Good Samaritan Clinic in Fort Smith, Arkansas (AR)
Table of contents:
- Overview
- Detailed Reports
- Checklist
- Statements Regarding Other IRS Filings and Tax Compliance
- Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
- Statement of Revenue
- Statement of Functional Expenses
- Balance Sheet
- Reason for Public Charity Status
- Support Schedule for Organizations Described in Section 509(a)(2)
- Revenue, Expenses, and Changes in Net Assets or Fund Balances
- Statement of Functional Expenses
- Balance Sheets
- Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
- Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
- Current Officers, Directors, Trustees, and Key Employees
- Other Information
- Analysis of Income-Producing Activities
- Information Regarding Taxable Subsidiaries and Disregarded Entities
- Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
- Statements About Activities
- Reason for Non-Private Foundation Status
- Support Schedule
- Lobbying Expenditures by Electing Public Charities
- Organizations performing similar types of work
| Good Samaritan Clinic | |
| Employer Identification Number (EIN) | 710863639 |
| Name of Organization | Good Samaritan Clinic |
| In Care of Name | Michael Schluterman |
| Address | 615 N B St, Fort Smith, AR 72901-2125 |
| Subsection | Charitable Organization |
| Ruling Date | 10/2002 |
| Deductibility | Contributions are deductible |
| Foundation | Organization which receives a substantial part of its support from a governmental unit or the general public |
| Organization | Corporation |
| Exempt Organization Status | Unconditional Exemption |
| Tax Period | 06/2014 |
| Assets | $1,000,000 to $4,999,999 |
| Income | $500,000 to $999,999 |
| Filing Requirement | 990 (all other) or 990EZ return |
| Asset Amount | $1,029,720 |
| Amount of Income | $537,771 |
| Form 990 Revenue Amount | $537,771 |
| National Taxonomy of Exempt Entities (NTEE) | Health - General and Rehabilitative: Health Treatment Facilities, Primarily Outpatient |
Non-representatives - add comments:
Amount of income in 2014: $537,771
| Good Samaritan Clinic: | $537,771 |
| Other organizations performing similar types of work: | $502,277 |
Assets in 2014: $1,029,720
| This organization: | $1,029,720 |
| Other organizations performing similar types of work: | $342,333 |
Expenses in 2014: $653,878
| This organization: | $653,878 |
| Other organizations performing similar types of work: | $551,906 |
Income to expenses ratio in 2014: 0.8
| This organization: | 0.8 |
| Other organizations performing similar types of work: | 1.0 |
Expenses allocated to program services in 2007: 88.1%
| This organization: | 88.1% |
| Other organizations performing similar types of work: | 84.7% |
Number of employees in 2014: 14
| This organization: | 14 |
| Other organizations performing similar types of work: | 12 |
Grants share in income in 2014: 88.9%
| Good Samaritan Clinic: | 88.9% |
| Other organizations performing similar types of work: | 8.9% |
Revenue for 2014
Assets at the end of 2014
Functional expenses for 2014
Support schedule
| Checklist | |||
| 2012 | 2013 | 2014 | |
|---|---|---|---|
| Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? | No | No | Yes |
| Is the organization required to complete Schedule B, Schedule of Contributors? | Yes | Yes | Yes |
| Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? | No | No | No |
| Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? | No | No | No |
| 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? | No | No | No |
| 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? | No | No | No |
| Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? | No | No | No |
| Did the organization maintain collections of works of art, historical treasures, or other similar assets? | No | No | No |
| Did the organization report an amount for escrow or custodial account liability; serve as a custodian or provide credit counseling, debt management, credit repair, or debt negotiation services? | No | No | No |
| Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? | No | No | No |
| Did the organization report an amount for land, buildings, and equipment? | Yes | Yes | Yes |
| Did the organization report an amount for investments-other securities that is 5% or more of its total assets? | Yes | Yes | Yes |
| Did the organization report an amount for investments-program related that is 5% or more of its total assets? | No | No | No |
| Did the organization report an amount for other assets that is 5% or more of its total assets? | No | No | No |
| Did the organization report an amount for other liabilities? | No | No | No |
| 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)? | Yes | Yes | Yes |
| Did the organization obtain separate, independent audited financial statements for the tax year? | Yes | Yes | Yes |
| Was the organization included in consolidated, independent audited financial statements for the tax year? | No | No | No |
| Is the organization a school described in section 170(b)(1)(A)(ii)? | No | No | No |
| Did the organization maintain an office, employees, or agents outside of the United States? | No | No | No |
| 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? | No | No | No |
| Did the organization report more than $5,000 of grants or other assistance to or for any foreign organization? | No | No | No |
| Did the organization report more than $5,000 of aggregate grants or other assistance to or for foreign individuals? | No | No | No |
| Did the organization report a total of more than $15,000 of expenses for professional fundraising services? | No | No | No |
| Did the organization report more than $15,000 total of fundraising event gross income and contributions? | No | No | No |
| Did the organization report more than $15,000 of gross income from gaming activities? | No | No | No |
| Did the organization operate one or more hospital facilities? | No | No | No |
| Did the organization attach a copy of its audited financial statements? | No | No | No |
| Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government? | No | No | No |
| Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals? | No | No | No |
| Did the organization answer 'Yes' about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? | No | No | No |
| 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? | No | No | No |
| Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? | No | No | No |
| Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? | No | No | No |
| Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year? | No | No | No |
| Did the organization engage in an excess benefit transaction with a disqualified person during the year? | No | No | No |
| 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? | No | No | No |
| Did the organization report any amount for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? | No | No | No |
| 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? | No | No | No |
| Was the organization a party to a business transaction with one of the following parties | |||
| A current or former officer, director, trustee, or key employee? | No | No | No |
| A family member of a current or former officer, director, trustee, or key employee? | No | No | No |
| 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? | No | No | No |
| Did the organization receive more than $25,000 in non-cash contributions? | No | No | No |
| Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? | No | No | No |
| Did the organization liquidate, terminate, or dissolve and cease operations? | No | No | No |
| Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? | No | No | No |
| Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? | No | No | No |
| Was the organization related to any tax-exempt or taxable entity? | No | No | No |
| Did the organization have a controlled entity within the meaning of section 512(b)(13)? | No | No | No |
| Did the organization make any transfers to an exempt non-charitable related organization? | No | No | No |
| 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? | No | No | No |
| Statements Regarding Other IRS Filings and Tax Compliance | ||||
| 2011 | 2012 | 2013 | 2014 | |
|---|---|---|---|---|
| The number reported in Box 3 of Form 1096 | 0 | 0 | 0 | |
| The number of Forms W-2G | 0 | 0 | 0 | |
| Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? | No | No | No | |
| 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 | 12 | 13 | 14 | |
| Did the organization file all required federal employment tax returns? | Yes | Yes | Yes | |
| Did the organization have unrelated business gross income of $1,000 or more during the year? | No | No | No | No |
| Has it filed a Form 990-T for this year? | No | No | No | |
| 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)? | No | No | No | |
| Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? | No | No | No | |
| Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? | No | No | No | |
| Did the organization file Form 8886-T? | No | No | No | |
| 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? | No | No | No | |
| Did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? | No | No | No | |
| 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? | No | No | No | |
| Did the organization notify the donor of the value of the goods or services provided? | No | No | No | |
| Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? | No | No | No | |
| Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? | No | No | No | |
| Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? | No | No | No | |
| If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? | No | No | No | |
| If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? | No | No | No | |
| Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? | No | No | No | |
| Did the sponsoring organization make any taxable distributions under section 4966? | No | No | No | |
| Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? | No | No | No | |
| Initiation fees and capital contributions | $0 | $0 | $0 | $0 |
| Gross receipts for public use of club facilities | $0 | $0 | $0 | $0 |
| Gross income from members or shareholders | $0 | $0 | $0 | $0 |
| Gross income from other sources | $0 | $0 | $0 | $0 |
| Is the organization filing Form 990 in lieu of Form 1041? | No | No | No | |
| The amount of tax-exempt interest received or accrued during the year | $0 | $0 | $0 | |
| Is the organization licensed to issue qualified health plans in more than one state? | No | No | No | |
| The amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans | $0 | $0 | $0 | |
| The amount of reserves on hand | $0 | $0 | $0 | |
| Did the organization receive any payments for indoor tanning services during the tax year? | No | No | No | |
| Has it filed a Form 720 to report these payments? | No | No | No | |
| Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors | |||
| 2012 | 2013 | 2014 | |
|---|---|---|---|
| Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees | |||
| Total reportable compensation from the organization | $0 | $55,000 | $56,520 |
| Total reportable compensation from related organizations | $0 | $0 | $0 |
| Total estimated amount of other compensation from the organization and related organizations | $0 | $0 | $0 |
| Total number of individuals who received more than $100,000 of reportable compensation from the organization | 0 | 0 | 0 |
| Total number of independent contractors who received more than $100,000 of compensation from the organization | 0 | 0 | 0 |
| Statement of Revenue | ||||
| 2011 | 2012 | 2013 | 2014 | |
|---|---|---|---|---|
| Total revenue | $392,710 | $591,229 | $531,812 | $537,771 |
| Contributions, Gifts, Grants and Other Similar Amounts | $348,795 | $551,542 | $482,055 | $478,232 |
| Program Service Revenue | $29,831 | $25,750 | $32,533 | $31,402 |
| 0 | $25,750 | $32,533 | $31,402 | |
| All other program service revenue | $0 | $0 | $0 | |
| Other Revenue | ||||
| Investment income (including dividends, interest, and other similar amounts) | $15,352 | $10,174 | $10,238 | $6,626 |
| Income from investment of tax-exempt bond proceeds | $0 | $0 | $0 | $0 |
| Royalties | $0 | $0 | $0 | $0 |
| Net rental income | $0 | $0 | $0 | $0 |
| Net gain/loss from sales of assets other than inventory | $-1,268 | $-1,458 | $6,855 | $19,487 |
| Gross amount from sales of assets other than inventory (Securities / Other) | $0 / $0 | $0 / $0 | $6,855 / $0 | $19,487 / $0 |
| Less: cost or other basis and sales expenses (Securities / Other) | $1,268 / $0 | $1,458 / $0 | $0 / $0 | $0 / $0 |
| Gain or (loss) (Securities / Other) | $-1,268 / $0 | $-1,458 / $0 | $6,855 / $0 | $19,487 / $0 |
| Net income/loss from fundraising events | $0 | $0 | $0 | $0 |
| Net income/loss from gaming activities | $0 | $0 | $0 | $0 |
| Net income/loss from sales of inventory | $0 | $0 | $0 | $0 |
| Miscellaneous Revenue | $0 | $5,221 | $131 | $2,024 |
| 0 | $5,221 | $131 | $2,024 | |
| All other revenue | $0 | $0 | $0 | |
| Statement of Functional Expenses | ||||
| 2011 | 2012 | 2013 | 2014 | |
|---|---|---|---|---|
| Total functional expenses | $563,236 | $606,433 | $607,329 | $653,878 |
| Grants and other assistance to domestic organizations and domestic governments | $0 | $0 | $0 | |
| Grants and other assistance to domestic individuals | $0 | $0 | $0 | |
| Grants and other assistance to foreign organizations, foreign governments, and foreign individuals | $0 | $0 | $0 | |
| Benefits paid to or for members | $0 | $0 | $0 | |
| Compensation of current officers, directors, trustees, and key employees | $0 | $0 | $55,000 | $56,520 |
| Compensation not included above, to disqualified persons | $0 | $0 | $0 | |
| Other salaries and wages | $216,526 | $300,278 | $283,624 | $298,780 |
| Pension plan accruals and contributions | $0 | $0 | $0 | |
| Other employee benefits | $58,488 | $46,236 | $52,745 | |
| Payroll taxes | $23,122 | $24,621 | $27,088 | $29,204 |
| Fees for services (non-employees) | ||||
| Management | $0 | $0 | $0 | |
| Legal | $0 | $0 | $0 | |
| Accounting | $0 | $0 | $0 | |
| Lobbying | $0 | $0 | $0 | |
| Professional fundraising services | $0 | $0 | $0 | $0 |
| Investment management fees | $0 | $0 | $0 | |
| Other | $9,938 | $11,624 | $11,385 | |
| Advertising and promotion | $4,072 | $1,141 | $7,668 | |
| Office expenses | $0 | $0 | $0 | |
| Information technology | $0 | $0 | $0 | |
| Royalties | $0 | $0 | $0 | |
| Occupancy | $22,296 | $23,247 | $30,760 | |
| Travel | $245 | $72 | $0 | |
| Payments of travel or entertainment expenses for any federal, state, or local public officials | $0 | $0 | $0 | |
| Conferences, conventions, and meetings | $0 | $0 | $0 | |
| Interest | $0 | $0 | $0 | |
| Payments to affiliates | $0 | $0 | $0 | |
| Depreciation, depletion, and amortization | $17,077 | $15,692 | $18,874 | |
| Insurance | $18,869 | $22,288 | $27,263 | |
| Other expenses | $15,030 | $6,894 | $40,210 | |
| Other expenses | $17,107 | $11,826 | $28,347 | |
| Other expenses | $39,738 | $42,116 | $19,298 | |
| Other expenses | $57,576 | $42,350 | $9,495 | |
| Other expenses | $21,098 | $18,131 | $23,329 | |
| Balance Sheet | ||||
| 2011 | 2012 | 2013 | 2014 | |
|---|---|---|---|---|
| Total assets | $1,173,879 | $1,157,950 | $1,105,514 | $1,029,720 |
| Cash - non-interest-bearing | $184,124 | $163,167 | $173,173 | |
| Savings and temporary cash investments | $552,617 | $485,472 | $301,661 | |
| Pledges and grants receivable, net | $0 | $0 | $0 | |
| Accounts receivable, net | $0 | $0 | $0 | |
| Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees | $0 | $0 | $0 | |
| Loans and other receivables from other disqualified persons, persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations | $0 | $0 | $0 | |
| Notes and loans receivable, net | $0 | $0 | $0 | |
| Inventories for sale or use | $0 | $0 | $0 | |
| Prepaid expenses and deferred charges | $572 | $445 | $441 | |
| Land, buildings, and equipment: cost or other basis | $142,827 | $146,284 | $197,829 | |
| Investments - publicly traded securities | $0 | $0 | $0 | |
| Investments - other securities | $277,810 | $310,146 | $356,616 | |
| Investments - program-related | $0 | $0 | $0 | |
| Intangible assets | $0 | $0 | $0 | |
| Other assets | $0 | $0 | $0 | |
| Total liabilities | $25,494 | $29,152 | $36,096 | $51,288 |
| Accounts payable and accrued expenses | $29,152 | $36,096 | $51,288 | |
| Grants payable | $0 | $0 | $0 | |
| Deferred revenue | $0 | $0 | $0 | |
| Tax-exempt bond liabilities | $0 | $0 | $0 | $0 |
| Escrow or custodial account liability | $0 | $0 | $0 | |
| Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons | $0 | $0 | $0 | |
| Secured mortgages and notes payable to unrelated third parties | $0 | $0 | $0 | $0 |
| Unsecured notes and loans payable to unrelated third parties | $0 | $0 | $0 | $0 |
| Other liabilities (including federal income tax, payables to related third parties, and other liabilities) | $0 | $0 | $0 | |
| Total net assets or fund balances | $1,148,385 | $1,128,798 | $1,069,418 | $978,432 |
| Unrestricted net assets | $955,687 | $810,261 | $745,832 | |
| Temporarily restricted net assets | $390 | $85,436 | $58,879 | |
| Permanently restricted net assets | $172,721 | $173,721 | $173,721 | |
| Capital stock or trust principal, or current funds | $0 | $0 | $0 | |
| Paid-in or capital surplus, or land, building, or equipment fund | $0 | $0 | $0 | |
| Retained earnings, endowment, accumulated income, or other funds | $0 | $0 | $0 | $0 |
| Reason for Public Charity Status (for 2014) | |
| The organization is not a private foundation because it is: | An organization that normally receives: (1) more than 33 1/3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3 % 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 |
| Number of organizations supported | 0 |
| Sum of amounts of support | $0 |
| Support Schedule for Organizations Described in Section 509(a)(2) (for 2010 - 2014) | |
| 2010 - 2014 Total | |
|---|---|
| Public support | $2,390,702 |
| Subtotal | $2,390,702 |
| Gifts, grants, contributions, and membership fees received | $2,234,343 |
| 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 | $156,359 |
| Gross receipts from activities that are not an unrelated trade or business under section 513 | $0 |
| Tax revenues levied for the organization's benefit and either paid to or expended on its behalf | $0 |
| The value of services or facilities furnished by a governmental unit to the organization without charge | $0 |
| Less | $0 |
| Amounts received from disqualified persons | $0 |
| Amounts received from other than disqualified persons that exceed the greater of $5,000 or 1% of the total support | $0 |
| Total support | $2,454,873 |
| Public support | $2,390,702 |
| Subtotal | $64,171 |
| Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources | $64,171 |
| Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 | $0 |
| Net income from unrelated business activities, whether or not the business is regularly carried on | $0 |
| Other income | $0 |
| Revenue, Expenses, and Changes in Net Assets or Fund Balances | |||||
| 2003 | 2004 | 2005 | 2006 | 2007 | |
|---|---|---|---|---|---|
| Total revenue | $345,413 | $488,147 | $1,567,533 | $379,101 | $805,155 |
| Contributions, gifts, grants, and similar amounts received | $320,569 | $450,096 | $1,509,322 | $300,065 | $745,382 |
| Contributions to donor advised funds | $0 | $0 | |||
| Direct public support | $279,806 | $415,293 | $1,487,777 | $266,015 | $728,419 |
| Indirect public support | $28,264 | $0 | $0 | $0 | $0 |
| Government contributions (grants) | $12,499 | $34,803 | $21,545 | $34,050 | $16,963 |
| Program service revenue including government fees and contracts | $24,608 | $36,702 | $42,919 | $36,940 | $31,812 |
| Membership dues and assessments | $0 | $0 | $0 | $0 | $0 |
| Interest on savings and temporary cash investments | $236 | $0 | $0 | $0 | $0 |
| Dividends and interest from securities | $0 | $1,349 | $15,292 | $42,096 | $27,961 |
| Net rental income or (loss) | $0 | $0 | $0 | $0 | $0 |
| Gross rents | $0 | $0 | $0 | $0 | $0 |
| Less: rental expenses | $0 | $0 | $0 | $0 | $0 |
| Other investment income | $0 | $0 | $0 | $0 | $0 |
| Gain or (loss) from sales of assets other than inventory | $0 | $0 | $0 | $0 | $0 |
| Gross amount from sales of assets other than inventory | $0 | $0 | $0 | $0 | $0 |
| Less: cost or other basis and sales expenses | $0 | $0 | $0 | $0 | $0 |
| Net income or (loss) from special events and activities | $0 | $0 | $0 | $0 | $0 |
| Gross revenue | $0 | $0 | $0 | $0 | $0 |
| Less: direct expenses other than fundraising expenses | $0 | $0 | $0 | $0 | $0 |
| Gross profit or (loss) from sales of inventory | $0 | $0 | $0 | $0 | $0 |
| Gross sales of inventory, less returns and allowances | $0 | $0 | $0 | $0 | $0 |
| Less: cost of goods sold | $0 | $0 | $0 | $0 | $0 |
| Other revenue | $0 | $0 | $0 | $0 | $0 |
| Total expenses | $290,514 | $426,525 | $501,314 | $569,180 | $511,675 |
| Program services | $269,652 | $400,107 | $462,249 | $507,546 | $450,699 |
| Management and general | $15,998 | $20,128 | $27,138 | $33,235 | $30,340 |
| Fundraising | $4,864 | $6,290 | $11,927 | $28,399 | $30,636 |
| Payments to affiliates | $0 | $0 | $0 | $0 | $0 |
| Net assets or fund balances at end of year | $322,055 | $383,677 | $1,449,896 | $1,259,817 | $1,553,297 |
| Excess or (deficit) for the year | $54,899 | $61,622 | $1,066,219 | $-190,079 | $293,480 |
| Net assets or fund balances at beginning of year | $267,156 | $322,055 | $383,677 | $1,449,896 | $1,259,817 |
| Other changes in net assets or fund balances | $0 | $0 | $0 | $0 | $0 |
| Statement of Functional Expenses (for 2007) | ||||
| Total | Program services | Management and general | Fundraising | |
|---|---|---|---|---|
| Total functional expenses | $511,675 | $450,699 | $30,340 | $30,636 |
| Grants paid from donor advised funds | $0 | |||
| Other grants and allocations | $0 | |||
| Specific assistance to individuals | $0 | |||
| Benefits paid to or for members | $0 | |||
| Compensation of current officers, directors, key employees, etc. | $0 | $0 | $0 | $0 |
| Compensation of former officers, directors, key employees, etc. | $0 | $0 | $0 | $0 |
| Compensation and other distributions, not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) | $0 | $0 | $0 | $0 |
| Salaries and wages of employees not included above | $256,371 | $214,308 | $20,510 | $21,553 |
| Pension plan contributions not included above | $0 | $0 | $0 | $0 |
| Employee benefits not included above | $30,532 | $27,442 | $2,443 | $647 |
| Payroll taxes | $19,860 | $15,821 | $1,589 | $2,450 |
| Professional fundraising fees | $0 | $0 | $0 | $0 |
| Accounting fees | $0 | $0 | $0 | $0 |
| Legal fees | $0 | $0 | $0 | $0 |
| Supplies | $137,610 | $134,248 | $815 | $2,547 |
| Telephone | $0 | $0 | $0 | $0 |
| Postage and shipping | $6,095 | $2,559 | $488 | $3,048 |
| Occupancy | $19,238 | $17,699 | $1,539 | $0 |
| Equipment rental and maintenance | $506 | $506 | $0 | $0 |
| Printing and publications | $5,640 | $5,187 | $62 | $391 |
| Travel | $138 | $138 | $0 | $0 |
| Conferences, conventions, and meetings | $0 | $0 | $0 | $0 |
| Interest | $0 | $0 | $0 | $0 |
| Depreciation, depletion, etc. | $14,530 | $13,368 | $1,162 | $0 |
| Other expenses not covered above | $21,155 | $19,423 | $1,732 | $0 |
| Balance Sheets | |||||
| 2003 | 2004 | 2005 | 2006 | 2007 | |
|---|---|---|---|---|---|
| Total assets | $333,812 | $411,118 | $1,486,402 | $1,297,307 | $1,586,887 |
| Cash - non-interest-bearing | $129,518 | $167,695 | $158,338 | $43,198 | $110,081 |
| Savings and temporary cash investments | $4,229 | $36,887 | $600,517 | $753,680 | $870,800 |
| Accounts receivable less allowance for doubtful accounts | $0 | $0 | $0 | $0 | $0 |
| Pledges receivable less allowance for doubtful accounts | $0 | $0 | $526,977 | $306,041 | $413,700 |
| Grants receivable | $0 | $0 | $0 | $0 | $0 |
| Receivables from current and former officers, directors, trustees, and key employees | $0 | $0 | $0 | $0 | $0 |
| Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) | $0 | $0 | |||
| Other notes and loans receivable less allowance for doubtful accounts | $0 | $0 | $0 | $0 | $0 |
| Inventories for sale or use | $0 | $0 | $0 | $0 | $0 |
| Prepaid expenses and deferred charges | $0 | $0 | $0 | $0 | $584 |
| Investments - publicly-traded securities | $0 | $0 | |||
| Investments - other securities | $0 | $0 | $0 | $0 | $0 |
| Investments - land, buildings, and equipment less accumulated depreciation | $0 | $0 | $0 | $0 | $0 |
| Investments - other | $0 | $0 | $0 | $0 | $0 |
| Land, buildings, and equipment less accumulated depreciation | $200,065 | $206,536 | $200,570 | $194,388 | $191,722 |
| Other assets, including program-related investments | $0 | $0 | $0 | $0 | $0 |
| Total liabilities | $11,757 | $27,441 | $36,506 | $37,490 | $33,590 |
| Accounts payable and accrued expenses | $11,757 | $27,441 | $36,506 | $37,490 | $33,590 |
| Grants payable | $0 | $0 | $0 | $0 | $0 |
| Deferred revenue | $0 | $0 | $0 | $0 | $0 |
| Loans from officers, directors, trustees, and key employees | $0 | $0 | $0 | $0 | $0 |
| Tax-exempt bond liabilities | $0 | $0 | $0 | $0 | $0 |
| Mortgages and other notes payable | $0 | $0 | $0 | $0 | $0 |
| Other liabilities | $0 | $0 | $0 | $0 | $0 |
| Total liabilities and net assets/fund balances | $333,812 | $411,118 | $1,486,402 | $1,297,307 | $1,586,887 |
| Total net assets or fund balances | $322,055 | $383,677 | $1,449,896 | $1,259,817 | $1,553,297 |
| Reconciliation of Revenue per Audited Financial Statements With Revenue per Return | |||||
| 2003 | 2004 | 2005 | 2006 | 2007 | |
|---|---|---|---|---|---|
| Total revenue | $345,413 | $488,147 | $1,567,533 | $379,101 | $805,155 |
| Total revenue, gains, and other support per audited financial statements | $345,413 | $488,147 | $1,567,533 | $379,101 | $805,155 |
| Other expenses | $0 | $0 | $0 | $0 | $0 |
| Net unrealized gains on investments | $0 | $0 | $0 | $0 | $0 |
| Donated services and use of facilities | $0 | $0 | $0 | $0 | $0 |
| Recoveries of prior year grants | $0 | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 | $0 |
| Other revenue | $0 | $0 | $0 | $0 | $0 |
| Investment expenses | $0 | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 | $0 |
| Reconciliation of Expenses per Audited Financial Statements With Expenses per Return | |||||
| 2003 | 2004 | 2005 | 2006 | 2007 | |
|---|---|---|---|---|---|
| Total expenses | $290,514 | $426,525 | $501,314 | $569,180 | $511,675 |
| Total expenses and losses per audited financial statements | $290,514 | $426,525 | $501,314 | $569,180 | $511,675 |
| Other revenue | $0 | $0 | $0 | $0 | $0 |
| Donated services and use of facilities | $0 | $0 | $0 | $0 | $0 |
| Prior year adjustments | $0 | $0 | $0 | $0 | $0 |
| Losses | $0 | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 | $0 |
| Other expenses | $0 | $0 | $0 | $0 | $0 |
| Investment expenses | $0 | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 | $0 |
| Current Officers, Directors, Trustees, and Key Employees |
| Total number of officers, directors, and trustees permitted to vote on organization business at board meetings | 29 |
| Are any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or II-B, related to each other through family or business relationships? | No |
| Do any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or II-B, receive compensation from any other organizations, whether tax exempt or taxable, that are related to the organization? | No |
| Does the organization have a written conflict of interest policy? | No |
| Other Information | |
| Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return, and has it filed a tax return on Form 990-T for this year? | No |
| Was there a liquidation, dissolution, termination, or substantial contraction during the year? | No |
| Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? | No |
| Direct and indirect political expenditures | $0 |
| Did the organization file Form 1120-POL for this year? | No |
| Were substantially all dues nondeductible by members? | |
| Did the organization make only in-house lobbying expenditures of $2,000 or less? | |
| Dues, assessments, and similar amounts from members | $0 |
| Section 162(e) lobbying and political expenditures | $0 |
| Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices | $0 |
| Taxable amount of lobbying and political expenditures | $0 |
| Does the organization elect to pay the section 6033(e) tax on the amount above? | |
| If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount above to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? | |
| Initiation fees and capital contributions | $0 |
| Gross receipts for public use of club facilities | $0 |
| At any time during the year, did the organization, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)? | No |
| Amount of tax imposed on the organization during the year under: section 4911 | $0 |
| Amount of tax imposed on the organization during the year under: section 4912 | $0 |
| Amount of tax imposed on the organization during the year under: section 4955 | $0 |
| Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? | No |
| Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 | $0 |
| Amount of tax above, reimbursed by the organization | $0 |
| At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? | No |
| Did the organization acquire a direct or indirect interest in any applicable insurance contract? | No |
| Did the supporting organization, or a fund maintained by a sponsoring organization, have excess business holdings at any time during the year? | No |
| Number of employees employed in the pay period that includes March 12, 2006 | 0 |
| Analysis of Income-Producing Activities (for 2007) | |||||
| Unrelated business income | Excluded by section 512, 513, or 514 | Related or exempt function income | |||
|---|---|---|---|---|---|
| Business code | Amount | Exclusion code | Amount | ||
| Total | $0 | $59,773 | $0 | ||
| Program service revenue | |||||
| Program service revenue 1 | 000000 | $0 | Income from hospital services described in section 513(e) | $31,812 | $0 |
| Program service revenue 2 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 3 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 4 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 5 | 000000 | $0 | 00 | $0 | $0 |
| Medicare/Medicaid payments | 000000 | $0 | 00 | $0 | $0 |
| Fees and contracts from government agencies | 000000 | $0 | 00 | $0 | $0 |
| Membership dues and assessments | 000000 | $0 | 00 | $0 | $0 |
| Interest on savings and temporary cash investments | 000000 | $0 | 00 | $0 | $0 |
| Dividends and interest from securities | 000000 | $0 | Dividends, interest, payments with respect to securities loans, annuities, income from notional principal contracts, loan commitment fees, and other substantially similar income from ordinary and routine investments excluded by section 512(b)(1) | $27,961 | $0 |
| Net rental income or (loss) from real estate | |||||
| debt-financed property | 000000 | $0 | 00 | $0 | $0 |
| not debt-financed property | 000000 | $0 | 00 | $0 | $0 |
| Net rental income or (loss) from personal property | 000000 | $0 | 00 | $0 | $0 |
| Other investment income | 000000 | $0 | 00 | $0 | $0 |
| Gain or (loss) from sales of assets other than inventory | 000000 | $0 | 00 | $0 | $0 |
| Net income or (loss) from special events | 000000 | $0 | 00 | $0 | $0 |
| Gross profit or (loss) from sales of inventory | 000000 | $0 | 00 | $0 | $0 |
| Other revenue | 000000 | $0 | 00 | $0 | $0 |
| Information Regarding Taxable Subsidiaries and Disregarded Entities (for 2007) | |||
| EIN of corporation, partnership, or disregarded entity | Percentage of ownership interest | Total income | End-of-year assets |
|---|---|---|---|
| 0% | $0 | $0 | |
| 0% | $0 | $0 | |
| 0% | $0 | $0 | |
| 0% | $0 | $0 | |
| Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (for 2007) | ||
| Compensation | Contributions to employee benefit plans & deferred compensation | Expense account and other allowances |
|---|---|---|
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| Total number of other employees paid over $50,000 | 0 |
| Statements About Activities (for 2007) | |
| Expenses paid or incurred in connection with the lobbying activities | $0 |
| Did the organization receive or hold an easement for conservation purposes, including easements to preserve open space, the environment, historic land areas or historic structures? | No |
| Did the organization provide credit counseling, debt management, credit repair, or debt negotiation services? | No |
| Did the organization maintain any donor advised funds? | No |
| Did the organization make any taxable distributions under section 4966? | No |
| Did the organization make a distribution to a donor, donor advisor, or related person? | No |
| The total number of donor advised funds owned at the end of the tax year | $0 |
| The aggregate value of assets held in all donor advised funds owned at the end of the tax year | $0 |
| The total number of separate funds or accounts owned at the end of the tax year (excluding donor advised funds included above) where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts | $0 |
| The aggregate value of assets held in all funds or accounts included above at the end of the tax year | $0 |
| Reason for Non-Private Foundation Status | |
| The organization is not a private foundation because it is | Organization that receives a substantial part of its support from a governmental unit or from the general public |
| Support Schedule | |||||
| 2002 | 2003 | 2004 | 2005 | 2006 | |
|---|---|---|---|---|---|
| Total | $388,266 | $345,413 | $488,147 | $1,567,533 | $379,101 |
| Gifts, grants, and contributions received | $387,057 | $320,569 | $450,096 | $1,509,322 | $300,065 |
| Membership fees received | $0 | $0 | $0 | $0 | $0 |
| Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc., purpose | $0 | $24,608 | $36,702 | $42,919 | $36,940 |
| Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975 | $1,209 | $236 | $1,349 | $15,292 | $42,096 |
| Net income from unrelated business activities not included above | $0 | $0 | $0 | $0 | $0 |
| Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf | $0 | $0 | $0 | $0 | $0 |
| The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge | $0 | $0 | $0 | $0 | $0 |
| Other income | $0 | $0 | $0 | $0 | $0 |
| Lobbying Expenditures by Electing Public Charities (for 2007) | |
| Total exempt purpose expenditures | $0 |
| Total lobbying expenditures | $0 |
| Total lobbying expenditures to influence public opinion (grassroots lobbying) | $0 |
| Total lobbying expenditures to influence a legislative body (direct lobbying) | $0 |
| Other exempt purpose expenditures | $0 |
| Lobbying nontaxable amount | $0 |
| Grassroots nontaxable amount | $0 |
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| Organizations performing similar types of work | |||||
| Id | Name | Address | State | Established | Total Income |
|---|---|---|---|---|---|
| 1 | Good Samaritan Clinic | 615 N B St, Fort Smith, AR 72901-2125 | AR | 2002-10 | $537,771 |
| 2 | Texas Childrens Physician Group Inc, Texas Children's Physician Services Organization | Po Box 300630, Houston, TX 77230 | TX | 2010-03 | $328,182,777 |
| 3 | Mercy Clinic Oklahoma Communities | 645 Maryville Centre Dr Ste 100, Saint Louis, MO 63141-5846 | MO | 2014-06 | $132,945,875 |
| 4 | St Vincent Medical Group | 2 Saint Vincent Cir, Little Rock, AR 72205-5423 | AR | 2002-12 | $35,064,686 |
| 5 | River Valley Primary Care Services Incorporated | 9755 W Highway 22, Ratcliff, AR 72951 | AR | 2005-02 | $7,051,406 |
| 6 | Conway Interfaith Clinic Inc | 830 N Creek Dr, Conway, AR 72032-4711 | AR | 2003-07 | $751,990 |
| 7 | Tree Of Life Preventive Health Maintenance Inc | PO BOX 1672, Fort Smith, AR 72902-1672 | AR | 1996-03 | $314,784 |
| 8 | Christian Community Care Clnic Inc | 220 W South St, Benton, AR 72015-4250 | AR | 2001-01 | $194,400 |
| 9 | Christian Health Center Inc | 1115 Fairview Rd Sw, Camden, AR 71701-6416 | AR | 1999-01 | $153,380 |
| 10 | Madison County Medical Group Inc | PO BOX 860, Huntsville, AR 72740-0860 | AR | 2012-06 | $91,595 |
| 11 | Conway County Christian Clinic Inc | 1208 West Childress St, Morrilton, AR 72110 | AR | 2004-05 | $60,405 |
| 12 | Pine Street Free Clinic Inc | 1114 Ingram St, Conway, AR 72032-4428 | AR | 2003-01 | $17,657 |
| 13 | Clopton Clinic Charitable Foundation | PO BOX 17167, Jonesboro, AR 72403-6721 | AR | 2006-06 | $5,919 |
| 14 | Sparks Medical Foundation | PO BOX 10366, Fort Smith, AR 72917-0366 | AR | 2001-12 | $404 |
| 15 | African Women Health Project International, Awhpi Igc | P O Box 55793, Little Rock, AR 72215 | AR | 2004-10 | $0 |
| 16 | Bismarck Regional Community Health Center Inc | 101 Millennium Park Dr, Bismarck, AR 71929-7176 | AR | 2003-08 | $0 |
| 17 | Charitable Christian Medical Clini | 1202 South Main St, Hope, AR 71801 | AR | 1999-03 | $0 |
| 18 | Holistic Health Care Incorporated | PO BOX 366, Marshall, AR 72650-0366 | AR | 2000-03 | $0 |
| 19 | Modern Womens Clinic & Clinical Research Centre | 2901 Timber Creek Court, North Little Rock, AR 72116 | AR | 2006-03 | $0 |
| 20 | Rotary Centennial Dental Clinic | 1000 West Central, Harrison, AR 72601 | AR | 2004-01 | $0 |
| Number of organizations performing similar types of work | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Total | 1,490 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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