2014-11-06T08:43:21-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2013-01-01 310679012 COLUMBUS MEDICAL ASSOCIATION FOUNDATION COLU 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 PHILIP CASS CEO 6142407410 2014-10-10 1 BERNIE OSTROWSKI P00366367 6148493000 2013 2015-11-30 17:44:51Z PHILIP CASS 1390 DUBLIN ROAD COLUMBUS OH 43215 1439894 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. 19 19 20 19 -15393 -15393 160553 55548 202554 170286 2521655 1200997 275358 12973 3160120 1439804 1386608 1332564 0 0 554507 541644 0 0 222948 1082988 1254641 3024103 3128849 136017 -1689045 72297453 80034733 1303314 3935104 70994139 76099629 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 1667353 1332564 170196 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 1667353 1 1 0 0 0 1 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 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 14 0 1 20 1 0 0 0 0 0 0 0 0 0 0 X 19 19 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 TERESA C LONG TRUSTEE 1.00 2.00 X 0 0 0 NEDRA HADLEY TRUSTEE 1.00 1.00 X 0 0 0 OLIVIA THOMAS TRUSTEE 1.00 1.00 X 0 0 0 JOYCE PENN TRUSTEE 1.00 1.00 X 0 0 0 LINDA SIEFKAS VICE PRESIDENT 1.00 1.00 X X 0 0 0 RONALD BERGGREN TRUSTEE 1.00 1.00 X 0 0 0 MARC L PARNES PRESIDENT 1.00 2.00 X X 0 0 0 WARREN W TYLER TRUSTEE 1.00 1.00 X 0 0 0 EDWARD T BOPE TRUSTEE 1.00 1.00 X 0 0 0 CLAIRE V WOLFE TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM COTTON TRUSTEE 1.00 2.00 X 0 0 0 JASMINE GREEN TRUSTEE 1.00 1.00 X 0 0 0 MARK STAMM TRUSTEE 1.00 53.60 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 1.00 1.00 X 0 0 0 KAREN KING MD TRUSTEE 1.00 2.00 X 0 0 0 JASON MELILLO PRESIDENT ELECT 1.00 2.00 X X 0 0 0 PHILIP CASS CEO 20.00 37.10 X 0 155490 22752 JULIE EIKENBERRY CFO 23.80 30.80 X 129852 0 6444 WELDON MILBOURNE EXECUTIVE DIRECTOR 40.00 0.00 X 113700 0 6661 243552 155490 35857 2 0 1 0 0 55548 55548 RENTAL INCOME 900099 130886 130886 PROGRAMS 900099 39400 39400 170286 1201087 1201087 90 -90 -90 -90 LITIGATION PROCEEDS 900099 19009 19009 INSURANCE PROCEEDS 900099 4381 4381 ADMIN FEES FOR DONOR FUNDS 900099 3676 3676 -14093 -15393 1300 12973 1439804 170196 -15393 1229453 1332564 1332564 256657 62018 157864 36775 58544 23418 29272 5854 23243 9297 11622 2324 155264 62106 77632 15526 47936 19174 23968 4794 25458 25458 35036 35036 394291 394291 42264 10891 21892 9481 87935 38626 5899 43410 34049 5071 21651 7327 14152 2108 8999 3045 294649 61619 171411 61619 2400 2400 22610 5477 11656 5477 84818 8980 66858 8980 189439 15155 159129 15155 11660 2438 6784 2438 PROGRAM/VOLU ACTIVITIES 7668 7668 DUES & SUBSCRIPTIONS 7052 743 5566 743 TAXES & LICENSES 1160 1160 3128849 1667353 1238548 222948 416976 481941 47991 78687 1492 2289 5872477 1060091 2720857 4812386 69025103 74571032 85034 88398 72297453 80034733 429726 396751 56879 762 0 2762029 816709 775562 1303314 3935104 X 69847449 74863263 790853 879529 355837 356837 70994139 76099629 72297453 80034733 X -1689045 6779141 15393 X X 0 1 X 1 0 X X 0 0 0 COLUMBUS MEDICAL ASSOCIATION 314411074 501(C)(6) 1 1 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14 11 26076 25051 0 52625 1134348 375721 1 1 563865 1650 66667 0 0 4472 627710 514229 2345 59191 11900 563865 429811 31033 59345 5960 514229 471030 1500 58366 7498 523398 416466 3175 68632 17243 471030 0.00000 1.00000 0.00000 0 0 889580 889580 2912057 425624 2486433 1251977 136753 1115224 635394 355173 280221 183469 142541 40928 4812386 OTHER SECURITIES 74571032 F 74571032 REIMBURSEMENT TO AFFILIATES 399842 ASSETS HELD FOR OTHERS 375720 775562 X 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, 2013 AND 2012, 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 2010. 1 ACCESS HEALTHCOLUMBUS 22 E GAY STREET SUITE 801 COLUMBUS OH 43215 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) 660000 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 155490 0 0 0 0 0 6155 0 16597 0 178242 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. IN ADDITION, THE RETURN IS REVIEWED BY THE CFO WITH MEMBERS OF THE FINANCE COMMITTEE. 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 15,393. 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 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 1 1 0 1 1 1 1 0 0 CENTRAL OHIO TRAUMA SYSTEMS B 275600 GRANT PHYSICIANS CARE CONNECTION B 660000 GRANT CENTRAL OHIO TRAUMA SYSTEMS I 75455 PER SQ FT COLUMBUS MEDICAL ASSOCIATION O 155660 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS L 122987 MARKET RATE PHYSICIANS CARE CONNECTION L 132287 MARKET RATE CENTRAL OHIO TRAUMA SYSTEMS O 93333 AGREED UPON % OF TIME PHYSICIANS CARE CONNECTION O 92838 AGREED UPON % OF TIME