2021-10-19T14:32:55-05:00 2020-12-31 381357951 PLANTE & MORAN PLLC 2601 CAMBRIDGE CT STE 500 AUBURN HILLS MI 48326 990 2020-01-01 382395647 PROJECT COMPASSION HEALTH PROJ 9896523470 2825 WIENEKE RD SAGINAW MI 48603 TIMOTHY KALBFLEISCH SVP AND CFO 9896523470 2021-10-12 1 TIMOTHY KALBFLEISCH 999009999 TINA PETERS P00904574 2483757100 2021-09-28 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X WELLSPRING LUTHERAN SERVICES DAVID M GEHM 2825 WIENEKE RD SAGINAW MI 48603 7560581 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 7 144 1 0 0 38355 1133986 6715672 6198267 127 19 35340 228309 6789494 7560581 0 0 0 0 3357193 3954049 0 0 0 3869038 2992705 7226231 6946754 -436737 613827 5796121 6735400 5458036 5761599 338085 973801 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 6252930 6198267 SKILLED NURSING CARE PROVIDED 19,089 DAYS OF CARE AND 2,128 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS. 6252930 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 13 0 1 144 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 DAVID M GEHM PRESIDENT & CEO 0.00 40.00 X 0 281699 14979 SEAN DE FOUR SR. VP AND COO 0.25 39.75 X 0 193712 11785 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0.08 39.92 X 0 186318 7064 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.00 40.00 X 0 152982 11837 ERIC R MUSUM VP, CAA AND CTO 0.00 40.00 X 0 140880 11400 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 0 955591 57065 0 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 30368 CATERING SERVICE 686155 THERAPY MANAGEMENT INC 851 PENNIMAN AVE PLYMOUTH MI 48170 THERAPY SERVICES 222354 ARCTICAX US LTD PO BOX 72465 CLEVELAND OH 44195 COVID TESTING 165770 OMNICARE INC PO BOX 78000 DETROIT MI 48278 LONG TERM CARE PHARMACY 101823 4 5000 1128986 1133986 ROOM/CARE/SKILLED NURS 623000 6198267 6198267 6198267 19 19 INSURANCE PROCEEDS 525100 210000 210000 DISCOUNTS EARNED 900099 9302 9302 MISCELLANEOUS INCOME 900099 9007 9007 228309 7560581 6198267 0 228328 X 3446318 3234174 212144 36770 30219 6551 216638 187035 29603 254323 238781 15542 -209924 -209924 13676 13676 476 476 1123633 1089897 33736 13470 13434 36 55059 5922 49137 23742 1111 22631 208924 190986 17938 800 405 395 9766 9422 344 90456 90456 250513 200410 50103 93541 93541 MMQAA PROVIDER TAX 502654 502654 DRUGS/MEDICAL SUPPLIES 284211 284211 OTHER EXPENSE 249234 11214 238020 BAD DEBT EXPENSE 114306 114306 168168 48293 119875 6946754 6252930 693824 0 335685 662646 703264 1032189 98353 391863 5641498 1122301 4524314 4519197 134505 129505 5796121 6735400 324849 825096 0 4377 3704333 3635663 1428854 1296463 5458036 5761599 X 225857 866573 112228 107228 338085 973801 5796121 6735400 X 613827 21889 X 0 1 X 1 0 X 11685 6220 38355 1133986 1190246 7425498 7423516 7547223 6715672 6198267 35310176 7425498 7435201 7553443 6754027 7332253 36500422 1685 6220 38355 5000 51260 0 1685 6220 38355 5000 51260 36449162 11 18 17 127 19 192 11 18 17 127 19 192 15069 43361 49818 35340 228309 371897 7440578 7478580 7603278 6789494 7560581 36872511 0.98850 0.99490 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 1 476 476 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 1968 13895 12069 3794 0 536231 536231 4569144 863499 3705645 501941 251505 250436 34182 7297 26885 4519197 DUE TO AFFILIATES 1247058 INTEREST RATE SWAP MARK TO MARKET 49405 1296463 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 281699 0 0 0 0 0 7929 0 7050 0 296678 0 0 SEAN DE FOUR SR. VP AND COO 0 193712 0 0 0 0 0 4735 0 7050 0 205497 0 0 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0 186318 0 0 0 0 0 5557 0 1507 0 193382 0 0 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0 152982 0 0 0 0 0 5055 0 6782 0 164819 0 0 ERIC R MUSUM VP, CAA AND CTO 0 140880 0 0 0 0 0 4543 0 6857 0 152280 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 232,143. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 232,143. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 764,974. MANAGEMENT AND GENERAL EXPENSES 33,736. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 798,710. LAB TESTS: PROGRAM SERVICE EXPENSES 6,451. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,451. OTHER: PROGRAM SERVICE EXPENSES 86,329. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,329. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION -5,000. CHANGE IN VALUE OF INTEREST RATE SWAP 26,889. 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 209924 ACTUAL AMOUNT