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 SOCIAL SERVICE FOUNDATION
Employer identification number
41-1690681
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)
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 monetary support
Yes
No
Yes
No
Yes
No
(A)
LUTHERAN SOCIAL SERVICE OF MINNESOTA
410872993
1
Yes
Yes
Yes
66,771
Total
66,771
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.") .
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 SOCIAL SERVICE FOUNDATION
Employer identification number
41-1690681
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE FOUNDATION IS LUTHERAN SOCIAL SERVICE OF MINNESOTA.
FORM 990, PART VI, SECTION A, LINE 7A
THE FOUNDATION'S BOARD OF TRUSTEES IS COMPOSED OF AT LEAST SEVEN AND NO MORE THAN TWENTY-ONE INDIVIDUAL TRUSTEES, OF WHOM AT LEAST ONE-THIRD ARE MEMBERS OF A LUTHERAN CONGREGATION AND ONE OF WHOM IS THE CHIEF EXECUTIVE OFFICER OF THE LUTHERAN SOCIAL SERVICE WHO SERVES WITHOUT LIMITATION OF TERMS.
FORM 990, PART VI, SECTION A, LINE 7B
THE FOUNDATION'S BYLAWS MAY BE AMENDED BY THE BOARD OF TRUSTEES, AS PROVIDED BY LAW, SUBJECT TO THE POWER OF THE SOLE MEMBER AS PROVIDED BY LAW, TO ADOPT, AMEND, OR REPEAL BYLAWS ADOPTED, AMENDED, OR REPEALED BY THE BOARD OF TRUSTEES. NO AMENDMENT TO THESE BYLAWS THAT RELATES TO THE AFFILIATION REQUIREMENTS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA SHALL BE EFFECTIVE UNTIL APPROVAL HAS BEEN RECEIVED FROM THE SOLE MEMBER. ANY AMENDMENT WHICH RELATES TO THE REQUIREMENTS FOR AFFILIATION WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA MUST BE REPORTED TO THE MEMBERS OF THE FOUNDATION.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS REVIEWED IN DETAIL BY THE FOUNDATION'S MANAGEMENT AND IS PROVIDED TO EACH BOARD TRUSTEE FOR THEIR REVIEW AND FEEDBACK PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
NO MEMBER OF THE BOARD OF DIRECTORS SHALL BE EMPLOYED BY THE ORGANIZATION NOR SHALL THEY HOLD ANY DIRECT OR INDIRECT FINANCIAL INTEREST IN THE ASSETS, LEASES, BUSINESS TRANSACTIONS OR PROFESSIONAL SERVICES OF THE ORGANIZATION. EXCEPTIONS TO THIS POLICY MAY BE MADE BY THE BOARD OF DIRECTORS PURSUANT TO THE FOLLOWING REQUIREMENTS: (1) SHOULD ANY MEMBER OF THE BOARD OF DIRECTORS OR ANY INDIVIDUAL WHO SERVES ON A COMMITTEE OF THE BOARD BE INVOLVED IN ANY WAY, DIRECTLY OR INDIRECTLY, IN A BUSINESS OR FINANCIAL TRANSACTION PERTAINING TO THE ORGANIZATION, THAT PERSON SHALL MAKE KNOWN SUCH INVOLVEMENT TO THE BOARD BY PROVIDING FULL DISCLOSURE OF ALL INFORMATION RELEVANT TO THAT INVOLVEMENT; (2) UPON NOTICE BY THE INDIVIDUAL OF A BUSINESS OR FINANCIAL TRANSACTION PERTAINING TO THE ORGANIZATION, THE EXECUTIVE COMMITTEE SHALL CONSIDER SUCH INVOLVEMENT AND MAKE AN APPROPRIATE DECISION PERTAINING THERETO; AND (3) THE BOARD OR COMMITTEE MEMBER SHALL NOT PARTICIPATE IN ANY WAY WITH RESPECT TO THE DECISION AS TO SUCH MATTERS NOR SHALL THAT PERSON PARTICIPATE IN ANY VOTE TAKEN WITH RESPECT TO SUCH TRANSACTION. LUTHERAN SOCIAL SERVICE FOUNDATION HOLDS THE REASONABLE EXPECTATION THAT DIRECTORS, OFFICERS AND THE ORGANIZATION WILL, AT ALL TIMES, BE GUIDED BY HONESTY, GOOD SENSE AND HIGH ETHICAL STANDARDS. THE ORGANIZATION EXPECTS DIRECTORS AND OFFICERS TO HAVE A DUTY OF LOYALTY TO THE ORGANIZATION AND TO AVOID ANY CONFLICT OF INTEREST, AS OUTLINED BELOW, BETWEEN THEIR PERSONAL INTERESTS AND THE INTERESTS OF THE ORGANIZATION: (1) DIRECTORS AND OFFICERS MAY NOT USE THEIR POSITION TO MAKE A PERSONAL PROFIT OR GAIN OTHER PERSONAL ADVANTAGES; (2) SHOULD ANY DIRECTOR OF OFFICER BE INVOLVED IN ANY WAY, DIRECTLY OR INDIRECTLY, IN A BUSINESS OR FINANCIAL TRANSACTION PERTAINING TO THE ORGANIZATION, THAT PERSON SHALL MAKE KNOWN SUCH INVOLVEMENT TO MANAGEMENT BY PROVIDING FULL DISCLOSURE OF ALL INFORMATION RELEVANT TO THAT INVOLVEMENT; (3) OFFICERS ARE REQUIRED BY THE BOARD OF DIRECTORS TO ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT WHICH WILL BE MAINTAINED IN THE PERSONNEL FILES; (4) IF A MEMBER OF THE SENIOR MANAGEMENT TEAM HAS OR POTENTIALLY HAS SOME INVOLVEMENT IN A MATTER/ACTION THAT MAY BE A CONFLICT OF INTEREST, THAT INDIVIDUAL WILL EXCLUDE THEMSELVES FROM THE REVIEW AND DETERMINATION PROCESS OF THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15
THE FILING ORGANIZATION DOES NOT SET THE COMPENSATION OF THE CEO OR OTHER OFFICERS. THE COMPENSATION IS SET BY THE BOARD OF DIRECTORS OF THE ORGANIZATION'S SOLE MEMBER AND DOES INCLUDE APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION.
FORM 990, PART VI, SECTION C, LINE 19
THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FOUNDATION HAS WRITTEN A CONFLICT OF INTEREST POLICY WHICH IS PENDING BOARD APPROVAL AND ADOPTION FOR FY14.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.