ELMWOOD NURSING HOME INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ELMWOOD NURSING HOME INC (EIN 39-1190907)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-15
- IRS object ID
- 201921359349303167
- Schema version
- 2017v2.3
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule J
- Schedule L
- Schedule O
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-15T09:32:29-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | 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 | 4890 OWEN AYRES COURT SUITE 200 | AddressLine1Txt |
| City | EAU CLAIRE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | 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 | MARTY METTEN | PersonNm |
| Person Title | COO | PersonTitleTxt |
| Phone | 7158323003 | PhoneNum |
| Signature | 2019-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HOLLY POKRANDT CPA | PreparerPersonNm |
| PTIN | P00449155 | PTIN |
| Phone | 7158323407 | PhoneNum |
| Preparation | 2019-05-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 137.26.200.211 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-05-14 | IPDt |
| IP Tm | 09:45:58 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2F3CDBAF1037015F68690DD19EBC2430D808C728 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARTY METTEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3410 SKY PARK BLVD | AddressLine1Txt |
| City | EAU CLAIRE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,401,573 | 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 |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 73 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $122 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,360 | PYContributionsGrantsAmt |
| CY Contributions Grants | $562 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,225,061 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,256,382 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,137 | PYInvestmentIncomeAmt |
| CY Investment Income | $15,978 | CYInvestmentIncomeAmt |
| PY Other Revenue | $57,491 | PYOtherRevenueAmt |
| CY Other Revenue | $128,651 | CYOtherRevenueAmt |
| PY Total Revenue | $2,300,049 | PYTotalRevenueAmt |
| CY Total Revenue | $2,401,573 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,556,376 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,377,846 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $880,363 | PYOtherExpensesAmt |
| CY Other Expenses | $900,380 | CYOtherExpensesAmt |
| PY Total Expenses | $2,436,739 | PYTotalExpensesAmt |
| CY Total Expenses | $2,278,226 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$136,690 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $123,347 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,394,101 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,148,030 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $318,500 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $949,082 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,075,601 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,198,948 | NetAssetsOrFundBalancesEOYAmt |
| 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 | 0 | SignificantChangeInd |
| Expense | $2,069,319 | ExpenseAmt |
| Revenue | $2,256,382 | 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 PROVIDED 9,268 RESIDENT DAYS OF CARE IN FISCAL YEAR 2018. 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 | $2,069,319 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | 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 | Yes (1) | 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 | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | 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 | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 73 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| DAF Excess Business Holdings | 0 | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | 0 | TaxableDistributionsInd |
| Distribution To Donor | 0 | DistributionToDonorInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| 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 | Yes (1) | 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 | 0 | 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 | Yes (1) | 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 |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KELLY LARSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7158323003 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3410 SKY PARK BLVD | AddressLine1Txt |
| City | EAU CLAIRE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| JAMIE REITZ | |||||||
| SECRETARY/TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAN SCHULER | |||||||
| VICE PRESIDENT | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOLORES RADTKE | |||||||
| PRESIDENT | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NEIL BOLTIK | |||||||
| VILLAGE BOARD REPRESENTATI | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DONETTE STEWART | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DONNA LIEN | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN PELZEL | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| MARGE BINKOWSKI | |||||||
| TRUSTEE | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| MIKE CHRISTENSEN | |||||||
| CEO | 10.00 | Yes (X) | $0 | $203,377 | $30,770 | 30.00 | |
| MARTY METTENS | |||||||
| COO | 10.00 | Yes (X) | $0 | $129,375 | $10,221 | 30.00 | |
| ELLEN THOMPSON | |||||||
| ADMINISTRATOR | 40.00 | Yes (X) | $0 | $58,853 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $391,605 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $40,991 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GRACE LUTHERAN FOUNDATION INC | |||||
| 3410 SKY PARK BLVD | EAU CLAIRE | WI | 54701 | MANAGEMENT SERVICES | $167,978 |
| GENESIS REHABILITATION SERVICES | |||||
| PO BOX 821322 | PHILADELPHIA | PA | 19182 | THERAPY SERVICES | $123,933 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $562 | AllOtherContributionsAmt |
| Total Contributions | $562 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NURSING CARE AND HOUSI | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $2,256,382 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,256,382 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,256,382 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,978 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,978 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $35,335 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $35,335 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,335 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,335 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER REVENUE | 811000 | $81,891 | $81,891 |
| TRANSPORTATION REVENUE | 480000 | $6,574 | $6,574 |
| SENIOR MEALS PROGRAM | 624210 | $4,851 | $4,851 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $93,316 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,401,573 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,401,011 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,157,702 | TotalAmt |
| Program Services | $1,157,702 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,987 | TotalAmt |
| Program Services | $133,987 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,157 | TotalAmt |
| Program Services | $86,157 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,463 | TotalAmt |
| Management And General | $167,463 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400 | TotalAmt |
| Management And General | $400 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,945 | TotalAmt |
| Management And General | $18,945 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,281 | TotalAmt |
| Program Services | $163,281 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,485 | TotalAmt |
| Management And General | $3,485 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,020 | TotalAmt |
| Program Services | $8,027 | ProgramServicesAmt |
| Management And General | $9,993 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,109 | TotalAmt |
| Management And General | $8,109 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,956 | TotalAmt |
| Program Services | $88,956 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,617 | TotalAmt |
| Program Services | $9,617 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,431 | TotalAmt |
| Program Services | $70,431 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,973 | TotalAmt |
| Program Services | $44,973 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| FOOD AND DIETARY EXPENS | $94,816 | $94,816 | |
| SUPPLIES AND OTHER | $92,462 | $92,436 | $26 |
| NH ASSESSMENT | $69,360 | $69,360 | |
| BAD DEBT EXPENSE - PROG | $19,000 | $19,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,062 | TotalAmt |
| Program Services | $30,576 | ProgramServicesAmt |
| Management And General | $486 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,278,226 | TotalAmt |
| Program Services | $2,069,319 | ProgramServicesAmt |
| Management And General | $208,907 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,104 | BOYAmt |
| EOY | $1,126 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,700,194 | BOYAmt |
| EOY | $2,325,119 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153,943 | BOYAmt |
| EOY | $155,264 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,183 | BOYAmt |
| EOY | $18,768 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,992 | BOYAmt |
| EOY | $18,722 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,964,766 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,335,735 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $505,685 | BOYAmt |
| EOY | $629,031 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,394,101 | BOYAmt |
| EOY | $3,148,030 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,626 | BOYAmt |
| EOY | $351,596 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $168,874 | BOYAmt |
| EOY | $597,486 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $318,500 | BOYAmt |
| EOY | $949,082 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,601 | BOYAmt |
| EOY | $2,198,948 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,601 | BOYAmt |
| EOY | $2,198,948 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,394,101 | BOYAmt |
| EOY | $3,148,030 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $123,347 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| 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 | $5,051 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,641 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,437 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,360 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $562 | CurrentTaxYearAmt |
| Total | $18,051 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,721,794 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,848,438 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,499,351 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,225,061 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,256,382 | CurrentTaxYearAmt |
| Total | $12,551,026 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,726,845 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,854,079 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,503,788 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,227,421 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,256,944 | CurrentTaxYearAmt |
| Total | $12,569,077 | 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 | $12,569,077 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $52,180 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $49,483 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,463 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,137 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,978 | CurrentTaxYearAmt |
| Total | $151,241 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $52,180 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $49,483 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,463 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,137 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,978 | CurrentTaxYearAmt |
| Total | $151,241 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,779,025 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,903,562 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,522,251 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,242,558 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,272,922 | CurrentTaxYearAmt |
| Total | $12,720,318 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98810 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98610 | PublicSupportPY509Pct |
| Investment Income CY | 0.01190 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01390 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $383 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $383 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,000 | OtherCostOrOtherBasisAmt |
| Book Value | $7,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,795,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,498,115 | DepreciationAmt |
| Book Value | $297,195 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $928,246 | OtherCostOrOtherBasisAmt |
| Depreciation | $837,620 | DepreciationAmt |
| Book Value | $90,626 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $234,210 | OtherCostOrOtherBasisAmt |
| Book Value | $234,210 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $629,031 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $2,402,575 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,002 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $1,002 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,401,573 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,401,573 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,278,226 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,278,226 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,278,226 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE CHRISTENSEN | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $203,377 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $203,377 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAN SCHULER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | CURRENT OFFICER | RelationshipDescriptionTxt |
| Transaction | $44,197 | TransactionAmt |
| Transaction | PURCHASED PROPERTY | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | (A) NAME OF PERSON: DAN SCHULER (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: CURRENT OFFICER VICE-PRESIDENT (C) AMOUNT OF TRANSACTION: 44,197 (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 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | LATE FILED RETURN DUE TO CCH SOFTWARE OUTAGE | ExplanationTxt |