2015-05-07T15:21:26-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2013-07-01 200215979 LUTHERAN ASSISTED LIVING AT MIDDLETOWN INC LUTH 8603477144 628 CONGDON STREET WEST MIDDLETOWN CT 06457 LISA COHEN CFO 7742433900 2015-03-18 1 BARBARA MORRISON P00173340 6179848100 2015-03-18 2013 2016-02-25 16:41:14Z ANGELA BOVILL 14 EAST WORCESTER STREET SUITE 300 WORCESTER MA 01604 1036091 0 6011 X WWW.LSSNE.ORG X 2003 CT ELDERLY ASSISTED LIVING. 7 6 0 6 0 0 0 0 1003371 1031703 116 264 2940 4124 1006427 1036091 0 0 0 0 157418 153993 0 0 0 983145 1007151 1140563 1161144 -134136 -125053 6696235 6537327 6963761 6929906 -267526 -392579 WE ARE CALLED TO STRENGTHEN COMMUNITIES BY EMPOWERING PEOPLE TO RESPOND TO LIFE'S CHALLENGES. 0 0 1065866 0 1031703 THE ORGANIZATION OPERATES A 45 UNIT ASSISTED HOUSING FACILITY FOR THE ELDERLY. 1065866 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 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 0 0 0 1 5 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CT X X LISA COHEN 7742433900 14 EAST WORCESTER STREET SUITE 300 WORCESTER MA 01604 JEFF KINNEY CHAIR 0.30 4.20 X 0 0 0 GAIL BUCHER VICE CHAIR 0.30 4.20 X 0 0 0 KAREN GAYLIN SECRETARY 0.30 4.20 X 0 0 0 ANGELA BOVILL DIRECTOR/CEO 2.40 37.60 X X 0 226674 11960 GARTH GREIMANN FINANCIAL SECRETARY 0.30 4.20 X 0 0 0 DR DON SWEET DIRECTOR 0.30 4.20 X 0 0 0 WILLAM SWANSON DIRECTOR 0.30 4.20 X 0 0 0 LISA COHEN EXECUTIVE VP/CFO 2.40 37.60 X 0 152702 6477 DANA RAMISH EXECUTIVE VP/COO 2.40 37.60 X 0 92583 4982 NICHOLAS RUSSO TREASURER 2.40 37.60 X 0 121048 6379 ALANA GEARY CLERK 2.40 37.60 X 0 60467 7379 JILL FORBES VP OF CT OPERATIONS 2.40 37.60 X 0 121131 11007 JEAN M JACKSON VP OF HR 2.40 37.60 X 0 159137 5889 WILLIAM AMES SR. VP OF OPERATIONS 2.40 37.60 X 0 127510 4777 0 1061252 58850 0 0 1 0 0 RENTAL INCOME 623000 798071 798071 MEALS INCOME 623000 233632 233632 1031703 264 264 MISCELLANEOUS REVENUE 623000 4124 4124 4124 1036091 1031703 0 4388 123263 123263 15534 15534 15196 15196 49519 49519 45759 45759 33895 33895 7 7 38148 38148 133523 133523 67 67 240933 240933 198816 198816 24768 24768 RESIDENT CARE COSTS 241653 241653 BAD DEBT EXPENSE 63 63 1161144 1065866 95278 0 56334 47144 3761 111 25588 19802 7432800 1663275 5958742 5769525 651810 700745 6696235 6537327 42637 26565 2289 97 6534338 6501398 384497 401846 6963761 6929906 X -267526 -392579 -267526 -392579 6696235 6537327 -125053 0 X 0 1 X 1 0 X 935831 1029662 983972 1003371 1031703 4984539 935831 1029662 983972 1003371 1031703 4984539 0 0 0 4984539 630 454 105 116 264 1569 630 454 105 116 264 1569 5220 679 4674 2940 4124 17637 941681 1030795 988751 1006427 1036091 5003745 0.99620 0.99390 0.00030 0.00080 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2009 AMOUNT: $ 5,220. 2010 AMOUNT: $ 679. 2011 AMOUNT: $ 4,674. 2012 AMOUNT: $ 2,940. 2013 AMOUNT: $ 4,124. 7320936 1635690 5685246 111864 27585 84279 5769525 REPLACEMENT RESERVE 196080 TENANT SECURITY DEPOSITS 33824 GROUND LEASE AQUISITIONS COSTS, NET 78129 ESCROW DEPOSITS 65549 DEFERRED GROUND LEASE EXPENSE, NET 265118 LOAN ACQUISITION COSTS, NET 62045 700745 TENANT SECURITY DEPOSITS 33824 DUE TO RELATED PARTIES 68022 ACCRUED GROUND LEASE EXPENSE 300000 401846 X 1036091 0 1036091 0 1036091 1161144 0 1161144 0 1161144 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION FILES AS A TAX EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ENTITY'S 2011 THROUGH 2014 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. 0 0 0 0 0 0 0 0 0 ANGELA BOVILL DIRECTOR/CEO 0 198674 0 0 0 28000 0 0 0 11960 0 238634 0 0 LISA COHEN EXECUTIVE VP/CFO 0 152702 0 0 0 0 0 0 0 6477 0 159179 0 0 JEAN M JACKSON VP OF HR 0 159137 0 0 0 0 0 0 0 5889 0 165026 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE COPORATE MEMBER OF THE ORGANIZATION IS LUTHERAN SOCIAL SERVICES OF NEW ENGLAND, INC. ON SEPTEMBER 1, 2014 LUTHERAN SOCIAL SERVICES OF NEW ENGLAND, INC. BECAME ASCENTRIA CARE ALLIANCE. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER'S GOVERNING BOARD ELECTS ALL THE MEMBERS OF THIS ORGANIZATION'S GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE TRANSACTIONS SUBJECT TO MEMBER APPROVAL ARE ACQUISITIONS OF DEBT, SALE OF ASSETS, ANNUAL BUDGET, MERGERS AND BYLAW REVISIONS. FORM 990, PART VI, SECTION B, LINE 11 FINANCE MANAGEMENT WILL REVIEW THE 990 WHEN IT IS COMPLETED. THE AUDIT COMMITTEE OF THE LSS BOARD WILL PROVIDE SECONDARY REVIEW AND APPROVAL PRIOR TO SUBMISSION TO THE IRS. THE DOCUMENTS ARE POSTED TO THE BOARD INTRANET FOR REVIEW BY THE LSS FINANCE COMMITTEE AS WELL AS ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY TO DISCLOSE ANY CONFLICTS. CONFLICTS ARE REVIEWED BY THE CEO AND THE GOVERNANCE COMMITTEE. BOARD MEMBERS WITH CONFLICTS ARE RESTRICTED ON VOTING ON ANY ACTIONS RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. RELATED ORGANIZATIONS FILE UNDER GROUP EXEMPTION 6011 - DISCLOSURE NOT REQ CT 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0