2020-09-25T11:21:15-05:00 2019-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2019-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 CO FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK VICE PRESIDENT 6153299902 2020-09-14 1 KATHRYN J OKIMOTO P00746598 4254544919 2020-09-14 65.158.230.194 2020-09-14 11:58:04 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9C75230018D5B80955F7F8F52B6C41F090A63707 2019 2021-01-29 14:40:06Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 1278699 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. 6 6 2 7 0 0 3927994 1247990 0 0 5742 18514 -6442 -5336 3927294 1261168 2277863 1404881 0 0 51128 89451 0 0 1238 260016 146913 2589007 1641245 1338287 -380077 2331639 1961842 80 17285 2331559 1944557 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 1407089 1404881 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. 1407089 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 2 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 6 6 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 JEFFREY A AMENT PRESIDENT 1.00 20.00 X X 0 0 0 MICHAEL D MCCREADY VICE PRESIDENT 1.00 20.00 X X 0 0 0 EDDIE J VEDDER VICE PRESIDENT 1.00 20.00 X X 0 0 0 KELLY CURTIS SECRETARY 1.00 20.00 X X 0 0 0 STONE GOSSARD TREASURER 1.00 20.00 X X 0 0 0 MATTHEW D CAMERON DIRECTOR 1.00 0.00 X 0 0 0 JAMIE CHEEK VICE PRESIDENT 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 23729 1224261 4700 1247990 18514 18514 12050 23729 17531 -5481 -5481 REFUND 900099 145 145 145 1261168 0 0 13178 1404881 1404881 76402 76402 6868 6868 6181 6181 10007 1188 7969 850 9332 1020 8312 112255 112255 1134 1080 54 9567 9233 334 800 800 3218 3218 600 600 1641245 1407089 232918 1238 1206956 439685 1002459 903893 12224 0 618264 110000 0 2331639 1961842 80 17285 80 17285 X 1612632 1405203 718927 539354 2331559 1944557 2331639 1961842 X -380077 6723 -13648 X 0 0 0 X 1118345 2465361 253384 3927994 1244388 9009472 1118345 2465361 253384 3927994 1244388 9009472 113191 8896281 837 1026 1048 5742 18514 27167 18414 18414 145 145 9055198 0.98250 0.98180 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REFUND - 2019 AMOUNT: $ 145. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED AUCTION 35779 23729 12050 17531 35779 23729 12050 17531 17531 -5481 1 ARTS CORPS 4408 DELRIDGE WAY SW STE 110 SEATTLE WA 98106 912044679 501(C)(3) 50000 $10K FOR LA FESTA DEL ARTE; $30K FOR GENERAL FUNDS; $10K FOR THE RESIDENCE BUILDING CHANGES 1200 12TH AVE S SUITE 1200 SEATTLE WA 98144 911410450 501(C)(3) 250000 GRANT FOR THE DIVERSION PROJECT CHILDREN'S CANCER ASSOCIATION 1200 NW NAITO PKWY SUITE 140 PORTLAND OR 97209 931181662 501(C)(3) 19208 FOR MYMUSICRX DIGITAL CROHN'S & COLITIS FOUNDATION 9 LAKE BELLEVUE DR 203 BELLEVUE WA 98005 136193105 501(C)(3) 15000 $5K FOR FLAG FOOTBALL TOURNAMENT; $10K FOR 2019 ANNUAL BENEFIT LUNCHEON COLLEGE SUCCESS FOUNDATION 15500 SE 30TH PL 200 BELLEVUE WA 98007 912036088 501(C)(3) 6250 FOR TOMAS YOUNG LEADERSHIP 1000 SCHOLARSHIP CONSERVATION NORTHWEST 1829 10TH AVE W SUITE B SEATTLE WA 98119 943091547 501(C)(3) 50000 WILDERNESS PROTECTION FOR THE WILD CREST OF THE KETTLE RIVER RANGE EB MEDICAL RESEARCH FOUNDATION 2757 ANCHOR AVE LOS ANGELES CA 90064 943130081 501(C)(3) 51995 $40K FOR ROCK4EB, REST FOR GENERAL FUNDS EVERY MOTHER COUNTS 180 VARICK STREET SUITE 1116 NEW YORK NY 10014 454102644 501(C)(3) 100000 GENERAL FUNDS FRED HUTCHINSON CANCER RESEARCH CENTER 1100 FAIRVIEW AVE N SEATTLE WA 98109 237156071 501(C)(3) 30000 HELP THE HUTCH GLOBAL POVERTY PROJECT 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 105000 $100K FOR CURTIS SCHOLARSHIP GRANT; $5K FOR GLOBAL CITIZEN FESTIVAL IN CENTRAL PARK KING COUNTY DEPT OF COMMUNITY AND HUMAN SERVICES 401 5TH AVE SEATTLE WA 98104 916001327 501(C)(3) 200000 HOME SHOWS STUDENT FLEX FUND LIVING CLASSROOMS FOUNDATION 802 SOUTH CAROLINE STREET BALTIMORE MD 21231 521369524 501(C)(3) 20000 GIRLS' EMPOWERMENT MISSION MARCH FOR OUR LIVES 16130 VENTURA BLVD STE 320 ENCINO CA 91436 830885411 501(C)(3) 25000 PARKLAND RISING MOLOKAI LITTLE LEAGUE ASSOCIATION PO BOX 1045 KAUNAKAKAI HI 96748 912166201 501(C)(3) 10000 MOLOKAI LITTLE LEAGUE ALL STAR TOURNAMENT 2019 MOUNT BAKER COMMUNITY CLUB 2218 MT RAINIER DR S SEATTLE WA 98144 910980717 501(C)(3) 10000 RENEWING THE LEGACY CAPITAL CAMPAIGN NORTHERN CALIFORNIA WOMEN'S MUSIC FESTIVAL 4660 FOSBERG ROAD TURLOCK CA 95382 471361148 501(C)(3) 10000 GRANT FOR SOUNDGIRLS.ORG PATH WITH ART 312 2ND AVE S SEATTLE WA 98104 260599518 501(C)(3) 50000 3298 PURCHASE PRICE YAMAHA PIANO $50K FOR ART TRANSFORMS LUNCHEON; $3,297.90 DONATION OF YAMAHA PIANO PAYPAL GIVING FUND 1250 I ST NW UNIT 1202 WASHINGTON DC 20005 450931286 501(C)(3) 16280 $5,260.30 FOR EDWARD CHARLES FOUNDATION; $5,260.30 FOR PEACEFUL VALLEY DONKEY RESCUE; $5,260.30 FOR NOAH'S ANIMAL HOUSE FOUNDATION; $500 FOR MUSICARES MICHAEL MCDONALD RACES 2019 PEAK FOUNDATION PO BOX 36 ALBERTON MT 59820 364795389 501(C)(3) 50000 HANK ROAT MEMORIAL PARK RENOVATION PROCLAIM JUSTICE 2303 RR 620 SOUTH 135-462 LAKEWAY TX 78734 461395681 501(C)(3) 16667 ANTONIO WILLIAMS CASEWORK SEATTLE CHILDREN'S HOSPITAL PO BOX 5371 M/S S-200 SEATTLE WA 98145 911156519 501(C)(3) 50000 GREATEST NEEDS AT SEATTLE CHILDREN'S SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 SPRUCE STREET SCHOOL AUCTION SURFRIDER FOUNDATION 9883 PACIFIC HEIGHTS BLVD SUITE D SAN DIEGO CA 92121 953941826 501(C)(3) 5206 GENERAL FUNDS THE ANSWER ALS FOUNDATION 930 ROBERT E LEE BLVD NEW ORLEANS LA 70124 471643994 501(C)(3) 25000 GOLD LEVEL SPONSORSHIP/GAME CHANGER GALA THE ARMENIAN DRAMATIC ARTS ALLIANCE 3325 W GLENOAKS BLVD BURBANK CA 91504 830436115 501(C)(3) 10000 GRANT FOR TIME OF OUR LIES PROJECT THE BUSH SCHOOL 3400 E HARRISON ST SEATTLE WA 98112 910161095 501(C)(3) 10000 GENERAL FUNDS TOTEM STAR 4408 DELRIDGE WAY SW 118 SEATTLE WA 98106 823271788 501(C)(3) 15000 GENERAL FUNDS TOWN HALL SEATTLE 720 SENECA ST STE A SEATTLE WA 98101 911910904 501(C)(3) 10000 THE CAMPAIGN FOR TOWN HALL TREEHOUSE 2100 24TH AVE S SUITE 200 SEATTLE WA 98144 911425676 501(C)(3) 9632 TREEHOUSE AND PEARL JAM DECK THE HALL BALL PARTNERSHIP TSNE MISSION WORKS 1200 12TH AVE S SUITE 710 SEATTLE WA 98144 042261109 501(C)(3) 31275 A WAY HOME WASHINGTON ANCHOR COMMUNITY INITIATIVE WAR CHILD 200 DELAWARE AVE SUITE 900 BUFFALO NY 14202 200994157 501(C)(3) 20000 PROTECTING CHILDREN FROM THE BRUTAL IMPACT OF WAR WELD SEATTLE PO BOX 77570 SEATTLE WA 98177 813922645 501(C)(3) 50000 CLEAN-AND-SOBER DIVERSION HOUSING FOR PREVIOUSLY INCARCERATED AND THOSE IN RECOVERY WILD LOVE PRESERVE 12239 10TH AVE SOUTH BURIEN WA 98168 273729450 501(C)(3) 30000 $20K FOR 400-ACRE MATCH DRIVE CAMPAIGN & $10K FOR CAMPAIGN FOR WILD LOVE PRESERVE'S 10,000-ACRES 33 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. 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 KNOWLEDGABLE 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 XI, LINE 9: ACCRUAL TO CASH ADJUSTMENT -13,648. PEARL JAM LLC PO BOX 340020 NASHVILLE TN 372030020 911695049 MUSICAL ENTERTAINMENT WA N/A DEKERIVER LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 203277547 BUILDING RENTAL WA N/A TEN CLUB LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 912094535 FAN CLUB MERCHANDISE WA N/A MONKEYWRENCH FILMS LLC PO BOX 340020 NASHVILLE TN 372030020 264471983 FILM PRODUCTION CA N/A 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