2017-11-14T09:00:34-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2016-01-01 310679012 COLUMBUS MEDICAL ASSOCIATION FOUNDATION COLU 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 ROBERT E FALCONE CEO 6142407410 2017-11-13 1 Bernie Ostrowski P00366367 6148493000 2017-11-13 67.59.56.33 2017-11-13 10:21:35 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CDA108602048A852A3C7A9C68094104E2D92ED46 2016 2018-03-14 21:41:22Z ROBERT E FALCONE 1390 DUBLIN ROAD COLUMBUS OH 43215 2221725 0 X WWW.CMAFOHIO.ORG X 1958 OH THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS. 17 17 16 30 64909 63909 192295 251735 198120 216187 1762200 1593131 65097 129685 2217712 2190738 1389841 1246189 0 0 592832 550800 0 0 331014 1443955 1441100 3426628 3238089 -1208916 -1047351 74846432 75926709 4060389 3733304 70786043 72193405 X THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS. 0 0 1638986 1246189 279920 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 1638986 1 1 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 20 0 1 16 1 1 1 0 0 0 0 0 0 0 0 0 X 17 17 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 1.00 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 1.00 2.00 X X 1500 0 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 2.00 X 0 0 0 JASON MELILLO MD TRUSTEE (THRU MAY) 1.00 2.00 X 0 0 0 CHARLOTTE AGNONE MD TRUSTEE 1.00 2.00 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 2.00 X 0 0 0 ROBERT E FALCONE MD CEO 16.00 24.00 X 215332 0 20408 LAURIE HAWKINS CFO 20.00 20.00 X 127161 0 9181 WELDON MILBOURNE EXECUTIVE DIRECTOR 39.00 1.00 X 121308 0 29857 465301 0 59446 3 0 1 0 0 251735 251735 RENTAL INCOME 900099 134202 134202 PROGRAMS 900099 81985 81985 216187 1593131 1593131 76500 30987 45513 45513 45513 CAM 900099 60859 60859 INSURANCE PROCEEDS 900099 2874 2874 VENDING 900099 548 548 19891 19396 495 84172 2190738 279920 64909 1594174 1246189 1246189 50124 15037 24561 10526 359892 107968 176347 75577 15036 4510 7368 3158 70052 21016 34325 14711 55696 16709 27291 11696 424811 424811 189495 49268 87168 53059 109371 45864 17645 45862 2200 39 2122 39 223942 54179 131591 38172 2356 42 2272 42 189437 60345 68741 60351 91491 1631 88229 1631 200757 16060 168636 16061 TAXES & LICENSES 7240 129 6982 129 3238089 1638986 1268089 331014 191560 190117 160414 121415 363 30995 4345561 1273825 3180013 3071736 71208527 72404693 105555 107753 74846432 75926709 353775 339732 286058 95782 2582634 2486596 837922 811194 4060389 3733304 X 69687713 71152106 738293 681062 360037 360237 70786043 72193405 74846432 75926709 X -1047351 2474109 -19396 X X 0 1 X 1 0 X X 1 COLUMBUS MEDICAL ASSOCIATION 314411074 10 1 0 0 1 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Part IV, Section A, Line 3b: A DRAFT SCHEDULE A, PART III WAS PREPARED FOR COLUMBUS MEDICAL ASSOCIATION DURING THE PREPARATION OF COLUMBUS MEDICAL ASSOCIATION FOUNDATION'S 2015 990. THE CALCULATION SHOWS THAT THEY DO MEET THE PUBLIC SUPPORT TEST UNDER SECTION 509(A)(2). Part IV, Section A, Line 3c: LEADERSHIP IS RESPONSIBLE FOR APPROVING EXPENDITURES AND IS VERY AWARE OF THE NEED FOR COSTS TO BE USED FOR CHARITABLE PURPOSES. LEADERSHIP INCORPORATES THIS INTO THE PROCESS OF APPROVAL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8 5 45565 16295 99000 0 402627 531902 1 1 2128618 90912 75584 145459 19865 2129790 2479300 61785 1442 393390 20519 2128618 2715353 172004 115605 514019 9643 2479300 2779131 260590 134480 452242 6606 2715353 2753776 111068 57345 137098 3175 2785 2779131 0.12000 0.25000 0.63000 0 0 253580 253580 2047215 258339 1788876 1224535 281906 942629 613699 553095 60604 206532 180485 26047 3071736 OTHER SECURITIES 72404693 F 72404693 REIMBURSEMENT TO AFFILIATES 540960 ASSETS HELD FOR OTHERS 270234 811194 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 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) 332500 TO SUPPORT ITS CORE SERVICES CENTRAL OHIO TRAUMA SYSTEM 1390 DUBLIN ROAD COLUMBUS OH 43215 311592734 501 (C)(3) 261820 TO SUPPORT ITS CORE SERVICES PHYSICIANS CARE CONNECTION 1390 DUBLIN ROAD COLUMBUS OH 43215 311373719 501 (C)(3) 631000 TO PROVIDE FREE PRIMARY & SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERSERVED 3 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 215332 0 0 0 0 0 6487 0 13921 0 235740 0 0 0 WELDON MILBOURNE EXECUTIVE DIRECTOR 121308 0 0 0 0 0 7345 0 22512 0 151165 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 CHAIRPERSON AND SECRETARY/TREASURER ARE AUTHORIZED AND DIRECTED TO SEE THAT THIS POLICY IS FOLLOWED. Form 990, Part VI, Section B, line 15 COLUMBUS MEDICAL ASSOCIATION AND COLUMBUS MEDICAL ASSOCIATION FOUNDATION PERFORM THE COMPENSATION REVIEWS. THE BOARD OF DIRECTORS REVIEWS THE CEO'S COMPENSATION. THEN THE CEO REVIEWS THE COMPENSATION OF ALL OF THE STAFF. THE BOARD AND CEO ESTABLISH COMPENSATION BASED ON AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD. THE LAST COMPENSATION REVIEW WAS IN 2015 AND WILL BE UPDATED 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 -19,396. 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 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 1 1 0 0 CENTRAL OHIO TRAUMA SYSTEMS B 261820 GRANT PHYSICIANS CARE CONNECTION B 631000 GRANT CENTRAL OHIO TRAUMA SYSTEMS A 84629 PER SQ FT COLUMBUS MEDICAL ASSOCIATION O 111901 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS O 179799 AGREED UPON % OF TIME PHYSICIANS CARE CONNECTION O 172670 AGREED UPON % OF TIME COLUMBUS MEDICAL ASSOCIATION A 13496 PER SQ FT PHYSICIANS CARE CONNECTION A 35976 PER SQ FT