2012-03-01T15:18:26-06:00 2011-05-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2010-06-01 431425356 CITIZENS MEMORIAL HEALTH CARE FOUNDATION CITI 4173266000 1500 N OAKLAND AVENUE BOLIVAR MO 65613 DONALD J BABB 2012-01-18 true Brian D Todd 4178658701 2010 2016-02-24 21:20:13Z DONALD J BABB 1500 N OAKLAND AVENUE BOLIVAR MO 65613 33598482 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 7 838 62 2416 1208 158818 303900 30376030 30715253 77330 163981 -437865 -241958 30174313 30941176 92412 81642 0 0 17663431 17512367 0 0 0 12045755 12321956 29801598 29915965 372715 1025211 46337289 46811823 38215471 37527235 8121818 9284588 X TO SUPPORT AND ASSIST CITIZENS MEMORIAL HOSPITAL DISTRICT, OR ITS SUCCESSORS, OR ANY HEALTH CARE INSTITUTION WITH WHICH IT MAY MERGE. false false 17559216 25111427 PROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 82,000 RESIDENT DAYS) IN SKILLED FACILITIES. FOR MORE INFORMATION, SEE SCHEDULE O. 1046308 1478176 PROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 58 RESIDENTS PER DAY. FOR MORE INFORMATION, SEE SCHEDULE O. 476681 641397 PROVIDE 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. 4187688 81642 3536986 23269893 true true false true false false false true false true false false false true false false true false false false false false false true false false true true true true false false false false false false false false false false false false false false false true true false false false true 64 0 true 838 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 96322 446366 44909 GENE HUTCHESON 1.0 X 0 0 0 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 PATRICK DOUGLAS 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 GARY FULBRIGHT 45.0 X 0 209569 35032 CATHERINE MOLDER 45.0 X 0 85381 7719 RENEE MEYER 45.0 X 122844 0 9991 KENNETH SCHANDA 45.0 X 123968 0 9217 TIM FRANCKA 45.0 X 123909 0 9298 467043 741316 116166 3 false true false BKD LLP 910 E ST LOUIS STREET SPRINGFIELD MO 65801 CONSULTING/AUDIT/TAX 135307 1 72911 230989 303900 NET PATIENT SERVICE REVENUE 623000 30595266 30595266 CAFETERIA 722210 86287 86287 VENDING 722210 8208 8208 TRANSIT 900099 18155 18155 OTHER INCOME 623000 7337 7337 30715253 118295 118295 45185 45185 0 2315543 2502632 -187089 -187089 2416 -189505 501 501 501 501 47072 72911 154674 -107602 -107602 0 0 REPAYMENT OF SCHOLARSHIPS 900099 52733 52733 52733 30941176 30767986 2416 -133126 9000 9000 72642 72642 0 0 230007 230007 0 12985731 11090159 1895572 356472 276651 79821 2894112 2276732 617380 1046045 835119 210926 1698288 58824 1639464 25811 25811 135307 135307 0 0 0 250674 238387 12287 61149 61149 766948 486646 280302 80913 80913 0 1311922 852016 459906 126426 36491 89935 0 31761 18132 13629 923623 662937 260686 0 1354876 972473 382403 165348 37529 127819 MEDICAL SUPPLIES 3582631 3580938 1693 PROVIDER TAX/FEES 1567679 1567679 BAD DEBTS 194319 194319 DUES AND SUBSCRIPTIONS 41062 41062 MISCELLANEOUS 3219 3219 29915965 23269893 6646072 0 6743 84530 3632594 4834386 39720 117713 2903913 3041712 12536 0 141464 133867 1059249 994093 55755802 22306948 34561542 33448854 3253860 3372511 96734 105762 628934 678395 46337289 46811823 3607869 3881657 133444 133609 30755000 29615000 40083 37908 3638878 3828864 40197 30197 38215471 37527235 X 7082268 7880474 1039550 1404114 8121818 9284588 46337289 46811823 X 1025211 137559 X false true true X false X 97240 138156 105173 158818 220305 719692 28130116 29996149 30623480 30376030 30725926 149851701 28227356 30134305 30728653 30534848 30946231 150571393 150571393 1485266 2009690 2572519 2516299 2479023 11062797 1818 3174 2634 2161 9787 1485266 2011508 2575693 2518933 2481184 11072584 67671 36680 35856 30318 52733 223258 29780293 32182493 33340202 33084099 33480148 161867235 0.93022 0.93480 0.06840 0.06364 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1571 1571 false OTHER LOBBY ACTIVITIES SCHEDULE C, PART II-B, QUESTION 1I THE ORGANIZATION PAYS ANNUAL DUES TO THE MISSOURI HEALTH CARE ASSOCIATION (MHCA) AND THE AMERICAN HEALTH CARE ASSOCIATION (AHCA). A PORTION OF THESE DUES ARE ALLOCABLE TO LOBBYING: $860 MHCA AND $711 AHCA. false true 4378460 4378460 43141939 19178341 23963598 5629478 2502531 3126947 2605925 626076 1979849 33448854 0 PLEDGES PAYABLE 30197 30197 30941176 29915965 1025211 128531 9028 137559 1162770 33626499 128531 -63614 64917 33561582 -2620406 -2620406 30941176 32463729 2620406 2620406 29843323 72642 72642 29915965 ESCROW ACCOUNT LIABILITY SCHEDULE D, PART IV, QUESTION 2 THE 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 POSITION FORM 990, 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 FORM 990, SCHEDULE D, PART XI, LINE 8 CHANGE IN INVESTMENT IN EQUITY INVESTEE 9,028 OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XII, LINE 2D SCHOLARSHIPS (72,642) CHANGE IN INT IN EQUITY INVESTEE 9,028 ------------ TOTAL (63,614) OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XII, LINE 4B BURGANDY BALL EXPENSES (118,275) RENTAL EXPENSES (2,502,632) GAIN ON SALE OF FIXED ASSETS 501 ------------ TOTAL (2,620,406) OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XIII, LINE 2D SPECIAL EVENT EXPENSE 118,275 RENTAL EXPENSE 2,502,632 GAIN ON SALE OF FIXED ASSETS (501) ------------ TOTAL 2,620,406 OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XIII, LINE 4B SCHOLARSHIPS 72,642 GOLF TOURNAMENT 49394 37220 12174 16576 9040 3134 7649 BURGANDY BALL 70589 35691 34898 13211 34898 26950 43216 0 119983 72911 47072 16576 22251 38032 26950 50865 154674 -107602 true CITIZENS MEMORIAL HOSPITAL DISTRICT 1500 N OAKLAND AVENUE BOLIVAR MO 65613 431142176 GOVERNMENTAL 9000 SENIOR HEALTH CTR 1 VARIOUS SCHOLARHIPS AWARDED 33 72642 GRANT MONITORING SCHEDULE I, PART I, QUESTION 2 CITIZENS 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. false false false false false true false false false DONALD J BABB 87010 384911 9312 0 0 61455 850 30709 0 13350 97172 490425 0 0 GARY FULBRIGHT 0 191212 0 5631 0 12726 0 18690 0 16342 0 244601 0 0 CONTINGENT COMPENSATION SCHEDULE J, PART I, QUESTION 6 IN 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). INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR 431430093 097638BE9 2004-12-29 4065937 REFUND 01 & 03 BANK LOANS false false INDUSTRIAL DVLP AUTHORITY OF DALLAS COUNTY 431546885 234618AC0 2004-12-29 6477194 REFUND 1996 BONDS & CONSTRUCTI false false INDUSTRIAL DVLP AUTHORITY OF POLK COUNTY 010912805 731249AB4 2008-08-13 10429088 REFUND 06, 07 & 08 BANK LOANS false false INDUSTRIAL DVLP AUTHORITY OF THE CITY OF BOLIVAR 431430093 2009-12-15 3310000 REFUND SERIES 1998 REV BONDS false false 4110000 406900 81318 3621782 2008 false false true true 6575000 657500 3323687 129543 2464270 2008 false false true true 10500000 1050000 208582 9241418 2009 false false true true 3310000 3310000 false false true true false false false false false true false false false false false true false false false false false true false false false false false true false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false false ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 THE 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 DETAIL FORM 990, PART III, LINE 4A, 4B & 4C 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. 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 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. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 NET UNREALIZED GAIN ON INVESTMENT 128,531 CHANGES IN EQUITY INVESTEE 9,028 --------- TOTAL 137,559 CITIZENS MEMORIAL HOSPITAL 1500 N OAKLAND BOLIVAR MO 65613 431142176 HOSPITAL MO 501(C)(3) 3 NA RIVERSIDE MANAGEMENT & REHABILITATION 1500 N OAKLAND BOLIVAR MO 65613 431776752 MGT & REHAB MO 501(C)(3) 9 NA BOLIVAR MED BLDG BOLIVAR MO 65613 BOLIVAR MO 65613 262797636 MEDICAL BUILD MO NA EXCLUDED FROM TAX 7650 402400 false 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