2015-11-16T13:30:29-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 310679012 COLUMBUS MEDICAL ASSOCIATION FOUNDATION COLU 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 PHILIP CASS CEO 6142407410 2015-11-10 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-04-25 22:37:26Z PHILIP CASS 1390 DUBLIN ROAD COLUMBUS OH 43215 2457135 0 X WWW.GOODHEALTHCOLUMBUS.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 13 24 10154 0 55548 179431 170286 195604 1200997 2064113 12973 17987 1439804 2457135 1332564 1451107 0 0 541644 530444 0 0 305291 1254641 1492529 3128849 3474080 -1689045 -1016945 80034733 79820436 3935104 4098386 76099629 75722050 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 1753900 1451107 195604 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 1753900 1 1 0 0 0 1 0 0 0 1 1 1 0 0 1 1 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 19 0 1 13 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 OH 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 6000 0 0 NEDRA HADLEY TRUSTEE 1.00 1.00 X 0 0 0 OLIVIA THOMAS MD TRUSTEE 1.00 1.00 X 0 0 0 JOYCE PENN TRUSTEE (THRU MAY) 1.00 1.00 X 0 0 0 WARREN W TYLER TRUSTEE (THRU FEB) 1.00 1.00 X 0 0 0 EDWARD T BOPE MD TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM COTTON MD TRUSTEE (THRU MAY) 1.00 3.00 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 MARK STECHSCHULTE MD TRUSTEE 1.00 2.00 X 0 0 0 THOMAS MAUGER MD TRUSTEE (THRU MAY) 1.00 1.00 X 0 0 0 KAREN KING MD TRUSTEE 1.00 1.00 X 0 0 0 JASON MELILLO MD TRUSTEE 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 WILLIAM MATLOCK TRUSTEE 1.00 1.00 X 0 0 0 DON BROWN TRUSTEE 1.00 1.00 X 0 0 0 PHILIP CASS CEO 16.00 25.00 X 0 159147 10134 JULIE EIKENBERRY CFO 23.50 27.00 X 63850 0 3081 LAURIE HAWKINS CFO 23.50 27.00 X 62627 0 728 WELDON MILBOURNE DIRECTOR OF DEVELOPMENT AND PROGRAM ADMINISTRATOR 40.00 0.00 X 116379 0 21143 248856 159147 35086 1 0 1 0 0 179431 179431 RENTAL INCOME 900099 137078 137078 PROGRAMS 900099 58526 58526 195604 2064113 2064113 INSURANCE PROCEEDS 900099 2929 2929 LITIGATION PROCEEDS 900099 2528 2528 CREDIT CARD REDEMPTIONS 900099 1200 1200 11330 10154 1176 17987 2457135 195604 10154 2071946 1451107 1451107 276532 60837 154858 60837 29714 6537 16640 6537 20658 4545 11568 4545 150267 33059 84149 33059 53273 11720 29833 11720 424229 424229 124685 32418 57355 34912 106112 39913 26286 39913 2211 39 2133 39 339485 53469 232547 53469 2501 45 2411 45 121539 38716 44103 38720 132019 2354 127311 2354 239128 19130 200868 19130 TAXES & LICENSES 620 11 598 11 3474080 1753900 1414889 305291 481941 330061 78687 62657 2289 2333 5874253 1293625 4812386 4580628 74571032 74741459 88398 103298 80034733 79820436 396751 300205 762 111804 0 109547 2762029 2674491 775562 902339 3935104 4098386 X 74863263 74557158 879529 807055 356837 357837 76099629 75722050 80034733 79820436 X -1016945 649520 -10154 X X 0 1 X 1 0 X X 1 COLUMBUS MEDICAL ASSOCIATION 314411074 501(C)(6) 1 0 0 1 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 2014 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 10 15 4908 46066 11300 178390 364668 1064428 1 1 627710 76500 16525 13300 707435 563865 1650 66667 4472 627710 514229 2345 59191 11900 563865 429811 31033 59345 5960 514229 471030 1500 58366 7498 523398 0.00000 1.00000 0.00000 0 0 889580 889580 2912057 484116 2427941 1256494 211006 1045488 629799 440095 189704 186323 158408 27915 4580628 OTHER SECURITIES 74741459 F 74741459 REIMBURSEMENT TO AFFILIATES 507927 ASSETS HELD FOR OTHERS 394412 902339 X 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. PART X, LINE 2: THE FOUNDATION, COTS, AND THE PCC ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, CERTAIN FOUNDATION INVESTMENTS CAN RESULT IN FEDERAL UNRELATED BUSINESS INCOME TAXES. THE ASSOCIATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(6) OF THE INTERNAL REVENUE CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ASSOCIATION AND RECOGNIZE A TAX LIABILITY IF THE ASSOCIATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ASSOCIATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014 AND 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ASSOCIATION AND AFFILIATES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS AND MANAGEMENT BELIEVES THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2011. EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS N/A 391 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS N/A 1300000 0 0 0 0 0 0 1300391 0 1300391 1 0 0 0 0 0 1 HEALTHCARE COLLABORATIVE OF GREATER COLUMBUS 1429 KING AVE SUITE 200 COLUMBUS OH 43212 510426050 501 (C)(3) 350000 TO SUPPORT PHASE 1 FOR PATIENT CENTER MEDICAL HOME PROJECT CENTRAL OHIO TRAUMA SYSTEM 1390 DUBLIN ROAD COLUMBUS OH 43215 311592734 501 (C)(3) 275600 TO SUPPORT ITS CORE SERVICES PHYSICIANS CARE CONNECTION 1390 DUBLIN ROAD COLUMBUS OH 43215 311373719 501 (C)(3) 724500 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. 0 0 0 0 0 0 0 0 0 PHILIP CASS CEO 0 159147 0 0 0 0 0 6205 0 3929 0 169281 0 0 PART I, LINE 3: THE RELATED ORGANIZATION, COLUMBUS MEDICAL ASSOCIATION, PERFORMS THE COMPENSATION REVIEWS USING AN INDEPENDENT CONSULTANT, WRITTEN EMPLOYMENT CONTRACTS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. COLUMBUS MEDICAL ASSOCIATION FOUNDATION ALSO PARTICIPATES IN THIS PROCESS. 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 11 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 EXECUTIVE DIRECTOR'S COMPENSATION. THEN THE EXECUTIVE DIRECTOR REVIEWS THE COMPENSATION OF ALL OF THE OFFICERS. THE BOARD ESTABLISHES 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 2012 AND WILL BE UPDATED IN 2015. 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 -10,154. 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 PARATUS SOLUTIONS - DISSOLVED IN 2014 1390 DUBLIN ROAD COLUMBUS OH 43215 270650876 PROVIDING DISASTER PREPAREDNESS TO COMMUNITY OH N/A C 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 275600 GRANT PHYSICIANS CARE CONNECTION B 724500 GRANT CENTRAL OHIO TRAUMA SYSTEMS A 83472 PER SQ FT COLUMBUS MEDICAL ASSOCIATION O 150911 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS L 129314 MARKET RATE PHYSICIANS CARE CONNECTION L 128920 MARKET RATE CENTRAL OHIO TRAUMA SYSTEMS O 99152 AGREED UPON % OF TIME PHYSICIANS CARE CONNECTION O 98758 AGREED UPON % OF TIME COLUMBUS MEDICAL ASSOCIATION A 22567 PER SQ FT PHYSICIANS CARE CONNECTION A 31039 PER SQ FT