2019-11-15T12:16:45-06:00 2018-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2018-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK VICE PRESIDENT 6153299902 2019-11-14 1 JANE M SEARING P00000565 4254544919 2019-11-14 65.158.230.194 2019-11-14 13:21:18 PS P DE1D2BBAE0F1147E7A7EA18DABEA7E867F199504 A8F8671919AEAF184819608176B45343F82BD7C9 2018 2020-03-31 21:24:44Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 3945891 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 3 7 0 0 253384 3927994 0 0 1048 5742 18414 -6442 272846 3927294 974903 2277863 0 0 0 51128 0 0 29495 165092 260016 1139995 2589007 -867149 1338287 981128 2331639 25658 80 955470 2331559 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 2338187 2277863 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. 2338187 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 8 0 1 3 1 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 JAMIE CHEEK VICE PRESIDENT 1.00 0.00 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 0 0 0 0 0 0 0 VANDENBERG COMMUNICATIONS LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 PUBLIC RELATIONS 100004 1 31698 3896296 12155 3927994 5742 5742 12155 31698 18597 -6442 -6442 3927294 0 0 -700 2277863 2277863 47247 47247 333 333 3548 3548 40518 28419 5514 6585 19545 4525 7186 7834 153791 9880 142611 1300 18514 15620 690 2204 8416 1200 6854 362 5683 5683 2339 680 1659 FOREIGN TAXES 10078 10078 PRIZES 1132 1132 2589007 2338187 221325 29495 88920 1206956 889208 1002459 12224 3000 0 110000 981128 2331639 25658 80 25658 80 X 955470 1612632 718927 955470 2331559 981128 2331639 X 1338287 37802 X 0 0 0 X 881984 1118345 2465361 253384 3927994 8647068 881984 1118345 2465361 253384 3927994 8647068 126167 8520901 1715 837 1026 1048 5742 10368 18414 18414 2570 2570 8678420 0.98180 0.98210 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REFUND - 2014 AMOUNT: $ 2,570. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 FUNDRAISING SOUTH AMERICA 0 0 FUNDRAISING 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART I, LINE 3(3): VITALOGY FOUNDATION DOES FUNDRAISING IN SOUTH AMERICA, NORTH AMERICA AND EUROPE THROUGH PEARL JAM CONCERTS. EXPENSES FOR THESE FUNDRAISING EVENTS ARE DONATED BY PEARL JAM TOURING, INC. AUCTION 43853 31698 12155 18597 43853 31698 12155 18597 18597 -6442 1 ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 29360 $5K FOR LA FESTA DEL ARTE AND $24,360.20 FOR GENERAL FUND ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 20000 $10K FOR HIP HOP RESIDENCY AND $10K FOR GENERAL FUND ASSISTANCE LEAGUE OF SEATTLE 1415 N 45TH ST SEATTLE WA 98103 916055119 501(C)(3) 10000 FOR OPERATION SCHOOL BELL: TO PROVIDE NEW CLOTHING/SHOES TO LOW-INCOME STUDENTS GRADES K-5 IN SEATTLE PUBLIC SCHOOLS, HOMLESS SHELTERS, AND TRANSITIONAL HOUSING FACILITIES. BLUE MT CLINIC 610 N CALIFORNIA MISSOULA MT 59802 810365291 501(C)(3) 15000 USE TOWARD CAPITAL CAMPAIGN BUILDING CHANGES 1200 12TH AVE S SUITE 1200 SEATTLE WA 98144 911410450 501(C)(3) 500000 GENERAL FUND CHILDREN'S CANCER ASSOCIATION 1200 NW NAITO PKWY SUITE 140 PORTLAND OR 97209 931181662 501(C)(3) 34640 FOR MYMUSICRX DIGITAL CHILDREN'S CANCER ASSOCIATION 1200 NW NAITO PKWY SUITE 140 PORTLAND OR 97209 931181662 501(C)(3) 8380 FOR MYMUSICRX DIGITAL CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR SUITE 203 BELLEVUE WA 98005 136193105 501(C)(3) 25000 CAMP OASIS SUMMER CAMP CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR SUITE 203 BELLEVUE WA 98005 136193105 501(C)(3) 5000 CCFA FLAG FOOTBALL SPONSOR DESC 515 3RD AVE SEATTLE WA 98104 911275815 501(C)(3) 250000 GENERAL FUND DESC 515 3RD AVE SEATTLE WA 98104 911275815 501(C)(3) 22789 GENERAL FUND DONORSECHOOSEORG 134 WEST 24TH ST FLOOR 11 NEW YORK NY 10018 134129457 501(C)(3) 125000 BENEFITING PUBLIC SCHOOL CLASSROOM PROJECTS THAT IMPACT STUDENTS EXPERIENCING HOMELESSNESS EINSTEIN RISING 10129 MAIN ST 403 BELLEVUE WA 98004 464730931 501(C)(3) 6000 FOR SOCIAL ENTREPRENEUR DEVELOPMENT PROJECT EVERY MOTHER COUNTS 180 VARICK ST 1116 NEW YORK NY 10014 454102644 501(C)(3) 25000 GENERAL FUND FACING HOMELESSNESS 4001 9TH AVE NE SEATTLE WA 98105 462376967 501(C)(3) 50000 FOR THE PROJECT HUMANIZING HOMELESSNESS: PHOTOJOURNALISM FOR SOCIAL CHANGE FARESTART 700 VIRGINIA ST SEATTLE WA 98101 911546757 501(C)(3) 10000 GENERAL FUND GLOBAL POVERTY PROJECT INC 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 100000 CURTIS SCHOLARSHIP FUND KEXP 427 1ST AVE N SEATTLE WA 98109 912061474 501(C)(3) 19807 KEXP'S NEW HOME FUND MISSOULA FOOD BANK 1720 WYOMING ST MISSOULA MT 59801 810414143 501(C)(3) 10000 GENERAL FUND MISSOULA FOOD BANK 1720 WYOMING ST MISSOULA MT 59801 810414143 501(C)(3) 1250 GENERAL FUND MISSOULA FOOD BANK 1720 WYOMING ST MISSOULA MT 59801 810414143 501(C)(3) 1250 GENERAL FUND MISSOULA YOUTH HOMES PO BOX 7616 MISSOULA MT 59807 810331313 501(C)(3) 15000 GENERAL FUND MISSOULA YOUTH HOMES PO BOX 7616 MISSOULA MT 59807 810331313 501(C)(3) 1250 GENERAL FUND MISSOULA YOUTH HOMES PO BOX 7616 MISSOULA MT 59807 810331313 501(C)(3) 1250 GENERAL FUND MOCKINGBIRD SOCIETY 2100 24TH AVE S STE 240 SEATTLE WA 98144 912051340 501(C)(3) 50000 GENERAL FUND MOLOKAI LITTLE LEAGUE ASSOCIATION PO BOX 531 KAUNAKAKAI HI 96748 912166201 501(C)(3) 14500 MOLOKAI LITTLE LEAGUE MAJORS ALL STAR TOURNAMENT MUSICARES 3030 OLYMPIC BLVD SANTA MONICA CA 90404 954470909 501(C)(3) 8500 SPONSORSHIP GRANT FOR CONCERT FOR RECOVERY MUSICARES 3030 OLYMPIC BLVD SANTA MONICA CA 90404 954470909 501(C)(3) 5000 SPONSORSHIP GRANT FOR CONCERT FOR RECOVERY MUSLIM HOUSING SERVICES 6727 RAINIER AVE S 26 SEATTLE WA 98118 911987910 501(C)(3) 50000 GENERAL FUND PATH WITH ART 312 2ND AVE S SEATTLE WA 98104 260599518 501(C)(3) 50000 GENERAL FUND POVERELLO 1110 W BROADWAY ST MISSOULA MT 59802 237439391 501(C)(3) 15000 GENERAL FUND POVERELLO 1110 W BROADWAY ST MISSOULA MT 59802 237439391 501(C)(3) 1250 GENERAL FUND POVERELLO 1110 W BROADWAY ST MISSOULA MT 59802 237439391 501(C)(3) 1250 GENERAL FUND RCEDA 274 OLD CORVALLIS RD SUITE A HAMILTON MT 59840 810515595 501(C)(3) 90000 FOR CIRCLE 13 REAL CHANGE HOMELESS EMPOWERMENT PROJECT 219 1ST AVE S SUITE 220 SEATTLE WA 98104 911817387 501(C)(3) 50000 GENERAL FUND REAL CHANGE HOMELESS EMPOWERMENT PROJECT 219 1ST AVE S SUITE 220 SEATTLE WA 98104 911817387 501(C)(3) 22789 GENERAL FUND SEATTLE ARTS & LECTURES 340 15TH AVE E SEATTLE WA 98108 911384964 501(C)(3) 20000 SHERMAN ALEXIE LOVES LITERARY SERIES SEATTLE CENTER FOUNDATION 305 HARRISON ST ARMORY RM 308 SEATTLE WA 98109 911003385 501(C)(3) 50000 2018 SEATTLE/KING COUNTY CLINIC SEATTLE CHILDREN'S HOSPITAL FOUNDATION PO BOX 5371 M/S S-200 SEATTLE WA 981455005 911155619 501(C)(3) 10000 GENERAL FUND SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 32500 CAPITAL CAMPAIGN 2018 SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 ANNUAL FUND 2017-2018 SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 ANNUAL FUND 2017-2018 SURFRIDER FOUNDATION SAN DIEGO 9883 PACIFIC HEIGHTS BLVD STE D SAN DIEGO CA 92121 953941826 501(C)(3) 8322 GENERAL FUND THE ACTOR'S GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 60000 GENERAL FUND THE ACTOR'S GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 10000 GENERAL FUND THE IF PROJECT 6523 CALIFORNIA AVE SW 288 SEATTLE WA 98136 821848230 501(C)(3) 50000 GENERAL FUND THE IF PROJECT 6523 CALIFORNIA AVE SW 288 SEATTLE WA 98136 821848230 501(C)(3) 10000 GENERAL FUND THE KRISTEN ANN CARR FUND 39 WEST 32ND ST SUITE 1403 NEW YORK NY 10001 133800442 501(C)(3) 25000 GENERAL FUND TOWN HALL SEATTLE 720 SENECA ST SUITE A SEATTLE WA 98101 911910904 501(C)(3) 10000 FOR RENOVATIONS TO TOWN HALL'S HISTORIC HOME TREEHOUSE 2100 24TH AVE S SUITE 200 SEATTLE WA 98144 911425676 501(C)(3) 21310 GENERAL FUND TREEHOUSE 2100 24TH AVE S SUITE 200 SEATTLE WA 98144 911425676 501(C)(3) 3000 SPONSORSHIP FOR CHAMPIONS FOR FOSTER KIDS LUNCHEON 2018 UNITED WAY OF KING COUNTY 720 2ND AVE SEATTLE WA 98104 910565555 501(C)(3) 50000 FOR THE STREETS TO HOME PROGRAM WAR CHILD 200 DELAWARE AVE BUFFALO NY 14202 200994157 501(C)(3) 10000 GENERAL FUND WELD SEATTLE PO BOX 77570 SEATTLE WA 98177 813922645 501(C)(3) 50000 FOR CLEAN AND SOBER DIVERSION HOUSING FOR PREVIOUSLY INCARCERATED AND THOSE IN RECOVERY WILD LOVE PRESERVE 8202 NW STATE HIGHWAY 104 SUITE 102-33 KINGSTON WA 98346 273729450 501(C)(3) 15000 TO HELP SUPPORT THE WILD LOVE PRESERVE AT TWIN SISTERS LAND PURCHASE YMCA OF GREATER SEATTLE 909 FOURTH AVE SEATTLE WA 98104 910482710 501(C)(3) 100000 TO SUPPORT HOUSING AND HOMELESSNESS PREVENTION PROGRAMS YMCA OF GREATER SEATTLE 909 FOURTH AVE SEATTLE WA 98104 910482710 501(C)(3) 5000 TO SUPPORT A HOST HOMES PARTICIPANT YOUTHCARE 2500 NE 54TH ST SEATTLE WA 98105 910917079 501(C)(3) 9956 GENERAL FUND YWCA OF MISSOULA 1130 W BROADWAY MISSOULA MT 59802 810245851 501(C)(3) 15000 CAPITAL CAMPAIGN 2018 YWCA OF MISSOULA 1130 W BROADWAY MISSOULA MT 59802 810245851 501(C)(3) 1250 CAPITAL CAMPAIGN 2018 YWCA OF MISSOULA 1130 W BROADWAY MISSOULA MT 59802 810245851 501(C)(3) 1250 CAPITAL CAMPAIGN 2018 41 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 37,802. 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