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CABUN RURAL HEALTH SERVICES INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CABUN RURAL HEALTH SERVICES INC (EIN 71-0487596)
Tax period
2010-04-01 to 2011-03-31
Filed
2011-08-12
IRS object ID
201102249349300245
Schema version
2010v3.4
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)
Timestamp2011-08-12T07:34:06-04:00Timestamp
Tax Period End Date2011-03-31TaxPeriodEndDate

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 Date2010-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN710487596EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CABUN RURAL HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCABUNameControl
Phone8707984064Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameSHIRLEY STRICKLANDName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2011-08-08DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameCHERYL SCHLUTERMANName
Phone5013721040Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts6818020GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.chc-ar/org/health_maps_cabun.htmlWebSite
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 Employees95TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3676024ContributionsGrantsPriorYear
Contributions Grants Current Year4183623ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2902800ProgramServiceRevenuePriorYear
Program Service Revenue CY2615383ProgramServiceRevenueCY
Investment Income Prior Year7983InvestmentIncomePriorYear
Investment Income Current Year724InvestmentIncomeCurrentYear
Other Revenue Prior Year9957OtherRevenuePriorYear
Other Revenue Current Year12715OtherRevenueCurrentYear
Total Revenue Prior Year6596764TotalRevenuePriorYear
Total Revenue Current Year6812445TotalRevenueCurrentYear
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 Year3883836SalariesEtcPriorYear
Salaries Etc Current Year3900873SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2547212OtherExpensePriorYear
Other Expenses Current Year2517733OtherExpensesCurrentYear
Total Expenses Prior Year6431048TotalExpensesPriorYear
Total Expenses Current Year6418606TotalExpensesCurrentYear
Revenues Less Expenses Prior Year165716RevenuesLessExpensesPriorYear
Revenues Less Expenses CY393839RevenuesLessExpensesCY
Total Assets BOY2120501TotalAssetsBOY
Total Assets EOY2603243TotalAssetsEOY
Total Liabilities BOY234476TotalLiabilitiesBOY
Total Liabilities EOY323379TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1886025NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2279864NetAssetsOrFundBalancesEOY
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
Expense4199052Expense
Revenue2615383Revenue
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 Expense4199052TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
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
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109622NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees95NumberOfEmployees
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
States Where Copy Of Return Is FiledARStatesWhereCopyOfReturnIsFiled
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
BOARD VICE CHAIR1.0XX000
DON CAIN
BOARD SECRETARY1.0XX000
KRISTIE MAY
BOARD TREASURER1.0XX000
MELBA TOMLINSON
DIRECTOR1.0X000
JEANNE BENDER
DIRECTOR1.0X000
HOMER JONES
DIRECTOR1.0X000
LEANNE MCGOOGAN
DIRECTOR1.0X000
BETSY GRIFFIN
DIRECTOR1.0X000
CLOYS RUNYAN
DIRECTOR1.0X000
JOSEPH SARNICKI DO
CHIEF MEDICAL OFFICER40.0X22310309594
MELANIE SHEPPARD RN
CHIEF EXECUTIVE OFFICER40.0X8427701143
SHIRLEY STRICKLAND
CHIEF FINANCE OFFICER40.0X5398504890
ROBERT A FLOSS MD
PHYSICIAN36.016188005449X
JAMES ARRINGTON MD
PHYSICIAN36.0167477011760X
EVE COVAS MD
PHYSICIAN36.017519007279X
MICHAEL SINGH MD
PHYSICAN36.0154930011760X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1020842TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation51875TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
PSS
MEDICAL SUPPLIES334267
NETGAIN TECHNOLOGIES
COMP MAINTENANCE120109
EHS
MANAGEMENT SYSTEM258324
SOURCE ONE
X-RAY EQUIPMENT134606
F J CONSTRUCTION
CONSTRUCTION127870
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants3913726GovernmentGrants
All Other Contributions269897AllOtherContributions
Noncash Contributions269547NoncashContributions
Total Contributions4183623TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column2615383TotalRevenueColumn
Related Or Exempt Function Income2615383RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue2615383TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column6299TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$6,299ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other5575Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-5575Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-5575TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$5,575ExclusionAmount

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 Column12715TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,715ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue12715TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6812445TotalRevenueColumn
Related Or Exempt Function Income2615383RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$13,439ExclusionAmount

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)
Total380919Total
Program Services0ProgramServices
Management And General380919ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2947596Total
Program Services2034485ProgramServices
Management And General913111ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total336952Total
Program Services232570ProgramServices
Management And General104382ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total235406Total
Program Services162482ProgramServices
Management And General72924ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2608Total
Program Services1800ProgramServices
Management And General808ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total59878Total
Program Services41329ProgramServices
Management And General18549ManagementAndGeneral
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)
Total332742Total
Program Services229665ProgramServices
Management And General103077ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total13992Total
Program Services9658ProgramServices
Management And General4334ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total330408Total
Program Services228054ProgramServices
Management And General102354ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total101667Total
Program Services70172ProgramServices
Management And General31495ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total152718Total
Program Services105409ProgramServices
Management And General47309ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total35640Total
Program Services24599ProgramServices
Management And General11041ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total48747Total
Program Services33646ProgramServices
Management And General15101ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total17337Total
Program Services11966ProgramServices
Management And General5371ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total123009Total
Program Services84903ProgramServices
Management And General38106ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total21184Total
Program Services14622ProgramServices
Management And General6562ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
SUPPLIES8981566199242782320
REPAIRS & MAINTENANCE10865074992336580
BAD DEBTS EXPENSE10242810242800
DUES & MEMBERSHIPS5876340559182040
INCENTIVE EXPENSE3961273412270

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total105845Total
Program Services73055ProgramServices
Management And General32790ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6418606Total
Program Services4199052ProgramServices
Management And General2219554ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY307403BOY
EOY360611EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY243613BOY
EOY247776EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY13048BOY
EOY110496EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY427791BOY
EOY368610EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY114200BOY
EOY61494EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY176860BOY
EOY109385EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY35918BOY
EOY633EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2229420LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec885182LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY801668BOY
EOY1344238EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2120501BOY
EOY2603243EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY234476BOY
EOY185415EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY137964EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY234476BOY
EOY323379EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1886025BOY
EOY2279864EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1886025BOY
EOY2279864EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2120501BOY
EOY2603243EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses393839ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Years2776845CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2699627CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3284424CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3676024CurrentTaxYearMinus1Year
Current Tax Year4183623CurrentTaxYear
Total16620543Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2776845CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2699627CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3284424CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3676024CurrentTaxYearMinus1Year
Current Tax Year4183623CurrentTaxYear
Total16620543Total
FieldValueIRS element (for citing)
Public Support Total17016620543PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10487CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12158CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8047CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7983CurrentTaxYearMinus1Year
Current Tax Year6299CurrentTaxYear
Total44974Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years41623CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years48366CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years37313CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9957CurrentTaxYearMinus1Year
Current Tax Year12715CurrentTaxYear
Total149974Total
FieldValueIRS element (for citing)
Total Support16815491TotalSupport
Gross Receipts From Admissions Etc16552394GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.98841PublicSupportPertcentage170
Public Support Pertcent Prior Year0.98609PublicSupportPertcentPriorYear
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

Land Land

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

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis954339OtherCostOrOtherBasis
Depreciation255259Depreciation
Book Value699080BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis930565OtherCostOrOtherBasis
Depreciation610525Depreciation
Book Value320040BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis299467OtherCostOrOtherBasis
Depreciation19398Depreciation
Book Value280069BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1344238TotalOfBookValueLandBuildings
Total Revenue6812445TotalRevenue
Total Expenses6418606TotalExpenses
Excess Or Deficit For Year393839ExcessOrDeficitForYear
Excess Or Deficit Per FS393839ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt6818020TotRevenueEtcAuditedFinclStmt
Revenue Subtotal6818020RevenueSubtotal
Other Revenues Not Included-5575OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-5575RevenueNotRptdOnFinStmt
Total Revenue Per Form9906812445TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6424181TotExpensesEtcAuditedFinclStmt
Other Expenses Included5575OtherExpensesIncluded
Expenses Not Rptd F9905575ExpensesNotRptdF990
Expenses Subtotal6418606ExpensesSubtotal
Total Expenses Per Form9906418606TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierRECONCILIATION OF REVENUE AND EXPENSESIdentifier
Return ReferenceFORM 990, SCHEDULE D, PART XII, LINE 4(B) & PART XIII, LINE 2(D)ReturnReference
ExplanationPART XII LINE 4(B) TOTAL REVENUE PER AUDITED FINANCIAL STATEMENTS: $6,818,020 LOSS ON DISPOSAL OF ASSET INCLUDED IN REVENUE: $ <5,575> -------------------------------------------------------------- TOTAL REVENUE FORM 990, PART I, LINE 12: $6,812,445 PART XIII, LINE 2(D) TOTAL EXPENSES PER AUDITED FINANCIAL STATEMENTS: $6,424,181 LOSS ON DISPOSAL OF ASSET NOT INCLUDED IN EXPENSES: $ <5,575> --------------------------------------------------------------- TOTAL EXPENSES FORM 990, PART I, LINE 18: $6,418,606Explanation

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)

Base 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
ROBERT A FLOSS MD
161880000000054490167329000
JAMES ARRINGTON MD
1664370104000000117600179237000
EVE COVAS MD
175190000000072790182469000
JOSEPH SARNICKI DO
221923011800000095940232697000
MICHAEL SINGH MD
1530700186000000117600166690000

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 Contributions1NumberOfContributions
Noncash Contribs Rptd F990269547NoncashContribsRptdF990
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 (5 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.