2023-11-14T09:38:12-06:00 2022-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2022-01-01 208952945 FAIRFIELD MEDICAL CENTER FOUNDATION FAIR 7406878105 401 N EWING STREET LANCASTER OH 43130 TRACY KELLY EXECUTIVE DIRECTOR 7406878105 2023-11-14 1 TRACY KELLY 999009999 0 TYLER K GREENE CPA P01568275 3176334705 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TRACY KELLY 401 N EWING STREET LANCASTER OH 43130 1066548 0 X FMCHEALTH.ORG X 2007 OH THE FAIRFIELD MEDICAL CENTER FOUNDATION'S MISSION IS TO SOLICIT AND MANAGE CONTRIBUTIONS IN ORDER TO PROVIDE GRANT ASSISTANCE TO FAIRFIELD MEDICAL CENTER FOR NEEDED ITEMS OR PROGRAMS. 13 13 0 110 0 0 560310 633620 0 0 232117 239377 59074 83687 851501 956684 1246573 134366 0 0 360716 330921 0 0 195141 84005 146478 1691294 611765 -839793 344919 3576218 3310541 41483 37841 3534735 3272700 THE FAIRFIELD MEDICAL CENTER FOUNDATION'S MISSION IS TO SOLICIT AND MANAGE CONTRIBUTIONS IN ORDER TO PROVIDE GRANT ASSISTANCE TO FAIRFIELD MEDICAL CENTER TO ASSIST IN THEIR MISSION OF DELIVERING OUTSTANDING HEALTHCARE FOR THEIR PATIENTS AND FAMILIES, AND OUR COMMUNITIES. 0 0 53821 134366 FMC FOUNDATION AWARDS VARIOUS SCHOLARSHIPS BY WAY OF AN INDEPENDENT SCHOLARSHIP COMMITTEE TO THOSE WHO ARE PURSUING FURTHER EDUCATION IN THE MEDICAL FIELD. THE SCHOLARSHIPS ARE AWARDED BY AN INDEPENDENT COMMITTEE, BASED ON THE APPLICATIONS RECEIVED. 25621 THE FOUNDATION HELPS VARIOUS INDIVIDUALS WHO ARE AT OR BELOW THE 200% POVERTY LEVEL WITH ASSISTANCE TOWARD CANCER CARE, MAMMOGRAMS AND CARDIAC REHAB. IT ALSO PROVIDES THE SALARY FOR AN ADMINISTRATOR OF THE SCRIPT ASSIST PROGRAM WHICH HELPS THOSE WHO ARE AT OR BELOW THE 200% POVERTY LEVEL OBTAIN PRESCRIPTIONS FROM DRUG COMPANIES AT A REDUCED COST. THIS PROGRAM HAS HELPED MANY WHO OTHERWISE WOULD NOT HAVE BEEN ABLE TO PAY FOR THE PRESCRIPTIONS, OR FOR WHOM IT WOULD HAVE BEEN AN EXTREME HARDSHIP TO DO SO. 219055 FAIRFIELD MEDICAL CENTER FOUNDATION PROGRAM MISCELLANEOUS GRANTS FOR NEED NOT COVERED BY EQUIPMENT GRANTS, CANCER CARE, AND CARDIAC CARE, SUCH AS THE TRANQUILITY GARDEN FOR PATIENTS AND VISITORS OF FMC TO ENJOY, SPECIALTY SOAP FOR INFECTION CONTROL, AS WELL AS VARIOUS OTHER NEEDS. 298497 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 OH X TRACY KELLY EXECUTIVE DIRECTOR 7406878105 401 N EWING STREET LANCASTER OH 43130 JAMIE CULVER CHAIR 1.25 0.00 X X 0 0 0 BECKY BAKER DIRECTOR 0.40 0.00 X 0 0 0 DR SHASHI GOGATE DIRECTOR 0.40 0.00 X 0 0 0 JOSH GORDON DIRECTOR 0.40 0.00 X 0 0 0 DR JESSI HANNA DIRECTOR 0.40 0.00 X 0 0 0 MARIS MAHLER DIRECTOR 0.40 0.00 X 0 0 0 TEMPLE CUSTER MONTENEZ DIRECTOR 0.40 0.00 X 0 0 0 CHRISTA MOODY DIRECTOR 0.40 0.00 X 0 0 0 TRAVIS MARKWOOD DIRECTOR 0.40 0.00 X 0 0 0 SHARON SCRUGGS DIRECTOR 0.40 0.00 X 0 0 0 BRENDA SHAMBLIN DIRECTOR 0.40 0.00 X 0 0 0 CRAIG VANDERVOORT DIRECTOR 0.40 0.00 X 0 0 0 PENNY WASEM DIRECTOR 0.40 0.00 X 0 0 0 BRAD ROACH DIRECTOR PARTIAL TERM 0.40 0.00 X 0 0 0 TRACY KELLY EXECUTIVE DIRECTOR 40.00 0.00 X 75660 0 13725 75660 0 13725 0 0 0 0 0 47853 180519 405248 633620 105850 105850 133527 0 133527 133527 133527 17475 47853 25213 -7738 -7738 162860 84651 78209 78209 MISCELLANEOUS REVENUE 900099 13216 13216 13216 956684 13216 0 309848 134366 134366 89385 38436 22346 28603 195656 84132 48914 62610 29556 12709 7389 9458 16324 7019 4081 5224 5202 5202 528 528 31495 13543 7874 10078 2658 1143 665 850 4528 1947 1132 1449 PROGRAM EXPENSES 52776 52776 GIFT SHOP 16285 4071 12214 DONOR RELATIONS/TWIG RE 7571 1893 5678 DUES & SUB. 6057 6057 19378 13177 6201 611765 298497 118127 195141 173648 286555 997244 997244 122015 58393 67630 63622 2337696 1963120 3576218 3310541 41483 37841 41483 37841 X 3534735 3272700 3534735 3272700 3576218 3310541 344919 -606954 0 X 0 0 0 X 654898 638983 702134 560310 633620 3189945 654898 638983 702134 560310 633620 3189945 397824 2792121 73217 78837 51296 134464 105850 443664 225000 200000 2446 13216 440662 4074271 0.68530 0.74140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 122015 58393 63622 63622 GRAYSTONE MORGAN STANELY HELD INVESTMENTS 1963120 F 1963120 SNIDER HEART & LUNG 21681 14706 6975 3750 5204 GOLF TOURNAMENT 11368 868 10500 4800 8123 2692 1 32279 32279 152 492 65328 47853 17475 3902 4800 8123 8388 25213 -7738 1 CANCER CARE 171 3599 CARDIAC CARE REHABILITATION AND EDUCATION 146 19735 SCHOLARSHIPS 43 49010 HOSPITAL PROGRAMS FOR INDIVIDUAL ASSISTANCE 2194 50534 PART III LINE 1 CANCER CARE IS PAID ON BEHALF OF INDIGENT OR UNINSURED PATIENTS. ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY THE CONTRACTS AND COLLECTIONS OFFICE AND THE ONCOLOGY NURSE NAVIGATOR ON BEHALF OF THE FOUNDATION. ALL RECORDS ARE KEPT CONFIDENTIAL AND HIPAA REQUIREMENTS ARE FOLLOWED IN ALL CASES. PART III LINE 2 INDIVIDUALS APPLY FOR, AND RECEIVE ASSISTANCE FOR CARDIAC CARE AT 200% OR BELOW CURRENT POVERTY LEVEL. ALL APPLICANTS MUST BE REFERRED FOR CARDIAC CARE ASSISTANCE. ALL RECORDS ARE KEPT CONFIDENTIAL AND HIPAA REQUIREMENTS ARE FOLLOWED IN ALL CASES. PART III LINE 3 SCHOLARSHIPS ARE AWARDED TO INDIVIDUALS BY AN INDEPENDENT SCHOLARSHIP COMMITTEE. APPLICANTS MUST APPLY AND THESE SCHOLARSHIPS ARE AWARDED BASED ON PREDETERMINED CRITERIA. PART III LINE 4 THERE ARE SEVERAL PROGRAMS SUPPORTED BY THE FAIRFIELD MEDICAL CENTER FOUNDATION WHICH BENEFIT INDIVIDUALS SUCH AS A SCRIPTASSIST GAP PROGRAM THAT ASSISTS IN OBTAINING PRESCRIPTIONS THAT WOULD OTHERWISE BE UNAFFORDABLE. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 WAS MADE AVAILABLE TO BOARD MEMBERS FOR REVIEW, WITH THE OPPORTUNITY TO RESPOND WITH COMMENTS. FORM 990, PART VI, SECTION B, LINE 12C POLICIES ARE REVIEWED ANNUALLY WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 A MARKET ANALYSIS OF SALARIES IN THE AREA IS PERFORMED BY THE HUMAN RESOURCES DEPARTMENT OF FAIRFIELD MEDICAL CENTER FOR ALL EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST MADE TO MANAGEMENT. PART VII SECTION A LINE 10 SALARIES AND BENEFITS ARE PAID TO FAIRFIELD MEDICAL CENTER FOUNDATION EMPLOYEES AS AN INKIND CONTRIBUTION BY FAIRFIELD MEDICAL CENTER SO THERE ARE NO W2S OR PAYROLL TAXES FILED BY FAIRFIELD MEDICAL CENTER FOUNDATION. FAIRFIELD HEALTHCARE PROFESSIONALS INC 401 NORTH EWING LANCASTER OH 43130 311425884 PHYSICIAN PRACTICES OH 501(C)(3) LINE 11 FAIRFIELD MEDICAL CENTER 0 FAIRFIELD MEDICAL CENTER TWIG II 1724 E MAIN STREET LANCASTER OH 43130 237146033 SUPPORT FAIRFIELD MEDICAL CENTER OH 501(C)(3) LINE 12D, III-O N/A 0 FAIRFIELD MEDICAL CENTER 401 NORTH EWING LANCASTER OH 43130 310645626 HOSPITAL OH 501(C)(3) LINE 3 N/A 0 ZANE PROPERTIES CORPORATION 401 NORTH EWING STREET LANCASTER OH 43130 311202009 HOLDING COMPANY OH N/A C 0 OHIO PHYSICAL MEDICINE & REHAB INC 2405 N COLUMBUS ST SUITE 210 LANCASTER OH 43130 311639119 PHYSIATRISTS OH N/A S 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FAIRFIELD MEDICAL CENTER C 180519 COST