2019-11-14T12:27:40-06:00 2018-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2018-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 DESHA FURIN TREASURER 3602994201 2019-11-14 1 TERRI REXRODE CPA MST P00096513 9206620016 2019-11-13 74.87.127.216 2019-11-14 08:02:17 CS P FD80E9F6A2A78AE2356123F7B9F1F99F6856B854 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2018 2020-03-31 21:24:44Z DIANNE KUHN PRESIDENT 1211 24TH STREET ANACORTES WA 98221 1521849 0 X WWW.ISLANDHOSPITALFOUNDATION.ORG X 1978 WA TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH. 19 19 0 65 0 0 1281214 1261108 0 0 142834 110954 -75480 -43926 1348568 1328136 1086192 963122 0 0 31947 46515 0 0 7872 97077 68503 1215216 1078140 133352 249996 2909989 2931028 2545 61138 2907444 2869890 X THE MISSION OF THE FOUNDATION IS TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN AND AROUND ANACORTES, WASHINGTON 0 0 1011020 963122 SINCE 1962, ISLAND HOSPITAL HAS PROVIDED HIGH QUALITY, COMPASSIONATE AND PERSONALIZED HEALTH CARE TO OUR COMMUNITY. ISLAND HOSPITAL MAINTAINS A PROGRESSIVE STAND IN DELIVERING THE BEST HEALTH CARE EXPERIENCES FOR PATIENTS AND THEIR FAMILIES BY PLACING THEIR EMOTIONAL AND MEDICAL NEEDS FIRST AND FOREMOST. ISLAND HOSPITAL FOUNDATION SUPPORTS ISLAND HOSPITAL'S VITAL MISSION BY RAISING MUCH-NEEDED FUNDS FOR THE BENEFIT OF COMMUNITY HEALTH. FOUNDED IN 1978, THE FOUNDATION IS AN INDEPENDENT, NONPROFIT CORPORATION HEADED BY A 21-MEMBER VOLUNTEER BOARD OF DIRECTORS. THESE DEDICATED COMMUNITY AND BUSINESS LEADERS GENEROUSLY DONATE THEIR TIME, TALENTS, AND ENERGY TO DIRECT THE FOUNDATION'S POLICIES, PROVIDE FIDUCIARY OVERSIGHT, IMPLEMENT THE ANNUAL FUNDRAISING PLAN AND TO SECURE ITS FINANCIAL FUTURE THROUGH FUNDRAISING. THE ISLAND HOSPITAL FOUNDATION PROVIDES FUNDING FOR COMMITMENTS TO THE HOSPITAL THAT INCLUDE THE HEALTH RESOURCE CENTER, FREE AND LOW COST COMMUNITY HEALTH SCREENINGS, DIRECT CLINIC SUPPORT, MENTAL HEALTH COUNSELING THROUGH THE MENTAL HEALTH INTERVENTION SCHOOL PROGRAM, THE CHAPLAIN PROGRAM, AND PATIENT PROGRAMS INCLUDED MEDICAL RELIEF, ONCOLOGY RELIEF AND ONCOLOGY LODGING ASSISTANCE. NEW TECHNOLOGY EQUIPMENT ALONG WITH OTHER NEEDS ARE ALSO PROVIDED FOR AS THEY ARISE THROUGH THE YEAR. ADDITIONALLY, ISLAND HOSPITAL FOUNDATION PROVIDES FUNDING FOR HOSPITAL RENOVATION AND EXPANSION COSTS NOT MET BY TAX REVENUE. THIS INCLUDES THE MEDICAL ARTS PAVILION HOUSING CANCER CARE, PHYSICAL/OCCUPATIONAL/SPEECH THERAPY AND WOUND CARE. 1011020 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 5 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 19 19 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X CINDY ANDERSON 3602991300 1211 24TH STREET ANACORTES WA 98221 MEREDITH MACHIN PRESIDENT 3.00 X X 0 0 0 DIANNE KUHN VICE PRESIDENT 3.00 X X 0 0 0 CHUCK FLAGG SECRETARY 3.00 X X 0 0 0 DESHA FURIN TREASURER 3.00 X X 0 0 0 NICOLE COLEMAN DIRECTOR 1.00 X 0 0 0 LAURA BROWN-SNIDER DIRECTOR 1.00 X 0 0 0 KATHLEEN GARDE MD DIRECTOR 1.00 39.00 X 0 464552 38112 JAMIE CROMACK DIRECTOR 1.00 X 0 0 0 FRANK JERETZKY DIRECTOR 1.00 X 0 0 0 BRIAN HAYES DIRECTOR 1.00 X 0 0 0 TROY KUNZ DIRECTOR 1.00 X 0 0 0 KRISTA OICLES DIRECTOR 1.00 X 0 0 0 JENNIFER MANN DIRECTOR 1.00 X 0 0 0 DON SCHMUDE DIRECTOR 1.00 X 0 0 0 MARILYN STADLER DIRECTOR 1.00 X 0 0 0 JAMES TANGARO DIRECTOR 1.00 X 0 0 0 SHIRLEY VACANTI RN BSN DIRECTOR 1.00 X 0 0 0 GINA WALSH DIRECTOR 1.00 X 0 0 0 JEREMY MCNETT DIRECTOR 1.00 X 0 0 0 JEANNETTE PAPADAKIS FOUNDATION DIRECTOR 40.00 X 0 77610 7367 0 542162 45479 0 1 1 0 0 477166 783942 65582 1261108 55519 55519 80296 24861 55435 55435 55435 124926 477166 168852 -43926 -43926 1328136 0 0 67028 949799 949799 13323 13323 46515 31868 14647 11200 11200 16308 16308 30 30 32572 15579 10641 6352 1500 1500 6893 421 6452 20 1078140 1011020 59248 7872 269611 455099 16916 119693 2000 6110 68879 500 1500 2552083 2348626 2909989 2931028 2545 61138 2545 61138 X 2464517 2246306 241927 422584 201000 201000 2907444 2869890 2909989 2931028 249996 -287550 0 X 1 X 0 0 0 X 476276 432765 804452 1281214 1261108 4255815 476276 432765 804452 1281214 1261108 4255815 667421 3588394 50492 71666 74980 79684 55519 332341 4588156 1364347 0.78210 0.65450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2552097 -179108 8055 16308 2348626 2255536 304829 8268 2552097 2081962 170272 -3302 2255536 2145881 -41099 8220 14600 2081962 1714403 384090 87727 40339 2145881 0.91500 0.08500 0 0 0 X 1333076 -287550 139946 -147604 1480680 16308 -168852 -152544 1328136 1370630 139946 168852 308798 1061832 16308 16308 1078140 PART X, LINE 2: THE FOUNDATION HAS EVALUATED UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND WAS REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2018 AND 2017, THE FOUNDATION HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES -168,852. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 168,852. PART V, LINE 4 THE INCOME FROM THE ENDOWMENTS IS TO BE USED FOR TWO PURPOSES: 1) HOSPITAL IDENTIFIED COMMUNITY HEALTH NEEDS 2) PROVIDE FUNDS FOR THE BENEFIT OF THE OBSTETRICS DEPARTMENT GALA 602092 477166 124926 3394 13426 54101 97931 602092 477166 124926 3394 13426 54101 97931 168852 -43926 0 SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 (DBA ISLAND HOSPITAL) 1211 24TH STREET ANACORTES WA 98221 910729255 ISLAND HOSPITAL 947796 SUPPORT OF HOSPITAL 1 ONCOLOGY GRANTS 115 10323 SCHOLARSHIPS 2 3000 PART I, LINE 2: COMMON EXECUTIVE MANAGEMENT ENSURE THAT ALL FUNDS TRANSFERRED TO ISLAND HOSPITAL ARE USED FOR INTENDED PURPOSES. FOUNDATION AND HOSPITAL LEADERS MET REGULARLY WITH THE ANACORTES SCHOOL DISTRICT TO DISCUSS PROGRESS IN THEIR MENTAL HEALTH PROGRAMS, DURING WHICH THE FOUNDATION ENSURED THAT THE FUNDS WERE USED FOR APPROPRIATE PURPOSES. INDIVIDUALS RECEIVING ONCOLOGY GRANTS PROVIDE RECEIPTS SHOWING QUALIFIED EXPENSES AND ARE REIMBURSED. SCHOLARSHIP FUNDS ARE GIVEN DIRECTLY TO THE INDIVIDUAL'S SCHOOL. 0 0 0 0 0 0 0 0 0 KATHLEEN GARDE MD DIRECTOR 0 463586 0 0 0 966 0 17875 0 20237 0 502664 0 0 PART I, LINE 3 THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED BY ISLAND HOSPITAL. THE FOLLOWING WERE USED BY ISLAND HOSPITAL IN SETTING THE EXECUTIVE DIRECTOR'S COMPENSATION: 1. FORM 990 OF OTHER ORGANIZATIONS; 2. WRITTEN EMPLOYMENT CONTRACT; 3. COMPENSATION SURVEY OR STUDY. X IN-KIND GIFTS 0 65582 DONOR DETERMINED 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE REVIEWED THE FULL FORM 990, INCLUDING DISCLOSURES. PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF THE COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS IHF IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX-EXEMPT STATUS MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES EACH VOTING MEMBER OF THE BOARD SHALL ANNUALLY SIGN A STATEMENT WHICH DECLARES WHETHER SUCH PERSON IS AN INDEPENDENT DIRECTOR IF AT ANY TIME DURING THE YEAR, THE INFORMATION IN THE ANNUAL STATEMENT CHANGES MATERIALLY, THE DIRECTOR SHALL DISCLOSE SUCH CHANGES AND REVISE THE ANNUAL DISCLOSURE FORM THE EXECUTIVE COMMITTEE SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY BY REVIEWING ANNUAL STATEMENTS AND TAKING SUCH OTHER ACTIONS AS ARE NECESSARY FOR EFFECTIVE OVERSIGHT. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION HAS NO COMPENSATED EMPLOYEES FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SKAGIT COUNTY PUBLIC HOSPITAL DIST #2 (DBA ISLAND HOSPITAL) 1211 24TH STREET ANACORTES WA 98221 910729255 HEALTH CARE WA 115(1) N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0