2018-11-08T15:55:11-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 DESHA FURIN TREASURER 3602994201 2018-10-22 1 KURT BENNION CPA P01469618 4252506100 2018-10-22 67.137.57.251 2018-10-22 11:11:10 PD P EB0BBDEF6E86ED143E3AB707D06A90C6F6839315 33F877C3ABFBB78B8EF2964D67A95BC3B590144C 2017 2019-02-21 02:37:17Z MEREDITH MACHIN 1211 24TH STREET ANACORTES WA 98221 1558655 0 X WWW.ISLANDHOSPITALFOUNDATION.ORG X 1978 WA TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH. 18 18 0 75 0 0 804452 1281214 0 0 74980 142834 110815 -75480 990247 1348568 725728 1086192 0 0 0 31947 0 0 26101 70936 97077 796664 1215216 193583 133352 2607084 2909989 851 2545 2606233 2907444 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 1142581 1086192 0 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 FUDICIARY OVERSIGHT, IMPLEMENT THE ANNUAL FUNDRAISING PLAN AND (CONTINUED IN SCHEDULE O) 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. PATIENT PROGRAMS INCLUDE 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. 0 1142581 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 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 18 18 0 1 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X CINDY ANDERSON 3602991300 1211 24TH ST ANACORTES WA 98221 DESHA FURIN PRESIDENT 3.00 0.00 X X 0 0 0 MEREDITH MACHIN VICE PRESIDENT 3.00 0.00 X X 0 0 0 JAMIE CROMACK SECRETARY 3.00 0.00 X X 0 0 0 JEREMY MCNETT TREASURER 3.00 0.00 X X 0 0 0 NICOLE COLEMAN DIRECTOR 1.00 0.00 X 0 0 0 CHUCK FLAGG DIRECTOR 1.00 0.00 X 0 0 0 KATHLEEN GARDE MD DIRECTOR 1.00 40.00 X 0 452205 82487 RICH HUMPHREY DIRECTOR 1.00 0.00 X 0 0 0 FRANK JERETZKY DIRECTOR 1.00 0.00 X 0 0 0 DIANNE KUHN DIRECTOR 1.00 0.00 X 0 0 0 TROY KUNZ DIRECTOR 1.00 0.00 X 0 0 0 KRISTA OICLES DIRECTOR 1.00 0.00 X 0 0 0 KIM ORT DIRECTOR 1.00 0.00 X 0 0 0 DON SCHMUDE DIRECTOR 1.00 0.00 X 0 0 0 MARILYN STADLER DIRECTOR 1.00 0.00 X 0 0 0 JAMES TANGARO DIRECTOR 1.00 0.00 X 0 0 0 SHIRLEY VACANTI RN BSN DIRECTOR 1.00 0.00 X 0 0 0 GINA WALSH DIRECTOR 1.00 0.00 X 0 0 0 JEANNETTE PAPADAKIS EXECUTIVE DIRECTOR 40.00 0.00 X 0 75373 11426 0 527578 93913 0 0 1 0 0 399069 882145 38826 1281214 79684 79684 109800 46650 63150 63150 63150 87957 399069 163437 -75480 -75480 1348568 0 0 67354 1069365 1069365 16827 16827 31947 31947 6450 6450 10590 10590 4196 2098 2098 710 710 4767 4767 EXPENSES PAID BY ISLAND 68163 22344 19718 26101 MISCELLANEOUS EXPENSES 1676 1676 DUES & SUBSCRIPTIONS 525 525 1215216 1142581 46534 26101 231194 269611 104679 16916 12000 2000 3675 68879 500 2255536 2552083 2607084 2909989 851 2545 851 2545 X 2235146 2464517 170087 241927 201000 201000 2606233 2907444 2607084 2909989 133352 167547 312 0 X 1 X 0 0 0 X 684420 476276 432765 804452 1281214 3679127 684420 476276 432765 804452 1281214 3679127 234466 3444661 89 50492 71666 74980 79684 276911 67868 127161 628193 396110 87957 1307289 5263327 0.65450 0.63610 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING EVENT REVENUES MISCELLANEOUS INCOME 2255536 304829 8268 2552097 2081962 170272 -3302 2255536 2145881 -41099 8220 14600 2081962 1714403 384090 87727 40339 2145881 1503114 252194 40904 1714404 0.89600 0.07880 0.02520 0 0 0 X 1697075 167547 17523 163437 348507 1348568 0 1348568 1396176 17523 163437 180960 1215216 0 1215216 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 PART X, LINE 2: AS A CHARITABLE FOUNDATION, ISLAND HOSPITAL FOUNDATION IS A NONPROFIT CORPORATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A). THE FOUNDATION HAS ACCOUNTED FOR 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, 2017 AND 2016, THE FOUNDATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 163,437. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 163,437. GALA 363987 289574 74413 918 1500 25593 10083 60366 GOLF TOURNAMENT 123039 109495 13544 3189 11641 16157 205 33785 0 487026 399069 87957 4107 13141 41750 10288 94151 163437 -75480 1 SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 (DBA ISLAND HOSPITAL) 1211 24TH STREET ANACORTES WA 98221 910729255 ISLAND HOSPITAL 967383 1982 FMV MISCELLANEOUS NON-CASH ITEMS SUPPORT OF HEALTH PROGRAMS AT HOSPITAL ANACORTES SCHOOL DISTRICT 2202 M AVENUE ANACORTES WA 98221 916016222 ANACORTES SCHOOL DIS 100000 MENTAL HEALTH PROGRAMS 2 0 ONCOLOGY GRANTS 115 13827 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 438156 0 0 0 14049 0 64575 0 17912 0 534692 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 3 3509 DONOR DETERMINED X 5679 DONOR DETERMINED X 27 9005 DONOR DETERMINED X TRAVEL 12 11630 DONOR DETERMINED X EVENT TICKETS 20 4841 FACE VALUE X GIFT CERTIFICATES 32 4162 FACE VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALL DAY-TO-DAY MANAGEMENT AND ADMINISTRATIVE SERVICES ARE PROVIDED BY EMPLOYEES OF ISLAND HOSPITAL. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN JANUARY 2017 TO INCREASE THE MINIMUM NUMBER OF BOARD MEETINGS FROM SIX PER YEAR TO EIGHT PER YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE BOARD REVIEWED THE FULL FORM 990, INCLUDING DISCLOSURES. A PUBLIC DISCLOSURE COPY OF THE FORM 990 WAS PROVIDED TO THE ENTIRE BOARD FOR REVIEW 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 CONFILCT 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