CHARITABLE HEALTHCARE NETWORK INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
CHARITABLE HEALTHCARE NETWORK INC (EIN 22-3769296)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-05
IRS object ID
201513099349300026
Schema version
2014v5.0
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)
Return2015-11-05T14:21:36-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

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 E MAIN STREET SUITE 500AddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45502ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

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
Signature2015-11-03SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJESSE YOUNG CPAPreparerPersonNm
PTINP01236247PTIN
Phone9373992000PhoneNum
Preparation2015-10-20PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
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$874,347GrossReceiptsAmt
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 CLINCIS, TO BUILD A NETWORK AMONG FREE CLINICS AND TO BE AN ADVOCATE FOR FREE CLINICS AND THE PEOPLE THEY SERVE.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee24TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$511,879PYContributionsGrantsAmt
CY Contributions Grants$850,561CYContributionsGrantsAmt
PY Program Service Revenue$20,383PYProgramServiceRevenueAmt
CY Program Service Revenue$2,150CYProgramServiceRevenueAmt
PY Investment Income$122PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$200PYOtherRevenueAmt
CY Other Revenue$3,416CYOtherRevenueAmt
PY Total Revenue$532,584PYTotalRevenueAmt
CY Total Revenue$856,127CYTotalRevenueAmt
PY Grants And Similar Paid$393,592PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$386,805CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$115,960PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$377,727CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$11,536CYTotalFundraisingExpenseAmt
PY Other Expenses$49,610PYOtherExpensesAmt
CY Other Expenses$71,448CYOtherExpensesAmt
PY Total Expenses$559,162PYTotalExpensesAmt
CY Total Expenses$835,980CYTotalExpensesAmt
PY Revenues Less Expenses-$26,578PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$20,147CYRevenuesLessExpensesAmt
Total Assets BOY$373,607TotalAssetsBOYAmt
Total Assets EOY$297,380TotalAssetsEOYAmt
Total Liabilities BOY$227,777TotalLiabilitiesBOYAmt
Total Liabilities EOY$131,403TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$145,830NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$165,977NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED PEOPLE IN OHIO, TO STREGTHEN 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 SrvcYes (1)SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$386,805ExpenseAmt
Grant$386,805GrantAmt
Revenue$6,293RevenueAmt
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$308,269ExpenseAmt
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$62,915ExpenseAmt
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$757,989TotalProgramServiceExpensesAmt
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 ActivitiesYes (1)FundraisingActivitiesInd
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
Employee24EmployeeCnt
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 ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
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 Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
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 (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
KATHRYN CLARK RN
PRESIDENT5.00Yes (X)Yes (X)$0$0$0
ROBERT BAILY
VICE PRESIDENT5.00Yes (X)Yes (X)$0$0$0
JACK NEWTON MD
PAST 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
ANDREW MERRILL
TREASURER5.00Yes (X)Yes (X)$0$0$0
STEPHANIE BAILY CPA
DIRECTOR5.00Yes (X)$0$0$0
HEATHER BAIRD RN JD MPH
DIRECTOR5.00Yes (X)$0$0$0
MELISSA CANNEY
DIRECTOR5.00Yes (X)$0$0$0
LEE ELMORE
DIRECTOR5.00Yes (X)$0$0$0
ELAINE EWALD
DIRECTOR5.00Yes (X)$0$0$0
GERHARD H FEAGLES
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
ANN QUILLEN
DIRECTOR5.00Yes (X)$0$0$0
DEBORAH MILLER
EXECUTIVE DIRECTOR40.00Yes (X)$80,838$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$80,838TotalReportableCompFromOrgAmt
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$25,315MembershipDuesAmt
Government Grants$819,994GovernmentGrantsAmt
All Other Contributions$5,252AllOtherContributionsAmt
Total Contributions$850,561TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescEDUCATION EVENTDesc
Business900099BusinessCd
Total Revenue Column$2,150TotalRevenueColumnAmt
Related Or Exempt Func Income$2,150RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$2,150TotalProgramServiceRevenueAmt
Fundraising Gross Income$17,493FundraisingGrossIncomeAmt
Fundraising Direct Expenses$18,220FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$727TotalRevenueColumnAmt
Exclusion-$727ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$4,143TotalRevenueColumnAmt
Related Or Exempt Func Income$4,143RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,143OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$856,127TotalRevenueColumnAmt
Related Or Exempt Func Income$6,293RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$727ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$386,805TotalAmt
Program Services$386,805ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$80,838TotalAmt
Program Services$48,503ProgramServicesAmt
Management And General$28,293ManagementAndGeneralAmt
Fundraising$4,042FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$267,332TotalAmt
Program Services$267,332ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$29,557TotalAmt
Program Services$25,836ProgramServicesAmt
Management And General$3,254ManagementAndGeneralAmt
Fundraising$467FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,217TotalAmt
Management And General$7,217ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,074TotalAmt
Program Services$3,929ProgramServicesAmt
Fundraising$145FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$250TotalAmt
Program Services$250ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$7,800TotalAmt
Management And General$7,800ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$14,843TotalAmt
Program Services$10,669ProgramServicesAmt
Management And General$4,174ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,007TotalAmt
Program Services$1,866ProgramServicesAmt
Management And General$1,009ManagementAndGeneralAmt
Fundraising$1,132FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$420TotalAmt
Program Services$420ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
CONTRACT SERVICES$20,530$7,833$6,947$5,750
MISCELLANEOUS$4,487$4,487
EQUIPMENT$2,847$2,847
DUES AND SUBSCRIPTIONS$2,808$2,808

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,165TotalAmt
Program Services$1,699ProgramServicesAmt
Management And General$466ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$835,980TotalAmt
Program Services$757,989ProgramServicesAmt
Management And General$66,455ManagementAndGeneralAmt
Fundraising$11,536FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$132,986BOYAmt
EOY$44,654EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$115,676BOYAmt
EOY$115,676EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$123,380BOYAmt
EOY$131,902EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$650EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$9,455LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,957LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,565BOYAmt
EOY$4,498EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$373,607BOYAmt
EOY$297,380EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$218,289BOYAmt
EOY$118,810EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,488BOYAmt
EOY$12,593EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$227,777BOYAmt
EOY$131,403EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$145,830BOYAmt
EOY$165,977EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$145,830BOYAmt
EOY$165,977EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$373,607BOYAmt
EOY$297,380EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$20,147ReconcilationRevenueExpnssAmt
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$486,998CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$461,259CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$471,660CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$512,079CurrentTaxYearMinus1YearAmt
Current Tax Year$857,062CurrentTaxYearAmt
Total$2,789,058TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$63,442CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$43,181CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$18,158CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,383CurrentTaxYearMinus1YearAmt
Current Tax Year$17,285CurrentTaxYearAmt
Total$162,449TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$550,440CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$504,440CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$489,818CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$532,462CurrentTaxYearMinus1YearAmt
Current Tax Year$874,347CurrentTaxYearAmt
Total$2,951,507TotalAmt

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$2,951,507PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$415CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$74CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$507CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$122CurrentTaxYearMinus1YearAmt
Total$1,118TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$415CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$74CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$507CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$122CurrentTaxYearMinus1YearAmt
Total$1,118TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$550,855CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$504,514CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$490,325CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$532,584CurrentTaxYearMinus1YearAmt
Current Tax Year$874,347CurrentTaxYearAmt
Total$2,952,625TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99960PublicSupportCY509Pct
Public Support PY5090.99910PublicSupportPY509Pct
Investment Income CY0.00040InvestmentIncomeCYPct
Investment Income PY0.00090InvestmentIncomePYPct
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)
Political Expenditures$0PoliticalExpendituresAmt
Volunteer Hours0VolunteerHoursCnt
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
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$9,065OtherCostOrOtherBasisAmt
Depreciation$4,567DepreciationAmt
Book Value$4,498BookValueAmt

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$4,498TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescPAYROLL RELATED LIABILITIESDesc
Amt$12,593Amt
FieldValueIRS element (for citing)
Total Liability$12,593TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$487,542TotalRevEtcAuditedFinclStmtAmt
Other Revenue$18,220OtherRevenueAmt
Revenue Not Reported$18,220RevenueNotReportedAmt
Revenue Subtotal$469,322RevenueSubtotalAmt
Other Revenues Not Included$386,805OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$386,805RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$856,127TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$467,395TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$18,220OtherExpensesIncludedAmt
Expenses Not Reported$18,220ExpensesNotReportedAmt
Expenses Subtotal$449,175ExpensesSubtotalAmt
Other Expenses Not Included$386,805OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$386,805ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$835,980TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 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. THE ASSOCIATION'S OPEN AUDIT PERIODS ARE 2011 THROUGH 2013. 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 2D - OTHER ADJUSTMENTS:DIRECT FUNDRAISING EXPENSES 18,220.
PART XI, LINE 4B - OTHER ADJUSTMENTS:AMOUNTS DESIGNATED FOR MEMBER CLINICS 386,805.
PART XII, LINE 2D - OTHER ADJUSTMENTS:DIRECT FUNDRAISING EXPENSES 18,220.
PART XII, LINE 4B - OTHER ADJUSTMENTS:GRANTS DESIGNATED FOR MEMBER CLINICS 386,805.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1ANNUAL CONFERENCEEvent1Nm
Gross Receipts Event1$17,493GrossReceiptsEvent1Amt
Gross Revenue Event1$17,493GrossRevenueEvent1Amt
Rent Facility Costs Event1$16,459RentFacilityCostsEvent1Amt
Other Direct Expenses Event1$1,761OtherDirectExpensesEvent1Amt
Gross Receipts Total$17,493GrossReceiptsTotalAmt
Gross Revenue Total Events$17,493GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$16,459RentFcltyCostsTotalEventsAmt
Oth Direct Expnss Total Events$1,761OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$18,220DirectExpenseSummaryEventsAmt
Net Income Summary-$727NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (49 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxtAddress Line2USAddress/AddressLine2Txt
ASHLAND CHRISTIAN HEALTH CENTER
380 E 4TH STREETASHLANDOH44805421595274501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
ASIAN AMERICAN COMMUNITY SERVICES
2231 N HIGH STREET FIRST FLOORCOLUMBUSOH43201310898833501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
BELMONT COUNTY DIVISION OF WHEELING HEALTH RIGHT INC
61 29TH STREETWHEELINGWV26003311149085501(C)(3)$11,254TO PROVIDE SERVICES TO UNINSURED PATIENTS
BY THE WAY INC
1029 S BROAD STREETLANCASTEROH43130262934275501(C)(3)$6,314TO PROVIDE SERVICES TO UNINSURED PATIENTS
COLUMBUS FREE CLINIC
2231 N HIGH STREETCOLUMBUSOH43201010575698501(C)(3)$7,954TO PROVIDE SERVICES TO UNINSURED PATIENTS
LICKING COUNTY COMMUNITY HEALTH CLINIC
144 B W MAIN STREETNEWARKOH43055311340169501(C)(3)$6,290TO PROVIDE SERVICES TO UNINSURED PATIENTS
COMPASSION MEDICAL CLINIC OF WILLIAMS COUNTY
614 E EDGERTON STBRYANOH43506204352598501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
COMPASSIONATE CARE OF SHELBY COUNTY
PO BOX 4835SIDNEYOH45365208479583501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
FREE CLINIC OF CLINTON COUNTY
PO BOX 961WILMINTONGOH45177201109777501(C)(3)$6,315TO PROVIDE SERVICES TO UNINSURED PATIENTS
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS
GOOD NEIGHBOR HOUSE
627 E FIRST STREETDAYTONOH45402311374154501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
HEALTH PARTNERS OF MIAMI COUNTY
1300 N COUNTY ROAD 25ATROYOH45373311596731501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
HELPING HANDS HEALTH & WELLNESS CENTER
1420 MORSE ROADCOLUMBUSOH43229205937457501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
ISSO SEVA HEALTH CLINICS
13354 PEARL ROADSTRONGSVILLEOH44136203548724501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
JEFFERSON COUNTY 4TH STREET HEALTH CENTER
701 N 4TH STREETSTEUBENVILLEOH43952203924355501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
LAKE COUNTY FREE CLINIC
54 SOUTH STATE STREET SUITE 302PAINESVILLEOH44077341081191501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
LORAIN COUNTY FREE CLINIC INC
3323 PEARL AVENUELORAINOH44055341506180501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
MADISON COUNTY HEALTH PARTNERS
212 N MAIN STREET PO BOX 651LONDONOH43140202375865501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
MIDLOTHIAN FREE HEALTH CLINIC INC
388 E MIDLOTHIAN BLVDYOUNGSTOWNOH44507010887315501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
NEIGHBORHOOD CARE CENTER
17951 JEFFERSON PARK DRIVEMIDDLEBURG HEIGHTSOH44130340753531501(C)(3)$9,201TO PROVIDE SERVICES TO UNINSURED PATIENTS
NORTH COAST HEALTH MINISTRY
16110 DETROIT AVENUELAKEWOODOH44107341536257501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
OPPORTUNITY PARISH ECUMENICAL NEIGHBORHOOD MINISTRY FREE CLINIC
941 PRINCETON AVENUEAKRONOH44311341046107501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
OUCOM COMMUNITY HEALTH PROGRAMS - FREE CLINIC
105 RESEARCH AND TECHNOLOGY CENTERATHENSOH45701316402113501(C)(3)$8,910TO PROVIDE SERVICES TO UNINSURED PATIENTS
OXFORD COLLEGE CORNER CLINIC (DBA OXFORD FREE CLINIC)
PO BOX 390OXFORDOH45056204253386501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
PARMA HEALTH MINISTRY
7000 RIDGE ROADPARMAOH44129341754340501(C)(3)$6,314TO PROVIDE SERVICES TO UNINSURED PATIENTS
PHYSICIANS CARECONNECTION
1390 DUBLIN ROADCOLUMBUSOH43215311373719501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
REACH OUT OF MONTGOMERY COUNTY INC
25 E FORAKER STREETDAYTONOH45409311434282501(C)(3)$11,254TO PROVIDE SERVICES TO UNINSURED PATIENTS
THE BREATHING ASSOCIATION FREE LUNG HEALTH CLINIC
1520 OLD HENDERSON ROADCOLUMBUSOH432203639314387540501(C)(3)$11,254TO PROVIDE SERVICES TO UNINSURED PATIENTS
THE CLINIC AT FAITH MISSION
245 N GRANTCOLUMBUSOH43215314412586501(C)(3)$8,569TO PROVIDE SERVICES TO UNINSURED PATIENTS
TOLEDOLUCAS COUNTY CARENET INC
3231 CENTRAL PARK WEST DRIVE SUITETOLEDOOH43617431986672501(C)(3)$11,254TO PROVIDE SERVICES TO UNINSURED PATIENTS200
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS
TUSCARAWAS CLINIC FOR THE WORKING UNINSURED
420 REEVES AVENUE SUITE DDOVEROH44622208456793501(C)(3)$5,248TO PROVIDE SERVICES TO UNINSURED PATIENTS
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS
VINEYARD FREE HEALTH CLINICS
6000 COOPER ROADWESTERVILLEOH43081753210233501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
VINEYARD COMMUNITY CENTER
15187 PALMER ROADETNAOH43068310954398501(C)(3)$6,317TO PROVIDE SERVICES TO UNINSURED PATIENTS
VIOLA STARTZMAN FREE CLINIC
1874 CLEVELAND ROADWOOSTEROH44691341758151501(C)(3)$11,934TO PROVIDE SERVICES TO UNINSURED PATIENTS
WASHINGTON COUNTY FREE CLINIC
PO BOX 804MARIETTAOH45750452512931501(C)(3)$7,216TO PROVIDE SERVICES TO UNINSURED PATIENTS
WESTERN STARK MEDICAL CLINIC
820 AMHERST ROAD NEMASSILLONOH44646341887206501(C)(3)$11,254TO PROVIDE SERVICES TO UNINSURED PATIENTS
XENOS FREE CLINICS
3434 STONEVISTA LANECOLUMBUSOH43221310996318501(C)(3)$6,314TO PROVIDE SERVICES TO UNINSURED PATIENTS
HARTVILLE MIGRANT COUNCIL
PO BOX 682HARTVILLEOH44632340899100501(C)(3)$6,290TO PROVIDE SERVICES TO UNINSURED PATIENTS
LIVING WELL CLINIC
215 S ALLISON AVE PO BOX 15XENIAOH45385274307745501(C)(3)$6,314TO PROVIDE SERVICES TO UNINSURED PATIENTS
MEDINA HEALTH MINISTRY
970 E WASHINGTON STREET SUITE 104MEDINAOH44256300092944501(C)(3)$7,240TO PROVIDE SERVICES TO UNINSURED PATIENTS
PREGNANCY SUPPORT CENTER OF STARK COUNTY
4500 22ND ST NWCANTONOH44706341461765501(C)(3)$9,068TO PROVIDE SERVICES TO UNINSURED PATIENTS
VICTORY MINISTRIES
4142 WESTERVILLE ROADCOLUMBUSOH43224311117522501(C)(3)$6,315TO PROVIDE SERVICES TO UNINSURED PATIENTS
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS
TRIHEALTH
619 OAK STREETCINCINNATIOH45206311438846501(C)(3)$5,466TO PROVIDE SERVICES TO UNINSURED PATIENTS
(no name)
TO PROVIDE SERVICES TO UNINSURED PATIENTS

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 2DURING FISCAL YEAR 2015, THE ASSOCIATION RECEIVED A FEDERAL GRANT TO EMPLOY VISTA EMPLOYEES AT MEMBER CLINICS. THE VISTA EMPLOYEES PROVIDE SERVICES TO STRENGTHEN AND SUPPLEMENT EFFORTS TO ELIMINATE POVERTY AND POVERTY-RELATED HUMAN, SOCIAL, AND ENVIRONMENTAL PROBLEMS.
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 11BOARD 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 WILL RESEARCH AND DOCUMENT THEIR DELIBERATIONS REGARDING COMPENSATION FOR THE EXECUTIVE DIRECTOR AND EMPLOYEES.
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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