2013-08-23T08:24:48-05:00 2012-12-31 310800053 CLARK SCHAEFER HACKETT & CO 2525 N LIMESTONE STREET SPRINGFIELD OH 45503 990 2012-01-01 450914398 FIVE RIVERS HEALTH CENTERS FIVE 9377344141 3535 SALEM AVENUE NO 100 DAYTON OH 454062645 GINA MCFARLANE-EL 9377344141 2013-08-22 1 DEVESH KAMAL CPA P00201226 9373992000 2013-08-20 2012 2016-02-24 21:20:13Z GINA MCFARLANE-EL 3535 SALEM AVENUE NO 100 DAYTON OH 454062645 9530803 0 X HTTP://WWW.FIVERIVERSHEALTHCENTERS.ORG/ X 2011 OH FIVE RIVER HEALTH CENTERS AIMS TO LIVE OUT OUR MISSION FOR OUR PATIENTS - "YOUR HEALTHCARE MATTERS!" 13 13 36 0 0 0 4700300 7464399 2399574 2066404 0 0 0 0 7099874 9530803 0 0 0 0 142132 820524 0 0 0 6465564 9488848 6607696 10309372 492178 -778569 1691723 1688835 1199545 1975226 492178 -286391 FIVE RIVERS HEALTH CENTERS ARE COMMITTED TO PROVIDING QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY, WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. 0 0 9356537 2066404 PROVIDE QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. IN 2012, CARE WAS PROVIDED TO APPROXIMATELY 15,000 PATIENTS. 9356537 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 39 0 1 36 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X DAVID BRIDGE 9377346844 3535 SALEM AVENUE SUITE 100 DAYTON OH 45406 DR MARGARET DUNN 1.00 X X 0 0 0 ANN SCHUERMAN 1.00 X X 0 0 0 AMY WIEDEMAN 1.00 X X 0 0 0 RICHARD GOSHAY 1.00 X 0 0 0 RONA CLARK 1.00 X 0 0 0 JANIESHA HENDERSON 1.00 X 0 0 0 WANDA GUY 1.00 X 0 0 0 DWIGHT BROWN 1.00 X 0 0 0 JEFF COOPER 1.00 X 0 0 0 DEBRA MCCATHRON 1.00 X 0 0 0 VERA CROWE 1.00 X 0 0 0 DIANE WELBORN 1.00 X 0 0 0 JANET BEARFIELD 1.00 X 0 0 0 DAVE BRIDGE 40.00 X 83605 0 5589 GINA MCFARLANE-EL 40.00 X 90597 0 9133 174202 0 14722 0 0 0 0 WRIGHT STATE UNIVERSITY 3640 COLONEL GLENN HWY DAYTON OH 45435 MEDICAL SERVICES 933021 SAMARITAN FAMILY CARE INC 40 W 4TH STREET 1700 DAYTON OH 45402 MEDICAL SERVICES 130638 BONE AND JOINT SURGEONS INC 9000 N MAIN STREET STE 303 DAYTON OH 45415 MEDICAL SERVICES 102000 3 7464399 7464399 MEDICAID, NET 621400 1555009 1555009 MEDICARE, NET 621400 268767 268767 FIRST AND THIRD PARTIE 621400 200296 200296 OTHER GOVERNEMENTAL 621400 38308 38308 MISCELLANEOUS 624100 4024 4024 2066404 9530803 2066404 0 0 188924 188924 534949 441224 93725 38717 19743 18974 57934 37478 20456 39889 39889 975836 973770 2066 1332 157 1175 107739 92485 15254 1001196 979077 22119 8721 2287 6434 20804 11102 9702 63522 63522 87964 81825 6139 LEASED EMPLOYEES 4358467 4313346 45121 CONTRACT SERVICES 1810637 1676770 133867 PHARMACY COSTS 415093 415093 MEMBERSHIP DUES 249220 1704 247516 348428 246954 101474 10309372 9356537 952835 0 545084 338455 868166 1128284 18999 26144 299429 103477 259474 195952 1691723 1688835 179246 71824 1020299 1903402 1199545 1975226 X 492178 -286391 492178 -286391 1691723 1688835 -778569 0 X X 0 1 X 1 0 X 4700300 7464399 12164699 996783 2066404 3063187 5697083 9530803 15227886 0 0 0 15227886 5697083 9530803 15227886 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE ORGANIZATION WAS FORMED ON MAY 23, 2011 THUS CREATING A SHORT-YEAR TAX RETURN FOR 2011. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 239027 95675 143352 60402 7802 52600 195952 ACCRUED PAYROLL AND WITHHOLDING 52765 ACCRUED LEASED PAYROLL AND BENEFITS 1418820 OTHER ACCRUED LIABILITIES 431817 1903402 X 9530803 0 9530803 0 9530803 10309372 0 10309372 0 10309372 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: FIVE RIVERS HEALTH CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODT. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE CENTER'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE CENTER'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. THE CENTER'S OPEN AUDIT PERIOD IS 2011. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS AS THE CENTER HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE WILL REVIEW THE 990 AND APPROVE THE REPORT. AFTER APPROVING THE 990, THE FINANCE COMMITTEE WILL TAKE THE 990 TO THE BOARD FOR BOARD APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. OPERATING POLICIES HAVE BEEN IMPLEMENTED TO DETECT POTENTIAL CONFLICTS OF INTEREST. CONTRACTS OR EXPENDITURES THAT ARE GREATER THAN $50,000 MUST HAVE BOARD APPROVAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE USES MARKET DATA TO DETERMINE SALARIES. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATIONS 990 IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE FINANCE COMMITTEE FOR THE ORGANIZATION SELECTS AN INDEPENDENT ACCOUNTING FIRM TO CONDUCT THE AUDIT OF THE FINANCIAL STATEMENTS AND PROVIDES OVERSIGHT FOR THE WORK THAT IS CONDUCTED. THIS REPRESENTS NO CHANGE IN THE PROCESS FROM PROCEDURES CONDUCTED IN PRIOR PERIODS.