2018-09-07T12:01:03-05:00 2017-12-31 410991680 FAIRVIEW HEALTH SVCS 2450 RIVERSIDE AVE S DEPT C-207 LE MINNEAPOLIS MN 554541450 990 2017-01-01 412012560 EBENEZER LAKES ASSISTED LIVING EBEN 6128743460 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 JONATHAN LUNDBERG EBENEZER PRESIDENT 6128743460 2018-08-23 2018-09-07 162.96.9.2 2018-09-07 12:01:03 CD P 5CADB5576C0A467FBF6013688B7D33E9E8CCDAB4 5CADB5576C0A467FBF6013688B7D33E9E8CCDAB4 2017 2018-06-14 16:35:46Z MEADOWS ON FAIRVIEW JONATHAN LUNDBERG 2722 PARK AVENUE SOUTH MINNEAPOLIS MN 55407 4590775 false X WWW.FAIRVIEWEBENEZER.ORG X 2001 MN PROVIDE ASSISTED LIVING SERVICES TO IMPROVE THE QUALITY OF LIFE FOR THE ELDERLY AND DISABLED. 14 11 0 0 34956 33671 4195925 4538063 355 621 20028 18420 4251264 4590775 0 0 2429362 2639017 0 0 2415122 2363643 4844484 5002660 -593220 -411885 7810019 7693370 9893759 10188995 -2083740 -2495625 X EBENEZER 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 2110273 2460830 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. 1603716 2077233 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. 3713989 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 X 14 11 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 1347774 23564 MARK THOMAS EB CEO 2.00 40.00 X X 0 575565 80615 JONATHAN LUNDBERG EBENEZER PRE 2.00 40.00 X X 0 318253 20569 LAURA REED RN FHS CNO 2.00 40.00 X X 0 208276 9201 GINA DINGMAN DIRECTOR 0.25 2.00 X 0 0 0 KENT EKLUND 2ND VICE CHA 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 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 VICE CHA 0.25 2.00 X X 0 0 0 SCOTT WORDELMAN DIRECTOR 0.25 2.00 X 0 0 0 LINDA COLLINS DIRECTOR 0.25 2.00 X 0 0 0 TODD WILLETT EBENEZER CFO 2.00 40.00 X 0 250177 6107 2700045 140056 false true false 33671 33671 NURSING REVENUE 2937969 2937969 RENT REVENUE 1600094 1600094 4538063 621 621 MEAL INCOME 9993 9993 MISECLLANEOUS 8427 8427 18420 4590775 4538063 19041 X 2190047 2098186 91861 14372 12548 1824 262924 234125 28799 171674 155811 15863 22164 22164 23882 23882 693594 502881 190713 3247 10 3237 44911 7849 37062 321598 118489 203109 2233 940 1293 6213 4376 1837 257085 257085 293694 132 293562 SUPPLIES 460320 455327 4993 DEFERRED FINANCING COSTS 69150 69150 TAXES 60302 53795 6507 MISCELLANEOUS 40302 10251 30051 64948 59269 5679 5002660 3713989 1288671 0 450339 423300 807047 577990 331401 454092 174539 137181 8855495 2814695 5989082 6040800 57611 60007 7810019 7693370 313897 370311 590 3108 50674 58891 5925997 5780731 3602601 3975954 9893759 10188995 X -2083740 -2495625 -2083740 -2495625 7810019 7693370 -411885 X false true X true true true X 15749 22419 11434 34956 33671 118229 2368895 2169836 3649006 4195925 4538063 16921725 2384644 2192255 3660440 4230881 4571734 17039954 17039954 379 346 209 355 621 1910 379 346 209 355 621 1910 79906 8940 9091 20028 18420 136385 2464929 2201541 3669740 4251264 4590775 17178249 0.99190 0.98570 0.00000 0.00000 X PART III, LINE 12 MISCELLANEOUS & NONPATIENT MEALS 136,385 false true X 29265 29265 8353503 2539280 5814223 295004 213966 81038 177723 61449 116274 6040800 RELATED PARTY PAYABLE 3975954 3975954 X 4590775 4590775 4590775 5002661 1 1 5002660 5002660 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 THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABALE 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 JEPORDIZE 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. SCHEDULE D, PAGE 4, PART XII, LINE 2D BOOK / TAX DEPRECIATION DIFFERENCE 1 false true false false false false false false false JAMES HEREFORD FHS PRESIDENT/CEO 1200014 147760 23564 1371338 MARK THOMAS EB CEO 346507 183331 45727 61459 19156 656180 JONATHAN LUNDBERG EBENEZER PRESIDENT 318253 5789 14780 338822 LAURA REED RN FHS CNO 168276 40000 9201 217477 TODD WILLETT EBENEZER CFO 250177 6107 256284 SCHEDULE J, PAGE 1, PART I, LINE 4 MARK THOMAS 0 42,559 0 FORM 990 - ORGANIZATION'S MISSION EBENEZER 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 REVIEW 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 EBENEZER'S DUTY OF LOYALTY AND CONFLICT OF INTEREST STATEMENT IN COMPLIANCE WITH EBENEZER'S 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 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 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 51,551 94,711 0 PHYSICAL THERAPY SERVICES 419,732 0 0 CORPORATE SERVICES 0 96,002 0 LAUNDRY SERVICES 31,598 0 0 TOTAL 502,881 190,713 0 FORM 990, PART XI, LINE 9 ROUNDING 1 ROUNDING -1 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