Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY NORTH CAROLINA
Employer identification number
56-1270984
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
851,248
458,555
336,557
278,400
133,848
2,058,608
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
17,923,507
19,212,884
19,910,617
20,891,235
23,179,271
101,117,514
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
18,774,755
19,671,439
20,247,174
21,169,635
23,313,119
103,176,122
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
368,903
285,401
306,590
190,496
45,970
1,197,360
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
368,903
285,401
306,590
190,496
45,970
1,197,360
8
Public Support (Subtract line 7c from line 6.)
101,978,762
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
18,774,755
19,671,439
20,247,174
21,169,635
23,313,119
103,176,122
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
896,772
945,174
677,001
586,352
495,660
3,600,959
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
896,772
945,174
677,001
586,352
495,660
3,600,959
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
19,671,527
20,616,613
20,924,175
21,755,987
23,808,779
106,777,081
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
95.510 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
94.940 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
3.370 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
3.720 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY NORTH CAROLINA
Employer identification number
56-1270984
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 7B
ANY AMENDMENT TO THE BYLAWS MUST BE APPROVED BY THE MACEDONIA LUTHERAN CHURCH GOVERNING COUNCIL. THE MACEDONIA LUTHERAN CHURCH GOVERNING COUNCIL MUST ALSO APPROVE THE SLATE OF NEW MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 WAS REVIEWED IN DETAIL WITH THE AUDIT COMMITTEE OF OUR BOARD OF DIRECTORS PRIOR TO FILING. AFTER A DISCUSSION PERIOD AND A QUESTION AND ANSWER PERIOD, THE AUDIT COMMITTEE VOTED TO RECOMMEND TO THE FULL BOARD OF DIRECTORS THAT THE FORM 990 BE ACCEPTED AND FILED. A COPY OF THE ENTIRE FORM 990 WAS PROVIDED TO EACH MEMBER OF THE ENTIRE BOARD OF DIRECTORS WHO THEN VOTED TO ACCEPT THE RECOMMENDATION OF THE AUDIT COMMITTEE. FORM 990 WAS FILED AFTER A COPY WAS PROVIDED TO EACH BOARD MEMBER AND THE BOARD HAD APPROVED THE RECOMMENDATION OF THE AUDIT COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 12C
LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY, NORTH CAROLINA HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY, EACH OFFICER AND BOARD MEMBER WILL DISCLOSE AND THEN EXCUSE THEMSELVES FROM ANY DISCUSSION AND VOTE FOR ANY MATTER FOR WHICH A CONFLICT EXISTS FOR THEMSELVES OR ANY FAMILY MEMBER. ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD WITHOUT THE PRESENCE OF THE INTERESTED PARTY.
FORM 990, PART VI, SECTION B, LINE 15
LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY, NORTH CAROLINA FOLLOWS THE PROCESS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER, KEY MANAGEMENT, AND DIRECTOR COMPENSATION. ON AN ANNUAL BASIS THE ENTIRE GOVERNING BOARD REVIEWS AND APPROVES THE ENTIRE COMPENSATION PACKAGE OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER BASED ON COMPARABILITY FACTORS INCLUDING BUT NOT LIMITED TO THE SIZE OF THE ORGANIZATION, THE GEOGRAPHIC LOCATION OF THE ORGANIZATION, AND THE EMPLOYEE'S LENGTH OF SERVICE. THE EXECUTIVE COMMITTEE OF THE BOARD CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER, REVIEWS THE COMPARABILITY DATA, AND MAKES A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS WHO THEN APPROVE THE ENTIRE COMPENSATION PACKAGE.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO AVAILABLE AT THE NC DEPARTMENT OF INSURANCE WEBSITE AND THE ORGANIZATION'S FORM 990 IS AVAILABLE ON THE GUIDESTAR WEBSITE.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -283,757. CHANGE IN MARKET VALUE OF RATE SWAP AGREEMENT RELATED TO TAX-EXEMPT BONDS -35,924. TOTAL TO FORM 990, PART XI, LINE 5: -319,681.
CONTINUATION OF MISSION STATEMENT
FORM 990, PART 1, LINE 1
LUTHERAN RETIREMENT MINISTRIES OF ALAMANCE COUNTY THROUGH ITS CONTINUING CARE RETIREMENT COMMUNITY, TWIN LAKES COMMUNITY (LRM/TLC) PROVIDES COMPREHENSIVE SERVICES TO THE ELDERLY. PROGRAMS AND SERVICES PROVIDED INCLUDE (1) A SKILLED NURSING FACILITY; (2) A RESIDENTIAL MODEL ASSISTED LIVING FACILITY; (3) A MEMORY CARE FACILITY; (4) INDEPENDENT LIVING UNITS; (5) HOME CARE AGENCY; (6) REHABILITATIVE/THERAPY SERVICES; (7) AN ADULT DAY CARE CENTER; (8) A PARKINSON'S SUPPORT GROUP; (9) CARE GIVER SUPPORT AND EDUCATION CLASSES; (10) PROGRAMS/ACTIVITIES WITHIN THE SPECTRUM OF WELLNESS AND HEALTHY AGING; (11) COMMUNITY OUTREACH PROGRAMS; (12) STUDENT INTERNSHIPS AND EDUCATIONAL PRACTICUM'S; (13) GRIEF SUPPORT SERVICES; AND (14) RELIGIOUS/SPIRITUAL SERVICES. LRM/TLC SERVES A DIVERSE POPULATION OF APPROXIMATELY 1,000 INDIVIDUALS A YEAR. LRM/TLC IS AN ACCREDITED FACILITY THROUGH THE COMMISSION FOR ACCREDITATION OF REHABILITATIVE FACILITIES (CARF-CCRC). DURING THE YEAR, ITS SKILLED NURSING AND MEMORY CARE FACILITIES OBTAINED A "5 STAR" RATING THROUGH THE CMS SURVEY SYSTEM. LRM/TLC ACCEPTS MEDICAID PATIENTS AND PROVIDES FINANCIAL ASSISTANCE FOR PERSONS WHO WOULD NOT OTHERWISE QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS. ITS COMMUNITY OUTREACH PROGRAMS SUPPORTED OVER 50 GOVERNMENTAL, EDUCATIONAL, RELIGIOUS, AND NON-PROFIT CHARITABLE ORGANIZATIONS DURING THE YEAR. LRM/TLC PROVIDES WITHOUT CHARGE THE ONLY PARKINSON'S SUPPORT GROUP IN ALAMANCE COUNTY AND CONSISTENTLY SERVES 60 INDIVIDUALS AND FAMILIES.
PURPOSE OF GRANT TO LUTHERAN SERVICES IN AMERICA
SCHEDULE I, PART II, COLUMN H
THE GRANT IS TO PROVIDE EDUCATIONAL SEMINARS GEARED TO THE LEADERS OF THE 300+ NON-PROFIT SOCIAL MINISTRY CHURCH RELATED MEMBER ORGANIZATIONS OF LUTHERAN SERVICES IN AMERICA. THE SEMINARS PROVIDE BUSINESS, PERSONNEL, AND SELF-DEVELOPMENT TYPE TOPICS. THE CEO ACADEMY IS FOR NEW AND ESTABLISHED EXECUTIVES, WHILE THE LEADERSHIP ACADEMY IS FOR DEVELOPING SECOND TIER LEADERS WITHIN THE SYSTEM. EACH ACADEMY HAS BETWEEN 45 AND 50 ATTENDEES A YEAR.
DESCRIPTION OF PURPOSE FOR BOND ISSUE
SCHEDULE K, PART I, ROW A & B, COLUMN (F)
TO REFUND A PORTION OF THE COMMISSION'S OUTSTANDING HEALTH CARE FACILITIES REVENUE AND REVENUE REFUNDING BONDS (LUTHERAN RETIREMENT MINISTRIES PROJECT), SERIES 2007 AND PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.