2011-03-01T14:27:38-06:00 2010-05-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2009-06-01 431425356 CITIZENS MEMORIAL HEALTH CARE FOUNDATION CITI 4173266000 1500 N OAKLAND AVENUE BOLIVAR MO 65613 DONALD J BABB 2011-02-21 true Brian D Todd 4178658701 2009 2016-02-24 21:20:13Z DONALD J BABB 1500 N OAKLAND AVENUE BOLIVAR MO 65613 33334533 false X www.citizensmemorial.com X 1986 MO CARING FOR EVERY GENERATION THROUGH EXCEPTIONAL SERVICES BY LEADING PHYSICIANS AND A COMPASSIONATE HEALTHCARE TEAM. 8 7 856 65 2994 1700 105173 158818 30623480 30376030 200012 77330 -304285 -437865 30624380 30174313 107456 92412 0 0 17360666 17663431 0 0 0 12236406 12045755 29704528 29801598 919852 372715 49110821 46337289 41528301 38215471 7582520 8121818 TO SUPPORT CITIZENS MEMORIAL HOSPITAL DISTRICT AND LOCAL RURAL COMMUNITIES. FOR ADDITIONAL INFORMATION, SEE SCHEDULE O. false false 19284927 24638264 PROVIDE LONG TERM CARE SERVICES TO MEDICAID RECIPIENTS (APPROXIMATELY 82,000 RESIDENT DAYS) IN SKILLED FACILITIES. FOR MORE INFORMATION, SEE SCHEDULE O. 1114503 1322676 PROVIDE RESIDENTIAL CARE SERVICES FOR THE ELDERLY TO APPROXIMATELY 58 RESIDENTS PER DAY. FOR MORE INFORMATION, SEE SCHEDULE O. 619957 827053 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. 2643100 92412 3618355 23662487 true true false true false false false true false true 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 true 84 0 true 856 true true true false false false false true true false false false 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 DONALD J BABB 20.0 X X 106896 287537 15074 GENE HUTCHESON 1.0 X 0 0 0 DAVE STRADER 1.0 X X 0 0 0 BRAD GREGORY 1.0 X 0 0 0 ROBERT KIFER 1.0 X 0 0 0 PATRICK DOUGLAS 1.0 X X 0 0 0 DAVE BERRY 1.0 X 0 0 0 DEREK HUNTER 1.0 X 0 0 0 GARY FULBRIGHT 45.0 X 0 215049 20005 CATHERINE MOLDER 45.0 X 0 83412 9315 RENEE MEYER 45.0 X 125775 0 9872 RAJAB ECHESSA 45.0 X 107451 0 8323 KENNETH SCHANDA 45.0 X 127223 0 5505 TIM FRANCKA 45.0 X 122940 0 9849 590285 585998 77943 5 false true false BKD LLP 910 E ST LOUIS STREET SPRINGFIELD MO 65801 CONSULTING/AUDITING 136677 1 85023 73795 158818 NET PATIENT SERVICE REVENUE 623000 30257398 30257398 CAFETERIA 722210 82925 82925 VENDING 722210 12186 12186 TRANSIT 900099 18896 18896 OTHER INCOME 623000 4625 4625 30376030 176533 176533 0 0 2339766 2673553 -333787 -333787 2994 -336781 191808 30500 300329 21182 -108521 9318 -99203 -99203 30760 85023 165156 -134396 -134396 0 0 REPAYMENT OF SCHOLARSHIPS 900099 30318 30318 30318 30174313 30406348 2994 -393847 9000 9000 83412 83412 0 0 243343 243343 0 12886208 11111180 1775028 380518 302398 78120 3017676 2412827 604849 1135686 924642 211044 1546173 131045 1415128 17014 17014 136677 136677 0 0 8545 8545 99551 45892 53659 49867 49867 733279 490382 242897 66570 66570 0 1205424 663985 541439 126512 43723 82789 0 38396 21989 16407 1003821 1003821 0 1445803 1052672 393131 158706 14014 144692 DUES AND SUBSCRIPTIONS 39997 39997 BAD DEBTS 208048 208048 PROVIDER TAX/FEES 1568037 1568037 MISCELLANEOUS 18657 742 17915 MEDICAL SUPPLIES 3574678 3574678 29801598 23662487 6139111 0 13061 6743 4864936 3632594 74720 39720 2910091 2903913 41941 12536 137770 141464 1223074 1059249 54586459 20024917 35182914 34561542 3711487 3253860 89779 96734 861048 628934 49110821 46337289 3810833 3607869 118727 133444 32690000 30755000 48578 40083 4809966 3638878 50197 40197 41528301 38215471 X 6692676 7082268 889844 1039550 7582520 8121818 49110821 46337289 X false true true X false X 170514 97240 138156 105173 158818 669901 26164652 28130116 29996149 30623480 30376030 145290427 26335166 28227356 30134305 30728653 30534848 145960328 145960328 1345497 1485266 2009690 2572519 2516299 9929271 1818 3174 2634 7626 1345497 1485266 2011508 2575693 2518933 9936897 73570 67671 36680 35856 30318 244095 27754233 29780293 32182493 33340202 33084099 156141320 0.93480 0.94748 0.06364 0.05094 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 4333205 4333205 43442904 17337831 26105073 5346975 2133949 3213026 1463375 553137 910238 34561542 0 PLEDGES PAYABLE 40197 40197 30174313 29801598 372715 159628 6955 166583 539298 33086875 159628 -76457 83171 33003704 -2829391 -2829391 30174313 32547577 2829391 2829391 29718186 83412 83412 29801598 ESCROW ACCOUNT LIABILITY SCHEDULE D, PART IV, QUESTION 2 THE 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 DISCLOSURE FORM 990, SCHEDULE D, PART X, LINE 2 THE 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 ASSETS FORM 990, SCHEDULE D, PART XI, LINE 8 CHANGE IN INVESTMENT IN EQUITY INVESTEE 6,955 OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XII, LINE 2D SCHOLARSHIPS (83,412) CHANGE IN INT IN EQUITY INVESTEE 6,955 ------------ TOTAL (76,457) OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XII, LINE 4B FUNDRAISING EXPENSES (165,156) RENTAL EXPENSES (2,673,553) GAIN ON SALE OF FIXED ASSETS 9,318 ------------ TOTAL (2,829,391) OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XIII, LINE 2D SPECIAL EVENT EXPENSE 165,156 RENTAL EXPENSE 2,673,553 GAIN ON SALE OF FIXED ASSETS (9,318) ------------ TOTAL 2,829,391 OTHER RECONCILING ITEMS FORM 990, SCHEDULE D, PART XIII, LINE 4B SCHOLARSHIPS 83,412 GOLF TOURNAMENT 51233 43121 8112 16400 8432 2241 11507 BURGANDY BALL 64550 41902 22648 23220 22648 33053 47655 0 115783 85023 30760 16400 31652 24889 33053 59162 165156 -134396 true CITIZENS MEMORIAL HOSPITAL DISTRICT 1500 N OAKLAND AVENUE BOLIVAR MO 65613 431142176 GOVERNMENTAL 9000 SENIOR HEALTH CTR 1 0 VARIOUS SCHOLARHIPS AWARDED 46 83412 GRANT MONITORING SCHEDULE I, PART I, QUESTION 2 CITIZENS 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. false false false false false true false false false DONALD J BABB 83615 235042 23281 0 0 52495 800 8324 0 5950 107696 301811 GARY FULBRIGHT 0 188639 0 14077 0 12333 0 8344 0 11661 0 235054 CONTINGENT COMPENSATION SCHEDULE J, PART I, QUESTION 6 IN 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). 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 & CONSTRUCTION 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 true false true true 6575000 657500 3323687 129543 2464270 2008 true false true true 10500000 1050000 208582 9241418 2009 false false true true 3310000 3310000 2009 true 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 false false false false false false false false false false false false false false false false false false false NUMBER OF VOLUNTEERS FORM 990, PART I, QUESTION 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. 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 DETAIL FORM 990, PART III, QUESTION 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, 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 REVIEW FORM 990, PART VI, QUESTION 12 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, QUESTION 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, QUESTION 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. 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 MEDICAL BUILDING LLC BOLIVAR MO 65613 BOLIVAR MO 65613 262797636 MEDICAL BUILD MO NA EXCLUDED FROM TAX 6954 404598 false false false true false true false false false false true true false true false true false true true false BOLIVAR MEDICAL BUIDLING LLC J 92074