2014-11-17T09:21:50-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2013-01-01 382236926 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC AUSA 9896523470 PO BOX 329 FRANKENMUTH MI 48734 AMY E STORMS CFO 9896523470 2014-11-13 1 ROBERT LONG P00782202 2483522500 2013 2015-11-30 17:44:51Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM PO BOX 329 FRANKENMUTH MI 48734 4984597 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. 12 11 127 29 0 0 900 0 2558980 4869903 1 1 13219 114693 2573100 4984597 0 0 0 0 1335762 2620210 0 0 0 1358294 2471825 2694056 5092035 -120956 -107438 3698083 3904809 4085605 4389219 -387522 -484410 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 3725864 4869903 PROVIDED SKILLED NURSING CARE AND INDEPENDENT LIVING OPTIONS FOR 19,293 SENIOR DAYS. 3725864 1 0 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 17 0 1 127 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 0 0 MI X SUSAN L KUCK 9896523470 PO BOX 329 FRANKENMUTH MI 48734 DAVID M GEHM PRESIDENT & CEO 0.40 39.60 X X 0 203990 31668 DEBORAH DUTCHER DIRECTOR 0.20 0.80 X 0 0 0 ANTHONY GOLDEN CHAIR 0.20 0.80 X X 0 0 0 RANDY HARRIS DIRECTOR 0.20 0.80 X 0 0 0 MARY JO KRICK SECRETARY 0.20 0.80 X X 0 0 0 REV DON NEUENDORF DIRECTOR 0.20 0.80 X 0 0 0 PETER BENDER TREASURER 0.20 0.80 X X 0 0 0 SCOTT ZIMMER DIRECTOR 0.20 0.80 X 0 0 0 RITCH CUSHWAY VICE CHAIR 0.20 0.80 X X 0 0 0 DARRELL ZOLTON DIRECTOR 0.20 0.80 X 0 0 0 CHARLES WINTERSTEIN DIRECTOR 0.20 0.80 X 0 0 0 MARILYNN GOERING DIRECTOR 0.20 0.80 X 0 0 0 MAUREEN MCGEE COO - CAMPUS BASED SERVICE 8.00 32.00 X 0 104427 27312 AMY STORMS VP OF FINANCE/CFO 1.00 39.00 X 0 106809 12265 ERIC MUSUM INFORMATION TECHNOLOGY DIRECTOR 1.00 39.00 X 0 83141 9671 ALBERT KAUL VP OF HUMAN RESOURCES 1.00 39.00 X 0 90094 15921 0 588461 96837 0 0 1 0 REHABCARE GROUP INC 7733 FORSYTH BLVD STLOUIS MO 63102 THERAPY 169852 1 ROOM/CARE/SKILLED NURS 623990 4859342 4859342 RESIDENT RENTAL INCOME 623990 10523 10523 OTHER RESIDENT REIMB 623990 38 38 4869903 1 1 TV CHARGES 900099 15438 15438 REBATE INCOME 900099 6543 6543 MEALS - GUEST 900099 2111 2111 90601 90601 114693 4984597 4869903 0 114694 2217566 2065005 152561 36291 29965 6326 201256 185279 15977 165097 152345 12752 422300 422300 17976 17976 75 75 206204 69040 137164 2587 2587 17411 17411 4439 419 4020 3374 793 2581 85897 85897 134144 134144 61797 61797 MMQAA PROVIDER TAX 380428 380428 NET PATIENT CARE 371763 371763 DRUGS/MEDICAL SUPPLIES 299860 265179 34681 FOOD 239064 239064 224506 126971 97535 5092035 3725864 1366171 0 180147 472409 579892 436176 6660 5981 71172 0 1948664 353012 1448540 1595652 1360426 1360426 51246 34165 3698083 3904809 396896 399449 1669474 1669474 2019235 2320296 4085605 4389219 X -403993 -500881 16471 16471 -387522 -484410 3698083 3904809 X -107438 6861 3689 X X 0 1 X 1 0 X 22218 27176 900 50294 4178476 6044608 5007762 2558980 4869903 22659729 24479 9337 6208 17549 57573 4200694 6096263 5017099 2566088 4887452 22767596 0 184058 447724 107290 739072 184058 447724 107290 739072 22028524 781 343 126 1 1 1252 781 343 126 1 1 1252 38723 868653 16962 7011 97144 1028493 4240198 6965259 5034187 2573100 4984597 23797341 0.92570 0.93110 0.00010 0.00010 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME 0 0 0 0 0 0 0 0 1 75 75 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 7263 23496 24928 5831 0 180000 180000 1288620 130292 1158328 370519 160479 210040 109525 62241 47284 1595652 LOANS FROM RELATED PARTIES 225000 DUE TO AFFILIATES 1765117 ACCRUED OTHER LIABILITIES 330179 2320296 X PART IV, LINE 1B: RESIDENT TRUST ACCOUNT 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, 2013, 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, 2010. 0 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 0 203990 0 0 0 0 0 17500 0 14168 0 235658 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 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 2013 AND THE LAST IN-DEPTH COMPENSATION REVIEW OCCURRED IN 2010. 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 HOMES OF MICHIGAN, INC. BY CONTACTING THE CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION B, LINE 14: A WRITTEN DOCUMENT RENTENTION AND DOCUMENT DESTRUCTION POLICY IS CURRENTLY UNDER DEVELOPMENT. FORM 990, PART XI, LINE 9: RECOVERY OF BAD DEBT 3,689. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE AUDIT OVERSIGHT PROCEDURES FROM THE PREVIOUS YEAR. LUTHERAN HOMES OF MICHIGAN INC PO BOX 329 FRANKENMUTH MI 48734 381358410 NURSING CARE MI 501(C)(3) LINE 9 N/A 0 ELDER HOUSING LLC PO BOX 329 FRANKENMUTH MI 48734 201034873 SENIOR HOUSING MI 501(C)(3) LINE 9 LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOMES OF MICHIGAN FOUNDATION PO BOX 329 FRANKENMUTH MI 48734 261630687 DONATE FUNDS MI 501(C)(3) LINE 11A, I LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOME CARE PERSONAL ASSISTANCE PO BOX 329 FRANKENMUTH MI 48734 272138954 HOME CARE MI 501(C)(3) LINE 9 LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOME CARE AGENCY INC PO BOX 329 FRANKENMUTH MI 48734 383081979 SENIOR SERVICES MI 501(C)(3) LINE 9 LUTHERAN HOMES OF MICHIGAN INC 1 ALPENA VILLAGE PO BOX 329 FRANKENMUTH MI 48734 320090735 RESIDENTIAL CONTINUING CARE RETIREMENT FACILITY MI N/A GILBRALTAR 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 PO BOX 329 FRANKENMUTH MI 48734 383609879 HOUSING SERVICES MI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 LUTHERAN HOMES OF MICHIGAN INC P 850000 ACTUAL COST LUTHERAN HOMES OF MICHIGAN INC Q 340000 ACTUAL COST