2012-03-01T13:31:34-06:00 2011-09-30 DAVIDSON HOLLAND WHITESELL & CO PLLC 209 13TH AVE PLACE NW SUITE 200 HICKORY NC 28601 990 2010-10-01 201457341 LUTHERAN HOME-HICKORY INC LUTH 7046372870 PO BOX 947 SALISBURY NC 281450947 TED GOINS 7046372870 2012-03-01 1 SUSAN M BALKE 8283222070 2010 2016-02-24 21:20:13Z TED GOINS PO BOX 947 SALISBURY NC 281450947 14000523 0 X WWW.LSANC.NET X 2004 NC LUTHERAN NURSING HOMES PROVIDE NURSING CARE FOR THE RESIDENTS OF HICKORY AND THE SURROUNDING AREAS. 3 2 306 119 0 0 102078 57604 11733044 12872788 20618 59738 0 0 11855740 12990130 0 0 0 0 6489891 6794918 0 0 0 4516130 4873292 11006021 11668210 849719 1321920 4970864 6145841 922286 836266 4048578 5309575 X LUTHERAN NURSING HOMES PROVIDE NURSING CARE FOR THE RESIDENTS OF HICKORY AND THE SURROUNDING AREAS. 0 0 10812405 12872788 LUTHERAN 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. 10812405 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 16 0 306 1 0 0 0 0 0 0 0 0 X 3 2 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X LSA MANAGEMENT INC 7046372870 1416 S MARTIN LUTHER KING JR AVENUE SALISBURY NC 28144 MRS KAYE LEONARD 1.00 X 0 0 0 MR JERRY BRAMLEY 1.00 X 0 0 0 TED W GOINS JR 40.00 X X 0 225674 8533 KAREN K MADDRY 40.00 X 0 52621 6579 ANNETTE S CONRAD 40.00 X 0 146988 7364 KESHA L SMITH 40.00 X 0 85488 7237 DEBBIE MATHIS 40.00 X 0 150117 7403 AMBER MCINTOSH 40.00 X X 108160 0 7690 DAVID BEAM 40.00 X 0 133890 7201 JAMES FISHER 40.00 X 0 120062 7028 MICHAEL WALSH 40.00 X 0 105364 7634 ELIZABETH KUHN 40.00 X 0 105021 7627 JOHN C FRYE JR 40.00 X 0 115003 5527 CYNTHIA MCCOY 40.00 X 0 98580 6020 FRANCES NICHOLS 40.00 X 0 68116 5527 SHARON CONOLEY 40.00 X 0 80793 7143 BARBARA GARWOOD 40.00 X 0 51480 772 108160 1240228 79823 1 0 1 0 SUNDANCE REHABILITATION 6549 PAYSPHERE CIRCLE CHICAGO IL 60674 REHABILITATION SERVICES 1005844 INTERSCAPES 1323 THE PLAZA CHARLOTTE NC 28205 INTERIOR DESIGN 129489 2 20000 37604 57604 MEDICAID/MEDICARE SERV 623000 7529125 7529125 RESIDENT SERVICE REVEN 623000 5237864 5237864 ANCILLARY SERVICE REVE 623000 105799 105799 12872788 18633 18633 1051498 1010393 41105 41105 41105 12990130 12872788 0 59738 115850 115850 5453203 5305002 148201 23469 23469 778782 778782 423614 423614 500548 500548 1066 1066 16177 16177 3472 3472 5246 5246 768 768 600000 600000 15248 13982 1266 3400 3400 157594 157594 74017 74017 SUPPLIES 1408377 1405864 2513 CONTRACT SERVICES 1219683 1211730 7953 MEDICAID ASSESSMENT 317998 317998 UTILITIES 307308 307308 EQUIPMENT RENTAL AND MA 94586 85336 9250 147804 103541 44263 11668210 10812405 855805 0 2225990 2784558 133149 124321 682655 1078291 50028 47991 140 140 2213556 1589592 432715 623964 1446187 1486576 4970864 6145841 902943 817866 19343 18400 922286 836266 X 4011791 5286462 36787 23113 4048578 5309575 4970864 6145841 X 1321920 -60923 X X 0 1 1 X 0 X 129232 95547 159467 87078 57604 528928 10278237 10433370 10972143 11733044 12872788 56289582 10407469 10528917 11131610 11820122 12930392 56818510 0 0 0 56818510 61062 42940 16488 20618 18633 159741 61062 42940 16488 20618 18633 159741 10468531 10571857 11148098 11840740 12949025 56978251 0.99720 0.99680 0.00280 0.00320 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 51624 101000 152624 51624 51624 48624 3000 51624 1.00000 0 1 1 9513 6831 2682 2174070 1561237 612833 29973 21524 8449 623964 RESIDENTS' FUNDS 18400 INTERCOMPANY ACCOUNTS 934780 ASSETS LIMITED TO USE BY BOARD AND RES. AGREEMENT 326681 INVESTMENT IN ADULT LIFE PROGRAM PROJECT 201875 WORK IN PROGRESS 4840 1486576 RESIDENTS' FUNDS 18400 18400 12990130 11668210 1321920 -60923 -60923 1260997 12925736 -60923 -60923 12986659 3471 3471 12990130 11664739 0 11664739 3471 3471 11668210 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. X X 0 0 0 0 0 0 0 0 0 TED W GOINS JR 0 225674 0 0 0 0 0 2821 0 5712 0 234207 0 0 ANNETTE S CONRAD 0 146988 0 0 0 0 0 1837 0 5527 0 154352 0 0 DEBBIE MATHIS 0 150117 0 0 0 0 0 1876 0 5527 0 157520 0 0 FORM 990, PART VI, SECTION A, LINE 3 LSA MANAGEMENT INC PROVIDES MANAGEMENT SERVICES TO ALL LSA AFFILIATES FORM 990, PART VI, SECTION B, LINE 11 THE BOARD RECEIVES THE FORM 990 PRIOR TO THE FILING DEADLINE IN ORDER TO REVIEW. REVIEW IS DOCUMENTED IN THE JANUARY MINUTES. FORM 990, PART VI, SECTION B, LINE 12C 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 15 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 C, LINE 19 FORMS ARE POSTED ON GUIDESTAR AS WELL AS AVAILABLE AT THE LSA OFFICE LOCATED IN SALISBURY, NC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -60,923. FORM 990, PART XII, LINE 2C PROCESS HAS NOT CHANGED SINCE LAST YEAR. LUTHERAN SERVICES FOR THE AGING INC PO BOX 947 SALISBURY NC 28145 560500212 PARENT ORG NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LSA MANAGEMENT INC PO BOX 947 SALISBURY NC 28145 201457236 MANAGEMENT NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LSA PHARMACY INC PO BOX 947 SALISBURY NC 28145 201457251 PHARMACY NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME-ALBEMARLE INC PO BOX 947 SALISBURY NC 28145 201457298 SKILLED NURSING CARE AND ASSISTED LIVING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME AT TRINITY OAKS INC PO BOX 947 SALISBURY NC 28145 201457824 SKILLED NURSING CARE AND ASSISTED LIVING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME-HICKORY WEST INC PO BOX 947 SALISBURY NC 28145 201457410 SKILLED NURSING CARE NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME-WINSTON-SALEM INC PO BOX 947 SALISBURY NC 28145 561500212 SKILLED NURSING CARE NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME-FORSYTH COUNTY INC PO BOX 947 SALISBURY NC 28145 263328029 SKILLED NURSING CARE NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME-WILMINGTON INC PO BOX 947 SALISBURY NC 28145 260158686 SKILLED NURSING CARE NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME ALBEMARLE PROPERTY INC PO BOX 947 SALISBURY NC 28145 201457273 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME HICKORY PROPERTY INC PO BOX 947 SALISBURY NC 28145 201457319 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME AT TRINITY OAKS PROPERTY INC PO BOX 947 SALISBURY NC 28145 201457796 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME HICKORY WEST PROPERTY INC PO BOX 947 SALISBURY NC 28145 205304712 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME WINSTON-SALEM PROPERTY INC PO BOX 947 SALISBURY NC 28145 205304794 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN HOME WILMINGTON PROPERTY INC PO BOX 947 SALISBURY NC 28145 260158745 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN SERVICES PROPERTY INC PO BOX 947 SALISBURY NC 28145 203895886 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN RETIREMENT CENTER-SALISBURY INC PO BOX 947 SALISBURY NC 28145 561540214 INDEPENDENT AND ASSISTED LIVING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN RETIREMENT CENTER-WILMINGTON INC PO BOX 947 SALISBURY NC 28145 561500308 INDEPENDENT LIVING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN RETIREMENT CENTER AT LUTHERIDGE INC PO BOX 947 SALISBURY NC 28145 581823983 INDEPENDENT AND ASSISTED LIVING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LUTHERAN SERVICES FOR THE AGING FOUNDATION INC PO BOX 947 SALISBURY NC 28145 561681723 FOUNDATION NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 ABUNDANT LIVING ADULT DAY SERVICES INC PO BOX 947 SALISBURY NC 28145 561884652 ADULT DAY SERVICES NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LSA ELMS AT TANGLEWOOD INC PO BOX 947 SALISBURY NC 28145 263735637 ASSISTED LIVING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 LSA ELMS PROPERTY INC PO BOX 947 SALISBURY NC 28145 263739962 LEASING NC 501(C)(3) 509(A)(2) LUTHERAN SERVICES FOR THE AGING INC 0 0 1 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 LSA PHARMACY G 37632 LH HICKORY PROPERTY J 600000 LSA MANAGEMENT L 500548