2017-05-12T18:42:14-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2016-01-01 840194430 EBEN EZER LUTHERAN CARE CENTER EBEN 9708422861 122 HOSPITAL ROAD BRUSH CO 80723 SHELLY GRIFFITH CEO 9708422861 2017-05-11 1 JEFF PARKER P00970069 3034668822 67.137.57.251 2017-05-11 19:52:40 CD P 082ACE2F511E36C30C0E31AD8E141AA6B2332ED9 A9A0EAFF0212B6139E678F851E8CE171469640BE 2016 2021-01-29 14:40:06Z SHELLY GRIFFITH 122 HOSPITAL ROAD BRUSH CO 80723 13201621 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. 9 9 318 250 0 0 422556 322557 12201006 12559238 169849 189473 149140 130353 12942551 13201621 14536 11129 0 0 8627369 8782698 0 0 35861 3660090 3892697 12301995 12686524 640556 515097 16111228 16676869 4336457 4092372 11774771 12584497 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 11507718 11129 12559238 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. 11507718 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 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 18 0 318 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 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 ROGER SCHAEFER CHAIRMAN 1.00 2.00 X X 0 0 0 ROBERT CHAPIN VICE-CHAIR/TREASURER 1.00 2.00 X X 0 0 0 DR ALAN DAHMS SECRETARY 1.00 1.00 X X 0 0 0 GEORGE DIKEOU DIRECTOR 1.00 2.00 X 0 0 0 DR KERRY HART DIRECTOR 1.00 X 0 0 0 SONYA BASS DIRECTOR 1.00 2.00 X 0 0 0 PR PAUL OLSEN DIRECTOR 1.00 X 0 0 0 PR WENDY KALAN DIRECTOR 1.00 X 0 0 0 DR DAVID COBB DIRECTOR 1.00 X 0 0 0 SHELLY GRIFFITH CEO 39.00 1.00 X 116479 0 10598 LESLIE MASON CFO 34.00 1.00 X 59887 0 9245 176366 0 19843 1 0 0 0 OZ ARCHITECTURE 3003 LARIMER STREET DENVER CO 80205 ARCHITECTURE 436272 PREMERE REHAB 25117 SW PARKWAY STE D WILSONVILLE OR 97070 THERAPY 290542 COVENANT SOLUTIONS 5700 OLD ORCHARD ROAD SKOKIE IL 60077 DEVELOPMENT 145166 GERTGE TECHNOLOGY 829 PARK STREET FORT MORGAN CO 80701 IT 113183 4 322557 322557 PATIENT SERVICE 623000 12559238 12559238 12559238 145435 145435 44038 0 44038 44038 44038 MEAL TICKETS / GUEST MEALS 623000 70916 70916 BEAUTY SHOP 623000 20804 20804 TELEPHONE 623000 14377 14377 24256 24256 130353 13201621 12559238 0 319826 11129 11129 196209 165609 30600 6767160 6484666 282494 67434 62107 4715 612 1229930 1165474 62365 2091 521965 475804 43603 2558 14961 14961 45020 45020 40129 40129 783686 653776 129910 27285 27285 293460 280096 13364 53303 50924 2379 169035 78809 90226 662593 656791 5802 209495 122000 87495 SUPPLIES 646871 573079 73792 FOOD 509007 509007 MAINTENANCE AND REPAIR 175378 135380 39998 BAD DEBT 76324 76324 186150 145067 41083 12686524 11507718 1142945 35861 600 600 4121145 4346064 1178223 1110761 63712 72468 289216 71449 19231489 11608265 7095876 7623224 2807101 3190996 202431 209582 352924 51725 16111228 16676869 984559 990732 1061 1199 3223131 2974487 34980 37828 92726 88126 4336457 4092372 X 11774771 12584497 11774771 12584497 16111228 16676869 515097 294629 0 X X 0 1 X 1 0 X 188198 502209 504344 422556 322557 1939864 11598079 11623911 11456566 12199319 12559238 59437113 11786277 12126120 11960910 12621875 12881795 61376977 0 0 0 61376977 85382 101676 159063 110054 145435 601610 10011 3176 2046 15233 95393 104852 161109 110054 145435 616843 100012 129437 149716 145790 131420 656375 11981682 12360409 12271735 12877719 13158650 62650195 0.97970 0.98120 0.00980 0.00880 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2012 AMOUNT: $ 100,012. 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. BEAUTY SHOP - 2015 AMOUNT: $ 22,878. 2016 AMOUNT: $ 20,804. TELEPHONE - 2015 AMOUNT: $ 15,070. 2016 AMOUNT: $ 14,377. MISCELLANEOUS - 2015 AMOUNT: $ 34,928. 2016 AMOUNT: $ 25,323. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 448250 738 447512 448250 448250 448250 448250 298250 150000 448250 288250 10000 298250 1.00000 0 1 1 66372 66372 11869561 6790219 5079342 6255530 4818046 1437484 1040026 1040026 7623224 SECURITY DEPOSITS 3624 ASSET RETIREMENT OBLIGATION 81598 DEFERRED COMPENSATION 2904 88126 X 13498657 294629 2407 297036 13201621 0 13201621 12688931 2407 2407 12686524 0 12686524 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, 2016 AND 2015, THE ORGANIZATION DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: MISC. EXPENSES 2,407. PART XII, LINE 2D - OTHER ADJUSTMENTS: MISC. EXPENSES 2,407. 1 BRUSH SCHOOL DISTRICT 527 INDUSTRIAL PARK ROAD BRUSH CO 80723 846001734 GOVERNMENTAL 7500 SUPPORT EDUCATIONAL NEEDS OF STUDENTS IN LOCAL SCHOOL DISTRICT 1 PART I, LINE 2: GRANTS WERE PAID TO LOCAL AND COMMUNITY ORGANIZATIONS WHERE THE USAGE OF THE FUNDS CAN BE MONITORED. A CITY OF BRUSH COLORADO 846000638 117416BW6 2004-09-01 1350000 INDUSTRIAL DEVELOPMENT REVENUE 0 0 0 B CITY OF BRUSH COLORADO 846000638 117416BX4 2004-09-01 2125000 INDUSTRIAL DEVELOPMENT REVENUE 0 0 0 A 490000 1350000 27000 1323000 1 0 1 1 B 2125000 42500 2082500 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF BRUSH COLORADO DATE THE REBATE COMPUTATION WAS PERFORMED: 09/01/2014 ISSUER NAME: CITY OF BRUSH COLORADO DATE THE REBATE COMPUTATION WAS PERFORMED: 09/01/2014 SCHEDULE K, PAGE 1, PART II, LINE 14 THE 2004 BONDS WERE ISSUED TO REFUND A PREVIOUS BOND ISSUE FROM 11/1/1994. SCHEDULE K, PAGE 2, PART IV, LINE 3, COLUMN C AS OF NOVEMBER 1, 2012 (THROUGH OCTOBER 31, 2024), THE INTEREST RATE WAS SET AT A FIXED RATE OF 5% FOR THE SERIES 2004B BONDS. THE BONDS HAD PREVIOUSLY BEEN LISTED AS A VARIABLE RATE ISSUE ON FORM 8038 AND ON TAX RETURNS PRIOR TO 2015. 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 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 IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, 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. 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 322557 FMV