2017-11-15T07:16:18-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 27400 Northwestern Highway Southfield MI 48034 990 2016-01-01 381358410 LUTHERAN HOMES OF MICHIGAN INC LUTH 9896523470 4100 PIER NORTH BLVD No STE A FLINT MI 48504 AMY E STORMS CFO 9896523470 2017-11-14 1 TINA PETERS P00904574 2483522500 2017-11-14 67.59.56.30 2017-11-14 10:41:48 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 737380BCD7AD51223FD12A91753DF01CE9F34789 2016 2021-01-29 14:40:06Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD No STE A FLINT MI 48504 46257313 0 X WWW.WELLSPRINGLUTHERAN.COM X 1892 MI MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 8 8 1000 166 -15761 -15762 0 0 43566334 43596169 59000 77394 1668560 2520316 45293894 46193879 0 0 0 0 25159383 24960553 0 0 310420 20618263 21245779 45777646 46206332 -483752 -12453 51453482 50603639 38279730 36692820 13173752 13910819 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 37274178 43596169 SKILLED NURSING CARE UNIT AND HOME FOR THE AGED UNIT PROVIDED 109,729 DAYS OF CARE AND 20,906 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS OF THREE NURSING HOMES 37274178 1 0 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 122 0 1 1000 1 1 1 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 0 1 0 1 1 MI X ERIC MUSUM 9896523470 4100 PIER NORTH BLVD STE A FLINT MI 48504 RITCH CUSHWAY CHAIR 0.20 0.80 X X 0 0 0 ANTHONY D GOLDEN VICE CHAIR THRU 12/31/16 0.20 0.80 X X 0 0 0 PETE BENDER TREASURER/SECRETARY 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 CARL SCHOENOW DIRECTOR 0.20 0.80 X 0 0 0 AMY BENKO DIRECTOR AS OF 4/4/16 0.20 0.80 X 0 0 0 DAVID M GEHM PRESIDENT & CEO 39.30 0.70 X 272054 0 13637 ALBERT D KAUL VP HUMAN RESOURCES, CPO 39.80 0.20 X 133429 0 10446 MAUREEN MCGEE VP of Health Services 33.20 6.80 X 136454 0 9810 AMY STORMS Sr. VP Finance and CFO 39.50 0.50 X 168361 0 11608 ERIC R MUSUM VP, CAA and CTO 39.90 0.10 X 119208 0 9815 MICHAEL LOGAN Sr. VP/COO Senior Services 37.10 2.90 X 173963 0 6294 JILL M HAISER EXECUTIVE DIRECTOR 12.50 27.50 X 114314 0 9064 JONATHAN GOLM Director of Project Development 40.00 0.00 X 125251 0 4656 TODD E SEIBT Special Projects Director 40.00 0.00 X 118688 0 9439 VICTORIA L PARRISH Executive Director 40.00 0.00 X 118628 0 4638 1480350 0 89407 10 0 1 0 UNIDINE CORPORATION 1000 WASHINGTON STREET STE 510 BOSTON MA 02118 FOOD AND DINING MANAGEMENT 4383199 SELECT REHABILITATION 550 FRONTAGE RD STE 2415 NORTHFIELD IL 60093 THERAPY 3064695 OMNICARE INC 900 OMNICARE CENTER 201 EAST FOURT CINCINNATI OH 45202 PHARMACY SERVICES 763659 TSSF ARCHITECTS INC 122 N WASHINTON AVE SAGINAW MI 48607 ARCHITECTURE 587118 YORK RISK SERVICES GROUP 29200 NORTHWESTERN HWY STE 300 SOUTHFIELD MI 48034 MANAGEMENT 326758 10 SKILLED NURSING & HOME CARE 623000 42240381 42240381 FURNISHED SERVICES 623000 791097 791097 OTHER RESIDENT INCOME 623000 564691 564691 43596169 100121 100121 16946 32707 -15761 -15761 -15761 8000 30727 -22727 -22727 -22727 MANAGEMENT FEES 900099 1918883 1918883 CONSULTING INCOME 900099 383079 383079 MISCELLANEOUS INCOME 909900 118811 118811 115304 115304 2536077 46193879 43596169 -15761 2613471 X 1140283 891939 235292 13052 20219079 15948417 4037207 233455 264417 166815 91787 5815 1788792 1215339 555781 17672 1547982 1239722 294815 13445 134191 134191 2653 2653 9063215 8271009 792156 50 74572 72383 1594 595 375475 111192 258175 6108 252309 43730 207715 864 1985075 1692518 292557 198351 53781 129929 14641 89828 46334 40769 2725 1437226 1437226 1787141 1429713 357428 619316 619316 MMQAA PROVIDER TAX 2024682 2024682 DRUGS AND MEDICAL SUPPL 1812447 1810514 242 1691 BAD DEBT EXPENSE 537632 537632 OTHER EXPENSE 519329 127657 391672 332337 153575 178455 307 46206332 37274178 8621734 310420 15957123 11729973 4144436 3995908 6764696 6797731 112289 134745 855686 590334 57771735 34126341 18969495 23645394 810448 933069 3839309 2776485 51453482 50603639 3381390 3669453 11266928 12775286 22106102 19975241 1525310 272840 38279730 36692820 X 10539991 11165504 2633761 2348703 0 396612 13173752 13910819 51453482 50603639 X -12453 254370 495150 X X 0 1 X 1 0 X 679023 162512 154862 0 0 996397 23834371 31335747 34208084 43566334 43596169 176540705 23547 30842 0 0 0 54389 24536941 31529101 34362946 43566334 43596169 177591491 679023 161762 154862 995647 0 679023 161762 154862 995647 176595844 22799 52950 61834 74242 100121 311946 22799 52950 61834 74242 100121 311946 0 787 -9695 3284 -15761 -21385 1337379 3154910 2058108 1665276 2536077 10751750 25897119 34737748 36473193 45309136 46216606 188633802 0.93620 0.92290 0.00170 0.00140 X Schedule A, Part III, Line 12, Explanation of Other Income: CONSULTING AND OTHER INCOME 0 0 0 0 0 0 0 0 1 2653 2653 0 Part II-B, Line 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 2666 36640 36877 2429 0 2553370 2553370 40582754 26207552 14375202 56708 32482 24226 3721255 2561858 1159397 10857648 5324449 5533199 23645394 DEPOSITS 257576 BENEFICIAL INTEREST IN WELLSPRING FOUNDATION 2518909 2776485 RESIDENT SECURITY DEPOSITS 207400 INTEREST RATE SWAP 65440 272840 Part IV, Line 1b: LUTHERAN HOMES OF MICHIGAN, INC. IS REQUIRED TO MAINTAIN RESIDENT TRUST FUNDS AT ITS NURSING HOMES. X X 0 0 0 0 0 0 0 0 0 DAVID M GEHM PRESIDENT & CEO 270554 0 1500 0 0 0 0 0 13637 0 285691 0 0 0 AMY STORMS Sr. VP Finance and CFO 166861 0 1500 0 0 0 0 0 11608 0 179969 0 0 0 MICHAEL LOGAN Sr. VP/COO Senior Services 173963 0 0 0 0 0 0 0 6294 0 180257 0 0 0 A MICHIGAN STRATEGIC FUND LIMITED OBLIGATION REVENUE BONDS (WELLSPRING LUTHER 521417332 2015-10-29 13524231 SEE BELOW 0 0 0 A 13524231 270484 12661828 591919 1 0 0 1 A 0 0 0 0 1 0 0 A 0 1 0 0 1 1 HUNTINGTON NATIONAL BANK 10.000000000000 0 0 0 0 1 A 0 SCHEDULE K, PART I, BOND ISSUES (F) DESCRIPTION OF PURPOSE: PROCEEDS OF THE BONDS WERE USED TO FINANCE HEALTHCARE FACILITIES AND $7,196,494 PROCEEDS WERE USED TO REFINANCE BANK LOAN WHICH HAD REFUNDED BONDS ISSUED TO FINANCE HEALTHCARE AND HOUSING FACILITIES. Form 990, Part VI, Section B, line 11b PRIOR TO FILING THE FORM 990 RETURN, ELECTRONIC COPIES 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 2015 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 IX, line 11g CONTRACTED THERAPY SERVICES: Program service expenses 3,097,918. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,097,918. OTHER CONTRACTED SERVICES: Program service expenses 4,837,166. Management and general expenses 601,805. Fundraising expenses 0. Total expenses 5,438,971. OTHER: Program service expenses 335,925. Management and general expenses 190,351. Fundraising expenses 50. Total expenses 526,326. Form 990, Part XI, line 9: IMPAIRMENT LOSS -135,230. CHANGE IN VALUE OF INTEREST RATE SWAP 410,847. CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION 219,533. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE AUDIT OVERSIGHT PROCEDURES FROM THE PREVIOUS YEAR. LHM ASSET MANAGEMENT LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 200055004 ASSET MANAGEMENT MI 9426 74468 LUTHERAN HOMES OF MICHIGAN INC AGING ENRICHED SERVICES LLC 4100 PIER NORTH BLVD STE A FLINT MI 48504 FOLLOW-UP COMMUNICATION SERVICES MI -43811 124395 LUTHERAN HOMES OF MICHIGAN INC 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 LUTHERAN HOMES OF MICHIGAN FOUNDATION 4100 PIER NORTH BLVD STE A FLINT MI 48504 261630687 DONATE FUNDS MI 501(C)(3) Line 12a, 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 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 PROJECT COMPASSION HEALTH 4100 PIER NORTH BLVD STE A FLINT MI 48504 382395647 SKILLED NURSING FACILITY 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 LUTHERAN HOMES OF MICHIGAN INC RELATED -48978 180464 0 1 0.50000 GIBRALTAR LDHALP 26200 LAHSER RD STE 300 SOUTHFIELD MI 48034 301829767 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI GIBRALTAR MANOR DEVELOPMENT INC RELATED -3 208 0 0 MONROE ELDERLY LDHALP 5309 TRANSPORTATION BLVD CLEVELAND OH 44125 383609893 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI LHM HOUSING SERVICES INC RELATED -3 148 0 0 ALPENA PINES LDHALP 9710 JUNCTION ROAD FRANKENMUTH MI 48434 260236982 PROVIDE AFFORDABLE HOUSING TO THE ELDERLY MI ALPENA PINES DEVELOPMENT INC RELATED -4 180 0 0 LHM HOUSING SERVICES INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 383609879 HOUSING SERVICES MI LUTHERAN HOMES OF MICHIGAN INC C -6 307 0.79000 1 GIBRALTAR MANOR DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 202240778 HOUSING SERVICES MI N/A C -3 208 0.50000 0 ALPENA PINES DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 260237019 HOUSING SERVICES MI N/A C -4 180 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY Q 553072 ACTUAL AMOUNT LUTHERAN HOME CARE AGENCY Q 1118930 ACTUAL AMOUNT LUTHERAN HOME CARE PERSONAL ASSISTANCE Q 371307 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION S 105063 ACTUAL AMOUNT PROJECT COMPASSION HEALTH Q 1040000 ACTUAL AMOUNT