2012-05-11T13:32:02-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 8112 MARYLAND AVE SUITE 400 ST LOUIS MO 63105 990 2011-01-01 440579862 THE OZARKS METHODIST MANOR OZAR 4172582573 205 S COLLEGE AVE MARIONVILLE MO 65705 MORRIS DOCK 4172582573 2012-05-07 1 GREG W SCHMITTGENS P00292367 3149666622 2011 2016-02-24 21:20:13Z MORRIS DOCK 205 S COLLEGE AVE MARIONVILLE MO 65705 6478561 0 X WWW.GBGM-UMC.ORG/METHODISTMANOR X 1925 MO RETIREMENT VILLAGE OPERATIONS: 82 BED RESIDENTIAL CARE FACILITY, 78 BED SKILLED NURSING FACILITY, 58 COTTAGES, AND SUPPORTING SERVICES. 13 13 206 0 0 0 87562 26744 5996682 6281744 50589 104410 104346 52016 6239179 6464914 0 0 0 0 3529062 3712779 0 0 0 3445727 3123394 6974789 6836173 -735610 -371259 6705913 5757708 3624140 3186355 3081773 2571353 TO PROVIDE CONTINUING CARE TO THE ELDERLY, MEETING THEIR NEEDS AS THEY CHANGE DURING THE AGING PROCESS, PROVIDING RETIREMENT HOMES AND SUPPORT, ASSISTED LIVING AND SKILLED NURSING. 0 0 5909525 6333760 RETIREMENT VILLAGE OPERATIONS - 76 BED RESIDENTIAL CARE FACILITY, 78 BED SKILLED NURSING FACILITY, 58 COTTAGES, AND SUPPORTING SERVICES 5909525 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 25 0 1 206 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 0 0 0 X ROBERTA FRENCH 4172582573 205 S COLLEGE MARIONVILLE MO 65705 X DR RON MCINTIRE 1.00 X 0 0 0 TERRELL BARKETT 1.00 X X 0 0 0 RICHARD DELMONT 1.00 X 0 0 0 MORRIS DOCK 1.00 X X 0 0 0 RALPH PROSSER 1.00 X 0 0 0 REV LEE MILLER 1.00 X 0 0 0 JOE W MCCARTY 1.00 X X 0 0 0 REV MICHAEL BLACKSHER 1.00 X X 0 0 0 NANCY HANSFORD 1.00 X 0 0 0 TJ MCKENZIE 1.00 X 0 0 0 REV FRED ROYER 1.00 X 0 0 0 DOUGLAS STROEMEL 1.00 X 0 0 0 MARK RUNDEL 1.00 X 0 0 0 0 0 0 0 0 0 0 LIFE CARE SERVICES LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT FEES 523092 REHABCARE 7733 FORSYTH BLVD SUITE 1700 ST LOUIS MO 63105 AGENCY STAFFING 448922 MERCY HEALTH PLANS 550 MARYVILLE CENTRE DRIVE SUITE 30 ST LOUIS MO 63141 HEALTH INSURANCE 374151 SYSCO OF KANSAS CITY 1915 E KANSAS CITY RD OLATHE KS 66061 FOOD SERVICE 352502 AJ GALLAGHER RISK MGMT SVCS RM 12444 POWERSCOURT DRIVE SUITE 500 ST LOUIS MO 63131 INSURANCE 288109 5 26744 26744 PATIENT SERVICE REVENU 623000 6270940 6270940 OTHER REVENUES 623000 10804 10804 6281744 62033 62033 56024 13647 42377 42377 42377 OTHER REVENUE 623000 52016 52016 52016 6464914 6333760 0 104410 2985449 2776206 209243 14025 9940 4085 491418 365274 126144 221887 206760 15127 182980 182980 4866 4866 23635 23635 12790 12790 33403 33403 18220 1575 16645 377028 323237 53791 7125 7125 279325 279325 31282 21657 9625 2287 2287 390588 390588 178455 178455 THERAPIES 532316 532316 FOOD & FOOD SUPPLIES 376239 376239 LICENSES & FEES 268520 266691 1829 CONTRACT LABOR 137139 135247 1892 267196 191067 76129 6836173 5909525 926648 0 384438 67035 920012 782364 91284 143361 11308625 8847653 2768866 2460972 2270947 2003163 95520 111156 131597 140074 43249 49583 6705913 5757708 1731275 1763608 1872360 1401353 20505 21394 3624140 3186355 X 2044557 1539251 40359 35245 996857 996857 3081773 2571353 6705913 5757708 X -371259 -139161 X X 0 1 0 X 0 X 100934 55833 86547 87562 26744 357620 5808253 5892458 6549624 6109706 6171372 30531413 5909187 5948291 6636171 6197268 6198116 30889033 0 0 0 30889033 85370 81975 55217 55646 62033 340241 85370 81975 55217 55646 62033 340241 5994557 6030266 6691388 6252914 6260149 31229274 0.98910 0.98840 0.01090 0.01140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2304481 20 -39896 191638 12790 2060177 2392554 300960 375000 14033 2304481 2038185 458149 91500 12280 2392554 2963991 4000 -836237 -79000 -14569 2038185 0.51610 0.48390 1 0 196487 196487 8364435 6621461 1742974 809518 610219 199299 906078 671989 234089 1032107 943984 88123 2460972 RESIDENTS' PERSONAL FUNDS 21394 21394 6464914 6836173 -371259 -142097 2936 -139161 -510420 6368553 8050 8050 6360503 104411 104411 6464914 6873859 142097 142097 6731762 104411 104411 6836173 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: EARNINGS FROM THE ORGANIZATION'S ENDOWMENT FUNDS PRIMARILY USED TO PROVIDE SCHOLARSHIPS TO THE EMPLOYEES FOR NURSING EDUCATION, AND OTHER PROGRAM NEEDS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MANOR HAS ADOPTED ASC 740-10, INCOME TAXES, AS IT RELATES TO UNCERTAIN TAX POSITIONS, AND HAS EVALUATED ITS TAX POSITIONS TAKEN FOR ALL OPEN TAX YEARS. CURRENTLY, THE 2008 AND SUBSEQUENT TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR THE ORGANIZATION. HOWEVER, THE MANOR IS NOT CURRENTLY UNDER AUDIT NOR HAVE THEY BEEN CONTACTED BY THE IRS. BASED ON THE EVALUATION OF THE MANOR'S TAX POSITIONS, MANAGEMENT BELIEVES ALL POSITIONS TAKEN WOULD BE UPHELD UNDER AN EXAMINATION. NO PROVISION FOR THE EFFECT OF UNCERTAIN TAX POSITIONS HAS BEEN RECORDED AS OF DECEMBER 31, 2011 AND 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED NET ASSETS-GAIN (LOSS) ON ANNUITY AGREEMENTS 2,936. PART XII, LINE 2D - OTHER ADJUSTMENTS: ASSETS RELEASED FROM RESTRICTION 8,050. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 104,411. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 104,411. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES ARE PERFORMED BY LIFE CARE SERVICES. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO SEPARATE COMMITTEES, N/A. FORM 990, PART VI, SECTION B, LINE 11 DRAFT FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH GENERAL BOARD OVERSIGHT AND ANNUAL REVIEW. ALSO, INDIVIDUAL DIRECTORS ARE REQUIRED TO SIGN NON-CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE PER REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -142,097. TEMPORARILY RESTRICTED NET ASSETS-GAIN (LOSS) ON ANNUITY AGREEMENTS 2,936. TOTAL TO FORM 990, PART XI, LINE 5: -139,161. THE ORGANIZATION'S BOARD OF DIRECTORS IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT.