PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION (EIN 91-1538852)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-07
- IRS object ID
- 201531279349301293
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-07T13:28:43-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 911194016 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK NUBER PS | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10900 NE 4TH STREET SUITE 1700 | AddressLine1 |
| City | BELLEVUE | City |
| State | WA | State |
| ZIP Code | 98004 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911538852 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEAC | BusinessNameControlTxt |
| Phone | 3604147900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1615 DELAWARE | AddressLine1 |
| City | LONGVIEW | City |
| State | WA | State |
| ZIP Code | 98632 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRIS SEARING | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 3604147900 | PhoneNum |
| Signature | 2015-05-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SARA ELIZABETH J HYRE | PreparerPersonNm |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | PhoneNum |
| Preparation | 2015-05-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRIS SEARING | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1615 DELAWARE | AddressLine1 |
| City | LONGVIEW | City |
| State | WA | State |
| ZIP Code | 98632 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,174,834 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | PEACEHEALTH.ORG/FOUNDATION/ST-JOHN/PAGES/DEFAULT | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | SUPPORT OF PEACEHEALTH ST. JOHN MEDICAL CENTER BY BUILDING SOCIAL AND FINANCIAL RESOURCES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 28 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 23 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 100 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,187,425 | PYContributionsGrantsAmt |
| CY Contributions Grants | $871,834 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $142,025 | PYInvestmentIncomeAmt |
| CY Investment Income | $129,196 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$23,636 | PYOtherRevenueAmt |
| CY Other Revenue | -$32,438 | CYOtherRevenueAmt |
| PY Total Revenue | $1,305,814 | PYTotalRevenueAmt |
| CY Total Revenue | $968,592 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,146,274 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,238,501 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $16,063 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $14,581 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $17,611 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $173,471 | PYOtherExpensesAmt |
| CY Other Expenses | $111,623 | CYOtherExpensesAmt |
| PY Total Expenses | $1,335,808 | PYTotalExpensesAmt |
| CY Total Expenses | $1,364,705 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$29,994 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$396,113 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,557,886 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,770,219 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,229,861 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,009,227 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,328,025 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,760,992 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE CULTIVATE THE UNDERSTANDING, INVOLVEMENT, COOPERATION AND PHILANTHROPIC SUPPORT OF ALL WHO WORK TOGETHER TO PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. BUILDING SOCIAL AND FINANCIAL RESOURCES FOR THE PRESENT AND FUTURE REFLECTS OUR COMMITMENT TO THE COMMUNITY AND TO EACH INDIVIDUAL'S HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $461,091 | ExpenseAmt |
| Grant | $461,091 | GrantAmt |
| Desc | HOSPITAL SUPPORT - FUNDS RAISED WITH NO SPECIFIC PROJECT RESTRICTION ARE USED TO SUPPORT THE GENERAL OPERATING AND CAPITAL NEEDS OF THE HOSPITAL. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $762,410 | ExpenseAmt |
| Grant | $762,410 | GrantAmt |
| Desc | MAMMOGRAPHY - FUNDS RAISED TO SUPPORT THE NEEDS OF THE BREAST CENTER IN THE HOSPITAL. CURRENTLY FUNDS HAVE BEEN RAISED TOWARD A COMPLETE REMODEL OF THE BREAST CENTER IN 2014. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $15,000 | ExpenseAmt |
| Grant | $15,000 | GrantAmt |
| Desc | THE FUND IS TO SUPPORT THE NEEDS OF LOWER COLUMNBIA REGIONAL CANCER CENTER. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,238,501 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 28 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 23 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LISA ANDERSON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3604142115 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 123 INTERNATIONAL WAY | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OR | State |
| ZIP Code | 97477 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| CHRIS SEARING | |||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| STEVEN CABRALES MD | |||||||
| PRESIDENT (THRU 9/2013) | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $396,033 | $33,663 |
| BILL BOEHM | |||||||
| VICE PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARK S PURCELL | |||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $18,308 | $0 |
| CORI DOLAN | |||||||
| CFO (THRU 9/2013) | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $96,128 | $8,165 |
| DENIS GABEL | |||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KIRK RABOIN | |||||||
| BOARD MEMBER | 1.00 | 40.00 | Yes (X) | $0 | $228,059 | $23,538 | |
| JOSIAH JOHNSON | |||||||
| BOARD MEMBER | 1.00 | 40.00 | Yes (X) | $0 | $387,433 | $34,070 | |
| JAMES NAKASHIMA MD | |||||||
| BOARD MEMBER (THRU 10/2013) | 1.00 | 40.00 | Yes (X) | $0 | $254,098 | $37,738 | |
| JOANNA ASPLUND | |||||||
| BOARD MEMBER | 1.00 | 40.00 | Yes (X) | $0 | $59,420 | $2,487 | |
| MICHAEL MCNELLIS MD | |||||||
| BOARD MEMBER | 1.00 | 40.00 | Yes (X) | $0 | $353,049 | $31,120 | |
| LILIAN STONEKING PA-C | |||||||
| BOARD MEMBER | 1.00 | 40.00 | Yes (X) | $0 | $117,914 | $15,423 | |
| JOHN BERWIND DDS | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JACKIE EVANS | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| EARL FISHER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JULIE KENDALL | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAULINE KIRCHNER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TOM RENAUD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JUDIE WILSON | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| GERRIE BOOTH | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| FRANCENA DODD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE JABUSCH | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BILL MARCUM | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ROSE MARIE NIGRO | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DON RODMAN | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BILL SARI | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RONI ZIEGLER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| WILLIAM CHESLOCK | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DON CIANCI | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| GENE GUTTORMSEN | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DOUG STAFFORD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JANICE CARTER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BETH LAUFER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| GARY PARAFINCZUK | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JORI SCRUGGS-BROWN | |||||||
| CFO (THRU 1/2014) | 1.00 | Yes (X) | $0 | $139,405 | $12,150 | ||
| CATHY BARR | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 0.00 | Yes (X) | $0 | $122,710 | $17,997 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,172,557 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $216,351 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Fundraising | $309,427 | FundraisingAmt |
| All Other Contributions | $562,407 | AllOtherContributionsAmt |
| Noncash Contributions | $129,978 | NoncashContributionsAmt |
| Total Contributions | $871,834 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $66,875 | TotalRevenueColumnAmt |
| Exclusion | $66,875 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $113,024 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $50,703 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $62,321 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,321 | TotalRevenueColumnAmt |
| Exclusion | $62,321 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $110,621 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $309,427 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $155,539 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$44,918 | TotalRevenueColumnAmt |
| Exclusion | -$44,918 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $12,480 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,480 | TotalRevenueColumnAmt |
| Exclusion | $12,480 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $968,592 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $96,758 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,238,501 | TotalAmt |
| Program Services | $1,238,501 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,798 | TotalAmt |
| Management And General | $34,798 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,581 | TotalAmt |
| Fundraising | $14,581 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,142 | TotalAmt |
| Management And General | $12,142 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Management And General | $100 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,270 | TotalAmt |
| Management And General | $47,270 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,403 | TotalAmt |
| Management And General | $11,403 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| FUNDRAISING EXP. | $3,030 | $3,030 | |
| BAD DEBT | $2,880 | $2,880 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,364,705 | TotalAmt |
| Program Services | $1,238,501 | ProgramServicesAmt |
| Management And General | $108,593 | ManagementAndGeneralAmt |
| Fundraising | $17,611 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,649 | BOYAmt |
| EOY | $18,310 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $865,027 | BOYAmt |
| EOY | $494,258 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $141,894 | BOYAmt |
| EOY | $31,581 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,750 | BOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,002,781 | BOYAmt |
| EOY | $3,473,969 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,465,785 | BOYAmt |
| EOY | $3,752,101 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,557,886 | BOYAmt |
| EOY | $7,770,219 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,646 | BOYAmt |
| EOY | $37 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,900 | BOYAmt |
| EOY | $10,405 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,189,315 | BOYAmt |
| EOY | $1,998,785 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,229,861 | BOYAmt |
| EOY | $2,009,227 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,628,641 | BOYAmt |
| EOY | $2,114,858 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,625,801 | BOYAmt |
| EOY | $2,550,459 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,073,583 | BOYAmt |
| EOY | $1,095,675 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,328,025 | BOYAmt |
| EOY | $5,760,992 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,557,886 | BOYAmt |
| EOY | $7,770,219 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$396,113 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $347,426 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $481,654 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $989,924 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,472,995 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,615,880 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,187,425 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $871,834 | CurrentTaxYearAmt |
| Total | $6,138,058 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $989,924 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,472,995 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,615,880 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,187,425 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $871,834 | CurrentTaxYearAmt |
| Total | $6,138,058 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $840,447 | SubstantialContributorsTotAmt |
| Public Support Total170 | $5,297,611 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $62,671 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $61,878 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $68,465 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,668 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $66,875 | CurrentTaxYearAmt |
| Total | $326,557 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $7,308 | CurrentTaxYearMinus2YearsAmt |
| Total | $7,308 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $6,471,923 | TotalSupportAmt |
| Public Support CY170 | 0.81860 | PublicSupportCY170Pct |
| Public Support PY170 | 0.80510 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part IV Form990ScheduleAPartIVGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II LINE 10 FOR 2011: | FormAndLineReferenceDesc |
| Explanation | TAX REFUND: $7,308 | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,271,121 | BeginningYearBalanceAmt |
| Contributions | $730 | ContributionsAmt |
| Investment Earnings Or Losses | $214,561 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $35,271 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,451,141 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,190,365 | BeginningYearBalanceAmt |
| Contributions | $58,717 | ContributionsAmt |
| Investment Earnings Or Losses | $119,115 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $26,536 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $70,540 | AdministrativeExpensesAmt |
| End Year Balance | $1,271,121 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,525,574 | BeginningYearBalanceAmt |
| Contributions | $59,885 | ContributionsAmt |
| Investment Earnings Or Losses | -$33,723 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $34,319 | GrantsOrScholarshipsAmt |
| Other Expenditures | $327,052 | OtherExpendituresAmt |
| End Year Balance | $1,190,365 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,273,932 | BeginningYearBalanceAmt |
| Contributions | $33,599 | ContributionsAmt |
| Investment Earnings Or Losses | $241,023 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $22,980 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,525,574 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,139,166 | BeginningYearBalanceAmt |
| Contributions | $11,410 | ContributionsAmt |
| Investment Earnings Or Losses | $164,123 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $40,767 | GrantsOrScholarshipsAmt |
| End Year Balance | $1,273,932 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.76000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.24000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| CASH VALUE OF LIFE INSURANCE | $168,856 |
| SPLIT-INTEREST AGREEMENTS | $3,583,245 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,752,101 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SPLIT-INTEREST AGREEMENTS | Desc |
| Amt | $1,998,785 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,998,785 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $2,332,857 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $347,426 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $450,223 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $481,654 | OtherRevenueAmt |
| Revenue Not Reported | $1,279,303 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,053,554 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$84,962 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$84,962 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $968,592 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,899,890 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $450,223 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $84,962 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $535,185 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,364,705 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,364,705 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENT FUNDS ARE HELD FOR SPECIFIC PURPOSE AND GIVEN BASED ON OUR ENDOWMENT SPENDING POLICY AT THE DIRECTION OF OUR FINANCE COMMITTEE. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | SPLIT INTEREST VALUE CHANGE 481,654. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES REPORTED ON AFS AS EXPENSES -84,962. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES REPORTED ON AFS AS EXPENSES 84,962. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1Amt |
| Gross Receipts Event1 | $169,190 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $137,715 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $31,475 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $11,200 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $6,300 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $7,229 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $12,531 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | DECEMBER GALA | NameOfEvent2Amt |
| Gross Receipts Event2 | $226,115 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $153,474 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $72,641 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $38,061 | RentFacilityCostsEvent2Amt |
| Entertainment Event2 | $400 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $60,978 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $24,743 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $18,238 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $6,505 | GrossRevenueOtherEventsAmt |
| Rent Fclty Costs Other Events | $2,352 | RentFcltyCostsOtherEventsAmt |
| Food And Beverage Other Events | $5,782 | FoodAndBeverageOtherEventsAmt |
| Entertainment Other Events | $6,188 | EntertainmentOtherEventsAmt |
| Oth Direct Expnss Other Events | $4,518 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $420,048 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $309,427 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $110,621 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $11,200 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $46,713 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $13,011 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $6,588 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $78,027 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $155,539 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$44,918 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH ST JOHN MEDICAL CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1615 DELAWARE STREET | AddressLine1 |
| City | LONGVIEW | City |
| State | WA | State |
| ZIP Code | 98632 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 910939479 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $1,181,871 | CashGrantAmt |
| Non Cash Assistance | $56,630 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | GIFTS IN KIND FROM DONORS | NonCashAssistanceDesc |
| Purpose Of Grant | GENERAL SUPPORT FOR PEACEHEALTH ST. JOHN MEDICAL CENTER | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | OUR FINANCE COMMITTEE AWARDS AND MONITORS THE DISTRIBUTION AND USE OF THE FUNDS ACCORDING TO DONOR INTENT. THE HOSPITAL'S FINANCE DEPARTMENT DISTRIBUTES FUNDS AFTER FOUNDATION APPROVAL AND ANY UNUSED FUNDS ARE RETURNED TO THE FOUNDATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN CABRALES MD | ||||||||||||||
| PRESIDENT (THRU 9/2013) | $0 | $314,944 | $0 | $0 | $0 | $81,089 | $0 | $26,052 | $0 | $7,611 | $0 | $429,696 | $0 | $0 |
| KIRK RABOIN | ||||||||||||||
| BOARD MEMBER | $0 | $226,227 | $0 | $0 | $0 | $1,832 | $0 | $22,711 | $0 | $827 | $0 | $251,597 | $0 | $0 |
| JOSIAH JOHNSON | ||||||||||||||
| BOARD MEMBER | $0 | $381,690 | $0 | $5,000 | $0 | $743 | $0 | $26,052 | $0 | $8,018 | $0 | $421,503 | $0 | $0 |
| JAMES NAKASHIMA MD | ||||||||||||||
| BOARD MEMBER (THRU 10/2013) | $0 | $244,860 | $0 | $6,274 | $0 | $2,964 | $0 | $31,152 | $0 | $6,586 | $0 | $291,836 | $0 | $0 |
| MICHAEL MCNELLIS MD | ||||||||||||||
| BOARD MEMBER | $0 | $351,329 | $0 | $0 | $0 | $1,720 | $0 | $30,313 | $0 | $807 | $0 | $384,169 | $0 | $0 |
| JORI SCRUGGS-BROWN | ||||||||||||||
| CFO (THRU 1/2014) | $0 | $129,422 | $0 | $9,725 | $0 | $258 | $0 | $12,150 | $0 | $0 | $0 | $151,555 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 3: | THE COMPENSATION OF BOARD MEMBERS AND OFFICERS ARE PAID BY THE RELATED ORGANIZATION, PEACEHEALTH. PEACEHEALTH USES WRITTEN EMPLOYMENT CONTRACT AND COMPENSATION SURVEY/STUDY TO ESTABLISH THE COMPENSATION REPORTED IN SCHEDULE J PART II. |
| SCHEDULE J, PART I, LINE 4B: | THE ORGANIZATION'S BOARD MEMBER JOSIAH JOHNSON, IS PEACEHEALTH'S SENIOR VP AND ELIGIBLE TO PARTICIPATE IN PEACEHEALTH'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. CONTRIBUTIONS TO THE PLAN ARE DISCLOSED ON SCHEDULE J AS DEFERRED COMPENSATION. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK NUBER PS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | GREATER THAN 5% SHAREHOLDER IS SISTER-IN-LAW OF BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $34,798 | TransactionAmt |
| Transaction | ACCOUNTING SERVICES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 13 | ContributionCnt |
| Noncash Contributions Rpt F990 | $45,074 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 7 | ContributionCnt |
| Noncash Contributions Rpt F990 | $2,070 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | AUCTION ITEMS | 143 | $70,577 | FMV |
| Yes (X) | KIDS ITEMS | 28 | $7,087 | FMV |
| Yes (X) | MISC. ITEMS | 6 | $5,170 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | THE NUMBER OF CONTRIBUTORS IS THE NUMBER OF ITEMS DONATED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE 6: VOLUNTEERS | THE FOUNDATION HAS A DIVERSE GROUP OF VOLUNTEERS. SOME VOLUNTEERS SERVE AS FOUNDATION BOARD MEMBERS, WHILE OTHERS SERVE AT THE GALA AND GOLF TOURNAMENT FUNDRAISERS. |
| FORM 990, PART VI, SECTION B, LINE 11 | ONCE THE FORM 990 IS COMPLETED BY OUR INDEPENDENT ACCOUNTING FIRM IT IS REVIEWED BY THE GOVERNANCE COMMITTEE. EVERY MEMBER OF THE BOARD WILL RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE GOVERNANCE COMMITTEE IN CONSULTATION WITH THE BOARD PRESIDENT AND EXECUTIVE DIRECTOR ARE RESPONSIBLE FOR ENSURING THAT ALL TOPICS BROUGHT BEFORE THE BOARD ARE FREE FROM CONFLICT. DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW OF ANY CONFLICTS ARE MADE AT THIS LEVEL. IF A CONFLICT ARISES, THE INDIVIDUAL AT RISK IS CONTACTED AND ASKED TO EXCUSE HIM OR HER FROM THE ROOM DURING DISCUSSION AND VOTING. ALL MEMBERS OF THE BOARD, AS WELL AS STAFF, ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE FOUNDATION EXECUTIVE DIRECTOR 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 EXECUTIVE DIRECTOR 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. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE ONLINE THROUGH GUIDESTAR AND UPON REQUEST. |
| FORM 990, PART VII, COLUMN B: | THE BOARD MEMBERS THAT RECEIVE COMPENSATION FROM A RELATED ORGANIZATION (PEACEHEALTH ST. JOHN MEDICAL CENTER) ARE NOT BEING COMPENSATED FOR THEIR BOARD SERVICE. THE COMPENSATION RELATES TO SERVICES (ESTIMATED 40 HOURS/WEEK) PROVIDED TO THE RELATED ORGANIZATION (PEACEHEALTH ST. JOHN MEDICAL CENTER). |
| FORM 990, PART VIII & IX | THE FOUNDATION RECEIVES DONATED FACILITIES AND SERVICES FROM ST. JOHN MEDICAL CENTER AND PEACEHEALTH CORPORATION, WHICH INCLUDE SPACE RENTAL, THE USE OF PROPERTY AND EQUIPMENT, UTILITIES, AND EMPLOYEE SERVICES. THE ESTIMATED FAIR MARKET VALUE OF $447,453 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES, BUT HAS BEEN REMOVED FROM FORM 990, PARTS VIII AND IX, REVENUE AND EXPENSE, PER THE INSTRUCTIONS TO FORM 990. |
| FORM 990, PART XI, LINE 9: | SPLIT INTEREST VALUE CHANGE 481,654. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| PEACEHEALTH | ||||||||||
| 1115 SE 164TH AVENUE | VANCOUVER | WA | 98683 | 910939479 | HOSPITAL | WA | 501(C)(3) | 3 | PEACEHEALTH | 0 |
| THE WHATCOM HOSPICE FOUNDATION | ||||||||||
| 2901 SQUALICUM PARKWAY | BELLINGHAM | WA | 98225 | 943146369 | SUPPORT WHATCOM HOSPICE | WA | 501(C)(3) | 11A - TYPE III-O | PEACEHEALTH | 0 |
| KETCHIKAN GENERAL HOSPITAL FOUNDATION | ||||||||||
| 3100 TONGASS AVE | KETCHIKAN | AK | 99901 | 651225184 | SUPPORT KETCHIKAN GENERAL HOSPITAL | AK | 501(C)(3) | 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) | 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) | 11A - TYPE 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) | 11A - TYPE I | PEACEHEALTH | 0 |
| PEACEHEALTH ST JOSEPH MEDICAL CENTER FOUNDATION | ||||||||||
| 800 EAST CHESTNUT STREET SUITE LL1 | BELLINGHAM | WA | 98225 | 721545902 | SUPPORT ST. JOSEPH HOSPITAL | WA | 501(C)(3) | 7 | PEACEHEALTH | 0 |
| HEALTH VENTURES | ||||||||||
| PO BOX 10905 | EUGENE | OR | 97440 | 911350776 | HEALTHCARE JOINT VENTURES | OR | 501(C)(3) | 7 | PEACEHEALTH | 0 |
| PEACEHEALTH SOUTHWEST MEDICAL CENTER | ||||||||||
| PO BOX 1600 | VANCOUVER | WA | 98668 | 911231436 | HOSPITAL | WA | 501(C)(3) | 3 | PEACEHEALTH | 0 |
| PEACE ISLAND MEDICAL CENTER | ||||||||||
| 1117 SPRING STREET | FRIDAY HARBOR | WA | 98250 | 383868360 | HOSPITAL | WA | 501(C)(3) | 3 | PEACEHEALTH | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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