2018-11-15T15:10:39-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 27400 NORTHWESTERN HIGHWAY SOUTHFIELD MI 48034 990 2017-01-01 381358410 LUTHERAN HOMES OF MICHIGAN INC LUTH 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 AMY E STORMS CFO 9896523470 2018-11-14 1 TINA PETERS P00904574 2483522500 2018-11-14 67.59.56.31 2018-11-14 13:58:46 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 852ED58CBC9AA6807749D456DA873D43AD1BF2F7 2017 2019-02-21 02:37:17Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 46717183 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. 8 8 946 161 -13121 -13121 0 248002 43596169 43528728 77394 154439 2520316 2665644 46193879 46596813 0 0 0 0 24960553 24579173 0 0 309614 21245779 21965533 46206332 46544706 -12453 52107 50603639 53964289 36692820 38871778 13910819 15092511 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 37812593 43528728 SKILLED NURSING CARE UNIT AND HOME FOR THE AGED UNIT PROVIDED 104,204 DAYS OF CARE AND 18,225 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS OF THREE NURSING HOMES 37812593 1 1 0 1 0 0 0 0 1 0 1 0 0 1 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 1 114 0 1 946 1 1 1 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 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 REV DON NEUENDORF DIRECTOR - THRU 5/23/17 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 DAVID M GEHM PRESIDENT & CEO 38.54 1.46 X 269261 0 14151 ALBERT D KAUL VP HUMAN RESOURCES, CPO 39.39 0.61 X 132304 0 11024 MAUREEN MCGEE VP OF HEALTH SERVICES 33.20 6.80 X 131708 0 9623 AMY STORMS SR. VP FINANCE AND CFO 39.50 0.50 X 166163 0 12233 ERIC R MUSUM VP, CAA AND CTO 39.29 0.71 X 115973 0 10256 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES 28.01 11.98 X 174080 0 6793 JILL M HAISER EXECUTIVE DIRECTOR 12.50 27.50 X 113486 0 9763 JONATHAN GOLM DIRECTOR OF PROJECT DEVELO 40.00 0.00 X 131328 0 4931 TODD E SEIBT SPECIAL PROJECTS DIRECTOR 40.00 0.00 X 124574 0 10028 VICTORIA L PARRISH EXECUTIVE DIRECTOR 40.00 0.00 X 122834 0 4593 TIMOTHY KALBFLEISCH FINANCE COMPLIANCE DIRECTOR 40.00 0.00 X 122544 0 1779 1604255 0 95174 11 0 1 0 SELECT REHABILITATION 550 FRONTAGE RD STE 2415 NORTHFIELD IL 60093 THERAPY 3007893 UNIDINE 1000 WASHINGTON STREET STE 510 BOSTON MA 02118 DINING MANAGEMENT SERVICES 3000777 TSSF ARCHITECTS INC 122 N WASHINGTON AVE SAGINAW MI 48607 ARCHITECT DESIGN 413413 YORK RISK SERVICES GROUP ONE UPPER POND RD BLDG F 4TH FLOOR PARSIPPANY NJ 07054 CLAIMS & RISK MANAGEMENT SERVICES 411015 KAWKAWLIN ROOFING COMPANY 2924 OLD KAWKAWLIN ROAD KAWKAWLIN MI 48631 CONSTRUCTION 392515 11 248002 248002 SKILLED NURSING & HOME CARE 623000 42027919 42027919 FURNISHED SERVICES 623000 768731 768731 OTHER RESIDENT INCOME 623000 732078 732078 43528728 232453 232453 13235 26356 -13121 -13121 -13121 16000 94014 -78014 -78014 -78014 MANAGEMENT FEES 900099 1521895 1521895 CONSULTING INCOME 900099 557350 557350 MISCELLANEOUS INCOME 909900 123093 123093 476427 476427 2678765 46596813 43528728 -13121 2833204 X 1176819 920537 242353 13929 19787108 15608640 3941697 236771 281971 187531 87253 7187 1818218 1242911 557311 17996 1515057 1223137 274567 17353 62571 62571 2799 2799 9521688 8734067 787621 91518 90371 722 425 335021 111929 219765 3327 263416 55341 208005 70 1937332 1649268 288064 148515 54825 83474 10216 79492 41714 36328 1450 1597839 1597839 2021386 1617109 404277 697464 697464 MMQAA PROVIDER TAX 2174435 2174435 DRUGS AND MEDICAL SUPPL 1767867 1766896 396 575 BAD DEBT EXPENSE 464601 464601 OTHER EXPENSE 459195 102827 356368 340394 168615 171464 315 46544706 37812593 8422499 309614 11729973 12672215 3995908 4403689 6797731 6727834 134745 150347 590334 825285 59504416 34355322 23645394 25149094 933069 915613 2776485 3120212 50603639 53964289 3669453 3613958 12775286 7642666 19975241 27626313 272840 -11159 36692820 38871778 X 11165504 11972986 2348703 2677259 396612 442266 13910819 15092511 50603639 53964289 X 52107 644590 484995 X X 0 1 X 1 0 X 162512 154862 0 0 248002 565376 31335747 34208084 43566334 43596169 43528728 196235062 30842 0 0 0 0 30842 31529101 34362946 43566334 43596169 43776730 196831280 161762 154862 248002 564626 0 161762 154862 248002 564626 196266654 52950 61834 74242 100121 232453 521600 52950 61834 74242 100121 232453 521600 787 -9695 3284 -15761 -13120 -34505 3154910 2058108 1665276 2536077 2678765 12093136 34737748 36473193 45309136 46216606 46674828 209411511 0.93720 0.93620 0.00250 0.00170 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CONSULTING AND OTHER INCOME 0 0 0 0 0 0 0 0 1 2799 2799 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 2429 39566 40065 1930 0 2430284 2430284 47327244 27570658 19756586 56708 40171 16537 3116741 1966002 1150739 6573439 4778491 1794948 25149094 DEPOSITS 227093 BENEFICIAL INTEREST IN WELLSPRING FOUNDATION 2893119 3120212 RESIDENT SECURITY DEPOSITS 154650 INTEREST RATE SWAP -165809 -11159 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 269261 0 0 0 0 0 7285 0 6866 0 283412 0 0 0 AMY STORMS SR. VP FINANCE AND CFO 166163 0 0 0 0 0 5468 0 6765 0 178396 0 0 0 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES 174080 0 0 0 0 0 0 0 6793 0 180873 0 0 0 PART I, LINE 4A TODD SEIBT IN THE AMOUNT OF $13,305 A MICHIGAN STRATEGIC FUND LIMITED OBLIGATION REVENUE BONDS (WELLSPRING LUTHER 521417332 2015-10-29 13524231 SEE BELOW 0 0 0 A 13524231 270484 12661828 591919 1 0 1 1 A 0 0 0 0 1 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. THE LAST ANNUAL PERFORMANCE REVIEW OCCURRED IN 2015 AND THE LAST IN-DEPTH COMPENSATION REVIEW OCCURRED IN 2017. 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 3,095,642. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,095,642. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 5,264,755. MANAGEMENT AND GENERAL EXPENSES 632,920. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,897,675. OTHER: PROGRAM SERVICE EXPENSES 373,670. MANAGEMENT AND GENERAL EXPENSES 154,701. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 528,371. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF INTEREST RATE SWAP 231,251. IMPAIRMENT LOSS -120,466. CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 374,210. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE AUDIT OVERSIGHT PROCEDURES FROM THE PREVIOUS YEAR. LHM ASSET MANAGEMENT LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 200055004 ASSET MANAGEMENT MI 51876 175103 LUTHERAN HOMES OF MICHIGAN INC AGING ENRICHED SERVICES LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 FOLLOW-UP COMMUNICATION SERVICES MI 20206 472516 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 -13975 177977 0 1 0.50000 GIBRALTAR LDHALP 26200 LAHSER RD STE 300 SOUTHFIELD MI 48034 301829767 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI GIBRALTAR MANOR DEVELOPMENT INC RELATED -6 200 0 0 MONROE ELDERLY LDHALP 5309 TRANSPORTATION BLVD CLEVELAND OH 44125 383609893 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI LHM HOUSING SERVICES INC RELATED -3 142 0 0 ALPENA PINES LDHALP 9710 JUNCTION ROAD FRANKENMUTH MI 48434 260236982 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI ALPENA PINES DEVELOPMENT INC RELATED -5 175 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 -4 148 0.79000 1 GIBRALTAR MANOR DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 202240778 HOUSING SERVICES MI N/A C -6 200 0.50000 0 ALPENA PINES DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 260237019 HOUSING SERVICES MI N/A C -5 175 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 158601 ACTUAL AMOUNT LUTHERAN HOME CARE AGENCY M 95761 ACTUAL AMOUNT LUTHERAN HOME CARE PERSONAL ASSISTANCE Q 137370 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION C 248002 ACTUAL AMOUNT PROJECT COMPASSION HEALTH Q 639835 ACTUAL AMOUNT LUTHERAN HOME CARE AGENCY Q 278032 ACTUAL AMOUNT