BETA

COMMUNITY HEALTH FOUNDATION OF FAIRFIELD: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH FOUNDATION OF FAIRFIELD (EIN 57-0930442)
Tax period
2021-07-01 to 2022-06-30
Filed
2024-04-30
IRS object ID
202421219349301992
Schema version
2021v4.2
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

FieldValueIRS element (for citing)
Return2024-04-30T14:59:56-05:00ReturnTs
Tax Period End2022-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN620713250PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KRAFTCPAS PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line16136 SHALLOWFORD ROAD 101AddressLine1Txt
CityCHATTANOOGACityNm
State AbbreviationTNStateAbbreviationCd
ZIP374217214ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN570930442EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH FOUNDATION OF FAIRFIELDBusinessNameLine1Txt
Business Name Line2JOHN A MARTIN PRIMARY HEALTH CAREBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone8036356099PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line156 US HWY 321 BYPASS NORTHAddressLine1Txt
CityWINNSBOROCityNm
State AbbreviationSCStateAbbreviationCd
ZIP29180ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARK SHAFFERPersonNm
Person TitleMEDICAL DIRECTORPersonTitleTxt
Phone8036356099PhoneNum
Signature2024-04-30SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMARKPersonFirstNm
Person LastSHAFFERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonFRANCES E LEAHYPreparerPersonNm
PTINP00713593PTIN
Phone4238947400PhoneNum
Preparation2024-04-26PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnYes (X)AmendedReturnInd

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1JOHN A MARTIN PRIMARY HEALTH CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerMARK SHAFFERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line156 US HWY 321 BYPASS NORTHAddressLine1Txt
CityWINNSBOROCityNm
State AbbreviationSCStateAbbreviationCd
ZIP29180ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$568,283GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1992FormationYr
Legal Domicile StateSCLegalDomicileStateCd
Activity Or MissionOPERATION OF A MEDICAL CLINIC IN A RURAL AREA.ActivityOrMissionDesc
Contract TerminationYes (X)ContractTerminationInd
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee6TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$190,700PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$727,906PYProgramServiceRevenueAmt
CY Program Service Revenue$512,693CYProgramServiceRevenueAmt
PY Investment Income$6PYInvestmentIncomeAmt
CY Investment Income$36,449CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$918,612PYTotalRevenueAmt
CY Total Revenue$549,142CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$593,052PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$34,156CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$402,445PYOtherExpensesAmt
CY Other Expenses$248,729CYOtherExpensesAmt
PY Total Expenses$995,497PYTotalExpensesAmt
CY Total Expenses$282,885CYTotalExpensesAmt
PY Revenues Less Expenses-$76,885PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$266,257CYRevenuesLessExpensesAmt
Total Assets BOY$390,383TotalAssetsBOYAmt
Total Assets EOY$226,126TotalAssetsEOYAmt
Total Liabilities BOY$434,072TotalLiabilitiesBOYAmt
Total Liabilities EOY$243TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$43,689NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$225,883NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionOPERATION OF A MEDICAL CLINIC IN A RURAL AREA.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant ChangeYes (1)SignificantChangeInd
Expense$238,131ExpenseAmt
Revenue$512,693RevenueAmt
DescTHE ORGANIZATION OPERATES AN ACADEMIC CLINICAL CENTER IN A RURAL AREA TO DELIVER HEALTH CARE TO A DEFINED POPULATION. OPERATIONS CEASED IN JANUARY 2022 WHEN PRISMA HEALTH ASSUMED OPERATIONS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$787ExpenseAmt
DescTHE ORGANIZATION ALSO DELIVERS HEALTH RELATED EDUCATIONAL SERVICES TO STUDENTS IN MEDICAL SCHOOL, PUBLIC HEALTH AND SOCIAL WORK.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$238,918TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial LiquidationYes (1)PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document8IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee6EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldSCStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMARK SHAFFER MDPersonNm
Phone8036356099PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line156 US HWY 321 BYPASS NORTHAddressLine1Txt
CityWINNSBOROCityNm
State AbbreviationSCStateAbbreviationCd
ZIP29180ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
KIMBERLY SEIBLES
VICE CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
LESS HALL MD
USC DEAN REPRESENTATIVE1.00Yes (X)$0$0$0
DORIS LEITNER
CHAIR1.00Yes (X)Yes (X)$0$0$0
THOMAS CHANDLER PHD
USC DEAN REPRESENTATIVE1.00Yes (X)$0$0$0
DEE MATTOX
DIRECTOR1.00Yes (X)$0$0$0
BERTHA GOINS
DIRECTOR1.00Yes (X)$0$0$0
SUSAN GROSSLIGHT
DIRECTOR1.00Yes (X)$0$0$0
SHERYL MITCHELL
DIRECTOR1.00Yes (X)$0$0$0
MARK SHAFFER
MEDICAL DIRECTOR1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHEALTH CARE SERVICESDesc
Business621400BusinessCd
Total Revenue Column$512,693TotalRevenueColumnAmt
Related Or Exempt Func Income$512,693RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$512,693TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2TotalRevenueColumnAmt
Exclusion$2ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$55,588OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$19,141OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$36,447OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$36,447TotalRevenueColumnAmt
Exclusion$36,447ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$549,142TotalRevenueColumnAmt
Related Or Exempt Func Income$512,693RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$36,449ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$27,144TotalAmt
Program Services$23,771ProgramServicesAmt
Management And General$3,373ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,184TotalAmt
Program Services$4,485ProgramServicesAmt
Management And General$699ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,828TotalAmt
Program Services$1,607ProgramServicesAmt
Management And General$221ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$3,757TotalAmt
Program Services$3,569ProgramServicesAmt
Management And General$188ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,769TotalAmt
Management And General$7,769ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$11,001TotalAmt
Program Services$8,982ProgramServicesAmt
Management And General$2,019ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$40,768TotalAmt
Program Services$38,499ProgramServicesAmt
Management And General$2,269ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$208TotalAmt
Program Services$208ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$11,826TotalAmt
Management And General$11,826ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$15,546TotalAmt
Program Services$14,769ProgramServicesAmt
Management And General$777ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CONTRACT LABOR$62,654$52,502$10,152
SUPPLIES$51,617$49,036$2,581
COMPUTER EXPENSE$32,262$30,649$1,613
INJECTIONS AND VACCINES$4,364$4,364

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$6,957TotalAmt
Program Services$6,477ProgramServicesAmt
Management And General$480ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$282,885TotalAmt
Program Services$238,918ProgramServicesAmt
Management And General$43,967ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$136,448BOYAmt
EOY$148,171EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$35,617BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$128,168BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$166,007LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$88,052LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$90,150BOYAmt
EOY$77,955EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$390,383BOYAmt
EOY$226,126EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$413,569BOYAmt
EOY$243EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$20,065BOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$438BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$434,072BOYAmt
EOY$243EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$43,689BOYAmt
EOY$225,883EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$43,689BOYAmt
EOY$225,883EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$390,383BOYAmt
EOY$226,126EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$266,257ReconcilationRevenueExpnssAmt
Prior Period Adjustments$3,315PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$24,743CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$190,700CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$215,443TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,016,589CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,042,371CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$893,402CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$727,906CurrentTaxYearMinus1YearAmt
Current Tax Year$612,693CurrentTaxYearAmt
Total$4,292,961TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,016,589CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,067,114CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$893,402CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$918,606CurrentTaxYearMinus1YearAmt
Current Tax Year$612,693CurrentTaxYearAmt
Total$4,508,404TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$4,508,404PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$103CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$148CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$81CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6CurrentTaxYearMinus1YearAmt
Current Tax Year$2CurrentTaxYearAmt
Total$340TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$103CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$148CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$81CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6CurrentTaxYearMinus1YearAmt
Current Tax Year$2CurrentTaxYearAmt
Total$340TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,016,692CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,067,262CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$893,483CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$918,612CurrentTaxYearMinus1YearAmt
Current Tax Year$612,695CurrentTaxYearAmt
Total$4,508,744TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99990PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$166,007OtherCostOrOtherBasisAmt
Depreciation$88,052DepreciationAmt
Book Value$77,955BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$77,955TotalBookValueLandBuildingsAmt

Schedule N IRS990ScheduleN

Disposition Of Assets Detail DispositionOfAssetsDetail

FieldValueIRS element (for citing)
Assets Distri Or Expnss PaidPHYSICAL ASSETSAssetsDistriOrExpnssPaidDesc
Distribution2022-04-12DistributionDt
Fair Market Value Of Asset$112,103FairMarketValueOfAssetAmt
Method Of FMV DeterminationFAIR MARKET VALUE - IN PLACEMethodOfFMVDeterminationTxt

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PRISMA HEALTHBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 26869AddressLine1Txt
CityGREENVILLECityNm
State AbbreviationSCStateAbbreviationCd
ZIP29616ZIPCd
FieldValueIRS element (for citing)
Director Of Successor20DirectorOfSuccessor2Ind
Employee Of Successor20EmployeeOfSuccessor2Ind
Owner Of Successor20OwnerOfSuccessor2Ind
Receive Compensation20ReceiveCompensation2Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, SCHEDULE N, PART IIFormAndLineReferenceDesc
ExplanationTHE ORGANIZATION STARTED THE PROCESS OF CLOSING DOWN BUSINESS AND TRANSFERRING PHYSICAL ASSETS TO PRISMA HEALTH IN 2021. AN OFFICIAL APPRAISAL OF THE ASSETS WAS $112,103, BUT THE PAYMENT RECIEVED WAS $55,588 AS SHOWN ON PAGE 9 OF THE 990. AS PART OF THIS TRANSFER, PRISMA HEALTH ALSO ASSUMED THE ACCOUNTS PAYABLE BALANCE OF THE ORGANIZATION. THIS AMENDED RETURN REFLECTS THE SALE OF THE ASSETS, AND THE ELIMINATION OF ACCOUNTS RECIEVABLE AND ACCOUNTS PAYABLE. OPERATIONS FOR COMMUNITY HEALTH FOUNDATION OF FAIRFIELD COUNTY IS PLANNED TO FULLY CEASE AND FILE A FINAL RETURN IN 2024.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 3DAY TO DAY OPERATIONS OF THE ACADEMIC CLINIC CENTER IN A RURAL AREA CEASED IN JANUARY 2022 WHEN PRISMA HEALTH TOOK OVER THOSE OPERATIONS.
FORM 990 AMENDED RETURN, PART IV, LINE 32FORM 990, PART IV, LINE 32 WAS CHANGED FROM NO TO YES DUE TO THE SALE OF ASSETS. SCHEDULE N IS ATTACHED.
FORM 990, PART VI, SECTION B, LINE 11BTHE GOVERNING BODY IS GIVEN AN OPPORTUNITY TO REVIEW THE FORM 990 BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION FOR TOP MANAGEMENT IS DETERMINED AND PAID BY RELATED ORGANIZATIONS. THESE ORGANIZATIONS ARE THE UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE AND THE UNIVERSITY OF SOUTH CAROLINA. NO OTHER OFFICER OR EMPLOYEE OF THE ORGANIZATION IS PAID MORE THAN $100,000.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS AND OTHER PUBLIC DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VIITHE BOARD OF DIRECTORS AUTHORIZED DR. MARK SHAFFER TO SIGN THE FORM 990. HE IS NOT AN OFFICIAL OFFICER FOR THE ORGANIZATION, BUT AN AUTHORIZED REPRESENTATIVE.
FORM 990 AMENDED RETURN, PART VIII, LINES 2 AND 7FORM 990, PART VIII, LINE 2, PROGRAM SERVICE REVENUE WAS AMENDED TO ELIMINATE ACCOUNTS RECEIVABLE. FORM 990, PART VIII, LINE 7, OTHER REVENUE INCLUDES THE SALE OF ASSETS NOT PREVIOUSLY REPORTED.
FORM 990 AMENDED RETURN, PART IX, MULTIPLE LINESFORM 990, PART IX, EXPENSES WERE AMENDED TO ELIMINATE ACCOUNTS PAYABLE BALANCES. AFFECTED EXPENSES LINES ARE AS FOLLOWS: LINE 7, 9, 10, 11C, 16, 22, 24A, 24C, 24E, 25
FORM 990 AMENDED RETURN, PART X, MULTIPLE LINESFORM 990, PART X, BALANCE SHEET BALANCES WERE AMENDED TO ELIMINATE ACCOUNTS RECEIVABLE, ACCOUNTS PAYABLE, AND FIXED ASSETS WERE DECREASED BY THE SALE OF ASSETS. LINES AFFECTED ARE AS FOLLOWS: LINE 1, 4, 10A-C, 16, 17, 19, 23, 26, 27, 32, 33
FORM 990 AMENDED RETURN, PART XI, MULTIPLE LINESFORM 990, PART XI, LINES AFFECTED ARE AS FOLLOWS: LINE 1, 2, 3, 8, 10
FORM 990 AMENDED RETURN, SCHEDULE A, PART III, LINE 2FORM 990, SCHEDULE A, PART III REFLECTS THE AMENDED REVENUE ON LINE 2.
FORM 990 AMENDED RETURN, SCHEDULE D, PART VI, LINE 1A-EFORM 990, SCHEDULE D, PART IV WAS AMENDED FOR THE SALE OF ASSETS.

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