2014-02-14T13:10:32-06:00 2013-09-30 LANGDON & COMPANY LLP 223 US HIGHWAY 70 EAST SUITE 100 GARNER NC 275294051 990 2012-10-01 201457341 LUTHERAN HOME - HICKORY INC LUTH 7046372870 PO BOX 947 SALISBURY NC 281450947 KIRBY NICKERSON 7046372870 2014-02-14 true ANTHONY T PANDISCIA 9196621001 2014-02-14 2012 2015-11-30 17:44:51Z TED GOINS PO BOX 947 SALISBURY NC 281450947 13380703 false X WWW.LSCAROLINAS.NET X 2004 NC LUTHERAN 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 O 20 20 328 130 0 48015 74694 13553490 13268504 5543 20841 25252 16659 13632300 13380698 20000 18547 0 7272328 7247346 0 0 5615910 5421362 12908238 12687255 724062 693443 7035464 7933170 951005 1135583 6084459 6797587 X LUTHERAN 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 O false false 12230356 18547 13268504 LUTHERAN 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. 12230356 true true false false false false false false false true true false false true false true false true false false false false false false false false false false true true false false false false false false false false false false false false false true true true false false true 32 0 true 328 true false false false false false false false false false false X 20 20 false true false false false false false true true false false true true true true true true true true false X X SUSAN MILLER 7046372870 1416 S MARTIN LUTHER KING JR AVE SALISBURY NC 28144 X TED GOINS JR 40.00 1.00 X X 0 253247 8557 REV SUSAN BAME 1.00 1.00 X 0 0 0 REV DR LEONARD BOLICK 1.00 1.00 X 0 0 0 JERRY BRAMLEY 1.00 1.00 X 0 0 0 DR JOHN BUMGARNER 1.00 1.00 X 0 0 0 JOYCE ERICSON 1.00 1.00 X 0 0 0 REV MARY FINKLEA 1.00 1.00 X 0 0 0 JOY FISHER 1.00 1.00 X 0 0 0 REV DR THOMAS HURLOCKER 1.00 1.00 X 0 0 0 JOYCELYN JOHNSON 1.00 1.00 X 0 0 0 KAYE LEONARD 1.00 1.00 X 0 0 0 BETTY LOHR 1.00 1.00 X 0 0 0 DR SHANNON MATHEWS 1.00 1.00 X 0 0 0 LORETTA MEYERS 1.00 1.00 X 0 0 0 DOUG NELSON 1.00 1.00 X 0 0 0 DEREK SHOEMAKE 1.00 1.00 X 0 0 0 STEVE STANFIELD-SWITZER 1.00 1.00 X 0 0 0 ERIC VAUGHN 1.00 1.00 X 0 0 0 REV DR HERMAN YOOS III 1.00 1.00 X 0 0 0 J WHITE IDDINGS JR 1.00 1.00 X 0 0 0 ROSEBUD REUBEL 1.00 1.00 X 0 0 0 KESHA SMITH 40.00 1.00 X 0 141323 6896 ELIZABETH KUHN 40.00 1.00 X 0 126562 6637 AMBER MCINTOSH 40.00 X 119161 0 6582 MYRA GRIFFIE 40.00 1.00 X 0 110166 5353 KIRBY NICKERSON 40.00 1.00 X 0 82765 6068 KAREN MADDRY 40.00 1.00 X 0 54612 6135 MARCHETA CAMPBELL 40.00 X 0 0 0 PATRICK FOLEY 40.00 1.00 X 0 144119 6984 ANNETTE CONRAD 40.00 1.00 X 0 51809 1568 119161 964603 54780 1 true true false GENESIS HEALTHCARE 6549 PAYSPHERE CIRCLE CHICAGO IL 60674 THERAPY SRVCS 901248 INTERSCAPES INC 1323 THE PLAZA CHARLOTTE NC 28205 INTERIOR DESIGN 102926 2 18547 56147 74694 SERVICE FEE REVENUES 12087229 12087229 ANCILLARY INCOME 1181275 1181275 13268504 19796 19796 1050 5 1045 1045 1045 OTHER INCOME 16659 16659 16659 13380698 13286208 19796 18547 18547 130700 124534 6166 5926342 5635606 290736 713674 713674 476630 476630 530056 530056 3712 3712 17332 17332 9064 188 8876 18513 1801 16712 600000 600000 14578 11724 2854 5695 5695 163082 163082 59552 59552 ANCILLARY EXPENSES 1546141 1546141 PHARMACY DRUGS 711912 711912 FOOD 524493 524493 BED ASSESSMENT 340198 340198 877034 826075 50959 12687255 12230356 456899 0 1708482 1716115 1227699 1162316 40231 36930 140 140 2514678 1817823 710790 696855 504370 543523 2843752 3777291 7035464 7933170 951005 928498 207085 951005 1135583 X 6021361 6782882 63098 14705 6084459 6797587 7035464 7933170 693443 19685 X false true X true false X 159467 87078 57604 48015 74694 426858 10972143 11733044 12872788 13578742 13285163 62441880 11131610 11820122 12930392 13626757 13359857 62868738 62868738 16488 20618 18633 5543 19796 81078 16488 20618 18633 5543 19796 81078 11148098 11840740 12949025 13632300 13379653 62949816 0.99870 0.99830 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 504059 38763 542822 152624 351435 504059 51624 101000 152624 51624 51624 48624 3000 51624 1.00000 false true true 18864 4795 14069 2328340 1652491 675849 167474 160537 6937 696855 INTERCOMPANY 3589135 OTHER ASSETS 159373 CIP 20713 DUE FROM AFFILIATE 8070 3777291 13400383 19685 19685 13380698 13380698 12687255 12687255 12687255 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 THE 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 FOOTNOTE SCHEDULE D, PAGE 3, PART X SUBSTANTIALLY 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 INFORMATION SCHEDULE D, PAGE 4, PART XIII PART 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. true RHYNE SCHOLARSHIP 3 15000 FMV HOLLAR SCHOLARSHIP 2 3547 FMV PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 THE 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. false false false false false false false false false TED GOINS JR 253247 2493 6064 261804 PATRICK FOLEY 144119 1441 5543 151103 ANNETTE CONRAD 51809 514 1054 53377 ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION LUTHERAN 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 DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4A 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. ADDITIONAL INFORMATION FORM 990, PART VI WHISTLEBLOWER 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 DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 LSA 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 990 FORM 990, PAGE 6, PART VI, LINE 11B THE 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 POLICY FORM 990, PAGE 6, PART VI, LINE 12C BOARD 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 OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A ALL 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 OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B ALL 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 EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 FORMS 990 ARE POSTED ON GUIDESTAR AND AVAILABLE UPON REQUEST AT THE LSA OFFICE LOCATED IN SALISBURY, NC. ADDITIONAL INFORMATION FORM 990, PART VII FORMER 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. ABUNDANT LIVING ADULT DAY SERVICES INC PO BOX 947 SALISBURY NC 28145 561884652 ADULT DAY NC 501C3 9 LSA INC true LFS REAL PROPERTIES INC PO BOX 2369 SALISBURY NC 28145 581820383 REAL ESTAT NC 501C2 LFS true LSA ELMS AT TANGLEWOOD INC PO BOX 947 SALISBURY NC 28145 263735637 ASSIST LVG NC 501C3 9 LSA INC true LSA ELMS PROPERTY INC PO BOX 947 SALISBURY NC 28145 263739962 LEASING NC 501C3 9 LSA INC true LSA MANAGEMENT INC PO BOX 947 SALISBURY NC 28145 201457236 MANAGEMENT NC 501C3 9 LSA INC true LSA PHARMACY INC PO BOX 947 SALISBURY NC 28145 201457251 PHARMACY NC 501C3 9 LSA INC true LUTHERAN FAMILY SERVICES IN THE CAROLINAS PO BOX 2369 SALISBURY NC 28145 561286323 COMM. SVC NC 501C3 11B LSA INC true LUTHERAN HOME - ALBEMARLE INC PO BOX 947 SALISBURY NC 28145 201457298 NURSING NC 501C3 9 LSA INC true LUTHERAN HOME - FORSYTH COUNTY INC PO BOX 947 SALISBURY NC 28145 263328029 NURSING NC 501C3 9 LSA INC true LUTHERAN HOME - HICKORY WEST INC PO BOX 947 SALISBURY NC 28145 201457410 NURSING NC 501C3 9 LSA INC true LUTHERAN HOME - WILMINGTON INC PO BOX 947 SALISBURY NC 28145 260158686 NURSING NC 501C3 9 LSA INC true LUTHERAN HOME - WINSTON-SALEM INC PO BOX 947 SALISBURY NC 28145 561500212 NURSING NC 501C3 9 LSA INC true LUTHERAN HOME ALBEMARLE PROPERTY INC PO BOX 947 SALISBURY NC 28145 201457273 LEASING NC 501C3 9 LSA INC true LUTHERAN HOME AT TRINITY OAKS PROPERTY INC PO BOX 947 SALISBURY NC 28145 201457796 LEASING NC 501C3 9 LSA INC true LUTHERAN HOME AT TRINITY OAKS INC PO BOX 947 SALISBURY NC 28145 201457824 NURSING NC 501C3 9 LSA INC true LUTHERAN HOME FORSYTH COUNTY PROPERTY INC PO BOX 947 SALISBURY NC 28145 461188488 LEASING NC 501C3 9 LSA INC true LUTHERAN HOME HICKORY PROPERTY INC PO BOX 947 SALISBURY NC 28145 201457319 LEASING NC 501C3 9 LSA INC true LUTHERAN HOME HICKORY WEST PROPERTY INC PO BOX 947 SALISBURY NC 28145 205304712 LEASING NC 501C3 9 LSA INC true LUTHERAN HOME WILMINGTON PROPERTY INC PO BOX 947 SALISBURY NC 28145 260158745 LEASING NC 501C3 9 LSA INC true LUTHERAN HOME WINSTON-SALEM PROPERTY INC PO BOX 947 SALISBURY NC 28145 205304794 LEASING NC 501C3 9 LSA INC true LUTHERAN RETIREMENT CENTER - SALISBURY INC PO BOX 947 SALISBURY NC 28145 561540214 ASSIST LVG NC 501C3 9 LSA INC true LUTHERAN RETIREMENT CENTER - WILMINGTON INC PO BOX 947 SALISBURY NC 28145 561500308 INDEP. LVG NC 501C3 9 LSA INC true LUTHERAN RETIREMENT CENTER AT LUTHERIDGE INC PO BOX 947 SALISBURY NC 28145 581823983 ASSIST LVG NC 501C3 9 LSA INC true LUTHERAN SERVICES FOR THE AGING FOUNDATION INC PO BOX 947 SALISBURY NC 28145 561681723 FOUNDATION NC 501C3 9 LSA INC true LUTHERAN SERVICES FOR THE AGING INC (LSA INC) PO BOX 947 SALISBURY NC 28145 560752160 PARENT ORG NC 501C3 9 N/A false LUTHERAN SERVICES PROPERTY INC PO BOX 947 SALISBURY NC 28145 203895886 LEASING NC 501C3 9 LSA INC true LSA THERAPY INC PO BOX 947 SALISBURY NC 28145 461886488 THERAPY NC 501C3 9 LSA INC true MOUNTAIN RIDGE GROUP HOME INC PO BOX 2369 SALISBURY NC 28145 581782084 GROUP HOME NC 501C3 7 LFS true WHITTECAR HOME INC PO BOX 2369 SALISBURY NC 28145 581940152 GROUP HOME NC 501C3 7 LFS true PACE AT HOME INC 1915 FAIRGROVE CHURCH ROAD NEWTON NC 28658 273462373 CARE SVC NC 501C3 3 N/A false false false true true false false false true false false true false true false false false false false false LUTHERAN SERVICES FOR THE AGING INC C 15000 FMV LSA FOUNDATION C 3547 FMV LSA MANAGEMENT INC D 1389559 FMV CONTROL GROUP INTERCOMPANY RECPAY D 256297 FMV LUTHERAN HOME - WILMINGTON INC D 1000000 FMV LUTHERAN RETIREMENT CENTER - SALISBURY INC D 943278 FMV LSA FOUNDATION D 8070 FMV LSA PHARMACY INC H 715082 FMV LUTHERAN HOME HICKORY PROPERTY INC K 600000 FMV LSA MANAGEMENT INC M 530056 FMV LSA PHARMACY INC M 27341 FMV LUTHERAN SERVICES FOR THE AGING INC C 15000 FMV LSA FOUNDATION C 3547 FMV LSA MANAGEMENT INC D 1389559 FMV CONTROL GROUP INTERCOMPANY RECPAY D 256297 FMV LUTHERAN HOME - WILMINGTON INC D 1000000 FMV LUTHERAN RETIREMENT CENTER - SALISBURY INC D 943278 FMV LSA FOUNDATION D 8070 FMV LSA PHARMACY INC H 715082 FMV LUTHERAN HOME HICKORY PROPERTY INC K 600000 FMV LSA MANAGEMENT INC M 530056 FMV LSA PHARMACY INC M 27341 FMV ADDITIONAL INFORMATION SCHEDULE R CONTROL GROUP INTERCOMPANY RECPAY CONSISTS OF SHORTTERM INTERCOMPANY ALLOCATIONS BETWEEN THE ENTITIES WITHIN THE CONTROLLED GROUP