Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 617,588 | 593,129 | 350,292 | 696,498 | 542,931 | 2,800,438 |
| 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 | 27,360,788 | 27,728,898 | 29,381,904 | 29,944,082 | 30,573,321 | 144,988,993 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 485,659 | 243,954 | 234,742 | 247,981 | 248,607 | 1,460,943 |
| 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 | 28,464,035 | 28,565,981 | 29,966,938 | 30,888,561 | 31,364,859 | 149,250,374 |
| 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.) | 149,250,374 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 28,464,035 | 28,565,981 | 29,966,938 | 30,888,561 | 31,364,859 | 149,250,374 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 872,635 | 1,280,294 | 964,823 | 1,290,630 | 1,307,308 | 5,715,690 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 872,635 | 1,280,294 | 964,823 | 1,290,630 | 1,307,308 | 5,715,690 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 1,463 | 1,463 | ||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 42,447 | 290,454 | 403,943 | 330,025 | 195,370 | 1,262,239 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 29,379,117 | 30,136,729 | 31,335,704 | 32,510,679 | 32,867,537 | 156,229,766 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2014 AMOUNT: $ 3,428. 2015 AMOUNT: $ 1,774. 2016 AMOUNT: $ 1,297. 2017 AMOUNT: $ 1,090. 2018 AMOUNT: $ 693. WORKERS COMP REIMB - 2015 AMOUNT: $ 680. 2016 AMOUNT: $ 3,070. NON-CHARITABLE FUNDRAISING RECEIPTS - 2014 AMOUNT: $ 17,712. 2015 AMOUNT: $ 9,864. 2016 AMOUNT: $ 10,500. 2017 AMOUNT: $ 11,280. 2018 AMOUNT: $ 14,375. GROSS RECEIPTS OF INVENTORY - 2014 AMOUNT: $ 21,307. 2015 AMOUNT: $ 20,286. 2016 AMOUNT: $ 20,385. 2017 AMOUNT: $ 14,379. 2018 AMOUNT: $ 12,721. APPLICATION FEES - 2015 AMOUNT: $ 17,850. 2016 AMOUNT: $ 15,300. 2017 AMOUNT: $ 15,000. 2018 AMOUNT: $ 12,450. ADMINISTRATIVE FEES - 2015 AMOUNT: $ 240,000. 2016 AMOUNT: $ 353,391. 2017 AMOUNT: $ 288,276. 2018 AMOUNT: $ 155,131. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE, COMPOSED OF THE FOUR BOARD OFFICERS, CAN ACT FOR THE BOARD ON ROUTINE BUSINESS BETWEEN MEETINGS AND IN EMERGENCIES. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION OUTSOURCES MANAGEMENT OF FACILITIES AND FOOD SERVICE. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS OF THE ORGANIZATION WERE AMENDED DURING THE YEAR TO NAME LUTHERAN SOCIAL MINISTRIES OF MARYLAND AS THE ORGANIZATION'S SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CONGREGATIONS OF THE WESTMINSTER CONFERENCE OF THE DELAWARE-MARYLAND SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (THE "ELCA") CONSTITUTE THE ORIGINAL MEMBERS. CURRENT MEMBER CONGREGATIONS ARE NOTED IN THE BYLAWS. ANY OTHER DULY ORGANIZED LUTHERAN CONGREGATION OF THE DELAWARE-MARYLAND SYNOD OF THE ELCA ("SYNOD") OR ITS SUCCESSOR MAY BECOME A MEMBER CONGREGATION UPON APPROVAL BY THE CORPORATION. ANY CONGREGATION THAT IS NO LONGER AFFILIATED WITH THE SYNOD WILL IMMEDIATELY CEASE TO BE A MEMBER CONGREGATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE TRUSTEES SHALL BE APPOINTED BY THE PARENT, LUTHERAN SOCIAL MINISTRIES OF MARYLAND. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE CORPORATE CONGREGATIONS' APPROVAL ARE REQUIRED TO ELECT THE BOARD AND APPROVE THE INDEPENDENT AUDIT FIRM. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY BOTH THE PRESIDENT/CEO AND THE VP OF FINANCE. ONCE THE REVIEW HAS BEEN COMPLETED, THE 990 IS GIVEN TO THE ENTIRE BOARD AND REVIEWED AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO THE RETURN BEING FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | CARROLL LUTHERAN VILLAGE (CLV), AS THE WHOLLY OWNED SUBSIDIARY OF LUTHERAN SOCIAL MINISTRIES OF MARYLAND (LSMMD), FOLLOWS LUTHERAN SOCIAL MINISTRIES OF MARYLAND'S ESTABLISHED POLICY AND STANDARDS REGARDING CODE OF CONDUCT AND CONFLICTS OF INTEREST TO ASSURE THAT THE VILLAGE'S BUSINESS IS CONDUCTED IN A FAIR AND INDEPENDENT MANNER. THE POLICY APPLIES TO OFFICERS, DIRECTORS, BOARD COMMITTEE MEMBERS AND EMPLOYEES OF CLV, EACH OF WHOM IS CONSIDERED AN INTERESTED PERSON. ALL MEMBERS OF THE BOARD OF TRUSTEES ARE REQUIRED TO SIGN A STATEMENT ACKNOWLEDGING THE CODE OF CONDUCT, WHICH INCLUDES A CONFLICT OF INTEREST STATEMENT AND A COMMITMENT TO COMPLIANCE UPON INITIAL SERVICE AND ANNUALLY THEREAFTER. ALL EMPLOYEES ARE REQUIRED TO ATTEND MANDATORY TRAINING ON COMPLIANCE AND THE CODE OF INTEGRITY. THE POLICY CLEARLY STATES THAT AN INTERESTED PERSON MAY HAVE A CONFLICT WHEN THAT PERSON, OR AN IMMEDIATE FAMILY MEMBER, IS OR HAS A FINANCIAL INTEREST IN AN ENTITY THAT CONDUCTS BUSINESS WITH CLV. IT IS THE RESPONSIBILITY OF ANY INTERESTED PERSON WHO HAS A CONFLICT OF INTEREST TO DISCLOSE IT IN ACCORDANCE WITH THE CODE OF INTEGRITY. THE PRESIDENT/CEO REVIEWS DISCLOSURES OF CONFLICTS OF INTEREST TO DETERMINE IF A CONFLICT EXISTS. IF AN INTERESTED PERSON FAILS TO DISCLOSE A CONFLICT OF INTEREST, APPROPRIATE DISCIPLINARY AND/OR CORRECTION ACTION WILL BE TAKEN. IF PROPERLY DISCLOSED, THE INTERESTED PERSON WILL RECUSE HIMSELF OR HERSELF FROM ANY DECISIONS INVOLVING THE CONFLICT. CARROLL LUTHERAN VILLAGE CONTRACTED WITH FRIENDS SERVICES ALLIANCE COMPLIANCE PROGRAM IN 2013 TO ASSIST WITH THE ORGANIZATION'S ONGOING COMPLIANCE EFFORTS. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD AND IS INCLUDED AS PART OF ALL AGREEMENTS AND/OR CONTRACTS. FURTHER, A TRI-FOLD PAMPHLET WITH AN OVERVIEW OF CLV'S CODE OF INTEGRITY IS PROVIDED TO ALL VENDORS WITH WHOM CLV HAS AN AGREEMENT OR CONTRACTUAL RELATIONSHIP. THE PAMPHLET ALSO OUTLINES THE CONFLICT OF INTEREST POLICY AND HOW VENDORS MAY REQUEST A FULL COPY. THE CODE OF INTEGRITY IS POSTED PUBLICLY ON THE CLV WEB SITE WWW.CLVILLAGE.ORG. |
| FORM 990, PART VI, SECTION B, LINE 15 | CARROLL LUTHERAN VILLAGE FOLLOWS THE PRACTICE OF ITS PARENT COMPANY, LUTHERAN SOCIAL MINISTRIES OF MARYLAND, IN WHICH THE BOARD EXECUTIVE COMMITTEE, INCLUDING THE BOARD CHAIRPERSON, PARTICIPATES 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 WHICH IS WITHIN FAIR MARKET RANGE FOR THE INDUSTRY. THE FULL BOARD REVIEWS AND APPROVES THE COMPENSATION OF THE PRESIDENT/CEO. DISCUSSIONS ARE DOCUMENTED AT COMMITTEE AND BOARD LEVELS. |
| 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, PART XI, LINE 9: | TRANSFER TO AFFILIATES -175,000. |
| Software ID: | |
| Software Version: |