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Nonprofiteer
← COMMONWEALTH HEALTH FREE CLINIC INC

Form 990 for tax year 2022

Filed by COMMONWEALTH HEALTH FREE CLINIC INC.

Totals

Total revenue
$940,676
Total expenses
$906,105
Contributions and grants received
$867,565
Grants paid
$0
Program service revenue
$67,795
Investment income
$97
Other revenue
$5,219
Total assets, end of year
$1,162,720
Total liabilities, end of year
$84,280
Net assets or fund balances, end of year
$1,078,440
Program services expenses (Part IX)
$891,348
Management and general expenses
$14,757
Fundraising expenses
$0
Program service expenses (Part III)
$891,348

Program services were 98.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $867,565

  • 2a · Program service revenue: NET PATIENT SERVICE REVENUE

    total $67,795 · related or exempt $67,795

  • 3 · Investment income

    total $97 · excluded $97

  • 4 · Income from investment of tax-exempt bond proceeds

    total $0

  • 5 · Royalties

    total $0

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 6d · Net rental income or loss

    total $0

  • 7d · Net gain or loss

    total $0

  • 8a · Fundraising events: gross income

    $0

  • 8b · Fundraising events: direct expenses

    $0

  • 8c · Net income from fundraising events

    total $0

  • 9a · Gaming: gross income

    $0

  • 9b · Gaming: direct expenses

    $0

  • 9c · Net income from gaming

    total $0

  • 10a · Gross sales of inventory

    $0

  • 10b · Cost of goods sold

    $0

  • 10c · Net income from sales of inventory

    total $0

  • 11a · Other revenue: MISCELLANEOUS REVENUE

    total $5,219 · excluded $5,219

  • 11e · Other revenue, total

    $5,219

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $0

  • 2 · Grants to domestic individuals

    total $0

  • 3 · Grants to foreign organizations and individuals

    total $0

  • 4 · Benefits paid to or for members

    total $0

  • 5 · Compensation of officers, directors and key employees

    total $144,580 · program services $144,580

  • 6 · Compensation of disqualified persons

    total $0

  • 7 · Other salaries and wages

    total $0

  • 8 · Pension plan contributions

    total $0

  • 9 · Other employee benefits

    total $0

  • 10 · Payroll taxes

    total $0

  • 11a · Fees: management

    total $0

  • 11b · Fees: legal

    total $0

  • 11c · Fees: accounting

    total $4,399 · management and general $4,399

  • 11d · Fees: lobbying

    total $0

  • 11e · Fees: professional fundraising services

    total $0

  • 11f · Fees: investment management

    total $0

  • 11g · Fees: other

    total $594,929 · program services $587,991 · management and general $6,938

  • 12 · Advertising and promotion

    total $920 · management and general $920

  • 13 · Office expenses

    total $53,328 · program services $50,828 · management and general $2,500

  • 14 · Information technology

    total $0

  • 15 · Royalties

    total $0

  • 16 · Occupancy

    total $25,388 · program services $25,388

  • 17 · Travel

    total $0

  • 18 · Travel or entertainment for public officials

    total $0

  • 19 · Conferences, conventions and meetings

    total $0

  • 20 · Interest

    total $0

  • 21 · Payments to affiliates

    total $0

  • 22 · Depreciation, depletion and amortization

    total $6,498 · program services $6,498

  • 23 · Insurance

    total $8,633 · program services $8,633

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $67,430 · program services $67,430

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $887,414 · end of year $925,655

  • 2 · Savings and temporary cash investments

    beginning of year $131,651 · end of year $131,401

  • 3 · Pledges and grants receivable

    beginning of year $52,498 · end of year $42,690

  • 4 · Accounts receivable

    beginning of year $10,201 · end of year $7,696

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 7 · Other notes and loans receivable

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $0 · end of year $0

  • 9 · Prepaid expenses and deferred charges

    beginning of year $0 · end of year $0

  • 10a · Land, buildings and equipment: cost or other basis

    $91,233

  • 10b · Land, buildings and equipment: accumulated depreciation

    $35,955

  • 10c · Land, buildings and equipment, net

    beginning of year $24,501 · end of year $55,278

  • 11 · Investments: publicly traded securities

    beginning of year $0 · end of year $0

  • 12 · Investments: other securities

    beginning of year $0 · end of year $0

  • 13 · Investments: program-related

    beginning of year $0 · end of year $0

  • 14 · Intangible assets

    beginning of year $0 · end of year $0

  • 15 · Other assets

    beginning of year $1,275 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $10,802 · end of year $28,402

  • 18 · Grants payable

    beginning of year $0 · end of year $0

  • 19 · Deferred revenue

    beginning of year $0 · end of year $0

  • 20 · Tax-exempt bond liabilities

    beginning of year $0 · end of year $0

  • 21 · Escrow or custodial account liability

    beginning of year $0 · end of year $0

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $0 · end of year $0

  • 24 · Unsecured notes and loans payable

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $52,869 · end of year $55,878

  • 27 · Net assets without donor restrictions

    beginning of year $1,043,869 · end of year $1,078,440

  • 28 · Net assets with donor restrictions

    beginning of year $0 · end of year $0

Mission and programs · 2022

Mission

THE COMMONWEALTH HEALTH FREE CLINIC PROVIDES BASIC MEDICAL AND DENTAL SERVICES FOR INDIVIDUALS WHO STRUGGLE WITH APPROPRIATE OR AFFORDABLE ACCESS TO HEALTHCARE.

  • 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 ADDITIONAL INFORMATION.

    Expenses $891,348 · Revenue $67,795

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Ms Connie D Smith

    CEO/PRESIDENT

    Total calculated
    $1,306,184
    From this org
    $0
    From related orgs
    $1,285,993
    Other
    $20,191
    Hours/week
    2 + 52 related

    Schedule J breakdown matched by us

    Base
    $0 + $992,844 related
    Bonus
    $0
    Other
    $0 + $293,149 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $20,191 related
    Filer's total
    $0 + $1,306,184 related

  • Mr Wade Stone

    EXECUTIVE VICE PRESIDENT

    Total calculated
    $521,137
    From this org
    $0
    From related orgs
    $501,132
    Other
    $20,005
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $471,203 related
    Bonus
    $0
    Other
    $0 + $29,929 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $20,005 related
    Filer's total
    $0 + $521,137 related

  • Mr David Gray

    EXECUTIVE VICE PRESIDENT

    Total calculated
    $429,151
    From this org
    $0
    From related orgs
    $385,152
    Other
    $43,999
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $376,518 related
    Bonus
    $0
    Other
    $0 + $8,634 related
    Deferred
    $0 + $9,150 related
    Nontaxable benefits
    $0 + $34,849 related
    Filer's total
    $0 + $429,151 related

  • Ms Michele W Lawless

    EXECUTIVE VICE PRESIDENT / CFO

    Total calculated
    $425,240
    From this org
    $0
    From related orgs
    $421,749
    Other
    $3,491
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $415,047 related
    Bonus
    $0
    Other
    $0 + $6,702 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $3,491 related
    Filer's total
    $0 + $425,240 related

  • Ms Katrina Wood

    VP/CHIEF NURSING OFFICER

    Total calculated
    $254,718
    From this org
    $0
    From related orgs
    $219,378
    Other
    $35,340
    Hours/week
    2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $216,316 related
    Bonus
    $0
    Other
    $0 + $3,062 related
    Deferred
    $0 + $5,519 related
    Nontaxable benefits
    $0 + $29,821 related
    Filer's total
    $0 + $254,718 related

  • Dr Josh Phillips

    DIRECTOR / DENTIST

    Total calculated
    $164,695
    From this org
    $144,580
    From related orgs
    $0
    Other
    $20,115
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $144,580
    Bonus
    $0
    Other
    $0
    Deferred
    $4,392
    Nontaxable benefits
    $15,723
    Filer's total
    $164,695

  • Dr Mark Yurchisin

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    2

  • Mr Joe Natcher

    SECRETARY

    Total calculated
    $0
    Hours/week
    2 + 4 related

  • Dr Michael Hubbard

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    2

  • Mrs Cathy Bishop

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 4 related

  • Dr Jacqueline Pope - Tarrence

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2 + 2 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

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
PART I, LINE 4B
------------------ 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 $274,682 WADE STONE $27,694

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • MED PLAZA PTRS LTD

    NONE · REAL ESTATE · KY · share of income $0 · share of assets $0

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2022
Filed
15 February 2024
IRS schema version
2022v5.0
Source object
202420459349301017

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