2023-11-15T12:54:06-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 4334 MUNSON STREET SUITE 200 CANTON OH 44718 990 2022-01-01 463060489 NORTH CANTON MEDICAL FOUNDATION NORT 3304331411 6046 WHIPPLE AVE NW NORTH CANTON OH 44720 JOHN HUMPHREY MD EXECUTIVE DIRECTOR 3304331411 2023-11-15 1 JOHN HUMPHREY MD 999009999 1 JENNIFER COLEMAN P00743188 3304972000 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOHN HUMPHREY MD 6046 WHIPPLE AVE NW NORTH CANTON OH 44720 10974861 0 X WWW.NCMF.COM X 2013 OH TO IMPROVE COMMUNITY HEALTH AND WELLNESS THROUGH COLLABORATION AND FINANCIAL SUPPORT. 20 19 2 19 0 0 91591 116707 0 0 2354771 -208276 7086 554490 2453448 462921 297499 382596 0 0 107237 101228 0 0 0 192133 157027 596869 640851 1856579 -177930 24782814 22064104 230000 101300 24552814 21962804 NORTH CANTON MEDICAL FOUNDATION'S MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR COMMUNITY THROUGH COLLABORATION AND FINANCIAL SUPPORT. 0 0 494055 382596 0 NORTH CANTON MEDICAL FOUNDATION COLLABORATES WITH AND SPONSORS PROGRAMS THAT PROVIDE FOR HEALTH AND WELLNESS FOR THE COMMUNITY, INCLUDING AN EMPHASIS ON THE UNDERSERVED IN OUR COMMUNITY. EXAMPLES OF PROGRAMS WE CURRENTLY FUND INCLUDE INVOLVEMENT IN AND SUPPORT OF THE HARTVILLE MIGRANT MEDICAL CLINIC; INVOLVEMENT IN AND SUPPORT OF ACCESS HEALTH STARK COUNTY; MELANOMA AWARENESS EDUCATION PROGRAMS; AND A CANCER RELIEF FUND THAT PROVIDES TEMPORARY FINANCIAL SUPPORT TO CANCER PATIENTS NEEDING ASSISTANCE WITH CANCER TREATMENT-RELATED COSTS. ITS MISSION IS TO EASE THE SUFFERING OF CANCER PATIENTS BY PROVIDING FOR THEIR IMMEDIATE NEEDS IN WAYS NOT PROVIDED FOR BY OTHER PROGRAMS AND TO SUPPORT RETIRED PHYSICIANS WHO VOLUNTEER IN THE COMMUNITY THROUGH THE RETIRED PHYSICIANS PROGRAM. 494055 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X STACY REMARK 3304331411 6046 WHIPPLE AVE NW NORTH CANTON OH 44720 DR JOHN HUMPHREY MD EXECUTIVE DIRECTOR 30.00 X X 75833 0 0 RONALD MANSE CHAIRMAN 2.00 X X 0 0 0 LISA WARBURTON-GREGORY VICE CHAIRMAN 2.00 X X 0 0 0 ROD A MOORE SECRETARY 2.00 X X 0 0 0 WILLIAM R COOK TREASURER 2.00 X X 0 0 0 BRIAN BELDEN BOARD MEMBER 2.00 X 0 0 0 DR WILLIAM FAYEN BOARD MEMBER 2.00 X 0 0 0 GEORGE FILM BOARD MEMBER 2.00 X 0 0 0 JOHN GAETANO BOARD MEMBER 2.00 X 0 0 0 TIFFANY GOOD WITMER BOARD MEMBER 2.00 X 0 0 0 DR MATTHEW HIESTAND BOARD MEMBER 2.00 X 0 0 0 CHUCK HOOVER BOARD MEMBER 2.00 X 0 0 0 EILEEN IVAN BOARD MEMBER 2.00 X 0 0 0 DR PAUL MANUSZAK BOARD MEMBER 2.00 X 0 0 0 MARCY MERTES BOARD MEMBER 2.00 X 0 0 0 GERRY RADCLIFFE RN BOARD MEMBER 2.00 X 0 0 0 WILLIAM SCHAUER BOARD MEMBER 2.00 X 0 0 0 JOHN SCHUSTER MD BOARD MEMBER 2.00 X 0 0 0 SARA TIMKEN BOARD MEMBER 2.00 X 0 0 0 LISA ZELLERS BOARD MEMBER 2.00 X 0 0 0 75833 0 0 0 0 0 0 0 116707 116707 418990 418990 9884674 10511940 -627266 -627266 -627266 STARKAP DISTRIBUTION 900099 554477 554477 BWC REFUND 900099 13 13 554490 462921 -627266 0 973480 382596 382596 75833 75833 17333 17333 8062 8062 12390 12390 110554 110554 10423 10423 9250 1013 8237 200 200 2725 2725 CANCER RELIEF FUND 7500 7500 MISCELLANEOUS 2377 110 2267 RETIRED PHYSICIANS PROG 1608 1608 640851 494055 146796 0 269831 133584 25867 25870 14063 5624 153690 24473053 21745336 24782814 22064104 100000 1300 130000 100000 230000 101300 X 21872070 19769399 2680744 2193405 24552814 21962804 24782814 22064104 X -177930 -2183833 -8438 -219809 X 1 X 0 0 0 X 250458 51209 94012 91591 116707 603977 250458 51209 94012 91591 116707 603977 149456 454521 213891 212057 119832 169150 418990 1133920 117 401770 7086 554490 963463 2701360 0.16830 0.19980 X ORGANIZATION HISTORY:ORGANIZED IN 2013, NORTH CANTON MEDICAL FOUNDATION (NCMF) AWARDS GRANTS TO ORGANIZATIONS THAT FOCUS ON PROGRAMS OR SERVICES THAT WILL HAVE A POSITIVE, SUSTAINABLE IMPACT ON THE HEALTH OF OUR COMMUNITY. FORMERLY A MEDICAL CARE FACILITY STARTED BY RALPH T. WARBURTON, M.D. AND FOUR OTHER STARK COUNTY PHYSICIANS TO NOW A GRANT-GIVING ORGANIZATION, NCMF STILL HOLDS TRUE TO ITS LEGACY AND MISSION OF "IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITY THROUGH COLLABORATIONS AND FINANCIAL SUPPORT". THEY CURRENTLY SUPPORT THE HARTVILLE MIGRANT MEDICAL CLINIC, ACCESS HEALTH STARK COUNTY, MELANOMA AWARENESS EDUCATION PROGRAMS, A PARKINSON'S DISEASE EXERCISE PROGRAM THROUGH THE NORTH CANTON YMCA, A CANCER RELIEF FUND AND PHYSICAL REHABILITATION PROGRAMS FOR CANCER PATIENTS.CUMULATIVELY THROUGH 2022, GRANTS HAVE BEEN AWARDED TOTALING $7,417,971.SOURCES OF SUPPORT:NORTH CANTON MEDICAL FOUNDATION HAS A FUNDRAISING PLAN IN PLACE TO GENERATE CONTRIBUTIONS INCLUDING REQUESTS FROM THE WEBSITE, BOARD CONTRIBUTIONS, FUNDRAISING ACTIVITIES, GRANT WRITING AND VARIOUS COLLABORATION EFFORTS WITH COMMUNITY PARTNERS. GOVERNING BODY:NORTH CANTON MEDICAL FOUNDATION CURRENTLY HAS EIGHTEEN UNPAID VOLUNTEER BOARD MEMBERS/DIRECTORS REPRESENTING A BROAD CROSS SECTION OF THE GENERAL PUBLIC. THESE MEMBERS/DIRECTORS INCLUDE LOCAL PHYSICIANS, BUSINESS OWNERS, ATTORNEYS, CPAS, AND COMMUNITY LEADERS. NONE OF THE MEMBERS/DIRECTORS ARE RELATED TO EACH OTHER OR HAVE ANY DIRECT AFFILIATION WITH ANY OF THE RECURRING DONORS TO NCMF. REPLACEMENT BOARD MEMBERS/DIRECTORS ARE NOMINATED BASED ON THEIR COMMUNITY INVOLVEMENT AND ABILITY TO REPRESENT A BROAD CROSS-SECTION OF THE GENERAL PUBLIC.PUBLICLY SUPPORTED ORGANIZATION:THE NORTH CANTON MEDICAL FOUNDATION SERVES THE INTERESTS OF THE GENERAL COMMUNITY, THE BOARD OF DIRECTORS REPRESENTS THE INTERESTS OF THE GENERAL COMMUNITY, AND THE ORGANIZATION HAD A PLAN IN PLACE TO GENERATE CONTRIBUTIONS FROM THE GENERAL PUBLIC. THE ORGANIZATION BELIEVES THE FACTS-AND-CIRCUMSTANCES TEST IS MET THUS CONTINUING ITS QUALIFICATION AS A PUBLICLY SUPPORTED ORGANIZATION. ORGANIZATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16254767 53467 -2194001 64311 72300 13977622 14138085 2502371 288000 97689 16254767 13157425 2 1059671 79013 14138085 11695061 2092772 550000 80408 13157425 12899815 100 -1140174 64680 11695061 0.93526 0.05318 0.01157 1 0 0 INVESTMENTS HELD WITH STARK COMMUNITY FOUNDATION 13746119 F BENEFICIAL INTEREST IN CHARITABLE TRUST 743378 F INVESTMENTS HELD WITH STIFEL NICOLAUS 7255838 F MINERAL RIGHTS 1 C 21745336 PART V, LINE 4: AS DIRECTED BY THE GOVERNING BODY OF THE FOUNDATION, THE ORGANIZATION'S ENDOWMENT FUNDS ARE INTENDED TO BE USED TO PROVIDE GRANT FUNDING AND COLLABORATIVE SUPPORT TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF OUR COMMUNITY. 1 ACCESS HEALTH STARK COUNTY INC 408 9TH ST SW CANTON OH 44707 462949527 501(C)(3) 125000 0 CHW PROJECT & CHILDHOOD VACCINE PROJECT AULTMAN HEALTH FOUNDATION 2600 6TH ST SW CANTON OH 44710 340714538 501(C)(3) 53040 0 AULTMAN CANCER DIETICIAN PROGRAM DOMESTIC VIOLENCE PROJECT INC PO BOX 9459 CANTON OH 44711 341263226 501(C)(3) 30000 0 DVPI'S MEDICAL ADVOCACY PROGRAM HAMMER & NAILS INC 1404 7TH ST NW CANTON OH 44703 341919568 501(C)(3) 8000 0 PROJECT DIRECTOR LABOR AND MATERIALS HARTVILLE MIGRANT COUNCIL INC PO BOX 682 HARTVILLE OH 44632 340899100 501(C)(3) 25000 0 PUTTING HEALTH FIRST HEALTH POLICY INSTITUTE OF OHIO 140 E TOWN ST STE 1000 COLUMBUS OH 43215 300186863 501(C)(3) 35000 0 FORUM SERIES SPONSOR AND GENERAL OPERATING SUPPORT MARGARET B SHIPLEY CHILD HEALTH CLINIC 919 2ND ST NE 1132 CANTON OH 44704 340714781 501(C)(3) 10000 0 2021 MEDICAL SUPPLY PROJECT STARK COUNTY HUNGER TASK FORCE INC 408 9TH ST SW CANTON OH 44707 341374549 501(C)(3) 10000 0 BACKPACK PROGRAM STARK COUNTY MENTAL HEALTH & ADDICTION RECOVERY 121 CLEVELAND AVENUE SW CANTON OH 44702 GOVERNMENT 16667 0 STARK COUNTY BEHAVIORAL HEALTH CONTINUOUS IMPROVEMENT PROJECT UNITED WAY OF GREATER STARK COUNTY INC 401 MARKET AVENUE NORTH SUITE 300 CANTON OH 44702 134254191 501(C)(3) 33333 0 STRONG NEIGHBORHOODS, STRONG FAMILIES CENTENNIAL PROJECT VANTAGE AGING 388 SOUTH MAIN STREET SUITE 325 AKRON OH 44311 510148544 501(C)(3) 15000 0 MEALS ON WHEELS (MOW) PROGRAM 10 1 PART I, LINE 2: GRANT RECIPIENTS ARE REQUIRED TO RESPOND TO THE FOLLOWING QUESTIONS SIX MONTHS AFTER THE GRANT IS RECEIVED AND PROVIDE A FINAL REPORT 12 MONTHS AFTER THE GRANT IS RECEIVED. THE FINAL REPORT IS TO PROVIDE DOCUMENTATION OF HOW THE GRANT FUNDS WERE SPENT. GRANT RECIPIENT QUESTIONS: A. WHAT WERE THE OUTCOMES IN RELATION TO THE GOALS AND OBJECTIVES OF THE GRANT? WHAT HAS CHANGED, IMPROVED, OR HAPPENED AS A RESULT OF YOUR EFFORTS? WAS THERE IMPACT MADE? B. EXPLAIN ANY DIFFERENCES BETWEEN THE PROPOSED AND ACTUAL OUTCOMES OF THE GOALS AND OBJECTIVES. HOW IS YOUR ORGANIZATION USING THESE OUTCOMES AND LESSONS LEARNED TO IMPROVE ORGANIZATIONAL EFFECTIVENESS? C. DESCRIBE THE VALUE OF THIS PROJECT TO THE COMMUNITY AND TO THE ORGANIZATION. D. BRIEFLY SUMMARIZE THE PROJECT'S EVALUATION PROCESS. HOW DID YOU EVALUATE THE PROJECT, AND WHAT DID YOU LEARN FROM THE EVALUATION? E. COMPLETE FINANCIAL REPORT THAT INCLUDES A DESCRIPTION OF THE USE OF THE FUNDS THAT THE ORGANIZATION WAS GRANTED. THE REPORT MUST INCLUDE AN ITEMIZED BUDGET AND/OR RECEIPTS FOR EQUIPMENT OR MATERIALS THAT WERE PURCHASED. F. ATTACH ANY BROCHURES, NEWSPAPER ARTICLES, OR ADDITIONAL INFORMATION THAT ILLUSTRATES THE OUTCOMES AND ACCOMPLISHMENTS FROM THE GRANT. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT 990 IS REVIEWED WITH THE CHAIRMAN AND THE OUTSIDE ACCOUNTING FIRM AND THE FINAL 990 IS EMAILED TO THE BOARD BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST QUESTIONNAIRE EACH YEAR. THE QUESTIONNAIRES ARE REVIEWED BY OUR EXECUTIVE DIRECTOR AND CONFLICTS ARE NOTED. MEMBERS WHO HAVE AFFILIATIONS WITH POTENTIAL GRANT RECIPIENTS ALWAYS ABSTAIN FROM GRANT VOTING. BEYOND THE QUESTIONNAIRE, IF A POTENTIAL CONFLICT ARISES, THE INTERESTED PERSON IS REQUIRED TO DISCLOSE ALL MATERIAL FACTS RELATING TO THE POTENTIAL CONFLICT TO THE CHAIRMAN OF THE BOARD. THE CHAIRMAN THEN HAS THE DISCRETION TO DETERMINE WHETHER THE CONFLICT MERITS DISCLOSURE TO THE BOARD AS A WHOLE, MAKING SURE TO ERR ON THE SIDE OF DISCLOSURE. IF THE CHAIRMAN ELECTS TO DISCLOSE THE POTENTIAL CONFLICT TO THE BOARD, THE BOARD DISCUSSES THE POTENTIAL CONFLICT AT ITS NEXT REGULAR MEETING. THE INTERESTED PERSON IS REQUIRED TO LEAVE THE MEETING ROOM DURING THE DISCUSSION. THE REMAINING BOARD MEMBERS THEN VOTE ON WHETHER OR NOT AN ACTUAL CONFLICT EXISTS. IF A CONFLICT IS DETERMINED TO EXIST, THE INTERESTED PERSON MAKES A FULL STATEMENT OF FACTS REGARDING THE CONFLICT, INCLUDING ITS POSSIBLE OR ACTUAL RELATIONSHIP TO THE FOUNDATION'S ACTIVITIES. IF APPROPRIATE, A NON-INTERESTED BOARD MEMBER OR OTHER INDIVIDUAL MAY BE APPOINTED BY THE CHAIRMAN OF THE BOARD TO INVESTIGATE ALTERNATIVES TO ANY PROPOSED TRANSACTION RELATED TO THE FOUNDATION INVOLVING THE CONFLICT. ANY ACTION BY THE BOARD TO ENGAGE IN A TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT MUST BE BY A MAJORITY VOTE OF THE NON-INTERESTED MEMBERS OF THE BOARD THAT THE TRANSACTION IS IN THE FOUNDATION'S BEST INTERESTS AND IS FAIR AND REASONABLE TO THE FOUNDATION. TO PROTECT THE INTERESTS OF THE FOUNDATION, THE BOARD OF DIRECTORS SHALL TAKE APPROPRIATE DISCIPLINARY ACTION WITH RESPECT TO A PERSON WHO VIOLATES THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 PRIOR TO DECISIONS BEING MADE REGARDING COMPENSATION, THERE ARE COMPARISONS DONE, INCLUDING MGMA COMPENSATION SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGES TO BENEFICIAL INTERESTS IN CHARITABLE TRUST HELD BY OTHERS -219,809.