EBENEZER LAKES ASSISTED LIVING: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- EBENEZER LAKES ASSISTED LIVING (EIN 41-2012560)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-10-01
- IRS object ID
- 201432749349300503
- Schema version
- 2013v3.0
- 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 | 2014-10-01T07:27:31-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S 6TH ST 2300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55407 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHAN GRYGAR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6128743460 | PhoneNum |
| Signature | 2014-09-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAWRENCE H MOHR CPA | PreparerPersonNm |
| PTIN | P00447603 | PTIN |
| Phone | 6128764500 | PhoneNum |
| Preparation | 2014-09-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| 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 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55407 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,465,929 | 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 | TO PROVIDE ASSISTED LIVING SERVICES TO IMPROVE THE QUALITY OF LIFE FOR THE ELDERLY AND DISABLED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 87 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $21,662 | PYContributionsGrantsAmt |
| CY Contributions Grants | $15,749 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,276,737 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,368,895 | CYProgramServiceRevenueAmt |
| PY Investment Income | $261 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,379 | CYInvestmentIncomeAmt |
| PY Other Revenue | $94,758 | PYOtherRevenueAmt |
| CY Other Revenue | $79,906 | CYOtherRevenueAmt |
| PY Total Revenue | $2,393,418 | PYTotalRevenueAmt |
| CY Total Revenue | $2,465,929 | 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 | $1,050,112 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,080,203 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,305,571 | PYOtherExpensesAmt |
| CY Other Expenses | $1,333,420 | CYOtherExpensesAmt |
| PY Total Expenses | $2,355,683 | PYTotalExpensesAmt |
| CY Total Expenses | $2,413,623 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $37,735 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $52,306 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,114,603 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,001,898 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,084,193 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,919,182 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $30,410 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $82,716 | 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, PYSCHOLOGICAL, 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,757,561 | ExpenseAmt |
| Revenue | $2,448,801 | RevenueAmt |
| Desc | PROVIDE ASSISTED LIVING FOR THE ELDERLY AND DISABLED THROUGH A HUD SPONSORED PROGRAM. THE FACILITY HAS 59 UNITS. | Desc |
| Total Program Service Expenses | $1,757,561 | 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 | 0 | 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 | 0 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | TERRY HAKES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6128743479 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2722 PARK AVENUE | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55407 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 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 |
|---|---|---|---|---|---|---|---|
| MAGGIE COLLINS | |||||||
| BOARD CHAIR | 1.00 | 10.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KENT EKLUND | |||||||
| DIRECTOR | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | |
| SHARY MULHERE | |||||||
| BOARD SECRETARY | 1.00 | 10.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| PASTOR CHRISTOPHER NELSON | |||||||
| DIRECTOR | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | |
| JEANNE RIPLEY | |||||||
| DIRECTOR | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN SELSTAD | |||||||
| DIRECTOR | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | |
| MARK THOMAS | |||||||
| PRESIDENT & CEO | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $502,629 | $39,364 |
| DEBORAH PAONE | |||||||
| DIRECTOR | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | |
| RICHARD HOWARD | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $387,035 | $38,130 | |
| STEPHAN GRYGAR | |||||||
| VICE PRESIDENT & CFO | 1.00 | 40.00 | Yes (X) | $0 | $240,881 | $26,075 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,130,545 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $103,569 | 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 |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $15,749 | RelatedOrganizationsAmt |
| Total Contributions | $15,749 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RENT REVENUE | 532000 | $1,806,911 | $1,806,911 |
| ELDERLY CARE SERVICES | 623000 | $561,984 | $561,984 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,368,895 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $379 | TotalRevenueColumnAmt |
| Exclusion | $379 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,000 | TotalRevenueColumnAmt |
| Exclusion | $1,000 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| DEBT FORGIVENESS-RP | 900099 | $69,467 | $69,467 |
| MISCELLANEOUS | 900099 | $10,439 | $10,439 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $79,906 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,465,929 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,448,801 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,379 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $874,847 | TotalAmt |
| Program Services | $646,902 | ProgramServicesAmt |
| Management And General | $227,945 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,885 | TotalAmt |
| Management And General | $2,885 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,382 | TotalAmt |
| Program Services | $746 | ProgramServicesAmt |
| Management And General | $136,636 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,089 | TotalAmt |
| Management And General | $65,089 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,574 | TotalAmt |
| Program Services | $43,574 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,435 | TotalAmt |
| Program Services | $9,435 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,252 | TotalAmt |
| Program Services | $245,252 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,144 | TotalAmt |
| Program Services | $1,144 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,541 | TotalAmt |
| Program Services | $1,311 | ProgramServicesAmt |
| Management And General | $94,230 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,312 | TotalAmt |
| Program Services | $220,312 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,272 | TotalAmt |
| Program Services | $3,272 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $325,203 | TotalAmt |
| Program Services | $325,203 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,417 | TotalAmt |
| Program Services | $197,417 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,878 | TotalAmt |
| Program Services | $48,878 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| OVERHEAD ALLOCATIONS | $129,277 | $129,277 | |
| ELDERLY CARE EXPENSE | $14,115 | $14,115 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,413,623 | TotalAmt |
| Program Services | $1,757,561 | ProgramServicesAmt |
| Management And General | $656,062 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $436,766 | BOYAmt |
| EOY | $339,859 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $625,256 | BOYAmt |
| EOY | $711,788 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,087 | BOYAmt |
| EOY | $98,756 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,291 | BOYAmt |
| EOY | $23,815 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,210,624 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,704,653 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,596,791 | BOYAmt |
| EOY | $5,505,971 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,412 | BOYAmt |
| EOY | $321,709 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,114,603 | BOYAmt |
| EOY | $7,001,898 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $165,927 | BOYAmt |
| EOY | $163,140 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,479 | BOYAmt |
| EOY | $3,004 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,326,506 | BOYAmt |
| EOY | $6,303,905 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $584,281 | BOYAmt |
| EOY | $449,133 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,084,193 | BOYAmt |
| EOY | $6,919,182 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,410 | BOYAmt |
| EOY | $82,716 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,410 | BOYAmt |
| EOY | $82,716 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,114,603 | BOYAmt |
| EOY | $7,001,898 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $52,306 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 | 0 | FederalGrantAuditRequiredInd |
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 | $792 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,388 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,010 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,663 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,749 | CurrentTaxYearAmt |
| Total | $51,602 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,089,781 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,510,477 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,148,019 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,276,737 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,368,895 | CurrentTaxYearAmt |
| Total | $11,393,909 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,090,573 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,515,865 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,156,029 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,298,400 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,384,644 | CurrentTaxYearAmt |
| Total | $11,445,511 | 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 | $11,445,511 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $727 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $333 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $69 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $261 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $379 | CurrentTaxYearAmt |
| Total | $1,769 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $727 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $333 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $69 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $261 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $379 | CurrentTaxYearAmt |
| Total | $1,769 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,610 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,395 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,190 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $94,757 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $79,906 | CurrentTaxYearAmt |
| Total | $205,858 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,096,910 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,529,593 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,168,288 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,393,418 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,464,929 | CurrentTaxYearAmt |
| Total | $11,653,138 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98220 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98550 | PublicSupportPY509Pct |
| Investment Income CY | 0.00020 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00310 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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
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 | $6,843,129 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,608,022 | DepreciationAmt |
| Book Value | $5,235,107 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $150,230 | OtherCostOrOtherBasisAmt |
| Depreciation | $39,686 | DepreciationAmt |
| Book Value | $110,544 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $188,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $56,945 | DepreciationAmt |
| Book Value | $131,055 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,505,971 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| TENANT SECURITY DEPOSITS | $54,588 |
| PREMIUM ON BONDS | $185,534 |
| AMOUNT DUE TO EBENEZER SOCIETY, A RELATED PARTY | $205,518 |
| MANAGEMENT FEE PAYABLE TO EBENEZER MANAGEMENT SERVICE, A RELATED PARTY | $3,493 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $449,133 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,465,929 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,465,929 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,465,929 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,413,623 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,413,623 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,413,623 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | IN 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 2013. OPEN TAX YEARS SUBJECT TO EXAMINATION BY THE U.S. AND STATE TAXING AUTHORITIES ARE FOR THE YEARS 2010 TO 2012, WHICH STATUES EXPIRES 2014 TO 2016, 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
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK THOMAS | ||||||||||||||
| PRESIDENT & CEO | $0 | $495,573 | $0 | $0 | $0 | $7,056 | $0 | $17,850 | $0 | $21,514 | $0 | $541,993 | $0 | $0 |
| RICHARD HOWARD | ||||||||||||||
| DIRECTOR | $0 | $383,393 | $0 | $0 | $0 | $3,642 | $0 | $17,850 | $0 | $20,280 | $0 | $425,165 | $0 | $0 |
| STEPHAN GRYGAR | ||||||||||||||
| VICE PRESIDENT & CFO | $0 | $235,058 | $0 | $0 | $0 | $5,823 | $0 | $9,619 | $0 | $16,456 | $0 | $266,956 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | MARK 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MARK THOMAS, STEPHAN GRYGAR AND RICHARD HOWARD: BUSINESS RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 8B | NO COMMITTEES HAVE AUTHORITY TO ACT ON THE BEHALF OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 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 12C | ALL 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, (ON 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 15 | RAISES 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 19 | EBENEZER LAKES ASSISTED LIVING FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY CAN BE OBTAINED UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | FOOD SERVICE: PROGRAM SERVICE EXPENSES 225,872. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 225,872. EXTERNAL VENDORS: PROGRAM SERVICE EXPENSES 19,380. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,380. |
| 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 9 | N/A | 0 | |
| EBENEZER RIDGES ASSISTED LIVING | |||||||||||
| 13810 COMMUNITY DRIVE | BURNSVILLE | MN | 55337 | 411964691 | ASSISTED LIVING FACILITY | MN | 501(C)(3) | LINE 9 | 0 | EBENEZER SOCIETY | |
| EBENEZER RIDGES | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411287792 | NURSING HOME CARE | MN | 501(C)(3) | LINE 9 | 0 | EBENEZER SOCIETY | |
| EBENEZER SOCIETY FOUNDATION | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411356565 | SUPPORT EBENEZER SOCIETY | MN | 501(C)(3) | LINE 11C, III-FI | 0 | EBENEZER SOCIETY | |
| EBENEZER RIDGE POINT APARTMENTS INC | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411769727 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 9 | 0 | EBENEZER SOCIETY | |
| EBENEZER TOWERS | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 237005359 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 9 | 0 | EBENEZER SOCIETY | |
| EBENEZER PARK APARTMENTS | |||||||||||
| 2722 PARK AVENUE SOUTH | MINNEAPOLIS | MN | 55407 | 411378656 | AFFORDABLE HOUSING | MN | 501(C)(3) | LINE 9 | 0 | EBENEZER SOCIETY | |
| FAIRVIEW FOUNDATION | |||||||||||
| 2450 RIVERSIDE AVENUE | MINNEAPOLIS | MN | 55454 | 411573810 | 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 9 | 0 | EBENEZER SOCIETY | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| FAIRVIEW WOODS ASSISTED LIVING LLC | |||||||
| 470 FAIRVIEW BOULEVARD | RED WING | MN | 55066 | 204381407 | ASSISTED LIVING FACILITY | MN | N/A |
| YORK GARDENS LLC | |||||||
| 3451 PARKLAWN AVE | EDINA | MN | 55435 | 262912486 | ASSISTED LIVING FACILITY | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2722 PARK AVENUE SOUTH | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55407 | ZIPCode |
| 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 |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| EBENEZER MANAGEMENT SERVICES INC | ||
| M | $43,574 | AGREED UPON RATE |
| EBENEZER SOCIETY | ||
| P | $2,195,988 | COST |
Comments