656 HOUSING MN 501C3 10 N/A true EBENEZER LAKES SENIOR HOUSING 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 320190409 HOUSING MN 501C3 10 N/A true EBENEZER MANAGEMENT SERVICES INC 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 411567046 MGMT SVCS MN N/A false false false false false false false false false false false false false true false true true false false false