2014-08-06T09:51:10-05:00 2013-12-31 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2013-01-01 430926316 Independence Health System Inc % BONNIE SCHNURBUSCH INDE 5735476546 800 South Kingshighway Suite Perryville MO 63775 BRIAN DREYER PRESIDENT, BOARD OF DIRECTORS 5735476546 2014-08-05 true Donna J Larson 3142315544 2013 2015-11-30 17:44:51Z BONNIE SCHNURBUSCH 800 S KINGSHIGHWAY PERRYVILLE MO 63775 8334436 false X www.independencehealthsystem.org X 1969 MO TO PROVIDE THE ELDERLY WITH RETIREMENT & HEALTH CARE SERVICES DEDICATED TO EXCELLENCE, IN AN ENVIRONMENT WHICH PROMOTES LIVING WITH DIGNITY, SERCURITY & INDEPENDENCE. 9 9 254 22 0 27009 30160 8263832 8191250 50962 32423 88026 80603 8429829 8334436 0 0 0 0 3675459 3755573 0 0 0 3843768 3638921 7519227 7394494 910602 939942 9211220 9921571 7062036 6720252 2149184 3201319 TO PROVIDE THE ELDERLY WITH RETIREMENT AND HEALTH CARE SERVICES WHICH ARE DEDICATED TO EXCELLENCE, IN AN ENVIRONMENT WHICH PROMOTES LIVING WITH DIGNITY, SECURITY AND INDEPENDENCE. false false 5971343 8191250 PROVIDED LONG TERM CARE FOR THE ELDERLY AT VARIOUS STAGES: SKILLED NURSING FACILTY, 123 LICENSED BEDS; RESIDENTIAL CARE, 95 LICENSED BEDS; INDEPENDENT LIVING, TWO COTTAGES AND THREE DUPLEXES. ACCEPT MEDICARE, MEDICAID, AND PRIVATE PAY WHERE APPLICABLE. 5971343 true true false false false false false false false true true false false true false false true false false false false false false false false false false false false true true false false false false false false false false false false false false false false false false false false false true 28 0 true 254 true false false false false false false false false false false X 9 9 true true false false false false false true true false false true true true true true true true false false X BONNIE SCHNURBUSCH 5735476546 800 S KINGSHIGHWAY PERRYVILLE MO 63775 TERRI GREEN BOARD MEMBER 1.0 0.0 X 0 0 0 EDWARD WELKER PRESIDENT 1.5 0.0 X X 0 0 0 PATTY WICHERN BOARD MEMBER 1.0 0.0 X 0 0 0 VIDA YAMNITZ BOARD MEMBER 1.0 0.0 X 0 0 0 DENIS ERNST VICE-PRESIDENT 1.5 0.0 X X 0 0 0 DON PALISCH BOARD MEMBER 1.0 0.0 X 0 0 0 PAT LUEHRS BOARD MEMBER 1.0 0.0 X 0 0 0 JUDITH ERNST SECRETARY/TREASURER 1.5 0.0 X X 0 0 0 BRIAN DREYER BOARD MEMBER 1.0 0.0 X 0 0 0 BONNIE SCHNURBUSCH ADMINISTRATOR/CEO 40.0 0.0 X 0 0 0 THREASA WHITE ACCOUNTANT/CFO 40.0 0.0 X 65199 0 3183 65199 0 3183 0 false false true PERRY COUNTY Health Systems 434 North West Street PERRYVILLE MO 63775 Management Services 197389 Rehab Care Group Inc PO Box 503534 ST LOUIS MO 63150 Therapy Services 478369 2 30160 30160 Room and Board 623000 8191250 8191250 8191250 32323 32323 0 0 0 0 0 100 100 100 100 0 0 0 Beauty & Barber Shop 812900 33452 33452 Maintenance Fees 900099 15480 15480 Employee & Guest Meals 722513 18552 18552 13119 13119 80603 8334436 8191250 113026 0 0 0 0 68382 68382 0 3113301 2705539 407762 0 296940 255465 41475 276950 235740 41210 197389 112709 84680 17525 17525 38764 38764 0 0 0 300927 296407 4520 11716 6690 5026 1043996 596122 447874 0 0 325729 185991 139738 0 0 0 304535 304535 0 355077 319569 35508 105584 60288 45296 Food 253903 253903 NFRA Fees 490446 490446 Licenses and Fees 19247 10990 8257 Bad Debt Expense 84260 84260 0 0 89823 52689 37134 7394494 5971343 1423151 0 6064 15472 4843620 5103286 0 0 516045 574136 0 0 0 0 0 0 41607 45566 0 0 11672077 9472263 2422821 2199814 468905 1081100 0 0 0 0 0 0 912158 902197 9211220 9921571 582511 525727 0 0 99525 99525 6380000 6095000 0 0 0 0 0 0 0 0 0 0 7062036 6720252 X 2149184 3201319 0 0 0 0 2149184 3201319 9211220 9921571 X 939942 112195 -2 X false true X true false X 0 0 35150 27009 30160 92319 6701240 7934326 8217467 8351858 8271853 39476744 0 0 0 6701240 7934326 8252617 8378867 8302013 39569063 0 0 0 0 0 0 0 0 0 0 0 0 0 39569063 51436 60463 44968 43462 32323 232652 0 51436 60463 44968 43462 32323 232652 0 0 6752676 7994789 8297585 8422329 8334336 39801715 0.99416 0.99261 0.00585 0.00739 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 814911 580672 9969 594190 811362 816790 583703 12205 597787 814911 823841 576554 12045 595650 816790 815115 583443 18183 592900 823841 825978 569786 18644 599293 815115 1.00000 false false 254200 254200 10391214 8754877 1636337 1026663 717386 309277 0 2199814 Investments Held for Bond Rese 811362 Bond Issuance Costs 90835 902197 8354903 112195 112195 8242708 91728 91728 8334436 7302766 7302766 91728 91728 7394494 PART V, LINE 4 ENDOWMENT FUNDS THE ENDOWMENT FUNDS ARE TO BE USED FOR BOND PAYMENTS. PART X, LINE 2 UNCERTAIN TAX POSITIONS 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. PART XI & XII, LINE 4B OTHER RECONCILING ITEMS BAD DEBT EXPENSE $84,260 GAIN ON SALE OF ASSETS $100 MISCLASSIFIED REVENUE $7,368 -------- TOTAL $91,728 X false false false false false false false false false BONNIE SCHNURBUSCH ADMINISTRATOR/CEO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VII, LINE 5 INDEPENDENCE HEALTH SYSTEM, INC. PAYS PERRY COUNTY HEALTH SYSTEMS $197,389, WHICH INCLUDES THE USE OF BONNIE SCHNURBUSCH AS THEIR EXECUTIVE DIRECTOR. A PERRY COUNTY MISSOURI 434002739 71459eat3 2008-03-01 7525000 Refunding 1996B, 1997B, 1998B true false false A 1430000 6095000 7525000 604070 1839722 0 90835 0 0 0 0 0 2008 true false true true A 0 A false true true true false false 0 false 0 false false A false PART IV, LINE 2C REBATE COMPUTATION WAS PERFORMED ON 3/1/2013. PART VI, LINE 2 BUSINESS RELATIONSHIPS BOARD MEMBERS JUDY ERNST AND BRIAN DREYER HAVE A BUSINESS RELATIONSHIP. ADMINISTRATOR BONNIE SCHNURBUSCH AND BOARD MEMBER BRIAN DREYER HAVE A BUSINESS RELATIONSHIP. PART VI, SECTION A, LINE 3 DELEGATION OF CONTROL THE ORGANIZATION OPERATES UNDER AN ANNUAL MANAGEMENT AGREEMENT WITH PERRY COUNTY MEMORIAL HOSPITAL, AN UNRELATED ENTITY. THE HOSPITAL IS RESPONSIBLE FOR THE GENERAL SUPERVISION AND MANAGEMENT OF THE DAILY OPERATION OF THE ORGANIZATION, AS WELL AS PROVIDING THE SERVICES OF THE ORGANIZATION'S ADMINISTRATOR. PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990 THE FORM 990 IS REVIEWED BY THE CEO AND CFO WITH THE PREPARER AND PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. PART VI, SECTION B, LINE 12C ORGANIZATION'S PRACTICE FOR MONITORING COMPLIANCE A LETTER AND QUESTIONNAIRE CONCERNING THE POSSIBILITY OF CONFLICTS OF INTEREST IS SENT TO EACH MEMBER OF THE BOARD OF DIRECTORS, THE CEO, AND THE CFO. A LETTER PERTAINING TO CONFLICTS OF INTEREST IS SIGNED BY EACH DEPARTMENT HEAD. RESPONSES ARE REVIEWED BY THE HR DIRECTOR, CFO, & CEO, DEPENDING ON WHETHER IT IS A BOARD OF DIRECTOR MEMBER OR DEPARTMENT HEAD. BOARD OF DIRECTOR MEMBERS WOULD ABSTAIN FROM ANY VOTE WHERE A POSSIBLE CONFLICT OF INTEREST MIGHT ARISE. PART VI, SECTION B, LINE 15A COMPENSATION REVIEW A COMPENSATION REVIEW WAS CONDUCTED IN 2013 BY PATRICK CARRON, CEO OF PERRY COUNTY HEALTH SYSTEMS, AND THE BOARD OF DIRECTORS. PART VI, SECTION B, LINE 15B OTHER OFFICER COMPENSATION REVIEW THE CEO CONDUCTED THE ANNUAL PERFORMANCE AND SALARY REVIEW OF THE CFO IN JULY 2013. PART VI, SECTION C, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES ROUNDING DIFFERENCE: $-2