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← THIRD STREET COMMUNITY CLINIC INC

Form 990 for tax year 2023

Filed by THIRD STREET COMMUNITY CLINIC INC.

Totals

Total revenue
$22,438,116
Total expenses
$24,966,032
Contributions and grants received
$7,334,079
Grants paid
$0
Program service revenue
$15,326,819
Investment income
-$257,608
Other revenue
$34,826
Total assets, end of year
$18,374,674
Total liabilities, end of year
$6,531,413
Net assets or fund balances, end of year
$11,843,261
Program services expenses (Part IX)
$19,356,268
Management and general expenses
$5,609,764
Fundraising expenses
$0
Program service expenses (Part III)
$19,356,268

Program services were 77.5% 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.

  • 1e · Government grants (contributions)

    $6,156,566

  • 1f · All other contributions, gifts and grants

    $1,177,513

  • 2a · Program service revenue: MEDICAID & MEDICARE REVENUE

    total $2,577,638 · related or exempt $2,577,638

  • 2b · Program service revenue: PATIENT SERVICES REVENUE

    total $8,007,620 · related or exempt $8,007,620

  • 2c · Program service revenue: PHARMACY REVENUE

    total $3,955,629 · related or exempt $3,955,629

  • 2d · Program service revenue: CPC INCOME

    total $28,645 · related or exempt $28,645

  • 2e · Program service revenue: INSURANCE INCENTIVE PAYMENTS

    total $677,463 · related or exempt $677,463

  • 2f · All other program service revenue

    total $79,824 · related or exempt $79,824 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $13,812 · excluded $13,812

  • 6a · Gross rents

    real property $9,243

  • 6b · Less rental expenses

    real property $8,211

  • 6c · Rental income or loss

    real property $1,032 · personal property $0

  • 6d · Net rental income or loss

    total $1,032 · excluded $1,032

  • 7a · Gross sales of assets other than inventory

    securities $4,242,921

  • 7b · Less cost or other basis and sales expenses

    securities $4,514,341

  • 7c · Gain or loss

    securities -$271,420 · other assets $0

  • 7d · Net gain or loss

    total -$271,420 · excluded -$271,420

  • 11a · Other revenue: MISCELLANEOUS REVENUE

    total $33,794 · related or exempt $0 · unrelated business $0 · excluded $33,794

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $33,794

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $0 · program services $0

  • 2 · Grants to domestic individuals

    total $0 · program services $0

  • 3 · Grants to foreign organizations and individuals

    total $0 · program services $0

  • 4 · Benefits paid to or for members

    total $0 · program services $0

  • 5 · Compensation of officers, directors and key employees

    total $1,580,243 · program services $1,226,252 · management and general $353,991 · fundraising $0

  • 6 · Compensation of disqualified persons

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 7 · Other salaries and wages

    total $12,723,445 · program services $9,873,258 · management and general $2,850,187 · fundraising $0

  • 8 · Pension plan contributions

    total $479,685 · program services $372,230 · management and general $107,455 · fundraising $0

  • 9 · Other employee benefits

    total $1,722,901 · program services $1,336,953 · management and general $385,948 · fundraising $0

  • 10 · Payroll taxes

    total $1,095,107 · program services $849,791 · management and general $245,316 · fundraising $0

  • 11a · Fees: management

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 11b · Fees: legal

    total $3,452 · program services $0 · management and general $3,452 · fundraising $0

  • 11c · Fees: accounting

    total $18,045 · program services $0 · management and general $18,045 · fundraising $0

  • 11d · Fees: lobbying

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 11e · Fees: professional fundraising services

    total $0 · fundraising $0

  • 11f · Fees: investment management

    total $1,407 · program services $0 · management and general $1,407 · fundraising $0

  • 11g · Fees: other

    total $1,294,442 · program services $801,596 · management and general $492,846 · fundraising $0

  • 12 · Advertising and promotion

    total $157,615 · program services $97,605 · management and general $60,010 · fundraising $0

  • 13 · Office expenses

    total $1,209,350 · program services $748,902 · management and general $460,448 · fundraising $0

  • 14 · Information technology

    total $364,879 · program services $225,955 · management and general $138,924 · fundraising $0

  • 15 · Royalties

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 16 · Occupancy

    total $628,865 · program services $389,431 · management and general $239,434 · fundraising $0

  • 17 · Travel

    total $91,729 · program services $56,804 · management and general $34,925 · fundraising $0

  • 18 · Travel or entertainment for public officials

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 19 · Conferences, conventions and meetings

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 20 · Interest

    total $3,371 · program services $0 · management and general $3,371

  • 21 · Payments to affiliates

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 22 · Depreciation, depletion and amortization

    total $459,431 · program services $444,003 · management and general $15,428 · fundraising $0

  • 23 · Insurance

    total $117,640 · program services $72,850 · management and general $44,790 · fundraising $0

  • 24a · Other expenses: PHARMACY EXPENSE

    total $2,428,372 · program services $2,428,372 · management and general $0 · fundraising $0

  • 24b · Other expenses: DENTAL & MEDICAL EQUIP EXP

    total $391,651 · program services $242,534 · management and general $149,117 · fundraising $0

  • 24c · Other expenses: BAD DEBT EXPENSE

    total $182,138 · program services $182,138 · management and general $0 · fundraising $0

  • 24d · Other expenses: PATIENT BILLING EXPENSE

    total $12,264 · program services $7,594 · management and general $4,670 · fundraising $0

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $996,292 · end of year $1,158,751

  • 2 · Savings and temporary cash investments

    beginning of year $1,254,487 · end of year $147,853

  • 3 · Pledges and grants receivable

    beginning of year $282,595 · end of year $2,864,470

  • 4 · Accounts receivable

    beginning of year $940,891 · end of year $2,779,943

  • 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 $48,937 · end of year $184,858

  • 9 · Prepaid expenses and deferred charges

    beginning of year $93,669 · end of year $103,141

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

    $15,219,240

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

    $6,932,198

  • 10c · Land, buildings and equipment, net

    beginning of year $5,020,880 · end of year $8,287,042

  • 11 · Investments: publicly traded securities

    beginning of year $2,220,812 · end of year $701,463

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 14 · Intangible assets

    beginning of year $0 · end of year $0

  • 15 · Other assets

    beginning of year $1,028,843 · end of year $2,147,153

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,887,104 · end of year $3,439,627

  • 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 $43,956 · end of year $911,165

  • 25 · Other liabilities

    beginning of year $743,241 · end of year $2,180,621

  • 27 · Net assets without donor restrictions

    beginning of year $9,213,105 · end of year $9,188,532

  • 28 · Net assets with donor restrictions

    beginning of year $0 · end of year $2,654,729

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $0 · end of year $0

Mission and programs · 2023

Mission

THIRD STREET COMMUNITY CLINIC (DBA THIRD STREET FAMILY HEALTH SERVICES) IS A COMMUNITY HEALTH CENTER WITH A MISSION TO DELIVER COMPREHENSIVE HEALTH AND WELLNESS CARE, ACCESSIBLE TO ALL IN THE COMMUNITIES WE SERVE IN ASHLAND, CRAWFORD, AND RICHLAND COUNTIES.

  • THIRD STREET FAMILY HEALTH SERVICES PROVIDED MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO A TOTAL OF 20,310 PATIENTS DURING ITS FISCAL YEAR ENDED DECEMBER 31, 2023. THESE PATIENTS MADE A TOTAL OF 17,214 VISITS TO THE CLINIC'S DENTAL FACILITY DURING 2023; 44,511 VISITS TO THE CLINIC'S MEDICAL FACILITY DURING 2023 (FOR MEDICAL AND BEHAVIORAL HEALTH SERVICES) AND 11,489 VISITS TO ITS OBSTETRIC AND GYNECOLOGY FACILITY DURING 2023. THIS INCLUDES VIRTUAL VISITS. DURING 2023, THE FILING ORGANIZATION WAS AWARDED THE AMBULATORY HEALTH CARE ACCREDITATION AND THE BEHAVORIAL HEALTH CARE ACCREDITATION, BOTH FROM THE JOINT COMMISSION, AND CONTINUE TO BE CERTIFIED. THE ORGANIZATION HAS 11 SITES.

    Expenses $19,356,268 · Revenue $15,326,819

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • ALEX GOFF

    TREASURER- TERM ENDED

    Total calculated
    $0
    Hours/week
    1
  • AMBER WERTMAN

    VICE PRESIDENT / VICE CHAIR

    Total calculated
    $0
    Hours/week
    1
  • BARRETT THOMAS

    TREASURER

    Total calculated
    $0
    Hours/week
    1
  • DOROTHY STRATTON

    Secretary / Chair of Quality

    Total calculated
    $0
    Hours/week
    1
  • JAMES DOLAN

    PRESIDENT / CHAIR

    Total calculated
    $0
    Hours/week
    1
  • ALLEN HOCKER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • BRIGITTE COLES

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • CINDY WETTERAU

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • CODY ALBERT

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • DOUGLAS NEWSOME

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • DR JULIE CHAYA

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • DR KHUSHWANT PITTENGER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • JALEN REESE

    BOARD MEMBEER

    Total calculated
    $0
    Hours/week
    1
  • JOE DEVANY

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • JOE STAFFORD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • KATHY WELLS

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • MATT DAHM

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • SUSAN BAKER

    BOARD MEMBER - TERM ENDED

    Total calculated
    $0
    Hours/week
    1
  • TOM WALKER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1
  • VERONICA GROFF

    BOARD MEMBER- TERM ENDED

    Total calculated
    $0
    Hours/week
    1
  • BARBARA SULLINGER

    CHIEF FINANCIAL OFFICER

    Total calculated
    $154,801
    From this org
    $131,864
    From related orgs
    $0
    Other
    $22,937
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $131,864
    Bonus
    $0
    Other
    $0
    Deferred
    $4,309
    Nontaxable benefits
    $18,628
    Filer's total
    $154,801
  • DR BRETT TOWARD

    CHIEF MEDICAL OFFICER

    Total calculated
    $143,241
    From this org
    $123,763
    From related orgs
    $0
    Other
    $19,478
    Hours/week
    40
  • DR DAVID HOAG

    CHIEF DENTAL OFFICER

    Total calculated
    $204,865
    From this org
    $174,546
    From related orgs
    $0
    Other
    $30,319
    Hours/week
    39

    Schedule J breakdown matched by us

    Base
    $174,546
    Bonus
    $0
    Other
    $0
    Deferred
    $6,421
    Nontaxable benefits
    $23,898
    Filer's total
    $204,865
  • DR SHENG LIU

    CHIEF CLINICAL OFFICER

    Total calculated
    $281,015
    From this org
    $266,382
    From related orgs
    $0
    Other
    $14,633
    Hours/week
    32

    Schedule J breakdown matched by us

    Base
    $266,382
    Bonus
    $0
    Other
    $0
    Deferred
    $6,586
    Nontaxable benefits
    $8,047
    Filer's total
    $281,015
  • JAVAR JACKSON

    CHIEF OPERATING OFFICER

    Total calculated
    $222,373
    From this org
    $193,105
    From related orgs
    $0
    Other
    $29,268
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $166,583
    Bonus
    $26,522
    Other
    $0
    Deferred
    $5,370
    Nontaxable benefits
    $23,898
    Filer's total
    $222,373
  • PEGGY ANDERSON

    CHIEF EXECUTIVE OFFICER

    Total calculated
    $217,752
    From this org
    $211,791
    From related orgs
    $0
    Other
    $5,961
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $183,793
    Bonus
    $27,998
    Other
    $0
    Deferred
    $5,961
    Nontaxable benefits
    $0
    Filer's total
    $217,752
  • CARLOS MOLINA ARRIOLA

    PSYCHATRIST

    Total calculated
    $356,196
    From this org
    $322,961
    From related orgs
    $0
    Other
    $33,235
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $322,961
    Bonus
    $0
    Other
    $0
    Deferred
    $9,337
    Nontaxable benefits
    $23,898
    Filer's total
    $356,196
  • CAROLYN CHAMBERS

    ASST CHIEF MED OFFICER / OBGYN

    Total calculated
    $322,701
    From this org
    $295,770
    From related orgs
    $0
    Other
    $26,931
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $265,979
    Bonus
    $29,791
    Other
    $0
    Deferred
    $8,057
    Nontaxable benefits
    $18,874
    Filer's total
    $322,701
  • CHEL LEES

    PHYSICIAN

    Total calculated
    $195,127
    From this org
    $181,347
    From related orgs
    $0
    Other
    $13,780
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $181,347
    Bonus
    $0
    Other
    $0
    Deferred
    $5,712
    Nontaxable benefits
    $8,068
    Filer's total
    $195,127
  • JESSICA ROSE BRENT

    PODIATRIST

    Total calculated
    $189,889
    From this org
    $161,799
    From related orgs
    $0
    Other
    $28,090
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $155,091
    Bonus
    $6,708
    Other
    $0
    Deferred
    $5,158
    Nontaxable benefits
    $22,932
    Filer's total
    $189,889
  • KEITH DAVIS

    PHYSICIAN

    Total calculated
    $193,551
    From this org
    $167,049
    From related orgs
    $0
    Other
    $26,502
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $167,049
    Bonus
    $0
    Other
    $0
    Deferred
    $5,482
    Nontaxable benefits
    $21,020
    Filer's total
    $193,551
  • MELISSA PASKEY (VERCHIO)

    PHYSICIAN

    Total calculated
    $342,098
    From this org
    $311,025
    From related orgs
    $0
    Other
    $31,073
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $281,234
    Bonus
    $29,791
    Other
    $0
    Deferred
    $8,220
    Nontaxable benefits
    $22,853
    Filer's total
    $342,098

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

  • 3 · Written employment contract
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan
  • 5a · Pay contingent on this organization's revenues
  • 6a · Pay contingent on this organization's net earnings

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5b · Pay contingent on a related organization's revenues
  • 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)

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
THE FOLLOWING EMPLOYEES PARTICIPATED IN A 457F NONQUALIFIED EXECUTIVE DEFERRED COMPENSATION PLAN DURING 2023 AND ARE INCLUDED ON FORM 990, PART VII: PEGGY ANDERSON, JESSICA BRENT, CAROLYN CHAMBERS, DAVID HOAG, BARBARA SULLINGER, AND BRENT TOWARD. NO CONTRIBUTIONS WERE MADE TO THE PLAN BY THE ORGANIZATION FOR ANY INDIVIDUALS DURING 2023. PARTICIPANT ELIGIBILITY IS DETERMINED BY THE ORGANIZATION.
Schedule J, Part I, Line 5a Compensation contingent on revenues of the organization
WHILE CERTAIN BONUSES ARE NOT TIED TO REVENUE GENERATION OF THE ORGANIZATION AND ARE DESIGNED TO RECOGNIZE SUCCESS OR HARDSHIP OF THE ORGANIZATION, PROJECT, INDIVIDUAL, OR DEPARTMENT, THERE ARE BONUSES THAT ARE DETERMINED IN WHOLE OR IN PART BY THE REVENUES OF SPECIFIC ACTIVITIES. THESE BONUSES AND THE BONUSES REFERENCED IN LINE 5 ARE ADMINISTRED AT THE DISCRETION OF THE ORGANIZATION AND ARE NOT REQUIRED PURSUANT TO CONTRACTS IN-PLACE.
Schedule J, Part I, Line 6a Compensation contingent on net earnings of the organization
IN ADDITION TO THE BONUSES REFERENCED ON LINE 5, THERE ARE BONUSES THAT ARE CONTINGENT ON THE NET EARNINGS OF AN ACTIVITY. THESE BONUSES ARE CALCULATED AS A PERCENTAGE OF ANY REVENUES IN EXCESS OF COSTS INCURRED.

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.

Provenance

Return type
form_990
Tax year
2023
Filed
15 November 2024
IRS schema version
2023v5.1
Source object
202403209349308345

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