ELMWOOD NURSING HOME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: ELMWOOD NURSING HOME INC (EIN 39-1190907)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2013-11-14
IRS object ID: 201313189349303001
Schema version: 2012v2.1
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 D
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-14T11:00:53-06:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	391277627	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BAUMAN ASSOCIATES LTD	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1225	AddressLine1
City	EAU CLAIRE	City
State	WI	State
ZIP Code	547021225	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	391190907	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ELMWOOD NURSING HOME INC	BusinessNameLine1
Business Name Line2	HERITAGE OF ELMWOOD NURSING HOME	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	ELMW	NameControl
Phone	7156392911	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	232 E SPRINGER AVE	AddressLine1
City	ELMWOOD	City
State	WI	State
ZIP Code	54740	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	RODNEY GILLES	Name
Title	ADMINISTRATOR	Title
Phone	7156392911	Phone
Date Signed	2013-10-29	DateSigned

Preparer Preparer

Field	Value	IRS element (for citing)
Name	MICHAEL R MAI CPA	Name
PTIN	P00004966	PTIN
Phone	7158342001	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	RODNEY GILLES	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	232 E SPRINGER AVE	AddressLine1
City	ELMWOOD	City
State	WI	State
ZIP Code	54740	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	2864307	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Other	X	TypeOfOrganizationOther
Type Of Org Other Description	WISCONSIN NON STOCK, NOT FOR PROFIT	TypeOfOrgOtherDescription
Year Formation	1972	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE NURSING HOME CARE FOR THE COMMUNITY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	6	NbrIndependentVotingMembers
Total Nbr Employees	92	TotalNbrEmployees
Total Nbr Volunteers	43	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	6016	ContributionsGrantsPriorYear
Contributions Grants Current Year	3573	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	2834850	ProgramServiceRevenuePriorYear
Program Service Revenue CY	2811005	ProgramServiceRevenueCY
Investment Income Prior Year	21158	InvestmentIncomePriorYear
Investment Income Current Year	16130	InvestmentIncomeCurrentYear
Other Revenue Prior Year	33139	OtherRevenuePriorYear
Other Revenue Current Year	33599	OtherRevenueCurrentYear
Total Revenue Prior Year	2895163	TotalRevenuePriorYear
Total Revenue Current Year	2864307	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	1786880	SalariesEtcPriorYear
Salaries Etc Current Year	1822022	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	839171	OtherExpensePriorYear
Other Expenses Current Year	870960	OtherExpensesCurrentYear
Total Expenses Prior Year	2626051	TotalExpensesPriorYear
Total Expenses Current Year	2692982	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	269112	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	171325	RevenuesLessExpensesCY
Total Assets BOY	2485612	TotalAssetsBOY
Total Assets EOY	2647896	TotalAssetsEOY
Total Liabilities BOY	505272	TotalLiabilitiesBOY
Total Liabilities EOY	496231	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1980340	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	2151665	NetAssetsOrFundBalancesEOY
Mission Description	PROVIDING NURSING HOME CARE TO THE PEOPLE IN THE COMMUNITY.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	2392648	Expense
Revenue	2811005	Revenue
Description	NURSING HOME CARE - PROVIDES NURSING HOME CARE TO ITS RESIDENTS.	Description
Total Program Service Expense	2392648	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	0	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	1	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	13	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	92	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	7	NbrVotingGoverningBodyMembers
Number Independent Voting Members	6	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	0	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	0	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ADMINISTRATOR - NURSING HOME	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	7156392911	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	232 E SPRINGER AVE	AddressLine1
City	ELMWOOD	City
State	WI	State
ZIP Code	54740	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
DEB FEILER
PRESIDENT	0.50	X	0	0	0
DELORES RADTKE
BOARD MEMBER	0.50	X	0	0	0
DAN SCHULER
SEC - TREAS.	0.50	X	0	0	0
PHIL DZUBAY
VICE PRESIDENT	0.50	X	0	0	0
NEIL BOLTIK
BOARD MEMBER	0.50	X	0	0	0
TOM WEBER
BOARD MEMBER	0.50	X	0	0	0
DONNA LIEN
BOARD MEMBER	0.50	X	0	0	0
RODNEY J GILLES
ADMINISTRATOR	40.00		69367	0	2081	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	69367	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	2081	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
All Other Contributions	3573	AllOtherContributions
Total Contributions	3573	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NURSING CARE AND HOUSI	623000	2739726	2739726
OTHER INCOME	623000	71279	71279

Field	Value	IRS element (for citing)
Total Program Service Revenue	2811005	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	16130	TotalRevenueColumn
Exclusion	$16,130	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	33599	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	33599	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	33599	TotalRevenueColumn
Exclusion	$33,599	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	2864307	TotalRevenueColumn
Related Or Exempt Function Income	2811005	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$49,729	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	69367	Total
Management And General	69367	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	1523889	Total
Program Services	1506555	ProgramServices
Management And General	17334	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	111088	Total
Program Services	109007	ProgramServices
Management And General	2081	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	117678	Total
Program Services	117678	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	9357	Total
Program Services	9357	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	94707	Total
Program Services	94707	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	92248	Total
Management And General	92248	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
DIETARY	149331	149331
PLANT OPERATIONS	146417	146417
ADMINISTRATIVE	124475	5171	119304
PROVIDER ASSESSMENT	93840	93840

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	160585	Total
Program Services	160585	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	2692982	Total
Program Services	2392648	ProgramServices
Management And General	300334	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	4770	BOY
EOY	4651	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1527402	BOY
EOY	1685617	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	246961	BOY
EOY	252320	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	7917	BOY
EOY	7917	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	38275	BOY
EOY	44782	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	2571779	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	1958170	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	619862	BOY
EOY	613609	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	40425	BOY
EOY	39000	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	2485612	BOY
EOY	2647896	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	271702	BOY
EOY	285014	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	233570	BOY
EOY	211217	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	505272	BOY
EOY	496231	EOY

Field	Value	IRS element (for citing)
Do Not Follow SFAS117	X	DoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Field	Value	IRS element (for citing)
BOY	1980340	BOY
EOY	2151665	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1980340	BOY
EOY	2151665	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2485612	BOY
EOY	2647896	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	171325	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	1	AccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
FS Audited	0	FSAudited
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	8531	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	5374	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	6714	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	6016	CurrentTaxYearMinus1Year
Current Tax Year	3573	CurrentTaxYear
Total	30208	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2781717	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2525342	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2601824	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2834850	CurrentTaxYearMinus1Year
Current Tax Year	2811004	CurrentTaxYear
Total	13554737	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2790248	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2530716	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2608538	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2840866	CurrentTaxYearMinus1Year
Current Tax Year	2814577	CurrentTaxYear
Total	13584945	Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Amts From Subst Contributors AmtsFromSubstContributors

Field	Value	IRS element (for citing)
Total	0	Total

Support From DQ Ps Etc SupportFromDQPsEtc

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Public Support Total509	13584945	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	15123	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	18624	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	52292	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	54297	CurrentTaxYearMinus1Year
Current Tax Year	49729	CurrentTaxYear
Total	190065	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	15123	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	18624	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	52292	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	54297	CurrentTaxYearMinus1Year
Current Tax Year	49729	CurrentTaxYear
Total	190065	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2805371	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2549340	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2660830	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2895163	CurrentTaxYearMinus1Year
Current Tax Year	2864306	CurrentTaxYear
Total	13775010	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.98620	PublicSupportPercentage509
Prior Year Support Percentage	0.98770	PriorYearSupportPercentage
Investment Income Percentage	0.01380	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.01230	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	7000	OtherCostOrOtherBasis
Book Value	7000	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1760964	OtherCostOrOtherBasis
Depreciation	1299726	Depreciation
Book Value	461238	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	803815	OtherCostOrOtherBasis
Depreciation	658444	Depreciation
Book Value	145371	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	613609	TotalOfBookValueLandBuildings

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	DAN SCHULER	NamePerson

Field	Value	IRS element (for citing)
Relationship	CURRENT OFFICER SECRETARY - TREASURER	Relationship
Amount Of Transaction	92248	AmountOfTransaction
Description Of Transaction	PURCHASED PROPERTY, LIABILITY, WORKERS COMPENSATION INSURANCE, AND DIRECTORS AND OFFICERS INSURANCE FROM UNITED HEARTLAND THROUGH INSURANCE AGENT DAN SCHULER.	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 6	THE VILLAGE OF ELMWOOD IS THE ONLY MEMBER OF THE ORGANIZATON. THE VILLAGE APPOINTS 7 BOARD MEMBERS FOR THE ELMWOOD NURSING HOME, INC.
FORM 990, PART VI, SECTION A, LINE 7A	THE ORGANIZATION'S MEMBERS ELECT THE GOVERNING BOARD.
FORM 990, PART VI, SECTION A, LINE 8B	THE ORGANIZATION DOES NOT APPOINT ANY COMMITTEES TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11	THE BOARD OF DIRECTORS AND RODNEY GILLES WILL REVIEW THE 990 PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE BOARD OF DIRECTORS REVIEWS THE POLICY ANNUALLY AND THEY DISCLOSE ANY CONFLICTS AT THAT TIME.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS ANNUALLY REVIEWS COMPENSATION AMOUNTS FOR THE EMPLOYEES OF THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19	ELMWOOD NURSING HOME, INC. MAKES ITS 990 AVAILABLE UPON REQUEST.
FORM 990, PART XII, LINE 2C:	THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE COMPILATION OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. NO CHANGES HAVE BEEN MADE SINCE PRIOR YEAR.