2017-06-02T09:30:09-05:00 2016-12-31 310800053 CLARK SCHAEFER HACKETT & CO 14 East Main Street Suite 500 Springfield OH 45502 990 2016-01-01 311533908 Columbus Neighborhood Health Center Inc COLU 6146455500 1800 Watermark Drive No 420 Columbus OH 43215 Dewitt Harrell CFO 6146455500 2017-05-31 1 Jesse Young CPA P01236247 9373992000 2017-05-31 65.186.15.240 2017-05-31 13:38:42 ED P 8D96D53E8A648CF5C5DB9CF66BA0AEDB2CDC5209 C2F47ED791055C5DDCDF6A32451FD928BA2C2B7F 2016 2021-01-29 14:40:06Z PrimaryOne Health DeWitt Harrell 1800 Watermark Drive No 420 Columbus OH 43215 31792021 0 X www.primaryonehealth.org X 1997 OH To serve the community by providing services to individuals and families with barriers to health care. 13 13 350 10 0 0 11092641 11453144 15623761 19607384 3622 2582 86330 728911 26806354 31792021 0 0 0 0 16450805 19458124 0 0 0 9432169 10563269 25882974 30021393 923380 1770628 9462160 11598893 1735741 2101846 7726419 9497047 X To serve the Central Ohio community with affordable, easy to access healthcare services. 0 0 20313808 17665394 Medical services: Primary care physicians are trained to treat over 90% of all illnesses. These physicians are trained in other specialty areas, including internal medicine, geriatrics, and preventative medicine. Physicians provide immunizations, well-baby/child check-ups, physicals, sick visits, blood pressure checks, glucose screenings, sports physicals, flu shots, minor surgeries, and many other services. CNHC also provides obstetrics and gynecology care including care during pregnancy, well woman annual exams, evaluation and treatment of abnormal pap smears, menopausal consultation, evaluation and treatment of pelvic pain, and contraception. 2911447 1776009 Dental Services: CNHC provides top-notch preventive and operative dentistry for adults and children services include preventative exams, x-rays, cleanings, fluoride treatments, sealants, fillings and extractions, and root canals. Along with delivering high quality dental care, CNHC makes dental visits a comfortable experience. During 2016, CNHC received donated salary of $482,776 of full time dentist and three full time dental assistants from an agreement with Columbus Public Health. The value of these services is not included in revenue or expense on the 990. 1631359 894892 Vision Services: CNHC PROVIDES TOP-NOTCH OPTOMETRY SERVICES. SERVICES INCLUDE COMPREHENSIVE VISION ANALYSIS, CONTACT LEN DIAGNOSTIC EXAM, DIAGNOSIS AND TREATMENT OF EYE INFECTIONS AND OTHER DISEASES, REFRACTIVE SURGERY CONSULATION, VISION CORRECTION PRODUCTS SUCH AS ADULT AND CHILDREN EYE FRAMES. 770553 Homeless Program: CNHC recognizes the struggles of the homeless community, including the challenge of obtaining access to primary healthcare, mental healthcare, and substancec abuse counseling. CNHC provides case management, outreach services, chronic disease management, supportive housing linkage, health education promotion, and prevention services, transportation services, ancillary serices, mental healthcare access, and substance abuse counseling. 770553 25627167 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 35 0 1 350 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DeWitt Harrell 6148591911 1800 Watermark Drive Ste 420 Columbus OH 43215 X Carole Anderson Chair 1.00 X X 0 0 0 Candi Pringle CHAIR-ELECT 1.00 X X 0 0 0 Jacqueline Downey Secretary 1.00 X X 0 0 0 Dewitt Harrell Treasurer 1.00 X X 0 0 0 Seleshi Asfaw TruSTEE 1.00 X 0 0 0 Mark Craddolph TRUSTEE 1.00 X 0 0 0 Kevin Dixon IMMEDIATE PAST CHAIR 1.00 X 0 0 0 David Ford TRUSTEE 1.00 X 0 0 0 Lawrence Halm TRUSTEE 1.00 X 0 0 0 SONIA JOHNSON-CAREY TRUSTEE 1.00 X 0 0 0 Roshelle Pate TRUSTEE 1.00 X 0 0 0 Ada Sanchez TRUSTEE 1.00 X 0 0 0 Samantha Shuler Trustee 1.00 X 0 0 0 Winifred Taylor TRUSTEE 1.00 X 0 0 0 Nancie Bechtel Ex-Officio Member 1.00 X 0 0 0 Charleta Tavares Chief Executive Officer 40.00 X 202111 0 15392 Ralph Reed Fraley Chief Operating Officer 32.00 X 146100 0 0 Aaron Clark Chief Medical Officer 36.00 X 203456 0 0 FIKRU NIGUSSE CFO (THROUGH MAY 2016) 40.00 X 64510 0 6206 TIM PATTON CFO (JULY TO DEC 2016) 40.00 X 50117 0 6639 Jeffrey Marable Director of OB/GYN 40.00 X 258250 0 38206 Sara Bazan Internal Medicine Physician 40.00 X 205270 0 16413 Sumit Sharma internal Medicine Physician 40.00 X 171184 0 32615 Preeti Agrawal Internal Medicine Physician 40.00 X 177529 0 15692 Gary Gillen Internal Medicine Physician 40.00 X 192764 0 12041 1671291 0 143204 28 0 1 0 Ohio Hispanic Coalition 6161 Busch Blvd Suite 311 Columbus OH 43229 INTERPRETATION Services 558353 Allscriptsmisys 8529 Six Forks Rd RALEIGH NC 27615 IT, EMR, & Management 399023 US PROTECTIONS SERVICE LLC 5785 EMPORIUM SQUARE COlumbus OH 43231 SECURITY 210479 OHIO STATE UNIVERSITY - FAMILY MEDICINE 2231 N HIGH STREET COLUmbus OH 43201 PHYSICIAN SERVICES 203456 Morally Excellent LLC PO Box 93 Hilliard OH 43026 Office Cleaning & Maintenance 141826 7 11408708 44436 11453144 PAtient Fees Revenue 621400 15101730 15101730 PHARMACY REVENUE 621400 4481418 4481418 RENTAL INCOME 621400 23264 23264 Miscellaneous Program Revenue 621400 972 972 19607384 2582 2582 OTHER EXEMPT PURPOSE REVENUE 621400 393161 393161 INCENTIVE FOR EHR 621400 335750 335750 728911 31792021 20336295 0 2582 694531 101728 592803 15031748 13304935 1726813 2575650 2004115 571535 1156195 968988 187207 9335 9335 40001 40001 2669209 2396612 272597 62634 41238 21396 632353 500773 131580 1594339 1386380 207959 63109 32024 31085 99419 15466 83953 298249 224025 74224 73217 44401 28816 Supplies 3447789 3418754 29035 Bad Debts 541954 541954 employee recruitment an 258696 45456 213240 Miscellaneous Patient C 124398 115998 8400 648567 484320 164247 30021393 25627167 4394226 0 5977529 7059018 655545 775031 1635067 2414322 173347 409041 3791008 2869527 848262 921481 10000 10000 162410 10000 9462160 11598893 1706991 2101846 28750 1735741 2101846 X 7726419 9497047 7726419 9497047 9462160 11598893 1770628 0 X X 0 1 X 1 1 1 X 10678284 11250060 11466912 11092641 11453144 55941041 10678284 11250060 11466912 11092641 11453144 55941041 55941041 11456 12401 5926 3622 2582 35987 84028 79611 552562 721135 752175 2189511 58166539 61572891 0.96170 0.99930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1446480 1242188 204292 2134455 1595748 538707 210073 31591 178482 921481 X 31732843 482776 -541954 -59178 31792021 0 31792021 29962215 482776 -541954 -59178 30021393 0 30021393 Part X, Line 2: PrimaryOne 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 PrimaryOne's tax-exempt purpose is subject to taxation as unrelated business income. PrimaryOne'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 PrimaryOne has determined it does not have unrelated business income subject to taxation. Part XI, Line 2d - Other Adjustments: Bad debt expense shown net of gross revenue -541,954. Part XII, Line 2d - Other Adjustments: Bad debt expense shown net of gross revenue -541,954. X X X 0 0 0 0 0 0 0 0 0 Charleta Tavares Chief Executive Officer 186961 0 15150 0 0 0 15392 0 0 0 217503 0 0 0 Aaron Clark Chief Medical Officer 189670 0 13786 0 0 0 0 0 0 0 203456 0 0 0 Jeffrey Marable Director of OB/GYN 238600 0 19650 0 0 0 20066 0 18140 0 296456 0 0 0 Sara Bazan Internal Medicine Physician 184620 0 20650 0 0 0 16413 0 0 0 221683 0 0 0 Sumit Sharma internal Medicine Physician 169714 0 1470 0 0 0 14717 0 17898 0 203799 0 0 0 Preeti Agrawal Internal Medicine Physician 176479 0 1050 0 0 0 15692 0 0 0 193221 0 0 0 Gary Gillen Internal Medicine Physician 174114 0 18650 0 0 0 12041 0 0 0 204805 0 0 0 Part I, Line 3 In determining compensation for the Chief Executive Officer, top management, and other key employees, the Columbus Neighborhood Health Center, Inc. uses comparative compensation information from other FQHC's and the local market. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an outside accounting firm. The Finance Committee, the Executive Board Committee, and/or the full Board of Directors then review the Form 990 and make a decision whether or not to accept the Form 990. A copy of the Form is given to the Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c Board members are required to sign a conflict of interest statement annually. Healthcare providers have the conflict of interest policy in their contracts, and the conflict of interest policy is available to all staff through the employee handbook. The conflict of interest policy is based on the honor system of notifying management if a conflict of interest exists. Form 990, Part VI, Section B, line 15 In determining compensation for the Chief Executive Officer, top management, and other key employees, the Columbus Neighborhood Health Center, Inc. uses comparative compensation information from other FQHC's and the local market. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. FORM 990, PART VII, SECTION A IN MARCH 2017, DEWITT HARRELL, THE ORGANIZATIONS FORMER BOARD TREASURER BECAME THE CHIEF FINANCIAL OFFICER. Form 990, Part XII, Line 2c: PROCESS HAS NOT CHANGED SINCE PRIOR YEAR. Neighborhood Health Network LLC 1800 Watermark Drive Ste 420 Columbus OH 43215 311533908 Healthcare OH 0 0 CNHC