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LUTHERAN HOME-HICKORY INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
LUTHERAN HOME-HICKORY INC (EIN 20-1457341)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-02-14
IRS object ID
201410459349301961
Schema version
2012v2.3
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)
Timestamp2014-02-14T13:10:32-06:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LANGDON & COMPANY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1223 US HIGHWAY 70 EAST SUITE 100AddressLine1
CityGARNERCity
StateNCState
ZIP Code275294051ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN201457341EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LUTHERAN HOME - HICKORY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLUTHNameControl
Phone7046372870Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 947AddressLine1
CitySALISBURYCity
StateNCState
ZIP Code281450947ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKIRBY NICKERSONName
TitleTREASURERTitle
Phone7046372870Phone
Date Signed2014-02-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameANTHONY T PANDISCIAName
Phone9196621001Phone
Date Prepared2014-02-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTED GOINSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 947AddressLine1
CitySALISBURYCity
StateNCState
ZIP Code281450947ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13380703GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LSCAROLINAS.NETWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionLUTHERAN HOME - HICKORY, INC. PROVIDES LONG-TERM AND SHORT-TERM SKILLED NURSING, ASSISTED LIVING, SPECIAL CARE FOR PEOPLE WITH DEMENTIA, AND REHABILITATION SERVICES TO FRAIL OLDER ADULTS AND OTHERS IN A RESIDENTIAL SETTING IN SUPPORT OF THE LUTHERAN SERVICES FOR THE AGING, INC. (LSA), A MINISTRY OF THE NORTH CAROLINA SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. THE ORGANIZATION STRIVES TO EXPRESS GOD'S LOVE IN CHRIST TO THOSE WE SERVE BY: PROVIDING MULTIPLE SERVICES FOR SENIORS INCLUDING NURSING CARE, ADULT DAY CARE, AND RETIREMENT LIVING; MINISTERING TO THEIR NEEDS IN TRADITIONAL AND INNOVATIVE WAYS; AND DEMONSTRATING RESPONSIBLE STEWARDSHIP. THE PEOPLE OF LSA ARE COMPASSIONATE PEOPLE, WITH LOVING SPIRITS AND GENEROUS HEARTS. RESIDENTS, STAFF, CLIENTS, PARTICIPANTS, FAMILIES, AND VOLUNTEERS ALL STRIVE TO BE OF SERVICE TO GOD AND THE COMMUNITY. MANY OF THE THOSE SERVED BY LSA HAVE BEEN SERVICE ORIENTED AND PHILANTHROPICALLY INCLINED THROUGHOUT THEIR LIVES AND CONTINUE TO SEEK OActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees328TotalNbrEmployees
Total Nbr Volunteers130TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year48015ContributionsGrantsPriorYear
Contributions Grants Current Year74694ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13553490ProgramServiceRevenuePriorYear
Program Service Revenue CY13268504ProgramServiceRevenueCY
Investment Income Prior Year5543InvestmentIncomePriorYear
Investment Income Current Year20841InvestmentIncomeCurrentYear
Other Revenue Prior Year25252OtherRevenuePriorYear
Other Revenue Current Year16659OtherRevenueCurrentYear
Total Revenue Prior Year13632300TotalRevenuePriorYear
Total Revenue Current Year13380698TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year20000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY18547GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7272328SalariesEtcPriorYear
Salaries Etc Current Year7247346SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5615910OtherExpensePriorYear
Other Expenses Current Year5421362OtherExpensesCurrentYear
Total Expenses Prior Year12908238TotalExpensesPriorYear
Total Expenses Current Year12687255TotalExpensesCurrentYear
Revenues Less Expenses Prior Year724062RevenuesLessExpensesPriorYear
Revenues Less Expenses CY693443RevenuesLessExpensesCY
Total Assets BOY7035464TotalAssetsBOY
Total Assets EOY7933170TotalAssetsEOY
Total Liabilities BOY951005TotalLiabilitiesBOY
Total Liabilities EOY1135583TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6084459NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6797587NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionLUTHERAN HOME - HICKORY, INC. PROVIDES LONG-TERM AND SHORT-TERM SKILLED NURSING, ASSISTED LIVING, SPECIAL CARE FOR PEOPLE WITH DEMENTIA, AND REHABILITATION SERVICES TO FRAIL OLDER ADULTS AND OTHERS IN A RESIDENTIAL SETTING IN SUPPORT OF THE LUTHERAN SERVICES FOR THE AGING, INC. (LSA), A MINISTRY OF THE NORTH CAROLINA SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. THE ORGANIZATION STRIVES TO EXPRESS GOD'S LOVE IN CHRIST TO THOSE WE SERVE BY: PROVIDING MULTIPLE SERVICES FOR SENIORS INCLUDING NURSING CARE, ADULT DAY CARE, AND RETIREMENT LIVING; MINISTERING TO THEIR NEEDS IN TRADITIONAL AND INNOVATIVE WAYS; AND DEMONSTRATING RESPONSIBLE STEWARDSHIP. THE PEOPLE OF LSA ARE COMPASSIONATE PEOPLE, WITH LOVING SPIRITS AND GENEROUS HEARTS. RESIDENTS, STAFF, CLIENTS, PARTICIPANTS, FAMILIES, AND VOLUNTEERS ALL STRIVE TO BE OF SERVICE TO GOD AND THE COMMUNITY. MANY OF THE THOSE SERVED BY LSA HAVE BEEN SERVICE ORIENTED AND PHILANTHROPICALLY INCLINED THROUGHOUT THEIR LIVES AND CONTINUE TO SEEK OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense12230356Expense
Grants18547Grants
Revenue13268504Revenue
DescriptionLUTHERAN HOME - HICKORY, INC. OFFERS SHORT-TERM REHABILITATION, LONG-TERM CARE, AND ASSISTED LIVING SERVICES TO PEOPLE OF ALL FAITHS AND ECONOMIC STATUS. THE ORGANIZATION ALSO PROVIDES SKILLED NURSING AND ASSISTED LIVING CARE FOR THE OFTEN DIFFICULT-TO-PLACE ALZHEIMER'S RESIDENTS. LUTHERAN HOME - HICKORY, INC. STRIVES TO BE A TRUE HOME FOR ITS RESIDENTS, A PLACE OF COMFORT, SECURITY AND BELONGING. STAFF EMPHASIZE BOTH QUALITY CARE AND QUALITY OF LIFE. MEANINGFUL ACTIVITIES BRING RESIDENTS, STAFF, FAMILIES AND VOLUNTEERS TOGETHER IN A SPIRIT OF FUN AND FELLOWSHIP. STAFF ARE COMMITTED TO PROVIDING COMPASSIONATE CARE AND PERSONAL ATTENTION TO RESIDENTS WHILE MEETING THE UNIQUE MEDICAL, EMOTIONAL, AND SPIRITUAL NEEDS OF EACH INDIVIDUAL. CHAPLAINS ARE AVAILABLE TO OFFER SUPPORT AND GUIDANCE TO FAMILIES AND RESIDENTS DURING ADMISSION AND THROUGHOUT THEIR STAY. DURING THE YEAR ENDED SEPTEMBER 30, 2013, LUTHERAN HOME - HICKORY, INC. PROVIDED 61,318 DAYS OF CARE TO 528 RESIDENTS.Description
Total Program Service Expense12230356TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109632NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees328NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSUSAN MILLERNamePerson
Telephone Number7046372870TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11416 S MARTIN LUTHER KING JR AVEAddressLine1
CitySALISBURYCity
StateNCState
ZIP Code28144ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormer
TED GOINS JR
PRESIDENT40.001.00XX02532478557
REV SUSAN BAME
DIRECTOR1.001.00X000
REV DR LEONARD BOLICK
DIRECTOR1.001.00X000
JERRY BRAMLEY
DIRECTOR1.001.00X000
DR JOHN BUMGARNER
DIRECTOR1.001.00X000
JOYCE ERICSON
DIRECTOR1.001.00X000
REV MARY FINKLEA
DIRECTOR1.001.00X000
JOY FISHER
DIRECTOR1.001.00X000
REV DR THOMAS HURLOCKER
DIRECTOR1.001.00X000
JOYCELYN JOHNSON
DIRECTOR1.001.00X000
KAYE LEONARD
DIRECTOR1.001.00X000
BETTY LOHR
DIRECTOR1.001.00X000
DR SHANNON MATHEWS
DIRECTOR1.001.00X000
LORETTA MEYERS
DIRECTOR1.001.00X000
DOUG NELSON
DIRECTOR1.001.00X000
DEREK SHOEMAKE
DIRECTOR1.001.00X000
STEVE STANFIELD-SWITZER
DIRECTOR1.001.00X000
ERIC VAUGHN
DIRECTOR1.001.00X000
REV DR HERMAN YOOS III
DIRECTOR1.001.00X000
J WHITE IDDINGS JR
DIRECTOR1.001.00X000
ROSEBUD REUBEL
DIRECTOR1.001.00X000
KESHA SMITH
CHIEF OPER.40.001.00X01413236896
ELIZABETH KUHN
DIRECTOR R&D40.001.00X01265626637
AMBER MCINTOSH
ADMINISTRATO40.00X11916106582
MYRA GRIFFIE
CHIEF OPER.40.001.00X01101665353
KIRBY NICKERSON
TREASURER/CF40.001.00X0827656068
KAREN MADDRY
SECRETARY40.001.00X0546126135
MARCHETA CAMPBELL
ADMINISTRATO40.00X000
PATRICK FOLEY
CHIEF OPER.40.001.0001441196984X
ANNETTE CONRAD
TREASURER40.001.000518091568X
FieldValueIRS element (for citing)
Total Reportable Comp From Org119161TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs964603TotalReportableCompFrmRltdOrgs
Total Other Compensation54780TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GENESIS HEALTHCARE
6549 PAYSPHERE CIRCLECHICAGOIL60674THERAPY SRVCS901248
INTERSCAPES INC
1323 THE PLAZACHARLOTTENC28205INTERIOR DESIGN102926
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Related Organizations18547RelatedOrganizations
All Other Contributions56147AllOtherContributions
Total Contributions74694TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
SERVICE FEE REVENUES1208722912087229
ANCILLARY INCOME11812751181275
FieldValueIRS element (for citing)
Total Program Service Revenue13268504TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column19796TotalRevenueColumn
Exclusion$19,796ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1050Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1045Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1045TotalRevenueColumn
Related Or Exempt Function Income1045RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Total Revenue Column16659TotalRevenueColumn
Related Or Exempt Function Income16659RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue16659TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13380698TotalRevenueColumn
Related Or Exempt Function Income13286208RelatedOrExemptFunctionIncome
Exclusion$19,796ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total18547Total
Program Services18547ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total130700Total
Program Services124534ProgramServices
Management And General6166ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5926342Total
Program Services5635606ProgramServices
Management And General290736ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total713674Total
Program Services713674ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total476630Total
Program Services476630ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total530056Total
Program Services530056ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3712Total
Management And General3712ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total17332Total
Management And General17332ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total9064Total
Program Services188ProgramServices
Management And General8876ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total18513Total
Program Services1801ProgramServices
Management And General16712ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total600000Total
Program Services600000ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total14578Total
Program Services11724ProgramServices
Management And General2854ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total5695Total
Program Services5695ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total163082Total
Program Services163082ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total59552Total
Management And General59552ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
ANCILLARY EXPENSES15461411546141
PHARMACY DRUGS711912711912
FOOD524493524493
BED ASSESSMENT340198340198

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total877034Total
Program Services826075ProgramServices
Management And General50959ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12687255Total
Program Services12230356ProgramServices
Management And General456899ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1708482BOY
EOY1716115EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1227699BOY
EOY1162316EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY40231BOY
EOY36930EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY140BOY
EOY140EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2514678LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1817823LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY710790BOY
EOY696855EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY504370BOY
EOY543523EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2843752BOY
EOY3777291EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7035464BOY
EOY7933170EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY951005BOY
EOY928498EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
EOY207085EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY951005BOY
EOY1135583EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6021361BOY
EOY6782882EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY63098BOY
EOY14705EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6084459BOY
EOY6797587EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7035464BOY
EOY7933170EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses693443ReconcilationRevenueExpenses
Reconciliation Unrealized Invest19685ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years159467CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years87078CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years57604CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year48015CurrentTaxYearMinus1Year
Current Tax Year74694CurrentTaxYear
Total426858Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10972143CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11733044CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12872788CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13578742CurrentTaxYearMinus1Year
Current Tax Year13285163CurrentTaxYear
Total62441880Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11131610CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11820122CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12930392CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13626757CurrentTaxYearMinus1Year
Current Tax Year13359857CurrentTaxYear
Total62868738Total
FieldValueIRS element (for citing)
Public Support Total50962868738PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16488CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20618CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18633CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5543CurrentTaxYearMinus1Year
Current Tax Year19796CurrentTaxYear
Total81078Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16488CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20618CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18633CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5543CurrentTaxYearMinus1Year
Current Tax Year19796CurrentTaxYear
Total81078Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11148098CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11840740CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12949025CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13632300CurrentTaxYearMinus1Year
Current Tax Year13379653CurrentTaxYear
Total62949816Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99870PublicSupportPercentage509
Prior Year Support Percentage0.99830PriorYearSupportPercentage
Investment Income Percentage0.00000InvestmentIncomePercentage
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 Balance504059BeginningOfYearBalance
Investment Earnings Or Losses38763InvestmentEarningsOrLosses
End Of Year Balance542822EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance152624BeginningOfYearBalance
Investment Earnings Or Losses351435InvestmentEarningsOrLosses
End Of Year Balance504059EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance51624BeginningOfYearBalance
Contributions101000Contributions
End Of Year Balance152624EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance51624BeginningOfYearBalance
End Of Year Balance51624EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance48624BeginningOfYearBalance
Contributions3000Contributions
End Of Year Balance51624EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18864OtherCostOrOtherBasis
Depreciation4795Depreciation
Book Value14069BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2328340OtherCostOrOtherBasis
Depreciation1652491Depreciation
Book Value675849BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis167474OtherCostOrOtherBasis
Depreciation160537Depreciation
Book Value6937BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings696855TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
INTERCOMPANY3589135
OTHER ASSETS159373
CIP20713
DUE FROM AFFILIATE8070
FieldValueIRS element (for citing)
Total Book Value Other Assets3777291TotalBookValueOtherAssets
Tot Revenue Etc Audited Fincl Stmt13400383TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments19685NetUnrealizedGainsInvestments
Revenue Not Rptd F99019685RevenueNotRptdF990
Revenue Subtotal13380698RevenueSubtotal
Total Revenue Per Form99013380698TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12687255TotExpensesEtcAuditedFinclStmt
Expenses Subtotal12687255ExpensesSubtotal
Total Expenses Per Form99012687255TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
INTENDED USES FOR ENDOWMENT FUNDSSCHEDULE D, PAGE 2, PART V, LINE 4THE ORGANIZATION'S ENDOWMENT CONSISTS OF DONOR-RESTRICTED INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. INCOME FROM THE ENDOWMENTS ARE USED BUT NOT LIMITED TO FUTURE EXPANSION, EQUIPMENT PURCHASES AND FUTURE PROGRAM SERVICE NEEDS.
LIABILITY UNDER FIN 48 FOOTNOTESCHEDULE D, PAGE 3, PART XSUBSTANTIALLY ALL AFFILIATES OF LSA AND LFS ARE ORGANIZED AS NORTH CAROLINA NOT-FOR-PROFIT ORGANIZATIONS AND ARE EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3) UNDER A GROUP EXEMPTION OF THE ELCA. LFS REAL PROPERTIES, INC. IS EXEMPT UNDER IRC SECTION 501(C)(2). THE ORGANIZATIONS RECORD A LIABILITY FOR ANY TAX POSITION TAKEN THAT IS BENEFICIAL TO THE ORGANIZATIONS, INCLUDING ANY RELATED INTEREST AND PENALTIES, WHEN IT IS MORE LIKELY THAN NOT THE POSITION OF MANAGEMENT WITH RESPECT TO A TRANSACTION OR CLASS OF TRANSACTIONS WILL BE OVERTURNED BY A TAXING AUTHORITY UPON EXAMINATION. MANAGEMENT BELIEVES THERE ARE NO SUCH POSITIONS AS OF SEPTEMBER 30, 2013 OR 2012. TAX YEARS SUBSEQUENT TO 2008 REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS.
SUPPLEMENTAL FINANCIAL INFORMATIONSCHEDULE D, PAGE 4, PART XIIIPART V - ENDOWMENT FUNDS AMOUNTS REPORTED AS THE CURRENT YEAR END OF YEAR BALANCE AMONG THE CONTROL GROUP ACCURATELY TIE BACK TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuation
RHYNE SCHOLARSHIP315000FMV
HOLLAR SCHOLARSHIP23547FMV

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationTHE ORGANIZATION MAINTAINS CONTACT RECORDS ON RESIDENT GRANT RECIPIENTS AS WELL AS CONSISTENTLY FOLLOWS UP WITH INDIVIDUALS TO ENSURE THEY ARE MEETING THE ORGANIZATION'S REQUIREMENTS AND REMAIN ELIGIBLE FOR THE GRANT. PART III, LINE 1 - ADDITIONAL INFORMATION ALTHOUGH REPORTED IN AGGREGATE FOR PURPOSES OF TRANSPARENCY, NO SINGLE GRANT MADE IN THE CURRENT YEAR WAS VALUED AT AN AMOUNT GREATER THAN 5,000.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

TitleTitleComp Based On Related OrgsCompBasedOnRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgs
TED GOINS JR
PRESIDENT25324724936064261804
PATRICK FOLEY
CHIEF OPER OFFICER14411914415543151103
ANNETTE CONRAD
TREASURER51809514105453377

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONLUTHERAN HOME - HICKORY, INC. PROVIDES LONG-TERM AND SHORT-TERM SKILLED NURSING, ASSISTED LIVING, SPECIAL CARE FOR PEOPLE WITH DEMENTIA, AND REHABILITATION SERVICES TO FRAIL OLDER ADULTS AND OTHERS IN A RESIDENTIAL SETTING IN SUPPORT OF THE LUTHERAN SERVICES FOR THE AGING, INC. (LSA), A MINISTRY OF THE NORTH CAROLINA SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. THE ORGANIZATION STRIVES TO EXPRESS GOD'S LOVE IN CHRIST TO THOSE WE SERVE BY: PROVIDING MULTIPLE SERVICES FOR SENIORS INCLUDING NURSING CARE, ADULT DAY CARE, AND RETIREMENT LIVING; MINISTERING TO THEIR NEEDS IN TRADITIONAL AND INNOVATIVE WAYS; AND DEMONSTRATING RESPONSIBLE STEWARDSHIP. THE PEOPLE OF LSA ARE COMPASSIONATE PEOPLE, WITH LOVING SPIRITS AND GENEROUS HEARTS. RESIDENTS, STAFF, CLIENTS, PARTICIPANTS, FAMILIES, AND VOLUNTEERS ALL STRIVE TO BE OF SERVICE TO GOD AND THE COMMUNITY. MANY OF THE THOSE SERVED BY LSA HAVE BEEN SERVICE ORIENTED AND PHILANTHROPICALLY INCLINED THROUGHOUT THEIR LIVES AND CONTINUE TO SEEK OPPORTUNITIES FOR COMMUNITY SERVICE IN THEIR OLDER YEARS. FOR THE YOUNG-ELDERS OF THE RETIREMENT COMMUNITIES THOSE OPPORTUNITIES ARE ABUNDANT. RESIDENTS THERE LOG IN HUNDREDS OF VOLUNTEER HOURS FOR LOCAL CHURCHES, HABITAT FOR HUMANITY, THE ALZHEIMER'S ASSOCIATION, THE STATE VETERANS HOSPITAL, FUNDRAISING FOR CANCER RESEARCH, LITERACY COUNCILS, LOCAL HOSPITALS, FOOD PANTRIES, HOMELESS SHELTERS, THE UNITED WAY, AND MENTORING PROJECTS FOR LOCAL ELEMENTARY SCHOOLS. THEY HAVE PACKED BOXES FOR SAMARITAN'S PURSE, GATHERED COATS FOR KIDS, AND COLLECTED CANNED GOODS FOR FOOD PANTRIES. THEY HAVE SEWN, KNITTED, CROCHETED, AND QUILTED COUNTLESS ITEMS FOR CAUSES THROUGHOUT THE STATE AND BEYOND. THE MORE FRAIL ELDERS OF THE LUTHERAN NURSING HOMES AND ADULT DAY SERVICES MAY BE LESS VISIBLE, BUT ARE EQUALLY COMMITTED TO COMMUNITY SERVICE. SUPPORTED BY STAFF AND VOLUNTEERS, THEY HAVE HELD BLOOD DRIVES, BAKE SALES, AND CRAFT SALES. THEY HAVE HOSTED BREAKFASTS FOR FIRE, POLICE, AND EMERGENCY SERVICE PERSONNEL, COLLECTED SCHOOL SUPPLIES FOR KIDS, AND ADOPTED NEEDY FAMILIES AT CHRISTMAS. THEY HAVE LOGGED IN HUNDREDS OF HOURS IN PROJECTS FOR LOCAL SCHOOLS AND HOSPITALS, THE ARC, THE ALZHEIMER'S ASSOCIATION, MADD (MOTHERS AGAINST DRUNK DRIVING), MEAL-ON-WHEELS, THE HUMANE SOCIETY, THE AMERICAN RED CROSS, THE UNITED WAY, AND MORE. LSA ALSO SERVES ITS COMMUNITIES BY WORKING COLLABORATIVELY WITH COLLEGES AND UNIVERSITIES THROUGHOUT NORTH CAROLINA INCLUDING CATAWBA, LIVINGSTONE, AND LENOIR-RHYNE COLLEGES; CATAWBA VALLEY, GASTON, ROWAN-CABARRUS, STANLY, CALDWELL AND FORSYTH COMMUNITY COLLEGES; APPALACHIAN STATE, WINSTON-SALEM STATE, AND DUKE UNIVERSITIES; THE UNIVERSITY OF NORTH CAROLINA, AND HOOD THEOLOGICAL SEMINARY. THESE COLLABORATIVE EFFORTS ENHANCE COOPERATION, FOSTER GROWTH AND COOPERATION, AND ULTIMATELY IMPROVE THE QUALITY OF LIFE FOR THE INSTITUTIONS AND THE COMMUNITIES. LSA ALSO ENCOURAGES COMMUNITY MEMBERS TO SEEK VOLUNTEER, EDUCATIONAL, AND SPIRITUAL OPPORTUNITIES THROUGH ITS MINISTRIES. THE MINISTRIES OF LSA ARE ACTIVE, BUSY PLACES WHERE MULTIPLE GENERATIONS MEET IN A SPIRIT OF FUN, FELLOWSHIP AND COOPERATION. RESOURCES ARE AVAILABLE TO THE COMMUNITY ADDRESSING A BROAD RANGE OF AGING ISSUES SUCH AS HEALTHY AGING, NURSING HOME CARE, ADULT DAY CARE, ALZHEIMER'S DISEASE, MEDICAID AND MEDICARE, AND HEALTHCARE DIRECTIVES.
FIRST ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4AOF EACH INDIVIDUAL. CHAPLAINS ARE AVAILABLE TO OFFER SUPPORT AND GUIDANCE TO FAMILIES AND RESIDENTS DURING ADMISSION AND THROUGHOUT THEIR STAY. DURING THE YEAR ENDED SEPTEMBER 30, 2013, LUTHERAN HOME - HICKORY, INC. PROVIDED 61,318 DAYS OF CARE TO 528 RESIDENTS.
ADDITIONAL INFORMATIONFORM 990, PART VIWHISTLEBLOWER POLICY LUTHERAN SERVICES FOR THE AGING, INC. & AFFILIATES ARE COMMITTED TO THEIR ROLE IN PREVENTING HEALTH CARE FRAUD AND ABUSE AND COMPLYING WITH APPLICABLE STATE AND FEDERAL LAWS RELATED TO HEALTH CARE FRAUD AND ABUSE. THE CIVIL FALSE CLAIMS ACT PROVIDES FOR PROTECTION FOR EMPLOYEES FROM RETALIATION. ANY EMPLOYEE WHO IS DISCHARGED, DEMOTED, SUSPENDED, THREATENED, HARASSED, OR DISCRIMINATED AGAINST IN TERMS AND CONDITIONS OF EMPLOYMENT BECAUSE OF LAWFUL ACTS CONDUCTED IN FURTHERANCE OF AN ACTION UNDER THE FCA MAY BRING AN ACTION IN FEDERAL DISTRICT COURT SEEKING REINSTATEMENT, TWO TIMES THE AMOUNT OF BACK PAY PLUS INTEREST, AND OTHER ENUMERATED COSTS, DAMAGES, AND FEES. DOCUMENTATION RETENTION AND DESTRUCTION POLICY EACH ENTITY WITHIN THE LUTHERAN SERVICES FOR THE AGING, INC. & AFFILIATES GROUP WILL ENSURE THAT RECORDS ARE RETAINED FOR THE REQUIRED TIME PERIODS ESTABLISHED BY STATE LAWS, FEDERAL REGULATIONS, AND PAYOR REQUIREMENTS TO MEET THE NEEDS OF LEGITIMATE USERS. AT THE END OF THE RETENTION PERIOD, EACH ENTITY WILL ENSURE THAT DESTRUCTION OF RECORDS IS PERFORMED ACCORDING TO SPECIFIC PROCEDURE AND AUTHORIZATION WITH APPROPRIATE SUPERVISION OF DESTRUCTION. THE PROPER METHOD OF DESTRUCTION FOR ANY PAPER RECORD IS BY SHREDDING OR INCINERATION ONLY. PRIOR TO THE DESTRUCTION OF ANY FACILITY RECORDS, WHETHER ORIGINAL OR COMPUTER MEDIA, A CHECK WILL BE MADE TO ENSURE THE RETENTION PERIOD HAS EXPIRED AS DEFINED BY STATE LAWS AND FACILITY POLICIES. ANY RECORDS IN OPEN INVESTIGATION, AUDIT, OR LITIGATION WILL NOT BE DESTROYED. FOR FACILITIES USING ELECTRONIC MEDICAL RECORDS, RECORDS WILL BE STORED IN THE SYSTEM INDEFINITELY AND THE DESTRUCTION PROCESS WILL NOT APPLY.
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3LSA MANAGEMENT, INC. PROVIDES ADMINISTRATIVE SUPPORT, MANAGEMENT, ACCOUNTING, INFORMATION TECHNOLOGY, AND RESOURCE DEVELOPMENT SERVICES TO LUTHERAN SERVICES FOR THE AGING AND ITS AFFILIATES. SEE SCHEDULE R, PART V.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 IS REVIEWED BY THE CHIEF FINANCE OFFICER AND MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. ANY MATTERS ARE RAISED TO THE OUTSIDE ACCOUNTANTS FOR COLLABORATION AND ULTIMATE RESOLUTION.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CBOARD MEMBERS RECEIVE A BOARD MANUAL AS PART OF ORIENTATION WHEN THEY JOIN THE BOARD, WHICH INCLUDES THE CORPORATE COMPLIANCE POLICY AND BYLAWS. BOTH THE POLICY AND THE BYLAWS ADDRESS CONFLICT OF INTEREST. THEREAFTER, ANNUALLY, THE BOARD OF DIRECTORS RECEIVE CORPORATE COMPLIANCE TRAINING AND COMPLETE A CONFLICT OF INTEREST DISCLOSURE.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15AALL COMPENSATION LIMITS ARE COMPARED TO STATE AND NATIONAL RANGES BASED ON FACILITY SIZE AND EXPERIENCE OF STAFF. THE BOARD OF DIRECTORS APPROVE THE COMPENSATION OF THE PRESIDENT WHICH IS PAID BY THE MANAGING ORGANIZATION OF THE CONTROL GROUP.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BALL COMPENSATION LIMITS ARE COMPARED TO STATE AND NATIONAL RANGES BASED ON FACILITY SIZE AND EXPERIENCE OF STAFF. THE PRESIDENT APPROVES THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES. OFFICERS OF THE CONTROLLED GROUP ARE PAID BY THE MANAGING ORGANIZATION AND CERTAIN ORGANIZATIONS WITHIN THE CONTROL GROUP ALSO COMPENSATE KEY EMPLOYEES DIRECTLY.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19FORMS 990 ARE POSTED ON GUIDESTAR AND AVAILABLE UPON REQUEST AT THE LSA OFFICE LOCATED IN SALISBURY, NC.
ADDITIONAL INFORMATIONFORM 990, PART VIIFORMER OFFICERS PATRICK FOLEY SERVED AS CHIEF OPERATING OFFICER UNTIL 10/12/12 AND HIS 2012 W-2 INCOME IS PROPERLY REPORTED ON PART VII. KESHA SMITH THEN TOOK OVER THE CHIEF OPERATING OFFICER POSITION, WHICH REPLACED HER PREVIOUS CHIEF ADMIN OFFICER POSITION. ANNETTE CONRAD SERVED AS TREASURER UNTIL 2/10/12 AND HER 2012 W-2 INCOME IS PROPERLY REPORTED ON PART VII. MARCHETA CAMPBELL TOOK THE POSITION OF ADMINISTRATOR IN MARCH OF 2013 AND THEREFORE DID NOT RECEIVE COMPENSATION IN CALENDAR YEAR 2012 OR A CORRESPONDING 2012 FROM W-2. AMBER MCINTOSH SERVED AS ADMINISTRATOR UNTIL MARCH 2013 AND HER 2012 W-2 INCOME IS PROPERLY REPORTED ON PART VII. PART VII, SECTION A - COLUMN (B) HOURS FOR RELATED ORGANIZATIONS BOARD MEMBERS AND OFFICERS DEVOTE TIME TO ALL ENTITIES WITHIN THE CONTROL GROUP.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (30 entries)

Business Name Line2NameOfDisregardedEntity/BusinessNameLine2Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ABUNDANT LIVING ADULT DAY SERVICES
INCPO BOX 947SALISBURYNC28145561884652ADULT DAYNC501C39LSA INCtrue
LFS REAL PROPERTIES INC
PO BOX 2369SALISBURYNC28145581820383REAL ESTATNC501C2LFStrue
LSA ELMS AT TANGLEWOOD INC
PO BOX 947SALISBURYNC28145263735637ASSIST LVGNC501C39LSA INCtrue
LSA ELMS PROPERTY INC
PO BOX 947SALISBURYNC28145263739962LEASINGNC501C39LSA INCtrue
LSA MANAGEMENT INC
PO BOX 947SALISBURYNC28145201457236MANAGEMENTNC501C39LSA INCtrue
LSA PHARMACY INC
PO BOX 947SALISBURYNC28145201457251PHARMACYNC501C39LSA INCtrue
LUTHERAN FAMILY SERVICES IN THE
CAROLINASPO BOX 2369SALISBURYNC28145561286323COMM. SVCNC501C311BLSA INCtrue
LUTHERAN HOME - ALBEMARLE INC
PO BOX 947SALISBURYNC28145201457298NURSINGNC501C39LSA INCtrue
LUTHERAN HOME - FORSYTH COUNTY INC
PO BOX 947SALISBURYNC28145263328029NURSINGNC501C39LSA INCtrue
LUTHERAN HOME - HICKORY WEST INC
PO BOX 947SALISBURYNC28145201457410NURSINGNC501C39LSA INCtrue
LUTHERAN HOME - WILMINGTON INC
PO BOX 947SALISBURYNC28145260158686NURSINGNC501C39LSA INCtrue
LUTHERAN HOME - WINSTON-SALEM INC
PO BOX 947SALISBURYNC28145561500212NURSINGNC501C39LSA INCtrue
LUTHERAN HOME ALBEMARLE PROPERTY
INCPO BOX 947SALISBURYNC28145201457273LEASINGNC501C39LSA INCtrue
LUTHERAN HOME AT TRINITY OAKS
PROPERTY INCPO BOX 947SALISBURYNC28145201457796LEASINGNC501C39LSA INCtrue
LUTHERAN HOME AT TRINITY OAKS INC
PO BOX 947SALISBURYNC28145201457824NURSINGNC501C39LSA INCtrue
LUTHERAN HOME FORSYTH COUNTY
PROPERTY INCPO BOX 947SALISBURYNC28145461188488LEASINGNC501C39LSA INCtrue
LUTHERAN HOME HICKORY PROPERTY
INCPO BOX 947SALISBURYNC28145201457319LEASINGNC501C39LSA INCtrue
LUTHERAN HOME HICKORY WEST PROPERTY
INCPO BOX 947SALISBURYNC28145205304712LEASINGNC501C39LSA INCtrue
LUTHERAN HOME WILMINGTON PROPERTY
INCPO BOX 947SALISBURYNC28145260158745LEASINGNC501C39LSA INCtrue
LUTHERAN HOME WINSTON-SALEM
PROPERTY INCPO BOX 947SALISBURYNC28145205304794LEASINGNC501C39LSA INCtrue
LUTHERAN RETIREMENT CENTER -
SALISBURY INCPO BOX 947SALISBURYNC28145561540214ASSIST LVGNC501C39LSA INCtrue
LUTHERAN RETIREMENT CENTER -
WILMINGTON INCPO BOX 947SALISBURYNC28145561500308INDEP. LVGNC501C39LSA INCtrue
LUTHERAN RETIREMENT CENTER AT
LUTHERIDGE INCPO BOX 947SALISBURYNC28145581823983ASSIST LVGNC501C39LSA INCtrue
LUTHERAN SERVICES FOR THE AGING
FOUNDATION INCPO BOX 947SALISBURYNC28145561681723FOUNDATIONNC501C39LSA INCtrue
LUTHERAN SERVICES FOR THE AGING
INC (LSA INC)PO BOX 947SALISBURYNC28145560752160PARENT ORGNC501C39falseN/A
LUTHERAN SERVICES PROPERTY INC
PO BOX 947SALISBURYNC28145203895886LEASINGNC501C39LSA INCtrue
LSA THERAPY INC
PO BOX 947SALISBURYNC28145461886488THERAPYNC501C39LSA INCtrue
MOUNTAIN RIDGE GROUP HOME INC
PO BOX 2369SALISBURYNC28145581782084GROUP HOMENC501C37LFStrue
WHITTECAR HOME INC
PO BOX 2369SALISBURYNC28145581940152GROUP HOMENC501C37LFStrue
PACE AT HOME INC
1915 FAIRGROVE CHURCH ROADNEWTONNC28658273462373CARE SVCNC501C33falseN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgtruePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (22 entries)

Business Name Line2NameOfOtherOrganization/BusinessNameLine2Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LUTHERAN SERVICES FOR THE AGING
INCC15000FMV
LSA FOUNDATION
C3547FMV
LSA MANAGEMENT INC
D1389559FMV
CONTROL GROUP INTERCOMPANY RECPAY
D256297FMV
LUTHERAN HOME - WILMINGTON INC
D1000000FMV
LUTHERAN RETIREMENT CENTER -
SALISBURY INCD943278FMV
LSA FOUNDATION
D8070FMV
LSA PHARMACY INC
H715082FMV
LUTHERAN HOME HICKORY PROPERTY INC
K600000FMV
LSA MANAGEMENT INC
M530056FMV
LSA PHARMACY INC
M27341FMV
LUTHERAN SERVICES FOR THE AGING
INCC15000FMV
LSA FOUNDATION
C3547FMV
LSA MANAGEMENT INC
D1389559FMV
CONTROL GROUP INTERCOMPANY RECPAY
D256297FMV
LUTHERAN HOME - WILMINGTON INC
D1000000FMV
LUTHERAN RETIREMENT CENTER -
SALISBURY INCD943278FMV
LSA FOUNDATION
D8070FMV
LSA PHARMACY INC
H715082FMV
LUTHERAN HOME HICKORY PROPERTY INC
K600000FMV
LSA MANAGEMENT INC
M530056FMV
LSA PHARMACY INC
M27341FMV

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierADDITIONAL INFORMATIONIdentifier
Return ReferenceSCHEDULE RReturnReference
ExplanationCONTROL GROUP INTERCOMPANY RECPAY CONSISTS OF SHORTTERM INTERCOMPANY ALLOCATIONS BETWEEN THE ENTITIES WITHIN THE CONTROLLED GROUPExplanation