2019-11-13T12:34:58-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-01-01 310679012 COLUMBUS MEDICAL ASSOCIATION FOUNDATION COLU 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 ROBERT E FALCONE CEO 6142407410 2019-11-12 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-12 67.59.56.31 2019-11-12 13:45:55 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 5FCF717F5751041EDBE682B6F9E5BC94B7CB642E 2018 2020-03-31 21:24:44Z ROBERT E FALCONE 1390 DUBLIN ROAD COLUMBUS OH 43215 1113792 0 X WWW.CMAFOHIO.ORG X 1958 OH THROUGH GRANT-MAKING, CMAF IMPROVES THE HEALTH OF RESIDENTS IN CENTRAL OHIO. 18 18 18 30 40946 39946 259422 56263 157863 216764 1644804 765633 159962 46706 2222051 1085366 1226910 1502076 0 0 606005 675067 0 0 268710 1325830 1102550 3158745 3279693 -936694 -2194327 83451624 77061682 3229057 3248758 80222567 73812924 X THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION, THROUGH THE GOVERNANCE AND OVERSIGHT OF ITS BOARD OF PHYSICIANS AND OTHER EXPERTS, EFFECTS CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF THE RESIDENTS OF CENTRAL OHIO. 0 0 1850960 1502076 223576 THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS.PRIORITIES:- TRANSFORMING CLINICAL HEALTH CARE DELIVERY TO: BE PATIENT CENTERED, BE BASED ON HEALTH / WELLNESS PARADIGM, BE BASED ON CLEARLY DEFINED PATIENT / DOCTOR RESPONSIBILITY, BE A PARTNERSHIP BETWEEN PATIENT / DOCTOR / PAYER- SUPPORTING AND IMPROVING HEALTH CARE SAFETY NET CLINICAL SERVICES TO UNINSURED AND UNDERINSURED POPULATIONS SUCH AS SUPPORT FOR THE NEWLY CONSOLIDATED PHYSICIANS FREE CLINIC / VOLUNTARY CARE NETWORK. - SAVING AND IMPROVING LIVES THROUGH A COORDINATION OF TRAUMA AND EMERGENCY HEALTH CARE RESOURCES THROUGH SUPPORT FOR THE CENTRAL OHIO TRAUMA SYSTEM- ADVANCING LEADERSHIP CAPACITY OF YOUTH TO ENGAGE IN HEALTH PHILANTHROPY 1850960 1 0 0 0 0 1 0 0 0 1 1 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 13 0 1 18 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X LAURIE HAWKINS 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 JAMES L NICHOLS SECRETARY/TREASURER 4.00 1.00 X X 0 0 0 LINDA SIEFKAS VICE PRESIDENT 1.00 1.00 X X 0 0 0 MARC L PARNES MD PRESIDENT 2.00 3.00 X X 0 7000 0 NEDRA HADLEY TRUSTEE 1.00 1.00 X 0 0 0 ALVIN RODACK TRUSTEE 1.00 1.00 X 0 0 0 EDWARD T BOPE MD TRUSTEE 1.00 1.00 X 0 0 0 JASMINE GREEN TRUSTEE 1.00 1.00 X 0 0 0 MARK STAMM TRUSTEE 1.00 1.00 X 0 0 0 BRET KOCKENTIET MD TRUSTEE 1.00 1.00 X 0 0 0 GREG SAWCHYN MD TRUSTEE 1.00 1.00 X 0 0 0 KAREN KING MD TRUSTEE 1.00 1.00 X 0 0 0 BARBARA LACH TRUSTEE 1.00 1.00 X 0 0 0 MYSHEIKA WILLIAMS ROBERTS MD TRUSTEE 1.00 1.00 X 0 0 0 JEFF HALL MD TRUSTEE 1.00 1.00 X 0 0 0 DON BROWN TRUSTEE 1.00 1.00 X 0 0 0 ANITA SOMANI MD TRUSTEE 1.00 1.00 X 0 0 0 JEFFERY JANIS MD TRUSTEE 1.00 1.00 X 0 0 0 BETH LISTON MD TRUSTEE 1.00 1.00 X 0 0 0 ROBERT E FALCONE MD CEO 23.00 17.00 X 250447 0 16084 LAURIE HAWKINS CFO 21.00 19.00 X 126449 0 29563 WELDON MILBOURNE EXECUTIVE DIRECTOR 39.00 1.00 X 130839 0 9995 507735 7000 55642 3 0 1 0 0 56263 56263 RENTAL INCOME 900099 143221 143221 CAM 900099 59112 59112 PROGRAMS 900099 14431 14431 216764 765633 765633 76500 28426 48074 48074 48074 OTHER INCOME 900099 6812 6812 INSURANCE PROCEEDS 900099 -1052 -1052 -7128 -7128 -1368 1085366 223576 40946 764581 1502076 1502076 164871 49461 80787 34623 312572 93772 153160 65640 44514 13354 21812 9348 95569 28671 46829 20069 57541 17262 28195 12084 337588 337588 98508 25612 45314 27582 66398 25422 15554 25422 262550 71743 140453 50354 3420 61 3298 61 19963 6359 7244 6360 83930 1496 80938 1496 186052 14884 156284 14884 TAXES & LICENSES 44141 787 42567 787 3279693 1850960 1160023 268710 242280 166822 99885 93205 40636 22220 4314471 1504703 2972728 2809768 79985899 73857063 110196 112604 83451624 77061682 250383 197289 2385467 2279349 593207 772120 3229057 3248758 X 78950672 72545453 808658 802733 463237 464738 80222567 73812924 83451624 77061682 X -2194327 -4222443 7128 X X 0 1 X 1 0 X X 1 COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED 200385860 10 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 9 3 28446 4000 1000 2000 915644 202715 1 1 2296037 35813 -31754 21961 0 17131 2261004 2129790 95934 160398 68597 510 20978 2296037 2128618 90912 75584 145459 19865 2129790 2479300 61785 1442 393390 20519 2128618 2715353 172004 115605 514019 9643 2479300 0.14000 0.23000 0.63000 0 0 253580 253580 2047215 375323 1671892 1243803 457925 785878 561801 479178 82623 208072 192277 15795 2809768 OTHER SECURITIES 73857063 F 73857063 REIMBURSEMENT TO AFFILIATES 514296 ASSETS HELD FOR OTHERS 257824 772120 PART V, LINE 4: FUNDS SHALL BE USED TO MAKE GRANTS TO ELIGIBLE ORGANIZATIONS, PROGRAMS OR PROJECTS IN FURTHERANCE OF THE MISSION OF THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION. ASIA 0 0 INVESTMENTS N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 HEALTHCARE COLLABORATIVE OF GREATER COLUMBUS 1429 KING AVE SUITE 200 COLUMBUS OH 43212 510426050 501 (C)(3) 275000 TO SUPPORT ITS CORE SERVICES CENTRAL OHIO TRAUMA SYSTEM 1390 DUBLIN ROAD COLUMBUS OH 43215 311592734 501 (C)(3) 300000 TO SUPPORT ITS CORE SERVICES PHYSICIANS CARE CONNECTION 1390 DUBLIN ROAD COLUMBUS OH 43215 311373719 501 (C)(3) 500000 TO PROVIDE FREE PRIMARY & SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERSERVED PHYSICIANS LEADERSHIP ACADEMY 1390 DUBLIN ROAD COLUMBUS OH 43215 822152009 501 (C)(3) 306923 TO EDUCATE PHYSICIANS THROUGH LEADERSHIP TRAINING COLUMBUS FOUNDATION 1234 E BROAD ST COLUMBUS OH 43205 316044264 501 (C)(3) 10000 FOR CRITICAL NEEDS FUND 5 0 PART I, LINE 2: A MEMORANDUM OF AGREEMENT IS SIGNED BETWEEN THE GRANTEE AND GRANTOR THAT DESCRIBES THE CONDITIONS FOR THE GRANT TO INCLUDE PAYMENT AND REPORTING PROCESSES. X X X X 0 0 0 0 0 0 0 0 0 ROBERT E FALCONE MD CEO 244447 0 0 0 6000 0 14233 0 1851 0 266531 0 0 0 LAURIE HAWKINS CFO 126449 0 0 0 0 0 8060 0 21503 0 156012 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COLUMBUS MEDICAL ASSOCIATION IS THE ORGANIZATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS AND APPROVE CHANGES IN THE BY-LAWS AND CODE OF REGULATIONS. IN ADDITION THE SOLE MEMBER HAS THE AUTHORITY TO APPROVE DECISIONS SUCH AS DISSOLVING THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS PROVIDED TO THE BOARD MEMBERS FOR THEIR REVIEW BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY SENDS A DISCLOSURE FORM TO ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES REQUIRING THEM TO DISCLOSE ANY CONFLICTS OF INTEREST. ANY NEW BOARD MEMBERS ARE ADVISED OF THE POLICY UPON ENTERING THE DUTIES OF HIS/HER OFFICE. THOSE CONFLICTS ARE THEN ADDRESSED BY THE BOARD. VOTING AND PARTICIPATION RESTRICTIONS ARE IMPOSED ON THOSE WITH ANY CONFLICTS. THE BOARD PRESIDENT AND SECRETARY/TREASURER ARE AUTHORIZED AND DIRECTED TO SEE THAT THIS POLICY IS FOLLOWED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PERFORMS COMPENSATION REVIEWS. THE CEO REVIEW IS HANDLED BY THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION BOARD AND THE CEO EVALUATION COMMITTEE. THE CEO HAS AN EMPLOYMENT CONTRACT AND IT WAS LAST UPDATE IN 2017. THE CEO REVIEWS THE COMPENSATION FOR ALL STAFF. THE CEO ESTABLISHES COMPENSATION BASED ON INFLATION RATES, AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS AND STUDYS AND APPROVAL BY THE JOINT FINANCE COMMITTEE AND THE BOARD. THE OUTSIDE REVIEW IS CONDUCTED EVERY THREE YEARS AND THE LAST ONE WAS IN 2018. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: UNRELATED BUSINESS INCOME FROM INVESTMENT IN PARTNERSHIPS 7,128. FORM 990, PART XII, LINE 2C THE TREASURERS OF THE FILING ORGANIZATION AND ITS RELATED ENTITIES ARE MEMBERS OF THE JOINT FINANCE COMMITTEE. THIS COMMITTEE MAKES DECISIONS CONCERNING THE SELECTION OF THE INDEPENDENT AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED 1390 DUBLIN ROAD COLUMBUS OH 43215 200385860 PROVIDING HEALTH AND WELLNESS SERVICES OH 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION 1 COLUMBUS MEDICAL ASSOCIATION 1390 DUBLIN ROAD COLUMBUS OH 43215 314411074 ADVANCING COMMUNITY HEALTH THROUGH ADVOCACY, EDUCATION AND SERVICE OH 501(C)(6) N/A 0 CENTAL OHIO TRAUMA SYSTEM 1390 DUBLIN ROAD COLUMBUS OH 43215 311592734 REDUCING INJURIES AND SAVING LIVES BY IMPROVING TRAUMA CARE OH 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION 1 PHYSICIANS CARE CONNECTION 1390 DUBLIN ROAD COLUMBUS OH 43215 311373719 COORDINATING VOLUNTARY HEALTH CARE SERVICES OH 501(C)(3) LINE 3 COLUMBUS MEDICAL ASSOCIATION 1 PHYSICIANS LEADERSHIP ACADEMY 1390 DUBLIN ROAD COLUMBUS OH 43215 822152009 SUPPORT PHYSICIANS WITH LEADERSHIP TRAINING OH 501(C)(3) LINE 2 COLUMBUS MEDICAL ASSOCIATION 1 1 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 CENTRAL OHIO TRAUMA SYSTEMS B 300000 GRANT PHYSICIANS CARE CONNECTION B 500000 GRANT CENTRAL OHIO TRAUMA SYSTEMS A 79514 PER SQ FT COLUMBUS MEDICAL ASSOCIATION O 69801 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS O 149375 AGREED UPON % OF TIME PHYSICIANS CARE CONNECTION O 147966 AGREED UPON % OF TIME COLUMBUS MEDICAL ASSOCIATION A 12727 PER SQ FT PHYSICIANS CARE CONNECTION A 48943 PER SQ FT PHYSICIANS LEADERSHIP ACADEMY B 306923 GRANT PHYSICIANS LEADERSHIP ACADEMY A 2037 PER SQ FT