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.") . | 782,606 | 136,625 | 400,042 | 383,595 | 69,749 | 1,772,617 |
| 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 | 45,859,896 | 43,894,970 | 51,367,834 | 53,498,139 | 56,249,914 | 250,870,753 |
| 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 | 46,642,502 | 44,031,595 | 51,767,876 | 53,881,734 | 56,319,663 | 252,643,370 |
| 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.) | 252,643,370 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 46,642,502 | 44,031,595 | 51,767,876 | 53,881,734 | 56,319,663 | 252,643,370 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,384,671 | 4,461,673 | 1,403,620 | 23,526,948 | 823,431 | 31,600,343 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,384,671 | 4,461,673 | 1,403,620 | 23,526,948 | 823,431 | 31,600,343 |
| 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.) .. | 958,942 | 904,108 | 922,317 | 841,159 | 731,968 | 4,358,494 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 48,986,115 | 49,397,376 | 54,093,813 | 78,249,841 | 57,875,062 | 288,602,207 |
| 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 |
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| Return Reference | Explanation |
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| 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 6 | LUTHERAN HOME AND SERVICES FOR THE AGED, INC. IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD IS APPOINTED BY THE SOLE CORPORATE MEMBER, LUTHERAN HOME AND SERVICES FOR THE AGED, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | SOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE SOLE CORPORATE MEMBER, LUTHERAN HOME AND SERVICES FOR THE AGED, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION REVIEWS THE TAX RETURN WITH THE AUDIT COMMITTEE OF LUTHERAN LIFE MINISTRIES,(THE SOLE CORPORATE MEMBER OF ITS PARENT, LUTHERAN HOME AND SERVICES FOR THE AGED, INC.) TO REPORT TO THE BOARD OF LUTHERAN LIFE MINISTRIES, WHICH PROVIDES FINAL APPROVAL OF THE TAX RETURNS OF ALL SUBSIDIARIES. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY REQUIRES BOARD MEMBERS, DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO DISCLOSE TO THE BOARD OF DIRECTORS WHEN A CONFLICT MAY EXIST. THE POLICY AND COMPLIANCE WITH THIS POLICY ARE REVIEWED ANNUALLY BY THE AUDIT COMMITTEE OF ITS PARENT LUTHERAN LIFE MINISTRIES(WHICH IS THE SOLE CORPORATE MEMBER OF ITS PARENT, LUTHERAN HOME AND SERVICES FOR THE AGED, INC.) |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS DETERMINED WITH THE HELP OF AN INDEPENDENT COMPENSATION CONSULTANT AND THE COMPENSATION COMMITTEE OF LUTHERAN LIFE MINISTRIES (WHICH IS THE SOLE CORPORATE MEMBER OF ITS PARENT, LUTHERAN HOME AND SERVICES FOR THE AGED, INC.) ULTIMATE APPROVAL FOR THE COMPENSATION AMOUNT FOR THE CEO RESTS WITH THE BOARD OF LUTHERAN LIFE MINISTRIES. THE LUTHERAN LIFE MINISTRIES BOARD PROVIDES COUNSEL TO THE CEO FOR THE COMPENSATION OF ANY OFFICERS AND KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE TAX RETURN, FINANCIAL STATEMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | SERVICE CONTRACTS - LHA ADMIN : PROGRAM SERVICE EXPENSES 18,832. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,832. CONSULTING - LHA ADM : PROGRAM SERVICE EXPENSES 50,521. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,521. CONTRACTED SERVICES - LHA ADM : PROGRAM SERVICE EXPENSES 86,263. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,263. GUEST PREACHERS - PASTORAL SERVICES : PROGRAM SERVICE EXPENSES 3,306. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,306. CONTRACTED SERVICES - RESIDENT LIFE : PROGRAM SERVICE EXPENSES 2,508. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,508. CONTRACTED THERAPY SERVICES - RESID: PROGRAM SERVICE EXPENSES 75,932. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,932. SERVICE CONTRACTS - NRSG ADMIN : PROGRAM SERVICE EXPENSES 80,645. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,645. CONSULTING - NURSING ADMIN : PROGRAM SERVICE EXPENSES 78. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78. PHYSCIANS'' FEES - NURS ADMIN : PROGRAM SERVICE EXPENSES 36,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,000. PHARM PROFES FEES - NURS ADMIN : PROGRAM SERVICE EXPENSES 51,581. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,581. CONSULTING - MED RECORDS : PROGRAM SERVICE EXPENSES 1,076. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,076. P.T. DIRECT - THERAPY : PROGRAM SERVICE EXPENSES 4,920,596. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,920,596. SPEECH DIRECT - THERAPY : PROGRAM SERVICE EXPENSES 6,257. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,257. INSPECTION & LICENSE FEES - POM : PROGRAM SERVICE EXPENSES 38,210. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,210. CONTRACTED SERVICES - CULINARY SERV : PROGRAM SERVICE EXPENSES 464. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 464. CONSULTING - HEARTHSTONE : PROGRAM SERVICE EXPENSES 250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250. PHYSCIAN/HOSPITAL EXPENSE - 1A/1B : PROGRAM SERVICE EXPENSES 5,745. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,745. CONTRACTED SERVICES - ACCOUNTING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 92,890. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,890. SERVICE CONTRACTS - HEARTHSTONE : PROGRAM SERVICE EXPENSES 3,008. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,008. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF NET ASSETS TO LUTHERAN LIFE COMMUNITIES -7,100,000. LOSS ON IMPAIRMENT OF NOTE RECEIVABLE -197,885. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR |
| Software ID: | |
| Software Version: |