2012-04-16T20:58:12-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2010-07-01 161644288 LUTHERAN HOME OF SOUTHBURY INC LUTH 2032649135 990 MAIN STREET NORTH SOUTHBURY CT 06488 ANGELA WALLINGFORD 7742433900 2012-03-23 1 BARBARA J MORRISON 6179848100 2012-03-19 2010 2016-02-24 21:20:13Z HEATHER FELTMAN 14 EAST WORCESTER STREET SUITE 300 WORCESTER MA 01604 11039905 0 6011 X WWW.LSSNE.ORG X 1985 CT THE ORGANIZATION PROVIDES SKILLED NURSING & RESIDENTIAL CARE TO THE ELDERLY. 9 8 204 70 0 0 161118 179508 10780990 10856882 32100 3515 0 0 10974208 11039905 0 0 0 0 6484406 6097702 0 0 44758 4701214 4560363 11185620 10658065 -211412 381840 8324098 8606023 6102547 5695451 2221551 2910572 IN RESPONSE TO CHRIST'S LOVE, LUTHERAN SOCIAL SERVICES SERVES AND CARES FOR PEOPLE IN NEED. 0 0 9473447 10856882 THE ORGANIZATION IS A 120 BED FACILITY WHICH PROVIDES SKILLED NURSING AND RESIDENTIAL CARE SERVICES TO THE ELDERLY. 9473447 1 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 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 0 1 0 0 0 0 1 6 0 204 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CT X LISA COHEN 7742433900 14 EAST WORCESTER STREET SUITE 300 WORCESTER MA 01604 JEFF KINNEY 0.30 X 0 0 0 GARTH GREIMANN 0.30 X 0 0 0 GAIL BUCHER 0.30 X 0 0 0 KAREN GAYLIN 0.30 X 0 0 0 LOREN KORTE 0.30 X 0 0 0 DON SWEET 0.30 X 0 0 0 REV CARL ANTON 0.30 X 0 0 0 KATIE BENASHSKI 0.30 X 0 0 0 HEATHER FELTMAN 4.20 X X 0 239584 2350 ANGELA WALLINGFORD 4.20 X 0 162308 12280 BONNIE OLSON 4.20 X 0 113639 0 ALANA GEARY 4.20 X 0 67500 0 WILLIAM AMES 4.20 X 0 145000 0 TODD GAERTNER 40.00 X 104000 0 10922 104000 728031 25552 1 0 1 0 UNIDINE ONE GATEWAY SUITE 751 NEWTON MA 02458 DINING SERVICES 850311 LUTHERAN SOCIAL SERVICES OF NEW ENGLAND 888 WORCESTER STREET SUITE 160 WELLESLEY MA 02482 MANAGEMENT FEES 780735 2 179508 179508 ROOM AND BOARD 623000 10844396 10844396 GUILD INCOME 623000 12486 12486 10856882 3515 3515 11039905 10856882 0 3515 5002552 4770868 231684 2153 2153 726435 692791 33644 366562 349585 16977 814059 780735 33324 43060 43060 31446 31446 331542 320108 11434 5860 3546 2314 155757 155757 17504 17504 550437 550437 3669 3669 3079 3079 19320 19320 306297 306297 75488 75488 FOOD 1019277 1019277 PROVIDER TAX 663391 663391 OTHER MEDICAL 230482 230482 BAD DEBTS 136185 136185 MISCELLANEOUS EXPENSE 74994 74994 78516 78516 10658065 9473447 1139860 44758 48378 240449 1573833 1444605 50973 46640 72991 78577 8879663 7227075 1846583 1652588 4731340 5143164 8324098 8606023 1438207 1505929 305144 359876 3565000 3195000 794196 634646 6102547 5695451 X -699225 -338899 959493 981006 1961283 2268465 2221551 2910572 8324098 8606023 X 381840 307181 X 0 1 1 X 0 X 659817 198930 145684 161118 179508 1345057 10161949 8178393 11263604 10765691 10844396 51214033 10821766 8377323 11409288 10926809 11023904 52559090 0 0 0 52559090 78655 55429 38950 32100 3515 208649 78655 55429 38950 32100 3515 208649 58033 598 9052 15299 12486 95468 10958454 8433350 11457290 10974208 11039905 52863207 0.99420 0.99230 0.00390 0.00510 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1961283 307182 2268465 1847664 113619 1961283 2238664 -391000 1847664 1.00000 1 0 14814 14814 5645781 4875982 769799 1939305 1247812 691493 1279763 1103281 176482 1652588 DEFERRED FINANCING COSTS, NET 92241 RESIDENT TRUST ACCOUNTS 38767 BENEFICIAL INTERESTS IN THIRD-PARTY 2268465 DUE FROM RELATED ORGANIZATIONS 981006 RENEWAL AND REPLACEMENT FUND 393411 DEBT SERVICE RESERVE FUND 1347069 PROJECT FUND 1397 EARNINGS FUND 20808 5143164 THIRD PARTY SETTLEMENTS 162575 DUE TO RELATED ORGANIZATIONS 472071 634646 11039905 10658065 381840 307181 307181 689021 11028471 -11434 -11434 11039905 0 11039905 10646631 0 10646631 11434 11434 10658065 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: IN ACCORDANCE WITH THE DONOR REQUIREMENTS THE ENDOWMENT FUNDS ARE HELD IN PERPETUITY UNTIL APPROPRIATED FOR EXPENDITURE TO BE USED FOR GENERAL PURPOSES OF THE ORGANIZATION. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT INTEREST IN PERPE 307,181. PART XII, LINE 2D - OTHER ADJUSTMENTS: GUILD FUND, NET OF EXPENSES -11,434. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GUILD FUND, NET OF EXPENSES 11,434. 0 0 0 0 0 0 0 0 0 HEATHER FELTMAN 0 239584 0 0 0 0 0 0 0 2350 0 241934 0 0 ANGELA WALLINGFORD 0 162308 0 0 0 0 0 0 0 12280 0 174588 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS LUTHERAN SOCIAL SERVICES OF NEW ENGLAND, INC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS GOVERNING BOARD ELECTS ALL THE MEMBERS OF THE ORGANIZATIONS GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE TRANSACTIONS SUBJECT TO MEMBER APPROVAL ARE ACQUISITIONS OF DEBT, SALE OF ASSETS, ANNAUL BUDGET APPROVAL, APPROVAL OF MERGER, APPROVE BYLAW REVISIONS. FORM 990, PART VI, SECTION B, LINE 11 FINANCE MANAGEMENT WILL REVIEW THE 990S WHEN THEY ARE COMPLETED. THE AUDIT COMMITTEE OF THE LSS BOARD WILL PROVIDE SECONDARY REVIEW AND APPROVAL PRIOR TO SUBMISSION TO THE IRS.THE DOCUMENTS ARE POSTED TO THE BOARD INTRANET FOR REVIEW BY THE LSS FINANCE COMMITTEE AS WELL AS ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ALL THE MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY TO DISCLOSE ANY CONFLICTS. CONFLICTS ARE REVIEWED BY THE CEO AND THE GOVERNANCE COMMITTEE. BOARD MEMBERS WITH CONFLICTS ARE RESTRICTED ON VOTING ON ANY ACTIONS RELATED TO THE CONFLICT. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN BENEFIT INTEREST IN PERPE 307,181. TOTAL TO FORM 990, PART XI, LINE 5: 307,181. RELATED ORGANIZATIONS FILE UNDER GROUP EXEMPTION 6011 - DISCLOSURE NOT REQ CT 0 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 0