2014-11-17T13:46:39-06:00 2013-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVE SUITE 801 EVERETT WA 982013510 990 2013-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 RICH HUMPHREY TREASURER 3602994201 2014-11-11 1 ROBERT GRANNUM P00355876 4252597227 2013 2015-11-30 17:44:51Z STEVE RUTZ 1211 24TH STREET ANACORTES WA 98221 924247 0 X WWW.ISLANDHOSPITALFOUNDATION.ORG X 1978 WA THE MISSION OF THE FOUNDATION IS TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH, IN AND AROUND ANACORTES, WASHINGTON. 20 20 0 50 0 0 581891 648420 0 0 63414 71629 -119219 -112532 526086 607517 366995 577827 0 0 0 0 0 0 23976 139001 211271 505996 789098 20090 -181581 2224551 2301503 0 0 2224551 2301503 TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN AND AROUND ANACORTES, WASHINGTON. 0 0 100000 100000 FUND HOSPITAL RENOVATION AND EXPANSION COSTS NOT MET BY TAX REVENUE. 581292 477827 FACILITATE OPERATIONAL NEEDS OF COMMUNITY PROGRAMS AND SERVICES OF LOCAL PUBLIC HOSPITAL DISTRICT. 681292 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 20 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X NANCY RYTAND 3602994201 1211 24TH ST ANACORTES WA 98221 X STEVE RUTZ PRESIDENT 2.00 X X 0 0 0 DAVE MARGESON VICE PRESIDENT 2.00 X X 0 0 0 AARON RASMUSSEN TREASURER 2.00 X X 0 0 0 COLLEEN CRAIG SECRETARY 2.00 X X 0 0 0 SHELLIE BOGOSIAN IMMEDIATE PAST PRESIDENT 1.00 X 0 0 0 JOSH BALDWIN DIRECTOR 1.00 X 0 0 0 DR MARK BACKMAN DIRECTOR 1.00 X 0 0 0 JERREL BARTO DIRECTOR 1.00 X 0 0 0 LANI DONOHOE DIRECTOR 1.00 X 0 0 0 CHRIS JENSEN DIRECTOR 1.00 X 0 0 0 RICHARD HUMPHREY DIRECTOR 1.00 X 0 0 0 JIM ROE DIRECTOR 1.00 X 0 0 0 DIANE RUSHER DIRECTOR 1.00 X 0 0 0 ANNE SMITH DIRECTOR 1.00 X 0 0 0 MICHAEL MAST DIRECTOR 1.00 X 0 0 0 TOM MURPHY DIRECTOR 1.00 X 0 0 0 KRISTIA OICLES DIRECTOR 1.00 X 0 0 0 BILL RABEL DIRECTOR 1.00 X 0 0 0 DR DAVID SLEPYAN DIRECTOR 1.00 X 0 0 0 MARILYN STADLER DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 303383 345037 45397 648420 89 89 207870 136330 71540 71540 71540 67868 303383 180400 -112532 -112532 607517 0 0 -40903 577827 577827 9698 9698 4500 1800 1575 1125 50554 50554 47047 17662 15455 13930 8036 8036 MISCELLANEOUS 38510 29589 8921 BAD DEBT EXPENSE 33449 33449 BANK FEES 19477 19477 789098 681292 83830 23976 100 158328 -13506 107508 0 25450 142958 1933165 2172051 2224551 2301503 0 0 0 0 X 2224551 2301503 2224551 2301503 2224551 2301503 -181581 258533 0 X X 0 0 0 X 516446 427076 830493 581891 648420 3004326 516446 427076 830493 581891 648420 3004326 561389 2442937 29458 31696 35821 63414 89 160478 3164804 615103 0.77190 0.76220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1503114 224453 47732 1679835 1374984 173234 45104 1503114 1386988 33591 -17903 27692 1374984 252065 1129508 119052 62572 51065 1386988 250221 1844 252065 0.85020 0.11970 0.03010 0 0 0 EQUITY FUNDS 1964332 F MONEY MARKET FUNDS 6719 F FIXED INCOME FUNDS 201000 F 2172051 PART V, LINE 4: THE INCOME FROM THE ENDOWMENTS IS TO BE USED FOR TWO PURPOSES: HOSPITAL IDENTIFIED COMMUNITY HEALTH NEEDS AND TO PROVIDE FUNDS FOR THE BENEFIT OF THE BIRTHING CENTER. GALA OF HOPE 283011 242260 40751 43813 66118 6677 1340 GOLF CLASSIC 88240 61123 27117 11192 34516 16744 371251 303383 67868 55005 100634 6677 18084 180400 -112532 1 ISLAND HOSPITAL SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 1211 24TH STREET ANACORTES WA 98221 910729255 SKAGIT COUNTY 577827 SUPPORT OF HEALTH PROGRAMS AT HOSPITAL 1 PART I, LINE 2: ALL GRANTS AND ASSISTANCE ARE ONLY PROVIDED TO THE SUPPORTED ORGANIZATION ISLAND HOSPITAL AND UTILIZED ONLY FOR THE PURPOSE OF THAT GRANT (I.E. HEALTH SCREENING PROGRAM, DIABETES CARE). ISLAND HOSPITAL IS RESPONSIBLE FOR ENSURING FUNDS TRANSFERRED FROM ISLAND HOSPITAL FOUNDATION ARE DESIGNATED AND UTILIZED ONLY FOR THE PURPOSE INSTRUCTED, AND THE FOUNDATION RECEIVES REPORTS SHOWING FUNDS WERE DISBURSED TO DEPARTMENTS AS INSTRUCTED. X 125 FAIR MARKET VALUE X 40 FAIR MARKET VALUE X 12 15675 FAIR MARKET VALUE X GIFT CERTIFIC 28 17306 FAIR MARKET VALUE X VARIOUS 13 10959 FAIR MARKET VALUE X TICKETS 4 1292 FAIR MARKET VALUE 0 1 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTORS IS THE ACTUAL NUMBER OF CONTRIBUTORS OF NON-CASH ITEMS, EXCLUDING CONTRIBUTORS OF SERVICES. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE BEFORE IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C 1. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, AND D. UNDERSTANDS IHF IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. 2. EACH VOTING MEMBER OF THE BOARD SHALL ANNUALLY SIGN A STATEMENT WHICH DECLARES WHETHER SUCH PERSON IS AN INDEPENDENT DIRECTOR. 3. IF AT ANY TIME DURING THE YEAR, THE INFORMATION IN THE ANNUAL STATEMENT CHANGES MATERIALLY, THE DIRECTOR SHALL DISCLOSE SUCH CHANGES AND REVISE THE ANNUAL DISCLOSURE FORM. 4. THE EXECUTIVE COMMITTEE SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY BY REVIEWING ANNUAL STATEMENTS AND TAKING SUCH OTHER ACTIONS AS ARE NECESSARY FOR EFFECTIVE OVERSIGHT. FORM 990, PART VI, SECTION C, LINE 19 ALL ORGANIZATIONAL, FINANCIAL, AND TAX DOCUMENTS, INCLUDING FORM 990, ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE METHOD BY WHICH THE FOUNDATION ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT REVIEW, OR COMPILATION OF ITS FINANCIAL STATEMENTS AND SELECTION OF ITS INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART VI, LINE 7A FOR THE BOARD SELECTION, THE PRESIDENT, VICE PRESIDENT, AND PAST PRESIDENT RECRUIT AND BRING IN CANDIDATES. THE ENTIRE BOARD THEN VOTES ON ELECTING CANDIDATES TO THE BOARD. FINANCIAL, BUDGETARY AND GOVERNING DECISIONS REQUIRE A MAJORITY VOTE OF THE BOARD TO BE ADOPTED BY THE ORGANIZATION.