2013-10-25T15:34:47-05:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 310679012 COLUMBUS MEDICAL ASSOCIATION FOUNDATION COLU 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 PHILIP CASS 6142407410 2013-10-07 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-03-07 17:11:31Z X PHILIP CASS 1390 DUBLIN ROAD COLUMBUS OH 43215 3160252 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. 18 18 15 19 1454 454 114605 160553 48405 202554 2806216 2521655 373211 275358 3342437 3160120 1308203 1386608 0 0 812541 554507 0 0 225758 994700 1082988 3115444 3024103 226993 136017 66744843 72297453 1078279 1303314 65666564 70994139 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 1730087 1386608 470041 SEE SCHEDULE OTHE 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 THE CAPABILITIES OF MEDICAL PROFESSIONALS AND INCREASING THE DIVERSITY OF THE HEALTH CARE WORKFORCE, ESPECIALLY WITHIN PRIMARY CARE- ADVANCING LEADERSHIP CAPACITY OF YOUTH TO ENGAGE IN HEALTH PHILANTHROPY 1730087 1 1 0 0 0 1 0 0 0 0 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 17 0 1 15 1 1 1 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X JULIE EIKENBERRY 6142407410 1390 DUBLIN ROAD COLUMBUS OH 43215 JAMES L NICHOLS 1.00 1.00 X X 0 0 0 DWIGHT SCARBOROUGH MD JAN-JUNE 1.00 1.00 X 0 0 0 TERESA C LONG 1.00 2.00 X 0 0 0 NEDRA HADLEY 1.00 1.00 X 0 0 0 OLIVIA THOMAS 1.00 1.00 X 0 0 0 JOYCE PENN 1.00 1.00 X 0 0 0 LINDA SIEFKAS 1.00 1.00 X X 0 0 0 RONALD BERGGREN 1.00 1.00 X 0 0 0 BEN ESPY 1.00 1.00 X 0 0 0 MARC L PARNES 1.00 2.00 X X 0 0 0 WARREN W TYLER 1.00 1.00 X 0 0 0 MARK A BECHTEL MD JAN-JUNE 1.00 2.00 X 0 0 0 JEFFREY BELL MD JAN-JUNE 1.00 2.00 X 0 0 0 JENNIFER WRENN MD 1.00 1.00 X 0 0 0 EDWARD T BOPE 1.00 1.00 X 0 0 0 CLAIRE V WOLFE 1.00 1.00 X 0 0 0 M VALERIANA MOELLER JAN-JUNE 1.00 2.00 X X 0 0 0 WILLIAM COTTON 1.00 2.00 X 0 0 0 JASMINE GREEN 1.00 1.00 X 0 0 0 MARK STAMM 1.00 53.60 X 0 0 0 BRET KOCKENTIET MD 1.00 1.00 X 0 0 0 MARK STECHSCHULTE MD 1.00 2.00 X 0 0 0 PHILIP CASS 20.00 37.10 X 0 208343 26336 JULIE EIKENBERRY 23.80 30.80 X 125427 0 4711 125427 208343 31047 1 0 1 0 0 160553 160553 RENTAL INCOME 900099 159161 159161 PROGRAMS 900099 43393 43393 202554 2521787 2521787 132 -132 -132 -132 REIMBURSEMENTS 900099 267619 267619 LITIGATION PROCEEDS 900099 3665 3665 INSURANCE PROCEEDS 900099 2620 2620 1454 1454 275358 3160120 470041 1454 2528072 1386608 1386608 130138 31446 80045 18647 173506 69402 86753 17351 25650 10260 12825 2565 175173 70069 87587 17517 50040 20016 25020 5004 17764 17764 30355 30355 324304 324304 35457 9137 18366 7954 94631 41567 6348 46716 296790 44206 188727 63857 8751 1303 5565 1883 132633 27737 77159 27737 2408 2408 23497 5692 12113 5692 2928 310 2308 310 91350 7308 76734 7308 11010 2302 6406 2302 DUES & SUBSCRIPTIONS 8681 915 6851 915 PROGRAM/VOLU ACTIVITIES 1809 1809 TAXES & LICENSES 620 620 3024103 1730087 1068258 225758 300723 416976 73809 47991 1645 1492 3377087 656230 1363745 2720857 64922566 69025103 82355 85034 66744843 72297453 245444 429726 0 56879 832835 816709 1078279 1303314 X 64558571 69847449 720063 790853 387930 355837 65666564 70994139 66744843 72297453 X 136017 5193012 -1454 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 68102 27095 78400 17981 1059246 411589 1 1 253580 253580 2335745 24372 2311373 140437 87461 52976 431761 355338 76423 215564 189059 26505 2720857 OTHER SECURITIES 69025103 F 69025103 REIMBURSEMENT TO AFFILIATES 405120 ASSETS HELD FOR OTHERS 411589 816709 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 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, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE 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 2009. 1 ACCESS HEALTHCOLUMBUS 22 E GAY STREET SUITE 801 COLUMBUS OH 43215 510426050 501 (C)(3) 375000 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 COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC 1390 DUBLIN ROAD COLUMBUS OH 43215 311373719 501 (C)(3) 560000 TO PROVIDE FREE PRIMARY & SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERSERVED BUCKEYE RANCH 5665 HOOVER ROAD COLUMBUS OH 43123 310642111 501 (C)(3) 29000 TO SUPPORT CHARITABLE PURPOSES BBB EDUCATIONAL FOUNDATION 1169 DUBLIN ROAD COLUMBUS OH 43215 314152770 501 (C)(3) 10000 TO SUPPORT CHARITABLE PURPOSES THE OHIO CANCER RESEARCH ASSOCIATES 50 WEST BROAD STREET 1132 COLUMBUS OH 43215 311038309 501 (C)(3) 7500 PROVIDES FOR FUNDS FOR SEED GRANTS FOR YOUNG INVESTIGATORS/RESEARCH IN CANCER RESEARCH RECREATION UNLIMITED 7700 PIPER ROAD ASHLEY OH 43003 311813336 501 (C)(3) 5000 TO SUPPORT CHARITABLE PURPOSES MENTAL HEALTH AMERICA 2323 W 5TH AVE SUITE 160 COLUMBUS OH 43204 314412697 501 (C)(3) 25000 TO SUPPORT CHARITABLE PURPOSES 8 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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. 1 0 0 0 0 0 0 0 0 PHILIP CASS 0 208343 0 0 0 0 0 8233 0 18103 0 234679 0 0 PART I, LINE 4A FORMER COO JUDY D'ANDREA RECEIVED $45,750 OF SEVERANCE PAYMENTS IN INSTALLEMENTS FROM OCTOBER 7, 2011 THROUGH FEBRUARY 10, 2012. THE PORTION FOR THE 2012 CALENDAR YEAR WAS $12,872. SUPPLEMENTAL INFORMATION PART III 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 COO 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. THOSE CONFLICTS ARE THEN ADDRESSED BY THE BOARD. VOTING AND PARTICIPATION RESTRICTIONS ARE IMPOSED ON THOSE WITH ANY CONFLICTS. 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 18 THE FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FLOW THROUGH INCOME FROM PRIVATE EQUITY INVESTMENT FUND V, LP FORM K-1 -1,454. 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 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION 1 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 CENTRAL OHIO TRAUMA SYSTEMS B 275600 GRANT PHYSICIANS CARE CONNECTION B 560000 GRANT COLUMBUS MEDICAL ASSOCIATION O 196218 SPLIT COSTS PHYSICIANS CARE CONNECTION O 86131 AGREED UPON % OF TIME PHYSICIANS CARE CONNECTION L 136018 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS O 86190 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS L 137751 MARKET RATE COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED C 75155 DONOR ADVISED FUND