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CABUN RURAL HEALTH SERVICES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CABUN RURAL HEALTH SERVICES INC (EIN 71-0487596)
Tax period
2012-04-01 to 2013-03-31
Filed
2014-01-21
IRS object ID
201410219349300901
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-01-21T11:39:53-06:00Timestamp
Tax Period End Date2013-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 3667AddressLine1
CityLITTLE ROCKCity
StateARState
ZIP Code722033667ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN710487596EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CABUN RURAL HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% SHIRLEY STRICKLANDInCareOfName
Name ControlCABUNameControl
Phone8707984064Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1196AddressLine1
Address Line2SuiteAddressLine2
CityHAMPTONCity
StateARState
ZIP Code71744ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSHIRLEY STRICKLANDName
TitleCHIEF FINANCIAL OFFICERTitle
Phone8707984064Phone
Date Signed2014-01-11DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMBER SHERRILLName
Phone5013721040Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMELANIE SHEPPARDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1986 AUSTIN STREETAddressLine1
CityCAMDENCity
StateARState
ZIP Code71701ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6702677GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteSEE SCHEDULE OWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileARStateLegalDomicile
Activity Or Mission DescriptionTO MEET THE NEEDS AND PROVIDE SERVICES TO PERSONS IN NEED OF PRIMARY MEDICAL CARE AND WORK WITH OTHER HEALTH CENTER PROVIDERS IN THE AREA TO FORM AN INTEGRATED SYSTEM FOR DELIVERY OF HEALTH CARE SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees90TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4173590ContributionsGrantsPriorYear
Contributions Grants Current Year3637415ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2734108ProgramServiceRevenuePriorYear
Program Service Revenue CY3038046ProgramServiceRevenueCY
Investment Income Prior Year3828InvestmentIncomePriorYear
Investment Income Current Year2382InvestmentIncomeCurrentYear
Other Revenue Prior Year3835OtherRevenuePriorYear
Other Revenue Current Year24834OtherRevenueCurrentYear
Total Revenue Prior Year6915361TotalRevenuePriorYear
Total Revenue Current Year6702677TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3965942SalariesEtcPriorYear
Salaries Etc Current Year4229677SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2450070OtherExpensePriorYear
Other Expenses Current Year2265084OtherExpensesCurrentYear
Total Expenses Prior Year6416012TotalExpensesPriorYear
Total Expenses Current Year6494761TotalExpensesCurrentYear
Revenues Less Expenses Prior Year499349RevenuesLessExpensesPriorYear
Revenues Less Expenses CY207916RevenuesLessExpensesCY
Total Assets BOY3131823TotalAssetsBOY
Total Assets EOY3547245TotalAssetsEOY
Total Liabilities BOY352610TotalLiabilitiesBOY
Total Liabilities EOY560116TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2779213NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2987129NetAssetsOrFundBalancesEOY
Mission DescriptionTO MEET THE NEEDS AND PROVIDE SERVICES TO PERSONS IN NEED OF PRIMARY MEDICAL CARE AND WORK WITH OTHER HEALTH CENTER PROVIDERS IN THE AREA TO FORM AN INTEGRATED SYSTEM FOR DELIVERY OF HEALTH CARE SERVICES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense4286242Expense
Revenue3038046Revenue
DescriptionCABUN RURAL HEALTH SERVICES, INC. HAS CLINIC SITES IN HAMPTON, STRONG, BEARDEN, LEWISVILLE, HOPE, AND AMITY TO PROVIDE MEDICAL SERVICES TO PEOPLE IN THE SURROUNDING AREAS. DISCOUNTED SERVICES AND PRESCRIPTION ASSISTANCE ARE PROVIDED TO THOSE WHO QUALIFY. CABUN WORKS WITH OTHER HEALTH CARE PROVIDERS FOR SPECIALIZED SERVICES THROUGH REFERRAL.Description
Total Program Service Expense4286242TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109616NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees90NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteesfalseMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSHIRLEY STRICKLANDNamePerson
Telephone Number8709182344TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11783 E AR 274 HWYAddressLine1
CityHAMPTONCity
StateARState
ZIP Code71744ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
LILLIE RANDALL
BOARD CHAIR1.0XX000
JUANET GASKIN
DIRECTOR1.0X000
DON CAIN
BOARD SECRETARY/TREASURER1.0XX000
KRISTIE MAY
DIRECTOR1.0X000
JEANNE BENDER
DIRECTOR1.0X000
HOMER JONES
DIRECTOR1.0X000
LEANNE MCGOOGAN
DIRECTOR1.0X000
JAMES RAWLS
BOARD VICE CHAIR1.0XX000
CLOYS RUNYAN
DIRECTOR1.0X000
TRAVIS JOE MCNIEL
DIRECTOR1.0X000
SHIRLEY STRICKLAND
CHIEF FINANCIAL OFFICER40.0X6145204936
JOSEPH SARNICKI
CHIEF MEDICAL OFFICER40.0X232614010382
MELANIE SHEPPARD
CHIEF EXECUTIVE OFFICER40.0X9200001206
JAMES ARRINGTON MD
PHYSICIAN40.0183172012547X
EVE COVAS MD
PHYSICIAN40.018406307304X
MICHAEL SINGH MD
PHYSICAN40.0163233012395X
PATRICIA ELETHORP DO
PHYSICAN40.017551508384X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1092049TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation57154TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PSS
PO BOX 741378ATLANTAGA30374MEDICAL SUPPLIES345360
SUCCESS EHS
PO BOX 204485DALLASTX75320PATIENT MGMT SYSTEM109709
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants3197990GovernmentGrants
All Other Contributions439425AllOtherContributions
Noncash Contributions144749NoncashContributions
Total Contributions3637415TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column3038046TotalRevenueColumn
Related Or Exempt Function Income3038046RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue3038046TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2382TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,382ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column24834TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$24,834ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue24834TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6702677TotalRevenueColumn
Related Or Exempt Function Income3038046RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$27,216ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total412020Total
Program Services0ProgramServices
Management And General412020ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3179020Total
Program Services2334176ProgramServices
Management And General844844ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total344029Total
Program Services223619ProgramServices
Management And General120410ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total294608Total
Program Services191495ProgramServices
Management And General103113ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2958Total
Program Services1923ProgramServices
Management And General1035ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total60726Total
Program Services39472ProgramServices
Management And General21254ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total268370Total
Program Services174440ProgramServices
Management And General93930ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total14852Total
Program Services9654ProgramServices
Management And General5198ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total258431Total
Program Services167980ProgramServices
Management And General90451ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total39412Total
Program Services25618ProgramServices
Management And General13794ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total126473Total
Program Services82207ProgramServices
Management And General44266ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total40256Total
Program Services26166ProgramServices
Management And General14090ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total58706Total
Program Services38159ProgramServices
Management And General20547ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total14112Total
Program Services9173ProgramServices
Management And General4939ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total181067Total
Program Services117694ProgramServices
Management And General63373ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total22145Total
Program Services14394ProgramServices
Management And General7751ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
SUPPLIES8221525343992877530
REPAIRS & MAINTENANCE10392967554363750
BAD DEBTS EXPENSE18470718470700
DUES & MEMBERSHIPS5305634486185700

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13732Total
Program Services8926ProgramServices
Management And General4806ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6494761Total
Program Services4286242ProgramServices
Management And General2208519ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY422773BOY
EOY239666EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY250923BOY
EOY252661EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY159063BOY
EOY174071EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY373419BOY
EOY470115EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY415845BOY
EOY789854EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY129912BOY
EOY120560EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4177BOY
EOY4921EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2560416LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1065019LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1375711BOY
EOY1495397EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3131823BOY
EOY3547245EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY242757BOY
EOY387543EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY109853BOY
EOY172573EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY352610BOY
EOY560116EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2779213BOY
EOY2987129EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2779213BOY
EOY2987129EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3131823BOY
EOY3547245EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses207916ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3284424CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3676024CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4183623CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4173590CurrentTaxYearMinus1Year
Current Tax Year3637415CurrentTaxYear
Total18955076Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3284424CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3676024CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4183623CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4173590CurrentTaxYearMinus1Year
Current Tax Year3637415CurrentTaxYear
Total18955076Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17018955076PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8047CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7983CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6299CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3828CurrentTaxYearMinus1Year
Current Tax Year2382CurrentTaxYear
Total28539Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years37313CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9957CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12715CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3835CurrentTaxYearMinus1Year
Current Tax Year24834CurrentTaxYear
Total88654Total
FieldValueIRS element (for citing)
Total Support19072269TotalSupport
Gross Receipts From Admissions Etc15421219GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.99386PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99172PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis45049OtherCostOrOtherBasis
Book Value45049BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1180421OtherCostOrOtherBasis
Depreciation319106Depreciation
Book Value861315BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1002026OtherCostOrOtherBasis
Depreciation745445Depreciation
Book Value256581BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis332920OtherCostOrOtherBasis
Depreciation468Depreciation
Book Value332452BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1495397TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt6517970TotRevenueEtcAuditedFinclStmt
Other Revenues-184707OtherRevenues
Revenue Not Rptd F990-184707RevenueNotRptdF990
Revenue Subtotal6702677RevenueSubtotal
Total Revenue Per Form9906702677TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6310054TotExpensesEtcAuditedFinclStmt
Expenses Subtotal6310054ExpensesSubtotal
Other Expenses Not Included184707OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt184707ExpensesNotRptdOnFinStmt
Total Expenses Per Form9906494761TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
RECONCILIATION OF REVENUE AND EXPENSESFORM 990, SCHEDULE D, PART XI, LINE 2(D) & PART XII, LINE 4(B)PART XI LINE 2(D) TOTAL REVENUE PER AUDITED FINANCIAL STATEMENTS: $6,517,970 BAD DEBT EXPENSE - $(184,707) -------------------------------------------------------------- TOTAL REVENUE FORM 990, PART I, LINE 12: $6,702,677 PART XII, LINE 4(B) TOTAL EXPENSES PER AUDITED FINANCIAL STATEMENTS: $6,310,054 BAD DEBT EXPENSES: + $ 184,707 --------------------------------------------------------------- TOTAL EXPENSES FORM 990, PART I, LINE 18: $6,494,761
FIN 48 DISCLOSUREFORM 990, SCHEDULE D, PART X, LINE 2MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JAMES ARRINGTON MD
PHYSICIAN1831720000000125470195719000
EVE COVAS MD
PHYSICIAN184063000000073040191367000
MICHAEL SINGH MD
PHYSICAN1632330000000123950175628000
PATRICIA ELETHORP DO
PHYSICAN175515000000083840183899000
JOSEPH SARNICKI
CHIEF MEDICAL OFFICER2252140740000000103820242996000

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions677NumberOfContributions
Noncash Contribs Rptd F990144749NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DOCUMENTING COMMITTEES ACTING ON ITS BEHALFFORM 990, PART VI, SECTION A, LINE 8BTHE GOVERNING BOARD SERVES AS ALL COMMITTEES.
REVIEW OF FORM 990FORM 990, PART VI, SECTION B, LINE 11BFORM 990 WAS REVIEWED BY THE CEO AND CFO BEFORE IT WAS FILED. THE BOARD REVIEWED THE FORM AFTER IT WAS FILED.
COMPLIANCE WITH CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CBOARD APPLICANTS FILL OUT A QUESTIONNAIRE THAT INCLUDES ANY INTERESTS IN THE COMPANY. IF THE CLINIC WANTS TO USE ANY SERVICES THAT HAVE A CONTACT TO AN EMPLOYEE, THE BOARD REVIEWS THE REQUEST AND MAY GIVE APPROVAL. THE CLINIC HAS AN ANTI-NEPOTISM POLICY THAT PREVENTS HIRING ANYONE WHO IS IMMEDIATELY RELATED TO AN EMPLOYEE. IF THERE ARE NO OTHER QUALIFIED APPLICANTS, THE BOARD MAY APPROVE HIRING.
PROCESS FOR DETERMINING COMPENSATIONFORM 990, PART VI, SECTION B, LINE 15A & 15BTHE LAST REVIEW WAS DONE IN 2009. THE BOARD OF DIRECTORS REVIEWED THE DOL SALARY REVIEWS AND A REVIEW DONE BY THE COMMUNITY HEALTH CENTERS OF ARKANSAS FOR COMPARISON.
DOCUMENTS AVAILABLE TO THE PUBLICFORM 990, PART VI, SECTION C, LINE 19ALL DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
ORGANIZATION'S WEBSITEFORM 990, PAGE 1, LINE JORGANIZATION'S WEBSITE: WWW.CHC-AR.ORG/NEWS/CABUN-RURAL-HEALTH-SERVICES