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
CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Employer identification number
25-0969458
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.") .
71,512
66,444
123,861
266,432
312,995
841,244
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......
28,500,928
29,032,179
31,697,021
34,504,766
37,153,153
160,888,047
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...
0
0
0
0
0
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
0
0
0
0
0
6
Total. Add lines 1 through 5.
28,572,440
29,098,623
31,820,882
34,771,198
37,466,148
161,729,291
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
161,729,291
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...
28,572,440
29,098,623
31,820,882
34,771,198
37,466,148
161,729,291
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
728,725
1,335,828
-285,346
2,873,946
1,910,428
6,563,581
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
728,725
1,335,828
-285,346
2,873,946
1,910,428
6,563,581
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.)
246,935
412,601
394,523
341,662
2,853,339
4,249,060
13
Total support (Add lines 9, 10c, 11 and 12.).
29,548,100
30,847,052
31,930,059
37,986,806
42,229,915
172,541,932
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
93.733 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
95.150 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
3.804 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
3.767 %
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
A total of 2,853,339 is in other income. The following is the breakdown. Related organization income: management fees $360,000 and space rental $407,152. Space rental to outside health care entities to provide services to our residents and employees was received in the amount of $44,629. In addition unrealized gains of $1,971,912 related to market value adjustments on investments is also in this category. The organization received a supplemental payment from Kore Energy in the amount of $28,562. This was an agreement that was entered into to voluntarily participate in their program to curtail electrical services. The remainder is miscellaneous income collected for resident related activities.
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000077
Software Version:
v1.00
-
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
CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Employer identification number
25-0969458
Identifier
Return Reference
Explanation
F990_P03_S00_L00a
Form 990, Part III (Cont. 1)
Concordia's Community benefit continues to support our region's community in a number of ways. Annually Concordia holds multiple community festivals. At the Cabot Campus, the Summer Festival (attended by nearly 500 visitors) and the Oktoberfest (attended by over 1,500 visitors) continues to provide a fun-filled family day for our community. Each event included free children and family activities, music and entertainment. Food was provided for a small fee and children under the age of 12 ate for free. Cabot Campus Haven activities included the donation of hats and mittens to families in need through Katies Kitchen in Butler and troops over seas through the LifeLine Program at Christ Lutheran Church in New Castle. Haven activities also collected and distributed canned goods for a variety of area food banks, sandles for children in Hattie following the earthquake, men's clothing for Veterans returning home. Concordia's LifeLong Learning Institute (a senior college concept) is open to seniors in the community. In the Fall 2010 semester 76 seniors participated in 8 classes and 62 participated in the 8 Spring 2011 semester classes. Employees within Concordia participated in an Adopt-A-Resident program. Through this program, Christmas gifts were provided to Concordia Community assisted living and skilled nursing residents to fulfill their Christmas wishes. The baseball field at the Cabot Campus is utilized each spring and summer by the Saxonburg Baseball Association's Youth Baseball Program. The use of Concordia's baseball field offers them additional space for practices and games enhancing the quality of the program for the children. Concordia's Adult Day Services offers monthly Alzheimer's Support Group meetings with free client care to all attendees each month. This meeting offers worry-free support for the caregiver both through educational information provided at the meeting and confidence in knowing their loved one is being taken care of while they are attending the meeting. There is also a free trial day offered to all those considering regular use of the Adult Day Services at Concordia. At the Ridgewood and Orchard Campuses, community festivals were hosted at each of the facilities for family, friends, residents and community members.
F990_P06_S0A_L06
Form 990, Part VI, Section A, Line 6
Concordia Lutheran Health and Human Care has seven Board members on their Board of Directors that meet quarterly. In addition, Concordia Lutheran Ministries (parent company) is the sole member of Concordia Lutheran Health and Human Care.
F990_P06_S0A_L07a
Form 990, Part VI, Section A, Line 7a
Concordia Lutheran Ministries (parent company) is the sole member of Concordia Lutheran Health and Human Care and elects their board of directors.
F990_P06_S0A_L07b
Form 990, Part VI, Section A, Line 7b
Concordia Lutheran Ministries as the sole member of Concordia Lutheran Health and Human Care has certain reserve powers over Board decisions of Concordia Lutheran Health and Human Care.
F990_P06_S0B_L11b
Form 990, Part VI, Section B, Line 11b
The Form 990 is prepared internally. The document is then reviewed by the Chief Financial Officer and others on the accounting management team. The board is sent draft copies of the 990, prior to filing, in order to provide questions, comments and feedback. Questions and comments were addressed accordingly. A copy of the final 990 is made available to all board members.
F990_P06_S0B_L12c
Form 990, Part VI, Section B, Line 12c
Board members must update the conflict of interest statement annually and are required to disclose any potential conflict of interest prior to discussion on a topic where a conflict may exist. The Board will determine if a conflict exists and act accordingly, which may include the conflicted Board member recusing himself/herself from discussion and any votes related to the matter. In addition, Corporate Compliance training for board members is held annually by the Corporate Compliance Officer.
F990_P06_S0B_L15
Form 990, Part VI, Section B, Line 15
The Executive Committee of Concordia Lutheran Ministries (parent company) approves the compensation for the Chief Executive Officer annually. Compensation includes base compensation, deferred compensation, and other fringe benefits such as health insurance. The committee uses data from state and national associations for organizations of similar size to compare compensation. Executive Committee decisions for CEO compensation are communicated to the Chief Financial Officer. Compensation for key employees is determined by the CEO. Data from state and national associations is used for comparison purposes.
F990_P06_S0C_L19
Form 990, Part VI, Section C, Line 19
Governing documents, conflict of interest policies and financial statements are made available to the public upon request. Concordia Lutheran Ministries publishes an annual report that summarizes the financial operations of the organization and its affiliates which is mailed to all Concordia constituents and is also available to the public upon request. In addition, IRS Form 990 is available at no cost on Guidestar.org.
F990_P07_S0B_L01A
Form 990, Part VII, Section B, Line 1(A)
There were no independent contractors who received greather than $100,000
F990_P11_S00_L02
Form 990, Part XI, Line 2
The organization was included in a consolidated audited financial statement with Concordia Lutheran Ministries and its Related Subsidiaries in accordance with Generally Accepted Accounting Principles
F990_P11_S00_L05
Form 990, Part XI, Line 5
Transfer of net assets to related organization
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000077
Software Version:
v1.00
-
TIN:
TY 2010 ReasonableCauseExplanation
Name:
CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
EIN: 25-0969458
Software ID:10000077
Software Version:v1.00
Explanation:
An extension filed on from 8868 has been filed and approved