ISLAND HOSPITAL HEALTH FOUNDATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ISLAND HOSPITAL HEALTH FOUNDATION (EIN 91-1030686)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-09-22
- IRS object ID
- 201732659349300563
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-09-22T19:32:24-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911030686 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ISLAND HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ISLA | BusinessNameControlTxt |
| Phone | 3602994201 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1211 24TH STREET | AddressLine1Txt |
| City | ANACORTES | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98221 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEREMY MCNETT | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 3602994201 | PhoneNum |
| Signature | 2017-09-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | STEVEN B BASS CPA | PreparerPersonNm |
| PTIN | P00004800 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2017-09-05 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-09-22 | IPDt |
| IP Tm | 07:21:14 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 46F349674EE889A40ED7A1CF827C4699A2F49015 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A0046212CE9672327E854F40E28815F016E88894 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DESHA FURIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1211 24TH STREET | AddressLine1Txt |
| City | ANACORTES | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98221 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,275,542 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| All Affiliates Included | Yes (1) | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ISLANDHOSPITALFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 55 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $432,765 | PYContributionsGrantsAmt |
| CY Contributions Grants | $804,452 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $71,666 | PYInvestmentIncomeAmt |
| CY Investment Income | $74,980 | CYInvestmentIncomeAmt |
| PY Other Revenue | $365,570 | PYOtherRevenueAmt |
| CY Other Revenue | $110,815 | CYOtherRevenueAmt |
| PY Total Revenue | $870,001 | PYTotalRevenueAmt |
| CY Total Revenue | $990,247 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $498,771 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $725,728 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $75,483 | PYOtherExpensesAmt |
| CY Other Expenses | $70,936 | CYOtherExpensesAmt |
| PY Total Expenses | $574,254 | PYTotalExpensesAmt |
| CY Total Expenses | $796,664 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $295,747 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $193,583 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,372,862 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,607,084 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,899 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $851 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,358,963 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,606,233 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF THE FOUNDATION IS TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN AND AROUND ANACORTES, WASHINGTON. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $277,811 | ExpenseAmt |
| Grant | $277,811 | GrantAmt |
| Desc | FUNDS HOSPITAL RENOVATION AND EXPANSION COSTS NOT MET BY TAX REVENUE. THIS INCLUDES THE MEDICAL ARTS PAVILION HOUSING CANCER CARE, PHYSICAL/OCCUPATIONAL/SPEECH THERAPY AND WOUND CARE. ADDITIONALLY, ISLAND HOSPITAL FOUNDATION PROVIDES FUNDING FOR COMMITMENTS TO THE HOSPITAL THAT INCLUDE THE HEALTH RESOURCE CENTER, FREE AND LOW COST COMMUNITY HEALTH SCREENINGS, DIRECT CLINIC SUPPORT, MENTAL HEALTH COUNSELING THROUGH THE MENTAL HEALTH INTERVENTION SCHOOL PROGRAM, AND PATIENT PROGRAMS. PATIENT PROGRAMS INCLUDE MEDICAL RELIEF, ONCOLOGY RELIEF AND ONCOLOGY LODGING ASSISTANCE. OTHER NEEDS ARE ALSO PROVIDED FOR AS THEY ARISE THROUGH THE YEAR. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $475,202 | ExpenseAmt |
| Grant | $447,917 | GrantAmt |
| Desc | SINCE 1962, ISLAND HOSPITAL HAS PROVIDED HIGH QUALITY, COMPASSIONATE AND PERSONALIZED HEALTH CARE TO OUR COMMUNITY. ISLAND HOSPITAL MAINTAINS A PROGRESSIVE STAND IN DELIVERING THE BEST HEALTH CARE EXPERIENCES FOR PATIENTS AND THEIR FAMILIES BY PLACING THEIR EMOTIONAL AND MEDICAL NEEDS FIRST AND FOREMOST. THE ISLAND HOSPITAL FOUNDATION SUPPORTS THE ISLAND HOSPITAL'S VITAL MISSION BY RAISING MUCH-NEEDE FUNDS FOR THE BENEFIT OF COMMUNITY HEALTH. FOUNDED IN 1979, THE FOUNDATION IS AN INDEPENDENT, NONPROFIT CORPORATION HEADED BY A 18-MEMBER VOLUNTEER BOARD OF DIRECTORS. THESE DEDICATED CIVIL AND BUSINESS LEADERS GENEROUSLY DONATE THEIR TIME, TALENTS, AND ENERGY TO DIRECT THE FOUNDATION'S POLICIES AND SECURE IT'S FINANCIAL FUTURE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $753,013 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CINDY ANDERSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3602991300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1211 24TH ST | AddressLine1Txt |
| City | ANACORTES | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98221 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| TROY KUNZ | |||||||
| PRESIDENT | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DESHA FURIN | |||||||
| VICE PRESIDENT | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| NORM ALLAN | |||||||
| TREASURER | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MEREDITH MACHIN | |||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JOSH BALDWIN | |||||||
| DIRECTOR (THROUGH 6/20/16) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| NICOLE COLEMAN | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JAMIE CROMACK | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CHUCK FLAGG | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KATHLEEN GARDE MD | |||||||
| DIRECTOR (THROUGH 11/15/16) | 1.00 | 40.00 | Yes (X) | $0 | $456,653 | $74,857 | |
| FRANK JERETZKY | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RICH HUMPHREY | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEREMY MCNETT | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TOM MURPHY | |||||||
| DIRECTOR (THROUGH 4/1/16) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KRISTA OICLES | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RUSTAN ROBERTSON | |||||||
| DIRECTOR (THROUGH 9/30/16) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DON SCHMUDE | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARILYN STADLER | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SHIRLY VACANTI | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEANNETTE PAPADAKIS | |||||||
| FOUNDATION DIRECTOR | 40.00 | 0.00 | Yes (X) | $0 | $73,872 | $2,264 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $530,525 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $77,121 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $804,452 | AllOtherContributionsAmt |
| Noncash Contributions | $212,839 | NoncashContributionsAmt |
| Total Contributions | $804,452 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,980 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $74,980 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $396,110 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $285,295 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $110,815 | TotalRevenueColumnAmt |
| Exclusion | $110,815 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $990,247 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $74,980 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $110,815 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $711,834 | TotalAmt |
| Program Services | $711,834 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,894 | TotalAmt |
| Program Services | $13,894 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $285 | TotalAmt |
| Management And General | $285 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,420 | TotalAmt |
| Management And General | $12,420 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,198 | TotalAmt |
| Management And General | $19,198 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $680 | TotalAmt |
| Program Services | $650 | ProgramServicesAmt |
| Management And General | $30 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,416 | TotalAmt |
| Program Services | $764 | ProgramServicesAmt |
| Management And General | $1,652 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,500 | TotalAmt |
| Management And General | $1,500 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SALARY STIPEND - ASSIST | $24,869 | $24,869 | $0 |
| MISCELLANEOUS EXPENSE | $5,242 | $5,242 | |
| BOARD EXPENSES | $3,747 | $670 | $3,077 |
| BANK FEES | $579 | $332 | $247 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $796,664 | TotalAmt |
| Program Services | $753,013 | ProgramServicesAmt |
| Management And General | $43,651 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,469 | BOYAmt |
| EOY | $231,194 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,931 | BOYAmt |
| EOY | $104,679 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,500 | BOYAmt |
| EOY | $12,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,675 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,081,962 | BOYAmt |
| EOY | $2,255,536 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,372,862 | BOYAmt |
| EOY | $2,607,084 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,899 | BOYAmt |
| EOY | $851 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,899 | BOYAmt |
| EOY | $851 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,061,078 | BOYAmt |
| EOY | $2,235,146 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,885 | BOYAmt |
| EOY | $170,087 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $201,000 | BOYAmt |
| EOY | $201,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,358,963 | BOYAmt |
| EOY | $2,606,233 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,372,862 | BOYAmt |
| EOY | $2,607,084 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $193,583 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $109,113 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | -$55,426 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ISLAND HOSPITAL -SKAGIT CNTY PHD #2 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910729255 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $694,276 | SupportAmt |
| Other Support | $31,452 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $694,276 | SupportSumAmt |
| Other Support Sum | $31,452 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | 0 | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SECTION B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | BOARD MEMBERS OF THE FOUNDATION NOMINATE POTENTIAL NEW MEMBERS WHO MEET THE CRITERIA ESTABLISHED FOR BOARD MEMBERSHIP. NOMINEES ARE MEMBERS OF THE MEDICAL STAFF OF THE HOSPITAL, HAVE SPECIAL SKILLS THAT BENEFIT THE FOUNDATION OR HIGH PROFILE MEMBERS OF THE COMMUNITY WHO ARE COMMITTED TO THE HOSPITAL AND THE FOUNDATION. THE BOARD THEN ELECTS THE HIGHEST QUALIFIED NOMINEES. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,081,962 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $170,272 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | -$3,302 | OtherExpendituresAmt |
| End Year Balance | $2,255,536 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,145,881 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$41,099 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $8,220 | OtherExpendituresAmt |
| Administrative Expenses | $14,600 | AdministrativeExpensesAmt |
| End Year Balance | $2,081,962 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,714,403 | BeginningYearBalanceAmt |
| Contributions | $384,090 | ContributionsAmt |
| Investment Earnings Or Losses | $87,727 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $40,339 | OtherExpendituresAmt |
| End Year Balance | $2,145,881 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,503,114 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $252,194 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $40,904 | OtherExpendituresAmt |
| End Year Balance | $1,714,404 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,374,984 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $173,234 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $45,104 | OtherExpendituresAmt |
| End Year Balance | $1,503,114 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INCOME FROM THE ENDOWMENTS IS TO BE USED FOR TWO PURPOSES: HOSPITAL IDENTIFIED COMMUNITY HEALTH NEEDS; AND, TO PROVIDE FUNDS FOR THE BENEFIT OF THE OBSTETRICS DEPARTMENT. |
| PART X, LINE 2: | AS A CHARITABLE FOUNDATION, ISLAND HOSPITAL FOUNDATION IS A NOT-FOR-PROFIT CORPORATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A). THE FOUNDATION HAS ACCOUNTED FOR UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND WAS REASONABLY ESTIMATED. AS OF DECEMEBER 31, 2016, THE FOUNDATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | DIRECT FUNDRAISING EXPENSES |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT FUNDRAISING EXPENSES IN-KIND CONTRIBUTIONS OF SERVICES |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $293,317 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $293,317 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $3,265 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $18,283 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $43,819 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $6,156 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $57,881 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF TOURNAMENT | Event2Nm |
| Gross Receipts Event2 | $102,793 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $102,793 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $17,476 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $9,988 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $16,230 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $103,968 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $8,230 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $396,110 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $396,110 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $20,741 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $28,271 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $60,049 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $110,124 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $66,111 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $285,296 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $110,814 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ISLAND HOSPITAL SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1211 24TH STREET | AddressLine1Txt |
| City | ANACORTES | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98221 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 910729255 | RecipientEIN |
| IRC Section | 170(C) | IRCSectionDesc |
| Cash Grant | $680,382 | CashGrantAmt |
| Non Cash Assistance | $31,452 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | SUPPORT OF HEALTH PROGRAMS AT HOSPITAL | NonCashAssistanceDesc |
| Purpose Of Grant | SUPPORT OF HEALTH PROGRAMS AT HOSPITAL | PurposeOfGrantTxt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| ONCOLOGY GRANTS | 40 | $10,894 |
| SCHOLARSHIPS | 2 | $3,000 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHLEEN GARDE MD | PersonNm |
| Title | DIRECTOR (THROUGH 11/15/16) | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $456,653 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $64,575 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $10,282 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $531,510 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MISCELLANEOUS ITEMS | Desc |
| Contribution | 2 | ContributionCnt |
| Noncash Contributions Rpt F990 | $87,855 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 33: | FormAndLineReferenceDesc |
| Explanation | NUMBER OF CONTRIBUTORS IS THE ACTUAL NUMBER OF CONTRIBUTORS OF NON-CASH ITEMS, EXCLUDING CONTRIBUTORS OF SERVICES | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | LINE 11A EXPLANATION - FORM 990 IS REVIEWED BY THE BOARD BEFORE SIGNATURE AND FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | 1. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF THE COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON A. HAS RECEIVED A COPY OF THE CONFILCT OF INTEREST POLICY B. HAS READ AND UNDERSTANDS THE POLICY C. HAS AGREED TO COMPLY WITH THE POLICY D. UNDERSTANDS IHF IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX-EXEMPT STATUS MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. 2. EACH VOTING MEMBER OF THE BOARD SHALL ANNUALLY SIGN A STATEMENT WHICH DECLARES WHETHER SUCH PERSON IS AN INDEPENDENT DIRECTOR. 3. IF AT ANY TIME DURING THE YEAR, THE INFORMATION IN THE ANNUAL STATEMENT CHANGES MATERIALLY, THE DIRECTOR SHALL DISCLOSE SUCH CHANGES AND REVISE THE ANNUAL DISCLOSURE FORM. 4. THE EXECUTIVE COMMITTEE SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY BY REVIEWING ANNUAL STATEMENTS AND TAKING SUCH OTHER ACTIONS AS ARE NECESSARY FOR EFFECTIVE OVERSIGHT |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ISLAND HOSPITAL - SKAGIT COUNTY PHD #2 | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1211 24TH STREET | AddressLine1Txt |
| City | ANACORTES | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98221 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910729255 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivitiesTxt |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Exempt Code Section | 170(C) | ExemptCodeSectionTxt |
| Public Charity Status | LN3_HOSPITALCOOPINSE | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ISLAND HOSPITAL | ||
| B | $680,382 | CASH |
| ISLAND HOSPITAL | ||
| B | $31,452 | FMV |
| ISLAND HOSPITAL | ||
| O | $115,717 | CASH |
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