2017-10-17T12:18:49-05:00 2016-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2016-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK TREASURER 6153299902 2017-10-06 1 JANE SEARING P00000565 4254544919 2017-10-06 65.158.230.194 2017-10-06 10:16:52 PD P EE9472A6866F5D2CC65667176191C38BB98995E0 AF755E6880FB94712E4631ABAF967EBF4D5251DA 2016 2021-01-29 14:40:06Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 2486612 0 X N/A X 2004 WA TO RAISE FUNDS FROM THE GENERAL PUBLIC IN ORDER TO SUPPORT OTHER NONPROFIT 501(C)(3) ORGANIZATIONS AND GOVERNMENTAL INSTITUTIONS THROUGH CHARITABLE DONATIONS AND GRANTS WHICH ARE TO BE USED FOR EDUCATIONAL, CHARITABLE, RELIGIOUS, SCIENTIFIC, LITERARY AND/OR CONSERVATION PURPOSES. 6 6 0 6 0 0 1118345 2465361 0 0 837 1026 0 -25 1119182 2466362 608828 1679261 0 0 5550 12526 0 0 5529 195854 206871 810232 1898658 308950 567704 1280574 1848278 0 0 1280574 1848278 X TO RAISE FUNDS FROM THE GENERAL PUBLIC IN ORDER TO SUPPORT OTHER NONPROFIT 501(C)(3) ORGANIZATIONS AND GOVERNMENTAL INSTITUTIONS THROUGH CHARITABLE DONATIONS AND GRANTS WHICH ARE TO BE USED FOR EDUCATIONAL, CHARITABLE, RELIGIOUS, SCIENTIFIC, LITERARY AND/OR CONSERVATION PURPOSES. 0 0 1857308 1679261 GRANTS AWARDED TO SPECIFIC CHARITABLE ORGANIZATIONS AND INDIVIDUALS CHOSEN BY THE OFFICERS OF THE FOUNDATION IN ACCORDANCE WITH THE PRIMARY PURPOSE OF VITALOGY FOUNDATION'S EXEMPT STATUS. 1857308 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X JAMIE CHEEK CO FBMM INC 6153299902 PO BOX 340020 NASHVILLE TN 372030020 X JEFFREY A AMENT PRESIDENT 1.00 20.00 X X 0 0 0 MICHAEL D MCCREADY VICE PRESIDENT 1.00 20.00 X X 0 0 0 EDDIE J VEDDER VICE PRESIDENT 1.00 20.00 X X 0 0 0 KELLY CURTIS SECRETARY 1.00 20.00 X X 0 0 0 STONE C GOSSARD TREASURER 1.00 20.00 X X 0 0 0 MATTHEW D CAMERON DIRECTOR 1.00 0.00 X 0 0 0 JAMIE CHEEK TREASURER 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 2465361 20250 2465361 1026 1026 20225 20250 -25 -25 2466362 0 0 1001 1473377 1473377 11000 11000 194884 194884 12025 12025 501 501 14518 3945 8830 1743 12628 12628 169820 169820 4623 1837 2786 5282 4282 1000 1898658 1857308 35821 5529 583441 385118 697133 1463160 1280574 1848278 0 0 X 1280574 1848278 1280574 1848278 1280574 1848278 567704 0 X 0 0 0 X 245320 1066775 881984 1118345 2465361 5777785 245320 1066775 881984 1118345 2465361 5777785 3562 5774223 2011 1083 1715 837 1026 6672 34878 2570 37448 5821905 0.99180 0.98900 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REFUND - 2013 AMOUNT: $ 33,236. 2014 AMOUNT: $ 2,570. EXPENSE REIMBURSEMENT - 2013 AMOUNT: $ 1,642. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 NORTH AMERICA 0 0 GRANTMAKING 69680 SOUTH AMERICA 0 0 GRANTMAKING 100704 SUB-SAHARAN AFRICA 0 0 GRANTMAKING 14500 NORTH AMERICA 0 0 FUNDRAISING CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 10000 0 0 0 0 0 0 194884 0 194884 SOUTH AMERICA DONATION TO GENERAL FUND 33568 CASH PAYMENT NORTH AMERICA TO SUPPORT A FOOD BANK 17420 CASH PAYMENT SOUTH AMERICA DONATION TO GENERAL FUND 33568 CASH PAYMENT SOUTH AMERICA DONATION TO GENERAL FUND 33568 CASH PAYMENT NORTH AMERICA RELIEF FUND 17420 CASH PAYMENT NORTH AMERICA RELIEF FUND 17420 CASH PAYMENT NORTH AMERICA RELIEF FUND 17420 CASH PAYMENT SUB-SAHARAN AFRICA TO HELP SUPPORT A VOLUNTEER HOUSE 7000 CASH PAYMENT CENTRAL AMERICA AND THE CARIBBEAN DONATION TO THE GENERAL FUND 10000 CASH PAYMENT 9 0 0 0 0 0 0 0 PART I, LINE 2: VITALOGY FOUNDATION REQUESTS LETTERS FROM THE OUTSIDE ORGANIZATIONS BEGINNING SIX (6) MONTHS AFTER THE GRANT WAS PAID. THESE LETTERS MUST DETAIL HOW THE GRANT IS BEING USED, AND IF ANY FUNDS REMAIN, HOW THE REMAINING FUNDS WILL BE USED. THESE LETTERS CONTINUE TO BE REQUESTED BY VITALOGY FOUNDATION UNTIL THE GRANT HAS BEEN USED IN FULL. PART I, LINE 3: VITALOGY FOUNDATION USES THE CASH METHOD OF ACCOUNTING TO REPORT EXPENDITURES WITHIN THE ORGANIZATION'S FINANCIAL STATEMENTS. PART I, LINE 3(3): VITALOGY FOUNDATION DOES FUNDRAISING IN NORTH AMERICA THROUGH PEARL JAM CONCERTS. EXPENSES FOR THESE FUNDRAISING EVENTS ARE DONATED BY PEARL JAM TOURING, INC. 1 AMERICAN HEARING IMPAIRED HOCKEY ASSOCIATION 4214 W 77TH PLACE CHICAGO IL 60652 237380537 501(C)(3) 10000 TO SUPPORT THE AHIHA SUMMER HOCKEY CAMP ARTSBRIDGE INC PO BOX 113 SWAMPSCOTT MA 01907 260409968 501(C)(3) 18181 TO SUPPORT THE ARTSBRIDGE INSTITUTE FOR MUSIC IN COMMON'S SUMMER LEADERSHIP PROGRAM CALIFORNIA WOMEN'S MUSIC FESTIVAL 486 CONSTITUTION AVE CAMARILLO CA 93012 471361148 501(C)(3) 10000 SOUNDGIRLS LIVE SOUND CAMP FOR GIRLS CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 77200 SUPPORTS CCFA'S MISSION TO CURE CROHN'S DISEASE AND ULCERATIVE COLITIS AND TO INCREASE QUALITY OF LIFE OF THOSE AFFECTED CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 2500 SUPPORTS CCFA'S CAMP OASIS SCHOLARSHIP FUND DESC 515 THIRD AVE SEATTLE WA 98104 911275815 501(C)(3) 43282 DONATION TO THE GENERAL FUND EB RESEARCH PARTNERSHIP 1725 YORK AVE STE 29G NEW YORK NY 10128 272417202 501(C)(3) 56667 TO FUND RESEARCH AIMED AT TREATING AND ULTIMATELY CURING EB EINSTEIN RISING PO BOX 362 MERCER ISLAND WA 98040 464730931 501(C)(3) 6000 DONATION TO THE GENERAL FUND EQUALITY NC PO BOX 28768 RALEIGH NC 27611 581374041 501(C)(3) 25000 DONATION TO THE GENERAL FUND FERRY COUNTY RAIL TRAIL PARTNERS PO BOX 3 MALO WA 99150 651300513 501(C)(3) 25000 TO PRESERVE THE RAIL CORRIDOR FOR THE LONG TERM ECONOMIC BENEFIT OF FERRY COUNTY AND CREATE A NON-MOTORIZED TRAIL FIGHT THE FEAR CAMPAIGN 902 27TH AVE SEATTLE WA 98122 810759628 501(C)(3) 20000 DONATION TO THE GENERAL FUND - SELF DEFENSE TRAINING FRANKIE'S FRIENDS 2950 BUSCH LAKE RD TAMPA FL 33614 593581823 501(C)(3) 16000 TO SUPPORT THE WA STATE HOPE FUND GLOBAL POVERTY PROJECT INC 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 63500 DONATION TO THE GENERAL FUND HEDGEBROOK 216 1ST AVE S STE 251 SEATTLE WA 98104 800012629 501(C)(3) 6000 TO SUPPORT SONGWRITERS RESIDENCY PROGRAM INTONATION MUSIC WORKSHOP 4434 S LAKE PARK AVE RM 110 CHICAGO IL 60653 260799250 501(C)(3) 39191 TO HELP SUPPORT IN-SCHOOL AND AFTER-SCHOOL ROCK BAND MUSIC PROGRAMS FOR CHICAGO YOUTH KEXP 113 DEXTER AVE N SEATTLE WA 98109 912061474 501(C)(3) 13000 TO HELP SUPPORT "BREAKING NEW GROUND TOGETHER: THE CAMPAIGN FOR KEXP'S NEW HOME" LGBT CENTER OF RALEIGH 324 SOUTH HARRINGTON ST RALEIGH NC 27603 262998186 501(C)(3) 25000 TO HELP SUPPORT A TRANSGENDER INITIATIVE TO HELP FACILITATE CONVERSATIONS ABOUT THE LGBT COMMUNITY IN NORTH CAROLINA LOOKING OUT FOUNDATION PO BOX 150227 NASHVILLE TN 37215 455300890 501(C)(3) 25000 TO HELP SUPPORT THE STORY CAMPAIGN MAKE-A-WISH FOUNDATION OF MONTANA 175 N 27TH ST STE 1214 BILLINGS MT 59101 300882267 501(C)(3) 9000 DONATION TO THE GENERAL FUND MARY'S PLACE 1830 9TH AVE SEATTLE WA 98101 272087950 501(C)(3) 25000 DONATION TO THE GENERAL FUND MOLOKAI LITTLE LEAGUE ASSOCIATION PO BOX 1045 KAUNAKAKAI HI 96748 231688231 501(C)(3) 10000 DONATION TO THE GENERAL FUND OCEANIC SOCIETY PO BOX 844 ROSS CA 94957 943105570 501(C)(3) 10000 DONATION TO THE GENERAL FUND PARNTERS IN HEALTH 800 BOYLSTON ST STE 1400 BOSTON MA 02199 043567502 501(C)(3) 20000 DONATION TO THE GENERAL FUND PATIENT ADVOCATE FOUNDATION 421 BUTLER FARM RD HAMPTON VA 23666 541806317 501(C)(3) 9148 FUNDS WILL BE USED TO SUPPORT THE "JENNIFER JAFF CARELINE FOR PATIENTS WITH IBD" PEOPLE'S EMERGENCY CENTER 325 N 39TH ST PHILADELPHIA PA 19104 232017882 501(C)(3) 19046 DONATION TO THE GENERAL FUND POST-PRISON EDUCATION PROGRAM 810 THIRD AVE STE 180 SEATTLE WA 98104 204841958 501(C)(3) 10000 DONATION TO THE GENERAL FUND QUEER ORIENTED RADICAL DAYS OF SUMMER 710 E HUDSON AVE DURHAM NC 27704 461395253 501(C)(3) 25000 TO HELP SUPPORT SUMMER PROGRAMS REWA 4008 MARTIN LUTHER KING JR WAY S SEATTLE WA 98108 911296964 501(C)(3) 10000 DONATION TO THE GENERAL FUND ROXBURY YOUTHWORKS INC 841 PARKER ST STE 104-106 ROXBURY CROSSING MA 02120 042733854 501(C)(3) 18181 TO HELP YOUTH CAUGHT IN CYCLES OF POVERTY, VICTIMIZATION AND VIOLENCE TO TRANSITION SUCCESSFULLY INTO ADULTHOOD RUTGERS UNIVERSITY FOUNDATION 7 COLLEGE AVE WINANTS HALL NEW BRUNSWICK NJ 08901 237318742 501(C)(3) 10000 TO HELP SUPPORT THE GLORIA STEINEM ENDOWED CHAIR IN MEDIA, CULTURE, AND FEMINIST STUDIES SEATTLE ARTS & LECTURES 205 S FINDLAY ST SEATTLE WA 98108 911384964 501(C)(3) 15000 TO HELP SUPPORT COLLABORATION WITH SHERMAN ALEXIE TO CURATE AND HOST A THREE=PART SERIES SEATTLE CANCER CARE ALLIANCE 825 EASTLAKE AVE E SEATTLE WA 98109 911935159 501(C)(3) 50000 DONATION TO THE GENERAL FUND SEATTLE CHILDREN'S HOSPITAL FOUNDATION PO BOX 5371 M/S S-200 SEATTLE WA 98145 911156519 501(C)(3) 50000 DONATION TO THE GENERAL FUND SEATTLE THEATRE GROUP 911 PINE ST SEATTLE WA 98101 943130227 501(C)(3) 10000 DONATION TO THE GENERAL FUND SEATTLE'S UNION GOSPEL MISSION PO BOX 202 SEATTLE WA 98111 910595029 501(C)(3) 10000 DONATION TO THE GENERAL FUND SONGBIRD SINGS INC PO BOX 44 SHELBURNE FALLS MA 01370 270471892 501(C)(3) 18180 TO HELP SUPPORT VETERANS VOICES - A PROGRAM TO HELP HEAL TRAUMA THROUGH MUSIC AND SONGWRITING SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 2500 DONATION TO THE GENERAL FUND SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 45000 DONATION TO THE ANNUAL FUND THAT SUPPORTS ART, MUSIC, PE, ELECTIVES, AND FINANCIAL AID THE ACTOR'S GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 25000 DONATION TO THE GENERAL FUND THE GLEASON INITIATIVE FOUNDATION 930 ROBERT E LEE BLVD NEW ORLEANS LA 70124 453689316 501(C)(3) 10000 DONATION TO THE GENERAL FUND THE GREATER SEATTLE BUREARU OF FEARLESS IDEAS 8414 GREENWOOD AVE N SEATTLE WA 98103 412128333 501(C)(3) 25055 TO HELP SUPPORT BFI CORE PROGRAMS INCLUDING AFTER SCHOOL TUTORING, WRITING WORKSHOPS, AND IN-SCHOOL PROGRAMS FOR YOUTH TIDES FOUNDATION PO BOX 29903 SAN FRANCISCO CA 94129 510198509 501(C)(3) 25000 TO HELP SUPPORT THE FORWARD TOGETHER MORAL MOVEMENT TOWN HALL SEATTLE 1119 8TH AVE SEATTLE WA 98101 911910904 501(C)(3) 10000 TO HELP SUPPORT THE LOVE THIS TOWN: THE CAMPAIGN FOR TOWN HALL TREEHOUSE 2100 24TH AVE S STE 200 SEATTLE WA 98122 911425676 501(C)(3) 11773 TO HELP SUPPORT KIDS IN FOSTER CARE GRADUATE FROM HIGH SCHOOL TREEHOUSE 2100 24TH AVE S STE 200 SEATTLE WA 98122 911425676 501(C)(3) 41818 DONATION TO THE GENERAL FUND UNITED WAY OF GENESEE COUNTY 111 E COURT ST STE 3A FLINT MI 48502 381359516 501(C)(3) 125000 TO HELP SUPPORT THE FLINT WATER FUND VETERANS MULTI-SERVICE CENTER 213 N 4TH ST PHILADELPHIA PA 19106 232764079 501(C)(3) 19121 TO HELP SUPPORT ASSISTANCE TO WOMEN VETERANS WAR CHILD US AVANT BUILDING STE 900 200 DELAWARE AVE BUFFALO NY 14202 200994157 501(C)(3) 50000 DONATION TO THE GENERAL FUND WE DEFY 4100 W ELDORADO PARKWAY 100-375 MCKINNEY TX 75070 474543790 501(C)(3) 17544 DONATION TO THE GENERAL FUND WEST SEATTLE FOOD BANK 3419 SW MORGAN ST SEATTLE WA 98126 911464412 501(C)(3) 24000 DONATION TO THE GENERAL FUND WESTSIDE SCHOOL 10404 34TH AVE SW SEATTLE WA 98146 911151493 501(C)(3) 25000 TO HELP SUPPORT THE TUITION ASSISTANCE PROGRAM WILD LOVE PRESERVE 12239 10TH AVE S BURIEN WA 98168 273729450 501(C)(3) 15000 TO HELP SUPPORT PRESERVATION OF IDAHO WILD HORSES WOUNDED WARRIORS ABILITIES RANCH CORP PO BOX 1035 PINELLAS PARK FL 33780 463660965 501(C)(3) 16619 TO HELP BUILD WWAR HEAD QUARTERS IN PINELLAS PARK YMCA OF METRO CHICAGO 1030 W VAN BUREN CHICAGO IL 60607 362179782 501(C)(3) 39191 TO HELP SUPPORT SAFETY AND VIOLENCE PREVENTION YOUTHCARE 2500 NE 54TH ST SEATTLE WA 98105 910917079 501(C)(3) 10000 DONATION TO THE GENERAL FUND ZUMIX 260 SUMNER ST BOSTON MA 02128 043132674 501(C)(3) 18180 TO HELP SUPPORT THE YOUTH DEVELOPMENT PROGRAM 53 0 HOUSING AND LIVING COSTS 1 0 11000 BOOK VALUE BASIC LIVING COSTS TO AID REFUGEE FAMILY IN SETTLING INTO NEW HOME IN THE US PART I, LINE 2: VITALOGY FOUNDATION SELECTS GRANTEES THROUGH AN INTERNAL PROCESS WITH THE FOUNDATION'S BOARD OF DIRECTORS. EACH POTENTIAL GRANTEE'S REQUEST IS REVIEWED BY EACH BOARD MEMBER TO ENSURE IT MEETS THE VITALOGY FOUNDATION'S MISSION GUIDELINES AND THE CHARITY WILL USE THE GRANT EXCLUSIVELY TO CARRY OUT THE "AS DETAILED" CHARITABLE PROJECT, OR FOR GENERAL OPERATIONS, EXCLUSIVELY FOR EXEMPT PURPOSES. ONCE THE GRANTEE HAS BEEN APPROVED, VITALOGY FOUNDATION PROVIDES THE CHARITY WITH A GRANTEE FORM THAT REQUESTS DETAILED INFORMATION ON THE ORGANIZATION INCLUDING ITS TAX ID NUMBER, IRS TAX DETERMINATION LETTER, AS WELL AS THE FUNDS REQUESTED AND HOW THEY WILL BE USED, A DISCLAIMER THAT NO GOODS OR SERVICES WERE EXCHANGED FOR THE GRANT, AND A REQUEST FOR UPDATES AND REPORTS. AFTER THE GRANTEE FORM IS IN HAND, THE CHARITY IS SENT THE FUNDS ALONG WITH THE FOUNDATION'S DONATION ACKNOWLEDGEMENT LETTER WHICH REQUESTS A SIGNATORY BACK CONFIRMING RECEIPT OF THE FUNDS. VITALOGY FOUNDATION FOLLOWS-UP WITH THE GRANTEES TO ENSURE THEY ARE ADHERING TO OUR GUIDELINES THROUGH REGULAR PHONE CALLS AS WELL AS REQUESTING WRITTEN UPDATES EVERY SIX MONTHS. THE VITALOGY FOUNDATION TEAM ALSO MAKES SITE VISITS TO SELECT LARGER SCALE GRANTEES TO GET FIRST HAND KNOWLEDGE OF HOW THE FUNDS ARE BEING APPLIED/DISPERSED IN THE FIELD. FROM THESE REPORTS AND CORRESPONDENCE WITH THE GRANTEE, THE VITALOGY FOUNDATION TEAM PROVIDES UPDATES TO THE BOARD OF DIRECTORS TWO WAYS; THROUGH WEEKLY PROJECT UPDATES AND THROUGH A MORE DETAILED ANNUAL PROJECT UPDATE AS WARRANTED BASED UPON THE SIZE OF THE GRANT. TO TRACK THESE PROJECTS, THE GRANTEES' WRITTEN REPORTS, TEAM CORRESPONDENCE, AND BOARD UPDATES ARE FILED ALONG WITH THE CORRESPONDING GRANTEE FORM AND IRS LETTER ACKNOWLEDGEMENT. INTERNALLY, VITALOGY FOUNDATION KEEPS A RUNNING CONTRIBUTION SUMMARY OF ALL GRANTS MADE TO DATE BY YEAR THAT INCLUDES TRACKING ON UPDATES RECEIVED BY GRANTEES. X POSTERS 270 20250 FAIR MARKET VALUE 0 0 0 PART I, COLUMN (B): THE NUMBER REPORTED IN COLUMN (B) REPRESENTS THE NUMBER OF ITEMS RECEIVED. FORM 990, PART I, LINE 6, TOTAL NUMBER OF VOLUNTEERS THE TOTAL NUMBER OF VOLUNTEERS CONSIST OF THE SIX NON-COMPENSATED BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 ALL MEMBERS OF THE BOARD HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM, REVIEWED BY OUTSIDE CONSULTANTS KNOWLEDGABLE ABOUT THE ORGANIZATION, AND PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 VITALOGY FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FORM 990 AVAILABLE TO INTERESTED PARTIES UPON REQUEST. PEARL JAM LLC PO BOX 340020 NASHVILLE TN 372030020 911695049 MUSICAL ENTERTAINMENT WA N/A DEKERIVER LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 203277547 BUILDING RENTAL WA N/A TEN CLUB LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 912094535 FAN CLUB MERCHANDISE WA N/A MONKEYWRENCH FILMS LLC PO BOX 340020 NASHVILLE TN 372030020 264471983 FILM PRODUCTION CA N/A MONKEYWRENCH INC PO BOX 340020 NASHVILLE TN 372030020 331062443 MUSICAL RECORDINGS WA N/A S 0 PEARL JAM TOURING INC PO BOX 340020 NASHVILLE TN 372030020 911531093 MUSICAL ENTERTAINMENT NV N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0