efile Public Visual Render
ObjectId: 201911169349300431 - Submission: 2019-04-26
TIN: 47-2584315
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.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
18
Open to Public Inspection
Name of the organization
NATIONAL LUTHERAN INC
Employer identification number
47-2584315
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
(1)
COMMUNITY SERVICES LLC
2301 RESEARCH BLVD STE 310
ROCKVILLE
,
MD
20850
37-1843616
PROJECT MANAGEMENT
MD
1,768,808
360,541
NATIONAL LUTHERAN INC
(2)
MYPOTENTIAL MD
2301 RESEARCH BLVD STE 310
ROCKVILLE
,
MD
20850
81-2686381
HEALTH CLINIC
MD
361,948
76,753
COMMUNITY SERVICES LLC
(3)
MYPOTENTIAL VA
2301 RESEARCH BLVD STE 310
ROCKVILLE
,
MD
20850
47-4102818
HEALTH CLINIC
VA
1,298,102
237,876
COMMUNITY SERVICES LLC
(4)
TVOR CLINIC LLC
2301 RESEARCH BLVD STE 310
ROCKVILLE
,
MD
20850
30-0962299
HEALTH CLINIC
MD
108,758
45,912
COMMUNITY SERVICES LLC
(5)
IMPACT 1890 LLC
2301 RESEARCH BLVD STE 310
ROCKVILLE
,
MD
20850
30-1007964
GRANT PAYMENTS
MD
0
0
NATIONAL LUTHERAN INC
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)
THE VILLAGE AT ORCHARD RIDGE INC
400 CLOCKTOWER RIDGE DRIVE
WINCHESTER
,
VA
22603
26-3445374
CONTINUTING CARE RETIREMENT COMMUNITY
VA
501(C)(3)
LINE 10
NATIONAL LUTHERAN INC
Yes
(2)
THE VILLAGE AT ROCKVILLE INC
9701 VEIRS DRIVE
ROCKVILLE
,
MD
20850
53-0196624
CONTINUTING CARE RETIREMENT COMMUNITY
MD
501(C)(3)
LINE 10
NATIONAL LUTHERAN INC
Yes
(3)
THE LEGACY AT NORTH AUGUSTA INC
1410 A NORTH AUGUSTA STREET
STAUNTON
,
VA
24401
45-2857307
RESIDENTIAL CARE AND ASSISTED LIVING FACILITY
VA
501(C)(3)
LINE 10
NATIONAL LUTHERAN INC
Yes
(4)
THE VILLAGE AT PROVIDENCE POINT INC
2301 RESEARCH BLVD
ROCKVILLE
,
MD
20850
45-4024593
CONTINUTING CARE RETIREMENT COMMUNITY
MD
501(C)(3)
LINE 10
NATIONAL LUTHERAN INC
Yes
(5)
NATIONAL LUTHERAN HOME FOR THE AGED INC
2301 RESEARCH BLVD
ROCKVILLE
,
MD
20850
26-2222476
SUPPORTING ORGANIZATION
MD
501(C)(3)
LINE 12A, I
NATIONAL LUTHERAN INC
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Page 2
Schedule R (Form 990) 2018
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)
PRIMROSE INTEL LLC
2301 RESEARCH BLVD STE 450
ROCKVILLE
,
MD
20850
82-4733502
SOFTWARE SOLUTIONS
MD
NATIONAL LUTHERAN INC
-368,445
314,659
No
Yes
90.000 %
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) 2018
Page 3
Schedule R (Form 990) 2018
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
Yes
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
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
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
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
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
(1)
THE VILLAGE AT ROCKVILLE INC
D
20,869,989
COST
(2)
THE LEGACY AT NORTH AUGUSTA INC
D
9,181,918
COST
(3)
THE VILLAGE AT ORCHARD RIDGE INC
D
17,512,235
COST
(4)
THE VILLAGE AT ROCKVILLE INC
E
119,250
COST
(5)
THE VILLAGE AT ORCHARD RIDGE INC
E
494,913
COST
(6)
NATIONAL LUTHERAN HOME FOR THE AGED INC
E
48,434,437
COST
(7)
THE VILLAGE AT ROCKVILLE INC
L
2,440,001
COST
(8)
THE VILLAGE AT ORCHARD RIDGE INC
L
1,515,000
COST
(9)
THE LEGACY AT NORTH AUGUSTA INC
L
443,000
COST
(10)
THE VILLAGE AT ROCKVILLE INC
O
124,237
COST
(11)
THE VILLAGE AT ORCHARD RIDGE INC
O
124,237
COST
(12)
THE LEGACY AT NORTH AUGUSTA INC
O
124,237
COST
(13)
THE VILLAGE AT ORCHARD RIDGE INC
R
8,357,151
COST
(14)
PRIMROSE INTEL LLC
B
750,000
COST
Schedule R (Form 990) 2018
Page 4
Schedule R (Form 990) 2018
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) 2018
Page 5
Schedule R (Form 990) 2018
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) 2018
Additional Data
Software ID:
Software Version: