2012-09-28T07:28:07-05:00 2011-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2011-01-01 310679012 COLUMBUS MEDICAL ASSOCIATION FOUNDATION COLU 6142407410 431 EAST BROAD STREET COLUMBUS OH 43215 PHILIP CASS 6142407410 2012-09-19 1 BERNIE OSTROWSKI P00366367 6148493000 2011 2016-02-24 21:20:13Z PHILIP CASS 431 EAST BROAD STREET COLUMBUS OH 43215 3342437 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 13 19 0 0 138370 114605 121020 48405 2326947 2806216 318478 373211 2904815 3342437 1067625 1308203 0 0 901592 812541 0 0 189061 773408 994700 2742625 3115444 162190 226993 71821410 66744843 1029470 1078279 70791940 65666564 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 1952454 1308203 408261 SEE 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 PHILANTHROPY 1952454 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 15 0 1 13 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 JULIE EIKENBERRY 6142407410 431 EAST BROAD STREET COLUMBUS OH 43215 X JAMES L NICHOLS 1.00 X X 0 0 0 DWIGHT SCARBOROUGH MD 1.00 X 0 0 0 TERESA C LONG 1.00 X 0 0 0 NEDRA HADLEY 1.00 X 0 0 0 OLIVIA THOMAS 1.00 X 0 0 0 JOYCE PENN 1.00 X 0 0 0 LINDA SIEFKAS 1.00 X 0 0 0 RONALD BERGGREN 1.00 X 0 0 0 BEN ESPY 1.00 X 0 0 0 MARC L PARNES 1.00 X X 0 0 0 WARREN W TYLER 1.00 X 0 0 0 MARK A BECHTEL MD 1.00 X 0 0 0 JEFFREY BELL MD 1.00 X 0 0 0 JENNIFER WRENN MD 1.00 X 0 0 0 EDWARD T BOPE 1.00 X 0 0 0 CLAIRE V WOLFE 1.00 X 0 0 0 M VALERIANA MOELLER 1.00 X X 0 0 0 WILLIAM COTTON 1.00 X 0 0 0 JASMINE GREEN 1.00 X 0 0 0 PHILIP CASS 20.00 X 0 207139 26153 JUDY D'ANDREA 23.80 X 149567 0 18365 JULIE EIKENBERRY 23.80 X 30611 0 0 WELDON MILBOURNE 40.00 X 115526 0 9733 295704 207139 54251 2 0 1 0 0 114605 114605 PROGRAMS 900099 48405 48405 48405 2806216 2806216 102000 0 102000 102000 102000 REIMBURSEMENTS 900099 257856 257856 LITIGATION PROCEEDS 900099 12099 12099 INSURANCE PROCEEDS 900099 1256 1256 271211 3342437 408261 0 2819571 1308203 1308203 171093 41343 105235 24515 392630 157052 196315 39263 22480 8992 11240 2248 176938 70775 88469 17694 49400 19760 24700 4940 3196 3196 37510 37510 305526 305526 30102 7757 15592 6753 95882 42116 6432 47334 31802 4737 20223 6842 8236 1227 5237 1772 105681 22101 61479 22101 2774 2774 29330 7105 15120 7105 3745 396 2953 396 72989 5839 61311 5839 7087 1482 4123 1482 BAD DEBT EXPENSE 249852 249852 DUES & SUBSCRIPTIONS 7373 777 5819 777 PROGRAM/VOLU ACTIVITIES 2940 2940 TAXES & LICENSES 675 675 3115444 1952454 973929 189061 443934 300723 244193 73809 14884 1645 2280481 916736 1408234 1363745 0 69630503 64922566 79662 82355 71821410 66744843 296847 245444 732623 832835 1029470 1078279 X 69460132 64558571 818525 720063 513283 387930 70791940 65666564 71821410 66744843 X 226993 -5352369 X X 0 1 1 X 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 12 121948 59952 56500 131800 993492 687009 1 1 636000 636000 864842 317797 547045 140437 75412 65025 431761 338961 92800 207441 184566 22875 1363745 OTHER SECURITIES 64922566 F 64922566 REIMBURSEMENT TO AFFILIATES 451338 ASSETS HELD FOR OTHERS 381497 832835 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 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. 1 ACCESS HEALTHCOLUMBUS 22 E GAY STREET SUITE 801 COLUMBUS OH 43215 510426050 501 (C)(3) 400000 TO SUPPORT PHASE 1 FOR PATIENT CENTER MEDICAL HOME PROJECT CENTRAL OHIO TRAUMA SYSTEM 431 E BROAD STREET COLUMBUS OH 43215 311592734 501 (C)(3) 275600 TO SUPPORT ITS 2010 CORE SERVICES COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC 431 E BROAD STREET COLUMBUS OH 43215 311373719 501 (C)(3) 560000 TO PROVIDE FREE PRIMARY & SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERSERVED FRANKLIN PARK CONSERVATORY WOMEN'S BOARD 1777 E BROAD STREET COLUMBUS OH 43203 311191469 501 (C)(3) 15000 FOR HORICULTURE & EDUCATION PROGRAMS AT THE CONSERVATORY COLUMBUS ITALIAN FESTIVAL- ST JOHN THE BAPTIST CATHOLIC CHURCH 720 HAMLET ST COLUMBUS OH 43215 501 (C)(3) 20000 SPONSORSHIP GRANT FOR COMMUNITY BASED FESTIVAL 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 THE COLUMBUS CHAMBER OF COMMERCE 150 SOUTH FRONT STREET 200 COLUMBUS OH 43215 314152950 501 (C)(3) 5000 SPONSORSHIP GRANT TO SUPPORT COMMUNITY LEADERSHIP FORUM AND AWARDS FOCUSED ON DIVERSITY, INNOVATION AND SUSTAINABILITY OSU NURSING FUND 1480 W LANE AVE COLUMBUS OH 43221 311145986 501 (C)(3) 5000 PROVIDES SCHOLARSHIP SUPPORT FOR MEMBERS OF THE NURSING PROFESSION 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. X 1 1 1 0 0 0 0 0 0 0 0 PHILIP CASS 0 0 0 207139 0 0 0 12411 0 13742 0 233292 0 0 JUDY D'ANDREA 0 0 122117 0 27450 0 5354 0 13011 0 167932 0 0 0 PART I, LINE 1A THE EXECUTIVE DIRECTOR, WELDON MILBOURNE, RECEIVES CLUB DUES. THESE CLUB DUES ARE NOT TREATED AS TAXABLE. PART I, LINE 4A JUDY D'ANDREA RECEIVED $45,750 OF SEVERANCE PAYMENTS IN INSTALLEMENTS FROM OCTOBER 7, 2011 THROUGH FEBRUARY 10, 2012. 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 2008 AND WILL BE UPDATED IN 2012. 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. FORM 990, PART VII THE 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 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -5,352,369. FORM 990, LINE 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 431 E BROAD STREET COLUMBUS OH 43215 200385860 PROVIDING HEALTH AND WELLNESS SERVICES OH 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION 1 COLUMBUS MEDICAL ASSOCIATION 431 E BROAD STREET COLUMBUS OH 43215 314411074 ADVANCING COMMUNITY HEALTH THROUGH ADVOCACY, EDUCATION AND SERVICE OH 501(C)(6) N/A 0 CENTAL OHIO TRAUMA SYSTEM 431 E BROAD STREET COLUMBUS OH 43215 311592734 REDUCING INJURIES AND SAVING LIVES BY IMPROVING TRAUMA CARE OH 501(C)(3) LINE 7 COLUMBUS MEDICAL ASSOCIATION 1 COLUMBUS MEDICAL ASSOCIATION PHYSICIANS FREE CLINIC 431 E BROAD STREET COLUMBUS OH 43215 311373719 COORDINATING VOLUNTARY HEALTH CARE SERVICES OH 501(C)(3) LINE 3 COLUMBUS MEDICAL ASSOCIATION 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 0 0 CENTRAL OHIO TRAUMA SYSTEMS B 275600 GRANT COLUMBUS MEDICAL ASSOCIATION - PHYSICIANS FREE CLINIC B 560000 GRANT COLUMBUS MEDICAL ASSOCIATION N 187063 SPLIT COSTS COLUMBUS MEDICAL ASSOCIATION - PHYSICIANS FREE CLINIC N 73684 AGREED UPON % OF TIME COLUMBUS MEDICAL ASSOCIATION - PHYSICIANS FREE CLINIC K 103581 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS N 74566 AGREED UPON % OF TIME CENTRAL OHIO TRAUMA SYSTEMS K 98300 MARKET RATE