2019-11-04T07:46:22-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 27400 NORTHWESTERN HIGHWAY SOUTHFIELD MI 48034 990 2018-01-01 382236926 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC AUSA 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 17:09:31 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 3714939 0 X WWW.WELLSPRINGLUTHERAN.COM X 1980 MI MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 8 8 94 20 0 0 16030 328 3475490 3703852 416 -666 23312 10759 3515248 3714273 0 0 0 0 2245089 2310289 0 0 0 1506152 1640218 3751241 3950507 -235993 -236234 2037986 2463554 5209356 5850846 -3171370 -3387292 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 3177842 3714611 SKILLED NURSING CARE AND INDEPENDENT LIVING OPTIONS PROVIDED 12,905 DAYS OF CARE AND 1,462 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS. 3177842 1 0 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 10 0 1 94 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 KEITH STONE DIRECTOR 0.20 0.80 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 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 0.00 40.00 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 1.33 38.67 X 0 96189 3431 0 788930 52955 0 0 1 0 SELECT REHABILITATION 2600 COMPASS RD GLENVIEW IL 60026 THERAPY SERVICES 342446 GORDON FOOD SERVICE INC 1300 GEZON PARKWAY SW WYOMING MI 49509 FOOD SERVICE 126074 2 328 328 ROOM/CARE/SKILLED NURS 623990 3699844 3699844 OTHER RESIDENT REIMB 623990 4008 4008 3703852 666 -666 -666 -666 REBATE INCOME 900099 9100 9100 MISCELLANEOUS INCOME 900099 1294 1294 MEALS - GUEST 900099 365 365 10759 3714273 3714611 0 -666 X 1918716 1737532 181184 21459 16823 4636 227766 148339 79427 142348 128854 13494 309145 309145 1693 1693 265 265 479407 469092 10315 4583 4053 530 23236 709 22527 17274 520 16754 187479 165283 22196 4196 2428 1768 10244 8947 1297 53506 53506 92531 74025 18506 50647 50647 DRUGS/MEDICAL SUPPLIES 173720 173649 71 FOOD 106222 106222 MISCELLANEOUS EXPENSE 88437 50227 38210 MMQAA PROVIDER TAX 22504 22504 15129 15129 3950507 3177842 772665 0 247444 628737 282899 362554 4053 4669 21210 16624 2314771 897931 1437249 1416840 45131 34130 2037986 2463554 259663 266652 4949693 5584194 5209356 5850846 X -3201929 -3418998 30559 31706 -3171370 -3387292 2037986 2463554 X -236234 20312 X 0 1 X 1 0 X 5795 0 3069 16030 328 25222 4495177 4736077 4492977 3475490 3703852 20903573 1844 9383 600 313 365 12505 4502816 4745460 4496646 3491833 3704545 20941300 0 92868 23311 6723 24191 16145 163238 92868 23311 6723 24191 16145 163238 20778062 2 1 0 1 0 4 2 1 1 4 32885 45872 33345 22999 10394 145495 4535703 4791333 4529991 3514833 3714939 21086799 0.98540 0.97820 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 0 0 0 0 0 0 0 0 1 265 265 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 3316 127371 123559 7128 0 180000 180000 1495369 430531 1064838 639402 467400 172002 1416840 DUE TO AFFILIATES 5484058 ACCRUED OTHER LIABILITIES 103737 RESIDENT SECURITY DEPOSITS 13050 INTEREST RATE SWAP MARK TO MARKET -16651 5584194 PART IV, LINE 1B: AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY, INC. 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: PROGRAM SERVICE EXPENSES 350,298. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350,298. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 63,070. MANAGEMENT AND GENERAL EXPENSES 10,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,385. OTHER: PROGRAM SERVICE EXPENSES 55,724. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,724. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 19,165. CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 1,147. 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 LUTHERAN HOME CARE AGENCY INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 383081979 SENIOR SERVICES 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 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 0 0 0 0 1 1 0 1 0 0 1 LUTHERAN HOMES OF MICHIGAN INC P 309145 ACTUAL AMOUNT