2013-02-15T12:24:27-06:00 2012-09-30 LANGDON & COMPANY LLP 223 US HIGHWAY 70 EAST SUITE 100 GARNER NC 275294051 990 2011-10-01 201457341 LUTHERAN HOME - HICKORY INC LUTH 7046372870 PO BOX 947 SALISBURY NC 281450947 TED GOINS 7046372870 2013-02-11 true ANTHONY T PANDISCIA 9196621001 2013-02-13 2011 2016-03-07 17:11:31Z TED GOINS PO BOX 947 SALISBURY NC 281450947 13632300 false X WWW.LSANC.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 19 18 329 119 0 57604 48015 12872788 13553490 59738 5543 25252 12990130 13632300 20000 0 6794918 7272328 0 0 4873292 5615910 11668210 12908238 1321920 724062 6145841 7035464 836266 951005 5309575 6084459 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 11287667 20000 13553490 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, 2012, LUTHERAN HOME - HICKORY, INC. PROVIDED 63,128 DAYS OF CARE TO 500 RESIDENTS. 11287667 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 29 0 329 true false false false false false false false false false false X 19 18 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 X X 0 233724 8258 REV SUSAN BAME 1.00 X 0 0 0 REV DR LEONARD BOLICK 1.00 X 0 0 0 JERRY BRAMLEY 1.00 X 0 0 0 DR JOHN BUMGARNER 1.00 X 0 0 0 JOYCE ERICSON 1.00 X 0 0 0 REV MARY FINKLEA 1.00 X 0 0 0 JOY FISHER 1.00 X 0 0 0 REV DR THOMAS HURLOCKER 1.00 X 0 0 0 JOYCELYN JOHNSON 1.00 X 0 0 0 KAYE LEONARD 1.00 X 0 0 0 BETTY LOHR 1.00 X 0 0 0 DR SHANNON MATHEWS 1.00 X 0 0 0 LORETTA MEYERS 1.00 X 0 0 0 DOUG NELSON 1.00 X 0 0 0 DEREK SHOEMAKE 1.00 X 0 0 0 STEVE STANFIELD-SWITZER 1.00 X 0 0 0 ERIC VAUGHN 1.00 X 0 0 0 REV DR HERMAN YOOS III 1.00 X 0 0 0 AMBER MCINTOSH 40.00 X 112769 0 6467 ELIZABETH KUHN 40.00 X 0 109483 6108 MYRA GRIFFIE 40.00 X 0 104904 5588 KESHA SMITH 40.00 X 0 103810 6286 KAREN MADDRY 40.00 X 0 48836 5899 TONYA HILLIARD 40.00 X 37699 0 857 KIRBY NICKERSON 40.00 X 0 0 0 ANNETTE CONRAD 40.00 X 0 162842 7210 DEBORAH MATHIS 40.00 X 0 69900 3539 PATRICK FOLEY 40.00 X 0 38077 5369 150468 871576 55581 1 true true false SUNDANCE REHABILITATION 6549 PAYSPHERE CIRCLE CHICAGO IL 60674 THERAPY SRVCS 1437488 INTERSCAPES INC 1323 THE PLAZA CHARLOTTE NC 28205 INTERIOR DESIGN 171228 2 20000 28015 48015 SERVICE FEE REVENUES 12049856 12049856 ANCILLARY INCOME 1503634 1503634 13553490 5543 5543 OTHER INCOME 25252 25252 25252 13632300 13578742 5543 20000 20000 228622 218048 10574 5647280 5375626 271654 942062 942062 454364 454364 541094 541094 2094 2094 17276 17276 14948 685 14263 11328 1943 9385 600000 600000 13371 12283 1088 3776 3776 169532 169532 105270 105270 ANCILLARY EXPENSES 1676627 1676627 PHARMACY DRUGS 619446 619446 FOOD 523999 523999 BED ASSESSMENT 331778 331778 985371 937498 47873 12908238 11287667 1620571 0 2784558 1708482 124321 1078291 1227699 47991 40231 140 140 2448664 1737874 623964 710790 504370 1486576 2843752 6145841 7035464 817866 951005 18400 836266 951005 X 5286462 6021361 23113 63098 5309575 6084459 6145841 7035464 X 724062 50822 X false true true X false X 95547 159467 87078 57604 48015 447711 10433370 10972143 11733044 12872788 13578742 59590087 10528917 11131610 11820122 12930392 13626757 60037798 60037798 42940 16488 20618 18633 5543 104222 42940 16488 20618 18633 5543 104222 10571857 11148098 11840740 12949025 13632300 60142020 0.99830 0.99720 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false 152624 351435 504059 51624 101000 152624 51624 51624 48624 3000 51624 0.65000 0.35000 false true true 9513 4081 5432 2273557 1581231 692326 165594 152562 13032 710790 INTERCOMPANY 2663127 OTHER ASSETS 180625 2843752 13632300 12908238 724062 50822 50822 774884 13683122 50822 50822 13632300 13632300 12908238 12908238 12908238 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 THE ORGANIZATION EVALUATES ITS UNCERTAIN TAX POSITIONS USING PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ACCOUNTING STANDARDS CODIFICATION (ASC) 740-10-25, RECOGNITION OF A TAX POSITION. ACCORDINGLY, THE ORGANIZATION'S POLICY TO RECORD A LIABILITY FOR ANY TAX POSITION TAKEN THAT IS BENEFICIAL TO THE ORGANIZATION, 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, 2012. TAX YEARS SUBSEQUENT TO 2008 REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. SUPPLEMENTAL FINANCIAL INFORMATION SCHEDULE D, PAGE 4, PART XIV PART V - ENDOWMENT FUNDS THE PRIOR YEAR'S NET INVESTMENT EARNINGS FOR ENDOWMENT FUNDS CORRESPONDS TO THE PRESENTATION AS REPORTED ON A CONSOLIDATED BASIS ON THE PRIOR YEAR FORM 990 FOR LUTHERAN SERVICES FOR THE AGING FOUNDATION, INC. (AN AFFILIATE REPORTED ON SCHEDULE R). REPORTING FOR THE CURRENT YEAR FORM 990 HAS BEEN REVISED TO PROMOTE ACCURACY AND TRANSPARENCY BUT THERE HAS BEEN NO CHANGE TO THE ENDOWMENT POLICIES. THE AMOUNTS REPORTED AS THE END OF YEAR BALANCE PROPERLY REFLECT THIS ORGANIZATION'S ENDOWMENT FUNDS AT 9/30/12 AND THE AGGREGATE ENDOWMENT FUNDS REPORTED FOR THE CONTROL GROUP ACCURATELY RECONCILE TO THE 9/30/12 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. true RESIDENT GRANTS 5 20000 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 233724 2313 5945 241982 ANNETTE CONRAD 162842 1612 5598 170052 DEBORAH MATHIS 69900 762 2777 73439 PATRICK FOLEY 38077 381 4988 43446 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, 2012, LUTHERAN HOME - HICKORY, INC. PROVIDED 63,128 DAYS OF CARE TO 500 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 MANAGEMENT SERVICES TO ALL LSA AFFILIATES, INCLUDING THIS ORGANIZATION. 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 ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY AND THE POLICY IS REVIEWED AT A REGULARLY SCHEDULED BOARD MEETING. EACH MEMBER SIGNS A STATEMENT INDICATING THIS COMPLIANCE WITH THE POLICY. WHEN NEW MEMBERS JOIN THE BOARD MID-TERM, THEY ALSO RECEIVE THIS INFORMATION AND COMPLETE THE SAME STATEMENT INDICATING THEIR COMPLIANCE WITH THE POLICY. 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 KIRBY NICKERSON TOOK THE POSITION OF TREASURER/CFO IN JUNE OF 2012 AND THEREFORE DID NOT RECEIVE COMPENSATION IN CALENDAR YEAR 2011 OR A CORRESPONDING 2011 FORM W-2. ANNETTE CONRAD SERVED AS TREASURER FROM 10/1/11 TO 2/10/12. DEBORAH MATHIS SERVED AS CHIEF OPERATING OFFICER UNTIL 6/4/11. SHE DID NOT RECEIVE ANY FISCAL YEAR COMPENSATION BUT HER 2011 W-2 INCOME IS PROPERLY REPORTED ON PART VII. PATRICK FOLEY SERVED AS CHIEF OPERATING OFFICER FROM 9/26/11 TO 10/12/12 AND HIS 2011 W-2 INCOME IS PROPERLY REPORTED ON PART VII. OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 OTHER CHANGES IN NET ASSETS RELATE TO AMOUNTS REPORTED ON SCHEDULE D, PART XII. 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 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 true true true false false true false false true false true false false false false false false LUTHERAN HOME HICKORY PROPERTY INC B 150000 ACTUAL AMOUNT LUTHERAN SERVICES FOR THE AGING INC C 20000 ACTUAL AMOUNT LSA MANAGEMENT INC D 469767 ACTUAL AMOUNT CONTROL GROUP INTERCOMPANY RECPAY D 250081 ACTUAL AMOUNT LUTHERAN HOME - WILMINGTON INC D 1000000 ACTUAL AMOUNT LUTHERAN RETIREMENT CENTER - SALISBURY INC D 943278 ACTUAL AMOUNT LSA PHARMACY INC G 619446 ACTUAL AMOUNT LUTHERAN HOME HICKORY PROPERTY INC J 600000 ACTUAL AMOUNT LSA MANAGEMENT INC L 541094 ACTUAL AMOUNT LSA PHARMACY INC L 26433 ACTUAL AMOUNT LUTHERAN HOME HICKORY PROPERTY INC B 150000 ACTUAL AMOUNT LUTHERAN SERVICES FOR THE AGING INC C 20000 ACTUAL AMOUNT LSA MANAGEMENT INC D 469767 ACTUAL AMOUNT CONTROL GROUP INTERCOMPANY RECPAY D 250081 ACTUAL AMOUNT LUTHERAN HOME - WILMINGTON INC D 1000000 ACTUAL AMOUNT LUTHERAN RETIREMENT CENTER - SALISBURY INC D 943278 ACTUAL AMOUNT LSA PHARMACY INC G 619446 ACTUAL AMOUNT LUTHERAN HOME HICKORY PROPERTY INC J 600000 ACTUAL AMOUNT LSA MANAGEMENT INC L 541094 ACTUAL AMOUNT LSA PHARMACY INC L 26433 ACTUAL AMOUNT ADDITIONAL INFORMATION SCHEDULE R CONTROL GROUP INTERCOMPANY RECPAY CONSISTS OF SHORTTERM INTERCOMPANY ALLOCATIONS BETWEEN THE ENTITIES WITHIN THE CONTROLLED GROUP