Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| 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.") .... | 845,728 | 350,000 | 240 | 1,195,968 | ||
| 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.. | 845,728 | 350,000 | 240 | 1,195,968 | ||
| 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. | 1,195,968 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 845,728 | 350,000 | 240 | 1,195,968 | ||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 103,795 | 126,044 | 88,466 | 35,152 | 353,457 | |
| 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). | 1,549,425 | |||||






| 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...... | ||||||
| 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. | ||||||
| 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.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 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.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| CHANGES IN PROGRAM SERVICES | FORM 990, PART III, LINE 3 | AT A BOARD MEEING ON JUNE 20, 2011 THE BOARD OF LOUISIANA RURAL HEALTH SERVICES CORPORATION APPROVED A RESOLUTION TO WIND DOWN THE AFFAIRS OF THE CORPORATION AND MERGE THE ACTIVITIES OF LOUISIANA RURAL HEALTH SERVICES CORPORATION INTO THE SOUTHEASTERN LOUISIANA AREA HEALTH EDUCATION CENTER FOUNDATION (72-1155014). ALL ASSETS OF LOUISIANA RURAL HEALTH SERVICES CORPORATION WERE TRANSFERRED TO SOUTHEASTERN LOUISIANA AREA HEALTH EDUCATION CENTER FOUNDATION AND THE BOARD MEMBERS OF LOUISIANA RURAL HEALTH SERVICES CORPORATION WERE RELIEVED OF THEIR DUTIES EFFECTIVE JUNE 30, 2011. |
| FORM 990, PART VI, SECTION A, LINE 2 | CHERYL TANNER AND MARY ANN CAGLE ARE RELATED THROUGH FAMILY RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZAITON CEASED ALL ACTIVITIES AT THE END OF THE YEAR. THE ENTITY TRANSFERRED ALL OF ITS ASSETS TO SOUTHEASTERN LOUISIANA AREA HEALTH EDUCATION CENTER FOUNDATION ON 06/30/11. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE ORGANIZATION'S FORM 990 WILL BE PRESENTED AT AN EXECUTIVE COMMITTEE MEETING. DURING THIS MEETING THE TAX RETURN WILL BE REVIEWED FOR ACCURACY AND COMPLETENESS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | TO ENSURE THAT THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES, THE ORGANIZATION PERFORMS PERIODIC REVIEWS OF THE CONFLICT OF INTEREST POLICY. EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: RECEIVED A COPY OF THE POLICY, READ AND UNDERSTANDS THE POLICY, AGREES TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION'S EXEMPT PURPOSE. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION RELIES ON COMPARABLE DATA TO DETERMINE THE AMOUNT OF COMPENSATION, AND DOCUMENTATION IS MAINTAINED REGARDING THE DETERMINATION OF THESE AMOUNTS. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR DETERMINING COMPENSATION ARE INDEPENDENT OF THOSE BEING COMPENSATED. | |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | TRANSFER TO SOUTHEASTERN LOUISIANA AREA HEALTH EDUCATION CENTER FOUNDATION -2,799,918. TOTAL TO FORM 990, PART XI, LINE 5: -2,799,918. |
| COMPENSATION OF OFFICERS: | FORM 990, PART XII: | THE W-2S OF THE OFFICERS ARE PREPARED AND ISSUED BY SOUTHEAST LOUISIANA AREA HEALTH EDUCATION CENTER(SEL-AHEC, FEIN 72-1155014). SEL-AHEC AND LRHSC ARE NOT RELATED, BUT FOR COST SAVING PURPOSES, SEL-AHEC PROCESSES AND PAYS THE SALARIES FOR LRHSC'S EMPLOYEES. LRHSC REIMBURSES SEL-AHEC FOR THE SALARIES PAID. |
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