2013-07-30T16:04:09-05:00 2012-10-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2011-11-01 911022358 YAKIMA VALLEY MEMORIAL HOSPITAL CHARITABLE FOUNDATION YAKI 5095765794 2701 TIETON DRIVE YAKIMA WA 98902 ANNE CAFFERY 5095765794 2013-07-25 1 CHRISTOPHER E RIVARD P00022321 5092487750 2011 2016-02-24 21:20:13Z THE MEMORIAL FOUNDATION ANNE CAFFERY 2701 TIETON DRIVE YAKIMA WA 98902 5510345 0 X WWW.MEMFOUND.ORG X 1978 WA THE FOUNDATION RAISES AND DISTRIBUTES FUNDS TO PROMOTE AND SUPPORT HEALTH CARE SERVICES IN COORDINATION WITH YAKIMA VALLEY MEMORIAL HOSPITAL. 28 28 0 234 0 0 4233991 2324045 0 0 98823 102294 -2462 -14128 4330352 2412211 2525548 5387509 0 0 0 0 0 0 101552 251886 278112 2777434 5665621 1552918 -3253410 8347851 5217588 438542 377859 7909309 4839729 X TO ADVANCE HEALTH IMPROVEMENT THROUGH PHILANTHROPY BY EDUCATING AND INVOLVING OUR COMMUNITY. 0 0 1533274 1533274 CHILDREN'S VILLAGE - SUPPORTING SERVICES FOR CHILDREN WITH SPECIAL HEALTHCARE NEEDS 78382 78382 NORTH STAR LODGE - SUPPORTING A FULL-SERVICE OUTPATIENT CANCER TREATMENT FACILITY. 80362 80362 HOSPICE HOME HEALTH CARE - SUPPORTING HOSPICE/HOME HEALTH SERVICES INCLUDING END OF LIFE SERVICES TO PATIENTS (INCLUDING PALLIATIVE CARE/TRANSITIONS). 3695491 3695491 SUPPORT NUMEROUS HEALTHCARE/HEALTHCARE RELATED PROGRAMS. 3695491 3695491 5387509 1 1 0 0 0 1 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 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 28 28 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WA X BONNIE DWARSHUIS 5092495204 2811 TIETON DRIVE YAKIMA WA 98902 X DARRELL BLUE 1.00 X 0 0 0 ANNE NAPIER CAFFERY 40.00 X X 0 0 0 LEE CALLARMAN 1.00 X 0 0 0 WEST H CAMPBELL 1.00 X 0 0 0 BILL DOLSEN 1.00 X 0 0 0 DR DANIEL DOORNINK 1.00 X 0 0 0 CHRIS FALK 1.00 X 0 0 0 JUDI GILMORE 1.00 X 0 0 0 MARIE HALVERSON 1.00 X X 0 0 0 DR JAMES HAVEN 1.00 X 0 0 0 BRUCE HEISER 1.00 X 0 0 0 ROYAL KEITH 1.00 X 0 0 0 RICK LINNEWEH 1.00 X 0 0 0 DR TIMOTHY MELHORN 1.00 X 0 0 0 MICHAEL MOEN 1.00 X 0 0 0 MARGARET NUTLEY 1.00 X 0 0 0 SCOTT OLANDER 1.00 X 0 0 0 CARLOS OLIVARES 1.00 X 0 0 0 MARY JO PEREZ 1.00 X 0 0 0 B JEAN PRYOR 2.00 X X 0 0 0 CINDI STEWART 1.00 X 0 0 0 MARVIN SUNDQUIST 1.00 X 0 0 0 PATRICIA TEMPLE 1.00 X 0 0 0 BILL WHEELER 2.00 X X 0 0 0 ANN WILLIS 1.00 X 0 0 0 DR ROBERT WILLIAMS 1.00 X 0 0 0 ROBERT G PRICE 1.00 X 0 0 0 DOLORES DESSERAULT 1.00 X 0 0 0 0 0 0 0 0 0 0 0 32808 2291237 126152 2324045 82019 82019 3093354 3073079 20275 20275 20275 9077 32808 20057 -10980 -10980 1850 4998 -3148 -3148 2412211 0 0 88166 5387509 5387509 15879 15879 65880 44854 21026 4933 4933 771 771 REIMBURSED EXPENSES 95720 56777 38943 NET ANNUITY 52531 52531 UNCOLLECTIBLE PLEDGES 25497 25497 OTHER 16901 1586 15315 5665621 5387509 176560 101552 781830 748508 1551221 949552 3520960 2966830 2095833 150749 398007 401949 8347851 5217588 438542 377859 438542 377859 X 1670446 1213561 5926178 3313483 312685 312685 7909309 4839729 8347851 5217588 X -3253410 183830 X X 0 1 1 X 0 X 5637615 3047277 3902384 4233991 2324045 19145312 5637615 3047277 3902384 4233991 2324045 19145312 2200363 16944949 336671 146797 93945 129853 82019 789285 18120 25680 57421 18988 10927 131136 20065733 0.84450 0.84040 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GROSS RECEIPTS FROM EVENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 270000 36604 1 1 445636 49548 1742 493442 437873 9402 1639 445636 389617 49888 1632 437873 323655 67626 1664 389617 0.63000 0.37000 0 0 0 CHARITABLE TRUST 163841 GIFT ANNUITIES 238108 401949 DUE TO YVMH 57035 DEFERRED LIABILITIES 258866 DUE TO EPIC 30979 DUE TO NURSING HOME 30979 377859 2412211 5665621 -3253410 183830 183830 -3069580 2621096 183830 25055 208885 2412211 0 2412211 5690676 25055 25055 5665621 0 5665621 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE FOR THE ENDOWMENT FUNDS ARE CHILDREN'S HEALTHCARE NEEDS AND CANCER PATIENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION QUALIFYING UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE FOUNDATION'S TAX-EXEMPT PURPOSE WOULD BE SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE FOUNDATION DID NOT ENGAGE IN AN ACTIVITY UNRELATED TO ITS TAX-EXEMPT PURPOSE; ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH REQUIREMENTS RELATED TO ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES, THE FOUNDATION HAS DETERMINED THEY HAVE NO UNCERTAIN TAX POSITIONS AT OCTOBER 31, 2012 AND 2011. IN ADDITION, THE FOUNDATION QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170((B)(1)(A)AND HAS BEEN CLASSIFIED AS OTHER THAN A PRIVATE FOUNDATION UNDER SECTION 509(A)(1). PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT EXPENSES OF FUNDRAISING EVENTS 25,055. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT EXPENSES OF FUNDRAISING EVENTS 25,055. GOLF TOURNAMENT 41885 32808 9077 2920 11151 4415 1571 41885 32808 9077 2920 11151 4415 1571 20057 -10980 1 YAKIMA VALLEY MEMORIAL HOSPITAL 2811 TIETON DR YAKIMA WA 98902 910567263 501(C)3 5387509 TO PROVIDE SUPPORT TO THE YAKIMA VALLEY MEMORIAL HOSPITAL IN THEIR PURSUIT OF HEALTH IMPROVEMENT, EDUCATION AND IMPROVING OUR COMMUNITY. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE PRESIDENT/CEO REVIEWS BUDGETS AND PROFIT/LOSS STATEMENTS OF THE PROGRAMS RECEIVING ALLOCATION AWARDS ON, AT LEAST, AN ANNUAL BASIS. X 1 350 FMV X 324 FMV X 4 118197 FMV ON DATE OF TRANSFER X 517 1105 SELLING PRICE X RAFFLE PRIZES 1 4998 RETAIL X GIFT CARDS 22 710 FMV X MEMBERSHIPS 4 469 FMW 1 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE REVIEW AND APPROVAL OF THE FORM 990 IS DELEGATED TO THE EXECUTIVE COMMITTEE OF THE BOARD. THE FORM 990 IS THEN SUBMITTED TO THE FULL VOTING BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES TO SIGN NEW CONFLICT OF INTEREST STATEMENTS. FORM 990, PART VI, SECTION B, LINE 15 SALARIES FOR TOP MANAGEMENT ARE DETERMINED AND REVIEWED BY THE HOSPITAL'S BOARD OF DIRECTORS AND COMPENSATION COMMITTEE. THE FOUNDATION DOES NOT PAY WAGES, IT REIMBURSES THE HOSPITAL FOR APPLICABLE EMPLOYEE COSTS. FORM 990, PART VI, SECTION C, LINE 18 UPON REQUEST DURING BUSINESS HOURS, MONDAY THROUGH FRIDAY, 8:00 AM - 4:30 PM FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST DURING BUSINESS HOURS, MONDAY THROUGH FRIDAY, 8:00 AM - 4:30 PM CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 183,830. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR.