MEMORIAL HEALTH SYSTEM FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MEMORIAL HEALTH SYSTEM FOUNDATION (EIN 84-1576338)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-11
IRS object ID
201333169349300648
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-11T17:45:25-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1STOCKMAN KAST RYAN & CO LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1102 N CASCADE AVENUE SUITE 400AddressLine1
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80903ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN841576338EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE MEMORIAL HEALTH SYSTEM FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% STEVE WEBERInCareOfName
Name ControlMEMONameControl
Phone7193654483Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11519 E BOULDER STAddressLine1
Address Line2SuiteAddressLine2
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80909ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCARY BLANCHETTEName
TitleEXECUTIVE DIRECTORTitle
Phone7193654483Phone
Date Signed2013-11-07DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDOREEN B MERZName
Phone7196301186Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCary BlanchetteNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11519 E BOULDERAddressLine1
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80909ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4906102GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2001YearFormation
State Legal DomicileCOStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE PHILANTHROPIC RESOURCES TO ASSIST MEMORIAL HEALTH SYSTEM.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees5TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1652735ContributionsGrantsPriorYear
Contributions Grants Current Year1612367ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year18656InvestmentIncomePriorYear
Investment Income Current Year17650InvestmentIncomeCurrentYear
Other Revenue Prior Year-44200OtherRevenuePriorYear
Other Revenue Current Year-32926OtherRevenueCurrentYear
Total Revenue Prior Year1627191TotalRevenuePriorYear
Total Revenue Current Year1597091TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year787898GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY695215GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year550181SalariesEtcPriorYear
Salaries Etc Current Year617287SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year385440TotalFundrsngExpCurrentYear
Other Expense Prior Year235948OtherExpensePriorYear
Other Expenses Current Year61216OtherExpensesCurrentYear
Total Expenses Prior Year1574027TotalExpensesPriorYear
Total Expenses Current Year1373718TotalExpensesCurrentYear
Revenues Less Expenses Prior Year53164RevenuesLessExpensesPriorYear
Revenues Less Expenses CY223373RevenuesLessExpensesCY
Total Assets BOY4372863TotalAssetsBOY
Total Assets EOY4591986TotalAssetsEOY
Total Liabilities BOY36231TotalLiabilitiesBOY
Total Liabilities EOY25597TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4336632NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4566389NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MEMORIAL HEALTH SYSTEM FOUNDATION SEEKS TO BECOME THE PRIMARY PHILANTHROPIC RESOURCE TO ELEVATE THE COMMUNITY'S HEALTH OF CURRENT AND FUTURE GENERATIONS. CONTINUED ON SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense159108Expense
Grants112609Grants
DescriptionCHILD LIFE: FUNDS TO ASSIST THE CHILD LIFE PROGRAM AND THERAPISTS. CHILD LIFE PROGRAM PROVIDES CRITICAL EMOTIONAL AND EDUCATIONAL SUPPORT TO CHILDREN AND THEIR FAMILIES DURING TREATMENT IN INPATIENT PEDIATRIC UNITS, OUTPATIENT CLINICS, AND THE EMERGENCY DEPARTMENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense70945Expense
Grants70945Grants
DescriptionEMPLOYEE ASSISTANCE: FUNDS DONATED BY EMPLOYEES FOR EMPLOYEE EMERGENCY ASSISTANCE. THE PURPOSE OF THE EMPLOYEE ASSISTANCE FUND IS TO PROVIDE FINANCIAL ASSISTANCE TO ELIGIBLE EMPLOYEES OF MEMORIAL HOSPITAL WHO ARE EXPERIENCING SEVERE FINANCIAL DISTRESS RESULTING FROM AN EXTRAORDINARY EMERGENCY OR CATASTROPHIC EVENT. THE FUND IS ADMINISTERED BY THE MEMORIAL HOSPITAL EMPLOYEE ASSISTANCE FUND COMMITTEE.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense84962Expense
Grants60132Grants
DescriptionKOHLS CARES FOR CAR SAFETY: 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. SEE SCHEDULE O FOR CONTINUATIONDescription

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense467588Expense
Grants451529Grants
DescriptionOTHERDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp467588TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt451529TotalOfOtherProgramServiceGrnt
Total Program Service Expense782603TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees5NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSTEVE WEBERNamePerson
Telephone Number7193654483TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11519 E BOULDERAddressLine1
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80909ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
David I Greenberg MD
Director1.0X000
Mary Ellen McNally
Board Chair1.0XX
Joseph Camiolo
Director1.0X
Peggy Carmack
Treasurer1.0XX
William Crouch MD
Secretary1.0XX
Mike Edmonds Ph D
Director1.0X
Lana Janc
Director1.0X
Thomas Naughton
Director1.0X
Kevin O'Gara
Vice Chair1.0XX
Annette Seagraves
Director1.0XX
Karen Anthony
Director1.0X
Ronald Rubin
Director1.0X
Mike Scialdone
Ex-officio1.0X
Larry McEvoy
Ex-officio1.0X
Deborah Lafferty
Ex-officio1.0X
Darlene Larson
Ex-officio1.0X
Cary Blanchette
Exec. Dir.40.014378332842X
William Stohlmann
Director of Planning & Campaig40.011204627298X
FieldValueIRS element (for citing)
Total Reportable Comp From Org255829TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation60140TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events190911FundraisingEvents
Related Organizations719664RelatedOrganizations
All Other Contributions701792AllOtherContributions
Noncash Contributions154642NoncashContributions
Total Contributions1612367TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column21548TotalRevenueColumn
Exclusion$21,548ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3224137Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3228035Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-3898Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-3898TotalRevenueColumn
Exclusion-$3,898ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events48050GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events190911CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses80976FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-32926TotalRevenueColumn
Exclusion-$32,926ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1597091TotalRevenueColumn
Exclusion-$15,276ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total519473Total
Program Services519473ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total175742Total
Program Services175742ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total302788Total
Program Services13284ProgramServices
Management And General81262ManagementAndGeneral
Fundraising208242Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total253430Total
Program Services51121ProgramServices
Management And General77440ManagementAndGeneral
Fundraising124869Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total61069Total
Program Services16572ProgramServices
Management And General14843ManagementAndGeneral
Fundraising29654Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total868Total
Management And General868ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total5375Total
Management And General5375ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total6172Total
Fundraising6172Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total11967Total
Program Services1799ProgramServices
Management And General3936ManagementAndGeneral
Fundraising6232Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10681Total
Program Services3204ProgramServices
Management And General5341ManagementAndGeneral
Fundraising2136Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total2108Total
Management And General843ManagementAndGeneral
Fundraising1265Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2210Total
Program Services442ProgramServices
Management And General1326ManagementAndGeneral
Fundraising442Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraisingProgram ServicesProgramServices
CONTINUING EDUCATION731629264390
MISCELLANEOUS79027902
EMPLOYEE GIVING CAMPAIGN
EQUIPMENT RENTAL48302898966966

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1787Total
Management And General715ManagementAndGeneral
Fundraising1072Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1373718Total
Program Services782603ProgramServices
Management And General205675ManagementAndGeneral
Fundraising385440Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY50865BOY
EOY54924EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4059368BOY
EOY4306413EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY60225BOY
EOY19268EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY5250BOY
EOY4857EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis50542LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec48690LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3028BOY
EOY1852EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY194127BOY
EOY204672EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4372863BOY
EOY4591986EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY35211BOY
EOY25597EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1020BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY36231BOY
EOY25597EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY753993BOY
EOY711622EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3388464BOY
EOY3660592EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY194175BOY
EOY194175EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4336632BOY
EOY4566389EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4372863BOY
EOY4591986EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses223373ReconcilationRevenueExpenses
Reconciliation Unrealized Invest14941ReconciliationUnrealizedInvest
Reconcilation Other Changes-8557ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
EIN846002995EIN
Type Of Organization03TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$613,042Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts613042SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance194127BeginningOfYearBalance
Investment Earnings Or Losses10545InvestmentEarningsOrLosses
End Of Year Balance204672EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance197646BeginningOfYearBalance
Investment Earnings Or Losses-3519InvestmentEarningsOrLosses
End Of Year Balance194127EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance205009BeginningOfYearBalance
Investment Earnings Or Losses12637InvestmentEarningsOrLosses
Grants Or Scholarships20000GrantsOrScholarships
End Of Year Balance197646EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance181500BeginningOfYearBalance
Investment Earnings Or Losses23509InvestmentEarningsOrLosses
End Of Year Balance205009EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance212665BeginningOfYearBalance
Investment Earnings Or Losses-31165InvestmentEarningsOrLosses
End Of Year Balance181500EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.94871PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.05129TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis50542OtherCostOrOtherBasis
Depreciation48690Depreciation
Book Value1852BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings1852TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt1752809TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments14941NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities59801DonatedSrvcAndUseOfFacilities
Other Revenues80976OtherRevenues
Revenue Not Rptd F990155718RevenueNotRptdF990
Revenue Subtotal1597091RevenueSubtotal
Total Revenue Per Form9901597091TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt1523052TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities59801DonatedServicesUseOfFacilities
Other Expenses Included89533OtherExpensesIncluded
Expenses Not Rptd F990149334ExpensesNotRptdF990
Expenses Subtotal1373718ExpensesSubtotal
Total Expenses Per Form9901373718TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierExplanationExplanation
PART V, LINE 4THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO PROVIDE EDUCATION TO OUTREACH PROGRAMS, TRAUMA NURSES, AND BLOOD DONOR TECHS.
Part X Line 2The Foundation believes that it does not have any uncertain tax positions that are material to the financial statements.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS EXPENSES RECLASS: $80,976
PART XIII, LINE 2DSPECIAL EVENTS EXPENSES RECLASS: $80,976 WRITE-OFF OF PLEDGES RECEIVABLE: $8,557

Schedule G IRS990ScheduleG

Fundraiser Activity Information FundraiserActivityInformation (2 entries)

Name Of IndividualNameOfIndividualActivityActivityFundraiser Control Of FundsFundraiserControlOfFunds
PATRICIA WOODS 1322 N25th st CSGRANT WRITINGfalse
Tess Powers 1009 Pioneer Lane CSGRANT WRITINGfalse

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALANameOfEvent1
Gross Receipts Event1205253GrossReceiptsEvent1
Charitable Contributions Event1168913CharitableContributionsEvent1
Gross Revenue Event136340GrossRevenueEvent1
Rent Facility Costs Event137939RentFacilityCostsEvent1
Food And Beverage Event17653FoodAndBeverageEvent1
Entertainment Event13295EntertainmentEvent1
Other Direct Expenses Event117697OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNAMENTNameOfEvent2
Gross Receipts Event233708GrossReceiptsEvent2
Charitable Contributions Event221998CharitableContributionsEvent2
Gross Revenue Event211710GrossRevenueEvent2
Non Cash Prizes Event21940NonCashPrizesEvent2
Rent Facility Costs Event27537RentFacilityCostsEvent2
Food And Beverage Event23585FoodAndBeverageEvent2
Other Direct Expenses Event21330OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Other Events0GrossReceiptsOtherEvents
Charitable Contrib Other Events0CharitableContribOtherEvents
Gross Revenue Other Events0GrossRevenueOtherEvents
Cash Prizes Other Events0CashPrizesOtherEvents
Non Cash Prizes Other Events0NonCashPrizesOtherEvents
Rent Facility Costs Other Events0RentFacilityCostsOtherEvents
Food And Beverage Other Events0FoodAndBeverageOtherEvents
Entertainment Other Events0EntertainmentOtherEvents
Other Direct Expenses Other Events0OtherDirectExpensesOtherEvents
Gross Receipts Total238961GrossReceiptsTotal
Charitable Contributions Total190911CharitableContributionsTotal
Gross Revenue Total Events48050GrossRevenueTotalEvents
Cash Prizes Total Events0CashPrizesTotalEvents
Non Cash Prizes Total Events1940NonCashPrizesTotalEvents
Rent Facility Costs Total Events45476RentFacilityCostsTotalEvents
Food And Beverage Total Events11238FoodAndBeverageTotalEvents
Entertainment Total Events3295EntertainmentTotalEvents
Other Direct Expenses Total Events19027OtherDirectExpensesTotalEvents
Direct Expense Summary Events80976DirectExpenseSummaryEvents
Net Income Summary-32926NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL HEALTH SYSTEMSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12502 E PIKES PEAK AVEAddressLine1
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80909ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient846002995EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant519473AmountOfCashGrant
Purpose Of GrantFINANCIAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (8 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrant
Circle of Hope23453205
Employee Assistance4170945
Renee's Friends176096
Grace Fund510102
Colo Spgs Children's General Fund2553
Pediatric's Family Support Fund62506
Rehab Patient Care Unit11809
Circle of Hope Komen5230526

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE I, PART I, LINE 2:Identifier
ExplanationTHE FOUNDATION EXECUTIVE DIRECTOR REVIEWS ALL GRANTS AND REQUESTS FOR MONIESYExplanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonCary BlanchetteNamePerson
TitleExec. Dir.Title
Base Compensation Filing Org143783BaseCompensationFilingOrg
Deferred Comp Filing Org16573DeferredCompFilingOrg
Nontaxable Benefits Filing Org16269NontaxableBenefitsFilingOrg
Total Compensation Filing Org176625TotalCompensationFilingOrg

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest

Books And Publications BooksAndPublications

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9908162NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F99024330NoncashContribsRptdF990
Method Of Determining RevenuesMAREKT VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory
Drugs And Medical SuppliesDrugsAndMedicalSupplies
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionTOYSDescription
Number Of Contributions116NumberOfContributions
Noncash Contribs Rptd F990122150NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
FORM 990, PART III, LINE 1CONTINUED: THE 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: NEONATAL INTENSIVE CARE UNIT EXPANSION, DIGITAL MAMMOGRAPHY EQUIPMENT, COOLING CAP AND CANCER, CARDIOLOGY, CHILDREN'S HOSPITAL AND WOMEN'S PROGRAMS AND SERVICES.
FORM 990, PART IV, LINE 4CKOHL'S CARES FOR CAR SAFETY CONTINUED: OUR MEMBERS INCLUDE CHILD PASSENGER SAFETY SEAT TECHNICIANS AND ARE AVAILABLE TO CONDUCT CAR SEAT CHECKS AT A VARIETY OF LOCATIONS THROUGHOUT THE COMMUNITY. WE SPEAK TO THOUSANDS OF PEOPLE A YEAR AND CAN PROVIDE EDUCATION AT EVENTS UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 11:ONCE THE 990 IS PREPARED, THE EXECUTIVE DIRECTOR ADVISES THE BOARD MEMBERS THAT IT IS READY FOR REVIEW. A COPY OF THE 990 IS AVAILABLE IN THE FOUNDATION OFFICE.
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 HIM/HERSELF FROM ANY VOTE IF THERE IS A CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15:MEMORIAL HEALTH SYSTEM'S HUMAN RESOURCE DEPARTMENT AND CEO WORK TOGETHER TO DETERMINE THE COMPENSATION FOR THE FOUNDATION CEO WITH THE ADVICE AND CONSENT OF THE FOUNDATION EXECUTIVE COMMITTEE. OTHER KEY EMPLOYEES OF THE FOUNDATION ARE COMPENSATED BASED ON THE HEALTH SYSTEM'S COMPENSATION POLICIES.
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 9WRITE OFF OF PLEDGES RECEIVABLE: ($8,557)
FORM 990, PART XII, LINE 2C:NO CHANGES TO OVERSIGHT PROCESS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL HEALTH SYSTEMSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11400 EAST BOULDERAddressLine1
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80909ZIPCode
FieldValueIRS element (for citing)
EIN846002995EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateCOLegalDomicileState
Public Charity StatusN/APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Memorial Health System
B613042FMV
MEMORIAL HEALTH SYSTEM
K46859FMV
MEMORIAL HEALTH SYSTEM
P719200FMV

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