2021-05-14T16:16:50-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2020-01-01 840194430 EBEN EZER LUTHERAN CARE CENTER EBEN 9708422861 122 HOSPITAL ROAD BRUSH CO 80723 SHELLY GRIFFITH CEO 9708422861 2021-05-12 1 SHELLY GRIFFITH 999009999 SARAH HINTZ P00492291 3037795710 2021-05-12 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SHELLY GRIFFITH 122 HOSPITAL ROAD BRUSH CO 80723 16156050 0 X WWW.EBENEZER-CARES.ORG X 1903 CO PROVIDE SKILLED NURSING CARE AND RELATED SERVICES TO THE ELDERLY AND PERSONS WITH SPECIALS NEEDS. 12 12 295 321 0 0 910504 3421983 13133364 12252681 -251894 158164 129730 101292 13921704 15934120 4939 2012 0 0 9090396 8499983 0 0 46071 5389345 6663377 14484680 15165372 -562976 768748 38525819 44579106 28864900 34151039 9660919 10428067 X THE EBEN EZER LUTHERAN CARE CENTER (THE CARE CENTER) WAS ESTABLISHED TO PROVIDE SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING, INDEPENDENT LIVING, PERSONAL CARE AND HOMEMAKING AND LIFELINE EMERGENCY RESPONSE SERVICES TO THE ELDERLY AND PERSONS WITH SPECIAL NEEDS. THE CARE CENTER IS CERTIFIED FOR MEDICARE AND MEDICAID AND IS AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH OF AMERICA. 0 0 13764996 2012 12252681 PROVIDING SKILLED NURSING CARE, RESPITE CARE, ASSISTED LIVING, INDEPENDENT LIVING, PERSONAL CARE, HOMEMAKING AND LIFELINE EMERGENCY RESPONSE SERVICES TO THE EDERLY AND PERSONS WITH SPECIAL NEEDS. THE CARE CENTER PROVIDED SERVICE TO MORE THAN 400 PERSONS FOR PERSONAL AND HOMEMAKING CARE AND RESIDENTIAL SERVICES TO OVER 150 PERSONS. 13764996 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 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 1 1 1 0 0 1 19 0 1 295 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CO X LESLIE MASON 9708422861 122 HOSPITAL ROAD BRUSH CO 80723 SHELLY GRIFFITH CEO 30.00 10.00 X 164071 0 21172 LESLIE MASON CFO 39.00 1.00 X 123641 0 21011 CAROLYN RUHL ADMINISTRATOR 40.00 0.00 X 109849 0 2703 MIKE BERRYHILL CHAIR 1.00 1.00 X X 0 0 0 MARK FRASIER VICE CHAIR 1.00 1.00 X X 0 0 0 ALAN DAHMS PHD SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 SONYA BASS DIRECTOR 1.00 2.00 X 0 0 0 ROBERT CHAPIN DIRECTOR 1.00 2.00 X 0 0 0 DAVID COBB DIRECTOR 1.00 0.00 X 0 0 0 GEORGE DIKEOU DIRECTOR 1.00 2.00 X 0 0 0 CURT FREED DIRECTOR 1.00 1.00 X 0 0 0 WENDY KALAN DIRECTOR 1.00 0.00 X 0 0 0 CATHY LINDELL DIRECTOR 1.00 1.00 X 0 0 0 ROGER SCHAEFER DIRECTOR 1.00 1.00 X 0 0 0 MARC TORMOHOLEN DIRECTOR 1.00 1.00 X 0 0 0 397561 0 44886 3 0 1 0 FRANSEN PITTMAN GENERAL CONTRACT 9563 S KINGSTON COURT ENGLEWOOD CO 80112 CONSTRUCTION 8138594 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 1087616 PREMERE REHAB 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 THERAPY SERVICES 372136 GERTGE TECHNOLOGY 109 CLAYTON STREET BRUSH CO 80723 IT 185413 HANDICARE USA INC PO BOX 360660 PITTSBURGH PA 15251 PATIENT ASSISTANCE 150222 6 1790268 1631715 3421983 PATIENT SERVICE REV. 623000 12252681 12252681 12252681 45855 45855 334239 221930 112309 112309 112309 MISCELLANEOUS 623000 40838 40838 MEALS/CATERING 623000 28677 28677 TELEPHONE 623000 16522 16522 15255 15255 101292 15934120 12252681 0 259456 2012 2012 332943 332943 6912248 6617387 251997 42864 64249 59967 3424 858 884949 839007 45942 305594 303245 2349 27557 27557 49254 49254 1514108 1507757 6351 21777 21777 393079 372941 20138 22419 22195 224 859166 526013 333153 2186956 2186956 273306 140613 132693 SUPPLIES 630302 598579 31723 FOOD 334413 334413 MAINTENANCE AND REPAIR 198760 112616 86144 LEASE AND RENTAL EXPENS 37847 37847 114433 81671 32762 15165372 13764996 1354305 46071 600 433 4063507 4227453 1336440 1163719 69859 117887 107853 279341 51208811 13445103 31257230 37763708 247229 262743 1443101 763822 38525819 44579106 1516029 909550 2544 3304 49258 65379 27062757 32926779 234312 246027 28864900 34151039 X 9660919 10428067 9660919 10428067 38525819 44579106 768748 -1600 0 X X 0 1 X 1 1 1 X 322557 1247752 1525403 910504 3421983 7428199 12559238 13259391 12491457 13133364 12252681 63696131 12881795 14507143 14016860 14043868 15674664 71124330 0 0 0 71124330 145435 109484 67565 39991 45855 408330 145435 109484 67565 39991 45855 408330 131420 157974 225285 129730 101292 745701 13158650 14774601 14309710 14213589 15821811 72278361 0.98400 0.98180 0.00560 0.00680 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - BEAUTY SHOP MEALS TRANSPORTATION ETC - MEAL TICKETS / GUEST MEALS - 2016 AMOUNT: $ 70,916. 2017 AMOUNT: $ 58,517. 2018 AMOUNT: $ 64,452. 2019 AMOUNT: $ 47,967. 2020 AMOUNT: $ 28,677. BEAUTY SHOP - 2016 AMOUNT: $ 20,804. 2017 AMOUNT: $ 22,631. 2018 AMOUNT: $ 19,993. 2019 AMOUNT: $ 15,589. 2020 AMOUNT: $ 10,756. TELEPHONE - 2016 AMOUNT: $ 14,377. 2017 AMOUNT: $ 16,361. 2018 AMOUNT: $ 16,052. 2019 AMOUNT: $ 16,802. 2020 AMOUNT: $ 16,522. MISCELLANEOUS - 2016 AMOUNT: $ 25,323. 2017 AMOUNT: $ 60,465. 2018 AMOUNT: $ 116,130. 2019 AMOUNT: $ 35,258. 2020 AMOUNT: $ 40,838. TRANSPORTATION - 2018 AMOUNT: $ 8,658. 2019 AMOUNT: $ 14,114. 2020 AMOUNT: $ 4,499. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 655071 91355 91355 655071 611907 123801 80637 655071 655071 84690 127854 611907 654333 79981 79243 655071 655071 738 654333 0.00000 1.00000 0.00000 0 1 1 66372 66372 43709735 9174507 34535228 7152977 4270596 2882381 279727 279727 37763708 ASSET RETIREMENT OBLIGATION 246027 246027 X 15935482 -1600 2962 1362 15934120 0 15934120 15168334 2962 2962 15165372 0 15165372 PART IV, LINE 2B: THE CARE CENTER IS THE TRUSTEE OF FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS IN THE SKILLED NURSING FACILITY. PART V, LINE 4: ENDOWMENTS ARE HELD BY EBEN EZER LUTHERAN CARE CENTER FOUNDATION, A RELATED ORGANIZATION. THE ENDOWMENT CONSISTS OF THREE INDIVIDUAL FUNDS ESTABLISHED TO SUPPORT THE OPERATIONS OF THE ORGANIZATION. PART X, LINE 2: THE ORGANIZATION EVALUATES THEIR UNCERTAIN TAX POSITIONS, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF THEIR POLICIES AND PROCEDURES, REVIEW OF THEIR REGULAR TAX FILINGS, AND DISCUSSIONS WITH OUTSIDE EXPERTS. AS OF DECEMBER 31, 2020 AND 2019, THE ORGANIZATION DID NOT HAVE ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: MISC. EXPENSES 2,962. PART XII, LINE 2D - OTHER ADJUSTMENTS: MISC. EXPENSES 2,962. X X 0 0 0 0 0 0 0 0 0 SHELLY GRIFFITH CEO 139071 0 25000 0 0 0 3489 0 17683 0 185243 0 0 0 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 A, LINE 2 SHELLY GRIFFITH, CEO, AND SONYA BASS, DIRECTOR, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE INDEPENDENT CPA FIRM WITH INFORMATION PROVIDED BY MANGEMENT. WHEN PREPARATION IS COMPLETED AND A DRAFT IS AVAILABLE THE AUDIT COMMITTEE REVIEWS THE FORM 990 IN DETAIL BEFORE IT IS FILED AND APPROVES THE FILING OF THE RETURN. THE BOARD OF DIRECTORS THEN IS PROVIDED WITH A COPY OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT APPLIES TO BOARD MEMBERS. AT EVERY BOARD MEETING, THE MEMBERS ARE ASKED IF THERE HAS BEEN A CHANGE IN THEIR INDEPENDENCE WITH THE ORGANIZATION. CONTRACTS AND OTHER TRANSACTIONS WHICH MAY INVOLVE A DIRECT OR INDIRECT CONFLICT OF INTEREST BETWEEN THE BOARD MEMBER AND EBEN EZER SHALL BE VALID, BINDING AND ENFORCEABLE AND SHALL NOT BE VOIDABLE BY EBEN EZER IF (1) THE MATERIAL FACTS OF THE INTEREST ARE FULLY DISCLOSED IN ADVANCE TO THE BOARD OF DIRECTORS OF EBEN EZER, AND (2) AFTER ASCERTAINMENT IN GOOD FAITH OF THE FAIRNESS OF THE TRANSACTION, EVEN THOUGH THE NUMBER OF DISINTERESTED BOARD MEMBERS MAY BE LESS THAN A QUORUM. A BOARD MEMBER WITH A CONFLICT SHOULD NOT ONLY REFRAIN FROM VOTING BUT SHOULD ALSO BE EXCUSED, IF POSSIBLE, FROM ANY BOARD DISCUSSION INVOLVING THE PROPOSED TRANSACTION. MOREOVER, THAT BOARD MEMBER SHOULD NOT PARTICIPATE IN NEGOTIATING THE TERMS OF THE PROPOSED TRANSACTION. ANY CONFLICTS ARE DOCUMENTED WITHIN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15A LINE 15A - THE BOARD REVIEWS SURVEYS FROM OTHER SIMILAR ORGANIZATIONS ON COMPENSATION LEVELS. THE BOARD REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO BASED ON COMPARABLE COMPENSATION. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF HOW THE COMPENSATION IS SET. THE LAST YEAR THE COMPENSATION WAS REVIEWED WAS 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND / OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 12, PART XII, LINE 2C - SELECTION OF INDEPENDENT ACCOUNTANT THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. EBEN EZER LUTHERAN CARE CENTER FOUNDATION 122 HOSPITAL ROAD BRUSH CO 80723 742480396 SUPPORT CO 501(C)(3) LINE 12A, I EBEN EZER LUTHERAN CARE CENTER 1 EBEN EZER LUTHERAN HOUSING CENTER 1900 EDISON STREET BRUSH CO 80723 840884015 HOUSING CO 501(C)(3) LINE 10 EBEN EZER LUTHERAN CARE CENTER 1 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 EBEN EZER LUTHERAN CARE CENTER FOUNDATION C 852000 FMV