2020-11-04T10:52:27-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2019-01-01 383081979 LUTHERAN HOME CARE AGENCY INC LUTH 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 TIMOTHY KALBFLEISCH SVP AND CFO 9896523470 2020-10-28 1 TINA PETERS P00904574 2483522500 2020-10-28 68.34.66.206 2020-10-28 15:09:35 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3BA07AC1E7B37A4123F7B0FAF00AF3DF039E44A3 2019 2021-01-29 14:40:06Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 3546369 0 X WWW.WELLSPRINGLUTHERAN.COM X 1992 MI MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 7 7 45 26 0 0 92274 130000 2934318 3412919 2230 2525 616 925 3029438 3546369 0 0 0 0 1517182 1604441 0 0 0 1610970 1973370 3128152 3577811 -98714 -31442 1071939 1635608 1520670 2220720 -448731 -585112 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 2470545 3413099 THE LUTHERAN HOME CARE AGENCY FULFILLED ITS TAX-EXEMPT PURPOSE THROUGH THE PROVISION OF NURSING, REHAB (PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPY), SOCIAL SERVICES, SPIRITUAL AND OTHER SUPPORTIVE PROGRAMS TO FRAIL ELDERLY, DISABLED PERSONS, AND TERMINALLY ILL INDIVIDUALS. IN ADDITION, THE LHCA PROVIDES ADDITIONAL SERVICES TO THE COMMUNITY AT LARGE THROUGH EDUCATION, GRIEF SUPPORT, FLU SHOT CLINICS, AND VARIOUS WELLNESS PROGRAMS. OVERALL, THE LHCA PROVIDED A TOTAL OF 18,664 VISITS WHICH INCLUDED SERVICES SUCH AS NURSING CARE; SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPIES; MEDICAL, SOCIAL, AND PERSONAL SERVICES; AND HOSPICE SERVICES TO 826 INDIVIDUALS. 2470545 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 11 0 1 45 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X LAURA MCKAY 9892627381 4100 PIER NORTH BLVD STE A FLINT MI 48504 DAVID M GEHM PRESIDENT & CEO 0.00 40.00 X 0 265141 14956 AMY STORMS SR. VP FINANCE/CFO - THRU 7/15/19 0.08 39.92 X 0 171737 7702 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0.08 39.92 X 0 158086 5989 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.00 40.00 X 0 142822 11690 SEAN DE FOUR SR. VP AND COO 0.25 39.75 X 0 148484 5907 ERIC R MUSUM VP, CAA AND CTO 0.00 40.00 X 0 139522 11214 RITCH CUSHWAY CHAIRMAN 0.20 0.80 X X 0 0 0 PETE BENDER TREASURER/SECRETARY 0.20 0.80 X X 0 0 0 DARRELL ZOLTON DIRECTOR 0.20 0.80 X 0 0 0 PAUL NYQUIST DIRECTOR 0.20 0.80 X 0 0 0 CARL SCHOENOW DIRECTOR 0.20 0.80 X 0 0 0 AMY BENKO DIRECTOR 0.20 0.80 X 0 0 0 KEITH STONE DIRECTOR - PART YEAR 0.20 0.80 X 0 0 0 KAREN STORCK DIRECTOR 0.20 0.80 X 0 0 0 0 1025792 57458 0 0 1 0 SELECT REHABILITATION PO BOX 71985 CHICAGO IL 60694 OCCUPATIONAL/PHYSICAL/SPEECH THERAPY 424928 LUTHERAN HOMES OF MICHIGAN - FRANKEMUTH 725 W GENESEE FRANKENMUTH MI 48734 HOSPICE CARE 357431 LUTHERAN HOME CARE PERSONAL ASSISTANCE 4100 PIER NORTH BLVD SUITE A FLINT MI 48504 RENT 120000 3 130000 130000 HOME CARE SERVICES 621610 3412919 3412919 3412919 2525 2525 MISCELLANEOUS 990009 745 745 FURNISHED SERVICES 990009 180 180 925 3546369 3413099 0 3270 X 1387046 914116 472930 24535 12249 12286 88750 44805 43945 104110 68564 35546 198245 198245 104 104 728102 715670 12432 3033 1523 1510 57589 130 57459 75542 75542 142004 60 141944 77188 72742 4446 9525 3457 6068 32096 25677 6419 18876 18876 DRUGS AND SUPPLIES 528264 528264 RENTAL EQUIPMENT 43726 42016 1710 LICENSES AND FEES 12611 1142 11469 FOUNDATION EXPENSES 10589 10589 35876 29541 6335 3577811 2470545 1107266 0 438722 485242 304191 335774 22022 42180 586752 506948 67891 79804 239113 692608 1071939 1635608 86884 231283 1433786 1989437 1520670 2220720 X -687844 -719286 239113 134174 -448731 -585112 1071939 1635608 X -31442 -104939 X 0 1 X 1 0 X 0 0 120759 92274 130000 343033 3551829 3403313 3028531 2934318 3412919 16330910 9000 9854 491 260 180 19785 3560829 3413167 3149781 3026852 3543099 16693728 120759 92274 130000 343033 0 120759 92274 130000 343033 16350695 1193 1520 1714 2230 2525 9182 1193 1520 1714 2230 2525 9182 4487 2287 251 356 745 8126 3566509 3416974 3151746 3029438 3546369 16711036 0.97840 0.98540 0.00050 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 104 104 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 586752 506948 79804 79804 ASSETS LIMITED AS-TO-USE 134174 DUE FROM AFFILIATES 558434 692608 DUE TO AFFILIATES 1989437 1989437 1 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 0 265141 0 0 0 0 0 7750 0 7206 0 280097 0 0 AMY STORMS SR. VP FINANCE/CFO - THRU 7/15/19 0 171737 0 0 0 0 0 3593 0 4109 0 179439 0 0 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0 158086 0 0 0 0 0 4714 0 1275 0 164075 0 0 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0 142822 0 0 0 0 0 4750 0 6940 0 154512 0 0 SEAN DE FOUR SR. VP AND COO 0 148484 0 0 0 0 0 0 0 5907 0 154391 0 0 ERIC R MUSUM VP, CAA AND CTO 0 139522 0 0 0 0 0 4408 0 6806 0 150736 0 0 PART I, LINE 3 THE PROCESS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT/CEO IS UNDERTAKEN BY LUTHERAN HOMES OF MICHIGAN, INC., A RELATED ORGANIZATION. THE PROCESS INCLUDES USE OF A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A AMY STORMS RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $52,856. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS LUTHERAN HOMES OF MICHIGAN, INC. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE MEMBER, LUTHERAN HOMES OF MICHIGAN, INC., HAS THE AUTHORITY TO APPOINT/ELECT INDIVIDUALS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990 RETURN, ELECTRONIC COPIES OF THE FORM 990 WERE SENT TO THE MEMBERS OF THE BOARD OF DIRECTORS. THE MEMBERS' INPUTS AND COMMENTS WERE SOLICITED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE COLLECTED IN THE BEGINNING OF EACH NEW BOARD YEAR. THE FORMS ARE REVIEWED BY THE CEO. IF A CONFLICT EXISTS, THE CEO REVIEWS WITH THE BOARD CHAIR AND DETERMINES THE APPROPRIATE ACTION, WHICH IS TYPICALLY TO REMOVE THE INDIVIDUAL FROM THE POSITION OF CONFLICT FOR THE SPECIFIC TRANSACTION/PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE CORPORATE OFFICE OF WELLSPRING LUTHERAN SERVICES BY CONTACTING THE CHIEF FINANCIAL OFFICER. FORM 990, PART IX, LINE 11G INPATIENT CARE: PROGRAM SERVICE EXPENSES 624,905. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 624,905. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 20,629. MANAGEMENT AND GENERAL EXPENSES 12,432. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,061. OTHER: PROGRAM SERVICE EXPENSES 70,136. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,136. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION -104,939. LUTHERAN HOMES OF MICHIGAN INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 381358410 NURSING CARE MI 501(C)(3) LINE 10 N/A 0 LUTHERAN HOMES OF MICHIGAN FOUNDATION 4100 PIER NORTH BLVD STE A FLINT MI 48504 261630687 DONATE FUNDS MI 501(C)(3) LINE 12A LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOME CARE PERSONAL ASSISTANCE 4100 PIER NORTH BLVD STE A FLINT MI 48504 272138954 HOME CARE MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 382236926 RETIREMENT COMMUNITY MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 PROJECT COMPASSION HEALTH 4100 PIER NORTH BLVD STE A FLINT MI 48504 382395647 SKILLED NURSING FACILITY MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 ALPENA VILLAGE 4100 PIER NORTH BLVD STE A FLINT MI 48504 320090735 RESIDENTIAL CONTINUING CARE RETIREMENT FACILITY MI N/A GIBRALTER 26200 LAHSER RD STE 300 SOUTHFIELD MI 48034 301829767 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI N/A MONROE ELDERLY LDHALP 5309 TRANSPORTATION BLVD CLEVELAND OH 44125 383609893 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI N/A ALPENA PINES LDHALP 9710 JUNCTION ROAD FRANKENMUTH MI 48434 260236982 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI N/A LHM HOUSING SERVICES INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 383609879 HOUSING SERVICES MI N/A C 0 GIBRALTER MANOR DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 202240778 HOUSING SERVICES MI N/A C 0 ALPENA PINES DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 260237019 HOUSING SERVICES MI N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 LUTHERAN HOME CARE PERSONAL ASSISTANCE K 120000 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN P 373222 ACTUAL COST LUTHERAN HOMES OF MICHIGAN L 198245 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION C 130000 ACTUAL AMOUNT