2016-03-01T13:39:59-06:00 2015-06-30 461497033 EKS&H LLLP 7979 E TUFTS AVE SUITE 400 DENVER CO 80237 990 2014-07-01 841576338 THE MEMORIAL HEALTH SYSTEM FOUNDATION MEMO 7193654483 1519 E BOULDER ST COLORADO SPRINGS CO 80909 CARI KARNS SENIOR DIRECTOR 7193654483 2016-02-29 1 DORI J EGGETT P00645252 3037409400 2014 2016-08-17 19:52:53Z CARI KARNS 1519 E BOULDER ST COLORADO SPRINGS CO 80909 1574908 0 X N/A X 2001 CO TO PROVIDE PHILANTHROPIC RESOURCES TO ASSIST MEMORIAL HEALTH SYSTEM. 10 10 5 0 0 0 643641 1435202 0 0 6443 26393 -19842 -35465 630242 1426130 361636 1677370 0 0 245404 533157 0 0 398490 103080 216179 710120 2426706 -79878 -1000576 4613041 3787118 14472 117703 4598569 3669415 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 392711 392711 THE UNDESIGNATED CAPITAL FUND WAS CREATED TO FUND UNDESIGNATED CAPITAL PROJECTS FOR UCH-MHS WHICH CAN INCLUDE RENOVATON AND EXPANSION PROJECTS AS WELL AS EQUIPMENT. DURING FY15, FUNDING WAS PROVIDED TOWARD THE PURCHASE OF A 3D MAMMOGRAPHY SYSTEM FOR THE UCH-MHS RADIOLOGY AREA 227137 227137 THE HAROLD F SHORE AND MARY SHORE TRUST WAS SET UP IN THEIR MEMORY TO BE USED SOLELY FOR CHILDREN'S, WOMEN'S AND EMERGENCY SERVICES ON THE MAIN CAMPUS OF MEMORIAL. DURING FY15, FUNDING WAS PROVIDED TO PURCHASE 7 INFANT WARMERS, 7 FETAL MONITORS AND A SURGICAL CART FOR THE MOTHER/BABY AREA OF THE HOSPITAL. 91888 91888 THE MEMORIAL HEALTH SYSTEM FOUNDATION HAS PARTNERED WITH KOHL'S CARES FOR CAR SAFETY TO HELP PREVENT INJURY TO CHILDREN AGES 0 TO 14 YEARS OF AGE. OUR MEMBERS INCLUDE CHILD PASSENGER SAFETY SEAT TECHNICIANS ARE ARE AVAILABLE TO CONDUCT CAR SEAT CHECKS AT A VARIETY OF LOCATIONS THROUGHOUT THE COMMUNITY. WE SPEAK TO THOUSANDS OF PEOPLE PER YEAR AND CAN PROVIDE EDUCATION AT EVENTS UPON REQUEST. 1056367 965634 VARIOUS PATIENT CARE AND STAFF EDUCATION FUNDS. 1056367 965634 1768103 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 6 0 5 0 0 0 0 0 0 1 1 0 0 0 0 X 10 10 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 DAVID I GREENBERG MD DIRECTOR 1.00 X 0 0 0 MARY ELLEN MCNALLY DIRECTOR 1.00 X 0 0 0 ROBERT KILEY MD DIRECTOR 1.00 X 0 0 0 PEGGY CARMACK TREASURER 1.00 X X 0 0 0 MARK BROWN DIRECTOR 1.00 X 0 0 0 LANA JANC DIRECTOR 1.00 X 0 0 0 THOMAS NAUGHTON DIRECTOR 1.00 X 0 0 0 KEVIN O'GARA BOARD CHAIR 1.00 X X 0 0 0 GEORGE HAYES DIRECTOR 1.00 X 0 0 0 BETSY PLANTE DIRECTOR 1.00 X 0 0 0 CARY BLANCHETTE EXEC. DIR. TERM ENDED 3/2015 40.00 X 141226 0 25266 ERIN HENNINGER INTERIM EXEC. DIR. ENDED 9/2015 40.00 X 0 0 0 141226 0 25266 1 0 1 0 0 241741 734290 459171 14215 1435202 20295 20295 6098 0 6098 6098 6098 113313 241741 148778 -35465 -35465 1426130 0 0 -9072 1545194 1545194 132176 132176 166492 66597 99895 325445 58568 64204 202673 11177 2263 1922 6992 28228 5714 4855 17659 1815 367 312 1136 30438 3044 15219 12175 19779 19779 12014 12014 35678 13696 21982 9298 675 1998 6625 16107 288 11034 4785 35684 10255 17092 8337 40919 7746 23239 9934 2424 970 1454 3900 1110 820 1970 3516 703 2110 703 DUES 3616 1446 2170 MISCELLANEOUS 2806 2806 2426706 1768103 260113 398490 53772 55846 4258461 1480477 40696 33613 19477 32973 61945 58003 7458 3942 233177 2180267 4613041 3787118 14472 115103 0 2600 14472 117703 X 719741 809454 3684653 2665786 194175 194175 4598569 3669415 4613041 3787118 X -1000576 80141 -8719 X 0 1 X 1 0 X 1652735 1612367 1643755 643614 1435202 6987673 1652735 1612367 1643755 643614 1435202 6987673 2914294 4073379 16820 21548 14547 540 20295 73750 7061423 0.57680 0.62400 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 233177 7137 240314 225820 7357 233117 204672 21148 225820 194127 10545 204672 197646 -3519 20000 194127 0.80800 0.19200 0 0 61945 58003 3942 3942 X 1667664 80141 12615 148778 241534 1426130 0 1426130 2596820 12615 157499 170114 2426706 0 2426706 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, 2015 AND 2014, 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, 2015 AND 2014, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 148,778. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 148,780. PLEDGE WRITE OFFS (PROGRAMS) 8,719. GALA 259984 161741 98243 12185 69662 500 30264 GOLF TOURNAMENT 27228 17678 9550 7249 3441 2197 2 67842 62322 5520 2417 11756 9107 355054 241741 113313 21851 84859 500 41568 148778 -35465 1 UCH - MHC 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 460796114 501(C)(3) 1545194 FINANCIAL SUPPORT 1 0 LIVING EXPENSES 513 101090 PHARMACY/CENTRAL SUPPLY EDUCATION 20 14538 LYMPHEDEMA GARMENTS/WIGS 80 10767 MASSAGE THERAPY 58 5781 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 X X 1 0 0 0 0 0 0 0 0 CARY BLANCHETTE EXEC. DIR. TERM ENDED 3/2015 136758 0 4468 0 0 0 10464 0 14802 0 166492 0 0 0 PART I, LINE 4A CARY BLANCHETTE RECEIVED $75,597.60 AS A SEVERANCE PAYMENT DURING FISCAL YEAR 15. X 1 375 FMV X 118 FMV X 4440 FMV X 1 600 FMV X 1 800 FMV X TOYS 8 7882 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 SURVEYS 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 -8,719. .