2021-12-17T11:10:43-06:00 2021-06-30 930623286 ALDRICH CPAS AND ADVISORS LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2020-07-01 911538852 PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION PEAC 3604316789 1615 DELAWARE LONGVIEW WA 98632 BETH LAUFER PRESIDENT 3604316789 2021-11-30 1 BETH LAUFER 999009999 DEBRA D SMITH P00646873 5035857774 2021-11-30 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z BETH LAUFER 1615 DELAWARE LONGVIEW WA 98632 1652118 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/ST-JOHN/ X 1986 WA SUPPORT OF PEACEHEALTH ST. JOHN MEDICAL CENTER BY BUILDING SOCIAL AND FINANCIAL RESOURCES. 19 16 0 100 0 0 795424 835025 0 0 73898 234917 35374 -4681 904696 1065261 418819 1474500 0 0 0 0 0 0 4716 26831 17407 445650 1491907 459046 -426646 6723423 6327285 1201279 988441 5522144 5338844 THE MISSION OF THE FOUNDATION IS TO SUPPORT PEACEHEALTH ST. JOHN MEDICAL CENTER, LOCATED IN LONGVIEW, WASHINGTON, BY SOLICITING, RECEIVING, MANAGING, ADMINISTERING AND DISTRIBUTING FUNDS OR OTHER GIFTS TO OR FOR THE BENEFIT OF PEACEHEALTH ST. JOHN MEDICAL CENTER. 0 0 1474500 1474500 TRANSFERS TO PEACEHEALTH ST. JOHN MEDICAL CENTER TO SUPPORT THEIR PROGRAM SERVICES. 1474500 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 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 0 0 0 1 27 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 19 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X SACRED HEART MEDICAL CENTER FOUNDATION 5412227112 123 INTERNATIONAL WAY SPRINGFIELD OR 97477 BETH LAUFER PRESIDENT 1.00 X X 0 0 0 PJ PETERSON SECRETARY 1.00 X X 0 0 0 CAL LANTZ TREASURER 1.00 X X 0 0 0 JOEL HANSON VICE PRESIDENT 1.00 X X 0 0 0 CHRIS SEARING DIRECTOR 1.00 X 0 0 0 CRAIG ANNEBERG DIRECTOR 1.00 X 0 0 0 BILL BOEHM DIRECTOR 1.00 X 0 0 0 ERIC BRUDI DIRECTOR 1.00 X 0 0 0 JANICE CARTER DIRECTOR 1.00 X 0 0 0 BILL CHESLOCK DIRECTOR 1.00 X 0 0 0 DON CIANCI DIRECTOR 1.00 X 0 0 0 JACKIE EVANS DIRECTOR 1.00 X 0 0 0 SHARON GIBB DIRECTOR 1.00 X 0 0 0 ANGIE GILREATH DIRECTOR 1.00 X 0 0 0 SISTER ANNE HAYES DIRECTOR 1.00 X 0 0 0 ARLEEN HUBBLE DIRECTOR 1.00 X 0 0 0 SAVAN KONG DIRECTOR 1.00 X 0 0 0 BILL MARCUM DIRECTOR 1.00 X 0 0 0 KATHLEEN MCCOOL DIRECTOR 1.00 X 0 0 0 DAVID MINTHORN DIRECTOR 1.00 X 0 0 0 TOM RENAUD DIRECTOR 1.00 X 0 0 0 DOUG STAFFORD DIRECTOR 1.00 X 0 0 0 LILLIAN STONEKING DIRECTOR 1.00 X 0 22955 10816 CATHY BARR EXECUTIVE DIRECTOR 40.00 X 0 171874 22451 CHERELLE MONTANYE CAO, ST. JOHN MEDICAL CENT 1.00 40.00 X 0 439763 23640 0 634592 56907 0 0 1 0 0 13445 821580 13272 835025 77200 77200 739893 582176 157717 157717 157717 0 13445 4681 -4681 -4681 1065261 0 0 230236 1474500 1474500 10122 10122 1788 1788 FUNDRAISING EXPENSE 4716 0 0 4716 BAD DEBT 781 0 781 0 1491907 1474500 12691 4716 500650 276109 3660515 3115033 66281 81459 701939 1229349 1794038 1625335 6723423 6327285 0 30874 0 20000 1201279 937567 1201279 988441 X 1370447 1695875 4151697 3642969 5522144 5338844 6723423 6327285 X -426646 295823 -52477 X 0 1 X 1 0 X 591332 891572 840709 795424 835025 3954062 591332 891572 840709 795424 835025 3954062 375984 3578078 132613 137237 115186 95911 77200 558147 59613 23346 44641 35374 0 162974 4675183 0.76530 0.75280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1616639 66946 302553 20867 1965271 1594641 2302 25607 5911 1616639 1521419 88944 51130 66852 1594641 1461701 1338 88051 29671 1521419 1354433 1469 131469 25670 1461701 1.00000 0 0 0 CASH VALUE OF LIFE INSURANCE 242281 SPLIT-INTEREST AGREEMENTS 1329277 CONTRIBUTION RECEIVABLE FROM REMAINDER TRUST 53777 1625335 LIABILITIES UNDER SPLIT-INTEREST AGREEMENTS 909265 BARGAIN SALE AGREEMENTS 28302 937567 X 1985923 295823 682757 -47796 930784 1055139 10122 10122 1065261 2169223 682757 4681 687438 1481785 10122 10122 1491907 PART V, LINE 4: THE ENDOWMENT FUNDS ARE FOR PROGRAM ACTIVITIES. PART X, LINE 2: FOR THE YEARS ENDED JUNE 30, 2021 AND 2020, MANAGEMENT OF THE FOUNDATION BELIEVES THERE HAS BEEN NO ACTIVITY THAT WOULD JEOPARDIZE THE TAX POSITION, BEING A TAX EXEMPT ORGANIZATION, AND THAT IT IS MORE LIKELY THAN NOT, BASED ON THE TECHNICAL MERITS, THAT THIS POSITION WOULD BE SUSTAINED UPON EXAMINATION. THE FOUNDATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE. THERE WERE NONE FOR THE YEARS ENDED JUNE 30, 2021 AND 2020. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 4,681. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -62,331. CHANGE IN VALUE OF CONTRIBUTIONS RECEIVABLE FROM REMAINDER TRUSTS 9,854. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 4,681. 1 PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 501(C)(3) 1461228 13272 FMV IN-KIND MATERIALS GENERAL SUPPORT FOR PEACEHEALTH ST. JOHN MEDICAL CENTER 1 0 PART I, LINE 2: OUR FINANCE COMMITTEE AWARDS AND MONITORS THE DISTRIBUTION AND USE OF THE FUNDS ACCORDING TO DONOR INTENT. FUNDS ARE DISTRIBUTED TO THE HOSPITAL DEPARTMENTS ONLY AFTER RECEIPT OF AN INVOICE AND ONLY FUNDED FOR THE EXACT AMOUNT. 0 0 0 0 0 0 0 0 0 CHERELLE MONTANYE CAO, ST. JOHN MEDICAL CENT 0 298006 0 141757 0 0 0 0 0 23640 0 463403 0 0 CATHY BARR EXECUTIVE DIRECTOR 0 149126 0 22748 0 0 0 0 0 22451 0 194325 0 0 PART I, LINE 3 THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES. EMPLOYEES ARE COMPENSATED BY PEACEHEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACEHEALTH ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THE RANGES OF PAY RATES ARE REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE FORM 990 IS COMPLETED BY OUR INDEPENDENT ACCOUNTING FIRM IT IS REVIEWED BY THE GOVERNANCE COMMITTEE. EVERY MEMBER OF THE BOARD WILL RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE GOVERNANCE COMMITTEE IN CONSULTATION WITH THE BOARD PRESIDENT AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENSURING THAT ALL TOPICS BROUGHT BEFORE THE BOARD ARE FREE FROM CONFLICT. DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW OF ANY CONFLICTS ARE MADE AT THIS LEVEL. IF A CONFLICT ARISES, THE INDIVIDUAL AT RISK IS CONTACTED AND ASKED TO EXCUSE HIM OR HER FROM THE ROOM DURING DISCUSSION AND VOTING. ALL MEMBERS OF THE BOARD, AS WELL AS STAFF, ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION EXECUTIVE DIRECTOR IS COMPENSATED BY PEACE HEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACE HEALTH THEN ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/ SKILLS/ COMPETENCE TO DO THE JOB. THIS RATE, OFFERED TO THE EXECUTIVE DIRECTOR AT TIME OF HIRE, WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -62,331. CHANGE IN VALUE OF CONTRIBUTIONS RECEIVABLE FROM REMAINDER TRUSTS 9,854. PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 HOSPITAL WA 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0