2024-11-14T12:57:06-06:00 2023-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2023-01-01 208952945 FAIRFIELD MEDICAL CENTER FOUNDATION FAIR 7406878105 401 N EWING STREET LANCASTER OH 43130 TRACY KELLY EXECUTIVE DIRECTOR 7406878105 2024-11-14 1 1 EMILIE M KNIERIEM CPA P01330194 3176334705 2024-11-14 2023 2024-10-15 13:58:12Z TRACY KELLY 401 N EWING STREET LANCASTER OH 43130 1190178 0 X FMCHEALTH.ORG X 2007 OH THE FAIRFIELD MEDICAL CENTER FOUNDATION'S MISSION IS TO SOLICIT AND MANAGE CONTRIBUTIONS IN ORDER TO PROVIDE GRANT ASSISTANCE TO FAIRFIELD MEDICAL CENTER FOR NEEDED ITEMS OR PROGRAMS. 13 13 0 13 0 0 633620 741994 0 0 239377 81524 83687 279812 956684 1103330 134366 105125 0 0 330921 305474 0 0 387075 146478 1264476 611765 1675075 344919 -571745 3310541 2998157 37841 50897 3272700 2947260 THE FAIRFIELD MEDICAL CENTER FOUNDATION'S MISSION IS TO SOLICIT AND MANAGE CONTRIBUTIONS IN ORDER TO PROVIDE GRANT ASSISTANCE TO FAIRFIELD MEDICAL CENTER TO ASSIST IN THEIR MISSION OF DELIVERING OUTSTANDING HEALTHCARE FOR THEIR PATIENTS AND FAMILIES, AND OUR COMMUNITIES. 0 0 194735 33673 FMC FOUNDATION AWARDS VARIOUS SCHOLARSHIPS BY WAY OF AN INDEPENDENT SCHOLARSHIP COMMITTEE TO THOSE WHO ARE PURSUING FURTHER EDUCATION IN THE MEDICAL FIELD. THE SCHOLARSHIPS ARE AWARDED BY AN INDEPENDENT COMMITTEE, BASED ON THE APPLICATIONS RECEIVED. 168549 29145 THE FOUNDATION HELPS VARIOUS INDIVIDUALS WHO ARE AT OR BELOW THE 200% POVERTY LEVEL WITH ASSISTANCE TOWARD CANCER CARE, MAMMOGRAMS AND CARDIAC REHAB. IT ALSO PROVIDES THE SALARY FOR AN ADMINISTRATOR OF THE SCRIPT ASSIST PROGRAM WHICH HELPS THOSE WHO ARE AT OR BELOW THE 200% POVERTY LEVEL OBTAIN PRESCRIPTIONS FROM DRUG COMPANIES AT A REDUCED COST. THIS PROGRAM HAS HELPED MANY WHO OTHERWISE WOULD NOT HAVE BEEN ABLE TO PAY FOR THE PRESCRIPTIONS, OR FOR WHOM IT WOULD HAVE BEEN AN EXTREME HARDSHIP TO DO SO. 568470 42307 FAIRFIELD MEDICAL CENTER FOUNDATION PROGRAM MISCELLANEOUS GRANTS FOR NEED NOT COVERED BY EQUIPMENT GRANTS, CANCER CARE, AND CARDIAC CARE, SUCH AS THE TRANQUILITY GARDEN FOR PATIENTS AND VISITORS OF FMC TO ENJOY, SPECIALTY SOAP FOR INFECTION CONTROL, AS WELL AS VARIOUS OTHER NEEDS. 931754 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 OH X TRACY KELLY EXECUTIVE DIRECTOR 7406878105 401 N EWING STREET LANCASTER OH 43130 CRAIG VANDERVOORT CHAIR 1.25 0.00 X X 0 0 0 BECKY BAKER DIRECTOR 0.40 0.00 X 0 0 0 DR SHASHI GOGATE DIRECTOR 0.40 0.00 X 0 0 0 JOSH GORDON DIRECTOR 0.40 0.00 X 0 0 0 DR JESSI HANNA DIRECTOR 0.40 0.00 X 0 0 0 PHIL SETTECASE DIRECTOR 0.40 0.00 X 0 0 0 TEMPLE CUSTER MONTENEZ DIRECTOR 0.40 0.00 X 0 0 0 CHRISTA MOODY DIRECTOR 0.40 0.00 X 0 0 0 TRAVIS MARKWOOD DIRECTOR 0.40 0.00 X 0 0 0 SHARON SCRUGGS DIRECTOR 0.40 0.00 X 0 0 0 DENISE BAUER DIRECTOR 0.40 0.00 X 0 0 0 PENNY WASEM DIRECTOR 0.40 0.00 X 0 0 0 JAMIE CULVER DIRECTOR 0.40 0.00 X 0 0 0 MARIS MAHLER DIRECTOR PARTIAL TERM 0.40 0.00 X 0 0 0 BRENDA SHAMBLIN DIRECTOR PARTIAL TERM 0.40 0.00 X 0 0 0 TRACY KELLY EXECUTIVE DIRECTOR 40.00 0.00 X 0 76500 15321 0 76500 15321 0 0 0 0 0 3009 738985 741994 72256 72256 9268 0 9268 9268 9268 148737 3009 36022 112715 112715 217923 50826 167097 167097 1103330 0 0 361336 X 105125 105125 263026 113101 65757 84168 27379 11773 6845 8761 15069 6480 3767 4822 397341 397341 125016 53757 31254 40005 105 45 26 34 4897 2106 1224 1567 BAD DEBT EXPENSE 562851 242026 140713 180112 MISCELLANEOUS EXPENSE 153683 104504 49179 PROGRAM EXPENSES 18427 18427 DUES & SUB. 2156 2156 1675075 931754 356246 387075 286555 153899 997244 295000 122015 63290 63622 58725 1963120 2490533 3310541 2998157 37841 11279 0 39618 37841 50897 X 3272700 2947260 3272700 2947260 3310541 2998157 -571745 246305 0 X 0 0 0 X 638983 702134 560310 633620 741995 3277042 638983 702134 560310 633620 741995 3277042 139046 3137996 78837 51296 134464 105850 72257 442704 200000 2446 13216 215662 3935408 0.79740 0.68530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 122015 63290 58725 58725 GRAYSTONE MORGAN STANELY HELD INVESTMENTS 2490533 F 2490533 RELATED PARTY LIABILITIES 39618 39618 FOOD & WINE TASTING 36307 1000 35307 2713 2099 418 GOLF TOURNAMENT 61135 260 60875 1400 5265 7149 497 3 54304 1749 52555 2036 4190 1466 8789 151746 3009 148737 3436 12168 10714 9704 36022 112715 1 CANCER CARE 1062 10071 CARDIAC CARE REHABILITATION AND EDUCATION 21 19074 SCHOLARSHIPS 25 33673 HOSPITAL PROGRAMS FOR INDIVIDUAL ASSISTANCE 3100 42307 PART III LINE 1 CANCER CARE IS PAID ON BEHALF OF INDIGENT OR UNINSURED PATIENTS. ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY THE CONTRACTS AND COLLECTIONS OFFICE AND THE ONCOLOGY NURSE NAVIGATOR ON BEHALF OF THE FOUNDATION. ALL RECORDS ARE KEPT CONFIDENTIAL AND HIPAA REQUIREMENTS ARE FOLLOWED IN ALL CASES. PART III LINE 2 INDIVIDUALS APPLY FOR, AND RECEIVE ASSISTANCE FOR CARDIAC CARE AT 200% OR BELOW CURRENT POVERTY LEVEL. ALL APPLICANTS MUST BE REFERRED FOR CARDIAC CARE ASSISTANCE. ALL RECORDS ARE KEPT CONFIDENTIAL AND HIPAA REQUIREMENTS ARE FOLLOWED IN ALL CASES. PART III LINE 3 SCHOLARSHIPS ARE AWARDED TO INDIVIDUALS BY AN INDEPENDENT SCHOLARSHIP COMMITTEE. APPLICANTS MUST APPLY AND THESE SCHOLARSHIPS ARE AWARDED BASED ON PREDETERMINED CRITERIA. PART III LINE 4 THERE ARE SEVERAL PROGRAMS SUPPORTED BY THE FAIRFIELD MEDICAL CENTER FOUNDATION WHICH BENEFIT INDIVIDUALS SUCH AS A SCRIPTASSIST GAP PROGRAM THAT ASSISTS IN OBTAINING PRESCRIPTIONS THAT WOULD OTHERWISE BE UNAFFORDABLE. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 WAS MADE AVAILABLE TO BOARD MEMBERS FOR REVIEW, WITH THE OPPORTUNITY TO RESPOND WITH COMMENTS. FORM 990, PART VI, SECTION B, LINE 12C POLICIES ARE REVIEWED ANNUALLY WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 A MARKET ANALYSIS OF SALARIES IN THE AREA IS PERFORMED BY THE HUMAN RESOURCES DEPARTMENT OF FAIRFIELD MEDICAL CENTER FOR ALL EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST MADE TO MANAGEMENT. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 397,341. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 397,341. PART VII SECTION A LINE 10 FAIRFIELD MEDICAL CENTER FOUNDATION REIMBURSES FAIRFIELD MEDICAL CENTER FOR THE SALARIES, BENEFITS, AND PAYROLL TAXES EXPENSES THAT ARE PAID TO THE FAIRFIELD MEDICAL CENTER FOUNDATION'S EMPLOYEES. THERE ARE NO W2'S OR PAYROLL TAXES FILED BY FAIRFIELD MEDICAL CENTER FOUNDATION. FAIRFIELD HEALTHCARE PROFESSIONALS INC 401 NORTH EWING LANCASTER OH 43130 311425884 PHYSICIAN PRACTICES OH 501(C)(3) LINE 11 FAIRFIELD MEDICAL CENTER 0 FAIRFIELD MEDICAL CENTER TWIG II 1724 E MAIN STREET LANCASTER OH 43130 237146033 SUPPORT FAIRFIELD MEDICAL CENTER OH 501(C)(3) LINE 12D, III-O N/A 0 FAIRFIELD MEDICAL CENTER 401 NORTH EWING LANCASTER OH 43130 310645626 HOSPITAL OH 501(C)(3) LINE 3 N/A 0 ZANE PROPERTIES CORPORATION 401 NORTH EWING STREET LANCASTER OH 43130 311202009 HOLDING COMPANY OH N/A C 0 OHIO PHYSICAL MEDICINE & REHAB INC 2405 N COLUMBUS ST SUITE 210 LANCASTER OH 43130 311639119 PHYSIATRISTS OH N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0