2018-11-08T10:18:36-06:00 2017-12-31 310800053 CLARK SCHAEFER HACKETT & CO 14 EAST MAIN STREET SUITE 500 SPRINGFIELD OH 45502 990 2017-01-01 450914398 FIVE RIVERS HEALTH CENTERS FIVE 9377344141 2261 PHILADELPHIA DRIVE SUITE 200 DAYTON OH 45046 GINA MCFARLANE - EL CEO 9377346844 2018-11-08 1 JESSE YOUNG CPA P01236247 9373992000 2018-11-05 70.61.45.114 2018-11-08 07:39:41 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C2F47ED791055C5DDCDF6A32451FD928BA2C2B7F 2017 2019-02-21 02:37:17Z GINA MCFARLANE - EL 2261 PHILADELPHIA DRIVE SUITE 200 DAYTON OH 45046 22898422 0 X WWW.FIVERIVERSHEALTHCENTERS.ORG X 2011 OH FIVE RIVERS HEALTH CENTERS, A FEDERALLY-QUALIFIED HEALTH CENTER, IS COMMITTED TO PROVIDING QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY, WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. 14 14 318 0 0 0 9995233 11588626 8991902 11261369 757 48427 -68499 0 18919393 22898422 0 0 0 0 9347671 11485190 0 0 0 7517295 8293861 16864966 19779051 2054427 3119371 5834421 9039278 1602596 1688082 4231825 7351196 FIVE RIVERS HEALTH CENTERS ARE COMMITTED TO PROVIDING QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY, WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. 0 0 16552507 11261369 PROVIDE QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. IN 2016, CARE WAS PROVIDED TO APPROXIMATELY 20,000 PATIENTS. 16552507 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 70 0 1 318 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X GINA MCFARLANE - EL 9377346844 2261 PHILADELPHIA DR DAYTON OH 45406 AMY WIEDEMAN PRESIDENT 1.00 X X 0 0 0 RONA CLARK VICE PRESIDENT 1.00 X X 0 0 0 RENEE GEORGE TREASURER 1.00 X X 0 0 0 DWIGHT BROWN SECRETARY 1.00 X X 0 0 0 TISCHA COATES DIRECTOR 1.00 X 0 0 0 JEFF COOPER DIRECTOR 1.00 X 0 0 0 VERA CROWE DIRECTOR 1.00 X 0 0 0 ERIC FORD DIRECTOR 1.00 X 0 0 0 RICHARD GOSHAY DIRECTOR 1.00 X 0 0 0 AAMIR KHANNIAZI DIRECTOR 1.00 X 0 0 0 NANCY SCHIFFER DIRECTOR 1.00 X 0 0 0 DIANE WELBORN DIRECTOR 1.00 X 0 0 0 JO BOUCHARD DIRECTOR 1.00 X 0 0 0 DR BRENDA ROMAN DIRECTOR 1.00 X 0 0 0 GINA MCFARLANE-EL EXECUTIVE DIRECTOR 40.00 X 202369 0 24563 DIANE CUMMINS COO 40.00 X 110889 0 9146 DAVID MITTELKAMP CFO (THROUGH NOV 2017) 40.00 X 115783 0 14707 CARL CRUTCHFIELD DENTIST 40.00 X 151679 0 7915 GENEVA WALKER DENTIST 40.00 X 143581 0 14046 MARY GORNIAK CERTIFIED NURSE MIDWIFE 40.00 X 146720 0 6916 VINCENT BONANO INTERNAL MEDICINE SPECIALIST 40.00 X 138446 0 7205 KATHRYN LOWRY COLLINS CERTIFIED NURSE MIDWIFE 40.00 X 120381 0 15885 1129848 0 100383 10 0 1 0 WRIGHT STATE PHYSICIANS 725 UNIVERSITY BOULEVARD DAYTON OH 45435 MEDICAL SERVICES 1191175 PREMIER HEALTH SPECIALISTS INC 110 N MAIN ST DAYTON OH 45402 MEDICAL SERVICES 127370 ADVANCED MICROELECTRONICS INC DBA THE 6001 EAST OLD HWY 50 VINCENNES IN 47591 IT SERVICES 103698 3 5757483 5831143 786039 11588626 MEDICAID, NET 621400 7980469 7980469 PHARMACY 621400 1208664 1208664 MEDICARE, NET 621400 839876 839876 FIRST AND THIRD PARTIES, NET 621400 553606 553606 COMPREHENSIVE PRIMARY CARE (CPC) 624100 392929 392929 285825 285825 11261369 48427 48427 22898422 11261369 0 48427 477457 477457 8994176 7685967 1308209 1244764 1020688 224076 768793 643527 125266 49141 49141 27000 27000 103055 94990 8065 16408 1870 14538 124716 85548 39168 1573637 1447490 126147 43987 29026 14961 70612 25486 45126 5924 5924 278741 177203 101538 69831 68947 884 CONTRACT SERVICES 2596973 2329768 267205 DONATED SUPPLIES 786039 786039 PHARMACY COSTS 773454 773454 MEDICAL SUPPLIES 741413 741038 375 1032930 641466 391464 19779051 16552507 3226544 0 3277426 5803390 616020 893897 908893 1211260 12864 17150 116120 178384 1910284 975087 903098 935197 5834421 9039278 412819 446480 22780 2060 1166997 1239542 1602596 1688082 X 4231825 7351196 4231825 7351196 5834421 9039278 3119371 0 X X 0 1 X 1 1 1 X 8201000 6065227 8437082 9995233 11588626 44287168 8201000 6065227 8437082 9995233 11588626 44287168 44287168 757 48427 49184 44336352 126183800 0.99890 1.00000 X 554477 185259 369218 1355807 789828 565979 935197 ACCRUED PAYROLL AND WITHHOLDING 987171 OTHER ACCRUED LIABILITIES 126671 CAPITAL LEASE 125700 1239542 X 24019284 1120862 1120862 22898422 0 22898422 20899913 1120862 1120862 19779051 0 19779051 PART X, LINE 2: FIVE RIVERS 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 THE CENTER'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE CENTER'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS AS THE CENTER HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION. X X 0 0 0 0 0 0 0 0 0 GINA MCFARLANE-EL EXECUTIVE DIRECTOR 194169 0 8200 0 0 0 8699 0 15864 0 226932 0 0 0 CARL CRUTCHFIELD DENTIST 150079 0 1600 0 0 0 6371 0 1544 0 159594 0 0 0 GENEVA WALKER DENTIST 142196 0 1385 0 0 0 6077 0 7969 0 157627 0 0 0 MARY GORNIAK CERTIFIED NURSE MIDWIFE 143429 0 3291 0 0 0 5391 0 1525 0 153636 0 0 0 PART I, LINE 3 THE COMPENSATION COMMITTEE USES MARKET DATA TO DETERMINE SALARIES. X VACCINES 0 786039 COST OF MATERIALS 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE WILL REVIEW THE 990 AND APPROVE THE REPORT. AFTER APPROVING THE 990, THE FINANCE COMMITTEE WILL TAKE THE 990 TO THE BOARD FOR BOARD APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. OPERATING POLICIES HAVE BEEN IMPLEMENTED TO DETECT POTENTIAL CONFLICTS OF INTEREST. CONTRACTS OR EXPENDITURES THAT ARE GREATER THAN $50,000 MUST HAVE BOARD APPROVAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE USES MARKET DATA TO DETERMINE SALARIES. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATIONS 990 IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE FOR THE ORGANIZATION SELECTS AN INDEPENDENT ACCOUNTING FIRM TO CONDUCT THE AUDIT OF THE FINANCIAL STATEMENTS AND PROVIDES OVERSIGHT FOR THE WORK THAT IS CONDUCTED. THIS REPRESENTS NO CHANGE IN THE PROCESS FROM PROCEDURES CONDUCTED IN PRIOR PERIODS.