Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ARKANSAS HEALTH GROUP
Employer identification number
71-0781138
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% 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. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
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......
77,663,828
85,130,315
87,689,823
84,658,010
82,895,232
418,037,208
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
77,663,828
85,130,315
87,689,823
84,658,010
82,895,232
418,037,208
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
418,037,208
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
77,663,828
85,130,315
87,689,823
84,658,010
82,895,232
418,037,208
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
139,776
135,291
155,805
151,317
173,987
756,176
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
139,776
135,291
155,805
151,317
173,987
756,176
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
333,781
404,092
553,945
324,925
427,911
2,044,654
13
Total support (Add lines 9, 10c, 11 and 12.).
78,137,385
85,669,698
88,399,573
85,134,252
83,497,130
420,838,038
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
99.335 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.361 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.180 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.182 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ARKANSAS HEALTH GROUP
Employer identification number
71-0781138
Identifier
Return Reference
Explanation
CONFLICT OF INTEREST ENFORCEMENT AND MONITORING
FORM 990, PAGE 6, PART VI, LINE 12(C)
BAPTIST HEALTH SENIOR LEADERSHIP REVIEWS ALL ANNUAL SUBMISSIONS FOR DIRECTOR LEVEL (AND ABOVE) AND WILL RESEARCH, INVESTIGATE, AND CONCLUDE ON ANY RESPONSE WHICH MIGHT REFLECT VARIANCE FROM THE ESTABLISHED POLICY.
COMPENSATION PROCESS AND REVIEW FOR OFFICERS AND KEY EMPLOYEES
FORM 990, PAGE 6, PART VI, LINE 15(a) & LINE 15(b)
COMPENSATION FOR THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, AND TOP MANAGEMENT OFFICIALS WERE REVIEWED AND APPROVED BY BAPTIST HEALTH'S PRESIDENT AND VICE PRESIDENT. ANY CHANGES IN THOSE ROLES OR ADDITIONAL LEADERSHIP POSITIONS ARE SUBJECT TO THE SAME LEVEL OF REVIEW AND APPROVAL. COMPENSATION FOR THE CHIEF FINANCIAL OFFICER OF THE ORGANIZATION WAS SUBMITTED FOR APPROVAL BY THE VICE PRESIDENT TO THE PRESIDENT AND SENIOR VICE PRESIDENT IN 2009.
GOVERNING DOCUMENTS AVAILABILITY
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION DOES NOT CURRENTLY MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
DESCRIPTION OF MEMBERS
FORM 990, PAGE 6, PART VI, LINE 6
ARKANSAS HEALTH GROUP IS A NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION WHOSE SOLE MEMBER IS BAPTIST HEALTH, WHICH IS AN ARKANSAS NONPROFIT HOSPITAL. BAPTIST HEALTH APPOINTS ALL BOARD MEMBERS. PER THE BYLAWS, MEMBERSHIP POWERS ARE: THE MEMBER HAS THE POWERS AND VOTING RIGHTS TO ELECT THE DIRECTORS OF THE CORPORATION, REQUIRE THE CORPORATION TO IMPLEMENT THE CORPORATION STRATEGIC PLAN AND TO COMPLY WITH ANY SYSTEM-WIDE STRATEGIC PLAN APPROVED BY THE MEMBER, APPROVE THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION, WHICH BUDGETS SHALL BE DEVELOPED BY THE CORPORATION IN CONSULTATION WITH THE MEMBER, REQUIRE THE CORPORATION TO MAINTAIN ADEQUATE LEVELS OF INSURANCE OR SELF-INSURANCE PROGRAMS, AS WELL AS OTHER FORMS OF RISK FINANCING. THE MEMBER'S POWER SHALL INCLUDE THE AUTHORITY TO SPECIFY MAXIMUM SELF-INSURED RETENTION LEVELS AND MINIMUM EXCESS INSURANCE LEVELS, APPROVE ANY AMENDMENT TO EITHER THE ARTICLES OF INCORPORATION OF THE CORPORATION OR BYLAWS, APPROVE A PLAN OF DISSOLUTION OF THE CORPORATION, APPROVE A PLAN OR MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER CORPORATION, APPROVE THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION. THE RIGHT TO VOTE WITH RESPECT TO EVERY CORPORATE ACTION SHALL BE RESERVED FOR THE DIRECTORS OF THE CORPORATION, SUBJECT TO THE POWERS AND RIGHTS OF THE MEMBER AS PROVIDED UNDER THE BYLAWS.
PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11
FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. THE CHIEF FINANCIAL OFFICER OF ARKANSAS HEALTH GROUP AND A DIRECTOR OF BAPTIST HEALTH PROVIDED FURTHER REVIEW BEFORE FILING.
AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONS
FORM 990, PAGE 7, PART VII, SECTION A
LARRY LAZENBY - 40 HOURS WILL RUSHER - 20 HOURS TROY WELLS - 20 HOURS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.