2024-04-30T14:59:56-05:00 2022-06-30 620713250 KRAFTCPAS PLLC 6136 SHALLOWFORD ROAD 101 CHATTANOOGA TN 374217214 990 2021-07-01 570930442 COMMUNITY HEALTH FOUNDATION OF FAIRFIELD JOHN A MARTIN PRIMARY HEALTH CARE COMM 8036356099 56 US HWY 321 BYPASS NORTH WINNSBORO SC 29180 MARK SHAFFER MEDICAL DIRECTOR 8036356099 2024-04-30 1 MARK SHAFFER 999009999 FRANCES E LEAHY P00713593 4238947400 2024-04-26 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X JOHN A MARTIN PRIMARY HEALTH CARE MARK SHAFFER 56 US HWY 321 BYPASS NORTH WINNSBORO SC 29180 568283 0 X N/A X 1992 SC OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. X 8 8 6 0 0 0 190700 0 727906 512693 6 36449 0 0 918612 549142 0 0 0 0 593052 34156 0 0 0 402445 248729 995497 282885 -76885 266257 390383 226126 434072 243 -43689 225883 X OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. 0 1 238131 512693 THE 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. 787 THE ORGANIZATION ALSO DELIVERS HEALTH RELATED EDUCATIONAL SERVICES TO STUDENTS IN MEDICAL SCHOOL, PUBLIC HEALTH AND SOCIAL WORK. 238918 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 8 0 1 6 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 1 1 0 SC X MARK SHAFFER MD 8036356099 56 US HWY 321 BYPASS NORTH WINNSBORO SC 29180 X X KIMBERLY SEIBLES VICE CHAIRMAN 1.00 X X 0 0 0 LESS HALL MD USC DEAN REPRESENTATIVE 1.00 X 0 0 0 DORIS LEITNER CHAIR 1.00 X X 0 0 0 THOMAS CHANDLER PHD USC DEAN REPRESENTATIVE 1.00 X 0 0 0 DEE MATTOX DIRECTOR 1.00 X 0 0 0 BERTHA GOINS DIRECTOR 1.00 X 0 0 0 SUSAN GROSSLIGHT DIRECTOR 1.00 X 0 0 0 SHERYL MITCHELL DIRECTOR 1.00 X 0 0 0 MARK SHAFFER MEDICAL DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 X HEALTH CARE SERVICES 621400 512693 512693 512693 2 2 55588 19141 36447 36447 36447 549142 512693 0 36449 X 27144 23771 3373 5184 4485 699 1828 1607 221 3757 3569 188 7769 7769 11001 8982 2019 40768 38499 2269 208 208 11826 11826 15546 14769 777 CONTRACT LABOR 62654 52502 10152 SUPPLIES 51617 49036 2581 COMPUTER EXPENSE 32262 30649 1613 INJECTIONS AND VACCINES 4364 4364 6957 6477 480 282885 238918 43967 0 X 136448 148171 35617 128168 0 166007 88052 90150 77955 390383 226126 413569 243 20065 438 434072 243 X -43689 225883 -43689 225883 390383 226126 X 266257 3315 0 X 0 0 0 X 24743 190700 0 215443 1016589 1042371 893402 727906 612693 4292961 1016589 1067114 893402 918606 612693 4508404 0 0 0 4508404 103 148 81 6 2 340 103 148 81 6 2 340 1016692 1067262 893483 918612 612695 4508744 0.99990 0.99990 0.00010 0.00010 X 166007 88052 77955 77955 PHYSICAL ASSETS 2022-04-12 112103 FAIR MARKET VALUE - IN PLACE PRISMA HEALTH PO BOX 26869 GREENVILLE SC 29616 0 0 0 0 FORM 990, SCHEDULE N, PART II THE 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. FORM 990, PART III, LINE 3 DAY 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 32 FORM 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 11B THE GOVERNING BODY IS GIVEN AN OPPORTUNITY TO REVIEW THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION 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 19 GOVERNING DOCUMENTS AND OTHER PUBLIC DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII THE 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 7 FORM 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 LINES FORM 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 LINES FORM 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 LINES FORM 990, PART XI, LINES AFFECTED ARE AS FOLLOWS: LINE 1, 2, 3, 8, 10 FORM 990 AMENDED RETURN, SCHEDULE A, PART III, LINE 2 FORM 990, SCHEDULE A, PART III REFLECTS THE AMENDED REVENUE ON LINE 2. FORM 990 AMENDED RETURN, SCHEDULE D, PART VI, LINE 1A-E FORM 990, SCHEDULE D, PART IV WAS AMENDED FOR THE SALE OF ASSETS.