2022-11-08T13:36:28-06:00 2021-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2021-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 CO FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK VICE PRESIDENT 6153299902 2022-11-04 1 JAMIE CHEEK XXX-XX-XXXX LISA MCCREEDY P01771202 4254544919 2022-11-04 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 570148 0 X N/A X 2004 WA THE VITALOGY FOUNDATION IS A PUBLIC NON-PROFIT ORGANIZATION THAT WAS FOUNDED IN 2006 BY THE MEMBERS OF PEARL JAM AND THEIR MANAGER. THE FOUNDATION SUPPORTS THE EFFORTS OF NON-PROFIT ORGANIZATIONS DOING COMMENDABLE WORK IN THE FIELDS OF COMMUNITY HEALTH, THE ENVIRONMENT, ARTS & EDUCATION AND SOCIAL CHANGE. 5 5 3 7 13701 4297 1363549 532909 0 0 14131 7494 48456 11951 1426136 552354 1306572 911367 0 0 105325 175168 0 0 34735 299719 84586 1711616 1171121 -285480 -618767 1664191 1038176 7435 9631 1656756 1028545 THE FOUNDATION SUPPORTS THE EFFORTS OF NON-PROFIT ORGANIZATIONS DOING COMMENDABLE WORK IN THE FIELDS OF COMMUNITY HEALTH, THE ENVIRONMENT, ARTS & EDUCATION AND SOCIAL CHANGE. 0 0 911367 911367 GRANTS AWARDED TO SPECIFIC CHARITABLE ORGANIZATIONS AND INDIVIDUALS CHOSEN BY THE OFFICERS OF THE FOUNDATION IN ACCORDANCE WITH THE PRIMARY PURPOSE OF VITALOGY FOUNDATION'S EXEMPT STATUS. 911367 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 2 0 1 3 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 5 5 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X JAMIE CHEEK CO FBMM INC 6153299902 PO BOX 340020 NASHVILLE TN 372030020 X STONE GOSSARD PRESIDENT, DIRECTOR 1.00 20.00 X X 0 0 0 MICHAEL D MCCREADY VICE PRESIDENT, DIRECTOR 1.00 20.00 X X 0 0 0 EDDIE J VEDDER SECRETARY, DIRECTOR 1.00 20.00 X X 0 0 0 JEFFREY A AMENT TREASURER, DIRECTOR 1.00 0.00 X X 0 0 0 MATTHEW D CAMERON DIRECTOR 1.00 20.00 X 0 0 0 JAMIE CHEEK TREASURER 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 7176 525733 3315 532909 7494 7494 3315 7176 5065 -1750 -1750 26430 12729 13701 13701 552354 0 13701 5744 X 851367 851367 60000 60000 136688 136688 27109 27109 11371 11371 6276 6276 9633 9633 897 897 30933 15465 15468 20808 1541 19267 814 814 1439 1439 600 600 UBI TAXES PAID 12556 12556 630 630 1171121 911367 225019 34735 202687 42384 759940 662817 701514 332975 50 0 1664191 1038176 7435 9631 7435 9631 X 989750 655190 667006 373355 1656756 1028545 1664191 1038176 X -618767 -4788 -4656 X 0 0 0 X 253384 3927994 1247990 1363549 532909 7325826 253384 3927994 1247990 1363549 532909 7325826 225960 7099866 1048 5742 18514 14131 7494 46929 18414 29525 2547 50486 145 145 7423386 0.95640 0.98280 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REFUND - 2019 AMOUNT: $ 145. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 GRANTMAKING 10000 SOUTH ASIA 0 0 GRANTMAKING 50000 0 0 0 0 0 0 60000 0 60000 EUROPE (INCLUDING ICELAND & GREENLAND) GENERAL SUPPORT 10000 WIRE 0 SOUTH ASIA GENERAL SUPPORT 50000 WIRE 0 2 0 1 0 0 0 0 0 PART I, LINE 2: VITALOGY FOUNDATION SELECTS GRANTEES THROUGH AN INTERNAL PROCESS WITH THE FOUNDATION'S BOARD OF DIRECTORS. EACH POTENTIAL GRANTEE'S REQUEST IS REVIEWED BY EACH BOARD MEMBER TO ENSURE IT MEETS THE VITALOGY FOUNDATION'S MISSION GUIDELINES AND THE CHARITY WILL USE THE GRANT EXCLUSIVELY TO CARRY OUT THE "AS DETAILED" CHARITABLE PROJECT, OR FOR GENERAL OPERATIONS, EXCLUSIVELY FOR EXEMPT PURPOSES. ONCE THE GRANTEE HAS BEEN APPROVED, VITALOGY FOUNDATION PROVIDES THE CHARITY WITH A GRANTEE FORM THAT REQUESTS DETAILED INFORMATION ON THE ORGANIZATION INCLUDING ITS TAX ID NUMBER, AS WELL AS THE FUNDS REQUESTED AND HOW THEY WILL BE USED, A DISCLAIMER THAT NO GOODS OR SERVICES WERE EXCHANGED FOR THE GRANT, AND A REQUEST FOR UPDATES AND REPORTS. AFTER THE GRANTEE FORM IS IN HAND, THE CHARITY IS SENT THE FUNDS ALONG WITH THE FOUNDATION'S DONATION ACKNOWLEDGEMENT LETTER WHICH REQUESTS A SIGNATORY BACK CONFIRMING RECEIPT OF THE FUNDS. VITALOGY FOUNDATION FOLLOWS-UP WITH THE GRANTEES TO ENSURE THEY ARE ADHERING TO OUR GUIDELINES THROUGH REQUESTING WRITTEN UPDATES EVERY SIX MONTHS. THE VITALOGY FOUNDATION TEAM ALSO MAKES SITE VISITS TO SELECT LARGER SCALE GRANTEES TO GET FIRST HAND KNOWLEDGE OF HOW THE FUNDS ARE BEING APPLIED/DISPERSED IN THE FIELD. FROM THESE REPORTS AND CORRESPONDENCE WITH THE GRANTEE, THE VITALOGY FOUNDATION TEAM PROVIDES UPDATES TO THE BOARD OF DIRECTORS TWO WAYS; THROUGH WEEKLY PROJECT UPDATES AND THROUGH A MORE DETAILED ANNUAL PROJECT UPDATE AS WARRANTED BASED UPON THE SIZE OF THE GRANT. TO TRACK THESE PROJECTS, THE GRANTEES' WRITTEN REPORTS, TEAM CORRESPONDENCE, AND BOARD UPDATES ARE FILED ALONG WITH THE CORRESPONDING GRANTEE FORM. INTERNALLY, VITALOGY FOUNDATION KEEPS A RUNNING CONTRIBUTION SUMMARY OF ALL GRANTS MADE TO DATE BY YEAR THAT INCLUDES TRACKING ON UPDATES RECEIVED BY GRANTEES. PART I, LINE 3: EXPENDITURES ARE ACCOUNTED FOR ON A CASH BASIS. PART III ACCOUNTING METHOD: PART IV, LINE 1: FORM 926 IS NOT REQUIRED TO BE FILED BECAUSE THE TRANSFER TO A FOREIGN CORPORATION DOES NOT MEET THE REPORTING REQUIREMENTS IN THE IRC SEC 6038(A)(1)(A). AUCTION 10491 7176 3315 5065 10491 7176 3315 5065 5065 -1750 1 BUILDING CHANGES 1200 12TH AVENUE SOUTH SUITE 1200 SEATTLE WA 98144 911410450 501(C)(3) 30000 0 TO FUND A PART TIME CONSULTANT TO ASSIST THE CENTRALIZED DIVERSION FUND IN DEVELOPING AN ADVOCACY AND DEVELOPMENT STRATEGY AND EXECUTE STRATEGY CHIEF SEATTLE CLUB 410 - 2ND AVENUE EXTENSION SOUTH SEATTLE WA 98104 910852503 501(C)(3) 65000 0 TO SUPPORT THE COAST SALISH WELCOME POLE TO BE INSTALLED CHIPPEWA CREE TRIBE 96 CLINIC RD NORTH BOX ELDER MT 59521 810242827 501(C)(3) 10000 0 TO IDENTIFY FOOD SOVEREIGNTY SOLUTIONS TO CREATE A PATHWAY FOR FOOD SECURITY AND DECREASE DEPENDENCY ON OUTSIDE RESOURCES GLOBAL POVERTY PROJECT 594 BROADWAY 207 NEW YORK NY 10012 421772557 501(C)(3) 187238 0 $100,500 FOR SCHOLARSHIP, $86,738.24 TO A PROGRAM DESIGNED TO EQUIP YOUNG PEOPLE WITH TOOLS TO BECOME CHANGEMAKERS AND ETHICAL LEADERS COLLEGE SUCCESS FOUNDATION 15500 SE 30TH PL STE 200 BELLEVUE WA 98007 912036088 501(C)(3) 12500 0 LEADERSHIP 1000 FUND CONSERVATION NORTHWEST 1829 10TH AVE W SUITE B SEATTLE WA 98119 943091547 501(C)(3) 25000 0 FOR HERITAGE CAMPAIGN CORE 6464 W SUNSET BLVD STE 530 LOS ANGELES CA 90028 271703237 501(C)(3) 35000 0 GENERAL SUPPORT CHRON'S & COLITIS FOUNDATION 9 LAKE BELLEVUE DR 203 BELLEVUE WA 98005 136193105 501(C)(3) 50000 0 ANNUAL FUND DESC 515 THIRD AVE SEATTLE WA 98104 911275815 501(C)(3) 20000 0 GENERAL SUPPORT EB RESEARCH PARTNERSHIP 132 EAST 43RD STREET SUITE 432 NEW YORK NY 10017 272417202 501(C)(3) 8500 0 EDITING FOR VIDEO FOR EB FUNDRAISER FOOD LIFELINE 815 S 96TH ST SEATTLE WA 98108 911090450 501(C)(3) 20000 0 TO PURCHASE FOOD AND SUPPLIES FOR MEMBER BOOK BANKS I'LL TELL YOU MY STORY 3407 35TH AVE SW SEATTLE WA 98126 824611055 501(C)(3) 25000 0 GENERAL SUPPORT JAIL GUITAR DOORS 842 N FAIRFAX AVE LOS ANGELES CA 90046 270998581 501(C)(3) 10000 0 TO SUPPORT THE BUILD OUT OF RECORDING STUDIO AND OUTFITTING COMPUTER LEARNING LAB FOR JGD'S CAPO CENTER LEAGUE OF CONSERVATION VOTERS EDUCATION FUND 740 15TH ST NW FL 7 WASHINGTON DC 20005 521379661 501(C)(3) 15000 0 LCV EDUCATION FUND NJ VOLUNTARY ORGANIZATIONS 1636-44 ROUTE 38 SUITE 315 LUMBERTON NJ 08048 562336149 501(C)(3) 40000 0 HURRICANE IDA PATH WITH ART 312 2ND AVE S SEATTLE WA 98104 260599518 501(C)(3) 10000 0 GENERAL SUPPORT PLENTY DOORS COMMUNITY DEVELOPMENT CORP PO BOX 1061 CROW AGENCY MT 59022 822045927 501(C)(3) 10000 0 COVID SUPPLIES SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 0 ANNUAL FUND SURFRIDER FOUNDATION 942 CALLE NEGOCIO SUITE 350 SAN CLEMENTE CA 92673 953941826 501(C)(3) 75000 0 ORANGE COUNTY OIL SPILL THE ACTORS' GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 25000 0 GENERAL SUPPORT THE BARACK OBAMA FOUNDATION 5235 SOUTH HARPER COURT NO 1140 CHICAGO IL 60615 464950751 501(C)(3) 25000 0 GIRLS OPPORTUNITY ALLIANCE UNIDOS SOUTH OC PO BOX 1874 SAN JUAN CAPISTRANO CA 92693 823510252 501(C)(3) 10000 0 COVID-SAFE ACADEMIC PROGRAMS FOR 2021 WHATCOM COMMUNITY FOUNDATION 1500 CORNWALL AVE SUITE 202 BELLINGHAM WA 98225 911726410 501(C)(3) 20000 0 GENERAL SUPPORT YELLOW BIRD LIFE WAYS CENTER PO BOX 1138 LAME DEER MT 59043 834458369 501(C)(3) 10000 0 TO SUPPORT THE FOOD SECURITY, SOVEREIGNTY & WELLNESS PROGRAM YWCA OF MISSOULA 1800 S 3RD ST W MISSOULA MT 59801 810245851 501(C)(3) 15000 0 TOWARD MEADOWLARK FACILITY SUPPORT AND FEED 3756 W AVENUE 40 STE K 184 LOS ANGELES CA 90065 854223098 501(C)(3) 25750 0 GENERAL SUPPORT MONTANA POOL SERVICE FOUNDATION 305 S 4TH ST E STE 200 MISSOULA MT 59801 812347350 501(C)(3) 6879 0 FOR WILLIAMSWORKS SERVICES 27 0 PART I, LINE 2: VITALOGY FOUNDATION SELECTS GRANTEES THROUGH AN INTERNAL PROCESS WITH THE FOUNDATION'S BOARD OF DIRECTORS. EACH POTENTIAL GRANTEE'S REQUEST IS REVIEWED BY EACH BOARD MEMBER TO ENSURE IT MEETS THE VITALOGY FOUNDATION'S MISSION GUIDELINES AND THE CHARITY WILL USE THE GRANT EXCLUSIVELY TO CARRY OUT THE "AS DETAILED" CHARITABLE PROJECT, OR FOR GENERAL OPERATIONS, EXCLUSIVELY FOR EXEMPT PURPOSES. ONCE THE GRANTEE HAS BEEN APPROVED, VITALOGY FOUNDATION PROVIDES THE CHARITY WITH A GRANTEE FORM THAT REQUESTS DETAILED INFORMATION ON THE ORGANIZATION INCLUDING ITS TAX ID NUMBER, IRS TAX DETERMINATION LETTER, AS WELL AS THE FUNDS REQUESTED AND HOW THEY WILL BE USED, A DISCLAIMER THAT NO GOODS OR SERVICES WERE EXCHANGED FOR THE GRANT, AND A REQUEST FOR UPDATES AND REPORTS. AFTER THE GRANTEE FORM IS IN HAND, THE CHARITY IS SENT THE FUNDS ALONG WITH THE FOUNDATION'S DONATION ACKNOWLEDGEMENT LETTER WHICH REQUESTS A SIGNATORY BACK CONFIRMING RECEIPT OF THE FUNDS. VITALOGY FOUNDATION FOLLOWS-UP WITH THE GRANTEES TO ENSURE THEY ARE ADHERING TO OUR GUIDELINES THROUGH REGULAR PHONE CALLS AS WELL AS REQUESTING WRITTEN UPDATES EVERY SIX MONTHS. THE VITALOGY FOUNDATION TEAM ALSO MAKES SITE VISITS TO SELECT LARGER SCALE GRANTEES TO GET FIRST HAND KNOWLEDGE OF HOW THE FUNDS ARE BEING APPLIED/DISPERSED IN THE FIELD. FROM THESE REPORTS AND CORRESPONDENCE WITH THE GRANTEE, THE VITALOGY FOUNDATION TEAM PROVIDES UPDATES TO THE BOARD OF DIRECTORS TWO WAYS; THROUGH WEEKLY PROJECT UPDATES AND THROUGH A MORE DETAILED ANNUAL PROJECT UPDATE AS WARRANTED BASED UPON THE SIZE OF THE GRANT. TO TRACK THESE PROJECTS, THE GRANTEES' WRITTEN REPORTS, TEAM CORRESPONDENCE, AND BOARD UPDATES ARE FILED ALONG WITH THE CORRESPONDING GRANTEE FORM AND IRS LETTER ACKNOWLEDGEMENT. INTERNALLY, VITALOGY FOUNDATION KEEPS A RUNNING CONTRIBUTION SUMMARY OF ALL GRANTS MADE TO DATE BY YEAR THAT INCLUDES TRACKING ON UPDATES RECEIVED BY GRANTEES. PEARL JAM TOURING INC 35%+ CONTROLLED ENTITY OF DIRECTORS 141085 EXPENSE REIMBURSEMENT OF 35%+ CONTROLLED ENTITY OF DIRECTORS STONE GOSSARD, MATTHEW CAMERON, MICHAEL MCCREADY, EDDIE VEDDER, AND JEFFREY AMENT. 0 FORM 990, PART VI, SECTION A, LINE 2 ALL MEMBERS OF THE BOARD HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM, REVIEWED BY OUTSIDE CONSULTANTS KNOWLEDGEABLE ABOUT THE ORGANIZATION, AND PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 VITALOGY FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FORM 990 AVAILABLE TO INTERESTED PARTIES UPON REQUEST. FORM 990, PART IX, LINE 11G GENERAL OPERATING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 15,465. FUNDRAISING EXPENSES 10,182. TOTAL EXPENSES 25,647. SELLER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 5,286. TOTAL EXPENSES 5,286. FORM 990, PART XI, LINE 9: ACCRUAL TO CASH ADJUSTMENT -4,656. PEARL JAM LLC PO BOX 340020 NASHVILLE TN 372030020 911695049 MUSICAL ENTERTAINMENT WA N/A 0 0 DEKERIVER LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 203277547 BUILDING RENTAL WA N/A 0 0 TEN CLUB LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 912094535 FAN CLUB MERCHANDISE WA N/A 0 0 MONKEYWRENCH FILMS LLC PO BOX 340020 NASHVILLE TN 372030020 264471983 FILM PRODUCTION CA N/A 0 0 MONKEYWRENCH INC PO BOX 340020 NASHVILLE TN 372030020 331062443 MUSICAL RECORDINGS WA N/A S 0 PEARL JAM TOURING INC PO BOX 340020 NASHVILLE TN 372030020 911531093 MUSICAL ENTERTAINMENT NV N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0