2013-05-13T09:40:02-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2012-01-01 440579862 THE OZARKS METHODIST MANOR OZAR 4172582573 205 S COLLEGE AVE MARIONVILLE MO 65705 MORRIS DOCK 4172582573 2013-05-13 1 JEFF PARKER P00970069 3149254300 2012 2016-02-24 21:20:13Z MORRIS DOCK 205 S COLLEGE AVE MARIONVILLE MO 65705 6490414 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. 13 13 214 30 0 0 26744 28960 6281744 6209414 104410 112812 52016 139228 6464914 6490414 0 0 0 0 3712779 3759334 0 0 0 3123394 3193674 6836173 6953008 -371259 -462594 5757708 5450192 3186355 3135142 2571353 2315050 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 5954807 6348642 RETIREMENT VILLAGE OPERATIONS: 82 BED RESIDENTIAL CARE FACILITY, 78 BED SKILLED NURSING FACILITY, 58 COTTAGES, AND SUPPORTING SERVICES. 5954807 1 0 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 29 0 214 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 1 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 REV RALPH PROSSER 1.00 X 0 0 0 REV MICHAEL BLACKSHER 1.00 X X 0 0 0 NANCY HANSFORD 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 JIM HODGE 1.00 X 0 0 0 JEFF ROBINSON 1.00 X X 0 0 0 ROB CLEMENTS 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 525571 SYSCO OF KANSAS CITY 1915 E KANSAS CITY RD OLATHE KS 66061 FOOD SERVICE 397989 LIFE CARE SERVICES LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT FEES 319941 MARIONVILLE PHARMACY PO BOX 217 MARIONVILLE MO 65705 PHARMACY SERVICE 176386 EMPIRE ELECTRIC PO BOX 219239 KANSAS CITY MO 641219239 UTILITIES 157991 6 28960 28960 NET PATIENT SERVICE RE 623000 4941596 4941596 THERAPIES / OTHER REVE 623000 1267818 1267818 6209414 59938 59938 14454 38420 0 0 14454 38420 52874 52874 MISCELLANEOUS 623000 55160 55160 UTILITIES 623000 32741 32741 GUEST & EMPLOYEE MEALS 623000 27805 27805 23522 23522 139228 6490414 6348642 0 112812 3022081 2809014 213067 11577 8430 3147 488136 359063 129073 237540 221966 15574 194339 194339 8234 8234 23260 23260 12557 12557 45824 45824 17854 1110 16744 406880 348209 58671 13983 13983 249700 249700 35940 24182 11758 355622 355622 184420 184420 THERAPIES 498490 498490 FOOD & FOOD SUPPLIES 380172 380172 LICENSES & FEES 288943 287524 1419 MISCELLANEOUS 141672 141672 335784 223829 111955 6953008 5954807 998201 0 67035 183287 782364 677626 143361 171318 11341904 9175852 2460972 2166052 2003163 2089554 111156 116158 140074 0 49583 46197 5757708 5450192 1763608 1772019 1401353 1343126 21394 19997 3186355 3135142 X 1539251 1284966 35245 33227 996857 996857 2571353 2315050 5757708 5450192 X -462594 200259 6032 X X 0 1 X 0 0 X 55833 86547 87562 26744 28960 285646 5892458 6549624 6109706 6171372 6348642 31071802 5948291 6636171 6197268 6198116 6377602 31357448 0 0 0 31357448 81975 55217 55646 62033 59938 314809 81975 55217 55646 62033 59938 314809 6030266 6691388 6252914 6260149 6437540 31672257 0.99010 0.98910 0.00990 0.01090 X 2060177 266309 160000 12556 2153930 2304481 20 -39896 191638 12790 2060177 2392554 300960 375000 14033 2304481 2038185 458149 91500 12280 2392554 2963991 4000 -836237 -79000 -14569 2038185 0.54000 0.46000 1 0 196487 196487 8405709 6870368 1535341 822066 637992 184074 904010 715780 188230 1013632 951712 61920 2166052 RESIDENTS' PERSONAL FUNDS 19997 19997 X 6684148 200259 6032 206291 6477857 12557 12557 6490414 6940451 0 6940451 12557 12557 6953008 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, 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 2009 TO 2011 ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON BENEFICIAL INTEREST IN TRUST 6,032. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TEMPORARILY RESTRICTED NET ASSETS-GAIN (LOSS) ON ANNUITY AGREEMENTS 6,032. 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 CHNAGED 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 319941 MANAGEMENT AGREEMENT