COMMUNITY HEALTH FOUNDATION OF FAIRFIELD: Form 990EZ, tax year 2022
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- Organization
- COMMUNITY HEALTH FOUNDATION OF FAIRFIELD (EIN 57-0930442)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-04-30
- IRS object ID
- 202431219349201133
- Schema version
- 2022v5.0
- 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 | 2024-04-30T15:01:31-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 620713250 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRAFTCPAS PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6136 SHALLOWFORD ROAD 101 | AddressLine1Txt |
| City | CHATTANOOGA | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 374217214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 570930442 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH FOUNDATION OF FAIRFIELD | BusinessNameLine1Txt |
| Business Name Line2 | JOHN A MARTIN PRIMARY HEALTH CARE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 8036356099 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56 US HWY 321 BYPASS NORTH | AddressLine1Txt |
| City | WINNSBORO | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29180 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK SHAFFER | PersonNm |
| Person Title | MEDICAL DIRECTOR | PersonTitleTxt |
| Phone | 8036356099 | PhoneNum |
| Signature | 2024-04-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MARK | PersonFirstNm |
| Person Last | SHAFFER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | FRANCES E LEAHY | PreparerPersonNm |
| PTIN | P00713593 | PTIN |
| Phone | 4238947400 | PhoneNum |
| Preparation | 2024-04-30 | 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 | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Website Address | N/A | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $63,869 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Program Service Revenue | $63,869 | ProgramServiceRevenueAmt |
| Total Revenue | $63,869 | TotalRevenueAmt |
| Salaries Other Comp Empl Bnft | $1,124 | SalariesOtherCompEmplBnftAmt |
| Fees And Other Pymt To Ind Cntrct | $10,834 | FeesAndOtherPymtToIndCntrctAmt |
| Occupancy Rent Utlts And Maint | $1,563 | OccupancyRentUtltsAndMaintAmt |
| Printing Publications Postage | $353 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $19,512 | OtherExpensesTotalAmt |
| Total Expenses | $33,386 | TotalExpensesAmt |
| Excess Or Deficit For Year | $30,483 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $225,883 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $256,366 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,171 | BOYAmt |
| EOY | $187,448 | EOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,955 | BOYAmt |
| EOY | $68,918 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,126 | BOYAmt |
| EOY | $256,366 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243 | BOYAmt |
| EOY | $0 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,883 | BOYAmt |
| EOY | $256,366 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | THE ORGANIZATION PREVIOUSLY OPERATED 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, HOWEVER, ONGOING COLLECTIONS CONTINUED THROUGH 2022 AND 2023. | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $0 | GrantsAndAllocationsAmt |
| Program Service Expenses | $13,010 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $13,010 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (7 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| MARK SHAFFER | ||||
| MEDICAL DIRECTOR | 1.00 | $0 | $0 | $0 |
| KIMBERLY SEIBLES | ||||
| CHAIR | 1.00 | $0 | $0 | $0 |
| LESS HALL MD | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| DORIS LEITNER | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| THOMAS CHANDLER PHD | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| BERTHA GOINS | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| SHERYL MITCHELL | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | SC | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK SHAFFER MD | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56 US HWY 321 BYPASS NORTH | AddressLine1Txt |
| City | WINNSBORO | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29180 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8036356099 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Other Employee Paid Over100k | 0 | OtherEmployeePaidOver100kCnt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,743 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $190,700 | CurrentTaxYearMinus2YearsAmt |
| Total | $215,443 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,042,371 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $893,402 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $727,906 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $612,693 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $63,869 | CurrentTaxYearAmt |
| Total | $3,340,241 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,067,114 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $893,402 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $918,606 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $612,693 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $63,869 | CurrentTaxYearAmt |
| Total | $3,555,684 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $3,555,684 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $148 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $81 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2 | CurrentTaxYearMinus1YearAmt |
| Total | $237 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $148 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $81 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2 | CurrentTaxYearMinus1YearAmt |
| Total | $237 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,067,262 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $893,483 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $918,612 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $612,695 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $63,869 | CurrentTaxYearAmt |
| Total | $3,555,921 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99990 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99990 | PublicSupportPY509Pct |
| Investment Income CY | 0.00010 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: DEPRECIATION. AMOUNT: 9,037. DESCRIPTION: BANK CHARGES. AMOUNT: 642. DESCRIPTION: INSURANCE. AMOUNT: 1,408. DESCRIPTION: EDUCATION MATERIALS. AMOUNT: 217. DESCRIPTION: MEALS. AMOUNT: 200. DESCRIPTION: PROFESSIONAL DEVELOPMENT. AMOUNT: 50. DESCRIPTION: GENERAL OFFICE SUPPLIES. AMOUNT: 184. DESCRIPTION: COMPUTER EXPENSE. AMOUNT: 7,774. TOTAL TO FORM 990-EZ, LINE 16: 19,512. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 77,955. END OF YEAR AMOUNT: 68,918. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. | DeclarationDesc |
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