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
THE LUTHERAN HOME INC
Employer identification number
39-0807205
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.") .
54,875
401,681
941,940
631,769
8,907,441
10,937,706
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......
20,391,550
19,369,060
18,427,282
20,817,680
21,617,329
100,622,901
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.
20,446,425
19,770,741
19,369,222
21,449,449
30,524,770
111,560,607
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.)
111,560,607
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...
20,446,425
19,770,741
19,369,222
21,449,449
30,524,770
111,560,607
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
2,395
729
1,392
1
1,054
5,571
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
2,395
729
1,392
1
1,054
5,571
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.)..
20,448,820
19,771,470
19,370,614
21,449,450
30,525,824
111,566,178
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
100.000 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.980 %
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 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.020 %
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
THE LUTHERAN HOME INC
Employer identification number
39-0807205
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, RELIGIOUS AND SCIENTIFIC PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION SHALL HAVE A SINGLE CLASS OF MEMBERS AND THE SOLE MEMBER OF SUCH CLASS SHALL BE LUTHERAN LIVING SERVICES, INC (THE "MEMBER"), WHICH IS A WISCONSIN NONPROFIT CORPORATION AND AN ENTITY RECOGNIZED AS EXEMPT UNDER IRC SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBER SHALL HAVE SOLE VOTING POWER TO ELECT THE DIRECTORS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBER SHALL HAVE SOLE VOTING POWER TO AUTHORIZE ANY AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION AND/OR THESE BY-LAWS THAT IMPAIR THE RIGHTS OF THE MEMBERS.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 IS PRESENTED TO THE BOARD FOR ITS REVIEW AND APPROVAL PRIOR TO FILING. COPIES ARE MADE AVAILABLE TO ANY MEMBER OF THE BOARD UPON THEIR REQUEST.
FORM 990, PART VI, SECTION B, LINE 12C
EACH YEAR DURING THE FIRST BOARD MEETING OF THE YEAR, ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM, WHICH IS TURNED INTO THE PRESIDENT/CEO OF THE COMPANY.
FORM 990, PART VI, SECTION B, LINE 15
TYPICALLY IN DECEMBER, THE COMPENSATION COMMITTEE MEETS TO REVIEW THE PERFORMANCE, CURRENT COMPENSATION AND BENEFITS, INDUSTRY-SPECIFIC INDEPENDENT SALARY SURVEY INFORMATION FOR THE CEO AND PRESIDENT (OR THE TWO FULL-TIME EXECUTIVES), EXAMINE ANY OTHER CURRENT COMPENSATION INFORMATION DEEMED COMPARABLE AND NECESSARY, AND THEN CONSIDER AND APPROVE ANY CHANGES IN COMPENSATION AND BENEFITS FOR THE CEO AND PRESIDENT. THE COMMITTEE THEN REVIEWS AND APPROVES THE CEO'S RECOMMENDATIONS FOR COMPENSATION CHANGES FOR OTHER OFFICERS AND SENIOR MANAGERS. THE COMMITTEE WILL ALSO REVIEW AND APPROVE THE CEO'S PLAN FOR ANY INCENTIVE COMPENSATION PROGRAM AND PLAN BEING CONSIDERED FOR ANY OFFICER OR SENIOR EXECUTIVE. ANY INCENTIVES (BONUSES OR OTHERWISE) THAT ARE BEING AWARDED PURSUANT TO AN APPROVED PLAN ARE APPROVED BY THE COMMITTEE FOLLOWING THE END OF THE FISCAL YEAR AND PRIOR TO PAYMENT.
FORM 990, PART VI, SECTION C, LINE 19
THE LUTHERAN HOME PROVIDES THE AFOREMENTIONED DOCUMENTS TO THE PUBLIC UPON REQUEST. CURRENTLY THE ANNUAL REPORT, IF APPLICABLE, IS AVAILABLE ON OUR WEBSITE.
FORM 990, PART IX, LINE 11G
MISCELLANEOUS: PROGRAM SERVICE EXPENSES 2,486,010. MANAGEMENT AND GENERAL EXPENSES 71,648. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,557,658.
FORM 990, PART XII, LINE 2C:
THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.
FORM 990, PART XI, LINE 9:
LUTHERAN LIVING SERVICES, INC IS THE PARENT OF THE LUTHERAN HOME, INC. (HOME) AND IS AFFILIATED WITH THE LUTHERAN HOME FOUNDATION, INC. (FOUNDATION). THE FOUNDATION IS A NON-STOCK, NON-PROFIT CORPORATION ORGANIZED TO RAISE FUNDS TO SUPPORT THE OPERATION OF LUTHERAN LIVING SERVICES AND ITS AFFILIATIONS. DURING THE YEAR THE FOUNDATION RECEIVED $102,301 OF TEMPORARILY RESTRICTED ASSETS DESIGNATED FOR THE HOME, AND HAS ALSO RELEASED $2,962,775 OF PREVIOUSLY RESTRICTED ASSETS FOR THE PURPOSE THEY WERE SPECIFIED FOR LEAVING A NET CHANGE IN RESTRICTED ASSETS OF $2,860,474 AS OF DECEMBER 31, 2013. THE HOME HAS REFLECTED THIS CHANGE IN RESTRICTED NET ASSETS IN PART XI, LINE 9.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.