2024-10-14T15:53:05-05:00 2023-12-31 310800053 CLARK SCHAEFER HACKETT & CO 14 EAST MAIN STREET SUITE 500 SPRINGFIELD OH 45502 990 2023-01-01 271092132 FAIRFIELD COMMUNITY HEALTH CENTER FAIR 7402776043 220 E WALNUT ST LANCASTER OH 43130 DANIEL FISHER CFO 7402776043 2024-10-14 1 0 APRIL CAULFIELD P01949369 9373992000 2024-10-14 2023 2024-10-15 13:58:12Z DANIEL FISHER 220 E WALNUT STREET LANCASTER OH 43130 8586132 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 85 12 0 0 2595409 2524413 5679664 6020790 222 4644 148041 29258 8423336 8579105 0 0 0 0 5396691 5435566 0 0 7062 2589498 3009917 7986189 8445483 437147 133622 7553150 10144046 4148912 6606186 3404238 3537860 X FAIRFIELD COMMUNITY HEALTH CENTER (FCHC) IS A FEDERALLY QUALIFIED HEALTH CENTER, COMMUNITY-BASED AND PATIENT-DIRECTED ORGANIZATION. FCHC PROVIDES COMPREHENSIVE PRIMARY HEALTH SERVICES FOR UNINSURED OR UNDER INSURED RESIDENTS OF FAIRFIELD COUNTY. MEDICAL SERVICES, INCLUDING, BEHAVIORAL ARE PROVIDED WITHOUT DISCRIMINATION TO AGE, RACE, ETHNICITY, OR ABILITY TO PAY. 0 0 4480025 6057075 PROVIDE QUALITY HEALTH CARE 4480025 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 3 0 1 85 1 0 0 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 X THE ORGANIZATION 7402776043 220 E WALNUT ST LANCASTER OH 43130 PAUL MARTIN PRESIDENT 1.00 X X 0 0 0 JEFF NELSON 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 KENNETH GRIMMETT TRUSTEE 1.00 X 0 0 0 LORELLE DRIGGS TRUSTEE 1.00 X 0 0 0 DEBBY ROCKWOOD TRUSTEE 1.00 X 0 0 0 PENNY PETERS-GUEST TRUSTEE 1.00 X 0 0 0 SHERRILL HUNT TRUSTEE 1.00 X 0 0 0 ROBERTA CHILCOTE TRUSTEE 1.00 X 0 0 0 CHANDLER HALL TRUSTEE 1.00 X 0 0 0 SANDY SMITH TRUSTEE 1.00 X 0 0 0 TROY HAMPTON CMO 40.00 X 238090 0 30270 DANIEL FISHER CFO 40.00 X 97242 0 10984 LISA EVANGELISTA CEO 40.00 X 158797 0 23329 MARK IRVING PHYSICIAN ASSISTANT 40.00 X 127864 0 9948 MIKAEL SCHILB PHYSICIAN 40.00 X 154517 0 15621 MELANIE STEVENS PHYSICIAN 40.00 X 196360 0 21440 EAN BETT PHYSICIAN 40.00 X 152750 0 0 AARON MURFIN CNP 40.00 X 138449 0 13784 1264069 0 125376 9 0 1 0 0 15686 2154690 354037 2524413 PATIENT SERVICE REVENU 621400 3108843 3108843 340B PHARMACY REVENUE 621400 2015442 2015442 VALUE BASED REIMBURSEM 621400 678123 678123 RESIDENCY PROGRAM REVE 621400 176976 176976 OHIO WORKFORCE FUNDS 621400 30606 30606 10800 10800 6020790 4644 4644 0 15686 7027 -7027 -7027 MISCELLANEOUS INCOME 621400 33296 33296 MEDICAL RECORDS 621400 2989 2989 36285 8579105 6057075 0 -2383 558712 558712 3897284 2604143 1293141 77598 72517 5081 563115 361485 201630 338857 194894 143963 1678 1678 24549 24549 619142 59965 559177 70844 70844 9782 9782 25682 25682 360568 54785 305783 19095 4300 14795 10832 150 10682 287831 287831 240672 240672 32096 26923 5173 SUPPLIES 1129239 1004636 124603 BAD DEBT EXPENSE 64868 64868 DUES AND SUBSCRIPTIONS 48379 14460 33919 MISCELLANEOUS EXPENSES 40699 40699 23961 16899 7062 8445483 4480025 3958396 7062 497096 227106 43985 935193 1261209 204276 25684 9037793 631783 713324 8406010 150169 5203261 29883 7553150 10144046 527440 717798 155000 115000 3466472 5603567 0 169821 4148912 6606186 X 3230060 3524781 174178 13079 3404238 3537860 7553150 10144046 133622 0 X X 0 1 X 1 1 1 X 2060247 2878400 3086588 2595409 2524413 13145057 6078508 5961509 5679664 6020790 23740471 2060247 8956908 9048097 8275073 8545203 36885528 36885528 256 222 4644 5122 94069 127426 36285 257780 37148430 0.99290 0.98260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2500 2500 8556777 392689 8164088 37468 6783 30685 179751 139931 39820 261297 92380 168917 8406010 FINANCING LEASE LIABILITY 169821 169821 X 8586132 0 8586132 -7027 -7027 8579105 8452510 0 8452510 -7027 -7027 8445483 PART X, LINE 2: FAIRFIELD COMMUNITY HEALTH CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO FCHC'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. FCHC'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE -7,027. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE -7,027. GOLF OUTING 15686 15686 900 205 5922 15686 15686 900 205 5922 7027 -7027 X 0 0 0 0 0 0 0 0 0 TROY HAMPTON CMO 238090 0 0 0 0 0 19500 0 10770 0 268360 0 0 0 LISA EVANGELISTA CEO 158797 0 0 0 0 0 16574 0 6755 0 182126 0 0 0 MIKAEL SCHILB PHYSICIAN 154517 0 0 0 0 0 7209 0 8412 0 170138 0 0 0 MELANIE STEVENS PHYSICIAN 196360 0 0 0 0 0 15750 0 5690 0 217800 0 0 0 EAN BETT PHYSICIAN 152750 0 0 0 0 0 0 0 0 0 152750 0 0 0 AARON MURFIN CNP 138449 0 0 0 0 0 3068 0 10716 0 152233 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 XII, LINE 2C: PROCESS HAS NOT CHANGED FROM PRIOR YEAR.