2015-11-11T10:18:41-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2014-01-01 382236926 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC AUSA 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 AMY E STORMS CFO 9896523470 2015-11-11 1 TINA M PETERS CPA P00904574 2483522500 2014 2016-04-25 22:37:26Z X WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 4535703 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. 6 6 143 6 0 0 0 5795 4869903 4495177 1 2 114693 34729 4984597 4535703 0 0 0 0 2620210 2570707 0 0 0 2471825 2430152 5092035 5000859 -107438 -465156 3904809 3162219 4389219 4706064 -484410 -1543845 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 4124681 4495177 PROVIDED SKILLED NURSING CARE AND INDEPENDENT LIVING OPTIONS FOR 16,385 SENIOR DAYS. 4124681 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 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 1 143 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 0 0 MI X ERIC MUSUM 9896523470 4100 PIER NORTH BLVD STE A FLINT MI 48504 ANTHONY D GOLDEN CHAIR 0.20 0.80 X X 0 0 0 RITCH CUSHWAY VICE CHAIR 0.20 0.80 X X 0 0 0 PETER BENDER TREASURER 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 SCOTT ZIMMER DIRECTOR - PARTIAL YEAR 0.20 0.80 X 0 0 0 DEBORAH DUTCHER DIRECTOR - PARTIAL YEAR 0.20 0.80 X 0 0 0 RANDY HARRIS DIRECTOR - PARTIAL YEAR 0.20 0.80 X 0 0 0 MARY JO KRICK SECRETARY - PARTIAL YEAR 0.20 0.80 X X 0 0 0 DAVID M GEHM PRESIDENT & CEO 0.40 39.60 X 0 199926 29733 ALBERT KAUL VP HUMAN RESOURCES, CPO 3.60 36.40 X 0 93049 15194 MAUREEN MCGEE COO - CAMPUS BASED SERVICES 10.00 30.00 X 0 106863 26330 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES 0.80 39.20 X 0 151997 4189 AMY STORMS VP FINANCE AND CFO 1.00 39.00 X 0 117875 11585 ERIC MUSUM VP, CAA AND CTO 0.00 40.00 X 0 91124 9984 0 760834 97015 0 0 1 0 SELECT REHABILITATION 550 FRONTAGE RD STE 2415 NORTHFIELD IL 60093 THERAPY 320459 1 5795 5795 ROOM/CARE/SKILLED NURS 623990 4480657 4480657 OTHER RESIDENT REIMB 623990 8060 8060 RESIDENT RENTAL INCOME 623990 6460 6460 4495177 2 2 DISCOUNTS AND REBATES 900099 12569 12569 MEALS - GUEST 900099 1844 1844 20316 20316 34729 4535703 4495177 0 34731 2125112 1940817 184295 27540 24591 2949 255821 208167 47654 162234 144716 17518 408857 408857 6351 6351 30 30 138411 81827 56584 4281 4281 36219 36219 18347 18347 141168 122095 19073 2524 2524 5387 4078 1309 67556 67556 147663 147663 39940 39940 NET PATIENT CARE 439908 439908 MMQAA PROVIDER TAX 429263 429263 DRUGS/MEDICAL SUPPLIES 269242 269242 FOOD 121153 121153 153852 123605 30247 5000859 4124681 876178 0 472409 403313 436176 387304 5981 5124 25295 2046476 482801 1595652 1563675 1360426 760426 34165 17082 3904809 3162219 399449 367271 1669474 1738647 2320296 2600146 4389219 4706064 X -500881 -1560316 16471 16471 -484410 -1543845 3904809 3162219 X -465156 -594279 X X 0 1 X 1 0 X 27176 900 5795 33871 6044608 5007762 2558980 4869903 4495177 22976430 24479 9337 6208 17549 1844 59417 6096263 5017099 2566088 4887452 4502816 23069718 0 184058 447724 107290 92868 831940 184058 447724 107290 92868 831940 22237778 343 126 1 1 2 473 343 126 1 1 2 473 868653 16962 7011 97144 32885 1022655 6965259 5034187 2573100 4984597 4535703 24092846 0.92300 0.92570 0.00000 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 30 30 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 5831 21098 20637 6291 0 180000 180000 1347649 184835 1162814 396861 224838 172023 121966 73128 48838 1563675 DUE TO AFFILIATES 2326745 ACCRUED OTHER LIABILITIES 273401 2600146 X PART IV, LINE 1B: AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY, INC. IS REQUIRED TO MAINTAIN RESIDENT TRUST FUNDS AT ITS NURSING HOMES. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2011. 0 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 0 199926 0 0 0 0 0 17500 0 12233 0 229659 0 0 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES 0 151997 0 0 0 0 0 0 0 4189 0 156186 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 A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER, LUTHERAN HOMES OF MICHIGAN, INC. FORM 990, PART VI, SECTION B, LINE 11 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 B, LINE 15 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 2014 AND THE LAST IN-DEPTH COMPENSATION REVIEW OCCURRED IN 2014. 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 VI, SECTION B, LINE 14: A WRITTEN DOCUMENT RETENTION AND DOCUMENT DESTRUCTION POLICY IS CURRENTLY UNDER DEVELOPMENT. FORM 990, PART XI, LINE 9: INTEREST RATE SWAP ADJUSTMENT 5,721. GOODWILL IMPAIRMENT -600,000. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE AUDIT OVERSIGHT PROCEDURES FROM THE PREVIOUS YEAR. LUTHERAN HOMES OF MICHIGAN INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 381358410 NURSING CARE MI 501(C)(3) LINE 9 N/A 0 ELDER HOUSING LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 201034873 SENIOR HOUSING MI 501(C)(3) LINE 9 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 11A, 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 9 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 9 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 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 LUTHERAN HOMES OF MICHIGAN INC P 125000 ACTUAL COST