EBENEZER LAKES ASSISTED LIVING: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- EBENEZER LAKES ASSISTED LIVING (EIN 41-2012560)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201733179349303033
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-13T11:12:55-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 412012560 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EBENEZER LAKES ASSISTED LIVING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | EBEN | BusinessNameControlTxt |
| Phone | 6128743460 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2722 PARK AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55407 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD WILLETT | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 6128743460 | PhoneNum |
| Signature | 2017-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-13 | IPDt |
| IP Tm | 08:22:51 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | EB5B0B88F5DF23A80CA306F7B03D11E28B72914C | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9C59EE6D3CCD21689CFBADFF7A4DB800BA897A92 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEADOWS ON FAIRVIEW | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK THOMAS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2722 PARK AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55407 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,251,264 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAIRVIEWEBENEZER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1906 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE ASSISTED LIVING SERVICES TO IMPROVE THE QUALITY OF LIFE FOR THE ELDERLY AND DISABLED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 87 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $11,434 | PYContributionsGrantsAmt |
| CY Contributions Grants | $34,956 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,649,006 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,195,925 | CYProgramServiceRevenueAmt |
| PY Investment Income | $209 | PYInvestmentIncomeAmt |
| CY Investment Income | $355 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,091 | PYOtherRevenueAmt |
| CY Other Revenue | $20,028 | CYOtherRevenueAmt |
| PY Total Revenue | $3,669,740 | PYTotalRevenueAmt |
| CY Total Revenue | $4,251,264 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,203,780 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,429,362 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,224,568 | PYOtherExpensesAmt |
| CY Other Expenses | $2,415,122 | CYOtherExpensesAmt |
| PY Total Expenses | $4,428,348 | PYTotalExpensesAmt |
| CY Total Expenses | $4,844,484 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$758,608 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$593,220 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,718,252 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,810,019 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,208,772 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,893,759 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,490,520 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,083,740 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,333,172 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,183,690 | RevenueAmt |
| Desc | TO PROVIDE ASSISTED LIVING FOR THE ELDERLY AND DISABLED THROUGH A HUD SPONSORED PROGRAM. THE FACILITY HAS 61 UNITS AND WELCOMES PERSONS OF DIVERSE VULTURES AND FAITH TRADITIONS. WE PRACTICE RESPONSIBLE STEWARDSHIP OF HUMANS, PROPERTY, AND FINANCIAL RESOURCES AND ENCOURAGE CONTINUAL LEARNING AND INNOVATION TO STRIVE FOR EXCELLENCE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,149,981 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,012,235 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $4,483,153 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 60 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 87 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONNIE BEDNAREK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6128743460 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2722 PARK AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55407 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| RICHARD HOWARD | |||||||
| CHAIR | 0.25 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JOHN SELSTAD | |||||||
| 1ST VICE CHAIR | 0.25 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KENT EKLUND | |||||||
| 2ND VICE CHAIR | 0.25 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SHARY MULHERE | |||||||
| SECRETARY | 0.25 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MAGGIE COLLINS | |||||||
| DIRECTOR THROUGH MAY 2016 | 0.25 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| TERRY HAKES | |||||||
| DIRECTOR THROUGH DECEMBER 2016 & STAFF | 0.25 | 40.00 | Yes (X) | $0 | $193,184 | $18,484 | |
| THOMAS HOKR | |||||||
| DIRECTOR | 0.25 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| DEB PAONE | |||||||
| DIRECTOR THROUGH SEPTEMBER 2016 | 0.25 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| JEANNE RIPLEY | |||||||
| DIRECTOR | 0.25 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| CARL RUNCK | |||||||
| DIRECTOR | 0.25 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| MARK THOMAS | |||||||
| PRESIDENT & CEO | 2.00 | 40.00 | Yes (X) | Yes (X) | $0 | $482,641 | $77,779 |
| JONATHAN LUNDBERG | |||||||
| COO & ASSISTANT SECRETARY | 2.00 | 40.00 | Yes (X) | $0 | $280,819 | $16,630 | |
| TODD WILLETT | |||||||
| TREASURER | 2.00 | 40.00 | Yes (X) | $0 | $36,060 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $992,704 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $112,893 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTREX | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8120 PENN AVENUE S SUITE 227 | AddressLine1Txt |
| City | BLOOMINGTON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55431 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | THERAPY SERVICES | ServicesDesc |
| Compensation | $434,059 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $19,956 | RelatedOrganizationsAmt |
| All Other Contributions | $15,000 | AllOtherContributionsAmt |
| Total Contributions | $34,956 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NURSING REVENUE | 623000 | $2,667,353 | $2,667,353 |
| RENT REVENUE | 532000 | $1,528,572 | $1,528,572 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,195,925 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $355 | TotalRevenueColumnAmt |
| Exclusion | $355 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $14,667 | $14,667 |
| MEAL INCOME | 900099 | $5,361 | $5,361 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $20,028 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,251,264 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,195,925 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $20,383 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,027,440 | TotalAmt |
| Program Services | $1,875,200 | ProgramServicesAmt |
| Management And General | $152,240 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,094 | TotalAmt |
| Program Services | $14,094 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,298 | TotalAmt |
| Program Services | $232,298 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,530 | TotalAmt |
| Program Services | $155,530 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,266 | TotalAmt |
| Management And General | $41,266 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,912 | TotalAmt |
| Management And General | $17,912 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,897 | TotalAmt |
| Program Services | $476,206 | ProgramServicesAmt |
| Management And General | $1,691 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,170 | TotalAmt |
| Program Services | $525 | ProgramServicesAmt |
| Management And General | $9,645 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,860 | TotalAmt |
| Program Services | $45 | ProgramServicesAmt |
| Management And General | $56,815 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $858 | TotalAmt |
| Program Services | $858 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $339,583 | TotalAmt |
| Program Services | $339,583 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,277 | TotalAmt |
| Program Services | $4,824 | ProgramServicesAmt |
| Management And General | $453 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,697 | TotalAmt |
| Program Services | $20,467 | ProgramServicesAmt |
| Management And General | $6,230 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $312,017 | TotalAmt |
| Program Services | $312,017 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,532 | TotalAmt |
| Program Services | $297,532 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,869 | TotalAmt |
| Program Services | $51,869 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $258,376 | $258,376 | |
| FOOD | $257,683 | $256,476 | $1,207 |
| BAD DEBT | $72,597 | $72,597 | |
| OVERHEAD | $57,592 | $57,592 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,936 | TotalAmt |
| Program Services | $129,661 | ProgramServicesAmt |
| Management And General | $1,275 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,844,484 | TotalAmt |
| Program Services | $4,483,153 | ProgramServicesAmt |
| Management And General | $361,331 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $257,709 | BOYAmt |
| EOY | $450,339 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $760,862 | BOYAmt |
| EOY | $807,047 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $314,518 | BOYAmt |
| EOY | $331,401 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,565 | BOYAmt |
| EOY | $174,539 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,510,025 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,520,943 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,246,145 | BOYAmt |
| EOY | $5,989,082 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,453 | BOYAmt |
| EOY | $57,611 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,718,252 | BOYAmt |
| EOY | $7,810,019 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $350,225 | BOYAmt |
| EOY | $313,897 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,783 | BOYAmt |
| EOY | $590 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,729 | BOYAmt |
| EOY | $50,674 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,031,483 | BOYAmt |
| EOY | $5,925,997 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,773,552 | BOYAmt |
| EOY | $3,602,601 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,208,772 | BOYAmt |
| EOY | $9,893,759 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,490,520 | BOYAmt |
| EOY | -$2,083,740 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,490,520 | BOYAmt |
| EOY | -$2,083,740 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,718,252 | BOYAmt |
| EOY | $7,810,019 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$593,220 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $21,663 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,749 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $22,419 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,434 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $34,956 | CurrentTaxYearAmt |
| Total | $106,221 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,276,737 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,368,895 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,169,836 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,649,006 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,195,925 | CurrentTaxYearAmt |
| Total | $14,660,399 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,298,400 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,384,644 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,192,255 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,660,440 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,230,881 | CurrentTaxYearAmt |
| Total | $14,766,620 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $14,766,620 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $261 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $379 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $346 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $209 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $355 | CurrentTaxYearAmt |
| Total | $1,550 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $261 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $379 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $346 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $209 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $355 | CurrentTaxYearAmt |
| Total | $1,550 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $94,757 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $79,906 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,940 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,091 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,028 | CurrentTaxYearAmt |
| Total | $212,722 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,393,418 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,464,929 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,201,541 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,669,740 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,251,264 | CurrentTaxYearAmt |
| Total | $14,980,892 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98570 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98400 | PublicSupportPY509Pct |
| Investment Income CY | 0.00010 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS NONPATIENT MEALS | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,265 | OtherCostOrOtherBasisAmt |
| Book Value | $29,265 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,018,683 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,285,967 | DepreciationAmt |
| Book Value | $5,732,716 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $172,516 | OtherCostOrOtherBasisAmt |
| Depreciation | $55,645 | DepreciationAmt |
| Book Value | $116,871 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $289,561 | OtherCostOrOtherBasisAmt |
| Depreciation | $179,331 | DepreciationAmt |
| Book Value | $110,230 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,989,082 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RELATED PARTY PAYABLE | Desc |
| Amt | $3,602,601 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,602,601 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,251,264 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,251,264 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,251,264 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,844,484 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,844,484 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,844,484 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| PART X, LINE 2: | THE PROJECT 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 PROJECT'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE PROJECT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE PROJECT IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OTHER TAXES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TERRY HAKES | ||||||||||||||
| DIRECTOR THROUGH DECEMBER 2016 & STA | $0 | $193,184 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,484 | $0 | $211,668 | $0 | $0 |
| MARK THOMAS | ||||||||||||||
| PRESIDENT & CEO | $0 | $307,721 | $0 | $174,920 | $0 | $0 | $0 | $59,397 | $0 | $18,382 | $0 | $560,420 | $0 | $0 |
| JONATHAN LUNDBERG | ||||||||||||||
| COO & ASSISTANT SECRETARY | $0 | $243,739 | $0 | $37,080 | $0 | $0 | $0 | $0 | $0 | $16,630 | $0 | $297,449 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | MARK THOMAS PARTICIPATES IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ADMINISTERED BY FAIRVIEW. THE CONTRIBUTION TO THIS PLAN DURING 2016 WAS $40,847. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT OF EBENEZER LAKES ASSISTED LIVING IS PROVIDED THROUGH AN AGREEMENT WITH EBENEZER MANAGEMENT SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | EBENEZER SOCIETY, A MINNESOTA NONPROFIT ORGANIZATION, IS THE SOLE MEMBER OF EBENEZER LAKES ASSISTED LIVING. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE PRESIDENT OF EBENEZER LAKES ASSISTED LIVING IS A VOTING MEMBER OF THE BOARD OF DIRECTORS. EBENEZER SOCIETY, THE SOLE MEMBER, APPOINTS ALL OTHER DIRECTORS. |
| FORM 990, PART VI, SECTION A, 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 THIS 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 ORGANIZATION AND ALL OTHER ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS ORGANIZATION, BEFORE AUTHORIZED EXPENDITURES MAY BE MADE THEREFROM; (D) STRATEGIC PLANS OF THIS ORGANIZATIONAND 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 BENEFITS 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 OF APPROVAL OVER SUCH GOVERNANCE ACTION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BY THE CFO AND PRESIDENT, THEN IT WAS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, 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, PART VI, SECTION B, LINE 15 | FAIRVIEW DETERMINES THE COMPENSATION FOR THE PRESIDENT/CEO AND COO. THE SOCIETY DETERMINES THE COMPENSATION FOR THE TREASURER. |
| FORM 990, PART VI, SECTION C, LINE 19 | EBENEZER LAKES ASSISTED LIVING'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY CAN BE OBTAINED UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FAIRVIEW HEALTH SERVICES | |||||||||||
| 2450 RIVERSIDE AVENUE | MINNEAPOLIS | MN | 55454 | 410991680 | HOSPITAL/HEALTHCARE PROVIDER | MN | 501(C)(3) | LINE 3 | N/A | 0 | |
| EBENEZER SOCIETY | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 410706141 | NURSING HOME CARE/ADMIN SUPPORT | MN | 501(C)(3) | LINE 10 | N/A | 0 | |
| EBENEZER RIDGES ASSISTED LIVING | |||||||||||
| 13810 COMMUNITY DRIVE | BURNSVILLE | MN | 55337 | 411964691 | ASSISTED LIVING | MN | 501(C)(3) | LINE 10 | 0 | EBENEZER SOCIETY | |
| EBENEZER RIDGES | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411287792 | NURING HOME CARE | MN | 501(C)(3) | LINE 10 | 0 | EBENEZER SOCIETY | |
| EBENEZER SOCIETY FOUNDATION | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411356565 | MANAGEMENT SUPPORT - EBENEZER | MN | 501(C)(3) | LINE 12A, I | 0 | EBENEZER SOCIETY | |
| EBENEZER RIDGE POINT APARTMENTS INC | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411769727 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 10 | 0 | EBENEZER SOCIETY | |
| EBENEZER TOWERS | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 237005359 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 10 | 0 | EBENEZER SOCIETY | |
| EBENEZER PARK APARTMENTS | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411378656 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 10 | 0 | EBENEZER SOCIETY | |
| FAIRVIEW FOUNDATION | |||||||||||
| 2450 RIVERSIDE AVENUE | MINNEAPOLIS | MN | 55454 | 411573810 | MANAGEMENT SUPPORT - FAIRVIEW HEALTH SERVICES | MN | 501(C)(3) | LINE 7 | 0 | FAIRVIEW HEALTH SERVICES | |
| EBENEZER LAKES SENIOR HOUSING | |||||||||||
| 5430 MEADOW LANE | WYOMING | MN | 55092 | 320190409 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 10 | 0 | EBENEZER SOCIETY | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| FAIRVIEW WOODS ASSISTED LIVING LLC | |||||||
| 470 FAIRVIEW BOULEVARD | RED WING | MN | 55066 | 204381407 | ASSISTED LIVING | MN | N/A |
| YORK GARDENS LLC | |||||||
| 3451 PARKLAWN AVENUE | EDINA | MN | 55435 | 262912486 | ASSISTED LIVING | MN | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EBENEZER MANAGEMENT SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2722 PARK AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55407 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411567046 | EIN |
| Primary Activities | MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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