Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 17,000 | 31,000 | 19,996 | 67,996 | ||
| 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 | 17,000 | 31,000 | 19,996 | 67,996 | ||
| 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).. | 26,280 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 41,716 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 17,000 | 31,000 | 19,996 | 67,996 | ||
| 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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | 67,996 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF LUTHERAN VILLAGE AT MILLER'S GRANT IS CARROLL LUTHERAN VILLAGE, A MARYLAND NONSTOCK CORPORATION. SOME LVMG BOARD MEMBERS ARE PARENT BOARD MEMBERS OF CLV OR KEY MANAGEMENT OF CLV. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE TRUSTEES SHALL BE APPOINTED BY THE MEMBER, CARROLL LUTHERAN VILLAGE; PROVIDED, HOWEVER, THAT GREY ROCK COMMUNITY, INC., A MARYLAND NONSTOCK CORPORATION, SHALL BE ENTITLED TO NOMINATE 4 INDIVIDUALS TO SERVE AS TRUSTEES AND THE MEMBER SHALL APPOINT SUCH INDIVIDUALS NOMINATED BY GREY ROCK AS TRUSTEES. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS FIRST REVIEWED BY BOTH THE PRESIDENT/CEO AND VP OF FINANCE. ONCE THEIR REVIEW HAS BEEN COMPLETED THE 990 IS GIVEN TO THE ENTIRE BOARD TO REVIEW PRIOR TO THE RETURN BEING FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | LUTHERAN VILLAGE AT MILLER'S GRANT, AS THE WHOLLY OWNED SUBSIDIARY OF CARROLL LUTHERAN VILLAGE, FOLLOWS CAROLL LUTHERAN VILLAGE'S CONFLICTS OF INTEREST POLICY. CARROLL LUTHERAN VILLAGE HAS AN ESTABLISHED POLICY AND STANDARDS REGARDING CONFLICT OF INTEREST. MANY BOARD AND COMMITTEE MEMBERS ARE ACTIVE AS COMMUNITY AND BUSINESS LEADERS IN CARROLL COUNTY AND WILL AT TIMES FIND THEMSELVES IN A POSITION WHERE THERE MAY BE A DEGREE OF CONFLICT WITH THE VILLAGE'S BUSINESS. THESE CONFLICTS ARE EXPECTED AND THE FACT THAT THEY WILL REGULARLY OCCUR DOES NOT PRECLUDE SUCH A MEMBER FROM SERVING ON THE BOARD OR COMMITTEE. THE VILLAGE IN FACT NEEDS THE VARIED EXPERTISE OF ITS BOARD AND COMMITTEE VOLUNTEERS AND BELIEVES THAT BOARD POLICY OF DISCLOSURE AND ABSTENTION ASSURES THAT THE VILLAGE'S BUSINESS IS CONDUCTED IN A FAIR AND INDEPENDENT MANNER. THE CARROLL LUTHERAN VILLAGE (CLV) CONFLICT OF INTEREST POLICY APPLIES TO OFFICERS, DIRECTORS, BOARD COMMITTEE MEMBERS AND EMPLOYEES OF CLV, EACH OF WHOM IS CONSIDERED AN INTEREST PERSON. AN ENTITY WITH A CLV TRANSACTION IS ANY INDIVIDUAL OR BUSINESS ORGANIZATION WHICH PROPOSES TO ENTER INTO ANY TRANSACTION WITH CLV INVOLVING: 1) THE SALE, PURCHASE, LEASE OR RENTAL OF ANY PROPERTY OR ASSET, 2) EMPLOYMENT, OR RENDITION OF SERVICES, PERSONAL OR OTHERWISE, 3) THE AWARD OF ANY GRANT, CONTRACT, OR SUBCONTRACT, OR 4) THE INVESTMENT OR DEPOSIT OF ANY FUNDS OF CLV. AN INTERESTED PERSON HAS A FINANCIAL INTEREST IN AN ENTITY IF SUCH PERSON OR AN IMMEDIATE FAMILY MEMBER (INCLUDING ALL LINEAL RELATIVES AND THEIR SPOUSES, SIBLINGS AND THEIR SPOUSES) HAS AN OWNERSHIP INTEREST IN THE ENTITY OR IS AN EMPLOYEE OF OR RECEIVES COMPENSATION FROM THE ENTITY. COMPENSATION INCLUDES ANY DIRECT OR INDIRECT REMUNERATION OR SUBSTANTIAL GIFTS OR FAVORS. AN INTERESTED PERSON HAS A CONFLICT OF INTEREST WHEN THAT PERSON, OR AN IMMEDIATE FAMILY MEMBER, IS OR HAS A FINANCIAL INTEREST IN, AN ENTITY WITH A CLV TRANSACTION. CONFLICTS OF INTEREST CAN ALSO ARISE IN OTHER INSTANCES. THE TYPES OF ACTIVITIES WHICH MAY CREATE A CONFLICT OF INTEREST INCLUDE: 1) OUTSIDE ACTIVITIES: TO RENDER DIRECTIVE, MANAGERIAL OR CONSULTATIVE SERVICES TO ANY OUTSIDE CONCERN THAT DOES BUSINESS WITH, OR COMPETES WITH, THE SERVICES OF CLV, OR TO RENDER OTHER SERVICES IN COMPETITION WITH CLV. 2) GIFTS, GRATUITIES AND ENTERTAINMENT: TO ACCEPT GIFTS, ENTERTAINMENT OR OTHER FAVORS FROM ANY OUTSIDE CONCERN THAT DOES, OR IS SEEKING TO DO BUSINESS WITH OR IS A COMPETITOR OF CLV. 3) INSIDE INFORMATION: TO DISCLOSE OR USE INFORMATION RELATING TO THE BUSINESS OF CLV FOR THE PERSONAL PROFIT OR ADVANTAGE OF THE INDIVIDUAL OR HIS/HER IMMEDIATE FAMILY. IT IS THE RESPONSIBILITY OF AN INTERESTED PERSON TO APPROPRIATELY DISCLOSE TO CLV ANY POTENTIAL CONFLICTS OF INTEREST. ONCE DISCLOSED, IT IS THE RESPONSIBILITY OF THE CEO/PRESIDENT TO DETERMINE IF A CONFLICT EXISTS. THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES MAY BE UTILIZED BY THE CEO/PRESIDENT, IF NEEDED TO DETERMINE A POTENTIAL CONFLICT OF INTEREST. IF AN INTERESTED PERSON HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION WILL BE TAKEN. THE CONFLICT OF INTEREST POLICY STATEMENT IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES AND IS A NORMAL PART OF ALL AGREEMENTS AND/OR CONTRACTS. AN APPROPRIATE STATEMENT FORM IS AVAILABLE AND MUST BE SIGNED AND ON FILE FOR ALL INTERESTED PERSONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | CARROLL LUTHERAN VILLAGE'S (THE FILING ORGANIZATION'S PARENT) BOARD OF TRUSTEES' EXECUTIVE COMMITTEE, INCLUDING THE CHAIRMAN, SERVES AS A COMPENSATION COMMITTEE. WITH THE SUPPORT OF THE VP OF HUMAN RESOURCES, THE COMMITTEE USES A VARIETY OF SURVEYS AND COMPENSATION CONSULTANTS TO DETERMINE A RECOMMENDED COMPENSATION AMOUNT FOR THE PRESIDENT/CEO. THE CARROLL LUTHERAN VILLAGE BOARD REVIEWS AND APPROVES THE COMPENSATION OF THE PRESIDENT/CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS, FORM 990, AND OTHER OPERATING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CERTAIN GOVERNING DOCUMENTS AND POLICIES ARE CONSIDERED PROPRIETARY AND ARE NOT GENERALLY DISCLOSED. THE ORGANIZATION IS IN FULL COMPLIANCE WITH ALL REGULATIONS CONCERNING DISCLOSURE AT THE FEDERAL, STATE, AND LOCAL LEVELS. |
| FORM 990, PAGE 5, LINES 2A AND 2B: | LUTHERAN VILLAGE AT MILLERS GRANT IS CURRENTLY IN THE MARKETING PHASE OF DEVELOPMENT. ALL COSTS ASSOCIATED WITH THIS PROJECT ARE CURRENTLY BEING CAPITALIZED. THIS IS WHY THERE ARE EMPLOYEES LISTED ON LINE 2A OF PART V BUT NO CORRESPONDING SALARIES BEING REPORTED ON THE STATEMENT OF FUNCTIONAL EXPENSES. |
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