2011-11-15T16:31:44-06:00 2010-12-31 MARKSNELSON VOHLAND CAMPBELL RADETIC LLC 1310 E 104TH ST SUITE 300 KANSAS CITY MO 64131 990 2010-01-01 431821821 MIDWEST CARE CENTER IX INC MIDW 8169413977 225 WEST 124TH STREET KANSAS CITY MO 641451183 W TERRENCE BROWN 8169413977 2011-11-10 1 LINDA A CAMPBELL 8167437700 2010 2016-02-24 21:20:13Z CRYSTAL PINES REHAB & HEALTH CARE W TERRENCE BROWN 225 W 124TH ST KANSAS CITY MO 64145 14172413 0 X N/A X 1998 MO OPERATION OF A SKILLED NURSING CENTER X 5 5 163 21 0 0 0 969653 6518812 5696591 20593 743586 1495 10463 6540900 7420293 0 0 0 0 3388386 2934372 0 0 0 3072684 2834217 6461070 5768589 79830 1651704 7218050 3126205 6206426 462877 1011624 2663328 X TO PROVIDE QUALITY PROFESSIONAL HEALTH AND REHABILITATION SERVICES 0 1 5673387 5707054 MIDWEST CARE CENTER IX, INC. DBA CRYSTAL PINES REHABILITATION AND HEALTHCARE CENTER IS A SKILLED NURSING FACILITY WITH 114 LICENSED BEDS WHICH ARE BOTH MEDICARE AND MEDICAID CERTIFIED. AT CRYSTAL PINES, WE STRIVE TO PROVIDE OUR RESIDENTS WITH AN ENVIRONMENT THAT FEELS LIKE HOME IN COMBINATION WITH EXCELLENT PHYSICAL, EMOTIONAL, AND SPIRITUAL WELL-BEING. WE ENCOURAGE OUR RESIDENTS TO PARTICIPATE IN FACILITY DECISIONS SUCH AS THEIR CHOICE OF ACTIVITIES, MEALS, AND ROOMATES WHEN POSSIBLE. WE KEEP OUR RESIDENTS INFORMED IN REGARDS TO WHAT IS TRANSPIRING WITHIN THE FACILITY (THEIR HOME) AND WE ARE AN INTEGRAL PART OF THEIR COMMUNITY. THE COMMUNITY SUPPORT CONTINUES TO BE STRONG WITHIN THIS FACILITY AND THE SUPPORT OF THE FAMILY COUNCIL IS A GIFT TO THIS FACILITY. THE COUNCIL ENRICHES THE LIVES OF OUR RESIDENTS BY VOLUNTEERING THEIR TIME AND DONATIONS TO ENHANCE THE DAILY ACTIVITIES THAT WE PROVIDE. 5673387 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 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 1 0 1 0 0 0 0 1 8 0 163 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL MO X W TERRENCE BROWN 8169413977 225 W 124TH ST KANSAS CITY MO 641451183 X EDWARD T WEAVER 1.00 X X 0 14500 0 W TERRENCE BROWN 1.00 X X 0 28969 0 MICHAEL A MICHAUD 1.00 X X 0 14500 0 MERLE SPRINGER 1.00 X 0 14500 0 MARK BRYANT 1.00 X 0 13250 0 IRENE GLASS 40.00 X 72277 0 0 72277 85719 0 0 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 348245 ILLINOIS HELATHCARE MANAGEMENT II LLC 7611 STATE LINE KANSAS CITY MO 64114 MANAGEMENT SERVICES 340145 HEALTH CARE SERVICES GROUP 3220 TILLMAN DRIVE 300 BENSALEM PA 19020 LAUNDRY SERVICES 178075 SYSCO FOOD SERVICES PO BOX 5037 DES PLAINES IL 60017 RAW FOOD 142385 ENLOE DRUGS INC PO BOX 952011 ST LOUIS MO 63195 PHARMACEUTICALS 131385 5 969653 969653 NET PATIENT SERVICE RE 623990 5696591 5696591 5696591 4920 4920 7490786 6752120 738666 738666 738666 MISCELLANEOUS INCOME 900099 10463 10463 10463 7420293 5707054 0 743586 72277 72277 2420333 2420333 184329 184329 257433 257433 340145 340145 37507 37507 50093 50093 669025 669025 20587 20587 84888 84888 7602 7602 387616 387616 219186 219186 179590 179590 SUPPLIES 454296 454296 MISCELLANEOUS 156621 156621 UTILITIES 131933 131933 BAD DEBT 47069 47069 EQUIPMENT 27737 27737 20322 20322 5768589 5673387 95202 0 773152 397529 1358750 462168 13207 103083 133280 5013524 331957 1757605 7218050 3126205 667396 462877 5446601 92429 0 6206426 462877 X 1011624 2663328 1011624 2663328 7218050 3126205 1651704 0 X 0 1 1 X 0 X 969653 969653 6018564 6266456 6482657 6518812 5696591 30983080 6018564 6266456 6482657 6518812 6666244 31952733 0 256809 21603 278412 256809 21603 278412 31674321 1517 21288 10460 20593 743586 797444 1517 21288 10460 20593 743586 797444 823 1483 1139 1495 10463 15403 6020904 6289227 6494256 6540900 7420293 32765580 0.96670 0.98970 0.02430 0.00180 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DEBT SERVICE 2378 DUE FROM AFFILIATES 1755227 1757605 7420293 5768589 1651704 0 1651704 18504085 11083792 11083792 7420293 0 7420293 12652205 6883616 6883616 5768589 0 5768589 PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM RELATED ORGANIZATIONS PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM RELATED ORGANIZATIONS SCHEDULE D, PART X, LINE 2: MIDWEST CARE CENTER IX, INC. HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, MIDWEST CARE CENTER IX, INC. IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MIDWEST CARE CENTER IX, INC. FLIES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. MIDWEST CARE CENTER IX, INC. IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007. SOLD PROPERTY USED FOR NURSING CENTER 2010-06-24 6100000 SALES PRICE 272514364 TI-CRYSTAL LAKE LLC 7611 STATE LINE ROAD KANSAS CITY MO 64114 LIMITED LIABILITY COMPANY 0 0 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 CRYSTAL PINES MADE A SIGNIFICANT CHANGE IN THE WAY THEY CONDUCTED BUSINESS IN 2010. THEY SOLD THE PROPERTY THAT WAS USED FOR PROVIDING SERVICES TO FULFILL THEIR CHARITABLE MISSION. CURRENTLY, THEY ARE IN THE PROCESS OF LOOKING FOR A REPLACEMENT. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR THE OPERATION AND MANAGEMENT OF THE NURSING HOME FACILITIES. THE MANAGEMENT AGREEMENTS GIVE DAILY OPERATING AUTHORITY TO THE MANAGEMENT COMPANY; HOWEVER, ULTIMATE AUTHORITY REMAINS WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION SHALL CONSIST OF THE INDIVIDUALS WHO ARE IN GOOD STANDING AND ARE SERVING ON THE BOARD OF DIRECTORS. THE SOLE DUTY OF THE MEMBERS SHALL BE TO VOTE ON THE BOARD OF DIRECTORS CANDIDATES. FORM 990, PART VI, SECTION A, LINE 7A A MAJORITY OF THE MEMBERS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS AT ANY MEETINGS OF THE MEMBERS; PROVIDED, HOWEVER, THAT IF LESS THAN A MAJORITY OF THE MEMBERS ARE PRESENT AT SAID MEETING, A MAJORITY OF THE MEMBERS PRESENT MAY ADJOURN THE MEETING FROM TIME TO TIME WITHOUT FURTHER NOTICE. EACH MEMBER PRESENT SHALL BE ENTITLED TO ONE VOTE UPON EACH MATTER SUBMITTED TO A VOTE AT ANY SUCH MEETING. MEMBERS MAY BE REMOVED, FOR CAUSE, UPON THE AFFIRMATIVE VOTE OF A MAJORITY OF THE REMAINING MEMBERS. IN THE EVENT OF THE REMOVAL OF A MEMBER, THE REMAINING MEMBERS MAY FILL SUCH VACANCY OR VACANCIES UPON THE AFFIRMATIVE VOTE OF A MAJORITY OF THE REMAINING MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE ACT OF THE MAJORITY OF THE MEMBERS PRESENT AT A MEETING OF THE MEMBERS AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS OF THE ORGANIZATION DETERMINED THAT A COPY OF FORM 990 WOULD BE PROVIDED TO A COMMITTEE OF THE BOARD SO THAT THE COMMITTEE COULD REVIEW THE 990 IN DETAIL AND THEN ADVISE THE ENTIRE BOARD REGARDING ANY ISSUES THAT NEED TO BE DETERMINED BY, OR DISCLOSED TO, THE ENTIRE BOARD OF DIRECTORS. IN ADDITION, THE ENTIRE FORM 990 WAS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS SUFFICIENTLY PRIOR TO FILING THE FORM SO THAT ANY COMMENTS COULD BE PROVIDED TO THE ORGANIZATION IN TIME TO PERMIT ANY NECESSARY REVISIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT REQUIRES ANNUAL EXECUTION OF A CERTIFICATION WITH RESPECT TO CONFLICTS AND ROUTINE DISCLOSURE IF THERE IS A CONFLICT IN CONNECTION WITH A MATTER THAT COMES BEFORE THE BOARD. THE BOARD MONITORS AND ENFORCES COMPLIANCE WITH THIS POLICY BY REQUIRING THE ANNUAL CERTIFICATION AND BY REMINDING BOARD MEMBERS OF THEIR OBLIGATIONS WITH RESPECT TO CONFLICTS ON AN ON-GOING BASIS. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST, THEN THEY WILL NOT VOTE ON THE CONFLICTING ISSUE AT-HAND. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. AVERAGE HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A EDWARD T. WEAVER 3 W. TERRENCE BROWN 3 MICHAEL A. MICHAUD 3 MERLE SPRINGER 3 MARK BRYANT 3 MIDAMERICA CARE FOUNDATION INC 225 W 124TH ST KANSAS CITY MO 641451183 510271905 NURSING MO 501(C)(3) LINE 9 0 MIDWEST CARE CENTER INC 225 W 124TH ST KANSAS CITY MO 641451183 431629475 NURSING MO 501(C)(3) LINE 9 0 MIDWEST CARE CENTER II INC 225 W 124TH ST KANSAS CITY MO 641451183 431710786 NURSING MO 501(C)(3) LINE 9 0 MIDWEST CARE CENTER VIII INC 225 W 124TH ST KANSAS CITY MO 641451183 431821818 NURSING MO 501(C)(3) LINE 9 0 MAC HEALTHCARE INCORPORATED 225 W 124TH ST KANSAS CITY MO 641451183 431818627 PRIVATE FOUNDATION MO 501(C)(3) PF 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0