2016-01-13T15:06:28-06:00 2015-06-30 310800053 CLARK SCHAEFER HACKETT & CO 14 E MAIN STREET SUITE 500 SPRINGFIELD OH 45502 990 2014-07-01 311181991 COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION COMM 9375237000 200 MEDICAL CENTER DRIVE SPRINGFIELD OH 45504 JOY A ROGERS EXECUTIVE DIRECTOR 9375237000 2016-01-11 1 DARRIN SPITZER P01399907 9373992000 2016-01-11 2014 2016-04-25 22:37:26Z COMMUNITY HEALTH FOUNDATION JOY A ROGERS 200 MEDICAL CENTER DRIVE SPRINGFIELD OH 45505 166304 0 X WWW.COMMUNITY-HEALTH-FOUNDATION.ORG X 1986 OH TO PRESERVE REPRODUCTIVE SERVICES, TO PROMOTE HEALTH AND WELLNESS AND TO ADVOCATE FOR QUALITY HEALTHCARE THROUGH GRANT MAKING AND EDUCATION. 15 15 39 40 0 0 96842 96639 0 0 333996 0 47802 69665 478640 166304 68164 125500 0 0 141637 146363 0 0 22959 371658 432867 581459 704730 -102819 -538426 21999001 22523806 124781 45718 21874220 22478088 X TO PRESERVE REPRODUCTIVE SERVICES, TO PROMOTE HEALTH AND WELLNESS AND TO ADVOCATE FOR QUALITY HEALTHCARE THROUGH GRANT MAKING AND EDUCATION. 0 0 170703 0 0 REPRODUCTIVE HEALTH EDUCATION AND INFORMATION:THROUGH ITS REPRODUCTIVE HEALTH EDUCATION, CHF PROVIDED COMPREHENSIVE SEXUALITY EDUCATION PROGRAMS TO MIDDLE AND HIGH SCHOOL YOUTH USING TRAINED AND CERTIFIED HEALTH EDUCATORS, SERVING 1,536 STUDENTS AT 9 DIFFERENT VENUES. THE PURPOSE OF THIS EDUCATION IS TO IMPROVE ADOLESCENT SEXUAL HEALTH BY REDUCING THE INCIDENCE OF RISK ]TAKING SEXUAL BEHAVIORS IN TEENS, LOWERING UNPLANNED PREGNANCY RATES AND REDUCING THE NUMBER OF SEXUALLY TRANSMITTED INFECTIONS. CHF ALSO COORDINATES THE PREP (PERSONAL RESPONSIBILITY EDUCATION PROGRAM) PROGRAM IN CLARK, CHAMPAIGN, GREENE AND LOGAN COUNTIES. THE PREP PROGRAM IS PRESENTED TO YOUTH IN FOSTER CARE AND ADJUDICATED YOUTH AND CONTAINS 19 MODULES FEATURING INFORMATION ON DAILY LIVING SKILLS, FINANCIAL LITERACY AND HEALTHY RELATIONSHIP SKILLS TO INCLUDE COMPREHENSIVE SEXUAL EDUCATION AMONG OTHER TOPICS. 125500 125500 0 COMMUNITY GRANT PROGRAM:CHF PROVIDES SUPPORT TO NON-PROFIT ORGANIZATIONS THROUGH ITS COMMUNITY GRANTS PROGRAM, INITIATED IN FYE 6/30/15. GRANT FUNDS ARE DIRECTED TO PROJECTS AND INITIATIVES THAT SUPPORT AND PROMOTE: HEALTHY LIVING, REPRODUCTIVE HEALTH, HEALTHY RELATIONSHIPS AND MENTAL AND EMOTIONAL HEALTH. GRANT FUNDS WERE PROVIDED TO 25 ORGANIZATIONS DURING FYE JUNE 30, 2015. 81287 0 FAMILY HEALTH EDUCATION:CHF DISTRIBUTED OVER 5,500 COPIES OF ITS HEALTH RESOURCE GUIDE FOR CLARK AND CHAMPAIGN COUNTIES TO THE GENERAL PUBLIC AND SOCIAL SERVICE OR HEALTH AGENCIES THAT SERVE THE PUBLIC. THERE IS NO CHARGE FOR THIS PUBLICATION. THE GUIDE WAS ALSO MAINTAINED AND UPDATED ON OUR WEBSITE AND IS SEARCHABLE AND DOWNLOADABLE. CHF CONTINUED ITS FREE FAMILY HEALTH EDUCATION PROGRAM AND AN INTERACTIVE PUBLIC HEALTH EXPO WAS HELD DURING FYE JUNE 30, 2015, "HEALTHY FAMILIES '14". THIS EVENT FEATURES "TALK WITH A DOC" SESSIONS, EXHIBITS, DEMONSTRATIONS, AND HEALTH SCREENINGS; APPROXIMATELY 400 PERSONS ATTENDED THIS HEALTH AND WELLNESS EDUCATIONAL EVENT. CHF ALSO PARTICIPATES IN MANY HEALTH FAIRS AND EXPOS PROVIDING "MY PLATES" TO ELEMENTARY AGED CHILDREN TO PROMOTE HEALTHY EATING HABITS AND PORTION CONTROL. ADDITIONALLY, CHF PRODUCED AND DISTRIBUTED A "HEALTHY DINING GUIDE" WITH INFORMATION ON HEALTHIER MENU CHOICES AT AREA RESTAURANTS. 154446 CHF PROVIDES CLINICAL REPRODUCTIVE SERVICES IN ITS PAVILION TO INCLUDE TUBAL LIGATIONS, VASECTOMIES AND CONTRACEPTIVE SHOTS. 154446 531936 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 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 1 0 0 0 1 14 0 1 39 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JOY A ROGERS 9375237000 200 MEDICAL CENTER DRIVE SPRINGFIELD OH 45505 JAMES F PEIFER CHAIR 2.00 X X 0 0 0 ROBYN KOCH-SCHUMAKER VICE CHAIR 1.00 X X 0 0 0 STEPHEN NEELY TREASURER 1.00 X X 0 0 0 CATHRYN S BALAS SECRETARY 1.00 X X 0 0 0 DARRELL KITCHEN TRUSTEE 1.00 X 0 0 0 ELILLIAN DAUGHERTY MD TRUSTEE 1.00 X 0 0 0 SHAWN S OSTERHOLT MD TRUSTEE 1.00 X 0 0 0 SHEILA RICE TRUSTEE 1.00 X 0 0 0 TED VANDER ROEST TRUSTEE 1.00 X 0 0 0 MARK ELLIOTT TRUSTEE 1.00 X 0 0 0 RANDALL COMER TRUSTEE 1.00 X 0 0 0 MARIA GOESER TRUSTEE 1.00 X 0 0 0 ANNE HOLTZ TRUSTEE 1.00 X 0 0 0 STEPHANIE MCCUISTION TRUSTEE 1.00 X 0 0 0 ERIC ESPINOSA MD TRUSTEE 1.00 X 0 0 0 JOY A ROGERS EXECUTIVE DIRECTOR 40.00 X 93354 0 0 93354 0 0 0 0 0 0 ROCKING HORSE CENTER 651 S LIMESTONE STREET SPRINGFIELD OH 45505 LEASED EMPLOYEES 198922 COMMUNITY MERCY HEALTH PARTNERS 100 MEDICAL CENTER DR SPRINGFIELD OH 45504 EQUIPMENT MAINTENANCE 138937 2 96639 96639 61114 0 61114 61114 61114 OTHER INCOME 621400 8551 8551 8551 166304 8551 0 61114 125500 125500 96263 38505 38505 19253 49678 27306 22372 422 422 66343 53074 13269 8919 8919 32440 32440 36497 32792 3705 27556 20438 5860 1258 6846 4631 919 1296 14467 10428 3642 397 122074 114831 6488 755 23952 15898 8054 PROGRAM EXPENSE 39048 39048 MARKETING/WEB MANAGEMEN 17614 17614 OTHER EXPENSE 15793 10131 5662 MEDICAL SUPPLIES 15246 15246 6072 6072 704730 531936 149835 22959 491308 590726 10186 24830 25038 22914 4027220 524606 3560477 3502614 17797144 18268382 114848 114340 21999001 22523806 124781 45718 124781 45718 X 21106459 21704060 767761 774028 21874220 22478088 21999001 22523806 X -538426 1142294 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 496138 24142 12101 508179 456214 70654 30730 496138 433953 10700 25713 14152 456214 428052 12841 21638 28578 433953 407486 8682 20450 8566 428052 0.38810 0.00000 0.61190 0 0 350000 109180 459180 1016099 1972923 205974 2783048 579018 318632 260386 3502614 BENEFICIAL INTEREST IN FUND HELD BY SPRINGFIELD 18268382 F 18268382 X 1308598 1142294 1142294 166304 0 166304 704730 0 704730 0 704730 PART V, LINE 4: TO PROVIDE CLINICAL SERVICES, PRIMARY REPRODUCTIVE HEALTH SERVICES AND OTHER HEALTH SERVICES NOT PROVIDED BY COMMUNITY MERCY HEALTH PARTNERS AND PROVIDE REPRODUCTIVE HEALTH AND WOMEN'S HEALTH EDUCATION AND INFORMATION. PART X, LINE 2: THE FOUNDATION HAS ADOPTED ACCOUNTING RULES THAT PRESCRIBE WHEN TO RECOGNIZE, AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN, OR EXPECTED TO BE TAKEN, ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE FOUNDATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON ITS REVIEW, MANAGEMENT DOES NOT BELIEVE THE FOUNDATION HAS TAKEN ANY MATERIAL UNCERTAIN TAX POSITIONS, INCLUDING ANY POSITION THAT WOULD PLACE THE FOUNDATION'S TAX EXEMPT STATUS IN JEOPARDY AS OF JUNE 30, 2015. THE FOUNDATION BELIEVES THEY ARE NO LONGER SUBJECT TO INCOME EXAMINATIONS FOR FISCAL YEARS PRIOR TO 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN FUNDS HELD BY SPRINGFIELD FOUNDATION PART XII, LINE 2D - OTHER ADJUSTMENTS: OTHER 0 BIG BROTHERS BIG SISTERS 625 BURT ST SPRINGFIELD OH 45505 310955969 501(C)(3) 10000 CAMP OTY'OKWA GRANT CATHOLIC CHARITIES 701 E COLUMBIA ST SPRINGFIELD OH 45503 310536968 501(C)(3) 10000 "PAVING" THE ROAD TO GOOD HEALTH COMMUNITY MERCY FOUNDATION 100 W MCCREIGHT SPRINGFIELD OH 45504 311443778 501(C)(3) 8949 MED ASSIST ROCKING HORSE COMMUNITY HEALTH 1 E PLEASANT ST SPRINGFIELD OH 45506 311593544 501(C)(3) 8750 SCREENING INCENTIVE PROGRAMS RECOVERY ZONE PO BOX 765 WEST LIBERTY OH 43357 311576428 501(C)(3) 7500 WELLNESS MANAGEMENT & RECOVERY COMMUNITY MERCY MED ASSIST 30 W MCCREIGHT AVE SPRINGFIELD OH 45504 311443778 501(C)(3) 7126 MED ASSIST PRESCRIPTION ASSISTANCE PROGRAM ON-THE-RISE FARMS 4177 DIALTON ROAD SPRINGFIELD OH 45502 043750441 501(C)(3) 7000 OPERATING EXPENSES PROJECT WOMAN 525 EAST HOME ROAD SPRINGFIELD OH 45503 237391095 501(C)(3) 7000 ALL READY AND PAVE PROGRAM DEAF COMMUNITY RESOURCE CENTER 3323 STANLEY AVE DAYTON OH 45404 205202136 501(C)(3) 6000 DEAF COMMUNITY HEALTHIER LIVING SPRIGFIELD CHRISTIAN YOUTH MINISTRIES 1500 BROADWAY ST SPRINGFIELD OH 45504 311623059 501(C)(3) 7000 GIRL POWER, AFTER SCHOOL PROGRAM 10 10 FORM 990, PART VI, SECTION B, LINE 11 IN THE EVENT THERE IS NOT A TIMELY BOARD MEETING FOR CONTEMPORANEOUS REVIEW, FORM 990 IS FORWARDED VIA ELECTRONIC MAIL OR U.S. MAIL TO EACH BOARD MEMBER FOR HIS/HER REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990 IS ALSO REVIEWED AND DISCUSSED BY THE EXECUTIVE COMMITTEE AND/OR THE FINANCE COMMITTEE PRIOR TO FILING. BOTH COMMITTEES HAVE AUTHORITY TO ACT ON BEHALF OF THE BOARD TO DIRECT THE EXECUTIVE DIRECTOR TO SIGN AND TO FILE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C CHF REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY: 1) EACH PERSON NOMINATED TO THE BOARD OF TRUSTEES COMPLETES A CONFLICTS OF INTEREST DISCLOSURE CERTIFICATE; 2) ANNUALLY BY FEBRUARY 15, EACH TRUSTEE COMPLETES A CONFLICTS OF INTEREST DISCLOSURE CERTIFICATE; 3) A SUMMARY OF ALL CONFLICTS DISCLOSED BY TRUSTEES IS DISTRIBUTED TO ALL TRUSTEES AT THE APRIL QUARTERLY MEETING; 4) TRUSTEES WITH A CONFLICT RELATIVE TO SPECIFIC ITEMS OF DELIBERATION ARE ADVISED BY THE CHAIR TO REFRAIN FROM DISCUSSION AND VOTING OR ARE EXCUSED FROM THE MEETING IF THE CONFLICT IS MATERIAL; 5) THE CONTEMPORANEOUS MINUTES OF THE MEETING REFLECT THE NATURE OF THE CONFLICT AND THE FACT THAT THE MEMBER DID NOT PARTICIPATE IN DISCUSSION OR VOTING ON THE ITEM UNDER DELIBERATION. FORM 990, PART VI, SECTION B, LINE 15A A COMPENSATION COMMITTEE OF 3-4 DISINTERESTED MEMBERS OF THE BOARD OF TRUSTEES IS APPOINTED BY THE CHAIRMAN OF THE BOARD. PROGRESS REPORT ON CEO GOALS IS REVIEWED, PERFORMANCE REVIEW SCORE SHEETS ARE COMPLETED INDIVIDUALLY BY MEMBERS, AND CEO PERFORMANCE IS REVIEWED AND COMPENSATION DETERMINED DURING A MEETING OF THE WHOLE COMMITTEE. COMPENSATION IS SET TAKING INTO ACCOUNT PERFORMANCE (MERIT) AND MARKET RANGES FOR SIMILAR POSITIONS. THERE ARE NO OTHER OFFICERS OR KEY EMPLOYEES RECEIVING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 MOST RECENT FORM 990 PLUS PRIOR TWO FISCAL YEARS' 990S ARE POSTED ON COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION WEBSITE. REQUESTS FOR A COPY OF THE FORM 990 FOR ANY FISCAL YEAR MAY BE MADE BY TELEPHONE, ELECTRONIC MAIL, U.S. MAIL OR IN PERSON. REQUESTS WILL BE HONORED WITHIN 5 WORKING DAYS. A NOMINAL CHARGE TO COVER THE COST OF COPYING MAY BE MADE. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS MAY BE REQUESTED BY TELEPHONE, ELECTRONIC MAIL, U.S. MAIL OR IN PERSON; REQUESTS WILL BE HONORED WITHIN 5 WORKING DAYS. A NOMINAL CHARGE MAY BE MADE. AUDITED ANNUAL FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION WEBSITE. FORM 990, PART XI, LINE 9: SEE SCHEDULE D 1,142,294. PART XI LINE 2C COMMUNITY HOSPITAL HEALTH SERVICES FOUNDATION HAS NOT CHANGED ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. COMMUNITY MERCY HEALTH SYSTEM 1 S LIMESTONE ST SPRINGFIELD OH 45502 300272454 COMMUNITY HEALTH SYSTEM OH 501(C)(3) LINE 3 N/A 0 COMMUNITY MERCY HEALTH PARTNERS 1 S LIMESTONE ST SPRINGFIELD OH 45501 310785684 COMMUNITY HEALTH SYSTEM OH 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0