2016-10-13T21:29:48-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2015-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 NORM ALLAN TREASURER 3602994201 2016-10-13 1 STEVEN BASS CPA P00004800 4252506100 2016-10-13 2015 2017-02-10 21:41:12Z MARK BACKMAN MD 1211 24TH STREET ANACORTES WA 98221 1132624 0 1 X WWW.ISLANDHOSPITALFOUNDATION.ORG X 1978 WA TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH. 20 20 0 55 0 0 476267 432765 0 0 86133 71666 29380 365570 591780 870001 498561 498771 0 0 108892 0 0 0 0 -97678 75483 509775 574254 82005 295747 2265573 2372862 67020 13899 2198553 2358963 THE MISSION OF THE FOUNDATION IS TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN AND AROUND ANACORTES, WASHINGTON. 0 0 246000 246000 0 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 COUNCELING 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. 260385 252771 0 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 20-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. 0 506385 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 X 20 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X JEANNETTE PAPADAKIS 3602994201 1211 24TH ST ANACORTES WA 98221 MARK BACKMAN MD PRESIDENT 3.00 X X 0 0 0 TROY KUNZ VICE PRESIDENT 3.00 X X 0 0 0 BILL RABEL TREASURER 3.00 X X 0 0 0 DESHA FURIN SECRETARY 3.00 X X 0 0 0 NORM ALLAN DIRECTOR 1.00 X 0 0 0 JOSH BALDWIN DIRECTOR 1.00 X 0 0 0 NICOLE COLEMAN DIRECTOR 1.00 X 0 0 0 JAMIE CROMACK DIRECTOR 1.00 X 0 0 0 KATHLEEN GARDE MD DIRECTOR 1.00 X 0 0 0 RICH HAMPHREY DIRECTOR 1.00 X 0 0 0 MEREDITH MACHIN DIRECTOR 1.00 X 0 0 0 JEREMY MCNETT DIRECTOR 1.00 X 0 0 0 TOM MURPHY DIRECTOR 1.00 X 0 0 0 KRISTA OICLES DIRECTOR 1.00 X 0 0 0 RUSTAN ROBERTSON DIRECTOR 1.00 X 0 0 0 STEVE RUTZ DIRECTOR 1.00 X 0 0 0 MARILYN STADLER DIRECTOR 1.00 X 0 0 0 LARRY BUGHI DIRECTOR 1.00 X 0 0 0 COLLEEN CRAIG DIRECTOR 1.00 X 0 0 0 TOM LACROIX DIRECTOR 1.00 X 0 0 0 JEANNETTE PAPADAKIS FOUNDATION DIRECTOR 40.00 X 0 59008 0 0 59008 0 0 0 0 0 0 432765 188744 432765 71666 71666 361980 262623 99357 99357 MISCELLANOUS REVENUE 900099 266213 266213 266213 870001 337879 0 99357 492284 492284 6487 6487 10729 10729 24750 24750 19239 19239 11697 11697 SUPPLIES 4692 4692 BAD DEBT 2922 2922 0 MISCELLANEOUS EXPENSE 1454 1454 574254 506385 67869 0 65770 112469 0 143931 52329 34500 1250 0 343 0 2145881 2081962 2265573 2372862 67020 13899 67020 13899 X 1879579 2061078 117974 96885 201000 201000 2198553 2358963 2265573 2372862 295747 -88367 -46970 0 X X 0 1 X 1 0 X X 1 ISLAND HOSPITAL -SKAGIT CNTY PHD #2 910729255 3 1 498771 0 1 498771 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SECTION B, LINE 1 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2145881 -41099 8220 14600 2081962 1714403 384090 87727 40339 2145881 1503114 252194 40904 1714404 1374984 173234 45104 1503114 386988 33591 -1790 27692 391097 0.88790 0.09650 0.01560 0 0 0 X 1044257 -88367 -88367 1132624 -262623 -262623 870001 883847 309593 309593 574254 0 574254 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, 2015, THE FOUNDATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. PART XI, LINE 4B - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES -262,623. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES 262,623. IN-KIND CONTRIBUTIONS OF SERVICES 46,970. WA GALA 265096 0 265096 2390 2604 25018 6248 170978 GOLF TOURNAMENT 96884 0 96884 17309 7987 17342 6195 6552 0 0 0 0 361980 361980 19699 10591 42360 12443 177530 262623 99357 JEANNETTE PAPADAKIS 1211 24TH STREET ANACORTES WA 98221 1 ISLAND HOSPITAL SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 1211 24TH STREET ANACORTES WA 98221 910729255 170(C) 492284 SUPPORT OF HEALTH PROGRAMS AT HOSPITAL SUPPORT OF HEALTH PROGRAMS AT HOSPITAL ONCOLOGY GRANTS 16 3478 SCHOLARSHIPS 2 3000 X MISCELLANEOUS ITEMS 90 53000 FAIR MARKET VALUE 0 0 0 PART I, LINE 33: NUMBER OF CONTRIBUTORS IS THE ACTUAL NUMBER OF CONTRIBUTORS OF NON-CASH ITEMS, EXCLUDING CONTRIBUTORS OF SERVICES FORM 990, PART VI, SECTION B, LINE 11 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. FORM 990 PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR THE SELECTION PROCESS DURING THE FILING YEAR. ISLAND HOSPITAL - SKAGIT COUNTY PHD #2 1211 24TH STREET ANACORTES WA 98221 910729255 HEALTH CARE WA 170(C) LN3_HOSPITALCOOPINSE 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 ISLAND HOSPITAL B 492284 CASH ISLAND HOSPITAL O 99025 CASH