2015-05-15T12:30:37-05:00 2014-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2013-07-01 721545902 PEACEHEALTH ST JOSEPH MEDICAL CENTER FOUNDATION PEAC 3607886866 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 MARK MCCAMPBELL NW NETWORK CDO 3607566865 2015-05-13 1 SARA ELIZABETH J HYRE P00235495 4254544919 2015-05-13 2013 2016-03-07 17:11:31Z MARK MCCAMPBELL 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 1803995 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/ST-JOSEPH X 2003 WA TO RAISE CONTRIBUTIONS AND ESTABLISH ENDOWMENTS TO SUPPORT PEACEHEALTH ST. JOSEPH MEDICAL CENTER ACTIVITIES. 23 22 0 39 0 0 2549089 1716957 0 0 55375 50192 18027 -216149 2622491 1551000 2114187 704703 0 0 0 0 0 0 494183 963198 643939 3077385 1348642 -454894 202358 4635803 4951527 259430 266199 4376373 4685328 X PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOUNDATION EXISTS TO ACQUIRE AND RECOGNIZE CHARITABLE GIFTS AND BEQUESTS THAT ASSIST PEACEHEALTH ST. JOSEPH MEDICAL CENTER IN FULFILLING ITS MISSION, ADHERING TO ITS CORE VALUES AND PROVIDING MEDICAL SERVICES TO THE WHATCOM REGION. THE FOUNDATION WILL:- PROVIDE INDIVIDUALS AND INSTITUTIONS WITH AN OPPORTUNITY TO EXTENDTHE GIFT OF HEALTH TO CITIZENS IN NORTHWEST WASHINGTON STATE.- SUPPORT THE APPLICATION OF INNOVATIVE PATIENT CARE SERVICES TOIMPROVE THE HEALTH CARE SERVICES OF THIS AREA.- ACHIEVE FOR THE MEDICAL CENTER A HIGHER LEVEL OF MUTUALUNDERSTANDING AND INVOLVEMENT WITH THE COMMUNITIES IT SERVES.- PHILANTHROPIC OPPORTUNITIES SHOULD ENHANCE THE ABILITY OF ST. JOSEPHMEDICAL CENTER TO PROVIDE HEALING AND COMPASSIONATE HEALTHCARE RESPECTING EVERY PERSON'S HUMAN DIGNITY. 0 0 663703 663703 SUPPORT OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOR EDUCATION, PATIENT SUPPORT, NURSING SUPPORT, RESEARCH, CAPITAL EXPENDITURES, SCHOLARSHIPS AND CHARITY CARE. THE FOUNDATION RECEIVES FROM PEACEHEALTH ST. JOSEPH MEDICAL CENTER AND PEACEHEALTH CORPORATION DONATED USE OF FACILITIES AND SERVICES, WHICH INCLUDE SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES, AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $459,121 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES, AND 446,711 OF SUCH CONTRIBUTION OF HOSPITAL PERSONNEL HAS BEEN INCLUDED ON FORM 990 TO ACCURATELY REFLECT THE FINANCIAL POSITION OF THE FOUNDATION. 41000 41000 THE WHATCOM HOSPICE FOUNDATION TRANSFERS. THE WHATCOM HOSPICE FOUNDATION'S MISSION IS TO SUPPORT HOSPICE SERVICES IN WHATCOM COUNTY AND THE SURROUNDING AREA. 704703 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 23 22 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 WA X NICOLE POYNER 3607886540 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 X CHARLES ARIZ MD DIRECTOR 1.00 0.00 X 0 0 0 BRADLEY BEARDEN OD DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL BRADBURN DIRECTOR 1.00 0.00 X 0 0 0 BRAD DEHAAN DIRECTOR 1.00 0.00 X 0 0 0 AMY ESARY DIRECTOR 1.00 0.00 X 0 0 0 MARION ROBIN FOOTE TREASURER 1.00 0.00 X X 0 0 0 ROSEMARIE FRANCIS DIRECTOR 1.00 0.00 X 0 0 0 WILLIAM HALL MD DIRECTOR 1.00 0.00 X 0 0 0 DENNY HOLMSTROM DIRECTOR 1.00 0.00 X 0 0 0 JOHN HUNTLEY PRESIDENT 1.00 0.00 X X 0 0 0 FRANK IMHOF DIRECTOR 1.00 0.00 X 0 0 0 KATIE JANSEN DIRECTOR 1.00 0.00 X 0 0 0 LYNNETTE JENSEN DIRECTOR 1.00 0.00 X 0 0 0 CHET KENOYER DIRECTOR 1.00 0.00 X 0 0 0 RICHARD J LEONE MD DIRECTOR 1.00 40.00 X 0 699303 44241 MIKE PERRY DIRECTOR 1.00 0.00 X 0 0 0 SARAH ROTHENBUHLER DIRECTOR 1.00 0.00 X 0 0 0 JOHN SITKIN DIRECTOR 1.00 0.00 X 0 0 0 NANCY STEIGER REGIONAL CEO & CHIEF MISSION OFFICER (THRU 6/14) 1.00 40.00 X X 0 626598 39117 HOLLY STUDLEY DIRECTOR 1.00 0.00 X 0 0 0 SHAUN SULLIVAN MD VICE PRESIDENT 1.00 0.00 X X 0 0 0 CHRISTINE THOMPSON SECRETARY 1.00 0.00 X X 0 0 0 CHERYL WEG DIRECTOR 1.00 0.00 X 0 0 0 DOUG WIGHT DIRECTOR 1.00 0.00 X 0 0 0 MARK MCCAMPBELL VP OF PHILANTHROPY, NW NETWORK CDO 1.00 40.00 X 0 245219 9212 0 1571120 92570 0 0 1 0 0 386313 634156 696488 669356 1716957 50192 50192 13676 0 13676 13676 13676 23170 386313 252995 -229825 -229825 1551000 0 0 -165957 704703 704703 26955 26955 2280 2280 160461 23647 136814 CONTRIBUTED SALARIES 446711 89342 357369 BANK CHARGES 7532 7532 1348642 704703 149756 494183 2387884 2523789 941372 643037 1038616 1486601 190530 204225 77401 93875 4635803 4951527 259430 266199 259430 266199 X 1835283 2157119 2170814 2157933 370276 370276 4376373 4685328 4635803 4951527 X 202358 174287 -67690 X 0 1 X 1 0 X 1295391 1730933 3358922 2549089 1716957 10651292 1295391 1730933 3358922 2549089 1716957 10651292 1026446 9624846 50603 44176 58577 71020 63868 288244 2382 2382 10941918 0.87960 0.86630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1386904 54250 204559 2220 1643493 1273160 113744 1386904 1125630 154645 -2293 4000 822 1273160 989556 67276 69561 763 1125630 880911 52598 56047 989556 0.66700 0.22500 0.10800 0 0 0 1735417 174287 12410 -2280 184417 1551000 0 1551000 1426462 12410 67690 80100 1346362 2280 2280 1348642 PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR CAPITAL, SCHOLARSHIPS, AND ACCESS CARE (CHARITY CARE). PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT FEE -2,280. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PLEDGES 67,690. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEE 2,280. SCHEDULE D, PART XI, LINE 2A: NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS 157,813 CHANGE IN SPLIT INTEREST VALUE 16,474 TOTAL 174,287 SCHEDULE D, PART XI, LINE 2B AND PART XII, LINE 2A: THE FOUNDATION RECEIVES FROM PEACEHEALTH ST. JOSEPH MEDICAL CENTER AND PEACEHEALTH CORPORATION DONATED USE OF FACILITIES AND SERVICES, WHICH INCLUDE SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES, AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $459,121 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES, AND $446,711 OF SUCH CONTRIBUTION OF HOSPITAL PERSONNEL HAS BEEN INCLUDED ON FORM 990 TO ACCURATELY REFLECT THE FINANCIAL POSITION OF THE FOUNDATION; $12,410 OF CONTRIBUTED USE OF FACILITIES HAS BEEN REMOVED FROM THE FORM 990. GALA 397822 379022 18800 62756 12553 155651 WOMEN'S HEALTH FORUM 11661 7291 4370 500 5536 1380 14619 409483 386313 23170 500 68292 13933 170270 252995 -229825 1 PEACEHEALTH ST JOSEPH MEDICAL CENTER 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 910565889 501(C)(3) 654433 9270 FMV SUPPLIES PATIENT CARE THE WHATCOM HOSPICE FOUNDATION 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 943146369 501(C)(3) 41000 N/A N/A HOSPICE PROGRAM OF ST JOSEPH'S 2 0 PART I, LINE 2: THE FOUNDATION RECEIVES BACKUP DOCUMENTATION (USUALLY IN THE FORM OF AN INVOICE) FROM THE GRANTEE SHOWING FUNDS WERE USED FOR THEIR INTENDED PURPOSE. 0 1 0 0 0 0 0 0 0 RICHARD J LEONE MD DIRECTOR 0 585000 0 15000 0 99303 0 43634 0 607 0 743544 0 0 NANCY STEIGER REGIONAL CEO & CHIEF MISSION OFFICER 0 577798 0 35000 0 13800 0 35489 0 3628 0 665715 0 0 MARK MCCAMPBELL VP OF PHILANTHROPY, NW NETWORK CDO 0 216122 0 10000 0 19097 0 4541 0 4671 0 254431 0 0 PART I, LINE 4B THERE IS A 457(F) PLAN FOR SENIOR VPS, PRESIDENT AND CHIEF MISSION OFFICER. NANCY STEIGER AND RICHARD J. LEONE ARE PARTICIPANTS IN THIS PLAN, NANCY DID NOT RECEIVE ANY PAYMENT, AND RICHARD RECEIVED PAYMENT OF $17,582 DURING THE REPORTING YEAR. X 4 8400 FMV X CON. SALARIES 1 446711 BOOK VALUE X SUPPLIES 1 187416 COST X MISC. GIFTS 28 26829 FMV 0 0 1 0 PART I, COLUMN (B): PART I COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART I, LINE 6: THERE ARE 24 VOLUNTEERS THAT SERVE AS BOARD MEMBERS, AND 15 VOLUNTEERS THAT HELP WITH FOUNDATION COMMITTEES AND CLERICAL DUTIES IN THE OFFICE OF DEVELOPMENT, SUPPORTING BOTH PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOUNDATION AND WHATCOM HOSPICE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A SEE BELOW DESCRIPTION TO FORM 990, PART VI, SECTION A, LINE 7B. FORM 990, PART VI, SECTION A, LINE 7B AS STATED IN THE ARTICLES OF INCORPORATION "THE FOUNDATION SHALL BE ORGANIZED AND OPERATED EXCLUSIVELY FOR THE PURPOSE OF SUPPORTING PEACEHEALTH ST. JOSEPH MEDICAL CENTER, A PART OF PEACEHEALTH WHATCOM REGION, LOCATED IN BELLINGHAM, WASHINGTON, IN FURTHERANCE OF THE HEALTHCARE MISSION OF ITS OWNER, PEACEHEALTH". THE FOLLOWING ACTIONS OF THE BOARD REQUIRE APPROVAL FROM PEACEHEALTH. 1) THE FOUNDATION SHALL NOT HAVE POWER TO GUARANTEE PAYMENT OR PERFORMANCE BY THIRD PARTIES WITHOUT THE PRIOR WRITTEN CONSENT OF THE PRESIDENT OF PEACEHEALTH OR HIS/HER DELEGATE. 2) THE FOUNDATION SHALL HAVE NO POWER TO MERGE OR CONSOLIDATE WITH OTHER ORGANIZATIONS OR TO CREATE OR ACQUIRE OTHER ORGANIZATIONS OR TO VOLUNTARILY DISSOLVE AND WIND UP ITS AFFAIRS OR TO ENTER INTO ANY ASSIGNMENT OF INCOME OR ASSETS FOR THE BENEFIT OF CREDITORS OR TO SEEK THE PROTECTION OF DEBTOR RELIEF LAWS, WITHOUT HAVING OBTAINED THE PRIOR WRITTEN CONSENT OF THE PRESIDENT OF PEACEHEALTH. 3) WRITTEN CONSENT MUST BE OBTAINED BY THE PRESIDENT OF PEACEHEALTH, OR HIS OR HER DELEGATE, TO THE EXACT LANGUAGE OF ANY PROPOSED CHANGE IN ARTICLES AND BYLAWS. THIS CONSENT SHALL HAVE BEEN FIRST OBTAINED PRIOR TO ANY CHANGE TO THE ARTICLES OF INCORPORATION OR BYLAWS BECOMING EFFECTIVE. 4) ALL PROPOSED NOMINATIONS (OF DIRECTORS) MUST BE APPROVED BY PEACEHEALTH. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS THE FORM 990. ADDITIONALLY, AN ELECTRONIC COPY WITHOUT DONOR NAMES IS PROVIDED TO ALL OTHER BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, DIRECTORS, AGENTS, AND EMPLOYEES ARE REQUIRED TO SIGN ANNUALLY, OUR IN-DEPTH CONFLICT OF INTEREST DISCLOSURE POLICY WHICH AFFIRMS THEY HAVE READ, UNDERSTOOD AND AGREED WITH THE CONFLICT OF INTEREST POLICY AND HAVE ANSWERED ALL QUESTIONS ON THE DISCLOSURE FULLY AND HONESTLY. THE OFFICERS, DIRECTORS, AGENTS, AND EMPLOYEES ARE COVERED UNDER THE POLICY. EACH BOARD MEMBER IS REQUIRED TO SIGN A COPY WHICH IS REVIEWED BY THE EXECUTIVE DIRECTOR. IT MUST BE SIGNED BEFORE THEY ATTEND ANY BOARD OR COMMITTEE MEETINGS. BEFORE AN ITEM IS PUT ON AN AGENDA, THE BOARD/COMMITTEE WILL REVIEW AND ASCERTAIN IF THERE WILL BE ANY CONFLICTS ON THE BOARD AND IF SO, THE BOARD MEMBER IS CONTACTED AND TOLD ABOUT THE SUBJECT OF DISCUSSION. THE BOARD/COMMITTEE DECIDES IF IT IS IN FACT A CONFLICT AND IF SO, THE BOARD MEMBER IS ASKED TO EXCUSE THEMSELVES FROM THE ROOM DURING DISCUSSION AND VOTING BY THE EXECUTIVE DIRECTOR OR COMMITTEE CHAIR. FORM 990, PART VI, SECTION B, LINE 15A THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER IS COMPENSATED BY PEACEHEALTH (A RELATED ORGANIZATION) WHICH USES A MARKET BASED COMPENSATION PROGRAM UTILIZING SEVERAL INDEPENDENT THIRD PARTY COMPENSATION MARKET SURVEYS TO ESTABLISH PAY RANGES FOR THE POSITION. PEACEHEALTH THEN ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THIS RATE OFFERED TO THE CHIEF DEVELOPMENT OFFICER AT TIME OF HIRE WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS. COMPENSATION WAS LAST REVIEWED ON JUNE 30, 2014. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE IN THE FOUNDATION OFFICE UPON REQUEST. FORM 990, PART VI, LINE 16B: THE FOUNDATION FOLLOWS THE JOINT VENTURE POLICY OF THE PARENT ORGANIZATION, PEACEHEALTH. FORM 990, PART VII, SECTION A: THE ORGANIZATION MADE REASONABLE EFFORTS TO OBTAIN THE INFORMATION REQUIRED FOR PART VII BY DISTRIBUTING A QUESTIONNAIRE TO EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE LISTED IN PART VII. THE QUESTIONNAIRE INCLUDED THE NAME, TITLE, DATE, AND SIGNATURE OF EACH PERSON REPORTING INFORMATION AND CONTAINS PERTINENT INSTRUCTIONS AND DEFINITIONS. FORM 990, PART XI, LINE 9: LOSS ON UNCOLLECTIBLE PLEDGES -67,690. PEACEHEALTH 1115 SE 164TH AVE VANCOUVER WA 98683 910939479 HOSPITAL WA 501(C)(3) LINE 3 PEACEHEALTH 0 THE WHATCOM HOSPICE FOUNDATION 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 943146369 SUPPORT WHATCOM HOSPICE WA 501(C)(3) LINE 11D, III-O PEACEHEALTH 0 PEACEHEALTH KETCHIKAN MEDICAL CENTER FOUNDATION 3100 TONGASS AVE KETCHIKAN AK 99901 651225184 SUPPORT KETCHIKAN GENERAL HOSPITAL AK 501(C)(3) LINE 7 PEACEHEALTH 0 COTTAGE GROVE COMMUNITY HOSPITAL FOUNDATION PO BOX 134 COTTAGE GROVE OR 97424 930688381 PROVIDE FINANCIAL AID TO COTTAGE GROVE COMMUNITY HOSPITAL OR 501(C)(3) LINE 7 PEACEHEALTH 0 PEACE HARBOR HOSPITAL FOUNDATION 400 9TH STREET FLORENCE OR 97439 931084126 PROVIDE FINANCIAL AID TO PEACE HARBOR HOSPITAL OR 501(C)(3) LINE 11A, I PEACEHEALTH 0 SACRED HEART MEDICAL CENTER FOUNDATION PO BOX 10905 EUGENE OR 97440 936026548 PROVIDE FINANCIAL AID TO SACRED HEART MEDICAL CENTER OR 501(C)(3) LINE 11A, I PEACEHEALTH 0 PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION 1615 DELAWARE LONGVIEW WA 98632 911538852 SUPPORT ST. JOHN MEDICAL CENTER WA 501(C)(3) LINE 7 PEACEHEALTH 0 HEALTH VENTURES PO BOX 10905 EUGENE OR 97440 911350776 HEALTHCARE JOINT VENTURES WA 501(C)(3) LINE 7 PEACEHEALTH 0 PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION PO BOX 1600 VANCOUVER WA 98668 911231436 SUPPORT SW WASHINGTON MEDICAL CENTER WA 501(C)(3) LINE 7 PEACEHEALTH 0 PEACE ISLAND MEDICAL CENTER 1117 SPRING STREET STATUE FRIDAY HARBOR WA 98250 383868360 HOSPITAL WA 501(C)(3) LINE 3 PEACEHEALTH 0 CHARITABLE ANNUITY TRUSTS (6) INVESTMENT & CHARITABLE GIVING WA N/A T 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 1