2013-03-05T11:38:47-06:00 2012-05-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-06-01 431425356 CITIZENS MEMORIAL HEALTH CARE FOUNDATION % RENEE MEYER CITI 4173266000 1500 N OAKLAND AVENUE BOLIVAR MO 65613 DONALD J BABB 2013-01-28 true Brian D Todd 4178658701 2011 2016-02-25 16:41:14Z DONALD J BABB 1500 N OAKLAND AVENUE BOLIVAR MO 65613 39933814 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 7 942 76 6719 1511 303900 3734023 30715253 33329516 163981 352688 -241958 -269101 30941176 37147126 81642 80200 0 0 17512367 19704957 0 0 0 12321956 13565626 29915965 33350783 1025211 3796343 46811823 48795367 37527235 35824253 9284588 12971114 X TO SUPPORT AND ASSIST CITIZENS MEMORIAL HOSPITAL DISTRICT, OR ITS SUCCESSORS, OR ANY HEALTH CARE INSTITUTION WITH WHICH IT MAY MERGE. false true 20130476 27559731 PROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 165,719 RESIDENT DAYS) IN SKILLED FACILITIES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 1033979 1375829 PROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 26,055 RESIDENT DAYS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION 485892 615563 PROVIDE HOME CHORE SERVICES TO PEOPLE LIVING AT HOME BUT UNABLE TO COMPLETELY CARE FOR THEMSELVES. THROUGH HOMEMAKER PLUS, 34,617 SERVICE UNITS WERE PROVIDED THROUGH LIGHT HOUSEKEEPING, LAUNDRY, SHOPPING AND RESPITE CARE SERVICES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 4536844 80200 3809709 26187191 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 true false false false false true true true false false true 78 0 true 942 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 X DONALD J BABB 20.0 X X 109672 313827 43606 DAVE STRADER 1.0 X X 0 0 0 BRAD GREGORY 1.0 X X 0 0 0 ROBERT KIFER 1.0 X 0 0 0 DAVE BERRY 1.0 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 45.0 X 0 224430 33724 CATHERINE MOLDER 45.0 X 0 89196 8293 RENEE MEYER 45.0 X 136088 0 10038 KENNETH SCHANDA 45.0 X 124545 0 9694 TIM FRANCKA 45.0 X 128414 0 10955 CHRIS MCBRATNEY 45.0 X 106030 0 13281 604749 627453 129591 5 false true false BKD LLP 910 E ST LOUIS STREET SPRINGFIELD MO 65806 CONSULTING/AUDIT/TAX 195274 1 84471 3649552 3127543 3734023 NET PATIENT SERVICE REVENUE 623000 33185528 33185528 CAFETERIA 722210 94929 94929 VENDING 722210 8564 8564 TRANSIT 900099 24643 24643 OTHER INCOME 623000 15852 15852 33329516 145804 145804 0 0 2402510 2532659 -130149 -130149 6719 -136868 280094 73210 206884 206884 206884 43734 84471 180819 -137085 -137085 0 0 REPAYMENT OF SCHOLARSHIPS 900099 31316 31316 LOSS ON ESTINGUISHMENT OF DEBT 900099 -33183 -33183 -1867 37147126 33360832 6719 45552 X 9000 9000 71200 71200 0 0 256697 256697 0 14456435 12470668 1985767 393869 301561 92308 3396112 2685769 710343 1201844 977027 224817 1830429 1830429 28996 28996 154204 154204 0 0 0 195086 189786 5300 45857 45857 2268271 1878135 390136 186837 62834 124003 0 1146989 792485 354504 169426 62140 107286 0 31477 19580 11897 849133 609853 239280 0 1411406 1013681 397725 147166 147166 BAD DEBT 251586 251586 MEDICAL SUPPLIES & DRUGS 2766390 2766390 LICENSES, DUES, SUBSCRIPTIONS 48733 48733 PROVIDER TAX & FEES 1980852 1980852 52788 44644 8144 33350783 26187191 7163592 0 84530 240805 4834386 3937883 117713 476401 3041712 3192351 0 0 0 0 0 0 133867 147100 994093 938080 60442264 24437089 33448854 36005175 3372511 2742573 105762 115383 0 0 0 0 678395 999616 46811823 48795367 3881657 4221089 0 0 133609 148747 29615000 27820000 37908 41409 0 0 3828864 3371299 0 0 30197 221709 37527235 35824253 X 7880474 11350264 1404114 1620850 0 0 9284588 12971114 46811823 48795367 X 3796343 -109817 X false true true X false X 138156 105173 158818 303900 3734023 4440070 29996149 30623480 30376030 30715253 33329516 155040428 30134305 30728653 30534848 31019153 37063539 159480498 159480498 2009690 2572519 2516299 2479023 2548314 12125845 1818 3174 2634 2161 2615 12402 2011508 2575693 2518933 2481184 2550929 12138247 36680 35856 30318 52733 31316 186903 32182493 33340202 33084099 33553070 39645784 171805648 0.92826 0.93022 0.07065 0.06840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1464 1464 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: $859 MHCA AND $605 AHCA. false true 0 4458460 4458460 0 47206711 20990605 26216106 0 6350773 2823890 3526883 0 2426320 622594 1803726 36005175 0 DUE TO RELATED PARTY 201512 PLEDGES PAYABLE 20197 221709 37147126 33350783 3796343 -119438 9621 -109817 3686526 39472703 -119438 -61579 -181017 39653720 -2506594 -2506594 37147126 35786177 2506594 2506594 33279583 71200 71200 33350783 ESCROW ACCOUNT LIABILITY SCHEDULE D, PART IV, LINE 2B THE FOUNDATION WAS THE TRUSTEE OF $41,409 AND $37,908, RESPECTIVELY, AT MAY 31, 2012 AND 2011, 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 CHANGES IN NET ASSETS SCHEDULE D, PART XI, LINE 8 9,621 CHANGE IN INVESTMENT IN EQUITY INVESTEE OTHER RECONCILING ITEMS SCHEDULE D, PART XII, LINE 2D (71,200) SCHOLARSHIPS GRANTED 9,621 CHANGE IN INVESTMENT IN EQUITY INVESTEE --------- (61,579) TOTAL OTHER RECONCILING ITEMS SCHEDULE D, PART XII, LINE 4B (180,819) BURGANDY BALL EXPENSES (2,532,659) RENTAL EXPENSES 206,884 GAIN ON SALE OF FIXED ASSETS ------------ (2,506,594) TOTAL OTHER RECONCILING ITEMS SCHEDULE D, PART XIII, LINE 2D 180,819 SPECIAL EVENT EXPENSE 2,532,659 RENTAL EXPENSE (206,884) GAIN ON SALE OF FIXED ASSETS ----------- 2,506,594 TOTAL OTHER RECONCILING ITEMS SCHEDULE D, PART XIII, LINE 4B 71,200 SCHOLARSHIPS GRANTED GOLF TOURNAMENT 48374 38120 10254 920 16508 9574 680 7313 BURGANDY BALL 79831 46351 33480 20444 33480 29429 62471 0 128205 84471 43734 920 16508 30018 34160 29429 69784 180819 -137085 true CITIZENS MEMORIAL HOSPITAL DISTRICT 1500 N OAKLAND AVENUE BOLIVAR MO 65613 431142176 GOVERNMENTAL 9000 SENIOR HEALTH CTR 1 VARIOUS SCHOLARHIPS AWARDED 32 71200 GRANT MONITORING SCHEDULE I, PART I, LINE 2 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 89905 266707 19767 0 0 47120 899 30746 0 11961 110571 356534 0 0 GARY FULBRIGHT 0 200499 0 10827 0 13104 0 18911 0 14813 0 258154 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 2012, 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). INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR 431430093 097638BE9 2004-12-29 4065937 REFUND 01 & 03 BANK LOANS false false false INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY 431546885 234618AC0 2004-12-29 6477194 REFUND 1996 BONDS & CONSTRUCTION false false false INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY 010912805 731249AB4 2008-08-13 10429088 REFUND 06, 07, & 08 BANK LOANS false false false INDUSTRIAL DVLP AUTHORITY OF THE CITY OF ASH GROVE 431915231 043722AA5 2009-07-01 2910000 REFUND SERIES 2001 REV BONDS false false false 0 0 4110000 406900 0 0 81318 0 0 3621782 0 0 2008 true false true true 0 0 6575000 657500 0 3323687 129543 0 0 2464270 0 0 2008 false false true true 0 0 10500000 1050000 0 0 208582 0 0 9241418 0 0 2009 false false true true 0 0 2910000 0 0 0 0 0 0 2910000 0 0 2009 true false true true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true 0 false false false 0 false 0 false false false false false 0 false 0 false false false false false 0 false 0 false false false false false 0 false 0 false false X INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR 431430093 2009-12-15 3310000 REFUND SERIES 1998 REV BONDS false false false INDUSTRIAL DVLP AUTH OF THE CITY OF ELDORADO SPRGS 260025115 2012-01-27 2680000 REFUND SERIES 2001 REV BONDS false false false 0 0 3310000 0 0 0 0 0 0 3310000 0 0 2009 true false true true 0 0 2680000 0 0 0 0 0 0 2680000 0 0 2012 true false true true 0 0 false false false 0 false 0 false false false false false 0 false 0 false false X 1 3127543 FMV false false false METHOD OF DETERMINING NONCASH CONTRIBUTION AMOUNTS SCHEDULE M, PART I, COLUMN D ON SEPTEMBER 1, 2011, CITIZENS MEMORIAL HEALTH CARE FOUNDATION ENTERED INTO A MERGER WITH ANOTHER MISSOURI NON-PROFIT CORPORATION. THE ORGANIZATION RECOGNIZED THIS MERGER AS A CONTRIBUTION WITH A NET VALUE OF $3,127,543. THIS AMOUNT IS CALCULATED AS FOLLOWS: 42,513 ACCOUNTS RECEIVABLE 5,846 INVENTORY 2,925 OTHER RECEIVABLES 2,203,796 BUILDING 80,000 LAND 362,570 FURNITURE, FIXTURES & EQUIPMENT 524,000 CERTIFICATE OF NEED 8,438 COST REPORT SETTLEMENT (74,444) PTO ACCRUED (3,200) MCR LEVEL PAYMENTS (15,027) ACCRUED NFRA (9,874) OTHER LIABILITIES ---------- 3,127,543 TOTAL 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. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 IN SEPTEMBER OF 2011 THE ORGANIZATION ACQUIRED LAKE STOCKTON HEALTH CARE FACILITY, A 75-BED MEDICAID-CERTIFIED AND MEDICARE-CERTIFIED NURSING CARE FACILITY LOCATED IN STOCKTON, MO. THIS FACILITY EXPANDS THE ORGANIZATIONS ABILITY TO PROVIDE LONG TERM CARE SERVICES TO THE RESIDENTS IN AND AROUND STOCKTON, MO. 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 ONE. 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. A FINAL DRAFT WILL BE DISCUSSED AT A MEETING OF THE FULL BOARD OF DIRECTORS. 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. HOURS FOR A RELATED ORGANIZATION FORM 990, PART VII, COLUMN B DONALD J. BABB, GARY FULBRIGHT, AND CATHERINE MOLDER EACH WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR CITIZENS MEMORIAL HOSPITAL. 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 OR FUND BALANCES FORM 990, PART XI, LINE 5 119,438 NET UNREALIZED GAIN ON INVESTMENT (9,621) CHANGES IN INVESTMENT IN EQUITY INVESTEE -------- 109,817 TOTAL 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 NA false BOLIVAR MED BLDG BOLIVAR MO 65613 BOLIVAR MO 65613 262797636 MEDICAL BUILD MO CMHCF EXCLUDED FROM TAX 7503 388047 false 0 false 0.51000 false false false true false false false false true true false false false true false true true false BOLIVAR MEDICAL BUIDLING LLC J 92074 FMV