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
2011
Open to Public Inspection
Name of the organization
Concordia Lutheran Ministries Foundation
Employer identification number
20-5138266
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
Concordia Lutheran Ministries of Pittsburgh
270209886
9
Yes
Yes
Yes
542,180
(2)
Concordia Lutheran Health and Human Care
250969458
9
Yes
Yes
Yes
217,525
(3)
Good Samaritan Hospice
251818793
9
Yes
Yes
Yes
31,358
(4)
Concordia Visiting Nurses
421704067
9
Yes
Yes
Yes
6,356
(5)
Rebecca Residence dba Concordia at Rebecca Residence
250974311
9
Yes
Yes
Yes
2,875
Total
800,294
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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......
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.
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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.).
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
Additional Data
Software ID:
11000129
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
2011
Open to Public Inspection
Name of the organization
Concordia Lutheran Ministries Foundation
Employer identification number
20-5138266
Identifier
Return Reference
Explanation
F990_P06_S0A_L06
Form 990, Part VI, Section A, Line 6
Concordia Lutheran Ministries (EIN 20-5138278) is the sole member of Concordia Lutheran Ministries Foundation.
F990_P06_S0A_L07a
Form 990, Part VI, Section A, Line 7a
The sole member, Concordia Lutheran Ministries (EIN 20-5138278), assigns the board of directors.
F990_P06_S0A_L07b
Form 990, Part VI, Section A, Line 7b
The sole member, Concordia Lutheran Ministries (EIN 20-5138278), has final approval over all of the organization's board of directors' decisions and actions.
F990_P06_S0B_L11b
Form 990, Part VI, Section B, Line 11b
The return is emailed to the board of directors prior to submission. Any questions concerning the return are addressed via email prior to submission.
F990_P06_S0B_L12c
Form 990, Part VI, Section B, Line 12c
The corporate compliance officer attends at least one board meeting per year to educate the board members on the compliance policies, including the conflict of interest policy. Board members are required to disclose any potential conflicts 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.
F990_P06_S0B_L15
Form 990, Part VI, Section B, Line 15
Concordia Lutheran Ministries Foundation has no employees. The processes listed on Line 15 are performed by affiliate organizations (Concordia Lutheran Health and Human Care EIN, 25-0969458, Concordia Visiting Nurses, EIN-42-1704067, and Concordia Lutheran Ministries of Pittsburgh, EIN 27-0209886) for those persons listed in part VII and on Schedule J.
F990_P06_S0C_L19
Form 990, Part VI, Section C, Line 19
Concordia Lutheran Ministries (EIN 20-5138278) publishes as annual report that summarizes the financial operations of the organization and its affiliates which is mailed to all of its constituents and is available to the public upon request. IRS From 990 is available at no cost at guidestar.org or upon request.
F990_P07_S0A_L01a
Form 990, Part VII, Section A, Line 1a
Michael Falbo is the Director of Finance of Concordia Lutheran Ministries of Pittsburgh (EIN 27-0209886) William Giallombardo is the Chief Financial Officer of Concordia Visiting Nurses (EIN 42-1704067). He spends an additional eight hours per week on affiliate boards. Kim Young is the Controller of Concordia Lutheran Health and Human Care (EIN 25-0969458). She spends an additional three hours per week on affiliate boards. Keith Frndak is the Chief Executive Officer of Concordia Lutheran Ministries (EIN 20-5138278) and Subsidiaries. He spends an additional eight hours per week on affiliate boards. Paul Brand is the Chief Financial Officer of Concordia Lutheran Ministries (EIN 20-5138278) and Subsidiaries. He spends an additional seven hours on affiliate boards.
F990_P10_S00_L20
Form 990, Part X, Line 20
There is no Schedule K for this entry. The bond related to the $5,269,590 recorded under "tax exempt bond liability" is listed in its entirety on the 990 for Concordia Lutheran Health and Human Care (EIN 25-0969458).
F990_P11_S00_L05
Form 990, Part XI, Line 5
($1,425,080)-Unrealized losses on investments. ($4,381,056)-Funds transferred to Concordia Lutheran Ministries (EIN 20-5138278). $12,512-Funds transferred from Rebecca Residence dba Concordia at Rebecca Residence (EIN 25-0974311). ($61,202)-Reconcile present value of gift annuities. $426-Reconcile gift annuity interest.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000129
Software Version:
v1.00
-
TIN:
TY 2011 ReasonableCauseExplanation
Name:
Concordia Lutheran Ministries Foundation
EIN: 20-5138266
Software ID:11000129
Software Version:v1.00
Explanation:
Filed IRS Form 8868 for the initial three month extension and the additional three month extension. Additional time was needed to gather information and complete the Form 990 accurately.