2012-11-14T16:28:35-06:00 2011-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2011-01-01 930854433 MID-COLUMBIA HEALTH FOUNDATION MID- 5412961111 1700 E 19TH STREET THE DALLES OR 97058 DUANE FRANCIS 5412961111 2012-11-14 1 WESLEY B HANSEN P00226581 5036974118 2011 2016-02-24 21:20:13Z DUANE FRANCIS 1700 E 19TH STREET THE DALLES OR 97058 2819320 0 X WWW.MCMC.NET X 1983 OR WORK TOGETHER WITH AND PROVIDE FINANCIAL SUPPORT TO MID-COLUMBIA MEDICAL CENTER IN ORDER TO PROVIDE ACCESS TO QUALITY HEALTHCARE FOR OUR COMMUNITY. 14 10 9 94 0 0 1023355 940397 0 0 12181 70514 97594 72288 1133130 1083199 1034364 467622 0 0 295259 299992 0 0 0 155505 163975 1485128 931589 -351998 151610 3015558 3075338 249058 242826 2766500 2832512 WORK TOGETHER WITH AND PROVIDE FINANCIAL SUPPORT TO MID-COLUMBIA MEDICAL CENTER IN ORDER TO PROVIDE ACCESS TO QUALITY HEALTHCARE FOR OUR COMMUNITY. 0 0 916801 467622 1083199 THE PRIMARY PURPOSE OF THE FOUNDATION IS TO PROVIDE FUND RAISING FOR THE MID-COLUMBIA MEDICAL CENTER (ID# 93-0386936) AS WELL AS GRANTS / SCHOLARSHIPS TO THE GENERAL PUBLIC. 916801 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 0 0 9 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 OR X MID-COLUMBIA MEDICAL CENTER 5412961111 1700 E 19TH STREET THE DALLES OR 97058 PHIL KASER 1.00 X 0 0 0 ROBERT BAILEY 1.00 X 0 0 0 SHAWN CARROLL 1.00 X 0 0 0 PAM CLAUSEN 1.00 X 0 0 0 NAOMI GRIMSLEY 1.00 X 0 0 0 DR FRANK TODA 1.00 X 0 0 0 ROB CARNAHAN 1.00 X 0 0 0 CYNTHIA KORTGE 1.00 X 0 0 0 JASON COREY 1.00 X 0 0 0 LINDA TRAUTZ 1.00 X 0 0 0 DR PAULA LEE-VALKOV 1.00 X 0 0 0 DUANE FRANCIS 1.00 X 0 483759 130991 DAVE GILDERSLEEVE 1.00 X 0 0 0 BRIAN LAUTERBACH 1.00 X 0 0 0 0 483759 130991 0 0 1 0 0 455625 484772 940397 34494 34494 1743658 1707638 36020 36020 36020 64585 28483 36102 36102 COFFEE CART FUND 722210 36186 36186 36186 1083199 0 0 142802 390787 390787 76835 76835 266486 266486 33506 33506 3200 3200 7105 7105 104451 104451 16770 16770 3252 3252 500 500 SUPPLIES 19695 4907 14788 PUBLIC RELATIONS 7785 7785 MISCELLANEOUS 1217 1217 931589 916801 14788 0 373561 444565 2184105 661362 132346 79215 37166 113011 7818 7068 67378 63952 3926 3426 1506912 276636 259779 3015558 3075338 5009 6324 244049 236502 249058 242826 X 1488210 1572131 918748 898984 359542 361397 2766500 2832512 3015558 3075338 X 151610 -85598 X X 0 1 1 X 0 X 221663 490845 888476 590612 484772 2676368 221663 490845 888476 590612 484772 2676368 2676368 99403 56150 6541 12181 70514 244789 2921157 493533 0.91620 0.92500 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1278290 413749 6603 438261 1260381 357664 32657 402 23127 367596 358543 13818 890 15587 357664 347617 10659 6106 5839 358543 0.64410 0.06920 0.28670 0 0 67378 63952 3426 3426 CHARITABLE REMAINDER TRUST 259779 259779 DUE TO MID-COLUMBIA MEDICAL CENTER 74717 LONG TERM DEBT - ANNUITIES 161785 236502 1083199 931589 151610 -79239 -6359 -85598 66012 107345534 -79239 106341574 106262335 1083199 0 1083199 103806413 102874825 102874825 931588 0 931588 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -6,359. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE OF OTHER ENTITIES IN AUDITED F/S 106,347,933. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -6,359. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES OF OTHER ENTITIES IN AUDITED F/S 102,874,825. PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE DISCLOSURE FOR UNCERTAIN TAX POSITIONS: INCOME TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN THE STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2011 AND 2010. TOURN OF TRADITION 28885 28885 11338 FESTIVAL OF TREES 28610 28610 9286 1 7090 7090 7859 64585 64585 28483 28483 36102 1 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 257799 SUPPORT HOSPITAL ACTIVITIES. MAMMOGRAPHY ASSIST FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 37779 ASSISTING MAMMOGRAPHY PATIENTS. CELILO CENTER FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 21857 ASSISTING CANCER PATIENTS. CHAPLAINS FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 18230 EMERGENCY FUNDING FOR PATIENTS. AREA OF GREATEST NEED FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 6620 SUPPORT HOSPITAL ACTIVITIES DIGITAL IMAGING FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 5925 DIGITAL IMAGING EQUIPMENT & SERVICES 1 0 ROOD MEMORIAL SCHOLARSHIP 32 60830 VARIOUS MID-COLUMBIA MEDICAL CENTER SCHOLARSHIPS 16 7505 VARIOUS MID-COLUMBIA MEDICAL CENTER NURSING SCHOLARSHIPS 11 8500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AN INTERNAL GRANT MANAGER TRACKS ALL EXPENSES RELATED TO THE GRANT AND REPORTS THEM PERIODICALLY IN A WRITTEN REPORT TO THE GRANTOR. SOME GRANTS CONTAIN LINE-ITEM BUDGETS WHICH ALSO MUST BE MET AND ARE SUBJECT TO AUDIT BY THE GRANTOR. X X X X X 0 1 0 0 0 0 0 0 0 DUANE FRANCIS 0 483759 0 0 0 0 0 99572 0 31419 0 614750 0 0 PART I, LINE 4B DUANE FRANCIS - $84,872 PATRICK GRIMSLEY SPOUSE OF CURRENT DIRECTOR NAOMI GRIMSLEY 335361 EMPLOYMENT AS ER PHYSICIAN AND MEDICAL DIRECTOR 0 DESIGN STRUCTURES LLC ENTITY IN WHICH CURRENT DIRECTOR DAVE GILDERSLEEVE SERVES AS AN OFFICER 1775432 VARIOUS CONSTRUCTION PROJECTS 0 FORM 990, PART VI, SECTION A, LINE 6 HEALTHCARE FOR THE MID-COLUMBIA REGION IS THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C WE ANNUALLY REQUIRE ALL EMPLOYEES AND DIRECTORS TO SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. IF A CONFLICT WAS DISCOVERED FOR AN EMPLOYEE OR DIRECTOR WITH A SIGNED DISCLOSURE STATEMENT, THEY WOULD BE SUBJECT TO CORRECTIVE ACTION UP TO AND INCLUDING TERMINATION FOR VIOLATION OF OUR POLICY. IF THEY SELF-DISCLOSED A POTENTIAL CONFLICT OF INTEREST ON THE FORM, WE WOULD GATHER INFORMATION ON THE ISSUE AND MAKE A DETERMINATION ON HOW SEVERE THE CONFLICT IS AND WHETHER OR NOT THE EMPLOYEE OR DIRECTOR COULD REMAIN AN EMPLOYEE. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY WITH EMPLOYEES AS PART OF THE PERFORMANCE REVIEW PROCESS. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS COMPENSATED BY HEALTH CARE FOR THE MID-COLUMBIA REGION, A RELATED ORGANIZATION. THE BOARD OF HEALTH CARE FOR THE MID-COLUMBIA REGION ENGAGES A PROFESSIONAL FIRM TO DO A REGIONAL AND NATIONAL SURVEY, ALONG WITH A COMPARISON OF ORGANIZATION COMPLEXITY AND STRUCTURE, AND THEN RECOMMENDS A SALARY AND BENEFITS RANGE TO THE BOARD. THIS IS ALL DONE CONFIDENTIALLY WITHOUT CEO PARTICIPATION. THE CEO THEN NEGOTIATES WITH THE BOARD, WHICH COMPARES THE COMPENSATION DISCUSSED WITH THE ANALYSIS PREVIOUSLY DESCRIBED AND VOTES ON AND APPROVES A NEW CONTRACT IN EXECUTIVE SESSION WITHOUT CEO PRESENCE OR PARTICIPATION IN THE VOTE. COMPENSATION OF THE ORGANIZATIONS OFFICERS OR KEY EMPLOYEES IS DETERMINED BY A SURVEY OF MARKET RATES FOR SIMILAR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 CURRENTLY NOT AVAILABLE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -79,239. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -6,359. TOTAL TO FORM 990, PART XI, LINE 5: -85,598. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THEIR FINANCIAL STATEMENTS & SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HEALTH CARE FOR THE MID-COLUMBIA REGION 1700 E 19TH STREET THE DALLES OR 97058 930847905 HEALTH SERVICES OR 501(C)(3) 3 HEALTHCARE FOR THE MID-COLUMBIA REGION 0 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREET THE DALLES OR 97058 930386936 ACUTE HOSPITAL CARE OR 501(C)(3) 3 HEALTHCARE FOR THE MID-COLUMBIA REGION 0 DRY HOLLOW INC 1700 E 19TH STREET THE DALLES OR 97058 930631350 RENTAL BUILDING OR HEALTHCARE FOR THE MID-COLUMBIA REGION C MID-COLUMBIA HEALTH SERVICES 1700 E 19TH STREET THE DALLES OR 97058 930840781 MEDICAL BILLING OR HEALTHCARE FOR THE MID-COLUMBIA REGION C 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 MID-COLUMBIA MEDICAL CENTER B 448799 GRANTS PAID MID-COLUMBIA MEDICAL CENTER C 455625 GRANT RECEIVED MID-COLUMBIA MEDICAL CENTER E 74717 LOANS FROM RELATED PARTY MID-COLUMBIA MEDICAL CENTER N 299992 EMPLOYEE GROSS PAY MID-COLUMBIA MEDICAL CENTER P 149186 ACTUAL EXPENSES