2025-04-16T07:46:09-05:00 2023-10-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-07-01 391190907 ELMWOOD NURSING HOME INC HERITAGE OF ELMWOOD ELMW 7158323003 232 E SPRINGER AVE ELMWOOD WI 54740 HOLLY MALASZUK SECRETARY/TREASURER 7156393792 2025-04-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-04-13 2023 2025-03-06 01:10:19Z X HOLLY MALASZUK 232 E SPRINGER AVE ELMWOOD WI 54740 205761 0 X HTTP://HERITAGEOFELMWOOD.COM/ X WISCONSIN NO 1972 WI TO RESPOND TO THE SPIRITUAL, PHYSICAL, AND SOCIAL NEEDS OF PEOPLE IN ORDER TO ENHANCE HUMAN DIGNITY AND GROWTH BY PROVIDING HIGH QUALITY SERVICE. X 7 7 0 8 0 0 108085 3950 2409639 201028 4121 783 0 0 2521845 205761 0 1610260 0 0 1344300 330079 0 0 0 1423068 239419 2767368 2179758 -245523 -1973997 2571819 0 597822 0 1973997 0 X TO RESPOND TO THE SPIRITUAL, PHYSICAL, AND SOCIAL NEEDS OF PEOPLE IN ORDER TO ENHANCE HUMAN DIGNITY AND GROWTH BY PROVIDING HIGH QUALITY SERVICE. 0 1 2132727 1610260 201028 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. 2132727 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 0 1 1 1 0 X HOLLY MALASZUK 7156393792 323 W WINTER AVENUE ELMWOOD WI 54740 X NEIL BOLTIK PRESIDENT 0.50 X X 0 0 0 SEPTEMBER PODOLI SECRETARY/TREASURER (THRU 08/23) 0.50 X X 0 0 0 JOSH BLESKACEK TRUSTEE 0.50 X 0 0 0 PAT GERAETS TRUSTEE 0.50 X 0 0 0 JASON SEVERSON TRUSTEE 0.50 X 0 0 0 PAUL UNSER TRUSTEE 0.50 X 0 0 0 LUKE WEIX TRUSTEE 0.50 X 0 0 0 MARK WOLF TRUSTEE 0.50 X 0 0 0 DAVID WEST ADMINISTRATOR 40.00 X 0 0 0 0 0 0 0 0 0 0 0 3950 3950 NURSING CARE & HOUSING 623000 200955 200955 73 73 201028 783 783 205761 201028 0 783 1610260 1610260 285498 285498 4026 4026 16002 16002 24553 24553 23212 23212 30 30 4667 4667 101188 101188 75 75 547 113 434 7864 7864 16599 11287 5312 681 681 22284 22077 207 22689 22349 340 NH ASSESSMENT 17340 17340 SUPPLIES AND OTHER 8213 4144 4069 FOOD AND DIETARY EXPENS 5107 5107 BAD DEBT EXPENSE 4312 4312 4611 3790 821 2179758 2132727 47031 0 1740 0 961544 0 0 264623 0 0 0 0 0 5677 0 0 0 1338235 0 0 0 0 0 0 2571819 0 213458 0 3406 0 380958 0 597822 0 X 1973997 0 1973997 0 2571819 0 -1973997 0 X 0 0 0 X 61001 256792 300 108085 3950 430128 2283802 2251675 2578508 2409639 201028 9724652 2344803 2508467 2578808 2517724 204978 10154780 0 0 0 10154780 15464 15258 11850 6873 783 50228 15464 15258 11850 6873 783 50228 2360267 2523725 2590658 2524597 205761 10205008 0.99510 0.99490 0.00490 0.00510 X FORM 990 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 0 1 X 0 PART IV, LINE 2B: THE ORGANIZATION HOLDS RESIDENT TRUST FUNDS AS DEPOSITS. THESE TRUST FUNDS ARE NOT AVAILABLE FOR USE IN DAILY OPERATIONS OF THE NURSING HOME. 1 VILLAGE OF ELMWOOD 323 WEST WINTER AVENUE ELMWOOD WI 54740 396006258 GOVERNMENT 1610260 0 TRANSFER OF NET ASSETS UPON DISSOLUTION 1 0 PART I, LINE 2: ALL NET ASSETS OF THE FILING ORGANIZATION WERE TRANSFERRED TO THE VILLAGE OF ELMWOOD UPON THE DATE OF DISSOLUTION. NET ASSETS OF ELMWOOD NURSING HOME INC. 2023-10-31 1610260 NET BOOK VALUE 396006258 VILLAGE OF ELMWOOD 323 WEST WINTER AVENUE ELMWOOD WI 54740 GOVERNMENT 1 1 0 0 1 1 1 1 0 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. 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. 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.