2020-11-10T11:29:33-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 2601 CAMBRIDGE CT STE 500 AUBURN HILLS MI 48326 990 2019-01-01 381358410 LUTHERAN HOMES OF MICHIGAN INC LUTH 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 TIMOTHY KALBFLEISCH SVP AND CFO 9896523470 2020-11-04 1 TINA PETERS P00904574 2483757100 2020-11-04 68.34.66.206 2020-11-04 13:39:50 ES 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 42512900 0 X WWW.WELLSPRINGLUTHERAN.COM X 1892 MI MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 7 7 719 107 1169681 327305 180052 253077 41454569 33338014 3683531 876952 2714228 3119964 48032380 37588007 0 0 0 0 23147002 19632243 0 0 228752 21243999 17737878 44391001 37370121 3641379 217886 53300034 52626040 34597378 33413953 18702656 19212087 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 30593164 32168333 SKILLED NURSING CARE UNIT AND HOME FOR THE AGED UNIT PROVIDED 64,115 DAYS OF CARE AND 9,472 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS OF TWO NURSING HOMES 30593164 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 116 0 1 719 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 MI X LAURA MCKAY 9892627381 4100 PIER NORTH BLVD STE A FLINT MI 48504 DAVID M GEHM PRESIDENT & CEO 38.54 1.46 X 265141 0 14956 AMY STORMS SR. VP FINANCE/CFO - THRU 7/15/19 39.50 0.50 X 171737 0 7702 JONATHAN GOLM DIRECTOR OF PROJECT DEVELOPMENT 40.00 0.00 X 169675 0 6192 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 39.50 0.50 X 158086 0 5989 ALBERT D KAUL VP HUMAN RESOURCES, CPO 39.39 0.61 X 142822 0 11690 SEAN DE FOUR SR. VP AND COO 28.01 11.98 X 148484 0 5907 ERIC R MUSUM VP, CAA AND CTO 39.29 0.71 X 139522 0 11214 JILL HAISER VP OF MISSION ADVANCEMENT 12.50 27.50 X 126614 0 10531 VICTORIA PARRISH EXECUTIVE DIRECTOR 40.00 0.00 X 126272 0 8820 RENEE DILLON DIRECTOR OF CLINICAL OVERSIGHT 40.00 0.00 X 119068 0 4694 MICHAEL STEPHENSON NURSING HOME ADMINISTRATOR 40.00 0.00 X 100181 0 9534 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 1667602 0 97229 12 0 1 0 UNIDINE PO BOX 102289 ATLANTA GA 30368 CATERING SERVICE 3665264 SELECT REHABILITATION PO BOX 71985 CHICAGO IL 60694 THERAPY 1422821 OMNICARE INC PO BOX 78000 DETROIT MI 48278 LONG TERM CARE PHARMACY 384798 DHHS CASHIERING PO BOX 30802 LANSING MI 48933 CASHIERING 287239 POINTCLICKCARE TECHNOLOGIES INC PO BOX 674802 DETROIT MI 48267 ELECTRONIC HEALTH RECORDS 279811 14 253077 3406 253077 SKILLED NURSING & HOME CARE 623000 31386123 31386123 OTHER RESIDENT INCOME 623000 1418380 248699 1169681 FURNISHED SERVICES 623000 533511 533511 33338014 379169 379169 9840 0 9840 9840 9840 5422676 4895420 29473 527256 -29473 497783 497783 CONSULTING INCOME 900099 1414797 1414797 MANAGEMENT FEES 900099 1224832 1224832 MISCELLANEOUS INCOME 900099 28296 28296 442199 442199 3110124 37588007 32168333 1169681 3996916 X 1083251 882192 189254 11805 15618479 12784369 2662523 171587 243757 173125 65158 5474 1459759 1068106 378219 13434 1226997 1022384 191471 13142 150211 150211 1928 1928 7127466 6534292 593174 225570 225448 122 286095 58867 220623 6605 231647 60853 170662 132 1580034 1325752 252239 2043 127642 57280 67173 3189 94204 50507 42698 999 1559308 1559308 1851752 1481402 370350 580170 580170 MMQAA PROVIDER TAX 1822725 1822725 DRUGS AND MEDICAL SUPPL 1025581 1025140 266 175 OTHER EXPENSE 586485 113813 472627 45 BAD DEBT EXPENSE 250119 250119 236941 97482 139459 37370121 30593164 6548205 228752 16813516 16301605 3117888 2895500 7971903 8475713 87236 77978 737016 654340 50847497 29929434 20873912 20918063 770768 754718 2927795 2548123 53300034 52626040 3128553 1905576 4505118 4394803 26908880 25994637 54827 1118937 34597378 33413953 X 15773928 15851491 2928728 3360596 18702656 19212087 53300034 52626040 X 217886 765192 -473647 X 0 1 X 1 0 X 0 0 248002 180052 253077 681131 43566334 43596169 43528728 41454569 33338014 205483814 43566334 43596169 43776730 41634621 33591091 206164945 248002 166665 249671 664338 0 248002 166665 249671 664338 205500607 74242 100121 232453 212875 379169 998860 74242 100121 232453 212875 379169 998860 3284 0 0 0 327305 330589 1665276 2536077 2678765 2725559 3110124 12715801 45309136 46232367 46687948 44573055 37407689 220210195 0.93320 0.94130 0.00450 0.00310 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CONSULTING AND OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1928 1928 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 1828 69011 66888 3951 0 1200443 1200443 41171147 25077750 16093397 67928 56763 11165 2450566 1379481 1071085 5957413 3415440 2541973 20918063 RESIDENT SECURITY DEPOSITS 106500 INTEREST RATE SWAP 694696 ACCRUED OTHER LIABILITIES 317741 1118937 PART IV, LINE 1B: LUTHERAN HOMES OF MICHIGAN, INC. IS REQUIRED TO MAINTAIN RESIDENT TRUST FUNDS AT ITS NURSING HOMES. X X 1 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 265141 0 0 0 0 0 7750 0 7206 0 280097 0 0 0 AMY STORMS SR. VP FINANCE/CFO - THRU 7/15/19 171737 0 0 0 0 0 3593 0 4109 0 179439 0 0 0 JONATHAN GOLM DIRECTOR OF PROJECT DEVELOPMENT 169675 0 0 0 0 0 5064 0 1128 0 175867 0 0 0 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 158086 0 0 0 0 0 4714 0 1275 0 164075 0 0 0 ALBERT D KAUL VP HUMAN RESOURCES, CPO 142822 0 0 0 0 0 4750 0 6940 0 154512 0 0 0 SEAN DE FOUR SR. VP AND COO 148484 0 0 0 0 0 0 0 5907 0 154391 0 0 0 ERIC R MUSUM VP, CAA AND CTO 139522 0 0 0 0 0 4408 0 6806 0 150736 0 0 0 PART I, LINE 4A AMY STORMS RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $52,856. A MICHIGAN STRATEGIC FUND LIMITED OBLIGATION REVENUE BONDS (WELLSPRING LUTHER 521417332 2015-10-29 13524231 SEE BELOW 0 0 0 A 3237208 13524231 123618 13400613 1 0 1 1 A 0 0 0 0 1 1 0.23940 0 0 A 0 1 0 0 1 1 HUNTINGTON NATIONAL BANK 10.000000000000 0 0 0 0 1 A 0 SCHEDULE K, PART I, BOND ISSUES (F) DESCRIPTION OF PURPOSE: PROCEEDS OF THE BONDS WERE USED TO FINANCE HEALTHCARE FACILITIES AND $7,196,494 PROCEEDS WERE USED TO REFINANCE BANK LOAN WHICH HAD REFUNDED BONDS ISSUED TO FINANCE HEALTHCARE AND HOUSING FACILITIES. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990 RETURN, ELECTRONIC COPIES 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 B, LINE 15A THE EXECUTIVE COMMITTEE OF THE BOARD, UNDER THE BOARD CHAIR'S LEADERSHIP, IS RESPONSIBLE FOR ANNUAL PERFORMANCE REVIEW AND COMPENSATION ADJUSTMENT OF THE CEO, WHEN APPROPRIATE. OUTSIDE SOURCES OR COMPARATIVE REVIEW ARE TAKEN INTO CONSIDERATION WHEN SETTING TOTAL COMPENSATION. A COMPREHENSIVE PERFORMANCE EVALUATION WAS COMPLETED IN 2019; COMPENSATION WAS NOT ADJUSTED AT THAT TIME. 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 CONTRACTED THERAPY SERVICES: PROGRAM SERVICE EXPENSES 1,621,881. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,621,881. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,608,644. MANAGEMENT AND GENERAL EXPENSES 410,399. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,019,043. OTHER: PROGRAM SERVICE EXPENSES 303,767. MANAGEMENT AND GENERAL EXPENSES 182,775. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 486,542. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP -905,515. CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 431,868. LHM ASSET MANAGEMENT LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 200055004 ASSET MANAGEMENT MI 23847 95672 LUTHERAN HOMES OF MICHIGAN INC AGING ENRICHED SERVICES LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 472636131 FOLLOW-UP COMMUNICATION SERVICES MI 328305 589268 LUTHERAN HOMES OF MICHIGAN INC THE SPRINGS OF FRANKENMUTH LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 842433251 INDEPENDENT LIVING COMMUNITY MI -53310 1096110 LUTHERAN HOMES OF MICHIGAN INC LUTHERAN HOME CARE AGENCY INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 383081979 HOME CARE MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOMES OF MICHIGAN FOUNDATION 4100 PIER NORTH BLVD STE A FLINT MI 48504 261630687 DONATE FUNDS MI 501(C)(3) LINE 12A, I 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 LUTHERAN HOMES OF MICHIGAN INC RELATED -11875 161725 0 1 0.50000 GIBRALTER LDHALP 26200 LAHSER RD STE 300 SOUTHFIELD MI 48034 301829767 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI GIBRALTAR MANOR DEVELOPMENT INC RELATED -5 184 0 0 MONROE ELDERLY LDHALP 5309 TRANSPORTATION BLVD CLEVELAND OH 44125 383609893 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI LHM HOUSING SERVICES INC RELATED -5 125 0 0 ALPENA PINES LDHALP 9710 JUNCTION ROAD FRANKENMUTH MI 48434 260236982 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI ALPENA PINES DEVELOPMENT INC RELATED -6 161 0 0 LHM HOUSING SERVICES INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 383609879 HOUSING SERVICES MI LUTHERAN HOMES OF MICHIGAN INC C -5 137 0.79000 1 GIBRALTAR MANOR DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 202240778 HOUSING SERVICES MI N/A C -5 184 0.50000 0 ALPENA PINES DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 260237019 HOUSING SERVICES MI N/A C -6 161 0.50000 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY Q 239039 ACTUAL AMOUNT LUTHERAN HOME CARE AGENCY M 373222 ACTUAL AMOUNT LUTHERAN HOME CARE PERSONAL ASSISTANCE Q 115542 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION C 253077 ACTUAL AMOUNT PROJECT COMPASSION HEALTH Q 427725 ACTUAL AMOUNT LUTHERAN HOME CARE AGENCY Q 198245 ACTUAL AMOUNT