2016-11-15T17:09:38-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2015-01-01 381358410 LUTHERAN HOMES OF MICHIGAN INC LUTH 9896523470 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 AMY E STORMS CFO 9896523470 2016-11-15 1 LYNNE HUISMANN P00053811 2483522500 2015 2017-02-10 21:41:12Z WELLSPRING LUTHERAN SERVICES DAVID M GEHM 4100 PIER NORTH BLVD NO STE A FLINT MI 48504 45898373 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. 7 7 1102 175 3284 0 154862 0 34208084 43566334 94897 59000 2048412 1668560 36506255 45293894 0 0 0 0 21776557 25159383 0 0 237712 13319923 20618263 35096480 45777646 1409775 -483752 38898839 51453482 27076314 38279730 11822525 13173752 MOTIVATED BY CHRIST'S LOVE, WE ENGAGE PEOPLE AS THEY EXPERIENCE AND EMBRACE THEIR GOD-GIVEN POTENTIAL. 0 0 34506544 43566334 SKILLED NURSING CARE UNIT AND HOME FOR THE AGED UNIT PROVIDED 108,325 DAYS OF CARE AND 22,020 DAYS OF REHABILITATION, ROOM AND BOARD, NURSING CARE AND RELIGIOUS SERVICES FOR RESIDENTS OF THREE NURSING HOMES 34506544 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 1 120 0 1 1102 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 1 1 MI X ERIC MUSUM 9896523470 4100 PIER NORTH BLVD STE A FLINT MI 48504 ANTHONY D GOLDEN VICE CHAIR 0.25 1.75 X X 0 0 0 RITCH CUSHWAY CHAIR 0.25 0.75 X X 0 0 0 PETER BENDER TREASURER/SECRETARY 0.25 0.75 X X 0 0 0 REV DON NEUENDORF DIRECTOR 0.25 0.75 X 0 0 0 DARRELL ZOLTON DIRECTOR 0.25 0.75 X 0 0 0 PAUL NYQUIST DIRECTOR 0.25 0.75 X 0 0 0 CARL SCHOENOW DIRECTOR 0.25 0.75 X 0 0 0 DAVID M GEHM PRESIDENT & CEO 36.50 3.50 X 246795 0 23015 ALBERT KAUL VP HUMAN RESOURCES, CPO 40.00 0.00 X 117918 0 9298 MAUREEN MCGEE VP OF HEALTH SERVICES 37.50 2.50 X 131948 0 9283 AMY STORMS SR VP FINANCE AND CFO 40.00 0.00 X 137491 0 9995 ERIC MUSUM VP, CAA AND CTO 39.67 0.33 X 112230 0 9020 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES 37.67 2.33 X 170148 0 5693 JONATHAN GOLM DIRECTOR OF PROJECT DEVELOPMENT 40.00 0.00 X 122631 0 4610 TODD SEIBT SPECIAL PROJECTS DIRECTOR 40.00 0.00 X 112731 0 8464 VICTORIA PARRISH EXECUTIVE DIRECTOR 40.00 0.00 X 111418 0 4245 1263310 0 83623 9 0 1 0 SELECT REHABILITATION 550 FRONTAGE RD STE 2415 NORTHFIELD IL 60093 THERAPY 1861625 UNIDINE CORPORATION 1000 WASHINGTON STREET STE 510 BOSTON MA 02118 FOOD AND DINING MANAGEMENT 803480 OMNICARE INC 900 OMNICARE CENTER 201 EAST FOURT CINCINNATI OH 45202 PHARMACY SERVICES 573799 YORK RISK SERVICES GROUP 29200 NORTHWESTERN HWY STE 300 SOUTHFIELD MI 48034 MANAGEMENT 217719 PLANTE MORAN 27400 NORTHWESTERN HWY SOUTHFIELD MI 48034 ACCOUNTING 153573 7 SKILLED NURSING & HOME CARE 623000 42237697 42237697 FURNISHED SERVICES 623000 818893 818893 OTHER RESIDENT INCOME 623000 509744 509744 43566334 74242 74242 31371 28087 3284 3284 3284 478650 82500 444060 132332 34590 -49832 -15242 -15242 MANAGEMENT FEES 900099 1032734 1032734 CONSULTING INCOME 900099 369249 369249 MISCELLANEOUS INCOME 909900 151372 151372 111921 111921 1665276 45293894 43566334 3284 1724276 X 1012087 805702 197638 8747 20377214 16221893 3979213 176108 269603 174697 90462 4444 1898671 1375118 509470 14083 1601808 1295387 294506 11915 220962 220962 153573 153573 1454 1454 5849278 5436685 412593 136482 114667 21724 91 256145 27193 226172 2780 229535 45006 183647 882 1788565 1504835 283730 204039 30175 158361 15503 99640 44881 52718 2041 970206 970206 1717522 1717522 585625 585625 MMQAA PROVIDER TAX 2092231 2092231 FOUNDATION EXPENSES 2088887 2088887 PATIENT CARE 1788092 1788092 FOOD 761499 761499 1674528 1070961 602449 1118 45777646 34506544 11033390 237712 6158064 15957123 3858675 4144436 4961643 6764696 71260 112289 652219 855686 51837454 32867959 19990294 18969495 715543 810448 2491141 3839309 38898839 51453482 2320630 3381390 11266928 23703441 22106102 1052243 1525310 27076314 38279730 X 9221083 10539991 2601442 2633761 11822525 13173752 38898839 51453482 X -483752 -223910 2058889 X X 0 1 X 1 0 X 25481 679023 162512 154862 219468 1241346 32430881 23834371 31335747 34208084 43566334 165375417 42450 23547 30842 96839 32498812 24536941 31529101 34362946 43785802 166713602 25144 679023 161762 154862 219468 1240259 0 25144 679023 161762 154862 219468 1240259 165473343 43767 22799 52950 61834 74242 255592 43767 22799 52950 61834 74242 255592 787 -9695 3284 -5624 4108839 1337379 3154910 2058108 1665276 12324512 36651418 25897119 34737748 36473193 45528604 179288082 0.92290 0.92600 0.00140 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 1454 1454 0 PART II-B, LINE 1: MEMBERSHIP FEE ALLOCATED TO LOBBYING. 1 3247 29531 30113 2666 0 2648969 2648969 39332453 24767398 14565055 56708 24794 31914 3517258 2922481 594777 6282066 5153286 1128780 18969495 LOAN CLOSING COSTS 1113918 DEPOSITS 318036 OTHER ASSETS 2407355 3839309 OTHER AFFILIATED ORGANIZATIONS 801935 RESIDENT SECURITY DEPOSITS 261250 INTEREST RATE SWAP 462125 1525310 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 246795 0 0 0 0 0 0 0 23015 0 269810 0 0 0 MICHAEL LOGAN SR. VP/COO SENIOR SERVICES 170148 0 0 0 0 0 0 0 5693 0 175841 0 0 0 A MICHIGAN STRATEGIC FUND LIMITED OBLIGATION REVENUE BONDS 2015-10-29 11266928 VARIOUS 0 0 0 A 11878 11255050 123618 7343311 3800000 1 0 0 0 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 FORM 990, PART VI, SECTION B, LINE 11 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 PATIENT CARE: PROGRAM SERVICE EXPENSES 5,436,685. MANAGEMENT AND GENERAL EXPENSES 412,593. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,849,278. FORM 990, PART XI, LINE 9: RECOVERY OF BAD DEBT 80,169. CONTRIBUTED CAPITAL 10,000. CHANGE IN VALUE OF INTEREST RATE SWAP -339,635. TRANSFER OF ASSETS FROM LUTHERAN HOMES OF MICHIGAN FOUNDATION 2,308,355. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES TO THE AUDIT OVERSIGHT PROCEDURES FROM THE PREVIOUS YEAR. LHM ASSET MANAGEMENT LLC 244 WALNUT STREET FRANKENMUTH MI 48734 200055004 ASSET MANAGEMENT MI 52546 359507 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 9 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 11A, 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 9 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 9 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 -23430 291842 0 1 0.50000 GIBRALTAR 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 LUTHERAN HOMES OF MICHIGAN INC C -7 322 0.79000 1 GIBRALTAR MANOR DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 202240778 HOUSING SERVICES MI N/A C -4 217 0.50000 0 ALPENA PINES DEVELOPMENT INC 4100 PIER NORTH BLVD STE A FLINT MI 48504 260237019 HOUSING SERVICES MI N/A C -5 190 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 LUTHERAN HOMES OF MICHIGAN FOUNDATION S 2308355 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION P 2088887 ACTUAL AMOUNT LUTHERAN HOMES OF MICHIGAN FOUNDATION R 207143 ACTUAL AMOUNT LUTHERAN HOME CARE AGENCY Q 142794 ACTUAL AMOUNT LUTHERAN HOME CARE PERSONAL ASSISTANCE Q 75617 ACTUAL AMOUNT