2017-11-15T07:16:18-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 27400 Northwestern Highway Southfield MI 48034 990 2016-01-01 382395647 PROJECT COMPASSION HEALTH PROJ 9896523470 4100 PIER NORTH BLVD No STE A FLINT MI 48504 AMY E STORMS CFO 9896523470 2017-11-13 1 TINA PETERS P00904574 2483522500 2017-11-09 67.59.56.32 2017-11-13 12:53:00 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 852ED58CBC9AA6807749D456DA873D43AD1BF2F7 2016 2021-01-29 14:40:06Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD No STE A FLINT MI 48504 7440578 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 7 0 0 0 0 8409043 7425498 2003 11 0 15069 8411046 7440578 0 0 0 0 3652507 3912143 0 0 0 4253936 4297708 7906443 8209851 504603 -769273 5109896 7264446 4162023 5879753 947873 1384693 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 6534255 7425498 SKILLED NURSING CARE PROVIDED 21,313 DAYS OF CARE AND 6,826 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS. 6534255 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 26 0 1 160 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 0 0 0 0 MI X ERIC MUSUM 9896523470 4100 PIER NORTH BLVD SUITE A FLINT MI 48504 RITCH CUSHWAY CHAIR 0.20 0.80 X X 0 0 0 ANTHONY D GOLDEN VICE CHAIR THRU 12/31/16 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 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 AS OF 4/4/16 0.20 0.80 X 0 0 0 DAVID M GEHM PRESIDENT & CEO 0.00 40.00 X 0 272054 13637 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.00 40.00 X 0 133429 10446 MAUREEN MCGEE VP of Health Services 0.00 40.00 X 0 136454 9810 AMY STORMS Sr. VP Finance and CFO 0.00 40.00 X 0 168361 11608 ERIC R MUSUM VP, CAA and CTO 0.00 40.00 X 0 119208 9815 MICHAEL LOGAN Sr. VP/COO Senior Services 0.00 40.00 X 0 173963 6294 0 1003469 61610 0 0 1 0 ENCORE REHABILITATION SERVICES 30230 ORCHARD LAKE ROAD FARMINGTON HILLS MI 48334 THERAPY SERVICES 581604 HEALTH CARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 DIETARY/HOUSEKEEPING SERVICES 340868 SELECT REHABILITATION 2600 COMPASS RD GLENVIEW IL 60026 THERAPY SERVICES 262403 OMNICARE INC 2455 PEPPERIDGE TRAIL BRIGHTON MI 48114 LONG TERM CARE PHARMACY 217671 4 ROOM/CARE/SKILLED NURS 623000 7423843 7423843 OTHER RESIDENT REIMBUR 623000 1655 1655 7425498 11 11 MISCELLANEOUS INCOME 900099 8476 8476 DISCOUNTS EARNED 900099 6593 6593 15069 7440578 7425498 0 15080 X 3324631 2958294 366337 32550 23903 8647 255433 203492 51941 299529 265666 33863 782100 782100 81615 81615 511 511 1581458 1528729 52729 4726 4424 302 36519 3060 33459 49318 515 48803 278921 245812 33109 2993 1177 1816 6819 5287 1532 148766 148766 122166 97733 24433 122519 122519 DRUGS/MEDICAL SUPPLIES 501557 501557 MMQAA PROVIDER TAX 274028 274028 BAD DEBT EXPENSE 198619 198619 EQUIPMENT AND RENTAL 70999 54563 16436 34074 18630 15444 8209851 6534255 1675596 0 555576 845812 875880 1291983 23938 0 14195 87782 5079514 122166 3617959 4957348 22348 0 0 81521 5109896 7264446 205939 558719 3956084 5321034 4162023 5879753 X 947873 1303172 81521 947873 1384693 5109896 7264446 X -769273 1206093 X X 0 1 X 1 0 X 7254921 8477899 8080096 8409043 7425498 39647457 7254921 8477899 8080096 8409043 7425498 39647457 0 0 0 39647457 262 96 2003 11 2372 262 96 2003 11 2372 15069 15069 7255183 8477899 8080192 8411046 7440578 39664898 0.99960 0.99990 0.00010 0.00010 X Schedule A, Part III, Line 12, Explanation of Other Income: MISCELLANEOUS INCOME 0 0 0 0 0 0 0 0 1 511 511 0 Part II-B, Line 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 2337 331 2006 0 536231 536231 4289212 91388 4197824 250172 30388 219784 3899 390 3509 4957348 DUE TO AFFILIATES 5297184 INTEREST RATE SWAP MARK TO MARKET 23850 5321034 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 270554 0 1500 0 0 0 0 0 13637 0 285691 0 0 AMY STORMS Sr. VP Finance and CFO 0 166861 0 1500 0 0 0 0 0 11608 0 179969 0 0 MICHAEL LOGAN Sr. VP/COO Senior Services 0 173963 0 0 0 0 0 0 0 6294 0 180257 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 4 ON JANUARY 1, 2016, PROJECT COMPASSION HEALTH WAS ACQUIRED BY LUTHERAN HOMES OF MICHIGAN, INC. THROUGH A MEMBER SUBSTITUTION WHEREBY LUTHERAN HOMES OF MICHIGAN ACQUIRED PROJECT COMPASSION HEALTH IN RETURN FOR ASSUMING CERTAIN LIABILITIES. AS A RESULT OF THE ACQUISITION, THE ARTICLES OF INCORPORATION WERE AMENDED FOR PROJECT COMPASSION HEALTH. THE SIGNIFICANT CHANGES ARE AS FOLLOWS: ARTICLE 3.1 - THE ORGANIZATION IS ORGANIZED ON A NONSTOCK, MEMBERSHIP BASIS. ARTICLE 5.2 - THE SOLE MEMBER OF THE CORPORATION SHALL BE THE LUTHERAN HOMES OF MICHIGAN, INC., WHICH SHALL HAVE THE POWERS PROVIDED BY LAW, THE BYLAWS OR THESE RESTATED ARTICLES OF INCORPORATION, INCLUDING, BUT NOT LIMITED TO, THE EXCLUSIVE POWER TO: 5.2.1 - APPOINT OR REPLACE AND TO REMOVE, WITH OR WITHOUT CAUSE, OFFICERS OR DIRECTORS OF THE CORPORATION; 5.2.2 - APPOINT DIRECTORS TO FILL VACANCIES ON THE BOARD OF DIRECTORS; 5.2.3 - AMEND OR REPEAL THE BYLAWS AND ADOPT NEW BYLAWS; 5.2.4 - AMEND THE ARTICLES OF INCORPORATION AND ADOPT NEW ARTICLES; 5.2.5 - VOTE ON ALL MATTERS ON WHICH THE VOTE OF THE SOLE MEMBER WITH VOTING RIGHTS IS REQUIRED UNDER LAW, THE BYLAWS OR THESE ARTICLES OF INCORPORATION. ARTICLE VII - THE ARTICLES OF INCORPORATION AND THE BYLAWS MAY BE AMENDED AS FOLLOWS: (A) BY THE AFFIRMATIVE VOTE OF THE SOLE MEMBER OF THE CORPORATION, AT A MEETING OF THE MEMBER CALLED FOR THAT PURPOSE; OR (B) BY THE WRITTEN CONSENT OF THE SOLE MEMBER AS PROVIDED IN SECTION 5.1. 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 828,534. Management and general expenses 0. Fundraising expenses 0. Total expenses 828,534. OTHER CONTRACTED SERVICES: Program service expenses 538,411. Management and general expenses 35,729. Fundraising expenses 0. Total expenses 574,140. LAB TESTS: Program service expenses 38,201. Management and general expenses 0. Fundraising expenses 0. Total expenses 38,201. OTHER: Program service expenses 123,583. Management and general expenses 17,000. Fundraising expenses 0. Total expenses 140,583. Form 990, Part XI, line 9: REMOVAL OF BEGINNING NET ASSETS DUE TO BUSINESS COMBINATION -947,873. GAIN FROM NET ASSETS ACQUIRED AT FAIR VALUE AS PART OF BUSINESS COMBINATION 2,111,681. CHANGE IN VALUE OF INTEREST RATE SWAP -39,236. TEMPORARILY RESTRICTED CHAPEL FUND ASSETS 81,521. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE AUDIT OVERSIGHT PROCEDURES FROM THE PREVIOUS YEAR. FORM 990, PART VI, SECTION B, LINE 14: A WRITTEN DOCUMENT RETENTION POLICY AND DOCUMENT DESTRUCTION POLICY IS CURRENTLY UNDER DEVELOPMENT. 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 0 0 0 0 0 0 0 1 0 0 0 LUTHERAN HOMES OF MICHIGAN INC P 1040000 ACTUAL AMOUNT