2018-05-15T16:34:28-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2017-01-01 840194430 EBEN EZER LUTHERAN CARE CENTER EBEN 9708422861 122 HOSPITAL ROAD BRUSH CO 80723 SHELLY GRIFFITH CEO 9708422861 2018-05-15 1 JEFF PARKER P00970069 3034668822 2017 2022-09-23 18:48:47Z SHELLY GRIFFITH 122 HOSPITAL ROAD BRUSH CO 80723 14814925 0 X WWW.EBENEZER-CARES.ORG X 1903 CO THE EBEN EZER LUTHERAN CARE CENTER (THE CARE CENTER) WAS ESTABLISHED TO PROVIDE SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING, INDEPENDENT LIVING, PERSONAL CARE AND HOMEMAKING AND LIFELINE EMERGENCY RESPONSE SERVICES TO THE ELDERLY AND PERSONS WITH SPECIAL NEEDS. THE CARE CENTER IS CERTIFIED FOR MEDICARE AND MEDICAID AND IS AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH OF AMERICA. 10 10 334 250 0 0 322557 1247752 12559238 13259391 189473 149808 130353 157974 13201621 14814925 11129 4086 0 0 8782698 8891687 0 0 35838 3892697 3765971 12686524 12661744 515097 2153181 16676869 30732694 4092372 15590988 12584497 15141706 X THE EBEN EZER LUTHERAN CARE CENTER (THE CARE CENTER) WAS ESTABLISHED TO PROVIDE SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING, INDEPENDENT LIVING, PERSONAL CARE AND HOMEMAKING AND LIFELINE EMERGENCY RESPONSE SERVICES TO THE ELDERLY AND PERSONS WITH SPECIAL NEEDS. THE CARE CENTER IS CERTIFIED FOR MEDICARE AND MEDICAID AND IS AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH OF AMERICA. 0 0 11574637 4086 13259391 PROVIDING SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING, INDEPENDENT LIVING, PERSONAL CARE, HOMEMAKING AND LIFELINE EMERGENCY RESPONSE SERVICES TO THE EDERLY AND PERSONS WITH SPECIAL NEEDS. THE CARE CENTER PROVIDED SERVICE TO MORE THAN 400 PERSONS FOR PERSONAL AND HOMEMAKING CARE AND RESIDENTIAL SERVICES TO OVER 300 PERSONS. 11574637 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 18 0 334 1 0 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LESLIE MASON 9708422861 122 HOSPITAL ROAD BRUSH CO 80723 CURT FREED PHD DIRECTOR 1.00 X 0 0 0 SONYA BASS DIRECTOR 1.00 2.00 X 0 0 0 ROBERT CHAPIN VICE-CHAIR/TREASURER 1.00 2.00 X X 0 0 0 GEORGE DIKEOU DIRECTOR 1.00 2.00 X 0 0 0 PR WENDY KALAN DIRECTOR 1.00 X 0 0 0 DR DAVID COBB DIRECTOR 1.00 X 0 0 0 ALAN DAHMS PHD DIRECTOR 1.00 1.00 X 0 0 0 ROGER SCHAEFER CHAIRMAN 1.00 2.00 X X 0 0 0 CATHY LINDELL DIRECTOR 1.00 1.00 X 0 0 0 JACK DARNELL DIRECTOR 1.00 1.00 X 0 0 0 SHELLY GRIFFITH CEO 39.00 1.00 X 128970 0 11083 LESLIE MASON CFO 35.00 1.00 X 63578 0 9580 192548 0 20663 1 0 0 0 FRANSEN PITTMAN GENERAL CONTRACT 9563 S KINGSTON COURT ENGLEWOOD CO 80112 BUILDING GC 9918336 OZ ARCHITECTURE 3003 LARIMER STREET DENVER CO 80205 ARCHITECTURE SERVICES 461139 PREMERE REHAB 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 THERAPY SERVICES 361425 ARCH CONSULTANTS LTD 250 PARKWAY DRIVE SUITE 350 LINCOLNSHIRE IL 60069 PLANNING & DEVELOPEMENT 211330 GERTGE TECHNOLOGY 829 PARK STREET FORT MORGAN CO 80701 IT SUPPORT & PHASE 1 147854 6 1247752 1247752 PATIENT SERVICE REVENUE 623000 13259391 13259391 13259391 109484 109484 40324 0 40324 40324 40324 MEAL TICKETS / GUEST MEALS 623000 58517 58517 MISCELLANEOUS 623000 50014 50014 BEAUTY SHOP 623000 22631 22631 26812 26812 157974 14814925 13259391 0 307782 4086 4086 233211 202611 30600 6865419 6583373 282046 65785 62657 2516 612 1175123 1131293 41762 2068 552149 488847 60744 2558 22128 22128 42840 42840 45118 45118 834009 775424 58585 27558 27558 314455 298240 16215 47591 45456 2135 106302 35371 70931 671177 671177 208062 117480 90582 SUPPLIES 526042 495327 30715 FOOD 504027 504027 MAINTENANCE AND REPAIR 176472 138932 37540 BAD DEBT 61107 61107 179083 134282 44801 12661744 11574637 1051269 35838 600 600 4346064 4638461 1110761 866065 72468 73154 71449 113362 32831623 12130611 7623224 20701012 3190996 3818806 209582 225933 51725 295301 16676869 30732694 990732 2800115 1199 883 2974487 0 37828 35007 12663739 88126 91244 4092372 15590988 X 12584497 15141706 12584497 15141706 16676869 30732694 2153181 404028 0 X X 0 1 X 1 0 X 502209 504344 422556 322557 1247752 2999418 11623911 11456566 12199319 12559238 13259391 61098425 12126120 11960910 12621875 12881795 14507143 64097843 0 0 0 64097843 101676 159063 110054 145435 109484 625712 3176 2046 5222 104852 161109 110054 145435 109484 630934 129437 149716 145790 131420 157974 714337 12360409 12271735 12877719 13158650 14774601 65443114 0.97940 0.97970 0.00960 0.00980 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2013 AMOUNT: $ -6,929. BEAUTY SHOP MEALS TRANSPORTATION ETC - 2013 AMOUNT: $ 136,366. 2014 AMOUNT: $ 149,716. MEAL TICKETS / GUEST MEALS - 2015 AMOUNT: $ 72,914. 2016 AMOUNT: $ 70,916. 2017 AMOUNT: $ 58,517. BEAUTY SHOP - 2015 AMOUNT: $ 22,878. 2016 AMOUNT: $ 20,804. 2017 AMOUNT: $ 22,631. TELEPHONE - 2015 AMOUNT: $ 15,070. 2016 AMOUNT: $ 14,377. 2017 AMOUNT: $ 16,361. MISCELLANEOUS - 2015 AMOUNT: $ 34,928. 2016 AMOUNT: $ 25,323. 2017 AMOUNT: $ 60,465. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 447512 79981 79243 448250 448250 738 447512 448250 448250 448250 448250 298250 150000 448250 1.00000 0 1 1 66372 66372 11995655 7007554 4988101 6428787 5123057 1305730 14340809 14340809 20701012 SECURITY DEPOSITS 4628 ASSET RETIREMENT OBLIGATION 86616 91244 X 15221340 404028 2387 406415 14814925 0 14814925 12664131 2387 2387 12661744 0 12661744 PART IV, LINE 2B: THE CARE CENTER IS THE TRUSTEE OF FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS IN THE SKILLED NURSING FACILITY. PART V, LINE 4: ENDOWMENTS ARE HELD BY EBEN EZER LUTHERAN CARE CENTER FOUNDATION, A RELATED ORGANIZATION. THE ENDOWMENT CONSISTS OF THREE INDIVIDUAL FUNDS ESTABLISHED TO SUPPORT THE OPERATIONS OF THE ORGANIZATION. PART X, LINE 2: THE ORGANIZATION EVALUATES THEIR UNCERTAIN TAX POSITIONS, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF THEIR POLICIES AND PROCEDURES, REVIEW OF THEIR REGULAR TAX FILINGS, AND DISCUSSIONS WITH OUTSIDE EXPERTS. AS OF DECEMBER 31, 2017 AND 2016, THE ORGANIZATION DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: MISC. EXPENSES 2,387. PART XII, LINE 2D - OTHER ADJUSTMENTS: MISC. EXPENSES 2,387. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD AND SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION TAKEN SHALL NOT BE IN CONFLICT WITH THE POLICIES, OR ANY PRIOR ACTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD. IT SHALL CONSIDER ALL MATTERS REFERRED TO IT BY THE BOARD AND SHALL ACT FOR THE BOARD IN EMERGENCIES. THE EXECUTIVE COMMITTEE SHALL NOT ACT WITHOUT BOARD APPROVAL IN THE FOLLOWING MATTERS: (I) ANY SALE OR PURCHASE OF LAND OR BUILDINGS, (II) ANY FUNDING FOR CAPITAL IMPROVEMENTS THROUGH EITHER MORTGAGE FUNDING OR A FUND CAMPAIGN, (III) ANY ESTABLISHMENT OF ADMINISTRATIVE POSITIONS, INCLUDING POSITION DESCRIPTIONS AND FILLING OF SAID POSITIONS. FORM 990, PART VI, SECTION A, LINE 2 SHELLY GRIFFITH, CEO, AND SONYA BASS, DIRECTOR, ARE SISTER-IN-LAWS. FORM 990, PART VI, SECTION B, LINE 11B THE AUDIT COMMITTEE REVIEWS THE FORM 990 IN DETAIL BEFORE IT IS FILED AND APPROVES THE FILING OF THE RETURN. THE BOARD OF DIRECTORS THEN IS PROVIDED WITH A COPY OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY. AT EVERY BOARD MEETING, THE MEMBERS ARE ASKED IF THERE HAS BEEN A CHANGE IN THEIR INDEPENDENCE WITH THE ORGANIZATION. THIS INFORMATION IS DOCUMENTED WITHIN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - THE BOARD REVIEWS SURVEYS FROM OTHER SIMILAR ORGANIZATIONS ON COMPENSATION LEVELS. THE BOARD REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO BASED ON COMPARABLE COMPENSATION. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF HOW THE COMPENSATION IS SET. LINE 15B - THE CEO REVIEWS SURVEYS FROM OTHER SIMILAR ORGANIZATIONS ON COMPENSATION LEVELS. THE CEO REVIEWS AND APPROVES THE COMPENSATION FOR THE CFO BASED ON COMPARABLE COMPENSATION. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF HOW THE COMPENSATION IS SET. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND / OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 12, PART XII, LINE 2C - SELECTION OF INDEPENDENT ACCOUNTANT THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SCHEDULE K AS THE TAX-EXEMPT BONDS WERE PAID OFF IN 2017, THERE IS NO LONGER A LIABILITY BALANCE EXCEEDING $100K FROM TAX-EXEMPT BOND ISSUANCES SO SCHEDULE K HAS BEEN REMOVED FROM THE 2017 RETURN ACCORDINGLY. EBEN EZER LUTHERAN CARE CENTER FOUNDATION 122 HOSPITAL ROAD BRUSH CO 80723 742480396 SUPPORT CO 501(C)(3) LINE 12A, I EBEN EZER LUTHERAN CARE CENTER 1 EBEN EZER LUTHERAN HOUSING CENTER 1900 EDISON STREET BRUSH CO 80723 840884015 HOUSING CO 501(C)(3) LINE 10 EBEN EZER LUTHERAN CARE CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 EBEN EZER LUTHERAN CARE CENTER FOUNDATION C 1247752 FMV