2017-08-08T07:30:51-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2016-01-01 571092940 AFFINITY HEALTH CENTER AFFI 8039096363 500 LAKESHORE PARKWAY ROCK HILL SC 29730 ANITA CASE EXECUTIVE DIRECTOR 8039096363 2017-06-23 1 JOHN NORMAN P01506766 7049985200 2017-06-23 67.137.57.251 2017-06-23 09:33:44 ED P 6F636B89A86A9A682028BE6E9BC328246B976532 3C485677A447CDC9C2378483A7D05D1EA93E43C8 2016 2021-01-29 14:40:06Z ANITA CASE 500 LAKESHORE PARKWAY ROCK HILL SC 29730 9286432 0 X AFFINITYHEALTHCENTER.ORG X 2000 SC TO PROVIDE HIGH-QUALITY COMPREHENSIVE HEALTHCARE WITH COMPASSION, DIGNITY AND RESPECT. 13 13 63 42 0 0 2327979 3403356 309030 5862431 743 637 2707967 -1764 5345719 9264660 599217 666312 0 0 1844830 2401470 0 0 8670 1643558 4397200 4087605 7464982 1258114 1799678 10670683 12916825 505933 794270 10164750 12122555 TO SERVE THE HEALTHCARE NEEDS OF OUR COMMUNITY BY PROVIDING ACCESS TO HIGH-QUALITY, COMPREHENSIVE CARE WITH COMPASSION, DIGNITY AND RESPECT. 0 0 5682845 596009 5865679 MEDICAL CARE IS PROVIDED IN A DIGNIFIED, COMPASSIONATE MANNER. WITH ACCESS TO QUALITY CARE, PATIENTS CAN LIVE LONGER AND HEALTHIER LIVES. MEDICAL SERVICES AT AFFINITY HEALTH CENTER INCLUDE 1) PRIMARY CARE; 2) HIV SPECIALITY CARE; 3) ORAL HEALTH CARE; 4) BEHAVIORAL HEALTH SERVICES; 5) PHLEMOTOMY/LABORATORY SERVICES; 6) NUTRITIONAL COUNSELING; AND 7) SPECIALTY CARE REFERRALS. AHC MEDICAL SERVICES ARE PROVIDED WITHOUT REGARD FOR ABILITY TO PAY AND CHARGES ARE BASED ON A SLIDING FEE SCALE. 788826 70283 SUPPORT SERVICES ARE INTENDED TO HELP PATIENTS ENGAGE IN AND REMAIN ENGAGED IN MEDICAL TREATEMENT AND TO ASSIST THEM WITH REDUCING ANY BARRIERS TO CARE. SERVICES INCLUDE 1) MEDICAL CASE MANAGEMENT; 2) HEALTH EDUCATION; 3) OUTREATCH TO THOSE OUT OF CARE; 4) EDUCATIONAL AND THERAPEUTIC SUPPORT GROUPS; 5) REFERRAL SERVICES AND ASSISTANCE WITH ACCESSING PUBLIC BENEFITS; 6) HOUSING SERVICES; 7) TRANSPORTATION ASSISTANCE TO MEDICAL APPOINTMENTS; AND 8) INTERPRETING SERVICES. ALL SUPPORT SERVICES ARE PROVIDED AT NO COST TO THE PATIENT. 361148 20 AFFINITY HEALTH CENTER PROVIDES HEALTH EDUCATION SERVICES TO THE COMMUNITY WHICH INCLUDE INFORMATION ABOUT HIV AND OTHER SEXUALLY TRANSMITTED DISEASES. IN ADDITION, AHC PROVIDES FREE, CONFIDENTIAL, RAPID (20 MINUTE) HIV AND HEPATITIS C SCREENING AS WELL AS FREE SCREENING FOR OTHER SEXUALLY TRANSMITTED DISEASES. ADDITIONALLY, AFFINITY HEALTH CENTER HAS A PEER PROGRAM THAT UTILIZES PEOPLE LIVING WITH HIV/AIDS TO PROVIDE SUPPORT TO OTHERS LIVING WITH THIS DISEASE AND A VOLUNEER PROGRAM TO ENGAGE COMMUNITY MEMBERS IN SERVICE TO OTHERS. ALL PREVENTION SERVICES ARE PROVIDED AT NO COST TO THE RECIPIENT. 6832819 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 76 0 1 63 1 0 0 0 0 0 1 1 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 SC X X X BRYAN C MARTIN 8039096363 500 LAKESHORE PARKWAY ROCK HILL SC 29730 MAURICE REVELL BOARD CHAIR 1.00 X X 0 0 0 JENNIFER MCDANIEL BOARD VICE-CHAIR 1.00 X X 0 0 0 MELISSA CASSELL TREASURER 1.00 X X 0 0 0 JANICE CHISM SECRETARY 1.00 X X 0 0 0 LECLAIR BOONE DIRECTOR 1.00 X 0 0 0 JOANN DEBOE-WILSON DIRECTOR 1.00 X 0 0 0 NINA FEEMSTER DIRECTOR 1.00 X 0 0 0 STEVEN MCLAREN DIRECTOR 1.00 X 0 0 0 BIANCA PRESCOTT DIRECTOR 1.00 X 0 0 0 MIGUEL RULLAN DIRECTOR 1.00 X 0 0 0 AUSTIN WANG DIRECTOR 1.00 X 0 0 0 TAMMY WELLS DIRECTOR 1.00 X 0 0 0 KAREN WORTHY DIRECTOR 1.00 X 0 0 0 ANITA CASE EXECUTIVE DIRECTOR 40.00 X 107543 0 4564 BRYAN MARTIN FINANCE DIRECTOR 40.00 X 80957 0 4351 188500 0 8915 1 0 0 0 LABORATORY CORPORATION OF AMERICA PO BOX 2270 BURLINGTON NC 27216 MEDICAL LAB SERVICES 229802 RPA DESIGN PC 5960 FAIRVIEW ROAD SUITE 500 CHARLOTTE NC 28210 ARCHITECTURE AND ENGINEERING SERVICES 181223 BARTON & ASSOCIATES INC 300 JUBILEE DRIVE PEABODY MA 01960 LOCUM TENENS SERVICES 144343 SERVCOM USA LLC 3284 LAKE WYLIE DRIVE ROCK HILL SC 29730 INFORMATION TECHNOLOGY SERVICES 121060 4 37625 41625 3115442 208664 40796 3403356 340B PHARMACY REVENUE 624100 5418883 5418883 PATIENT SERVICE REVENU 624100 443548 443548 5862431 637 637 16760 41625 21772 -5012 -5012 OTHER REVENUE 624100 3248 3248 3248 9264660 5865679 0 -4375 666312 666312 188500 80372 108128 1874944 1620792 248173 5979 173138 142014 30550 574 164888 136006 28397 485 23800 23800 13383 13383 137985 129968 8008 9 17753 3239 14513 1 78151 66416 11549 186 201019 175568 24691 760 65399 56270 8951 178 58868 37659 21208 1 52995 30396 22579 20 73955 62263 11485 207 29817 23020 6682 115 PHARMACEUTICALS 2295810 2295810 340B PROGRAM SERVICES 566080 566080 LAB SERVICES 245992 245992 PHYSICIAN ON SITE 185848 185848 350345 308794 41396 155 7464982 6832819 623493 8670 7958139 6429880 1050866 1437349 334034 503750 23111 21908 48722 66610 2162804 350221 1255811 1812583 2644745 10670683 12916825 505933 794270 505933 794270 X 10105934 12121647 58816 908 10164750 12122555 10670683 12916825 1799678 158127 0 X X 0 1 X 1 1 1 X 2025899 1993139 2369257 2327979 3403356 12119630 9000 20550 29550 2025899 1993139 2369257 2336979 3423906 12149180 12149180 1113 491 612 743 637 3596 2445 3248 5693 12158469 21174347 0.99920 0.99930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 439126 439126 1119999 190087 929912 65772 4750 61022 260144 155384 104760 277763 277763 1812583 X 9337127 73104 73104 9264023 637 637 9264660 7538086 73104 73104 7464982 0 7464982 PART X, LINE 2: AFFINITY HEALTH CENTER HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, INCOME EARNED IN FURTHERANCE OF ITS TAX-EXEMPT PURPOSE IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. ANY ACTIVITIES NOT DIRECTLY RELATED TO ITS TAX-EXEMPT PURPOSE ARE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. MANAGEMENT IS NOT AWARE OF ANY MATERIAL UNCERTAIN TAX POSITIONS AND NO LIABILITY HAS BEEN RECOGNIZED AT DECEMBER 31, 2016. IF APPLICABLE, INTEREST AND PENALTIES ASSOCIATED WITH TAX UNCERTAINTIES ARE CLASSIFIED AS ADDITIONAL INCOME TAXES IN THE STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 637. DAZZLE & DENIM 58385 42625 15760 1975 12062 900 6835 58385 42625 15760 1975 12062 900 6835 21772 -6012 1 OFF-SITE SPECIALTY CARE VISITS 209 97084 FMV MEDICATIONS 225 39714 FMV INSURANCE PREMIUMS/COPAYS 268 438406 FMV MEDICAL SUPPLIES 89 20685 FMV HOUSING 16 11413 FMV TRANSPORTATION 304 25289 FMV FOOD ASSISTANCE, TRANSLATOR SERVICES, OTHER ASSISTANCE 216 33721 FMV PART I, LINE 2: AFFINITY HEALTH CENTER PROVIDES ASSISTANCE TO CLIENTS BASED ON NEED FOR EXPENSES SUCH AS SPECIALTY CARE, MEDICATIONS, HOUSING, INSURANCE PREMIUMS, EMERGENCY FOOD, AND TRANSPORTATION TO MEDICAL APPOINTMENTS. PAYMENTS ARE MADE DIRECTLY TO OUTSIDE SERVICE PROVIDERS RATHER THAN TO CLIENTS. AHC REQUIRES SUPERVISORY APPROVAL OF ALL PAYMENT REQUESTS. THE FINANCE DEPARTMENT VERIFIES APPROPRIATE DOCUMENTATION IS SUBMITTED FOR EXPENDITURES. PRIOR TO SIGNING CHECKS, THE EXECUTIVE DIRECTOR REVIEWS ALL DOCUMENTATION TO ENSURE APPROPRIATE USE OF FUNDS. AN OFFICER OF THE BOARD OF DIRECTORS SIGNS OFF ON ANY PAYMENTS OVER $5,000. SERVCOM USA LLC ENTITY CO-OWNED BY SON OF DIRECTOR, JANICE CHISM 185421 ENTITY PROVIDED INFORMATION TECHNOLOGY SERVICES AND EQUIPMENT 0 X IT EQUIPMENT AND SOFTWARE 1 24150 FMV OF EQUIPMENT AND X PROGRAM SUPPLIES 13 16646 COST 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S FORM 990 IS GIVEN ANNUALLY TO THE ENTIRE BOARD IN ITS ENTIRETY FOR REVIEW AND FORMAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C AFFINITY HEALTH CENTER (AHC) HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED WITH NEW BOARD MEMBERS DURING BOARD ORIENTATION. AT THAT TIME BOARD MEMBERS INDICATE IN WRITING ANY CONFLICTS OF INTEREST WITH AHC. OFFICERS AND DIRECTORS ARE REQUIRED TO DISCLOSE ON AN ANNUAL BASIS ANY POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 AFFINITY HEALTH CENTER (AHC) HIRED AN INDEPENDENT HUMAN RESOURCES CONSULTANT IN 2014 TO CONDUCT A SALARY SURVEY AND RECOMMEND SALARY RANGES FOR ALL POSITIONS INCLUDING THE EXECUTIVE DIRECTOR. IN 2014 AHC'S BOARD OF DIRECTORS APPROVED THE REVISED RANGES. THE FULL BOARD IS RESPONSIBLE FOR THE ANNUAL PERFORMANCE REVIEW OF THE EXECUTIVE DIRECTOR, INCLUDING DETERMINATION OF ANNUAL COMPENSATION ADJUSTMENTS. AFFINITY HEALTH CENTER (AHC) HIRED AN INDEPENDENT HUMAN RESOURCES CONSULTANT IN 2014 TO CONDUCT A SALARY SURVEY AND RECOMMEND SALARY RANGES FOR ALL POSITIONS INCLUDING THE EXECUTIVE DIRECTOR. IN 2014 AHC'S BOARD OF DIRECTORS APPROVED THE REVISED RANGES. THE ANNUAL PERFORMANCE REVIEWS FOR OTHER OFFICERS OR KEY EMPLOYEES IS CONDUCTED IN ACCORDANCE WITH AHC POLICY BY APPROPRIATE SUPERVISOR. DETERMINATION OF ANNUAL COMPENSATION ADJUSTMENTS WITHIN APPROVED RANGES IS DETERMINED BY THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 AFFINITY HEALTH CENTER PROVIDES THESE DOCUMENTS TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR FORM 990, PART I, LINES 9 AND 11 REVENUE GENERATED FROM PARTICIPATION IN THE 340B DRUG PROGRAM HAS BEEN RECLASSIFIED FOR THE CURRENT YEAR (AND GOING FORWARD) FROM OTHER REVENUE TO PROGRAM SERVICE REVENUE. FOR CONSISTENCY WITH THE NUMBERS REPORTED IN THE PRIOR YEAR RETURN, WE HAVE NOT RECLASSIFIED THE NUMBERS IN THE PRIOR YEAR COLUMN.