2017-11-15T16:40:44-06:00 2016-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2016-01-01 911893957 THE MAX FOUNDATION MAXF 4257788660 200 NE PACIFIC STREET NO 103 SEATTLE WA 98105 PATRICIA GARCIA-GONZALEZ CEO 4257788660 2017-11-15 1 FRANCES OLSON P01228048 4254544919 2017-11-15 65.158.230.194 2017-11-15 13:10:57 PS P 2B2DEA4753FF73F509AA69CE98283B1CE794F691 9273B9FFDB2B96DFB504C5E012083FE2649E47A2 2016 2017-02-10 21:41:12Z PATRICIA GARCIA-GONZALEZ 200 NE PACIFIC STREET NO 103 SEATTLE WA 98105 16554541 0 X WWW.THEMAXFOUNDATION.ORG X 1997 WA INCREASE GLOBAL ACCESS TO TREATMENT, CARE, AND SUPPORT FOR PEOPLE LIVING WITH CANCER. 7 6 10 1000 0 0 2765925 13925957 1934951 2606624 4598 5672 16819 16288 4722293 16554541 671794 12766957 0 0 1134493 1341779 0 0 167658 1171717 1913854 2978004 16022590 1744289 531951 4036871 4570279 101612 177977 3935259 4392302 X AT THE MAX FOUNDATION WE BELIEVE ALL PEOPLE LIVING WITH CANCER DESERVE ACCESS TO THE BEST TREATMENT, CARE, AND SUPPORT. WE DECREASE PREMATURE MORTALITY OF CANCER BY CHANNELING HUMANITARIAN DONATIONS OF LIFE-SAVING ONCOLOGY PRODUCTS TO UNDERSERVED POPULATIONS IN COUNTRIES WHERE THOSE PRODUCTS ARE NOT LOCALLY AVAILABLE. 0 0 15436269 12766957 2606624 A KEY FOCUS OF THE ORGANIZATION IS EXPANDING HUMANITARIAN ACCESS TO LIFE-SAVING, INNOVATIVE TREATMENTS FOR CANCER IN LOW AND MIDDLE INCOME COUNTRIES. WE RECEIVE DONATIONS OF ONCOLOGY PRODUCTS FROM DRUG MANUFACTURERS AND CHANNEL THEM TO INDIVIDUAL PATIENTS VIA OUR NETWORK HEALTHCARE PROVIDERS AND CANCER TREATMENT CENTERS. OUR PRIMARY CLIENT IS A PATIENT WHO IS TREATED BY ONE OF OUR PARTNER PHYSICIANS, DIAGNOSED WITH A SPECIFIC CANCER, AND PRESCRIBED A MEDICATION FOR WHICH THE ONLY AVAILABLE FORM OF ACCESS IS A HUMANITARIAN CHANNEL THROUGH MAX ACCESS SOLUTIONS. WE USE A SOPHISTICATED WEB-ENGINE PLATFORM DEVELOPED IN-HOUSE TO ALLOW US TO WORK IN REAL TIME WITH HCP AND CREATE INDIVIDUALIZED PROGRAM LIFE CYCLES TO MEET EACH PATIENT'S NEEDS.WE FURTHER ACT AS HEALTHCARE NAVIGATORS FOR THESE PATIENTS, HELPING THEM WALK THROUGH THE ACCESS PROGRAM ENVIRONMENT. IN ORDER TO OPTIMIZE TREATMENT, WITHIN OUR CAPABILITIES WE PROVIDE EMOTIONAL AND LOGISTICAL SUPPORT AND EDUCATION ONE ON ONE OR IN GROUPS, AND ADVOCATE ON THEIR BEHALF WHEN NEEDED, CREATE COMMUNITIES AROUND PATIENTS BY SUPPORTING PATIENT ORGANIZATIONS, AND SET UP AWARENESS INITIATIVES IN THE PATIENT'S COMMUNITY. 15436269 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 1 11 0 1 10 1 0 1 IN MY 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X PATRICIA GARCIA-GONZALEZ 4257788660 200 NE PACIFIC STREET SUITE 103 SEATTLE WA 98105 PATRICIA GARCIA-GONZALEZ CEO 50.00 4.00 X X 184640 0 16821 PAULA BOULTBEE PRESIDENT 4.00 1.00 X 0 0 0 ROBERT FARMER DIRECTOR 2.00 0.00 X 0 0 0 DAVID TINGSTAD SECRETARY 2.00 1.00 X X 0 0 0 TRACEY HIGGINS DIRECTOR 2.00 0.00 X X 0 0 0 JERRY SCOTT TREASURER 2.00 1.00 X X 0 0 0 GRANT RUBENSTEIN DIRECTOR 2.00 0.00 X 0 0 0 ERIN L SCHWARTZ VP -STRATEGIC PTNRS & COMMUNICATIONS 40.00 0.00 X 100892 0 8550 285532 0 25371 2 0 1 0 0 13925957 13165210 13925957 PATIENT CARE 624100 2203124 2203124 MEDICAL TEST KITS 624100 403500 403500 2606624 5672 5672 8 8 REIMBURSEMENTS 900099 11312 11312 OTHER INCOME 900099 4968 4968 16280 16554541 2606624 0 21960 10000 10000 12756957 12756957 201461 161169 20146 20146 47833 47833 913628 721336 96146 96146 85907 68725 8591 8591 92950 74360 9295 9295 31654 31654 42830 42830 551026 484470 66556 8868 4434 887 3547 110242 43591 57955 8696 25294 25294 125829 100663 12583 12583 173073 155765 8654 8654 38156 26709 11447 10052 10052 SPONSORED EDU. PROJECTS 780257 780257 BUS. LICENSE & TAXES 9822 9822 MISCELLANEOUS 6751 6751 16022590 15436269 418663 167658 2044267 2427185 4715 2564 387809 164811 234853 0 1195977 1810106 17568 16710 274465 135612 144721 138853 6961 10050 4036871 4570279 98646 177977 2966 0 101612 177977 X 2477415 2425577 1457844 1966725 3935259 4392302 4036871 4570279 X 531951 -74908 X 0 0 0 X 502731 623457 1068789 2765925 13925957 18886859 1901640 2173988 1848461 1950643 2617936 10492668 2404371 2797445 2917250 4716568 16543893 29379527 439354 346500 590176 2308029 13508210 17192269 0 439354 346500 590176 2308029 13508210 17192269 12187258 3 3535 4071 4605 5680 17894 3 3535 4071 4605 5680 17894 590 1120 4968 6678 2404374 2800980 2921911 4722293 16554541 29404099 0.41450 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2014 AMOUNT: $ 590. 2015 AMOUNT: $ 1,120. 2016 AMOUNT: $ 4,968. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 74559 18640 55919 199906 116972 82934 138853 1 CENTRAL AMERICA AND THE CARIBBEAN 1 3 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 73000 EAST ASIA AND THE PACIFIC 4 11 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 7982000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 GRANTS 1000 MIDDLE EAST AND NORTH AFRICA 0 0 GRANTS 7000 NORTH AMERICA 2 2 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 85000 SOUTH ASIA 2 20 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 1406000 SOUTH AMERICA 2 5 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 856000 SUB-SAHARAN AFRICA 5 5 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 2939000 RUSSIA & THE NEWLY INDEPENDENT STATES 1 1 PROGRAM SERVICES, GRANTS EDUCATIONAL WORKSHOPS, PATIENT COUNSELING, DIRECT DRUG DONATION 332000 16 46 1 1 17 47 13349000 332000 13681000 SUB-SAHARAN AFRICA IMPROVE ACCESS TO TESTING N/A 10000 DONATION OF DIAGNOSTIC TESTING TOOL FAIR MARKET VALUE EAST ASIA & THE PACIFIC IMPROVE ACCESS TO TESTING N/A 13000 DONATION OF DIAGNOSTIC TESTING TOOL FAIR MARKET VALUE SOUTH ASIA DEVELOP TESTING PROGRAM 20000 WIRE TRANSFER EAST ASIA & THE PACIFIC DEVELOP TESTING PROGRAM 14935 WIRE TRANSFER 4 0 DRUG EAST ASIA AND THE PACIFIC TOTAL 51 7701109 CANCER TREATMENT DRUG WHOLESALE ACQUISITION COST DRUG RUSSIA AND THE NEWLY INDEPENDENT STATES TOTAL 2 312600 CANCER TREATMENT DRUG WHOLESALE ACQUISITION COST DRUG SOUTH AMERICA TOTAL 5 667609 CANCER TREATMENT DRUG WHOLESALE ACQUISITION COST DRUG SOUTH ASIA TOTAL 11 1081075 CANCER TREATMENT DRUG WHOLESALE ACQUISITION COST DRUG SUB-SAHARAN AFRICA TOTAL 52 2786647 CANCER TREATMENT DRUG WHOLESALE ACQUISITION COST 1 1 0 0 0 0 PART I, LINE 2: PROTOCOL FOR GRANTMAKING 1.THE PROGRAM OFFICER MAKING GRANT REQUESTS WILL NEED TO DETERMINE WHO IS DIRECTLY INVOLVED IN THE EXCHANGE OF FUNDS. A) IF FUNDS GO DIRECTLY TO THE PATIENT OR THE PATIENT'S FAMILY, THE PATIENT NAME IS CHECKED AGAINST THE SPECIALLY DESIGNATED NATIONALS LIST (SDN). B) IF FUNDS GO DIRECTLY TO A LABORATORY, THE NAME OF THE LABORATORY AND THE INDIVIDUAL RECEIVING THE FUNDS ARE CHECKED. LIKEWISE, IF IT IS A BANK, THE NAME OF THE BANK AND THE INDIVIDUAL NAME ON THE ACCOUNT ARE CHECKED. C) OUR REGIONAL STAFF MEMBERS UNDERGO A RIGOROUS HIRING PROCESS. IN ADDITION, MS STAFF ARE PERIODICALLY CHECKED AGAINST THE SDN LIST. HOWEVER, IF FUNDS MOVE THROUGH THE HANDS OF MS STAFF TO OTHER INDIVIDUALS OR ENTITIES, THE TRANSACTION IS SUBJECT TO THE SAME PROTOCOL. MS STAFF INDICATE THE INDIVIDUAL OR ENTITY THAT IS DIRECTLY INVOLVED IN THE EXCHANGE OF FUNDS. 2. THE ADMINISTRATIVE ASSISTANT REVIEWS THE SDN LIST AND OFAC COUNTRY SANCTIONS TO DETERMINE IF: A) THE PATIENT OR INDIVIDUAL APPEARS ON THE SDN LIST. B) THE PATIENT OR INDIVIDUAL RESIDES IN A SANCTIONED OFAC COUNTRY THAT LIMITS THIS GRANT. 3. THE INDIVIDUAL PATIENT GRANTS FORM INDICATES WHICH NAME(S) WERE CROSS-REFERENCED WITH THE SDN LIST. 4. IF THE PATIENT OR COUNTRY SHOWS UP ON EITHER LIST, IT WILL BE BROUGHT TO THE CEO AND THE CEO ASSISTANT'S ATTENTION AND THE PROGRAM OFFICER WILL BE GIVEN INSTRUCTIONS ON HOW TO INFORM THE MAX STATION AND THE PROPOSED RECIPIENT THAT THE GRANT IS DENIED. PART I, LINE 3: THE EXPENDITURES REPORTED ON SCHEDULE F, PART I, LINE 3 ARE ON THE ACCRUAL BASIS OF ACCOUNTING. PART IV, LINE 1: FORM 926 IS NOT REQUIRED TO BE FILED BECAUSE THE TRANSFER TO A FOREIGN CORPORATION DOES NOT MEET THE REPORTING REQUIREMENTS IN IRC SEC. 6038(A)(1)(A). 1 FRED HUTCHISON CANCER RESEARCH CENTER 1100 FAIRVIEW AVE N D4 100 SEATTLE WA 98109 237156071 501(C)(3) 10000 DIAGNOSTIC TESTING DEVELOPMENT 1 0 PART I, LINE 2: THE MAX FOUNDATION REQUESTS A REPORT AT THE CLOSE OF A PROJECT. X 1 1 X X X 0 0 0 0 0 0 0 0 0 PATRICIA GARCIA-GONZALEZ CEO 174640 0 10000 0 0 0 0 0 16821 0 201461 0 0 0 PART I, LINE 1A THE MAX FOUNDATION PAYS FOR A COMPANY WIDE FITNESS CLUB MEMBERSHIP THAT ALL STAFF AND BOARD MEMBERS MAY MAKE USE OF. IT IS NOT TREATED AS TAXABLE INCOME. INES GARCIA-GONZALEZ SEE PART V 47833 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: INES GARCIA GONZALEZ(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF PATRICIA GARCIA-GONZALEZ, CEO.(D) DESCRIPTION OF TRANSACTION: CONTRACTOR X 1003 13165210 WHOLESALE ACQ. COST 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B REPRESENTS THE NUMBER OF MEDICINE BOTTLES CONTRIBUTED. FORM 990, PART I, LINE 6, VOLUNTEERS: IN 2016 THE ORGANIZATION RAN TWO GLOBAL AWARENESS CAMPAIGNS IN COLLABORATION WITH 70 PATIENT ASSOCIATIONS PARTNERS OF THE MAX GLOBAL NETWORK. WITH SUPPORT FROM THE ORGANIZATION THESE PARTNERS ORGANIZED CANCER AWARENESS AND EDUCATION EVENTS. VOLUNTEERS HELPED ORGANIZE THESE EVENTS, AS WELL AS PROVIDED SUPPORT DURING THE EVENTS. UNCOMPENSATED BOARD MEMBERS FROM PARTNER ORGANIZATIONS ALSO SERVE AS VOLUNTEERS. FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURN IS PREPARED BY AN OUTSIDE ACCOUNTANT. AFTER PREPARATION, THE FINANCE COMMITTEE PERFORMS A REVIEW OF THE RETURN. THE RETURN IS THEN FILED WITH THE IRS. A COPY IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD HAS ADOPTED A CONFLICT OF INTEREST POLICY AND THE POLICY IS REVIEWED ON AN ANNUAL BASIS. EACH YEAR, BOARD MEMBERS AND OFFICERS MUST REVIEW THE POLICY AND DETERMINE IF ANY CONFLICT OF INTERESTS EXIST. IN 2015 AND 2016, THE DISCLOSURES WERE REVIEWED BY THE EXECUTIVE ASSISTANT. SHOULD A CONFLICT ARISE, IT WOULD BE REVIEWED BY THE CONSULTING CFO, CEO AND BOARD TREASURER. NO BOARD MEMBER OR OFFICER MAY VOTE ON ANY MATTER UNDER CONSIDERATION IN WHICH SUCH PERSON HAS A CONFLICT OF INTEREST. FURTHER, ANY PERSON WITH A MATERIAL CONFLICT OF INTEREST IN ANY DECISION SHOULD BE ABSENT FROM THE ROOM DURING THE BOARD'S REVIEW, INCLUDING ITS VOTE, ON THE DECISION IN QUESTION. FORM 990, PART VI, SECTION B, LINE 15A THE CEO HAS A CONTRACT WITH THE BOARD, LAST DATED AND APPROVED ON MAY 28, 2013. IN THIS CONTRACT, A BASE SALARY AND A YEARLY PERCENTAGE INCREASE HAS BEEN ESTABLISHED, AS WELL AS A YEARLY BONUS. IN JANUARY OF 2016, ORGANIZATION WIDE GUIDELINES FOR SALARY/COMPENSATION FOR CONTRACTORS WERE VOTED ON AND APPROVED BY THE BOARD. EMPLOYEE COMPENSATION REVIEWS OCCUR IN JANUARY OF EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9: PRIOR PERIOD ADJUSTMENTS FOR PRIOR YEAR ACCRUALS -74,908. MAXSTATION MALAYSIA SDN BHD UNIT 1302 LOBBY 1 BLOCK A DAMAN SELANGOR MY 320492996 PATIENT ORIENTED PROGRAMS MY 170161 89155 THE MAX FOUNDATION MAXAID 200 NE PACIFIC STREET SEATTLE WA 98105 352577906 SUPPORT MAX FOUNDATION WA 501(C)(3) LINE 12A, I THE MAX FOUNDATION 1 THE MAX FOUNDATION SOUTH AFRICA TRUST 10 COSMOSPLACE DOORNPOORT PRETORIA SF 0186 TO SUPPORT MAX FOUNDATION SF MAX FOUNDATION T -20 15 1.00000 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0