2014-05-15T13:19:33-05:00 2013-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2012-07-01 721545902 PEACEHEALTH ST JOSEPH MEDICAL CENTER FOUNDATION PEAC 3607886866 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 MARK MCCAMPBELL 3607566865 2014-05-15 1 SARA ELIZABETH J HYRE P00235495 4254544919 2014-05-15 2012 2015-11-30 17:44:51Z MARK MCCAMPBELL 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 2624904 0 X WWW.THEHOSPITALFOUNDATION.ORG X 2003 WA TO RAISE CONTRIBUTIONS AND ESTABLISH ENDOWMENTS TO SUPPORT PEACEHEALTH ST. JOSEPH MEDICAL CENTER ACTIVITIES. 28 26 0 45 0 0 3358922 2549089 0 0 48410 55375 -120523 18027 3286809 2622491 2371286 2114187 0 0 0 0 0 0 766508 257686 963198 2628972 3077385 657837 -454894 5178621 4635803 378797 259430 4799824 4376373 X PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOUNDATION EXISTS TO ACQUIRE AND RECOGNIZE CHARITABLE GIFTS AND BEQUESTS THAT ASSIST PEACEHEALTH ST. JOSEPH MEDICAL CENTER IN FULFILLING ITS MISSION, ADHERING TO ITS CORE VALUES AND PROVIDING MEDICAL SERVICES TO THE WHATCOM REGION. THE FOUNDATION WILL:- PROVIDE INDIVIDUALS AND INSTITUTIONS WITH AN OPPORTUNITY TO EXTENDTHE GIFT OF HEALTH TO CITIZENS IN NORTHWEST WASHINGTON STATE.- SUPPORT THE APPLICATION OF INNOVATIVE PATIENT CARE SERVICES TOIMPROVE THE HEALTH CARE SERVICES OF THIS AREA.- ACHIEVE FOR THE MEDICAL CENTER A HIGHER LEVEL OF MUTUALUNDERSTANDING AND INVOLVEMENT WITH THE COMMUNITIES IT SERVES.- PHILANTHROPIC OPPORTUNITIES SHOULD ENHANCE THE ABILITY OF ST. JOSEPHMEDICAL CENTER TO PROVIDE HEALING AND COMPASSIONATE HEALTHCARE RESPECTING EVERY PERSON'S HUMAN DIGNITY. 1 1 1680639 1680639 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 $604,246 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES, AND 571,650 OF SUCH CONTRIBUTION OF HOSPITAL PERSONNEL HAS BEEN INCLUDED ON FORM 990 TO ACCURATELY REFLECT THE FINANCIAL POSITION OF THE FOUNDATION. 45300 45300 THE WHATCOM HOSPICE FOUNDATION TRANSFERS. THE WHATCOM HOSPICE FOUNDATION'S MISSION IS TO SUPPORT HOSPICE SERVICES IN WHATCOM COUNTY AND THE SURROUNDING AREA. 388248 388248 SUPPORT OF PEACEHEALTH PEACE ISLAND MEDICAL CENTER FOR PATIENT SUPPORT, NURSING SUPPORT, CAPITAL EXPENDITURES, AND CHARITY CARE. SPECIFICALLY $250K WAS RECEIVED FOR THE IMAGING EQUIPMENT PURCHASED FOR THE MEDICAL CENTER. 2114187 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 28 26 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 WA X NICOLE POYNER 3607886540 809 E CHESTNUT ST BELLINGHAM WA 98225 X CHARLES ARIZ MD 2.00 0.00 X 0 0 0 ANITA WISEMAN 1.00 0.00 X 0 0 0 ROSE FIDELMA 0.50 0.00 X 0 0 0 JAN JURGENSEN 0.50 0.00 X 0 0 0 MICHAEL BRADBURN 2.00 0.00 X 0 0 0 BRAD DEHAAN 2.00 0.00 X 0 0 0 AMY ESARY 2.00 0.00 X 0 0 0 MARION ROBIN FOOTE 2.00 0.00 X X 0 0 0 ROSEMARIE FRANCIS 2.00 0.00 X 0 0 0 WILLIAM HALL MD 2.00 0.00 X 0 0 0 DENNY HOLMSTROM 2.00 0.00 X 0 0 0 JOHN HUNTLEY 2.00 0.00 X X 0 0 0 FRANK IMHOF 2.00 0.00 X 0 0 0 KATIE JANSEN 2.00 0.00 X 0 0 0 LYNNETTE JENSEN 2.00 0.00 X 0 0 0 SIMON JOHNSON 2.00 0.00 X 0 0 0 JEFFREY KAUFMAN 2.00 0.00 X 0 0 0 CHET KENOYER 2.00 0.00 X 0 0 0 RICHARD J LEONE MD 2.00 0.00 X 0 0 0 MIKE PERRY 2.00 0.00 X 0 0 0 SARAH ROTHENBUHLER 2.00 0.00 X 0 0 0 NANCY STEIGER 2.00 40.00 X X 0 463124 175381 DIANE STROUT 2.00 40.00 X 0 154779 0 HOLLY STUDLEY 2.00 0.00 X 0 0 0 SHAUN SULLIVAN MD 2.00 0.00 X X 0 0 0 CHRISTINE THOMPSON 2.00 0.00 X X 0 0 0 CHERYL WEG 2.00 0.00 X 0 0 0 DOUG WIGHT 2.00 0.00 X 0 0 0 BRADLEY BEARDEN 2.00 0.00 X 0 0 0 ANNA WILLIAMS 2.00 0.00 X 0 0 0 MARK MCCAMPBELL 0.00 40.00 X 0 203594 2833 0 821497 178214 0 0 1 0 0 15405 977862 1555822 1297149 2549089 55375 55375 15645 0 15645 15645 15645 4795 15405 2413 2382 2382 2622491 0 0 73402 2019398 2019398 94789 94789 25967 25967 2100 2100 102982 922 102060 209072 17706 191366 8065 2058 6007 19226 2801 16425 24136 24136 CONTRIBUTED SALARIES 571650 121000 450650 3077385 2114187 196690 766508 2910203 2387884 1089079 941372 909824 1038616 174866 190530 94649 77401 5178621 4635803 378797 259430 378797 259430 X 1545487 1835283 2884061 2170814 370276 370276 4799824 4376373 5178621 4635803 X -454894 66054 3 -34614 X 0 1 X 1 0 X 2111682 1295391 1730933 3358922 2549089 11046017 2111682 1295391 1730933 3358922 2549089 11046017 1188738 9857279 106465 50603 44176 58577 71020 330841 2382 2382 11379240 0.86630 0.65230 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1273160 113744 1386904 1125630 154645 -2293 4000 822 1273160 989556 67276 69561 763 1125630 880911 52598 56047 989556 473753 422870 -4812 10900 880911 0.66000 0.27000 0.07000 0 0 0 2700797 48805 32596 -3095 78306 2622491 0 2622491 3124251 32596 17365 49961 3074290 3095 3095 3077385 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR CAPITAL, SCHOLARSHIPS, AND ACCESS CARE (CHARITY CARE). PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT DEDUCTIONS -995. INVESTMENT FEE -2,100. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PLEDGES 17,365. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT DEDUCTIONS 995. INVESTMENT FEE 2,100. SCHEDULE D, PART XI, LINE 2A: NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS 66,054 CHANGE IN SPLIT INTEREST VALUE -17,249 TOTAL 48,805 SCHEDULE D, PART XI, LINE 2B AND PART XII, LINE 2A: 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 $604,246 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES, AND 571,650 OF SUCH CONTRIBUTION OF HOSPITAL PERSONNEL HAS BEEN INCLUDED ON FORM 990 TO ACCURATELY REFLECT THE FINANCIAL POSITION OF THE FOUNDATION, THE REST OF $32,596 USE OF FACILITIES HAS BEEN REMOVED FROM THE FORM 990 AS PER THE INSTRUCTIONS. DENIM & DIAMONDS 13053 13053 1561 WOMEN'S HEALTH LUNCHEON 7147 2352 4795 852 20200 15405 4795 852 1561 2413 2382 1 PEACEHEALTH ST JOSEPH MEDICAL CENTER 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 910565889 501(C)(3) 1314653 265066 FMV EQUIPMENT, TOTEM POLES, STATUES PATIENT CARE THE WHATCOM HOSPICE FOUNDATION 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 943146369 501(C)(3) 45300 FOR HOSPICE HOUSE AND GENERAL HOSPICE PROGRAM EXPENSE PEACE ISLAND MEDICAL CENTER 1117 SPRING STREET FRIDAY HARBOR WA 98250 383868360 501(C)(3) 350000 38248 FMV STATUE, GRAND OPENING EXPENSES FACILITY PEACEHEALTH SYSTEM SUPPORT SERVICES 1115 SE 164TH AVE VANCOUVER WA 98683 910939479 501(C)(3) 6131 GRANT WORK RELATING TO THE UNIVERSITY OF COLORADO DENVER GRANT 4 0 RESEARCH REGARDING CARDIAC PATIENTS 1 94789 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION RECEIVES BACKUP DOCUMENTATION (USUALLY IN THE FORM OF AN INVOICE) FROM THE GRANTEE SHOWING FUNDS WERE USED FOR THEIR INTENDED PURPOSE. 0 1 0 0 0 0 0 0 0 NANCY STEIGER 0 459822 0 0 0 3302 0 140845 0 34536 0 638505 0 0 DIANE STROUT 0 153279 0 0 0 1500 0 0 0 0 0 154779 0 0 MARK MCCAMPBELL 0 203594 0 0 0 0 0 0 0 2833 0 206427 0 0 PART I, LINE 4B THERE IS A 457(F) PLAN FOR SENIOR VPS, PRESIDENT AND CHIEF MISSION OFFICER. NANCY STEIGER IS A PARTICIPANT IN THIS PLAN AND SHE DID NOT RECEIVE ANY PAYMENT DURING THE REPORTING YEAR. X 3 100500 FMV X 1 10165 FMV X SUPPLIES 1 406212 COST X CT SCANNER 1 160000 FMV X PIANO 1 37000 FMV X MISCELLANEOUS EVENT AND PROGRAM GIFTS 12 11622 FMV X CON. SALARIES 571650 BOOK VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS IS BASED ON THE NUMBER OF CONTRIBUTORS DURING THE YEAR. FORM 990, PART I, LINE 6: THERE ARE 30 VOLUNTEERS THAT SERVE AS BOARD MEMBERS, AND 15 VOLUNTEERS THAT HELP WITH FOUNDATION COMMITTEES AND CLERICAL DUTIES IN THE OFFICE OF DEVELOPMENT, SUPPORTING BOTH PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOUNDATION AND WHATCOM HOSPICE FOUNDATION. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 SUPPORT OF PEACEHEALTH PEACE ISLAND MEDICAL CENTER IS A NEW PROGRAM. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 PURSUING PERFECTIONS PROJECT WAS CEASED DUE TO LIMITED DURATION OF FUNDING FOR THE PROJECT, THE PROJECT WAS FUNDED BY GRANTS THROUGH MICROSOFT AND THE STATE OF WASHINGTON, AND THOSE GRANTS WERE COMPLETED IN FISCAL YEAR 2012. FORM 990, PART VI, SECTION A, LINE 7A SEE BELOW DESCRIPTION TO FORM 990, PART VI, SECTION A, LINE 7B. FORM 990, PART VI, SECTION A, LINE 7B AS STATED IN THE ARTICLES OF INCORPORATION "THE FOUNDATION SHALL BE ORGANIZED AND OPERATED EXCLUSIVELY FOR THE PURPOSE OF SUPPORTING PEACEHEALTH ST. JOSEPH MEDICAL CENTER, A PART OF PEACEHEALTH WHATCOM REGION, LOCATED IN BELLINGHAM, WASHINGTON, IN FURTHERANCE OF THE HEALTHCARE MISSION OF ITS OWNER, PEACEHEALTH". THE FOLLOWING ACTIONS OF THE BOARD REQUIRE APPROVAL FROM PEACEHEALTH. 1) THE FOUNDATION SHALL NOT HAVE POWER TO GUARANTEE PAYMENT OR PERFORMANCE BY THIRD PARTIES WITHOUT THE PRIOR WRITTEN CONSENT OF THE PRESIDENT OF PEACEHEALTH OR HIS/HER DELEGATE. 2) THE FOUNDATION SHALL HAVE NO POWER TO MERGE OR CONSOLIDATE WITH OTHER ORGANIZATIONS OR TO CREATE OR ACQUIRE OTHER ORGANIZATIONS OR TO VOLUNTARILY DISSOLVE AND WIND UP ITS AFFAIRS OR TO ENTER INTO ANY ASSIGNMENT OF INCOME OR ASSETS FOR THE BENEFIT OF CREDITORS OR TO SEEK THE PROTECTION OF DEBTOR RELIEF LAWS, WITHOUT HAVING OBTAINED THE PRIOR WRITTEN CONSENT OF THE PRESIDENT OF PEACEHEALTH. 3) WRITTEN CONSENT MUST BE OBTAINED BY THE PRESIDENT OF PEACEHEALTH, OR HIS OR HER DELEGATE, TO THE EXACT LANGUAGE OF ANY PROPOSED CHANGE IN ARTICLES AND BYLAWS. THIS CONSENT SHALL HAVE BEEN FIRST OBTAINED PRIOR TO ANY CHANGE TO THE ARTICLES OF INCORPORATION OR BYLAWS BECOMING EFFECTIVE. 4) ALL PROPOSED NOMINATIONS (OF DIRECTORS) MUST BE APPROVED BY PEACEHEALTH. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS THE FORM 990. ADDITIONALLY, AN ELECTRONIC COPY WITHOUT DONOR NAMES IS PROVIDED TO ALL OTHER BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, DIRECTORS, 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 THE 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 COMMITTEE 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 CHIEF DEVELOPMENT OFFICER 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 CHIEF DEVELOPMENT OFFICER 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 IN THE FOUNDATION OFFICE UPON REQUEST. FORM 990, PART VI, LINE 16B: THE FOUNDATION FOLLOWS THE JOINT VENTURE POLICY OF THE PARENT ORGANIZATION, PEACEHEALTH. FORM 990, PART VII, SECTION A: THE ORGANIZATION MADE REASONABLE EFFORTS TO OBTAIN THE INFORMATION REQUIRED FOR PART VII BY DISTRIBUTING A QUESTIONNAIRE TO EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE LISTED IN PART VII. THE QUESTIONNAIRE INCLUDED THE NAME, TITLE, DATE, AND SIGNATURE OF EACH PERSON REPORTING INFORMATION AND CONTAINS PERTINENT INSTRUCTIONS AND DEFINITIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN SPLIT INTEREST VALUE -17,249. LOSS ON UNCOLLECTIBLE PLEDGES -17,365. PEACEHEALTH 1115 SE 164TH AVE VANCOUVER WA 98683 910939479 HOSPITAL WA 501(C)(3) 3 - HOSPITAL PEACEHEALTH 0 THE WHATCOM HOSPICE FOUNDATION 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 943146369 SUPPORT WHATCOM HOSPICE WA 501(C)(3) 11D - TYPE III PEACEHEALTH 0 PEACEHEALTH KETCHIKAN MEDICAL CENTER FOUNDATION 3100 TONGASS AVE KETCHIKAN AK 99901 651225184 SUPPORT KETCHIKAN GENERAL HOSPITAL AK 501(C)(3) 7 - 509(A)(1) 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 - 509(A)(1) 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 JOHN MEDICAL CENTER FOUNDATION 1615 DELAWARE LONGVIEW WA 98632 911538852 SUPPORT ST. JOHN MEDICAL CENTER WA 501(C)(3) 7 - 509(A)(1) PEACEHEALTH 0 HEALTH VENTURES PO BOX 10905 EUGENE OR 97440 911350776 HEALTHCARE JOINT VENTURES WA 501(C)(3) 7 - 509(A)(1) PEACEHEALTH 0 PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION PO BOX 1600 VANCOUVER WA 98668 911231436 SUPPORT SW WASHINGTON MEDICAL CENTER WA 501(C)(3) 7 - 509(A)(1) PEACEHEALTH 0 PEACE ISLAND MEDICAL CENTER 1117 SPRING STREET STATUE FRIDAY HARBOR WA 98250 383868360 HOSPITAL WA 501(C)(3) 3 - HOSPITAL PEACEHEALTH 0 CHARITABLE ANNUITY TRUSTS (6) INVESTMENT & CHARITABLE GIVING WA N/A T 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 1