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ObjectId: 201531279349301018 - Submission: 2015-05-07
TIN: 20-5138266
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
See separate instructions.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
Concordia Lutheran Ministries Foundation
Employer identification number
20-5138266
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Concordia Lutheran Ministries
134 Marwood Road
Cabot
,
PA
16023
20-5138278
To manage, oversee, and carry out the purpose of the affiliated 501(c)(3) organizations
PA
501(c)(3)
509(a)(3)
N/A
No
(2)
Concordia Lutheran Health and Human Care
134 Marwood Road
Cabot
,
PA
16023
25-0969458
To provide skilled nursing, personal care, independent living, and rehabilitation services
PA
501(c)(3)
509(a)(2)
Concordia Lutheran Ministries
20-5138278
No
(3)
Concordia Visiting Nurses
613 North Pike Road
Cabot
,
PA
16023
42-1704067
To provide home health care services
PA
501(c)(3)
509(a)(2)
Concordia Lutheran Ministries
20-5138278
No
(4)
Concordia Lutheran Ministries of Pittsburgh
1300 Bower Hill Road
Pittsburgh
,
PA
15243
27-0209886
To provide skilled nursing, personal care, independent living services, and rehabilitation services
PA
501(c)(3)
509(a)(2)
Concordia Lutheran Ministries
20-5138278
No
(5)
Concordia of Ohio
970 Sumner Parkway
Copley
,
OH
44321
61-1682165
To provide healthcare and retirement services in Ohio
OH
501(c)(3)
509(a)(2)
Concordia Lutheran Ministries
20-5138278
No
(6)
Rebecca Residence
3746 Cedar Ridge Road
Allison Park
,
PA
15101
25-0974311
To provide skilled nursing, personal care, and rehabilitation services
PA
501(c)(3)
509(a)(2)
Concordia Lutheran Health and Human Care
25-0969458
No
(7)
Good Samaritan Hospice of Pittsburgh
3500 Brooktree Road
Wexford
,
PA
15090
25-1818793
To provide inpatient and outpatient hospice services
PA
501(c)(3)
509(a)(2)
Concordia Lutheran Health and Human Care
25-0969458
No
(8)
Concordia Tele-Caregivers
613 North Pike Road
Cabot
,
PA
16023
25-1881783
To provide free monitoring services to homebound clients to ensure that they are up and well
PA
501(c)(3)
509(a)(1)
Concordia Visiting Nurses
42-1704067
No
(9)
Concordia Visiting Nurses of Ohio
613 North Pike Road
Cabot
,
PA
16023
46-3845269
Home Health Services
OH
509(a)(2)
Concordia Visiting Nurses
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Page 2
Schedule R (Form 990) 2013
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
Providence Pharmacy Services
615 North Pike Road
Cabot
,
PA
16023
22-3885810
To provide institutional pharmacy and consulting services
PA
Concordia Providence LLC
20-5138278
Related
No
No
0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Concordia Medical Equipment
615 North Pike Road
Cabot
,
PA
16023
20-4386767
Rental/sales of medical equipment and supplies
PA
Concordia Lutheran Ministries
20-5138278
C
0 %
Schedule R (Form 990) 2013
Page 3
Schedule R (Form 990) 2013
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.
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1a
No
b
Gift, grant, or capital contribution to related organization(s)
.
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1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
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1c
Yes
d
Loans or loan guarantees to or for related organization(s)
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1d
No
e
Loans or loan guarantees by related organization(s)
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1e
No
f
Dividends from related organization(s)
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1f
No
g
Sale of assets to related organization(s)
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1g
No
h
Purchase of assets from related organization(s)
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1h
No
i
Exchange of assets with related organization(s)
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1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
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1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
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1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
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1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
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1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
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1n
Yes
o
Sharing of paid employees with related organization(s)
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1o
No
p
Reimbursement paid to related organization(s) for expenses
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1p
Yes
q
Reimbursement paid by related organization(s) for expenses
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1q
Yes
r
Other transfer of cash or property to related organization(s)
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1r
Yes
s
Other transfer of cash or property from related organization(s)
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1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
Schedule R (Form 990) 2013
Page 4
Schedule R (Form 990) 2013
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2013
Page 5
Schedule R (Form 990) 2013
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2013
Additional Data
Software ID:
13000241
Software Version:
v1.00