FURP.ORG / PUBLIC DATA EXPLORER

COMMUNITY HEALTH SERVICE AGENCY INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH SERVICE AGENCY INC (EIN 75-1528614)
Tax period
2011-02-01 to 2012-01-31
Filed
2012-12-14
IRS object ID
201213499349300521
Schema version
2011v1.2
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)
Timestamp2012-12-14T09:35:09-08:00Timestamp
Tax Period End Date2012-01-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ScottSingletonFincher & CoBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14815 King Street Suite AAddressLine1
CityGreenvilleCity
StateTXState
ZIP Code75401ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-02-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN751528614EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH SERVICE AGENCY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone9034555986Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 1908AddressLine1
CityGREENVILLECity
StateTXState
ZIP Code75403ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHELLE CARTERName
TitleCFOTitle
Date Signed2012-12-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHannah C NelsonName
Phone9034554765Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAN SHEPHERDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1368 CR 2060AddressLine1
CityKLONDIKECity
StateTXState
ZIP Code75448ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9946690GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.completemedicalhome.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1976YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTo provide community oriented primary health care, including, medical & dental care, education, and social services to the residents of Hunt, Fannin, Kaufman, Delta, and Collin counties, with a particular emphasis on those individuals and families that have difficulty accessing health care services because of financial, language, and/or cultural barriers.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees183TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year3655853ContributionsGrantsPriorYear
Contributions Grants Current Year4479416ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6251058ProgramServiceRevenuePriorYear
Program Service Revenue CY5461976ProgramServiceRevenueCY
Investment Income Prior Year8048InvestmentIncomePriorYear
Investment Income Current Year5298InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year9914959TotalRevenuePriorYear
Total Revenue Current Year9946690TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6285050SalariesEtcPriorYear
Salaries Etc Current Year5874135SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3987149OtherExpensePriorYear
Other Expenses Current Year3766383OtherExpensesCurrentYear
Total Expenses Prior Year10272199TotalExpensesPriorYear
Total Expenses Current Year9640518TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-357240RevenuesLessExpensesPriorYear
Revenues Less Expenses CY306172RevenuesLessExpensesCY
Total Assets BOY6125361TotalAssetsBOY
Total Assets EOY6051588TotalAssetsEOY
Total Liabilities BOY2724503TotalLiabilitiesBOY
Total Liabilities EOY2344558TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3400858NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3707030NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide community oriented primary health care, including, medical & dental care, education, and social services to the residents of Hunt, Fannin, Kaufman, Delta, and Collin counties, with a particular emphasis on those individuals and families that have difficulty accessing health care services because of financial, language, and/or cultural barriers.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense7736453Expense
Revenue2209400Revenue
DescriptionThe organization provided general health and family planning services to its service area. During the year the Agency provided over 65,000 patient encounters under the Section 330 grant, Medicaid and Medicare.Description
Total Program Service Expense7736453TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
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
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
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 With109636NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees183NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
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 CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
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
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDAN SHEPHERDNamePerson
Telephone Number9034555986TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14500 WESLEY STREETAddressLine1
CityGREENVILLECity
StateTXState
ZIP Code75403ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
NEDA JUMPER
Director2.00X000
LETICIA CASTILLO
Director2.00X000
SHANNON REIMER
Director2.00X000
BRENDA SUE GREGG
Director2.00X000
NONA JORDAN
Director2.00X000
MICHELLE CARTER
CFO40.008633907926X
DAN SHEPHERD
CEO40.0012400008978X
KEITH WINTERS
Treasurer2.00000X
JAMES BARR PHD
Secretary2.00000X
STAN MCKEE
Vice President2.00000X
PAUL PAINTER
President2.00000X
ROXANA CRUZ MD
MEDICAL DIRECTOR40.00136019010791X
ANN MARIE LEDLEY OB
PHYSICIAN40.0019151307468X
RIZWANA KHAN MD
PHYSICIAN40.0016111905544X
VENKATA VALLURY MD
PHYSICIAN40.0015519105544X
JACK LEWIS
DENTIST40.00113253012190X
FieldValueIRS element (for citing)
Total Reportable Comp From Org967434TotalReportableCompFromOrg
Total Other Compensation58441TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LABCORPBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1P O BOX 12140AddressLine1
CityGREENVILLECity
StateTXState
ZIP Code75401ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesLABORATORY SRVCSDescriptionOfServices
Compensation429300Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants3950021GovernmentGrants
All Other Contributions529395AllOtherContributions
Noncash Contributions293731NoncashContributions
Total Contributions4479416TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
TITLE XX FAMILY PLANNING403442403442
TITLE V FEES118472118472
PRIVATE PATIENT FEES22094002209400
MEDICARE/MEDICAID26584172658417
BREAST & CERVICAL CANCER7224572245
FieldValueIRS element (for citing)
Total Program Service Revenue5461976TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5298TotalRevenueColumn
Exclusion$5,298ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9946690TotalRevenueColumn
Related Or Exempt Function Income5461976RelatedOrExemptFunctionIncome
Exclusion$5,298ExclusionAmount

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)
Total370746Total
Program Services71752ProgramServices
Management And General298994ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4435980Total
Program Services3686115ProgramServices
Management And General749865ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total29901Total
Program Services23986ProgramServices
Management And General5915ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total649608Total
Program Services521104ProgramServices
Management And General128504ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total387900Total
Program Services311166ProgramServices
Management And General76734ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total35956Total
Management And General35956ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20650Total
Management And General20650ManagementAndGeneral

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)
Total842529Total
Program Services825344ProgramServices
Management And General17185ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total10895Total
Program Services10748ProgramServices
Management And General147ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total862221Total
Program Services738365ProgramServices
Management And General123856ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total235397Total
Program Services152236ProgramServices
Management And General83161ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total421760Total
Program Services308438ProgramServices
Management And General113322ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total66113Total
Program Services13233ProgramServices
Management And General52880ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total15661Total
Program Services7207ProgramServices
Management And General8454ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total354118Total
Program Services235094ProgramServices
Management And General119024ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total20350Total
Management And General20350ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
RECRUITMENT & TRAINING870936824318850
MEMBERSHIPS36655955827097
DONATED PHARMACY293731293731
CONTINUING MEDICAL EDUCATION1124110614627
BAD DEBT PROVISION438395438395

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13618Total
Program Services11124ProgramServices
Management And General2494ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9640518Total
Program Services7736453ProgramServices
Management And General1904065ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY114665BOY
EOY133402EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1684078BOY
EOY951715EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY869502BOY
EOY371968EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY27362BOY
EOY47924EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7079909LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2533330LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3429754BOY
EOY4546579EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6125361BOY
EOY6051588EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1045827BOY
EOY495892EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY337993BOY
EOY209314EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1340683BOY
EOY1568035EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY71317EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2724503BOY
EOY2344558EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3381454BOY
EOY3687626EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY19404BOY
EOY19404EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3400858BOY
EOY3707030EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6125361BOY
EOY6051588EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses306172ReconcilationRevenueExpenses
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 Years2850083CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2961541CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3372022CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3655853CurrentTaxYearMinus1Year
Current Tax Year4479416CurrentTaxYear
Total17318915Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2850083CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2961541CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3372022CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3655853CurrentTaxYearMinus1Year
Current Tax Year4479416CurrentTaxYear
Total17318915Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17017318915PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years74333CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years29222CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15311CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8048CurrentTaxYearMinus1Year
Current Tax Year5298CurrentTaxYear
Total132212Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4377CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years8463CurrentTaxYearMinus2Years
Total12840Total
FieldValueIRS element (for citing)
Total Support17463967TotalSupport
Public Support Pertcentage1700.99170PublicSupportPertcentage170
Public Support Pertcent Prior Year0.98440PublicSupportPertcentPriorYear
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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis237668OtherCostOrOtherBasis
Book Value237668BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4257790OtherCostOrOtherBasis
Depreciation832587Depreciation
Book Value3425203BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2104816OtherCostOrOtherBasis
Depreciation1465114Depreciation
Book Value639702BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis479635OtherCostOrOtherBasis
Depreciation235629Depreciation
Book Value244006BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4546579TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASES PAYABLEDescription
Amount$71,317Amount
FieldValueIRS element (for citing)
Total Of Amounts71317TotalOfAmounts
Total Revenue9946690TotalRevenue
Total Expenses9640518TotalExpenses
Excess Or Deficit For Year306172ExcessOrDeficitForYear
Excess Or Deficit Per FS306172ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9946690TotRevenueEtcAuditedFinclStmt
Revenue Subtotal9946690RevenueSubtotal
Total Revenue Per Form9909946690TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9640518TotExpensesEtcAuditedFinclStmt
Expenses Subtotal9640518ExpensesSubtotal
Total Expenses Per Form9909640518TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XIdentifier
Return ReferencePart X : FIN48 FootnoteReturnReference
ExplanationTHE AGENCY ADOPTED THE PROVISIONS OF FASB ASC TOPIC 740-10, INCOME TAXES (PREVIOUSLY KNOW AS FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES). MANAGEMENT BELIEVES IT HAS NO UNCERTAIN TAX POSITIONS, AND ACCORDINGLY THERE IS NO LIABILITY RECORDED FOR UNRECOGNIZED TAX BENEFITS AT JANUARY 31, 2012 AND 2011.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
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
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
VENKATA VALLURY MD
15172434675544160735
RIZWANA KHAN MD
15838327365544166663
ANN MARIE LEDLEY OB
1915136506198981962

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions2NumberOfContributions
Noncash Contribs Rptd F990293731NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MKT VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableTHE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesSALARY COMPARISONS FOR KEY EMPLOYEES ARE COMPARED TO LOCAL SERVICE AREA PAY RATES IN ORDER TO REMAIN COMPETITIVE. KEY EMPLOYEES' COMPENSATION IS DETERMINED BY THE CEO AND REVIEWED WITH THE BOARD OF DIRECTORS.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsTHIS POLICY IS PART OF A CODE OF CONDUCT THAT ALL EMPLOYEES AND THE BOARD OF DIRECTORS SIGN. IT IS ALSO PART OF THE BYLAWS OF THE AGENCY AND INCLUDED IN THE BOARD OF DIRECTORS ORIENTATION. THIS POLICY IS REVIEWED AT ANNUAL BOARD TRAININGS.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessTHE CEO AND CFO OF THE AGENCY WILL PARTICIPATE IN COMPLETING THE FORM 990 AS WELL AS REVIEWING THE 990 BEFORE SUBMISSION. THE AGENCY'S CFO WILL REVIEW THE FORM 990 WITH THE BOARD OF DIRECTORS BEFORE SUBMISSION.