HAZEL STREET NURSING ASSOCIATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: HAZEL STREET NURSING ASSOCIATION (EIN 74-3094439)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-05-15
IRS object ID: 201401359349310000
Schema version: 2012v2.1
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
Form 990
Schedule A
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-05-15T19:51:06-05:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	463521651	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	HOWARD CPA PLLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	2200 ANDOVER CT UNIT 1302	AddressLine1
City	Little Rock	City
State	AR	State
ZIP Code	72227	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	743094439	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	HAZEL STREET NURSING ASSOCIATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	HAZE	NameControl

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	6811 SOUTH HAZEL STREET	AddressLine1
City	PINE BLUFF	City
State	AR	State
ZIP Code	71603	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	BRIAN MILLER	Name
Title	EXECUTIVE DIREC	Title
Phone	8705410342	Phone
Date Signed	2014-05-01	DateSigned
Authorize Third Party	false	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	JOHN B HOWARD	Name
PTIN	P01689539	PTIN
Phone	5015906676	Phone
Date Prepared	2014-05-15	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	JOE RATLIFF	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1200 W 41ST	AddressLine1
City	PINE BLUFF	City
State	AR	State
ZIP Code	71603	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	5055575	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.DAVISLIFECARE.ORG	WebSite
Type Of Organization Association	X	TypeOfOrganizationAssociation
Year Formation	2003	YearFormation
State Legal Domicile	AR	StateLegalDomicile
Activity Or Mission Description	OPERATION OF A NURSING FACILITY FOR THE BENEFIT OF RESIDENTS MOST OF WHICH ARE ELDERLY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	6	NbrIndependentVotingMembers
Total Nbr Employees	101	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	5053599	ProgramServiceRevenuePriorYear
Program Service Revenue CY	5053599	ProgramServiceRevenueCY
Investment Income Current Year	0	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1976	OtherRevenuePriorYear
Other Revenue Current Year	1976	OtherRevenueCurrentYear
Total Revenue Prior Year	5055575	TotalRevenuePriorYear
Total Revenue Current Year	5055575	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	2675153	SalariesEtcPriorYear
Salaries Etc Current Year	2836136	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2704876	OtherExpensePriorYear
Other Expenses Current Year	2414756	OtherExpensesCurrentYear
Total Expenses Prior Year	5380029	TotalExpensesPriorYear
Total Expenses Current Year	5250892	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-324454	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-195317	RevenuesLessExpensesCY
Total Assets BOY	393022	TotalAssetsBOY
Total Assets EOY	474034	TotalAssetsEOY
Total Liabilities BOY	2169917	TotalLiabilitiesBOY
Total Liabilities EOY	2446246	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	-1776895	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	-1972212	NetAssetsOrFundBalancesEOY
Mission Description	OPERATION OF A NURSING FACILITY FOR THE BENEFIT OF RESIDENTS MOST OF WHICH ARE ELDERLY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	4906050	Expense
Revenue	5055575	Revenue
Description	OPERATION OF A NURSING FACILITY FOR THE BENEFIT OF RESIDENTS MOST OF WHICH ARE ELDERLY.	Description
Total Program Service Expense	4906050	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	3	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	101	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	7	NbrVotingGoverningBodyMembers
Number Independent Voting Members	6	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Written Policy Or Procedure	false	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	AR	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	JOE RATLIFF	NamePerson
Telephone Number	8705410342	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1200 W 41ST	AddressLine1
City	PINE BLUFF	City
State	AR	State
ZIP Code	71603	ZIPCode

Field	Value	IRS element (for citing)
No Listed Persons Compensated	X	NoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
ARCHIE SANDERS
DIRECTOR	2.00	X	0	0	0
Chris Hart
DIRECTOR	2.00	X	0	0	0
JAMES A LINDSEY MD
DIRECTOR	2.00	X	0	0	0
JOANN KONGENSKE
VICE-CHAIR	4.00	X	0	0	0	X
JOE RATLIFF
Executive Director	40.00	X	0	0	0	X
KENNY BONDS
CHAIRMAN	4.00	X	0	0	0	X
Lloyd A Franklin
Director	2.00	X	0	0	0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	0	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	0	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Delta Rehab
707 E Eldridge	Wynne	AR	72396	Therapy Services	103055
Healthcare Services Group
3220 Tillman Dr Ste 300	Bensalem	PA	19020	Dietary Services	279934

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	2	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	REVENUE FROM SERVICES	Description
Business Code	623000	BusinessCode
Total Revenue Column	5053599	TotalRevenueColumn
Related Or Exempt Function Income	5053599	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	5053599	TotalProgramServiceRevenue

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	Other	Description
Business Code	623000	BusinessCode
Total Revenue Column	1976	TotalRevenueColumn
Related Or Exempt Function Income	1976	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	1976	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	5055575	TotalRevenueColumn
Related Or Exempt Function Income	5055575	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2511636	Total
Program Services	2316492	ProgramServices
Management And General	195144	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	2503	Total
Management And General	2503	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	321997	Total
Program Services	311297	ProgramServices
Management And General	10700	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	12000	Total
Management And General	12000	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	209	Total
Management And General	209	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	12255	Total
Management And General	12255	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	883210	Total
Program Services	882595	ProgramServices
Management And General	615	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	1592	Total
Program Services	1592	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	5375	Total
Management And General	5375	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	62883	Total
Management And General	62883	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	21101	Total
Management And General	21101	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
PURCHASED SERVICES	325095	315941	9154
LICENSE-FEES & Bank Charges	362231	359597	2634
SUPPLIES	536805	526536	10269
MANAGMENT FEE	192000	192000

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	5250892	Total
Program Services	4906050	ProgramServices
Management And General	344842	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	22715	BOY
EOY	168328	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	88727	BOY
EOY	75709	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	13000	BOY
EOY	13000	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	3081	BOY
EOY	14381	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	481010	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	287755	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	256138	BOY
EOY	193255	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	9361	BOY
EOY	9361	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	393022	BOY
EOY	474034	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	632776	BOY
EOY	1114094	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	142228	BOY
EOY	100801	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1394913	BOY
EOY	1231351	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2169917	BOY
EOY	2446246	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	-1776895	BOY
EOY	-1972212	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	-1776895	BOY
EOY	-1972212	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	393022	BOY
EOY	474034	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-195317	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1355	CurrentTaxYearMinus4Years
Total	1355	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5519594	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	5867995	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	5477512	CurrentTaxYearMinus2Years
Total	16865101	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5520949	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	5867995	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	5477512	CurrentTaxYearMinus2Years
Total	16866456	Total

Field	Value	IRS element (for citing)
Public Support Total509	16866456	PublicSupportTotal509

Other Income509 OtherIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	6548	CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years	3462	CurrentTaxYearMinus2Years
Total	10010	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5527497	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	5867995	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	5480974	CurrentTaxYearMinus2Years
Total	16876466	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99940	PublicSupportPercentage509
Prior Year Support Percentage	0.99610	PriorYearSupportPercentage
Investment Income Percentage	0.00000	InvestmentIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	271803	InvestmentCostOrOtherBasis
Depreciation	88996	Depreciation
Book Value	182807	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	209207	InvestmentCostOrOtherBasis
Depreciation	198759	Depreciation
Book Value	10448	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	193255	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	REFUNDABLE DEPOSITS	Description
Book Value	9361	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	9361	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DUE TO DAVIS NURSING	Description
Amount	$1,231,351	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	1231351	TotalOfAmounts

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
O01	Form 990 governing body review Part VI line 11	The Board of Directors reviewed a copy of Form 990 prior to filing.
O02	Conflict of interest policy compliance Part VI line 12c	The Board members acknowledge the conflict of interest policy and are to disclose any conflict of interest.
O03	CEO executive director top management comp Part VI line 15a	The Board of Directors determines and approves any compensation of top management personnel.
O04	Other officer or key employee compensation Part VI line 15b	The Board of Directors determines and approves the compensation of key employees.
O05	Form 990 availability to public Part VI line 18	Form 990 is not made available to the public.
O06	Governing documents etc available to public Part VI line 19	The Organization does not make the audited financial statements or Form 990 available to the public.