2023-11-15T13:55:19-06:00 2022-12-31 310962125 WHITED SEIGNEUR SAMS & RAHE CPAS LLP 213 SOUTH PAINT STREET CHILLICOTHE OH 456013828 990 2022-01-01 271092132 FAIRFIELD COMMUNITY HEALTH CENTER FAIR 7402776043 220 E WALNUT STREET LANCASTER OH 43130 DANIEL FISHER CHIEF FINANCIAL OFFICER 7402776043 2023-10-16 1 DANIEL FISHER 999009999 0 JAY SEIGNEUR P01455483 7407022600 2023-10-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X DANIEL FISHER 220 E WALNUT STREET LANCASTER OH 43130 8423336 0 X FAIRFIELDCHC.ORG X 2009 OH TO PROVIDE QUALITY HEALTHCARE TO ALL INDIVIDUALS REGARDLESS OF AVAILABLE INCOME OR WHETHER THEY CARRY INSURANCE. 12 12 94 0 0 0 3086588 2595409 5961509 5679664 -13288 222 94069 148041 9128878 8423336 0 0 0 0 5700233 5396691 0 0 0 2736574 2589498 8436807 7986189 692071 437147 4015452 7553150 914799 4148912 3100653 3404238 X FAIRFIELD COMMUNITY HEALTH CENTER (FCHC) IS A FEDERALLY QUALIFIED HEALTH CENTER, COMMUNITY-BASED AND PATIENT-DIRECTED ORGANIZATION. FCHC PROVIDES COMPREHENSIVE PRIMARY HEALTH CARE SERVICES FOR UNINSURED OR UNDER INSURED RESIDENTS OF FAIRFIELD COUNTY. MEDICAL SERVICES, INCLUDING, BEHAVIORAL ARE PROVIDED WITHOUT DISCRIMINATION TO AGE, RACE, ETHNICITY, OR ABLILITY TO PAY. 0 0 4547137 5807090 PROVIDE QUALITY HEALTH CARE. 4547137 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 94 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OH X THE ORGANIZATION 7402776043 220 E WALNUT STREET LANCASTER OH 43130 X PAUL MARTIN VICE PRESIDENT 1.00 X X 0 0 0 DAVID SPICER TREASURER 1.00 X X 0 0 0 SAMANTHA SHAFER SECRETARY 1.00 X X 0 0 0 SANDY SMITH PRESIDENT 1.00 X X 0 0 0 LORELLE DRIGGS DIRECTOR 1.00 X 0 0 0 SHERRILL HUNT DIRECTOR 1.00 X 0 0 0 ROBERTA CHILCOTE DIRECTOR 1.00 X 0 0 0 KENNETH GRIMMETT DIRECTOR 1.00 X 0 0 0 JEFF NELSON DIRECTOR 1.00 X 0 0 0 REBECCA OSBORNE DIRECTOR 1.00 X 0 0 0 SANDRA CASEY DIRECTOR 1.00 X 0 0 0 DEBBY ROCKWOOD DIRECTOR 1.00 X 0 0 0 PENNY PETERS DIRECTOR 1.00 X 0 0 0 DR TROY HAMPTON DO CHIEF MEDICAL OFFICER 40.00 X 233530 0 0 MARK IRVING PA-C PHYSICIAN ASSISTANT 40.00 X 140348 0 0 DR MIKAEL SCHILB PHYSICIAN 40.00 X 224672 0 0 TYLER ZWAHLEN EMPLOYEE 40.00 X 106556 0 0 DR MELANIE STEVENS DO EMPLOYEE 40.00 X 190161 0 0 AARON MURFIN NP EMPLOYEE 40.00 X 129920 0 0 1025187 0 0 8 0 1 0 0 2445840 149569 2595409 FEES FOR SERVICES 621400 3323269 3323269 340B REVENUE 621400 1987440 1987440 CPC REVENUE 621400 212735 212735 RESIDENCY PROGRAM 621400 133287 133287 OHIO WORKFORCE FUNDS 621400 16156 16156 6777 6777 5679664 222 222 20615 0 20615 20615 MISCELLANEOUS 621400 93784 93784 INCENTIVE REVENUE 621400 27725 27725 MEDICAL RECORDS 621400 4003 4003 1914 1914 127426 8423336 5807090 0 20837 580939 580939 3863906 2649415 1214491 100076 56625 43451 508729 332404 176325 343041 200889 142152 16688 16688 190680 55464 135216 66890 66890 27441 27441 466925 466925 273371 222448 50923 17837 6614 11223 107505 107505 157993 98597 59396 28220 21713 6507 SUPPLIES 818245 757205 61040 BAD DEBT 117685 117685 COMMUNICATIONS 113644 113644 MISC 74913 74913 111461 28078 83383 7986189 4547137 3439052 0 562491 497096 654062 935193 262874 204276 1886956 1173632 604526 713324 1931499 5203261 4015452 7553150 388651 527440 1914 155000 524234 3466472 914799 4148912 X 3058045 3230060 42608 174178 3100653 3404238 4015452 7553150 X 437147 -133562 X X 0 0 0 X 1948522 2060247 2878401 3086588 2595409 12569167 1948522 2060247 2878401 3086588 2595409 12569167 12569167 256 222 478 94069 127426 221495 12791140 22518368 0.98260 0.99210 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2500 2500 547860 5048 542812 30630 5104 25526 136310 132517 3793 1169656 1030963 138693 713324 CONSTRUCTION IN PROCESS 5203261 5203261 8423336 0 8423336 0 8423336 7986189 0 7986189 0 7986189 GOLF OUTING 20615 20615 20615 20615 20615 X 0 0 0 0 0 0 0 0 0 DR TROY HAMPTON DO CHIEF MEDICAL OFFICER 233530 0 0 0 0 0 0 0 0 0 233530 0 0 0 DR MIKAEL SCHILB PHYSICIAN 224672 0 0 0 0 0 0 0 0 0 224672 0 0 0 DR MELANIE STEVENS DO EMPLOYEE 190161 0 0 0 0 0 0 0 0 0 190161 0 0 0 PART I, LINE 3 SALARIES FOR ALL POSITIONS EXCEPT THE CEO ARE ESTABLISHED BY THE CEO BASED ON COMPARABLE POSITIONS IN LOCAL/PRIVATE NON-PROFIT CORPORATIONS. THE BOARD ESTABLISHES THE CEO SALARY BASED ON COMPARABLE POSITIONS IN LOCAL, PUBLIC AND/OR PRIVATE NON-PROFIT CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES OF THE ORGANIZATION ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A SALARIES FOR ALL POSITIONS EXCEPT THE CEO ARE ESTABLISHED BY THE CEO BASED ON COMPARABLE POSITIONS IN LOCAL/PRIVATE NON-PROFIT CORPORATIONS. THE BOARD ESTABLISHES THE CEO SALARY BASED ON COMPARABLE POSITIONS IN LOCAL, PUBLIC AND/OR PRIVATE NON-PROFIT CORPORATIONS. FORM 990, PART VI, SECTION C, LINE 18 ALL GOVERNING DOCUMENTS AND FINANCIAL INFORMATION AVAILABLE UPON REQUEST FROM THE BUSINESS OFFICE. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS AND FINANCIAL INFORMATION AVAILABLE UPON REQUEST FROM THE BUSINESS OFFICE. FORM 990, PART XI, LINE 9: NET ASSETS WERE RESTATED TO COMPLY FASB ASC 842 -133,562. FORM 990, PART XII, LINE 2C: AUDIT IS REVIEWED BY MANAGEMENT AND PRESENTED TO BOARD FOR ACCEPTANCE.