COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY (EIN 46-0530293)
- Tax period
- 2020-11-01 to 2021-10-31
- Filed
- 2022-08-11
- IRS object ID
- 202202239349301600
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-11T10:01:26-05:00 | ReturnTs |
| Tax Period End | 2021-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 341827159 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GILMORE JASION MAHLER LTD | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1785 INDIAN WOOD CIRCLE | AddressLine1Txt |
| City | MAUMEE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43537 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460530293 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH AND WELLNESS PARTNERS | BusinessNameLine1Txt |
| Business Name Line2 | OF LOGAN COUNTY | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 9375994128 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 212 E COLUMBUS AVE | AddressLine1Txt |
| City | BELLEFONTAINE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43311 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TARA BAIR | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 9375994128 | PhoneNum |
| Signature | 2022-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TARA | PersonFirstNm |
| Person Last | BAIR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DIANN STRETTEN | PreparerPersonNm |
| PTIN | P01983935 | PTIN |
| Phone | 4197942000 | PhoneNum |
| Preparation | 2022-08-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TARA BAIR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 212 E COLUMBUS AVE | AddressLine1Txt |
| City | BELLEFONTAINE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,376,896 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHWPLC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Other Organization Dsc | PARTNERSHIP | OtherOrganizationDsc |
| Formation | 2012 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY'S MISSION IS TO SERVE AS COMMUNITY PARTNERS IN HEALTHCARE BY PROVIDING ECONOMIC-BASED, WHOLE PERSON, WHOLE COMMUNITY PRIMARY CARE TO ANYONE AND EVERYONE IN OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 99 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,020,406 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,144,282 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,317,599 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,228,750 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,262 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,369 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $2,495 | CYOtherRevenueAmt |
| PY Total Revenue | $10,340,267 | PYTotalRevenueAmt |
| CY Total Revenue | $10,376,896 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,296,565 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,296,816 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,290,941 | PYOtherExpensesAmt |
| CY Other Expenses | $3,802,156 | CYOtherExpensesAmt |
| PY Total Expenses | $8,587,506 | PYTotalExpensesAmt |
| CY Total Expenses | $10,098,972 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,752,761 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $277,924 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,687,719 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,780,960 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $478,431 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,293,748 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,209,288 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,487,212 | NetAssetsOrFundBalancesEOYAmt |
| Mission | COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY'S MISSION IS TO SERVE AS COMMUNITY PARTNERS IN HEALTHCARE BY PROVIDING ECONOMIC-BASED, WHOLE PERSON, WHOLE COMMUNITY PRIMARY CARE TO ANYONE AND EVERYONE IN OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,322,970 | ExpenseAmt |
| Revenue | $8,231,245 | RevenueAmt |
| Desc | HEALTH SERVICES PROVIDED TO COMMUNITY RESIDENTS. | Desc |
| Total Program Service Expenses | $7,322,970 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 99 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREW HERSHBERGER | PersonNm |
| Phone | 9375994128 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4879 US ROUTE 68 SOUTH | AddressLine1Txt |
| City | WEST LIBERTY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43357 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| LIBBY MCCLURE | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHRIS JOSEPH | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KYLE LENTZ | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK GIBSON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE MERRIN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GREGORY RAINS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AMBER HANLEY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID BRIAN ROCKHOLD | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DON BURLEY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES SCHWIND | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KYLE SPRINGS | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BEN VOLLRATH | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KENNETH MILLER | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $226,865 | $0 | $15,600 | ||
| TARA BAIR | |||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | $135,208 | $0 | $10,204 | ||
| ANDREW HERSHBERGER | |||||||
| CFO | 40.00 | Yes (X) | $94,266 | $0 | $18,370 | ||
| JOEL KAUFFMAN | |||||||
| CHIEF INFORMATION OFFICER | 40.00 | Yes (X) | $75,103 | $0 | $3,269 | ||
| WILLIE STOLTZFUS | |||||||
| SPECIAL PROJECT OFFICER | 40.00 | Yes (X) | $59,471 | $0 | $6,602 | ||
| BETH JOHNSON | |||||||
| QUALITY IMPROVEMENT OFFICE | 40.00 | Yes (X) | $62,056 | $0 | $0 | ||
| JILLIAN SHELLABARGER | |||||||
| CHIEF BH MEDICAL OFFICER | 40.00 | Yes (X) | $238,762 | $0 | $14,206 | ||
| CHARLES KRATZ | |||||||
| PHYSICIAN | 40.00 | $206,968 | $0 | $22,873 | Yes (X) | ||
| TRACY DETWILER | |||||||
| BEHAVIORAL HEALTH PROVIDER | 40.00 | $120,634 | $0 | $4,825 | Yes (X) | ||
| JASON MARTINEZ | |||||||
| PHARMACIST | 40.00 | $127,891 | $0 | $19,724 | Yes (X) | ||
| JUSTIN GILDOW | |||||||
| CERTIFIED NURSE PRACTITIONER | 40.00 | $164,109 | $0 | $21,051 | Yes (X) | ||
| JOSHUA BRYANT | |||||||
| CERTIFIED NURSE PRACTITIONER | 40.00 | $100,658 | $0 | $7,158 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,611,991 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $143,882 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HAZELET HEALTHCARE CONSULTING | |||||
| PO BOX 2022 | INDIANA | PA | 15701 | CONTRACTED BILLING COMPANY | $209,688 |
| ECLINICALWORKS LLC | |||||
| PO BOX 847950 | BOSTON | MA | 02284 | SOFTWARE SUBSCRIPTION | $165,108 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,144,093 | GovernmentGrantsAmt |
| All Other Contributions | $189 | AllOtherContributionsAmt |
| Total Contributions | $2,144,282 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 624100 | $5,210,000 | $5,210,000 |
| PHARMACY REVENUES | 624100 | $2,883,685 | $2,883,685 |
| OTHER INCOME | 624100 | $135,065 | $135,065 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,228,750 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,369 | TotalRevenueColumnAmt |
| Exclusion | $1,369 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 532000 | BusinessCd |
| Total Revenue Column | $2,495 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,495 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,495 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,376,896 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,231,245 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,369 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,286,253 | TotalAmt |
| Program Services | $1,003,949 | ProgramServicesAmt |
| Management And General | $282,304 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,630,590 | TotalAmt |
| Program Services | $2,833,755 | ProgramServicesAmt |
| Management And General | $796,835 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,855 | TotalAmt |
| Program Services | $84,104 | ProgramServicesAmt |
| Management And General | $46,751 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $857,117 | TotalAmt |
| Program Services | $550,890 | ProgramServicesAmt |
| Management And General | $306,227 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $392,001 | TotalAmt |
| Program Services | $238,894 | ProgramServicesAmt |
| Management And General | $153,107 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,836 | TotalAmt |
| Management And General | $86,836 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,616 | TotalAmt |
| Management And General | $5,616 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $356,202 | TotalAmt |
| Management And General | $356,202 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,440 | TotalAmt |
| Management And General | $50,440 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,174 | TotalAmt |
| Program Services | $15,049 | ProgramServicesAmt |
| Management And General | $85,125 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,104 | TotalAmt |
| Management And General | $11,104 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $646,567 | TotalAmt |
| Program Services | $399,374 | ProgramServicesAmt |
| Management And General | $247,193 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,101 | TotalAmt |
| Program Services | $62,615 | ProgramServicesAmt |
| Management And General | $29,486 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,141 | TotalAmt |
| Program Services | $30,519 | ProgramServicesAmt |
| Management And General | $622 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,429 | TotalAmt |
| Program Services | $326 | ProgramServicesAmt |
| Management And General | $15,103 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| 340B PHARMACY | $1,171,140 | $1,171,140 | |
| MEDICAL SUPPLIES AND EQ | $545,945 | $545,945 | |
| OFFICE SUPPLIES AND EQU | $500,440 | $286,354 | $214,086 |
| DUES AND SUBSCRIPTIONS | $39,508 | $25,738 | $13,770 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,513 | TotalAmt |
| Program Services | $74,318 | ProgramServicesAmt |
| Management And General | $75,195 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,098,972 | TotalAmt |
| Program Services | $7,322,970 | ProgramServicesAmt |
| Management And General | $2,776,002 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,914,605 | BOYAmt |
| EOY | $2,373,927 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,720 | BOYAmt |
| EOY | $39,445 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $580,094 | BOYAmt |
| EOY | $962,957 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,882 | BOYAmt |
| EOY | $180,011 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,237,476 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $118,093 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,744 | BOYAmt |
| EOY | $1,119,383 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $101,134 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,342 | BOYAmt |
| EOY | $4,103 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,687,719 | BOYAmt |
| EOY | $4,780,960 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,793 | BOYAmt |
| EOY | $231,947 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $620,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $346,638 | BOYAmt |
| EOY | $441,801 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $478,431 | BOYAmt |
| EOY | $1,293,748 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,173,522 | BOYAmt |
| EOY | $3,451,496 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,766 | BOYAmt |
| EOY | $35,716 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,209,288 | BOYAmt |
| EOY | $3,487,212 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,687,719 | BOYAmt |
| EOY | $4,780,960 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $277,924 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $84,234 | OtherCostOrOtherBasisAmt |
| Book Value | $84,234 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $695,476 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,318 | DepreciationAmt |
| Book Value | $693,158 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $90,598 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,787 | DepreciationAmt |
| Book Value | $55,811 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,429 | OtherCostOrOtherBasisAmt |
| Depreciation | $65,481 | DepreciationAmt |
| Book Value | $3,948 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $297,739 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,507 | DepreciationAmt |
| Book Value | $282,232 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,119,383 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED PAYROLL & OTHER LIABILITIES | Desc |
| Amt | $441,801 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $441,801 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,376,896 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,376,896 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,376,896 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,098,972 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,098,972 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,098,972 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT OF THE ORGANIZATION IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE ORGANIZATION, SUCH AS TAX EXEMPTION DESIGNATION, IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY. MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS FOR WHICH IT IS REASONABLY POSSIBLE THAT A SIGNIFICANT CHANGE IN A TAX POSITION WILL OCCUR IN THE NEXT TWELVE MONTHS. THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE PRIOR THREE FISCAL YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JILLIAN SHELLABARGER | ||||||||||||||
| CHIEF BH MEDICAL OFFICER | $237,762 | $0 | $1,000 | $0 | $0 | $0 | $9,629 | $0 | $4,577 | $0 | $252,968 | $0 | $0 | $0 |
| KENNETH MILLER | ||||||||||||||
| CHIEF MEDICAL OFFICER | $225,865 | $0 | $1,000 | $0 | $0 | $0 | $9,378 | $0 | $6,222 | $0 | $242,465 | $0 | $0 | $0 |
| CHARLES KRATZ | ||||||||||||||
| PHYSICIAN | $205,968 | $0 | $1,000 | $0 | $0 | $0 | $8,743 | $0 | $14,130 | $0 | $229,841 | $0 | $0 | $0 |
| JUSTIN GILDOW | ||||||||||||||
| CERTIFIED NURSE PRACTITIONER | $163,109 | $0 | $1,000 | $0 | $0 | $0 | $6,921 | $0 | $14,130 | $0 | $185,160 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | OACHC AND NACHC'S COMPENSATION SURVEY WITH BOARD APPROVAL. |
| PART I, LINE 6 | BASED UPON THE ORGANIZATION'S FINANCIAL METRICS IN THE FOURTH QUARTER OF THE FISCAL YEAR, A BONUS OF $1000 WAS PAID TO ALL EMPLOYEES WHO HAD WORKED MORE THAN ONE YEAR. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | YES, JAMES SCHWIND, DIRECTOR OF CARE COORDINATION AT MARY RUTAN HOSPITAL, FOR WHOM CHWP HAS MULTIPLE ARMS LENGTH AGREEMENTS WITH; KENNETH MILLER, CMO: OFFICER OF OAKHILL MEDICAL CENTER FOR WHOM CHWP HAS AN ARMS LENGTH LEASE AGREEMENT THAT WAS IN PLACE SINCE 2014, PRIOR TO HIS EMPLOYMENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | SUBMITTED TO THE EXECUTIVE BOARD FOR REVIEW; SUBMITTED TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THEY QUARTERLY REVIEW TO ENSURE THEY HAVE DISCLOSED ALL CONFLICTS OF INTEREST. WHEN THERE IS A REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE FINANCIAL INTEREST, THE CEO, BOARD OR COMMITTEE IN CHARGE IS TO BE NOTIFIED. THE INTERESTED PERSON THEN MAKES A PRESENTATION OF A LIMITED TIME PERIOD. IF THE BOARD OR COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THEY MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | CHWPLC'S EXECUTIVE COMMITTEE ENGAGED IN THE PROCESS OF COMPARATIVE DATA FROM THE NATIONAL ASSOCAITION OF COMMUNITY HEALTH CENTERS (NACHC) AND SOUGHT SUPPORT FROM THE OHIO ASSOCIATON OF COMMUNITY HEALTH CENTER'S EXECUTIVE DIRECTOR (PRIMARY CARE ASSOCIATION) FOR EXECUTIVE PAY. KEY MEDICAL EMPLOYEES WHO ARE PATIENT SERVICE PROVIDERS ARE COMPARED TO STATE AND LOCAL AVERAGE FOR FQHC'S AND NON-FQHC'S AT LEAST EVERY TWO YEARS TO COMPARE WAGE DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST |