2011-11-15T17:11:25-06:00 2010-12-31 DELAP LLP 4500 SW KRUSE WAY NO 200 LAKE OSWEGO OR 97035 990 2010-01-01 930854433 MID-COLUMBIA HEALTH FOUNDATION MID- 5412961111 1700 E 19TH STREET THE DALLES OR 97058 DUANE FRANCIS 5412961111 2011-11-11 1 WESLEY B HANSEN 5036974118 2010 2016-03-07 17:11:31Z DUANE FRANCIS 1700 E 19TH STREET THE DALLES OR 97058 1164947 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. 13 12 4 0 0 0 1325534 1023355 0 0 6541 12181 137955 97594 1470030 1133130 542308 1034364 0 0 291246 295259 0 0 0 165545 155505 999099 1485128 470931 -351998 3359272 3015558 270082 249058 3089190 2766500 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 1467107 1034364 1133130 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. 1467107 1 1 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 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 4 1 0 0 0 0 0 0 0 0 0 0 X 13 12 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 JENNIFER DEWEY 1.00 X 0 0 0 ZIPPORAH DILLON 0.00 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 454040 123877 DAVE GILDERSLEEVE 1.00 X 0 0 0 BRIAN LAUTERBACH 1.00 X 0 0 0 0 454040 123877 0 0 1 0 0 437199 586156 1023355 12181 12181 84284 31817 52467 52467 COFFEE CART FUND 722210 45127 45127 45127 1133130 0 0 109775 931603 931603 102761 102761 81207 81207 190715 190715 23337 23337 107540 107540 17843 17843 856 856 1108 1108 1360 1360 SUPPLIES 22113 4092 18021 PUBLIC RELATIONS 3787 3787 MISCELLANEOUS 898 898 1485128 1467107 18021 0 235869 373561 2169786 2184105 40954 132346 637983 37166 4879 7818 67378 63452 5034 3926 264767 276636 3359272 3015558 4518 5009 265564 244049 270082 249058 X 1420282 1488210 1331458 918748 337450 359542 3089190 2766500 3359272 3015558 X -351998 29308 X X 0 1 1 X 0 X 240101 221663 490845 888476 590612 2431697 240101 221663 490845 888476 590612 2431697 2431697 22967 99403 56150 6541 12181 197242 2628939 497927 0.92500 0.91310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 357664 32657 402 23127 367596 358543 13818 890 15587 357664 347617 10659 6106 5839 358543 0.00000 0.98010 0.01990 0 0 67378 63452 3926 3926 CHARITABLE REMAINDER TRUST 276636 276636 DUE TO MID-COLUMBIA MEDICAL CENTER 71766 LONG TERM DEBT - ANNUITIES 172283 244049 1133130 1485128 -351998 4021 25287 29308 -322690 101209227 4021 100072076 100076097 1133130 0 1133130 100159679 98674551 98674551 1485128 0 1485128 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE OF OTHER ENTITIES IN AUDITED F/S 100,046,789. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 25,287. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES OF OTHER ENTITIES IN AUDITED F/S 98,674,551. 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, 2010 AND 2009. TOURN OF TRADITION 39146 39146 14209 FESTIVAL OF TREES 35768 35768 8268 1 9370 9370 9340 84284 84284 31817 31817 52467 1 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 43736 SUPPORT HOSPITAL ACTIVITIES. CHAPLAIN'S FUND AND MCMC EMPLOYEES MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 17091 EMERGENCY FUNDING FOR PATIENTS. CELILO CENTER FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 12180 ASSISTING CANCER PATIENTS. DIGITAL IMAGING FUND MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 750000 DIGITAL IMAGING EQUIPMENT & SERVICES GREAT'N SMALL MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREETS THE DALLES OR 97058 930386936 501(C)(3) 14626 CHILD CARE AND DEVELOPMENT BACKPACKS FOR KIDS 304 FISH HATCHERY ROAD GOLDENDALE WA 98620 264392912 501(C)(3) 5000 TO PROVIDE CHILDREN WITH NUTRITIOUS EASY TO PREPARE FOODS TO TAKE HOME ON WEEKEND AND HOLIDAYS WHEN OTHER FOOD RESOURSES MAY NOT BE AVAILABLE TO THEM 2 ROOD MEMORIAL SCHOLARSHIP 35 79161 VARIOUS MID-COLUMBIA MEDICAL CENTER SCHOLARSHIPS 14 9800 MID-COLUMBIA MEDICAL CENTER BOARD OF TRUSTEES 2 4000 VARIOUS NURSING SCHOLARSHIPS 6 5800 EVELYN KASER SCHOLARSHIP 4 4000 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 454040 0 0 0 0 0 95531 0 28346 0 577917 0 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 BOARD 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 GAINS ON INVESTMENTS: 4,021. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 25,287. TOTAL TO FORM 990, PART XI, LINE 5: 29,308. 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 19TH AND NEVADA STREETS THE DALLES OR 97058 930847905 HEALTH SERVICES OR 501(C)(3) 3 HEALTHCARE FOR THE MID-COLUMBIA REGION 0 MID-COLUMBIA MEDICAL CENTER 19TH AND NEVADA STREETS THE DALLES OR 97058 930386936 ACUTE HOSPITAL CARE OR 501(C)(3) 3 HEALTHCARE FOR THE MID-COLUMBIA REGION 0 DRY HOLLOW INC 19TH NEVADA STREETS THE DALLES OR 97058 930631350 RENTAL BUILDING OR HEALTHCARE FOR THE MID-COLUMBIA REGION C MID-COLUMBIA HEALTH SERVICES 19TH NEVADA STREETS THE DALLES OR 97058 930840781 HEALTH & PERSONAL CARE 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 793736 GRANTS PAID MID-COLUMBIA MEDICAL CENTER C 437199 GRANT RECEIVED MID-COLUMBIA MEDICAL CENTER E 71766 LOANS FROM RELATED PARTY MID-COLUMBIA MEDICAL CENTER N 295259 EMPLOYEE GROSS PAY MID-COLUMBIA MEDICAL CENTER P 141940 ACTUAL EXPENSES