2015-07-29T17:58:40-05:00 2014-10-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2013-11-01 911022358 YAKIMA VALLEY MEMORIAL HOSPITAL CHARITABLE FOUNDATION YAKI 5095765794 2701 TIETON DRIVE YAKIMA WA 98902 ANNE CAFFERY PRESIDENT/CEO 5095765794 2015-07-27 1 CHRISTOPHER E RIVARD P00022321 5092487750 2013 2016-02-25 16:41:14Z THE MEMORIAL FOUNDATION ANNE CAFFERY 2701 TIETON DRIVE YAKIMA WA 98902 3560443 0 X WWW.MEMFOUND.ORG X 1978 WA THE FOUNDATION RAISES AND DISTRIBUTES FUNDS TO PROMOTE AND SUPPORT HEALTH CARE SERVICES IN COORDINATION WITH YAKIMA VALLEY MEMORIAL HOSPITAL. 26 26 0 175 0 0 3177689 3103097 0 0 256504 393948 34188 49639 3468381 3546684 2329552 2056586 0 0 0 0 0 0 91482 294287 264630 2623839 2321216 844542 1225468 6345203 7641116 386742 321171 5958461 7319945 X ADVANCE AND TRANSFORM HEALTHCARE IN YAKIMA. 0 0 571182 571182 CHILDREN'S VILLAGE - SUPPORTING SERVICES FOR CHILDREN WITH SPECIAL HEALTHCARE NEEDS 48765 48765 NORTH STAR LODGE - SUPPORTING A FULL-SERVICE OUTPATIENT CANCER TREATMENT FACILITY. 280171 280171 HOSPICE HOME HEALTH CARE - SUPPORTING HOSPICE/HOME HEALTH SERVICES INCLUDING END OF LIFE SERVICES TO PATIENTS (INCLUDING PALLIATIVE CARE/TRANSITIONS). 1156468 1156468 SUPPORT NUMEROUS HEALTHCARE/HEALTHCARE RELATED PROGRAMS. 1156468 1156468 2056586 1 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 1 1 0 0 1 0 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 0 0 0 X 26 26 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X BONNIE DWARSHUIS 5092495204 2811 TIETON DRIVE YAKIMA WA 98902 X BILL WHEELER CHAIRMAN 2.00 X X 0 0 0 BRUCE HEISER VICE CHAIR 2.00 X X 0 0 0 B JEAN PRYOR TREASURER 2.00 X X 0 0 0 ANNE NAPIER CAFFERY BOARD SECRETARY/FOUNDATION PRESIDENT 40.00 X X 0 0 0 JAMES BERG TRUSTEE 1.00 X 0 0 0 DARRELL BLUE TRUSTEE 1.00 X 0 0 0 LEE CALLARMAN TRUSTEE 1.00 X 0 0 0 WEST H CAMPBELL TRUSTEE 1.00 X 0 0 0 DOLORES DESSERAULT TRUSTEE 1.00 X 0 0 0 BILL DOLSEN TRUSTEE 1.00 X 0 0 0 DR DANIEL DOORNINK TRUSTEE 1.00 X 0 0 0 CHRIS FALK TRUSTEE 1.00 X 0 0 0 JENNIFER FALK TRUSTEE 1.00 X 0 0 0 JUDI GILMORE TRUSTEE 1.00 X 0 0 0 MARIE HALVERSON EXECUTIVE COMMITTEE MEMBER-AT-LARGE 2.00 X 0 0 0 DR JAMES HAVEN TRUSTEE 1.00 X 0 0 0 ROYAL KEITH TRUSTEE 1.00 X 0 0 0 RICK LINNEWEH TRUSTEE 1.00 X 0 0 0 DR TIMOTHY MELHORN TRUSTEE 1.00 X 0 0 0 MICHAEL MOEN TRUSTEE 1.00 X 0 0 0 RUSS MYERS TRUSTEE 1.00 X 0 0 0 MARGARET NUTLEY TRUSTEE 1.00 X 0 0 0 SCOTT OLANDER TRUSTEE 1.00 X 0 0 0 ROBERT G PRICE EXECUTIVE COMMITTEE MEMBER AT LARGE 2.00 X 0 0 0 MARY JO PEREZ TRUSTEE 1.00 X 0 0 0 CINDI STEWART TRUSTEE 1.00 X 0 0 0 TOM STOKES TRUSTEE 1.00 X 0 0 0 MARVIN SUNDQUIST TRUSTEE 1.00 X 0 0 0 PATRICIA TEMPLE TRUSTEE 1.00 X 0 0 0 DR ROBERT WILLIAMS TRUSTEE 1.00 X 0 0 0 ANN WILLIS TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 0 96077 6765 3000255 64201 3103097 349658 349658 56189 11899 44290 44290 44290 51499 96077 1860 49639 49639 3546684 0 0 443587 2056586 2056586 21140 21140 62183 34005 28178 2757 2757 REIMBURSED EXPENSES 97908 49403 48505 NET ANNUITY 60020 60020 UNCOLLECTIBLE PLEDGES 14186 14186 OTHER 6436 5823 613 2321216 2056586 173148 91482 1580827 1847806 721164 666920 3474814 4827349 150643 110913 417755 188128 6345203 7641116 386742 321171 386742 321171 X 1212449 1328619 4533329 5678641 312685 312685 5958461 7319945 6345203 7641116 1225468 136016 0 X X 0 1 X 1 0 X 3902384 4233991 2324045 3177689 3103097 16741206 3902384 4233991 2324045 3177689 3103097 16741206 1610601 15130605 93945 129853 82019 101381 349658 756856 17498062 0.86470 0.88780 X SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: GROSS RECEIPTS FROM EVENTS 2009 AMOUNT: $ 57,421. 2010 AMOUNT: $ 18,988. 2011 AMOUNT: $ 10,927. 2012 AMOUNT: $ 35,751. 2013 AMOUNT: $ 51,499. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 27472 10000 140866 1 1 0 540717 25743 566460 493442 48519 1244 540717 445636 49548 1742 493442 437873 9402 1639 445636 389617 49888 1632 437873 0.00000 0.55200 0.44800 0 0 0 DUE TO YVMH 173949 DEFERRED LIABILITIES 75948 DUE TO EPIC 35637 DUE TO NURSING HOME 35637 321171 X 3684560 136016 1860 137876 3546684 0 3546684 2323076 1860 1860 2321216 0 2321216 PART V, LINE 4: THE INTENDED USE FOR THE ENDOWMENT FUNDS ARE CHILDREN'S HEALTHCARE NEEDS AND CANCER PATIENTS. PART X, LINE 2: THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION QUALIFYING UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE FOUNDATION'S TAX-EXEMPT PURPOSE WOULD BE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE FOUNDATION DID NOT ENGAGE IN AN ACTIVITY UNRELATED TO ITS TAX-EXEMPT PURPOSE; ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH REQUIREMENTS RELATED TO ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES, THE FOUNDATION HAS DETERMINED THEY HAVE NO UNCERTAIN TAX POSITIONS AT OCTOBER 31, 2014 AND 2013. IN ADDITION, THE FOUNDATION QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170((B)(1)(A)AND HAS BEEN CLASSIFIED AS OTHER THAN A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT EXPENSES OF FUNDRAISING EVENTS 1,860. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT EXPENSES OF FUNDRAISING EVENTS 1,860. X X X X X X 0 WA LINNEWEH RETIREMENT 80700 51550 29150 GOLF TOURNAMENT 44109 28138 15971 1 22767 16389 6378 1860 147576 96077 51499 1860 1860 49639 1 YAKIMA VALLEY MEMORIAL HOSPITAL 2811 TIETON DR YAKIMA WA 98902 910567263 501(C)3 2056586 TO PROVIDE SUPPORT TO THE YAKIMA VALLEY MEMORIAL HOSPITAL IN THEIR PURSUIT O 1 0 PART I, LINE 2: THE PRESIDENT/CEO REVIEWS BUDGETS AND PROFIT/LOSS STATEMENTS OF THE PROGRAMS RECEIVING ALLOCATION AWARDS ON, AT LEAST, AN ANNUAL BASIS. X 7 505 FMV X 611 FMV X 3 52462 FMV ON DATE OF TRANSFER X 86 2128 SELLING PRICE X 1 15 SELLING PRICE X RAFFLE PRIZES 1 6126 RETAIL X GIFT CARDS 77 1880 FMV X CHILDREN'S TO 849 324 FMV X TRIPS 5 150 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE REVIEW AND APPROVAL OF THE FORM 990 IS DELEGATED TO THE EXECUTIVE COMMITTEE OF THE BOARD. THE FORM 990 IS THEN SUBMITTED TO THE FULL VOTING BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES TO SIGN NEW CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI, SECTION B, LINE 15 SALARIES FOR TOP MANAGEMENT ARE DETERMINED AND REVIEWED BY THE HOSPITAL'S BOARD OF DIRECTORS AND COMPENSATION COMMITTEE. THE FOUNDATION DOES NOT PAY WAGES, IT REIMBURSES THE HOSPITAL FOR APPLICABLE EMPLOYEE COSTS. FORM 990, PART VI, SECTION C, LINE 18 UPON REQUEST DURING BUSINESS HOURS, MONDAY THROUGH FRIDAY, 8:00 AM - 5:00 PM FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST DURING BUSINESS HOURS, MONDAY THROUGH FRIDAY, 8:00 AM - 5:00 PM FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR.