2025-02-14T12:20:45+00:00 2024-03-31 440160260 Forvis Mazars LLP 1222 Demonbreun St Suite 950 Nashville TN 372033357 990 2023-04-01 611292739 COMMONWEALTH HEALTH FREE CLINIC INC COMM 2707451551 800 PARK STREET BOWLING GREEN KY 42101 MICHELE LAWLESS EVP - CFO 2025-02-14 true true Jeff Smith P00289876 6154549800 2025-02-13 2023 2025-03-06 01:10:19Z CONNIE D SMITH 800 PARK STREET BOWLING GREEN KY 42101 1115374 false X MEDCENTERHEALTH.ORG/LOCATION/COMMUNITY-CLINIC X 1995 KY THE COMMONWEALTH HEALTH FREE CLINIC PROVIDES BASIC MEDICAL AND DENTAL SERVICES FOR INDIVIDUALS WHO STRUGGLE WITH APPROPRIATE OR AFFORDABLE ACCESS TO HEALTHCARE. 8 4 0 57 0 0 867565 952799 67795 159109 97 95 5219 3371 940676 1115374 0 0 144580 148193 0 0 761525 854812 906105 1003005 34571 112369 1162720 1255567 84280 64758 1078440 1190809 THE COMMONWEALTH HEALTH FREE CLINIC PROVIDES BASIC MEDICAL AND DENTAL SERVICES FOR INDIVIDUALS WHO STRUGGLE WITH APPROPRIATE OR AFFORDABLE ACCESS TO HEALTHCARE. false false 989905 159109 COMMONWEALTH HEALTH FREE CLINIC, INC. ("CHFC") OPENED ON JANUARY 2, 1996 TO PROVIDE BASIC MEDICAL AND DENTAL DIAGNOSTIC AND TREATMENT SERVICES FOR THE UNINSURED AND UNDERINSURED OF SOUTH-CENTRAL KENTUCKY. CHFC ALSO SERVES INDIVIDUALS WHO MAY BE COVERED BY SOME FORM OF INSURANCE, BUT WHO ARE UNABLE TO ACCESS A PROVIDER FOR ACUTE OR CHRONIC HEALTH ISSUES. SEE SCHEDULE O FOR ADDTIONAL INFORMATION. 989905 true true false false false false false false false true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 12 0 true 0 false false false false false false false false false false false false X 8 4 false false false false true true false true true false false true true true true true true false false false KY X JENNY GREENWELL 2707451551 800 PARK STREET BOWLING GREEN KY 42101 DR MARK YURCHISIN CHAIRMAN 2.0 X X 0 0 0 DR MICHAEL HUBBARD VICE CHAIR 2.0 X X 0 0 0 MR DAVID GRAY EXECUTIVE VICE PRESIDENT 2.0 50.0 X X 0 427268 92783 MR JOE NATCHER SECRETARY 2.0 4.0 X X 0 0 0 MS CONNIE D SMITH CEO/PRESIDENT 2.0 52.0 X X 0 1317162 119091 DR JACQUELINE POPE - TARRENC DIRECTOR 2.0 2.0 X 0 7415 0 DR JOSH PHILLIPS DIRECTOR / DENTIST 40.0 X 148193 0 20183 MRS CATHY BISHOP DIRECTOR 2.0 4.0 X 0 0 0 MR WADE STONE EXECUTIVE VICE PRESIDENT 2.0 50.0 X 0 438705 61739 MS KATRINA WOOD EVP/CHIEF NURSING OFFICER 2.0 50.0 X 0 258853 37153 MS MICHELE W LAWLESS EXECUTIVE VICE PRESIDENT / CFO 2.0 50.0 X 0 481930 47348 148193 2931333 378297 1 false true false 0 952799 952799 NET PATIENT SERVICE REVENUE 621400 159109 159109 0 0 0 0 159109 95 95 0 0 0 0 MISCELLANEOUS REVENUE 900099 3371 3371 0 0 0 0 3371 1115374 159109 0 3466 X 148193 148193 4841 4841 702976 698550 4426 0 910 910 51242 50697 545 22602 22602 2332 2332 9712 9712 10647 10647 MEDICAL SUPPLIES 49504 49504 OTHER TAXES & LICENSES 46 46 0 0 0 0 1003005 989905 13100 0 925655 1006297 131401 131143 42690 45217 7696 30125 0 0 0 0 88452 45667 55278 42785 0 0 0 0 1162720 1255567 28402 8764 0 0 55878 55994 84280 64758 X 1078440 1190809 1078440 1190809 1162720 1255567 112369 0 X false true X true false X Schedule A, Part I, Line 3 COMMONWEALTH HEALTH FREE CLINIC'S PUBLIC CHARITY CLASSIFICATION HAS BEEN DESIGNATED AS A HOSPITAL DESCRIBED IN SECTION 170(B)(1)(A)(III) BY THE IRS. SCHEDULE H HAS NOT BEEN COMPLETED BY COMMONWEALTH HEALTH FREE CLINIC AS IT DOES NOT OPERATE A STATE LICENSED HOSPITAL FACILITY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 88452 45667 42785 42785 PAYABLE TO AFFILIATES 55994 55994 1115374 0 0 1115374 0 0 1115374 1003005 0 0 1003005 0 0 1003005 Schedule D, Part X, Line 2 INCOME TAXES THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE THAT ADDRESSED THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN48 (ASC 740). MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. false true false false false false false false false MS CONNIE D SMITH CEO/PRESIDENT 0 1036405 0 0 0 280757 0 98270 0 20821 0 1436253 0 0 MR DAVID GRAY EXECUTIVE VICE PRESIDENT 0 418139 0 0 0 9129 0 57983 0 34800 0 520051 0 0 DR JOSH PHILLIPS DIRECTOR / DENTIST 147565 0 0 0 628 0 4500 0 15683 0 168376 0 0 0 MR WADE STONE EXECUTIVE VICE PRESIDENT 0 435730 0 0 0 2975 0 44704 0 17035 0 500444 0 0 MS MICHELE W LAWLESS EXECUTIVE VICE PRESIDENT / CFO 0 475135 0 0 0 6795 0 43823 0 3525 0 529278 0 0 MS KATRINA WOOD EVP/CHIEF NURSING OFFICER 0 255207 0 0 0 3646 0 6499 0 30654 0 296006 0 0 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan CERTAIN EXECUTIVES OF COMMONWEALTH HEALTH CORPORATION PARTICIPATE IN A SUPPLEMENTAL RETIREMENT PLAN. THE CURRENT YEAR INCREASE IN THE ACCRUED BENEFIT, AS ACTUARIALLY DETERMINED, IS REPORTED AS COMPENSATION. THE FOLLOWING ARE THE INDIVIDUALS PARTICIPATING IN THE PLAN AND THE CURRENT YEAR INCREASES REPORTED AS COMPENSATION: CONNIE SMITH $262,117 WADE STONE $ -0- Schedule J, Part I, Line 3 THE CEO IS COMPENSATED BY COMMONWEALTH HEALTH CORPORATION (CHC), A RELATED ORGANIZATION. CHC USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS CHFC CURRENTLY OPERATES PROGRAMS THAT EASE THE FINANCIAL BURDEN TO PATIENTS IN NEED OF BASIC MEDICAL AND DENTAL CARE, OFFERING SERVICES THAT INCLUDE: - OUTPATIENT NON-EMERGENCY CLINICAL SERVICES - DENTISTRY - COMMUNITY HEALTH EDUCATION AND COUNSELING - ACCESS TO PHARMACEUTICALS - OUTPATIENT COMMUNITY HEALTH PROMOTION SERVICES - FOREIGN LANGUAGE TRANSLATION SERVICES - PRIMARY CARE PREVENTIVE SERVICES - COORDINATION OF CARE AND SOCIAL SUPPORT SERVICES - SPECIAL CLINIC SERVICES THE CLINIC IS LOCATED AT 740 EAST TENTH STREET, BOWLING GREEN, KENTUCKY. PATIENTS ARE ALSO SEEN AT MED CENTER HEALTH'S PRIMARY CARE LOCATION AT 825 E 2ND AVE IN BOWLING GREEN, KY. ALL QUALIFYING PATIENTS ATTEST THAT THEIR FAMILY INCOME FALLS AT OR BELOW 250% OF THE NATIONAL POVERTY GUIDELINES. DURING THE FISCAL YEAR ENDING MARCH 31, 2024, CHFC PROVIDED ASSISTANCE THROUGH: - 3,070 PATIENT VISITS - 4,880 DIAGNOSTIC PROCEDURES - 454 VOLUNTEER HOURS - 854 PRESCRIPTIONS SINCE INCEPTION, THE FREE CLINIC HAS HAD OVER 65,000 VOLUNTEER HOURS, PROVIDED ASSISTANCE THROUGH MORE THAN 135,000 PATIENT VISITS, AND HAS PROVIDED OVER 363,800 PRESCRIPTIONS. Form 990, Part VI, Line 6 Classes of members or stockholders COMMONWEALTH HEALTH CORPORATION ("CHC") IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. ARTICLE V OF THE BYLAWS SAYS "COMMONWEALTH HEALTH CORPORATION SHALL HAVE THE RIGHT AND POWER TO APPOINT AND REMOVE DIRECTORS OF THE CORPORATION AND TO APPROVE CHANGES IN THE ARTICLES OF INCORPORATION AND THESE BYLAWS." Form 990, Part VI, Line 7a Members or stockholders electing members of governing body COMMONWEALTH HEALTH CORPORATION ("CHC") IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. ARTICLE V OF THE BYLAWS SAYS "COMMONWEALTH HEALTH CORPORATION SHALL HAVE THE RIGHT AND POWER TO APPOINT AND REMOVE DIRECTORS OF THE CORPORATION AND TO APPROVE CHANGES IN THE ARTICLES OF INCORPORATION AND THESE BYLAWS." Form 990, Part VI, Line 11b Review of form 990 by governing body Form 990 is sent to board members via secure email. Each board member receives access to review the form prior to the designated filing date. Form 990, Part VI, Line 12c Conflict of interest policy THE COMMONWEALTH HEALTH CORPORATION (CHC) (APPLICABLE TO THE CORPORATION AND/OR ITS AFFILIATES) CODE OF CONDUCT EXPLICITLY STATES MEMBERS OF THE BOARD, ADMINISTRATION, THE MEDICAL STAFF AND ALL EMPLOYEES ARE EXPECTED TO AVOID CONFLICTS OF INTEREST. FURTHER, IT REQUIRES DISCLOSURE OF ANY POTENTIAL CONFLICTS OF INTEREST IN A TIMELY MANNER. ALL INDIVIDUALS SIGN AN ACKNOWLEDGEMENT THAT THEY RECEIVED A COPY OF THE CODE OF CONDUCT, ARE FAMILIAR WITH ITS CONTENT AND UNDERSTAND THEIR RESPONSIBILITIES TO AVOID NON-COMPLIANT ACTIVITY. CHC'S REGULATORY COMPLIANCE AND COMPENSATION COMMITTEE (RCC) REVIEWS AND APPROVES ALL CONTRACTS BETWEEN CHC AND/OR ITS AFFILIATES AND DISQUALIFIED ENTITIES. THE REVIEW IS DESIGNED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST BY BOARD MEMBERS AND/OR OFFICERS. RCC MEMBERS ARE PROHIBITED FROM TAKING PART IN DECISIONS REGARDING TRANSACTIONS WITH WHICH HE/SHE HAS A CONFLICT OF INTEREST. ANNUALLY, WRITTEN INQUIRY IS MADE (BY QUESTIONNAIRE) OF BOARD MEMBERS AND OFFICERS SEEKING DISCLOSURE OF CONFLICTS OF INTEREST OR INFORMATION THAT RELATES TO FAMILY MEMBERS. TRANSACTIONS ARISING ARE REVIEWED BY MANAGEMENT AS THEY OCCUR. Form 990, Part VI, Line 19 Required documents available to the public GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ONLY MADE AVAILABLE IF REQUIRED, AND IN THE MANNER REQUIRED, BY A GOVERNING AGENCY. Form 990, Part IX, Line 11g Other Fees CONTRACT FEES - Total Expense: 208063, Program Service Expense: 208063, Management and General Expenses: , Fundraising Expenses: ; BILLING FEES - Total Expense: 4426, Program Service Expense: , Management and General Expenses: 4426, Fundraising Expenses: ; EMPLOYEE SUPPORT FEES - Total Expense: 490487, Program Service Expense: 490487, Management and General Expenses: , Fundraising Expenses: ; FORM 990, PART VI, SECTION B, LINE 15 DETERMINING COMPENSATION EMPLOYEE OFFICERS OF THIS ENTITY ARE EMPLOYEES OF COMMONWEALTH HEALTH CORPORATION WHICH USES INDEPENDENT CONSULTANTS TO ANNUALLY REVIEW COMPENSATION. COMPENSATION-RELATED DETERMINATIONS ARE CONDUCTED IN ACCORDANCE WITH APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE AND REGULATIONS TO QUALIFY FOR THE PRESUMPTION THAT THE COMPENSATION IS REASONABLE, INCLUDING BUT NOT LIMITED TO APPROVAL BY AN AUTHORIZED COMMITTEE OF THE BOARD OF DIRECTORS WHO DO NOT HAVE A CONFLICT OF INTEREST, OBTAINING AND RELYING ON APPROPRIATE DATA AS TO COMPARABILITY, AND CONCURRENT DOCUMENTATION OF THE BASIS FOR THE COMPENSATION DETERMINATIONS. FORM 990, PART XII, LINE 2C OVERSIGHT PROCESS THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. BOWLING GREEN-WARREN CNTY COMM HOSP CORP 800 PARK STREET BOWLING GREEN KY 42101 610920842 HOSPITAL KY 501(c)(3) 3 CHC INC false COMMONWEALTH HEALTH FOUNDATION 800 PARK STREET BOWLING GREEN KY 42101 611362000 SUPPORT KY 501(c)(3) 7 CHC INC false COMMONWEALTH REGIONAL SPECIALTY HOSPITAL 800 PARK STREET BOWLING GREEN KY 42101 542142034 HOSPITAL KY 501(c)(3) 3 CHC INC false THE MEDICAL CENTER AT FRANKLIN 800 PARK STREET BOWLING GREEN KY 42101 611362001 HOSPITAL KY 501(c)(3) 3 CHC INC false COMMONWEALTH HEALTH CORPORATION 800 PARK STREET BOWLING GREEN KY 42101 311118087 SUPPORT KY 501(c)(3) 10 NA false THE MEDICAL CENTER AT ALBANY 800 PARK STREET BOWLING GREEN KY 42101 811312058 HOSPITAL KY 501(c)(3) 3 CHC INC false MED PLAZA PTRS LTD 800 PARK STREET BOWLING GREEN KY 42101 611080340 REAL ESTATE KY NA N/A 0 0 false false false true false false false false false false false false false true false false true true false false