2022-10-21T10:09:01-05:00 2021-12-31 381357951 PLANTE & MORAN PLLC 2601 CAMBRIDGE CT STE 300 AUBURN HILLS MI 48326 990 2021-01-01 382395647 PROJECT COMPASSION HEALTH PROJ 9896523470 2825 WIENEKE RD SAGINAW MI 48603 TIMOTHY KALBFLEISCH SVP AND CFO 9896523470 2022-10-20 1 TIMOTHY KALBFLEISCH 999009999 TINA PETERS P00904574 2483757100 2022-10-20 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 2825 WIENEKE RD SAGINAW MI 48603 8605522 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. 7 7 105 0 0 0 1133986 2038559 6198267 6521774 19 -4813 228309 45194 7560581 8600714 0 0 0 0 3954049 3969455 0 0 0 2992705 3312355 6946754 7281810 613827 1318904 6735400 7020409 5761599 4645212 973801 2375197 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 6494504 6566968 SKILLED NURSING CARE PROVIDED 18,462 DAYS OF CARE AND 3,208 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS. 6494504 1 1 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 1 105 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X LAURA MCKAY 9892627381 2825 WIENEKE RD SAGINAW MI 48603 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 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 237693 8565 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0.08 39.92 X 0 182701 1293 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.00 40.00 X 0 151101 8259 ERIC R MUSUM VP, CAA AND CTO 0.00 40.00 X 0 137081 7829 SEAN DE FOUR - END 3521 SR. VP AND COO 0.25 39.75 X 0 35387 1851 0 743963 27797 0 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 30368 CATERING SERVICE 765192 THERAPY MANAGEMENT INC 851 PENNIMAN AVE PLYMOUTH MI 48170 THERAPY SERVICES 316009 ARCTICAX US LTD PO BOX 72465 CLEVELAND OH 44195 COVID TESTING 232430 3 500 2038059 2038559 ROOM/CARE/SKILLED NURS 623000 6521774 6521774 6521774 -5 -5 4808 -4808 -4808 -4808 MISCELLANEOUS INCOME 561000 40443 40443 DISCOUNTS EARNED 561000 4751 4751 45194 8600714 6566968 0 -4813 X 3487553 3275273 212280 225749 212332 13417 256153 240563 15590 -295936 -295936 14116 14116 476 476 1270247 1227814 42433 4870 3895 975 34702 2636 32066 23643 23643 227387 209812 17575 121 80 41 7514 7257 257 73345 73345 278765 223012 55753 120125 120125 COVID-19 EXPENSE 478416 478416 MMQAA PROVIDER TAX 465119 465119 DRUGS/MEDICAL SUPPLIES 329190 329190 BAD DEBT EXPENSE 167631 167631 112624 56545 56079 7281810 6494504 787306 0 662646 237314 1032189 2294925 391863 36954 5530557 1241934 4519197 4288623 129505 162593 6735400 7020409 825096 417928 4377 0 3635663 3541129 1296463 686155 5761599 4645212 X 866573 2266650 107228 108547 973801 2375197 6735400 7020409 X 1318904 82492 X 0 1 X 1 0 X 11685 6220 38355 1133986 2038559 3228805 7423516 7547223 6715672 6198267 6521774 34406452 7435201 7553443 6754027 7332253 8560333 37635257 1685 6220 38355 5000 500 51760 0 1685 6220 38355 5000 500 51760 37583497 18 17 127 19 -5 176 18 17 127 19 -5 176 43361 49818 35340 228309 45194 402022 7478580 7603278 6789494 7560581 8605522 38037455 0.98810 0.98850 0.00000 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 1 476 476 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 3794 14229 15112 2911 0 536231 536231 4585267 1079483 3505784 374877 150443 224434 34182 12008 22174 4288623 DUE TO AFFILIATES 686155 686155 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 237693 0 0 0 0 0 0 0 8565 0 246258 0 0 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0 182701 0 0 0 0 0 0 0 1293 0 183994 0 0 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0 151101 0 0 0 0 0 0 0 8259 0 159360 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 SERVICES: PROGRAM SERVICE EXPENSES 320,930. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 320,930. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 766,539. MANAGEMENT AND GENERAL EXPENSES 42,433. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 808,972. LAB TESTS: PROGRAM SERVICE EXPENSES 16,836. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,836. OTHER: PROGRAM SERVICE EXPENSES 123,509. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,509. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 1,319. CHANGE IN VALUE OF INTEREST RATE SWAP 81,173. FORM 990, PAGE 1 SECTION C: PROJECT COMPASSION HEALTH IS ALSO D/B/A LIVONIA WOODS NURSING AND REHABILITATION. LUTHERAN HOMES OF MICHIGAN INC 2825 WIENEKE RD SAGINAW MI 48603 381358410 NURSING CARE MI 501(C)(3) LINE 10 N/A 0 LUTHERAN HOMES OF MICHIGAN FOUNDATION 2825 WIENEKE RD SAGINAW MI 48603 261630687 DONATE FUNDS MI 501(C)(3) LINE 12A LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOME CARE PERSONAL ASSISTANCE 2825 WIENEKE RD SAGINAW MI 48603 272138954 HOME CARE MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC 2825 WIENEKE RD SAGINAW MI 48603 382236926 RETIREMENT COMMUNITY MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 LUTHERAN HOME CARE AGENCY INC 2825 WIENEKE RD SAGINAW MI 48603 383081979 HOME CARE MI 501(C)(3) LINE 10 LUTHERAN HOMES OF MICHIGAN INC 1 ALPENA VILLAGE 2825 WIENEKE RD SAGINAW MI 48603 320090735 RESIDENTIAL CONTINUING CARE RETIREMENT FACILITY MI N/A 0 1 GIBRALTER LDHALP 26200 LAHSER RD STE 300 SOUTHFIELD MI 48034 301829767 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI N/A 0 0 MONROE ELDERLY LDHALP 5309 TRANSPORTATION BLVD CLEVELAND OH 44125 383609893 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI N/A 0 0 ALPENA PINES LDHALP 9710 JUNCTION ROAD FRANKENMUTH MI 48434 260236982 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI N/A 0 0 LHM HOUSING SERVICES INC 2825 WIENEKE RD SAGINAW MI 48603 383609879 HOUSING SERVICES MI N/A C 0 GIBRALTER MANOR DEVELOPMENT INC 2825 WIENEKE RD SAGINAW MI 48603 202240778 HOUSING SERVICES MI N/A C 0 ALPENA PINES DEVELOPMENT INC 2825 WIENEKE RD SAGINAW MI 48603 260237019 HOUSING SERVICES MI N/A C 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 1 1 0 LUTHERAN HOMES OF MICHIGAN INC Q 295936 ACTUAL AMOUNT