ELMWOOD NURSING HOME INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- ELMWOOD NURSING HOME INC (EIN 39-1190907)
- Tax period
- 2023-07-01 to 2023-10-31
- Filed
- 2025-04-16
- IRS object ID
- 202511069349300716
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-04-16T07:46:09-05:00 | ReturnTs |
| Tax Period End | 2023-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391190907 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELMWOOD NURSING HOME INC | BusinessNameLine1Txt |
| Business Name Line2 | HERITAGE OF ELMWOOD | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ELMW | BusinessNameControlTxt |
| Phone | 7158323003 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 232 E SPRINGER AVE | AddressLine1Txt |
| City | ELMWOOD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54740 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HOLLY MALASZUK | PersonNm |
| Person Title | SECRETARY/TREASURER | PersonTitleTxt |
| Phone | 7156393792 | PhoneNum |
| Signature | 2025-04-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2025-04-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | HOLLY MALASZUK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 232 E SPRINGER AVE | AddressLine1Txt |
| City | ELMWOOD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $205,761 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://HERITAGEOFELMWOOD.COM/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Other Organization Dsc | WISCONSIN NO | OtherOrganizationDsc |
| Formation | 1972 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO RESPOND TO THE SPIRITUAL, PHYSICAL, AND SOCIAL NEEDS OF PEOPLE IN ORDER TO ENHANCE HUMAN DIGNITY AND GROWTH BY PROVIDING HIGH QUALITY SERVICE. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $108,085 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,950 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,409,639 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $201,028 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,121 | PYInvestmentIncomeAmt |
| CY Investment Income | $783 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,521,845 | PYTotalRevenueAmt |
| CY Total Revenue | $205,761 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,610,260 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,344,300 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $330,079 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,423,068 | PYOtherExpensesAmt |
| CY Other Expenses | $239,419 | CYOtherExpensesAmt |
| PY Total Expenses | $2,767,368 | PYTotalExpensesAmt |
| CY Total Expenses | $2,179,758 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$245,523 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,973,997 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,571,819 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $597,822 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,973,997 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO RESPOND TO THE SPIRITUAL, PHYSICAL, AND SOCIAL NEEDS OF PEOPLE IN ORDER TO ENHANCE HUMAN DIGNITY AND GROWTH BY PROVIDING HIGH QUALITY SERVICE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $2,132,727 | ExpenseAmt |
| Grant | $1,610,260 | GrantAmt |
| Revenue | $201,028 | RevenueAmt |
| Desc | THE PRIMARY ACTIVITY OF THE NURSING HOME IS TO PROVIDE SKILLED NURSING CARE FOR THE AGED AND DISABLED OF THE SURROUNDING AREA. THE NURSING HOME SERVES THE ELMWOOD, WISCONSIN AREA COMMUNITY BY OPERATING A 34-BED SKILLED NURSING FACILITY. THE NURSING HOME OFFERS LONG-TERM AND SHORT-TERM CARE ALONG WITH REHABILITATIVE SERVICES TO THEIR SENIOR RESIDENTS. SOME OF THE SPECIALIZED CARE SERVICES INCLUDE PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, IV AND OXYGEN THERAPY, RESTORATIVE CARE, AND TRACHEOTOMY CARE. | Desc |
| Total Program Service Expenses | $2,132,727 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | Yes (1) | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLLY MALASZUK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7156393792 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 W WINTER AVENUE | AddressLine1Txt |
| City | ELMWOOD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| NEIL BOLTIK | ||||||
| PRESIDENT | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SEPTEMBER PODOLI | ||||||
| SECRETARY/TREASURER (THRU 08/23) | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JOSH BLESKACEK | ||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |
| PAT GERAETS | ||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |
| JASON SEVERSON | ||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |
| PAUL UNSER | ||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |
| LUKE WEIX | ||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MARK WOLF | ||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DAVID WEST | ||||||
| ADMINISTRATOR | 40.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $3,950 | AllOtherContributionsAmt |
| Total Contributions | $3,950 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NURSING CARE & HOUSING | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $200,955 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $200,955 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $73 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $201,028 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $783 | TotalRevenueColumnAmt |
| Exclusion | $783 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $205,761 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $201,028 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $783 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,610,260 | TotalAmt |
| Program Services | $1,610,260 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $285,498 | TotalAmt |
| Program Services | $285,498 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,026 | TotalAmt |
| Program Services | $4,026 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,002 | TotalAmt |
| Program Services | $16,002 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,553 | TotalAmt |
| Program Services | $24,553 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,212 | TotalAmt |
| Management And General | $23,212 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30 | TotalAmt |
| Management And General | $30 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,667 | TotalAmt |
| Management And General | $4,667 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,188 | TotalAmt |
| Program Services | $101,188 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75 | TotalAmt |
| Management And General | $75 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $547 | TotalAmt |
| Program Services | $113 | ProgramServicesAmt |
| Management And General | $434 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,864 | TotalAmt |
| Management And General | $7,864 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,599 | TotalAmt |
| Program Services | $11,287 | ProgramServicesAmt |
| Management And General | $5,312 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $681 | TotalAmt |
| Program Services | $681 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,284 | TotalAmt |
| Program Services | $22,077 | ProgramServicesAmt |
| Management And General | $207 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,689 | TotalAmt |
| Program Services | $22,349 | ProgramServicesAmt |
| Management And General | $340 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NH ASSESSMENT | $17,340 | $17,340 | |
| SUPPLIES AND OTHER | $8,213 | $4,144 | $4,069 |
| FOOD AND DIETARY EXPENS | $5,107 | $5,107 | |
| BAD DEBT EXPENSE | $4,312 | $4,312 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,611 | TotalAmt |
| Program Services | $3,790 | ProgramServicesAmt |
| Management And General | $821 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,179,758 | TotalAmt |
| Program Services | $2,132,727 | ProgramServicesAmt |
| Management And General | $47,031 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,740 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $961,544 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $264,623 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,677 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,338,235 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,571,819 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $213,458 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,406 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $380,958 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $597,822 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,973,997 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,973,997 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,571,819 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,973,997 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $61,001 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $256,792 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $300 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,085 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,950 | CurrentTaxYearAmt |
| Total | $430,128 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,283,802 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,251,675 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,578,508 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,409,639 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $201,028 | CurrentTaxYearAmt |
| Total | $9,724,652 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,344,803 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,508,467 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,578,808 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,517,724 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $204,978 | CurrentTaxYearAmt |
| Total | $10,154,780 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $10,154,780 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,464 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,258 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,850 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,873 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $783 | CurrentTaxYearAmt |
| Total | $50,228 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,464 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,258 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,850 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,873 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $783 | CurrentTaxYearAmt |
| Total | $50,228 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,360,267 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,523,725 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,590,658 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,524,597 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $205,761 | CurrentTaxYearAmt |
| Total | $10,205,008 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99510 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99490 | PublicSupportPY509Pct |
| Investment Income CY | 0.00490 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00510 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS FILING A FINAL FORM 990 FOR THE CURRENT YEAR OF FILING. AS A RESULT, THE COLUMNS OF SCHEDULE A, PART III REPRESENT THE FOLLOWING FISCAL YEARS. 2023 COLUMN: 07/01/2023 - 10/31/2023 2022 COLUMN: 07/01/2022 - 06/30/2023 2021 COLUMN: 07/01/2021 - 06/30/2022 2020 COLUMN: 07/01/2020 - 06/30/2021 2019 COLUMN: 07/01/2019 - 06/30/2020 | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, LINE 2B: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HOLDS RESIDENT TRUST FUNDS AS DEPOSITS. THESE TRUST FUNDS ARE NOT AVAILABLE FOR USE IN DAILY OPERATIONS OF THE NURSING HOME. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VILLAGE OF ELMWOOD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 WEST WINTER AVENUE | AddressLine1Txt |
| City | ELMWOOD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 396006258 | RecipientEIN |
| IRC Section | GOVERNMENT | IRCSectionDesc |
| Cash Grant | $1,610,260 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | TRANSFER OF NET ASSETS UPON DISSOLUTION | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ALL NET ASSETS OF THE FILING ORGANIZATION WERE TRANSFERRED TO THE VILLAGE OF ELMWOOD UPON THE DATE OF DISSOLUTION. | ExplanationTxt |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | NET ASSETS OF ELMWOOD NURSING HOME INC. | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2023-10-31 | DistributionDt |
| Fair Market Value Of Asset | $1,610,260 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | NET BOOK VALUE | MethodOfFMVDeterminationTxt |
| EIN | 396006258 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VILLAGE OF ELMWOOD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 WEST WINTER AVENUE | AddressLine1Txt |
| City | ELMWOOD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | GOVERNMENT | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | Yes (1) | DirectorOfSuccessorInd |
| Employee Of Successor | Yes (1) | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2E: | PERSON(S) INVOLVED: HOLLY MALASZUK, NEIL BOLTIK, PAT GERAETS, JASON SEVERSON, PAUL UNSER, AND MARK WOLF |
| PART I, LINE 2E: | EXPLANATION OF INVOLVEMENT: HOLLY MALASZUK IS THE VILLAGE CLERK/TREASURER OF THE TRANSFEREE ORGANIZATION.NEIL BOLTIK, PAT GERAETS, JASON SEVERSON, PAUL UNSER, AND MARK WOLF ARE BOARD MEMBERS OF THE TRANSFEREE ORGANIZATION. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | THE ORGANIZATION IS FILING A FINAL RETURN AND TRANSFERED ALL ASSETS AND OPERATIONS TO THE VILLAGE OF ELMWOOD TO CONTINUE THEIR MISSION. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE NURSING HOME HAS MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE NURSING HOME'S MEMBERS ELECT THE GOVERNING BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | RECOMMENDATIONS FROM THE NURSING HOME MEMBERS MUST BE APPROVED BY THE VILLAGE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE NURSING HOME DOES NOT APPOINT ANY COMMITTEES TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED AND APPROVED BY THE TREASURER. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE NURSING HOME ANNUALLY REVIEWS UPDATED CONFLICT OF INTEREST STATEMENTS FROM MEMBERS OF THE BOARD OF DIRECTORS. ANY NOTED CONFLICTS ARE DISCUSSED, AND DURING THE YEAR, IF CONFLICTS ARE NOTED DURING VOTES, THOSE CONFLICTING MEMBERS ABSTAIN FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE NURSING HOME'S EXECUTIVE LEVEL EMPLOYEES AND KEY EMPLOYEES ARE PROVIDED UNDER THE MANAGEMENT SERVICES AGREEMENT WITH GRACE LUTHERAN FOUNDATION, INC. (AN UNRELATED NOT-FOR PROFIT ORGANIZATION WHICH SPECIALIZES IN SKILLED NURSING, LONG-TERM CARE, AND HOUSING SERVICES FOR ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY). THE CONTRACT TERMS ARE RENEWED ANNUALLY. THE BOARD OF DIRECTORS OF THE NURSING HOME, REVIEWS THE CONTRACT TERMS TO ENSURE THAT QUALITY SERVICES ARE BEING ACHIEVED AT THE LOWEST POSSIBLE COST FOR THE PROGRAMS BEING PROVIDED. THE BOARD ALSO CONSULTS WITH OTHER WISCONSIN NURSING HOME ASSOCIATION MEMBERS TO ENSURE THAT THE AMOUNTS BEING PAID ARE CONSISTENT FOR ADMINISTRATIVE SERVICES OF THOSE PAID THROUGHOUT THE REGION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE NURSING HOME MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION. |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | THE ORGANIZATION IS FILING THEIR RETURN LATE. THIS IS A FINAL YEAR RETURN AND AS A RESULT OF FINANCIAL AND OPERATIONAL TURMOIL TRANSFERRED THEIR ASSETS AND OPERATIONS TO THE VILLAGE OF ELMWOOD TO CARRYON. THE ORGANIZATION HAD PREVIOUSLY RELIED UPON CONTRACTED MANAGEMENT TO ASSIST IN COMPILING THE INFORMATION NECESSARY TO PROVIDE TO THEIR PAID PREPARER FOR A COMPLETE AND ACCURATE RETURN. WITH THE TURNOVER, THERE WAS CONFUSION OVER WHO WAS HANDLING THE FINAL YEAR RETURN. THE ORGANIZATION HAS NO REMAINING ASSETS AND REQUESTS THE IRS CONSIDER ALL THESE FACTS AND CIRCUMSTANCES IN ABATING ANY PENALTIES AND INTEREST. | ExplanationTxt |