2015-11-16T12:01:46-06:00 2014-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2014-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 WILLIAM RABEL TREASURER 3602994201 2015-11-13 1 ROBERT GRANNUM P00355876 4252597227 2014 2016-02-25 16:41:14Z MARK BACKMAN 1211 24TH STREET ANACORTES WA 98221 842751 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 55 0 0 608884 476267 0 0 130503 86133 -112532 29380 626855 591780 507890 498561 0 0 0 108892 0 0 30488 175364 -97678 683254 509775 -56399 82005 2311082 2521701 0 67020 2311082 2454681 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. 458280 398561 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. 558280 1 1 0 0 0 0 0 0 0 1 0 0 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 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 20 20 0 0 0 1 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X JEANNETTE PAPADAKIS 3602994201 1211 24TH ST ANACORTES WA 98221 MARK BACKMAN PRESIDENT 3.00 X X 0 0 0 TOM MURPHY VICE PRESIDENT 3.00 X X 0 0 0 RICHARD HUMPHREY TREASURER 3.00 X X 0 0 0 BILL RABEL SECRETARY 3.00 X X 0 0 0 STEVE RUTZ IMMEDIATE PAST PRESIDENT 1.00 X 0 0 0 JOSH BALDWIN DIRECTOR 1.00 X 0 0 0 SHELLIE BOGOSIAN DIRECTOR 1.00 X 0 0 0 LARRY BUGHI DIRECTOR 1.00 X 0 0 0 COLLEEN CRAIG DIRECTOR 1.00 X 0 0 0 DIXIE DAVID DIRECTOR 1.00 X 0 0 0 DESHA FURIN DIRECTOR 1.00 X 0 0 0 TROY KUNZ DIRECTOR 1.00 X 0 0 0 TOM LACROIX DIRECTOR 1.00 X 0 0 0 DAVE MARGESON DIRECTOR 1.00 X 0 0 0 KRISTA OICLES DIRECTOR 1.00 X 0 0 0 AARON RASMUSSEN DIRECTOR 1.00 X 0 0 0 RUSTAN ROBERTSON DIRECTOR 1.00 X 0 0 0 JIM ROE DIRECTOR 1.00 X 0 0 0 DAVID SLEPYAN DIRECTOR 1.00 X 0 0 0 MARILYN STADLER DIRECTOR 1.00 X 0 0 0 BERNADETTE STANEK FOUNDATION DIRECTOR (1/2014-9/2014) 40.00 X 41413 0 7799 41413 0 7799 0 0 0 0 0 198005 278262 40970 476267 50492 50492 188831 153190 35641 35641 35641 127161 198005 97781 29380 29380 591780 0 0 115513 490049 490049 8512 8512 84132 33653 29446 21033 24760 9904 8666 6190 12260 12260 12019 12019 8500 8500 12029 12029 7275 4010 3265 ADMINISTRATIVE EXPENSE 22498 22498 BAD DEBT EXPENSE 123 123 FRAUD EXPENSE NET OF IN -178634 -178634 6252 6252 509775 558280 -78993 30488 7601 64864 136636 66551 58600 308457 0 1250 0 343 2108245 2080236 2311082 2521701 0 67020 0 67020 X 1993009 2135707 117073 117974 201000 201000 2311082 2454681 2311082 2521701 82005 23673 37921 0 X 1 X 0 1 0 X 427076 830493 581891 608884 476267 2924611 427076 830493 581891 608884 476267 2924611 158587 2766024 31696 35821 63414 58963 50492 240386 3164997 503338 0.87390 0.79730 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1714403 87727 40339 1761791 1503114 252194 40904 1714404 1374984 173234 45104 1503114 1386988 33591 -17903 27692 1374984 252065 1129508 119052 62572 51065 1386988 0.84870 0.03410 0.11720 0 0 0 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, 2014, THE FOUNDATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. GALA OF HOPE 244026 150381 93645 41138 516 4295 9162 GOLF CLASSIC 81140 47624 33516 1023 36551 5096 325166 198005 127161 1023 77689 516 4295 14258 97781 29380 1 ISLAND HOSPITAL SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 1211 24TH STREET ANACORTES WA 98221 910729255 170(C) 490049 SUPPORT OF HEALTH PROGRAMS AT HOSPITAL 1 0 ONCOLOGY GRANTS 24 8512 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 VARIOUS 64 40970 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 V, LINE 2A: ISLAND HOSPITAL FOUNDATION HAS AN OPERATING AGREEMENT WITH AN UNRELATED THIRD PARTY WHICH INCLUDES SHARING OF EMPLOYEES UNDER A COMMON PAYMASTER ARRANGMENT. FORM 990, PART VI, SECTION A, LINE 5 IN 2014, THE FOUNDATION IDENTIFIED FRAUDULENT ACTIVITY. TOTAL LOSS WAS ESTIMATED TO BE APPROXIMATELY $285,000. THE PORTION OF THE LOSS THAT RELATED TO 2014 AND 2013 WAS ESTIMATED AT $77,494 AND $90,101, RESPECTIVELY. THE LOSS IS EXPECTED TO BE COVERED BY INSURANCE TO THE EXTENT ALLOWED BY THE INSURANCE CONTRACT LESS DEDUCTIBLES. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT FORM 990 WAS PROVIDED TO THE FULL BOARD FOR REVIEW. AFTER CHANGES WERE INCORPORATED THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWED THE FILING PRIOR TO SUBMISSION TO 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.