FURP.ORG / PUBLIC DATA EXPLORER

CITIZENS MEMORIAL HEALTH CARE FOUNDATION: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CITIZENS MEMORIAL HEALTH CARE FOUNDATION (EIN 43-1425356)
Tax period
2009-06-01 to 2010-05-31
Filed
2011-03-01
IRS object ID
201100609349300410
Schema version
2009v1.7
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)
Timestamp2011-03-01T14:27:38-06:00Timestamp
Tax Period End Date2010-05-31TaxPeriodEndDate

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 Date2009-06-01TaxPeriodBeginDate

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 Signed2011-02-21DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts33334533GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.citizensmemorial.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionCARING FOR EVERY GENERATION THROUGH EXCEPTIONAL SERVICES BY LEADING PHYSICIANS AND A COMPASSIONATE HEALTHCARE TEAM.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees856TotalNbrEmployees
Total Nbr Volunteers65TotalNbrVolunteers
Total Gross UBI2994TotalGrossUBI
Net Unrelated Business Txbl Income1700NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year105173ContributionsGrantsPriorYear
Contributions Grants Current Year158818ContributionsGrantsCurrentYear
Program Service Revenue Prior Year30623480ProgramServiceRevenuePriorYear
Program Service Revenue CY30376030ProgramServiceRevenueCY
Investment Income Prior Year200012InvestmentIncomePriorYear
Investment Income Current Year77330InvestmentIncomeCurrentYear
Other Revenue Prior Year-304285OtherRevenuePriorYear
Other Revenue Current Year-437865OtherRevenueCurrentYear
Total Revenue Prior Year30624380TotalRevenuePriorYear
Total Revenue Current Year30174313TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year107456GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY92412GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year17360666SalariesEtcPriorYear
Salaries Etc Current Year17663431SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12236406OtherExpensePriorYear
Other Expenses Current Year12045755OtherExpensesCurrentYear
Total Expenses Prior Year29704528TotalExpensesPriorYear
Total Expenses Current Year29801598TotalExpensesCurrentYear
Revenues Less Expenses Prior Year919852RevenuesLessExpensesPriorYear
Revenues Less Expenses CY372715RevenuesLessExpensesCY
Total Assets BOY49110821TotalAssetsBOY
Total Assets EOY46337289TotalAssetsEOY
Total Liabilities BOY41528301TotalLiabilitiesBOY
Total Liabilities EOY38215471TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7582520NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8121818NetAssetsOrFundBalancesEOY
Mission DescriptionTO SUPPORT CITIZENS MEMORIAL HOSPITAL DISTRICT AND LOCAL RURAL COMMUNITIES. FOR ADDITIONAL INFORMATION, SEE SCHEDULE O.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense19284927Expense
Revenue24638264Revenue
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)
Expense1114503Expense
Revenue1322676Revenue
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)
Expense619957Expense
Revenue827053Revenue
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 Exp2643100TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt92412TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev3618355TotalOfOtherProgramServiceRev
Total Program Service Expense23662487TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
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
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109684NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees856NumberOfEmployees
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
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

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DONALD J BABB
EXECUTIVE DIRECTOR20.0XX10689628753715074
GENE HUTCHESON
BOARD MEMBER1.0X000
DAVE STRADER
BOARD PRESIDENT1.0XX000
BRAD GREGORY
BOARD MEMBER1.0X000
ROBERT KIFER
BOARD MEMBER1.0X000
PATRICK DOUGLAS
BOARD VICE PRESIDENT1.0XX000
DAVE BERRY
BOARD MEMBER1.0X000
DEREK HUNTER
BOARD MEMBER1.0X000
GARY FULBRIGHT
BOARD TREASURER - NONVOTING45.0X021504920005
CATHERINE MOLDER
BOARD SECRETARY - NONVOTING45.0X0834129315
RENEE MEYER
DIRECTOR OF FINANCE45.0X12577509872
RAJAB ECHESSA
PHYSICAL THERAPIST45.010745108323X
KENNETH SCHANDA
DIRECTOR OF REHAB SERVICES45.012722305505X
TIM FRANCKA
ADMIN DIR - LONG TERM CARE45.012294009849X
FieldValueIRS element (for citing)
Total Reportable Comp From Org590285TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs585998TotalReportableCompFrmRltdOrgs
Total Other Compensation77943TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
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/AUDITINGDescriptionOfServices
Compensation136677Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events85023FundraisingEvents
All Other Contributions73795AllOtherContributions
Total Contributions158818TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE6230003025739830257398
CAFETERIA7222108292582925
VENDING7222101218612186
TRANSIT9000991889618896
OTHER INCOME62300046254625
FieldValueIRS element (for citing)
Total Program Service Revenue30376030TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column176533TotalRevenueColumn
Exclusion$176,533ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2339766Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2673553Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-333787Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-333787TotalRevenueColumn
Unrelated Business Revenue2994UnrelatedBusinessRevenue
Exclusion-$336,781ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities191808Securities
Other30500Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities300329Securities
Other21182Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-108521Securities
Other9318Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-99203TotalRevenueColumn
Exclusion-$99,203ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events30760GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events85023CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses165156FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-134396TotalRevenueColumn
Exclusion-$134,396ExclusionAmount

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 Column30318TotalRevenueColumn
Related Or Exempt Function Income30318RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue30318TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column30174313TotalRevenueColumn
Related Or Exempt Function Income30406348RelatedOrExemptFunctionIncome
Unrelated Business Revenue2994UnrelatedBusinessRevenue
Exclusion-$393,847ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total9000Total
Program Services9000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total83412Total
Program Services83412ProgramServices

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)
Total243343Total
Management And General243343ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12886208Total
Program Services11111180ProgramServices
Management And General1775028ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total380518Total
Program Services302398ProgramServices
Management And General78120ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3017676Total
Program Services2412827ProgramServices
Management And General604849ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1135686Total
Program Services924642ProgramServices
Management And General211044ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1546173Total
Program Services131045ProgramServices
Management And General1415128ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total17014Total
Management And General17014ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total136677Total
Management And General136677ManagementAndGeneral

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)
Total8545Total
Management And General8545ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total99551Total
Program Services45892ProgramServices
Management And General53659ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total49867Total
Management And General49867ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total733279Total
Program Services490382ProgramServices
Management And General242897ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total66570Total
Management And General66570ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1205424Total
Program Services663985ProgramServices
Management And General541439ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total126512Total
Program Services43723ProgramServices
Management And General82789ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total38396Total
Program Services21989ProgramServices
Management And General16407ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1003821Total
Program Services1003821ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1445803Total
Program Services1052672ProgramServices
Management And General393131ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total158706Total
Program Services14014ProgramServices
Management And General144692ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
DUES AND SUBSCRIPTIONS3999739997
BAD DEBTS208048208048
PROVIDER TAX/FEES15680371568037
MISCELLANEOUS1865717915742
MEDICAL SUPPLIES35746783574678

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total29801598Total
Program Services23662487ProgramServices
Management And General6139111ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY13061BOY
EOY6743EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4864936BOY
EOY3632594EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY74720BOY
EOY39720EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2910091BOY
EOY2903913EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY41941BOY
EOY12536EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY137770BOY
EOY141464EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1223074BOY
EOY1059249EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis54586459LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec20024917LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY35182914BOY
EOY34561542EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3711487BOY
EOY3253860EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY89779BOY
EOY96734EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY861048BOY
EOY628934EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY49110821BOY
EOY46337289EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3810833BOY
EOY3607869EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY118727BOY
EOY133444EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY32690000BOY
EOY30755000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY48578BOY
EOY40083EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4809966BOY
EOY3638878EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY50197BOY
EOY40197EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY41528301BOY
EOY38215471EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6692676BOY
EOY7082268EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY889844BOY
EOY1039550EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7582520BOY
EOY8121818EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY49110821BOY
EOY46337289EOY
FieldValueIRS element (for citing)
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 Years170514CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years97240CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years138156CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year105173CurrentTaxYearMinus1Year
Current Tax Year158818CurrentTaxYear
Total669901Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years26164652CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years28130116CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years29996149CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30623480CurrentTaxYearMinus1Year
Current Tax Year30376030CurrentTaxYear
Total145290427Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years26335166CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years28227356CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30134305CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30728653CurrentTaxYearMinus1Year
Current Tax Year30534848CurrentTaxYear
Total145960328Total
FieldValueIRS element (for citing)
Public Support Total509145960328PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1345497CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1485266CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2009690CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2572519CurrentTaxYearMinus1Year
Current Tax Year2516299CurrentTaxYear
Total9929271Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years1818CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3174CurrentTaxYearMinus1Year
Current Tax Year2634CurrentTaxYear
Total7626Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1345497CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1485266CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2011508CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2575693CurrentTaxYearMinus1Year
Current Tax Year2518933CurrentTaxYear
Total9936897Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years73570CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years67671CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years36680CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year35856CurrentTaxYearMinus1Year
Current Tax Year30318CurrentTaxYear
Total244095Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years27754233CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years29780293CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years32182493CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year33340202CurrentTaxYearMinus1Year
Current Tax Year33084099CurrentTaxYear
Total156141320Total
FieldValueIRS element (for citing)
Public Support Percentage5090.93480PublicSupportPercentage509
Prior Year Support Percentage0.94748PriorYearSupportPercentage
Investment Income Percentage0.06364InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.05094PriorYrInvestIncomePercentage
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 Basis4333205OtherCostOrOtherBasis
Book Value4333205BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis43442904OtherCostOrOtherBasis
Depreciation17337831Depreciation
Book Value26105073BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5346975OtherCostOrOtherBasis
Depreciation2133949Depreciation
Book Value3213026BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1463375OtherCostOrOtherBasis
Depreciation553137Depreciation
Book Value910238BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings34561542TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPLEDGES PAYABLEDescription
Amount$40,197Amount
FieldValueIRS element (for citing)
Total Of Amounts40197TotalOfAmounts
Total Revenue30174313TotalRevenue
Total Expenses29801598TotalExpenses
Excess Or Deficit For Year372715ExcessOrDeficitForYear
Net Unrealized GL On Investments159628NetUnrealizedGLOnInvestments
Other$6,955OtherAmount
Total Adjustments166583TotalAdjustments
Excess Or Deficit Per FS539298ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt33086875TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments159628NetUnrealizedGainsInvestments
Other Revenues-76457OtherRevenues
Revenue Not Rptd F99083171RevenueNotRptdF990
Revenue Subtotal33003704RevenueSubtotal
Other Revenues Not Included-2829391OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-2829391RevenueNotRptdOnFinStmt
Total Revenue Per Form99030174313TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt32547577TotExpensesEtcAuditedFinclStmt
Other Expenses Included2829391OtherExpensesIncluded
Expenses Not Rptd F9902829391ExpensesNotRptdF990
Expenses Subtotal29718186ExpensesSubtotal
Other Expenses Not Included83412OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt83412ExpensesNotRptdOnFinStmt
Total Expenses Per Form99029801598TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ESCROW ACCOUNT LIABILITYSCHEDULE D, PART IV, QUESTION 2THE FOUNDATION WAS THE TRUSTEE OF $40,083 AND $48,578, RESPECTIVELY, AT MAY 31, 2010 AND 2009, 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.
FIN 48 DISCLOSUREFORM 990, SCHEDULE D, PART X, LINE 2THE ORGANIZATION ADOPTED THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. BECAUSE NO MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED, A DISCLOSURE WAS NOT INCLUDED IN THE FOOTNOTES TO THE FINANCIAL STATEMENTS.
OTHER CHANGES IN NET ASSETSFORM 990, SCHEDULE D, PART XI, LINE 8CHANGE IN INVESTMENT IN EQUITY INVESTEE 6,955
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XII, LINE 2DSCHOLARSHIPS (83,412) CHANGE IN INT IN EQUITY INVESTEE 6,955 ------------ TOTAL (76,457)
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XII, LINE 4BFUNDRAISING EXPENSES (165,156) RENTAL EXPENSES (2,673,553) GAIN ON SALE OF FIXED ASSETS 9,318 ------------ TOTAL (2,829,391)
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XIII, LINE 2DSPECIAL EVENT EXPENSE 165,156 RENTAL EXPENSE 2,673,553 GAIN ON SALE OF FIXED ASSETS (9,318) ------------ TOTAL 2,829,391
OTHER RECONCILING ITEMSFORM 990, SCHEDULE D, PART XIII, LINE 4BSCHOLARSHIPS 83,412

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event151233GrossReceiptsEvent1
Charitable Contributions Event143121CharitableContributionsEvent1
Gross Revenue Event18112GrossRevenueEvent1
Non Cash Prizes Event116400NonCashPrizesEvent1
Rent Facility Costs Event18432RentFacilityCostsEvent1
Food And Beverage Event12241FoodAndBeverageEvent1
Other Direct Expenses Event111507OtherDirectExpensesEvent1
Name Of Event2BURGANDY BALLNameOfEvent2
Gross Receipts Event264550GrossReceiptsEvent2
Charitable Contributions Event241902CharitableContributionsEvent2
Gross Revenue Event222648GrossRevenueEvent2
Rent Facility Costs Event223220RentFacilityCostsEvent2
Food And Beverage Event222648FoodAndBeverageEvent2
Entertainment Event233053EntertainmentEvent2
Other Direct Expenses Event247655OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total115783GrossReceiptsTotal
Charitable Contributions Total85023CharitableContributionsTotal
Gross Revenue Total Events30760GrossRevenueTotalEvents
Non Cash Prizes Total Events16400NonCashPrizesTotalEvents
Rent Facility Costs Total Events31652RentFacilityCostsTotalEvents
Food And Beverage Total Events24889FoodAndBeverageTotalEvents
Entertainment Total Events33053EntertainmentTotalEvents
Other Direct Expenses Total Events59162OtherDirectExpensesTotalEvents
Direct Expense Summary Events165156DirectExpenseSummaryEvents
Net Income Summary-134396NetIncomeSummary

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
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantVARIOUS SCHOLARHIPS AWARDEDTypeOfGrant
Number Of Recipients46NumberOfRecipients
Amount Of Cash Grant83412AmountOfCashGrant

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 SCHOLARSHIP COMMITTEE MADE UP OF BOARD MEMBERS, EMPLOYEES AND COMMUNITY MEMBERS. APPLICATIONS FOR THE SCHOLARSHIP MUST BE SUBMITTED EACH YEAR BY MARCH 1. THE COMMITTEE DETERMINES WHO THE SCHOLARSHIPS ARE AWARDED TO. IF THE AWARDED DOES NOT ENROLL IN A MEDICAL RELATED CLASS TIMELY, THE SCHOLARSHIP IS WITHDRAWN. MANY OF THE PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL AND NOT THE INDIVIDUAL.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 OrgsTotalCompensationRelatedOrgs
DONALD J BABB
83615235042232810052495800832405950107696301811
GARY FULBRIGHT
0188639014077012333083440116610235054

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierCONTINGENT COMPENSATIONIdentifier
Return ReferenceSCHEDULE J, PART I, QUESTION 6ReturnReference
ExplanationIN FY 2010, 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 & CONSTRUCTIONfalsefalse
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 MaintaindAdequateBooksAndRecdsMaintaindAmount DefeasedAmountDefeased
41100004069008131836217822008truefalsetruetrue
657500065750012954324642702008truefalsetruetrue3323687
10500000105000020858292414182009falsefalsetruetrue
33100002009truefalsetruetrue3310000

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

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

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NUMBER OF VOLUNTEERSFORM 990, PART I, QUESTION 6THE 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. ORGANIZATION MISSION FORM 990, PART III, QUESTION 1 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.
PROGRAM SERVICE ACTIVITY DETAILFORM 990, PART III, QUESTION 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, QUESTION 4D OTHER PROGRAM SERVICES INCLUDE ACTIVITIES WHICH PROMOTE THE ORGANIZATION'S EXEMPT PURPOSE. BOARD MEMBER BUSINESS RELATIONSHIP FORM 990, PART VI, QUESTION 2 BOARD MEMBERS BRAD GREGORY AND DAVE STRADER HAVE A BUSINESS RELATIONSHIP. 990 REVIEW PROCESS FORM 990, PART VI, QUESTION 11A 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, QUESTION 12ANNUALLY, 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, QUESTION 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, QUESTION 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.

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 MEDICAL BUILDING LLCBusinessNameLine1

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 Income6954ShareOfTotalIncome
Share Of EOY Assets404598ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
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 OrgstruePerformOfServicesByOtherOrgs
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