2020-11-04T10:41:38-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 2601 CAMBRIDGE CT STE 500 AUBURN HILLS MI 48326 990 2019-01-01 382395647 PROJECT COMPASSION HEALTH PROJ 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 TIMOTHY KALBFLEISCH SVP AND CFO 9896523470 2020-10-28 1 TINA PETERS P00904574 2483757100 2020-10-28 68.34.66.206 2020-10-28 15:12:11 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3BA07AC1E7B37A4123F7B0FAF00AF3DF039E44A3 2019 2021-01-29 14:40:06Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 6789494 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 7 151 4 0 0 6220 38355 7547223 6715672 17 127 49818 35340 7603278 6789494 0 0 0 0 3446667 3357193 0 0 0 4422562 3869038 7869229 7226231 -265951 -436737 6783096 5796121 5903060 5458036 880036 338085 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 6213731 6715672 SKILLED NURSING CARE PROVIDED 21,106 DAYS OF CARE AND 2,069 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS. 6213731 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 20 0 1 151 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 4100 PIER NORTH BLVD SUITE A FLINT MI 48504 DAVID M GEHM PRESIDENT & CEO 0.79 39.21 X 0 265141 14956 AMY STORMS SR. VP FINANCE/CFO - THRU 7/15/19 0.08 39.92 X 0 171737 7702 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0.08 39.92 X 0 158086 5989 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0.00 40.00 X 0 142822 11690 SEAN DE FOUR SR. VP AND COO 8.99 31.01 X 0 148484 5907 ERIC R MUSUM VP, CAA AND CTO 0.00 40.00 X 0 139522 11214 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 KEITH STONE DIRECTOR - PART YEAR 0.20 0.80 X 0 0 0 KAREN STORCK DIRECTOR 0.20 0.80 X 0 0 0 0 1025792 57458 0 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 30368 CATERING SERVICE 692753 SELECT REHABILITATION PO BOX 71985 CHICAGO IL 60694 THERAPY SERVICES 333851 PRN ON DEMAND 851 PENNIMAN AVE PLYMOUTH MI 48170 STAFFING SERVICES 306081 OMNICARE INC PO BOX 78000 DETROIT MI 48278 LONG TERM CARE PHARMACY 103466 4 38355 38355 ROOM/CARE/SKILLED NURS 623000 6715672 6715672 6715672 127 127 MISCELLANEOUS INCOME 900099 24700 24700 DISCOUNTS EARNED 900099 10640 10640 35340 6789494 6715672 0 35467 X 2917964 2715462 202502 29288 24111 5177 194208 176902 17306 215733 200566 15167 427725 427725 38010 38010 461 461 1587436 1552661 34775 3555 3555 50767 5927 44840 26471 452 26019 241749 219967 21782 5594 4334 1260 11130 10204 926 122732 122732 242884 194307 48577 74497 74497 MMQAA PROVIDER TAX 595674 595674 DRUGS/MEDICAL SUPPLIES 348475 348475 OTHER EXPENSE 58783 29129 29654 EQUIPMENT AND RENTAL 53219 29397 23822 -20124 -20124 7226231 6213731 1012500 0 1087685 335685 871797 703264 134829 98353 5396104 871790 4535243 4524314 153542 134505 6783096 5796121 531846 324849 3704333 5371214 1428854 5903060 5458036 X 767408 225857 112628 112228 880036 338085 6783096 5796121 X -436737 -105214 X 0 1 X 1 0 X 0 0 11685 6220 38355 56260 8409043 7425498 7423516 7547223 6715672 37520952 8409043 7425498 7435201 7553443 6754027 37577212 1685 6220 38355 46260 0 1685 6220 38355 46260 37530952 2003 11 18 17 127 2176 2003 11 18 17 127 2176 15069 43361 49818 35340 143588 8411046 7440578 7478580 7603278 6789494 37722976 0.99490 0.99700 0.00010 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 1 461 461 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 2116 11637 11785 1968 0 536231 536231 4481176 652864 3828312 363467 214026 149441 15230 4900 10330 4524314 DUE TO AFFILIATES 1352560 INTEREST RATE SWAP MARK TO MARKET 76294 1428854 PART IV, LINE 1B: PROJECT COMPASSION HEALTH IS REQUIRED TO MAINTAIN RESIDENT TRUST FUNDS AT ITS NURSING HOME. 1 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 0 265141 0 0 0 0 0 7750 0 7206 0 280097 0 0 AMY STORMS SR. VP FINANCE/CFO - THRU 7/15/19 0 171737 0 0 0 0 0 3593 0 4109 0 179439 0 0 TIMOTHY KALBFLEISCH SR. VP FINANCE AND CFO 0 158086 0 0 0 0 0 4714 0 1275 0 164075 0 0 ALBERT D KAUL VP HUMAN RESOURCES, CPO 0 142822 0 0 0 0 0 4750 0 6940 0 154512 0 0 SEAN DE FOUR SR. VP AND COO 0 148484 0 0 0 0 0 0 0 5907 0 154391 0 0 ERIC R MUSUM VP, CAA AND CTO 0 139522 0 0 0 0 0 4408 0 6806 0 150736 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. PART I, LINE 4A AMY STORMS RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $52,856. 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 367,882. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 367,882. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,078,476. MANAGEMENT AND GENERAL EXPENSES 34,775. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,113,251. LAB TESTS: PROGRAM SERVICE EXPENSES 14,358. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,358. OTHER: PROGRAM SERVICE EXPENSES 91,945. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,945. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION -400. CHANGE IN VALUE OF INTEREST RATE SWAP -104,814. 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 GIBRALTER 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 1 0 0 0 1 1 0 1 0 1 0 LUTHERAN HOMES OF MICHIGAN INC P 427725 ACTUAL AMOUNT