SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
LUTHERAN HOME FOR THE AGED
DBA THE VILLAGE AT LUTHER SQUARE
Employer identification number

25-0990591
Return Reference Explanation
Form 990, Part VI, Line 11b: Form 990 Review Process The draft form 990 is reviewed in detail by the Chief Executive Officer and at least one member of the board of director's executive committee prior to submission.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts Conflict of interest statements are reviewed as part of the purchase process for services outside of the scope, identified in the conflicts statements, when dealing with those companies disclosed.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The Compensation Committee followed procedures, in whole and in part, to document data and decision using a document written by Steven T. Miller, Director Exempt Organizations, IRS titled "Rebuttable Presumption Procedure is Key to Easy Intermediate Sanctions Compliance."
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Governing Documents and Conflict of Interest Policy are available upon request. Financial Statements are defaulted to the public disclosure of the IRS form 990.
Other Changes In Net Assets Or Fund Balances - Other Increases Pension Related Changes Other than Net Periodic Pension Cost = $29866
Other Changes In Net Assets Or Fund Balances - Other Increases Valuation Gain Beneficial Interest in Perpetual Trust = $26050
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


Additional Data


Software ID: 16000303
Software Version: 2016v3.0