2014-07-23T11:47:56-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2013-01-01 440579862 THE OZARKS METHODIST MANOR OZAR 4172582573 205 S COLLEGE AVE MARIONVILLE MO 65705 JEFF ROBINSON TREASURER 4172582573 2014-07-09 1 JEFF PARKER P00970069 3149254300 2013 2015-11-30 17:44:51Z MICHAEL BLACKSHER 205 S COLLEGE AVE MARIONVILLE MO 65705 7595678 0 X OZARKSMETHODISTMANOR.COM X 1925 MO RETIREMENT VILLAGE OPERATIONS: 82 BED RESIDENTIAL CARE FACILITY, 78 BED SKILLED NURSING FACILITY, 58 COTTAGES, AND SUPPORTING SERVICES. 12 12 179 0 0 0 28960 1527938 6209414 5788657 112812 162132 139228 116951 6490414 7595678 0 0 0 0 3759334 3462039 0 0 0 3193674 2890191 6953008 6352230 -462594 1243448 5450192 6634812 3135142 2969122 2315050 3665690 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 5386752 5788657 RETIREMENT VILLAGE OPERATIONS: 82 BED RESIDENTIAL CARE FACILITY, 78 BED SKILLED NURSING FACILITY, 58 COTTAGES, AND SUPPORTING SERVICES. 5386752 1 1 0 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 1 0 0 0 1 26 0 179 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X ROBERTA FRENCH 4172582573 205 S COLLEGE MARIONVILLE MO 65705 X DR RON MCINTIRE DIRECTOR 1.00 X 0 0 0 TERRELL BARKETT SECRETARY 1.00 X X 0 0 0 RICHARD DELMONT DIRECTOR 1.00 X 0 0 0 MORRIS DOCK DIRECTOR 1.00 X 0 0 0 REV MICHAEL BLACKSHER CHAIRPERSON 1.00 X X 0 0 0 REV FRED ROYER DIRECTOR 1.00 X 0 0 0 DOUGLAS STROEMEL DIRECTOR 1.00 X 0 0 0 MARK RUNDEL DIRECTOR 1.00 X 0 0 0 JIM HODGE DIRECTOR 1.00 X 0 0 0 JEFF ROBINSON TREASURER 1.00 X X 0 0 0 ROB CLEMENTS DIRECTOR 1.00 X 0 0 0 LARRY BROWN VICE-CHAIRPERSON 1.00 X X 0 0 0 0 0 0 0 0 0 0 REHABCARE PO BOX 503534 ST LOUIS MO 631503534 THERAPY SERVICES 406965 LIFE CARE SERVICES LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 343774 2 1527938 1527938 NET PATIENT SERVICE RE 623000 4499432 4499432 THERAPIES / OTHER REVE 623000 1289225 1289225 5788657 94253 94253 66951 928 0 0 66951 928 67879 67879 MISCELLANEOUS 623000 43940 43940 UTILITIES 623000 26993 26993 GUEST & EMPLOYEE MEALS 623000 22247 22247 23771 23771 116951 7595678 5788657 0 279083 2800312 2601719 198593 10512 7464 3048 439193 289098 150095 212022 197623 14399 186064 186064 7335 7335 26378 26378 13170 13170 48574 48574 46629 13 46616 386830 327399 59431 21540 21540 281542 281542 40816 26472 14344 335850 335850 186504 186504 FOOD & FOOD SUPPLIES 363721 363721 THERAPIES 357521 357521 LICENSES & FEES 330259 326483 3776 PROVISION FOR UNCOLLECT 63916 63916 193542 159357 34185 6352230 5386752 965478 0 183287 253871 677626 620490 171318 70736 11565407 9504930 2166052 2060477 2089554 3495775 116158 89918 2382 46197 41163 5450192 6634812 1772019 1843879 1343126 1099454 19997 25789 3135142 2969122 X 1284966 1239032 33227 1429801 996857 996857 2315050 3665690 5450192 6634812 X 1243448 91274 15918 X X 0 1 X 0 0 X 86547 87562 26744 28960 1527938 1757751 6549624 6109706 6171372 6348642 5905608 31084952 6636171 6197268 6198116 6377602 7433546 32842703 0 1426137 1426137 1426137 1426137 31416566 55217 55646 62033 59938 94253 327087 55217 55646 62033 59938 94253 327087 6691388 6252914 6260149 6437540 7527799 33169790 0.94710 0.99010 0.00990 0.00990 X SCHEDULE A, PART IV, LIST OF UNUSUAL GRANTS: DESCRIPTION: BEQUEST DATE: 12/31/13 AMOUNT: 1501415. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 996857 996857 996857 996857 1.00000 1 0 196487 196487 8564939 7112355 1452584 822824 663889 158935 916941 758609 158332 1064216 970077 94139 2060477 RESIDENTS' PERSONAL FUNDS 25789 25789 X 7689700 91274 15918 107192 7582508 13170 13170 7595678 6339060 0 6339060 13170 13170 6352230 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. PART X, LINE 2: THE MANOR QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE MANOR IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. THE MANOR IS CLASSIFIED AS A PUBLICLY SUPPORTED CHARITABLE ORGANIZATION UNDER SECTION 509(A)(2) OF THE CODE AND CONTRIBUTIONS TO THE MANOR QUALIFY AS A CHARITABLE TAX DEDUCTION FOR THE CONTRIBUTOR. THE MANOR IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE MANOR'S INCOME TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON BENEFICIAL INTEREST IN TRUST 15,918. 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. FORM 990, PART VI, SECTION B, LINE 11 DRAFT FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING. 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. FORM 990, PART XI, LINE 9: GAIN / (LOSS) ON ANNUITY AGREEMENTS 15,918. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION'S BOARD OF DIRECTORS IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE IS NO SEPARATE COMMITTEE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LIFE CARE SERVICES 400 LOCUST SUITE 280 DES MOINES IA 50309 MANAGEMENT OF COMMUNITY IA N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 LIFE CARE SERVICES N 343774 MANAGEMENT AGREEMENT