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ObjectId: 201913469349300231 - Submission: 2019-12-12
TIN: 20-5849983
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
DEER CREEK MANOR INC (NFP)
C/O LUTHERAN SOCIAL SERVICES OF ILLINOIS
Employer identification number
20-5849983
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)
ASSISI HOMES - DOWNER PLACE INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-4083919
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(2)
AURORA SENIOR HOUSING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-4274216
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(3)
BATAVIA COUNCIL ON AGING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3084946
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(4)
THE CORNERSTONE FOUNDATION INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3289363
SOCIAL SERV.
IL
501(C)(3)
LINE 12A, I
LUTHERAN SOCIAL SERVICES OF IL
No
(5)
DEKALB HOUSING FOR THE HANDICAPPED INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3077011
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(6)
FORSBERG CHRISTIAN RETIREMENT CENTER INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3396547
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(7)
FOX HILL SENIOR HOUSING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
27-3372031
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(8)
FREEPORT SENIOR HOUSING II INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-4401036
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(9)
FREEPORT SENIOR HOUSING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3774949
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(10)
LUTHER CENTER INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
26-2564449
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(11)
LUTHERAN SOCIAL SERVICES OF ILLINOIS
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-2584799
SOCIAL SERV.
IL
501(C)(3)
LINE 7
N/A
No
(12)
MATINS INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-4376713
SOCIAL SERV.
IL
501(C)(3)
LINE 12A, I
LUTHERAN SOCIAL SERVICES OF IL
No
(13)
NORTHWEST CHICAGO GROUP HOMES INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3693249
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(14)
OUR SAVIOR'S SENIOR HOUSING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3868008
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(15)
ROCHELLE SENIOR HOUSING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3936045
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(16)
ROLLING MEADOWS SENIOR LIVING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
06-1825461
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(17)
SALEM VILLAGE IIIINC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3736904
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(18)
SPRING RIDGE HOUSING FOR SENIORS INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
05-0536005
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(19)
TABOR LUTHERAN SENIOR HOUSING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3868007
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
(20)
VESPER MANAGEMENT CORPORATION
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-3396543
SOCIAL SERV.
IL
501(C)(3)
LINE 12A, I
LUTHERAN SOCIAL SERVICES OF IL
No
(21)
VICTORIAN WOODS SENIOR LIVING INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
05-0536002
HOUSING
IL
501(C)(3)
LINE 10
LUTHERAN SOCIAL SERVICES OF IL
No
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
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)
LSSI ROCKFORD PROPERTY INC
1001 E TOUHY AVE SUITE 50
DES PLAINES
,
IL
60018
36-2903955
HOUSING
IL
N/A
C
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
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
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
No
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
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
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
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
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
(1)
LUTHERAN SOCIAL SERVICE OF ILLINOIS
P
26,991
FMV
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
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