2017-10-11T18:37:13-05:00 2016-12-31 910189318 Moss Adams LLP 805 SW Broadway Portland OR 97205 990 2016-01-01 911022358 The Memorial Foundation MEMO 5095765794 2701 Tieton Drive Yakima WA 98902 Erin Black Chief Executive Officer 5095765794 2017-10-10 1 Wendy Campos P00448102 5032421447 2017-10-09 12.129.7.100 2017-10-10 10:46:34 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D983BCCB14F58FEA2964ADA2E2BA40929A762B4D 2016 2021-01-29 14:40:06Z Erin Black 2701 Tieton Drive Yakima WA 98902 5352443 0 X www.memfound.org X 1978 WA Advance and transform healthcare in Yakima. 23 23 0 56 0 0 1427546 4021050 0 0 72583 225799 0 13616 1500129 4260465 322973 1743811 0 0 0 510103 0 0 123259 79674 212747 402647 2466661 1097482 1793804 9185050 11016066 541377 426575 8643673 10589491 X Advance and transform healthcare in Yakima. 1 0 657312 657312 CHILDREN'S VILLAGE - SUPPORTING SERVICES FOR CHILDREN WITH SPECIAL HEALTHCARE NEEDS 194950 194950 NORTH STAR LODGE - Supporting a full-service outpatient cancer treatment facility. 214470 214470 HOSPICE HOME HEALTH CARE - SUPPORTING HOSPICE/HOME HEALTH SERVICES INCLUDING END OF LIFE SERVICES TO PATIENTS AT HOME AND IN AN IN-PATIENT SETTING (Including Palliative care/transitions). 759359 677079 SUPPORT NUMEROUS HEALTHCARE/HEALTHCARE RELATED PROGRAMS. 759359 677079 1826091 1 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 23 23 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BONNIE DWARSHUIS 5092495204 2811 TIETON DRIVE Yakima WA 98902 Bruce Heiser Chairman 2.00 X X 0 0 0 Robert G Price Vice Chairman 2.00 X X 0 0 0 B Jean Pryor Secretary/Treasurer 2.00 X X 0 0 0 Bill Wheeler Immediate Past President 1.00 X X 0 0 0 Anne Napier Caffery Former CEO- Thru 4/9/16 40.00 X 26800 0 9380 Erin Black CEO -As of 5/31/16 40.00 X 72540 0 25389 Darrell Blue Trustee 1.00 X 0 0 0 Lee Callarman Trustee 1.00 X 0 0 0 West H Campbell Trustee 1.00 X 0 0 0 Dolores Desserault Trustee 1.00 X 0 0 0 Bill Dolsen Trustee 1.00 X 0 0 0 Dr Daniel Doornink Trustee 1.00 X 0 0 0 Doug Ellison Executive Committee Member 1.00 X 0 0 0 Jennifer Falk Trustee 1.00 X 0 0 0 Marie Halverson Executive Committee Member 1.00 X 0 0 0 Dr James Haven Trustee 1.00 X 0 0 0 Royal Keith Trustee 1.00 X 0 0 0 Rick Linneweh Trustee 1.00 X 0 0 0 Carol M Loudon Trustee 1.00 X 0 0 0 Dr Timothy Melhorn Trustee 1.00 X 0 0 0 Michael Moen Trustee 1.00 X 0 0 0 Tom Stokes Executive Committee Member 1.00 X 0 0 0 Patricia Temple Trustee 1.00 X 0 0 0 Dr Robert Williams Trustee 1.00 X 0 0 0 Ann Willis Trustee 1.00 X 0 0 0 99340 0 34769 0 0 0 0 0 95845 3925205 90328 4021050 156472 156472 1145599 1076272 69327 69327 69327 29322 95845 15706 13616 13616 4260465 0 0 239415 1743811 1743811 134109 134109 375994 52671 240164 83159 9225 9225 41463 41463 27890 27890 11852 1691 10161 3918 3918 Dues 51786 51312 474 Miscellaneous 26121 1484 7925 16712 Supplies 18134 4076 10530 3528 NET ANNUITY 13102 13102 0 0 9256 9256 2466661 1826091 517311 123259 2709053 3495196 1407184 1554276 4811958 5852266 87722 114328 169133 0 9185050 11016066 541377 426575 541377 426575 X 1821192 1956263 6509796 8320543 312685 312685 8643673 10589491 9185050 11016066 X 1793804 292014 -140000 X 0 1 X 1 0 X 3177689 3103097 2453353 1427546 4021050 14182735 3177689 3103097 2453353 1427546 4021050 14182735 2825376 11357359 101381 349658 182832 78576 156472 868919 15051654 29322 0.75460 0.84690 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 25000 0 119804 0 1 1 558895 31613 1296 589212 567685 -8479 311 558895 566460 2441 1216 567685 540717 27061 1318 566460 493442 48519 1244 540717 0.53000 0.47000 0 0 0 Due to VMM 289252 Deferred Liabilities 68609 Due to EPIC 34357 Due to Nursing Home 34357 426575 X 4552481 292016 292016 4260465 0 4260465 2466661 0 2466661 0 2466661 Part V, Line 4: The intended use for the endowment funds are children's healthcare needs and cancer patients. Part X, Line 2: THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION QUALIFYING UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE FOUNDATION'S TAX-EXEMPT PURPOSE WOULD BE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE FOUNDATION DID NOT ENGAGE IN AN ACTIVITY UNRELATED TO ITS TAX-EXEMPT PURPOSE; ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH REQUIREMENTS RELATED TO ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES, THE FOUNDATION HAS DETERMINED THEY HAVE NO UNCERTAIN TAX POSITIONS AT December 31, 2016 and 2015. IN ADDITION, THE FOUNDATION QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170((B)(1)(A)AND HAS BEEN CLASSIFIED AS OTHER THAN A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). Passion for the Village 125167 95845 29322 2959 4143 8604 125167 95845 29322 2959 4143 8604 15706 13616 1 Virginia Mason Memorial 2811 Tieton Dr Yakima WA 98902 910567263 501(c)3 1743811 To provide support to the Virgina Mason Memorial in their pursuit of Health Improvement, Education, and Improving our community. 1 Part I, Line 2: Grants (allocations) applications are submitted to the Foundation annually and are reviewed by The Memorial Foundation Allocation Committee, a sub-committee of The Memorial Foundation Board of Trustees. The role of The Memorial Foundation Allocation Committee is to: annually review grant applications from Virginia Mason Memorial programs for Foundation funding for the next calendar year; recommend allocation funding to the Foundation Executive Committee for their review and for approval by The Memorial Foundation Board of Trustees. The CEO reviews budgets and Profit/Loss statements of the programs receiving allocation awards on, at least, an annual basis. The committe also ensures that the funds are only used in the United States of America. X 3712 Cost/Selling Price X 3 40616 Selling Price X Seattle Seahawks & Sounders Suites 1 41000 Sale of Comparable X Sawyer Gardens Event Rental 1 5000 Sale of Comparable 0 1 0 Part I, Column (b): Number of Contributions Form 990, Part III, line 2 Women's and Children's Service Line will maintain continuity of care consistent with Virginia Mason Memorial's strategic goals and objectives around women's and children's services to the Yakima Valley. The overall goal is to more concretely define women's and children's services into a more formal service line at Virginia Mason Memorial. Expected outcomes would be more seamless transitions of care for women and children in our health system, reduction of wait times for testing, increased service and satisfaction related to the areas of women's and children's services, a more structured approach to women's and children's services, and a structure that allows Memorial to grow the service line. Form 990, Part VI, Section B, line 11b The review and approval of the Form 990 is delegated to the Executive Committee of the Board. The Form 990 is then submitted to the full voting board for review. Form 990, Part VI, Section B, line 12c Annually requires all officers, directors, trustees and key employees to sign new conflict of interest statements. The body of the statement states that the disclosure is made because the said Foundation has, or might reasonably be expected in the future to have a relationship, transaction or business dealing with the said organization which might in some way constitute a Conflict of Interest with respect to the undersigned because of his/her membership on the Board of Trustees and his/her association with the above-listed business or organization. The undersigned agrees that, if at any time any matter should come before the Board of Trustees concerning the above-listed organization or business, the undersigned shall make known the potential conflict and withdraw from the meeting so long as the matter shall continue under discussion and shall not either vote on the matter under discussion or attempt to influence a decision of the Board of Trustees with respect to such matters. The undersigned further agreees that, in the even his/her relationship with the above-listed business or organization should change, or should other relationships with other businesses or organizations be estatblished which would give rise to a potential Confilict of Interest, he/she shall inform the Board of Trustees and withdraw from participation in any decisions affecting such business or organization. Form 990, Part VI, Section B, line 15 Salaries for top management are determined and reviewed by the Hospital's Board of Directors and Compensation Committee. The Foundation does not pay wages, it reimburses the Hospital for applicable employee costs. Form 990, Part VI, Section C, line 18 The Form 990 is available upon request during business hours, Monday through Friday, 8:00 am - 5:00 pm. Form 990, Part VI, Section C, line 19 The governing documents, confilict of interest policy, and financial statements are available upon request during business hours, Monday through Friday, 8:00 am - 5:00 pm. Form 990, Part XI, line 9: Pledges Allowance -140,000.