Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
215 WEST GRANT STREET
 
Room/suite
City or town, state or country, and ZIP + 4
DEXTER, MO63841
D Employer identification number

43-6054187
E Telephone number

G Gross receipts $ 737,036
F Name and address of principal officer:
DARLA GROSSMAN
824 S LEWIS ST
DEXTER,MO63841
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.REGIONALHF.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1964
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION'S STATEMENT OF PURPOSES, AS PRESENTED IN THE CORPORATE BY-LAWS, IS (1) TO ENSURE, AS OWNER AND LESSOR, THE VIABILITY OF THE COMMUNITY HOSPITAL LOCATED IN DEXTER, MISSOURI, FORMERLY KNOWN AS THE DEXTER MEMORIAL HOSPITAL, BY SCRUTINIZING THE LESSEE'S OPERATION OF THE HOSPITAL TO ENSURE THAT THE LESSEE ABIDES BY THE LEASE TERMS AND CONTINUES TO PROVIDE THE HEALTH CARE NEEDED IN THE DEXTER AREA; AND (2) TO BUILD HEALTHIER COMMUNITIES THROUGH THE IMPLEMENTATION OF PROGRAMS AND SERVICES DESIGNED TO ENHANCE OVERALL COMMUNITY HEALTH AND WELLNESS. THE ORGANIZATION ORIGINALLY OPERATED A FULL SERVICE 50 BED COMMUNITY HOSPITAL, INCLUDING PROVISION OF LIMITED CHARITABLE CARE TO THE DEXTER, MISSOURI COMMUNITY AS ITS PROGRAM SERVICE ACTIVITY DURING THE PERIOD 1968 - 1999. IN 1999, IN ORDER TO MAINTAIN THE OPERATIONS OF THE HOSPITAL WITHOUT CUTTING ESSENTIAL SERVICES TO THE DEXTER, MISSOURI COMMUNITY, THE ORGANIZATION LEASED THE HOSPITAL FACILITIES, INCLUDING LAND, BUILDINGS AND EQUIP
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 12
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 16
6 Total number of volunteers (estimate if necessary) ............. 6 35
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 450,638 445,796
9 Program service revenue (Part VIII, line 2g) ......... 4,450 5,376
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 34,688 -23,097
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 204,179 205,646
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 693,955 633,721
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 70,235 25,299
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 286,405 300,462
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 208,648 211,679
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 565,288 537,440
19 Revenue less expenses. Subtract line 18 from line 12....... 128,667 96,281
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 3,177,684 3,274,298
21 Total liabilities (Part X, line 26)............. 4,957 5,290
22 Net assets or fund balances. Subtract line 21 from line 20..... 3,172,727 3,269,008
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: THE ORGANIZATION'S STATEMENT OF PURPOSES, AS PRESENTED IN THE CORPORATE BY-LAWS, IS (1) TO ENSURE, AS OWNER AND LESSOR, THE VIABILITY OF THE COMMUNITY HOSPITAL LOCATED IN DEXTER, MISSOURI, FORMERLY KNOWN AS THE DEXTER MEMORIAL HOSPITAL, BY SCRUTINIZING THE LESSEE'S OPERATION OF THE HOSPITAL TO ENSURE THAT THE LESSEE ABIDES BY THE LEASE TERMS AND CONTINUES TO PROVIDE THE HEALTH CARE NEEDED IN THE DEXTER AREA; AND (2) TO BUILD HEALTHIER COMMUNITIES THROUGH THE IMPLEMENTATION OF PROGRAMS AND SERVICES DESIGNED TO ENHANCE OVERALL COMMUNITY HEALTH AND WELLNESS. THE ORGANIZATION ORIGINALLY OPERATED A FULL SERVICE 50 BED COMMUNITY HOSPITAL, INCLUDING PROVISION OF LIMITED CHARITABLE CARE TO THE DEXTER, MISSOURI COMMUNITY AS ITS PROGRAM SERVICE ACTIVITY DURING THE PERIOD 1968 - 1999. IN 1999, IN ORDER TO MAINTAIN THE OPERATIONS OF THE HOSPITAL WITHOUT CUTTING ESSENTIAL SERVICES TO THE DEXTER, MISSOURI COMMUNITY, THE ORGANIZATION LEASED THE HOSPITAL FACILITIES, INCLUDING LAND, BUILDINGS AND EQUIP
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 296,462 including grants of $   ) (Revenue $ 9,162 )
MOTHER-TO-MOTHER - THIS PROGRAM IS AN INCENTIVE BASED MENTORING PROGRAM FOR PREGNANT AND PARENTING YOUNG WOMEN. TRAINING, EDUCATION, AND EQUIPMENT ARE PROVIDED THAT ENABLE YOUNG MOTHERS TO BECOME BETTER PARENTS AND REDUCE THE OCCURRENCES OF CHILD ABUSE AND NEGLECT. TWO SCHEDULED GROUP MEETINGS EACH MONTH PROVIDE TIME AND INFORMATION FOR YOUNG MOTHERS AND THEIR CHILDREN TO INTERACT WITH STAFF AND OTHER YOUNG FAMILIES. BEING AN INCENTIVE BASED PROGRAM MENTEES GO OVER AN INCENTIVE FORM ONCE A MONTH WITH THEIR MENTOR AND ARE AWARDED BABY BUCKS FOR DEVELOPING POSITIVE PARENTING SKILLS AND RESPONSIBILITIES. THEY IN TURN MAY SPEND THEIR BABY BUCKS IN THE BABY BOUTIQUE WHICH IS STOCKED WITH CLOTHING, DIAPERS, WIPES, EDUCATIONAL TOYS, SAFETY EQUIPMENT, AND INFANT SUPPLIES. YOUNG MOTHERS, FATHERS, AND CHILDREN VERY MUCH ENJOY COMING BY THE OFFICE TO VISIT AND PLAY IN THE RESOURCE CENTER. DURING THESE MEETINGS THE CHILDREN ENJOY THE PLAYROOM AND THE PARENTS GET TO INTERACT WITH STAFF IN A RELAXING, STRESS FREE ATMOSPHERE. MOTHER-TO-MOTHER IS A 3 PHASE PROGRAM. PHASE 1 IS WHEN A YOUNG WOMAN ENTERS THE PROGRAM DURING HER PREGNANCY. SHE ENTERS PHASE 2 WHEN THE CHILD IS BORN. WHEN THE CHILD REACHES ITS FIRST BIRTHDAY THE MOTHER THEN DECIDES IF SHE WANTS TO ENTER PHASE 3 OF THE PROGRAM. IF SHE CHOOSES TO ENTER PHASE 3 SHE MUST EITHER CONTINUE HER EDUCATION OR OBTAIN EMPLOYMENT. MOTHER-TO-MOTHER IS ALL ABOUT EDUCATION AND YOUNG MOTHERS CREATING SAFE AND STABLE HOMES FOR THEIR FAMILIES. EMPHASIS IS GIVEN TO PROMOTING POSITIVE TRAINING AND SKILLS THAT ENABLE THE YOUNG MOTHER TO DEVELOP A FINANCIALLY SECURE FUTURE FOR HER AND HER FAMILY. IF THEY DO NOT HAVE A HIGH SCHOOL DIPLOMA THEY ARE REQUIRED TO ENTER OUR GED PROGRAM. THE GED PROGRAM IS OPEN NOT ONLY TO MOTHERS BUT ALSO FATHERS. IF THEY WANT TO BEGIN OR CONTINUE WITH COLLEGE OR TECHNICAL SCHOOL CLASSES A STAFF PERSON IS AVAILABLE TO PROVIDE THEM WITH ASSISTANCE TO FURTHER THEIR EDUCATION OR TECHNICAL SKILLS. ASSISTANCE IS PROVIDED TO THOSE THAT ARE LOOKING FOR EMPLOYMENT BY HELPING WITH JOB SEARCHES, RESUMES, APPROPRIATE CLOTHING FOR INTERVIEWS, AND TIPS ON GOOD INTERVIEW PRESENTATIONS. DURING 2012 A TOTAL OF 123 YOUNG PARENTS AND CHILDREN PARTICIPATED IN THE MOTHER-TO-MOTHER PROGRAM. THE MOTHER TO MOTHER PROGRAM IS PRIMARILY FUNDED BY GRANTS AND DONOR CONTRIBUTIONS.
4b (Code:   ) (Expenses $ 122,653 including grants of $   ) (Revenue $   )
PRESCRIPTION DRUG ASSISTANCE PROGRAM - THIS PROGRAM HELPS THE UNINSURED AND LOW-INCOME TO SECURE PRESCRIPTION MEDICATIONS AVAILABLE THROUGH PHARMACEUTICAL COMPANY'S INDIGENT PROGRAMS. DURING 2012 THE VOLUNTEERS AND STAFF ASSISTED INDIVIDUALS TO SECURE 3,588 PRESCRIPTION MEDICATIONS, AT A TOTAL MONETARY VALUE OF 3,163,086.
4c (Code:   ) (Expenses $ 10,000 including grants of $ 10,000 ) (Revenue $   )
HEALTHCARE RELATED SCHOLARSHIPS - THIS PROGRAM PROVIDES SCHOLARSHIPS TO ENCOURAGE LOCAL RESIDENTS TO PURSUE HEALTHCARE RELATED CAREERS. FOUR DEXTER COMMUNITY REGIONAL HEALTHCARE SCHOLARSHIPS WERE AWARDED IN 2012 IN THE AMOUNT OF 2,500 EACH TO A GRADUATING SENIOR AND TO THREE CURRENT COLLEGE STUDENTS WHO MET THE 3.25 GPA REQUIREMENT FOR SCHOLARSHIP RENEWAL. ALL OF THESE STUDENTS MUST BE A RESIDENT OF STODDARD COUNTY AND PURSUE TRAINING IN A HEALTHCARE RELATED FIELD. THESE SCHOLARSHIPS ARE OFFERED IN AN ATTEMPT TO INCREASE THE NUMBER OF HEALTHCARE PROVIDERS IN THE COUNTY. HIGH SCHOOL SENIORS MAY APPLY FOR THIS 10,000 SCHOLARSHIP IF THEY HAVE A MINIMUM ACT SCORE OF 25 AND THEY ARE ATTENDING A STODDARD COUNTY SCHOOL OR ARE HOME SCHOOLED IN STODDARD COUNTY. EACH APPLICANT MUST PROVIDE A SHORT BIOGRAPHY AND ANSWER AN ESSAY QUESTION REGARDING THEIR CAREER GOALS. THREE INDEPENDENT JUDGES FROM OUTSIDE STODDARD COUNTY REVIEW THE APPLICATIONS AND THE ESSAY. THESE JUDGES DO NOT KNOW THE NAMES OF THE APPLICANTS. THE SCHOLARSHIP IS AWARDED TO THE APPLICANT WITH THE HIGHEST COMBINED NUMERICAL SCORE. THE HIGH SCHOOL SENIOR IS AWARDED THE SCHOLARSHIP AT THE ANNUAL MEETING OF THE REGIONAL HEALTHCARE FOUNDATION.
(Code:   ) (Expenses $ 22,045 including grants of $ 15,299 ) (Revenue $   )
A GED PROGRAM IS OFFERED TO PARTICIPANTS OF MOTHER-TO-MOTHER AND TO ALL OTHER PARENTING YOUNG MEN AND WOMEN UNDER THE AGE OF THIRTY. THE ORGANIZATION AWARDS GRANTS TO OTHER NON-PROFIT ORGANIZATIONS THAT FURTHER ITS HEALTHCARE MISSION. DURING THE YEAR, GRANTS WERE AWARDED TO PARENTS AS TEACHERS FOR EARLY CHILDHOOD EDUCATIONAL ASSISTANCE. MO-SMILES RECEIVED A GRANT TO PROMOTE DENTAL CARE FOR THE UNINSURED OR POVERTY STRICKEN AT A LOCAL MONTHLY CLINIC. OTHER AWARDS WERE GIVEN TO LOCAL CHARITIES TO ASSIST WITH CANCER TREATMENTS AND MENTAL HEALTH.
4d Other program services (Describe in Schedule O.)
(Expenses $ 22,045 including grants of $ 15,299 ) (Revenue $   )
4e Total program service expensesMediumBullet451,160
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J.......................
23
 
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
11
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
16
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
10
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
 
No
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletADMINISTRATIVE SECRETARY215 WEST GRANT STREETDEXTERMO63841 (573) 624-1607
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) HALL YVONNE........................................................................
DIR/SECY/EMP
 40.00
.......................   		X   X       57,508 0 0
(2) BISCHOF THOMAS E........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(3) BOOKER KRISTI........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(4) MILLS MATT........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(5) GROSSMAN DARLA........................................................................
DIR/PRESIDEN
 5.00
.......................   		X   X       0 0 0
(6) KANE WILLIAM T........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(7) TAYLOR MARY ANN........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(8) MATHIS AARON........................................................................
DIR/VICE PRE
 3.00
.......................   		X   X       0 0 0
(9) NORMAN JACK........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(10) PIPPINS JR BILL........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(11) HUFFMAN JACK........................................................................
DIR/TREASURE
 3.00
.......................   		X   X       0 0 0
(12) KELLER DONNA........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(13) THROWER ELISSA........................................................................
EXEC DIRECTO
 40.00
.......................   		    X       29,385 0 1,200
(14) EDWARDS SANDY........................................................................
ADMIN SECY
 24.00
.......................   		    X       11,619 0 0






Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 98,512   1,200
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet  
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
 
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet  
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b 200
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 37,034
f All other contributions, gifts, grants, and
similar amounts not included above1f 		408,562
g Noncash contributions included in lines
1a-1f:$ 		49,454
h Total. Add lines 1a-1f.......MediumBullet 445,796
Program Service Revenue Business Code
2a RENT INCOME 531120 5,201 5,201    
b PROGRAM PARTICIPANT REVENUE 532000 175 175    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 5,376
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 31,180     31,180
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 240,000  
b Less: rental expenses 34,028  
c Rental income or (loss) 205,972  
d Net rental income or (loss).......MediumBullet 205,972     205,972
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 10,723  
b Less: cost or other basis and sales expenses 65,000  
c Gain or (loss) -54,277  
d Net gain or (loss)..........MediumBullet -54,277     -54,277
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 3,961
b Less: cost of goods sold ..b 4,287
c Net income or (loss) from sales of inventory..MediumBullet -326     -326
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 633,721 5,376   182,549
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 8,040 8,040
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 17,259 17,259
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees ....        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 276,358 232,277 44,081  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits ....... 1,200   1,200  
10 Payroll taxes ........... 22,904 19,260 3,644  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 9,349 632 8,717  
c Accounting ........... 17,493 11,890 5,603  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 6,268 5,968 300  
12 Advertising and promotion .... 4,357 3,917 440  
13 Office expenses ....... 17,530 14,441 3,089  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 34,209 25,550 8,659  
17 Travel ............ 15,451 13,146 2,305  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 960   960  
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 14,028 9,977 4,051  
23 Insurance .............. 4,478 2,997 1,481  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a OPERATING SUPPLIES 77,224 76,289 935  
b MISCELLANEOUS 8,683 8,593 90  
c TRAINING 697 400 297  
d LAUNDRY AND UNIFORMS 498 498    
e All other expenses 454 26 428  
25 Total functional expenses. Add lines 1 through 24e 537,440 451,160 86,280 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 198 1 200
2 Savings and temporary cash investments ......... 2,162,247 2 2,358,271
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net .............   4  
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ............. 979 7 417
8 Inventories for sale or use .............. 3,000 8 3,000
9 Prepaid expenses and deferred charges ..........   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 5,033,185
b Less: accumulated depreciation ..... 10b 4,407,820 673,421 10c 625,365
11 Investments—publicly traded securities .......... 271,499 11 285,705
12 Investments—other securities. See Part IV, line 11 ..... 65,000 12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 1,340 15 1,340
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 3,177,684 16 3,274,298
Liabilities 17 Accounts payable and accrued expenses ......... 4,957 17 5,290
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................   25  
26 Total liabilities. Add lines 17 through 25......... 4,957 26 5,290
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 3,172,727 27 3,269,008
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 3,172,727 33 3,269,008
34 Total liabilities and net assets/fund balances ........ 3,177,684 34 3,274,298
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
633,721
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
537,440
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
96,281
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
3,172,727
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
3,269,008
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... 213,303 188,803 228,729 450,638 445,796 1,527,269
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3 213,303 188,803 228,729 450,638 445,796 1,527,269
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..           556,980
6 Public support. Subtract line 5 from line 4.           970,289
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4.. 213,303 188,803 228,729 450,638 445,796 1,527,269
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 303,447 321,598 260,709 274,688 271,180 1,431,622
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).           2,958,891
12
12
90,989
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
32.790 %
15
15
28.380 %
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
THE ORGANIZATION MEETS THE FACTS AND CIRCUMSTANCES TEST BASED UPON ITS OPERATIONS AS DESCRIBED IN FORM 990, PART III, AS WELL AS THE FOLLOWING ITEMS: THE ORGANIZATION IS ACTIVE IN ITS EFFORTS TO INCREASE BOTH THE NUMBER OF FUNDING SOURCES AS WELL AS THE TOTAL DOLLARS RECEIVED FROM THOSE SOURCES. THOSE EFFORTS INCLUDE THE CONTINUOUS EFFORTS OF OUR EXECUTIVE STAFF AND OUR GRANTWRITER TO EXPLORE NEW SOURCES OF FUNDING AND INCREASE LEVELS OF CURRENT GRANTS. OUR CURRENT BOARD OF DIRECTORS IS DIVERSE IN THAT WE HAVE MEMBERS FROM THE AREA WHO ARE ACTIVE IN LOCAL BUSINESSES, MEDICINE, INVESTMENTS, BANKING AND REAL ESTATE AND REPRESENT THE INTERESTS OF THE COMMUNITY AND ITS HEALTHCARE NEEDS. OUR ORGANIZATION'S VARIOUS HEALTH AND WELLNESS SERVICES ARE PROVIDED TO ALL MEMBERS OF THE GENERAL PUBLIC. OUR ORGANIZATION'S REGULAR MEMBERSHIP IS AVAILABLE TO ANY PERSON WHO MAKES A MINIMUM CONTRIBUTION OF 50 TO THE ORGANIZATION. THE MEMBER IS THEN ENTITLED TO TAKE PART IN THE ANNUAL MEETING WITH FULL VOTING RIGHTS. EACH MEMBER IS ENTITLED TO ONE VOTE, REGARDLESS OF THE AMOUNT OF HIS OR HER INITIAL MEMBERSHIP CONTRIBUTION. THE MEMBERS ARE ENCOURAGED TO TAKE AN ACTIVE ROLL IN DONATIONS AND VOLUNTEER OPPORTUNITIES WITHIN THE ORGANIZATION AND IT'S VARIOUS PROGRAMS.
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION 		Employer identification number

43-6054187
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION 		Employer identification number

43-6054187
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION 		Employer identification number

43-6054187
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   188,608 188,608
b Buildings ................   4,606,733 4,192,753 413,980
c Leasehold improvements ............        
d Equipment ................   166,487 149,475 17,012
e Other .................   71,357 65,592 5,765
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 625,365
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 731,019
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 8,072
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 50,911
e Add lines 2a through 2d ..................... 2e 58,983
3 Subtract line 2e from line 1..................... 3 672,036
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b -38,315
c Add lines 4a and 4b....................... 4c -38,315
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 633,721
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 576,443
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 39,003
e Add lines 2a through 2d...................... 2e 39,003
3 Subtract line 2e from line 1..................... 3 537,440
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 537,440
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 2D RECEIVABLE-01/01 -1,026 RECEIVABLE-01/01 -498 RECEIVABLE-01/01 -3,455 RECEIVABLE-12/31 1,599 OTHER 14 CORPORATE LIQUIDATION LOSS PREVIOUSLY DEDUCTED ON AUDIT FS 54,277
REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES PART VIII LINE 6B -34,028 COST OF GOODS SOLD PART VIII LINE 10B -4,287
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES PART VIII LINE 6B 34,028 COST OF GOODS SOLD PART VIII LINE 10B 4,287 PREPAID INSURANCE-NET CHANGE -70 PREPAID RENT-NET CHANGE 200 ACCOUNTS PAYABLE-01/01 4,611 ACCOUNTS PAYABLE-12/31 -1,542 ACCRUED PAID TIME OFF-NET CHANGE -2,548 OTHER 37
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number
43-6054187
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) SCHOLARSHIPS 4 10,000      
(2) SPECIAL NEEDS ASSISTANCE 11 3,481      
(3) GENERIC MEDICATIONS 10 3,678      
(4) OTHER 1 100      






Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 THE ORGANIZATION HAS DIRECT CONTACT AND KNOWLEDGE OF THE USE OF THIS FUNDING BY THE RECEPIENT ORGANIZATIONS. THE NUMBER OF RECEPIENTS NOTED IN PART III ARE COMPUTED BASED UPON THE ORGANIZATION'S ACCOUNTING RECORDS.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) ELIZABETH BISCHOF DIRECTOR'S WIFE 26,545 EMPLOYEE'S WAGES   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		X 49,454 EST FAIR MARKET VALUE
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) (2012)
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION THE ORGANIZATION'S STATEMENT OF PURPOSES, AS PRESENTED IN THE CORPORATE BY-LAWS, IS (1) TO ENSURE, AS OWNER AND LESSOR, THE VIABILITY OF THE COMMUNITY HOSPITAL LOCATED IN DEXTER, MISSOURI, FORMERLY KNOWN AS THE DEXTER MEMORIAL HOSPITAL, BY SCRUTINIZING THE LESSEE'S OPERATION OF THE HOSPITAL TO ENSURE THAT THE LESSEE ABIDES BY THE LEASE TERMS AND CONTINUES TO PROVIDE THE HEALTH CARE NEEDED IN THE DEXTER AREA; AND (2) TO BUILD HEALTHIER COMMUNITIES THROUGH THE IMPLEMENTATION OF PROGRAMS AND SERVICES DESIGNED TO ENHANCE OVERALL COMMUNITY HEALTH AND WELLNESS. THE ORGANIZATION ORIGINALLY OPERATED A FULL SERVICE 50 BED COMMUNITY HOSPITAL, INCLUDING PROVISION OF LIMITED CHARITABLE CARE TO THE DEXTER, MISSOURI COMMUNITY AS ITS PROGRAM SERVICE ACTIVITY DURING THE PERIOD 1968 - 1999. IN 1999, IN ORDER TO MAINTAIN THE OPERATIONS OF THE HOSPITAL WITHOUT CUTTING ESSENTIAL SERVICES TO THE DEXTER, MISSOURI COMMUNITY, THE ORGANIZATION LEASED THE HOSPITAL FACILITIES, INCLUDING LAND, BUILDINGS AND EQUIPMENT TO AN UNRELATED HEALTHCARE ORGANIZATION THAT OPERATED THE HOSPITAL. SINCE THEN, OTHER ORGANIZATIONS HAVE LEASED THE FACILITIES AND OPERATED THE HOSPITAL TO PROVIDE FOR THE HEALTH CARE NEEDS OF THE DEXTER COMMUNITY. THE ORGANIZATION PROVIDES CONTINUED SUPPORT FOR THE HEALTH AND WELLNESS OF PERSONS IN THE DEXTER, MISSOURI COMMUNITY THROUGH IMPLEMENTATION OF VARIOUS HEALTHCARE RELATED PROGRAMS THAT RELATE TO ITS TAX EXEMPT PURPOSE. PRIMARY AMONG THEM ARE MOTHER-TO-MOTHER, PRESCRIPTION DRUG ASSISTANCE AND HEALTHCARE RELATED SCHOLARSHIPS. OTHER PROGRAMS INCLUDE LICENSE TO CARE (CHILD ABUSE PREVENTION), SPECIAL MEDICAL NEEDS ASSISTANCE, FITNESS CHALLENGES AND A GED PROGRAM. THE ORGANIZATION'S THREE LARGEST PROGRAM SERVICES (BY EXPENSES) ARE MOTHER-TO-MOTHER, PRESCRIPTION DRUG ASSISTANCE AND HEALTHCARE RELATED SCHOLARSHIPS. THE ACTIVITIES IN THESE PROGRAMS ARE DESCRIBED IN PART III ITEM 4 AND ARE NOT REPEATED HERE. OTHER ORGANIZATION PROGRAMS INCLUDE: THE ORGANIZATION PARTNERS WITH THE CHILDREN'S TRUST FUND IN PROMOTING CHILD ABUSE AND PREVENTION. THE ORGANIZATION HAS BEEN AWARDED FOUR SOUTHEAST MISSOURI COUNTIES FROM WHICH THEY WILL RECEIVE 100% OF THE 25 DONATED TO THE CTF LICENSE PLATE PROGRAM. THE ORGANIZATION WILL USE THIS MONEY FOR CHILD ABUSE PREVENTION SERVICES. THE FOUNDATION FITNESS CHALLENGE HAS BECOME AN ANNUAL WEIGHT LOSS CHALLENGE WHERE MEMBERS OF THE COMMUNITY SIGNUP IN TEAMS OF FOUR AND CHALLENGE THEMSELVES TO TAKE OFF POUNDS IN THEIR OWN SENSIBLE WAY WHILE WEIGHING IN WEEKLY FOR ACCOUNTABILITY. THE FOUNDATION'S WALKERS FOR WELLNESS EXERCISE PROGRAM HAS BEEN ADDED TO ENCOURAGE COMMUNITY MEMBERS TO WALK AT A CONVENIENT LOCATION TO PROMOTE A MORE ACTIVE, HEALTHY LIFESTYLE. WALKERS LOG IN AT TWO SITES TO DOCUMENT PARTICIPATION. THE FOUNDATION ASSISTS SOME MEMBERS OF THE COMMUNITY WHO MEET 150% OF THE FEDERAL POVERTY GUIDELINE WITH GENERIC MEDICATIONS AND SPECIAL MEDICAL SUPPLIES SUCH AS ADULT DIAPERS OR HOME MEDICAL EQUIPMENT.
FIRST ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4A YOUNG MOTHERS, FATHERS, AND CHILDREN VERY MUCH ENJOY COMING BY THE OFFICE TO VISIT AND PLAY IN THE RESOURCE CENTER. DURING THESE MEETINGS THE CHILDREN ENJOY THE PLAYROOM AND THE PARENTS GET TO INTERACT WITH STAFF IN A RELAXING, STRESS FREE ATMOSPHERE. MOTHER-TO-MOTHER IS A 3 PHASE PROGRAM. PHASE 1 IS WHEN A YOUNG WOMAN ENTERS THE PROGRAM DURING HER PREGNANCY. SHE ENTERS PHASE 2 WHEN THE CHILD IS BORN. WHEN THE CHILD REACHES ITS FIRST BIRTHDAY THE MOTHER THEN DECIDES IF SHE WANTS TO ENTER PHASE 3 OF THE PROGRAM. IF SHE CHOOSES TO ENTER PHASE 3 SHE MUST EITHER CONTINUE HER EDUCATION OR OBTAIN EMPLOYMENT. MOTHER-TO-MOTHER IS ALL ABOUT EDUCATION AND YOUNG MOTHERS CREATING SAFE AND STABLE HOMES FOR THEIR FAMILIES. EMPHASIS IS GIVEN TO PROMOTING POSITIVE TRAINING AND SKILLS THAT ENABLE THE YOUNG MOTHER TO DEVELOP A FINANCIALLY SECURE FUTURE FOR HER AND HER FAMILY. IF THEY DO NOT HAVE A HIGH SCHOOL DIPLOMA THEY ARE REQUIRED TO ENTER OUR GED PROGRAM. THE GED PROGRAM IS OPEN NOT ONLY TO MOTHERS BUT ALSO FATHERS. IF THEY WANT TO BEGIN OR CONTINUE WITH COLLEGE OR TECHNICAL SCHOOL CLASSES A STAFF PERSON IS AVAILABLE TO PROVIDE THEM WITH ASSISTANCE TO FURTHER THEIR EDUCATION OR TECHNICAL SKILLS. ASSISTANCE IS PROVIDED TO THOSE THAT ARE LOOKING FOR EMPLOYMENT BY HELPING WITH JOB SEARCHES, RESUMES, APPROPRIATE CLOTHING FOR INTERVIEWS, AND TIPS ON GOOD INTERVIEW PRESENTATIONS. DURING 2012 A TOTAL OF 123 YOUNG PARENTS AND CHILDREN PARTICIPATED IN THE MOTHER-TO-MOTHER PROGRAM. THE MOTHER TO MOTHER PROGRAM IS PRIMARILY FUNDED BY GRANTS AND DONOR CONTRIBUTIONS.
THIRD ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4C OR ARE HOME SCHOOLED IN STODDARD COUNTY. EACH APPLICANT MUST PROVIDE A SHORT BIOGRAPHY AND ANSWER AN ESSAY QUESTION REGARDING THEIR CAREER GOALS. THREE INDEPENDENT JUDGES FROM OUTSIDE STODDARD COUNTY REVIEW THE APPLICATIONS AND THE ESSAY. THESE JUDGES DO NOT KNOW THE NAMES OF THE APPLICANTS. THE SCHOLARSHIP IS AWARDED TO THE APPLICANT WITH THE HIGHEST COMBINED NUMERICAL SCORE. THE HIGH SCHOOL SENIOR IS AWARDED THE SCHOLARSHIP AT THE ANNUAL MEETING OF THE REGIONAL HEALTHCARE FOUNDATION.
ALL OTHER ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4D A GED PROGRAM IS OFFERED TO PARTICIPANTS OF MOTHER-TO-MOTHER AND TO ALL OTHER PARENTING YOUNG MEN AND WOMEN UNDER THE AGE OF THIRTY. THE ORGANIZATION AWARDS GRANTS TO OTHER NON-PROFIT ORGANIZATIONS THAT FURTHER ITS HEALTHCARE MISSION. DURING THE YEAR, GRANTS WERE AWARDED TO PARENTS AS TEACHERS FOR EARLY CHILDHOOD EDUCATIONAL ASSISTANCE. MO-SMILES RECEIVED A GRANT TO PROMOTE DENTAL CARE FOR THE UNINSURED OR POVERTY STRICKEN AT A LOCAL MONTHLY CLINIC. OTHER AWARDS WERE GIVEN TO LOCAL CHARITIES TO ASSIST WITH CANCER TREATMENTS AND MENTAL HEALTH.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PAGE 6, PART VI, LINE 4 AT THE 04/26/12 ANNUAL MEETING, THE MEMBERSHIP APPROVED TWO CHANGES IN THE BY-LAWS RELATING TO THE COMPOSITION OF THE BOARD OF DIRECTORS. FIRST WAS TO ELIMINATE THE PROVISION THAT THE HOSPITAL CHIEF OF STAFF AUTOMATICALLY BE A MEMBER OF THE BOARD OF DIRECTORS. SINCE THE FOUNDATION NO LONGER OPERATES THE HOSPITAL, THIS WAS NO LONGER APPROPRIATE, ESPECIALLY SINCE THE FOUNDATION AND THE HOSPITAL MUST DEAL AT ARMS LENGTH ON MATTERS RELATING TO THE LEASE. SECOND WAS TO ELIMINATE THE PROVISION THAT REQUIRED CERTAIN MEMBERS OF THE BOARD OF DIRECTORS TO RESIDE IN SPECIFIED AREAS OF STODDARD COUNTY. THIS PROVISION WAS ORGINALLY ADDED IN THE MID 1960'S WHEN FUNDS WERE RAISED TO BUILD THE HOSPITAL AND MATCHING FUND REQUIREMENTS SPECIFIED THAT EACH AREA'S CONTRIBUTORS SHOULD BE REPRESENTED ON THE BOARD. SINCE THE FOUNDATION NO LONGER OPERATES THE HOSPITAL, THIS PROVISION IS NO LONGER APPROPRIATE.
CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 THE ORGANIZATION'S BY-LAWS AT ARTICLE IV MEMBERSHIP, SECTION 1 MEMBERS STATES: THE CORPORATION SHALL OPERATE UPON A MEMBERSHIP BASIS. THERE SHALL BE ONE CLASS OF MEMBERS AS FOLLOWS: REGULAR MEMBERSHIPS WITH VOTING PRIVILEGES, WHO SHALL INCLUDE THOSE CHARTER MEMBERS WHO SIGNED THE ARTICLES OF INCORPORATION AND ALSO THOSE PERSONS WHO MAKE CONTRIBUTIONS IN MONEY, PROPERTY OR SERVICES IN THE MINIMUM CUMULATIVE SUM OR VALUE OF FIFTY (50.00) DOLLARS OR MORE AND APPLY FOR MEMBERSHIP AND ARE DULY REGISTERED AS SUCH. THE BOARD OF DIRECTORS SHALL MAKE THE DETERMINATION AS TO THE VALUE OF THE PROPERTY OR SERVICES GIVEN. NO PERSON SHALL BE ELIGIBLE FOR MEMBERSHIP UNTIL THE MONEY, PROPERTY OR SERVICES CONTRIBUTED IS ACTUALLY RECEIVED AND VALUED BY THE CORPORATION.
ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A ARTICLE IV:MEMBERSHIP SECTION 2. MEETINGS OF MEMBERS: THE ANNUAL MEETING OF THE MEMBERS OF THIS CORPORATION FOR THE PURPOSE OF ELECTING DIRECTORS, IS HELD ON THE FOURTH THURSDAY OF APRIL EACH YEAR.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B ACTIONS OF OUR MEMBER ELECTED BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY THE ORGANIZATION'S MEMBERS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE DRAFT COPY OF FORM 990 IS REVIEWED BY THE PREPARER, EXECUTIVE DIRECTOR AND OTHER ORGANIZATION STAFF PRIOR TO ITS COMPLETION. A COPY OF THE FORM 990 IS EMAILED TO THE MEMBERS OF THE BOARD OF DIRECTORS AND STAFF PRIOR TO ITS FILING. RETURN WILL BE REVIEWED BY BOARD OF DIRECTORS IN ITS NEXT SCHEDULED MEETING.
ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE ORGANIZATION'S BY-LAWS ARTICLE IX, SECTION 2 "DUALITY OF INTEREST" STATES ITS CONFLICT OF INTEREST POLICY. THE POLICY REQUIRES ANY MEMBER TO DISCLOSE CONFLICTS BEFORE DISCUSSIONS OR ACTIONS ARE TAKEN. THAT POLICY IS STATED AS FOLLOWS: ANY DIRECTOR, OFFICER, EMPLOYEE, OR COMMITTEE MEMBER HAVING AN INTEREST, DIRECT OR INDIRECT, IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL, AND FRANK DISCLOSURE OF HIS INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL INCLUDE ANY RELEVANT AND MATERIAL FACTS, KNOWN TO SUCH PERSON, ABOUT THE CONTRACT OR TRANSACTION WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE TO THE CORPORATION'S INTEREST. AFTER MAKING SUCH DISCLOSURE, OR IN THE ABSENCE OF SUCH A DISCLOSURE A DETERMINATION BY A MAJORITY OF THE OTHER BOARD MEMBERS PRESENT THAT SUCH A CONFLICT DOES EXIST, SUCH DIRECTOR, OFFICER, EMPLOYEE OR COMMITTEE MEMBER HAVING SUCH CONFLICT SHALL REMOVE HIMSELF/HERSELF FROM THE MEETING DURING THE DISCUSSION AND VOTE ON THE MATTER AT HAND. THE FACT OF SUCH REMOVAL SHALL BE NOTED IN THE MINUTES OF THE MEETING. THE BOARD MAY ADOPT DUALITY OF INTEREST POLICIES REQUIRING: (A) REGULAR ANNUAL STATEMENTS FROM DIRECTORS, OFFICERS, AND EMPLOYEES THAT DISCLOSE EXISTING AND POTENTIAL DUALITIES OF INTEREST. (B) CORRECTIVE AND DISCIPLINARY ACTIONS WITH RESPECT TO TRANSGRESSIONS OF SUCH POLICIES. FOR THE PURPOSE OF THIS SECTION, A PERSON SHALL BE DEEMED TO HAVE AN "INTEREST" IN A CONTRACT OR OTHER TRANSACTION IF HE IS THE PARTY (OR ONE OF THE PARTIES) CONTRACTING OR DEALING WITH THE FOUNDATION, OR IS A DIRECTOR, OFFICER, OR HAS A SIGNIFICANT FINANCIAL OR INFLUENTIAL INTEREST IN OR WITH THE ENTITY CONTRACTING OR DEALING WITH THE FOUNDATION.
COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD OF DIRECTORS INCLUDES A NUMBER OF LOCAL BUSINESSMEN AND WOMEN. THEY CONSIDER THE PAY LEVELS OF SIMILAR POSITIONS IN LOCAL BUSINESSES AS WELL AS OTHER LOCAL NOT FOR PROFIT ORGANIZATIONS IN THEIR DETERMINATION OF THE COMPENSATION AND BENEFIT PACKAGE PROVIDED TO THE EXECUTIVE DIRECTOR. THIS PROCESS IS DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS.
COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B FOR OTHER THAN THE EXECUTIVE DIRECTOR, COMPENSATION LEVELS ARE DETERMINED ON AN ANNUAL BASIS BY THE EXECUTIVE DIRECTOR, IN CONSULTATION WITH THE MEMBERS OF THE BOARD. THESE COMPENSATION LEVELS ARE BASED UPON SIMILAR POSITIONS IN THE FOR PROFIT ARENA, AS WELL AS FUNDING SOURCE GUIDELINES FOR THOSE WHOSE COMPENSATION IS FUNDED BY GRANT REVENUES.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 ALL OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY (WHICH IS INCLUDED IN OUR BY-LAWS) AND DETAILED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT OUR OFFICES, LOCATED AT 215 WEST GRANT STREET IN DEXTER MO. THIS IS COMMUNICATED TO THE GENERAL MEMBERSHIP EACH YEAR AT THE ANNUAL MEMBERSHIP MEETING.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DEXTER COMMUNITY REGIONAL
HEALTHCARE FOUNDATION
Employer identification number

43-6054187
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No












For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CROWLEY RIDGE MEDICAL ARTS INC

215 W GRANT
DEXTER,MO63841
20-5196430 		RE RENTAL MO N/A
           No












Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CROWLEY RIDGE MEDICAL ARTS INC

 S 10,723 LIQUIDATION DISTRIBUTION





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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