2017-01-30T15:29:03-06:00 2016-06-30 930623286 AKT LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2015-07-01 721545902 PEACEHEALTH ST JOSEPH MEDICAL CENTER FOUNDATION PEAC 3607886866 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 KATIE JANSEN TREASURER 3607886866 2017-01-11 1 DEBRA D SMITH P00646873 5035857774 2017-01-11 2015 2021-01-29 14:40:06Z KATIE JANSEN 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 4499159 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/ST-JOSEPH X 2003 WA RAISE CONTRIBUTIONS & ESTABLISH ENDOWMENTS TO SUPPORT PEACEHEALTH ST.JOSEPH MEDICAL CENTER. 25 23 0 39 0 0 2330547 4227893 0 0 32270 73485 0 -49334 2362817 4252044 641941 230223 0 0 0 0 0 0 0 14833 13772 656774 243995 1706043 4008049 7748898 10369353 1463469 159298 6285429 10210055 THE MISSION OF THE FOUNDATION IS TO SUPPORT PEACEHEALTH ST. JOSEPH MEDICAL CENTER, LOCATED IN BELLINGHAM, WASHINGTON, BY SOLICITING, RECEIVING, MANAGING, ADMINISTERING AND DISTRIBUTING FUNDS OR OTHER GIFTS TO OR FOR THE BENEFIT OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER. 0 0 230223 230223 SUPPORT OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOR EDUCATION, PATIENT SUPPORT, NURSING SUPPORT, RESEARCH, CAPITAL EXPENDITURES, SCHOLARSHIPS AND CHARITY CARE. THE FOUNDATION RECEIVES FROM PEACEHEALTH ST. JOSEPH MEDICAL CENTER AND PEACEHEALTH CORPORATION DONATED USE OF FACILITIES AND SERVICES, WHICH INCLUDE SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $781,787 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES BUT PER IRS RULES IS NOT REFLECTED ON THE FORM 990. 230223 1 1 0 0 0 0 0 0 0 1 0 0 0 0 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 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 25 23 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WA X LISA ANDERSON 5415106366 1615 DELAWARE ST LONGVIEW WA 98632 X SHAUN SULLIVAN MD PRESIDENT & VICE PRESIDENT 1.00 X X 0 0 0 CHRISTINE THOMPSON SECRETARY 1.00 X X 0 0 0 KATIE JANSEN TREASURER 1.00 X X 0 0 0 JOHN HUNTLEY PAST PRESIDENT 1.00 X X 0 0 0 CHARLES ARIZ MD DIRECTOR 1.00 X 0 0 0 BRAD BEARDEN OD DIRECTOR 1.00 X 0 0 0 MICHAEL BRADBURN DIRECTOR 1.00 X 0 0 0 BRAD DEHAAN DIRECTOR 1.00 X 0 0 0 AMY ESARY DIRECTOR 1.00 X 0 0 0 ROSEMARIE FRANCIS DIRECTOR 1.00 X 0 0 0 WILLIAM HALL DIRECTOR 1.00 X 0 0 0 FRANK IMHOF DIRECTOR 1.00 X 0 0 0 DONNA INGLIS DIRECTOR 1.00 X 0 0 0 LYNETTE JENSEN DIRECTOR 1.00 X 0 0 0 CHET KENOYER DIRECTOR 1.00 X 0 0 0 MIKE PERRY DIRECTOR 1.00 X 0 0 0 SARAH ROTHENBUHLER DIRECTOR 1.00 X 0 0 0 MARCUS SCHUMACHER DIRECTOR 1.00 X 0 0 0 JON SITKIN DIRECTOR 1.00 X 0 0 0 HOLLY STUDLEY DIRECTOR 1.00 X 0 0 0 ROBERT TULL DIRECTOR 1.00 X 0 0 0 CHERYL WEG DIRECTOR 1.00 X 0 0 0 DOUGLAS WIGHT DIRECTOR 1.00 X 0 0 0 ANNA WILLIAMS DIRECTOR 1.00 X 0 0 0 DALE ZENDER DIRECTOR 1.00 40.00 X 0 483395 37266 ANNE RASMUSSEN EXECUTIVE DIRECTOR 20.00 20.00 X 0 139045 5948 0 622440 43214 0 0 1 0 0 230431 3997462 291338 4227893 143218 143218 71221 140954 -69733 -69733 -69733 56827 230431 106161 -49334 -49334 4252044 0 0 24151 230223 230223 BANK FEES 7405 0 7405 0 BAD DEBT ALLOWANCE 6367 0 6367 0 243995 230223 13772 0 3497008 6458471 1740585 1030562 2211101 2644815 211790 222467 88414 13038 7748898 10369353 3443 1049 19418 35117 1440608 123132 1463469 159298 X 2368545 4861583 3346608 4576952 570276 771520 6285429 10210055 7748898 10369353 X 4008049 58034 -141457 X 0 1 X 1 0 X 3358922 2549089 1716957 2330547 4227893 14183408 3358922 2549089 1716957 2330547 4227893 14183408 1695685 12487723 58577 71020 63868 42237 143218 378920 2382 2382 14564710 0.85740 0.84600 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2012944 701244 26194 9649 2730733 1643493 321263 51711 3523 2012944 1386904 54250 204559 2220 1643493 1273160 113744 1386904 1125630 154645 -2293 4000 822 1273160 0.63000 0.28000 0.09000 0 0 0 PAYABLE TO PEACEHEALTH ST. JOSEPH MEDICAL CENTER 123132 123132 X 5230465 58034 818479 101908 978421 4252044 0 4252044 1305839 818479 243365 1061844 243995 0 243995 PART V, LINE 4: THE ENDOWMENT FUNDS ARE TO FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. 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: CHANGE IN VALUE OF ASSETS HELD IN TRUST -4,253. SPECIAL EVENT EXPENSES NETTED WITH REVENUE 106,161. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PLEDGE 137,204. SPECIAL EVENT EXPENSES NETTED WITH REVENUE 106,161. GALA 287258 230431 56827 34500 4785 5543 61333 287258 230431 56827 34500 4785 5543 61333 106161 -49334 1 PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 501(C)(3) 230223 PATIENT SERVICES 1 0 0 0 0 0 0 0 0 0 DALE ZENDER DIRECTOR 0 405078 0 74384 0 3933 0 32360 0 4906 0 520661 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 50 FMV X 4437 FMV X 3 267452 FMV X PIANO 1 11827 FMV X BEVERAGES 1 4890 FMV X GIFT CARD & OTHER 1 1897 FMV X SWAG BAGS 1 785 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED BY AN INDEPENDENT CPA FIRM AND IS PRESENTED TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, AGENTS AND EMPLOYEES ARE REQUIRED TO SIGN ANNUALLY, OUR IN-DEPTH CONFLICT OF INTEREST DISCLOSURE POLICY WHICH AFFIRMS THEY HAVE READ, UNDERSTOOD AND AGREED WITH THE CONFLICT OF INTEREST POLICY AND HAVE ANSWERED ALL QUESTIONS ON THE DISCLOSURE FULLY AND HONESTLY. THE OFFICERS, DIRECTORS, AGENTS AND EMPLOYEES ARE COVERED UNDER THIS POLICY. EACH BOARD MEMBER IS REQUIRED TO SIGN A COPY WHICH IS REVIEWED BY THE EXECUTIVE DIRECTOR. IT MUST BE SIGNED BEFORE THEY ATTEND ANY BOARD OR COMMITTEE MEETINGS. BEFORE AN ITEM IS PUT ON AN AGENDA, THE BOARD/COMMITTEE WILL REVIEW AND ASCERTAIN IF THERE WILL BE ANY CONFLICTS ON THE BOARD AND IF SO, THE BOARD MEMBER IS CONTACTED AND TOLD ABOUT THE SUBJECT OF DISCUSSION. THE BOARD/COMMITTEE DECIDES IF IT IS IN FACT A CONFLICT AND IF SO, THE BOARD MEMBER IS ASKED TO EXCUSE THEMSELVES FROM THE ROOM DURING DISCUSSION AND VOTING BY THE EXECUTIVE DIRECTOR OR COMMITTEE CHAIR. FORM 990, PART VI, SECTION B, LINE 15A THE FOUNDATION'S EXECUTIVE DIRECTOR IS 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 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 DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS. COMPENSATION WAS LAST REVIEWED ON JUNE 30, 2016. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE IN THE FOUNDATION OFFICE UPON REQUEST. FORM 990 PART VIII, LINE 30 ANNE RASMUSSEN, EXECUTIVE FIRECTOR : HER COMPENSATION IS PAID BY THE RELATED ORGANIZATION FOR SERVICES TO THE FILING ORGANIZATION. HER REPORTABLE COMPENSATION IS ZERO FOR THE FILING ORGANIZATION BUT HER AVERAGE HOURS PER WEEK IS 20 AS SHE SPENDS PART OF HER WORKING AT THE FILING ORGANIZATION AND AT WHATCOM HOSPICE FOUNDATION (A RELATED ORGANIZATION TO PEACEHEALTH). FORM 990, PART XI, LINE 9: CHANGE IN GIFT ANNUITY OBLIGATIONS -4,253. LOSS ON UNCOLLECTIBLE PLEDGE -137,204. 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