2015-09-21T16:43:26-05:00 2013-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2013-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 WILLIAM RABEL TREASURER 3602994201 2015-09-21 1 ROBERT GRANNUM P00355876 4252597227 2013 2016-02-25 16:41:14Z X STEVE RUTZ 1211 24TH STREET ANACORTES WA 98221 943585 0 X WWW.ISLANDHOSPITALFOUNDATION.ORG X 1978 WA TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN ANACORTES, LA CONNER, NORTH WHIDBEY ISLAND AND THE SAN JUAN ISLANDS. 20 20 0 50 0 0 581891 608884 0 0 63414 130503 -119219 -112532 526086 626855 366995 507890 0 0 0 0 0 0 23976 139001 175364 505996 683254 20090 -56399 2224551 2311082 0 0 2224551 2311082 TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN ANACORTES, LA CONNER, NORTH WHIDBEY ISLAND AND THE SAN JUAN ISLANDS. 0 0 100000 100000 FUND HOSPITAL RENOVATION AND EXPANSION COSTS NOT MET BY TAX REVENUE. THIS INCLUDES THE MEDICAL ARTS PAVILION HOUSING CANCER CARE, PHYSICAL THERAPY, AND WOUND CARE. 468681 407890 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 ISLAND HOSPITAL'S VITAL MISSION BY RAISING MUCH-NEEDED 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 ITS FINANCIAL FUTURE. 568681 1 1 0 0 0 0 0 0 0 1 0 1 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 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 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 NANCY RYTAND 3602994201 1211 24TH ST ANACORTES WA 98221 X STEVE RUTZ PRESIDENT 2.00 X X 0 0 0 DAVE MARGESON VICE PRESIDENT 2.00 X X 0 0 0 AARON RASMUSSEN TREASURER 2.00 X X 0 0 0 COLLEEN CRAIG SECRETARY 2.00 X X 0 0 0 SHELLIE BOGOSIAN IMMEDIATE PAST PRESIDENT 1.00 X 0 0 0 RICHARD HUMPHREY DIRECTOR 1.00 X 0 0 0 LANI DONOHOE DIRECTOR 1.00 X 0 0 0 MARILYN STADLER DIRECTOR 1.00 X 0 0 0 KRISTIA OICLES DIRECTOR 1.00 X 0 0 0 JOSH BALDWIN DIRECTOR 1.00 X 0 0 0 JIM ROE DIRECTOR 1.00 X 0 0 0 TOM MURPHY DIRECTOR 1.00 X 0 0 0 DIANE RUSHER DIRECTOR 1.00 X 0 0 0 ANNE SMITH DIRECTOR 1.00 X 0 0 0 DR DAVID SLEPYAN DIRECTOR 1.00 X 0 0 0 DR MARK BACKMAN DIRECTOR 1.00 X 0 0 0 BILL RABEL DIRECTOR 1.00 X 0 0 0 MICHAEL MAST DIRECTOR 1.00 X 0 0 0 JERREL BARTO DIRECTOR 1.00 X 0 0 0 CHRIS JENSEN DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 303383 305501 45397 608884 58963 58963 207870 136330 71540 71540 71540 67868 303383 180400 -112532 -112532 626855 0 0 17971 502699 502699 5191 5191 9698 9698 19477 19477 4500 1800 1575 1125 35741 35741 47047 17662 15455 13930 8036 8036 ADMINISTRATIVE EXPENSES 36356 36356 DONOR RECOGNITION EVENT 8921 8921 BAD DEBT EXPENSE 5588 5588 683254 568681 90597 23976 100 7601 158328 78163 107508 58600 25450 0 1933165 2166718 2224551 2311082 0 0 0 0 X 2224551 1993009 117073 201000 2224551 2311082 2224551 2311082 X -56399 233031 -90101 X X 1 X 0 1 0 X 516446 427076 688785 581891 608884 2823082 516446 427076 688785 581891 608884 2823082 397356 2425726 29458 31696 35821 63414 58963 219352 3042434 615103 0.79730 0.76220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1503114 252194 40904 1714404 1374984 173234 45104 1503114 1386988 33591 -17903 27692 1374984 252065 1129508 119052 62572 51065 1386988 250221 1844 252065 0.84870 0.11720 0.03410 0 0 0 EQUITY FUNDS 1907245 F MONEY MARKET FUNDS 58473 F FIXED INCOME FUNDS 201000 F 2166718 X 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 BIRTHING CENTER. 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 PERSUANT 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 PROBABLY AND WAS REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2013, THE FOUNDATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. GALA OF HOPE 283011 242260 40751 43813 66118 6677 1340 GOLF CLASSIC 88240 61123 27117 11192 34516 16744 371251 303383 67868 55005 100634 6677 18084 180400 -112532 1 ISLAND HOSPITAL SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 1211 24TH STREET ANACORTES WA 98221 910729255 170(C) 502699 SUPPORT OF HEALTH PROGRAMS AT HOSPITAL 1 0 ONCOLOGY GRANTS 22 5191 PART I, LINE 2: ALL GRANTS AND ASSISTANCE ARE ONLY PROVIDED TO THE SUPPORTED ORGANIZATION ISLAND HOSPITAL AND UTILIZED ONLY FOR THE PURPOSE OF THAT GRANT (I.E. HEALTH SCREENING PROGRAM, DIABETES CARE). ISLAND HOSPITAL IS RESPONSIBLE FOR ENSURING FUNDS TRANSFERRED FROM ISLAND HOSPITAL FOUNDATION ARE DESIGNATED AND UTILIZED ONLY FOR THE PURPOSE INSTRUCTED, AND THE FOUNDATION RECEIVES REPORTS SHOWING FUNDS WERE DISBURSED TO DEPARTMENTS AS INSTRUCTED. X 125 FAIR MARKET VALUE X 40 FAIR MARKET VALUE X 12 15675 FAIR MARKET VALUE X GIFT CERTIFIC 28 17306 FAIR MARKET VALUE X VARIOUS 13 10959 FAIR MARKET VALUE X TICKETS 4 1292 FAIR MARKET VALUE 0 1 0 PART I, COLUMN (B): 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 FORM 990 IS REVIEWED BY THE FULL BOARD BEFORE IT IS SIGNED AND FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C 1. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, AND D. UNDERSTANDS IHF IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY 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 ALL ORGANIZATIONAL, FINANCIAL, AND TAX DOCUMENTS, INCLUDING FORM 990, ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS DUE TO FRAUD -90,101. FORM 990, PART XII, LINE 1: FORM 990 WAS AMENDED TO REFLECT COMPILATION FINANCIAL STATEMENT RESULTS FOR THE YEAR ENDING DECEMBER 31, 2013. THE FOLLOWING REVENUE ITEMS WERE AMENDED AS FOLLOWS: - LINE 1F OTHER CONTRIBUTIONS DECREASED BY $39,536. - LINE 3 INVESTMENT INCOME INCREASED BY $58,874 DUE TO AN INCREASE IN SAVINGS INVESTMENTS. FORM 990, PART IX, LINES 1, 12, AND 24 FORM 990 WAS AMENDED TO REFLECT COMPILATION FINANCIAL STATEMENT RESULTS FOR THE YEAR ENDING DECEMBER 31, 2013. THE FOLLOWING FUNCTIONAL EXPENSE ITEMS WERE AMENDED AS FOLLOWS: - LINE 1 DECREASE OF GRANTS AND OTHER ASSISTANCE TO GOVERNMENTS AND ORGANIZATIONS OF $80,128. - LINE 12 DECREASE OF ADVERTISING BY $14,813 - LINE 24 OTHER EXPENSES INCREASED BY $63,445 TO REFLECT THE DECREASE IN BAD DEBT EXPENSE BY $27,861, INCREASE IN ADMINISTRATIVE EXPENSE OF $6,767, INCREASE IN MEDICAL SUPPLIES OF $10,191, AND INCREASE IN LOSS DUE TO FRAUD OF $90,101 TO MATCH THE FINANCIAL STATEMENTS. FORM 990, PART X, LINES 1, 2, 3, 4, AND 12. FORM 990 WAS AMENDED TO REFLECT COMPILATION FINANCIAL STATEMENT RESULTS FOR THE YEAR ENDING DECEMBER 31, 2013. THE FOLLOWING ASSETS WERE AMENDED AS FOLLOWS: - LINE 1 INCREASE IN CASH AND NON-INTEREST BEARING OF $7,601 TO ACCURATE GROUP ACCOUNTS. - LINE 2 INCREASE IN SAVINGS AND INVESTMENTS BY $91,669 TO MATCH FINANCIAL STATEMENTS. - LINE 3 INCREASE IN GRANTS RECEIVEABLE OF $64,188. - LINE 4 DECREASE IN ACCOUNTS RECEIVABLE OF $148,546. - LINE 12 DECREASE IN INVESTMENTS - OTHER SECURITIES BY $5,333. FORM 990, SCHEDULE A, SECTION A. FORM 990 WAS AMENDED TO REFLECT COMPILATION FINANCIAL STATEMENT RESULTS FOR THE YEAR ENDING DECEMBER 31, 2013. SCHEDULE A, SECTION A WAS AMENDED TO REFLECT THE DECREASE IN CONTRIBUTIONS AND THE INCREASE OF INTEREST INCOME. FORM 990, SCHEDULE D, PART VII. FORM 990 WAS AMENDED TO REFLECT COMPILATION FINANCIAL STATEMENT RESULTS FOR THE YEAR ENDING DECEMBER 31, 2013. SCHEDULE D, PART VII WAS AMENDED TO SHOW THE INCREASE OF INVESTMENTS.