FURP.ORG / PUBLIC DATA EXPLORER

CITIZENS MEMORIAL HEALTH CARE FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CITIZENS MEMORIAL HEALTH CARE FOUNDATION (EIN 43-1425356)
Tax period
2010-06-01 to 2011-05-31
Filed
2012-03-01
IRS object ID
201210619349302331
Schema version
2010v3.7
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)
Timestamp2012-03-01T15:18:26-06:00Timestamp
Tax Period End Date2011-05-31TaxPeriodEndDate

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 Date2010-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431425356EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CITIZENS MEMORIAL HEALTH CARE FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCITINameControl
Phone4173266000Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameDONALD J BABBName
TitleEXECUTIVE DIRECTORTitle
Date Signed2012-01-18DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts33598482GrossReceipts
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 Employees838TotalNbrEmployees
Total Nbr Volunteers62TotalNbrVolunteers
Total Gross UBI2416TotalGrossUBI
Net Unrelated Business Txbl Income1208NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year158818ContributionsGrantsPriorYear
Contributions Grants Current Year303900ContributionsGrantsCurrentYear
Program Service Revenue Prior Year30376030ProgramServiceRevenuePriorYear
Program Service Revenue CY30715253ProgramServiceRevenueCY
Investment Income Prior Year77330InvestmentIncomePriorYear
Investment Income Current Year163981InvestmentIncomeCurrentYear
Other Revenue Prior Year-437865OtherRevenuePriorYear
Other Revenue Current Year-241958OtherRevenueCurrentYear
Total Revenue Prior Year30174313TotalRevenuePriorYear
Total Revenue Current Year30941176TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year92412GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY81642GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year17663431SalariesEtcPriorYear
Salaries Etc Current Year17512367SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12045755OtherExpensePriorYear
Other Expenses Current Year12321956OtherExpensesCurrentYear
Total Expenses Prior Year29801598TotalExpensesPriorYear
Total Expenses Current Year29915965TotalExpensesCurrentYear
Revenues Less Expenses Prior Year372715RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1025211RevenuesLessExpensesCY
Total Assets BOY46337289TotalAssetsBOY
Total Assets EOY46811823TotalAssetsEOY
Total Liabilities BOY38215471TotalLiabilitiesBOY
Total Liabilities EOY37527235TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8121818NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9284588NetAssetsOrFundBalancesEOY
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
Expense17559216Expense
Revenue25111427Revenue
DescriptionPROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 82,000 RESIDENT DAYS) IN SKILLED FACILITIES. FOR MORE INFORMATION, SEE SCHEDULE O.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1046308Expense
Revenue1478176Revenue
DescriptionPROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 58 RESIDENTS PER DAY. FOR MORE INFORMATION, SEE SCHEDULE O.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense476681Expense
Revenue641397Revenue
DescriptionPROVIDE HOME CHORE SERVICES TO PEOPLE LIVING AT HOME BUT UNABLE TO COMPLETELY CARE FOR THEMSELVES. THROUGH HOMEMAKER PLUS, 46,500 SERVICE UNITS WERE PROVIDED THROUGH LIGHT HOUSEKEEPING, LAUNDRY, SHOPPING AND RESPITE CARE SERVICES. FOR MORE INFORMATION, SEE SCHEDULE O.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp4187688TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt81642TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev3536986TotalOfOtherProgramServiceRev
Total Program Service Expense23269893TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
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 EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109664NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees838NumberOfEmployees
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
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DONALD J BABB
EXECUTIVE DIRECTOR20.0XX9632244636644909
GENE HUTCHESON
RETIRED BOARD MEMBER1.0X000
DAVE STRADER
BOARD PRESIDENT1.0XX000
BRAD GREGORY
BOARD VICE PRESIDENT1.0XX000
ROBERT KIFER
BOARD MEMBER1.0X000
PATRICK DOUGLAS
RETIRED BOARD MEMBER1.0X000
DAVE BERRY
BOARD MEMBER1.0X000
DEREK HUNTER
BOARD MEMBER1.0X000
D MICHEALE MEENTS
BOARD MEMBER1.0X000
NEALE JOHNSON
BOARD MEMBER1.0X000
GARY FULBRIGHT
BOARD TREASURER - NONVOTING45.0X020956935032
CATHERINE MOLDER
BOARD SECRETARY - NONVOTING45.0X0853817719
RENEE MEYER
DIRECTOR OF FINANCE45.0X12284409991
KENNETH SCHANDA
DIRECTOR OF REHAB SERVICES45.012396809217X
TIM FRANCKA
ADMIN DIR - LONG TERM CARE45.012390909298X
FieldValueIRS element (for citing)
Total Reportable Comp From Org467043TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs741316TotalReportableCompFrmRltdOrgs
Total Other Compensation116166TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonBKD LLPNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS STREETAddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code65801ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONSULTING/AUDIT/TAXDescriptionOfServices
Compensation135307Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events72911FundraisingEvents
All Other Contributions230989AllOtherContributions
Total Contributions303900TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE6230003059526630595266
CAFETERIA7222108628786287
VENDING72221082088208
TRANSIT9000991815518155
OTHER INCOME62300073377337
FieldValueIRS element (for citing)
Total Program Service Revenue30715253TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column118295TotalRevenueColumn
Exclusion$118,295ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column45185TotalRevenueColumn
Exclusion$45,185ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2315543Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2502632Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-187089Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-187089TotalRevenueColumn
Unrelated Business Revenue2416UnrelatedBusinessRevenue
Exclusion-$189,505ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other501Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other501Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column501TotalRevenueColumn
Exclusion$501ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events47072GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events72911CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses154674FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-107602TotalRevenueColumn
Exclusion-$107,602ExclusionAmount

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

FieldValueIRS element (for citing)
DescriptionREPAYMENT OF SCHOLARSHIPSDescription
Business Code900099BusinessCode
Total Revenue Column52733TotalRevenueColumn
Related Or Exempt Function Income52733RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue52733TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column30941176TotalRevenueColumn
Related Or Exempt Function Income30767986RelatedOrExemptFunctionIncome
Unrelated Business Revenue2416UnrelatedBusinessRevenue
Exclusion-$133,126ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total9000Total
Program Services9000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total72642Total
Program Services72642ProgramServices

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)
Total230007Total
Management And General230007ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12985731Total
Program Services11090159ProgramServices
Management And General1895572ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total356472Total
Program Services276651ProgramServices
Management And General79821ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2894112Total
Program Services2276732ProgramServices
Management And General617380ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1046045Total
Program Services835119ProgramServices
Management And General210926ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1698288Total
Program Services58824ProgramServices
Management And General1639464ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total25811Total
Management And General25811ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total135307Total
Management And General135307ManagementAndGeneral

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)
Total250674Total
Program Services238387ProgramServices
Management And General12287ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total61149Total
Management And General61149ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total766948Total
Program Services486646ProgramServices
Management And General280302ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total80913Total
Management And General80913ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1311922Total
Program Services852016ProgramServices
Management And General459906ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total126426Total
Program Services36491ProgramServices
Management And General89935ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total31761Total
Program Services18132ProgramServices
Management And General13629ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total923623Total
Program Services662937ProgramServices
Management And General260686ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1354876Total
Program Services972473ProgramServices
Management And General382403ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total165348Total
Program Services37529ProgramServices
Management And General127819ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES358263135809381693
PROVIDER TAX/FEES15676791567679
BAD DEBTS194319194319
DUES AND SUBSCRIPTIONS4106241062
MISCELLANEOUS32193219

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total29915965Total
Program Services23269893ProgramServices
Management And General6646072ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6743BOY
EOY84530EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3632594BOY
EOY4834386EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY39720BOY
EOY117713EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2903913BOY
EOY3041712EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY12536BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY141464BOY
EOY133867EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1059249BOY
EOY994093EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis55755802LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22306948LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY34561542BOY
EOY33448854EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3253860BOY
EOY3372511EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY96734BOY
EOY105762EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY628934BOY
EOY678395EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY46337289BOY
EOY46811823EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3607869BOY
EOY3881657EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY133444BOY
EOY133609EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY30755000BOY
EOY29615000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY40083BOY
EOY37908EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3638878BOY
EOY3828864EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY40197BOY
EOY30197EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY38215471BOY
EOY37527235EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7082268BOY
EOY7880474EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1039550BOY
EOY1404114EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8121818BOY
EOY9284588EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY46337289BOY
EOY46811823EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1025211ReconcilationRevenueExpenses
Reconcilation Other Changes137559ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years97240CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years138156CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years105173CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year158818CurrentTaxYearMinus1Year
Current Tax Year220305CurrentTaxYear
Total719692Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years28130116CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years29996149CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30623480CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30376030CurrentTaxYearMinus1Year
Current Tax Year30725926CurrentTaxYear
Total149851701Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years28227356CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30134305CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30728653CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30534848CurrentTaxYearMinus1Year
Current Tax Year30946231CurrentTaxYear
Total150571393Total
FieldValueIRS element (for citing)
Public Support Total509150571393PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1485266CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2009690CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2572519CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2516299CurrentTaxYearMinus1Year
Current Tax Year2479023CurrentTaxYear
Total11062797Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years1818CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3174CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2634CurrentTaxYearMinus1Year
Current Tax Year2161CurrentTaxYear
Total9787Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1485266CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2011508CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2575693CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2518933CurrentTaxYearMinus1Year
Current Tax Year2481184CurrentTaxYear
Total11072584Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years67671CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years36680CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35856CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30318CurrentTaxYearMinus1Year
Current Tax Year52733CurrentTaxYear
Total223258Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years29780293CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years32182493CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years33340202CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year33084099CurrentTaxYearMinus1Year
Current Tax Year33480148CurrentTaxYear
Total161867235Total
FieldValueIRS element (for citing)
Public Support Percentage5090.93022PublicSupportPercentage509
Prior Year Support Percentage0.93480PriorYearSupportPercentage
Investment Income Percentage0.06840InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.06364PriorYrInvestIncomePercentage
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$1,571OtherActivitiesAmount
Total Lobbying Expenditures IIB1571TotalLobbyingExpendituresIIB
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 $711 AHCA.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4378460OtherCostOrOtherBasis
Book Value4378460BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis43141939OtherCostOrOtherBasis
Depreciation19178341Depreciation
Book Value23963598BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5629478OtherCostOrOtherBasis
Depreciation2502531Depreciation
Book Value3126947BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2605925OtherCostOrOtherBasis
Depreciation626076Depreciation
Book Value1979849BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings33448854TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPLEDGES PAYABLEDescription
Amount$30,197Amount
FieldValueIRS element (for citing)
Total Of Amounts30197TotalOfAmounts
Total Revenue30941176TotalRevenue
Total Expenses29915965TotalExpenses
Excess Or Deficit For Year1025211ExcessOrDeficitForYear
Net Unrealized GL On Investments128531NetUnrealizedGLOnInvestments
Other$9,028OtherAmount
Total Adjustments137559TotalAdjustments
Excess Or Deficit Per FS1162770ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt33626499TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments128531NetUnrealizedGainsInvestments
Other Revenues-63614OtherRevenues
Revenue Not Rptd F99064917RevenueNotRptdF990
Revenue Subtotal33561582RevenueSubtotal
Other Revenues Not Included-2620406OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-2620406RevenueNotRptdOnFinStmt
Total Revenue Per Form99030941176TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt32463729TotExpensesEtcAuditedFinclStmt
Other Expenses Included2620406OtherExpensesIncluded
Expenses Not Rptd F9902620406ExpensesNotRptdF990
Expenses Subtotal29843323ExpensesSubtotal
Other Expenses Not Included72642OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt72642ExpensesNotRptdOnFinStmt
Total Expenses Per Form99029915965TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ESCROW ACCOUNT LIABILITYSCHEDULE D, PART IV, QUESTION 2THE FOUNDATION WAS THE TRUSTEE OF $37,908 AND $40,083, RESPECTIVELY, AT MAY 31, 2011 AND 2010, 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 POSITIONFORM 990, SCHEDULE 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 CHANGES IN NET ASSETSFORM 990, SCHEDULE D, PART XI, LINE 8CHANGE IN INVESTMENT IN EQUITY INVESTEE 9,028
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XII, LINE 2DSCHOLARSHIPS (72,642) CHANGE IN INT IN EQUITY INVESTEE 9,028 ------------ TOTAL (63,614)
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XII, LINE 4BBURGANDY BALL EXPENSES (118,275) RENTAL EXPENSES (2,502,632) GAIN ON SALE OF FIXED ASSETS 501 ------------ TOTAL (2,620,406)
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XIII, LINE 2DSPECIAL EVENT EXPENSE 118,275 RENTAL EXPENSE 2,502,632 GAIN ON SALE OF FIXED ASSETS (501) ------------ TOTAL 2,620,406
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XIII, LINE 4BSCHOLARSHIPS 72,642

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event149394GrossReceiptsEvent1
Charitable Contributions Event137220CharitableContributionsEvent1
Gross Revenue Event112174GrossRevenueEvent1
Non Cash Prizes Event116576NonCashPrizesEvent1
Rent Facility Costs Event19040RentFacilityCostsEvent1
Food And Beverage Event13134FoodAndBeverageEvent1
Other Direct Expenses Event17649OtherDirectExpensesEvent1
Name Of Event2BURGANDY BALLNameOfEvent2
Gross Receipts Event270589GrossReceiptsEvent2
Charitable Contributions Event235691CharitableContributionsEvent2
Gross Revenue Event234898GrossRevenueEvent2
Rent Facility Costs Event213211RentFacilityCostsEvent2
Food And Beverage Event234898FoodAndBeverageEvent2
Entertainment Event226950EntertainmentEvent2
Other Direct Expenses Event243216OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total119983GrossReceiptsTotal
Charitable Contributions Total72911CharitableContributionsTotal
Gross Revenue Total Events47072GrossRevenueTotalEvents
Non Cash Prizes Total Events16576NonCashPrizesTotalEvents
Rent Facility Costs Total Events22251RentFacilityCostsTotalEvents
Food And Beverage Total Events38032FoodAndBeverageTotalEvents
Entertainment Total Events26950EntertainmentTotalEvents
Other Direct Expenses Total Events50865OtherDirectExpensesTotalEvents
Direct Expense Summary Events154674DirectExpenseSummaryEvents
Net Income Summary-107602NetIncomeSummary

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 Recipients33NumberOfRecipients
Amount Of Cash Grant72642AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGRANT MONITORINGIdentifier
Return ReferenceSCHEDULE I, PART I, QUESTION 2ReturnReference
ExplanationCITIZENS MEMORIAL HEALTH CARE FOUNDATION HAS A MEDICAL EXCELLENCE SCHOLAYSHIP 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.Explanation

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)

Base 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
8701038491193120061455850307090133509717249042500
GARY FULBRIGHT
019121205631012726018690016342024460100

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierCONTINGENT COMPENSATIONIdentifier
Return ReferenceSCHEDULE J, PART I, QUESTION 6ReturnReference
ExplanationIN FY 2011, 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).Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuer
INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR
431430093097638BE92004-12-294065937REFUND 01 & 03 BANK LOANSfalsefalse
INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY
431546885234618AC02004-12-296477194REFUND 1996 BONDS & CONSTRUCTIfalsefalse
INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY
010912805731249AB42008-08-1310429088REFUND 06, 07 & 08 BANK LOANSfalsefalse
INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR
4314300932009-12-153310000REFUND SERIES 1998 REV BONDSfalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindRefunding EscrowRefundingEscrow
41100004069008131836217822008falsefalsetruetrue
657500065750012954324642702008falsefalsetruetrue3323687
10500000105000020858292414182009falsefalsetruetrue
3310000falsefalsetruetrue3310000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsetrue
falsefalsefalsefalsefalsetrue

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART I, LINE 1THE ORGANZIATION 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. HOMEMAKER CHORE SERVICES.
PROGRAM SERVICE ACTIVITY DETAILFORM 990, PART III, LINE 4A, 4B & 4CWE 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. OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES INCLUDE ACTIVITIES WHICH PROMOTE THE ORGANIZATION'S EXEMPT PURPOSE. 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 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.
HOURS FOR A RELATED ORGANIZATIONFORM 990, PART VII, COLUMN BDONALD J. BABB, GARY FULBRIGHT, AND CATHERINE MOLDER EACH WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR CITIZENS MEMORIAL HOSPITAL.
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, LINE 5NET UNREALIZED GAIN ON INVESTMENT 128,531 CHANGES IN EQUITY INVESTEE 9,028 --------- TOTAL 137,559

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/BusinessNameLine1
CITIZENS MEMORIAL HOSPITAL
1500 N OAKLANDBOLIVARMO65613431142176HOSPITALMO501(C)(3)3NA
RIVERSIDE MANAGEMENT & REHABILITATION
1500 N OAKLANDBOLIVARMO65613431776752MGT & REHABMO501(C)(3)9NA

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 Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeEXCLUDED FROM TAXPredominantIncomeType
Share Of Total Income7650ShareOfTotalIncome
Share Of EOY Assets402400ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
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
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 OrgtrueOtherTransferToOtherOrg
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 TypeJTransactionType
Amount Involved92074AmountInvolved