2023-11-09T14:03:41-06:00 2022-12-31 FORVIS LLP 312 WALNUT STREET SUITE 3000 CINCINNATI OH 45202 990 2022-01-01 454682089 THE HEALTHSOURCE FOUNDATION % TOM DUCRO HEAL 5135767700 424 WARDS CORNER RD Suite 200 LOVELAND OH 45140 KIMBERLY PATTON CEO 5135767700 2023-11-15 true KIMBERLY PATTON 999009999 Aaron Hershberger P00961884 5136218300 2 2022 2023-04-26 12:10:37Z KIMBERLY PATTON 424 WARDS CORNER RD LOVELAND OH 45140 444437 false X WWW.HEALTHSOURCEOFOHIO.ORG/FOUNDATION X 2012 OH THE HEALTHSOURCE FOUNDATION IS COMMITTED TO PROVIDING OPPORTUNITIES AND ENCOURAGING EXPRESSIONS OF SUPPORT TO IMPACT THE MISSION OF HEALTHSOURCE OF OHIO. 6 6 0 40 0 566946 378969 0 0 18659 19937 -3967 13746 581638 412652 0 200000 0 0 0 0 0 0 0 157331 271655 157331 471655 424307 -59003 1754050 1635937 6900 219825 1747150 1416112 X DESCRIPTION OF ORGANIZATION MISSION THE FOUNDATION'S MISSION IS TO SUPPORT THE ACTIVITIES OF HEALTHSOURCE OF OHIO, A HEALTHCARE PROVIDER ORGANIZATION AS DESCRIBED IN SECTIONS 501(C)(3) AND 509(A)(1) OF THE INTERNAL REVENUE CODE. THE FOUNDATION ACTIVITIES WILL CONSIST OF RAISING FUNDS FOR MAKING GRANTS TO THE SUPPORTED ORGANIZATION. false false 471655 200000 THE HEALTHSOURCE FOUNDATION SHALL BE THE SOLE PHILANTHROPIC FUNDRAISING ARM OF HEALTHSOURCE OF OHIO AND ENDOW THE MISSION OF HEALTHSOURCE OF OHIO, TO - PROMOTE COMMUNITY AWARENESS AND ENGAGEMENT IN THE SUPPORT OF QUALITY PRIMARY HEALTH CARE FOR ALL PERSONS IN THE REGIONS THAT HEALTHSOURCE OF OHIO SERVES; AND - TO EDUCATE THE COMMUNITY ON HEALTHCARE ISSUES AND CONCERNS THAT LIMIT ACCESS TO PRIMARY CARE SERVICES THAT THE COMMUNITY HAS THE OPPORTUNITY TO IMPACT. 471655 true true false false false false false false false false false false false false false true false true false false false false false false true false false true false true false false false false false false false false false false false false true true true true false false true 0 0 0 false false false false false false false false false false false false X 6 6 false false false false true true true true true false false true true true true true true true true false X TOM DUCRO 5135767700 424 WARDS CORNER RD SUITE 200 LOVELAND OH 45140 KIMBERLY PATTON HSO CEO 1.0 40.0 X 0 351207 38816 KONSTANTINOS ELEFTER MEMBER 1.0 3.0 X 0 0 0 STEVE HOOD PAST CHAIRPERSON 1.0 0.0 X X 0 0 0 GAIL KOFORD CHAIRPERSON 1.0 0.0 X X 0 0 0 SANDY MONGOLD MEMBER 1.0 0.0 X 0 0 0 RANDY RILEY VICE CHAIRPERSON 1.0 0.0 X X 0 0 0 KEN SMITH MEMBER 1.0 0.0 X 0 0 0 0 351207 38816 0 false true false 0 101615 120000 157354 378969 0 19937 19937 0 0 0 0 0 0 45531 101165 31785 13746 13746 0 0 0 0 0 0 0 412652 33683 200000 200000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7140 7140 0 26527 26527 0 0 0 1311 1311 0 250 250 0 0 0 1105 1105 MISCELLANEOUS 25232 25232 COMP & BENEFIT REIMBURSEMENT 207940 207940 ALLOCATED EXP - DEPRECIATION 2150 2150 471655 471655 0 0 333623 427783 1410252 1158154 0 50000 10175 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1754050 1635937 6900 219825 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6900 219825 X 1747150 1416112 0 0 1747150 1416112 1754050 1635937 -59003 -272035 X false true X true false X X 1 HEALTHSOURCE OF OHIO INC 310884250 7 true 0 200000 1 0 200000 true false false false false false false false false false false false false false false false false SCHEDULE A, PART IV, SECTION B, LINE 1 SUPPORTING ORGANIZATIONS THE MANAGEMENT OF HEALTHSOURCE OF OHIO MANAGES HEALTHSOURCE FOUNDATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 X SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE HEALTHSOURCE AND THE FOUNDATION HAVE BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE (IRC) AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, BOTH ENTITIES ARE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. CENTERPRISE IS A SINGLE MEMBER LIMITED LIABILITY CORPORATION AND IS DISREGARDED FOR INCOME TAX PURPOSES. ALL THREE ENTITIES FILE RETURNS IN THE U.S. FEDERAL JURISDICTION. MORE THAN MED 132110 101615 30495 0 0 10590 10062 0 6929 5K WALK/RUN 15036 0 15036 0 0 0 0 0 4204 0 0 0 0 0 0 0 0 0 0 147146 101615 45531 0 0 10590 10062 0 11133 31785 13746 true HEALTHSOURCE OF OHIO INC 424 WARDS CORNER RD LOVELAND OH 45150 310884250 501(C)(3) 200000 PROGRAM SUPPORT 1 0 PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE BOARD OF HEALTHSOURCE FOUNDATION MAKES A DETERMINATION AS TO THE FUNDING TO BE PROVIDED TO THE RECIPIENT AND THE USE OF THOSE FUNDS. IN ADDITION, THE RECIPIENT REPORTS TO HEALTHSOURCE FOUNDATION AS TO THE USE OF FUNDS PROVIDED. X X X X false false false false false false false false false KIMBERLY PATTON HSO CEO 0 299783 0 47860 0 3564 0 15250 0 23566 0 390023 FORM 990, PART VI, SECTION A, LINE 6 GOVERNING BODY AND MANAGEMENT THE SOLE MEMBER OF THE HEALTHSOURCE FOUNDATION IS HEALTHSOURCE OF OHIO, INC. FORM 990, PART VI, SECTION A, LINE 7A GOVERNING BODY AND MANAGEMENT A MEMBER OF THE HEALTHSOURCE OF OHIO BOARD OF TRUSTEES SERVES AS A DUAL MEMBER TO THE HEALTHSOURCE FOUNDATION BOARD. SHE OR HE WILL BE APPOINTED BY THE HEALTHSOURCE OF OHIO BOARD. FORM 990, PART VI, SECTION A, LINE 7B GOVERNING BODY AND MANAGEMENT THE HEALTHSOURCE OF OHIO BOARD HAS FIDUCIARY AND DECISION-MAKING RESPONSIBILITIES FOR THE HEALTHSOURCE FOUNDATION BOARD. FORM 990, PART VI, SECTION B, LINE 11B PROCESS OF THE REVIEW OF FORM 990 THE HEALTHSOURCE FOUNDATION FORM 990 WAS PREPARED BY FORVIS, LLP, HEALTHSOURCE FOUNDATION'S AUDIT FIRM AND THEN REVIEWED IN DETAIL BY MANAGEMENT AND THE BOARD PRIOR TO THE RETURN BEING FILED WITH THE INTERNAL REVENUE SERVICE. THE REVIEW AND APPROVAL IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY THE BOARD SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY. ALL NEW MEMBERS ARE REQUIRED TO SIGN THE STATEMENT WHEN THEY ARE APPOINTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 REVIEW OF COMPENSATION BY RELATED ORGANIZATION HEALTHSOURCE FOUNDATION HAS NO PAID STAFF. THE BOARD OF HEALTHSOURCE OF OHIO, A RELATED TAX-EXEMPT ORGANIZATION, UTILIZES COMPARABLE DATA ALONG WITH SALARY COMPENSATION SURVEY GUIDELINES TO DETERMINE THE COMPENSATION PAID TO THE PRESIDENT/CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST, AND FINANCIAL STATEMENTS HEALTHSOURCE FOUNDATION MAKES ITS MOST RECENTLY AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. CENTERPRISE INC 424 WARDS CORNER ROAD LOVELAND OH 45140 461104165 CONSULTING OH HSO HEALTHSOURCE OF OHIO INC 424 WARDS CORNER ROAD LOVELAND OH 45140 310884250 HEALTH CARE OH 501(C)(3) 7 NA true false true true false false false false false false false false false false false false true false false false HEALTHSOURCE OF OHIO INC B 200000 BOOK VALUE CENTERPRISE INC C 120000 BOOK VALUE HEALTHSOURCE OF OHIO INC P 303440 BOOK VALUE