2014-04-14T16:21:17-05:00 2013-05-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2012-06-01 431425356 CITIZENS MEMORIAL HEALTH CARE FOUNDATION % RENEE MEYER CITI 4173266000 1500 N OAKLAND AVENUE Suite BOLIVAR MO 65613 DONALD J BABB 4173266000 2014-04-05 true Brian D Todd 4178658701 2012 2015-11-30 17:44:51Z DONALD J BABB 1500 N OAKLAND AVENUE BOLIVAR MO 65613 38735268 false X www.citizensmemorial.com X 1986 MO THE ORGANIZATION CARES FOR EVERY GENERATION THROUGH EXCEPTIONAL SERVICES BY LEADING PHYSICIANS AND A COMPASSIONATE HEALTHCARE TEAM. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 8 7 900 76 3053 1750 3734023 191699 33329516 37850394 352688 -56611 -269101 -172196 37147126 37813286 80200 111926 0 0 19704957 21104258 0 0 0 13565626 16238838 33350783 37455022 3796343 358264 48795367 49260628 35824253 35754267 12971114 13506361 X TO SUPPORT AND ASSIST CITIZENS MEMORIAL HOSPITAL DISTRICT, OR ITS SUCCESSORS, OR ANY HEALTH CARE INSTITUTION WITH WHICH IT MAY MERGE. false false 22974065 31872859 PROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 99,534 RESIDENT DAYS) IN SKILLED FACILITIES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 1121648 1509905 PROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 26,297 RESIDENT DAYS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 499115 601072 PROVIDE 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. 4807502 111926 3866558 29402330 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 true true true true false false false false false false false false false false false false false false false true true true false false true 101 0 true 900 true true true false false false false true true false false false false X 8 7 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 N OAKLAND AVENUE BOLIVAR MO 65613 DONALD J BABB 20.0 40.0 X X 106202 411147 44538 DAVE STRADER 1.0 X X 0 0 0 BRAD GREGORY 1.0 X X 0 0 0 DEREK HUNTER 1.0 X 0 0 0 D MICHEALE MEENTS 1.0 X 0 0 0 NEALE JOHNSON 1.0 X 0 0 0 RUSSEL PAYNE 1.0 X 0 0 0 WILLIAM DONNELL 1.0 X 0 0 0 GARY FULBRIGHT 1.0 45.0 X 0 227578 35036 CATHERINE MOLDER 1.0 45.0 X 0 90746 11563 RENEE MEYER 45.0 X 130641 0 10638 TIM FRANCKA 45.0 X 129464 0 10176 KENNETH SCHANDA 45.0 X 122672 0 9740 CHRIS MCBRATNEY 45.0 X 113831 0 13969 602810 729471 135660 5 false true false BKD LLP CONSULTING/AUDIT/TAX 151111 1 96442 95257 191699 NET PATIENT SERVICE REVENUE 623000 35769585 35769585 CAFETERIA 722514 102332 102332 RENT INCOME 531120 1910760 1910760 TRANSIT 900099 19071 19071 OTHER INCOME 623000 48646 48646 37850394 113096 113096 0 0 520195 575438 -55243 0 -55243 3053 -58296 16619 186326 -169707 -169707 -169707 43265 96442 160218 -116953 -116953 0 0 0 37813286 37850394 3053 -231860 X 9000 9000 102926 102926 0 0 248431 248431 0 0 15468421 13264250 2204171 444516 354775 89741 3653947 2909741 744206 1288943 1051081 237862 1929828 62724 1867104 5540 5540 151006 151006 0 0 0 181381 177492 3889 50916 50916 2432842 1992219 440623 203880 80119 123761 0 1502924 1043492 459432 176762 68649 108113 0 25150 13152 11998 1617983 1157288 460695 0 2202109 1575094 627015 151342 151342 MEDICAL SUPPLIES & DRUGS 2917251 2917251 PROVIDER TAX & FEES 2272031 2272031 BAD DEBT 303896 303896 LICENSE, DUES, SUBSCRIPTIONS 60710 60710 53287 47150 6137 37455022 29402330 8052692 0 240805 101481 3937883 3938929 476401 129968 3192351 3488052 0 0 0 0 0 0 147100 137045 938080 853093 62944334 26641047 36005175 36303287 2742573 3115334 115383 126546 0 0 983286 983286 16330 83607 48795367 49260628 4221089 4700148 0 0 148747 133356 27820000 26485000 41409 43105 0 0 3371299 4382461 0 0 221709 10197 35824253 35754267 X 11350264 11733719 1620850 1772642 0 0 12971114 13506361 48795367 49260628 X 358264 165820 11163 X false true X true false X 105173 158818 303900 3734023 191699 4493613 30623480 30376030 30715253 33329516 37850394 162894673 0 0 0 30728653 30534848 31019153 37063539 38042093 167388286 10000 10000 0 10000 10000 167378286 2572519 2516299 2479023 2548314 633291 10749446 3174 2634 2161 2452 2682 13103 2575693 2518933 2481184 2550766 635973 10762549 0 35856 30318 52733 31316 150223 33340202 33084099 33553070 39645621 38678066 178301058 0.93874 0.92826 0.06036 0.07065 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1454 1454 false OTHER LOBBY ACTIVITIES SCHEDULE C, PART II-B, QUESTION 1I 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: $860 MHCA AND $594 AHCA. false true X 4513460 4513460 47318930 22674129 24644801 6815469 3265814 3549655 4296475 701104 3595371 36303287 0 PLEDGES PAYABLE 10197 10197 38750296 165820 -91763 74057 38676239 -862953 -862953 37813286 38215049 862953 862953 37352096 102926 102926 37455022 ESCROW ACCOUNT LIABILITY SCHEDULE D, PART IV, LINE 2B THE 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 POSITION SCHEDULE D, PART X, LINE 2 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. OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE 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 1 SCHEDULE 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 25 SCHEDULE 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 1 SCHEDULE D, PART XII, LINE 4B $ 102,926 SCHOLARSHIPS GRANTED BURGANDY BALL 91091 63534 27557 8164 37240 22200 50204 GOLF TOURNEY 48616 32908 15708 920 16789 11128 6874 6699 0 139707 96442 43265 920 16789 19292 44114 22200 56903 160218 -116953 true CITIZENS MEMORIAL HOSPITAL DISTRICT 1500 N OAKLAND AVENUE BOLIVAR MO 65613 431142176 GOVERNMENTAL 9000 SENIOR HEALTH CTR 1 VARIOUS SCHOLARHIPS AWARDED 37 102926 GRANT MONITORING SCHEDULE I, PART I, LINE 2 & PART II, LINE 1 CITIZENS 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 MONITORING SCHEDULE I, PART I, LINE 2 & PART III, LINE 1 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. false false false false false true false false false DONALD J BABB 94994 411147 11208 0 0 0 950 31117 0 12471 107152 454735 0 0 GARY FULBRIGHT 0 207269 0 6588 0 13720 0 19303 0 15734 0 262615 0 0 CRITERIA TO ESTABLISH EXECUTIVE DIRECTOR COMPENSATION SCHEDULE J, PART I, LINE 3 THE 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 COMPENSATION SCHEDULE J, PART I, LINE 6 IN 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). A INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR 431430093 097638BE9 2004-12-29 4065937 REFUND 01 & 03 BANK LOANS false false false B INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY 431546885 234618AC0 2004-12-29 6477194 REFUND 1996 BONDS & CONSTRUCTION false false false C INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY 010912805 731249AB4 2008-08-13 10429088 REFUND 06, 07, & 08 BANK LOANS false false false D INDUSTRIAL DVLP AUTHORITY OF THE CITY OF ASH GROVE 431915231 043722AA5 2009-07-01 2910000 REFUND SERIES 2001 REV BONDS false false false A 0 0 4110000 406900 0 0 81318 0 0 3621782 0 0 2008 true false true true B 0 0 6575000 657500 0 3323687 129543 0 0 2464270 0 0 2008 false false true true C 0 0 10500000 1050000 0 0 208582 0 0 9241418 0 0 2009 false false true true D 0 0 2910000 0 0 0 0 0 0 2910000 0 0 2009 true false true true A false false false false 0.00000 0.00000 0.00000 false false false true B false false false false 0.00000 0.00000 0.00000 false false false true C false false false false 0.00000 0.00000 0.00000 false false false true D 0 A false true false false 0 false 0 false false B false true false false 0 false 0 false false C false true false false 0 false 0 false false D false true false false 0 false 0 false false A true B true C true D true TOTAL PROCEEDS OF ISSUE SCHEDULE K, PART II, LINE 3, COLUMNS A, B & C TOTAL 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 PERFORMED SCHEDULE K, PART IV, LINE 2C THE 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. A INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR 431430093 2009-12-15 3310000 REFUND SERIES 1998 REV BONDS false false false B INDUSTRIAL DVLP AUTH OF THE CITY OF ELDORADO SPRGS 260025115 2012-01-27 2680000 REFUND SERIES 2001 REV BONDS false false false A 0 0 3310000 0 0 0 0 0 0 3310000 0 0 2009 true false true true B 0 0 2680000 0 0 0 0 0 0 2680000 0 0 2012 true false true true A 0 B 0 A false true false false 0 false 0 false false B false true false false 0 false 0 false false A true B true ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 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, HEALTH TRANSPORTATION AND HOMEMAKER CHORE SERVICES. NUMBER OF VOLUNTEERS FORM 990, PART I, LINE 6 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. PROGRAM SERVICE ACTIVITY DETAIL FORM 990, PART III, LINES 4A, 4B, 4C & 4D 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 PERSONAL CARE SERVICES, HOUSEKEEPING CHORES, MEAL PLANNING, GROCERY SHOPPING AND A HOST OF OTHER IMPORTANT SERVICES. BOARD MEMBER BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS BRAD GREGORY AND DAVE STRADER HAVE A BUSINESS RELATIONSHIP. 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B 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. 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 REVIEW FORM 990, PART VI, SECTION B, LINE 12C 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. COMPENSATION REVIEW POLICY FORM 990, PART VI, SECTION B, LINE 15A 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. DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 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. BOARD MEMBER COMPENSATION FORM 990, PART VII, SECTION A NO 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 FEES FORM 990, PART IX, LINE 11A MANAGEMENT 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 ASSETS FORM 990, PART XI, LINE 9 $ 11,163 CHANGE IN EQUITY INVESTMENTS CITIZENS MEMORIAL HOSPITAL 1500 N OAKLAND BOLIVAR MO 65613 431142176 HOSPITAL MO 501(C)(3) 3 NA false RIVERSIDE MANAGEMENT & REHABILITATION 1500 N OAKLAND BOLIVAR MO 65613 431776752 MGT & REHAB MO 501(C)(3) 9 CMH false BOLIVAR MED BLDG BOLIVAR MO 65613 BOLIVAR MO 65613 262797636 MEDICAL BUILD MO CMHCF EXCLUDED FROM TAX 11951 371144 false 0 false 0.51000 false false false true false false false false false true true false false false true false true false false BOLIVAR MEDICAL BUIDLING LLC K 92074 FMV