2016-08-05T11:38:47-05:00 2015-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2015-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK TREASURER 6153299902 2016-08-01 1 KATHRYN J ONG P00746598 4254544919 2015 2016-12-15 16:53:06Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 1128462 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 7 0 0 881984 1118345 0 0 1715 837 2570 0 886269 1119182 882272 608828 0 0 7975 5550 0 0 21268 91823 195854 982070 810232 -95801 308950 973013 1280574 0 0 973013 1280574 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 700146 608828 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. 700146 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 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 FBMM INC CO JAMIE CHEEK 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 133347 984998 9280 1118345 837 837 9280 133347 9280 0 1119182 0 0 837 X 572828 572828 6000 6000 30000 30000 4837 4837 713 713 8892 3784 5108 12866 12866 91753 90000 753 1000 17971 145 2666 15160 1173 1173 FOREIGN TAXES 63199 63199 810232 700146 88818 21268 36787 583441 936226 697133 973013 1280574 0 0 X 973013 1280574 973013 1280574 973013 1280574 X 308950 -1389 X 0 0 0 X 707154 245320 1066775 881984 1118345 4019578 707154 245320 1066775 881984 1118345 4019578 4019578 1489 2011 1083 1715 837 7135 34878 2570 37448 4064161 0.98900 0.98590 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 1 SOUTH ASIA 0 0 GRANTMAKING 30000 NORTH AMERICA 0 0 FUNDRAISING SOUTH AMERICA 0 0 FUNDRAISING 0 0 0 0 0 0 30000 0 30000 SOUTH ASIA RELIEF FUND 20000 CASH PAYMENT 0 SOUTH ASIA RELIEF EFFORTS 10000 CASH PAYMENT 0 2 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 AND SOUTH AMERICA THROUGH PEARL JAM CONCERTS. EXPENSES FOR THESE FUNDRAISING EVENTS ARE DONATED BY PEARL JAM TOURING, INC. JANUARY SWEEPSTAKES 43066 41646 1420 1420 SEPTEMBER AUCTION 40000 39000 1000 1000 2 59561 52701 6860 6860 142627 133347 9280 9280 9280 0 1 CCFA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 16450 SUPPORTS 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 203 BELLEVUE WA 98005 136193105 501(C)(3) 25000 SUPPORTS CCFA'S CAMP OASIS SCHOLARSHIP FUND DESC 515 THIRD AVE SEATTLE WA 98104 911275815 501(C)(3) 25546 DONATION TO THE GENERAL FUND DOCTORS WITHOUT BORDERS 333 7TH AVE 2ND FLR NEW YORK NY 10001 133433452 501(C)(3) 10000 DONATION TO THE GENERAL FUND EB RESEARCH PARTNERSHIP 1725 YORK AVE STE 29G NEW YORK NY 10128 272417202 501(C)(3) 19400 TO FUND RESEARCH AIMED AT TREATING AND ULTIMATELY CURING EB FRED HUTCHINSON RESEARCH CENTER PO BOX 19024 MAIL STOP J5200 SEATTLE WA 98109 237156071 501(C)(3) 35546 TO SUPPORT BRAIN CANCER RESEARCH GLOBAL POVERTY PROJECT INC 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 8500 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 HOLLAND PROJECT 140 VESTA STREET RENO NV 89502 711017805 501(C)(3) 11000 DONATION TO THE GENERAL FUND KEXP 113 DEXTER AVE N SEATTLE WA 98109 912061474 501(C)(3) 24000 TO HELP SUPPORT "BREAKING NEW GROUND TOGETHER: THE CAMPAIGN FOR KEXP'S NEW HOME" MARY'S PLACE 1830 9TH AVE SEATTLE WA 98101 272087950 501(C)(3) 10000 DONATION TO THE GENERAL FUND MONTANA SKATEPARK ASSOCIATION 618 S HIGGINS AVE MISSOULA MT 59801 820583110 501(C)(3) 60000 TO HELP CREATE A PUBLIC, CONCRETE SKATEPARK IN STEVENSVILLE, MT OCEANIC SOCIETY PO BOX 437 ROSS CA 94957 943105570 501(C)(3) 10000 DONATION TO THE GENERAL FUND REVOLUTION PER MINUTE 1475 15TH ST SAN FRANCISCO CA 94103 721600331 501(C)(3) 10000 DONATION TO THE GENERAL FUND ROBIN HOOD FOUNDATION 826 BROADWAY 9TH FLOOR NEW YORK NY 10003 133441066 501(C)(3) 20000 TO HELP SUPPORT NEW YORKERS IN NEED ROCK SCHOOL 10903 NE 53RD ST KIRKLAND WA 98033 460494902 501(C)(3) 10000 TO COVER TEACHING ARTIST FEES TO PROVIDE SCHOLARSHIPS FOR YOUTH 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'S UNION GOSPEL MISSION PO BOX 202 SEATTLE WA 98111 910595029 501(C)(3) 10000 DONATION TO THE GENERAL FUND SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 5000 DONATION TO THE GENERAL FUND SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 DONATION TO THE ANNUAL FUND THAT SUPPORTS ART, MUSIC, PE, ELECTIVES, AND FINANCIAL AID STRONGHOLD SOCIETY 2022 E 134TH WAY THORNTON CO 80241 273621140 501(C)(3) 50000 TO 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 800 CHICAGO IL 60607 751835298 501(C)(3) 6000 TO HELP FUND BREAST CANCER RESEARCH AND TREATMENT THE ACTOR'S GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 25000 DONATION TO THE GENERAL FUND TREEHOUSE 2100 24TH AVE S STE 200 SEATTLE WA 98122 911425676 501(C)(3) 25000 DONATION TO THE GENERAL FUND TREEHOUSE 2100 24TH AVE S STE 200 SEATTLE WA 98122 911425676 501(C)(3) 4818 TO HELP SUPPORT KIDS IN FOSTER CARE GRADUATE FROM HIGH SCHOOL. WAR CHILD US AVANT BUILDING STE 900 200 DELAWARE AVE BUFFALO NY 14202 200994157 501(C)(3) 25000 DONATION TO THE GENERAL FUND 23 0 HOUSING AND LIVING COSTS 1 0 6000 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. FORM 990, PART I, LINE 6, TOTAL NUMBER OF VOLUNTEERS THE TOTAL NUMBER OF VOLUNTEERS CONSISTS 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 11 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. FORM 990, PART IX, LINE 11G FUNDRAISING 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. 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