2020-03-09T08:45:54-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 391190907 ELMWOOD NURSING HOME INC HERITAGE OF ELMWOOD ELMW 7158323003 232 E SPRINGER AVE ELMWOOD WI 54740 MARTY METTEN CEO 7158323003 2020-02-17 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-02-16 71.13.38.61 2020-02-17 11:53:33 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2020-09-23 17:36:50Z RAYMOND WEISS 3410 SKY PARK BLVD EAU CLAIRE WI 54701 2405389 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. 7 7 73 7 0 0 562 866 2256382 2390117 15978 14406 128651 0 2401573 2405389 0 0 0 0 1377846 1381125 0 0 0 900380 882169 2278226 2263294 123347 142095 3148030 3087037 949082 745994 2198948 2341043 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 0 2007228 2337554 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 PROVIDED 9,333 RESIDENT DAYS OF CARE IN FISCAL YEAR 2019. 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. 2007228 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 14 0 73 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 0 1 0 0 0 1 1 1 1 0 1 1 1 0 WI X KELLY LARSON 7158323003 3410 SKY PARK BLVD EAU CLAIRE WI 54701 X MARGE BINKOWSKI TRUSTEE 0.50 X 0 0 0 SUSAN PELZEL TRUSTEE 0.50 X 0 0 0 DONNA LIEN TRUSTEE 0.50 X 0 0 0 DONETTE STEWART TRUSTEE 0.50 X 0 0 0 NEIL BOLTIK VILLAGE BOARD REPRESENTATI 0.50 X 0 0 0 DOLORES RADTKE PRESIDENT 0.50 X X 0 0 0 DAN SCHULER VICE PRESIDENT 0.50 X X 0 0 0 JAMIE REITZ SECRETARY/TREASURER 0.50 X X 0 0 0 RANDOLPH BESTUL INTERIM CEO 10.00 30.00 X 0 12312 0 ELLEN THOMPSON ADMINISTRATOR 40.00 X 0 54381 0 MARTY METTEN COO 10.00 30.00 X 0 144724 11437 MIKE CHRISTENSEN THRU NOVEMBER CEO 10.00 30.00 X 0 226412 27772 0 437829 39209 0 0 1 0 GRACE LUTHERAN FOUNDATION INC 3410 SKY PARK BLVD EAU CLAIRE WI 54701 MANAGEMENT SERVICES 172355 1 866 866 NURSING CARE AND HOUSI 623000 2337554 2337554 RENTAL INCOME 532000 35137 35137 TRANSPORTATION REVENUE 480000 7944 7944 SENIOR MEALS PROGRAM 624210 7628 7628 1854 1854 2390117 14406 14406 2405389 2390117 0 14406 1146046 1146046 1206 1206 150592 150592 83281 83281 170005 170005 550 550 20453 20453 172410 167942 4468 2653 2653 10805 5338 5467 9853 9853 80257 52113 28144 12400 9151 3249 4513 4471 42 65908 65294 614 47256 46524 732 FOOD AND DIETARY EXPENS 100970 100970 SUPPLIES AND OTHER 83701 79224 4477 NH ASSESSMENT 69360 69360 BAD DEBT EXPENSE - PROG 11474 11474 19601 14242 5359 2263294 2007228 256066 0 1126 2909 2325119 1594323 155264 147293 18768 12838 18722 18633 3712684 2401643 629031 1311041 3148030 3087037 351596 166577 597486 579417 949082 745994 X 2198948 2341043 2198948 2341043 3148030 3087037 142095 0 X 0 1 X 1 0 X 5641 4437 2360 562 866 13866 2848438 2499351 2225061 2256382 2390117 12219349 2854079 2503788 2227421 2256944 2390983 12233215 0 0 0 12233215 49483 18463 15137 15978 14406 113467 49483 18463 15137 15978 14406 113467 2903562 2522251 2242558 2272922 2405389 12346682 0.99080 0.98810 0.00920 0.01190 X 0 0 0 0 0 0 0 0 1 383 383 0 PART II-B, LINE 1: ELMWOOD NURSING HOME INC HERITAGE OF ELMWOOD PAYS ANNUAL ASSOCIATION DUES TO LEADING AGE. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATION MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL INDUSTRY ENVRIONMENT. 7000 7000 1802793 1532704 270089 958598 868939 89659 944293 944293 1311041 2405389 0 2405389 0 2405389 2263294 0 2263294 0 2263294 0 0 0 0 0 0 0 0 0 MARTY METTEN COO 0 0 0 0 0 144724 0 0 0 0 0 144724 0 0 MIKE CHRISTENSEN THRU NOVEMBER CEO 0 226412 0 0 0 0 0 0 0 0 0 226412 0 0 PART I, LINE 3: COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL IS DETERMINED BY GRACE LUTHERAN FOUNDATION, INC. AND MANAGEMENT SERVICES FOR ELMWOOD NURSING HOME, INC. ARE PROVIDED UNDER A MANAGEMENT AGREEMENT WITH GRACE LUTHERAN FOUNDATION, INC. DAN SCHULER CURRENT OFFICER 45968 PURCHASED PROPERTY 0 SCHEDULE L, PART IV (A) NAME OF PERSON: DAN SCHULER (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: CURRENT OFFICER VICE-PRESIDENT (C) AMOUNT OF TRANSACTION: 45,968 (D) DESCRIPTION OF TRANSACTION: PURCHASED PROPERTY, LIABILITY, AND DIRECTORS AND OFFICERS INSURANCE FROM WESTBEND INSURANCE THROUGH INSURANCE AGENT DAN SCHULER (E) SHARING OF ORGANIZATION REVENUES? = NO FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 1, 2016, ELMWOOD NURSING HOME ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH GRACE LUTHERAN FOUNDATION, INC. (GLF), AN UNRELATED, NON-PROFIT, RELIGIOUS BASED SENIOR HEALTHCARE SERVICES ORGANIZATION BASED IN EAU CLAIRE, WISCONSIN. UNDER THIS AGREEMENT, GLF PROVIDES GENERAL ADMINISTRATIVE, CONSULTING, ACCOUNTING, HUMAN RESOURCES, AND FACILITY MANAGEMENT SERVICES UNDER THE DIRECTION OF THE BOARD OF DIRECTORS OF ELMWOOD NURSING HOME. UNDER THE MANGEMENT AGREEMENT, GLF IS ALSO RESPONSIBLE FOR THE SELECTION AND REVIEW OF THE ADMINISTRATOR OF ELMWOOD NURSING HOME. 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 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 A COPY OF THE FORM 990 WAS MADE AVAILABLE TO THE MEMBERS OF THE NURSING HOME'S GOVERNING BODY PRIOR TO THE SUBMISSION OF THE RETURN. THE FORM 990 WAS ALSO REVIEWED BY MANAGEMENT PRIOR TO SUBMISSION. 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 THROUGOUT 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. FORM 990 PART VII, SECTION A: EXPLANATION FOR HOURS WORKED BY OFFICERS: MIKE CHRISTENSEN AND MARTY METTEN ARE EMPLOYED BY THE MANAGEMENT SERVICES ORGANIZATION, GRACE LUTHERAN FOUNDATION, INC., AND AS SUCH A PART OF THEIR DUTIES IS TO PROVIDE MANAGEMENT AND OVERSIGHT TO ALL OF THE ENTITIES THAT GRACE LUTHERAN FOUNDATION HAS MANAGEMENT CONTRACT WITH, INCLUDING ELMWOOD NURSING HOME. PART VII OF THE FORM 990 INCLUDES AN APPROXIMATE AMOUNT OF TIME DEVOTED EACH WEEK TO THE ELMWOOD NURSING HOME, HOWEVER, THESE INDIVIDUALS OFTEN WORK WELL IN EXCESS OF THE AMOUNT OF HOURS LISTED IN ORDER TO SUPPORT AND FURTHER THE MISSION OF THE ELMWOOD NURSING HOME.