CHARITABLE HEALTHCARE NETWORK INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHARITABLE HEALTHCARE NETWORK INC (EIN 22-3769296)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201323189349304672
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T14:03:11-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310800053 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK SCHAEFER HACKETT & CO | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 E MAIN STREET SUITE 500 | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45502 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 223769296 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OHIO ASSOCIATION OF FREE CLINICS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | OHIO | NameControl |
| Phone | 6149950485 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 37 WEST BROAD STREET NO 350 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEBORAH MILLER | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 6149950485 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEVESH KAMAL | Name |
| PTIN | P00201226 | PTIN |
| Phone | 9373992000 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | DEBORAH MILLER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 37 WEST BROAD STREET NO 350 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 490325 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.OHIOFREECLINICS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 461259 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 471660 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 42211 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 18158 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 11 | InvestmentIncomePriorYear |
| Investment Income Current Year | 507 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 970 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 504451 | TotalRevenuePriorYear |
| Total Revenue Current Year | 490325 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 393605 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 393592 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 58158 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 4065 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 106329 | OtherExpensePriorYear |
| Other Expenses Current Year | 48773 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 499934 | TotalExpensesPriorYear |
| Total Expenses Current Year | 500523 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4517 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -10198 | RevenuesLessExpensesCY |
| Total Assets BOY | 281004 | TotalAssetsBOY |
| Total Assets EOY | 375558 | TotalAssetsEOY |
| Total Liabilities BOY | 98398 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 203150 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 182606 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 172408 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 457851 | Expense |
| Grants | 393592 | Grants |
| Revenue | 18158 | Revenue |
| Description | COLLECT 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. | Description |
| Total Program Service Expense | 457851 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 2 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEBORAH MILLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6149950485 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 37 WEST BROAD STREET NO 350 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| JOHN MORITZ | ||||||
| PRESIDENT | 5.00 | X | X | 0 | 0 | 0 |
| STEPHANIE BAILY CPA | ||||||
| TREASURER | 5.00 | X | X | 0 | 0 | 0 |
| SUSAN LABUDA SCHROP PHD | ||||||
| SECRETARY | 5.00 | X | X | 0 | 0 | 0 |
| LEE ELMORE | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| ROBERT BAILY | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| PAUL BAUMGARTNER | ||||||
| PAST PRESIDENT | 5.00 | X | 0 | 0 | 0 | |
| KATHRYN CLARK RN | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| ELAINE EWALD | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| GERALD H FEAGLES | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| DR ANNE KLOOS PT PHD NSC | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| ANDREW MERRILL | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| MELISSA CANNEY | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| THOMAS KERN JD | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| ANN QUILLEN | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| JOHANNA HENZ | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| JACK NEWTON MD | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| DEBORAH MILLER | ||||||
| EXECUTIVE DIRECTOR | 40.00 | X | 17500 | 0 | 0 | |
| MICHELLE FITZGIBBON | ||||||
| PAST EXECUTIVE DIRECTOR | 40.00 | X | 38500 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 56000 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Membership Dues | 23675 | MembershipDues |
| Government Grants | 437326 | GovernmentGrants |
| All Other Contributions | 10659 | AllOtherContributions |
| Total Contributions | 471660 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| CONFERENCE REGISTRATIO | 900099 | 12158 | 12158 |
| CONFERENCE SPONSORSHIP | 900099 | 6000 | 6000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 18158 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 507 | TotalRevenueColumn |
| Exclusion | $507 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 490325 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18158 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $507 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393592 | Total |
| Program Services | 393592 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56000 | Total |
| Program Services | 33600 | ProgramServices |
| Management And General | 19600 | ManagementAndGeneral |
| Fundraising | 2800 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2158 | Total |
| Program Services | 1295 | ProgramServices |
| Management And General | 755 | ManagementAndGeneral |
| Fundraising | 108 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4820 | Total |
| Management And General | 4820 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1904 | Total |
| Program Services | 1544 | ProgramServices |
| Management And General | 315 | ManagementAndGeneral |
| Fundraising | 45 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1120 | Total |
| Program Services | 560 | ProgramServices |
| Management And General | 560 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1250 | Total |
| Management And General | 1250 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 384 | Total |
| Management And General | 384 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23299 | Total |
| Program Services | 23299 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305 | Total |
| Program Services | 183 | ProgramServices |
| Management And General | 107 | ManagementAndGeneral |
| Fundraising | 15 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1600 | Total |
| Management And General | 1600 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices | FundraisingFundraising |
|---|---|---|---|---|
| MISCELLANEOUS | 7924 | 7924 | ||
| TELEPHONE | 2843 | 2132 | 711 | |
| CONTRACT SERVICES | 2090 | 732 | 1253 | 105 |
| BANK CHARGES | 560 | 560 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 674 | Total |
| Program Services | 393 | ProgramServices |
| Fundraising | 281 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 500523 | Total |
| Program Services | 457851 | ProgramServices |
| Management And General | 38607 | ManagementAndGeneral |
| Fundraising | 4065 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49012 | BOY |
| EOY | 41538 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115045 | BOY |
| EOY | 115553 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116389 | BOY |
| EOY | 218214 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 4455 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4202 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 558 | BOY |
| EOY | 253 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 281004 | BOY |
| EOY | 375558 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98398 | BOY |
| EOY | 196797 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 6353 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98398 | BOY |
| EOY | 203150 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 177606 | BOY |
| EOY | 172408 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5000 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 182606 | BOY |
| EOY | 172408 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 281004 | BOY |
| EOY | 375558 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -10198 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 672536 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 483256 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 486998 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 461259 | CurrentTaxYearMinus1Year |
| Current Tax Year | 471660 | CurrentTaxYear |
| Total | 2575709 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 46468 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 90352 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 63442 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 43181 | CurrentTaxYearMinus1Year |
| Current Tax Year | 18158 | CurrentTaxYear |
| Total | 261601 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 719004 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 573608 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 550440 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 504440 | CurrentTaxYearMinus1Year |
| Current Tax Year | 489818 | CurrentTaxYear |
| Total | 2837310 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 2837310 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3789 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1227 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 415 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 74 | CurrentTaxYearMinus1Year |
| Current Tax Year | 507 | CurrentTaxYear |
| Total | 6012 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3789 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1227 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 415 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 74 | CurrentTaxYearMinus1Year |
| Current Tax Year | 507 | CurrentTaxYear |
| Total | 6012 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 722793 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 574835 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 550855 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 504514 | CurrentTaxYearMinus1Year |
| Current Tax Year | 490325 | CurrentTaxYear |
| Total | 2843322 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99790 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99710 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00210 | InvestmentIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 1 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 0 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | SECURED FUNDING IN THE STATE BIENNIAL BUDGET THROUGH MEETINGS WITH KEY MEMBERS OF THE OHIO GENERAL ASSEMBLY. | Explanation |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4065 | OtherCostOrOtherBasis |
| Depreciation | 3812 | Depreciation |
| Book Value | 253 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 390 | OtherCostOrOtherBasis |
| Depreciation | 390 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 253 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PAYROLL RELATED LIABILITIES | Description |
| Amount | $6,353 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6353 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 96733 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 96733 | RevenueSubtotal |
| Other Revenues Not Included | 393592 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 393592 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 490325 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 106931 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 106931 | ExpensesSubtotal |
| Other Expenses Not Included | 393592 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 393592 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 500523 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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 ORGANIZATION'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE ORGANIZATION'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. THE ORGANIZATION'S OPEN AUDIT PERIODS ARE 2009 THROUGH 2011. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS AS THE ORGANIZATION HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | AMOUNTS DESIGNATED FOR MEMBER CLINICS 393,592. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | GRANTS DESIGNATED FOR MEMBER CLINICS 393,592. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (43 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant | Address Line2AddressUS/AddressLine2 |
|---|---|---|---|---|---|---|---|---|
| ASHLAND CHRISTIAN HEALTH CENTER | ||||||||
| 380 E 4TH STREET | ASHLAND | OH | 44805 | 421595274 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| ASIAN HEALTH CENTER | ||||||||
| 2231 N HIGH STREET FIRST FLOOR | COLUMBUS | OH | 43201 | 310898833 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| BELMONT COUNTY DIVISION OF WHEELING HEALTH RIGHT INC | ||||||||
| 61 29TH STREET | WHEELING | WV | 26003 | 311149085 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| BY THE WAY INC | ||||||||
| 1029 S BROAD STREET | LANCASTER | OH | 43130 | 262934275 | 501(C)(3) | 6857 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| COLUMBUS FREE CLINIC | ||||||||
| 2231 N HIGH STREET | COLUMBUS | OH | 43201 | 010575698 | 501(C)(3) | 6857 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| COMMUNITY HEALTH CLINIC | ||||||||
| 144 B W MAIN STREET | NEWARK | OH | 43055 | 311340169 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| COMPASSION MEDICAL CLINIC OF WILLIAMS COUNTY | ||||||||
| 206 W BEMENT STREET | BRYAN | OH | 43506 | 204352598 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| COMPASSIONATE CARE OF SHELBY COUNTY | ||||||||
| PO BOX 4835 | SIDNEY | OH | 45365 | 208479583 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| FREE CLINIC OF CLINTON COUNTY INC | ||||||||
| PO BOX 961 | WILMINGTON | OH | 45177 | 201109777 | 501(C)(3) | 6857 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| FREE CLINIC OF FULTON COUNTY | ||||||||
| PO BOX 173 | WAUSEON | OH | 43567 | 020792665 | 501(C)(3) | 6857 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| FREE CLINIC OF PICKAWAY COUNTY | ||||||||
| 1280 N COURT STE | CIRCLEVILLE | OH | 43113 | 331031454 | 501(C)(3) | 6858 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| FREE MEDICAL CLINIC OF GREATER CLEVELAND | ||||||||
| 12201 EUCLID AVENUE | CLEVELAND | OH | 44106 | 237078501 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| GOOD NEIGHBOR HOUSE | ||||||||
| 844 S PATTERSON BLVD | DAYTON | OH | 45402 | 311374154 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| HEALTH PARTNERS OF MIAMI COUNTY | ||||||||
| 1300 N COUNTY ROAD 25A | TROY | OH | 45373 | 311596731 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| HELPING HANDS HEALTH & WELLNESS CENTER | ||||||||
| 1421 MORSE ROAD | COLUMBUS | OH | 43229 | 205937457 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| ISSO SEVA HEALTH CLINICS | ||||||||
| 13354 PEARL ROAD | STRONGSVILLE | OH | 44136 | 203548724 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| JEFFERSON COUNTY 4TH STREET HEALTH CENTER | ||||||||
| 701 N 4TH STREET | STEUBENVILLE | OH | 43952 | 203924355 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| LAKE COUNTY FREE CLINIC | ||||||||
| 54 SOUTH STATE STREET SUITE 302 | PAINESVILLE | OH | 44077 | 341081191 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| LORAIN COUNTY FREE CLINIC INC | ||||||||
| 3323 PEARL AVENUE | LORAIN | OH | 44055 | 341506180 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| MADISON COUNTY HEALTH PARTNERS | ||||||||
| 210 N MAIN STREET | LONDON | OH | 43140 | 202375865 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| MIDLOTHIAN FREE HEALTH CLINIC INC | ||||||||
| 388 E MIDLOTHIAN BLVD | YOUNGSTOWN | OH | 44507 | 010887315 | 501(C)(3) | 6857 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| NEIGHBORHOOD CARE CENTER | ||||||||
| 17951 JEFFERSON PARK DRIVE | MIDDLEBURG HEIGHTS | OH | 44130 | 340753531 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| NORTH COAST HEALTH MINISTRY | ||||||||
| 16110 DETROIT AVENUE | LAKEWOOD | OH | 44107 | 341536257 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| OPPORTUNITY PARISH ECUMENICAL NEIGHBORHOOD MINISTRY FREE CLINIC | ||||||||
| 941 PRINCETON AVENUE | AKRON | OH | 44311 | 341046107 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| OUCOM COMMUNITY HEALTH PROGRAMS - FREE CLINIC | ||||||||
| 105 RESEARCH AND TECHNOLOGY CENTER | ATHENS | OH | 45701 | 316402113 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| OXFORD COLLEGE CORNER CLINIC (DBA OXFORD FREE CLINIC) | ||||||||
| PO BOX 390 | OXFORD | OH | 45056 | 204253386 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| PARMA HEALTH MINISTRY | ||||||||
| 7000 RIDGE ROAD | PARMA | OH | 44129 | 341754340 | 501(C)(3) | 6857 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| PHYSICIANS CARECONNECTION | ||||||||
| 431 E BROAD STREET | COLUMBUS | OH | 43215 | 311373719 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| REACH OUT OF MONTGOMERY COUNTY INC | ||||||||
| 25 E FORAKER STREET | DAYTON | OH | 45409 | 311434282 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| THE BREATHING ASSOCIATION FREE LUNG HEALTH CLINIC | ||||||||
| 1520 OLD HENDERSON ROAD | COLUMBUS | OH | 432203639 | 314387540 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| THE CLINIC AT FAITH MISSION | ||||||||
| 315 E LONG STREET | COLUMBUS | OH | 43215 | 314412586 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| THE MEDINA HEALTH MINISTRY | ||||||||
| PO BOX 30 | MEDINA | OH | 44258 | 300092944 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| TOLEDOLUCAS COUNTY CARENET INC | ||||||||
| 3231 CENTRAL PARK WEST DRIVE SUITE | TOLEDO | OH | 43617 | 431986672 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | 200 |
| TOTAL LIVING CENTER FREE MEDICAL CLINIC | ||||||||
| 2221 9TH STREET SW | CANTON | OH | 44706 | 341387834 | 501(C)(3) | 6858 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| TOWNHALL II MEDICAL CLINIC | ||||||||
| 155 N WATER STREET | KENT | OH | 44240 | 300024882 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| TUSCARAWAS CLINIC FOR THE WORKING UNINSURED | ||||||||
| 420 REEVES AVENUE SUITE D | DOVER | OH | 44622 | 208456793 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| UNIVERSITY OF CINCINNATI PHYSICIANS COMPANY | ||||||||
| PO BOX 670582 | CINCINNATI | OH | 452670582 | 311405915 | 501(C)(3) | 3280 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| VINEYARD FREE HEALTH CLINICS | ||||||||
| 6000 COOPER ROAD | WESTERVILLE | OH | 43081 | 753210233 | 501(C)(3) | 7872 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| VINEYARD FREE MEDICAL CLINIC | ||||||||
| 15187 PALMER ROAD | REYNOLDSBURG | OH | 43068 | 310954398 | 501(C)(3) | 6858 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| VIOLA STARTZMAN FREE CLINIC | ||||||||
| 1874 CLEVELAND ROAD | WOOSTER | OH | 44691 | 341758151 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| WASHINGTON COUNTY FREE CLINIC | ||||||||
| PO BOX 804 | MARIETTA | OH | 45750 | 452512931 | 501(C)(3) | 6858 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| WESTERN STARK MEDICAL CLINIC | ||||||||
| 820 AMHERST ROAD NE | MASSILLON | OH | 44646 | 341887206 | 501(C)(3) | 12300 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
| XENOS FREE CLINICS | ||||||||
| 3434 STONEVISTA LANE | COLUMBUS | OH | 43221 | 310996318 | 501(C)(3) | 6858 | TO PROVIDE SERVICES TO UNINSURED PATIENTS | |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS ELECT THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS ELECT THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | BOARD MEMBERS RECEIVE A COPY OF THE 990 AND APPROVE IT BEFORE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, 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 15 | THE BOARD OFFICERS WILL RESEARCH AND DOCUMENT THEIR DELIBERATIONS REGARDING COMPENSATION FOR THE EXECUTIVE DIRECTOR AND EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. |
| THIS PROCESS HAS NOT CHANGED. |
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