2019-11-04T07:43:11-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2018-01-01 383081979 LUTHERAN HOME CARE AGENCY INC LUTH 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 TIMOTHY KALBFLEISCH SVP AND CFO 9896523470 2019-10-30 1 TINA PETERS P00904574 2483522500 2019-10-30 67.59.56.30 2019-10-30 16:53:35 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 737380BCD7AD51223FD12A91753DF01CE9F34789 2018 2020-03-31 21:24:44Z WELLSPRING LUTHERAN SERVICES TIMOTHY KALBFLEISCH 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 3029438 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. 8 8 43 36 0 0 120759 92274 3028531 2934318 1714 2230 742 616 3151746 3029438 0 0 0 0 1630587 1517182 0 0 0 1619448 1610970 3250035 3128152 -98289 -98714 1048394 1071939 1406236 1520670 -357842 -448731 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 1984281 2934578 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 17,139 VISITS WHICH INCLUDED SERVICES SUCH AS NURSING CARE; SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPIES; MEDICAL, SOCIAL, AND PERSONAL SERVICES; AND HOSPICE SERVICES TO 771 INDIVIDUALS. 1984281 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 43 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X ERIC MUSUM 9896523470 4100 PIER NORTH BLVD STE A FLINT MI 48504 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 0.20 0.80 X 0 0 0 KAREN STORCK DIRECTOR 0.20 0.80 X 0 0 0 DAVID M GEHM PRESIDENT & CEO 0.00 40.00 X 0 262168 14566 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.22 39.78 X 0 136316 11469 AMY STORMS SR. VP FINANCE AND CFO 0.08 39.92 X 0 173313 12789 ERIC R MUSUM VP, CAA AND CTO 0.00 40.00 X 0 120944 10700 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES - THRU 6/1/18 1.08 38.92 X 0 96189 3431 0 788930 52955 0 0 1 0 SELECT REHABILITATION 2600 COMPASS RD GLENVIEW IL 60026 OCCUPATIONAL/PHYSICAL/SPEECH THERAPY 445917 LUTHERAN HOMES OF MICHIGAN 4100 PIER NORTH BLVD SUITE A FLINT MI 48504 HOSPICE CARE 177532 LUTHERAN HOME CARE PERSONAL ASSISTANCE 4100 PIER NORTH BLVD SUITE A FLINT MI 48504 RENT 120000 3 92274 92274 HOME CARE SERVICES 621610 2934318 2934318 2934318 2230 2230 MISCELLANEOUS 990009 356 356 FURNISHED SERVICES 990009 260 260 616 3029438 2934578 0 2586 X 1300624 881037 419587 21430 10628 10802 99852 56955 42897 95276 64127 31149 317642 317642 1079 1079 102 102 519408 510322 9086 3790 2690 1100 36052 455 35597 90145 90145 140986 144 140842 73034 69149 3885 5840 2924 2916 4693 3754 939 24311 24311 DRUGS AND SUPPLIES 298800 298800 RENTAL EQUIPMENT 56469 56162 307 LICENSES AND FEES 11989 1241 10748 FOUNDATION EXPENSES 9550 9550 17080 16343 737 3128152 1984281 1143871 0 521924 438722 287722 304191 6956 22022 556243 488352 504 67891 231288 239113 1048394 1071939 134383 86884 1271853 1433786 1406236 1520670 X -589130 -687844 231288 239113 -357842 -448731 1048394 1071939 X -98714 7825 X 0 1 X 1 0 X 21858 0 0 120759 92274 234891 4031886 3551829 3403313 3028531 2934318 16949877 3889 9000 9854 491 260 23494 4057633 3560829 3413167 3149781 3026852 17208262 21858 120759 92274 234891 0 21858 120759 92274 234891 16973371 1273 1193 1520 1714 2230 7930 1273 1193 1520 1714 2230 7930 758 4487 2287 251 356 8139 4059664 3566509 3416974 3151746 3029438 17224331 0.98540 0.98880 0.00050 0.00040 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 1 102 102 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 556243 488352 67891 67891 ASSETS LIMITED AS-TO-USE 239113 239113 DUE TO AFFILIATES 1433786 1433786 0 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 0 262168 0 0 0 0 0 7438 0 7128 0 276734 0 0 AMY STORMS SR. VP FINANCE AND CFO 0 173313 0 0 0 0 0 5722 0 7067 0 186102 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. 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 410,645. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 410,645. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 34,193. MANAGEMENT AND GENERAL EXPENSES 9,086. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,279. OTHER: PROGRAM SERVICE EXPENSES 65,484. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,484. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 7,825. 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 GIBRALTAR 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 0 0 0 1 0 0 0 LUTHERAN HOME CARE PERSONAL ASSISTANCE K 120000 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN P 317641 ACTUAL COST LUTHERAN HOMES OF MICHIGAN L 215287 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION C 92274 ACTUAL AMOUNT