FURP.ORG / PUBLIC DATA EXPLORER

COLUMBUS MEDICAL ASSOCIATION FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COLUMBUS MEDICAL ASSOCIATION FOUNDATION (EIN 31-0679012)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-09-28
IRS object ID
201202729349300800
Schema version
2011v1.2
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)
Timestamp2012-09-28T07:28:07-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310679012EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBUS MEDICAL ASSOCIATION FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone6142407410Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1431 EAST BROAD STREETAddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePHILIP CASSName
TitleCEOTitle
Phone6142407410Phone
Date Signed2012-09-19DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
PTINP00366367PTIN
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPHILIP CASSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1431 EAST BROAD STREETAddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3342437GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GOODHEALTHCOLUMBUS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionTHE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members19NbrIndependentVotingMembers
Total Nbr Employees13TotalNbrEmployees
Total Nbr Volunteers19TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year138370ContributionsGrantsPriorYear
Contributions Grants Current Year114605ContributionsGrantsCurrentYear
Program Service Revenue Prior Year121020ProgramServiceRevenuePriorYear
Program Service Revenue CY48405ProgramServiceRevenueCY
Investment Income Prior Year2326947InvestmentIncomePriorYear
Investment Income Current Year2806216InvestmentIncomeCurrentYear
Other Revenue Prior Year318478OtherRevenuePriorYear
Other Revenue Current Year373211OtherRevenueCurrentYear
Total Revenue Prior Year2904815TotalRevenuePriorYear
Total Revenue Current Year3342437TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1067625GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1308203GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year901592SalariesEtcPriorYear
Salaries Etc Current Year812541SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year189061TotalFundrsngExpCurrentYear
Other Expense Prior Year773408OtherExpensePriorYear
Other Expenses Current Year994700OtherExpensesCurrentYear
Total Expenses Prior Year2742625TotalExpensesPriorYear
Total Expenses Current Year3115444TotalExpensesCurrentYear
Revenues Less Expenses Prior Year162190RevenuesLessExpensesPriorYear
Revenues Less Expenses CY226993RevenuesLessExpensesCY
Total Assets BOY71821410TotalAssetsBOY
Total Assets EOY66744843TotalAssetsEOY
Total Liabilities BOY1029470TotalLiabilitiesBOY
Total Liabilities EOY1078279TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY70791940NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY65666564NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1952454Expense
Grants1308203Grants
Revenue408261Revenue
DescriptionSEE SCHEDULE OTHE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL 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 PHILANTHROPYDescription
Total Program Service Expense1952454TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds1DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109615NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees13NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members19NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JULIE EIKENBERRYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6142407410TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1431 EAST BROAD STREETAddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JAMES L NICHOLS
SECRETARY/TREASURER1.00XX000
DWIGHT SCARBOROUGH MD
TRUSTEE1.00X000
TERESA C LONG
TRUSTEE1.00X000
NEDRA HADLEY
TRUSTEE1.00X000
OLIVIA THOMAS
TRUSTEE1.00X000
JOYCE PENN
TRUSTEE1.00X000
LINDA SIEFKAS
TRUSTEE1.00X000
RONALD BERGGREN
TRUSTEE1.00X000
BEN ESPY
TRUSTEE1.00X000
MARC L PARNES
VICE PRESIDENT1.00XX000
WARREN W TYLER
TRUSTEE1.00X000
MARK A BECHTEL MD
TRUSTEE1.00X000
JEFFREY BELL MD
TRUSTEE1.00X000
JENNIFER WRENN MD
TRUSTEE1.00X000
EDWARD T BOPE
TRUSTEE1.00X000
CLAIRE V WOLFE
TRUSTEE1.00X000
M VALERIANA MOELLER
PRESIDENT1.00XX000
WILLIAM COTTON
TRUSTEE1.00X000
JASMINE GREEN
TRUSTEE1.00X000
PHILIP CASS
CEO20.00X020713926153
JUDY D'ANDREA
COO23.80X149567018365
JULIE EIKENBERRY
CFO23.80X3061100
WELDON MILBOURNE
EXECUTIVE DIRECTOR40.0011552609733X
FieldValueIRS element (for citing)
Total Reportable Comp From Org295704TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs207139TotalReportableCompFrmRltdOrgs
Total Other Compensation54251TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions114605AllOtherContributions
Total Contributions114605TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPROGRAMSDescription
Business Code900099BusinessCode
Total Revenue Column48405TotalRevenueColumn
Related Or Exempt Function Income48405RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue48405TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2806216TotalRevenueColumn
Exclusion$2,806,216ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real102000Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real102000Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column102000TotalRevenueColumn
Related Or Exempt Function Income102000RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
REIMBURSEMENTS900099257856257856
LITIGATION PROCEEDS90009912099$12,099
INSURANCE PROCEEDS9000991256$1,256
FieldValueIRS element (for citing)
Total Other Revenue271211TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3342437TotalRevenueColumn
Related Or Exempt Function Income408261RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,819,571ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1308203Total
Program Services1308203ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total171093Total
Program Services41343ProgramServices
Management And General105235ManagementAndGeneral
Fundraising24515Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total392630Total
Program Services157052ProgramServices
Management And General196315ManagementAndGeneral
Fundraising39263Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total22480Total
Program Services8992ProgramServices
Management And General11240ManagementAndGeneral
Fundraising2248Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total176938Total
Program Services70775ProgramServices
Management And General88469ManagementAndGeneral
Fundraising17694Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total49400Total
Program Services19760ProgramServices
Management And General24700ManagementAndGeneral
Fundraising4940Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3196Total
Management And General3196ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total37510Total
Management And General37510ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total305526Total
Management And General305526ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total30102Total
Program Services7757ProgramServices
Management And General15592ManagementAndGeneral
Fundraising6753Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total95882Total
Program Services42116ProgramServices
Management And General6432ManagementAndGeneral
Fundraising47334Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total31802Total
Program Services4737ProgramServices
Management And General20223ManagementAndGeneral
Fundraising6842Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8236Total
Program Services1227ProgramServices
Management And General5237ManagementAndGeneral
Fundraising1772Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total105681Total
Program Services22101ProgramServices
Management And General61479ManagementAndGeneral
Fundraising22101Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total2774Total
Management And General2774ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total29330Total
Program Services7105ProgramServices
Management And General15120ManagementAndGeneral
Fundraising7105Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total3745Total
Program Services396ProgramServices
Management And General2953ManagementAndGeneral
Fundraising396Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total72989Total
Program Services5839ProgramServices
Management And General61311ManagementAndGeneral
Fundraising5839Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total7087Total
Program Services1482ProgramServices
Management And General4123ManagementAndGeneral
Fundraising1482Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT EXPENSE249852249852
DUES & SUBSCRIPTIONS73737775819777
PROGRAM/VOLU ACTIVITIES29402940
TAXES & LICENSES675675

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3115444Total
Program Services1952454ProgramServices
Management And General973929ManagementAndGeneral
Fundraising189061Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY443934BOY
EOY300723EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY244193BOY
EOY73809EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY14884BOY
EOY1645EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2280481LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec916736LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1408234BOY
EOY1363745EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY69630503BOY
EOY64922566EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY79662BOY
EOY82355EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY71821410BOY
EOY66744843EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY296847BOY
EOY245444EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY732623BOY
EOY832835EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1029470BOY
EOY1078279EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY69460132BOY
EOY64558571EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY818525BOY
EOY720063EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY513283BOY
EOY387930EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY70791940BOY
EOY65666564EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY71821410BOY
EOY66744843EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses226993ReconcilationRevenueExpenses
Reconcilation Other Changes-5352369ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBUS MEDICAL ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
EIN314411074EIN
Type Of Organization501(C)(6)TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

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)
Number DA Fs Held14NumberDAFsHeld
Number Funds Held12NumberFundsHeld
Donor Advised Contributions121948DonorAdvisedContributions
Contrib To Funds And Other Accounts59952ContribToFundsAndOtherAccounts
Grants Paid From Donor Funds56500GrantsPaidFromDonorFunds
Grants Funds And Other Accounts131800GrantsFundsAndOtherAccounts
Aggregate DAF Value993492AggregateDAFValue
Aggregate Fund Value687009AggregateFundValue
Disclosed Orgs Legal Control1DisclosedOrgsLegalControl
Disclosed For Charitable Purposes1DisclosedForCharitablePurposes

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis636000OtherCostOrOtherBasis
Book Value636000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis864842OtherCostOrOtherBasis
Depreciation317797Depreciation
Book Value547045BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis140437OtherCostOrOtherBasis
Depreciation75412Depreciation
Book Value65025BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis431761OtherCostOrOtherBasis
Depreciation338961Depreciation
Book Value92800BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis207441OtherCostOrOtherBasis
Depreciation184566Depreciation
Book Value22875BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1363745TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionOTHER SECURITIESDescription
Book Value64922566BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities64922566TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
REIMBURSEMENT TO AFFILIATES$451,338
ASSETS HELD FOR OTHERS$381,497
FieldValueIRS element (for citing)
Total Of Amounts832835TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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, 2011 AND 2010, 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 2008.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
ACCESS HEALTHCOLUMBUS
22 E GAY STREET SUITE 801COLUMBUSOH43215510426050501 (C)(3)400000TO SUPPORT PHASE 1 FOR PATIENT CENTER MEDICAL HOME PROJECT
CENTRAL OHIO TRAUMA SYSTEM
431 E BROAD STREETCOLUMBUSOH43215311592734501 (C)(3)275600TO SUPPORT ITS 2010 CORE SERVICES
COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC
431 E BROAD STREETCOLUMBUSOH43215311373719501 (C)(3)560000TO PROVIDE FREE PRIMARY & SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERSERVED
FRANKLIN PARK CONSERVATORY WOMEN'S BOARD
1777 E BROAD STREETCOLUMBUSOH43203311191469501 (C)(3)15000FOR HORICULTURE & EDUCATION PROGRAMS AT THE CONSERVATORY
COLUMBUS ITALIAN FESTIVAL- ST JOHN THE BAPTIST CATHOLIC CHURCH
720 HAMLET STCOLUMBUSOH43215501 (C)(3)20000SPONSORSHIP GRANT FOR COMMUNITY BASED FESTIVAL
THE OHIO CANCER RESEARCH ASSOCIATES
50 WEST BROAD STREET 1132COLUMBUSOH43215311038309501 (C)(3)7500PROVIDES FOR FUNDS FOR SEED GRANTS FOR YOUNG INVESTIGATORS/RESEARCH IN CANCER RESEARCH
THE COLUMBUS CHAMBER OF COMMERCE
150 SOUTH FRONT STREET 200COLUMBUSOH43215314152950501 (C)(3)5000SPONSORSHIP GRANT TO SUPPORT COMMUNITY LEADERSHIP FORUM AND AWARDS FOCUSED ON DIVERSITY, INNOVATION AND SUSTAINABILITY
OSU NURSING FUND
1480 W LANE AVECOLUMBUSOH43221311145986501 (C)(3)5000PROVIDES SCHOLARSHIP SUPPORT FOR MEMBERS OF THE NURSING PROFESSION
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants8TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
PHILIP CASS
00020713900012411013742023329200
JUDY D'ANDREA
00122117027450053540130110167932000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1ATHE EXECUTIVE DIRECTOR, WELDON MILBOURNE, RECEIVES CLUB DUES. THESE CLUB DUES ARE NOT TREATED AS TAXABLE.
PART I, LINE 4AJUDY D'ANDREA RECEIVED $45,750 OF SEVERANCE PAYMENTS IN INSTALLEMENTS FROM OCTOBER 7, 2011 THROUGH FEBRUARY 10, 2012.
PART IIIPART 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.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6COLUMBUS MEDICAL ASSOCIATION IS THE ORGANIZATION'S SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE 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 11THE 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 12CTHE 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 15COLUMBUS 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 2008 AND WILL BE UPDATED IN 2012.
FORM 990, PART VI, SECTION C, LINE 18THE FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VIITHE HOURS DISTRIBUTION FOR RELATED ENTITIES ARE AS FOLLOWS: PHILIP CASS: A. COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC - 10 HOURS B. COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED - 0.1 HOURS C. COLUMBUS MEDICAL ASSOCIATION - 21.3 HOURS D. CENTRAL OHIO TRAUMA SYSTEM - 3.8 HOURS JUDY D'ANDREA: A. COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC - 10 HOURS B. COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED - 0.1 HOURS C. COLUMBUS MEDICAL ASSOCIATION - 11.3 HOURS D. CENTRAL OHIO TRAUMA SYSTEM - 7.5 HOURS JULIE EIKENBERRY A. COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC - 10 HOURS B. COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED - 0.1 HOURS C. COLUMBUS MEDICAL ASSOCIATION - 11.3 HOURS D. CENTRAL OHIO TRAUMA SYSTEM - 7.5 HOURS
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -5,352,369.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, LINE XII, LINE 2CTHE 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED
431 E BROAD STREETCOLUMBUSOH43215200385860PROVIDING HEALTH AND WELLNESS SERVICESOH501(C)(3)LINE 7COLUMBUS MEDICAL ASSOCIATION1
COLUMBUS MEDICAL ASSOCIATION
431 E BROAD STREETCOLUMBUSOH43215314411074ADVANCING COMMUNITY HEALTH THROUGH ADVOCACY, EDUCATION AND SERVICEOH501(C)(6)0N/A
CENTAL OHIO TRAUMA SYSTEM
431 E BROAD STREETCOLUMBUSOH43215311592734REDUCING INJURIES AND SAVING LIVES BY IMPROVING TRAUMA CAREOH501(C)(3)LINE 7COLUMBUS MEDICAL ASSOCIATION1
COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC
431 E BROAD STREETCOLUMBUSOH43215311373719COORDINATING VOLUNTARY HEALTH CARE SERVICESOH501(C)(3)LINE 3COLUMBUS MEDICAL ASSOCIATION1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CENTRAL OHIO TRAUMA SYSTEMS
B275600GRANT
COLUMBUS MEDICAL ASSOCIATION - PHYSICIANS FREE CLINIC
B560000GRANT
COLUMBUS MEDICAL ASSOCIATION
N187063SPLIT COSTS
COLUMBUS MEDICAL ASSOCIATION - PHYSICIANS FREE CLINIC
N73684AGREED UPON % OF TIME
COLUMBUS MEDICAL ASSOCIATION - PHYSICIANS FREE CLINIC
K103581AGREED UPON % OF TIME
CENTRAL OHIO TRAUMA SYSTEMS
N74566AGREED UPON % OF TIME
CENTRAL OHIO TRAUMA SYSTEMS
K98300MARKET RATE