2018-11-14T20:07:23-06:00 2017-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2017-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK TREASURER 6153299902 2018-11-07 1 JANE M SEARING P00000565 4254544919 2018-11-07 65.158.230.194 2018-11-07 10:50:48 PS P CD989A29B3516D8BA8B2D753A8BF0A7AAB1B012E A8F8671919AEAF184819608176B45343F82BD7C9 2017 2019-02-21 02:37:17Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 276690 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 0 6 0 0 2465361 253384 0 0 1026 1048 -25 18414 2466362 272846 1679261 974903 0 0 12526 0 0 0 46739 206871 165092 1898658 1139995 567704 -867149 1848278 981128 0 25658 1848278 955470 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 1022074 974903 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. 1022074 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 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 0 0 0 0 0 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 C GOSSARD TREASURER 1.00 20.00 X X 0 0 0 MATTHEW D CAMERON DIRECTOR 1.00 X 0 0 0 JAMIE CHEEK TREASURER 1.00 X 0 0 0 0 0 0 0 0 0 0 VANDENBERG COMMUNICATIONS LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 PUBLIC RELATIONS 103201 1 22530 230854 3844 253384 1048 1048 3220 22530 3220 0 19038 624 18414 18414 272846 0 0 19462 X 974903 974903 12791 6130 508 6153 17724 17724 115438 31845 51748 31845 500 500 16019 7868 702 7449 1328 1328 PRIZES 1100 1100 PROCESSING FEES 192 192 1139995 1022074 71182 46739 385118 88920 1463160 889208 0 3000 1848278 981128 0 25658 0 25658 X 1848278 955470 1848278 955470 1848278 981128 X -867149 -25659 X 0 0 0 X 1066775 881984 1118345 2465361 253384 5785849 1066775 881984 1118345 2465361 253384 5785849 43040 5742809 1083 1715 837 1026 1048 5709 18414 18414 34878 2570 37448 5847420 0.98210 0.99180 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REFUND - 2013 AMOUNT: $ 33,236. 2014 AMOUNT: $ 2,570. EXPENSE REIMBURSEMENT - 2013 AMOUNT: $ 1,642. NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 FUNDRAISING EUROPE (INCLUDING ICELAND & GREENLAND) 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 NORTH AMERICA AND EUROPE THROUGH PEARL JAM CONCERTS. EXPENSES FOR THESE FUNDRAISING EVENTS ARE DONATED BY PEARL JAM TOURING, INC. AUCTION 25750 22530 3220 3220 25750 22530 3220 3220 3220 0 1 AFSP 120 WALL STREET 29TH FLOOR NEW YORK NY 10005 133393329 501(C)(3) 10000 AFSP IS DEDICATED TO SAVING LIVES AND BRINGING HOPE TO THOSE AFFECTED BY SUICIDE. AMERICAN RED CROSS 431 18TH STREET NW WASHINGTON DC 20006 530196605 501(C)(3) 10050 FOR HURRICANE HARVEY DISASTER RELIEF ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 15000 "LA FESTA DEL ATRE AND "IT'S BIGGER THAN HIP HOP" PROJECTS CENTRAL MONTANA FOUNDATION PO BOX 334 LEWISTOWN MT 59457 810425314 501(C)(3) 160000 BIG SPRING SKATE PARK CHILDREN'S CANCER ASSOCIATION 1200 NW NAITO PKWY SUITE 140 PORTLAND OR 97209 931181662 501(C)(3) 8504 TO SUPPORT MYMUSICRX DIGITAL COLLEGE SUCCESS FOUNDATION 15500 SE 30TH PL SUITE 200 BELLEVUE WA 98007 912036088 501(C)(3) 6250 TO SUPPORT "LEADERSHIP 1000 SCHOLARSHIP" CONSERVATION NORTHWEST 1829 10TH AVE W SUITE B SEATTLE WA 98119 943091547 501(C)(3) 25000 TO SUPPORT "PROTECTING THE WILD CREST OF THE KETTLE RIVER RANGE" CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 25000 TO SUPPORT "CAMP OASIS 2017" CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 5000 TO SUPPORT "CCFA FLAG FOOTBALL TOURNAMENT 2017" CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 1500 TO SUPPORT "CCFA ANNUAL BENEFIT LUNCHEON TABLE" CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 7962 TO SUPPORT " CCFA TEAM CHALLENGE NEW ORLEANS 2017" DESC 514 THIRD AVE SEATTLE WA 98103 911275814 501(C)(3) 50553 DONATION TO THE GENERAL FUND EINSTEIN RISING 6523 25TH AVE NW SEATTLE WA 98117 464730931 501(C)(3) 6000 DONATION TO THE GENERAL FUND EVERY MOTHER COUNTS 180 VARICK ST 1116 NEW YORK NY 10014 454102644 501(C)(3) 41000 DONATION TO THE GENERAL FUND FRANKIE'S FRIENDS 4208 LIND AVE SW RENTON WA 98057 593581823 501(C)(3) 10000 DONATION TO THE GENERAL FUND FRANKIE'S FRIENDS 4208 LIND AVE SW RENTON WA 98057 593581823 501(C)(3) 2000 SPONSORSHIP FRED HUTCH PO BOX 19024 MS J5200 SEATTLE WA 98109 237156071 501(C)(3) 10000 TO SUPPORT "HUTCH AWARD LUNCHEON" FRIENDS OF KEXP 472 1ST AVE N SEATTLE WA 98109 912061474 501(C)(3) 13000 TO SUPPORT "KEXP'S NEW HOME" GLOBAL POVERTY PROJECT INC 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 60000 TO SUPPORT "CURTIS SCHOLARSHIP 2017" HOUSTON PET SET 4265 SAN FELIPE ST SUITE 1100 HOUSTON TX 77027 200800623 501(C)(3) 10050 DONATION TO THE GENERAL FUND INTERNATIONAL COMMITTEE OF THE RED CROSS 1100 CONNECTICUT AVE SUITE 500 WASHINGTON DC 20036 986001029 501(C)(3) 25000 TO SUPPORT "FOOD CRISIS APPEAL" JAIL GUITAR DOORS 842 NO FAIRFAX 2ND FLOOR LOS ANGELES CA 90046 270998581 501(C)(3) 10000 DONATION TO THE GENERAL FUND KULTURECITY 732 MONTGOMERY HIGHWAY PMB 392 VESAVIA HILLS AL 35216 463701145 501(C)(3) 13400 DONATION TO THE GENERAL FUND MERCY CORPS 45 SW ANKENY ST PORTLAND OR 97204 911148123 501(C)(3) 25000 DONATION TO THE GENERAL FUND MISSOULA FOOD BANK 219 S 3RD ST W MISSOULA MT 59801 810414143 501(C)(3) 40000 TO SUPPORT "ONE IN SIX RELOCATION/KIDS EMPOWER PACK" OLD DOG HAVEN 621 STATE ROUTE 9 NE PMB A-4 LAKE STEVENS WA 98258 651249528 501(C)(3) 7500 TO SUPPORT "OLD DOG HAVEN MARANDA FUND" OPERATION NEW UNIFORM INC 8825 PERIMETER PARK BLVD SUIT 503 JACKSONVILLE FL 32216 800962807 501(C)(3) 12852 TO SUPPORT "FINDING THE UNIFORM PROGRAM" OXFAM AMERICA 226 CAUSEWAY ST 5TH FLOOR BOSTON MA 02114 237069110 501(C)(3) 25000 TO SUPPORT "EMERGENCY RESPONSE TO FOOD CRISIS IN HORN OF AFRICA" PROCLAIM JUSTICE 5900 BALCONES DR STE 235 AUSTIN TX 78731 461395681 501(C)(3) 8333 DONATION TO THE GENERAL FUND ROCK AND ROLL HALL OF FAME FOUNDATION 162 WEST 56TH ST SUITE 405 NEW YORK NY 10019 133171867 501(C)(3) 33800 DONATION TO THE GENERAL FUND SEATTLE CHILDREN'S HOSPITAL FOUNDATION PO BOX 5371 M/S S-200 SEATTLE WA 98145 911156519 501(C)(3) 10000 DONATION TO THE GENERAL FUND SEATTLE THEATRE GROUP 911 PINE ST SEATTLE WA 98101 943130227 501(C)(3) 10000 TO SUPPORT "OPENING DOORS TO THE ARTS 2017" SPECIAL OLYMPICS MONTANA INC PO BOX 3507 GREAT FALLS MT 59403 810367064 501(C)(3) 9800 DONATION TO THE GENERAL FUND SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 32500 TO SUPPORT THE CAPITAL CAMPAIGN SURFRIDER FOUNDATION SAN DIEGO 9883 PACIFIC HEIGHTS BLVD SUITE D SAN DIEGO CA 92121 953941826 501(C)(3) 12386 DONATION TO THE GENERAL FUND THE BAIL PROJECT INC 11 29TH AVE UNIT 2 LOS ANGELES CA 90291 814985512 501(C)(3) 10000 DONATION TO THE GENERAL FUND THE BENNETT FOUNDATION 91-1410 MOANIANI ST SUITE C WAIPAHU HI 96797 471295315 501(C)(3) 10050 DONATION TO THE GENERAL FUND THE BRONX FREEDOM FUND 360 EAST 161ST ST BRONX NY 10451 261385792 501(C)(3) 10000 DONATION TO THE GENERAL FUND THE GLEASON INITIATIVE FOUNDATION 930 ROBERT E LEE NEW ORLEANS LA 70124 453689316 501(C)(3) 10000 DONATION TO THE GENERAL FUND THE GREATER SEATTLE BUREAU OF FEARLESS IDEAS 8414 GREENWOOD AVE N SEATTLE WA 98103 412127333 501(C)(3) 15553 DONATION TO THE GENERAL FUND TOWN HALL SEATTLE 1119 8TH AVE SEATTLE WA 98101 911910904 501(C)(3) 10000 DONATION TO THE GENERAL FUND TREEHOUSE 2100 24TH AVE S SUITE 200 SEATTLE WA 98122 911425676 501(C)(3) 10252 TO SUPPORT "THE END SUMMER CAMP" TREEHOUSE 2100 24TH AVE S SUITE 200 SEATTLE WA 98122 911425676 501(C)(3) 9418 TO SUPPORT "DECK THE HALL BALL" UJA FEDERATION OF NY 130 EAST 59TH ST ROOM 967 NEW YORK NY 10022 510172429 501(C)(3) 7000 DONATION TO THE GENERAL FUND UJA FEDERATION OF NY 130 EAST 59TH ST ROOM 967 NEW YORK NY 10022 510172429 501(C)(3) 5750 UJA FEDERATION 2017 MUSIC VISIONARY OF THE YEAR AWARD VETERANS OCEAN ADVENTURES INC 8803 SW 206TH LN CUTLER BAY FL 33189 264179467 501(C)(3) 17029 DONATION TO THE GENERAL FUND WAR CHILD USA INC TIMES SQUARE PO BOX 668 NEW YORK NY 10108 200994157 501(C)(3) 10000 DONATION TO THE GENERAL FUND WESTSIDE SCHOOL 10404 34TH AVE SW SEATTLE WA 98146 911151493 501(C)(3) 25000 DONATION TO THE GENERAL FUND 42 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. MICHAEL D MCCREADY VICE-PRESIDENT ATTENDANCE AT FUNDRAISING EVENT X 3000 3000 0 0 0 3000 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 IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 31,845. MANAGEMENT AND GENERAL EXPENSES 51,748. FUNDRAISING EXPENSES 31,845. TOTAL EXPENSES 115,438. FORM 990, PART XI, LINE 9: ACCRUAL TO CASH ADJUSTMENT -25,659. 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