2013-10-08T10:38:40-05:00 2012-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2012-01-01 911893957 THE MAX FOUNDATION MAXF 4257788660 110 WEST DAYTON AVENUE NO 205 EDMONDS WA 98020 PATRICIA GARCIA-GONZALEZ 4257788660 2013-10-07 1 SARAH B HUANG P00745974 4254544919 2013-10-04 2012 2016-02-25 16:41:14Z PATRICIA GARCIA-GONZALEZ 110 WEST DAYTON AVENUE NO 205 EDMONDS WA 98020 2404374 0 X WWW.THEMAXFOUNDATION.ORG X 1997 WA DEDICATED TO SERVING PEOPLE WORLDWIDE LIVING WITH BLOOD CANCER AND RARE CANCERS. 5 4 12 400 0 0 84917 502731 2025530 1900935 0 3 0 705 2110447 2404374 31174 46463 0 0 894493 889418 0 0 63822 924086 1281461 1849753 2217342 260694 187032 1318331 1505363 0 0 1318331 1505363 X MAX IS A US-REGISTERED NON-PROFIT WITH A GLOBAL FOCUS ON CANCER, SERVING FAMILIES WORLDWIDE BY FACILITATING ACCESS TO TREATMENT, SUPPORTING PATIENTS, PARTNERING WITH HEALTHCARE PROVIDERS AND BUILDING ADVOCACY EFFORTS IN COMMUNITIES AROUND THE WORLD.THE ORGANIZATION FULFILLS ITS MISSION THROUGH THREE PRIMARY INITIATIVES: A GLOBAL PATIENT HELPLINE PROVIDING FREE HEALTHCARE NAVIGATION AND ADVOCACY SERVICES TO PATIENTS AND CAREGIVERS; A PATIENT GROUP CAPACITY BUILDING INITIATIVE, PROVIDING LOGISTICAL SUPPORT TO GROUPS IN 25 COUNTRIES; AND A PATIENT ACCESS PROGRAM INITIATIVE AIMED AT FACILITATING THE CREATION AND IMPLEMENTATION OF CHANNELS OF ACCESS TO TREATMENT THROUGH THE DEVELOPMENT OF PRIVATE/PUBLIC PARTNERSHIPS. FURTHER, THE ORGANIZATION IS ENGAGED IN DEVELOPING AND IMPLEMENTING DISEASE EDUCATION TRAINING FOR PATIENTS AS WELL AS FOR HEALTHCARE PROVIDERS. 0 0 1990214 46463 1900935 IN 2012 THE FOUNDATION PROVIDED SERVICES TO PATIENTS AND THEIR FAMILIES WITH FINANCIAL AND ORGANIZATIONAL SUPPORT FOR THE ACTIVITIES OF PATIENT/FAMILY SUPPORT GROUPS THROUGHOUT THE WORLD.- ENROLLING AND ADMINISTRATING DIRECT PATIENT ACCESS TO TREATMENT PROGRAMS. THE ORGANIZATION ADMINISTERED SIX UNIQUE PATIENT ORIENTED PROGRAMS OF DIVERSE SCOPE AND FOCUS, IN PARTNERSHIP WITH INDUSTRY, GOVERNMENT AND PHYSICIANS IN 82 COUNTRIES HELPING OVER 30,000 PATIENTS.- THROUGH A PATIENT HELPLINE, SERVING APPROXIMATELY 24,727 PATIENTS IN OVER 129 COUNTRIES WITH COUNSELING AND EMOTIONAL SUPPORT. - ADVOCACY SERVICES TO 5,697 PATIENTS IN 96 COUNTRIES AND INFORMATIONAL REFERRALS TO 4,527 PATIENTS IN PATIENT ASSISTANCE PROGRAMS IN 66 COUNTRIES. 1990214 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 2 0 1 12 1 0 1 IN MY AR 0 0 0 0 0 0 0 0 X 5 4 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X PATRICIA GARCIA-GONZALEZ 4257788660 110 WEST DAYTON AVENUE SUITE 205 EDMONDS WA 98020 KENNETH WEYANT 2.00 X X 0 0 0 TRACEY HIGGINS 2.00 X X 0 0 0 ROBERT FARMER 4.00 X X 0 0 0 JAMES LUMSDEN 2.00 X X 0 0 0 PATRICIA GARCIA-GONZALEZ 50.00 X X 156859 0 10844 156859 0 10844 1 0 1 0 0 502731 502731 PATIENT CARE 624100 1900935 1900935 1900935 3 3 RETURNED FUNDS 900099 705 705 705 2404374 1900935 0 708 X 1000 1000 500 500 44963 44963 162503 146253 8125 8125 595159 535643 29758 29758 69576 62618 3479 3479 62180 55962 3109 3109 1213 1213 15068 15068 8514 4257 851 3406 55736 38130 17291 315 9307 8562 745 49996 43210 6786 82118 73906 8212 7503 7503 11967 11010 957 1385 1385 MAXSTATION CONTRACTORS 781510 711174 54706 15630 EDUCATIONAL PROJECTS 226244 214932 11312 MEDICAL EQUIPMENT 30900 30591 309 2217342 1990214 163306 63822 1272717 1470819 151044 120132 41982 30912 3632 3632 1318331 1505363 0 0 X 1318331 1505363 1318331 1505363 1318331 1505363 187032 0 X X 1 X 0 1 0 X 37372 53242 190352 84917 502731 868614 37372 53242 190352 84917 502731 868614 615344 253270 3 3 868617 9355697 0.29160 0.38720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 151044 120132 30912 30912 1 CENTRAL AMERICA AND THE CARIBBEAN 2 2 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 56000 EAST ASIA AND THE PACIFIC 5 17 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 294000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 GRANTS PATIENT GROUP GRANTS 3200 NORTH AMERICA 2 2 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 52000 SUB-SAHARAN AFRICA 1 1 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 38000 SOUTH AMERICA 1 3 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 97000 MIDDLE EAST AND NORTH AFRICA 0 0 GRANTS PATIENT GROUP GRANTS 2000 RUSSIA & THE NEWLY INDEPENDENT STATES 1 1 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 19000 SOUTH ASIA 4 18 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 256000 12 26 4 18 16 44 561200 256000 817200 0 0 1 0 0 0 PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.: SCHEDULE F, PART I, LINE 2: PROTOCOL FOR GRANTMAKING 1.THE PROGRAM OFFICER MAKING GRANT REQUESTS WILL NEED TO DETERMINE WHO IS DIRECTLY INVOLVED IN THE EXCHANGE OF FUNDS. A) IF FUNDS GO DIRECTLY TO THE PATIENT OR THE PATIENT'S FAMILY, THE PATIENT NAME IS CHECKED AGAINST THE SPECIALLY DESIGNATED NATIONALS LIST (SDN). B) IF FUNDS GO DIRECTLY TO A LABORATORY, THE NAME OF THE LABORATORY AND THE INDIVIDUAL RECEIVING THE FUNDS ARE CHECKED. LIKEWISE, IF IT IS A BANK, THE NAME OF THE BANK AND THE INDIVIDUAL NAME ON THE ACCOUNT ARE CHECKED. C) OUR REGIONAL STAFF MEMBERS UNDERGO A RIGOROUS HIRING PROCESS. IN ADDITION, MS STAFF ARE PERIODICALLY CHECKED AGAINST THE SDN LIST. HOWEVER, IF FUNDS MOVE THROUGH THE HANDS OF MS STAFF TO OTHER INDIVIDUALS OR ENTITIES, THE TRANSACTION IS SUBJECT TO THE SAME PROTOCOL. MS STAFF INDICATE THE INDIVIDUAL OR ENTITY THAT IS DIRECTLY INVOLVED IN THE EXCHANGE OF FUNDS. 2. PROGRAM OFFICERS REVIEW THE SDN LIST AND OFAC COUNTRY SANCTIONS TO DETERMINE IF: A) THE PATIENT OR INDIVIDUAL APPEARS ON THE SDN LIST. B) THE PATIENT OR INDIVIDUAL RESIDES IN A SANCTIONED OFAC COUNTRY THAT LIMITS THIS GRANT. 3. THE INDIVIDUAL PATIENT GRANTS FORM INDICATES WHICH NAME(S) WERE CROSS-REFERENCED WITH THE SDN LIST. 4. IF THE PATIENT OR COUNTRY SHOWS UP ON EITHER LIST, IT WILL BE BROUGHT TO THE EXECUTIVE DIRECTOR AND THE EXECUTIVE ASSISTANT'S ATTENTION AND THE PROGRAM OFFICER WILL BE GIVEN INSTRUCTIONS ON HOW TO INFORM THE MAX STATION AND THE PROPOSED RECIPIENT THAT THE GRANT IS DENIED. METHOD USED TO ACCCOUNT FOR EXPENDITURES: SCHEDULE F, PART I, LINE 3: THE EXPENDITURES REPORTED ON SCHEDULE F, PART I, LINE 3 ARE ON THE MODIFIED CASH BASIS OF ACCOUNTING. X X 0 0 0 0 0 0 0 0 0 PATRICIA GARCIA-GONZALEZ 151859 0 5000 0 0 0 0 0 10844 0 167703 0 0 0 INES GARCIA-GONZALEZ SEE PART V 45029 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: INES GARCIA GONZALEZ(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF PATRICIA GARCIA-GONZALEZ, EXECUTIVE DIRECTOR.(D) DESCRIPTION OF TRANSACTION: EMPLOYMENT FORM 990, PART I, LINE 6, VOLUNTEERS: DURING THE YEAR APPROXIMATELY 400 INDIVIDUALS SERVED AS VOLUNTEERS. THESE INDIVIDUALS ASSISTED WITH PATIENT SUPPORT EVENTS IN 25 COUNTRIES. EACH VOLUNTEER AVERAGES AROUND 120 VOLUNTEER HOURS DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION WERE AMENDED TO ALLOW A BROADER STATEMENT OF THE CORPORATION'S PURPOSE. PREVIOUSLY THE ARTICLES OF INCORPORATION ENUMERATED THE SPECIFIC EXEMPT ACTIVITIES OF THE MAX FOUNDATION. THIS HAS NOW BEEN REMOVED TO SIMPLY STATE THE ORGANIZATION IS OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC OR EDUCATIONAL PURPOSES. ADDITIONALLY, THE PRIOR VERSION OF THE ARTICLES OF INCORPORATION ALLOWED FOR THE BYLAWS TO CREATE MEMBERSHIP ALTHOUGH NO MEMBERSHIP WAS EVER CREATED. THIS ARTICLE HAS BEEN REMOVED SO THE ORGANIZATION NO LONGER HAS THE POTENTIAL TO HAVE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY AN OUTSIDE ACCOUNTANT. AFTER PREPARATION, THE EXECUTIVE DIRECTOR PERFORMS A REVIEW OF THE RETURN. THE RETURN IS THEN FILED WITH THE IRS. A COPY IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD HAS ADOPTED A CONFLICT OF INTEREST POLICY AND THE POLICY IS REVIEWED ON AN ANNUAL BASIS. EACH YEAR, EMPLOYEES AND BOARD MEMBERS MUST REVIEW THE POLICY AND DETERMINE IF ANY CONFLICT OF INTERESTS EXIST. IF A CONFLICT DOES ARISE, IT IS BROUGHT TO THE ATTENTION OF THE EXECUTIVE DIRECTOR AND BOARD AND APPROPRIATE ACTION IS TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. FORM 990, PART IX, LINE 24A, OTHER EXPENSES: MAXSTATIONS ARE LOCAL CANCER ADVOCATES WHO RECEIVE FUNDS FROM THE MAX FOUNDATION TO MANAGE SPECIFIC PROGRAMS OF THE ORGANIZATION IN THEIR COUNTRIES. MAXSTATIONS ACT AS A LIAISON BETWEEN THE ORGANIZATION AND LOCAL PARTNERS, PROVIDE EMOTIONAL SUPPORT TO PATIENTS AND BUILD LOCAL RESOURCES AROUND CANCER PATIENTS. MAXSTATION MALAYSIA SDN BHD UNIT 1302 LOBBY 1 BLOCK A DAMAN SELANGOR MY PATIENT ORIENTED PROGRAMS MY THE MAX FOUNDATION C -67819 83028 1.00000 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MAXSTATION MALAYSIA SDN BHD D 233272 CASH