2014-11-14T15:47:32-06:00 2013-12-31 271574632 FBMM TAX PLLC P O BOX 340020 NASHVILLE TN 372030020 990 2013-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 STONE C GOSSARD TREASURER 6153299902 2014-11-13 1 ROGER W DUNAWAY III P00815324 6153299902 2013 2015-11-30 17:44:51Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 1102736 0 X N/A X 2004 WA TO RAISE FUNDS THROUGH DONATIONS FROM THE GENERAL PUBLIC IN ORDER TO SUPPORT OTHER NONPROFIT 501(C)3 ORGANIZATIONS AND GOVERNMENTAL INSTITUTIONS THROUGH CHARITABLE DONATIONS AND GRANTS WHICH ARE TO BE USED FOR EDUCATIONAL, CHARITABLE, RELIGIOUS, SCIENTIFIC, LITERARY AND/OR CONSERVATION PURPOSES. 6 6 0 6 0 0 245320 1066775 0 0 2011 1083 0 34878 247331 1102736 373880 616761 0 0 0 0 0 0 3573 60533 42776 434413 659537 -187082 443199 625615 1068814 0 0 625615 1068814 X TO RAISE FUNDS THROUGH DONATIONS FROM THE GENERAL PUBLIC IN ORDER TO SUPPORT OTHER NONPROFIT 501(C)3 ORGANIZATIONS AND GOVERNMENTAL INSTITUTIONS THROUGH CHARITABLE DONATIONS AND GRANTS WHICH ARE TO BE USED FOR EDUCATIONAL, CHARITABLE, RELIGIOUS, SCIENTIFIC, LITERARY AND/OR CONSERVATION PURPOSES. 1 0 624563 613761 GRANTS AWARDED TO SPECIFIC CHARITABLE ORGANIZATIONS AND INDIVIDUALS CHOSEN BY THE OFFICERS OF THE FOUNDATION IN ACCORDANCE WITH THE PRIMARY PURPOSE OF VITALOGY FOUNDATION'S EXEMPT STATUS. 5032 3000 VITALOGY FOUNDATION SERVED AS THE FISCAL SPONSOR FOR HEAL EB, AN IRS APPROVED 501(C)(3) ORGANIZATION BETWEEN AUGUST 2013 THROUGH MAY 2014. HEAL EB IS AN ORGANIZATION DEDICATED TO TREATING AND FINDING A CURE FOR EPIDERMOLYSIS BULLOSA (EB). ONE GRANT FROM THE HEAL EB RESTRICTED FUNDS WAS MADE DURING 2013. ALL REMAINING RESTRICTED FUNDS WERE GRANTED TO 501(C)(3) ORGANIZATIONS THAT WERE APPROVED BY HEAL EB, AND SUPPORTED HEAL EB'S MISSION, IN 2014. 629595 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X FBMM INC CO JAMIE CHEEK 6153299902 PO BOX 340020 NASHVILLE TN 372030020 X JEFFREY A AMENT PRESIDENT 1.00 X X 0 0 0 MICHAEL D MCCREADY VICE PRESIDENT 1.00 X X 0 0 0 EDDIE J VEDDER VICE PRESIDENT 1.00 X X 0 0 0 KELLY CURTIS SECRETARY 1.00 X X 0 0 0 STONE C GOSSARD TREASURER 1.00 X X 0 0 0 MATTHEW D CAMERON DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 1066775 1066775 1083 1083 CANADIAN TAX REFUND 711130 33236 33236 EXPENSE REIMBURSEMENTS 711130 1642 1642 34878 1102736 0 0 35961 599649 599649 6112 6112 11000 11000 4323 1756 2567 3756 1872 1884 17863 8931 5359 3573 12946 275 12671 1147 1147 FOREIGN TAXES PAID 2741 2741 659537 629595 26369 3573 17144 209297 608471 859517 625615 1068814 0 0 X 625615 885286 0 183528 625615 1068814 625615 1068814 443199 0 X 0 0 0 X 341986 344950 707154 245320 1066775 2706185 341986 344950 707154 245320 1066775 2706185 2706185 2969 2710 1489 2011 1083 10262 34878 34878 2751325 0.98360 0.99140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 11000 0 0 0 0 0 0 11000 0 11000 CENTRAL AMERICA AND THE CARIBBEAN RELIEF FUND 11000 CASH PAYMENT 0 1 0 0 0 0 0 0 0 PART I, LINE 2: MONITORING GRANTS OUTSIDE THE UNITED STATES: VITALOGY FOUNDATION REQUESTS LETTERS FROM THE OUTSIDE ORGANIZATIONS BEGINNING SIX (6) MONTHS AFTER THE GRANT WAS PAID. THESE LETTERS MUST DETAIL HOW THE GRANT IS BEING USED, AND IF ANY FUNDS REMAIN, HOW THE REMAINING FUNDS WILL BE USED. THESE LETTERS CONTINUE TO BE REQUESTED BY VITALOGY FOUNDATION UNTIL THE GRANT HAS BEEN USED IN FULL. 1 826 SEATTLE 8414 GREENWOOD AVENUE NORTH SEATTLE WA 98113 412127333 501(C)(3) 6000 0 N/A N/A GENERAL SUPPORT FUND AHERO INC 1557 COLLEGE COURT MONTGOMERY AL 36106 453704451 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND ADVOCACY FOR PATIENTS WITH CHRONIC ILLNESS INC 195 FARMINGTON AVENUE SUITE 306 FARMINGTON CT 06032 830415607 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND AIR TRAFFIC CONTROL EDUCATION FUND INC 1475 15TH STREET SAN FRANCISCO CA 94103 721600331 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND CREATIVE VISIONS FOUNDATION 18820 PACIFIC COAST HIGHWAY SUITE 201 MALIBU CA 90265 391902814 501(C)(3) 54120 0 N/A N/A GENERAL SUPPORT FUND DOWNTOWN EMERGENCY SERVICE CENTER (DESC) 515 THIRD AVENUE SEATTLE WA 98104 911275815 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND FRIENDS OF KEXP 113 DEXTER AVENUE NORTH SEATTLE WA 98109 912061474 501(C)(3) 60000 0 N/A N/A GENERAL SUPPORT FUND GLOBAL POVERTY PROJECT 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND MARWEN 833 NEW ORLEANS STREET CHICAGO IL 60610 363523622 501(C)(3) 41585 0 N/A N/A GENERAL SUPPORT FUND MARY'S PLACE PO BOX 1711 SEATTLE WA 98111 272087950 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND NORTHWEST HARVEST PO BOX 12272 SEATTLE WA 98102 910826037 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND SEATTLE CHILDRENS HOSPITAL PO BOX 5371 SEATTLE WA 98145 911156519 501(C)(3) 64120 0 N/A N/A GENERAL SUPPORT FUND SEATTLE MUSIC PARTNERS 4533 SUNNYSIDE AVENUE NORTH SEATTLE WA 98103 208258002 501(C)(3) 54120 0 N/A N/A GENERAL SUPPORT FUND SEATTLE'S UNION GOSPEL MISSION PO BOX 202 SEATTLE WA 98111 910595029 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND SOUTH CHICAGO ART CENTER 3217 E 91ST STREET CHICAGO IL 60617 753152211 501(C)(3) 41585 0 N/A N/A GENERAL SUPPORT FUND TREEHOUSE 2100 24TH AVENUE SOUTH SUITE 200 SEATTLE WA 98144 911425676 501(C)(3) 20000 0 N/A N/A GENERAL SUPPORT FUND UNITED WAY OF CENTRAL OKLAHOMA PO BOX 837 OKLAHOMA CITY OK 73101 730589829 501(C)(3) 20000 0 N/A N/A TORNADO RELIEF FUND WAR CHILD USA INC 200 DELAWARE AVENUE AVANT BUILDING SUITE 900 BUFFALO NY 142022107 200994157 501(C)(3) 54120 0 N/A N/A GENERAL SUPPORT FUND YOUTHCARE 2500 NE 54TH STREET SEATTLE WA 98105 910917079 501(C)(3) 50000 0 N/A N/A GENERAL SUPPORT FUND 20 0 DIRECT CASH ASSISTANCE TO AN INDIGENT INDIVIDUAL FOR FOOD, CLOTHING, SHELTER, AND TUITION ASSISTANCE. 1 1250 4862 FMV NON-CASH ASSISTANCE IS COMPRISED OF COLLEGE TUITION AND EXPENSES FOR BOOKS, SUPPLIES, AND BOARDING. PART I, LINE 2: VITALOGY FOUNDATION SELECTS GRANTEES THROUGH AN INTERNAL PROCESS WITH THE FOUNDATION'S BOARD OF DIRECTORS. EACH POTENTIAL GRANTEE'S REQUEST IS REVIEWED BY EACH BOARD MEMBER TO ENSURE IT MEETS THE VITALOGY FOUNDATION'S MISSION GUIDELINES AND THE CHARITY WILL USE THE GRANT EXCLUSIVELY TO CARRY OUT THE "AS DETAILED" CHARITABLE PROJECT, OR FOR GENERAL OPERATIONS, EXCLUSIVELY FOR EXEMPT PURPOSES. ONCE THE GRANTEE HAS BEEN APPROVED, VITALOGY FOUNDATION PROVIDES THE CHARITY WITH A GRANTEE FORM THAT REQUESTS DETAILED INFORMATION ON THE ORGANIZATION INCLUDING ITS TAX ID NUMBER, IRS TAX DETERMINATION LETTER, AS WELL AS THE FUNDS REQUESTED AND HOW THEY WILL BE USED, A DISCLAIMER THAT NO GOODS OR SERVICES WERE EXCHANGED FOR THE GRANT, AND A REQUEST FOR UPDATES AND REPORTS. AFTER THE GRANTEE FORM IS IN HAND, THE CHARITY IS SENT THE FUNDS ALONG WITH THE FOUNDATION'S DONATION ACKNOWLEDGEMENT LETTER WHICH REQUESTS A SIGNATORY BACK CONFIRMING RECEIPT OF THE FUNDS. VITALOGY FOUNDATION FOLLOWS-UP WITH THE GRANTEES TO ENSURE THEY ARE ADHERING TO OUR GUIDELINES THROUGH REGULAR PHONE CALLS AS WELL AS REQUESTING WRITTEN UPDATES EVERY SIX MONTHS. THE VITALOGY FOUNDATION TEAM ALSO MAKES SITE VISITS TO SELECT LARGER SCALE GRANTEES TO GET FIRST HAND KNOWLEDGE OF HOW THE FUNDS ARE BEING APPLIED/DISPERSED IN THE FIELD. FROM THESE REPORTS AND CORRESPONDENCE WITH THE GRANTEE, THE VITALOGY FOUNDATION TEAM PROVIDES UPDATES TO THE BOARD OF DIRECTORS TWO WAYS; THROUGH WEEKLY PROJECT UPDATES AND THROUGH A MORE DETAILED ANNUAL PROJECT UPDATE AS WARRANTED BASED UPON THE SIZE OF THE GRANT. TO TRACK THESE PROJECTS, THE GRANTEES' WRITTEN REPORTS, TEAM CORRESPONDENCE, AND BOARD UPDATES ARE FILED ALONG WITH THE CORRESPONDING GRANTEE FORM AND IRS LETTER ACKNOWLEDGEMENT. INTERNALLY, VITALOGY FOUNDATION KEEPS A RUNNING CONTRIBUTION SUMMARY OF ALL BEQUEATHS TO DATE BY YEAR THAT INCLUDES TRACKING ON UPDATES RECEIVED BY GRANTEES. FORM 990, PART I, LINE 6, TOTAL NUMBER OF VOLUNTEERS: THE TOTAL NUMBER OF VOLUNTEERS CONSISTS OF THE SIX NON-COMPENSATED BOARD MEMBERS. FORM 990, PART III, LINE 2 VITALOGY FOUNDATION SERVED AS THE FISCAL SPONSOR FOR A SEPARATE 501(C)(3) ORGANIZATION NAMED HEAL EB. VITALOGY FOUNDATION TREATS ALL FUNDS FOR THE PURPOSE OF THIS PROGRAM AS RESTRICTED UNDER THE CHARITABLE TRUST DOCTRINE. FORM 990, PART VI, SECTION A, LINE 2 EXPLANATION OF BUSINESS RELATIONSHIP WITH OTHER OFFICERS OR DIRECTORS: ALL MEMBERS OF THE BOARD HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVEIWED BY AN OUTSIDE CPA FIRM AND THE BOARD MEMBERS PRIOR TO FILING THE TAX RETURN. FORM 990, PART VI, SECTION C, LINE 19 VITALOGY FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FORM 990 AVAILABLE TO INTERESTED PARTIES UPON REQUEST. PEARL JAM LLC PO BOX 340020 NASHVILLE TN 372030020 911695049 MUSICAL ENTERTAINMENT WA N/A DEKERIVER LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 203277547 BUILDING RENTAL WA N/A TEN CLUB LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 912094535 FAN CLUB MERCHANDISE WA N/A MONKEYWRENCH FILMS LLC PO BOX 340020 NASHVILLE TN 372030020 264471983 FILM PRODUCTION CA N/A PERMASEAL FILM PRODUCTION COMPANY LLC PO BOX 340020 NASHVILLE TN 372030020 264508356 FILM PRODUCTION WA N/A MONKEYWRENCH INC PO BOX 340020 NASHVILLE TN 372030020 331062443 MUSICAL RECORDINGS WA N/A S 0 PEARL JAM TOURING INC PO BOX 340020 NASHVILLE TN 372030020 911531093 MUSICAL ENTERTAINMENT NV N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0