2015-09-30T11:38:28-05:00 2014-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2014-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK TREASURER 6153299902 2015-09-24 1 JANE M SEARING P00000565 4254544919 2015-09-15 2014 2016-03-07 17:11:31Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 886269 0 X N/A X 2004 WA TO RAISE FUNDS THROUGH DONATIONS 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 6 0 0 1066775 881984 0 0 1083 1715 34878 2570 1102736 886269 616761 882272 0 0 0 7975 0 0 3020 42776 91823 659537 982070 443199 -95801 1068814 973013 0 0 1068814 973013 X TO RAISE FUNDS THROUGH DONATION 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 1 901614 832272 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. 50448 50000 VITALOGY FOUNDATION SERVED AS THE FISCAL SPONSOR FOR HEAL EB, AN IRS APPROVED 501(C)(3) ORGANIZATION BETWEEN AUGUST 2013 THROUGH MAY 2014. HEAL EB IS AN ORGANIZATION DEDICATED TO TREATING AND FINDING A CURE FOR EPIDERMOLYSIS BULLOSA (EB). ONE GRANT FROM THE HEAL EB RESTRICTED FUNDS WAS MADE DURING 2013. ALL REMAINING RESTRICTED FUNDS WERE GRANTED TO 501(C)(3) ORGANIZATIONS THAT WERE APPROVED BY HEAL EB, AND SUPPORTED HEAL EB'S MISSION, IN 2014. 952062 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 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 881984 881984 1715 1715 CANADIAN TAX REFUND 711130 2570 2570 2570 886269 0 0 4285 851034 851034 31238 31238 7409 7409 566 566 9562 2423 4600 2539 10890 8365 2525 59264 59002 262 6000 6000 6081 5888 193 26 26 982070 952062 26988 3020 209297 36787 859517 936226 1068814 973013 0 0 X 885286 973013 183528 0 1068814 973013 1068814 973013 -95801 0 X 0 0 0 X 344950 707154 245320 1066775 881984 3246183 344950 707154 245320 1066775 881984 3246183 3246183 2710 1489 2011 1083 1715 9008 34878 2570 37448 3292639 0.98590 0.98360 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. 1 EAST ASIA AND THE PACIFIC 0 0 GRANTMAKING 23738 SUB-SAHARAN AFRICA 0 0 GRANTMAKING 7500 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 FUNDRAISING 0 0 0 0 0 0 31238 0 31238 EAST ASIA AND THE PACIFIC RELIEF FUND 23738 CASH PAYMENT 0 SUB-SAHARAN AFRICA EDUCATION 7500 CASH PAYMENT 0 2 0 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 ORGANIZATIONS FINANCIAL STATEMENTS. PART I, LINE 3(3): VITALOGY FOUNDATION DOES FUNDRAISING IN EUROPE THROUGH PEARL JAM CONCERTS. EXPENSES FOR THESE FUNDRAISING EVENTS ARE DONATED BY PEARL JAM TOURING, INC. 1 ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 5750 HELPS BRING ARTS EDUCATION TO A REGION WHERE RACE LARGELY DETERMINES ARTS EDUCATION ACCESS AND TABLE SPONSORSHIP ATC RENAMING & REBRANDING CAMPAIGN 1475 15TH ST SAN FRANCISCO CA 98108 721600331 501(C)(3) 20000 FUNDS WILL BE USED FOR ATC'S REBRANDING AND RENAMING CAMPAIGN CASCADE VALLEY HOSPITAL 330 S STILLAGUAMISH AVE ARLINGTON WA 98223 911912269 501(C)(3) 10000 SUPPORT FUNERAL COSTS, FIRST RESPONDERS, AND FAMILIES AFFECTED BY THE LANDSLIDE CCFA 9 LAKE BELLEVUE DR STE 203 BELLEVUE WA 98005 136193105 501(C)(3) 15000 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 CONCERNED UNITED BIRTHPARENTS INC PO BOX 5538 SHERMAN OAKS CA 91413 042605741 501(C)(3) 25000 PROVIDE SCHOLARSHIP DOLLARS TO ATTEND FUTURE CUB RETREATS; DEFRAY COSTS TO BRING IN EDUCATION SPEAKERS FOR RETREATS; HIRE OF TECHNOLOGY AD CONSULTANT TO ADVISE CUB DESC 515 THIRD AVE SEATTLE WA 98104 911275815 501(C)(3) 10000 TO PROVIDE SHELTER AND TREATMENT TO COMMUNITY'S MOST VULNERABLE PEOPLE EB RESEARCH PARTNERSHIP 1725 YORK AVE STE 29G NEW YORK NY 10128 272417202 501(C)(3) 10000 TO FUND RESEARCH AIMED AT TREATING AND ULTIMATELY CURING EB FRIENDS OF KEXP 113 DEXTER AVE N SEATTLE WA 98109 912061474 501(C)(3) 10000 TO SUPPORT THE CAMPAIGN FOR KEXP'S NEW HOME HEAL EB 5404 ALTON PKWY STE 5-A 794 IRVINE CA 92604 455334708 501(C)(3) 151217 PAID OUT FUNDS TO HEAL EB THAT WERE COLLECTED WHILE ACTING AS ITS FISCAL SPONSOR (EB RESEARCH) HEDGEBROOK 216 1ST AVE S STE 251 SEATTLE WA 98104 800012629 501(C)(3) 6000 SUPPORTS THE HEDGEBROOK SONGWRITERS RESIDENCY PROGRAM LUCILLE PACKARD FOUNDATION FOR CHILDREN'S HEALTH 400 HAMILTON AVE STE 340 PALO ALTO CA 94301 770440090 501(C)(3) 50000 TO FURTHER THEIR GENE TRANSFER TRIALS WITH THE FDA MUSICARES 3030 OLYMPIC BLVD SANTA MONICA CA 90404 954470909 501(C)(3) 12000 PROVIDES A SAFETY NET OF CRITICAL ASSISTANCE FOR MUSIC PEOPLE IN TIMES OF NEED NORTH COUNTIES FAMILY SERVICES PO BOX 1103 DARRINGTON WA 98241 800594827 501(C)(3) 15000 TO RAISE FUNDS TO CONSTRUCT A SKATE PARK IN OLD SCHOOL PARK PROCLAIM JUSTICE 2303 RR 620 S 135-462 LAKEWAY TX 78734 461395681 501(C)(3) 20000 TO EFFECTIVELY ADVOCATE FOR INDIVIDUALS WHO HAVE BEEN WRONGFULLY CONVICTED REVOLUTION PER MINUTE 1475 15TH ST SAN FRANCISCO CA 94103 721600331 501(C)(3) 10000 PROVIDES ARTISTS WITH STRATEGY AND SUPPORT FOR THEIR ACTIVISM AND PHILANTHROPY ROCK & ROLL HALL OF FAME FOUNDATION 162 WEST 56TH ST STE 405 NEW YORK NY 10019 133171867 501(C)(3) 12000 ROCK AND ROLL HALL OF FAME INDUCTION DINNER ROCK SCHOOL 10903 NE 53RD ST KIRKLAND WA 98033 460494902 501(C)(3) 8000 TO COVER TEACHING ARTIST COSTS FOR CLASSES AND TO HELP COVER THE COSTS OF SUMMER CAMPS SEATTLE CHILDREN'S HOSPITAL FOUNDATION PO BOX 5371 M/S S-200 SEATTLE WA 98145 911156519 501(C)(3) 35723 TO SUPPORT THE GREATEST NEEDS FUND SEATTLE CHILDREN'S HOSPITAL FOUNDATION PO BOX 5371 M/S S-200 SEATTLE WA 98145 911156519 501(C)(3) 5000 TO SUPPORT THE UNCOMPENSATED CARE PROGRAM SILVERLAKE CONSERVATORY OF MUSIC 3920 W SUNSET BLVD LOS ANGELES CA 90029 270030546 501(C)(3) 25000 TO PURCHASE/RENOVATE A BUILDING TO SERVE AS THEIR LONG TERM HOME SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 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) 200000 TO BUILD A CONCRETE SKATEPARK ON THE BLACKFEET RESERVATION IN BROWNING, MT THE ACTOR'S GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 20000 TO SUPPORT THE GENERAL OPERATIONS OF THE ACTORS' GANG WHICH PRODUCES AND DEVELOPS ARTISTIC AND COMMUNITY OUTREACH PROGRAMS THE ARMENIAN DRAMATIC ARTS ALLIANCE 3325 N GLENOAKS BLVD BURBANK CA 91504 830436115 501(C)(3) 10000 FOR PRODUCTION OF THE TIME OF OUR LIES (PLAY ON LIFE OF HOWARD ZINN) TREEHOUSE 2100 24TH AVE S STE 200 SEATTLE WA 98122 911425676 501(C)(3) 20120 USED AS MATCHING TO MOTIVATE OTHERS TO GIVE GENEROUSLY AT THE ANNUAL HOLIDAY MAGIC RADIO EVENT TREEHOUSE 2100 24TH AVE S STE 200 SEATTLE WA 98122 911425676 501(C)(3) 2500 TO HELP ACHIEVE GOAL OF HELPING YOUTH IN FOSTER CARE GRADUATE FROM HIGH SCHOOL AT SAME RATE AS PEERS WAR CHILD US AVANT BUILDING STE 900 200 DELAWARE AVE BUFFALO NY 14202 200994157 501(C)(3) 35723 PROVIDES ACCESS TO EDUCATION, OPPORTUNITY AND JUSTICE FOR CHILDREN AND COMMUNITIES IN WAR-AFFECTED REGIONS OF THE WORLD WILD LOVE PRESERVE 12239 10TH AVE S BURIEN WA 98168 273729450 501(C)(3) 10000 USED TOWARDS EXPENSES TO CARE FOR WLP'S 130 ADOPTED IDAHO WILD HORSES 26 0 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 III, LINE 3 VITALOGY FOUNDATION SERVED AS THE FISCAL SPONSOR FOR A SEPARATE 501(C)(3) ORGANIZATION NAMED HEAL EB THRU MAY 2014. FORM 990, PART VI, SECTION A, LINE 2 ALL MEMBERS OF THE BOARD HAVE 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. 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