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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
LUTHERAN HOME CARE & HOSPICE INC FKA LUTHERAN HOME CARE SERVICES INC
Employer identification number
25-1689293
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
376,261
292,752
212,129
295,460
761,939
1,938,541
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......
13,189,968
15,501,841
15,968,981
18,924,033
22,446,150
86,030,973
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.
13,566,229
15,794,593
16,181,110
19,219,493
23,208,089
87,969,514
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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..
0
8
Public support (Subtract line 7c from line 6.)
87,969,514
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
13,566,229
15,794,593
16,181,110
19,219,493
23,208,089
87,969,514
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
59,191
65,297
120,397
76,422
119,244
440,551
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
59,191
65,297
120,397
76,422
119,244
440,551
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.)
..
120,059
161,711
273,826
394,683
353,513
1,303,792
13
Total support. (Add lines 9, 10c, 11, and 12.)..
13,745,479
16,021,601
16,575,333
19,690,598
23,680,846
89,713,857
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
98.060 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.200 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.490 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.560 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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
Schedule A (Form 990 or 990-EZ) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
LUTHERAN HOME CARE & HOSPICE INC FKA LUTHERAN HOME CARE SERVICES INC
Employer identification number
25-1689293
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
LUTHERAN HOME CARE & HOSPICE, INC.'S MANAGEMENT SERVICES ARE PROVIDED BY LUTHERAN SOCIAL SERVICES OF SOUTH CENTRAL PENNSYVLANIA, A TAX-EXEMPT AFFILIATE. LUTHERAN SOCIAL SERVICES CHARGES LHCH A MONTHLY FEE BASED ON A BUDGETED ALLOCATION OF THE EXPENSES OF THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER.
FORM 990, PART VI, SECTION A, LINE 6
THE MEMBERS OF LUTHERAN HOME CARE & HOSPICE, INC. ARE LUTHERAN SOCIAL SERVICES AND DIAKON, PENNSYLVANIA NON-PROFIT CORPORATIONS.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF DIRECTORS SHALL BE COMPOSED OF TWENTY (20) MEMBERS, EIGHTEEN (18) OF WHOM SHALL BE ELECTED BY LUTHERAN SOCIAL SERVICES AND TWO (2) OF WHOM SHALL BE ELECTED BY DIAKON. ONE OF THE LUTHERAN SOCIAL SERVICES' DIRECTORS SHALL BE THE CHIEF EXECUTIVE OFFICER OF LUTHERAN SOCIAL SERVICES (OR HIS/HER DESIGNEE) WHO SHALL SERVE AS AN EX-OFFICIO LUTHERAN SOCIAL SERVICES VOTING DIRECTOR. ONE OF THE DIAKON DIRECTORS SHALL BE THE CHIEF EXECUTIVE OFFICER OF DIAKON (OR HIS/HER DESIGNEE) WHO SHALL SERVE AS AN EX-OFFICIO VOTING DIAKON DIRECTOR.
FORM 990, PART VI, SECTION A, LINE 7B
THE BOARD MAY NOT TAKE ANY OF THE ACTIONS LISTED BELOW WITHOUT AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERSHIP INTERESTS HELD BY THE MEMBERS: (I) INITIATE, CEASE, OR SIGNIFICANTLY MODIFY ANY FUND-RAISING ACTIVITIES OR PLANS FOR THE SOLICITATION OF CHARITABLE CONTRIBUTIONS OR FOR THE SOLICITATION OR ACCEPTANCE AS A GIFT OF ANY REAL PROPERTY OR INTEREST THEREIN; (II) CHANGE THE AREA SERVED BY LHCH; (III) BORROW MORE THAN $100,000 UNDER TERMS WHICH PROVIDE FOR A REPAYMENT PERIOD IN EXCESS OF THREE MONTHS; (IV) ENTER INTO ANY LEASES WHICH WOULD OBLIGATE LHCH TO MAKE RENTAL PAYMENTS IN EXCESS OF $40,000 PER YEAR; (V) PURCHASE INSURANCE POLICIES; (VI) UNDERTAKE ANY CAPITAL EXPENDITURES IN EXCESS OF $50,000 AND ANY CAPITAL EXPENDITURES INVOLVING RELATED PARTIES WHICH, IN THE AGGREGATE, EXCEED 100,000; (VII) ADOPT ANY ORIGINAL OR REVISED CAPITAL OR OPERATING BUDGETS WHICH WOULD RESULT IN ANY EXPENDITURE IN EXCESS OF $100,000 OVER ANTICIPATED REVENUE; (VIII) INITIATE, CEASE, OR SIGNIFICANTLY MODIFY ANY OF LHCH'S LINES OF SERVICE, PRODUCTS, OR PROGRAMS; (IX) SELECT, REMOVE, OR REPLACE INDEPENDENT ACCOUNTANTS AND AUDITORS FOR LHCH; (X) AUTHORIZE AND DESIGNATE OFFICERS OF THE CORPORATION TO EXECUTE A DEED OF ASSIGNMENT FOR THE BENEFIT OF CREDITORS, FILE A VOLUNTARY PETITION IN BANKRUPTCY, FILE AN ANSWER CONSENTING TO THE APPOINTMENT OF A RECEIVER, OR FILE AN ANSWER TO AN INVOLUNTARY PETITION IN BANKRUPTCY; (XI) REQUIRE CAPITAL CONTRIBUTIONS FROM MEMBERS CONSISTING OF MONEY, INTANGIBLE PROPERTY, OR LABOR OR SERVICES ACTUALLY RECEIVED BY OR PERFORMED FOR LHCH OR FOR ITS BENEFIT, OR A COMBINATION THEROF IN ACCORDANCE WITH SECTION 5541 OF THE ACT AND PROVIDED THAT SUCH REQUIREMENTS IS PROPORTIONATE TO ALL MEMBERSHIP INTERESTS; (XII) REPAY CAPITAL CONTRIBUTIONS, IN WHOLE OR IN PART, TO ANY MEMBERS IN SUCH AMOUNT NOT TO EXCEED THE AMOUNT OF CAPITAL CONTRIBUTION IN ACCORDANCE WITH SECTION 5541 OF THE ACT AND PROVIDED THAT SUCH REPAYMENT IS PROPORTIONATE TO ALL MEMBERSHIP INTERESTS; (XIII) AMEND THE LHCH ARTICLES OF INCORPORATION OR BYLAWS SUBJECT TO THE RESTRICTIONS; (XIV) SELL, RELINQUISH, OR OTHERWISE AUTHORIZE OR CHANGE IN CONTROL OF MORE THAN 30% OF THE ASSETS OF LHCH SUBJECT TO THE GUIDELINES; (XV) AUTHORIZE FUNDAMENTAL CHANGES TO LHCH, INCLUDING THE ADOPTION OF A PLAN OF DISSOLUTION OF LHCH; THE ADOPTION OF A PLAN OF MERGER, CONSOLIDATION, DIVISION, CONVERSION OR AFFILIATION WITH ANOTHER ENTITY; AND CHANGE THE CURRENT LHCH CORPORATE ORGANIZATIONAL STRUCTURE SUBJECT TO THE GUIDELINES; (XVI) MAKE AN ADMISSION OF A NEW MEMBER OR TRANSFER OF A MEMBERSHIP INTEREST SUBJECT TO THE GUIDELINES,
FORM 990, PART VI, SECTION B, LINE 11
LUTHERAN HOME CARE & HOSPICE, INC. HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE RETURN IS THEN FINALIZED AND THE BOARD IS PROVIDED A COPY OF THE FORM 990 TO REVIEW BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C
LUTHERAN HOME CARE & HOSPICE, INC. ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A CONFLICTS OF INTEREST FORM, WHICH IS KEPT ON FILE BY THE ORGANIZATION. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE/SHE RECUSES THEMSELVES FROM VOTING. IF CONFLICTS ARE MADE KNOWN WITH OTHER EMPLOYEES IN THE ORGANIZATION, A PLAN IS DEVELOPED FOR THAT EMPLOYEE TO AVOID INFLUENCING DECISION MAKING IN THE AREA OF CONFLICT. THIS PLAN IS DEVELOPED BY THE EMPLOYEE'S MANAGER AND APPROVED BY THE DEPARTMENT DIRECTOR. THIS PLAN WILL BE AGREED UPON BY THE EMPLOYEE AND MONITORED BY THE MANAGER.
FORM 990, PART VI, SECTION B, LINE 15
LUTHERAN HOME CARE & HOSPICE'S CEO IS PAID BY LUTHERAN SOCIAL SERVICES. LUTHERAN SOCIAL SERVICES UTILIZES SALARY SURVEY INFORMATION TO DETERMINE THE COMPENSATION AMOUNTS OF ALL EMPLOYEES WITHIN THE ORGANIZATION, INCLUDING THE EXECUTIVE DIRECTOR AND KEY EMPLOYEES. THE SALARY SURVEY INFORMATION ENSURES THAT PAY RATES ARE COMPETITIVE. SALARY RANGES FOR JOB CLASSES ARE ADJUSTED BASED ON THE SALARY SURVEY INFORMATION AND THEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. A BUDGETED MERIT INCREASE PERCENTAGE IS ALSO SUBJECT TO BOARD APPROVAL. THE ORGANIZATION'S COMPENSATION PROCESS TAKES PLACE ANNUALLY AT THE NOVEMBER BOARD MEETING AND IS NOTED IN THE MINUTES. AN EXECUTIVE SESSION FOLLOWS THE BOARD MEETING TO DISCUSS THE ANNUAL EVALUATION AND COMPENSATION INCREASE FOR THE EXECUTIVE DIRECTOR.
FORM 990, PART VI, SECTION C, LINE 18
LUTHERAN HOME CARE & HOSPICE, INC. MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
THE CONSOLIDATED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY, ARE ALSO AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:
VALUATION GAIN IN BENEFICIAL INTEREST IN TRUST 24,176. TEMPORARILY RESTRICTED NET ASSETS 2,694. TEMPORARILY RESTRICTED INTEREST 20,806. PERMANENTLY RESTRICTED CONTRIBUTIONS 6,489.
FORM 990, PART XII, LINE 2C:
THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.