STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

LUTHERAN HOME-HICKORY INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
LUTHERAN HOME-HICKORY INC (EIN 20-1457341)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-03-01
IRS object ID
201210619349302276
Schema version
2010v3.4
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)
Timestamp2012-03-01T13:31:34-06:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DAVIDSON HOLLAND WHITESELL & CO PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1209 13TH AVE PLACE NW SUITE 200AddressLine1
CityHICKORYCity
StateNCState
ZIP Code28601ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

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)
NameTED GOINSName
TitlePRESIDENTTitle
Phone7046372870Phone
Date Signed2012-03-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSUSAN M BALKEName
Phone8283222070Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts14000523GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LSANC.NETWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionLUTHERAN NURSING HOMES PROVIDE NURSING CARE FOR THE RESIDENTS OF HICKORY AND THE SURROUNDING AREAS.ActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees306TotalNbrEmployees
Total Nbr Volunteers119TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year102078ContributionsGrantsPriorYear
Contributions Grants Current Year57604ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11733044ProgramServiceRevenuePriorYear
Program Service Revenue CY12872788ProgramServiceRevenueCY
Investment Income Prior Year20618InvestmentIncomePriorYear
Investment Income Current Year59738InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year11855740TotalRevenuePriorYear
Total Revenue Current Year12990130TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6489891SalariesEtcPriorYear
Salaries Etc Current Year6794918SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4516130OtherExpensePriorYear
Other Expenses Current Year4873292OtherExpensesCurrentYear
Total Expenses Prior Year11006021TotalExpensesPriorYear
Total Expenses Current Year11668210TotalExpensesCurrentYear
Revenues Less Expenses Prior Year849719RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1321920RevenuesLessExpensesCY
Total Assets BOY4970864TotalAssetsBOY
Total Assets EOY6145841TotalAssetsEOY
Total Liabilities BOY922286TotalLiabilitiesBOY
Total Liabilities EOY836266TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4048578NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5309575NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionLUTHERAN NURSING HOMES PROVIDE NURSING CARE FOR THE RESIDENTS OF HICKORY AND THE SURROUNDING AREAS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10812405Expense
Revenue12872788Revenue
DescriptionLUTHERAN HOME - HICKORY, INC. OFFERS SHORT-TERM REHABILITATION, LONG-TERM CARE, AND ASSISTED LIVING SERVICES TO PEOPLE OF ALL FAITHS AND ECONOMIC STATUS. TRINITY TERRACE AND SHEPHERD HOUSE PROVIDE SKILLED NURSING AND ASSISTED LIVING CARE FOR THE OFTEN DIFFICULT-TO-PLACE ALZHEIMER'S RESIDENTS. LH - HICKORY 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 ON ADMISSION AND THROUGHOUT THEIR STAY.DURING THE YEAR ENDED SEPTEMBER 30, 2011, LH - HICKORY PROVIDED 62,191 DAYS OF CARE TO 476 RESIDENTS.Description
Total Program Service Expense10812405TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109616NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees306NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LSA MANAGEMENT INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7046372870TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11416 S MARTIN LUTHER KING JR AVENUEAddressLine1
CitySALISBURYCity
StateNCState
ZIP Code28144ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
MRS KAYE LEONARD
BOARD CHAIR1.00X000
MR JERRY BRAMLEY
VICE CHAIR1.00X000
TED W GOINS JR
PRESIDENT40.00X02256748533X
KAREN K MADDRY
SECRETARY40.000526216579X
ANNETTE S CONRAD
TREASURER40.0001469887364X
KESHA L SMITH
ASST. SECRETARY40.000854887237X
DEBBIE MATHIS
CHIEF OPERATING OFFICER40.0001501177403X
AMBER MCINTOSH
ADMINISTRATOR40.0010816007690XX
DAVID BEAM
PHARMACIST40.0001338907201X
JAMES FISHER
PHARMACIST40.0001200627028X
MICHAEL WALSH
EXECUTIVE DIRECTOR40.0001053647634X
ELIZABETH KUHN
DIRECTOR R&D40.0001050217627X
JOHN C FRYE JR
ADMINISTRATOR40.0001150035527X
CYNTHIA MCCOY
ADMINISTRATOR40.000985806020X
FRANCES NICHOLS
EXECUTIVE DIRECTOR40.000681165527X
SHARON CONOLEY
EXECUTIVE DIRECTOR40.000807937143X
BARBARA GARWOOD
EXECUTIVE DIRECTOR40.00051480772X
FieldValueIRS element (for citing)
Total Reportable Comp From Org108160TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1240228TotalReportableCompFrmRltdOrgs
Total Other Compensation79823TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SUNDANCE REHABILITATION
6549 PAYSPHERE CIRCLECHICAGOIL60674REHABILITATION SERVICES1005844
INTERSCAPES
1323 THE PLAZACHARLOTTENC28205INTERIOR DESIGN129489
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Related Organizations20000RelatedOrganizations
All Other Contributions37604AllOtherContributions
Total Contributions57604TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID/MEDICARE SERV62300075291257529125
RESIDENT SERVICE REVEN62300052378645237864
ANCILLARY SERVICE REVE623000105799105799
FieldValueIRS element (for citing)
Total Program Service Revenue12872788TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column18633TotalRevenueColumn
Exclusion$18,633ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1051498Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1010393Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities41105Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column41105TotalRevenueColumn
Exclusion$41,105ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12990130TotalRevenueColumn
Related Or Exempt Function Income12872788RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$59,738ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total115850Total
Management And General115850ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5453203Total
Program Services5305002ProgramServices
Management And General148201ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total23469Total
Program Services23469ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total778782Total
Program Services778782ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total423614Total
Program Services423614ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total500548Total
Management And General500548ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1066Total
Management And General1066ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total16177Total
Management And General16177ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total3472Total
Management And General3472ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total5246Total
Management And General5246ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total768Total
Program Services768ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total600000Total
Program Services600000ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total15248Total
Program Services13982ProgramServices
Management And General1266ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total3400Total
Program Services3400ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total157594Total
Program Services157594ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total74017Total
Program Services74017ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES140837714058642513
CONTRACT SERVICES121968312117307953
MEDICAID ASSESSMENT317998317998
UTILITIES307308307308
EQUIPMENT RENTAL AND MA94586853369250

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total147804Total
Program Services103541ProgramServices
Management And General44263ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11668210Total
Program Services10812405ProgramServices
Management And General855805ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2225990BOY
EOY2784558EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY133149BOY
EOY124321EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY682655BOY
EOY1078291EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY50028BOY
EOY47991EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY140BOY
EOY140EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2213556LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1589592LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY432715BOY
EOY623964EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1446187BOY
EOY1486576EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4970864BOY
EOY6145841EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY902943BOY
EOY817866EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY19343BOY
EOY18400EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY922286BOY
EOY836266EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4011791BOY
EOY5286462EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY36787BOY
EOY23113EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4048578BOY
EOY5309575EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4970864BOY
EOY6145841EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1321920ReconcilationRevenueExpenses
Reconcilation Other Changes-60923ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years129232CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years95547CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years159467CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year87078CurrentTaxYearMinus1Year
Current Tax Year57604CurrentTaxYear
Total528928Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10278237CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10433370CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10972143CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11733044CurrentTaxYearMinus1Year
Current Tax Year12872788CurrentTaxYear
Total56289582Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10407469CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10528917CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11131610CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11820122CurrentTaxYearMinus1Year
Current Tax Year12930392CurrentTaxYear
Total56818510Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50956818510PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years61062CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years42940CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16488CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year20618CurrentTaxYearMinus1Year
Current Tax Year18633CurrentTaxYear
Total159741Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years61062CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years42940CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16488CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year20618CurrentTaxYearMinus1Year
Current Tax Year18633CurrentTaxYear
Total159741Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10468531CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10571857CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11148098CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11840740CurrentTaxYearMinus1Year
Current Tax Year12949025CurrentTaxYear
Total56978251Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99720PublicSupportPercentage509
Prior Year Support Percentage0.99680PriorYearSupportPercentage
Investment Income Percentage0.00280InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00320PriorYrInvestIncomePercentage
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 Balance51624BeginningOfYearBalance
Contributions101000Contributions
End Of Year Balance152624EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance48624BeginningOfYearBalance
Contributions3000Contributions
End Of Year Balance51624EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis9513OtherCostOrOtherBasis
Depreciation6831Depreciation
Book Value2682BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2174070OtherCostOrOtherBasis
Depreciation1561237Depreciation
Book Value612833BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis29973OtherCostOrOtherBasis
Depreciation21524Depreciation
Book Value8449BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings623964TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
RESIDENTS' FUNDS18400
INTERCOMPANY ACCOUNTS934780
ASSETS LIMITED TO USE BY BOARD AND RES. AGREEMENT326681
INVESTMENT IN ADULT LIFE PROGRAM PROJECT201875
WORK IN PROGRESS4840
FieldValueIRS element (for citing)
Total Book Value Other Assets1486576TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionRESIDENTS' FUNDSDescription
Amount$18,400Amount
FieldValueIRS element (for citing)
Total Of Amounts18400TotalOfAmounts
Total Revenue12990130TotalRevenue
Total Expenses11668210TotalExpenses
Excess Or Deficit For Year1321920ExcessOrDeficitForYear
Net Unrealized GL On Investments-60923NetUnrealizedGLOnInvestments
Total Adjustments-60923TotalAdjustments
Excess Or Deficit Per FS1260997ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt12925736TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-60923NetUnrealizedGainsInvestments
Revenue Not Rptd F990-60923RevenueNotRptdF990
Revenue Subtotal12986659RevenueSubtotal
Other Revenues Not Included3471OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt3471RevenueNotRptdOnFinStmt
Total Revenue Per Form99012990130TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11664739TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal11664739ExpensesSubtotal
Other Expenses Not Included3471OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt3471ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011668210TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:FUNDS ARE DESIGNATED FOR FUTURE EXPANSION, EQUIPMENT PURCHASES, OR FOR FUTURE PROGRAM SERVICE NEEDS.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:EFFECTIVE OCTOBER 1, 2009, THE ORGANIZATION IMPLEMENTED THE NEW ACCOUNTING REQUIREMENTS ASSOCIATED WITH UNCERTAINTY IN INCOME TAXES USING THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ASC 740, INCOME TAXES. USING THAT GUIDANCE, TAX POSITIONS INITIALLY NEED TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS WHEN IT IS MORE-LIKELY-THAN-NOT THE POSITIONS WILL BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES. IT ALSO PROVIDES GUIDANCE FOR DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. AS OF SEPTEMBER 30, 2011, THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT EXPENSES NETTED AGAINST INVESTMENT INCOME 3,471.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT EXPENSES NETTED AGAINST INVESTMENT INCOME 3,471.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
TED W GOINS JR
022567400000282105712023420700
ANNETTE S CONRAD
014698800000183705527015435200
DEBBIE MATHIS
015011700000187605527015752000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3LSA MANAGEMENT INC PROVIDES MANAGEMENT SERVICES TO ALL LSA AFFILIATES
FORM 990, PART VI, SECTION B, LINE 11THE BOARD RECEIVES THE FORM 990 PRIOR TO THE FILING DEADLINE IN ORDER TO REVIEW. REVIEW IS DOCUMENTED IN THE JANUARY MINUTES.
ON AN ANNUAL BASIS, ALL BOARDS 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 THEIR COMPLIANCE WITH THE POLICY. WHEN NEW MEMBERS JOIN THE BOARD MID-TERM, THEY ALSO RECEIVE THIS INFORMATION AND COMPLETE THE SAME STATEMENTS.FORM 990, PART VI, SECTION B, LINE 12C
ALL COMPENSATION LIMITS ARE COMPARED TO STATE AND NATIONAL REANGES BASED ON FACILITY SIZE AND EXPERIENCE OF STAFF. THE BOARD APPROVES THE PRESIDENT'S COMPENSATION.FORM 990, PART VI, SECTION B, LINE 15
FORMS ARE POSTED ON GUIDESTAR AS WELL AS AVAILABLE AT THE LSA OFFICE LOCATED IN SALISBURY, NC.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -60,923.FORM 990, PART XI, LINE 5:
PROCESS HAS NOT CHANGED SINCE LAST YEAR.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
LUTHERAN SERVICES FOR THE AGING INC
PO BOX 947SALISBURYNC28145560500212PARENT ORGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LSA MANAGEMENT INC
PO BOX 947SALISBURYNC28145201457236MANAGEMENTNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LSA PHARMACY INC
PO BOX 947SALISBURYNC28145201457251PHARMACYNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME-ALBEMARLE INC
PO BOX 947SALISBURYNC28145201457298SKILLED NURSING CARE AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME AT TRINITY OAKS INC
PO BOX 947SALISBURYNC28145201457824SKILLED NURSING CARE AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME-HICKORY WEST INC
PO BOX 947SALISBURYNC28145201457410SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME-WINSTON-SALEM INC
PO BOX 947SALISBURYNC28145561500212SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME-FORSYTH COUNTY INC
PO BOX 947SALISBURYNC28145263328029SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME-WILMINGTON INC
PO BOX 947SALISBURYNC28145260158686SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME ALBEMARLE PROPERTY INC
PO BOX 947SALISBURYNC28145201457273LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME HICKORY PROPERTY INC
PO BOX 947SALISBURYNC28145201457319LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME AT TRINITY OAKS PROPERTY INC
PO BOX 947SALISBURYNC28145201457796LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME HICKORY WEST PROPERTY INC
PO BOX 947SALISBURYNC28145205304712LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME WINSTON-SALEM PROPERTY INC
PO BOX 947SALISBURYNC28145205304794LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN HOME WILMINGTON PROPERTY INC
PO BOX 947SALISBURYNC28145260158745LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN SERVICES PROPERTY INC
PO BOX 947SALISBURYNC28145203895886LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN RETIREMENT CENTER-SALISBURY INC
PO BOX 947SALISBURYNC28145561540214INDEPENDENT AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN RETIREMENT CENTER-WILMINGTON INC
PO BOX 947SALISBURYNC28145561500308INDEPENDENT LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN RETIREMENT CENTER AT LUTHERIDGE INC
PO BOX 947SALISBURYNC28145581823983INDEPENDENT AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LUTHERAN SERVICES FOR THE AGING FOUNDATION INC
PO BOX 947SALISBURYNC28145561681723FOUNDATIONNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
ABUNDANT LIVING ADULT DAY SERVICES INC
PO BOX 947SALISBURYNC28145561884652ADULT DAY SERVICESNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LSA ELMS AT TANGLEWOOD INC
PO BOX 947SALISBURYNC28145263735637ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
LSA ELMS PROPERTY INC
PO BOX 947SALISBURYNC28145263739962LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org1PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
LSA PHARMACY
G37632
LH HICKORY PROPERTY
J600000
LSA MANAGEMENT
L500548