2014-05-14T17:15:16-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2013-01-01 840194430 EBEN EZER LUTHERAN CARE CENTER EBEN 9708422861 122 HOSPITAL ROAD BRUSH CO 80723 SHELLY GRIFFITH CEO 9708422861 2014-05-09 1 JEFF PARKER P00970069 3034668822 2013 2015-11-30 17:44:51Z SHELLY GRIFFITH 122 HOSPITAL ROAD BRUSH CO 80723 12615554 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. 10 10 323 250 3176 1400 188198 502209 11598079 11623911 175399 354847 109827 132613 12071503 12613580 3691 2176 0 0 7779918 7993655 0 0 46047 3649552 3564571 11433161 11560402 638342 1053178 14448920 15440095 4863698 4648952 9585222 10791143 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 PROVIDED SERVICE TO MORE THAN 400 PERSONS FOR PERSONAL AND HOMEMAKING CARE AND RESIDENTIAL SERVICES TO OVER 300 PERSONS. THE CARE CENTER IS CERTIFIED FOR MEDICARE AND MEDICAID AND IS AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH OF AMERICA. 0 0 10623912 2176 11623911 PROVIDING SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING, INDEPENDENT LIVING, PERSONAL CARE, HOMEMAKING AND LIFELINE EMERGENCY RESPONSE SERVICES TO THE ELDERLY 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. 10623912 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 13 0 323 1 1 1 0 0 0 0 0 0 0 X 10 10 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 ANDREW LARRICK SECRETARY 1.00 1.00 X X 0 0 0 GEORGE DIKEOU DIRECTOR 1.00 1.00 X 0 0 0 DR ALAN DAHMS DIRECTOR 1.00 1.00 X 0 0 0 MIKE BERRYHILL CHAIRMAN 1.00 1.00 X X 0 0 0 ROGER SCHAEFER DIRECTOR 1.00 1.00 X 0 0 0 DR KERRY HART DIRECTOR 1.00 X 0 0 0 ROBERT CHAPIN VICE-CHAIR/TREASURER 1.00 1.00 X X 0 0 0 NORMAN AARESTAD DIRECTOR 1.00 1.00 X 0 0 0 PAUL OLSEN DIRECTOR 1.00 X 0 0 0 PR WENDY KALAN DIRECTOR 1.00 X 0 0 0 SONYA BASS DIRECTOR 1.00 1.00 X 0 0 0 SHELLY GRIFFITH CEO 40.00 1.00 X 108767 0 8920 LESLIE MASON CFO 40.00 1.00 X 68177 0 7972 176944 0 16892 1 0 0 0 0 496798 5411 502209 PATIENT SERVICE 623000 11623911 11623911 11623911 101676 101676 5150 1974 3176 3176 3176 253171 0 253171 253171 253171 BEAUTY SHOP, MEALS, TRANSPORATION 623000 136366 136366 EARNINGS OF EQUITY INV 524298 -6929 -6929 129437 12613580 11623911 3176 484284 2176 2176 176944 146344 30600 6167112 5886045 281067 66064 58505 6947 612 1133399 1064557 66782 2060 450136 418756 28822 2558 6130 6130 39306 39306 25144 25144 208528 199615 8913 34881 34881 72790 69836 2954 207461 96869 110592 512784 505764 7020 192543 132517 60026 UNRELATED BUSINESS INCO 933 933 ANCILLARY 694567 694567 FOOD 508652 508652 SUPPLIES 403039 372768 26445 3826 657813 578404 73018 6391 11560402 10623912 890443 46047 596 600 3842745 4559927 960317 813750 55511 57320 63855 151576 90899 16284399 10005957 6154692 6278442 1817363 2384929 1464311 1192182 14448920 15440095 818445 824853 1677 1742 3899062 3685418 144514 136939 4863698 4648952 X 9585222 10791143 9585222 10791143 14448920 15440095 1053178 152743 0 X X 0 1 X 1 0 X 151590 543964 372771 188198 502209 1758732 11800024 11187753 11590548 11598079 11623911 57800315 11951614 11731717 11963319 11786277 12126120 59559047 0 0 0 59559047 45535 52021 66188 85382 101676 350802 1048 7393 10011 3176 21628 46583 59414 66188 95393 104852 372430 412425 125880 91561 100012 129437 859315 12410622 11917011 12121068 11981682 12360409 60790792 0.97970 0.98080 0.00610 0.00600 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 298250 150000 448250 288250 10000 298250 231847 56403 288250 231847 231847 224347 7500 231847 1.00000 0 1 1 66372 66372 10896635 5782662 5113973 5257809 4223295 1034514 63583 63583 6278442 DUE FROM FOUNDATION 245122 BOND ISSUANCE COSTS-NET 129985 BOND PROCEEDS HELD IN TRUST 479498 BOND INTEREST FUND 32707 BOND PRINCIPAL FUND 37501 INV IN CAPTIVE INSURANCE 267369 1192182 DEPOSITS OF RESIDENTS 38883 ASSET RETIREMENT OBLIGATION 68221 DEFERRED COMPENSATION 29835 136939 X 12768298 152743 1975 154718 12613580 0 12613580 11562377 1975 1975 11560402 0 11560402 PART V, LINE 4: ENDOWMENTS ARE HELD BY EBEN EZER LUTHERAN CARE CENTER FOUNDATION, A RELATED ORGANIZATION. THE ENDOWMENT CONSISTS OF TWO 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, 2013 AND 2012, THE ORGANIZATION DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMTP STATUS. THE TAX RETURNS FOR THE YEARS 2010 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,975. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,975. A CITY OF BRUSH COLORADO 846000638 117416BV8 2004-09-01 640000 INDUSTRIAL DEVELOPMENT REVENUE 0 0 0 B CITY OF BRUSH COLORADO 846000638 117416BW6 2004-09-01 1350000 INDUSTRIAL DEVELOPMENT REVENUE 0 0 0 C CITY OF BRUSH COLORADO 846000638 117416BX4 2004-09-01 2125000 INDUSTRIAL DEVELOPMENT REVENUE 0 0 0 A 415000 640000 34522 605478 1 0 1 1 B 1350000 69045 1280955 1 0 1 1 C 2125000 110472 2014528 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 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 PRIOR TAX RETURNS. 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 11 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 PRIOR TO FILING. 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 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. THE CEO REVIEWS AND APPROVES COMPENSATION FOR THE CFO AND OTHER KEY EMPLOYEES. 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 THESE POLICIES / PROCEDURES DID NOT CHANGE IN THE CURRENT YEAR. EBEN EZER LUTHERAN CARE CENTER FOUNDATION 122 HOSPITAL ROAD BRUSH CO 80723 742480396 SUPPORT CO 501(C)(3) LINE 11A, 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 7 EBEN EZER LUTHERAN CARE CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 EBEN EZER LUTHERAN CARE CENTER FOUNDATION C 502209 FMV