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LUTHERAN HOME-HICKORY INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
LUTHERAN HOME-HICKORY INC (EIN 20-1457341)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-02-07
IRS object ID
201120389349300012
Schema version
2009v1.7
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)
Timestamp2011-02-07T09:49:08-06:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

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 Date2009-10-01TaxPeriodBeginDate

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)
NameANNETTE CONRADName
TitleTREASURERTitle
Phone7046372870Phone
Date Signed2011-02-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDavidson Holland Whitesell Co PLLCName
Phone8283222070Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonANNETTE CONRADNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 947AddressLine1
CitySALISBURYCity
StateNCState
ZIP Code281450947ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12906046GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
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 Employees305TotalNbrEmployees
Total Nbr Volunteers113TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year159467ContributionsGrantsPriorYear
Contributions Grants Current Year102078ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10972144ProgramServiceRevenuePriorYear
Program Service Revenue CY11733044ProgramServiceRevenueCY
Investment Income Prior Year11999InvestmentIncomePriorYear
Investment Income Current Year20618InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year11143610TotalRevenuePriorYear
Total Revenue Current Year11855740TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6323954SalariesEtcPriorYear
Salaries Etc Current Year6489891SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4313965OtherExpensePriorYear
Other Expenses Current Year4516130OtherExpensesCurrentYear
Total Expenses Prior Year10637919TotalExpensesPriorYear
Total Expenses Current Year11006021TotalExpensesCurrentYear
Revenues Less Expenses Prior Year505691RevenuesLessExpensesPriorYear
Revenues Less Expenses CY849719RevenuesLessExpensesCY
Total Assets BOY4023962TotalAssetsBOY
Total Assets EOY4970864TotalAssetsEOY
Total Liabilities BOY845277TotalLiabilitiesBOY
Total Liabilities EOY922286TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3178685NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4048578NetAssetsOrFundBalancesEOY
Mission DescriptionLUTHERAN NURSING HOMES PROVIDE NURSING CARE FOR THE RESIDENTS OF HICKORY AND THE SURROUNDING AREAS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10085701Expense
Revenue11733044Revenue
DescriptionLUTHERAN HOME-HICKORY, INC. ("LH-HICKORY") 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. BECAUSE CHOOSING A NURSING HOME OFTEN COMES AT A DIFFICULT TIME CHAPLAINS ARE AVAILABLE TO OFFER SUPPORT AND GUIDANCE TO FAMILIES AND RESIDENTS ON ADMISSION AND THROUGHOUT THEIR STAY.During the year ended September 30, 2010, LH - Hickory provided 61,449 days of care to 408 residents.Description
Total Program Service Expense10085701TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109624NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees305NumberOfEmployees
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
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
States Where Copy Of Return Is FiledNCStatesWhereCopyOfReturnIsFiled
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 (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
HANS TEICH
VICE CHAIR1.00X000
KAYE LEONARD
BOARD CHAIR1.00X000
Ted Goins
PRESIDENT40.00X02323168616X
Annette Conrad
TREASURER40.0001500407403X
Karen Maddry
SECRETARY40.000550326628X
Amber McIntosh
Administrator40.0011348507797X
Debbie Mathis
Chief Operating Officer40.0001518697425X
Cynthia McCoy
Administrator40.0001009986032X
David Beam
Pharmacist40.0001379077251X
Elizabeth Kuhn
Director R & D40.0001061017649X
James Fisher
Pharmacist40.0001187857012X
John C Frye Jr
Administrator40.0001150035527X
Michael Walsh
Executive Director40.0001050636840X
FieldValueIRS element (for citing)
Total Reportable Comp From Org113485TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1273114TotalReportableCompFrmRltdOrgs
Total Other Compensation78180TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations15000RelatedOrganizations
All Other Contributions87078AllOtherContributions
Total Contributions102078TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID/MEDICARE SERV62300065410506541050
RESIDENT SERVICE REVEN62300050762095076209
ANCILLARY SERVICE REVE623000115785115785
FieldValueIRS element (for citing)
Total Program Service Revenue11733044TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column15609TotalRevenueColumn
Exclusion$15,609ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1055315Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1050306Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities5009Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5009TotalRevenueColumn
Exclusion$5,009ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11855740TotalRevenueColumn
Related Or Exempt Function Income11733044RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$20,618ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total113485Total
Management And General113485ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5414711Total
Program Services5238574ProgramServices
Management And General176137ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total545803Total
Program Services517208ProgramServices
Management And General28595ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total415892Total
Program Services394103ProgramServices
Management And General21789ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total284Total
Management And General284ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total16118Total
Management And General16118ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1631Total
Management And General1631ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total555971Total
Program Services555971ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total7144Total
Program Services4985ProgramServices
Management And General2159ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total139390Total
Program Services139390ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total82136Total
Program Services82136ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Supplies123370012252638437
Contract Services1202187116475437433
Management Fees432909432909
Bed Assessment345138345138
Utilities313649313649

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total185873Total
Program Services104530ProgramServices
Management And General81343ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11006021Total
Program Services10085701ProgramServices
Management And General920320ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1347891BOY
EOY2225990EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY97209BOY
EOY133149EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY804939BOY
EOY682655EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY47920BOY
EOY50028EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY140BOY
EOY140EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1885963LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1453248LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY444428BOY
EOY432715EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1281435BOY
EOY1446187EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4023962BOY
EOY4970864EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY827814BOY
EOY902943EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY17463BOY
EOY19343EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY845277BOY
EOY922286EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3146986BOY
EOY4011791EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY31699BOY
EOY36787EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3178685BOY
EOY4048578EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4023962BOY
EOY4970864EOY
FieldValueIRS element (for citing)
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 Years182145CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years129232CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years95547CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year159467CurrentTaxYearMinus1Year
Current Tax Year87078CurrentTaxYear
Total653469Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10322210CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10278237CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10433370CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10972143CurrentTaxYearMinus1Year
Current Tax Year11733044CurrentTaxYear
Total53739004Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10504355CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10407469CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10528917CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11131610CurrentTaxYearMinus1Year
Current Tax Year11820122CurrentTaxYear
Total54392473Total

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 Total50954392473PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years34600CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years61062CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years42940CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16488CurrentTaxYearMinus1Year
Current Tax Year20618CurrentTaxYear
Total175708Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years34600CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years61062CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years42940CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16488CurrentTaxYearMinus1Year
Current Tax Year20618CurrentTaxYear
Total175708Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10538955CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10468531CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10571857CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11148098CurrentTaxYearMinus1Year
Current Tax Year11840740CurrentTaxYear
Total54568181Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99680PublicSupportPercentage509
Prior Year Support Percentage0.99430PriorYearSupportPercentage
Investment Income Percentage0.00320InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00340PriorYrInvestIncomePercentage
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
End Of Year Balance51624EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1885963OtherCostOrOtherBasis
Depreciation1453248Depreciation
Book Value432715BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings432715TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
OTHER RECEIVABLES85398
RESIDENTS' FUNDS19343
INTERCOMPANY ACCOUNTS710069
ASSETS LIMITED TO USE BY BOARD AND RES. AGREEMENT326681
INVESTMENT IN ADULT LIFE PROGRAM PROJECT223125
WORK IN PROGRESS81571
FieldValueIRS element (for citing)
Total Book Value Other Assets1446187TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionRESIDENTS' FUNDSDescription
Amount$19,343Amount
FieldValueIRS element (for citing)
Total Of Amounts19343TotalOfAmounts
Total Revenue11855740TotalRevenue
Total Expenses11006021TotalExpenses
Excess Or Deficit For Year849719ExcessOrDeficitForYear
Net Unrealized GL On Investments20174NetUnrealizedGLOnInvestments
Total Adjustments20174TotalAdjustments
Excess Or Deficit Per FS869893ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt11869196TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments20174NetUnrealizedGainsInvestments
Other Revenues55209OtherRevenues
Revenue Not Rptd F99075383RevenueNotRptdF990
Revenue Subtotal11793813RevenueSubtotal
Other Revenues Not Included61927OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt61927RevenueNotRptdOnFinStmt
Total Revenue Per Form99011855740TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11004391TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal11004391ExpensesSubtotal
Other Expenses Not Included1630OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1630ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011006021TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:FUNDS ARE DESIGNATED FOR FUTURE EXPANSION, EQUIPMENT PURCHASES, OR FOR FUTURE PROGRAM SERVICE NEEDS.
Part X:Description of Uncertain Tax Positions Under FIN 48: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, 2010, the Organization has no uncertain tax positions that qualify for either recognition or disclosure in the financial statements.
Part XII, Line 2d - Other Adjustments:NET ASSETS RELEASED FROM RESTRICTION: 10822. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR PURCHASE OF EQUIPMENT: 44387.
Part XII, Line 4b - Other Adjustments:ASSETS RESTRICTED: 60297. INVESTMENT EXPENSES NETTED AGAINST INVESTMENT INCOME : 1630.
Part XIII, Line 4b - Other Adjustments:INVESTMENT EXPENSES NETTED AGAINST INVESTMENT INCOME : 1630.

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 Goins
023231600000290405712024093200
Annette Conrad
015004000000187605527015744300
Debbie Mathis
015186900000189805527015929400

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanation
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.
Form 990, Part VI, Section B, line 12cON 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 15ALL 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 19FORMS ARE POSTED ON GUIDESTAR AS WELL AS AVAILABLE AT THE LSA OFFICE LOCATED IN SALISBURY, NC.
Form 990, Part XI, Line 2cTHE EXECUTIVE COMMITTEE FUNCTIONS AS THE AUDIT COMMITTEE AND PERFORMS THE DUTIES AND RESPONSIBILITIES AS INDICATED ON PAGE 12, PART XI, LINE 2C. THE PROCESS HAS NOT CHANGED SINCE LAST YEAR.

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/BusinessNameLine1
LUTHERAN SERVICES FOR THE AGING INC
PO BOX 947SALISBURYNC28145560500212PARENT ORGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LSA MANAGEMENT INC
PO BOX 947SALISBURYNC28145201457236MANAGEMENTNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LSA PHARMACY INC
PO BOX 947SALISBURYNC28145201457251PHARMACYNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME-ALBEMARLE INC
PO BOX 947SALISBURYNC28145201457298SKILLED NURSING CARE AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME AT TRINITY OAKS INC
PO BOX 947SALISBURYNC28145201457824SKILLED NURSING CARE AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME-HICKORY WEST INC
PO BOX 947SALISBURYNC28145201457410SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME-WINSTON-SALEM INC
PO BOX 947SALISBURYNC28145561500212SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME-FORSYTH COUNTY INC
PO BOX 947SALISBURYNC28145263328029SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME-WILMINGTON INC
PO BOX 947SALISBURYNC28145260158686SKILLED NURSING CARENC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME ALBEMARLE PROPERTY INC
PO BOX 947SALISBURYNC28145201457273LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME HICKORY PROPERTY INC
PO BOX 947SALISBURYNC28145201457319LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME AT TRINITY OAKS PROPERTY INC
PO BOX 947SALISBURYNC28145201457796LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME HICKORY WEST PROPERTY INC
PO BOX 947SALISBURYNC28145205304712LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME WINSTON-SALEM PROPERTY INC
PO BOX 947SALISBURYNC28145205304794LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN HOME WILMINGTON PROPERTY INC
PO BOX 947SALISBURYNC28145260158745LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN SERVICES PROPERTY INC
PO BOX 947SALISBURYNC28145203895886LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN RETIREMENT CENTER-SALISBURY INC
PO BOX 947SALISBURYNC28145561540214INDEPENDENT AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN RETIREMENT CENTER-WILMINGTON INC
PO BOX 947SALISBURYNC28145561500308INDEPENDENT LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN RETIREMENT CENTER AT LUTHERIDGE INC
PO BOX 947SALISBURYNC28145581823983INDEPENDENT AND ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LUTHERAN SERVICES FOR THE AGING FOUNDATION INC
PO BOX 947SALISBURYNC28145561681723FOUNDATIONNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
ABUNDANT LIVING ADULT DAY SERVICES INC
PO BOX 947SALISBURYNC28145561884652ADULT DAY SERVICESNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LSA ELMS AT TANGLEWOOD INC
PO BOX 947SALISBURYNC28145263735637ASSISTED LIVINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
LSA ELMS PROPERTY INC
PO BOX 947SALISBURYNC28145263739962LEASINGNC501(C)(3)509(A)(2)LUTHERAN SERVICES FOR THE AGING INC
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
G527867
LH HICKORY PROPERTY
J555971
LSA MANAGEMENT
L432909