2021-12-09T08:00:54-06:00 2021-03-31 310800053 CLARK SCHAEFER HACKETT & CO 14 EAST MAIN STREET SUITE 500 SPRINGFIELD OH 45502 990 2020-04-01 341119524 FAMILY HEALTH SERVICES OF DARKE COUNTY INC FAMI 9375483806 5735 MEEKER RD GREENVILLE OH 45331 JARED POLLICK EXECUTIVE DIRECTOR 9375483806 2021-12-08 1 JARED POLLICK 999009999 JESSE YOUNG CPA P01236247 9373992000 2021-12-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JARED POLLICK 5735 MEEKER RD GREENVILLE OH 45331 30214636 0 X FAMILYHEALTHSERVICES.ORG X 1973 OH BUILDING HEALTHY LIVES TOGETHER 11 11 306 11 0 0 3402578 6053752 19614291 24065912 51963 94972 194905 0 23263737 30214636 0 0 0 0 13968413 16978091 0 0 0 6678856 8229699 20647269 25207790 2616468 5006846 20316160 27796147 2555950 3140204 17760210 24655943 X PROVIDE PRIMARY HEALTH CARE SERVICES FOR LOW-INCOME INDIVIDUALS BY MANAGING & OPERATING A HEALTH FACILITY & ITS PROGRAMS FOR ALL DARKE COUNTY RESIDENTS. 1 0 18862014 20206259 FAMILY HEALTH IS A SELF-SUSTAINING ORGANIZATION THAT BUILDS HEALTHY LIVES THROUGH THE PROVISION OF QUALITY, COMPREHENSIVE SERVICES. FAMILY HEALTH OFFERS MEDICAL SERVICES TO PATIENTS OF ALL AGES AS WELL AS DENTAL, BEHAVIORAL HEALTH, VISION, AND PHARMACY SERVICES. DURING THE 2021 FISCAL YEAR, THE CENTER HAD 26,649 PATIENTS AND 92,857 ENCOUNTERS. 2288450 3859653 C.H.N., LLC (CHN) IS A HOME HEALTH AGENCY CERTIFIED THROUGH OHIO DEPARTMENT OF HEALTH THAT IS COMMITTED TO MEETING THE HOME CARE NEEDS OF THE COMMUNITY. CHN PROVIDES SERVICES SUCH AS SKILLED NURSING, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AND AIDE HOMEMAKER SERVICES. 329553 WOMEN, INFANTS, AND CHILDREN PROGRAM - PROVIDES NUTRITION AND BREASTFEEDING EDUCATION FOR PREGNANT WOMEN AND WOMEN WITH SMALL CHILDREN. DURING THE 2021 FISCAL YEAR, THE CENTER HAD 1,376 PARTICIPANTS IN THE WIC PROGRAM AND HAD 5,504 ENCOUNTERS. 21480017 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 19 0 1 306 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X AUSTIE AUKER FINANCE DIRECTOR 9375483806 5735 MEEKER ROAD GREENVILLE OH 45331 KARA ALLREAD PRESIDENT 2.00 X X 0 0 0 DAVID FARST VICE PRESIDENT 2.00 X X 0 0 0 SONJA ETZELL SECRETARY 2.00 X X 0 0 0 JOY GREER TREASURER 2.00 X X 0 0 0 SCOTT CLUM TRUSTEE 2.00 X 0 0 0 CRYSTA BLOOMINGDALE TRUSTEE 2.00 X 0 0 0 TOM TREON TRUSTEE 2.00 X 0 0 0 KATHY O'DELL TRUSTEE 2.00 X 0 0 0 ROBB MAHER TRUSTEE 2.00 X 0 0 0 MIKE RIEMAN TRUSTEE 2.00 X 0 0 0 STEVE STENTZEL TRUSTEE 2.00 X 0 0 0 JARED POLLICK EXECUTIVE DIRECTOR 40.00 X 110026 0 20851 JEAN YOUNG EXECUTIVE DIRECTOR (THRU MAY 2020) 40.00 X 106822 0 13183 AUSTIE AUKER FINANCE DIRECTOR 40.00 X 93144 0 11546 CARLOS MENENDEZ MEDICAL DIRECTOR 40.00 X 230760 0 46059 KENNETH HARSHBARGER FAMILY PHYSICIAN 40.00 X 312814 0 59362 WILLIAM OSTERBUR FAMILY PHYSICIAN 40.00 X 298496 0 49528 JENNIFER RAWLINS FAMILY PHYSICIAN 40.00 X 280124 0 36885 EEMAN DAJANI PEDIATRIC DENTIST 40.00 X 256448 0 34657 THOMAS BROWN FAMILY PHYSICIAN 40.00 X 209166 0 39289 1897800 0 311360 34 0 1 0 STAFFMARK INVESTMENT LLC PO BOX 952386 ST LOUIS MO 63195 STAFFING COMPANY 289835 ECLINICALWORKS LLC PO BOX 847950 BOSTON MA 02284 EMR SOFTWARE AND SERVICE 107206 2 5501074 552678 468149 6053752 PATIENT SERVICE REVENUE 624100 17367215 17367215 PHARMACY REVENUE 446110 4182147 4182147 OTHER PROGRAM SERVICES 624100 2516550 2516550 24065912 94972 94972 30214636 24065912 0 94972 632390 69205 563185 13356938 12139630 1217308 82698 82698 1984531 1676061 308470 921534 779296 142238 103935 7399 96536 422988 376268 46720 120533 117133 3400 989 989 594629 543744 50885 85617 19275 66342 CONTRACTUAL FEES 2518282 1825293 692989 SUPPLIES 2277701 1894138 383563 PHARMACY COSTS 1301712 1301712 COMMUNICATION 276787 220830 55957 526526 426346 100180 25207790 21480017 3727773 0 6083895 10274854 676724 519903 507649 1861199 2584140 160186 126213 141954 185381 14437996 5163723 9039206 9274273 1230759 2956307 1279058 1210606 20316160 27796147 1295300 1798487 12891 1260650 1328826 2555950 3140204 X 17760210 24655943 17760210 24655943 20316160 27796147 X 5006846 502537 1386350 X X 0 1 X 1 1 1 X 3485413 3127946 3090659 3402578 6053752 19160348 3485413 3127946 3090659 3402578 6053752 19160348 19160348 61379 46079 75751 51963 94972 330144 -1461 -66710 28015 -128671 0 -168827 1089185 1095000 623586 1082104 2516550 6406425 25728090 88771552 0.74470 0.78240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 263199 263199 11875585 3959166 7916419 2070565 1204557 866008 228647 228647 9274273 DEFERRED COMPENSATION 1311825 REFUNDABLE ADVANCE 17001 1328826 X 30717173 502537 502537 30214636 0 30214636 25207790 0 25207790 0 25207790 PART X, LINE 2: FHS 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 THE FHS'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. CHN IS ORGANIZED AS A SINGLE MEMBER LLC, IN WHICH, FHS IS THE SOLE MEMBER. AS SUCH, THE INCOME FROM CHN IS REPORTED ON THE TAX RETURN OF FHS. FHS' REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. X X 0 1 0 0 0 0 0 0 0 CARLOS MENENDEZ MEDICAL DIRECTOR 205715 0 25045 0 0 0 29976 0 16083 0 276819 0 0 0 KENNETH HARSHBARGER FAMILY PHYSICIAN 310125 0 2689 0 0 0 38824 0 20538 0 372176 0 0 0 WILLIAM OSTERBUR FAMILY PHYSICIAN 295521 0 2975 0 0 0 37261 0 12267 0 348024 0 0 0 JENNIFER RAWLINS FAMILY PHYSICIAN 277111 0 3013 0 0 0 34466 0 2419 0 317009 0 0 0 EEMAN DAJANI PEDIATRIC DENTIST 200172 0 56276 0 0 0 32311 0 2346 0 291105 0 0 0 THOMAS BROWN FAMILY PHYSICIAN 204113 0 5053 0 0 0 24793 0 14496 0 248455 0 0 0 X 468149 0 0 0 FORM 990, PART III, LINE 2 FHS IS THE SOLE MEMBER OF C.H.N., LLC (CHN), A HOME HEALTH AGENCY CERTIFIED THROUGH THE OHIO DEPARTMENT OF HEALTH. EFFECTIVE JANUARY 31, 2020, CHN CONVERTED FROM AN S CORPORATION TO A SINGLE-MEMBER LLC OWNED BY FHS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED TO MANAGEMENT AND THE FULL BOARD FOR THEIR REVIEW AND APPROVAL PRIOR TO SUBMISSION. AN INSPECTION COPY WILL BE HELD BY THE EXECUTIVE SECRETARY FOR PUBLIC INSPECTION AT 5735 MEEKER ROAD. THE INSPECTION COPY IS NOT TO LEAVE THE PREMISES AND COPIES WILL NOT BE MADE FOR DISTRIBUTION UNLESS REQUESTED BY A BOARD MEMEBER FOR USE BY THAT BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE CONFLICT OF INTEREST FORMS ANNUALLY. IF ANY CONFLICTS ARE IDENTIFIED THEY ARE MONITORED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIALS: THE SALARY AMOUNT IS SET BY THE BOARD. IN DETERMINING THE SALARY AMOUNT THE BOARD USES MGMA (MEDICAL GROUP MANAGEMENT ASSOCIATION), A SOURCE OF INDUSTRY DATA. COMPENSATION PROCESS FOR OFFICERS: FAMILY HEALTH SERVICES PAYS BASED ON THE INDUSTRY MEDIAN BY USING INDUSTRY DATA FROM MGMA AND NACHC (NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS). FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST AT 5735 MEEKER RD. THE DOCUMENTS OR COPIES THEREOF ARE NOT PERMITTED TO LEAVE THE PREMISES. FORM 990, PART XI, LINE 9: CHN SINGLE MEMBER LLC CONVERSION 1,386,350. FORM 990, PART XII, LINE 2C PROCESS HAS NOT CHANGED SINCE PRIOR YEAR. COMPREHENSIVE HEALTH NETWORK 5420 STATE ROUTE 571 GREENVILLE OH 45331 311242113 HOME HEALTH CARE OH 4574439 3215436 FAMILY HEALTH SERVICES OF DARKE COUNTY