2022-11-09T09:05:41-06:00 2021-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-01-01 930854433 MID-COLUMBIA HEALTH FOUNDATION MID- 5412967275 PO BOX 1580 THE DALLES OR 97058 AMY SCHANNO-SUGG BOARD CHAIR 5412967275 2022-11-07 1 AMY SCHANNO-SUGG 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2022-11-04 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z AMANDA EVANS PO BOX 1580 THE DALLES OR 97058 1644931 0 X WWW.MCMC.NET/FOUNDATION X 1983 OR TO WORK TOGETHER WITH AND PROVIDE FINANCIAL SUPPORT TO MID-COLUMBIA MEDICAL CENTER IN ORDER TO PROVIDE ACCESS TO QUALITY HEALTHCARE FOR OUR COMMUNITY. 12 9 0 36 0 0 1331738 785232 10018 0 419642 783126 21833 61410 1783231 1629768 1583720 436404 0 0 369451 286035 0 0 0 258727 208715 2211898 931154 -428667 698614 6359130 7391294 259005 260967 6100125 7130327 TO WORK TOGETHER WITH AND PROVIDE FINANCIAL SUPPORT TO MID-COLUMBIA MEDICAL CENTER IN ORDER TO PROVIDE ACCESS TO QUALITY HEALTHCARE FOR OUR COMMUNITY. 0 0 446315 436404 0 THE PRIMARY PURPOSE OF THE FOUNDATION IS TO PROVIDE FUNDRAISING FOR THE MID-COLUMBIA MEDICAL CENTER (ID# 93-0386936) AS WELL AS GRANTS/SCHOLARSHIPS TO THE GENERAL PUBLIC SUPPORT. 446315 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 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 1 1 0 0 0 0 0 0 X 12 9 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X WENDY APLAND 5415065928 551 LONE PINE BLVD THE DALLES OR 97058 KRISTI TIMMONS CHAIR 1.00 X X 0 0 0 ERIC HOLEMAN VICE CHAIR (THRU DECEMBER) 1.00 40.00 X X 0 160221 30980 DR FRANK TODA TREASURER 1.00 X X 0 0 0 AMY SCHANNO-SUGG SECRETARY 1.00 40.00 X X 0 108091 23671 PAT ASHMORE DIRECTOR 1.00 X 0 0 0 ROBERT BAILEY DIRECTOR (THRU DECEMBER) 1.00 X 0 0 0 JORGE BARRAGAN JR DIRECTOR 1.00 X 0 0 0 DEAN DOLLARHIDE DIRECTOR 1.00 X 0 0 0 SHAE KASINGER DIRECTOR 1.00 X 0 0 0 DENNIS KNOX DIRECTOR 1.00 40.00 X 0 567010 29923 LORI ROSEBRAUGH DIRECTOR 1.00 X 0 0 0 MEREDITH SMITH DIRECTOR 1.00 X 0 0 0 AMANDA EVANS EXECUTIVE DIRECTOR 40.00 X 0 75337 10070 0 910659 94644 0 0 1 0 WESTBY ASSOCIATES INC 1603 OFFICERS ROW VANCOUVER WA 98661 CONSULTING/GRANT WRITING FEES 120418 1 4620 224342 556270 785232 784014 784014 888 -888 -888 -888 75685 4620 14275 61410 61410 1629768 0 0 844536 X 323889 323889 112515 112515 85407 85407 179780 179780 2594 2594 18254 18254 1500 1500 16907 16907 131342 131342 7803 7803 7413 4491 2922 34755 34755 4363 3185 1178 479 479 34 34 874 874 REPAIRS AND MAINTENANCE 1130 1130 TAXES AND LICENSES 1010 1010 MEDICAL SUPPLIES 486 486 DUES AND SUBSCRIPTIONS 85 85 534 534 931154 446315 484839 0 598500 466281 1657243 1816462 279212 290690 0 0 922 0 3823253 4817861 6359130 7391294 16367 23101 242638 237866 259005 260967 X 3586212 4253055 2513913 2877272 6100125 7130327 6359130 7391294 X 698614 286035 45553 X 0 1 X 1 0 X 517245 1095656 780176 1003494 785232 4181803 517245 1095656 780176 1003494 785232 4181803 1970524 2211279 75018 91712 756481 419642 784014 2126867 6308670 469606 0.35050 0.35610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1942329 30138 56280 23650 2005097 2135976 58970 47174 14500 285291 1942329 2044538 52326 59362 20250 2135976 1644624 403368 10096 13550 2044538 1387747 209917 60960 14000 1644624 0.68390 0.21060 0.10550 0 0 0 CRUT LIABILITY 205872 OTHER LIABILITIES 13391 DUE TO RELATED PARTIES 18603 237866 X PART V, LINE 4: MCHF ENDOWMENT FUND WAS ESTABLISHED IN 1987 FOR THE SPECIFIC PURPOSE OF FINANCING THE FOUNDATION'S OPERATING EXPENSES. IT IS UNDERSTOOD THAT ONLY THE INTEREST, NOT THE PRINCIPAL, MAY BE USED TOWARD THE FOUNDATION OPERATING EXPENSES. THE PURPOSE OF OTHER EVELYN KASER NURSING SCHOLARSHIP, LORNA & JOSEPH HALLIDAY FAMILY NURSING SCHOLARSHIP, MCMC BOARD OF TRUSTEES SCHOLARSHIP AND PERMANENT SCHOLARSHIP IS TO GAIN INTEREST TO US AS SCHOLARSHIP FOR SECONDARY EDUCATION OF STUDENTS. PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSISTIONS, THE MEDICAL CENTER DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSISTION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. FESTIVAL OF TREES 38780 2100 36680 514 TOURNAMENT OF TRADITION 41525 2520 39005 2884 4187 3646 3044 80305 4620 75685 2884 4187 3646 3558 14275 61410 1 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH ST THE DALLES OR 97058 930386936 501(C)(3) 230846 0 GENERAL SUPPORT THE DALLES MEALS ON WHEELS PO BOX 689 THE DALLES OR 97058 743164186 501(C)(3) 6500 0 WOMEN'S GIVING CIRCLE GRANT HELP MEAL TO INDIVIDUALS COLUMBIA GORGE FOOD BANK 3610 CRATES WAY THE DALLES OR 97058 930785786 501(C)(3) 6500 0 WOMEN'S GIVING CIRCLE GRANT HELP WITH NEW BUILDING 3 0 RANDY ROOD MEMORIAL SCHOLARSHIP 45 86665 WASCO LODGE MASONIC SCHOLARSHIP 3 6000 EVELYN KASER NURSING SCHOLARSHIP 7 5400 NON-TRADITIONAL NURSING SCHOLARSHIP 4 5350 MCMC BOARD OF TRUSTEES FUTURE HEALTHCARE PROFESSIONALS 2 4000 MCMC EMPLOYEE SCHOLARSHIP 3 3750 LORNA & JOSEPH HALLIDAY NURSING SCHOLARSHIP 4 750 MCMC DEPENDENT SCHOLARSHIP 1 600 PART I, LINE 2: FUNDING IS TRACKED THROUGH OUR JOURNAL SHEETS OF ALL THE DIFFERENT FUNDS WE HAVE. THE GRANTEES ARE REQUIRED TO PROVIDE AN END OF YEAR REPORT ON HOW FUNDS WERE USED. 0 0 0 0 0 0 0 0 0 DENNIS KNOX DIRECTOR 0 493262 0 67561 0 6187 0 14500 0 15423 0 596933 0 0 ERIC HOLEMAN VICE CHAIR (THRU DECEMBER) 0 160221 0 0 0 0 0 8508 0 22472 0 191201 0 0 FORM 990, PART VI, SECTION A, LINE 6 HEALTHCARE FOR THE MID-COLUMBIA REGION IS THE SOLE MEMBER. ON APRIL 4, 2019, THE OPERATIONS AND RELATED ASSETS AND LIABILITIES OF HEALTH CARE FOR THE MID-COLUMBIA REGION WERE MERGED INTO MID-COLUMBIA MEDICAL CENTER. AS A RESULT, MID-COLUMBIA MEDICAL CENTER NOW EXISTS AS THE PARENT OVER THE AFFILIATES OF THE FOUNDATION AND DRY HOLLOW. NO CHANGE TO THE OVERALL SCOPE OF OPERATIONS OCCURRED AS A RESULT OF THIS EVENT. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE RETURN IS SUBMITTED TO THE BOARD OF TRUSTEES FOR REVIEW. UPDATES ARE MADE AS NECESSARY BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C WE ANNUALLY REQUIRE DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS TO SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT, THEY WOULD BE SUBJECT TO CORRECTIVE ACTION UP TO AND INCLUDING TERMINATION FOR VIOLATION OF OUR POLICY. IF THEY SELF-DISCLOSED A POTENTIAL CONFLICT OF INTEREST ON THE FORM, WE WOULD GATHER INFORMATION ON THE ISSUE AND MAKE A DETERMINATION ON HOW SEVERE THE CONFLICT IS AND WHETHER OR NOT THE EMPLOYEE OR DIRECTOR COULD REMAIN AN OFFICER, DIRECTOR, OR EMPLOYEE. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION COMMITTEE WAS DESIGNED WHICH INCLUDED MEMBERS OF THE BOARD OF TRUSTEES, HR DIRECTOR, AND COMPENSATION SPECIALIST. COMPENSATION COMMITTEE AGED AND/OR UPDATED PREVIOUSLY SUPPLIED COMPENSATION DATA FROM OUTSIDE FIRM BASED ON COMMERCIALLY AVAILABLE SALARY SURVEYS. THE CEO THEN NEGOTIATES WITH THE BOARD, WHICH COMPARES THE COMPENSATION DISCUSSED WITH THE ANALYSIS PREVIOUSLY DESCRIBED AND VOTES ON AND APPROVES A NEW CONTRACT IN EXECUTIVE SESSION WITHOUT CEO PRESENCE OR PARTICIPATION IN THE VOTE. COMPENSATION OF THE ORGANIZATIONS OFFICERS OR KEY EMPLOYEES IS DETERMINED BY A SURVEY OF MARKET RATES FOR SIMILAR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL INFORMATION AVAILABLE TO THE PUBLIC AT THE CHARITABLE ACTIVITIES DIVISION OF THE OREGON DEPARTMENT OF JUSTICE. THE DOCUMENTS ARE AVAILABLE UPON REQUEST AS WELL. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 131,342. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,342. FORM 990, PART XI, LINE 9: CHANGE IN CRUT 45,553. HEALTH CARE FOR THE MID-COLUMBIA REGION 1700 E 19TH STREET THE DALLES OR 97058 930847905 HEALTH SERVICES OR 501(C)(3) LINE 12C, III-FI 0 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREET THE DALLES OR 97058 930386936 ACUTE HOSPITAL OR 501(C)(3) LINE 3 HEALTHCARE FOR THE MID-COLUMBIA REGION 1 DRY HOLLOW PROFESSIONAL CENTER INC PO BOX 1580 THE DALLES OR 97058 930631350 RENTAL BUILDING OR N/A C 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 0 MID-COLUMBIA MEDICAL CENTER B 230846 CASH MID-COLUMBIA MEDICAL CENTER C 224342 CASH MID-COLUMBIA MEDICAL CENTER L 326486 CASH FORM 990, SCHEDULE R, PART II HEALTH CARE FOR THE MID-COLUMBIA REGION WAS THE SOLE MEMBER. HCMCF WAS DISSOLVED ON 12/21/21 AND THE ASSETS IT HELD TRANSFERRED TO MID-COLUMBIA MEDICAL CENTER. AS A RESULT, MID-COLUMBIA MEDICAL CENTER NOW EXISTS AS THE PARENT OVER THE AFFILIATES OF THE FOUNDATION AND DRY HOLLOW. NO CHANGE TO THE OVERALL SCOPE OF OPERATIONS OCCURRED AS A RESULT OF THIS EVENT.