2024-11-15T11:56:48+00:00 2023-12-31 440160260 Forvis Mazars LLP 312 Walnut Street Suite 3000 Cincinnati OH 45202 990 2023-01-01 341753919 THIRD STREET COMMUNITY CLINIC THIR 4195226191 1404 Park Ave West Suite 2 MANSFIELD OH 44906 Peggy Anderson CHIEF EXECUTIVE OFFICER 4195226191 2024-11-15 true true Aaron Hershberger P00961884 5136218300 2024-11-15 2023 2024-10-15 13:58:12Z X THIRD STREET FAMILY HEALTH SERVICES PEGGY ANDERSON 1404 Park Ave West Suite 2 MANSFIELD OH 44906 26960668 false X WWW.TSFHS.ORG X 1993 OH THIRD STREET COMMUNITY CLINIC (DBA THIRD STREET FAMILY HEALTH SERVICES) IS A COMMUNITY HEALTH CENTER WITH A MISSION TO DELIVER COMPREHENSIVE HEALTH AND WELLNESS CARE, ACCESSIBLE TO ALL IN THE COMMUNITIES WE SERVE IN ASHLAND, CRAWFORD, AND RICHLAND COUNTIES. 17 17 296 17 0 0 7365339 7334079 13298390 15326819 116749 -257608 -7511 34826 20772967 22438116 0 0 0 0 15155334 17601381 0 0 0 5888847 7364651 21044181 24966032 -271214 -2527916 11887406 18374674 2674301 6531413 9213105 11843261 X THIRD STREET COMMUNITY CLINIC (DBA THIRD STREET FAMILY HEALTH SERVICES) IS A COMMUNITY HEALTH CENTER WITH A MISSION TO DELIVER COMPREHENSIVE HEALTH AND WELLNESS CARE, ACCESSIBLE TO ALL IN THE COMMUNITIES WE SERVE IN ASHLAND, CRAWFORD, AND RICHLAND COUNTIES. true false 19356268 0 15326819 THIRD STREET FAMILY HEALTH SERVICES PROVIDED MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO A TOTAL OF 20,310 PATIENTS DURING ITS FISCAL YEAR ENDED DECEMBER 31, 2023. THESE PATIENTS MADE A TOTAL OF 17,214 VISITS TO THE CLINIC'S DENTAL FACILITY DURING 2023; 44,511 VISITS TO THE CLINIC'S MEDICAL FACILITY DURING 2023 (FOR MEDICAL AND BEHAVIORAL HEALTH SERVICES) AND 11,489 VISITS TO ITS OBSTETRIC AND GYNECOLOGY FACILITY DURING 2023. THIS INCLUDES VIRTUAL VISITS. DURING 2023, THE FILING ORGANIZATION WAS AWARDED THE AMBULATORY HEALTH CARE ACCREDITATION AND THE BEHAVORIAL HEALTH CARE ACCREDITATION, BOTH FROM THE JOINT COMMISSION, AND CONTINUE TO BE CERTIFIED. THE ORGANIZATION HAS 11 SITES. 19356268 true true false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 80 0 true 296 true false false false false false false false false false false false false X 17 17 false false false false false false false true true false false true true true true true true true true false X BARBARA SULLINGER 4195226191 1404 Park Ave West Suite 2 MANSFIELD OH 44906 ALEX GOFF TREASURER- TERM ENDED 1.0 0.0 X X 0 0 0 AMBER WERTMAN VICE PRESIDENT / VICE CHAIR 1.0 0.0 X X 0 0 0 BARRETT THOMAS TREASURER 1.0 0.0 X X 0 0 0 DOROTHY STRATTON Secretary / Chair of Quality 1.0 0.0 X X 0 0 0 JAMES DOLAN PRESIDENT / CHAIR 1.0 0.0 X X 0 0 0 ALLEN HOCKER BOARD MEMBER 1.0 0.0 X 0 0 0 BRIGITTE COLES BOARD MEMBER 1.0 0.0 X 0 0 0 CINDY WETTERAU BOARD MEMBER 1.0 0.0 X 0 0 0 CODY ALBERT BOARD MEMBER 1.0 0.0 X 0 0 0 DOUGLAS NEWSOME BOARD MEMBER 1.0 0.0 X 0 0 0 DR JULIE CHAYA BOARD MEMBER 1.0 0.0 X 0 0 0 DR KHUSHWANT PITTENGER BOARD MEMBER 1.0 0.0 X 0 0 0 JALEN REESE BOARD MEMBEER 1.0 0.0 X 0 0 0 JOE DEVANY BOARD MEMBER 1.0 0.0 X 0 0 0 JOE STAFFORD BOARD MEMBER 1.0 0.0 X 0 0 0 KATHY WELLS BOARD MEMBER 1.0 0.0 X 0 0 0 MATT DAHM BOARD MEMBER 1.0 0.0 X 0 0 0 SUSAN BAKER BOARD MEMBER - TERM ENDED 1.0 0.0 X 0 0 0 TOM WALKER BOARD MEMBER 1.0 0.0 X 0 0 0 VERONICA GROFF BOARD MEMBER- TERM ENDED 1.0 0.0 X 0 0 0 BARBARA SULLINGER CHIEF FINANCIAL OFFICER 40.0 0.0 X 131864 0 22937 DR BRETT TOWARD CHIEF MEDICAL OFFICER 40.0 0.0 X 123763 0 19478 DR DAVID HOAG CHIEF DENTAL OFFICER 39.0 0.0 X 174546 0 30319 DR SHENG LIU CHIEF CLINICAL OFFICER 32.0 0.0 X 266382 0 14633 JAVAR JACKSON CHIEF OPERATING OFFICER 40.0 0.0 X 193105 0 29268 PEGGY ANDERSON CHIEF EXECUTIVE OFFICER 40.0 0.0 X 211791 0 5961 CARLOS MOLINA ARRIOLA PSYCHATRIST 40.0 0.0 X 322961 0 33235 CAROLYN CHAMBERS ASST CHIEF MED OFFICER / OBGYN 40.0 0.0 X 295770 0 26931 CHEL LEES PHYSICIAN 40.0 0.0 X 181347 0 13780 JESSICA ROSE BRENT PODIATRIST 40.0 0.0 X 161799 0 28090 KEITH DAVIS PHYSICIAN 40.0 0.0 X 167049 0 26502 MELISSA PASKEY (VERCHIO) PHYSICIAN 40.0 0.0 X 311025 0 31073 2541402 0 282207 28 false true false 0 6156566 1177513 7334079 MEDICAID & MEDICARE REVENUE 621400 2577638 2577638 PATIENT SERVICES REVENUE 621400 8007620 8007620 PHARMACY REVENUE 456110 3955629 3955629 CPC INCOME 621400 28645 28645 INSURANCE INCENTIVE PAYMENTS 621400 677463 677463 79824 79824 0 0 15326819 13812 13812 9243 8211 1032 0 1032 1032 4242921 4514341 -271420 0 -271420 -271420 MISCELLANEOUS REVENUE 900099 33794 0 0 33794 0 0 0 0 33794 22438116 15326819 0 -222782 0 0 0 0 0 0 0 0 1580243 1226252 353991 0 0 0 0 0 12723445 9873258 2850187 0 479685 372230 107455 0 1722901 1336953 385948 0 1095107 849791 245316 0 0 0 0 0 3452 0 3452 0 18045 0 18045 0 0 0 0 0 0 0 1407 0 1407 0 1294442 801596 492846 0 157615 97605 60010 0 1209350 748902 460448 0 364879 225955 138924 0 0 0 0 0 628865 389431 239434 0 91729 56804 34925 0 0 0 0 0 0 0 0 0 3371 0 3371 0 0 0 0 459431 444003 15428 0 117640 72850 44790 0 PHARMACY EXPENSE 2428372 2428372 0 0 DENTAL & MEDICAL EQUIP EXP 391651 242534 149117 0 BAD DEBT EXPENSE 182138 182138 0 0 PATIENT BILLING EXPENSE 12264 7594 4670 0 0 0 0 0 24966032 19356268 5609764 0 996292 1158751 1254487 147853 282595 2864470 940891 2779943 0 0 0 0 0 0 48937 184858 93669 103141 15219240 6932198 5020880 8287042 2220812 701463 0 0 0 0 1028843 2147153 11887406 18374674 1887104 3439627 0 0 0 0 0 0 0 0 0 0 43956 911165 743241 2180621 2674301 6531413 X 9213105 9188532 0 2654729 0 0 0 0 0 0 9213105 11843261 11887406 18374674 X -2527916 437595 4720477 X false true X true true true X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0 0.0 X 0 0 0 0 0 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 153680 153680 0 10039334 3584565 6454769 0 0 0 0 0 3429147 2562890 866257 0 1597079 784743 812336 8287042 Right of Use Asset 2147153 2147153 Lease Liability 2180621 2180621 22744127 437595 -139795 297800 22446327 -8211 -8211 22438116 24834448 51961 51961 24782487 183545 183545 24966032 Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 INVESTMENT MANAGEMENT FEES - -1407 BAD DEBT - -182138 NET ASSETS RELEASED FROM RESTRICTION - 43750 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements RENTAL EXPENSES - -8211 Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 RENTAL EXPENSES - 8211 NET ASSETS RELEASED FROM RESTRICTION - 43750 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements INVESTMENT MANAGEMENT FEES - 1407 BAD DEBT - 182138 X X false true false true false true false false false DR SHENG LIU CHIEF CLINICAL OFFICER 266382 0 0 0 0 0 6586 0 8047 0 281015 0 0 0 PEGGY ANDERSON CHIEF EXECUTIVE OFFICER 183793 0 27998 0 0 0 5961 0 0 0 217752 0 0 0 JAVAR JACKSON CHIEF OPERATING OFFICER 166583 0 26522 0 0 0 5370 0 23898 0 222373 0 0 0 DR DAVID HOAG CHIEF DENTAL OFFICER 174546 0 0 0 0 0 6421 0 23898 0 204865 0 0 0 BARBARA SULLINGER CHIEF FINANCIAL OFFICER 131864 0 0 0 0 0 4309 0 18628 0 154801 0 0 0 CARLOS MOLINA ARRIOLA PSYCHATRIST 322961 0 0 0 0 0 9337 0 23898 0 356196 0 0 0 MELISSA PASKEY (VERCHIO) PHYSICIAN 281234 0 29791 0 0 0 8220 0 22853 0 342098 0 0 0 KEITH DAVIS PHYSICIAN 167049 0 0 0 0 0 5482 0 21020 0 193551 0 0 0 CHEL LEES PHYSICIAN 181347 0 0 0 0 0 5712 0 8068 0 195127 0 0 0 CAROLYN CHAMBERS ASST CHIEF MED OFFICER / OBGYN 265979 0 29791 0 0 0 8057 0 18874 0 322701 0 0 0 JESSICA ROSE BRENT PODIATRIST 155091 0 6708 0 0 0 5158 0 22932 0 189889 0 0 0 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan THE FOLLOWING EMPLOYEES PARTICIPATED IN A 457F NONQUALIFIED EXECUTIVE DEFERRED COMPENSATION PLAN DURING 2023 AND ARE INCLUDED ON FORM 990, PART VII: PEGGY ANDERSON, JESSICA BRENT, CAROLYN CHAMBERS, DAVID HOAG, BARBARA SULLINGER, AND BRENT TOWARD. NO CONTRIBUTIONS WERE MADE TO THE PLAN BY THE ORGANIZATION FOR ANY INDIVIDUALS DURING 2023. PARTICIPANT ELIGIBILITY IS DETERMINED BY THE ORGANIZATION. Schedule J, Part I, Line 5a Compensation contingent on revenues of the organization WHILE CERTAIN BONUSES ARE NOT TIED TO REVENUE GENERATION OF THE ORGANIZATION AND ARE DESIGNED TO RECOGNIZE SUCCESS OR HARDSHIP OF THE ORGANIZATION, PROJECT, INDIVIDUAL, OR DEPARTMENT, THERE ARE BONUSES THAT ARE DETERMINED IN WHOLE OR IN PART BY THE REVENUES OF SPECIFIC ACTIVITIES. THESE BONUSES AND THE BONUSES REFERENCED IN LINE 5 ARE ADMINISTRED AT THE DISCRETION OF THE ORGANIZATION AND ARE NOT REQUIRED PURSUANT TO CONTRACTS IN-PLACE. Schedule J, Part I, Line 6a Compensation contingent on net earnings of the organization IN ADDITION TO THE BONUSES REFERENCED ON LINE 5, THERE ARE BONUSES THAT ARE CONTINGENT ON THE NET EARNINGS OF AN ACTIVITY. THESE BONUSES ARE CALCULATED AS A PERCENTAGE OF ANY REVENUES IN EXCESS OF COSTS INCURRED. Form 990, Part III, Line 2 New program services On October 2, 2023, the Organization entered into a Member Substitution Agreement with Community Counseling and Wellness Centers, Inc. (CCWC) and Community Counseling Services, Inc. (CCS), whereby the Organization became the sole corporate member of CCWC and CCS. CCWC and CCS are designated mental health and addiction treatment providers in Ohio formed to provide education, consultation and treatment services related to mental health, substance abuse, and housing services to all members of the communities they serve, regardless of income or ability to pay. Form 990, Part VI, Line 11b Review of form 990 by governing body FEDERAL FORM 990 IS PREPARED BY THE CLINIC'S INDEPENDENT AUDITOR AND IS REVIEWED BY THE CLINIC'S CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER. AFTER THIS REVIEW, THE FEDERAL FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO ITS BEING FILED. Form 990, Part VI, Line 12c Conflict of interest policy THE CLINIC PROVIDES ALL BOARD MEMBERS WITH A COPY OF ITS CONFLICT OF INTEREST POLICY ANNUALLY. BOARD MEMBERS ARE REQUIRED TO NOTIFY THE CLINIC OF ANY CONFLICTS THEY MAY HAVE. Form 990, Part VI, Line 15a Process to establish compensation of top management official COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS APPROVED BY THE BOARD OF DIRECTORS AND IS BASED ON WAGE COMPARABILITY DATA AND PERFORMANCE. THE MOST RECENT REVIEW WAS APPROVED BY THE BOARD ON 9/31/2023. Form 990, Part VI, Line 15b Process to establish compensation of other employees WAGE AND SALARY RANGES ARE BASED ON SKILLS, KNOWLEDGE, LEVEL OF RESPONSIBILITY, RANGE OF SERVICE AREA, EXPERIENCE REQUIRED TO PERFORM THE JOB, WAGES AND SALARIES FOR ANY POSITION AND ARE RECOMMENDED BY HUMAN RESOURCES AND APPROVED BY THE CHIEF EXECUTIVE OFFICER. WAGE AND SALARY RANGES SHALL TAKE INTO CONSIDERATION COMPARABLE COMPENSATION FOR SIMILAR POSITIONS IN THE MARKETPLACE. Form 990, Part VI, Line 19 Required documents available to the public THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue OTHER REVENUE - Total Revenue: 79824, Related or Exempt Function Revenue: 79824, Unrelated Business Revenue: 0, Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Form 990, Part XI, Line 9 Other changes in net assets or fund balances COMMUNITY COUNSELING AND WELLNESS CENTER AND COMMUNITY COUNSELING SERVICES TRANSFER OF NET ASSETS - 4720477; COMMUNITY COUNSELING ADN WELNESS CENTERS INC 320 EXECUTIVE DRIVE MARION OH 43302 310937618 HEALTHCARE SERVICES OH 501(c)(3) 10 THIRD STREET true COMMUNITY COUNSELING SERVICES INC 2458 STETZER ROAD BUCYRUS OH 44820 341222071 HEALTHCARE SERVICES OH 501(c)(3) 7 THIRD STREET true false false false false false false false false false false false false false false false false false false true COMMUNITY COUNSELING AND WELLNESS CENTER S 5857274 FAIR MARKET VALUE COMMUNITY COUNSELING SERVICES S -1136897 FAIR MARKET VALUE