2014-11-17T11:36:49-06:00 2013-12-31 461497033 EKS&H LLLP 7979 E TUFTS AVE SUITE 400 DENVER CO 80237 990 2013-01-01 841576338 THE MEMORIAL HEALTH SYSTEM FOUNDATION MEMO 7193654483 1519 E BOULDER ST COLORADO SPRINGS CO 80909 CARY BLANCHETTE EXECUTIVE DIRECTOR 7193654483 2014-11-17 1 RYAN C HARRIS P00614618 3037409400 2013 2015-11-30 17:44:51Z CARY BLANCHETTE 1744162 0 X N/A X 2001 CO TO PROVIDE PHILANTHROPIC RESOURCES TO ASSIST MEMORIAL HEALTH SYSTEM. 11 11 7 0 0 0 0 1643755 0 0 0 10647 0 -1144 0 1653258 0 754288 0 0 0 573213 0 0 448389 0 237482 0 1564983 0 88275 4591986 4680052 25597 7674 4566389 4672378 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 204856 204856 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. DURING 2013, 68 INDIVIDUALS WERE GIVEN ASSISTANCE FOR LIVING EXPENSES SUCH AS RENT, UTILITIES AND TRANSPORTATION. IN ADDITION, A COOL CAP UNIT, PHOTOTHERAPY LIGHT AND 55 NUTRITION WARMERS WERE PURCHASED. 121662 121662 THE ISOLETTE FUND WAS CREATED TO PURCHASE A NEW TRAVEL ISOLETTE TO REPLACE AN AGING AND OBSOLETE ISOLETTE IN THE MHS TRANSPORT DEPARTMENT. THE NEW ISOLETTE WAS SPECIFICALLY DESIGNED TO FUNCTION IN AN AMBULANCE WHILE TRANSPORTING AN INFANT. 98917 98917 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. 438765 328853 VARIOUS PATIENT CARE AND STAFF EDUCATION FUNDS 438765 328853 864200 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 5 0 1 7 1 0 0 0 0 0 1 1 0 0 0 0 0 X 11 11 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 MIKE SCIALDONE DIRECTOR 1.00 X 0 0 0 BETSY PLANTE DIRECTOR 1.00 X 0 0 0 MARLENE CHELL DIRECTOR 1.00 X 0 0 0 CARY BLANCHETTE EXEC. DIR. 40.00 X 136776 0 23996 136776 0 23996 1 0 1 0 0 159606 811697 672452 163270 1643755 14547 14547 3900 -3900 -3900 -3900 85860 159606 87004 -1144 -1144 1653258 0 0 9503 638224 638224 116064 116064 160772 64309 96463 341727 75440 63942 202345 10688 2257 2099 6332 56720 11977 11139 33604 3306 698 649 1959 5000 5000 1250 1250 105994 45251 60743 13639 1187 3075 9377 20410 1190 6939 12281 22605 5817 9695 7093 42056 8411 25234 8411 2111 844 1267 13937 2345 7683 3909 2951 590 1771 590 MISCELLANEOUS 4872 2451 2421 DUES 2657 1063 1594 1564983 864200 252394 448389 54924 18366 4306413 4324164 19268 92266 4857 10166 61945 52676 1852 9269 204672 225821 4591986 4680052 25597 2674 5000 25597 7674 X 711622 720655 3660592 3757548 194175 194175 4566389 4672378 4591986 4680052 X 88275 19503 -1789 X 0 1 X 1 0 X 1694182 1536017 1652735 1612367 1643755 8139056 1694182 1536017 1652735 1612367 1643755 8139056 2669107 5469949 24439 11757 16820 21548 14547 89111 8228167 0.66480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 204672 21148 225820 194127 10545 204672 197646 -3519 194127 205009 12637 20000 197646 181500 23509 205009 0.85990 0.14010 0 0 61945 52676 9269 9269 X 1791196 19503 32681 87004 139188 1652008 1250 1250 1653258 1685207 32681 88793 121474 1563733 1250 1250 1564983 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 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 DECEMBER 31, 2013. IF INCURRED, INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS ARE RECORDED IN THE PERIOD ASSESSED AS GENERAL AND ADMINISTRATIVE EXPENSES. NO INTEREST OR PENALTIES HAVE BEEN ASSESSED AS OF DECEMBER 31, 2013. TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION INCLUDE 2009 THROUGH THE CURRENT YEAR FOR STATE TAX REPORTING PURPOSES AND 2010 THROUGH THE CURRENT YEAR FOR FEDERAL TAX REPORTING PURPOSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES: $87,004 PART XII, LINE 2D - OTHER ADJUSTMENTS: WRITE OFF OF PLEDGES RECEIVABLE: $1,789 SPECIAL EVENT EXPENSES: $87,004 GALA 210916 137068 73848 37352 5175 7757 16728 GOLF TOURNAMENT 34550 22538 12012 12012 6306 1674 245466 159606 85860 49364 11481 7757 18402 87004 -1144 1 UCH - MHC 1400 E BOULDER STREET COLORADO SPRINGS CO 80909 460796114 501(C)(3) 638224 FINANCIAL SUPPORT 1 0 LIVING EXPENSES 142 86979 COLORADO SPRINGS CHILDREN'S GENERAL FUND 68 9268 WOMEN'S SERVICES 77 4733 PIKES PEAK COMMUNITY FUND 25 5334 SCHOLARSHIPS 7 9750 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 X 0 0 0 0 0 0 0 0 0 CARY BLANCHETTE EXEC. DIR. 136776 0 0 0 0 0 4126 0 19870 0 160772 0 0 0 X 2 5246 MARKET VALUE X 2113 MARKET VALUE X 13305 MARKET VALUE X 1 500 MARKET VALUE X TOYS 51 142106 MARKET VALUE 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: WRITE OFF OF PLEDGES RECEIVABLE -1,789.