2021-05-05T05:36:40-05:00 2020-12-31 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2020-01-01 520696196 AUGSBURG LUTHERAN HOME OF MD INC AUGS 3013542710 2301 RESEARCH BLVD NO 310 ROCKVILLE MD 20850 RICHARD MAZZA CHIEF FINANCIAL OFFICER 3013542710 2021-04-19 1 RICHARD MAZZA 999009999 JEFFREY J PETRELL CPA P00138808 4126356270 2021-04-19 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z THE VILLAGE AT AUGSBURG LAWRENCE R BRADSHAW 2301 RESEARCH BLVD NO 310 ROCKVILLE MD 20850 21747414 0 X WWW.THEVILLAGEATAUGSBURG.ORG X 1892 MD PROVIDES INDEPENDENT AND ASSISTED LIVING AND SKILLED NURSING TO OLDER ADULTS. 12 11 282 80 0 0 330804 3209949 15447565 16916838 505263 63708 13620 1344499 16297252 21534994 0 0 0 0 11131339 11984703 0 0 0 6130317 10580579 17261656 22565282 -964404 -1030288 32842978 49347173 32092541 31216510 750437 18130663 THE VILLAGE AT AUGSBURG, INC., IN ORDER TO FULFILL ITS CHRISTIAN MINISTRY, IS ORGANIZED TO HONOR, INSPIRE AND SUPPORT CHOICE AND OPPORTUNITY IN SERVICE TO SENIORS. 0 0 4663928 3884191 INDEPENDENT LIVING:INDEPENDENT LIVING RESIDENTS AT THE VILLAGE AT AUGSBURG, A NATIONAL LUTHERAN COMMUNITY, TAILOR THEIR OWN LIFE ENRICHMENT PROGRAMMING TO SUIT THEIR INDIVIDUAL TASTES AND FAVORED PASTIMES. FLOWERING TREES AND PLANTS ACCENT OUR WOODED, 52-ACRE CAMPUS CREATING A BEAUTIFUL OUTDOOR LIVING SPACE. RESIDENTS ENJOY PRIVACY AND INDEPENDENCE, SELECT AMENITIES AND SERVICES, FRIENDLY NEIGHBORS OF ALL FAITHS AND BACKGROUNDS, AND AN IDEAL LOCATION CLOSE TO SUBURBAN CONVENIENCES AND BALTIMORE ATTRACTIONS. 2815054 2344420 ASSISTED LIVING:ASSISTED LIVING RESIDENTS AT THE VILLAGE AT AUGSBURG, A NATIONAL LUTHERAN COMMUNITY, ENJOY PRIVATE SUITES WITH JUST THE RIGHT AMOUNT OF HELP THEY NEED FROM LICENSED NURSES WHO ARE AVAILABLE 24-7. ASSISTED LIVING STAFF MEMBERS CAREFULLY ASSESS INDIVIDUAL ABILITIES AND DESIRES TO ENSURE THE RIGHT COMBINATION OF ASSISTANCE AND INDEPENDENCE. DAILY SUPPORT INCLUDES ACTIVITIES SUCH AS DRESSING, BATHING, AND ADMINISTERING MEDICATIONS. REGISTERED NURSES AND SUPPORT STAFF ARE AVAILABLE AROUND THE CLOCK FOR ANY EMERGENCIES THAT MIGHT ARISE. 12833850 10688227 SKILLED NURSING:THE VILLAGE AT ROCKVILLE, A NATIONAL LUTHERAN COMMUNITY, OFFERS LONG-TERM, SKILLED NURSING SUPPORT IN A STATE-OF-THE-ART HEALTH CENTER KNOWN FOR A DISTINCTIVE CULTURE AND OUTSTANDING CARE. INTEGRATING THE LATEST INDUSTRY TRENDS, OUR CENTER USES A NEIGHBORHOOD MODEL TO EVOKE THE COMFORTABLE ENVIRONMENT OF HOME. RESIDENTS SAFELY PURSUE PREFERRED DAILY ACTIVITIES CONFIDENT IN KNOWING A HELPING HAND IS ALWAYS AVAILABLE. AN EXPERT, ATTENTIVE STAFF OF LICENSED REGISTERED NURSES, LICENSED PRACTICAL NURSES AND AN ATTENDING PHYSICIAN ENSURES THAT THE HIGHEST QUALITY OF AROUND-THE-CLOCK CARE IS PROVIDED IN THE LEAST INTRUSIVE MANNER POSSIBLE. 20312832 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 11 0 282 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MD X X RICHARD MAZZA CFO 3013542714 2301 RESEARCH BLVD SUITE 310 ROCKVILLE MD 20850 LAWRENCE BRADSHAW PRESIDENT/CEO 10.00 30.00 X X 0 435816 24772 ALBERT E LIETZAU IV CHAIR 1.00 X X 0 0 0 DARRELL DUGGINS VICE CHAIR 1.00 X X 0 0 0 ANGELA DIGNAN SECRETARY/TREASURER 1.00 X X 0 0 0 KARL SILEX DIRECTOR 1.00 X 0 0 0 LEANNE STACK-MARTIN DIRECTOR 1.00 X 0 0 0 JOAN CHALMERS DIRECTOR 1.00 X 0 0 0 ANNE C GOLLER DIRECTOR 1.00 X 0 0 0 SCOTT HEMMETER DIRECTOR 1.00 X 0 0 0 ROBERT L SEEGER DIRECTOR 1.00 X 0 0 0 STEVE THACKER DIRECTOR 1.00 X 0 0 0 THOMAS J WHITEFORD DIRECTOR 1.00 X 0 0 0 CYNTHIA WALTERS CHIEF OPERATING OFFICER 7.50 32.50 X 0 316985 27848 RICHARD MAZZA CHIEF FINAANCIAL OFFICER 7.50 32.50 X 0 249760 34752 GLENN SCHERER EXECUTIVE DIRECTOR 40.00 X 328533 0 0 OLAYINKA OWOLABI REGISTERED NURSE 40.00 X 141672 0 0 YETUNDE JOHNSON NURSING DIRECTOR 40.00 X 148182 0 0 JOAN DYER REGISTERED NURSE 40.00 X 135934 0 0 ANDREA BRAID ASSISTED LIVING PROGRAM MANAGER 40.00 X 129617 0 0 883938 1002561 87372 17 0 1 1 0 2280942 929007 3209949 SKILLED NURSING 623000 10688227 10688227 INDEPENDENT LIVING 623000 3884191 3884191 ASSISTED LIVING 623000 2344420 2344420 16916838 276128 276128 212420 -212420 -212420 -212420 PROVIDER RELIEF FUNDS 623000 1118728 1118728 OTHER ANCILLARY REVENUE 623000 104487 104487 MISCELLANEOUS 623000 82814 82814 38470 38470 1344499 21534994 16916838 0 1408207 328533 328533 9372097 8610048 762049 148654 148415 239 1183847 1168271 15576 951572 873710 77862 416430 416430 23129 23129 21605 21605 31767 31767 848796 659054 189742 136069 136069 662699 578316 84383 229359 228729 630 809165 798365 10800 11437 10532 905 577 577 469647 469647 3138305 3113496 24809 476672 476672 FOOD SERVICES 738588 737863 725 MEDICAL CARE FEES 717906 717906 MEDICAL SUPPLIES 657823 657823 REPAIRS & MAINTENANCE 483073 461738 21335 707532 601670 105862 22565282 20312832 2252450 0 1500 1923241 481517 1564663 1271575 230741 209531 72514974 41294490 17644849 31220484 12453936 12716379 2000000 465772 5963 32842978 49347173 2305007 2127783 3592620 3060907 14425727 12953948 590331 1730232 11178856 11343640 32092541 31216510 X 663153 17438821 87284 691842 750437 18130663 32842978 49347173 X -1030288 555363 17855151 X X 0 1 X 1 1 0 X 1387153 353735 457400 330804 3209949 5739041 1387153 353735 457400 330804 3209949 5739041 5739041 263755 364157 385695 275847 276128 1565582 32358 11210 35063 13620 1344499 1436750 8741373 78674624 0.65650 0.64050 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2016 AMOUNT: $ 32,358. 2017 AMOUNT: $ 11,210. 2018 AMOUNT: $ 35,063. 2019 AMOUNT: $ 13,620. 2020 AMOUNT: $ 225,771. PROVIDER RELIEF FUNDS - 2020 AMOUNT: $ 1,118,728. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1920 1920 0 PART II-B, LINE 1: AUGSBURG LUTHERAN HOME OF MD, INC. PAYS DUES TO LEADINGAGE MARYLAND. A PORTION OF THE DUES PAID TO THIS ORGANIZATION ARE ALLOCABLE TO LOBBYING EXPENSES. 5000000 5000000 52815038 30890479 21924559 14267671 10404011 3863660 432265 432265 31220484 REFUNDABLE ENTRANCE FEES 10461781 DUES TO AFFILIATES 881859 11343640 X 21393436 555363 555363 20838073 696921 696921 21534994 22533515 0 22533515 31767 31767 22565282 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND HAS BEEN RECOGNIZED AS TAX EXEMPT UNDER SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE AN ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE COMPANIES AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICES (IRS). THE ORGANIZATION HAS CONCLUDED THAT AS OF DECEMBER 31, 2020 AND 2019, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE FINANCIAL STATEMENTS. GENERALLY, TAX RETURNS FOR YEARS ENDED DECEMBER 31, 2018, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 31,767. DONOR RESTRICTED CONTRIBUTIONS 665,154. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 31,767. 0 0 0 0 0 0 0 1 0 LAWRENCE BRADSHAW PRESIDENT/CEO 0 426008 0 0 0 9808 0 11400 0 13372 0 460588 0 0 CYNTHIA WALTERS CHIEF OPERATING OFFICER 0 298120 0 0 0 18865 0 10046 0 17802 0 344833 0 0 RICHARD MAZZA CHIEF FINAANCIAL OFFICER 0 230272 0 0 0 19488 0 9887 0 24865 0 284512 0 0 GLENN SCHERER EXECUTIVE DIRECTOR 107444 0 5000 0 216089 0 0 0 0 0 328533 0 0 0 PART I, LINE 3 THE ORGANIZATION'S CEO IS PAID BY NATIONAL LUTHERAN, INC. NATIONAL LUTHERAN, INC. USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 7 BONUSES ARE DETERMINED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND ARE BASED ON A VARIETY OF FACTORS SUCH AS WHETHER CAMPUS BUDGETS ARE MET, HOW EACH CAMPUS DOES ON ITS RESPECTIVE ANNUAL NURSING/HEALTH CARE SURVEY AND HOW EACH SENIOR LEADER DOES IN OBTAINING HIS OR HER GOALS FOR THE YEAR. A MD HEALTH AND HIGHER EDUCATION FACILITY AUTHORITY 520936091 2013-12-05 18966000 REFINANCE 2009 BOND ISSUE 0 0 0 A 4749000 18966000 360622 18605378 2012 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 3 NATIONAL LUTHERAN, INC. (EIN 47-2584315), THE PARENT ENTITY, PROVIDES FINANCIAL AND MANAGEMENT FUNCTIONS FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 4 AUGSBURG LUTHERAN HOME OF MD, INC AFFILIATED WITH NATIONAL LUTHERAN, INC. ON JANUARY 1, 2020. FORM 990, PART VI, SECTION A, LINE 6 NATIONAL LUTHERAN, INC. IS THE SOLE MEMBER OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A NATIONAL LUTHERAN, INC., THE SOLE MEMBER OF AUGSBURG LUTHERAN HOME OF MD, INC., HAS THE RIGHT TO VOTE AND ELECT MEMBERS OF THE FILING ORGANIZATION'S BOARD OF TRUSTEES. THE MEMBER ALSO RESERVES THE RIGHT TO REMOVE ANY TRUSTEE WITH OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF THE FOLLOWING MATTERS IS RESERVED EXCLUSIVELY TO THE MEMBERSHIP. THE MEMBERSHIP MAY INITIATE AND IMPLEMENT ANY PROPOSAL WITH RESPECT TO ANY OF THE FOLLOWING AND, IF ANY PROPOSAL WITH RESPECT TO ANY OF THE FOLLOWING IS OTHERWISE INITIATED, IT SHALL NOT BECOME EFFECTIVE UNLESS APPROVED BY THE MEMBERSHIP. A. APPROVAL OF THE ROLE AND/OR MISSION STATEMENT, IF ANY; B. APPROVAL OF OPERATING AND CAPITAL BUDGET; C. APPROVAL OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE DEPARTMENT STAFF OF THE PARENT, NATIONAL LUTHERAN, INC. PERFORMS AN INITIAL REVIEW OF THE FORM 990. UPON APPROVAL, THE FORM 990 IS MADE AVAILABLE TO EACH BOARD MEMBER FOR REVIEW AND APPROVAL AT A BOARD MEETING PRIOR TO TRANSMISSION OF THE RETURN TO THE IRS. NATIONAL LUTHERAN, INC.'S BOARD WILL RECEIVE A COPY OF THE RETURN PRIOR TO THE IRS FILING AS WELL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT EACH YEAR. IF I CONFLICT IS IDENTIFIED, IT IS 1) IDENTIFIED AND DISCUSSED WITH THE BOARD AND 2) REVIEWED AND DOCUMENTED BY MANAGEMENT. IF AN ACTUAL OR POTENTIAL CONFLICT IS IDENTIFIED, THE BOARD MEMBER, OFFICER, OR EMPLOYEE WILL RECUSE HIM OR HERSELF FROM ANY CONVERSATIONS, DECISIONS, OR OTHER ACTIVITIES AND DISCUSSIONS INVOLVING THE CONFLICT. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE CONFLICT OF INTEREST POLICY AS POTENTIAL SOURCES OF CONFLICTS WITH INTERESTED PERSONS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S CEO IS PAID BY NATIONAL LUTHERAN, INC. (NLI). NLI'S BOARD DETERMINES THE COMPENSATION FOR THE CEO THROUGH THE COMBINED USE OF SEVERAL METHODS. THE NLI EXECUTIVE COMMITTEE SERVES AS A COMPENSATION COMMITTEE WHICH OVERSEES THE PROCESS. COMPENSATION SURVEYS ARE PERFORMED BY AN OUTSIDE HR CONSULTING FIRM, PRM, USING LOCAL MARKET DATA. THE CEO, EXECUTIVE DIRECTOR, AND DIRECTOR OF HUMAN RESOURCES USE SALARY SURVEYS TO DETERMINE THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES TO ASSURE THEY ARE WITHIN THE LOCAL MARKET RANGE. THE SERVICES THE INDIVIDUAL PROVIDES TO THE ORGANIZATION AND THE TENURE OF THE OFFICER ARE ALSO FACTORS CONSIDERED IN SALARY DETERMINATIONS. ONCE THE EXECUTIVE COMMITTEE GIVES ITS APPROVAL, ITS DECISIONS ARE NOTED AT THE BOARD LEVEL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AND AT NO COST. FORM 990, PART XI, LINE 9: FAIR VALUE ADJUSTMENT FOR AFFILIATION 17,855,151. FORM 990, PART XII, LINE 3B: THE ORGANIZATION IS REQUIRED TO UNDERGO A SINGLE AUDIT DUE TO AMOUNTS RECEIVED UNDER THE CARES ACT FROM HEALTH AND HUMAN SERVICES (HHS). THE ORGANIZATION IS AWAITING GUIDANCE FROM HHS RELATED TO THESE AUDITS AND WILL CONDUCT THE AUDITS WHEN THE GUIDANCE IS ISSUED. FORM 990, PART IX AUGSBURG LUTHERAN HOME OF MD, INC. DID NOT HAVE ANY FUNDRAISING EXPENSES AT THE COMMUNITY LEVEL, RATHER THESE EXPENSES ARE REMITTED FROM INVESTMENT ASSETS HELD BY THE PARENT ORGANIZATION, NATIONAL LUTHERAN, INC. NATIONAL LUTHERAN HOME FOR THE AGED INC 2301 RESEARCH BLVD ROCKVILLE MD 20850 262222476 SUPPORTING ORGANIZATION MD 501(C)(3) LINE 12A, I NATIONAL LUTHERAN INC 0 THE VILLAGE AT ROCKVILLE INC 9701 VEIRS DRIVE ROCKVILLE MD 20850 530196624 CONTINUING CARE RETIREMENT COMMUNITY MD 501(C)(3) LINE 10 NATIONAL LUTHERAN INC 0 THE VILLAGE AT ORCHARD RIDGE INC 400 CLOCKTOWER RIDGE DRIVE WINCHESTER VA 22603 263445374 CONTINUING CARE RETIREMENT COMMUNITY VA 501(C)(3) LINE 10 NATIONAL LUTHERAN INC 0 THE VILLAGE AT PROVIDENCE POINT INC 2301 RESEARCH BLVD ROCKVILLE MD 20850 454024593 CONTINUING CARE RETIREMENT COMMUNITY IN DEVELOPMENT STAGES MD 501(C)(3) LINE 10 NATIONAL LUTHERAN INC 0 NATIONAL LUTHERAN INC 2301 RESEARCH BLVD ROCKVILLE MD 20850 472584315 CORPORATE OVERSIGHT MD 501(C)(3) LINE 10 N/A 0 THE LEGACY AT NORTH AUGUSTA INC 1410 A NORTH AUGUSTA STREET STAUNTON VA 24401 452857307 RESIDENTAL CARE AND ASSISTED LIVING FACILITY VA 501(C)(3) LINE 10 NATIONAL LUTHERAN INC 0 PETALO LLC 1201 SEVEN LOCKS ROAD SUITE 360 ROCKVILLE MD 20854 824733502 SOFTWARE SOLUTIONS MD N/A 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1