ELMWOOD NURSING HOME INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: ELMWOOD NURSING HOME INC (EIN 39-1190907)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-03-22
IRS object ID: 201210829349300121
Schema version: 2010v3.4
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	2012-03-22T12:20:49-05:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

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	2010-07-01	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	2012-03-21	DateSigned

Preparer Preparer

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

Field	Value	IRS element (for citing)
Tax Year	2010	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	2660830	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	94	TotalNbrEmployees
Total Nbr Volunteers	5	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	5374	ContributionsGrantsPriorYear
Contributions Grants Current Year	6714	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	2492537	ProgramServiceRevenuePriorYear
Program Service Revenue CY	2601824	ProgramServiceRevenueCY
Investment Income Prior Year	18624	InvestmentIncomePriorYear
Investment Income Current Year	19527	InvestmentIncomeCurrentYear
Other Revenue Prior Year	32805	OtherRevenuePriorYear
Other Revenue Current Year	32765	OtherRevenueCurrentYear
Total Revenue Prior Year	2549340	TotalRevenuePriorYear
Total Revenue Current Year	2660830	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	1745499	SalariesEtcPriorYear
Salaries Etc Current Year	1693817	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	777132	OtherExpensePriorYear
Other Expenses Current Year	812603	OtherExpensesCurrentYear
Total Expenses Prior Year	2522631	TotalExpensesPriorYear
Total Expenses Current Year	2506420	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	26709	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	154410	RevenuesLessExpensesCY
Total Assets BOY	1963860	TotalAssetsBOY
Total Assets EOY	2228974	TotalAssetsEOY
Total Liabilities BOY	407042	TotalLiabilitiesBOY
Total Liabilities EOY	517746	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1556818	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1711228	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	2216070	Expense
Revenue	2601824	Revenue
Description	NURSING HOME CARE - PROVIDES NURSING HOME CARE TO ITS RESIDENTS.	Description
Total Program Service Expense	2216070	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
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
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	94	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
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
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	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
DEB FEILER
PRESIDENT	0.50	X	X	0	0	0
DELORES RADTKE
BOARD MEMBER	0.50	X		0	0	0
DAN SCHULER
SEC - TREAS.	0.50	X	X	0	0	0
PHIL DZUBAY
VICE PRESIDENT	0.50	X	X	0	0	0
JULIE COGNETTA
BOARD MEMBER	0.50	X		0	0	0
TOM WEBER
BOARD MEMBER	0.50	X		0	0	0
TRISHA KNOPS
BOARD MEMBER	0.50	X		0	0	0
RODNEY J GILLES
ADMINISTRATOR	40.00		X	65841	0	1975

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	65841	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	1975	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	6714	AllOtherContributions
Total Contributions	6714	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NURSING CARE AND HOUSI	623000	2545894	2545894
OTHER INCOME	623000	55930	55930

Field	Value	IRS element (for citing)
Total Program Service Revenue	2601824	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	19527	TotalRevenueColumn
Exclusion	$19,527	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	32765	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	32765	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	32765	TotalRevenueColumn
Exclusion	$32,765	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	2660830	TotalRevenueColumn
Related Or Exempt Function Income	2601824	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$52,292	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	65841	Total
Management And General	65841	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	1433950	Total
Program Services	1418267	ProgramServices
Management And General	15683	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	82869	Total
Program Services	80894	ProgramServices
Management And General	1975	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	111157	Total
Program Services	111157	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	7611	Total
Program Services	7611	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	90446	Total
Program Services	90446	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	93014	Total
Management And General	93014	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
PLANT OPERATIONS	134646	134646
DIETARY	128045	128045
ADMINISTRATIVE	118815	4978	113837
PROVIDER ASSESSMENT	93840	93840
NURSING	57925	57925

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	88261	Total
Program Services	88261	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	2506420	Total
Program Services	2216070	ProgramServices
Management And General	290350	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	4873	BOY
EOY	5004	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1065400	BOY
EOY	1303569	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	233055	BOY
EOY	190206	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	42127	BOY
EOY	43531	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	2405690	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	1767368	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	569224	BOY
EOY	638322	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	41264	BOY
EOY	40425	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	1963860	BOY
EOY	2228974	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	262051	BOY
EOY	258734	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	144991	BOY
EOY	259012	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	407042	BOY
EOY	517746	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	1556818	BOY
EOY	1711228	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1556818	BOY
EOY	1711228	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1963860	BOY
EOY	2228974	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	154410	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
FS Audited	0	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
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	6306	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	7621	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	8531	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	5374	CurrentTaxYearMinus1Year
Current Tax Year	6714	CurrentTaxYear
Total	34546	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2839106	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2777439	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2781717	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2525342	CurrentTaxYearMinus1Year
Current Tax Year	2601824	CurrentTaxYear
Total	13525428	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2845412	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2785060	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2790248	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2530716	CurrentTaxYearMinus1Year
Current Tax Year	2608538	CurrentTaxYear
Total	13559974	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	13559974	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	66660	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	28163	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	15123	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	18624	CurrentTaxYearMinus1Year
Current Tax Year	52292	CurrentTaxYear
Total	180862	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	66660	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	28163	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	15123	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	18624	CurrentTaxYearMinus1Year
Current Tax Year	52292	CurrentTaxYear
Total	180862	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2912072	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2813223	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2805371	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2549340	CurrentTaxYearMinus1Year
Current Tax Year	2660830	CurrentTaxYear
Total	13740836	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.98680	PublicSupportPercentage509
Prior Year Support Percentage	0.98710	PriorYearSupportPercentage
Investment Income Percentage	0.01320	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.01290	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	1655399	OtherCostOrOtherBasis
Depreciation	1183415	Depreciation
Book Value	471984	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	743291	OtherCostOrOtherBasis
Depreciation	583953	Depreciation
Book Value	159338	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	638322	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	99666	AmountOfTransaction
Description Of Transaction	PURCHASED PROPERTY, LIABILITY, WORKERS COMPENSATION, AND DIRECTORS AND OFFICERS INSURANCE FROM UNITED HEARTLAND THROUGH INSURANCE AGENT DAN SHULER.	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
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.
	THE BOARD OF DIRECTORS REVIEWS THE POLICY ANNUALLY AND THEY DISCLOSE ANY CONFLICTS AT THAT TIME.	FORM 990, PART VI, SECTION B, LINE 12C
	THE BOARD OF DIRECTORS ANNUALLY REVIEWS COMPENSATION AMOUNTS FOR THE EMPLOYEES OF THE ORGANIZATION.	FORM 990, PART VI, SECTION B, LINE 15
	ELMWOOD NURSING HOME, INC. MAKES ITS 990 AVAILABLE UPON REQUEST.	FORM 990, PART VI, SECTION C, LINE 19
	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.	FORM 990, PART XII, LINE 2C: