FURP.ORG / PUBLIC DATA EXPLORER

CITIZENS MEMORIAL HEALTH CARE FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CITIZENS MEMORIAL HEALTH CARE FOUNDATION (EIN 43-1425356)
Tax period
2012-06-01 to 2013-05-31
Filed
2014-04-14
IRS object ID
201421049349301042
Schema version
2012v2.3
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-04-14T16:21:17-05:00Timestamp
Tax Period End Date2013-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code658062523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431425356EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CITIZENS MEMORIAL HEALTH CARE FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% RENEE MEYERInCareOfName
Name ControlCITINameControl
Phone4173266000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 N OAKLAND AVENUEAddressLine1
Address Line2SuiteAddressLine2
CityBOLIVARCity
StateMOState
ZIP Code65613ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDONALD J BABBName
TitleEXECUTIVE DIRECTORTitle
Phone4173266000Phone
Date Signed2014-04-05DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDONALD J BABBNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11500 N OAKLAND AVENUEAddressLine1
CityBOLIVARCity
StateMOState
ZIP Code65613ZIPCode
FieldValueIRS element (for citing)
Gross Receipts38735268GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.citizensmemorial.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION CARES FOR EVERY GENERATION THROUGH EXCEPTIONAL SERVICES BY LEADING PHYSICIANS AND A COMPASSIONATE HEALTHCARE TEAM. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees900TotalNbrEmployees
Total Nbr Volunteers76TotalNbrVolunteers
Total Gross UBI3053TotalGrossUBI
Net Unrelated Business Txbl Income1750NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3734023ContributionsGrantsPriorYear
Contributions Grants Current Year191699ContributionsGrantsCurrentYear
Program Service Revenue Prior Year33329516ProgramServiceRevenuePriorYear
Program Service Revenue CY37850394ProgramServiceRevenueCY
Investment Income Prior Year352688InvestmentIncomePriorYear
Investment Income Current Year-56611InvestmentIncomeCurrentYear
Other Revenue Prior Year-269101OtherRevenuePriorYear
Other Revenue Current Year-172196OtherRevenueCurrentYear
Total Revenue Prior Year37147126TotalRevenuePriorYear
Total Revenue Current Year37813286TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year80200GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY111926GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year19704957SalariesEtcPriorYear
Salaries Etc Current Year21104258SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year13565626OtherExpensePriorYear
Other Expenses Current Year16238838OtherExpensesCurrentYear
Total Expenses Prior Year33350783TotalExpensesPriorYear
Total Expenses Current Year37455022TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3796343RevenuesLessExpensesPriorYear
Revenues Less Expenses CY358264RevenuesLessExpensesCY
Total Assets BOY48795367TotalAssetsBOY
Total Assets EOY49260628TotalAssetsEOY
Total Liabilities BOY35824253TotalLiabilitiesBOY
Total Liabilities EOY35754267TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12971114NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY13506361NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO SUPPORT AND ASSIST CITIZENS MEMORIAL HOSPITAL DISTRICT, OR ITS SUCCESSORS, OR ANY HEALTH CARE INSTITUTION WITH WHICH IT MAY MERGE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense22974065Expense
Revenue31872859Revenue
DescriptionPROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 99,534 RESIDENT DAYS) IN SKILLED FACILITIES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1121648Expense
Revenue1509905Revenue
DescriptionPROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 26,297 RESIDENT DAYS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense499115Expense
Revenue601072Revenue
DescriptionPROVIDE HOME CHORE SERVICES TO PEOPLE LIVING AT HOME BUT UNABLE TO COMPLETELY CARE FOR THEMSELVES. THROUGH HOMEMAKER PLUS, 32,276 SERVICE UNITS WERE PROVIDED THROUGH LIGHT HOUSEKEEPING, LAUNDRY, SHOPPING AND RESPITE CARE SERVICES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp4807502TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt111926TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev3866558TotalOfOtherProgramServiceRev
Total Program Service Expense29402330TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096101NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees900NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRENEE MEYERNamePerson
Telephone Number4173286258TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11500 N OAKLAND AVENUEAddressLine1
CityBOLIVARCity
StateMOState
ZIP Code65613ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DONALD J BABB
EXECUTIVE DIRECTOR20.040.0XX10620241114744538
DAVE STRADER
BOARD PRESIDENT1.0XX000
BRAD GREGORY
BOARD VICE PRESIDENT1.0XX000
DEREK HUNTER
BOARD MEMBER1.0X000
D MICHEALE MEENTS
BOARD MEMBER1.0X000
NEALE JOHNSON
BOARD MEMBER1.0X000
RUSSEL PAYNE
BOARD MEMBER1.0X000
WILLIAM DONNELL
BOARD MEMBER1.0X000
GARY FULBRIGHT
BOARD TREASURER - NONVOTING1.045.0X022757835036
CATHERINE MOLDER
BOARD SECRETARY - NONVOTING1.045.0X09074611563
RENEE MEYER
DIRECTOR OF FINANCE45.0X130641010638
TIM FRANCKA
ADMIN DIR-LONG TERM CARE45.0129464010176X
KENNETH SCHANDA
DIR OF REHAB SVCS45.012267209740X
CHRIS MCBRATNEY
ADMIN DIR-LONG TERM CARE45.0113831013969X
FieldValueIRS element (for citing)
Total Reportable Comp From Org602810TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs729471TotalReportableCompFrmRltdOrgs
Total Other Compensation135660TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonBKD LLPNamePerson
FieldValueIRS element (for citing)
Address Of ContractorAddressOfContractor
Description Of ServicesCONSULTING/AUDIT/TAXDescriptionOfServices
Compensation151111Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events96442FundraisingEvents
All Other Contributions95257AllOtherContributions
Total Contributions191699TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE6230003576958535769585
CAFETERIA722514102332102332
RENT INCOME53112019107601910760
TRANSIT9000991907119071
OTHER INCOME6230004864648646
FieldValueIRS element (for citing)
Total Program Service Revenue37850394TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column113096TotalRevenueColumn
Exclusion$113,096ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real520195Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real575438Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-55243Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-55243TotalRevenueColumn
Unrelated Business Revenue3053UnrelatedBusinessRevenue
Exclusion-$58,296ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other16619Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other186326Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-169707Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-169707TotalRevenueColumn
Exclusion-$169,707ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events43265GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events96442CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses160218FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-116953TotalRevenueColumn
Exclusion-$116,953ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column37813286TotalRevenueColumn
Related Or Exempt Function Income37850394RelatedOrExemptFunctionIncome
Unrelated Business Revenue3053UnrelatedBusinessRevenue
Exclusion-$231,860ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total9000Total
Program Services9000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total102926Total
Program Services102926ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total248431Total
Management And General248431ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15468421Total
Program Services13264250ProgramServices
Management And General2204171ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total444516Total
Program Services354775ProgramServices
Management And General89741ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3653947Total
Program Services2909741ProgramServices
Management And General744206ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1288943Total
Program Services1051081ProgramServices
Management And General237862ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1929828Total
Program Services62724ProgramServices
Management And General1867104ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5540Total
Management And General5540ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total151006Total
Management And General151006ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total181381Total
Program Services177492ProgramServices
Management And General3889ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total50916Total
Management And General50916ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2432842Total
Program Services1992219ProgramServices
Management And General440623ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total203880Total
Program Services80119ProgramServices
Management And General123761ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1502924Total
Program Services1043492ProgramServices
Management And General459432ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total176762Total
Program Services68649ProgramServices
Management And General108113ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total25150Total
Program Services13152ProgramServices
Management And General11998ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1617983Total
Program Services1157288ProgramServices
Management And General460695ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2202109Total
Program Services1575094ProgramServices
Management And General627015ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total151342Total
Management And General151342ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES & DRUGS29172512917251
PROVIDER TAX & FEES22720312272031
BAD DEBT303896303896
LICENSE, DUES, SUBSCRIPTIONS6071060710

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total53287Total
Program Services47150ProgramServices
Management And General6137ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total37455022Total
Program Services29402330ProgramServices
Management And General8052692ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY240805BOY
EOY101481EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3937883BOY
EOY3938929EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY476401BOY
EOY129968EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3192351BOY
EOY3488052EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY147100BOY
EOY137045EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY938080BOY
EOY853093EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis62944334LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec26641047LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY36005175BOY
EOY36303287EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2742573BOY
EOY3115334EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY115383BOY
EOY126546EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY983286BOY
EOY983286EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY16330BOY
EOY83607EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY48795367BOY
EOY49260628EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4221089BOY
EOY4700148EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY148747BOY
EOY133356EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY27820000BOY
EOY26485000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY41409BOY
EOY43105EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3371299BOY
EOY4382461EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY221709BOY
EOY10197EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY35824253BOY
EOY35754267EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11350264BOY
EOY11733719EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1620850BOY
EOY1772642EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12971114BOY
EOY13506361EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY48795367BOY
EOY49260628EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses358264ReconcilationRevenueExpenses
Reconciliation Unrealized Invest165820ReconciliationUnrealizedInvest
Reconcilation Other Changes11163ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years105173CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years158818CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years303900CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3734023CurrentTaxYearMinus1Year
Current Tax Year191699CurrentTaxYear
Total4493613Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years30623480CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30376030CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30715253CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year33329516CurrentTaxYearMinus1Year
Current Tax Year37850394CurrentTaxYear
Total162894673Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years30728653CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30534848CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years31019153CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year37063539CurrentTaxYearMinus1Year
Current Tax Year38042093CurrentTaxYear
Total167388286Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year10000CurrentTaxYear
Total10000Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year10000CurrentTaxYear
Total10000Total
FieldValueIRS element (for citing)
Public Support Total509167378286PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2572519CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2516299CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2479023CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2548314CurrentTaxYearMinus1Year
Current Tax Year633291CurrentTaxYear
Total10749446Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3174CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2634CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2161CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2452CurrentTaxYearMinus1Year
Current Tax Year2682CurrentTaxYear
Total13103Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2575693CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2518933CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2481184CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2550766CurrentTaxYearMinus1Year
Current Tax Year635973CurrentTaxYear
Total10762549Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years35856CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30318CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years52733CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31316CurrentTaxYearMinus1Year
Total150223Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years33340202CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years33084099CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years33553070CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39645621CurrentTaxYearMinus1Year
Current Tax Year38678066CurrentTaxYear
Total178301058Total
FieldValueIRS element (for citing)
Public Support Percentage5090.93874PublicSupportPercentage509
Prior Year Support Percentage0.92826PriorYearSupportPercentage
Investment Income Percentage0.06036InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.07065PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$1,454OtherActivitiesAmount
Total Lobbying Expenditures IIB1454TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER LOBBY ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, QUESTION 1IReturnReference
ExplanationTHE 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: $860 MHCA AND $594 AHCA.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4513460OtherCostOrOtherBasis
Book Value4513460BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis47318930OtherCostOrOtherBasis
Depreciation22674129Depreciation
Book Value24644801BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis6815469OtherCostOrOtherBasis
Depreciation3265814Depreciation
Book Value3549655BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4296475OtherCostOrOtherBasis
Depreciation701104Depreciation
Book Value3595371BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings36303287TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPLEDGES PAYABLEDescription
Amount$10,197Amount
FieldValueIRS element (for citing)
Total Of Amounts10197TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt38750296TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments165820NetUnrealizedGainsInvestments
Other Revenues-91763OtherRevenues
Revenue Not Rptd F99074057RevenueNotRptdF990
Revenue Subtotal38676239RevenueSubtotal
Other Revenues Not Included-862953OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-862953RevenueNotRptdOnFinStmt
Total Revenue Per Form99037813286TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt38215049TotExpensesEtcAuditedFinclStmt
Other Expenses Included862953OtherExpensesIncluded
Expenses Not Rptd F990862953ExpensesNotRptdF990
Expenses Subtotal37352096ExpensesSubtotal
Other Expenses Not Included102926OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt102926ExpensesNotRptdOnFinStmt
Total Expenses Per Form99037455022TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ESCROW ACCOUNT LIABILITYSCHEDULE D, PART IV, LINE 2BTHE FOUNDATION WAS THE TRUSTEE OF $43,105 AND $41,409, RESPECTIVELY, AT MAY 31, 2013 AND 2012, IN FUNDS RECEIVED ON BEHALF OF VARIOUS RESIDENTS. THE FOUNDATION HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THE BANK ACCOUNTS AND THE DISTRIBUTION OF THE FUNDS TO RESIDENTS.
UNCERTAIN TAX POSITIONSCHEDULE D, PART X, LINE 2MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12SCHEDULE D, PART XI, LINE 2D$ (102,926) SCHOLARSHIPS GRANTED 11,163 CHANGE IN INVESTMENT IN EQUITY INVESTEE ------------- (91,763)
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1SCHEDULE D, PART XI, LINE 4B$ (117,808) SPECIAL EVENT EXPENSE (169,707) LOSS ON SALE OF FIXED ASSETS (575,438) RENTAL EXPENSE -------------- $ (862,953)
OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25SCHEDULE D, PART XII, LINE 2D$ 117,808 SPECIAL EVENT EXPENSE 169,707 LOSS ON SALE OF FIXED ASSETS 575,438 RENTAL EXPENSE -------------- $ 862,953
OTHER EXPENSE INCLUDED ON FORM 990, PART XI, LINE 25, BUT NOT ON LINE 1SCHEDULE D, PART XII, LINE 4B$ 102,926 SCHOLARSHIPS GRANTED

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1BURGANDY BALLNameOfEvent1
Gross Receipts Event191091GrossReceiptsEvent1
Charitable Contributions Event163534CharitableContributionsEvent1
Gross Revenue Event127557GrossRevenueEvent1
Rent Facility Costs Event18164RentFacilityCostsEvent1
Food And Beverage Event137240FoodAndBeverageEvent1
Entertainment Event122200EntertainmentEvent1
Other Direct Expenses Event150204OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNEYNameOfEvent2
Gross Receipts Event248616GrossReceiptsEvent2
Charitable Contributions Event232908CharitableContributionsEvent2
Gross Revenue Event215708GrossRevenueEvent2
Cash Prizes Event2920CashPrizesEvent2
Non Cash Prizes Event216789NonCashPrizesEvent2
Rent Facility Costs Event211128RentFacilityCostsEvent2
Food And Beverage Event26874FoodAndBeverageEvent2
Other Direct Expenses Event26699OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total139707GrossReceiptsTotal
Charitable Contributions Total96442CharitableContributionsTotal
Gross Revenue Total Events43265GrossRevenueTotalEvents
Cash Prizes Total Events920CashPrizesTotalEvents
Non Cash Prizes Total Events16789NonCashPrizesTotalEvents
Rent Facility Costs Total Events19292RentFacilityCostsTotalEvents
Food And Beverage Total Events44114FoodAndBeverageTotalEvents
Entertainment Total Events22200EntertainmentTotalEvents
Other Direct Expenses Total Events56903OtherDirectExpensesTotalEvents
Direct Expense Summary Events160218DirectExpenseSummaryEvents
Net Income Summary-116953NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CITIZENS MEMORIAL HOSPITAL DISTRICTBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11500 N OAKLAND AVENUEAddressLine1
CityBOLIVARCity
StateMOState
ZIP Code65613ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient431142176EINOfRecipient
IRC SectionGOVERNMENTALIRCSection
Amount Of Cash Grant9000AmountOfCashGrant
Purpose Of GrantSENIOR HEALTH CTRPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantVARIOUS SCHOLARHIPS AWARDEDTypeOfGrant
Number Of Recipients37NumberOfRecipients
Amount Of Cash Grant102926AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
GRANT MONITORINGSCHEDULE I, PART I, LINE 2 & PART II, LINE 1CITIZENS MEMORIAL HEALTH CARE FOUNDATION MONITORS THE USE OF GRANTS FUNDS AWARDED TO CITIZENS MEMORIAL HOSPITAL THROUGH BOARD MEMBERS OF CITIZENS MEMORIAL HEALTH CARE FOUNDATION WHO ARE EMPLOYEES OF CITIZENS MEMORIAL HOSPITAL.
GRANT MONITORINGSCHEDULE I, PART I, LINE 2 & PART III, LINE 1CITIZENS 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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DONALD J BABB
EXECUTIVE DIRECTOR94994411147112080009503111701247110715245473500
GARY FULBRIGHT
BOARD TREASURER - NONVOTING020726906588013720019303015734026261500

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CRITERIA TO ESTABLISH EXECUTIVE DIRECTOR COMPENSATIONSCHEDULE J, PART I, LINE 3THE FOUNDATION'S EXECUTIVE DIRECTOR, DONALD BABB, IS PAID THROUGH CITIZENS MEMORIAL HOSPITAL DISTRICT. AT THE DISTRICT LEVEL, HIS COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS USING COMPARABLE STATISTICS FOR SIMILAR POSITIONS IN THE HEALTHCARE INDUSTRY.
CONTINGENT COMPENSATIONSCHEDULE J, PART I, LINE 6IN FY 2013, THE FOUNDATION'S BOARD APPROVED TO PAY OUT BONUSES AT 10% OF NET INCOME. THE BONUS IS ALLOCATED TO ALL MANAGEMENT AND STAFF, AND MR. BABB'S ALLOCATION OF THIS BONUS IS SHOWN ON SCHEDULE J, PART II, COLUMN B(II).

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR
A431430093097638BE92004-12-294065937REFUND 01 & 03 BANK LOANSfalsefalsefalse
INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY
B431546885234618AC02004-12-296477194REFUND 1996 BONDS & CONSTRUCTIONfalsefalsefalse
INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY
C010912805731249AB42008-08-1310429088REFUND 06, 07, & 08 BANK LOANSfalsefalsefalse
INDUSTRIAL DVLP AUTHORITY OF THE CITY OF ASH GROVE
D431915231043722AA52009-07-012910000REFUND SERIES 2001 REV BONDSfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A0041100004069000081318003621782002008truefalsetruetrue
B00657500065750003323687129543002464270002008falsefalsetruetrue
C0010500000105000000208582009241418002009falsefalsetruetrue
D0029100000000002910000002009truefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUseBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropRemedial Action TakenRemedialActionTakenNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
Afalsefalsefalsefalse0.000000.000000.00000falsefalsefalsetrue
Bfalsefalsefalsefalse0.000000.000000.00000falsefalsefalsetrue
Cfalsefalsefalsefalse0.000000.000000.00000falsefalsefalsetrue
D0

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Gross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqsRebate Not Due YetRebateNotDueYet
0
Afalsetruefalsefalsefalse0falsefalse
0
Bfalsetruefalsefalsefalse0falsefalse
0
Cfalsetruefalsefalsefalse0falsefalse
0
Dfalsefalsefalsefalse0falsefalsetrue

Form990 Schedule K Part V Form990ScheduleKPartV (4 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
Atrue
Btrue
Ctrue
Dtrue

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
TOTAL PROCEEDS OF ISSUESCHEDULE K, PART II, LINE 3, COLUMNS A, B & CTOTAL PROCEEDS OF ISSUE LISTED ON SCHEDULE K, PART II, LINE 3 FOR THE INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR BOND, THE INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY BOND, AND THE INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY BOND DO NOT AGREE TO THE ISSUE PRICE LISTED IN SCHEDULE K, PART I, COLUMN E. FOR ALL THREE BONDS, THIS DIFFERENCE IS DUE TO THE DISCOUNT RATE BETWEEN THE ISSUE AT MATURITY AND ISSUE PRICE.
DATE REBATE COMPUTATION WAS PERFORMEDSCHEDULE K, PART IV, LINE 2CTHE REBATE COMPUTATION FOR THE INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR BOND WAS PERFORMED 12/31/2012. THE REBATE COMPUTATION FOR THE INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY BOND WAS PERFORMED 12/31/2012. THE REBATE COMPUTATION FOR THE INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY BOND WAS PERFORMED 8/1/2013.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR
A4314300932009-12-153310000REFUND SERIES 1998 REV BONDSfalsefalsefalse
INDUSTRIAL DVLP AUTH OF THE CITY OF ELDORADO SPRGS
B2600251152012-01-272680000REFUND SERIES 2001 REV BONDSfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A0033100000000003310000002009truefalsetruetrue
B0026800000000002680000002012truefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCdPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers
A0
B0

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Gross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
0
Afalsetruefalsefalsefalse0falsefalse
0
Bfalsetruefalsefalsefalse0falsefalse

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
Atrue
Btrue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART I, LINE 1THE 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, HEALTH TRANSPORTATION AND HOMEMAKER CHORE SERVICES.
NUMBER OF VOLUNTEERSFORM 990, PART I, LINE 6THE 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.
PROGRAM SERVICE ACTIVITY DETAILFORM 990, PART III, LINES 4A, 4B, 4C & 4DWE 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 PERSONAL CARE SERVICES, HOUSEKEEPING CHORES, MEAL PLANNING, GROCERY SHOPPING AND A HOST OF OTHER IMPORTANT SERVICES.
BOARD MEMBER BUSINESS RELATIONSHIPFORM 990, PART VI, SECTION A, LINE 2BOARD MEMBERS BRAD GREGORY AND DAVE STRADER HAVE A BUSINESS RELATIONSHIP.
990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE 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. AFTER MANAGEMENT'S REVIEW, A COPY OF THE 990 WILL BE PROVIDED TO THE BOARD FOR THEIR REVIEW.
MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY REVIEWFORM 990, PART VI, SECTION B, LINE 12CANNUALLY, 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.
COMPENSATION REVIEW POLICYFORM 990, PART VI, SECTION B, LINE 15ATHE 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.
DOCUMENT DISCLOSUREFORM 990, PART VI, SECTION C, LINE 19MANY 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.
BOARD MEMBER COMPENSATIONFORM 990, PART VII, SECTION ANO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. DONALD J BABB RECEIVES COMPENSATION FROM CITIZENS MEMORIAL HEALTH CARE FOUNDATION FOR HIS ROLE AS EXECUTIVE DIRECTOR.
MANAGEMENT FEESFORM 990, PART IX, LINE 11AMANAGEMENT FEES REPORTED ON LINE 11A REPRESENTS THE FOUNDATION'S PORTION OF EXPENSES RELATING TO DEPARTMENTS SHARED WITH CITIZENS MEMORIAL HOSPITAL, A RELATED PARTY. AT NO POINT DURING THE YEAR DID THE FOUNDATION DELEGATE MANAGERIAL DUTIES TO THE HOSPITAL.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 9$ 11,163 CHANGE IN EQUITY INVESTMENTS

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CITIZENS MEMORIAL HOSPITAL
1500 N OAKLANDBOLIVARMO65613431142176HOSPITALMO501(C)(3)3NAfalse
RIVERSIDE MANAGEMENT & REHABILITATION
1500 N OAKLANDBOLIVARMO65613431776752MGT & REHABMO501(C)(3)9CMHfalse

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1BOLIVAR MED BLDGBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1BOLIVAR MO 65613AddressLine1
CityBOLIVARCity
StateMOState
ZIP Code65613ZIPCode
FieldValueIRS element (for citing)
EIN262797636EIN
Primary ActivityMEDICAL BUILDPrimaryActivity
Legal Domicile StateMOLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CMHCFBusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeEXCLUDED FROM TAXPredominantIncomeType
Share Of Total Income11951ShareOfTotalIncome
Share Of EOY Assets371144ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
Code V$0CodeVAmount
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.51000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1BOLIVAR MEDICAL BUIDLING LLCBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeKTransactionType
Amount Involved92074AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination