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ObjectId: 201620439349300307 - Submission: 2016-02-12
TIN: 20-1457824
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.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
LUTHERAN HOME AT TRINITY OAKS INC
Employer identification number
20-1457824
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)
ABUNDANT LIVING ADULT DAY SERVICES
PO BOX 947
SALISBURY
,
NC
28145
56-1884652
ADULT DAY
NC
501(C)(3)
LINE 9
LSA INC
Yes
(2)
LFS REAL PROPERTIES INC
PO BOX 2369
SALISBURY
,
NC
28145
58-1820383
REAL ESTATE
NC
501(C)(2)
LSA INC
Yes
(3)
LSA ELMS AT TANGLEWOOD INC
PO BOX 947
SALISBURY
,
NC
28145
26-3735637
ASSIST LVG
NC
501(C)(3)
LINE 9
LSA INC
Yes
(4)
LSA ELMS PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
26-3739962
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(5)
LSA MANAGEMENT INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457236
MANAGEMENT
NC
501(C)(3)
LINE 9
LSA INC
Yes
(6)
LSA PHARMACY INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457251
PHARMACY
NC
501(C)(3)
LINE 9
LSA INC
Yes
(7)
LUTHERAN FAMILY SERVICES IN THE CAROLINAS
PO BOX 2369
SALISBURY
,
NC
28145
56-1286323
COMM SVC
NC
501(C)(3)
LINE 11B, II
LSA INC
No
(8)
LUTHERAN HOME - FORSYTH COUNTY INC
PO BOX 947
SALISBURY
,
NC
28145
26-3328029
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(9)
LUTHERAN HOME - ALBEMARLE INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457298
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(10)
LUTHERAN HOME - WILMINGTON INC
PO BOX 947
SALISBURY
,
NC
28145
26-0158686
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(11)
LUTHERAN HOME - WINSTON-SALEM INC
PO BOX 947
SALISBURY
,
NC
28145
56-1500212
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(12)
LUTHERAN HOME FORSYTH COUNTY PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
46-1188488
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(13)
LUTHERAN HOME HICKORY PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457319
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(14)
LUTHERAN HOME HICKORY WEST PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
20-5304712
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(15)
LUTHERAN HOME WILMINGTON PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
26-0158745
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(16)
LUTHERAN HOME WINSTON-SALEM PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
20-5304794
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(17)
LUTHERAN RETIREMENT CENTER - SALISBURY
PO BOX 947
SALISBURY
,
NC
28145
56-1540214
ASSIST LVG
NC
501(C)(3)
LINE 9
LSA INC
Yes
(18)
LUTHERAN SERVICES FOR THE AGING FOUNDATION INC
PO BOX 947
SALISBURY
,
NC
28145
56-1681723
FOUNDATION
NC
501(C)(3)
LINE 9
LSA INC
Yes
(19)
LUTHERAN SERVICES FOR THE AGING INC
PO BOX 947
SALISBURY
,
NC
28145
56-0752160
PARENT ORG
NC
501(C)(3)
LINE 9
N/A
No
(20)
LUTHERAN SERVICES PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
20-3895886
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(21)
LSA THERAPY INC
PO BOX 947
SALISBURY
,
NC
28145
46-1886488
THERAPY
NC
501(C)(3)
LINE 9
LSA INC
Yes
(22)
TRINITY AT HOME INC
PO BOX 947
SALISBURY
,
NC
28145
46-4838098
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(23)
MOUNTAIN RIDGE GROUP HOME INC
PO BOX 2369
SALISBURY
,
NC
28145
58-1782084
GROUP HOME
NC
501(C)(3)
LINE 7
LFS
Yes
(24)
WHITTECAR HOME INC
PO BOX 2369
SALISBURY
,
NC
28145
58-1940152
GROUP HOME
NC
501(C)(3)
LINE 7
LFS
Yes
(25)
LUTHERAN RETIREMENT CENTER - LUTHERIDGE
PO BOX 947
SALISBURY
,
NC
28145
58-1823983
ASSIST LVG
NC
501(C)(3)
LINE 9
LSA INC
Yes
(26)
LUTHERAN HOME - HICKORY WEST INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457410
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(27)
LUTHERAN HOME ALBEMARLE PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457273
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(28)
LUTHERAN HOME AT TRINITY OAKS PROPERTY INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457796
LEASING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(29)
LUTHERAN HOME - HICKORY INC
PO BOX 947
SALISBURY
,
NC
28145
20-1457341
NURSING
NC
501(C)(3)
LINE 9
LSA INC
Yes
(30)
LUTHERAN RETIREMENT CENTER - WILMINGTON
PO BOX 947
SALISBURY
,
NC
28145
56-1500308
INDEP. LVG
NC
501(C)(3)
LINE 9
LSA INC
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Page 2
Schedule R (Form 990) 2014
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
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
Schedule R (Form 990) 2014
Page 3
Schedule R (Form 990) 2014
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
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
Yes
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
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) 2014
Page 4
Schedule R (Form 990) 2014
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) 2014
Page 5
Schedule R (Form 990) 2014
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) 2014
Additional Data
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