CHARITABLE HEALTHCARE NETWORK INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
CHARITABLE HEALTHCARE NETWORK INC (EIN 22-3769296)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-14
IRS object ID
201713189349309436
Schema version
2016v3.0
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

FieldValueIRS element (for citing)
Return2017-11-14T15:42:39-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN310800053PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLARK SCHAEFER HACKETT & COBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line114 East Main Street Suite 500AddressLine1Txt
CitySpringfieldCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45502ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN223769296EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1OHIO ASSOCIATION OF FREE CLINICSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlOHIOBusinessNameControlTxt
Phone6149146458PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line135 North Fourth Street No 350AddressLine1Txt
CityColumbusCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDEBORAH MILLERPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone6149146458PhoneNum
Signature2017-11-06SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJesse YOUNG CPAPreparerPersonNm
PTINP01236247PTIN
Phone9373992000PhoneNum
Preparation2017-11-06PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address174.233.139.242IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-06IPDt
IP Tm10:01:51IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdC2F47ED791055C5DDCDF6A32451FD928BA2C2B7FAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDEBORAH MILLERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line135 North Fourth Street No 350AddressLine1Txt
CityColumbusCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,112,411GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.OHIOFREECLINICS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2002FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionTO IMPROVE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED PEOPLE IN OHIO, TO STRENGTHEN THE CAPACITY OF OHIO'S FREE CLINCS, TO BUILD A NETWORK AMONG FREE CLINICS AND TO BE AN ADVOCATE FOR FREE CLINICS AND THE PEOPLE THEY SERVE.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee77TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,031,044PYContributionsGrantsAmt
CY Contributions Grants$1,095,712CYContributionsGrantsAmt
PY Program Service Revenue$6,935PYProgramServiceRevenueAmt
CY Program Service Revenue$7,570CYProgramServiceRevenueAmt
PY Investment Income$243PYInvestmentIncomeAmt
CY Investment Income$150CYInvestmentIncomeAmt
PY Other Revenue$11,656PYOtherRevenueAmt
CY Other Revenue$8,979CYOtherRevenueAmt
PY Total Revenue$1,049,878PYTotalRevenueAmt
CY Total Revenue$1,112,411CYTotalRevenueAmt
PY Grants And Similar Paid$377,630PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$368,424CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$540,179PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$595,749CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$9,349CYTotalFundraisingExpenseAmt
PY Other Expenses$104,299PYOtherExpensesAmt
CY Other Expenses$116,820CYOtherExpensesAmt
PY Total Expenses$1,022,108PYTotalExpensesAmt
CY Total Expenses$1,080,993CYTotalExpensesAmt
PY Revenues Less Expenses$27,770PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$31,418CYRevenuesLessExpensesAmt
Total Assets BOY$304,839TotalAssetsBOYAmt
Total Assets EOY$389,819TotalAssetsEOYAmt
Total Liabilities BOY$111,092TotalLiabilitiesBOYAmt
Total Liabilities EOY$164,654TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$193,747NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$225,165NetAssetsOrFundBalancesEOYAmt
MissionTO IMPROVE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED PEOPLE IN OHIO, TO STRENGTHEN THE CAPACITY OF OHIO'S FREE CLINICS, TO BUILD A NETWORK AMONG FREE CLINICS AND TO BE AN ADVOCATE FOR FREE CLINICS AND THE PEOPLE THEY SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$368,424ExpenseAmt
Grant$368,424GrantAmt
Revenue$13,249RevenueAmt
DescCOLLECT AND DISTRIBUTE FUNDS TO FREE CLINICS. PROMOTE NETWORKING AND INFORMATION SHARING AMONG OHIO FREE CLINICS, TO ADVOCATE ON BEHALF OF FREE CLINICS AND THE PEOPLE THEY SERVE AND TO MANAGE THE FREE CLINIC DATA.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$274,536ExpenseAmt
DescNAVIGATOR PROGRAM: ASSISTING PATIENTS OF THE ASSOCIATION'S MEMBER CLINICS IN ISSUES RELATD TO OHIO'S HEALTH INSURANCE EXCHANGE.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$330,164ExpenseAmt
Revenue$3,300RevenueAmt
DescVISTA PROGRAM: SERVICES TO STRENGTHEN AND SUPPLEMENT EFFORTS TO ELIMINATE POVERTY AND POVERTY-RELATED HUMAN, SOCIAL, AND ENVIRONMENTAL PROBLEMS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$973,124TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
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 OrganizationsYes (1)GrantsToOrganizationsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee77EmployeeCnt
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
Taxable Distributions0TaxableDistributionsInd
Distribution To Donor0DistributionToDonorInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
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 PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DEBORAH MILLERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6149146458PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line135 North Fourth Street No 350AddressLine1Txt
CityColumbusCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
ROBERT BAILY
Vice President5.00Yes (X)Yes (X)$0$0$0
PAUL BAUMGARTNER
PAST PRESIDENT5.00Yes (X)$0$0$0
SUSAN LABUDA SCHROP PHD
SECRETARY5.00Yes (X)Yes (X)$0$0$0
stephanie Baily cpa
TREASURER5.00Yes (X)Yes (X)$0$0$0
Jim Bennedict
DIRECTOR5.00Yes (X)$0$0$0
Heather Baird RN JD MPH
DIRECTOR5.00Yes (X)$0$0$0
Isi Ikharebha MPH
DIRECTOR5.00Yes (X)$0$0$0
Jamie Parsons
DIRECTOR5.00Yes (X)$0$0$0
Justin Coby
DIRECTOR5.00Yes (X)$0$0$0
Sue Meyer MD
DIRECTOR5.00Yes (X)$0$0$0
JOHANNA HENZ
DIRECTOR5.00Yes (X)$0$0$0
DR ANNE KLOOS PT PHD NSC
DIRECTOR5.00Yes (X)$0$0$0
DEBORAH MILLER
EXECUTIVE DIRECTOR40.00Yes (X)$74,998$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$74,998TotalReportableCompFromOrgAmt
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
Membership Dues$22,600MembershipDuesAmt
Government Grants$1,064,348GovernmentGrantsAmt
All Other Contributions$8,764AllOtherContributionsAmt
Total Contributions$1,095,712TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
Desceducation eventDesc
Business900099BusinessCd
Total Revenue Column$7,570TotalRevenueColumnAmt
Related Or Exempt Func Income$7,570RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$7,570TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$150TotalRevenueColumnAmt
Exclusion$150ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOther incomeDesc
Business900099BusinessCd
Total Revenue Column$8,979TotalRevenueColumnAmt
Related Or Exempt Func Income$8,979RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$8,979OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,112,411TotalRevenueColumnAmt
Related Or Exempt Func Income$16,549RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$150ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$368,424TotalAmt
Program Services$368,424ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$74,998TotalAmt
Program Services$37,499ProgramServicesAmt
Management And General$33,749ManagementAndGeneralAmt
Fundraising$3,750FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$487,413TotalAmt
Program Services$487,413ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$33,338TotalAmt
Program Services$31,115ProgramServicesAmt
Management And General$2,000ManagementAndGeneralAmt
Fundraising$223FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,430TotalAmt
Management And General$7,430ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,728TotalAmt
Program Services$5,344ProgramServicesAmt
Fundraising$384FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$6,472TotalAmt
Program Services$6,472ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$23,385TotalAmt
Management And General$23,385ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$24,789TotalAmt
Program Services$12,774ProgramServicesAmt
Management And General$12,015ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$14,281TotalAmt
Program Services$12,674ProgramServicesAmt
Management And General$1,607ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,540TotalAmt
Program Services$1,540ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,286TotalAmt
Management And General$2,286ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
CONTRACT SERVICES$12,479$4,992$2,495$4,992
MISCELLANEOUS$9,145$9,145
Dues and Subscriptions$3,572$3,572
equipment$2,962$2,962

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,751TotalAmt
Program Services$1,915ProgramServicesAmt
Management And General$836ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,080,993TotalAmt
Program Services$973,124ProgramServicesAmt
Management And General$98,520ManagementAndGeneralAmt
Fundraising$9,349FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$35,184BOYAmt
EOY$80,950EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$115,919BOYAmt
EOY$116,069EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$147,189BOYAmt
EOY$184,696EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,830BOYAmt
EOY$1,896EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$13,866LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,658LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,717BOYAmt
EOY$6,208EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$304,839BOYAmt
EOY$389,819EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$94,260BOYAmt
EOY$96,774EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$35,000EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,832BOYAmt
EOY$32,880EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$111,092BOYAmt
EOY$164,654EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$193,747BOYAmt
EOY$225,165EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$193,747BOYAmt
EOY$225,165EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$304,839BOYAmt
EOY$389,819EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$31,418ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
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 Minus4 Years$471,660CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$512,079CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$857,062CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,031,044CurrentTaxYearMinus1YearAmt
Current Tax Year$1,095,712CurrentTaxYearAmt
Total$3,967,557TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,158CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$20,383CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$17,285CurrentTaxYearMinus2YearsAmt
Current Tax Year$7,570CurrentTaxYearAmt
Total$63,396TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$489,818CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$532,462CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$874,347CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,031,044CurrentTaxYearMinus1YearAmt
Current Tax Year$1,103,282CurrentTaxYearAmt
Total$4,030,953TotalAmt

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$4,030,953PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$507CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$122CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$243CurrentTaxYearMinus1YearAmt
Current Tax Year$150CurrentTaxYearAmt
Total$1,022TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$507CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$122CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$243CurrentTaxYearMinus1YearAmt
Current Tax Year$150CurrentTaxYearAmt
Total$1,022TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year$8,979CurrentTaxYearAmt
Total$8,979TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$490,325CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$532,584CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$874,347CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,031,287CurrentTaxYearMinus1YearAmt
Current Tax Year$1,112,411CurrentTaxYearAmt
Total$4,040,954TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99750PublicSupportCY509Pct
Public Support PY5090.99970PublicSupportPY509Pct
Investment Income CY0.00030InvestmentIncomeCYPct
Investment Income PY0.00030InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Rallies DemonstrationsYes (1)RalliesDemonstrationsInd
Other Activities0OtherActivitiesInd
Total Lobbying Expenditures$0TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationSECURED FUNDING IN THE STATE BIENNIAL BUDGET THROUGH MEETINGS WITH KEY MEMBERS OF THE OHIO GENERAL ASSEMBLY.ExplanationTxt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,476OtherCostOrOtherBasisAmt
Depreciation$7,268DepreciationAmt
Book Value$6,208BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$390OtherCostOrOtherBasisAmt
Depreciation$390DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,208TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescPAYROLL RELATED LIABILITIESDesc
Amt$32,880Amt
FieldValueIRS element (for citing)
Total Liability$32,880TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$743,987TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$743,987RevenueSubtotalAmt
Other Revenues Not Included$368,424OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$368,424RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$1,112,411TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$712,569TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$712,569ExpensesSubtotalAmt
Other Expenses Not Included$368,424OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$368,424ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$1,080,993TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part X, Line 2:OHIO ASSOCIATION OF FREE CLINICS 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 ASSOCIAITON'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE ASSOCIATION'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 ASSOCIATION HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION.
Part XI, Line 4b - Other Adjustments:AMOUNTS DESIGNATED FOR MEMBER CLINICS 368,424.
Part XII, Line 4b - Other Adjustments:GRANTS DESIGNATED FOR MEMBER CLINICS 368,424.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (46 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
ASHLAND CHRISTIAN HEALTH CENTER
380 E 4TH STREETASHLANDOH44805421595274501(C)(3)$8,783TO PROVIDE SERVICES TO UNINSURED PATIENTS
ASIAN AMERICAN COMMUNITY SERVICES
2231 N HIGH STREET FIRST FLOORCOLUMBUSOH43201310898833501(C)(3)$6,995TO PROVIDE SERVICES TO UNINSURED PATIENTS
BY THE WAY INC
1029 S BROAD STREETLANCASTEROH43130262934275501(C)(3)$5,515TO PROVIDE SERVICES TO UNINSURED PATIENTS
COLUMBUS FREE CLINIC
2231 N HIGH STREETCOLUMBUSOH43201010575698501(C)(3)$7,131TO PROVIDE SERVICES TO UNINSURED PATIENTS
LICKING COUNTY COMMUNITY HEALTH CLINIC
144 B W MAIN STREETNEWARKOH43055311340169501(C)(3)$6,995TO PROVIDE SERVICES TO UNINSURED PATIENTS
COMPASSION MEDICAL CLINIC OF WILLIAMS COUNTY
614 E EDGERTON STBRYANOH43506204352598501(C)(3)$5,515TO PROVIDE SERVICES TO UNINSURED PATIENTS
COMPASSIONATE CARE OF SHELBY COUNTY
PO BOX 4835SIDNEYOH45365208479583501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
HEALTH PARTNERS OF MIAMI COUNTY
1300 N COUNTY ROAD 25ATROYOH45373311596731501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
HELPING HANDS HEALTH & WELLNESS CENTER
1420 MORSE ROADCOLUMBUSOH43229205937457501(C)(3)$10,842TO PROVIDE SERVICES TO UNINSURED PATIENTS
JEFFERSON COUNTY 4TH STREET HEALTH CENTER
701 N 4TH STREETSTEUBENVILLEOH43952203924355501(C)(3)$3,983TO PROVIDE SERVICES TO UNINSURED PATIENTS
LAKE COUNTY FREE CLINIC
54 SOUTH STATE STREET SUITE 302PAINESVILLEOH44077341081191501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
LORAIN COUNTY FREE CLINIC INC
3323 PEARL AVENUELORAINOH44055341506180501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
MIDLOTHIAN FREE HEALTH CLINIC INC
388 E MIDLOTHIAN BLVDYOUNGSTOWNOH44507010887315501(C)(3)$5,515TO PROVIDE SERVICES TO UNINSURED PATIENTS
NORTH COAST HEALTH MINISTRY
16110 DETROIT AVENUELAKEWOODOH44107341536257501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
OPPORTUNITY PARISH ECUMENICAL NEIGHBORHOOD MINISTRY FREE CLINIC
941 PRINCETON AVENUEAKRONOH44311341046107501(C)(3)$10,508TO PROVIDE SERVICES TO UNINSURED PATIENTS
OUCOM COMMUNITY HEALTH PROGRAMS - FREE CLINIC
105 RESEARCH AND TECHNOLOGY CENTERATHENSOH45701316402113501(C)(3)$8,783TO PROVIDE SERVICES TO UNINSURED PATIENTS
OXFORD COLLEGE CORNER CLINIC (DBA OXFORD FREE CLINIC)
PO BOX 390OXFORDOH45056204253386501(C)(3)$6,995TO PROVIDE SERVICES TO UNINSURED PATIENTS
PARMA HEALTH MINISTRY
7000 RIDGE ROADPARMAOH44129341754340501(C)(3)$5,321TO PROVIDE SERVICES TO UNINSURED PATIENTS
PHYSICIANS CARECONNECTION
1390 DUBLIN ROADCOLUMBUSOH43215311373719501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
REACH OUT OF MONTGOMERY COUNTY INC
25 E FORAKER STREETDAYTONOH45409311434282501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
THE BREATHING ASSOCIATION FREE LUNG HEALTH CLINIC
1520 OLD HENDERSON ROADCOLUMBUSOH432203639314387540501(C)(3)$8,783TO PROVIDE SERVICES TO UNINSURED PATIENTS
THE CLINIC AT FAITH MISSION
245 N GRANTCOLUMBUSOH43215314412586501(C)(3)$9,382TO PROVIDE SERVICES TO UNINSURED PATIENTS
TUSCARAWAS CLINIC FOR THE WORKING UNINSURED
420 REEVES AVENUE SUITE DDOVEROH44622208456793501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
VINEYARD FREE HEALTH CLINICS
6000 COOPER ROADWESTERVILLEOH43081753210233501(C)(3)$6,995TO PROVIDE SERVICES TO UNINSURED PATIENTS
VINEYARD COMMUNITY CENTER
15187 PALMER ROADETNAOH43068310954398501(C)(3)$8,783TO PROVIDE SERVICES TO UNINSURED PATIENTS
VIOLA STARTZMAN FREE CLINIC
1874 CLEVELAND ROADWOOSTEROH44691341758151501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
WASHINGTON COUNTY FREE CLINIC
PO BOX 804MARIETTAOH45750452512931501(C)(3)$3,993TO PROVIDE SERVICES TO UNINSURED PATIENTS
XENOS FREE CLINICS
3434 STONEVISTA LANECOLUMBUSOH43221310996318501(C)(3)$5,923TO PROVIDE SERVICES TO UNINSURED PATIENTS
HARTVILLE MIGRANT COUNCIL
PO Box 682HARTVILLEOH44632340899100501(C)(3)$8,783TO PROVIDE SERVICES TO UNINSURED PATIENTS
LIVING WELL CLINIC
215 S ALLISON AVE PO BOX 15XENIAOH45385274307745501(C)(3)$6,842TO PROVIDE SERVICES TO UNINSURED PATIENTS
MEDINA HEALTH MINISTRY
970 E WASHINGTON STREET SUITE 104MEDINAOH44256300092944501(C)(3)$5,515TO PROVIDE SERVICES TO UNINSURED PATIENTS
PREGNANCY SUPPORT CENTER OF STARK COUNTY
4500 22ND ST NWCANTONOH44706341461765501(C)(3)$10,995TO PROVIDE SERVICES TO UNINSURED PATIENTS
VICTORY MINISTRIES
4142 WESTERVILLE ROADCOLUMBUSOH43224311117522501(C)(3)$3,993TO PROVIDE SERVICES TO UNINSURED PATIENTS
Faithful Servants Free Clinic
65 Community Road Suite FTallmadgeOH44278454734159501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
Free Clinic of Fulton County
PO Box 173WauseonOH43567020792665501(C)(3)$3,585TO PROVIDE SERVICES TO UNINSURED PATIENTS
Good Samaritan Free Health Center
619 Oak Street -Accounting 3 WestCinCINNATIOH45206273893817501(C)(3)$12,568TO PROVIDE SERVICES TO UNINSURED PATIENTS
Grace Clinic of Delaware
40 S Franklin StDelawareOH43015270415624501(C)(3)$10,842TO PROVIDE SERVICES TO UNINSURED PATIENTS
Linworth Road Church
5400 Linworth RoadColumbusOH43235310881670501(C)(3)$3,064TO PROVIDE SERVICES TO UNINSURED PATIENTS
Bellbrook Open Arms Free Clinic
4403 OH-725 EBellbrookOH45305900902711501(C)(3)$2,859TO PROVIDE SERVICES TO UNINSURED PATIENTS
Collins Career center student based health center
11627 State Rouse 243ChesapeakeOH45619465241104501(C)(3)$2,859TO PROVIDE SERVICES TO UNINSURED PATIENTS
Community Care Free Medical Clinic
2150 S Byrne RdtoledoOH43614274077912501(C)(3)$8,517TO PROVIDE SERVICES TO UNINSURED PATIENTS
KidSmile Pediatric Dental Clinic
770 Bethel RoadColUMBUSOH43214263706958501(C)(3)$5,923TO PROVIDE SERVICES TO UNINSURED PATIENTS
Ohio Valley Health Center
1 Ross Park Blvd Ste 202StuebenvilleOH43952203924355501(C)(3)$4,647TO PROVIDE SERVICES TO UNINSURED PATIENTS
The Neighborhood Free Clinic
306 N Bush StreettolEDOOH43604271052744501(C)(3)$7,302TO PROVIDE SERVICES TO UNINSURED PATIENTS
University Family Physicians race track clinic
2123 Auburn Avenue Suite 340cinCINNATIOH45219501(C)(3)$3,063TO PROVIDE SERVICES TO UNINSURED PATIENTS
new life community outreach
25 West 5th AvenueColUMBUSOH43201352386294501(C)(3)$4,647TO PROVIDE SERVICES TO UNINSURED PATIENTS

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 2The Organization's board president and our board treasurer are husband and wife.
Form 990, Part VI, Section A, line 6THE MEMBERS ELECT THE MEMBERS OF THE GOVERNING BODY.
Form 990, Part VI, Section A, line 7aTHE MEMBERS ELECT THE MEMBERS OF THE GOVERNING BODY.
Form 990, Part VI, Section B, line 11bBOARD MEMBERS RECEIVE A COPY OF THE 990 AND APPROVE IT BEFORE FILING WITH THE IRS.
Form 990, Part VI, Section B, line 12cANNUALLY, THE BOARD OF DIRECTORS AND ITS OFFICERS, WILL COMPLETE A QUESTIONNAIRE TO ASSIST THE ORGANIZATION WITH DETERMINING THAT THEY ARE IN COMPLIANCE WITH THE POLICY.
Form 990, Part VI, Section B, line 15THE BOARD OFFICERS RESEARCH, DELIBERATE, AND APPROVE COMPENSATION FOR THE EXECUTIVE DIRECTOR.
Form 990, Part VI, Section C, line 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST.
Form 990, Part XII, Line 2cThis process has not changed.

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