EBEN EZER LUTHERAN CARE CENTER: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
EBEN EZER LUTHERAN CARE CENTER (EIN 84-0194430)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-09-26
IRS object ID
201202709349300030
Schema version
2011v1.2
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)
Timestamp2012-09-26T15:45:26-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN840869721EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EHRHARDT KEEFE STEINER & HOTTMAN PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line17979 E TUFTS AVENUE SUITE 400AddressLine1
CityDENVERCity
StateCOState
ZIP Code802372843ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN840194430EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1EBEN EZER LUTHERAN CARE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlEBENNameControl
Phone9708422861Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1122 HOSPITAL ROADAddressLine1
CityBRUSHCity
StateCOState
ZIP Code80723ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSHELLY GRIFFITHName
TitleCEOTitle
Phone9708422861Phone
Date Signed2012-09-25DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRYAN C HARRISName
PTINP00614618PTIN
Phone3037409400Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSHELLY GRIFFITHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1122 HOSPITAL ROADAddressLine1
CityBRUSHCity
StateCOState
ZIP Code80723ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16239034GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.EBENEZER-CARES.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1903YearFormation
State Legal DomicileCOStateLegalDomicile
Activity Or Mission DescriptionOUR MISSION IS TO PROVIDE HOUSING, HEALTH CARE, AND SPIRITUAL SERVICES FOR THOSE IN NEED.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees329TotalNbrEmployees
Total Nbr Volunteers250TotalNbrVolunteers
Total Gross UBI-2133TotalGrossUBI
Net Unrelated Business Txbl Income-2475NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year543964ContributionsGrantsPriorYear
Contributions Grants Current Year372771ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11187753ProgramServiceRevenuePriorYear
Program Service Revenue CY11626051ProgramServiceRevenueCY
Investment Income Prior Year140251InvestmentIncomePriorYear
Investment Income Current Year161576InvestmentIncomeCurrentYear
Other Revenue Prior Year133273OtherRevenuePriorYear
Other Revenue Current Year53925OtherRevenueCurrentYear
Total Revenue Prior Year12005241TotalRevenuePriorYear
Total Revenue Current Year12214323TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3999GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7092215SalariesEtcPriorYear
Salaries Etc Current Year7529952SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year74272TotalFundrsngExpCurrentYear
Other Expense Prior Year3905670OtherExpensePriorYear
Other Expenses Current Year3658847OtherExpensesCurrentYear
Total Expenses Prior Year10997885TotalExpensesPriorYear
Total Expenses Current Year11192798TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1007356RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1021525RevenuesLessExpensesCY
Total Assets BOY13278330TotalAssetsBOY
Total Assets EOY13862838TotalAssetsEOY
Total Liabilities BOY5197757TotalLiabilitiesBOY
Total Liabilities EOY5020132TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8080573NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8842706NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10130988Expense
Grants3999Grants
Revenue11626051Revenue
DescriptionPROVIDING SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING,INDEPENDENT LIVING, PERSONAL CARE, HOMEMAKING AND LIFELINEEMERGENCY RESPONSE SERVICES TO THE ELDERLY AND PERSONS WITHSPECIAL NEEDS. THE CARE CENTER PROVIDED SERVICE TO MORE THAN 400PERSONS FOR PERSONAL AND HOMEMAKING CARE AND RESIDENTIAL SERVICESTO OVER 300 PERSONS.Description
Total Program Service Expense10130988TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109617NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees329NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LESLIE MASONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9708422861TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1122 HOSPITAL ROADAddressLine1
CityBRUSHCity
StateCOState
ZIP Code80723ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ANDREW LARRICK
DIRECTOR/SECRETARY1.00XX000
GEORGE DIKEOU
DIRECTOR1.00X000
DR ALAN DAHMS
DIRECTOR1.00X000
MIKE BERRYHILL
CHAIRMAN1.00XX000
ROGER SCHAEFER
DIRECTOR1.00X000
DR KERRY HART
DIRECTOR1.00X000
JO ANN KRUGLET
SECRETARY1.00XX000
ROBERT CHAPIN
VICE-CHAIR/TREASURER1.00XX000
NORMAN AARESTAD
DIRECTOR1.00X000
PAUL OLSEN
DIRECTOR1.00X000
JEFF HANSON
DIRECTOR1.00X000
BARBARA BRADSHAW
CEO40.00X10293308489
SHELLY GRIFFITH
CFO40.00X6104707592
LESLIE MASON
CFO (STARTED JUNE 3, 2011)40.00X2839503563
FieldValueIRS element (for citing)
Total Reportable Comp From Org192375TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation19644TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations372771RelatedOrganizations
Total Contributions372771TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE6230001144507411445074
AUXILIARY623000180977180977
FieldValueIRS element (for citing)
Total Program Service Revenue11626051TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column66188TotalRevenueColumn
Exclusion$66,188ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2671Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real4841Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-2170Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-2170TotalRevenueColumn
Unrelated Business Revenue-2170UnrelatedBusinessRevenue

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4115258Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4019870Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities95388Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column95388TotalRevenueColumn
Exclusion$95,388ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
EARNINGS OF EQUITY INV52429853858$53,858
INSURANCE PROCEEDS62420022002200
INCOME FROM K-19000033737
FieldValueIRS element (for citing)
Total Other Revenue56095TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12214323TotalRevenueColumn
Related Or Exempt Function Income11628251RelatedOrExemptFunctionIncome
Unrelated Business Revenue-2133UnrelatedBusinessRevenue
Exclusion$215,434ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total3999Total
Program Services3999ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total212018Total
Management And General169198ManagementAndGeneral
Fundraising42820Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5848341Total
Program Services5551395ProgramServices
Management And General278202ManagementAndGeneral
Fundraising18744Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total58749Total
Program Services52429ProgramServices
Management And General5534ManagementAndGeneral
Fundraising786Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total968941Total
Program Services928288ProgramServices
Management And General39769ManagementAndGeneral
Fundraising884Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total441903Total
Program Services405305ProgramServices
Management And General29247ManagementAndGeneral
Fundraising7351Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total54449Total
Management And General54449ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total21887Total
Management And General21887ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total179121Total
Program Services168638ProgramServices
Management And General10483ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total25664Total
Program Services25664ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total67799Total
Program Services25109ProgramServices
Management And General42690ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total36295Total
Program Services36295ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total284757Total
Program Services284757ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total73433Total
Program Services67176ProgramServices
Management And General6199ManagementAndGeneral
Fundraising58Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total26352Total
Program Services16437ProgramServices
Management And General9915ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total282078Total
Program Services130314ProgramServices
Management And General151764ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total474263Total
Program Services467762ProgramServices
Management And General6501ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total246936Total
Program Services139387ProgramServices
Management And General107549ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
ANCILLARY716930716930
FOOD518455518455
SUPPLIES387686360416249972273
MAINTENANCE AND REPAIR1309961216079389

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total131746Total
Program Services110625ProgramServices
Management And General19765ManagementAndGeneral
Fundraising1356Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11192798Total
Program Services10130988ProgramServices
Management And General987538ManagementAndGeneral
Fundraising74272Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY500BOY
EOY700EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2444856BOY
EOY3414669EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1084794BOY
EOY1111390EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY53648BOY
EOY64904EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY76539BOY
EOY38957EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis15400265LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9038354LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6303760BOY
EOY6361911EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1586831BOY
EOY1371031EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1727402BOY
EOY1499276EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY13278330BOY
EOY13862838EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY774232BOY
EOY789754EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1968BOY
EOY1685EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY4291349BOY
EOY4097705EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY130208BOY
EOY130988EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5197757BOY
EOY5020132EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8080573BOY
EOY8842706EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8080573BOY
EOY8842706EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13278330BOY
EOY13862838EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1021525ReconcilationRevenueExpenses
Reconcilation Other Changes-259392ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years237613CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years691233CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years151590CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year543964CurrentTaxYearMinus1Year
Current Tax Year372771CurrentTaxYear
Total1997171Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9492751CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10332705CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11800024CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11187753CurrentTaxYearMinus1Year
Current Tax Year11590548CurrentTaxYear
Total54403781Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9730364CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11023938CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11951614CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11731717CurrentTaxYearMinus1Year
Current Tax Year11963319CurrentTaxYear
Total56400952Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50956400952PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years77555CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years80041CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years45535CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52021CurrentTaxYearMinus1Year
Current Tax Year66188CurrentTaxYear
Total321340Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10393CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7925CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1048CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7393CurrentTaxYearMinus1Year
Total26759Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years87948CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years87966CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years46583CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year59414CurrentTaxYearMinus1Year
Current Tax Year66188CurrentTaxYear
Total348099Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years151635CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years57716CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years412425CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year125880CurrentTaxYearMinus1Year
Current Tax Year91561CurrentTaxYear
Total839217Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9969947CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11169620CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12410622CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11917011CurrentTaxYearMinus1Year
Current Tax Year12121068CurrentTaxYear
Total57588268Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97940PublicSupportPercentage509
Prior Year Support Percentage0.97980PriorYearSupportPercentage
Investment Income Percentage0.00600InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00650PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance231847BeginningOfYearBalance
Contributions56403Contributions
End Of Year Balance288250EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance231847BeginningOfYearBalance
End Of Year Balance231847EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance224347BeginningOfYearBalance
Contributions7500Contributions
End Of Year Balance231847EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance224347BeginningOfYearBalance
End Of Year Balance224347EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis66372OtherCostOrOtherBasis
Book Value66372BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10196242OtherCostOrOtherBasis
Depreciation5230303Depreciation
Book Value4965939BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4978889OtherCostOrOtherBasis
Depreciation3808051Depreciation
Book Value1170838BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis158762OtherCostOrOtherBasis
Book Value158762BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6361911TotalOfBookValueLandBuildings

Other Assets OtherAssets (8 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM FOUNDATION386318
BOND ISSUANCE COSTS-NET153925
BOND PROCEEDS HELD IN TRUST479374
BOND INTEREST FUND44924
BOND PRINCIPAL FUND33333
INV. IN CAPTIVE INSURANCE374817
OTHER RECEIVABLE18813
INTEREST RECEIVABLE7772
FieldValueIRS element (for citing)
Total Book Value Other Assets1499276TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DEPOSITS OF RESIDENTS$36,675
ASSET RETIREMENT OBLIGATION$63,536
DEFERRED COMPENSATION$30,777
FieldValueIRS element (for citing)
Total Of Amounts130988TotalOfAmounts
Total Revenue12214323TotalRevenue
Total Expenses11192798TotalExpenses
Excess Or Deficit For Year1021525ExcessOrDeficitForYear
Net Unrealized GL On Investments-259355NetUnrealizedGLOnInvestments
Other-$37OtherAmount
Total Adjustments-259392TotalAdjustments
Excess Or Deficit Per FS762133ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt11959772TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-259355NetUnrealizedGainsInvestments
Revenue Not Rptd F990-259355RevenueNotRptdF990
Revenue Subtotal12219127RevenueSubtotal
Other Revenues Not Included-4804OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-4804RevenueNotRptdOnFinStmt
Total Revenue Per Form99012214323TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11197639TotExpensesEtcAuditedFinclStmt
Other Expenses Included4841OtherExpensesIncluded
Expenses Not Rptd F9904841ExpensesNotRptdF990
Expenses Subtotal11192798ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011192798TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: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.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE ORGANIZATION FOLLOWS A MORE-LIKELY-THAN-NOT MEASUREMENT METHODOLOGY TO REFLECT THE FINANCIAL STATEMENT IMPACT OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. AFTER EVALUATION THE TAX POSITIONS TAKEN, NONE ARE CONSIDERED TO BE UNCERTAIN; THEREFORE, NO AMOUNTS HAVE BEEN RECOGNIZED AS OF DECEMBER 31, 2011 OR 2010. IF INCURRED, INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS ARE RECORDED IN THE PERIOD ASSESSED AS OTHER EXPENSES. NO INTEREST OR PENALTIES HAVE BEEN ASSESSED AS OF DECEMBER 31, 2011 AND 2010. TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION INCLUDE 2008 THROUGH CURRENT FOR THE FEDERAL RETURN AND 2007 THROUGH CURRENT FOR THE COLORADO RETURN.
PART XI, LINE 8 - OTHER ADJUSTMENTS:INCOME FROM K-1 -37.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RENTAL EXPENSES -4,841. INCOME FROM K-1 37.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 4,841.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
CITY OF BRUSH COLORADO
846000638117416BV82004-09-01640000INDUSTRIAL DEVELOPMENT REVENUE000
CITY OF BRUSH COLORADO
846000638117416BW62004-09-011350000INDUSTRIAL DEVELOPMENT REVENUE000
CITY OF BRUSH COLORADO
846000638117416BX42004-09-012125000INDUSTRIAL DEVELOPMENT REVENUE000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
6400003452260547820041011
135000069045128095520041011
2125000110472201452820041011

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00000
00000
00000

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
110000
110000
110000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION MISSION STATEMENTFORM 990, PART III, LINE 1THE 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.
FORM 990, PART VI, SECTION A, LINE 1THE 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 FILING OF SAID POSITIONS.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15ATHE 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.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -259,355. INCOME FROM K-1 -37. TOTAL TO FORM 990, PART XI, LINE 5: -259,392.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
EBEN EZER LUTHERAN CARE CTR FOUNDATION
122 HOSPITAL ROADBRUSHCO80723742480396SUPPORTCO501(C)(3)LINE 11A, IN/A1
EBEN EZER LUTHERAN HOUSING CENTER
1900 EDISON STREETBRUSHCO80723840884015HOUSINGCO501(C)(3)LINE 7N/A1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1EBEN EZER LUTHERN CARE CENTER FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved372771AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination

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