2023-05-15T11:25:52-05:00 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 2023-05-15 1 MARK SHAFFER 999009999 FRANCES E LEAHY P00713593 4238947400 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JOHN A MARTIN PRIMARY HEALTH CARE MARK SHAFFER 56 US HWY 321 BYPASS NORTH WINNSBORO SC 29180 657452 0 X N/A X 1992 SC OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. 8 8 6 0 0 0 190700 0 727906 657450 6 2 0 0 918612 657452 0 0 0 0 593052 409640 0 0 0 402445 245599 995497 655239 -76885 2213 390383 388154 434072 412592 -43689 -24438 X OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. 0 1 595535 657450 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. 596322 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 0 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 HEALTH CARE SERVICES 621400 657450 657450 657450 2 2 657452 657450 0 2 320022 304021 16001 69016 65565 3451 20602 19572 1030 3757 3569 188 9233 9233 11001 8982 2019 40828 38559 2269 208 208 9374 9374 15546 14769 777 CONTRACT LABOR 67679 57527 10152 SUPPLIES 51617 49036 2581 COMPUTER EXPENSE 27237 25875 1362 INJECTIONS AND VACCINES 4364 4364 4755 4275 480 655239 596322 58917 0 136448 160437 35617 128168 128168 365997 266448 90150 99549 390383 388154 413569 392089 20065 20065 438 438 434072 412592 X -43689 -24438 -43689 -24438 390383 388154 2213 17038 0 X 0 0 0 X 24743 190700 215443 1016589 1042371 893402 727906 657540 4337808 1016589 1067114 893402 918606 657540 4553251 0 0 0 4553251 103 148 81 6 2 340 103 148 81 6 2 340 1016692 1067262 893483 918612 657542 4553591 0.99990 0.99990 0.00010 0.00010 X 365997 266448 99549 99549 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, 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.