FURP.ORG / PUBLIC DATA EXPLORER

MISSION HEALTH SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MISSION HEALTH SERVICES (EIN 74-2561471)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-10-30
IRS object ID
201333039349300618
Schema version
2012v2.0
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)
Timestamp2013-10-30T08:11:19-07:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Ross & Workman LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11223 W Chavez DrAddressLine1
CitySouth JordanCity
StateUTState
ZIP Code84095ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN742561471EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MISSION HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMISSNameControl
Phone8017452348Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12825 VIRGINIA WAYAddressLine1
CityOGDENCity
StateUTState
ZIP Code84403ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY KELSOName
TitlePresidentTitle
Date Signed2013-10-29DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSTEVEN L ROSSName
PTINP00067192PTIN
Phone8012549781Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY KELSONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11585 26TH STAddressLine1
CityOGDENCity
StateUTState
ZIP Code84401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14005350GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteWWW.MISSIONHEALTHSERVICES.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1990YearFormation
State Legal DomicileUTStateLegalDomicile
Activity Or Mission DescriptionMission Health Services is dedicated to providing for the needs of the elderly in the state of Utah through the operation of three skilled nursing care facilities, and one intermediate nursing care facility.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees544TotalNbrEmployees
Total Nbr Volunteers42TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year35701ContributionsGrantsPriorYear
Contributions Grants Current Year63482ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15917655ProgramServiceRevenuePriorYear
Program Service Revenue CY13678862ProgramServiceRevenueCY
Investment Income Prior Year1723662InvestmentIncomePriorYear
Investment Income Current Year3244InvestmentIncomeCurrentYear
Other Revenue Prior Year310582OtherRevenuePriorYear
Other Revenue Current Year259762OtherRevenueCurrentYear
Total Revenue Prior Year17987600TotalRevenuePriorYear
Total Revenue Current Year14005350TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8892298SalariesEtcPriorYear
Salaries Etc Current Year8103230SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year7077402OtherExpensePriorYear
Other Expenses Current Year5976336OtherExpensesCurrentYear
Total Expenses Prior Year15969700TotalExpensesPriorYear
Total Expenses Current Year14079566TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2017900RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-74216RevenuesLessExpensesCY
Total Assets BOY12123490TotalAssetsBOY
Total Assets EOY11939194TotalAssetsEOY
Total Liabilities BOY12575599TotalLiabilitiesBOY
Total Liabilities EOY12531726TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-452109NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-592532NetAssetsOrFundBalancesEOY
Mission DescriptionMission Health Services (MHS) is committed to providing for the special needs of the elderly throughout Utah. MHS facilities include three skilled nursing care facilities, and one intermediate nursing care facility. Currently, mhs employs over 500 Utahans who work and care for the frail, elderly, and those with special needs. MHS has a strong commitment to build and strengthen a sense of community through support for each other and among residents, staff and volunteers.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense13191965Expense
Revenue13678862Revenue
DescriptionMISSION HEALTH SERVICES (MHS) OPERATES FACILITIES (three SKILLED FACILITIES AND one INTERMEDIATE NURSING CARE FACILITy) IN THE STATE OF UTAH FOR long term care, rehabilitation services, and the care for those individuals with disabilities. BESIDES THE DONATED SERVICES LISTED IN THE RETURN, MHS ALSO DONATED COMMUNITY EDUCATION AND RELATED SERVICES AT AN APPROXIMATE VALUE OF $55,097. SIMILARLY, MHS PROVIDED UNPAID CARE TO INDIGENTS, waived UNREIMBURSED MEDICAid COSTS AND OTHER GIFTS TO THE COMMUNITY VALUED AT APPROXIMATELY $1,362,906, WHICH IS NEITHER REPORTED ON PAGE 1 NOR DISCLOSED ELSEWHERE IN THE RETURN.Description
Total Program Service Expense13191965TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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 ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109632NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees544NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
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 CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonGary KelsoNamePerson
Telephone Number8017452348TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11585 26TH STAddressLine1
CityOGDENCity
StateUTState
ZIP Code84401ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployee
LISA ARBOGAST
BOARD MEMBER1.000.00X250000
DAVID GESSEL
BOARD MEMBER1.000.00X350000
DIRK ANJEWIERDEN
Board Member1.000.00X450000
BRENT WEIL
Board Member1.000.00X300000
WARREN WALKER
REGIONAL VP40.000.00112019015077X
GARY KELSO
President40.000.00355176021791X
MARION SODERGREN
VP CLINICAL SERVICES40.000.0010500005508X
FieldValueIRS element (for citing)
Total Reportable Comp From Org585695TotalReportableCompFromOrg
Total Other Compensation42376TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SUPERIOR CARE PHARMACY
PO BOX 631285CINCINNATIOH45263PHARMACY201822
INFINITY REHABILITATION
M/S 24 PO BOX 5700PORTLANDOR97228THERAPY SVCS540310
HEALTHCARE SERVICES GROUP
3220 TILLMAN DR STE 300BENSALEMPA19020HOUSEKEEPING/LAUNDRY107224
AHMS
121 SE SHURFINE DR STE 9ANKENYIA50021ACCTG & ADMIN SRVCS229586
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
All Other Contributions63482AllOtherContributions
Noncash Contributions58792NoncashContributions
Total Contributions63482TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
UNCOMPENSATED CARE EXPNSE623000-1649630-1649630
PRIVATE CARE REVENUES62300015805141580514
MEDICARE/MEDICAID PAYMENT6230001374797813747978
FieldValueIRS element (for citing)
Total Program Service Revenue13678862TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3244TotalRevenueColumn
Exclusion$3,244ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
QUALITY INCENTIVE REVENUE623000193595193595
OTHER REVENUES6230004544345443
CFIRST, LLC INCOME6230002072420724
FieldValueIRS element (for citing)
Total Other Revenue259762TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14005350TotalRevenueColumn
Related Or Exempt Function Income13938624RelatedOrExemptFunctionIncome
Exclusion$3,244ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

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)
Total628071Total
Program Services110508ProgramServices
Management And General517563ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5883054Total
Program Services5883054ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1012470Total
Program Services1012470ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total579635Total
Program Services539582ProgramServices
Management And General40053ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total94112Total
Program Services61725ProgramServices
Management And General32387ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total256808Total
Program Services256808ProgramServices

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)
Total18352Total
Program Services18192ProgramServices
Management And General160ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total53230Total
Program Services52118ProgramServices
Management And General1112ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total155092Total
Program Services102386ProgramServices
Management And General52706ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total85578Total
Program Services39088ProgramServices
Management And General46490ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total673502Total
Program Services665714ProgramServices
Management And General7788ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total116353Total
Program Services10075ProgramServices
Management And General106278ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total40041Total
Management And General40041ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total620502Total
Program Services620408ProgramServices
Management And General94ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total598953Total
Program Services579652ProgramServices
Management And General19301ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total69687Total
Program Services58181ProgramServices
Management And General11506ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
DIETARY EXPENSES445060445060
NURSING EXPENSES541997541997
BED TAXES785823785823
PHYS., SPEECH, OCC. THERAPY881174881174

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total540072Total
Program Services527950ProgramServices
Management And General12122ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total14079566Total
Program Services13191965ProgramServices
Management And General887601ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4551903BOY
EOY3930702EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1102437BOY
EOY1148473EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY102154BOY
EOY92388EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis13134625LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8024192LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4816311BOY
EOY5110433EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1550685BOY
EOY1657198EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12123490BOY
EOY11939194EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY832076BOY
EOY986131EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY11743523BOY
EOY11545595EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12575599BOY
EOY12531726EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-452109BOY
EOY-592532EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-452109BOY
EOY-592532EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12123490BOY
EOY11939194EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-74216ReconcilationRevenueExpenses
Reconcilation Other Changes-66207ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
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 Years16507987CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16603652CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16335120CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15917655CurrentTaxYearMinus1Year
Current Tax Year13742344CurrentTaxYear
Total79106758Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Total0Total

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 Years16507987CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16603652CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16335120CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15917655CurrentTaxYearMinus1Year
Current Tax Year13742344CurrentTaxYear
Total79106758Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50979106758PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14706CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2507CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8230CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8647CurrentTaxYearMinus1Year
Current Tax Year3244CurrentTaxYear
Total37334Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14706CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2507CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8230CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8647CurrentTaxYearMinus1Year
Current Tax Year3244CurrentTaxYear
Total37334Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years359557CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years606932CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years249327CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year310582CurrentTaxYearMinus1Year
Current Tax Year259762CurrentTaxYear
Total1786160Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16882250CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17213091CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16592677CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16236884CurrentTaxYearMinus1Year
Current Tax Year14005350CurrentTaxYear
Total80930252Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97750PublicSupportPercentage509
Prior Year Support Percentage0.97930PriorYearSupportPercentage
Investment Income Percentage0.00050InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00100PriorYrInvestIncomePercentage
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 D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1325252OtherCostOrOtherBasis
Book Value1325252BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8957206OtherCostOrOtherBasis
Book Value8957206BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2852167OtherCostOrOtherBasis
Book Value2852167BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Depreciation8024192Depreciation
Book Value-8024192BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5110433TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
RESTRICTED CASH1061439
OTHER RECEIVABLE150000
ORGANIZATIONAL COSTS445759
FieldValueIRS element (for citing)
Total Book Value Other Assets1657198TotalBookValueOtherAssets
Tot Revenue Etc Audited Fincl Stmt13939143TotRevenueEtcAuditedFinclStmt
Revenue Subtotal13939143RevenueSubtotal
Other Revenues Not Included66207OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt66207RevenueNotRptdOnFinStmt
Total Revenue Per Form99014005350TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt14079566TotExpensesEtcAuditedFinclStmt
Expenses Subtotal14079566ExpensesSubtotal
Total Expenses Per Form99014079566TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierPart XI, Line 4bIdentifier
Return ReferencePart XI, Line 4b: Other revenue amounts included on 990 but not included in F/SReturnReference
ExplanationDONATIONS RECEIVED NOT ON BOOKS $62252 PARTNERSHIP INCOME NOT RECORDED ON BOOKS $3955Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
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 OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonGARY KELSONamePerson
TitlePresidentTitle
Base Compensation Filing Org252776BaseCompensationFilingOrg
Bonus Filing Org102400BonusFilingOrg
Nontaxable Benefits Filing Org21791NontaxableBenefitsFilingOrg
Total Compensation Filing Org376967TotalCompensationFilingOrg

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonSHERRY WALKERNamePerson
FieldValueIRS element (for citing)
RelationshipWIFE OF REG VPRelationship
Amount Of Transaction48802AmountOfTransaction
Description Of TransactionCOMPENSATION FOR SRVCSDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule M IRS990ScheduleM

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F99030306NoncashContribsRptdF990

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionDISNEY MEMORABILIADescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F9908623NoncashContribsRptdF990
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part XI, Line 9Other Changes In Net Assets Or Fund Balances - Other DecreasesPARTNERSHIP INCOME NOT RECORDED ON BOOKS = -$3955
Form 990, Part XI, Line 9Other Changes In Net Assets Or Fund Balances - Other DecreasesDONATIONS RECEIVED NOT ON BOOKS = -$62252
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableTHE GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesSALARY COMPENSATION SURVEYS ARE REVIEWED BY THE EXECUTIVE COMMITTEE EACH YEAR PRIOR TO APPROVAL. COMPENSATION FOR ADMINISTRATORS IS DETERMINED BY MARKET CONDITIONS. THE PRESIDENT HAS A SALARY CONTRACT, WHICH IS REVIEWED ANNUALLY TO MAKE SURE COMPENSATION IS IN LINE WITH INDUSTRY STANDARDS BASED ON SALARY INFORMATION AVAILABLE IN NATIONAL COMPENSATION REPORTS FOR TAX-EXEMPT ORGANIZATIONS. FOR THE 2012 TAX YEAR, THE BOARD CONTRACTED WITH AN OUTSIDE COMPANY TO CONDUCT A COMPENSATION STUDY. THE EXECUTIVE COMMITTEE REVIEWED AND APPROVED BONUSES AND COMPENSATION BASED ON THE STUDY.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsTHE BOARD MEMBERS, OFFICERS AND EMPLOYEES ARE COVERED UNDER THE POLICY ON CONFLICTS OF INTEREST AND DISCLOSURE OF CERTAIN INTERESTS. THEY ARE REQUIRED EACH YEAR TO COMPLETE A DISCLOSURE FORM IDENTIFYING ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES IN WHICH THEY MAY BE INVOLVED THAT MIGHT CONTRIBUTE TO A CONFLICT OF INTEREST ARISING. THE ORGANIZATION REGULARLY MONITORS AND ASSURES COMPLIANCE. ANY PERSONS WITH A CONFLICT ARE PROHIBITED FROM MAKING ANY DECISIONS RELATED TO THE CONFLICT.
Form 990, Part VI, Line 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessTHE FORM 990 IS DISTRIBUTED TO EACH BOARD MEMBER PRIOR TO RELEASE. THE BOARD MEMBERS REVIEW THE FORM. THE FORM IS EITHER DISCUSSED AT THE NEXT BOARD MEETING, IF BEFORE THE FILING DATE, OR THE BOARD MEMBERS SEND THEIR QUESTIONS AND COMMENTS TO THE PRESIDENT. AFTER THE FORM 990 IS FINALIZED, THE BOARD MEMBERS RECEIVE A COPY OF THE FINALIZED RETURN.
Form 990, Part VI, Line 2Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtBRENT WEIL, A BOARD MEMBER OF MISSION HEALTH SERVICES, IS THE SON-IN-LAW OF GARY KELSO, THE PRINCIPAL OFFICER.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
MISSION WEST JORDAN CARE CENTER LLC
1585 26TH STOGDENUT84401263762114OWNERSHIP OF BUILDING/LAND OF CARE CENTERUT67490943570MISSION HEALTH SERVICES
MISSION HILLSIDE REHABILITATION CTR LLC
1585 26TH STOGDENUT84401263762255OWNERSHIP OF BUILDING/LAND OF CARE CENTERUT343951349839MISSION HEALTH SERVICES
MISSION ALPINE VALLEY CARE CENTER LLC
1585 26TH STOGDENUT84401263762165OWNERSHIP OF BUILDING/LAND OF CARE CENTERUT107602566898MISSION HEALTH SERVICES
MISSION HEALTH LEASING LLC
1585 26TH STOGDENUT84401270634589SUBLEASE OF CARE CENTERS TO MISSION HEALTH SERVICESUT-40233MISSION HEALTH SERVICES
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 OrgfalseLoansOrGuaranteesToOtherOrg
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 OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg