BETA

VITALOGY FOUNDATION: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
VITALOGY FOUNDATION (EIN 20-1030462)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-08-05
IRS object ID
201632189349300443
Schema version
2015v2.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-08-05T11:38:47-05:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN911194016PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLARK NUBER PSBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110900 NE 4TH STREET SUITE 1700AddressLine1Txt
CityBELLEVUECityNm
State AbbreviationWAStateAbbreviationCd
ZIP98004ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN201030462EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1VITALOGY FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlVITABusinessNameControlTxt
Phone6153299902PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O FBMM INC PO BOX 340020AddressLine1Txt
CityNASHVILLECityNm
State AbbreviationTNStateAbbreviationCd
ZIP372030020ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAMIE CHEEKPersonNm
Person TitleTREASURERPersonTitleTxt
Phone6153299902PhoneNum
Signature2016-08-01SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKATHRYN J ONGPreparerPersonNm
PTINP00746598PTIN
Phone4254544919PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2016-12-15 16:53:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSTONE C GOSSARDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O FBMM INC PO BOX 340020AddressLine1Txt
CityNASHVILLECityNm
State AbbreviationTNStateAbbreviationCd
ZIP372030020ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,128,462GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2004FormationYr
Legal Domicile StateWALegalDomicileStateCd
Activity Or MissionTO 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.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$881,984PYContributionsGrantsAmt
CY Contributions Grants$1,118,345CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$1,715PYInvestmentIncomeAmt
CY Investment Income$837CYInvestmentIncomeAmt
PY Other Revenue$2,570PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$886,269PYTotalRevenueAmt
CY Total Revenue$1,119,182CYTotalRevenueAmt
PY Grants And Similar Paid$882,272PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$608,828CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,975PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,550CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$21,268CYTotalFundraisingExpenseAmt
PY Other Expenses$91,823PYOtherExpensesAmt
CY Other Expenses$195,854CYOtherExpensesAmt
PY Total Expenses$982,070PYTotalExpensesAmt
CY Total Expenses$810,232CYTotalExpensesAmt
PY Revenues Less Expenses-$95,801PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$308,950CYRevenuesLessExpensesAmt
Total Assets BOY$973,013TotalAssetsBOYAmt
Total Assets EOY$1,280,574TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$973,013NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,280,574NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$700,146ExpenseAmt
Grant$608,828GrantAmt
DescGRANTS 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.Desc
Total Program Service Expenses$700,146TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign ActivitiesYes (1)ForeignActivitiesInd
More Than5000 K To OrgYes (1)MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document4IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn0AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc0RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FBMM INC CO JAMIE CHEEKBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6153299902PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 340020AddressLine1Txt
CityNASHVILLECityNm
State AbbreviationTNStateAbbreviationCd
ZIP372030020ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JEFFREY A AMENT
PRESIDENT1.0020.00Yes (X)Yes (X)$0$0$0
MICHAEL D MCCREADY
VICE PRESIDENT1.0020.00Yes (X)Yes (X)$0$0$0
EDDIE J VEDDER
VICE PRESIDENT1.0020.00Yes (X)Yes (X)$0$0$0
KELLY CURTIS
SECRETARY1.0020.00Yes (X)Yes (X)$0$0$0
STONE C GOSSARD
TREASURER1.0020.00Yes (X)Yes (X)$0$0$0
MATTHEW D CAMERON
DIRECTOR1.000.00Yes (X)$0$0$0
JAMIE CHEEK
TREASURER1.000.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$133,347FundraisingAmt
All Other Contributions$984,998AllOtherContributionsAmt
Noncash Contributions$9,280NoncashContributionsAmt
Total Contributions$1,118,345TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$837TotalRevenueColumnAmt
Exclusion$837ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$9,280FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$133,347ContriRptFundraisingEventAmt
Fundraising Direct Expenses$9,280FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,119,182TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$837ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$572,828TotalAmt
Program Services$572,828ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$6,000TotalAmt
Program Services$6,000ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$30,000TotalAmt
Program Services$30,000ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,837TotalAmt
Management And General$4,837ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$713TotalAmt
Management And General$713ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$8,892TotalAmt
Management And General$3,784ManagementAndGeneralAmt
Fundraising$5,108FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$12,866TotalAmt
Management And General$12,866ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$91,753TotalAmt
Program Services$90,000ProgramServicesAmt
Management And General$753ManagementAndGeneralAmt
Fundraising$1,000FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$17,971TotalAmt
Program Services$145ProgramServicesAmt
Management And General$2,666ManagementAndGeneralAmt
Fundraising$15,160FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,173TotalAmt
Program Services$1,173ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescFOREIGN TAXESDesc
Total$63,199TotalAmt
Management And General$63,199ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$810,232TotalAmt
Program Services$700,146ProgramServicesAmt
Management And General$88,818ManagementAndGeneralAmt
Fundraising$21,268FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$36,787BOYAmt
EOY$583,441EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$936,226BOYAmt
EOY$697,133EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$973,013BOYAmt
EOY$1,280,574EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$973,013BOYAmt
EOY$1,280,574EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$973,013BOYAmt
EOY$1,280,574EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$973,013BOYAmt
EOY$1,280,574EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$308,950ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$1,389OtherChangesInNetAssetsAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$707,154CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$245,320CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,066,775CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$881,984CurrentTaxYearMinus1YearAmt
Current Tax Year$1,118,345CurrentTaxYearAmt
Total$4,019,578TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$707,154CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$245,320CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,066,775CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$881,984CurrentTaxYearMinus1YearAmt
Current Tax Year$1,118,345CurrentTaxYearAmt
Total$4,019,578TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$4,019,578PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,489CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,011CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,083CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,715CurrentTaxYearMinus1YearAmt
Current Tax Year$837CurrentTaxYearAmt
Total$7,135TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$34,878CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,570CurrentTaxYearMinus1YearAmt
Total$37,448TotalAmt
FieldValueIRS element (for citing)
Total Support$4,064,161TotalSupportAmt
Public Support CY1700.98900PublicSupportCY170Pct
Public Support PY1700.98590PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationREFUND - 2013 AMOUNT: $ 33,236. 2014 AMOUNT: $ 2,570. EXPENSE REIMBURSEMENT - 2013 AMOUNT: $ 1,642.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule F IRS990ScheduleF

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Account Activities Outside US AccountActivitiesOutsideUSGrp (3 entries)

RegionRegionTxtOfficesOfficesCntEmployeeEmployeeCntType Of Activities ConductedTypeOfActivitiesConductedTxtRegion Total ExpendituresRegionTotalExpendituresAmt
SOUTH ASIA00GRANTMAKING$30,000
NORTH AMERICA00FUNDRAISING
SOUTH AMERICA00FUNDRAISING
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continutation Total Office0ContinutationTotalOfficeCnt
Continutation Total Employee0ContinutationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$30,000SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$30,000TotalSpentAmt

Grants To Org Outside US GrantsToOrgOutsideUSGrp (2 entries)

RegionRegionTxtPurpose Of GrantPurposeOfGrantTxtCash GrantCashGrantAmtManner Of Cash DisbursementMannerOfCashDisbursementTxtNon Cash AssistanceNonCashAssistanceAmt
SOUTH ASIARELIEF FUND$20,000CASH PAYMENT$0
SOUTH ASIARELIEF EFFORTS$10,000CASH PAYMENT$0
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt
Transfer To Foreign Corp0TransferToForeignCorpInd
Interest In Foreign Trust0InterestInForeignTrustInd
Foreign Corp Ownership0ForeignCorpOwnershipInd
Passive Foreign Investmest Co0PassiveForeignInvestmestCoInd
Foreign Partnership0ForeignPartnershipInd
Boycott Countries0BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 AND SOUTH AMERICA THROUGH PEARL JAM CONCERTS. EXPENSES FOR THESE FUNDRAISING EVENTS ARE DONATED BY PEARL JAM TOURING, INC.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1JANUARY SWEEPSTAKESEvent1Nm
Gross Receipts Event1$43,066GrossReceiptsEvent1Amt
Charitable Contri Event1$41,646CharitableContriEvent1Amt
Gross Revenue Event1$1,420GrossRevenueEvent1Amt
Non Cash Prizes Event1$1,420NonCashPrizesEvent1Amt
Event2SEPTEMBER AUCTIONEvent2Nm
Gross Receipts Event2$40,000GrossReceiptsEvent2Amt
Charitable Contri Event2$39,000CharitableContriEvent2Amt
Gross Revenue Event2$1,000GrossRevenueEvent2Amt
Non Cash Prizes Event2$1,000NonCashPrizesEvent2Amt
Other Events Total2OtherEventsTotalCnt
Gross Receipts Other Events$59,561GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$52,701CharitableContriOtherEventsAmt
Gross Revenue Other Events$6,860GrossRevenueOtherEventsAmt
Non Cash Prizes Other Events$6,860NonCashPrizesOtherEventsAmt
Gross Receipts Total$142,627GrossReceiptsTotalAmt
Charitable Contributions Tot$133,347CharitableContributionsTotAmt
Gross Revenue Total Events$9,280GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$9,280NonCashPrizesTotalEventsAmt
Direct Expense Summary Events$9,280DirectExpenseSummaryEventsAmt
Net Income Summary$0NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (26 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxtAddress Line2USAddress/AddressLine2Txt
CCFA
9 LAKE BELLEVUE DR STE 203BELLEVUEWA98005136193105501(C)(3)$16,450SUPPORTS CCFA'S MISSION TO CURE CROHN'S DISEASE AND ULCERATIVE COLITIS AND TO INCREASE QUALITY OF LIFE OF THOSE AFFECTED
CCFA
9 LAKE BELLEVUE DR STE 203BELLEVUEWA98005136193105501(C)(3)$25,000SUPPORTS CCFA'S CAMP OASIS SCHOLARSHIP FUND
DESC
515 THIRD AVESEATTLEWA98104911275815501(C)(3)$25,546DONATION TO THE GENERAL FUND
DOCTORS WITHOUT BORDERS
333 7TH AVE 2ND FLRNEW YORKNY10001133433452501(C)(3)$10,000DONATION TO THE GENERAL FUND
EB RESEARCH PARTNERSHIP
1725 YORK AVE STE 29GNEW YORKNY10128272417202501(C)(3)$19,400TO FUND RESEARCH AIMED AT TREATING AND ULTIMATELY CURING EB
FRED HUTCHINSON RESEARCH CENTER
PO BOX 19024 MAIL STOP J5200SEATTLEWA98109237156071501(C)(3)$35,546TO SUPPORT BRAIN CANCER RESEARCH
GLOBAL POVERTY PROJECT INC
594 BROADWAY SUITE 207NEW YORKNY10012421772557501(C)(3)$8,500DONATION TO THE GENERAL FUND
HEDGEBROOK
216 1ST AVE S STE 251SEATTLEWA98104800012629501(C)(3)$6,000TO SUPPORT SONGWRITERS RESIDENCY PROGRAM
HOLLAND PROJECT
140 VESTA STREETRENONV89502711017805501(C)(3)$11,000DONATION TO THE GENERAL FUND
KEXP
113 DEXTER AVE NSEATTLEWA98109912061474501(C)(3)$24,000TO HELP SUPPORT "BREAKING NEW GROUND TOGETHER: THE CAMPAIGN FOR KEXP'S NEW HOME"
MARY'S PLACE
1830 9TH AVESEATTLEWA98101272087950501(C)(3)$10,000DONATION TO THE GENERAL FUND
MONTANA SKATEPARK ASSOCIATION
618 S HIGGINS AVEMISSOULAMT59801820583110501(C)(3)$60,000TO HELP CREATE A PUBLIC, CONCRETE SKATEPARK IN STEVENSVILLE, MT
OCEANIC SOCIETY
PO BOX 437ROSSCA94957943105570501(C)(3)$10,000DONATION TO THE GENERAL FUND
REVOLUTION PER MINUTE
1475 15TH STSAN FRANCISCOCA94103721600331501(C)(3)$10,000DONATION TO THE GENERAL FUND
ROBIN HOOD FOUNDATION
826 BROADWAY 9TH FLOORNEW YORKNY10003133441066501(C)(3)$20,000TO HELP SUPPORT NEW YORKERS IN NEED
ROCK SCHOOL
10903 NE 53RD STKIRKLANDWA98033460494902501(C)(3)$10,000TO COVER TEACHING ARTIST FEES TO PROVIDE SCHOLARSHIPS FOR YOUTH
SEATTLE CHILDREN'S HOSPITAL FOUNDATION
PO BOX 5371 M/S S-200SEATTLEWA98145911156519501(C)(3)$50,000DONATION TO THE GENERAL FUND
SEATTLE'S UNION GOSPEL MISSION
PO BOX 202SEATTLEWA98111910595029501(C)(3)$10,000DONATION TO THE GENERAL FUND
SPRUCE STREET SCHOOL
914 VIRGINIA STSEATTLEWA98101910963223501(C)(3)$5,000DONATION TO THE GENERAL FUND
SPRUCE STREET SCHOOL
914 VIRGINIA STSEATTLEWA98101910963223501(C)(3)$10,000DONATION TO THE ANNUAL FUND THAT SUPPORTS ART, MUSIC, PE, ELECTIVES, AND FINANCIAL AID
STRONGHOLD SOCIETY
2022 E 134TH WAYTHORNTONCO80241273621140501(C)(3)$50,000TO HELP FUND THE CONSTRUCTION AT THE PINE RIDGE SKATEPARK AS WELL AS THE WOUNDED KNEE SKATEPARK
SUSAN G KOMEN 3-DAY
820 W JACKSON BLVD SUITE 800CHICAGOIL60607751835298501(C)(3)$6,000TO HELP FUND BREAST CANCER RESEARCH AND TREATMENT
THE ACTOR'S GANG
9070 VENICE BLVDCULVER CITYCA90232954226223501(C)(3)$25,000DONATION TO THE GENERAL FUND
TREEHOUSE
2100 24TH AVE S STE 200SEATTLEWA98122911425676501(C)(3)$25,000DONATION TO THE GENERAL FUND
TREEHOUSE
2100 24TH AVE S STE 200SEATTLEWA98122911425676501(C)(3)$4,818TO HELP SUPPORT KIDS IN FOSTER CARE GRADUATE FROM HIGH SCHOOL.
WAR CHILD US
AVANT BUILDING STE 900 200 DELAWAREBUFFALONY14202200994157501(C)(3)$25,000DONATION TO THE GENERAL FUNDAVE
FieldValueIRS element (for citing)
Total501c3 Org23Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeHOUSING AND LIVING COSTSGrantTypeTxt
Recipient1RecipientCnt
Cash Grant$0CashGrantAmt
Non Cash Assistance$6,000NonCashAssistanceAmt
Valuation Method UsedBOOK VALUEValuationMethodUsedDesc
Non Cash AssistanceBASIC LIVING COSTS TO AID REFUGEE FAMILY IN SETTLING INTO NEW HOME IN THE USNonCashAssistanceDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationVITALOGY 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.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 6, TOTAL NUMBER OF VOLUNTEERSTHE TOTAL NUMBER OF VOLUNTEERS CONSISTS OF THE SIX NON-COMPENSATED BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 2ALL MEMBERS OF THE BOARD HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER.
FORM 990, PART VI, SECTION B, LINE 11THE 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 19VITALOGY FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FORM 990 AVAILABLE TO INTERESTED PARTIES UPON REQUEST.
FORM 990, PART IX, LINE 11GFUNDRAISING EXPENSE - PRIZES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 1,000. TOTAL EXPENSES 1,000. OTHER SERVICES : PROGRAM SERVICE EXPENSES 90,000. MANAGEMENT AND GENERAL EXPENSES 753. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,753.
FORM 990, PART XI, LINE 9:PY ACCRUAL TO CASH ADJUSTMENT -1,389.

Schedule R IRS990ScheduleR

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
PEARL JAM LLC
PO BOX 340020NASHVILLETN372030020911695049MUSICAL ENTERTAINMENTWAN/A
DEKERIVER LLC
1900 SOUTH CORGIAT DRIVESEATTLEWA98108203277547BUILDING RENTALWAN/A
TEN CLUB LLC
1900 SOUTH CORGIAT DRIVESEATTLEWA98108912094535FAN CLUB MERCHANDISEWAN/A
MONKEYWRENCH FILMS LLC
PO BOX 340020NASHVILLETN372030020264471983FILM PRODUCTIONCAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
MONKEYWRENCH INC
PO BOX 340020NASHVILLETN372030020331062443MUSICAL RECORDINGSWAN/AS0
PEARL JAM TOURING INC
PO BOX 340020NASHVILLETN372030020911531093MUSICAL ENTERTAINMENTNVN/AS0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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