2024-09-10T14:01:05-05:00 2023-10-31 410746749 CLIFTONLARSONALLEN LLP 1785 INDIAN WOOD CIRCLE MAUMEE OH 43537 990 2022-11-01 460530293 COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY COMM 9375994128 212 E COLUMBUS AVE BELLEFONTAINE OH 43311 TARA BAIR PRESIDENT/CEO 9375994128 2024-09-10 1 1 DIANN STRETTEN P01983935 4197942000 2024-09-10 2022 2024-08-08 14:25:15Z TARA BAIR 212 E COLUMBUS AVE BELLEFONTAINE OH 43311 14639091 0 X WWW.CHWPLC.ORG X PARTNERSHIP 2012 OH COMMUNITY HEALTH AND WELLNESS PARTNERS' MISSION IS TO PROVIDE QUALITY, WHOLE PERSON, PATIENT CENTERED HEALTH CARE TO ANYONE AND EVERYONE IN OUR COMMUNITY. 13 13 135 16 0 0 2961779 2163423 9754444 12426454 -3640 49214 0 0 12712583 14639091 15060 0 0 0 7661993 8570822 0 0 0 4641837 5765684 12318890 14336506 393693 302585 5213658 7824228 1332753 3640738 3880905 4183490 COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY'S MISSION IS TO SERVE AS COMMUNITY PARTNERS IN HEALTHCARE BY PROVIDING ECONOMIC-BASED, WHOLE PERSON, WHOLE COMMUNITY PRIMARY CARE TO ANYONE AND EVERYONE IN OUR COMMUNITY. 0 0 10722812 0 12427859 HEALTH SERVICES PROVIDED TO COMMUNITY RESIDENTS. 10722812 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 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 0 0 1 27 0 135 1 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 1 1 1 1 0 X JEFF FORMAN 9375991411 212 E COLUMBUS BELLEFOUNTAINE OH 43357 KYLE LENTZ CHAIRMAN 1.00 X X 0 0 0 DAVID BRIAN ROCKHOLD VICE CHARIMAN 1.00 X X 0 0 0 ELIZABETH MCCLURE SECRETARY 1.00 X X 0 0 0 KYLE SPRINGS TREASURER 1.00 X X 0 0 0 MARK GIBSON BOARD MEMBER 1.00 X 0 0 0 AMBER HANLEY BOARD MEMBER 1.00 X 0 0 0 MARCIA BAILEY BOARD MEMBER 1.00 X 0 0 0 KELLI BADER BOARD MEMBER 1.00 X 0 0 0 LYDIA HESS BOARD MEMBER 1.00 X 0 0 0 NEILL RHODES BOARD MEMBER 1.00 X 0 0 0 SARAH WARREN BOARD MEMBER 1.00 X 0 0 0 BECKY MARTIN BOARD MEMBER 1.00 X 0 0 0 JACKIE PRATER BOARD MEMBER 1.00 X 0 0 0 JEFF FORMAN CFO STARTING MAY 2023 40.00 X 0 0 0 ANDREW HERSHBERGER CFO THRU APRIL 2023 40.00 X 105243 0 20370 STEVEN TONEY CMO STARTING MAY 2023 21.00 X 131526 0 11641 KENNETH MILLER CMO THRU APRIL 2023 40.00 X 218276 0 20369 TARA BAIR PRESIDENT/CEO 40.00 X 151965 0 11436 KATHY SMITH CHIEF OPERATING OFFICER 40.00 X 99963 0 22909 JUSTIN GILDOW CERTIFIED NURSE PRACTITION 45.00 X 183077 0 22628 TRACY DETWILER BEHAVIORAL HEALTH PROVIDER 32.00 X 129348 0 5174 CHARLES KRATZ PHYSICIAN 40.00 X 209022 0 24522 JASON MARTINEZ PHARMACIST 40.00 X 142797 0 21040 JILLIAN SHELLABARGER PSYCHIATRIST 40.00 X 250072 0 16178 1621289 0 176267 16 0 1 0 HAZELET HEALTHYCARE CONSULTING 257 N 6TH ST INDIANA PA 15701 CONTRACTED BILLING COMPANY 227279 1 2058722 104701 2163423 PATIENT SERVICES 624100 6974759 6974759 PHARMACY REVENUES 624100 5310766 5310766 OTHER INCOME 624100 140929 140929 12426454 47809 47809 1405 0 1405 1405 1405 14639091 12427859 0 47809 804565 587332 217233 6369260 4661785 1707475 201012 142520 58492 653666 463067 190599 542319 404028 138291 66506 66506 2507 2507 361224 361224 700 700 164789 164789 84111 67107 17004 8837 4705 4132 721710 550604 171106 74410 61607 12803 21555 21555 100133 100133 28739 28739 340B PHARMACY 2599377 2599377 OFFICE SUPPLIES AND EQU 707495 376716 330779 MEDICAL SUPPLIES AND EQ 569837 569837 DUES AND SUBSCRIPTIONS 58935 38822 20113 194819 94472 100347 14336506 10722812 3613694 0 2259222 255879 1511345 111947 272931 917900 1387548 224767 151515 1803695 297758 1604665 1505937 89724 93127 5433 2645946 5213658 7824228 191350 200628 569519 515759 571884 2924351 1332753 3640738 X 3846189 4148774 34716 34716 3880905 4183490 5213658 7824228 302585 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 465248 465248 695476 67261 628215 212747 67473 145274 132485 73082 59403 297739 89942 207797 1505937 OPERATING RIGHT OF USE ASSETS 2645946 2645946 ACCRUED PAYROLL & OTHER LIABILITIES 405674 LEASE LIABILITY 2518677 2924351 X 14638391 0 14638391 700 700 14639091 14335806 0 14335806 700 700 14336506 PART X, LINE 2: MANAGEMENT OF THE ORGANIZATION IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE ORGANIZATION, SUCH AS TAX EXEMPTION DESIGNATION, IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY. MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS FOR WHICH IT IS REASONABLY POSSIBLE THAT A SIGNIFICANT CHANGE IN A TAX POSITION WILL OCCUR IN THE NEXT TWELVE MONTHS. THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE PRIOR THREE FISCAL YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 700. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 700. X X 0 0 0 0 0 1 0 0 0 JILLIAN SHELLABARGER PSYCHIATRIST 250072 0 0 0 0 0 10100 0 6078 0 266250 0 0 0 KENNETH MILLER CMO THRU APRIL 2023 218276 0 0 0 0 0 9236 0 11133 0 238645 0 0 0 CHARLES KRATZ PHYSICIAN 209022 0 0 0 0 0 8886 0 15636 0 233544 0 0 0 JUSTIN GILDOW CERTIFIED NURSE PRACTITION 183077 0 0 0 0 0 7834 0 14794 0 205705 0 0 0 JASON MARTINEZ PHARMACIST 142797 0 0 0 0 0 6246 0 14794 0 163837 0 0 0 TARA BAIR PRESIDENT/CEO 151965 0 0 0 0 0 6371 0 5065 0 163401 0 0 0 PART I, LINE 3 CHWPLC'S EXECUTIVE COMMITTEE ENGAGED IN THE PROCESS OF COMPARATIVE DATA FROM THE NATIONAL ASSOCAITION OF COMMUNITY HEALTH CENTERS (NACHC) AND SOUGHT SUPPORT FROM THE OHIO ASSOCIATON OF COMMUNITY HEALTH CENTER'S EXECUTIVE DIRECTOR (PRIMARY CARE ASSOCIATION) FOR EXECUTIVE PAY. KEY MEDICAL EMPLOYEES WHO ARE PATIENT SERVICE PROVIDERS ARE COMPARED TO STATE AND LOCAL AVERAGE FOR FQHC'S AND NON-FQHC'S AT LEAST EVERY TWO YEARS TO COMPARE WAGE DATA. FORM 990, PART VI, SECTION B, LINE 11B SUBMITTED TO THE EXECUTIVE BOARD FOR REVIEW; SUBMITTED TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THEY QUARTERLY REVIEW TO ENSURE THEY HAVE DISCLOSED ALL CONFLICTS OF INTEREST. WHEN THERE IS A REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE FINANCIAL INTEREST, THE CEO, BOARD OR COMMITTEE IN CHARGE IS TO BE NOTIFIED. THE INTERESTED PERSON THEN MAKES A PRESENTATION OF A LIMITED TIME PERIOD. IF THE BOARD OR COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THEY MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 CHWPLC'S EXECUTIVE COMMITTEE ENGAGED IN THE PROCESS OF COMPARATIVE DATA FROM THE NATIONAL ASSOCAITION OF COMMUNITY HEALTH CENTERS (NACHC) AND SOUGHT SUPPORT FROM THE OHIO ASSOCIATON OF COMMUNITY HEALTH CENTER'S EXECUTIVE DIRECTOR (PRIMARY CARE ASSOCIATION) FOR EXECUTIVE PAY. KEY MEDICAL EMPLOYEES WHO ARE PATIENT SERVICE PROVIDERS ARE COMPARED TO STATE AND LOCAL AVERAGE FOR FQHC'S AND NON-FQHC'S AT LEAST EVERY TWO YEARS TO COMPARE WAGE DATA. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST