2017-11-15T18:23:55-06:00 2016-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2016-01-01 930854433 MID-COLUMBIA HEALTH FOUNDATION MID- 5412967275 PO BOX 1580 THE DALLES OR 97058 EDWIN BODE CFO 5412967275 2017-11-13 1 MARK E EKLUND CPA P00156145 5036974118 2017-11-13 76.14.192.226 2017-11-13 15:52:42 PS P 6EE4B5945FCD93E65398A6249415A829E8D03AFF A037F773A43E5D098BFBF49CACF0A7B31F1836C7 2016 2017-02-10 21:41:12Z EDWIN BODE PO BOX 1580 THE DALLES OR 97058 1760849 0 X WWW.MCMC.NET/FOUNDATION X 1983 OR WORK TOGETHER WITH AND PROVIDE FINANCIAL SUPPORT TO MID-COLUMBIA MEDICAL CENTER IN ORDER TO PROVIDE ACCESS TO QUALITY HEALTHCARE FOR OUR COMMUNITY. 14 10 10 61 0 0 528364 717716 0 0 66345 184106 116080 116954 710789 1018776 654558 400961 0 0 25592 26557 0 0 0 24370 24846 704520 452364 6269 566412 4785360 5118305 493104 199196 4292256 4919109 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 452364 400961 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. 452364 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 10 1 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X X MID-COLUMBIA MEDICAL CENTER 5412961111 PO BOX 1580 THE DALLES OR 97058 DIANNE STORBY EX-OFFICIO DIRECTOR 1.00 50.00 X 0 323043 34542 DUANE FRANCIS EX-OFFICIO DIRECTOR 1.00 50.00 X 0 636086 770222 ROB CARNAHAN TREASURER 1.00 X X 0 0 0 BRIAN LAUTERBACH VICE-CHAIR 1.00 X X 0 0 0 DR FRANK TODA DIRECTOR 1.00 X 0 0 0 DR PAULA LEE-VALKOV DIRECTOR 1.00 40.00 X 0 18296 0 SHAWN CARROLL DIRECTOR 1.00 X 0 0 0 KRISTI TIMMONS SECRETARY 1.00 X X 0 0 0 CYNTHIA KORTGE DIRECTOR 1.00 X 0 0 0 JASON COREY DIRECTOR 1.00 X 0 0 0 ROBERT BAILEY DIRECTOR 1.00 X 0 0 0 PHIL KASER CHAIR 1.00 X X 0 0 0 ERIC HOLEMAN DIRECTOR 1.00 40.00 X 0 160115 27650 VESTA SMITH DIRECTOR 1.00 X 0 0 0 CELESTE HILL-THOMAS EXECUTIVE DIRECTOR 50.00 X 89344 89344 0 89344 1226884 832414 0 0 1 0 0 717716 70300 717716 68889 68889 826428 711211 115217 115217 115217 101242 30862 70380 70380 COFFEE CART FUND 722210 46574 46574 46574 1018776 0 0 301060 268904 268904 132057 132057 24202 24202 500 500 1855 1855 5673 5673 FOOD PURCHASES 18374 18374 SUPPLIES 799 799 452364 452364 0 0 381901 609008 1884910 1971723 34836 38334 40760 31088 3313 3545 39696 37838 5601 1858 2434039 2462749 4785360 5118305 23492 16078 297000 0 172612 183118 493104 199196 X 2288373 2545916 1625748 1992243 378135 380950 4292256 4919109 4785360 5118305 566412 60441 0 X X 0 1 X 1 0 X 300662 335624 254481 528364 717716 2136847 300662 335624 254481 528364 717716 2136847 650337 1486510 -18002 48024 53775 61065 68889 213751 2350598 459109 0.63240 0.65700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1429254 102815 51758 196080 1387747 1389999 11182 51092 23019 1429254 1345021 8511 48321 11854 1389999 1310867 12621 27470 5937 1345021 1287095 6237 23245 5710 1310867 0.62400 0.27450 0.10150 0 0 39578 37838 1740 118 118 1858 X PART V, LINE 4: THE FOUNDATION'S ENDOWMENT FUND IS A QUASI-ENDOWMENT THAT FUNDS THE MID-COLUMBIA HEALTH FOUNDATION OPERATING EXPENSES - ENDING BALANCE $865,975. THE REMAINING ENDOWMENT FUNDS SUPPORT SEVERAL SCHOLARSHIPS AND OTHER FUNDS EXPLAINED BELOW: TEMPORARY AND PERMANENTLY RESTRICTED FUNDS: - EVELYN KASER SCHOLARSHIP FUND: TO ASSIST INDIVIDUALS WHO ASPIRE TO BECOME REGISTERED NURSES AND INTEND TO PRACTICE THEIR PROFESSION IN THE MID-COLUMBIA REGION. - LORNA & JOSEPH HALLIDAY FAMILY NURSING SCHOLARSHIP FUND: TO ASSIST INDIVIDUALS ASPIRING TO BECOME REGISTERED NURSES WHO GREW UP IN THE MID-COLUMBIA REGION. - MCMC BOARD OF TRUSTEES MEDICAL PROFESSIONALS SCHOLARSHIP: TO HELP DEFRAY SOME COLLEGE EXPENSES FOR GRADUATING SENIORS FROM THE DALLES HIGH SCHOOL. - MASONS LODGE SCHOLARSHIP FUND: TO ASSIST INDIVIDUALS FROM THE LOCAL COMMUNITIES OF SHERMAN, DUFUR AND THE DALLES HIGH SCHOOLS TO ATTEND COLLEGE. - PERMANENT SCHOLARSHIP FUND: EARNS INTEREST THAT IS ANNUALLY TRANSFERRED TO THE MID-COLUMBIA MEDICAL CENTER SCHOLARSHIP FUND. PART X, LINE 2: INCOME TAX POSITIONS THAT MEET A "MORE-LIKELY-THAN-NOT" RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN THE REGION'S COMBINED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN THE STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015. FESTIVAL OF TREES 49809 49809 1948 7477 TOURNAMENT OF TRADTION GOLF BENEFIT 41066 41066 5514 9980 5 10367 10367 1507 4436 101242 101242 8969 21893 30862 70380 1 EVELYN KASER NURSING SCHOLARSHIP 5 5000 LORNA & JOSEPH HALLIDAY FAMILY NURSING SCHOLARSHIP 2 1200 MCMC BOARD OF TRUSTEES FUTURE HEALTH PROFESSIONALS 3 6000 NON-TRADITIONAL NURSING SCHOLARSHIP 7 6800 MCMC DEPENDENT SCHOLARSHIP 8 8512 MCMC EMPLOYEE SCHOLARSHIP 3 4962 RANDY ROOD MEMORIAL SCHOLARSHIP 45 99583 PART I, LINE 2: AN INTERNAL GRANT MANAGER TRACKS ALL EXPENSES RELATED TO THE GRANT AND REPORTS THEM PERIODICALLY IN A WRITTEN REPORT TO THE GRANTOR. SOME GRANTS CONTAIN LINE-ITEM BUDGETS WHICH ALSO MUST BE MET AND ARE SUBJECT TO AUDIT BY THE GRANTOR. X 0 0 X X X X X 1 1 0 0 0 0 0 0 0 DIANNE STORBY EX-OFFICIO DIRECTOR 0 323018 0 25 0 0 0 13250 0 21292 0 357585 0 0 DUANE FRANCIS EX-OFFICIO DIRECTOR 0 611061 0 25025 0 0 0 752875 0 17347 0 1406308 0 0 ERIC HOLEMAN DIRECTOR 0 160090 0 25 0 0 0 8298 0 19352 0 187765 0 0 CELESTE HILL-THOMAS EXECUTIVE DIRECTOR 89344 89344 0 0 0 0 0 0 0 0 89344 89344 0 0 PART I, LINES 4A-B DUANE FRANCIS: - SEVERENCE COMPENSATION FROM HEALTH CARE FOR THE MID-COLUMBIA REGION TO BE PAID OUT IN 2017: $621,190 - NONQUALIFIED DEFERRED COMPENSATION FROM MID-COLUMBIA MEDICAL CENTER: $101,088. PAYMENT OF THE DEFERRED COMPENSATION WHICH HAS BEEN ACCRUING SINCE 2003 WILL BE MADE IN TEN ANNUAL INSTALLMENTS OF $160,348 BEGINNING 1/1/17. MID-COLUMBIA MEDICAL CENTER RELATED TO MID-COLUMBIA MEDICAL CENTER BY COMMON PARENT ORGANIZATION. OPERATING EXPENSES X 31088 0 0 0 31088 X 1 70300 FMV - PUBLICLY-TRADED 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 HEALTHCARE FOR THE MID-COLUMBIA REGION IS THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS WERE PROVIDED ACCESS TO THE DRAFT TO REVIEW AT THE BOARD MEETING PRECEDING FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C WE ANNUALLY REQUIRE DIRECTORS, OFFICERS AND EXECUTIVE MANAGEMENT TEAM TO SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. IF A CONFLICT WAS DISCOVERED FOR A PERSON WITH A SIGNED 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 EMPLOYEE. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS COMPENSATED BY HEALTH CARE FOR THE MID-COLUMBIA REGION, A RELATED ORGANIZATION. THE BOARD OF HEALTH CARE FOR THE MID-COLUMBIA REGION ENGAGES A PROFESSIONAL FIRM TO DO A REGIONAL AND NATIONAL SURVEY, ALONG WITH A COMPARISON OF ORGANIZATION COMPLEXITY AND STRUCTURE, AND THEN RECOMMENDS A SALARY AND BENEFITS RANGE TO THE BOARD. THIS IS ALL DONE CONFIDENTIALLY WITHOUT CEO PARTICIPATION. 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 ACTIVITES DIVISION OF THE OREGON DEPARTMENT OF JUSTICE. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THEIR FINANCIAL STATEMENTS & SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 HEALTHCARE FOR THE MID-COLUMBIA REGION 0 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREET THE DALLES OR 97058 930386936 ACUTE HOSPITAL CARE OR 501(C)(3) LINE 3 HEALTHCARE FOR THE MID-COLUMBIA REGION 1 LPH&WC HOLDINGS LLC 1524 SHERMAN AVENUE HOOD RIVER OR 97031 811236711 RENTAL ACTIVITY OR N/A DRY HOLLOW INC 1700 E 19TH STREET THE DALLES OR 97058 930631350 RENTAL BUILDING OR N/A C 0 CHARITABLE REMAINDER TRUST (1) INVESTMENTS OR N/A T 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 MID-COLUMBIA MEDICAL CENTER D 31088 LOANS TO RELATED PARTY MID-COLUMBIA MEDICAL CENTER Q 584920 ACTUAL REIMBUSED EXPENSES