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
2012
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
123,861
266,432
312,995
238,537
444,715
1,386,540
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......
31,697,021
34,504,766
37,153,153
37,646,263
38,603,107
179,604,310
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.
31,820,882
34,771,198
37,466,148
37,884,800
39,047,822
180,990,850
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.)
180,990,850
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
31,820,882
34,771,198
37,466,148
37,884,800
39,047,822
180,990,850
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
-285,346
2,873,946
1,910,428
2,097,848
2,818,323
9,415,199
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
-285,346
2,873,946
1,910,428
2,097,848
2,818,323
9,415,199
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.)
..
394,523
341,662
2,853,339
-62,179
739,961
4,267,306
13
Total support. (Add lines 9, 10c, 11, and 12.)..
31,930,059
37,986,806
42,229,915
39,920,469
42,606,106
194,673,355
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
92.972 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
93.509 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
4.836 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
4.337 %
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
A total of $739,961 is in other income. The following is the breakdown. Related organization income: Space rental to related organizations - $495,956. Management fees to newly acquired related organization $127,500. Management fees to local hospital for skilled nursing consulting $38,542. Space rental to outside healthcare providers to administer services to our residents and employees $45,182. Supplemental payment from Kore Energy $10,417 - an agreement that was entered into to voluntarily participate in their program to curtail electrical services. Non-refundable pet deposits for independent living apartments $7,500. Misc. income $14,864.
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000197
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
2012
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 regions 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 in the community and the collection and distribution of canned goods for a variety of area food banks. Haven Chapel offerings are also donated to area charities that are helping those in need. During the year, space in the independent living dining room was used by both the Butler and Allegheny Valley Chambers of Commerce free of charge to hold events such as educational leadership training/lecture and the Meet and Move Networking lunch. Concordia's LifeLong Learning Institute (a senior college concept) is open to seniors in the community. During this year, there were 22 educational sessions offered between the spring and fall sessions. In that, 361 senior citizens registered and attended classes. There were 13 of the 22 courses that were offered complimentary free of charge. The remaining classes had a small nominal fee. Classes included but were not limited to Introduction to Computers, Creative Writing, Nutrition Tips for Seniors Health, Cooking Classes and Investing 101. Concordia employees, community churches and area businesses participated in an Adopt-A-Resident program. Through this program, Christmas gifts were provided to Concordia Community personal care and skilled nursing residents to fulfill their Christmas wishes. The baseball and soccer fields at the Cabot Campus are utilized each spring and summer by the athletic programs in the Saxonburg area. The use of Concordias fields offers them additional space for practices and games enhancing the quality of the program for the children. In addition to donating to the local communities for their fundraising events, for Fiscal Year ending 6/30/13, Concordia Lutheran Health and Human Care donated $13.8 million to 501(c )(3) Concordia Lutheran Ministries Foundation (EIN 20-5138266) which sponsors and supports many other community programs.
F990_P06_S0A_L02
Form 990, Part VI, Section A, Line 2
CEO and Chairman of Concordia, Keith Frndak and Board member Kay Frndak Suder are father and daughter.
F990_P06_S0A_L06
Form 990, Part VI, Section A, Line 6
Concordia Lutheran Health and Human Care has 9 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 entire 990, prior to filing, in order to provide questions, comments and feedback. Questions and comments were addressed accordingly. A copy of the finall 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, bonuses 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. The Executive Committee meets each October to determine CEO compensation for the fiscal year. 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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.