2011-06-29T07:34:12-05:00 2010-12-31 CLIFTON GUNDERSON LLP 333 S KIRKWOOD ROAD SUITE 300 ST LOUIS MO 63122 990 2010-01-01 440579862 THE OZARKS METHODIST MANOR OZAR 4172582573 205 S COLLEGE AVE MARIONVILLE MO 65705 GLORIA JONES 4172582573 2011-05-31 1 JULIEANNE BEASLEY 3149666622 2010 2016-02-24 21:20:13Z GLORIA JONES 205 S COLLEGE AVE MARIONVILLE MO 65705 6249399 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. 14 14 199 0 0 0 86547 87562 6381267 5996682 -37391 50589 168357 104346 6598780 6239179 0 0 0 0 3474797 3529062 0 0 0 3154465 3445727 6629262 6974789 -30482 -735610 7055594 6705913 3508382 3624140 3547212 3081773 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 6066062 6100243 RETIREMENT VILLAGE OPERATIONS - 76 BED RESIDENTIAL CARE FACILITY, 78 BED SKILLED NURSING FACILITY, 58 COTTAGES, AND SUPPORTING SERVICES 6066062 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 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 1 199 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 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 JACK EBERT 1.00 X 0 0 0 DR RON MCINTIRE 1.00 X 0 0 0 TERRELL BARKETT 1.00 X 0 0 0 RICHARD DELMONT 1.00 X X 0 0 0 MORRIS DOCK 1.00 X X 0 0 0 REV GLORIA JONES 1.00 X X 0 0 0 RALPH PROSSER 1.00 X 0 0 0 MARTHA BARTELSMEYER 1.00 X X 0 0 0 GARY TWITTY 1.00 X 0 0 0 REV LEE MILLER 1.00 X 0 0 0 JOE W MCCARTY 1.00 X 0 0 0 REV MICHAEL BLACKSHER 1.00 X 0 0 0 NANCY HANSFORD 1.00 X 0 0 0 TJ MCKENZIE 1.00 X 0 0 0 0 0 0 0 0 0 0 REHABCARE 7733 FORSYTH BLVD SUITE 1700 ST LOUIS MO 63105 AGENCY STAFFING 424737 LIFE CARE SERVICES LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT FEES 406343 NURSEFINDERS 236 E PRIMROSE ST SPRINGFIELD MO 65807 STAFFING 242984 3 87562 87562 PATIENT SERVICE REVENU 623000 5981650 5981650 OTHER REVENUES 623000 15032 15032 5996682 55646 55646 5163 9435 785 -4272 -785 -5057 -785 -4272 OTHER REVENUE 623000 104346 104346 104346 6239179 6100243 0 51374 2804454 2594607 209847 11901 10252 1649 492788 371832 120956 219919 204670 15249 184416 184416 5472 5472 22050 22050 14033 14033 22681 22681 19759 402 19357 393909 326767 67142 5398 5398 266464 266464 27454 16598 10856 395358 395358 177878 177878 THERAPIES 415212 415212 FOOD & FOOD SUPPLIES 380402 380402 CONTRACT LABOR 306506 294599 11907 PROVISION FOR UNCOLLECT 287919 287919 LICENSES & FEES 278492 277152 1340 242324 201147 41177 6974789 6066062 908727 0 203590 384438 1132349 920012 104143 91284 11225931 8457065 2964305 2768866 2366844 2270947 107881 95520 131597 131597 44885 43249 7055594 6705913 1407238 1731275 2079979 1872360 21165 20505 3508382 3624140 X 2496751 2044557 53604 40359 996857 996857 3547212 3081773 7055594 6705913 X -735610 270171 X X 0 1 0 X 0 X 109022 100934 55833 86547 87562 439898 5458046 5808253 5892458 6549624 6109706 29818087 5567068 5909187 5948291 6636171 6197268 30257985 0 6896 6896 6896 6896 30251089 71100 85370 81975 55217 55646 349308 71100 85370 81975 55217 55646 349308 5638168 5994557 6030266 6691388 6252914 30607293 0.98840 0.98400 0.01140 0.01580 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2392554 300960 375000 14033 2304481 2038185 458149 91500 12280 2392554 2963991 4000 -836237 -79000 -14569 2038185 0.54000 0.43000 1 0 196487 196487 8349233 6358435 1990798 807213 578526 228687 855389 613379 242010 1017609 906725 110884 2768866 RESIDENTS' PERSONAL FUNDS 20505 20505 6239179 6974789 -735610 256474 13697 270171 -465439 6508562 256474 26942 283416 6225146 14033 14033 6239179 6960756 0 6960756 14033 14033 6974789 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, DURING THE YEAR ENDED DECEMBER 31, 2009 AND HAS EVALUATED ITS TAX POSITIONS TAKEN FOR ALL OPEN TAX YEARS. CURRENTLY, THE 2007 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, 2010 AND 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED NET ASSETS-GAIN (LOSS) ON ANNUITY AGREEMENTS 13,697. PART XII, LINE 2D - OTHER ADJUSTMENTS: ASSETS RELEASED FROM RESTRICTION 26,942. 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 GAINS ON INVESTMENTS: 256,474. TEMPORARILY RESTRICTED NET ASSETS-GAIN (LOSS) ON ANNUITY AGREEMENTS 13,697. TOTAL TO FORM 990, PART XI, LINE 5: 270,171. THE ORGANIZATION'S BOARD OF DIRECTORS IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT.