2011-02-07T09:49:08-06:00 2010-09-30 DAVIDSON HOLLAND WHITESELL & CO PLLC 209 13TH AVE PLACE NW SUITE 200 HICKORY NC 28601 990 2009-10-01 201457236 LSA MANAGEMENT INC LSAM 7046372870 PO BOX 947 SALISBURY NC 281450947 ANNETTE CONRAD 7046372870 2011-02-06 1 Davidson Holland Whitesell Co PLLC 8283222070 2009 2016-02-24 21:20:13Z ANNETTE CONRAD PO BOX 947 SALISBURY NC 281450947 3075645 0 X WWW.LSANC.NET X 2004 NC PROVIDES MANAGEMENT, ACCOUNTING, INFORMATION TECHNOLOGY, AND RESOURCE DEVELOPMENT SERVICES TO THE AFFILIATES. 3 2 24 0 0 0 100200 10962 2802145 2909059 16249 59206 410 2918594 2979637 0 0 1755105 2023096 47250 0 0 562781 579664 2365136 2602760 553458 376877 26544742 8214775 23264087 5342684 3280655 2872091 PROVIDES MANAGEMENT, ACCOUNTING, INFORMATION TECHNOLOGY, AND RESOURCE DEVELOPMENT SERVICES TO THE AFFILIATES. 0 0 820756 2909469 LSA Management, Inc. ("LSAM") is an affiliate of Lutheran Services for the Aging, Inc., a social ministry of the Evangelical Lutheran Church in America. One of twenty-three affiliate organizations, LSAM is responsible for providing administrative support, financial management, information technology services, resource development and various support services to the affiliate corporations that minister to the aging. 820756 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 22 0 24 1 0 0 0 0 0 0 0 3 2 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NC X X LSA MANAGEMENT INC 7046372870 1416 S MARTIN LUTHER KING JR AV SALISBURY NC 28144 HANS TEICH 1.00 X 0 0 0 KAYE LEONARD 1.00 X 0 0 0 TED W GOINS JR 40.00 X X 232316 0 8616 KAREN K MADDRY 40.00 X 55032 0 6628 ANNETTE S CONRAD 40.00 X 150040 0 7403 DEBBIE MATHIS 40.00 X 151869 0 7425 ELIZABETH KUHN 40.00 X 106101 0 7649 DAVID BEAM 40.00 X 0 137907 7251 JAMES FISHER 40.00 X 0 118785 7012 AMBER MCINTOSH 40.00 X 0 113485 7797 MICHAEL WALSH 40.00 X 0 105063 6840 JOHN C FRYE JR 40.00 X 115003 0 5527 CYNTHIA MCCOY 40.00 X 0 100998 6032 810361 576238 78180 5 0 1 0 DAVID R POLSTON 3806 PARK AVE SUITE 2L WILMINGTON NC 28403 ARCHITECTURAL 123681 1 10962 10962 MANAGEMENT FEES 561000 2909059 2909059 2909059 58738 58738 96476 96008 468 468 468 OTHER REVENUE RELATING 561000 410 410 410 2979637 2909469 0 59206 437388 437388 1363390 535956 827434 14244 4239 10005 86159 25643 60516 121915 36285 85630 28863 28863 37905 37905 24000 24000 73270 40079 33191 25080 11709 13371 26707 26707 5093 5093 CONTRACT SERVICES 116077 46338 69739 PRINTING AND PUBLICATIO 67844 57819 10025 SOFTWARE EXPENSE 30236 2634 27602 TELEPHONE 23632 1514 22118 DUES & SUBSCRIPTIONS 20575 5482 15093 100382 26351 74031 2602760 820756 1782004 0 4148668 5762862 200000 129552 393731 430233 233915 593637 533935 121916 59702 653972 742201 21060401 822364 26544742 8214775 530268 531030 20110000 592787 2623819 4218867 23264087 5342684 X 3256397 2872091 24258 0 3280655 2872091 26544742 8214775 X 0 1 1 X 0 X 85198 100200 10962 196360 1982336 2038903 2324402 2802145 2909059 12056845 2067534 2038903 2324402 2902345 2920021 12253205 0 0 0 12253205 71333 237525 90481 16249 58738 474326 71333 237525 90481 16249 58738 474326 41022 630 410 42062 2138867 2317450 2415513 2918594 2979169 12769593 0.95960 0.95780 0.03710 0.03850 X 593637 533935 59702 59702 MISC INVESTMENTS 742201 F 742201 DEFERRED LOAN AND BOND ISSUANCE COSTS 822364 822364 FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 2774702 INTERCOMPANY ACCOUNTS 1444165 4218867 2979637 2602760 376877 48478 -833919 -785441 -408564 3046863 48478 35220 83698 2963165 5510 10962 16472 2979637 2597250 0 2597250 5510 5510 2602760 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 XI, Line 8 - Other Adjustments: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT: -781471. adjust prior years difference in capitalized assets and accum depr.: -52448. Part XII, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTION: 35220. Part XII, Line 4b - Other Adjustments: ASSETS RESTRICTED: 10962. X X X X X X X 1 GROUNLUND SAYTHER BRUNKOW ASSITANCE WITH CAPITAL CAMPAIGN 0 0 34875 -34875 34875 -34875 X X 0 0 0 0 0 0 0 0 0 TED W GOINS JR 232316 0 0 0 0 0 2904 0 5712 0 240932 0 0 0 ANNETTE S CONRAD 150040 0 0 0 0 0 1876 0 5527 0 157443 0 0 0 DEBBIE MATHIS 151869 0 0 0 0 0 1898 0 5527 0 159294 0 0 0 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2009-12-01 27364250 FOR CAPITAL EXPANSION PROJECTS 0 0 21403322 5960928 429045 20974277 2012 0 0 0 1 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 REVIEWD AT A REGULARLY SCHEDULED BOARD MEETING. EACH MEMBERS 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 RANGES BASED ON FACILITY SIZE AND EXPERIENCE OF STAFF. THE BOARD APPROVES THE COMPENSATION OF THE PRESIDENT. Form 990, Part VI, Section C, line 19 FORMS ARE POSTED ON GUIDESTAR AND AVAILABLE AT THE LSA OFFICE LOCATED IN SALISBURY, NC. Form 990, Part XI, Line 2c THE 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. 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 LSA PHARMACY INC PO BOX 947 SALISBURY NC 28145 201457251 PHARMACY NC 501(C)(3) 509(A)(2) lUTHERAN SERVICES FOR THE AGING INC 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 LUTHERAN HOME-HICKORY INC PO BOX 947 SALISBURY NC 28145 201457341 SKILLED NURSING CARE AND ASSISTED LIVING NC 501(C)(3) 509(A)(2) lUTHERAN SERVICES FOR THE AGING INC 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 LUTHERAN SERVICES FOR THE AGING INC K 471025 LSA PHARMACY INC K 210487 LUTHERAN HOME-ALBEMARLE INC K 246770 LUTHERAN HOME-HICKORY INC K 432909 LUTHERAN HOME AT TRINITY OAKS INC K 396225 LUTHERAN HOME-HICKORY WEST INC K 342551 LUTHERAN HOME-WINSTON-SALEM INC K 284274 LUTHERAN RETIREMENT CENTER AT LUTHERIDGE INC K 134635 LUTHERAN RETIREMENT CENTER-SALISBURY INC K 232940 LSA ELMS AT TANGLEWOOD INC K 135243 ABUNDANT LIVING ADULT DAY SERVICES INC K 22000 LUTHERAN HOME WILMINGTON PROPERTY INC Q 8715146 LUTHERAN HOME HICKORY WEST PROPERTY INC Q 1750863 LUTHERAN HOME WINSTON-SALEM PROPERTY INC Q 1575000 LSA ELMS PROPERTY INC Q 8933269 LUTHERAN SERVICES PROPERTY INC J 28530