2011-05-16T09:10:33-05:00 2010-06-30 LARSONALLEN LLP 300 Crown Colony Drive Suite 310 Quincy MA 02169 990 2009-07-01 161644288 LUTHERAN HOME OF SOUTHBURY INC LUTH 2032649135 990 MAIN STREET NORTH SOUTHBURY CT 06488 heather feltman 7819970800 2011-05-13 1 Barbara J Morrison 6179848100 2011-05-13 2009 2016-02-24 21:20:13Z heather feltman 888 worcester street suite 160 wellesley MA 02482 10974208 0 X www.lssne.org X 1985 CT The organization provides skilled nursing & residential care to the elderly. 9 9 232 70 0 0 145684 161118 11272656 10780990 38950 32100 0 11457290 10974208 0 0 6867612 6484406 0 138828 4604288 4701214 11471900 11185620 -14610 -211412 8402124 8324098 6082780 6102547 2319344 2221551 In response to christ's love, lutheran social services serves and cares for people in need. 0 0 10120251 10780990 The Organization is a 120 bed facility which provides skilled nursing and residential care services to the elderly. 10120251 1 1 0 0 0 0 0 0 1 1 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 1 10 0 232 1 0 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0 0 0 0 CT X Lisa Cohen 7819970800 888 Worcester Street Suite 160 Wellesley MA 02482 X 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 0.30 X X 0 261014 2352 Helena silva 0.30 X 0 140533 0 angela Wallingford 0.30 X 0 170494 12283 Bonnie Olson 0.30 X 0 119537 0 Alana Geary 0.30 X 0 67890 0 Todd Gaertner 40.00 X 104000 0 10922 104000 759468 25557 1 0 1 0 Unidine One Gateway Suite 751 Newton MA 02458 Dining Services 1040666 Lutheran Social Services of New England 888 Worcester Street Suite 160 Wellesley MA 02482 Management Fees 425470 2 161118 161118 room and board 623000 10765691 10765691 GUILD INCOME 623000 15299 15299 10780990 32100 32100 10974208 10780990 0 32100 5284137 4888151 395986 54802 50695 4107 763847 706883 56964 381620 353022 28598 528016 425468 102548 16646 16646 -6525 -6525 496517 460237 36280 10961 5664 5297 144599 144599 16713 16713 577872 577872 4895 4895 5104 5104 20087 20087 320885 320885 88723 88723 Food 1023410 1023410 Provider Tax 633871 633871 Bad Debts 396000 396000 other medical 228978 228978 Miscellaneous Expense 89511 89511 104951 104951 11185620 10120251 926541 138828 174453 48378 1714025 1573833 45756 50973 50386 72991 8787901 6941318 1936667 1846583 4480837 4731340 8402124 8324098 1521222 1438207 311228 305144 3915000 3565000 335330 794196 6082780 6102547 X -469592 -699225 941272 959493 1847664 1961283 2319344 2221551 8402124 8324098 X 0 1 1 X 0 X 165041 659817 198930 145684 161118 1330590 9975683 10161949 8178393 11263604 10765691 50345320 10140724 10821766 8377323 11409288 10926809 51675910 0 0 0 51675910 60793 78655 55429 38950 32100 265927 60793 78655 55429 38950 32100 265927 53329 58033 598 9052 15299 136311 10254846 10958454 8433350 11457290 10974208 52078148 0.99230 0.99090 0.00510 0.00560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1847664 113619 1961283 2238664 -391000 1847664 1.00000 1 0 14814 14814 7480737 5886904 1593833 1154536 944650 209886 137814 109764 28050 1846583 Deferred Financing Costs, Net 116241 Resident Trust Accounts 30240 Beneficial Interests in Third-Party 1961284 Due from Related Organizations 1038618 Renewal and Replacement Fund 393411 Debt Service Reserve Fund 1169360 Project Fund 1397 Earnings Fund 20789 4731340 Third Party Settlements 197157 Due to Related Organizations 597039 794196 10974208 11185620 -211412 113619 113619 -97793 10967315 -6893 -6893 10974208 0 10974208 11178727 0 11178727 6893 6893 11185620 Part V, Line 4: Description of Intended Use of Endowment Funds: 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 third party trust: 113619. Part XII, Line 2d - Other Adjustments: Guild Fund, Net of Expenses: -6893. Part XIII, Line 4b - Other Adjustments: Guild Fund, Net of Expenses: 6893. 0 0 0 0 0 0 0 0 0 Heather Feltman 0 261014 0 0 0 0 0 0 0 2352 0 263366 0 0 angela Wallingford 0 170494 0 0 0 0 0 0 0 12283 0 182777 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 and sale of assets. Form 990, Part VI, Section B, line 11 Finance management will review the 990's when they are completed. The finance commitee of the Board will provide secondary review prior to submission to the IRS. 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. Form 990, Part XI, Line 2c the organization has a committee that overseas the audit of the financial statements. Lutheran Community Services of Maine Inc 261 Sheep Davis Rd concord NH 03301 010544219 Community Services ME 501(c)(3) Line 9 Lutheran Social Services of New England Inc Lutheran Community Services of New Hampshire Inc 261 Sheep Davis Rd concord NH 03301 020527169 Community Services NH 501(c)(3) Line 9 LUtheran Social Services of New England Inc Lutheran Community Services of Massachusetts Inc 888 worcester street suite 160 wellesley MA 02482 043566243 Community Services MA 501(c)(3) Line 7 Lutheran Social Services of New England Inc Good news Garage - LSS Inc 331 N winooski avenue burlington VT 05401 030370713 Car donation program VT 501(c)(3) Line 7 LUtheran Social Services of New England Inc Fair havens inc 334 marion road middleboro MA 02346 042125640 Rest Home MA 501(c)(3) Line 9 Lutheran Social Services of New England Inc Lutheran Social Services of New England Foundation Inc 888 worcester street suite 160 wellesley MA 02482 043284683 fundraising MA 501(c)(3) Line 11c, III-FI N/A 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 0