Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 - ORGANIZATION'S MISSION | THE ORGANIZATION'S MISSION IS TO HOLD TITLE TO REAL PROPERTY AND RENT SUCH PROPERTY TO AN AFFILIATED EXEMPT ORGANIZATION. THE ORGANIZATION ALSO SHARES THE MISSION OF ITS PARENT, LUTHERAN FAMILY SERVICES IN THE CAROLINAS, TO EMBRACE CHRIST'S CALL TO SERVE AND WALK WITH THE MOST VULNERABLE IN OUR COMMUNITIES TOWARD HEALING AND WHOLENESS. |
| ADDITIONAL INFORMATION | FORM 990, PART VI | WHISTLEBLOWER POLICY LUTHERAN SERVICES FOR THE AGING, INC. & AFFILIATES ARE COMMITTED TO THEIR ROLE IN PREVENTING HEALTH CARE FRAUD AND ABUSE AND COMPLYING WITH APPLICABLE STATE AND FEDERAL LAWS RELATED TO HEALTH CARE FRAUD AND ABUSE. THE CIVIL FALSE CLAIMS ACT PROVIDES FOR PROTECTION FOR EMPLOYEES FROM RETALIATION. ANY EMPLOYEE WHO IS DISCHARGED, DEMOTED, SUSPENDED, THREATENED, HARASSED, OR DISCRIMINATED AGAINST IN TERMS AND CONDITIONS OF EMPLOYMENT BECAUSE OF LAWFUL ACTS CONDUCTED IN FURTHERANCE OF AN ACTION UNDER THE FCA MAY BRING AN ACTION IN FEDERAL DISTRICT COURT SEEKING REINSTATEMENT, TWO TIMES THE AMOUNT OF BACK PAY PLUS INTEREST, AND OTHER ENUMERATED COSTS, DAMAGES, AND FEES. DOCUMENTATION RETENTION AND DESTRUCTION POLICY EACH ENTITY WITHIN THE LUTHERAN SERVICES FOR THE AGING, INC. & AFFILIATES GROUP WILL ENSURE THAT RECORDS ARE RETAINED FOR THE REQUIRED TIME PERIODS ESTABLISHED BY STATE LAWS, FEDERAL REGULATIONS, AND PAYOR REQUIREMENTS TO MEET THE NEEDS OF LEGITIMATE USERS. AT THE END OF THE RETENTION PERIOD, EACH ENTITY WILL ENSURE THAT DESTRUCTION OF RECORDS IS PERFORMED ACCORDING TO SPECIFIC PROCEDURE AND AUTHORIZATION WITH APPROPRIATE SUPERVISION OF DESTRUCTION. THE PROPER METHOD OF DESTRUCTION FOR ANY PAPER RECORD IS BY SHREDDING OR INCINERATION ONLY. PRIOR TO THE DESTRUCTION OF ANY FACILITY RECORDS, WHETHER ORIGINAL OR COMPUTER MEDIA, A CHECK WILL BE MADE TO ENSURE THE RETENTION PERIOD HAS EXPIRED AS DEFINED BY STATE LAWS AND FACILITY POLICIES. ANY RECORDS IN OPEN INVESTIGATION, AUDIT, OR LITIGATION WILL NOT BE DESTROYED. FOR FACILITIES USING ELECTRONIC MEDICAL RECORDS, RECORDS WILL BE STORED IN THE SYSTEM INDEFINITELY AND THE DESTRUCTION PROCESS WILL NOT APPLY. |
| MANAGEMENT DELEGATED | FORM 990, PAGE 6, PART VI, LINE 3 | LSA MANAGEMENT, INC. PROVIDES MANAGEMENT SERVICES TO ALL LSA AFFILIATES, INCLUDING THIS ORGANIZATION. |
| SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS | FORM 990, PAGE 6, PART VI, LINE 4 | EFFECTIVE OCTOBER 1, 2011, LUTHERAN SERVICES FOR THE AGING, INC. AND LUTHERAN FAMILY SERVICES IN THE CAROLINAS AND AFFILIATES UNDERWENT AN ORGANIZATIONAL RESTRUCTURE FORMING A COLLECTIVE MINISTRY, LUTHERAN SERVICES CAROLINAS. DUE TO THE RESTRUCTURE, THE AUDITED FINANCIAL STATEMENTS ARE PRESENTED ON A CONSOLIDATED BASIS DUE TO THE EXISTENCE OF BOTH AN ECONOMIC INTEREST AND CONTROL. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE CHIEF FINANCE OFFICER AND MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. ANY MATTERS ARE RAISED TO THE OUTSIDE ACCOUNTANTS FOR COLLABORATION AND ULTIMATE RESOLUTION. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS 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 THIS COMPLIANCE WITH THE POLICY. WHEN NEW MEMBERS JOIN THE BOARD MID-TERM, THEY ALSO RECEIVE THIS INFORMATION AND COMPLETE THE SAME STATEMENT INDICATING THEIR COMPLIANCE WITH THE POLICY. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | ALL COMPENSATION LIMITS ARE COMPARED TO STATE AND NATIONAL RANGES BASED ON FACILITY SIZE AND EXPERIENCE OF STAFF. THE BOARD OF DIRECTORS APPROVE THE COMPENSATION OF THE PRESIDENT WHICH IS PAID BY THE MANAGING ORGANIZATION OF THE CONTROL GROUP. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | ALL COMPENSATION LIMITS ARE COMPARED TO STATE AND NATIONAL RANGES BASED ON FACILITY SIZE AND EXPERIENCE OF STAFF. THE PRESIDENT APPROVES THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES. OFFICERS OF THE CONTROLLED GROUP ARE PAID BY THE MANAGING ORGANIZATION AND CERTAIN ORGANIZATIONS WITHIN THE CONTROL GROUP ALSO COMPENSATE KEY EMPLOYEES DIRECTLY. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | FORMS 990 ARE POSTED ON GUIDESTAR AND AVAILABLE UPON REQUEST AT THE LSA OFFICE LOCATED IN SALISBURY, NC. |
| ADDITIONAL INFORMATION | FORM 990, PART VII | FORMER OFFICERS KIRBY NICKERSON TOOK THE POSITION OF TREASURER/CFO IN JUNE OF 2012 AND THEREFORE DID NOT RECEIVE COMPENSATION IN CALENDAR YEAR 2011 OR A CORRESPONDING 2011 FORM W-2. ANNETTE CONRAD SERVED AS TREASURER FROM 10/1/11 TO 2/10/12. DEBORAH MATHIS SERVED AS CHIEF OPERATING OFFICER UNTIL 6/4/11. SHE DID NOT RECEIVE ANY FISCAL YEAR COMPENSATION BUT HER 2011 W-2 INCOME IS PROPERLY REPORTED ON PART VII. PATRICK FOLEY SERVED AS CHIEF OPERATING OFFICER FROM 9/26/11 TO 10/12/12 AND HIS 2011 W-2 INCOME IS PROPERLY REPORTED ON PART VII. |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | THE 139,966 IS A RECONCILING ADJUSTMENT BETWEEN LFS REAL PROPERTIES AND ITS PARENT, LUTHERAN FAMILY SERVICES IN THE CAROLINAS (EIN: 56-1286323), AN I.R.C. 501(C)(3) TAX EXEMPT ENTITY (AS LISTED ON SCHEDULE R). THIS ADJUSTMENT IS REQUIRED IN ORDER TO ACCURATELY PERMIT CROSS REFERENCE BETWEEN THE BEGINNING-OF-YEAR NET ASSETS PER THE CURRENT YEAR AUDITED FINANCIAL STATEMENTS TO THE END-OF-YEAR ASSETS AS REPORTED ON THE PRIOR YEAR FORMS 990. |
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