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 Services of Georgia Inc
Employer identification number
58-1535692
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.") ....
10,454,126
11,281,225
11,817,179
12,676,232
13,044,798
59,273,560
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
10,454,126
11,281,225
11,817,179
12,676,232
13,044,798
59,273,560
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)..
0
6
Public support. Subtract line 5 from line 4.
59,273,560
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..
10,454,126
11,281,225
11,817,179
12,676,232
13,044,798
59,273,560
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
3,739
2,232
4,309
3,770
1,671
15,721
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
59,289,281
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
99.974 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
99.000 %
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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 Services of Georgia Inc
Employer identification number
58-1535692
Return Reference
Explanation
Part III, Line 4d DOMESTIC AND HERITAGE ADOPTION (CODE:624110)
ADOPTION SERVICES PROVIDE ACCESS TO STABLE AND COMPASSIONATE FAMILIES FOR CHILDREN WHO HAVE NOT EXPERIENCED SECURITY AND STABILITY IN THEIR LIVES. TWO TYPES OF SERVICES ARE PROVIDED: DOMESTIC ADOPTION OF CHILDREN (ESPECIALLY THOSE WITH SPECIAL NEEDS) AND COOPERATIVE DOMESTIC INFANT ADOPTION. LSG HAS A GRANT FROM THE DAVE THOMAS FOUNDATION FOR ADOPTION TO FIND HOMES FOR THE FOSTER CARE SYSTEMS LONGEST-WAITING CHILDREN, INCLUDING OLDER CHILDREN, SIBLING GROUPS, AND THOSE WITH BEHAVIORAL, EMOTIONAL, AND MEDICAL NEEDS. From October 2013 through September 2014, 9 children were places with adoptive families.
Part III, Line 4D FAMILY INTERVENTION SERVICES(CODE 624100)
FAMILY INTERVENTION SERVICE (FIS) OFFERS AN ARRAY OF SERVICES AND PROGRAMS TO FAMILIES AND CHILDREN FOCUSED ON STRENGTHENING FAMILY RELATIONSHIPS AND MAINTAINING OR BUILDING STRONG, HEALTHY FAMILY UNITS. FIS, OFFERED IN ATLANTA, ROME, AND SAVANNAH, INCLUDES THE TRIPLE P PARENTING PROGRAM, SAFECARE TRAINING FOR PARENTS WITH CHILDREN AGES FIVE AND UNDER, FAMILY REUNIFICATION SERVICES, FAMILY VISITATIONS CENTERS, COMPREHENSIVE CHILD AND FAMILY ASSESSMENTS, SUBSTANCE ABUSE ASSESSMENTS, DOMESTIC VIOLENCE ASSESSMENTS, FAMILY AND INDIVIDUAL THERAPY, HOMESTEAD, AND PARENT AID SERVICES. FIS PROVIDES SERVICES TO FAMILIES REFERRED FROM THE DEKALB COUNTY DRUG COURT THROUGH A GRANT ADMINISTERED BY GEORGIA STATE UNIVERSITY. FROM OCTOBER 2013 THROUGH SEPTEMBER 2014, 142 FAMILIES, 259 PARENTS, AND 266 CHILDREN RECEIVED ASSISTANCE NEEDED TO DEVELOP AND MAINTAIN HEALTHY FAMILY RELATIONSHIPS THROUGH ONE OR MORE OF THE FIS SERVICES.
Part III, Line 4D BEHAVIORAL HEALTH SERVICES (CODE: 624100)
BEHAVIORAL HEALTH SERVICES (BHS) PROVIDE ASSESSMENTS, COUNSELING, NURSING, AND PSYCHIATRIC SERVICES RELATED TO ISSUES SUCH AS DEPRESSION, BIPOLAR DISORDERS, POST-TRAUMATIC STRESS SYNDROME, SEXUAL OR PHYSICAL ABUSE, SUBSTANCE ABUSE, AND ATTENTION DEFICIT DISORDER. BHS UTILIZES A VARIETY OF OUTPATIENT COUNSELING SERVICES TO TREAT CLIENTS WITH THE ULTIMATE GOAL OF PROMOTING INDEPENDENCE AND SUSTAINED HEALTH. TREATMENT CAN BE FOR THE INDIVIDUAL, GROUP OR FAMILY UNIT WHEN APPROPRIATE. BHS SERVED 21 CLIENTS PERFORMING MORE THAN 201 COUNSELING SESSIONS.
Part III, Line 4D COMMUNITY SERVICES (CODE 624100)
LSG works cooperatively with Lutheran congregations and other social ministry organizations in fulfillment of its mission. Areas of focus in 2013 included supporting efforts to provide pastors with information and resources for suicide prevention and continued exploration of services for seniors.
Part VI, Section B Policies, Line 11B
THE FINANCE AND EXECUTIVE COMMITTEES OF THE BOARD OF DIRECTORS REVIEWED THE FORM 990 AND SCHEDULES AND APPROVED ALL DOCUMENTS, BY THE AUTHORITY VESTED IN THE COMMITTEES. A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS.
PART VI, SECTION B POLICIES, LINE 12C
THE NATURE OF LSGS BUSINESS REQUIRES THAT ALL EMPLOYEES SAFEGUARD THE INTEGRITY OF LSG. ACCORDINGLY, EMPLOYEES SHOULD AVOID SITUATIONS PRESENTING ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. A CONFLICT OF INTEREST IS BROADLY DEFINED TO INCLUDE ANY SITUATION IN WHICH EMPLOYEES ARE ENGAGED IN TWO OR MORE INCOMPATIBLE ACTIVITIES. A CONFLICT OF INTEREST INCLUDES INVOLVEMENT IN OUTSIDE INTERESTS THAT MAY CONFLICT WITH EMPLOYEES DUTIES AT LSG OR ADVERSELY AFFECT JOB PERFORMANCE. CONFLICTS OF INTEREST CAN RESULT FROM A VARIETY OF CIRCUMSTANCES, INCLUDING THE USE OF EMPLOYEES ASSOCIATION WITH LSG FOR PRIVATE ADVANTAGE; DEALINGS WITH CLIENTS OR SUPPLIERS; OUTSIDE BUSINESS ACTIVITIES AND ACCEPTANCE OF GIFTS OR PREFERENTIAL TREATMENT. SINCE THE APPEARANCE OF CONFLICTS OF INTEREST CAN BE AS DETRIMENTAL TO LSG AS A CONFLICT ITSELF, AGENCY POLICY ALSO APPLIES TO APPARENT CONFLICT OF INTEREST SUCH AS THE USE OF A RELATIVE TO PERFORM SERVICES FOR LSG WITHOUT MANAGEMENTS PRIOR APPROVAL. WHEN A CONFLICT OF INTEREST EXISTS OR IS SUSPECTED, EMPLOYEES HAVE A RESPONSIBILITY TO DISCLOSE INFORMATION THAT OTHERWISE MIGHT BE CONSIDERED PRIVATE OR PERSONAL, SUCH AS INFORMATION CONCERNING FINANCIAL TRANSACTIONS OR A SPOUSE OR RELATIVES EMPLOYMENT, TO ENSURE COMPLIANCE WITH LSGS RULES, GUIDELINES, STANDARDS, AND POLICIES. EMPLOYEES ENGAGING IN ACTIVITIES THAT ARE CONSIDERED TO BE A CONFLICT OF INTEREST OR GIVE THE APPEARANCE OF A CONFLICT OF INTEREST MAY BE SUBJECT TO DISCIPLINARY ACTION UP TO AND INCLUDING DISMISSAL.
PART VI, SECTION B POLICIES, LINE 15A
THE PERFORMANCE OF THE CEO IS REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THIS COMMITTEE, COMPOSED OF INDEPENDENT BOARD MEMBERS, ARRIVES AT AN ANNUAL COMPENSATION ADJUSTMENT AFTER COMPLETION OF THE ANNUAL REVIEW, AND FOLLOWING A REVIEW OF AN ANNUAL SURVEY OF THE COMPENSATION OF CEOS IN SIMILAR POSITIONS PUBLISHED BY THE LUTHERAN SERVICES IN AMERICA. THE DECISION IS DOCUMENTED IN MEETING MINUTES AND COMMUNICATED TO THE FULL BOARD.
PART VI, SECTION C DISCLOSURE, LINE 19
LSGS AUDIT REPORT, ANNUAL REPORT, AND FORM 990 ARE PROVIDED TO GUIDESTAR TO BE POSTED ON THEIR WEBSITE. THESE DOCUMENTS ARE ALSO AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.
Part XI, Line 9
$ 14,809 Change in value of residual trust (82,547) Impairment Loss $ (67,738) Total Part IX, Line 9
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.