2018-05-10T13:33:06-05:00 2017-06-30 461497033 EKS&H LLLP 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 990 2016-07-01 841576338 THE MEMORIAL HEALTH SYSTEM FOUNDATION MEMO 7193654483 175 SOUTH UNION BLVD NO 240 COLORADO SPRINGS CO 80910 CARI KARNS SENIOR DIRECTOR 7193654483 2018-05-09 1 DORI J EGGETT P00645252 3037409400 2016 2022-09-23 18:48:47Z CARI KARNS 175 SOUTH UNION BLVD NO 240 COLORADO SPRINGS CO 80910 1388897 0 X N/A X 2001 CO TO PROVIDE PHILANTHROPIC RESOURCES TO ASSIST MEMORIAL HEALTH SYSTEM. 13 13 5 0 0 0 1079180 1185902 0 0 67412 62083 -11831 -12097 1134761 1235888 957033 554495 0 0 435199 482887 15193 6621 313421 205529 203315 1612954 1247318 -478193 -11430 3744580 3336753 533554 42761 3211026 3293992 X SEE SCHEDULE OTHE MISSION OF MEMORIAL HEALTH SYSTEM FOUNDATION IS TO PROVIDE PHILANTHROPIC RESOURCES TO ASSIST MEMORIAL HEALTH SYSTEM TO PROVIDE THE HIGHEST QUALITY HEALTH CARE. PHILANTHROPIC SUPPORT IS BEING SOUGHT FOR CAPITAL, ENDOWMENT AND PROGRAMMATIC PURPOSES, INCLUDING CANCER, CARDIOLOGY, AND WOMEN'S PROGRAMS AND SERVICES. 0 0 50778 50778 THE EMPLOYEE ASSISTANCE FUND CONSISTS OF FUNDS DONATED BY EMPLOYEES FOR EMPLOYEE EMERGENCY ASSISTANCE. THE PURPOSE OF THE EMPLOYEE ASSISTANCE FUND IS TO PROVIDE FINANCIAL ASSISTANCE TO ELIGIBLE EMPLOYEES OF MEMORIAL HOSPITAL WHO ARE EXPERIENCING SEVERE FINANCIAL DISTRESS RESULTING FROM AN EXTRAORDINARY EMERGENCY OR CATASTROPHIC EVENT. THE FUND IS ADMINISTERED BY THE MEMORIAL HOSPITAL EMPLOYEE ASSISTANCE FUND COMMITTEE. 48271 48271 THE CIRCLE OF HOPE FUND CONSISTS OF FUNDS FROM VARIOUS SOURCES TO HELP CANCER PATIENTS. DESIGNATED TO HELP PATIENTS AND THEIR FAMILIES WHO ARE AT RISK OF LOSING THEIR HOUSE, JOB, AND INSURANCE BECAUSE OF CANCER; CAN PROVIDE ASSISTANCE FOR EXPENSES SUCH AS MEDICATION AND TRANSPORTATION TO THE HOSPITAL OR PHYSICIANS OFFICE. THIS FUND DOES NOT PAY FOR HOSPITAL OR DOCTOR BILLS. 47081 47081 FUNDS RECEIVED FOR THE MOTHER BABY FUND ARE USED FOR COMMUNITY OUTREACH PROGRAMS, CONTINUING EDUCATION, EQUIPMENT AND PATIENT SUPPORT PROGRAMS. DURING FY17, $33,106 WAS USED TO PURCHASE 4 CARDIAC MONITORS, A NITROUS OXIDE SYSTEM AND A FETAL MONITOR. 529852 408365 VARIOUS PATIENT CARE AND STAFF EDUCATION FUNDS. 529852 408365 675982 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 5 1 0 0 0 0 0 1 1 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 X STEVE WEBER 7193654483 175 SOUTH UNION BLVD SUITE 240 COLORADO SPRINGS CO 80910 MARGARET CARMACK BOARD CHAIR 1.00 X X 0 0 0 KEVIN O'GARA VICE CHAIR 1.00 X X 0 0 0 TATIANA BAILEY DIRECTOR 1.00 X 0 0 0 MARK BROWN DIRECTOR 1.00 X 0 0 0 BRADLEY BUTLER DIRECTOR 1.00 X 0 0 0 LANA JANC DIRECTOR 1.00 X 0 0 0 BRUCE PANTER DIRECTOR 1.00 X 0 0 0 BETSY PLANTE DIRECTOR 1.00 X 0 0 0 ERIC SCOTT DIRECTOR 1.00 X 0 0 0 JOEL YUHAS DIRECTOR 1.00 X 0 0 0 WERNER ZIEGLER DIRECTOR 1.00 X 0 0 0 DAVID GREENBERG DIRECTOR 1.00 X 0 0 0 MARY ELLEN MCNALLY DIRECTOR 1.00 X 0 0 0 CARI KARNS SR DIRECTOR OF DEVELOPMENT 40.00 X 125105 0 12821 125105 0 12821 1 0 0 0 0 292979 652862 240061 28365 1185902 62083 62083 140912 292979 153009 -12097 -12097 1235888 0 0 49986 318594 318594 235901 235901 152601 45780 76301 30520 270373 35357 43783 191233 6015 851 854 4310 50254 6505 8269 35480 3644 479 578 2587 1407 1407 24658 24658 6621 6621 20554 20554 2925 585 1755 585 3181 166 497 2518 15635 777 12534 2324 46728 13857 23526 9345 63434 12687 38060 12687 3 1 2 8887 1511 2044 5332 458 92 274 92 1397 1397 PRINTING 11359 2840 8519 DUES 2110 844 1266 MISCELLANEOUS 579 579 1247318 675982 257915 313421 141446 98450 1317231 1123786 18022 23350 25746 14868 61945 61347 1055 598 2241080 2075701 3744580 3336753 518854 31511 14700 11250 533554 42761 X 712045 790228 2304806 2309589 194175 194175 3211026 3293992 3744580 3336753 X -11430 94648 -252 X 0 1 X 1 0 X 1643755 643614 1435202 1079180 1185902 5987653 1643755 643614 1435202 1079180 1185902 5987653 3224016 2763637 14547 540 20295 67531 62083 164996 6152649 0.44920 0.56530 X FORM 990, SCHEDULE A, PART II: THE 2013 YEAR COLUMN OF SCHEDULE A, PART II IS A SHORT-YEAR TAX RETURN PERIOD FROM 1/1/2014 TO 6/30/2014 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 243696 21023 264719 240314 3382 243696 233177 7137 240314 225820 7357 233117 204672 21148 225820 0.73400 0.26600 0 0 61945 61347 598 598 X 1493965 94648 10420 153009 258077 1235888 0 1235888 1410999 10420 153261 163681 1247318 0 1247318 PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO PROVIDE EDUCATION TO OUTREACH PROGRAMS, TRAUMA NURSES, AND BLOOD DONOR TECHS. PART X, LINE 2: THE FOUNDATION IS A NON-PROFIT ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). ACCORDINGLY, NO PROVISION FOR THE INCOME TAXES IS MADE FOR FEDERAL, STATE OR LOCAL TAXES. IN ADDITION, THE IRS HAS DETERMINED THAT THE FOUNDATION IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE CODE. THE FOUNDATION APPLIES A MORE-LIKELY-THAN-NOT MEASUREMENT METHODOLOGY TO REFLECT THE FINANCIAL STATEMENT IMPACT OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. AFTER EVALUATING THE TAX POSITIONS TAKEN, NONE ARE CONSIDERED TO BE UNCERTAIN; THEREFORE, NO AMOUNTS HAVE BEEN RECOGNIZED AS OF JUNE 30, 2017 AND 2016, RESPECTIVELY. IF INCURRED, INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS ARE RECORDED IN THE PERIOD ASSESSED AS GENERAL AND ADMINISTRATIVE EXPENSE. NO INTEREST OR PENALTIES HAVE BEEN ASSESSED AS OF JUNE 30, 2017 AND 2016, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 153,009. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 153,009. PLEDGE WRITE OFFS (PROGRAMS) 252. CO GALA 343595 222538 121057 43728 12194 49661 GOLF TOURNAMENT 35042 25072 9970 8370 6353 311 2 55254 45369 9885 18172 1288 12932 433891 292979 140912 8370 68253 13482 62904 153009 -12097 1 UCH - MHS 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 460796114 501(C)(3) 290229 28365 FMV CLOTHING & HOUSEHOLD ITEMS, TOYS, FOOD, AND EVENT ITEMS FINANCIAL SUPPORT 1 LIVING EXPENSES 1055 160889 EDUCATIONAL 17 10177 LYMPHEDEMA GARMENTS/WIGS 156 14060 MASSAGE THERAPY 33 2376 SCHOLARSHIPS 23 48399 SCHEDULE I, PART I, LINE I THE FOUNDATION EXECUTIVE DIRECTOR REVIEWS ALL GRANTS AND REQUESTS FOR MONIES. ALL ASSISTANCE PROVIDED TO INDIVIDUALS IS PAID DIRECTLY TO THOSE THAT PROVIDE THE ASSISTANCE. THE FUNDS ARE NOT GIVEN DIRECTLY TO THE INDIVIDUALS. THUS, THE ORGANIZATION IS ABLE TO ENSURE THAT THE FUNDS ARE USED FOR THE INTENDED PURPOSES. X 15616 FMV X 3 3089 FMV X TOYS 10 3360 FMV X AUCTION ITEMS 4 3214 FMV X EVENT ITEMS 4 3086 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE MEMORIAL HOSPITAL FINANCE DEPARTMENT REVIEWS THE RETURN. A COPY OF THE FORM 990 IS EMAILED TO BOARD MEMBERS PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C AT THE ANNUAL BOARD MEETING, THE BOARD IS GIVEN A NEW COPY OF THE CONFLICT OF INTEREST STATEMENT. THE BOARD GOES OVER THE STATEMENT AND EACH BOARD MEMBER MUST SIGN THE DOCUMENT. THUS, EACH MEMBER SIGNS IT ANNUALLY AND IS REMINDED TO BRING ANY POTENTIAL CONFLICT TO THE BOARD'S AND EXECUTIVE DIRECTOR'S ATTENTION. THE BOARD MEMBER MUST ALSO RECUSE HIMSELF OR HERSELF FROM ANY VOTE IF THERE IS A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A SALARY SURVEY DATA THAT IS COMPILED BY THIRD PARTIES IS USED TO DETERMINE THE COMPENSATION OF THE EXECUTIVE DIRECTOR. REVIEW AND APPROVAL OF THE SALARY IS DONE BY THE MEMORIAL HOSPITAL AND UCH BOARDS. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF THE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE AT THE FOUNDATION OFFICE IF THE PUBLIC WISHES TO REVIEW THEM. FORM 990, PART XI, LINE 9: PROVISION FOR UNCOLLECTIBLE PLEDGES -252.