2019-11-04T07:47:29-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 27400 NORTHWESTERN HIGHWAY SOUTHFIELD MI 48034 990 2018-01-01 382395647 PROJECT COMPASSION HEALTH PROJ 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 17:07:28 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 7603278 0 X WWW.WELLSPRINGLUTHERAN.COM X 1982 MI MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 8 8 160 3 0 0 11685 6220 7423516 7547223 18 17 43361 49818 7478580 7603278 0 0 0 0 3699547 3446667 0 0 0 4100358 4422562 7799905 7869229 -321325 -265951 6580220 6783096 5510452 5903060 1069768 880036 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 6652367 7547223 SKILLED NURSING CARE PROVIDED 23,237 DAYS OF CARE AND 3,540 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS. 6652367 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 18 0 1 160 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 SUITE 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 0.79 39.21 X 0 262168 14566 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.39 39.61 X 0 136316 11469 AMY STORMS SR. VP FINANCE AND CFO 0.00 40.00 X 0 173313 12789 ERIC R MUSUM VP, CAA AND CTO 0.63 39.37 X 0 120944 10700 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES - THRU 6/1/18 8.99 31.01 X 0 96189 3431 0 788930 52955 0 0 1 0 SELECT REHABILITATION 2600 COMPASS RD GLENVIEW IL 60026 THERAPY SERVICES 548124 UNIDINE CORPORATION 1000 WASHINGTON ST 510 BOSTON MA 02118 CATERING SERVICE 538567 OMNICARE INC 2455 PEPPERIDGE TRAIL BRIGHTON MI 48114 LONG TERM CARE PHARMACY 144101 MEDICAL STAFFING NETWORK PO BOX 840292 DALLAS TX 75284 STAFFING SERVICES 118051 4 6220 6220 ROOM/CARE/SKILLED NURS 623000 7546973 7546973 OTHER RESIDENT REIMBUR 623000 250 250 7547223 17 17 MISCELLANEOUS INCOME 900099 34408 34408 DISCOUNTS EARNED 900099 15410 15410 49818 7603278 7547223 0 49835 X 3010407 2776488 233919 21729 16738 4991 190994 160270 30724 223537 205986 17551 583977 583977 20608 20608 435 435 1930646 1881999 48647 2308 2308 30735 2952 27783 26802 1190 25612 276539 243167 33372 2529 1335 1194 8264 7207 1057 122872 122872 251738 201390 50348 76951 76951 MMQAA PROVIDER TAX 463175 463175 DRUGS/MEDICAL SUPPLIES 424062 424062 BAD DEBT EXPENSE 92621 92621 OTHER EXPENSE 55178 10279 44899 53122 38328 14794 7869229 6652367 1216862 0 858912 1087685 753206 871797 145091 134829 5164149 628906 4742673 4535243 80338 153542 6580220 6783096 446106 531846 5064346 5371214 5510452 5903060 X 989430 767408 80338 112628 1069768 880036 6580220 6783096 X -265951 76219 X 0 1 X 1 0 X 0 0 0 11685 6220 17905 8080096 8409043 7425498 7423516 7547223 38885376 8080096 8409043 7425498 7435201 7553443 38903281 1685 6220 7905 0 1685 6220 7905 38895376 96 2003 11 18 17 2145 96 2003 11 18 17 2145 15069 43361 49818 108248 8080192 8411046 7440578 7478580 7603278 39013674 0.99700 0.99840 0.00010 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 435 435 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 1010 12516 11410 2116 0 536231 536231 4313763 457347 3856416 301387 168336 133051 12768 3223 9545 4535243 DUE TO AFFILIATES 5371214 5371214 PART IV, LINE 1B: PROJECT COMPASSION HEALTH IS REQUIRED TO MAINTAIN RESIDENT TRUST FUNDS AT ITS NURSING HOME. 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 CONTRACTED THERAPY SERVICES: PROGRAM SERVICE EXPENSES 560,559. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 560,559. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,159,694. MANAGEMENT AND GENERAL EXPENSES 48,647. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,208,341. LAB TESTS: PROGRAM SERVICE EXPENSES 27,338. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,338. OTHER: PROGRAM SERVICE EXPENSES 134,408. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,408. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 32,290. CHANGE IN VALUE OF INTEREST RATE SWAP 43,929. FORM 990, PAGE 1 SECTION C: PROJECT COMPASSION HEALTH IS ALSO D/B/A LIVONIA WOODS NURSING AND REHABILITATION. 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 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 ALPENA VILLAGE 4100 PIER NORTH BLVD STE A FLINT MI 48504 320090735 RESIDENTIAL CONTINUING CARE RETIREMENT FACILITY MI N/A GILBRALTAR LDHALP 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 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 0 LUTHERAN HOMES OF MICHIGAN INC P 583977 ACTUAL AMOUNT