2017-05-04T12:24:30-05:00 2016-06-30 461497033 EKS&H LLLP 7979 E TUFTS AVE SUITE 400 DENVER CO 80237 990 2015-07-01 841576338 THE MEMORIAL HEALTH SYSTEM FOUNDATION MEMO 7193654483 1519 E BOULDER ST COLORADO SPRINGS CO 80909 CARI KARNS SENIOR DIRECTOR 7193654483 2017-05-02 1 DORI J EGGETT P00645252 3037409400 2015 2021-01-29 14:40:06Z CARI KARNS 1519 E BOULDER ST COLORADO SPRINGS CO 80909 1273293 0 X N/A X 2001 CO TO PROVIDE PHILANTHROPIC RESOURCES TO ASSIST MEMORIAL HEALTH SYSTEM. 13 13 7 0 0 0 1435202 1079180 0 0 26393 67412 -35465 -11831 1426130 1134761 1677370 957033 0 0 533157 435199 22615 15193 297518 193564 205529 2426706 1612954 -1000576 -478193 3787118 3744580 117703 533554 3669415 3211026 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 391138 391138 THE CANCER EQUIPMENT FUND WAS ESTABLISHED TO PURCHASE EQUIPMENT RELATED TO CANCER TREATMENT. DURING FY16, A 3D MAMMOGRAPHY SYSTEM WAS PURCHASED FOR THE HOSPITAL'S RADIOLOGY UNIT AT PRINTERS PARK. 135250 135250 THE CS CHILDREN'S HOSPITAL GENERAL FUND WAS CREATED TO SUPPORT THE CHILDREN'S HOSPITAL AT MEMORIAL HOSPITAL. THE FUNDS ARE DISTRIBUTED UPON SPECIFIC REQUESTS FROM THE COLORADO CHILDREN'S HOSPITAL FOR THE BENEFIT AND CARE OF THE CHILDREN AND FAMILIES OF COLORADO SPRINGS AND COMMUNITIES SERVED BY THE CHILDREN'S HOSPITAL. 99413 85893 THE CARDIOVASCULAR SERVICES GENERAL FUND IS TO BE USED FOR COMMUNITY OUTREACH PROGRAMS, CONTINUING EDUCATION, EQUIPMENT, PATIENT SUPPORT PROGRAMS. DURING FY16, A NEW ULTRASOUND UNIT WAS PURCHASED FOR THE CARDIOVASCULAR AREA OF MEMORIAL HOSPITAL. 443507 344752 VARIOUS PATIENT CARE AND STAFF EDUCATION FUNDS. 443507 344752 1069308 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 4 0 7 0 0 0 0 0 0 1 1 0 0 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 1519 E BOULDER ST COLORADO SPRINGS CO 80909 X 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 MARGARET CARMACK BOARD CHAIR 1.00 X X 0 0 0 DAVID GREENBERG DIRECTOR 1.00 X 0 0 0 GEORGE HAYES DIRECTOR 1.00 X 0 0 0 LANA JANC DIRECTOR 1.00 X 0 0 0 MARY ELLEN MCNALLY DIRECTOR 1.00 X 0 0 0 KEVIN O'GARA VICE BOARD CHAIR 1.00 X 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 J WERNER ZIEGLER DIRECTOR 1.00 X 0 0 0 CARI KARNS SR DIRECTOR OF DEVELOPMENT 40.00 X 31104 0 3621 ERIN HENNINGER INTERIM EXEC. DIR. ENDED 9/2015 40.00 X 14296 0 2870 45400 0 6491 0 0 0 0 0 221330 618301 239549 9101 1079180 67531 67531 119 -119 -119 -119 126582 221330 138413 -11831 -11831 1134761 0 0 55581 768290 768290 188743 188743 118018 29505 59008 29505 262970 44593 46917 171460 9125 1580 1695 5850 39658 6673 6969 26016 5428 940 1008 3480 15296 1429 8150 5717 27562 27562 15193 15193 21951 21951 10928 1519 4131 5278 8727 548 1645 6534 15250 1288 10275 3687 43354 13006 21677 8671 45390 9078 27234 9078 1305 522 783 7007 1539 1777 3691 2886 577 1732 577 1116 1116 DUES 3330 1332 1998 MISCELLANEOUS 1427 1427 1612954 1069308 246128 297518 55846 141446 1480477 1317231 33613 18022 32973 25746 61945 60890 3942 1055 2180267 2241080 3787118 3744580 115103 518854 2600 14700 117703 533554 X 809454 712045 2665786 2304806 194175 194175 3669415 3211026 3787118 3744580 X -478193 26084 -6280 X 0 1 X 1 0 X 1612367 1643755 643614 1435202 1079180 6414118 1612367 1643755 643614 1435202 1079180 6414118 2717790 3696328 21548 14547 540 20295 67531 124461 6538579 0.56530 0.57680 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 240314 3382 243696 233177 7137 240314 225820 7357 233117 204672 21148 225820 194127 10545 204672 0.79680 0.20320 0 0 61945 60890 1055 1055 X 1312778 26084 13520 138413 178017 1134761 0 1134761 1771167 13520 144693 158213 1612954 0 1612954 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, 2016 AND 2015, 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, 2016 AND 2015, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 138,413. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 138,413. PLEDGE WRITE OFFS (PROGRAMS) 6,280. X 1 LYNN WAALKES 1519 E BOULDER ST COLORADO SPRINGS CO 80909 GRANTWRITING 0 48000 15193 32807 48000 15193 32807 CO GALA 279650 173773 105877 8821 51094 2750 37857 GOLF TOURNAMENT 34985 21775 13210 11359 3606 1627 1 33277 25782 7495 16793 925 3581 347912 221330 126582 20180 71493 3675 43065 138413 -11831 1 UCH - MHS 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 460796114 501(C)(3) 768290 FINANCIAL SUPPORT 1 0 LIVING EXPENSES 554 113643 EDUCATIONAL 33 24634 LYMPHEDEMA GARMENTS/WIGS 56 9577 MASSAGE THERAPY 28 1889 SCHOLARSHIPS 22 39000 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 1 1915 FMV X 2171 FMV X 3 525 FMV X 1 2780 FMV X CENTER PIECES FOR GALA EVENT 1 1200 FMV X TOYS 2 510 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 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 -6,280.