Lutheran Social Services of ND Return of Organization Exempt from Income Tax Form Public Disclosure Copy For 990 June 30, 2016

Transcription

1 Lutheran Soial Servies of ND Return of Organization Exempt from Inome Tax Form Puli Dislosure Copy For 990 June 0, 016

2 ** PUBLIC DISCLOSURE COPY ** OMB No Return of Organization Exempt From Inome Tax Form 990 Under setion 01(), 7, or 97(a)(1) of the Internal Revenue Code (exept private foundations) 01 Department of the Treasury Do not enter soial seurity numers on this form as it may e made puli. Open to Puli Internal Revenue Servie Information aout Form 990 and its instrutions is at Inspetion A For the 01 alendar year, or tax year eginning JUL 1, 01 and ending JUN 0, 016 B Chek if C Name of organization D Employer identifiation numer appliale: Address hange Name hange Lutheran Soial Servies of ND Doing usiness as -061 Initial return Numer and street (or P.O. ox if mail is not delivered to street address) Room/suite E Telephone numer Final return/ 911 0th Avenue South, PO Box terminated City or town, state or provine, ountry, and ZIP or foreign postal ode G Gross reeipts $ 1,0,81. Amended return Fargo, ND 8107 H(a) Is this a group return Appliation F Name and address of prinipal offier: Jessia Thomasson for suordinates? ~~ Yes No pending same as C aove H() Are all suordinates inluded? Yes No I Tax-exempt status: 01()() 01() ( ) (insert no.) 97(a)(1) or 7 If "No," attah a list. (see instrutions) J Wesite: H() Group exemption numer K Form of organization: Corporation Trust Assoiation Other L Year of formation: 196 M State of legal domiile: ND Part I Summary 1 Briefly desrie the organization s mission or most signifiant ativities: Lutheran Soial Servies of North Dakota operates programs to help people aross the entire Ativities & Governane Revenue Expenses Net Assets or Fund Balanes Sign Here Chek this ox if the organization disontinued its operations or disposed of more than % of its net assets. Numer of voting memers of the governing ody (Part VI, line 1a) Numer of independent voting memers of the governing ody (Part VI, line 1) ~~~~~~~~~~~~~~ Total numer of individuals employed in alendar year 01 (Part V, line a) ~~~~~~~~~~~~~~~~ Net unrelated usiness taxale inome from Form 990-T, line 16a Professional fundraising fees (Part I, olumn (A), line 11e) ~~~~~~~~~~~~~~ Total fundraising expenses (Part I, olumn (D), line ) 1,0,719. true, orret, and omplete. Delaration of preparer (other than offier) is ased on all information of whih preparer has any knowledge. Signature of offier Jessia Thomasson, CEO Type or print name and title ~~~~~~~~~~~~~~~~~~~~ Total numer of volunteers (estimate if neessary) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 a Total unrelated usiness revenue from Part VIII, olumn (C), line 1 ~~~~~~~~~~~~~~~~~~~~ Contriutions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~ Program servie revenue (Part VIII, line g) ~~~~~~~~~~~~~~~~~~~~~ Investment inome (Part VIII, olumn (A), lines,, and 7d) ~~~~~~~~~~~~~ Other revenue (Part VIII, olumn (A), lines, 6d, 8, 9, 10, and 11e) ~~~~~~~~ Total revenue - add lines 8 through 11 (must equal Part VIII, olumn (A), line 1) Grants and similar amounts paid (Part I, olumn (A), lines 1-) Benefits paid to or for memers (Part I, olumn (A), line ) ~~~~~~~~~~~ ~~~~~~~~~~~~~ Salaries, other ompensation, employee enefits (Part I, olumn (A), lines -10) ~~~ = = 6 7a 7 Prior Year Current Year,00,81. 6,9,9.,68,697. 1,68,. 17,. -96,60. 6,99. 11,7. 0,088,0. 8,0,91.,880,.,91, ,98,179. 9,0,0.,. 6,16. Print/Type preparer s name Preparer s signature Date Chek PTIN if Paid LISA CHAFFEE, CPA LISA CHAFFEE, CPA 0/01/17 self-employed P0019 Preparer Firm s name EIDE BAILLY LLP Firm s EIN Use Only Firm s address 10 17TH AVE S PO BO 9 9FARGO, ND Phone no May the IRS disuss this return with the preparer shown aove? (see instrutions) Yes No LHA For Paperwork Redution At Notie, see the separate instrutions. Form 990 (01) See Shedule O for Organization Mission Statement Continuation Date ,0. 9, Other expenses (Part I, olumn (A), lines 11a-11d, 11f-e) ~~~~~~~~~~~~~,,8. 7,010, Total expenses. Add lines 1-17 (must equal Part I, olumn (A), line ) ~~~~~~~ 8,70,0. 0,68, Revenue less expenses. Sutrat line 18 from line 1 1,8,80. -,,68. Beginning of Current Year End of Year 0 Total assets (Part, line 16) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~,911,6.,1,7. 1 Total liailities (Part, line 6) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6,,76. 8,9,. Net assets or fund alanes. Sutrat line 1 from line 0 17,6,980. 1,08,90. Part II Signature Blok Under penalties of perjury, I delare that I have examined this return, inluding aompanying shedules and statements, and to the est of my knowledge and elief, it is

3 Form 990 (01) Lutheran Soial Servies of ND -061 Part III Statement of Program Servie Aomplishments 1 Chek if Shedule O ontains a response or note to any line in this Part III Briefly desrie the organization s mission: Guided y God s love and grae, Lutheran Soial Servies of ND rings healing, help and hope. Page a Did the organization undertake any signifiant program servies during the year whih were not listed on the prior Form 990 or 990-EZ? If "Yes," desrie these new servies on Shedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization ease onduting, or make signifiant hanges in how it onduts, any program servies? ~~~~~~ If "Yes," desrie these hanges on Shedule O. Desrie the organization s program servie aomplishments for eah of its three largest program servies, as measured y expenses. Setion 01()() and 01()() organizations are required to report the amount of grants and alloations to others, the total expenses, and revenue, if any, for eah program servie reported. ( Code: ) ( Expenses $ 7,6,67. inluding grants of $,91,18. ) ( Revenue $ 1,68,. ) Lutheran Soial Servies of North Dakota is organized into six servie areas that represent the work we do around some of the most ritial issues in ND today. Yes Yes No No (See ontinuation on Shedule O) ( Code: ) ( Expenses $ inluding grants of $ ) ( Revenue $ ) ( Code: ) ( Expenses $ inluding grants of $ ) ( Revenue $ ) d e Other program servies (Desrie in Shedule O.) ( Expenses $ inluding grants of $ ) ( Revenue $ ) Total program servie expenses 7,6,67. Form 990 (01)

4 Form 990 (01) Lutheran Soial Servies of ND -061 Part IV Cheklist of Required Shedules a a d e f Is the organization desried in setion 01()() or 97(a)(1) (other than a private foundation)? If "Yes," omplete Shedule A~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization required to omplete Shedule B, Shedule of Contriutors? ~~~~~~~~~~~~~~~~~~~~~~ Did the organization engage in diret or indiret politial ampaign ativities on ehalf of or in opposition to andidates for puli offie? If "Yes," omplete Shedule C, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 01()() organizations. Did the organization engage in loying ativities, or have a setion 01(h) eletion in effet during the tax year? If "Yes," omplete Shedule C, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization a setion 01()(), 01()(), or 01()(6) organization that reeives memership dues, assessments, or similar amounts as defined in Revenue Proedure 98-19? If "Yes," omplete Shedule C, Part III ~~~~~~~~~~~~~~ Did the organization maintain any donor advised funds or any similar funds or aounts for whih donors have the right to provide advie on the distriution or investment of amounts in suh funds or aounts? If "Yes," omplete Shedule D, Part I Did the organization reeive or hold a onservation easement, inluding easements to preserve open spae, the environment, histori land areas, or histori strutures? If "Yes," omplete Shedule D, Part II~~~~~~~~~~~~~~ Did the organization maintain olletions of works of art, historial treasures, or other similar assets? If "Yes," omplete Shedule D, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount in Part, line 1, for esrow or ustodial aount liaility, serve as a ustodian for amounts not listed in Part ; or provide redit ounseling, det management, redit repair, or det negotiation servies? If "Yes," omplete Shedule D, Part IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization, diretly or through a related organization, hold assets in temporarily restrited endowments, permanent endowments, or quasi-endowments? If "Yes," omplete Shedule D, Part V ~~~~~~~~~~~~~~~~~~~~~~~~ If the organization s answer to any of the following questions is "Yes," then omplete Shedule D, Parts VI, VII, VIII, I, or as appliale. Did the organization report an amount for land, uildings, and equipment in Part, line 10? If "Yes," omplete Shedule D, Part VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for investments - other seurities in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "Yes," omplete Shedule D, Part VII ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for investments - program related in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "Yes," omplete Shedule D, Part VIII ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for other assets in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "Yes," omplete Shedule D, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for other liailities in Part, line? If "Yes," omplete Shedule D, Part ~~~~~~ Did the organization s separate or onsolidated finanial statements for the tax year inlude a footnote that addresses the organization s liaility for unertain tax positions under FIN 8 (ASC 70)? If "Yes," omplete Shedule D, Part ~~~~ Did the organization otain separate, independent audited finanial statements for the tax year? If "Yes," omplete Shedule D, Parts I and II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization inluded in onsolidated, independent audited finanial statements for the tax year? If "Yes," and if the organization answered "No" to line 1a, then ompleting Shedule D, Parts I and II is optional ~~~~~ Is the organization a shool desried in setion 170()(1)(A)(ii)? If "Yes," omplete Shedule E ~~~~~~~~~~~~~~ 1a Did the organization maintain an offie, employees, or agents outside of the United States? ~~~~~~~~~~~~~~~~ Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, usiness, investment, and program servie ativities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," omplete Shedule F, Parts I and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part I, olumn (A), line, more than $,000 of grants or other assistane to or for any foreign organization? If "Yes," omplete Shedule F, Parts II and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part I, olumn (A), line, more than $,000 of aggregate grants or other assistane to or for foreign individuals? If "Yes," omplete Shedule F, Parts III and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report a total of more than $1,000 of expenses for professional fundraising servies on Part I, olumn (A), lines 6 and 11e? If "Yes," omplete Shedule G, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $1,000 total of fundraising event gross inome and ontriutions on Part VIII, lines 1 and 8a? If "Yes," omplete Shedule G, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $1,000 of gross inome from gaming ativities on Part VIII, line 9a? If "Yes," omplete Shedule G, Part III a d 11e 11f 1a 1 1 1a Yes Page No 19 Form 990 (01)

5 Form 990 (01) Lutheran Soial Servies of ND -061 Part IV Cheklist of Required Shedules (ontinued) 0a 1 a d a Setion 01()(), 01()(), and 01()(9) organizations. Did the organization engage in an exess enefit transation with a disqualified person during the year? If "Yes," omplete Shedule L, Part I ~~~~~~~~~~~~~~~~ a Did the organization operate one or more hospital failities? If "Yes," omplete Shedule H ~~~~~~~~~~~~~~~~ If "Yes" to line 0a, did the organization attah a opy of its audited finanial statements to this return? ~~~~~~~~~~ Did the organization report more than $,000 of grants or other assistane to any domesti organization or domesti government on Part I, olumn (A), line 1? If "Yes," omplete Shedule I, Parts I and II ~~~~~~~~~~~~~~ Did the organization report more than $,000 of grants or other assistane to or for domesti individuals on Part I, olumn (A), line? If "Yes," omplete Shedule I, Parts I and III ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization answer "Yes" to Part VII, Setion A, line,, or aout ompensation of the organization s urrent and former offiers, diretors, trustees, key employees, and highest ompensated employees? If "Yes," omplete Shedule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a tax-exempt ond issue with an outstanding prinipal amount of more than $100,000 as of the last day of the year, that was issued after Deemer 1, 00? If "Yes," answer lines through d and omplete Shedule K. If "No", go to line a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest any proeeds of tax-exempt onds eyond a temporary period exeption? ~~~~~~~~~~~ Did the organization maintain an esrow aount other than a refunding esrow at any time during the year to defease any tax-exempt onds? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization at as an "on ehalf of" issuer for onds outstanding at any time during the year? ~~~~~~~~~~~ Is the organization aware that it engaged in an exess enefit transation with a disqualified person in a prior year, and that the transation has not een reported on any of the organization s prior Forms 990 or 990-EZ? If "Yes," omplete Shedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report any amount on Part, line, 6, or for reeivales from or payales to any urrent or former offiers, diretors, trustees, key employees, highest ompensated employees, or disqualified persons? If "Yes," omplete Shedule L, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization provide a grant or other assistane to an offier, diretor, trustee, key employee, sustantial ontriutor or employee thereof, a grant seletion ommittee memer, or to a % ontrolled entity or family memer of any of these persons? If "Yes," omplete Shedule L, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization a party to a usiness transation with one of the following parties (see Shedule L, Part IV instrutions for appliale filing thresholds, onditions, and exeptions): A urrent or former offier, diretor, trustee, or key employee? If "Yes," omplete Shedule L, Part IV ~~~~~~~~~~~ A family memer of a urrent or former offier, diretor, trustee, or key employee? If "Yes," omplete Shedule L, Part IV ~~ An entity of whih a urrent or former offier, diretor, trustee, or key employee (or a family memer thereof) was an offier, diretor, trustee, or diret or indiret owner? If "Yes," omplete Shedule L, Part IV~~~~~~~~~~~~~~~~~~~~~ Did the organization reeive more than $,000 in non-ash ontriutions? If "Yes," omplete Shedule M ~~~~~~~~~ Did the organization reeive ontriutions of art, historial treasures, or other similar assets, or qualified onservation ontriutions? If "Yes," omplete Shedule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization liquidate, terminate, or dissolve and ease operations? If "Yes," omplete Shedule N, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization sell, exhange, dispose of, or transfer more than % of its net assets? If "Yes," omplete Shedule N, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization own 100% of an entity disregarded as separate from the organization under Regulations setions and ? If "Yes," omplete Shedule R, Part I ~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization related to any tax-exempt or taxale entity? If "Yes," omplete Shedule R, Part II, III, or IV, and Part V, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a Did the organization have a ontrolled entity within the meaning of setion 1()(1)? ~~~~~~~~~~~~~~~~~~ If "Yes" to line a, did the organization reeive any payment from or engage in any transation with a ontrolled entity within the meaning of setion 1()(1)? If "Yes," omplete Shedule R, Part V, line ~~~~~~~~~~~~~~~~~~~ Setion 01()() organizations. Did the organization make any transfers to an exempt non-haritale related organization? If "Yes," omplete Shedule R, Part V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization ondut more than % of its ativities through an entity that is not a related organization and that is treated as a partnership for federal inome tax purposes? If "Yes," omplete Shedule R, Part VI ~~~~~~~~ Did the organization omplete Shedule O and provide explanations in Shedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to omplete Shedule O 0a 0 1 a d a 6 7 8a a 6 7 Yes Page No 8 Form 990 (01)

6 Form 990 (01) Lutheran Soial Servies of ND -061 Page Part V Statements Regarding Other IRS Filings and Tax Compliane Chek if Shedule O ontains a response or note to any line in this Part V 1a Enter the numer reported in Box of Form Enter -0- if not appliale ~~~~~~~~~~~ a Enter the numer of Forms W-G inluded in line 1a. Enter -0- if not appliale ~~~~~~~~~~ 1 Did the organization omply with akup withholding rules for reportale payments to vendors and reportale gaming If at least one is reported on line a, did the organization file all required federal employment tax returns? ~~~~~~~~~~ Note. If the sum of lines 1a and a is greater than 0, you may e required to e-file (see instrutions) ~~~~~~~~~~~ 7 Organizations that may reeive dedutile ontriutions under setion 170(). a Did the organization reeive a payment in exess of $7 made partly as a ontriution and partly for goods and servies provided to the payor? d e f g h a a a 1a Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained y the Sponsoring organizations maintaining donor advised funds. Setion 01()(7) organizations. Enter: Setion 01()(1) organizations. Enter: 1a Setion 97(a)(1) non-exempt haritale trusts. Is the organization filing Form 990 in lieu of Form 101? a (gamling) winnings to prize winners? a Enter the numer of employees reported on Form W-, Transmittal of Wage and Tax Statements, filed for the alendar year ending with or within the year overed y this return ~~~~~~~~~~ Did the organization have unrelated usiness gross inome of $1,000 or more during the year? ~~~~~~~~~~~~~~ If "Yes," has it filed a Form 990-T for this year? If "No," to line, provide an explanation in Shedule O ~~~~~~~~~~ a At any time during the alendar year, did the organization have an interest in, or a signature or other authority over, a finanial aount in a foreign ountry (suh as a ank aount, seurities aount, or other finanial aount)?~~~~~~~ If "Yes," enter the name of the foreign ountry: J See instrutions for filing requirements for FinCEN Form 11, Report of Foreign Bank and Finanial Aounts (FBAR). a Was the organization a party to a prohiited tax shelter transation at any time during the tax year? ~~~~~~~~~~~~ Did any taxale party notify the organization that it was or is a party to a prohiited tax shelter transation? ~~~~~~~~~ If "Yes," to line a or, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6a Does the organization have annual gross reeipts that are normally greater than $100,000, and did the organization soliit any ontriutions that were not tax dedutile as haritale ontriutions? If "Yes," did the organization inlude with every soliitation an express statement that suh ontriutions or gifts were not tax dedutile? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization notify the donor of the value of the goods or servies provided? Setion 01()(9) qualified nonprofit health insurane issuers. Note. See the instrutions for additional information the organization must report on Shedule O. Did the organization reeive any payments for indoor tanning servies during the tax year? ~~~~~~~~~~~~~~~~ If "Yes," has it filed a Form 70 to report these payments? If "No," provide an explanation in Shedule O 1a a ~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization sell, exhange, or otherwise dispose of tangile personal property for whih it was required to file Form 88? ~~~~~~~~~~~~~~~ If "Yes," indiate the numer of Forms 88 filed during the year ~~~~~~~~~~~~~~~~ Did the organization reeive any funds, diretly or indiretly, to pay premiums on a personal enefit ontrat? Did the organization, during the year, pay premiums, diretly or indiretly, on a personal enefit ontrat? 7d 10a 10 11a ~~~~~~~ ~~~~~~~~~ If the organization reeived a ontriution of qualified intelletual property, did the organization file Form 8899 as required? ~ If the organization reeived a ontriution of ars, oats, airplanes, or other vehiles, did the organization file a Form 1098-C? sponsoring organization have exess usiness holdings at any time during the year? ~~~~~~~~~~~~~~~~~~~ Did the sponsoring organization make any taxale distriutions under setion 966? Did the sponsoring organization make a distriution to a donor, donor advisor, or related person? Initiation fees and apital ontriutions inluded on Part VIII, line 1 ~~~~~~~~~~~~~~~ Gross reeipts, inluded on Form 990, Part VIII, line 1, for puli use of lu failities ~~~~~~ Gross inome from memers or shareholders ~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross inome from other soures (Do not net amounts due or paid to other soures against amounts due or reeived from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," enter the amount of tax-exempt interest reeived or arued during the year ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Is the organization liensed to issue qualified health plans in more than one state? ~~~~~~~~~~~~~~~~~~~~~ Enter the amount of reserves the organization is required to maintain y the states in whih the organization is liensed to issue qualified health plans ~~~~~~~~~~~~~~~~~~~~~~ Enter the amount of reserves on hand~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a a a 6a 6 7a 7 7 7e 7f 7g 7h 8 9a 9 1a 1a 1a Yes No 1 Form 990 (01)

7 Form 990 (01) Lutheran Soial Servies of ND -061 Page 6 Part VI Governane, Management, and Dislosure For eah "Yes" response to lines through 7 elow, and for a "No" response to line 8a, 8, or 10 elow, desrie the irumstanes, proesses, or hanges in Shedule O. See instrutions. Chek if Shedule O ontains a response or note to any line in this Part VI Setion A. Governing Body and Management 1a Enter the numer of voting memers of the governing ody at the end of the tax year ~~~~~~ If there are material differenes in voting rights among memers of the governing ody, or if the governing 6 8 a 9 Is there any offier, diretor, trustee, or key employee listed in Part VII, Setion A, who annot e reahed at the organization s mailing address? If "Yes," provide the names and addresses in Shedule O Setion B. Poliies (This Setion B requests information aout poliies not required y the Internal Revenue Code.) 1a a 16a exempt status with respet to suh arrangements? Setion C. Dislosure 17 List the states with whih a opy of this Form 990 is required to e filed JMN ody delegated road authority to an exeutive ommittee or similar ommittee, explain in Shedule O. Enter the numer of voting memers inluded in line 1a, aove, who are independent ~~~~~~ persons other than the governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization ontemporaneously doument the meetings held or written ations undertaken during the year y the following: Desrie in Shedule O the proess, if any, used y the organization to review this Form 990. Did the organization have a written onflit of interest poliy? If "No," go to line 1 ~~~~~~~~~~~~~~~~~~~~ Were offiers, diretors, or trustees, and key employees required to dislose annually interests that ould give rise to onflits? ~~~~~~ Did the organization regularly and onsistently monitor and enfore ompliane with the poliy? If "Yes," desrie in Shedule O how this was done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ for puli inspetion. Indiate how you made these availale. Chek all that apply. Own wesite Another s wesite Upon request Other (explain in Shedule O) Did any offier, diretor, trustee, or key employee have a family relationship or a usiness relationship with any other offier, diretor, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization delegate ontrol over management duties ustomarily performed y or under the diret supervision of offiers, diretors, or trustees, or key employees to a management ompany or other person? ~~~~~~~~~~~~~~ Did the organization make any signifiant hanges to its governing douments sine the prior Form 990 was filed? ~~~~~ Did the organization eome aware during the year of a signifiant diversion of the organization s assets? ~~~~~~~~~ Did the organization have memers or stokholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7a Did the organization have memers, stokholders, or other persons who had the power to elet or appoint one or more memers of the governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Are any governane deisions of the organization reserved to (or sujet to approval y) memers, stokholders, or The governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Eah ommittee with authority to at on ehalf of the governing ody? 1a 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~ 10a Did the organization have loal hapters, ranhes, or affiliates? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization have written poliies and proedures governing the ativities of suh hapters, affiliates, and ranhes to ensure their operations are onsistent with the organization s exempt purposes? ~~~~~~~~~~~~~ 11a Has the organization provided a omplete opy of this Form 990 to all memers of its governing ody efore filing the form? Did the organization have a written whistlelower poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a written doument retention and destrution poliy? ~~~~~~~~~~~~~~~~~~~~~~ Did the proess for determining ompensation of the following persons inlude a review and approval y independent persons, omparaility data, and ontemporaneous sustantiation of the delieration and deision? The organization s CEO, Exeutive Diretor, or top management offiial Other offiers or key employees of the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" to line 1a or 1, desrie the proess in Shedule O (see instrutions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest in, ontriute assets to, or partiipate in a joint venture or similar arrangement with a taxale entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization follow a written poliy or proedure requiring the organization to evaluate its partiipation in joint venture arrangements under appliale federal tax law, and take steps to safeguard the organization s Setion 610 requires an organization to make its Forms 10 (or 10 if appliale), 990, and 990-T (Setion 01()()s only) availale Desrie in Shedule O whether (and if so, how) the organization made its governing douments, onflit of interest poliy, and finanial statements availale to the puli during the tax year. State the name, address, and telephone numer of the person who possesses the organization s ooks and reords: Sarah Elliott th Avenue South, PO Box 18, Fargo, ND a 7 8a a 10 11a 1a a 1 16a 16 Yes Yes No No Form 990 (01)

8 Form 990 (01) Lutheran Soial Servies of ND -061 Page 7 Part VII Compensation of Offiers, Diretors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contrators Chek if Shedule O ontains a response or note to any line in this Part VII Setion A. List all of the organization s urrent offiers, diretors, trustees (whether individuals or organizations), regardless of amount of ompensation. Enter -0- in olumns (D), (E), and (F) if no ompensation was paid. List all of the organization s urrent key employees, if any. See instrutions for definition of "key employee." List the organization s five urrent highest ompensated employees (other than an offier, diretor, trustee, or key employee) who reeived reportale ompensation (Box of Form W- and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. List all of the organization s former offiers, key employees, and highest ompensated employees who reeived more than $100,000 of reportale ompensation from the organization and any related organizations. List all of the organization s former diretors or trustees that reeived, in the apaity as a former diretor or trustee of the organization, more than $10,000 of reportale ompensation from the organization and any related organizations. List persons in the following order: individual trustees or diretors; institutional trustees; offiers; key employees; highest ompensated employees; and former suh persons Offiers, Diretors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this tale for all persons required to e listed. Report ompensation for the alendar year ending with or within the organization s tax year. Chek this ox if neither the organization nor any related organization ompensated any urrent offier, diretor, or trustee. (A) (B) (C) (D) (E) (F) Name and Title Average hours per week (list any hours for related organizations elow line) Position (do not hek more than one ox, unless person is oth an offier and a diretor/trustee) Individual trustee or diretor Institutional trustee Offier Key employee Highest ompensated employee Former Reportale ompensation from the organization (W-/1099-MISC) Reportale ompensation from related organizations (W-/1099-MISC) Estimated amount of other ompensation from the organization and related organizations (1) Mark Strand 1.0 Board Chair () David Walth 1.0 Vie Chair () Rev. Sharon Baker 1.0 Seretary () Melanie Stillwell 1.0 Treasurer () Bishop Terry Brandt 1.0 Board Memer (6) Thomas Eide 1.0 Board Memer (7) Rev. Clark Jahnke 1.0 Board Memer (8) Jim Melland 1.0 Board Memer (9) Bishop Mark Narum 1.0 Board Memer (10) Rev. Lynn Ronserg 1.0 Board Memer (11) Murray Sagsveen 1.0 Board Memer (1) Deaoness Faith Swenson 1.0 Board Memer (1) Tom Wade 1.0 Board Memer (1) Susan Wefald 1.0 Board Memer (1) Jessia Thommason 7.00 CEO.00 11, ,16. (16) Joan Penner 7.00 CFO , ,90. (17) Steve Olson 0.00 Vie President of Operations , Form 990 (01)

9 Form 990 (01) Lutheran Soial Servies of ND -061 Page 8 Part VII Setion A. Offiers, Diretors, Trustees, Key Employees, and Highest Compensated Employees (ontinued) (A) (B) (C) (D) (E) (F) Name and title Average Position (do not hek more than one Reportale Reportale Estimated hours per ox, unless person is oth an ompensation ompensation amount of week offier and a diretor/trustee) from from related other (list any the organizations ompensation hours for organization (W-/1099-MISC) from the related (W-/1099-MISC) organization organizations and related elow organizations line) Individual trustee or diretor Institutional trustee Offier (18) Janell Regimal/VP Children's 0.00 Servies & Behavioral Health , ,6. (19) Shirley Dykshoorn/VP 0.00 Senior and Humanitarian Servies ,60. 0.,901. Key employee Highest ompensated employee Former 1 d Su-total~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total from ontinuation sheets to Part VII, Setion A ~~~~~~~~~~ Total (add lines 1 and 1) Did the organization list any former offier, diretor, or trustee, key employee, or highest ompensated employee on line 1a? If "Yes," omplete Shedule J for suh individual ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did any person listed on line 1a reeive or arue ompensation from any unrelated organization or individual for servies rendered to the organization? If "Yes," omplete Shedule J for suh person Setion B. Independent Contrators 1 Total numer of individuals (inluding ut not limited to those listed aove) who reeived more than $100,000 of reportale ompensation from the organization For any individual listed on line 1a, is the sum of reportale ompensation and other ompensation from the organization and related organizations greater than $10,000? If "Yes," omplete Shedule J for suh individual~~~~~~~~~~~~~ Complete this tale for your five highest ompensated independent ontrators that reeived more than $100,000 of ompensation from the organization. Report ompensation for the alendar year ending with or within the organization s tax year. 60, , , ,91. (A) (B) (C) Name and usiness address Desription of servies Compensation Roers Constrution 00 th St S, Fargo, ND 810 Constrution 1,8,71. Russ Reid Co. PO Box 901, Pasadena, CA Fundraising/Mailings,1. Capital Quest, 66 Gravelly Hills Rd, Louisville, TN 7777 Consulting 16,1. Yes No Total numer of independent ontrators (inluding ut not limited to those listed aove) who reeived more than $100,000 of ompensation from the organization 8 Form 990 (01)

10 Form 990 (01) Lutheran Soial Servies of ND -061 Part VIII Statement of Revenue Contriutions, Gifts, Grants and Other Similar Amounts Program Servie Revenue Other Revenue 1 a d e f g Nonash ontriutions inluded in lines 1a-1f: $ h 1a 1 1 1d 1e e Total. Add lines 11a-11d ~~~~~~~~~~~~~~~ 1 Total revenue. See instrutions. 1f Total. Add lines 1a-1f Business Code a Client & Program In ,8,6. 1,8,6. Misellaneous , ,199. d e f g 6 a d d 9 a 10 a 11 a d Government grants (ontriutions) All other ontriutions, gifts, grants, and similar amounts not inluded aove ~~ Total. Add lines a-f a a a Business Code Page 9 Chek if Shedule O ontains a response or note to any line in this Part VIII (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exluded exempt funtion usiness from tax under setions revenue revenue 1-1 Federated ampaigns Memership dues ~~~~~~ ~~~~~~~~ Fundraising events ~~~~~~~~ Related organizations ~~~~~~ All other program servie revenue ~~~~~ Investment inome (inluding dividends, interest, and other similar amounts) ~~~~~~~~~~~~~~~~~ Inome from investment of tax-exempt ond proeeds Royalties Gross rents ~~~~~~~ Less: rental expenses~~~ Rental inome or (loss) ~~ Net rental inome or (loss) 7 a Gross amount from sales of assets other than inventory Less: ost or other asis and sales expenses ~~~ Gain or (loss) ~~~~~~~ (i) Real (ii) Personal 70, ,68. (i) Seurities (ii) Other,,67. 1,07,0. Net gain or (loss) 8 a Gross inome from fundraising events (not inluding $ 18,00. of ontriutions reported on line 1). See Part IV, line 18 ~~~~~~~~~~~~~ Less: diret expenses~~~~~~~~~~ Net inome or (loss) from fundraising events Gross inome from gaming ativities. See Part IV, line 19 ~~~~~~~~~~~~~ Less: diret expenses ~~~~~~~~~ Net inome or (loss) from gaming ativities Gross sales of inventory, less returns and allowanes ~~~~~~~~~~~~~ Less: ost of goods sold ~~~~~~~~ Net inome or (loss) from sales of inventory Misellaneous Revenue All other revenue ~~~~~~~~~~~~~ 68,00. 18,00. 1,8,90.,9,01. 1,6,81.,6,6. 1,,61. 7, ,81.,10. 8,90. 6,9,9. 1,68,. 6,8. 6,8. 70,68.,0. 17, , ,898.,0.,0. 8,0,91. 1,68,.,0. -,07. 9 Form 990 (01)

11 Form 990 (01) Lutheran Soial Servies of ND -061 Part I Statement of Funtional Expenses Setion 01()() and 01()() organizations must omplete all olumns. All other organizations must omplete olumn (A). Chek if Shedule O ontains a response or note to any line in this Part I Do not inlude amounts reported on lines 6, (A) (B) (C) (D) 7, 8, 9, and 10 of Part VIII. Total expenses Program servie Management and Fundraising expenses general expenses expenses 1 Grants and other assistane to domesti organizations and domesti governments. See Part IV, line 1 ~ 1,9. 1, a d e f g a d Grants and other assistane to domesti individuals. See Part IV, line ~~~~~~~ Grants and other assistane to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 1 and 16 ~~~ Benefits paid to or for memers ~~~~~~~ Compensation of urrent offiers, diretors, trustees, and key employees ~~~~~~~~ Compensation not inluded aove, to disqualified persons (as defined under setion 98(f)(1)) and persons desried in setion 98()()(B) Other salaries and wages ~~~~~~~~~~ Pension plan aruals and ontriutions (inlude setion 01(k) and 0() employer ontriutions) Loying ~~~~~~~~~~~~~~~~~~ Professional fundraising servies. See Part IV, line 17 Investment management fees ~~~~~~~~ Other. (If line 11g amount exeeds 10% of line, olumn (A) amount, list line 11g expenses on Sh O.) Insurane ~~~~~~~~~~~~~~~~~ Other expenses. Itemize expenses not overed aove. (List misellaneous expenses in line e. If line e amount exeeds 10% of line, olumn (A) e All other expenses Total funtional expenses. Add lines 1 through e 6 Joint osts. Complete this line only if the organization reported in olumn (B) joint osts from a omined eduational ampaign and fundraising soliitation. Chek here if following SOP 98- (ASC 98-70) ~~~ Other employee enefits ~~~~~~~~~~ Payroll taxes ~~~~~~~~~~~~~~~~ Fees for servies (non-employees): Management ~~~~~~~~~~~~~~~~ Legal ~~~~~~~~~~~~~~~~~~~~ Aounting ~~~~~~~~~~~~~~~~~ Advertising and promotion ~~~~~~~~~ Offie expenses~~~~~~~~~~~~~~~ Information tehnology ~~~~~~~~~~~ Royalties ~~~~~~~~~~~~~~~~~~ Oupany ~~~~~~~~~~~~~~~~~ Travel ~~~~~~~~~~~~~~~~~~~ Payments of travel or entertainment expenses for any federal, state, or loal puli offiials Conferenes, onventions, and meetings ~~ Interest ~~~~~~~~~~~~~~~~~~ Payments to affiliates ~~~~~~~~~~~~ Depreiation, depletion, and amortization ~~,699,76.,699,76. 0,98. 16,60. 6,98. Page 10 6,98,9.,870,6. 69,178. 8,7. 8,. 19,77. 1,6. 1,71. 7,0. 6,00. 88,9., , ,7. 80,801. 1,068. 1,780. 1,780.,00.,00. 6,16. 6,16. 8,1. 8,1. 9,718. 6,6. 0,797. 8,7. 177,1. 118,91. 8,69. 9, ,0. 6,6. 6, , , , ,0. 18,1. 71, , ,170. 1,796. 7,7. 7,9.,1., ,99. 99,80. 66,70. 6,9. 17,. 16,. 11,18. 66,610. 8,16. 8,80.,68. 1,08. 1,08. amount, list line e expenses on Shedule O.) ~~ Disontinued Operations,77,.,77,. Event Expense 6, ,1.,716. Dues and Puliations,71. 8,91. 1,87.,0. Real Estate Expenses,90.,90. -, ,01. 17,7.,10. 0,68,17. 7,6,67. 1,99,887. 1,0, Form 990 (01)

12 Form 990 (01) Lutheran Soial Servies of ND -061 Page 11 Part Balane Sheet Net Assets or Fund Balanes Liailities Assets Chek if Shedule O ontains a response or note to any line in this Part (A) (B) Beginning of year End of year 1 Cash - non-interest-earing ~~~~~~~~~~~~~~~~~~~~~~~~~ 1 Savings and temporary ash investments ~~~~~~~~~~~~~~~~~~ 79,887. 8,1. Pledges and grants reeivale, net ~~~~~~~~~~~~~~~~~~~~~ 1,999,71. 1,9,06. Aounts reeivale, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ 6,787. 1,10. Loans and other reeivales from urrent and former offiers, diretors, trustees, key employees, and highest ompensated employees. Complete Part II of Shedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6 Loans and other reeivales from other disqualified persons (as defined under setion 98(f)(1)), persons desried in setion 98()()(B), and ontriuting employers and sponsoring organizations of setion 01()(9) voluntary employees enefiiary organizations (see instr). Complete Part II of Sh L ~~ 6 7 Notes and loans reeivale, net ~~~~~~~~~~~~~~~~~~~~~~~ 7 8 Inventories for sale or use ~~~~~~~~~~~~~~~~~~~~~~~~~~ 1,9, Prepaid expenses and deferred harges ~~~~~~~~~~~~~~~~~~ 1,18. 9,90. 10a Land, uildings, and equipment: ost or other asis. Complete Part VI of Shedule D ~~~ 10a 1,07,16. Less: aumulated depreiation ~~~~~~ 10,7, ,180, ,78,1. 11 Investments - pulily traded seurities ~~~~~~~~~~~~~~~~~~~,7,. 11,08,97. 1 Investments - other seurities. See Part IV, line 11 ~~~~~~~~~~~~~~ 1 1 Investments - program-related. See Part IV, line 11 ~~~~~~~~~~~~~ 1 1 Intangile assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 1 Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~ 6,08, ,106,6. 16 Total assets. Add lines 1 through 1 (must equal line ),911,6. 16,1,7. 17 Aounts payale and arued expenses ~~~~~~~~~~~~~~~~~~ 1,99, ,898,8. 18 Grants payale ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8, ,. 0 Tax-exempt ond liailities ~~~~~~~~~~~~~~~~~~~~~~~~~ 1,00, ,66,9. 1 Esrow or ustodial aount liaility. Complete Part IV of Shedule D ~~~~ 1 Loans and other payales to urrent and former offiers, diretors, trustees, key employees, highest ompensated employees, and disqualified persons. Complete Part II of Shedule L ~~~~~~~~~~~~~~~~~~~~~~~ Seured mortgages and notes payale to unrelated third parties ~~~~~~,87,609.,77,06. Unseured notes and loans payale to unrelated third parties ~~~~~~~~ 99,01. Other liailities (inluding federal inome tax, payales to related third parties, and other liailities not inluded on lines 17-). Complete Part of Shedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6,99. 8,1. 6 Total liailities. Add lines 17 through 6,, ,9,. Organizations that follow SFAS 117 (ASC 98), hek here and omplete lines 7 through 9, and lines and. 7 Unrestrited net assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1,881, ,10,78. 8 Temporarily restrited net assets ~~~~~~~~~~~~~~~~~~~~~~,98, ,69. 9 Permanently restrited net assets ~~~~~~~~~~~~~~~~~~~~~ 86, ,99. Organizations that do not follow SFAS 117 (ASC 98), hek here and omplete lines 0 through. 0 1 Capital stok or trust prinipal, or urrent funds ~~~~~~~~~~~~~~~ Paid-in or apital surplus, or land, uilding, or equipment fund ~~~~~~~~ 0 1 Retained earnings, endowment, aumulated inome, or other funds ~~~~ Total net assets or fund alanes ~~~~~~~~~~~~~~~~~~~~~~ 17,6,980. 1,08,90. Total liailities and net assets/fund alanes,911,6.,1,7. Form 990 (01)

13 Form 990 (01) Lutheran Soial Servies of ND -061 Page 1 Part I Reoniliation of Net Assets Chek if Shedule O ontains a response or note to any line in this Part I a Total revenue (must equal Part VIII, olumn (A), line 1) Total expenses (must equal Part I, olumn (A), line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Revenue less expenses. Sutrat line from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net assets or fund alanes at eginning of year (must equal Part, line, olumn (A)) ~~~~~~~~~~ Net unrealized gains (losses) on investments Donated servies and use of failities Investment expenses Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other hanges in net assets or fund alanes (explain in Shedule O) ~~~~~~~~~~~~~~~~~~~ 10 Net assets or fund alanes at end of year. Comine lines through 9 (must equal Part, line, olumn (B)) 10 1,08,90. Part II Finanial Statements and Reporting Chek if Shedule O ontains a response or note to any line in this Part II Yes No 1 Aounting method used to prepare the Form 990: Cash Arual Other If the organization hanged its method of aounting from a prior year or heked "Other," explain in Shedule O. Were the organization s finanial statements ompiled or reviewed y an independent aountant? ~~~~~~~~~~~~ If "Yes," hek a ox elow to indiate whether the finanial statements for the year were ompiled or reviewed on a separate asis, onsolidated asis, or oth: Separate asis Consolidated asis Both onsolidated and separate asis Were the organization s finanial statements audited y an independent aountant? ~~~~~~~~~~~~~~~~~~~ If "Yes," hek a ox elow to indiate whether the finanial statements for the year were audited on a separate asis, onsolidated asis, or oth: Separate asis Consolidated asis Both onsolidated and separate asis If "Yes" to line a or, does the organization have a ommittee that assumes responsiility for oversight of the audit, review, or ompilation of its finanial statements and seletion of an independent aountant?~~~~~~~~~~~~~~~ If the organization hanged either its oversight proess or seletion proess during the tax year, explain in Shedule O. a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit At and OMB Cirular A-1? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Shedule O and desrie any steps taken to undergo suh audits ,0,91. 0,68,17. -,,68. 17,6, ,68. a a 0. Form 990 (01)

14 OMB No SCHEDULE A (Form 990 or 990-EZ) Puli Charity Status and Puli Support Complete if the organization is a setion 01()() organization or a setion 01 97(a)(1) nonexempt haritale trust. Department of the Treasury Attah to Form 990 or Form 990-EZ. Open to Puli Internal Revenue Servie Information aout Shedule A (Form 990 or 990-EZ) and its instrutions is at Inspetion Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 Part I Reason for Puli Charity Status (All organizations must omplete this part.) See instrutions. The organization is not a private foundation eause it is: (For lines 1 through 11, hek only one ox.) a d e f g A hurh, onvention of hurhes, or assoiation of hurhes desried in setion 170()(1)(A)(i). A shool desried in setion 170()(1)(A)(ii). (Attah Shedule E (Form 990 or 990-EZ).) A hospital or a ooperative hospital servie organization desried in setion 170()(1)(A)(iii). A medial researh organization operated in onjuntion with a hospital desried in setion 170()(1)(A)(iii). Enter the hospital s name, ity, and state: An organization operated for the enefit of a ollege or university owned or operated y a governmental unit desried in setion 170()(1)(A)(iv). (Complete Part II.) A federal, state, or loal government or governmental unit desried in setion 170()(1)(A)(v). An organization that normally reeives a sustantial part of its support from a governmental unit or from the general puli desried in setion 170()(1)(A)(vi). (Complete Part II.) A ommunity trust desried in setion 170()(1)(A)(vi). (Complete Part II.) An organization that normally reeives: (1) more than 1/% of its support from ontriutions, memership fees, and gross reeipts from ativities related to its exempt funtions - sujet to ertain exeptions, and () no more than 1/% of its support from gross investment inome and unrelated usiness taxale inome (less setion 11 tax) from usinesses aquired y the organization after June 0, 197. See setion 09(a)(). (Complete Part III.) An organization organized and operated exlusively to test for puli safety. See setion 09(a)(). An organization organized and operated exlusively for the enefit of, to perform the funtions of, or to arry out the purposes of one or more pulily supported organizations desried in setion 09(a)(1) or setion 09(a)(). See setion 09(a)(). Chek the ox in lines 11a through 11d that desries the type of supporting organization and omplete lines 11e, 11f, and 11g. Type I. A supporting organization operated, supervised, or ontrolled y its supported organization(s), typially y giving the supported organization(s) the power to regularly appoint or elet a majority of the diretors or trustees of the supporting organization. You must omplete Part IV, Setions A and B. Type II. A supporting organization supervised or ontrolled in onnetion with its supported organization(s), y having ontrol or management of the supporting organization vested in the same persons that ontrol or manage the supported organization(s). You must omplete Part IV, Setions A and C. Type III funtionally integrated. A supporting organization operated in onnetion with, and funtionally integrated with, its supported organization(s) (see instrutions). You must omplete Part IV, Setions A, D, and E. Type III non-funtionally integrated. A supporting organization operated in onnetion with its supported organization(s) that is not funtionally integrated. The organization generally must satisfy a distriution requirement and an attentiveness requirement (see instrutions). You must omplete Part IV, Setions A and D, and Part V. Chek this ox if the organization reeived a written determination from the IRS that it is a Type I, Type II, Type III funtionally integrated, or Type III non-funtionally integrated supporting organization. Enter the numer of supported organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide the following information aout the supported organization(s). (i) Name of supported (ii) EIN (iii) Type of organization (iv) Is the organization (v) Amount of monetary (vi) Amount of organization (desried on lines 1-9 listed in your support (see other support (see aove (see instrutions)) governing doument? instrutions) instrutions) Yes No Total LHA For Paperwork Redution At Notie, see the Instrutions for Form 990 or 990-EZ Shedule A (Form 990 or 990-EZ) 01

15 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page Part II Support Shedule for Organizations Desried in Setions 170()(1)(A)(iv) and 170()(1)(A)(vi) (Complete only if you heked the ox on line, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed elow, please omplete Part III.) Setion A. Puli Support Calendar year (or fisal year eginning in) 1 Total. Add lines 1 through ~~~ 6 Puli support. Sutrat line from line. (a) 011 () 01 () 01 (d) 01 (e) 01 (f) Total Calendar year (or fisal year eginning in) (a) 011 () 01 () 01 (d) 01 (e) 01 (f) Total 7 Amounts from line ~~~~~~~ assets (Explain in Part VI.) ~~~~ Total support. Add lines 7 through 10 First five years. If the Form 990 is for the organization s first, seond, third, fourth, or fifth tax year as a setion 01()() 17a 10% -fats-and-irumstanes test If the organization did not hek a ox on line 1, 16a, or 16, and line 1 is 10% or more, 18 Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") ~~ Tax revenues levied for the organization s enefit and either paid to or expended on its ehalf ~~~~ The value of servies or failities furnished y a governmental unit to the organization without harge ~ The portion of total ontriutions y eah person (other than a governmental unit or pulily supported organization) inluded on line 1 that exeeds % of the amount shown on line 11, olumn (f) ~~~~~~~~~~~~ Setion B. Total Support Gross inome from interest, dividends, payments reeived on seurities loans, rents, royalties and inome from similar soures ~ Net inome from unrelated usiness ativities, whether or not the usiness is regularly arried on ~ Other inome. Do not inlude gain or loss from the sale of apital Gross reeipts from related ativities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ 1/% support test If the organization did not hek a ox on line 1 or 16a, and line 1 is 1/% or more, hek this ox and stop here. The organization qualifies as a pulily supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part VI how the organization meets the "fats-and-irumstanes" test. The organization qualifies as a pulily supported organization ~~~~~~~~~~~~~~~ 10% -fats-and-irumstanes test If the organization did not hek a ox on line 1, 16a, 16, or 17a, and line 1 is 10% or more, and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part VI how the organization meets the "fats-and-irumstanes" test. The organization qualifies as a pulily supported organization ~~~~~~~~ Private foundation. If the organization did not hek a ox on line 1, 16a, 16, 17a, or 17, hek this ox and see instrutions ,9. 108, ,171. 8, , ,1. 1,118.,. 9,68. 68, ,0,11. organization, hek this ox and stop here Setion C. Computation of Puli Support Perentage 1 Puli support perentage for 01 (line 6, olumn (f) divided y line 11, olumn (f)) ~~~~~~~~~~~~ Puli support perentage from 01 Shedule A, Part II, line 1 ~~~~~~~~~~~~~~~~~~~~~ a 1/% support test If the organization did not hek the ox on line 1, and line 1 is 1/% or more, hek this ox and stop here. The organization qualifies as a pulily supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Shedule A (Form 990 or 990-EZ) 01 % %

16 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Part III Support Shedule for Organizations Desried in Setion 09(a)() Calendar year (or fisal year eginning in) 1 6 The value of servies or failities furnished y a governmental unit to the organization without harge ~ Total. Add lines 1 through ~~~ 7a Amounts inluded on lines 1,, and reeived from disqualified persons Amounts inluded on lines and reeived from other than disqualified persons that exeed the greater of $,000 or 1% of the amount on line 1 for the year ~~~~~~ Add lines 7a and 7 ~~~~~~~ 8 Puli support. (Sutrat line 7 from line 6.) Calendar year (or fisal year eginning in) 9 Amounts from line 6 ~~~~~~~ 10a Gross inome from interest, dividends, payments reeived on seurities loans, rents, royalties and inome from similar soures ~ Unrelated usiness taxale inome (less setion 11 taxes) from usinesses aquired after June 0, 197 ~~~~ (a) 011 () 01 () 01 (d) 01 (e) 01 (f) Total (a) 011 () 01 () 01 (d) 01 (e) 01 (f) Total 1 First five years. If the Form 990 is for the organization s first, seond, third, fourth, or fifth tax year as a setion 01()() organization, hek this ox and stop here Setion C. Computation of Puli Support Perentage 1 16 Puli support perentage from 01 Shedule A, Part III, line 1 Setion D. Computation of Investment Inome Perentage Page Puli support perentage for 01 (line 8, olumn (f) divided y line 1, olumn (f)) ~~~~~~~~~~~~ 1 % 19a 1/% support tests If the organization did not hek the ox on line 1, and line 1 is more than 1/%, and line 17 is not 0 (Complete only if you heked the ox on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed elow, please omplete Part II.) Setion A. Puli Support Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") ~~ Gross reeipts from admissions, merhandise sold or servies performed, or failities furnished in any ativity that is related to the organization s tax-exempt purpose Gross reeipts from ativities that are not an unrelated trade or usiness under setion 1 ~~~~~ Tax revenues levied for the organization s enefit and either paid to or expended on its ehalf ~~~~ Setion B. Total Support Add lines 10a and 10 ~~~~~~ Net inome from unrelated usiness ativities not inluded in line 10, whether or not the usiness is regularly arried on ~~~~~~~ Other inome. Do not inlude gain or loss from the sale of apital assets (Explain in Part VI.) ~~~~ Total support. (Add lines 9, 10, 11, and 1.) Investment inome perentage for 01 (line 10, olumn (f) divided y line 1, olumn (f)) Investment inome perentage from 01 Shedule A, Part III, line 17 ~~~~~~~~~~~~~~~~~~ 16 ~~~~~~~~ 17 % more than 1/%, hek this ox and stop here. The organization qualifies as a pulily supported organization ~~~~~~~~~~ 1/% support tests If the organization did not hek a ox on line 1 or line 19a, and line 16 is more than 1/%, and line 18 is not more than 1/%, hek this ox and stop here. The organization qualifies as a pulily supported organization~~~~ Private foundation. If the organization did not hek a ox on line 1, 19a, or 19, hek this ox and see instrutions 1 18 Shedule A (Form 990 or 990-EZ) 01 % %

17 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page Part IV Supporting Organizations (Complete only if you heked a ox in line 11 on Part I. If you heked 11a of Part I, omplete Setions A and B. If you heked 11 of Part I, omplete Setions A and C. If you heked 11 of Part I, omplete Setions A, D, and E. If you heked 11d of Part I, omplete Setions A and D, and omplete Part V.) Setion A. All Supporting Organizations Yes No 1 Are all of the organization s supported organizations listed y name in the organization s governing douments? If "No" desrie in Part VI how the supported organizations are designated. If designated y lass or purpose, desrie the designation. If histori and ontinuing relationship, explain. 1 Did the organization have any supported organization that does not have an IRS determination of status under setion 09(a)(1) or ()? If "Yes," explain in Part VI how the organization determined that the supported organization was desried in setion 09(a)(1) or (). a Did the organization have a supported organization desried in setion 01()(), (), or (6)? If "Yes," answer () and () elow. a Did the organization onfirm that eah supported organization qualified under setion 01()(), (), or (6) and satisfied the puli support tests under setion 09(a)()? If "Yes," desrie in Part VI when and how the organization made the determination. Did the organization ensure that all support to suh organizations was used exlusively for setion 170()()(B) purposes? If "Yes," explain in Part VI what ontrols the organization put in plae to ensure suh use. a Was any supported organization not organized in the United States ("foreign supported organization")? If "Yes," and if you heked 11a or 11 in Part I, answer () and () elow. a Did the organization have ultimate ontrol and disretion in deiding whether to make grants to the foreign supported organization? If "Yes," desrie in Part VI how the organization had suh ontrol and disretion despite eing ontrolled or supervised y or in onnetion with its supported organizations. Did the organization support any foreign supported organization that does not have an IRS determination under setions 01()() and 09(a)(1) or ()? If "Yes," explain in Part VI what ontrols the organization used to ensure that all support to the foreign supported organization was used exlusively for setion 170()()(B) purposes. a Did the organization add, sustitute, or remove any supported organizations during the tax year? If "Yes," answer () and () elow (if appliale). Also, provide detail in Part VI, inluding (i) the names and EIN numers of the supported organizations added, sustituted, or removed; (ii) the reasons for eah suh ation; (iii) the authority under the organization s organizing doument authorizing suh ation; and (iv) how the ation was aomplished (suh as y amendment to the organizing doument). a Type I or Type II only. Was any added or sustituted supported organization part of a lass already 6 designated in the organization s organizing doument? Sustitutions only. Was the sustitution the result of an event eyond the organization s ontrol? Did the organization provide support (whether in the form of grants or the provision of servies or failities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the haritale lass enefited y one or more of its supported organizations, or (iii) other supporting organizations that also support or enefit one or more of the filing organization s supported organizations? If "Yes," provide detail in 7 Part VI. Did the organization provide a grant, loan, ompensation, or other similar payment to a sustantial ontriutor (defined in setion 98()()(C)), a family memer of a sustantial ontriutor, or a % ontrolled entity with 6 8 9a regard to a sustantial ontriutor? If "Yes," omplete Part I of Shedule L (Form 990 or 990-EZ). Did the organization make a loan to a disqualified person (as defined in setion 98) not desried in line 7? If "Yes," omplete Part I of Shedule L (Form 990 or 990-EZ). Was the organization ontrolled diretly or indiretly at any time during the tax year y one or more disqualified persons as defined in setion 96 (other than foundation managers and organizations desried 7 8 in setion 09(a)(1) or ())? If "Yes," provide detail in Part VI. Did one or more disqualified persons (as defined in line 9a) hold a ontrolling interest in any entity in whih 9a the supporting organization had an interest? If "Yes," provide detail in Part VI. Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal enefit 9 from, assets in whih the supporting organization also had an interest? If "Yes," provide detail in Part VI. 9 10a Was the organization sujet to the exess usiness holdings rules of setion 9 eause of setion 9(f) (regarding ertain Type II supporting organizations, and all Type III non-funtionally integrated supporting organizations)? If "Yes," answer 10 elow. 10a Did the organization have any exess usiness holdings in the tax year? (Use Shedule C, Form 70, to determine whether the organization had exess usiness holdings.) Shedule A (Form 990 or 990-EZ) 01 16

18 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page Part IV Supporting Organizations (ontinued) Yes No 11 a Has the organization aepted a gift or ontriution from any of the following persons? A person who diretly or indiretly ontrols, either alone or together with persons desried in () and () elow, the governing ody of a supported organization? A family memer of a person desried in (a) aove? A % ontrolled entity of a person desried in (a) or () aove? If "Yes" to a,, or, provide detail in Part VI. 11a Setion B. Type I Supporting Organizations Yes No 1 Did the diretors, trustees, or memership of one or more supported organizations have the power to regularly appoint or elet at least a majority of the organization s diretors or trustees at all times during the tax year? If "No," desrie in Part VI how the supported organization(s) effetively operated, supervised, or ontrolled the organization s ativities. If the organization had more than one supported organization, desrie how the powers to appoint and/or remove diretors or trustees were alloated among the supported organizations and what onditions or restritions, if any, applied to suh powers during the tax year. 1 Did the organization operate for the enefit of any supported organization other than the supported organization(s) that operated, supervised, or ontrolled the supporting organization? If "Yes," explain in Part VI how providing suh enefit arried out the purposes of the supported organization(s) that operated, supervised, or ontrolled the supporting organization. Setion C. Type II Supporting Organizations Yes No 1 Were a majority of the organization s diretors or trustees during the tax year also a majority of the diretors or trustees of eah of the organization s supported organization(s)? If "No," desrie in Part VI how ontrol or management of the supporting organization was vested in the same persons that ontrolled or managed the supported organization(s). 1 Setion D. All Type III Supporting Organizations Yes No 1 Did the organization provide to eah of its supported organizations, y the last day of the fifth month of the organization s tax year, (i) a written notie desriing the type and amount of support provided during the prior tax year, (ii) a opy of the Form 990 that was most reently filed as of the date of notifiation, and (iii) opies of the organization s governing douments in effet on the date of notifiation, to the extent not previously provided? 1 Were any of the organization s offiers, diretors, or trustees either (i) appointed or eleted y the supported organization(s) or (ii) serving on the governing ody of a supported organization? If "No," explain in Part VI how the organization maintained a lose and ontinuous working relationship with the supported organization(s). By reason of the relationship desried in (), did the organization s supported organizations have a signifiant voie in the organization s investment poliies and in direting the use of the organization s inome or assets at all times during the tax year? If "Yes," desrie in Part VI the role the organization s supported organizations played in this regard. Setion E. Type III Funtionally-Integrated Supporting Organizations 1 Chek the ox next to the method that the organization used to satisfy the Integral Part Test during the year (see instrutions): a The organization satisfied the Ativities Test. Complete line elow. The organization is the parent of eah of its supported organizations. Complete line elow. The organization supported a governmental entity. Desrie in Part VI how you supported a government entity (see instrutions). Ativities Test. Answer (a) and () elow. Yes No a Did sustantially all of the organization s ativities during the tax year diretly further the exempt purposes of the supported organization(s) to whih the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these ativities diretly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these ativities onstituted sustantially all of its ativities. a Did the ativities desried in (a) onstitute ativities that, ut for the organization s involvement, one or more of the organization s supported organization(s) would have een engaged in? If "Yes," explain in Part VI the reasons for the organization s position that its supported organization(s) would have engaged in these ativities ut for the organization s involvement. a Parent of Supported Organizations. Answer (a) and () elow. Did the organization have the power to regularly appoint or elet a majority of the offiers, diretors, or trustees of eah of the supported organizations? Provide details in Part VI. a Did the organization exerise a sustantial degree of diretion over the poliies, programs, and ativities of eah of its supported organizations? If "Yes," desrie in Part VI the role played y the organization in this regard Shedule A (Form 990 or 990-EZ) 01 17

19 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Part V Type III Non-Funtionally Integrated 09(a)() Supporting Organizations 1 Chek here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 0, See instrutions. All Setion A - Adjusted Net Inome Adjusted Net Inome (sutrat lines, 6 and 7 from line ) Setion B - Minimum Asset Amount a d e other Type III non-funtionally integrated supporting organizations must omplete Setions A through E. Net short-term apital gain Reoveries of prior-year distriutions Other gross inome (see instrutions) Add lines 1 through Depreiation and depletion Portion of operating expenses paid or inurred for prodution or olletion of gross inome or for management, onservation, or maintenane of property held for prodution of inome (see instrutions) Other expenses (see instrutions) Aggregate fair market value of all non-exempt-use assets (see instrutions for short tax year or assets held for part of year): Average monthly value of seurities Average monthly ash alanes Fair market value of other non-exempt-use assets Total (add lines 1a, 1, and 1) Disount laimed for lokage or other fators (explain in detail in Part VI): Aquisition indetedness appliale to non-exempt-use assets Sutrat line from line 1d Cash deemed held for exempt use. Enter 1-1/% of line (for greater amount, see instrutions). Net value of non-exempt-use assets (sutrat line from line ) Multiply line y.0 Reoveries of prior-year distriutions Minimum Asset Amount (add line 7 to line 6) a 1 1 1d (A) Prior Year (A) Prior Year (B) Current Year (optional) (B) Current Year (optional) Page 6 Setion C - Distriutale Amount Current Year Adjusted net inome for prior year (from Setion A, line 8, Column A) 1 Enter 8% of line 1 Minimum asset amount for prior year (from Setion B, line 8, Column A) Enter greater of line or line Inome tax imposed in prior year Distriutale Amount. Sutrat line from line, unless sujet to emergeny temporary redution (see instrutions) 6 Chek here if the urrent year is the organization s first as a non-funtionally-integrated Type III supporting organization (see instrutions). Shedule A (Form 990 or 990-EZ)

20 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page 7 Part V Type III Non-Funtionally Integrated 09(a)() Supporting Organizations (ontinued) Setion D - Distriutions Current Year Amounts paid to supported organizations to aomplish exempt purposes Amounts paid to perform ativity that diretly furthers exempt purposes of supported organizations, in exess of inome from ativity Administrative expenses paid to aomplish exempt purposes of supported organizations Amounts paid to aquire exempt-use assets Qualified set-aside amounts (prior IRS approval required) Other distriutions (desrie in Part VI). See instrutions. Total annual distriutions. Add lines 1 through 6. Distriutions to attentive supported organizations to whih the organization is responsive (provide details in Part VI). See instrutions. Distriutale amount for 01 from Setion C, line 6 Line 8 amount divided y Line 9 amount Setion E - Distriution Alloations (see instrutions) (i) Exess Distriutions (ii) Underdistriutions Pre-01 (iii) Distriutale Amount for 01 1 a d e f g h i j a a d e Distriutale amount for 01 from Setion C, line 6 Underdistriutions, if any, for years prior to 01 (reasonale ause required-see instrutions) Exess distriutions arryover, if any, to 01: From 01 From 01 Total of lines a through e Applied to underdistriutions of prior years Applied to 01 distriutale amount Carryover from 010 not applied (see instrutions) Remainder. Sutrat lines g, h, and i from f. Distriutions for 01 from Setion D, line 7: $ Applied to underdistriutions of prior years Applied to 01 distriutale amount Remainder. Sutrat lines a and from. Remaining underdistriutions for years prior to 01, if any. Sutrat lines g and a from line (if amount greater than zero, see instrutions). Remaining underdistriutions for 01. Sutrat lines h and from line 1 (if amount greater than zero, see instrutions). Exess distriutions arryover to 016. Add lines j and. Breakdown of line 7: Exess from 01 Exess from 01 Exess from 01 Shedule A (Form 990 or 990-EZ)

21 Shedule A (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page 8 Part VI Supplemental Information. Provide the explanations required y Part II, line 10; Part II, line 17a or 17; Part III, line 1; Part IV, Setion A, lines 1,,,,,, a, 6, 9a, 9, 9, 11a, 11, and 11; Part IV, Setion B, lines 1 and ; Part IV, Setion C, line 1; Part IV, Setion D, lines and ; Part IV, Setion E, lines 1, a,, a and ; Part V, line 1; Part V, Setion B, line 1e; Part V, Setion D, lines, 6, and 8; and Part V, Setion E, lines,, and 6. Also omplete this part for any additional information. (See instrutions.) Shedule A (Form 990 or 990-EZ) 01

22 ** PUBLIC DISCLOSURE COPY ** Shedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Servie Name of the organization Shedule of Contriutors Attah to Form 990, Form 990-EZ, or Form 990-PF. Information aout Shedule B (Form 990, 990-EZ, or 990-PF) and its instrutions is at OMB No Employer identifiation numer Organization type(hek one): Lutheran Soial Servies of ND -061 Filers of: Setion: Form 990 or 990-EZ 01()( ) (enter numer) organization 97(a)(1) nonexempt haritale trust not treated as a private foundation 7 politial organization Form 990-PF 01()() exempt private foundation 97(a)(1) nonexempt haritale trust treated as a private foundation 01()() taxale private foundation Chek if your organization is overed y the General Rule or a Speial Rule. Note. Only a setion 01()(7), (8), or (10) organization an hek oxes for oth the General Rule and a Speial Rule. See instrutions. General Rule For an organization filing Form 990, 990-EZ, or 990-PF that reeived, during the year, ontriutions totaling $,000 or more (in money or property) from any one ontriutor. Complete Parts I and II. See instrutions for determining a ontriutor s total ontriutions. Speial Rules For an organization desried in setion 01()() filing Form 990 or 990-EZ that met the 1/% support test of the regulations under setions 09(a)(1) and 170()(1)(A)(vi), that heked Shedule A (Form 990 or 990-EZ), Part II, line 1, 16a, or 16, and that reeived from any one ontriutor, during the year, total ontriutions of the greater of (1) $,000 or () % of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II. For an organization desried in setion 01()(7), (8), or (10) filing Form 990 or 990-EZ that reeived from any one ontriutor, during the year, total ontriutions of more than $1,000 exlusively for religious, haritale, sientifi, literary, or eduational purposes, or for the prevention of ruelty to hildren or animals. Complete Parts I, II, and III. For an organization desried in setion 01()(7), (8), or (10) filing Form 990 or 990-EZ that reeived from any one ontriutor, during the year, ontriutions exlusively for religious, haritale, et., purposes, ut no suh ontriutions totaled more than $1,000. If this ox is heked, enter here the total ontriutions that were reeived during the year for an exlusively religious, haritale, et., purpose. Do not omplete any of the parts unless the General Rule applies to this organization eause it reeived nonexlusively religious, haritale, et., ontriutions totaling $,000 or more during the year ~~~~~~~~~~~~~~~ $ Caution. An organization that is not overed y the General Rule and/or the Speial Rules does not file Shedule B (Form 990, 990-EZ, or 990-PF), ut it must answer "No" on Part IV, line, of its Form 990; or hek the ox on line H of its Form 990-EZ or on its Form 990-PF, Part I, line, to ertify that it does not meet the filing requirements of Shedule B (Form 990, 990-EZ, or 990-PF). LHA For Paperwork Redution At Notie, see the Instrutions for Form 990, 990-EZ, or 990-PF. Shedule B (Form 990, 990-EZ, or 990-PF) (01)

23 Shedule B (Form 990, 990-EZ, or 990-PF) (01) Name of organization Employer identifiation numer Page Lutheran Soial Servies of ND -061 Part I Contriutors (see instrutions). Use dupliate opies of Part I if additional spae is needed. (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution 1 $ Person Payroll,096,600. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll,060,16. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll,67,0. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll 91,81. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll,18,60. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution 6 Person Payroll $,698,0. Nonash (Complete Part II for nonash ontriutions.) Shedule B (Form 990, 990-EZ, or 990-PF) (01)

24 Shedule B (Form 990, 990-EZ, or 990-PF) (01) Name of organization Employer identifiation numer Page Lutheran Soial Servies of ND -061 Part I Contriutors (see instrutions). Use dupliate opies of Part I if additional spae is needed. (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution 7 Person Payroll $ 1,71,81. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution 8 Person Payroll $ 90,08. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution 9 $ Person Payroll,1,0. Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll Nonash (Complete Part II for nonash ontriutions.) (a) No. () Name, address, and ZIP + () Total ontriutions (d) Type of ontriution $ Person Payroll Nonash (Complete Part II for nonash ontriutions.) Shedule B (Form 990, 990-EZ, or 990-PF) (01)

25 Shedule B (Form 990, 990-EZ, or 990-PF) (01) Name of organization Page Employer identifiation numer Lutheran Soial Servies of ND -061 Part II Nonash Property (see instrutions). Use dupliate opies of Part II if additional spae is needed. (a) No. from Part I 1 () Desription of nonash property given Food donations reeived on various dates during the year () FMV (or estimate) (see instrutions) (d) Date reeived $,096, /0/16 (a) No. from Part I () Desription of nonash property given Food donations reeived on various dates during the year () FMV (or estimate) (see instrutions) (d) Date reeived $,060,16. 06/0/16 (a) No. from Part I () Desription of nonash property given Food donations reeived on various dates during the year () FMV (or estimate) (see instrutions) (d) Date reeived $,67,0. 06/0/16 (a) No. from Part I () Desription of nonash property given Food donations reeived on various dates during the year () FMV (or estimate) (see instrutions) (d) Date reeived $ 91,81. 06/0/16 (a) No. from Part I () Desription of nonash property given Food donations reeived on various dates during the year () FMV (or estimate) (see instrutions) (d) Date reeived $,18,60. 06/0/16 (a) No. from Part I 9 () Desription of nonash property given Food donations reeived on various dates during the year () FMV (or estimate) (see instrutions) (d) Date reeived $,1,0. 06/0/16 Shedule B (Form 990, 990-EZ, or 990-PF) (01)

26 Shedule B (Form 990, 990-EZ, or 990-PF) (01) Name of organization Page Employer identifiation numer Lutheran Soial Servies of ND -061 Part III (a) No. from Part I Exlusively religious, haritale, et., ontriutions to organizations desried in setion 01()(7), (8), or (10) that total more than $1,000 for the year from any one ontriutor. Complete olumns (a) through (e) and the following line entry. For organizations ompleting Part III, enter the total of exlusively religious, haritale, et., ontriutions of $1,000 or less for the year. (Enter this info. one.) $ Use dupliate opies of Part III if additional spae is needed. () Purpose of gift () Use of gift (d) Desription of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee (a) No. from Part I () Purpose of gift () Use of gift (d) Desription of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee (a) No. from Part I () Purpose of gift () Use of gift (d) Desription of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee (a) No. from Part I () Purpose of gift () Use of gift (d) Desription of how gift is held (e) Transfer of gift Transferee s name, address, and ZIP + Relationship of transferor to transferee Shedule B (Form 990, 990-EZ, or 990-PF) (01)

27 SCHEDULE D (Form 990) Complete if the organization answered "Yes" on Form 990, Part IV, line 6, 7, 8, 9, 10, 11a, 11, 11, 11d, 11e, 11f, 1a, or 1. Department of the Treasury Attah to Form 990. Internal Revenue Servie Information aout Shedule D (Form 990) and its instrutions is at OMB No Open to Puli Inspetion Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Aounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6. (a) Donor advised funds () Funds and other aounts a d a Total numer at end of year ~~~~~~~~~~~~~~~ Aggregate value of ontriutions to (during year) Aggregate value of grants from (during year) Aggregate value at end of year Complete lines a through d if the organization held a qualified onservation ontriution in the form of a onservation easement on the last day of the tax year. Held at the End of the Tax Year (i) (ii) ~~~~ ~~~~~~ ~~~~~~~~~~~~~ Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization s property, sujet to the organization s exlusive legal ontrol?~~~~~~~~~~~~~~~~~~ Did the organization inform all grantees, donors, and donor advisors in writing that grant funds an e used only for haritale purposes and not for the enefit of the donor or donor advisor, or for any other purpose onferring impermissile private enefit? Part II Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7. Purpose(s) of onservation easements held y the organization (hek all that apply). Preservation of land for puli use (e.g., rereation or eduation) Protetion of natural haitat Preservation of open spae Preservation of a historially important land area Preservation of a ertified histori struture Total numer of onservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total areage restrited y onservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~ Numer of onservation easements on a ertified histori struture inluded in (a) ~~~~~~~~~~~~ Numer of onservation easements inluded in () aquired after 8/17/06, and not on a histori struture listed in the National Register ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Numer of onservation easements modified, transferred, released, extinguished, or terminated y the organization during the tax year Numer of states where property sujet to onservation easement is loated Does the organization have a written poliy regarding the periodi monitoring, inspetion, handling of violations, and enforement of the onservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~ Staff and volunteer hours devoted to monitoring, inspeting, handling of violations, and enforing onservation easements during the year Amount of expenses inurred in monitoring, inspeting, handling of violations, and enforing onservation easements during the year $ Does eah onservation easement reported on line (d) aove satisfy the requirements of setion 170(h)()(B)(i) and setion 170(h)()(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ In Part III, desrie how the organization reports onservation easements in its revenue and expense statement, and alane sheet, and inlude, if appliale, the text of the footnote to the organization s finanial statements that desries the organization s aounting for onservation easements. Part III Organizations Maintaining Colletions of Art, Historial Treasures, or Other Similar Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. 1a If the organization eleted, as permitted under SFAS 116 (ASC 98), not to report in its revenue statement and alane sheet works of art, historial treasures, or other similar assets held for puli exhiition, eduation, or researh in furtherane of puli servie, provide, in Part III, the text of the footnote to its finanial statements that desries these items. If the organization eleted, as permitted under SFAS 116 (ASC 98), to report in its revenue statement and alane sheet works of art, historial treasures, or other similar assets held for puli exhiition, eduation, or researh in furtherane of puli servie, provide the following amounts relating to these items: Revenue inluded on Form 990, Part VIII, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $ Assets inluded in Form 990, Part ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the organization reeived or held works of art, historial treasures, or other similar assets for finanial gain, provide the following amounts required to e reported under SFAS 116 (ASC 98) relating to these items: Revenue inluded on Form 990, Part VIII, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $ Assets inluded in Form 990, Part Supplemental Finanial Statements LHA For Paperwork Redution At Notie, see the Instrutions for Form 990. Shedule D (Form 990) a d $ $ 01 Yes Yes Yes Yes No No No No

28 Shedule D (Form 990) 01 Lutheran Soial Servies of ND -061 Page Part III Organizations Maintaining Colletions of Art, Historial Treasures, or Other Similar Assets (ontinued) Using the organization s aquisition, aession, and other reords, hek any of the following that are a signifiant use of its olletion items a d e f d e If "Yes," explain the arrangement in Part III. Chek here if the explanation has een provided on Part III Part V Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10. d e f g a (i) (ii) (a) Current year () Prior year () Two years ak (d) Three years ak (e) Four years ak 1,17,6. 1,,68.,,8.,,7.,0,96. 69,87. 6, , ,98.,780.,9. 19,10., , ,00. Desrie in Part III the intended uses of the organization s endowment funds. Part VI Land, Buildings, and Equipment. Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part, line 10. 1a (hek all that apply): Puli exhiition Sholarly researh Preservation for future generations Loan or exhange programs Provide a desription of the organization s olletions and explain how they further the organization s exempt purpose in Part III. During the year, did the organization soliit or reeive donations of art, historial treasures, or other similar assets to e sold to raise funds rather than to e maintained as part of the organization s olletion? Yes Part IV Esrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part, line 1. 1a Is the organization an agent, trustee, ustodian or other intermediary for ontriutions or other assets not inluded on Form 990, Part? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 1d 1e 1f Yes Yes a(i) a(ii) (a) Cost or other () Cost or other () Aumulated (d) Book value asis (investment) asis (other) depreiation 1,6,66. 1,6,66. 8,6,99. 1,,. 7,01,9. Leasehold improvements ~~~~~~~~~~ d Equipment ~~~~~~~~~~~~~~~~~,008, ,1. 1,197,. e Other 17,0. 10,7. 6,66. Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part, olumn (B), line 10.) 9,78,1. Other If "Yes," explain the arrangement in Part III and omplete the following tale: Beginning alane Additions during the year ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Distriutions during the year ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ending alane ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a Did the organization inlude an amount on Form 990, Part, line 1, for esrow or ustodial aount liaility? ~~~~~ 1a Beginning of year alane Contriutions ~~~~~~~~~~~~~~ Net investment earnings, gains, and losses Grants or sholarships Other expenditures for failities and programs Administrative expenses End of year alane ~~~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~~~ Provide the estimated perentage of the urrent year end alane (line 1g, olumn (a)) held as: Board designated or quasi-endowment 89.6 % Permanent endowment % Temporarily restrited endowment.17 % The perentages on lines a,, and should equal 100%. a Are there endowment funds not in the possession of the organization that are held and administered for the organization y: unrelated organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" on line a(ii), are the related organizations listed as required on Shedule R? ~~~~~~~~~~~~~~~~~~~~ Desription of property Land ~~~~~~~~~~~~~~~~~~~~ Buildings ~~~~~~~~~~~~~~~~~~ Amount 7,96.,90. 1,8,0. 7,17. 71,00. 1,86,. 1,17,6. 1,,68.,,8.,,7. Yes No No No No Shedule D (Form 990)

29 Shedule D (Form 990) 01 Lutheran Soial Servies of ND -061 Page Part VII Investments - Other Seurities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11. See Form 990, Part, line 1. (a) Desription of seurity or ategory (inluding name of seurity) () Book value () Method of valuation: Cost or end-of-year market value (1) () () (H) Total. (Col. () must equal Form 990, Part, ol. (B) line 1.) Part VIII Investments - Program Related. Complete if the organization answered "Yes" on Form 990, Part IV, line 11. See Form 990, Part, line 1. (a) Desription of investment () Book value () Method of valuation: Cost or end-of-year market value (1) () () () () (6) (7) (8) (9) Total. (Col. () must equal Form 990, Part, ol. (B) line 1.) Part I Other Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part, line 1. (a) Desription () Book value (1) Interest Reeivale 8,817. () Due From LSS Housing, In. 8,090,. () Deferred Finaning Costs 7,19. () () (6) (7) (8) (9) Total. (Column () must equal Form 990, Part, ol. (B) line 1.) Part Other Liailities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part, line. 1. (a) Desription of liaility () Book value (9) Total. (Column () must equal Form 990, Part, ol. (B) line.). Finanial derivatives Closely-held equity interests Other (A) (B) (C) (D) (E) (F) (G) (1) () () () () (6) (7) (8) ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ Federal inome taxes Speial Assessments Payale 8,1. 8,1. Liaility for unertain tax positions. In Part III, provide the text of the footnote to the organization s finanial statements that reports the 8,106,6. organization s liaility for unertain tax positions under FIN 8 (ASC 70). Chek here if the text of the footnote has een provided in Part III Shedule D (Form 990)

30 Shedule D (Form 990) 01 Lutheran Soial Servies of ND -061 Page Part I Reoniliation of Revenue per Audited Finanial Statements With Revenue per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 1a. 1 Total revenue, gains, and other support per audited finanial statements ~~~~~~~~~~~~~~~~~~~ 1 1,619,869. a d e Add lines a through d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Sutrat line e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a Investment expenses not inluded on Form 990, Part VIII, line 7 ~~~~~~~~ a Other (Desrie in Part III.) ~~~~~~~~~~~~~~~~~~~~~~~~~~,11,86. Add lines a and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,11,86. Total revenue. Add lines and. (This must equal Form 990, Part I, line 1.) 8,0,91. Part II Reoniliation of Expenses per Audited Finanial Statements With Expenses per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 1a. 1 Total expenses and losses per audited finanial statements ~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 1,609,86. a d e a Amounts inluded on line 1 ut not on Form 990, Part VIII, line 1: Net unrealized gains (losses) on investments Donated servies and use of failities ~~~~~~~~~~~~~~~~~~~~~~ Reoveries of prior year grants Other (Desrie in Part III.) Add lines a through d ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts inluded on Form 990, Part VIII, line 1, ut not on line 1: Amounts inluded on line 1 ut not on Form 990, Part I, line : Donated servies and use of failities ~~~~~~~~~~~~~~~~~~~~~~ Prior year adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other losses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other (Desrie in Part III.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sutrat line e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts inluded on Form 990, Part I, line, ut not on line 1: Investment expenses not inluded on Form 990, Part VIII, line 7 Other (Desrie in Part III.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines a and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total expenses. Add lines and. (This must equal Form 990, Part I, line 18.) Part III Supplemental Information. Provide the desriptions required for Part II, lines,, and 9; Part III, lines 1a and ; Part IV, lines 1 and ; Part V, line ; Part, line ; Part I, lines d and ; and Part II, lines d and. Also omplete this part to provide any additional information. a d a d a -6,68. -1,9. 8,90.,767,. e -07,760. 1,97,69. 8,90. 1,600,91.,767,. 0,68,17. Part V, line : Inome is transferred to operations to e used to run the ageny. Part, Line : The Company is annually required to file a Return of Organization Exempt from Inome Tax (Form 990) with the IRS. In addition, the Company is sujet to inome tax on net inome that is derived from usiness ativities that are unrelated to their exempt purpose. The Company elieves it has appropriate support for any tax positions taken affeting its annual filing requirements and as suh, does not have any unertain tax positions that are material to the finanial statements. The Company would reognize future arued interest and penalties related to Shedule D (Form 990) 01

31 Shedule D (Form 990) 01 Lutheran Soial Servies of ND -061 Part III Supplemental Information (ontinued) Page unreognized tax enefits and liailities in inome tax expense if suh penalties and interest are inurred. Part I, Line d - Other Adjustments: Grant Expense Reported in Revenue on Finanial Statements -1,9. Part I, Line - Other Adjustments: Speial Events Expense Reported in Expenses on Finanial Statements -8,90. Revenue from Disontinued Operations,,881. Nonash Donations from Disontinued Operations 1,61,8. Net Assets Released from Restrition for Disontinued Operations -,896,109. Nonash Donations,710. Total to Shedule D, Part I, Line,11,86. Part II, Line d - Other Adjustments: Speial Events Expense Reported in Revenue on Form 990 8,90. Part II, Line - Other Adjustments: Grant Expense Reported in Revenue on Finanial Statements 1,9. Nonash Grants Given from Disontinued Operations 1,88,10. Operating Expenses from Disontinued Operations,77,. Depreiation Expense from Disontinued Operations 11,796. Nonash Donations,710. Total to Shedule D, Part II, Line,767,. Form 990, Part I and II: Shedule D (Form 990) 01

32 Shedule D (Form 990) 01 Lutheran Soial Servies of ND -061 Part III Supplemental Information (ontinued) Page Lutheran Soial Servies of ND is audited on a onsolidated asis with a related organization, Lutheran Soial Servies Housing, In. The amounts shown in Parts I and II of Shedule D are reoniliations of the net assets, revenues, and expenses of Lutheran Soial Servies of ND only, and do not inlude any portion of the net assets, revenues, or expenses of Lutheran Soial Servies Housing, In Shedule D (Form 990) 01

33 SCHEDULE G (iii) Did fundraiser (iv) Gross reeipts have ustody or ontrol of from ativity ontriutions? OMB No (Form 990 or 990-EZ) Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $1,000 on Form 990-EZ, line 6a. Department of the Treasury Attah to Form 990 or Form 990-EZ. Open to Puli Internal Revenue Servie Inspetion Information aout Shedule G (Form 990 or 990-EZ) and its instrutions is at Name of the organization Employer identifiation numer Part I a Did the organization have a written or oral agreement with any individual (inluding offiers, diretors, trustees or If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under whih the fundraiser is to e (i) Fundraising Ativities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17. Form 990-EZ filers are not required to omplete this part. 1 Indiate whether the organization raised funds through any of the following ativities. Chek all that apply. a Mail soliitations e Soliitation of non-government grants Internet and soliitations f Soliitation of government grants Phone soliitations g Speial fundraising events d In-person soliitations key employees listed in Form 990, Part VII) or entity in onnetion with professional fundraising servies? ompensated at least $,000 y the organization. Name and address of individual or entity (fundraiser) Supplemental Information Regarding Fundraising or Gaming Ativities Lutheran Soial Servies of ND -061 (ii) Ativity Yes (v) Amount paid to (or retained y) fundraiser listed in ol. (i) 01 No (vi) Amount paid to (or retained y) organization Russ Reid Co Yes No Colletions Drive Center, Fundraising Mailings 1,08,81. 6, ,666. Total 1,08,81. 6, ,666. List all states in whih the organization is registered or liensed to soliit ontriutions or has een notified it is exempt from registration or liensing. MN,ND LHA For Paperwork Redution At Notie, see the Instrutions for Form 990 or 990-EZ. Shedule G (Form 990 or 990-EZ) 01 See Part IV for ontinuations

34 Shedule G (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page Part II Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $1,000 of fundraising event ontriutions and gross inome on Form 990-EZ, lines 1 and 6. List events with gross reeipts greater than $,000. Revenue (a) Event #1 () Event # () Other events (d) Total events None (add ol. (a) through Chef s Gala ol. ()) (event type) (event type) (total numer) 1 Gross reeipts ~~~~~~~~~~~~~~ 7,710. 7,710. Less: Contriutions ~~~~~~~~~~~ 18,00. 18,00. Gross inome (line 1 minus line ),10.,10. Cash prizes ~~~~~~~~~~~~~~~ Diret Expenses Net inome summary. Sutrat line 10 from line, olumn (d) Part III Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than Revenue 1 Nonash prizes ~~~~~~~~~~~~~ Rent/faility osts ~~~~~~~~~~~~ Food and everages ~~~~~~~~~~ Entertainment ~~~~~~~~~~~~~~ Other diret expenses ~~~~~~~~~~ Diret expense summary. Add lines through 9 in olumn (d) $1,000 on Form 990-EZ, line 6a. Gross revenue (a) Bingo 1,700. 1, ,60. 6,60. ~~~~~~~~~~~~~~~~~~~~~~~~ () Pull tas/instant ingo/progressive ingo () Other gaming 8,90.,0. (d) Total gaming (add ol. (a) through ol. ()) Diret Expenses Cash prizes ~~~~~~~~~~~~~~~ Nonash prizes ~~~~~~~~~~~~~ Rent/faility osts ~~~~~~~~~~~~ 6 Other diret expenses Volunteer laor ~~~~~~~~~~~~~ Yes % Yes % Yes % No No No 7 Diret expense summary. Add lines through in olumn (d) ~~~~~~~~~~~~~~~~~~~~~~~~ 8 Net gaming inome summary. Sutrat line 7 from line 1, olumn (d) 9 Enter the state(s) in whih the organization onduts gaming ativities: a Is the organization liensed to ondut gaming ativities in eah of these states? ~~~~~~~~~~~~~~~~~~~~ If "No," explain: Yes No 10a Were any of the organization s gaming lienses revoked, suspended or terminated during the tax year? ~~~~~~~~~ If "Yes," explain: Yes No Shedule G (Form 990 or 990-EZ) 01

35 Shedule G (Form 990 or 990-EZ) 01 Lutheran Soial Servies of ND -061 Page 11 1 Does the organization ondut gaming ativities with nonmemers? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization a grantor, enefiiary or trustee of a trust or a memer of a partnership or other entity formed to administer haritale gaming? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes Yes No No 1 Indiate the perentage of gaming ativity onduted in: a The organization s faility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1a % An outside faility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 % 1 Enter the name and address of the person who prepares the organization s gaming/speial events ooks and reords: Name Address 1a Does the organization have a ontrat with a third party from whom the organization reeives gaming revenue? ~~~~~~ Yes No If "Yes," enter the amount of gaming revenue reeived y the organization $ and the amount of gaming revenue retained y the third party $. If "Yes," enter name and address of the third party: Name Address 16 Gaming manager information: Name Gaming manager ompensation $ Desription of servies provided Diretor/offier Employee Independent ontrator 17 Mandatory distriutions: a Is the organization required under state law to make haritale distriutions from the gaming proeeds to retain the state gaming liense? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes No Enter the amount of distriutions required under state law to e distriuted to other exempt organizations or spent in the organization s own exempt ativities during the tax year $ Part IV Supplemental Information. Provide the explanations required y Part I, line, olumns (iii) and (v); and Part III, lines 9, 9, 10, 1, 1, 16, and 17, as appliale. Also provide any additional information (see instrutions). Shedule G, Part I, Line, List of Ten Highest Paid Fundraisers: (i) Name of Fundraiser: Russ Reid Co. (i) Address of Fundraiser: 18 Colletions Drive Center, Chiago, IL Shedule G (Form 990 or 990-EZ) 01

36 Shedule G (Form 990 or 990-EZ) Lutheran Soial Servies of ND -061 Part IV Supplemental Information (ontinued) Page Shedule G (Form 990 or 990-EZ)

37 SCHEDULE I (Form 990) Department of the Treasury Internal Revenue Servie Name of the organization Part I Complete if the organization answered "Yes" on Form 990, Part IV, line 1 or. Attah to Form 990. Information aout Shedule I (Form 990) and its instrutions is at OMB No Open to Puli Inspetion Employer identifiation numer Lutheran Soial Servies of ND -061 General Information on Grants and Assistane Desrie in Part IV the organization s proedures for monitoring the use of grant funds in the United States. Part II Grants and Other Assistane to Domesti Organizations and Domesti Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 1, for any LHA Does the organization maintain reords to sustantiate the amount of the grants or assistane, the grantees eligiility for the grants or assistane, and the seletion riteria used to award the grants or assistane? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter total numer of setion 01()() and government organizations listed in the line 1 tale Enter total numer of other organizations listed in the line 1 tale Grants and Other Assistane to Organizations, Governments, and Individuals in the United States 01 reipient that reeived more than $,000. Part II an e dupliated if additional spae is needed. 1 (a) Name and address of organization () EIN () IRC setion (d) Amount of (e) Amount of (f) Method of (g) Desription of (h) Purpose of grant valuation (ook, or government if appliale ash grant non-ash non-ash assistane or assistane FMV, appraisal, assistane other) To provide Refugee Health Family HealthCare Center Mentoring servies to 01 NP Ave refugee arrivals to Fargo, ND ()() 6, inlude health To provide Nurse Case Fargo Cass Puli Health Management servies to 10 th St S refugee arrivals to Fargo, ND Fargo Cass Pu. Hlth 6,1. 0. inlude testing or follow To provide English Fargo Puli Shools-Fargo Adult language training for new Learning Center th Ave S - arriving refugees and for Fargo, ND Fargo Puli Shools 9, those in the United To provide English Gloal Friends Coalition Language Learning 600 Demers Ave, Suite 06A servies for adult Grand Forks, ND ()() 1,9. 0. refugees in an effort to To provide Nurse Case City of Grand Forks Puli Health Management staffing to Department - 11 South th Street provide refugee health Suite N01 - Grand Forks, ND G.F. Pu. Hlth Dept 11,7. 0. are and follow-up for To provide English North Dakota State College of Language Learning Siene th Ave North - servies for adult Fargo, ND ND State College 17, refugees in an effort to ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For Paperwork Redution At Notie, see the Instrutions for Form 990. Shedule I (Form 990) (01) See Part IV for Column (h) desriptions 6 Yes No 9. 0.

38 Shedule I (Form 990) Lutheran Soial Servies of ND -061 Page 1 Part II Continuation of Grants and Other Assistane to Governments and Organizations in the United States (Shedule I (Form 990), Part II.) (a) Name and address of () EIN () IRC setion (d) Amount of (e) Amount of (f) Method of (g) Desription of (h) organization or government if appliale ash grant non-ash non-ash assistane assistane valuation (ook, FMV, appraisal, other) Purpose of grant or assistane To provide English Afrian Initiative for Progress Language Learning support 1 South 1st St. Suite 00 or mentoring for Adult Fargo, ND ()(), refugees arriving in Cass To provide English Bismark Puli Shool Distrit Language Learning 100 College Drive servies for adult Bismark, ND Bismark Pu. S 18,7. 0. refugees in an effort to To provide Nurse Case Valley Community Health Centers Management servies to 1 S th Street Suite 01 refugee arrivals to Grand Forks, ND ()(),0. 0. inlude review of health Shedule I (Form 990)

39 Shedule I (Form 990) (01) Lutheran Soial Servies of ND -061 Part III Grants and Other Assistane to Domesti Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line. Part III an e dupliated if additional spae is needed. Page (a) Type of grant or assistane () Numer of () Amount of (d) Amount of nonash (e) Method of valuation (f) Desription of non-ash assistane reipients ash grant assistane (ook, FMV, appraisal, other) Case Relief, Emergeny Servies, Cash Assistane, Clothing, Housing Expenses, Food, Employment Assistane, and Other Program Expenses for Refugees 686 1,,8. 0. Travel, Insurane, Boarding Care, Reognition, Medial, Allowanes, and Gift Assistane for Senior Companion Partiipants 71 8,9. 0. Support Servies, Extended Servies, Immigration Expense, Program and Volunteer Expenses 19 76, Food, Clothing, Equipment, Building Supplies, Personal Supplies, Travel, and Eduation Assistane 97 6, Food Bank ,88,10.Average Prie per Pound Food Part IV Supplemental Information. Provide the information required in Part I, line, Part III, olumn (), and any other additional information. Part I, Line : Assistane is provided to needy individuals determined on a ase y ase asis. The individuals must indiate what the assistane will e used for prior to reeiving assistane. The New Amerians program diretor and state refugee oordinator routinely meet with the organizations reeiving grant funds. They monitor their udgets and ompare the organizations ativity reports with the ativities defined in the ontrats. Part II, line 1, Column (h): Shedule I (Form 990) (01)

40 Shedule I (Form 990) Lutheran Soial Servies of ND -061 Part IV Supplemental Information Page Name of Organization or Government: Family HealthCare Center (h) Purpose of Grant or Assistane: To provide Refugee Health Mentoring servies to refugee arrivals to inlude health orientation information for newly arriving refugees, health urriulum presentations, and home visitation y trained ethni ommunity health mentors. To provide Nurse Case Management servies to refugee arrivals to inlude review of health and medial reords for arriving refugees, health sreening ativities, and preparation for medial examination. Name of Organization or Government: Fargo Cass Puli Health (h) Purpose of Grant or Assistane: To provide Nurse Case Management servies to refugee arrivals to inlude testing or follow up for are related to TB, immunizations, or other hroni or infetious diseases in oordination with other health and medial providers. Name of Organization or Government: Fargo Puli Shools-Fargo Adult Learning Center (h) Purpose of Grant or Assistane: To provide English language training for new arriving refugees and for those in the United States for up to years from date of US arrival. Name of Organization or Government: Gloal Friends Coalition (h) Purpose of Grant or Assistane: To provide English Language Learning servies for adult refugees in an effort to gain self-suffiieny or to enhane their ELL skills in order to aomplish a level of ompetene for employment, training, and/or new ommunity adjustment. Name of Organization or Government: Shedule I (Form 990)

41 Shedule I (Form 990) Lutheran Soial Servies of ND -061 Part IV Supplemental Information Page City of Grand Forks Puli Health Department (h) Purpose of Grant or Assistane: To provide Nurse Case Management staffing to provide refugee health are and follow-up for immunizations, TB review and are, and follow-up for hroni health onditions as deemed appropriate within the sope of Grand Forks Puli Health. Name of Organization or Government: North Dakota State College of Siene (h) Purpose of Grant or Assistane: To provide English Language Learning servies for adult refugees in an effort to gain self-suffiieny or to enhane their ELL skills in order to aomplish a level of ompetene for employment, training, and/or new ommunity adjustment. Name of Organization or Government: Afrian Initiative for Progress (h) Purpose of Grant or Assistane: To provide English Language Learning support or mentoring for Adult refugees arriving in Cass County, North Dakota, who are in need of English Language Learning servies to support efforts toward jo plaement, jo enhanement, and greater self-suffiieny. Name of Organization or Government: Bismark Puli Shool Distrit (h) Purpose of Grant or Assistane: To provide English Language Learning servies for adult refugees in an effort to gain self-suffiieny or to enhane their ELL skills in order to aomplish a level of ompetene for employment, training, and/or new ommunity adjustment. Name of Organization or Government: Valley Community Health Centers (h) Purpose of Grant or Assistane: To provide Nurse Case Management servies to refugee arrivals to inlude review of health and medial Shedule I (Form 990)

42 Shedule I (Form 990) Lutheran Soial Servies of ND -061 Part IV Supplemental Information Page reords for arriving refugees, health sreening ativities, and full health exam when appropriate. Form 990, Shedule I, Part III, olumn (): The disaster response team works with emergeny management personnel at the ity and ounty levels to determine the numers of disaster vitims with unmet needs. The Great Plains Food Bank reeives monthly statistis from its partner agenies, inluding the numer of adults, hildren and seniors served Shedule I (Form 990)

43 SCHEDULE K (Form 990) Department of the Treasury Internal Revenue Servie Supplemental Information on Tax-Exempt Bonds Complete if the organization answered "Yes" on Form 990, Part IV, line a. Provide desriptions, explanations, and any additional information in Part VI. Attah to Form 990. Information aout Shedule K (Form 990) and its instrutions is at OMB No Open to Puli Inspetion Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 Part I Bond Issues See Part VI for Column (f) Continuations (a) Issuer name () Issuer EIN () CUSIP # (d) Date issued (e) Issue prie (f) Desription of purpose (g) Defeased (h) On ehalf (i) Pooled of issuer finaning Yes No Yes No Yes No City of Horae, North Finane A Dakota None 10/8/1 1,00,000. onstrution of L 01 B C D Part II Part III 1 Proeeds Amount of onds retired Amount of onds legally defeased Does the organization maintain adequate ooks and reords to support the final alloation of proeeds? Private Business Use Total proeeds of issue Gross proeeds in reserve funds Capitalized interest from proeeds Proeeds in refunding esrows Issuane osts from proeeds Credit enhanement from proeeds Working apital expenditures from proeeds Capital expenditures from proeeds Other spent proeeds Other unspent proeeds Year of sustantial ompletion Were the onds issued as part of a urrent refunding issue? Were the onds issued as part of an advane refunding issue? Has the final alloation of proeeds een made? Was the organization a partner in a partnership, or a memer of an LLC, whih owned property finaned y tax-exempt onds? Are there any lease arrangements that may result in private usiness use of A B C D,661. 1,00,000. 1,00,000. Yes No Yes No Yes No Yes No A B C D Yes No Yes No Yes No Yes No ond-finaned property? LHA For Paperwork Redution At Notie, see the Instrutions for Form 990. Shedule K (Form 990) 01 01

44 Shedule K (Form 990) 01 Lutheran Soial Servies of ND -061 Part III Private Business Use (Continued) a d Part IV 1 a d Are there any management or servie ontrats that may result in private usiness use of ond-finaned property? If "Yes" to line a, does the organization routinely engage ond ounsel or other outside ounsel to review any management or servie ontrats relating to the finaned property? Are there any researh agreements that may result in private usiness use of ond-finaned property? If "Yes" to line, does the organization routinely engage ond ounsel or other outside ounsel to review any researh agreements relating to the finaned property? Aritrage e Was the hedge terminated? A B C D Yes No Yes No Yes No Yes No Enter the perentage of finaned property used in a private usiness use y entities other than a setion 01()() organization or a state or loal government.00 % % % % Enter the perentage of finaned property used in a private usiness use as a result of unrelated trade or usiness ativity arried on y your organization, another setion 01()() organization, or a state or loal government.00 % % % % Total of lines and.00 % % % % Does the ond issue meet the private seurity or payment test? 8a Has there een a sale or disposition of any of the ond-finaned property to a nongovernmental person other than a 01()() organization sine the onds were issued? If "Yes" to line 8a, enter the perentage of ond-finaned property sold or disposed of % % % % If "Yes" to line 8a, was any remedial ation taken pursuant to Regulations setions and 1.1-? Has the organization estalished written proedures to ensure that all nonqualified onds of the issue are remediated in aordane with the requirements under Regulations setions and 1.1-? Has the issuer filed Form 808-T, Aritrage Reate, Yield Redution and Penalty in Lieu of Aritrage Reate? If "No" to line 1, did the following apply? Reate not due yet? Exeption to reate? No reate due? If "Yes" to line, provide in Part VI the date the reate omputation was performed Is the ond issue a variale rate issue? a Has the organization or the governmental issuer entered into a qualified hedge with respet to the ond issue? Name of provider Term of hedge Was the hedge superintegrated? A B C D Yes No Yes No Yes No Yes No Page Shedule K (Form 990) 01

45 Shedule K (Form 990) 01 Part IV Aritrage (Continued) a Were gross proeeds invested in a guaranteed investment ontrat (GIC)? 6 7 d Part V Proedures To Undertake Corretive Ation Name of provider Term of GIC Lutheran Soial Servies of ND -061 Was the regulatory safe haror for estalishing the fair market value of the GIC satisfied? Were any gross proeeds invested eyond an availale temporary period? Has the organization estalished written proedures to monitor the requirements of setion 18? Has the organization estalished written proedures to ensure that violations of federal tax requirements are timely identified and orreted through the voluntary losing agreement program if self-remediation is not availale under appliale regulations? Part VI Supplemental Information. Provide additional information for responses to questions on Shedule K (see instrutions). Shedule K, Part I, Bond Issues: (a) Issuer Name: City of Horae, North Dakota (f) Desription of Purpose: Finane onstrution of Lutheran Soial Servies Program Center A B C D Yes No Yes No Yes No Yes No A B C D Yes No Yes No Yes No Yes No Page Shedule K (Form 990) 01

46 SCHEDULE M (Form 990) OMB No J Complete if the organizations answered "Yes" on Form 990, Part IV, lines 9 or 0. Department of the Treasury Internal Revenue Servie J Attah to Form 990. J Information aout Shedule M (Form 990) and its instrutions is at Open To Puli Inspetion Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 Part I Types of Property (a) () () (d) Chek if Method of determining appliale nonash ontriution amounts Art - Works of art ~~~~~~~~~~~~~ Art - Historial treasures ~~~~~~~~~ Art - Frational interests ~~~~~~~~~~ Books and puliations ~~~~~~~~~~ Clothing and household goods ~~~~~~ Cars and other vehiles ~~~~~~~~~~ Boats and planes ~~~~~~~~~~~~~ Intelletual property Seurities - Pulily traded ~~~~~~~~~~~ ~~~~~~~~ Seurities - Closely held stok~~~~~~~ Seurities - Partnership, LLC, or trust interests Seurities - Misellaneous ~~~~~~~~~~~~~~ Qualified onservation ontriution - Histori strutures ~~~~~~~~ ~~~~~~~~~~~~ Qualified onservation ontriution - Other~ Real estate - Residential Real estate - Commerial ~~~~~~~~~ Real estate - Other ~~~~~~~~~ ~~~~~~~~~~~~ Colletiles ~~~~~~~~~~~~~~~~ Food inventory ~~~~~~~~~~~~~~ Drugs and medial supplies ~~~~~~~~ Taxidermy Historial artifats Sientifi speimens ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~ Arheologial artifats ~~~~~~~~~~ Other J ( ) Other J ( ) Other J ( ) Other J ( ) Numer of ontriutions or items ontriuted Numer of Forms 88 reeived y the organization during the tax year for ontriutions Nonash ontriution amounts reported on Form 990, Part VIII, line 1g for whih the organization ompleted Form 88, Part IV, Donee Aknowledgement ~~~~ 0a During the year, did the organization reeive y ontriution any property reported in Part I, lines 1 through 8, that it must hold for at least three years from the date of the initial ontriution, and whih is not required to e used for exempt purposes for the entire holding period? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," desrie the arrangement in Part II. Does the organization have a gift aeptane poliy that requires the review of any non-standard ontriutions? ~~~~~~ a Does the organization hire or use third parties or related organizations to soliit, proess, or sell nonash LHA ontriutions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," desrie in Part II. If the organization did not report an amount in olumn () for a type of property for whih olumn (a) is heked, desrie in Part II. Nonash Contriutions 01 8,710.FMV,900.Sale of Comparales 7 6,90.FMV ,61,8.$1.70 per Pound For Paperwork Redution At Notie, see the Instrutions for Form 990. Shedule M (Form 990) (01) 0a 1 a Yes No

47 Shedule M (Form 990) (01) Lutheran Soial Servies of ND -061 Page Part II Supplemental Information. Provide the information required y Part I, lines 0,, and, and whether the organization is reporting in Part I, olumn (), the numer of ontriutions, the numer of items reeived, or a omination of oth. Also omplete this part for any additional information. Shedule M, Part I, Column (): The numer of ontriutors listed for the food inventory donated in Part I, Line 19, Column () of the Shedule M is ased on the numer of pounds of food donated Shedule M (Form 990) (01) 6

48 SCHEDULE O (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Servie Name of the organization Supplemental Information to Form 990 or 990-EZ 01 OMB No Complete to provide information for responses to speifi questions on Form 990 or 990-EZ or to provide any additional information. Attah to Form 990 or 990-EZ. Open to Puli Information aout Shedule O (Form 990 or 990-EZ) and its instrutions is at Inspetion Employer identifiation numer Lutheran Soial Servies of ND -061 Form 990, Part I, Line 1, Desription of Organization Mission: state of North Dakota. These programs touh people of all ages. They help alleviate hunger, mend roken relationships, plae hildren in safe environments, aid elderly itizens and advoate on ehalf of the disenfranhised. Form 990, Part III, Line, Changes in Program Servies: On June 0, 016 the organization sold the food ank and all related assets and liailities to an unrelated third party. Form 990, Part III, Setion B, Line a: **Early Beginnings** *Adoption - Adoption Option, a partnership etween The Village Family Servie Center and LSSND, offers pregnany and parenting support servies, adoption servies and post-adoption searh and dislosure servies. aies were plaed in loving adoptive homes. *Pregnany Counseling - Pregnany Counseling is a servie for expetant mothers and/or their families that helps them look at their options and make life plans. 10 individuals were ounseled. *Healthy Families - Healthy Families provides free, voluntary home visitation servies to support expetant parents and parents of neworns in reating a safe and healthy home. 10 young families reeived in-home visits and assessments. *Child Care Aware - A training and information hu for parents and hild are providers, this program helps uild the apaity of the LHA For Paperwork Redution At Notie, see the Instrutions for Form 990 or 990-EZ. Shedule O (Form 990 or 990-EZ) (01)

49 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 hild are system in North Dakota to ensure hildren have opportunities to play and learn in safe and healthy environments. The Organization helped,16 families searh for hild are. *Bright & Early - With so muh growth happening in their first five years of life, hildren need quality hild are and early eduation programs to thrive. Through this wesite (rightandearlynd.org), parents an identify hild are and early eduation programs that go aove and eyond to prepare hildren for shool and life. 180 new hild are providers otained a quality rating. *Growing Futures - This statewide system is designed to support rewarding and suessful areers in the field of early are and eduation y validating individual professional ahievements, heightening professionalism and expanding areer opportunities. Growing Futures provided,18 hours of training to the early hildhood workfore. **Youth Interventions** *Restorative Justie - Restorative Justie reates safer ommunities y ringing vitims and offenders together with trained failitators in a strutured proess that repairs harm y helping people proess onflit. LSSND trains hundreds of eduators in restorative praties eah year to support their efforts to help kids proess onflit and ehaviors that have aused harm in positive ways. 1 teens were held aountale and hundreds of vitims provided reoniliation. *Day Report - Day Report promotes the well-eing of at-risk youth, ages 1-17, through after-shool struture, supervision and eduation. kids had a safe, produtive plae to e, learn and grow after shool. *Youth Court - Youth Court provides teen volunteers meaningful servie Shedule O (Form 990 or 990-EZ) (01) 8

50 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 learning as they serve as judge and jury for their peers who have een harged with offenses or have een referred y shool administrators. The kids are held aountale for their ations, ut in positive, eduational ways. 188 kids were diverted from ourt served y 8 teen volunteers. *Safer Tomorrows - Safer Tomorrows reates lasting hange y reduing hildhood exposure to violene. The program is a partnership with shools aross Grand Forks County. shools and,000+ kids were touhed over the life of the projet. *Attendant Care - Attendant Care helps keep kids out of jail y providing short-term are and supervision in a safe, non-institutional setting. 118 kids were kept safe in supervised settings. **Therapy Servies** *Aound Counseling - Aound Counseling rings quality, affordale ounseling to people in ommunities aross North Dakota. The therapy network mathes experiened therapists with individuals and families who are seeking are. people reeived mental health servies. *Luther Hall - Luther Hall helps kids ages in a home-like mental health setting with on-site shool and therapy servies. At Luther Hall, kids are in a safe and aring environment where they an learn aout themselves, how to address the hallenges they are faing, and find ways to uild stronger relationships with their families. hildren were provided with /7 are. *Family Counseling - LSSND often helps families stay together y providing intensive therapy to families who have a hild who is at high risk of eing plaed outside the home and is involved with the juvenile justie system. 607 individuals from 1 families reeived in-home Shedule O (Form 990 or 990-EZ) (01) 9

51 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 ounseling. *DIVERT - Through DIVERT, we onnet with families that have hildren exhiiting risky ehaviors to help them identify diffiulties and strengths, set goals for improvement and use ommunity resoures to get the help they need. 8 kids were diverted from going deeper into the juvenile justie system. *Gamlers Choie - We help resolve the emotional, relationship and finanial prolems that result from prolem gamlers addition. We support them and their families in their journey to reak free from gamling addition and hart a path toward reovery. 11 gamlers found help. *Violene Free - Engage with men and women who have ommitted ats of domesti violene in group therapy, to help them to form safe and respetful relationships with their loved ones. 6 men and women learned aout respetful relationships where power and ontrol are not used. **Affordale Housing** *Housing Development - LSSND works with loal leaders to identify ritial ommunity needs and then identify approahes for meeting them that have the est hane for suess. To address shortages, we uild and renovate to provide new, affordale housing. 9 new apartment units were opened in Hettinger and Watford City. *Preservation - Works with ommunities and loal partners to aquire, rehailitate and, ultimately, preserve existing affordale housing units in rural North Dakota ommunities. The organization is working to preserve 6 rent-susidized apartments in two ommunities. *Property Management - We wath over all the housing properties owned Shedule O (Form 990 or 990-EZ) (01) 0

52 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 y LSSND, as well as units owned y others around the state. The property management team is ommitted to eing oth ompassionate and ompetent, offering day-to-day on-site management while also addressing individual tenant needs. 1,06 people lived in homes managed y Lutheran Soial Servies. *Isaiah Investments - Gives people and usinesses a hane to invest in affordale housing and hild are in North Dakota through soial impat loans. The fund provides investors with a modest return while failitating powerful ommunity hange. **Senior Independene** *Senior Companions - Senior adults volunteer their time to provide life-affirming ompanionship to help older adults maintain their independene and ontinue living in their own homes, as well as respite are to family aregivers to help avoid aregiver urnout. 8,0 hours of ompanionship were given to 71 seniors in ounties. *Volunteer Companions - LSSND opens the doors to volunteer ompanions of all ages, who want to serve as a ompanion to a North Dakota senior. This simple at of ompanionship anishes isolation and uilds meaningful relationships, whih ultimately helps seniors live independently longer. This onneted volunteers and lients in 9 ommunities. *Aging Life Care Management - Care managers help families oordinate are for older adults and those with hroni illnesses. They serve as advoates and are oordinators, with the ultimate goal of delaying or preventing re-hospitalization or premature plaement in a long-term are faility. 7 families were onneted with are managers to navigate health-are options in a flexile, person entered manner Shedule O (Form 990 or 990-EZ) (01) 1

53 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 *Support and Servies at Home (SASH) Hu - SASH onnets partiipants with ommunity-ased servies and promotes health-are oordination y wrapping servies around people wherever they live. The program improves the health and funtional status of older adults, dereases health-are expenditures, and redues people s need for more expensive types of are. The Organization opened the 1st SASH hu in Jamestown in partnership with Guardian Angels, a loal home are ageny. Form 990, Part III, Setion B, Line a: **Humanitarian Assistane** *Disaster Response - Disaster Response leverages resoures to help individuals and ommunities in North Dakota prepare for and reover from disasters. The program provides preparedness training, reovery response and reruitment, oordination and supervision volunteers. The Organization responded to disasters in North Dakota ommunities. *Refugee Resettlement - As the only federally reognized and approved refugee resettlement organization working in the state, LSSND helps refugees integrate into their new home ommunities and egin uilding their new lives. We equip them with the tools they need to eome self-suffiient, help them find jos to support their families and ommunities, onnet them with English language learning opportunities and provide them with ase management servies. 611 refugees newly arrived. *Immigration Servies - New Amerian Servies helps refugees, immigrants and U.S. reunify with their families or ahieve the highest legal immigration status, inluding itizenship. We offer affordale immigration ounseling and proessing servies to refugees, asylees and others in need. 707 people reeived help with immigration related Shedule O (Form 990 or 990-EZ) (01)

54 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 servies. *Interpreter Servies - LSSND ridges the language divide etween individuals with limited or no English speaking aility and those who are serving them. Our trained interpreters offer them oral interpretation as well as written translation servies. 1 languages were interpreted. *Foster Care for Unaompanied Refugee Minors - This program enourages growth toward independene y plaing unaompanied refugee hildren with safe, nurturing foster or kinship families. We fous on uilding independent living skills and helping them find employment and eduation as they approah adulthood. 7 kids were ared for and onneted with foster are during this fisal year. *Servies to Older Refugees - Refugee elders are unlikely to find employment due to their language, physial and ultural arriers. LSSND helps them develop a sense of elonging through soial and ommunity ativities, allowing for a smoother integration into their new ommunities. Approximately 00 refugee elders resettled in Fargo-Moorhead sine 008. Form 990, Part VI, Setion A, line 6: The orporate memers of Lutheran Soial Servies of North Dakota are the Eastern North Dakota and the Western North Dakota Synods of the Evangelial Lutheran Churh in Ameria and the Lutheran Churh-Missouri Synod, North Dakota distrit. Form 990, Part VI, Setion A, line 7a: There are 1 people on the Board of Diretors. Three of these diretors Shedule O (Form 990 or 990-EZ) (01)

55 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 (two ishops and one president) serve y virtue of their offie, and the other 11 diretors are eleted y their orporate memers. Of these 11 diretors, the Eastern North Dakota Synod of the Evangelial Lutheran Churh in Ameria shall elet or appoint three diretors, the Western North Dakota Synod shall elet or appoint three diretors, the Lutheran Churh-Missouri Synod, North Dakota Distrit shall elet or appoint one diretor, and four at-large diretors shall e eleted y the oard. Form 990, Part VI, Setion A, line 8: There are no ommittees with the authority to at on ehalf of the oard. Form 990, Part VI, Setion B, line 11: The Controller will review the 990. A paket inluding the 990 will also e sent to the Board of Diretors for approval. The oard will e given a week to review the 990 and suggest any hanges that should e made. Form 990, Part VI, Setion B, Line 1: Board memers and employees have the responsiility to give notifiation if they have a onflit or potential onflit of interest. Board memers are not allowed to vote on any issue where there is a potential onflit of interest. All potential onflits are reviewed and it is determined if a onflit exists y the CEO with onsultation y the oard and/or legal ounsel if neessary. The oard of diretors, employees, volunteers and paid onsultants are all overed y the poliy. Form 990, Part VI, Setion B, Line 1: The President of the Board works with the Chief Talent Offier on a format for eletroni review of ompensation. This review ould also inlude some Shedule O (Form 990 or 990-EZ) (01)

56 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 employees and/or outside interests suh as peers and pastors. The President of the Board reeives the overall organization ompensation inreases. A ommittee meets to disuss review results, perentage inrease and any other potential inrease suh as onus or merit pay. Comparaility data is also examined. The CEO s ompensation is disussed with the full oard of diretors. The ompensation pakage goes into effet on the CEO s anniversary date. The Organization does a similar review using omparaility data for all offiers at least every years. Form 990, Part VI, Setion C, Line 19: The annual report is pulished on the organization s wesite. It is also mailed to present and potential donors and is availale at Lutheran Soial Servies offies. Areviated finanial information is inluded in the annual report. There are no other poliies or douments on the organization s wesite. The governing douments and onflit of interest poliy would also e availale upon request. Form 990, Part VIII, Line 1g, Part I, Line, and Part, Line 8: LSS ND failiates food donations for the Great Plains Food Bank. LSS ND ats as an intermediary for the donations of food. Donations of food are reorded as ontriution inome in Part VIII of the Form 990 and the distriutions of food from the Great Plains Food Bank is eing reorded as Grants/Other Assistane to individuals on Line in Part I of the Form 990. Donated and purhased food produt that hasn t een distriuted at year end is also inluded as inventory on Line 8 in Part of the Form 990. Food is valued ased on the average prie per pound Shedule O (Form 990 or 990-EZ) (01)

57 Shedule O (Form 990 or 990-EZ) (01) Page Name of the organization Employer identifiation numer Lutheran Soial Servies of ND -061 whih is set y Feeding Ameria. On June 0, 016, the Organization sold the food ank and all related assets and liailities to an unrelated party. The Organization determined this to e a strategi shift in operations for the Organization, and therefore has reported the sale as a disontinued operation Shedule O (Form 990 or 990-EZ) (01)

58 SCHEDULE R (Form 990) Complete if the organization answered "Yes" on Form 990, Part IV, line,,, 6, or 7. Attah to Form 990. Department of the Treasury Internal Revenue Servie Information aout Shedule R (Form 990) and its instrutions is at Name of the organization Related Organizations and Unrelated Partnerships OMB No Open to Puli Inspetion Employer identifiation numer Lutheran Soial Servies of ND -061 Part I Identifiation of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line. (a) () () (d) (e) (f) Name, address, and EIN (if appliale) of disregarded entity Primary ativity Legal domiile (state or foreign ountry) Total inome End-of-year assets Diret ontrolling entity Part II Identifiation of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line eause it had one or more related tax-exempt organizations during the tax year. (a) () () (d) (e) (f) (g) Name, address, and EIN of related organization Primary ativity Legal domiile (state or foreign ountry) Exempt Code setion Puli harity status (if setion 01()()) Diret ontrolling entity Setion 1()(1) ontrolled entity? Yes Lutheran Soial Servies Housing, In. - Lutheran Soial , 911 0th Ave S, Fargo, ND Providing Affordale Servies of North 810 Housing North Dakota 01()() Line 9 Dakota Lutheran Soial Servies Jamestown, In. - Lutheran Soial 7-90, 911 0th Ave S, Fargo, ND Servies Housing, 810 Rental Units for Elderly North Dakota 01()() Line 7 In. No For Paperwork Redution At Notie, see the Instrutions for Form 990. Shedule R (Form 990) LHA 7

59 Shedule R (Form 990) 01 Part III Identifiation of Related Organizations Taxale as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line eause it had one or more related organizations treated as a partnership during the tax year. (a) () () (d) (e) (f) (g) (h) (i) (j) (k) Legal Primary ativity domiile Diret ontrolling Predominant inome Share of total Share of Disproportionate Code V-UBI General or managing (state or entity (related, unrelated, inome end-of-year amount in ox alloations? partner? foreign exluded from tax under assets 0 of Shedule ountry) setions 1-1) Yes No K-1 (Form 106) Yes No Name, address, and EIN of related organization Lutheran Soial Servies of ND -061 Page Perentage ownership LSS Housing Tioga, LP , PO Box 18, Fargo, ND 8107 Rental Housing ND N/A N/A N/A N/A N/A N/A N/A N/A LSS Housing Williston, LP , PO Box 18, Fargo, ND 8107 Rental Housing ND N/A N/A N/A N/A N/A N/A N/A N/A Part IV Identifiation of Related Organizations Taxale as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line eause it had one or more related organizations treated as a orporation or trust during the tax year. (a) () () (d) (e) (f) (g) (h) (i) Name, address, and EIN of related organization Primary ativity Legal domiile (state or foreign ountry) Diret ontrolling entity Type of entity (C orp, S orp, or trust) Share of total inome Share of end-of-year assets Perentage ownership Yes No LSS Housing Tioga LLC PO Box 18 6 Unit Rental Fargo, ND 8107 Housing Projet ND N/A C CORP N/A N/A N/A LSS Housing Williston LLC PO Box 18 Affordale Senior Fargo, ND 8107 Housing ND N/A C CORP N/A N/A N/A Setion 1()(1) ontrolled entity? Shedule R (Form 990) 01

60 Shedule R (Form 990) 01 Lutheran Soial Servies of ND -061 Page Part V Transations With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line,, or 6. Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this shedule. Yes No 1 a d e During the tax year, did the organization engage in any of the following transations with one or more related organizations listed in Parts II-IV? Reeipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a ontrolled entity ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1a Gift, grant, or apital ontriution to related organization(s) Gift, grant, or apital ontriution from related organization(s) Loans or loan guarantees to or for related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans or loan guarantees y related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 1 1d 1e f g h i j Dividends from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sale of assets to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Purhase of assets from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exhange of assets with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lease of failities, equipment, or other assets to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1f 1g 1h 1i 1j k Lease of failities, equipment, or other assets from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ l Performane of servies or memership or fundraising soliitations for related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ m Performane of servies or memership or fundraising soliitations y related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ n Sharing of failities, equipment, mailing lists, or other assets with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ o Sharing of paid employees with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1k 1l 1m 1n 1o p q Reimursement paid to related organization(s) for expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Reimursement paid y related organization(s) for expenses~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1p 1q r s Other transfer of ash or property to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other transfer of ash or property from related organization(s) If the answer to any of the aove is "Yes," see the instrutions for information on who must omplete this line, inluding overed relationships and transation thresholds. (a) () () (d) Name of related organization Transation Amount involved Method of determining amount involved type (a-s) 1r 1s (1) Lutheran Soial Servies Housing, In. A,600.Arual () Lutheran Soial Servies Housing, In. D 8,090,.End of Year Balane () () () (6) Shedule R (Form 990) 01

61 Shedule R (Form 990) 01 Lutheran Soial Servies of ND -061 Page Part VI Unrelated Organizations Taxale as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 7. Provide the following information for eah entity taxed as a partnership through whih the organization onduted more than five perent of its ativities (measured y total assets or gross revenue) that was not a related organization. See instrutions regarding exlusion for ertain investment partnerships. (a) () () (d) (e) (f) (g) (h) (i) (j) (k) Are all Primary ativity Predominant inome partners se. Share of Share of Disproportionate amount in ox 0 managing Code V-UBI General or (related, unrelated, 01()() orgs.? total end-of-year alloations? partner? Name, address, and EIN of entity Legal domiile (state or foreign ountry) exluded from tax under setions 1-1) of Shedule K-1 inome assets Yes No Yes No (Form 106) Yes No Perentage ownership Shedule R (Form 990)

62 Shedule R (Form 990) 01 Lutheran Soial Servies of ND -061 Part VII Supplemental Information Provide additional information for responses to questions on Shedule R (see instrutions). Page Shedule R (Form 990) 01

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