PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION (EIN 91-1538852)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-04-25
- IRS object ID
- 201441159349300119
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-04-25T11:48:13-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911194016 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK NUBER PS | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911538852 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH ST JOHN MEDICAL CENTER FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PEAC | NameControl |
| Phone | 3604147900 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1615 DELAWARE | AddressLine1 |
| City | LONGVIEW | City |
| State | WA | State |
| ZIP Code | 98632 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CATHY BARR | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 3604147900 | Phone |
| Date Signed | 2014-04-24 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SARA ELIZABETH J HYRE | Name |
| PTIN | P00235495 | PTIN |
| Phone | 4254544919 | Phone |
| Date Prepared | 2014-04-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CATHY BARR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 2252368 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | PEACEHEALTH.ORG/FOUNDATION/ST-JOHN/PAGES/DEFAULT | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | SUPPORT OF PEACEHEALTH ST. JOHN MEDICAL CENTER BY BUILDING SOCIAL AND FINANCIAL RESOURCES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 29 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 22 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1615880 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1187425 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 36979 | InvestmentIncomePriorYear |
| Investment Income Current Year | 142025 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 12823 | OtherRevenuePriorYear |
| Other Revenue Current Year | -23636 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1665682 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1305814 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 825484 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1146274 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 17284 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 16063 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 37638 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 244296 | OtherExpensePriorYear |
| Other Expenses Current Year | 173471 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1087064 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1335808 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 578618 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -29994 | RevenuesLessExpensesCY |
| Total Assets BOY | 7367301 | TotalAssetsBOY |
| Total Assets EOY | 7557886 | TotalAssetsEOY |
| Total Liabilities BOY | 2388362 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2229861 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4978939 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5328025 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 349433 | Expense |
| Grants | 349433 | Grants |
| Description | UNRESTRICTED FUNDS - FUNDS RAISED WITH NO SPECIFIC PROJECT RESTRICTION ARE USED TO SUPPORT THE GENERAL OPERATING AND CAPITAL NEEDS OF THE HOSPITAL. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 338849 | Expense |
| Grants | 338849 | Grants |
| Description | 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 2013. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 119724 | Expense |
| Grants | 119724 | Grants |
| Description | HEART - FUNDS RAISED TO SUPPORT THE NEEDS OF THE CARDIAC CATH LAB DEPARTMENT OF THE HOSPITAL, TO SUPPORT PURCHASE OF CAPITAL AND OPERATING NEEDS OF THE PROGRAM. | Description |
Activity Other ActivityOther (7 entries)
| ExpenseExpense | GrantsGrants | DescriptionDescription |
|---|---|---|
| 114700 | 114700 | DAVID C. WRIGHT SUPPORTIVE CARE PROGRAM - FUNDS FOR USE IN THE PALLIATIVE CARE PROGRAM OF THE HOSPITAL, TO PROVIDE COMFORT AND END OF LIFE CARE. |
| 38265 | 38265 | CRITICAL CARE FUND |
| 36405 | 36405 | LOWER COLUMNBIA REGIONAL CANCER CENTER |
| 22269 | 22269 | RADIATION ONCOLOGY PROGRAM |
| 17948 | 17948 | DIALYSIS |
| 15684 | 15684 | OBSTETRICS |
| 92997 | 92997 | ALL OTHER PROGRAM SERVICES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 338268 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 338268 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 1146274 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 29 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 22 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRENDA MARSDEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3604142115 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3002 | AddressLine1 |
| City | LONGVIEW | City |
| State | WA | State |
| ZIP Code | 98632 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (33 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| MAILA CADD | |||||||
| PRESIDENT | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| STEVEN CABRALES MD | |||||||
| VICE PRESIDENT | 1.00 | 40.00 | X | X | 0 | 371775 | 31842 |
| CHRIS SEARING | |||||||
| TREASURER | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| PAULINE KIRCHNER | |||||||
| SECRETARY | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| MICHAEL MCNELLIS MD | |||||||
| BOARD MEMBER | 1.00 | 40.00 | X | 0 | 334775 | 30669 | |
| JOSIAH JOHNSON | |||||||
| BOARD MEMBER | 1.00 | 40.00 | X | 0 | 401090 | 110621 | |
| GERT MARTINI | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JOANNA ASPLUND | |||||||
| BOARD MEMBER | 1.00 | 40.00 | X | 0 | 39110 | 5419 | |
| JOHN BERWIND DDS | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JANICE CARTER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| DON CIANCI | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| BILL CHESLOCK OD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| SUZANNE CUSICK | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| EARL FISHER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| DENISE GABEL | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| GENE GUTTORMSEN | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| STEVE JABUSCH | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JULIE KENDALL | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| BILL MARCUM | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JAMES NAKASHIMA MD | |||||||
| BOARD MEMBER | 1.00 | 40.00 | X | 0 | 225575 | 39064 | |
| ROSE MARIE NIGRO CSJP | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| MARK PURCELL | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| TOM RENAUD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| PAT SARI | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| DOUG STAFFORD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| LILLIAN STONEKING PA | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JUDIE WILSON | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| RONI ZIEGLER | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| BILL BOEHM | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| LINDA DOERR | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| GWEN LARSON | |||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| CORI DOLAN | |||||||
| CHIEF FINANCIAL OFFICER | 1.00 | 40.00 | X | X | 0 | 76803 | 6295 |
| CATHY BARR | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 0.00 | X | 0 | 118145 | 19057 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1567273 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 242967 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Info In Schedule O Part VIII | X | InfoInScheduleOPartVIII |
| Fundraising Events | 343872 | FundraisingEvents |
| All Other Contributions | 843553 | AllOtherContributions |
| Noncash Contributions | 65009 | NoncashContributions |
| Total Contributions | 1187425 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 66668 | TotalRevenueColumn |
| Exclusion | $66,668 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 384417 | Securities |
| Other | 509500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 297876 | Securities |
| Other | 520684 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 86541 | Securities |
| Other | -11184 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 75357 | TotalRevenueColumn |
| Exclusion | $75,357 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 94133 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 343872 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 127994 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -33861 | TotalRevenueColumn |
| Exclusion | -$33,861 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 10225 | GrossIncomeGaming |
| Gaming Direct Expenses | 0 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10225 | TotalRevenueColumn |
| Exclusion | $10,225 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1305814 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $118,389 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1146274 | Total |
| Program Services | 1146274 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38341 | Total |
| Management And General | 38341 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16063 | Total |
| Fundraising | 16063 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14099 | Total |
| Management And General | 14099 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1895 | Total |
| Management And General | 1895 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73590 | Total |
| Management And General | 73590 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17064 | Total |
| Management And General | 17064 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | FundraisingFundraising | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| IND. FUNDRAISING EXP. | 21575 | 21575 | |
| REPAIR & MAINTENANCE | 2695 | 2695 | |
| BAD DEBT | 2550 | 2550 | |
| PROPERTY TAXES | 1662 | 1662 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1335808 | Total |
| Program Services | 1146274 | ProgramServices |
| Management And General | 151896 | ManagementAndGeneral |
| Fundraising | 37638 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81074 | BOY |
| EOY | 80649 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 660892 | BOY |
| EOY | 865027 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 149091 | BOY |
| EOY | 141894 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12697 | BOY |
| EOY | 1750 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 0 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 0 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 520684 | BOY |
| EOY | 0 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2719108 | BOY |
| EOY | 3002781 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3223755 | BOY |
| EOY | 3465785 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7367301 | BOY |
| EOY | 7557886 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 27646 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12500 | BOY |
| EOY | 12900 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2375862 | BOY |
| EOY | 2189315 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2388362 | BOY |
| EOY | 2229861 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1487352 | BOY |
| EOY | 1628641 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2420432 | BOY |
| EOY | 2625801 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1071155 | BOY |
| EOY | 1073583 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4978939 | BOY |
| EOY | 5328025 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7367301 | BOY |
| EOY | 7557886 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -29994 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 117574 | ReconciliationUnrealizedInvest |
| Reconcilation Prior Adjustment | 161089 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 100417 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 758558 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 989924 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1472995 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1615880 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1187425 | CurrentTaxYear |
| Total | 6024782 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 758558 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 989924 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1472995 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1615880 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1187425 | CurrentTaxYear |
| Total | 6024782 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 876743 | AmountsSubstContributorsTotal |
| Public Support Total170 | 5148039 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 102481 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 62671 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 61878 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 68465 | CurrentTaxYearMinus1Year |
| Current Tax Year | 66668 | CurrentTaxYear |
| Total | 362163 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 7308 | CurrentTaxYearMinus1Year |
| Total | 7308 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 6394253 | TotalSupport |
| Public Support Pertcentage170 | 0.80510 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.76250 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PART II LINE 10 FOR 2011: TAX REFUND: $7,308 | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1190365 | BeginningOfYearBalance |
| Contributions | 58717 | Contributions |
| Investment Earnings Or Losses | 119115 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 26536 | GrantsOrScholarships |
| Administrative Expenses | 70540 | AdministrativeExpenses |
| End Of Year Balance | 1271121 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1525574 | BeginningOfYearBalance |
| Contributions | 59885 | Contributions |
| Investment Earnings Or Losses | -33723 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 34319 | GrantsOrScholarships |
| Other Expenditures | 327052 | OtherExpenditures |
| End Of Year Balance | 1190365 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1273932 | BeginningOfYearBalance |
| Contributions | 33599 | Contributions |
| Investment Earnings Or Losses | 241023 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 22980 | GrantsOrScholarships |
| End Of Year Balance | 1525574 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1139166 | BeginningOfYearBalance |
| Contributions | 11410 | Contributions |
| Investment Earnings Or Losses | 164123 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 40767 | GrantsOrScholarships |
| End Of Year Balance | 1273932 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1403528 | BeginningOfYearBalance |
| Contributions | 6452 | Contributions |
| Investment Earnings Or Losses | -230851 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 39963 | GrantsOrScholarships |
| End Of Year Balance | 1139166 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.84000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.16000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| CASH VALUE OF LIFE INSURANCE | 159803 |
| SPLIT-INTEREST AGREEMENTS | 3305982 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3465785 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SPLIT-INTEREST AGREEMENTS | Description |
| Amount | $2,189,315 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2189315 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 2119010 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 117574 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 527447 | DonatedSrvcAndUseOfFacilities |
| Other Revenues | 100417 | OtherRevenues |
| Revenue Not Rptd F990 | 745438 | RevenueNotRptdF990 |
| Revenue Subtotal | 1373572 | RevenueSubtotal |
| Other Revenues Not Included | -67758 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -67758 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1305814 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1931013 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 527447 | DonatedServicesUseOfFacilities |
| Other Expenses Included | 67758 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 595205 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1335808 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1335808 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | 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 100,417. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES REPORTED ON AFS AS EXPENSES -67,758. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES REPORTED ON AFS AS EXPENSES 67,758. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 0 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Individual | PAT MARTIN | NameOfIndividual |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2621 CASCADE WAY | AddressLine1 |
| City | LONGVIEW | City |
| State | WA | State |
| ZIP Code | 98632 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | GRANT WRITER | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 5000 | GrossReceipts |
| Amount Retained By Contractor | 16063 | AmountRetainedByContractor |
| Net To Organization | -11063 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 5000 | TotalGrossReceipts |
| Total Retained By Contractors | 16063 | TotalRetainedByContractors |
| Total Net To Organization | -11063 | TotalNetToOrganization |
| Licensed States | WA | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 163385 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 143129 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 20256 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 9500 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 700 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 6341 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 12020 | OtherDirectExpensesEvent1 |
| Name Of Event2 | DECEMBER GALA | NameOfEvent2 |
| Gross Receipts Event2 | 251215 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 186755 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 64460 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 13371 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 21848 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 48181 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 23405 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 13988 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 9417 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 3987 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 6433 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 2000 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 3613 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 438005 | GrossReceiptsTotal |
| Charitable Contributions Total | 343872 | CharitableContributionsTotal |
| Gross Revenue Total Events | 94133 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 9500 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 18058 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 34622 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 2000 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 63814 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 127994 | DirectExpenseSummaryEvents |
| Net Income Summary | -33861 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACEHEALTH ST JOHN MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| 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) |
|---|---|---|
| EIN Of Recipient | 910939479 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 1141081 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 4773 | AmountOfNonCashAssistance |
| Method Of Valuation | FMV | MethodOfValuation |
| Description Of Non Cash Assistance | GIFTS IN KIND FROM DONORS | DescriptionOfNonCashAssistance |
| Purpose Of Grant | GENERAL SUPPORT FOR PEACEHEALTH ST. JOHN MEDICAL CENTER | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN CABRALES MD | ||||||||||||||
| VICE PRESIDENT | 0 | 323936 | 0 | 47839 | 0 | 0 | 0 | 25596 | 0 | 6246 | 0 | 403617 | 0 | 0 |
| MICHAEL MCNELLIS MD | ||||||||||||||
| BOARD MEMBER | 0 | 334775 | 0 | 0 | 0 | 0 | 0 | 29250 | 0 | 1419 | 0 | 365444 | 0 | 0 |
| JOSIAH JOHNSON | ||||||||||||||
| BOARD MEMBER | 0 | 340350 | 0 | 50258 | 0 | 10482 | 0 | 109781 | 0 | 840 | 0 | 511711 | 0 | 0 |
| JAMES NAKASHIMA MD | ||||||||||||||
| BOARD MEMBER | 0 | 219110 | 0 | 6465 | 0 | 0 | 0 | 28523 | 0 | 10541 | 0 | 264639 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUPPLEMENTAL INFORMATION | PART III | 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. |
| SUPPLEMENTAL INFORMATION | PART III | SCHEDULE J, PART I, LINE 4B: THE ORGANIZATION'S BOARD MEMBER JOSIAH JOHNSON, IS PEACEHEALTH'S CHIEF EXECUTIVE OFFICER 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
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK NUBER PS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | GREATER THAN 5% SHAREHOLDER IS SISTER-IN-LAW OF BOARD MEMBER | Relationship |
| Amount Of Transaction | 38341 | AmountOfTransaction |
| Description Of Transaction | ACCOUNTING SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSupplies
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 18 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 1728 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Number Of ContributionsNumberOfContributions | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|---|
| X | AUCTION ITEMS | 105 | 60236 | FMV |
| X | KIDS ITEMS | 172 | 3045 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of8283 Received | 0 | NumberOf8283Received |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 1 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: | Identifier |
| Return Reference | PART I, COLUMN (B): | ReturnReference |
| Explanation | THE NUMBER OF CONTRIBUTORS IS THE NUMBER OF ITEMS DONATED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 A, LINE 4 | TERMS FOR BOARD MEMBERS CHANGED TO NO MORE THAN FOUR SUCCESSIVE THREE-YEAR TERMS. EMERITUS BOARD MEMBERS SHALL NOT HAVE A VOTE EXCEPT WHILE SERVING ON A FOUNDATION COMMITTEE. | |
| 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 HR AND THE ADMINISTRATIVE DIRECTOR OF HR. 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). | COMPENSATION FROM RELATED ORGANIZATION: |
| 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 $520,673 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. | IN-KIND CONTRIBUTIONS & EXPENSES: |
| FORM 990, PART XI, LINE 9: | SPLIT INTEREST VALUE CHANGE 100,417. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI LINE 8: PRIOR PERIOD ADJUSTMENTS | CHARITABLE GIFT ANNUITY LIABILITY RECALCULATED AND CORRECTED: $161,089 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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