2018-04-05T10:01:10-05:00 2017-05-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2016-06-01 431425356 CITIZENS MEMORIAL HEALTH CARE FOUNDATION % RENEE MEYER CITI 4173266000 1500 N OAKLAND AVENUE BOLIVAR MO 65613 DONALD J BABB EXECUTIVE DIRECTOR 4173266000 2018-02-09 true Brian D Todd P00422601 4178658701 167.68.126.162 43032920180955000073 2018-04-05 P FAE652D3A4BDE2557C5160C671A5713CE4EFC6A6 AE6E5E46D41BC60DF08B4BEE75B34EFCBA1C7A6F 2016 2021-01-29 14:40:06Z DONALD J BABB 1500 N OAKLAND AVENUE BOLIVAR MO 65613 47763610 false X WWW.CITIZENSMEMORIAL.COM X 1986 MO THE ORGANIZATION CARES FOR EVERY GENERATION THROUGH EXCEPTIONAL SERVICES BY LEADING PHYSICIANS AND A COMPASSIONATE HEALTH TEAM. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 8 6 1025 96 0 0 160804 460170 45367861 46546395 950849 62153 -66990 381823 46412524 47450541 103434 115346 0 0 26112262 27352822 0 0 0 18808683 18714274 45024379 46182442 1388145 1268099 43091152 46072269 26161939 27652615 16929213 18419654 X TO SUPPORT AND ASSIST CITIZENS MEMORIAL HOSPITAL DISTRICT, OR ITS SUCCESSORS, OR ANY HEALTH CARE INSTITUTION WITH WHICH IT MAY MERGE. false false 25690526 34400660 PROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 111,830 RESIDENT DAYS) IN SKILLED FACILITIES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 3125186 4215670 PROVIDE HOME CHORE SERVICES TO PEOPLE LIVING AT HOME BUT UNABLE TO COMPLETELY CARE FOR THEMSELVES. THROUGH HOMEMAKER PLUS, 16,456 SERVICE UNITS WERE PROVIDED THROUGH LIGHT HOUSEKEEPING, LAUNDRY, SHOPPING AND RESPITE CARE SERVICES. DURING THE FISCAL YEAR, HOME HEALTH VISITS TOTALED 11,094 AND HOSPICE PATIENT DAYS WERE 15,114. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 1187075 1589100 PROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 26,438 RESIDENT DAYS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 5900686 115346 6340965 35903473 true true false true false false false false true false true false false false true false false true false false false false false false true false false false true true true false false false false false false false false false false false false false false false true true false false false true 99 0 true 1025 true false false false false false true true false false false false X 8 6 true false false false false false false true true false false true true true true true true false false true false X RENEE MEYER 4173286258 1500 NORTH OAKLAND AVE BOLIVAR MO 65613 X DONALD J BABB EXECUTIVE DIRECTOR 20.0 40.0 X X 162327 416609 20628 DAVE STRADER BOARD PRESIDENT 1.0 1.0 X X 0 0 0 BRAD GREGORY BOARD VICE PRESIDENT 1.0 1.0 X X 0 0 0 D MICHEALE MEENTS BOARD MEMBER 1.0 1.0 X 0 0 0 DEREK HUNTER BOARD MEMBER 1.0 1.0 X 0 0 0 NEALE JOHNSON BOARD MEMBER 1.0 1.0 X 0 0 0 RUSSEL PAYNE BOARD MEMBER 1.0 1.0 X 0 0 0 WILLIAM DONNELL BOARD MEMBER/PHYSICIAN 1.0 45.0 X 1200 198430 14594 CATHERINE S MOLDER BOARD SECRETARY-NONVOTING 1.0 45.0 X 0 104444 10786 GARY FULBRIGHT BOARD TREASURER-NONVOTING 1.0 45.0 X 0 292391 19928 RENEE M MEYER DIRECTOR OF FINANCE 45.0 1.0 X 205337 0 11336 KENNETH SCHANDA DIRECTOR OF LTC REHAB 45.0 0.0 X 130585 0 8637 THERESA DILL ADMINISTRATOR 45.0 0.0 X 104977 0 8154 TIM FRANCKA ADMIN DIRECTOR-LTC EAST 45.0 0.0 X 141220 0 11969 CHRIS MCBRATNEY ADMIN DIRECTOR-LTC WEST 45.0 0.0 X 130732 0 19708 876378 1011874 125740 6 false true false BKD LLP 910 E ST LOUIS STREET SPRINGFIELD MO 65806 CONSULTING/AUDIT/TAX 178238 MORELOCK-ROSS BUILDERS INC CONSTR CONTRACTOR 210058 BP BUILDERS LLC CONSTR CONTRACTOR 718258 SHELENHAMER CONSTRUCTION LLC CONSTR CONTRACTOR 258945 DEWITT ASSOC INC CONSTR CONTRACTOR 380071 8 102382 357788 460170 NET PATIENT SERVICE REVENUE 623000 44448611 44448611 RENT INCOME 531120 1378970 1378970 MANAGEMENT FEE 623000 150000 150000 CAFETERIA 722514 135903 135903 TRANSIT 900099 117470 117470 315441 315441 46546395 61734 61734 0 0 661762 141023 520739 0 520739 520739 419 419 419 419 37987 102382 172046 -134059 -134059 0 0 0 0 0 0 LOSS ON EXTINGUISHMENT OF DEBT 900099 -4857 -4857 -4857 47450541 46546395 443976 0 0 115346 115346 0 0 381367 381367 0 20203116 17317090 2886026 617465 456273 161192 4548997 3337071 1211926 1601877 1187109 414768 2154564 68592 2085972 18657 18657 164925 164925 0 0 0 356157 345132 11025 133179 133179 2988874 2193660 795214 284696 71949 212747 0 1632458 1123532 508926 358508 144328 214180 0 54387 35794 18593 1255517 894218 361299 0 1810191 1289274 520917 97477 2780 94697 MEDICAL SUPPLIES & DRUGS 4295224 4295224 PROVIDER TAX & FEES 2485101 2485101 BAD DEBT 422272 422272 LICENSES, DUES, SUBSCRIPTIONS 65318 65318 136769 118728 18041 46182442 35903473 10278969 0 596646 913570 3315791 2730984 22892 14359 3542495 3723456 0 0 0 0 0 0 108281 284353 296671 366158 67370349 33039954 31809162 34330395 1982263 2158687 428160 473433 0 0 983286 983286 5505 93588 43091152 46072269 4484120 4911464 0 39702 110486 170549 12665000 12545000 45072 43838 0 0 8292682 9662761 0 3912 564579 275389 26161939 27652615 X 15341535 16700579 1587678 1719075 0 0 16929213 18419654 43091152 46072269 X 1268099 177069 45273 X false true X true false X 191699 405354 244003 160804 460170 1462030 37850394 42747132 44523921 45367861 46546395 217035703 0 0 0 38042093 43152486 44767924 45528665 47006565 218497733 10000 5000 15000 0 10000 5000 15000 218482733 633291 632097 632124 816333 723496 3437341 1487 1482 834 26013 29816 634778 633579 632958 842346 723496 3467157 0 0 38676871 43786065 45400882 46371011 47730061 221964890 0.98431 0.97500 0.01562 0.02470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1409 1409 false SCHEDULE C, PART II-B, QUESTION 1(I) OTHER LOBBY ACTIVITIES: THE ORGANIZATION PAYS ANNUAL DUES TO THE MISSOURI HEALTH CARE ASSOCIATION (MHCA) AND THE AMERICAN HEALTH CARE ASSOCIATION (AHCA). A PORTION OF THESE DUES ARE ALLOCABLE TO LOBBYING: $872 MHCA AND $537 AHCA. false true X 5074769 5074769 51592592 27714898 23877694 257510 138331 119179 7783188 4181032 3602156 2662290 1005693 1656597 34330395 0 DUE TO RELATED PARTY 275389 275389 47699032 31527 47931 79458 47619574 -169033 -169033 47450541 46339988 272892 272892 46067096 115346 115346 46182442 SCHEDULE D, PART IV, LINE 2B ESCROW ACCOUNT LIABILITY THE FOUNDATION IS THE TRUSTEE OF $43,838 AND $45,072, RESPECTIVELY, AT MAY 31, 2017 AND 2016, IN FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS. THE FOUNDATION HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THE BANK ACCOUNTS AND THE DISTRIBUTION OF THE FUNDS TO RESIDENTS. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITION MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $ 118,004 NET ASSETS RELEASED FROM RESTRICTION (115,346) SCHOLARSHIPS GRANTED 45,273 CHANGE IN EQUITY INVESTMENT ----------- 47,931 SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (141,023) RENTAL EXPENSE (132,288) SPECIAL EVENT EXPENSE 55,897 TEMPORARILY RESTRICTED CONTRIBUTIONS 31,322 TEMPORARILY RESTRICTED INVESTMENT INCOME 16,640 SCHOLARSHIPS REFUNDED 419 GAIN ON SALE OF FIXED ASSETS ---------- $ (169,033) SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ 141,023 RENTAL EXPENSE 132,288 SPECIAL EVENT EXPENSE ( 419) GAIN ON SALE OF FIXED ASSETS ---------- $ 272,892 SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 115,346 SCHOLARSHIPS GRANTED BURGUNDY BALL 95283 65864 29419 5640 38794 37693 50161 GOLF TOURNAMENT 45086 36518 8568 920 16801 8568 5348 8121 0 140369 102382 37987 920 16801 14208 44142 37693 58282 172046 -134059 true VARIOUS SCHOLARHIPS AWARDED 40 83434 CANCER PATIENT ASSISTANCE 335 31767 SCHEDULE I, PART I, LINE 2 & PART III, LINE 1 GRANT MONITORING: CITIZENS MEMORIAL HEALTH CARE FOUNDATION HAS A MEDICAL EXCELLENCE SCHOLARSHIP COMMITTEE MADE UP OF BOARD MEMBERS, EMPLOYEES AND COMMUNITY MEMBERS. APPLICATIONS FOR THE SCHOLARSHIP MUST BE SUBMITTED EACH YEAR BY MARCH 1. THE COMMITTEE DETERMINES WHO THE SCHOLARSHIPS ARE AWARDED TO. IF THE AWARDED DOES NOT ENROLL IN A MEDICAL RELATED CLASS TIMELY, THE SCHOLARSHIP IS WITHDRAWN. MANY OF THE PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL AND NOT THE INDIVIDUAL. X true true false false false false false true false false false DONALD J BABB EXECUTIVE DIRECTOR 129019 375676 33308 3159 0 37774 1167 9914 0 9547 163494 436070 0 0 GARY FULBRIGHT BOARD TREASURER-NONVOTING 0 225148 0 23263 0 43980 0 10536 0 9392 0 312319 0 0 RENEE M MEYER DIRECTOR OF FINANCE 161546 0 27149 0 16642 0 7122 0 4214 0 216673 0 0 0 WILLIAM DONNELL BOARD MEMBER/PHYSICIAN 1200 195188 0 2078 0 1164 0 8244 0 6350 1200 213024 0 0 TIM FRANCKA ADMIN DIRECTOR-LTC EAST 126861 0 3428 0 10931 0 5534 0 6435 0 153189 0 0 0 CHRIS MCBRATNEY ADMIN DIRECTOR-LTC WEST 119875 0 2397 0 8460 0 5306 0 14402 0 150440 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: THE ORGANIZATION PAYS ANNUAL DUES FOR A COUNTRY CLUB MEMBERSHIP FOR THE FOLLOWING INDIVIDUALS: $ 1,826 TIM FRANCKA $ 1,826 RENEE MEYER $ 1,826 KENNETH SCHANDA THESE AMOUNTS ARE INCLUDED IN THE EMPLOYEES W-2 AS TAXABLE WAGES. SCHEDULE J, PART I, LINE 3 CRITERIA TO ESTABLISH EXECUTIVE DIRECTOR COMPENSATION: THE FOUNDATION'S EXECUTIVE DIRECTOR, DONALD BABB, IS PAID THROUGH CITIZENS MEM HOSPITAL DISTRICT. AT THE DISTRICT LEVEL, HIS COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS USING COMPARABLE STATISTIC FOR SIMILAR POSITIONS IN THE HEALTHCARE INDUSTRY. SCHEDULE J, PART I, LINE 6A CONTINGENT COMPENSATION: IN FY 2017, THE FOUNDATION'S BOARD APPROVED TO PAY OUT BONUSES AT 10% OF NET INCOME. THE BONUS IS ALLOCATED TO MANAGEMENT AND STAFF. DONALD BABB AND RENEE MEYER'S ALLOCATION OF THIS BONUS IS SHOWN IN SCHEDULE J, PART II, COLUMN B(II). A INDUSTRIAL DVLP AUTH OF DALLAS COUNTY 431546885 2014-02-25 5940000 REFUND SERIES 2004 REV BONDS false false false B INDUSTRIAL DVLP AUTH OF THE CITY OF ELDORDO SPRGS 260025115 2012-01-27 2680000 REFUND SERIES 2001 REV BONDS false false false C INDUSTRIAL DVLP AUTH OF POLK COUNTY 010912805 2014-02-25 6385000 REFUND SERIES 2004 REV BONDS/ACQUI false false false A 0 0 5940000 0 0 0 0 0 0 5940000 0 0 2014 true false true true B 0 0 2680000 0 0 0 0 0 0 2680000 0 0 2012 true false true true C 0 0 6385000 0 0 0 0 0 0 6385000 0 0 2014 true false true true A false false false false 0 false false false true B 0 false false true C false false false false 0 false false false true A false true false false false false 0 false 0 false false B false true false false false false 0 false 0 false false C false true false false false false 0 false 0 false false A true B true C true FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: THE ORGANIZATION WAS CREATED TO SUPPORT CMH HOSPITAL DISTRICT THROUGH LONG TERM CARE SERVICES SUCH AS SKILLED NURSING FACILITIES, RESIDENTIAL CARE FACILITIES, AND INDEPENDENT LIVING APARTMENTS, AND TO PROVIDE SERVICES TO THE LOCAL RURAL COMMUNITIES SUCH AS MEDICAL EQUIPMENT AND SUPPLIES, HOME HEALTH AND HOSPICE, HEALTH TRANSPORTATION AND HOMEMAKER CHORE SERVICES. FORM 990, PART I, LINE 6 NUMBER OF VOLUNTEERS: THE TOTAL NUMBER OF VOLUNTEERS INCLUDES NON-COMPENSATED MEMBERS OF THE BOARD OF DIRECTORS ALONG WITH OTHER AUXILIARY VOLUNTEERS WHO ASSIST WITH A VARIETY OF OPPORTUNITIES AT THE FOUNDATION'S FACILITIES. FORM 990, PART III, LINE 4A, 4B, 4C & 4D PROGRAM SERVICE ACTIVITY DETAIL: WE OFFER CARE AT EVERY STAGE OF LIFE BY PROVIDING HOME CARE, INDEPENDENT LIVING, RESIDENTIAL CARE AND SKILLED NURSING (LONG TERM CARE) FACILITIES. ALL FACILITIES OFFER RESIDENT AND FAMILY SERVICES INCLUDING SOCIAL SERVICES; DAILY ACTIVITIES AND MONTHLY OUTINGS; BEAUTY AND BARBER SERVICES; VISITS FROM COMMUNITY AND SCHOOL ORGANIZATIONS; AND LAUNDRY. CHURCH AND PHARMACY SERVICES. MONTHLY FAMILY SUPPORT GROUPS AND RESIDENT CARE PLANNING MEETINGS ASSIST FAMILY MEMBERS WITH EDUCATION AND RESOURCES TO ENHANCE THE QUALITY OF TIME SHARED WITH LOVED ONES. IN ADDITION, IF PATIENTS NEED A LITTLE EXTRA HELP, HOMEMAKER PLUS CAN HELP THEM REMAIN INDEPENDENT IN THEIR HOME. OUR SERVICES ARE PROVIDED ON A NONDISCRIMINATORY BASIS AND CAN BENEFIT EVERYONE, FROM THE ELDERLY AND PHYSICALLY CHALLENGED TO THE HEALTHY FAMILY ON THE GO. A CARING INDIVIDUAL WILL VISIT THE HOME AND ASSIST PATIENTS ON A LONG-TERM OR ONE-TIME BASIS WITH SKILLED NURSING, REHABILITATIVE SERVICES, HOUSEKEEPING CHORES, MEAL PLANNING, GROCERY SHOPPING AND A HOST OF OTHER IMPORTANT SERVICES. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBER BUSINESS RELATIONSHIP: BOARD MEMBERS BRAD GREGORGY AND DAVE STRADER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCESS THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, A DRAFT OF THE 990 WILL BE REVIEWED BY TOP MANAGEMENT. A FINAL DRAFT WILL BE DISCUSSED AT A MEETING OF THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY REVIEW: ANNUALLY, DURING THE MARCH BOARD OF DIRECTOR'S MEETING, THE OFFICERS AND DIRECTORS DISCLOSE ALL KNOWN CONFLICTS OF INTEREST. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST ABSTAINS FROM VOTING ON ANY MATTER RELATED TO THAT CONFLICT. IN ADDITION, ALL CORPORATE OFFICERS AND KEY EMPLOYEES ARE ANNUALLY REQUIRED TO REPORT POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION REVIEW POLICY: THE BOARD OF DIRECTORS OF CITIZENS MEMORIAL HOSPITAL DISTRICT ESTABLISHES THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER/EXECUTIVE DIRECTOR BASED UPON COMPENSATION FOR SIMILAR POSITIONS IN THE HEALTHCARE INDUSTRY. A WRITTEN EMPLOYMENT AGREEMENT DETAILS THE SALARY AND BENEFITS FOR THE CEO/EXECUTIVE DIRECTOR. CITIZENS MEMORIAL HEALTH CARE FOUNDATION PAYS A PERCENTAGE OF THE TOTAL BASED UPON THE ESTIMATED PERCENTAGE OF TIME SPLIT BETWEEN THE TWO ORGANIZATIONS. THIS PERCENTAGE IS NOT ANNUALLY REVIEWED OR APPROVED BY THE CITIZENS MEMORIAL HOSPITAL DISTRICT BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: MANY ORGANIZATION POLICIES ARE MADE AVAILABLE TO EMPLOYEES ON THE COMPANY INTRANET, FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST TO ALL BONDHOLDERS FOR A LEGITIMATE BUSINESS PURPOSE, AND THE AUDIT REPORT IS MADE AVAILABLE TO ALL LENDERS. IN GENERAL, DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC BY ANY OTHER MEANS. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO BOARD MEMBER RECEIVED COMPENSATION FOR THEIR DUTIES AS DIRECTORS. DONALD J BABB RECEIVES COMPENSATION FROM CITIZENS MEMORIAL HEALTH CARE FOUNDATION FOR HIS ROLE AS EXECUTIVE DIRECTOR. WILLIAM DONNELL IS COMPENSATED BY THE ORGANIZATION FOR SERVING AS MEDICAL DIRECTOR FOR A SKILLED NURSING FACILITY AND IS COMPENSATED BY CITIZENS MEMORIAL HOSPITAL, A RELATED ORGANIZATION, AS A PHYSICIAN. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 45,273 CHANGE IN EQUITY INVESTMENT CITIZENS MEMORIAL HOSPITAL 1500 N OAKLAND BOLIVAR MO 65613 431142176 HOSPITAL MO 501(C)(3) 3 NA false RIVERSIDE MANAGEMENT AND REHABILITATION 1500 N OAKLAND BOLIVAR MO 65613 431776752 MGT AND REHAB MO 501(C)(3) 10 CMH false CMH PROPERTIES 1500 N OAKLAND BOLIVAR MO 65613 463645590 RE HOLDINGS MO 501(C)(3) 12B II CMHCF true BOLIVAR MED BLG LLC 26-279763 BOLIVAR MO 65613 MEDICAL BLDG MO CMHCF EXCLUDED FROM TAX 30080 2317438 false false 0.56250 false false false true true false false false false true true false false true true true false false false