EBENEZER LAKES ASSISTED LIVING: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
EBENEZER LAKES ASSISTED LIVING (EIN 41-2012560)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-10-14
IRS object ID
201642889349300429
Schema version
2015v2.1
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

FieldValueIRS element (for citing)
Return2016-10-14T12:15:22-05:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390859910PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Baker Tilly Virchow Krause LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1225 S 6th St 2300AddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN412012560EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Ebenezer Lakes Assisted LivingBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlEBENBusinessNameControlTxt
Phone6128743460PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12722 Park Avenue SouthAddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55407ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTerry HakesPersonNm
Person TitleCFOPersonTitleTxt
Phone6128743460PhoneNum
Signature2016-09-23SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDianne Hickok CPAPreparerPersonNm
PTINP00043906PTIN
Phone6128764500PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMARK THOMASPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12722 Park Avenue SouthAddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55407ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$3,669,740GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.fairviewebenezer.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1906FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionTO PROVIDE ASSISTED LIVING SERVICES TO IMPROVE THE QUALITY OF LIFE FOR THE ELDERLY AND DISABLED.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee49TotalEmployeeCnt
Total Volunteers9TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$22,419PYContributionsGrantsAmt
CY Contributions Grants$11,434CYContributionsGrantsAmt
PY Program Service Revenue$2,169,836PYProgramServiceRevenueAmt
CY Program Service Revenue$3,649,006CYProgramServiceRevenueAmt
PY Investment Income$346PYInvestmentIncomeAmt
CY Investment Income$209CYInvestmentIncomeAmt
PY Other Revenue$8,940PYOtherRevenueAmt
CY Other Revenue$9,091CYOtherRevenueAmt
PY Total Revenue$2,201,541PYTotalRevenueAmt
CY Total Revenue$3,669,740CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,471,195PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,203,780CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,544,974PYOtherExpensesAmt
CY Other Expenses$2,224,568CYOtherExpensesAmt
PY Total Expenses$3,016,169PYTotalExpensesAmt
CY Total Expenses$4,428,348CYTotalExpensesAmt
PY Revenues Less Expenses-$814,628PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$758,608CYRevenuesLessExpensesAmt
Total Assets BOY$7,895,812TotalAssetsBOYAmt
Total Assets EOY$7,964,420TotalAssetsEOYAmt
Total Liabilities BOY$8,627,724TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,454,940TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$731,912NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$1,490,520NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionEBENEZER 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.WELCOME PERSONS OF DIVERSE CULTURES AND FAITH TRADITIONS.PRACTICE RESPONSIBLE STEWARDSHIP OF HUMAN, PROPERTY AND FINANCIAL RESOURCES.ENCOURAGE CONTINUING LEARNING AND INNOVATION.STRIVE FOR EXCELLENCE.MissionDesc
Significant New Program SrvcYes (1)SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$1,608,358ExpenseAmt
Revenue$1,865,944RevenueAmt
DescPROVIDE ASSISTED LIVING FOR THE ELDERLY AND DISABLED THROUGH A HUD SPONSORED PROGRAM. THE FACILITY HAS 61 UNITS. WELCOME PERSONS OF DIVERSE CULTURES AND FAITH TRADITIONS. PRACTICE RESPONSIBLE STEWARDSHIP OF HUMAN, PROPERTY AND FINANCIAL RESOURCES. ENCOURAGE CONTINUING LEARNING AND INNOVATION. STRIVE FOR EXCELLENCE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,132,404ExpenseAmt
Revenue$1,792,153RevenueAmt
DescPROVIDE TRANSITIONAL CARE FOR THE ELDERLY AND DISABLED THROUGH A HUD SPONSORED PROGRAM. THE TCU HAS 14 UNITS FOR THE BENEFIT OF INDIVIDUALS LEAVING THE HOPSITAL UNTIL THEY ARE STRONGE ENOUGH TO GO HOME.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$2,740,762TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document23IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee49EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Connie BednarakBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6128743460PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12722 Park AvenueAddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55407ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Kent Eklund
Director1.0010.00Yes (X)$0$0$0
RICHARD HOWARD
Director1.0010.00Yes (X)$0$0$0
Shary Mulhere
board Secretary1.0010.00Yes (X)$0$0$0Yes (X)
Deborah Paone
Director1.0010.00Yes (X)$0$0$0
JEANNE RIPLEY
Director1.0010.00Yes (X)$0$0$0
Carl Runck
Director (Part year)1.0010.00Yes (X)$0$0$0
Thomas Hokr
Director (Part year)1.0010.00Yes (X)$0$0$0
John Selstad
Vice Chair1.0010.00Yes (X)$0$0$0Yes (X)
Mark Thomas
President & CEO1.0040.00Yes (X)$0$564,065$42,021Yes (X)
Maggie Collins
Chair1.0010.00Yes (X)$0$0$0Yes (X)
stephan grygar
CFO (Part Year)1.0040.00$0$322,578$19,970Yes (X)
Terry Hakes
CFO (Part Year)1.0040.00$0$152,035$17,821Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,038,678TotReportableCompRltdOrgAmt
Total Other Compensation$79,812TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$11,434RelatedOrganizationsAmt
Total Contributions$11,434TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Housing Service Revenu623000$1,548,344$1,548,344
RENT REVENUE532000$1,466,431$1,466,431
Other Patient Revenue623000$634,231$634,231
FieldValueIRS element (for citing)
Total Program Service Revenue$3,649,006TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$209TotalRevenueColumnAmt
Exclusion$209ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Total Revenue Column$9,091TotalRevenueColumnAmt
Related Or Exempt Func Income$9,091RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$9,091OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,669,740TotalRevenueColumnAmt
Related Or Exempt Func Income$3,658,097RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$209ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,848,604TotalAmt
Program Services$1,003,483ProgramServicesAmt
Management And General$845,121ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$8,177TotalAmt
Management And General$8,177ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$210,106TotalAmt
Program Services$581ProgramServicesAmt
Management And General$209,525ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$136,893TotalAmt
Management And General$136,893ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$39,323TotalAmt
Management And General$39,323ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$11,621TotalAmt
Management And General$11,621ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$316,364TotalAmt
Program Services$316,364ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,049TotalAmt
Program Services$1,049ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$399,738TotalAmt
Program Services$19,406ProgramServicesAmt
Management And General$380,332ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$291,578TotalAmt
Program Services$291,578ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$4,911TotalAmt
Program Services$4,911ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$317,475TotalAmt
Program Services$317,475ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$289,259TotalAmt
Program Services$289,259ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$39,049TotalAmt
Program Services$39,049ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
ELDERLY CARE EXPENSE$457,607$457,607
Overhead Allocations$56,594$56,594

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$4,428,348TotalAmt
Program Services$2,740,762ProgramServicesAmt
Management And General$1,687,586ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$304,527BOYAmt
EOY$257,709EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$722,721BOYAmt
EOY$760,862EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$108,776BOYAmt
EOY$314,518EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$23,306BOYAmt
EOY$81,565EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$8,471,946LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,225,801LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,434,612BOYAmt
EOY$6,246,145EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$301,870BOYAmt
EOY$303,621EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,895,812BOYAmt
EOY$7,964,420EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$277,905BOYAmt
EOY$350,225EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,418BOYAmt
EOY$3,783EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$6,206,647BOYAmt
EOY$6,104,218EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,141,754BOYAmt
EOY$2,996,714EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,627,724BOYAmt
EOY$9,454,940EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$731,912BOYAmt
EOY-$1,490,520EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$731,912BOYAmt
EOY-$1,490,520EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,895,812BOYAmt
EOY$7,964,420EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$758,608ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,010CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$21,663CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,749CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$22,419CurrentTaxYearMinus1YearAmt
Current Tax Year$11,434CurrentTaxYearAmt
Total$79,275TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,148,019CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,276,737CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,368,895CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,169,836CurrentTaxYearMinus1YearAmt
Current Tax Year$3,649,006CurrentTaxYearAmt
Total$12,612,493TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,156,029CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,298,400CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,384,644CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,192,255CurrentTaxYearMinus1YearAmt
Current Tax Year$3,660,440CurrentTaxYearAmt
Total$12,691,768TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$12,691,768PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$261CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$379CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$346CurrentTaxYearMinus1YearAmt
Current Tax Year$209CurrentTaxYearAmt
Total$1,264TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$261CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$379CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$346CurrentTaxYearMinus1YearAmt
Current Tax Year$209CurrentTaxYearAmt
Total$1,264TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$12,190CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$94,757CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$79,906CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,940CurrentTaxYearMinus1YearAmt
Current Tax Year$9,091CurrentTaxYearAmt
Total$204,884TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,168,288CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,393,418CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,464,929CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,201,541CurrentTaxYearMinus1YearAmt
Current Tax Year$3,669,740CurrentTaxYearAmt
Total$12,897,916TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98400PublicSupportCY509Pct
Public Support PY5090.98210PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$29,265OtherCostOrOtherBasisAmt
Book Value$29,265BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,993,032OtherCostOrOtherBasisAmt
Depreciation$2,044,329DepreciationAmt
Book Value$5,948,703BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$168,379OtherCostOrOtherBasisAmt
Depreciation$49,460DepreciationAmt
Book Value$118,919BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$268,733OtherCostOrOtherBasisAmt
Depreciation$132,012DepreciationAmt
Book Value$136,721BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,537OtherCostOrOtherBasisAmt
Book Value$12,537BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,246,145TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
Tenant Security Deposits$49,729
Premium on Bonds$173,434
Amount Due to Ebenezer Society, A Related Party$2,769,974
Management fee payable to Ebenezer management Service, A Related Party$3,577
FieldValueIRS element (for citing)
Total Liability$2,996,714TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$3,669,740TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$3,669,740RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$3,669,740TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$4,428,348TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$4,428,348ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$4,428,348TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationIn accordance with the standard related to the accounting for uncertainty in income taxes, the Company addresses the determination of whether tax benefits claimed should be recorded in the financial statements. Under this guidance, the Company may recognize the tax benefit from an uncertain tax position only if is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merit of the position. Examples of tax positions include the tax-exempt status of the Company and various positions related to the potential sources of unrelated business taxable income. There are no unrecognized tax benefits identified or recorded as a liability during 2015. Open tax years subject to examination by the U.S. and state taxing authorities are for the years 2012 to 2014, which statues expires 2016 to 2018, respectively. The measurement and disclosure principles of the standard normally do not affect the financial statements of an entity that is not subject to income tax. However, there are certain exceptions where the Company would bear the burden of an uncertain tax position.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Mark Thomas
President & CEO$0$555,052$0$0$0$9,013$0$18,550$0$23,471$0$606,086$0$0
stephan grygar
CFO (Part Year)$0$318,548$0$0$0$4,030$0$8,449$0$11,521$0$342,548$0$0
Terry Hakes
CFO (Part Year)$0$152,035$0$0$0$0$0$0$0$17,821$0$169,856$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 4bMark Thomas participated in a supplemental non-qualified retirement plan from a related organization.
Part ii:MARK THOMAS AND STEPHAN GRYGAR ARE EMPLOYEES OF FAIRVIEW HEALTH SERVICES. THEIR SALARY IS PASSED TO EBENEZER SOCIETY AND IS AN EXPENSE OF EBENEZER SOCIETY.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, line 2LAKES ASSISTED LIVING STARTED A NEW TRANSITIONAL CARE UNIT PROGRAM IN 2015
Form 990, Part VI, Section A, line 2MARK THOMAS, STEPHAN GRYGAR AND RICHARD HOWARD: BUSINESS RELATIONSHIP
Form 990, Part VI, Section A, line 8bNo committees have authority to act on the behalf of the organization.
Form 990, Part VI, Section B, line 11The 990 is reviewed by the President and vice president before filing. Any comments or concerns will be discussed with the complete governing body. The complete governing body receives a copy of the 990 after the return has been filed.
Form 990, Part VI, Section B, line 12cALL POTENTIAL CONFLICTS OF INTEREST OR OTHER MATTERS RELATING TO THE DUTY OF LOYALTY RESPECTING ALL DIRECTORS OR OFFICERS OF FAIRVIEW (OF THE RANK OF SENIOR VICE PRESIDENT OR ABOVE), SHALL BE REPORTED TO THE FAIRVIEW SYSTEM BOARD VIA THE AUDIT AND COMPLIANCE COMMITTEE. ALL ISSUES RELATING TO THE DUTY OF LOYALTY RESPECTING ALL DIRECTORS, TRUSTEES, OR OFFICERS OF A FAIRVIEW DIVISION WITH AN OPERATING BOARD OR A FAIRVIEW SUBSIDIARY SHALL BE REPORTED TO THE BOARD OF TRUSTEES OR DIRECTORS OF THE APPROPRIATE DIVISION OR SUBSIDIARY. THE CHIEF COMPLIANCE OFFICE SHALL MONITOR CONFLICT ISSUES REPORTED AT THE DIVISION AND SUBSIDIARY LEVEL AND PERIODICALLY REPORT TO THE AUDIT AND COMPLIANCE COMMITTEE WITH RESPECT TO SUCH CONFLICTS. ALL POTENTIAL CONFLICTS OR OTHER ISSUES RELATING TO THE DUTY OF LOYALTY RESPECTING ALL OTHER INTERESTED PERSONS SHALL BE REPORTED TO FAIRVIEW'S CHIEF COMPLIANCE OFFICER, (OR IN THE CASES OF DIVISIONS AND SUBSIDIARIES TO THE CEO OF SUCH DIVISION OR SUBSIDIARY), AND IN HIS OR HER DISCRETION TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE FAIRVIEW SYSTEM BOARD. THE CHIEF COMPLIANCE OFFICER, IN CONJUNCTION WITH FAIRVIEW SENIOR MANAGEMENT, SHALL MAKE THE DECISION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST IS AN ACTUAL CONFLICT OF INTEREST WITH RESPECT TO SUCH OTHER PERSONS. IN THE CASE OF A CONFLICT OF INTEREST RELATING TO A DIRECTOR OR TRUSTEE OF A FAIRVIEW DIVISION WITH AN OPERATING BOARD OR A DIRECTOR, OFFICER OR EMPLOYEE OF A FAIRVIEW SUBSIDIARY, DECISIONS RELATING TO THE CONFLICT SHALL BE MADE BY THE DIVISION OR SUBSIDIARY USING GUIDELINES DEVELOPED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE FAIRVIEW SYSTEM BOARD. ALL SUCH MATTERS SHALL BE SUBJECT TO REVIEW BY THE AUDIT AND COMPLIANCE COMMITTEE.
Form 990, Part VI, Section B, line 15Raises are based on increase given for reimbursement by the state. Any increases above 1% are given based on market rates for the position. They are reviewed and approved by upper management.
Form 990, Part VI, Section C, line 19Ebenezer Lakes Assisted Living financial statements and conflict of interest policy can be obtained upon request.
FORM 990, PART XII, LINE 2C:THE ORGANIZATION DID NOT CHANGE EITHER THE OVERSIGHT PROCESS OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT DURING THE TAX YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Fairview Health Services
2450 Riverside AvenueMinneapolisMN55454410991680Hospital/healthcare providerMN501(c)(3)Line 3N/A0
ebenezer society
2722 Park Avenue SouthMinneapolisMN55407410706141nursing home care/admin supportMN501(c)(3)Line 9N/A0
Ebenezer Ridges Assisted Living
13810 Community DriveBurnsvilleMN55337411964691assisted living facilityMN501(c)(3)Line 90Ebenezer Society
Ebenezer Ridges
2722 Park Avenue SouthMinneapolisMN55407411287792Nursing home careMN501(c)(3)Line 90Ebenezer Society
Ebenezer Society Foundation
2722 Park Avenue SouthMinneapolisMN55407411356565Support Ebenezer SocietyMN501(c)(3)Line 11c, III-FI0Ebenezer Society
Ebenezer Ridge Point Apartments Inc
2722 Park Avenue SouthMinneapolisMN55407411769727affordable housingMN501(c)(3)Line 90Ebenezer Society
Ebenezer Towers
2722 Park Avenue SouthMinneapolisMN55407237005359affordable housingMN501(c)(3)Line 90Ebenezer Society
Ebenezer Park Apartments
2722 Park Avenue SouthMinneapolisMN55407411378656affordable housingMN501(c)(3)Line 90Ebenezer Society
Fairview Foundation
2450 Riverside AvenueminneapolisMN55454411573810Support Fairview Health ServicesMN501(c)(3)Line 70fairview health services
Ebenezer Lakes Senior Housing
5430 Meadow LaneWyomingMN55092320190409affordable housingMN501(c)(3)Line 90ebenezer Society

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
Fairview Woods Assisted Living LLC
470 Fairview BoulevardRed WingMN55066204381407assisted living facilityMNN/A
York Gardens LLC
3451 Parklawn AveEdinaMN55435262912486assisted living facilityMNN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Ebenezer Management Services IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12722 Park Avenue SouthAddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55407ZIPCd
FieldValueIRS element (for citing)
EIN411567046EIN
Primary ActivitiesManagement ServicesPrimaryActivitiesTxt
Legal Domicile StateMNLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Ebenezer Management Services Inc
M$39,323AGREED UPON RATE
Ebenezer Society
P$4,107,578Cost

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