2015-11-13T15:25:04-06:00 2015-06-30 930623286 AKT LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2014-07-01 721545902 PEACEHEALTH STJOSEPH MEDICAL CENTER FOUNDATION PEAC 3607886866 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 KATIE JANSEN TREASURER 3607886866 2015-11-11 1 JOSHUA MORROW CPA P01026428 5035857774 2015-11-11 2014 2016-04-25 22:37:26Z KATIE JANSEN 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 3065932 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/ST-JOSEPH X 2003 WA RAISE CONRIBUTIONS AND ESTABLISH ENDOWMENTS TO SUPPORT PEACEHEALTH ST.JOSEPH MEDICAL CENTER. 23 22 0 39 0 0 1716957 2330547 0 0 50192 32270 -216149 0 1551000 2362817 704703 641941 0 0 0 0 0 0 11953 643939 14833 1348642 656774 202358 1706043 4951527 7748898 266199 1463469 4685328 6285429 THE MISSION OF THE FOUNDATION IS TO SUPPORT PEACEHEALTH ST. JOSEPH MEDICAL CENTER, LOCATED IN BELLINGHAM, WASHINGTON, BY SOLICITING, RECEIVING, MANAGING, ADMINISTERING AND DISTRIBUTING FUNDS OR OTHER GIFTS TO OR FOR THE BENEFIT OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER. 0 0 641941 641941 SUPPORT OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOR EDUCATION, PATIENT SUPPORT, NURSING SUPPORT, RESEARCH, CAPITAL EXPENDITURES, SCHOLARSHIPS AND CHARITY CARE. THE FOUNDATION RECEIVES FROM PEACEHEALTH ST. JOSEPH MEDICAL CENTER AND PEACEHEALTH CORPORATION DONATED USE OF FACILITIES AND SERVICES, WHICH INCLUDE SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $875,336 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES BUT PER IRS RULES IS NOT REFLECTED ON THE FORM 990. 641941 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 23 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WA X NICOLE POYNER 3607886540 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 X JOHN HUNTLEY PRESIDENT 1.00 X X 0 0 0 SHAUN SULLIVAN MD VICE PRESIDENT 1.00 X X 0 0 0 MARION ROBIN FOOTE TREASURER 1.00 X X 0 0 0 CHRISTINE THOMPSON SECRETARY 1.00 X X 0 0 0 NANCY STEIGER DIRECTOR 1.00 X 0 0 0 MARK MCCAMPBELL DIRECTOR 1.00 40.00 X 0 317616 30047 WILLIAM HALL MD DIRECTOR 1.00 40.00 X 0 0 0 RICHARD J LEONE MD DIRECTOR 1.00 40.00 X 0 627496 36834 DALE ZENDER DIRECTOR 1.00 40.00 X 0 397701 36501 CHARLES ARIZ MD DIRECTOR 1.00 X 0 0 0 BRAD BEARDEN OD DIRECTOR 1.00 X 0 0 0 MICHAEL BRADBURN DIRECTOR 1.00 X 0 0 0 BRAD DEHAAN DIRECTOR 1.00 X 0 0 0 AMY ESARY DIRECTOR 1.00 X 0 0 0 ROSEMARIE FRANCIS DIRECTOR 1.00 X 0 0 0 DENNY HOLMSTROM DIRECTOR 1.00 X 0 0 0 FRANK IMHOF DIRECTOR 1.00 X 0 0 0 KATIE JANSEN DIRECTOR 1.00 X 0 0 0 LYNETTE JENSEN DIRECTOR 1.00 X 0 0 0 CHET KENOYER DIRECTOR 1.00 X 0 0 0 MIKE PERRY DIRECTOR 1.00 X 0 0 0 SARAH ROTHENBUHLER DIRECTOR 1.00 X 0 0 0 JON SITKIN DIRECTOR 1.00 X 0 0 0 HOLLY STUDLEY DIRECTOR 1.00 X 0 0 0 CHERYL WEG DIRECTOR 1.00 X 0 0 0 DOUG WIGHT DIRECTOR 1.00 X 0 0 0 ANNA WILLIAMS DIRECTOR 1.00 X 0 0 0 ANNE RASMUSSEN SEE SCHEDULE 0 EXECUTIVE DIRECTOR 20.00 0.00 X 0 131044 3753 0 1473857 107135 0 0 1 0 0 2330547 80874 2330547 34669 34669 700716 703115 -2399 -2399 -2399 2362817 0 0 32270 641941 641941 FUNDRAISING EXPENSE 11953 0 0 11953 BANK CHARGES 2880 0 2880 0 656774 641941 2880 11953 0 2523789 3497008 643037 1740585 1486601 2211101 204225 211790 93875 88414 4951527 7748898 266199 1463469 266199 1463469 X 2157119 2368545 2157933 3346608 370276 570276 4685328 6285429 4951527 7748898 X 1706043 28725 -134667 X 0 1 X 1 0 X 1730933 3358922 2549089 1716957 2330547 11686448 1730933 3358922 2549089 1716957 2330547 11686448 1560816 10125632 44176 58577 71020 63868 42237 279878 2382 2382 11968708 0.84600 0.87960 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1643493 321263 51711 3523 2012944 1386904 54250 204559 2220 1643493 1273160 113744 1386904 1125630 154645 -2293 4000 822 1273160 989556 67276 69561 763 1125630 0.60000 0.28000 0.12000 0 0 0 X 3261417 28725 875336 -5461 898600 2362817 0 2362817 1661316 875336 129206 1004542 656774 0 656774 PART V, LINE 4: THE ENDOWMENT FUNDS ARE TO FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. PART X, LINE 2: FOR THE YEARS ENDED JUNE 30, 2015 AND 2014, MANAGEMENT OF THE FOUNDATION BELIEVES THAT THERE HAS BEEN NO ACTIVITY THAT WOULD JEOPARDIZE THE TAX POSITION, BEING A TAX EXEMPT ORGANIZATION, AND THAT IT IS MORE LIKELY THAN NOT, BASED ON THE TECHNICAL MERITS, THAT THIS POSITION WOULD BE SUSTAINED UPON EXAMINATION. THE FOUNDATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE. THERE WERE NONE FOR THE YEARS ENDED JUNE 30, 2015 AND 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF ASSETS HELD IN TRUST -5,461. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PLEDGE 129,206. 1 PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 501(C)(3) 561067 80874 FMV MARBLE STATUE, HARP AND PATIENT SUPPLIES PATIENT CARE 1 0 0 0 0 0 0 0 0 0 MARK MCCAMPBELL DIRECTOR 0 241099 0 70412 0 6105 0 27300 0 2747 0 347663 0 0 RICHARD J LEONE MD DIRECTOR 0 564160 0 60260 0 3076 0 33420 0 3414 0 664330 0 0 DALE ZENDER DIRECTOR 0 351619 0 42709 0 3373 0 31720 0 4781 0 434202 0 0 PART I, LINE 3 THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES. EMPLOYEES ARE 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 ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THE RANGES OF PAY RATES ARE REVIEWED ON AN ANNUAL BASIS. X 1 76000 FMV X HARP 1 4000 FMV X SUPPLIES FOR PATIENTS 3 874 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED BY AN INDEPENDENT CPA FIRM AND IS PRESENTED TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, AGENTS AND EMPLOYEES ARE REQUIRED TO SIGN ANNUALLY, OUR IN-DEPTH CONFLICT OF INTEREST DISCLOSURE POLICY WHICH AFFIRMS THEY HAVE READ, UNDERSTOOD AND AGREED WITH THE CONFLICT OF INTEREST POLICY AND HAVE ANSWERED ALL QUESTIONS ON THE DISCLOSURE FULLY AND HONESTLY. THE OFFICERS, DIRECTORS, AGENTS AND EMPLOYEES ARE COVERED UNDER THIS POLICY. EACH BOARD MEMBER IS REQUIRED TO SIGN A COPY WHICH IS REVIEWED BY THE EXECUTIVE DIRECTOR. IT MUST BE SIGNED BEFORE THEY ATTEND ANY BOARD OR COMMITEE MEETINGS. BEFORE AN ITEM IS PUT ON AN AGENDA, THE BOARD/COMMITTEE WILL REVIEW AND ASCERTAIN IF THERE WILL BE ANY CONFLICTS ON THE BOARD AND IF SO, THE BOARD MEMBER IS CONTACTED AND TOLD ABOUT THE SUBJECT OF DISCUSSION. THE BOARD/COMMITTEE DECIDES IF IT IS IN FACT A CONFLICT AND IF SO, THE BOARD MEMBER IS ASKED TO EXCUSE THEMSELVES FROM THE ROOM DURING DISCUSSION AND VOTING BY THE EXECUTIVE DIRECTOR OR COMMITTEE CHAIR. FORM 990, PART VI, SECTION B, LINE 15A THE FOUNDATION'S 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 DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES. THE RANGES AND RATE OF PAY ARE REVIEWED ON AN ANNUAL BASIS. COMPENSATION WAS LAST REVIEWED ON JUNE 30, 2015. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE IN THE FOUNDATION OFFICE UPON REQUEST. FORM 990 PART VIII, LINE 30 ANNE RASMUSSEN, EXECUTIVE DIRECTOR: HER COMPENSATION IS PAID BY THE RELATED ORGANIZATION FOR SERVICES TO THE FILING ORGANIZATION. HER REPORTABLE COMPENSATION IS ZERO FOR THE FILING ORGANIZATION BUT HER AVERAGE HOURS PER WEEK IS 20 AS SHE SPENDS PART OF HER TIME WORKING AT THE FILING ORGANIZATION AND AT WHATCOM HOSPICE FOUNDATION (A RELATED ORGANIZATION TO PEACEHEALTH) FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF TRUST -5,461. LOSS ON UNCOLLECTIBLE PLEDGE -129,206. PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 HOSPITAL WA 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 0