2021-07-12T13:57:54-05:00 2020-12-31 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2020-01-01 250990591 LUTHERAN HOME FOR THE AGED LUTH 8144565433 100 STATE STREET SUITE 200 ERIE PA 16507 MARK GUSEK CEO 8144565433 2021-07-12 1 MARK GUSEK XXX-XX-XXXX JEFFREY J PETRELL CPA P00138808 4126356270 2021-07-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z LIFE - NORTHWESTERN PA MARK GUSEK 100 STATE STREET SUITE 200 ERIE PA 16507 45324142 0 X WWW.LIFENWPA.ORG X 1906 PA LIFE PROGRAM (LIVING INDEPENDENCE FOR THE ELDERLY) 9 9 288 9 0 0 177869 2092171 33350754 39049908 81776 3917287 4019279 191388 37629678 45250754 0 0 0 0 12321283 11284102 0 0 0 17881498 20135050 30202781 31419152 7426897 13831602 31291553 45659325 8507015 8759856 22784538 36899469 LIFE PROGRAM (LIVING INDEPENDENCE FOR THE ELDERLY) 0 0 26474250 39256147 LIFE PROGRAM (LIVING INDEPENDENCE FOR THE ELDERLY) - THIS IS A MANAGED CARE PROGRAM FOR FRAIL ELDERLY RECIPIENTS WHO HAVE BEEN DETERMINED TO NEED NURSING FACILITY LEVEL OF CARE, BUT WISH TO REMAIN IN THEIR HOMES AND COMMUNITIES AS LONG AS POSSIBLE. 26474250 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 35 0 288 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X WILLIAM FELDMANN 8144565433 100 STATE STREET SUITE 200 ERIE PA 16507 PASTOR ALBERT GESLER PRESIDENT 0.50 X X 0 0 0 WADE ROOT VICE PRESIDENT 0.50 X X 0 0 0 JEANNE TROPPER SECRETARY 0.50 X X 0 0 0 DAVID SLOMSKI TREASURER (RESIGNED 11/1/20) 0.50 X X 0 0 0 MELANIE BREWER BOARD MEMBER 0.50 X 0 0 0 DR FLOYD CSIR BOARD MEMBER 0.50 X 0 0 0 DR DENNIS MICHALAK BOARD MEMBER 0.50 X 0 0 0 ROLAND KING BOARD MEMBER 0.50 X 0 0 0 DR THOMAS MASTERS BOARD MEMBER 0.50 X 0 0 0 PASTOR MATTHEW DENNISON BOARD MEMBER 0.50 X 0 0 0 MARK GUSEK CEO 60.00 X 1328302 0 2277 WILLIAM FELDMANN CFO 60.00 X 229444 0 4513 GENTRY CHAPMAN DIRECTOR OF THERAPY 60.00 X 168250 0 16558 KEVIN SHAFFER MD PHYSICIAN 60.00 X 576599 0 4772 LAURA LYONS EXECUTIVE DIRECTOR 60.00 X 220945 0 5853 LORI HETRICK VP OF FINANCE 60.00 X 143891 0 7662 JUSTIN MILES DIRECTOR OF HUMAN RESOURCES 60.00 X 160156 0 8332 2827587 0 49967 9 0 1 0 SAINT VINCENT HEALTH CENTER 232 WEST 25TH STREET ERIE PA 16508 MEDICAL SERVICES 1112290 TABULA RASA HEALTHCARE 228 STRAWBRIDGE DRIVE MOORESTOWN NJ 08057 MEDICAL SERVICES 841958 STEWART SHARON REGIONAL HEALTH SYSTEMS PO BOX 419739 BOSTON MA 02241 MEDICAL SERVICES 629188 MEADVILLE MEDICAL CENTER 1034 GROVE STREET MEADVILLE PA 16335 MEDICAL SERVICES 536350 WEST PENN ALLEGHENY HEALTH SYSTEM INC PO BOX 951856 CLEVELAND OH 441930020 MEDICAL SERVICES 389838 20 2092171 2092171 RESIDENT CARE REVENUE 623000 39049908 39049908 39049908 47906 47906 58537 73388 -14851 -14851 -14851 3869381 0 3869381 3869381 3869381 MISCELLANEOUS 623000 206239 206239 206239 45250754 39256147 0 3902436 X 1564536 1564536 8386823 6066177 2320646 180501 110106 70395 522531 322886 199645 629711 384124 245587 119042 119042 41420 41420 12488482 12457929 30553 178980 178980 37985 37985 996489 996489 604426 604426 2094 2094 81433 81433 949598 949598 297363 297363 MEDICAL SUPPLIES 2373852 2373852 MISCELLANEOUS 466751 449021 17730 DIETARY 397971 397971 REPAIRS & MAINTENANCE 376938 376938 722226 722226 31419152 26474250 4944902 0 13326964 28651562 3703613 3497156 239085 251778 29908 34503 582728 692894 10313998 2887399 8538429 7426599 4870826 5104833 31291553 45659325 4390668 4887671 3849377 3514314 266970 357871 8507015 8759856 X 18105322 31936924 4679216 4962545 22784538 36899469 31291553 45659325 X 13831602 283329 X 0 1 X 1 0 X 127658 190098 178525 177869 2092171 2766321 17906554 20341150 26541225 33350754 39049908 137189591 18034212 20531248 26719750 33528623 41142079 139955912 0 0 0 139955912 190577 10376 5631 278536 106443 591563 190577 10376 5631 278536 106443 591563 12683 22959 3899165 206239 4141046 18224789 20554307 26748340 37706324 41454761 144688521 0.96730 0.96140 0.00410 0.00570 X 1 84092 84092 0 PART II-B, LINE 1: FEES PAID TO TRIAD STRATEGIES TO RENDER NON-GOVERNMENTAL AFFAIR SERVICES ON THE ORGANIZATION'S BEHALF. 1205726 1205726 6535231 1534276 5000955 751358 347791 403567 1821683 1005332 816351 7426599 BENEFICIAL INTEREST IN PERPETUAL TRUST 4962545 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 138833 RESIDENT FUNDS 3455 5104833 DEFERRED COMPENSATION LIABILITY 354416 RESIDENT FUNDS 3455 357871 X 45324142 73388 73388 45250754 0 45250754 31492540 73388 73388 31419152 0 31419152 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 IS RECOGNIZED AS TAX EXEMPT UNDER 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 THE ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION 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 SERVICE (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 CONSOLIDATED FINANCIAL STATEMENTS. GENERALLY, TAX RETURNS FOR YEARS ENDED DECEMBER 31, 2017, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 73,388. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 73,388. X X 0 0 0 1 0 0 0 0 0 MARK GUSEK CEO 274236 0 724772 0 329294 0 0 0 2277 0 1330579 0 0 0 WILLIAM FELDMANN CFO 116405 0 5000 0 108039 0 0 0 4513 0 233957 0 0 0 GENTRY CHAPMAN DIRECTOR OF THERAPY 130173 0 7500 0 30577 0 12027 0 4531 0 184808 0 0 0 KEVIN SHAFFER MD PHYSICIAN 273460 0 20000 0 283139 0 0 0 4772 0 581371 0 0 0 LAURA LYONS EXECUTIVE DIRECTOR 130543 0 20000 0 70402 0 1300 0 4553 0 226798 0 0 0 LORI HETRICK VP OF FINANCE 107030 0 2500 0 34361 0 3243 0 4419 0 151553 0 0 0 JUSTIN MILES DIRECTOR OF HUMAN RESOURCES 119804 0 15000 0 25352 0 6319 0 2013 0 168488 0 0 0 PART I, LINE 5 THE CEO RECEIVES A SUCCESS SHARING PAYMENT AS A PORTION OF HIS TOTAL COMPENSATION, APPROVED BY THE BOARD USING INTERNAL REVENUE SERVICE REBUTTABLE PRESUMPTION GUIDELINES, THAT IS BASED ON THE ORGANIZATION'S ANNUAL GROSS OPERATING REVENUE. FORM 990, PART VI, SECTION B, LINE 11B LUTHERAN HOME FOR THE AGED HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE RETURN IS THEN FINALIZED AND THE BOARD IS PROVIDED A COPY OF THE FORM 990 TO REVIEW BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C LUTHERAN HOME FOR THE AGED ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 LUTHERAN HOME FOR THE AGED BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 18 LUTHERAN HOME FOR THE AGED MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 LUTHERAN HOME FOR THE AGED MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 12,457,929. MANAGEMENT AND GENERAL EXPENSES 30,553. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,488,482. FORM 990, PART XI, LINE 9: VALUATION GAIN BENEFICIAL INTEREST IN PERPETUAL TRUST 283,329. VL HOLDINGS LLC 100 STATE STREET SUITE 200 ERIE PA 16507 611654116 REAL ESTATE PA LUTHERAN HOME FOR THE AGED