2018-10-31T13:01:41-05:00 2018-06-30 930623286 ALDRICH CPAS AND ADVISORS LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2017-07-01 911538852 PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION PEAC 3604147900 1615 DELAWARE LONGVIEW WA 98632 CHRIS SEARING TREASURER 3604147900 2018-10-29 1 DEBRA D SMITH P00646873 5035857774 2018-10-29 69.30.50.66 2018-10-29 10:54:12 PD P BC2C4DF824EE51780EEA9A6CF334AD792FB2CC26 D9A1FB6EA4AB5A1726AC02A5B21CCC8385F48D4F 2017 2019-02-21 02:37:17Z CHRIS SEARING 1615 DELAWARE LONGVIEW WA 98632 1581015 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/ST-JOHN X 1986 WA SUPPORT OF PEACEHEALTH ST. JOHN MEDICAL CENTER BY BUILDING SOCIAL AND FINANCIAL RESOURCES. 22 20 0 100 0 0 591332 891572 0 0 461503 306679 59613 23346 1112448 1221597 426530 1134227 0 0 0 0 0 0 2680 48673 37831 475203 1172058 637245 49539 7818046 7575096 1703849 1673203 6114197 5901893 THE MISSION OF THE FOUNDATION IS TO SUPPORT PEACEHEALTH ST. JOHN MEDICAL CENTER, LOCATED IN LONGVIEW, WASHINGTON, BY SOLICITING, RECEIVING, MANAGING, ADMINISTERING AND DISTRIBUTING FUNDS OR OTHER GIFTS TO OR FOR THE BENEFIT OF PEACEHEALTH ST. JOHN MEDICAL CENTER. 0 0 1134227 1134227 THE FOUNDATION PROVIDES SUPPORT TO PEACEHEALTH ST. JOHN MEDICAL CENTER IN LONGVIEW, WASHINGTON. 1134227 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 33 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 22 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X LORI MAUDLIN 5417434759 123 INTERNATIONAL WAY SPRINGFIELD OR 97477 DOUGLAS STAFFORD PRESIDENT 1.00 X X 0 0 0 BETH LAUFER VICE PRESIDENT 1.00 X X 0 0 0 CHRIS SEARING TREASURER 1.00 X X 0 0 0 PATRICIA PETERSON MD SECRETARY 1.00 X X 0 0 0 JUDITH ALLEN DIRECTOR 1.00 X 0 0 0 JANICE CARTER DIRECTOR 1.00 X 0 0 0 MICHAEL CARTER EDS DIRECTOR 1.00 X 0 0 0 WILLIAM CHESLOCK DO DIRECTOR 1.00 X 0 0 0 DON CIANCI DIRECTOR 1.00 X 0 0 0 JOEL HANSON DIRECTOR 1.00 X 0 0 0 ANNE HAYES DIRECTOR 1.00 X 0 0 0 ARLEEN HUBBLE DIRECTOR 1.00 X 0 0 0 CAL LANTZ DIRECTOR 1.00 X 0 0 0 ANGIE LEPPERT DIRECTOR 1.00 X 0 0 0 WILLIAM MARCUM DIRECTOR 1.00 X 0 0 0 KATHLEEN MCCOOL DIRECTOR 1.00 X 0 0 0 DAVID MINTHORN DIRECTOR 1.00 X 0 0 0 TOM RENAUD DIRECTOR 1.00 X 0 0 0 LILLIAN STONEKING PA DIRECTOR 1.00 40.00 X 0 136021 17343 RONI ZIEGLER DIRECTOR 1.00 X 0 0 0 CHERELLE MONTANYE CAO, ST. JOHN MEDICAL CENTER 1.00 40.00 X 0 87144 917 WILLIAM BOEHM DIRECTOR 1.00 X 0 0 0 CATHY BARR EXECUTIVE DIRECTOR 40.00 X 0 151143 24326 0 374308 42586 0 0 1 0 0 222493 669079 51097 891572 137237 137237 455148 285706 169442 169442 169442 86183 222493 73712 12471 12471 10875 0 10875 10875 1221597 0 0 330025 1134227 1134227 7656 7656 14177 14177 12780 12780 FUNDRAISING EXPENSE 2680 0 0 2680 BAD DEBT ALLOWANCE 538 0 538 0 1172058 1134227 35151 2680 1148868 948566 93805 118877 243052 382874 4073875 3881270 2258446 2243509 7818046 7575096 79783 60650 1624066 1612553 1703849 1673203 X 2100695 1764874 2969201 3078939 1044301 1058080 6114197 5901893 7818046 7575096 X 49539 -47857 -213986 X X 0 1 X 1 0 X 871834 1066675 439756 591332 891572 3861169 871834 1066675 439756 591332 891572 3861169 497497 3363672 66875 118653 13227 132613 137237 468605 6360 33010 59613 23346 122329 4452103 0.75550 0.33640 X 1461701 1338 88051 29671 1521419 1354433 1469 131469 25670 1461701 1315187 3390 79268 43412 1354433 1320301 2808 40274 48196 1315187 1349401 730 -129 29701 1320301 0.00000 0.70000 0.30000 0 0 0 CASH VALUE OF LIFE INSURANCE 211886 SPLIT-INTEREST AGREEMENTS 2031623 2243509 LIABILITIES UNDER SPLIT-INTEREST AGREEMENTS 1441774 BARGAIN SALE AGREEMENTS 170779 1612553 X 1632175 -47857 606365 75668 634176 997999 7656 215942 223598 1221597 1844479 606365 73712 680077 1164402 7656 7656 1172058 PART V, LINE 4: THE ENDOWMENT FUNDS ARE FOR PROGRAM ACTIVITIES. PART X, LINE 2: FOR THE YEARS ENDED JUNE 30, 2018 AND 2017, MANAGEMENT OF THE FOUNDATION BELIEVES THAT THERE HAS BEEN NO ACTIVITY THAT WOULD JEOPARDIZE THE TAX POSITION, BEING A TAX EXEMPT ORGANIZATION, AND THAT IT IS MORE LIKELY THAN NOT, BASED ON THE TECHNICAL MERITS, THAT THIS POSITION WOULD BE SUSTAINED UPON EXAMINATION. THE FOUNDATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE. THERE WERE NONE FOR THE YEARS ENDED JUNE 30, 2018 AND 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 73,712. CHANGE IN VALUE OF TRUST 1,956. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 215,942. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 73,712. GALA 197613 135050 62563 1000 29044 2877 3350 13328 GOLF TOURNAMENT 111063 87443 23620 8590 13980 1543 308676 222493 86183 9590 43024 2877 3350 14871 73712 12471 1 PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 501(C)(3) 1122235 11992 FMV MATERIALS GENERAL SUPPORT FOR PEACEHEALTH ST.JOHN MEDICAL CENTER 1 PART I, LINE 2: OUR FINANCE COMMITTEE AWARDS AND MONITORS THE DISTRIBUTION AND USE OF THE FUNDS ACCORDING TO DONOR INTENT, THE HOSPITAL'S FINANCE DEPARTMENT DISTRIBUTES FUNDS AFTER FOUNDATION APPROVAL AND ANY UNUSED FUNDS ARE RETURNED TO THE FOUNDATION. 0 0 0 0 0 0 0 0 0 LILLIAN STONEKING PA DIRECTOR 0 129498 0 3307 0 3216 0 16324 0 1019 0 153364 0 0 CATHY BARR EXECUTIVE DIRECTOR 0 135312 0 14643 0 1188 0 19560 0 4766 0 175469 0 0 PART I, LINE 3 THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES. EMPLOYEES ARE COMPENSATED BY PEACEHEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACEHEALTH ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THE RANGES OF PAY RATES ARE REVIEWED ON AN ANNUAL BASIS. X 1 490 X 75 X 8355 FMV X VARIOUS AUCTION ITEMS 107 41525 FMV X EVENT TICKETS 4 652 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11B ONCE THE FORM 990 IS COMPLETED BY OUR INDEPENDENT ACCOUNTING FIRM IT IS REVIEWED BY THE GOVERNANCE COMMITTEE. EVERY MEMBER OF THE BOARD WILL RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE GOVERNANCE COMMITTEE IN CONSULTATION WITH THE BOARD PRESIDENT AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENSURING THAT ALL TOPICS BROUGHT BEFORE THE BOARD ARE FREE FROM CONFLICT. DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW OF ANY CONFLICTS ARE MADE AT THIS LEVEL. IF A CONFLICT ARISES, THE INDIVIDUAL AT RISK IS CONTACTED AND ASKED TO EXCUSE HIM OR HER FROM THE ROOM DURING DISCUSSION AND VOTING. ALL MEMBERS OF THE BOARD, AS WELL AS STAFF, ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION EXECUTIVE DIRECTOR IS COMPENSATED BY PEACE HEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACE HEALTH THEN ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/ SKILLS/ COMPETENCE TO DO THE JOB. THIS RATE, OFFERED TO THE EXECUTIVE DIRECTOR AT TIME OF HIRE, WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -215,942. CHANGE IN VALUE OF TRUST 1,956. FORM 990, PART XII, LINE 2C THERE HAVE NOT BEEN ANY CHANGES FROM THE PREVIOUS YEAR. PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 HOSPITAL WA 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0