2017-01-19T18:00:07-06:00 2016-06-30 930623286 ALDRICH CPAS AND ADVISORS LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2015-07-01 911538852 PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION PEAC 3604147900 1615 DELAWARE STREET LONGVIEW WA 98632 CHRIS SEARING TREASURER 3604147900 2017-01-13 1 DEBRA D SMITH P00646873 5035857774 2017-01-13 2015 2021-01-29 14:40:06Z CHRIS SEARING 1615 DELAWARE STREET LONGVIEW WA 98632 857286 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 18 0 100 0 0 1066675 439756 0 0 531625 168559 6360 33010 1604660 641325 1194746 581606 0 0 0 0 0 0 0 89587 49283 1284333 630889 320327 10436 7513183 7389849 1926773 1953615 5586410 5436234 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 569041 569041 SUPPORT OF PEACEHEALTH ST. JOHN MEDICAL CENTER FOR ACCESS CARE, TECHNOLOGY ADVANCEMENT AND CAPITAL IMPROVEMENTS. THE FOUNDATION RECEIVES FROM PEACEHEALTH ST. JOHN MEDICAL CENTER AND PEACEHEALTH CORPORATION DONATED USE OF FACILITIES AND SERVICES, WHICH INCLUDES SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $252,575 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES BUT HAS BEEN REMOVED FROM THE 990 PER THE INSTRUCTIONS. ADDITIONALLY, THE FOUNDATION'S FUNDRAISING GENERATED CONTRIBUTION REVENUE OF $581,606 THAT WENT DIRECTLY TO THE MEDICAL CENTER. 54 54 MAMMOGRAPHY - FUNDS RAISED TO SUPPORT THE NEEDS OF THE BREAST CENTER IN THE HOSPITAL. CURRENTLY FUNDS HAVE BEEN RAISED TOWARD A COMPLETE REMODEL OF THE BREAST CENTER IN 2015. 12511 12511 THE FUND IS TO SUPPORT THE NEEDS OF LOWER COLUMBIA REGIONAL CANCER CENTER. 581606 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 18 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WA X X LISA ANDERSON 5415106366 1615 DELAWARE STREET LONGVIEW WA 98632 WILLIAM BOEHM PRESIDENT 1.00 X X 0 0 0 EARL FISHER TREASURER 1.00 X X 0 0 0 GENE GUTTORMSEN SECRETARY 1.00 5.00 X X 0 0 0 JACKIE EVANS EMERITUS 1.00 X 0 0 0 FRANCENA DODD EMERITUS 1.00 X 0 0 0 JUDITH ALLEN DIRECTOR 1.00 X 0 0 0 JOHN BERWIND DDS DIRECTOR 1.00 X 0 0 0 GERRIE BOOTH DIRECTOR 1.00 X 0 0 0 JANICE CARTER 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 JULIE KENDALL DIRECTOR 1.00 X 0 0 0 BETH LAUFER 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 DOUGLAS STAFFORD DIRECTOR 1.00 X 0 0 0 MARK PURCELL DIRECTOR 1.00 X 0 0 0 RONI ZIEGLER DIRECTOR 1.00 X 0 0 0 TOM RENAUD DIRECTOR 1.00 X 0 0 0 GARY PARAFINCZUK DIRECTOR 1.00 X 0 0 0 CHRIS SEARING TREASURER 1.00 X 0 0 0 KIRK RABOIN DIRECTOR 1.00 40.00 X 0 327184 35037 PATRICIA PETERSON MD DIRECTOR 1.00 40.00 X 0 254684 43234 LILLIAN STONEKING PA DIRECTOR 1.00 40.00 X 0 116385 16082 CATHY BARR EXECUTIVE DIRECTOR ST JOHN MEDICAL CENTER 40.00 X 0 141240 25424 0 839493 119777 0 0 1 0 0 220307 219449 82533 439756 13227 13227 307824 152492 155332 155332 155332 96479 220307 63469 33010 33010 641325 0 0 201569 581606 581606 4849 4849 9861 9861 17425 17425 IN KIND MATERIALS 22732 0 22732 0 BAD DEBT ALLOWANCE -5584 0 -5584 0 630889 581606 49283 0 533767 814675 41545 88857 507500 251595 4010638 4005131 2419733 2229591 7513183 7389849 0 53683 1926773 1899932 1926773 1953615 X 1872497 1753335 2547619 2641776 1166294 1041123 5586410 5436234 7513183 7389849 X 10436 -72390 -88222 X 0 1 X 1 0 X 1615880 1187425 871834 1066675 439756 5181570 1615880 1187425 871834 1066675 439756 5181570 3171129 2010441 68465 66668 66875 118653 13227 333888 6360 33010 39370 7308 7308 5562136 0.36150 0.45570 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1315187 3389 25183 43412 1300347 1320301 2808 40274 48196 1315187 1349401 730 -129 29701 1320301 1190365 58717 126855 26536 1349401 1525574 59885 -33723 34319 327052 1190365 0.00000 0.80000 0.20000 0 0 0 CASH VALUE OF LIFE INSURANCE 197735 SPLIT-INTEREST AGREEMENTS 2031856 2229591 LIABILITIES UNDER SPLIT-INTEREST AGREEMENTS 1572010 BARGAIN SALE AGREEMENTS 252829 DUE TO PEACEHEALTH ST. JOHN MEDICAL CENTER 75093 1899932 X 1202918 -72390 663585 -24753 566442 636476 4849 4849 641325 1353094 663585 63469 727054 626040 4849 4849 630889 PART V, LINE 4: THE ENDOWMENT FUNDS ARE FOR PROGRAM ACTIVITIES. PART X, LINE 2: FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, 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, 2016 AND 2015. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 63,469. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -87,134. CHANGE IN VALUE OF TRUST -1,088. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 63,469. DECEMBER GALA 268437 191596 76841 29897 1000 1750 9600 GOLF TOURNAMENT 48349 28711 19638 20266 956 316786 220307 96479 50163 1000 1750 10556 63469 33010 1 PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 501(C)(3) 581606 GENERAL SUPPORT FOR PEACEHEALTH ST.JOHN MEDICAL CENTER 1 0 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 KIRK RABOIN DIRECTOR 0 327184 0 0 0 0 0 31960 0 3077 0 362221 0 0 PATRICIA PETERSON MD DIRECTOR 0 254684 0 0 0 0 0 35691 0 7543 0 297918 0 0 CATHY BARR EXECUTIVE DIRECTOR ST JOHN MEDICAL C 0 141240 0 0 0 0 0 15612 0 9812 0 166664 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 1750 FMV X 3954 FMV X AUCTION ITEMS 168 54801 FMV X EVENT TICKETS 5 10903 FMV X LENOX HOLIDAY CHINA 1 5000 FMV X KIDS ITEMS 18 3925 FMV X IN KIND - MISCELLANEOUS 5 2200 FMV X WINE 1 1000 FMV 0 1 0 FORM 990, PART VI, SECTION A, LINE 4 BYLAWS WERE AMENDED AS OF APRIL 26, 2016. FORM 990, PART VI, SECTION B, LINE 11 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 15A 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 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 -87,134. CHANGE IN VALUE OF TRUST -1,088. 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