2013-11-15T16:11:53-06:00 2012-12-31 271574632 FBMM TAX PLLC P O BOX 340020 NASHVILLE TN 372030020 990 2012-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 STONE C GOSSARD 6153299902 2013-11-15 1 ROGER W DUNAWAY III P00815324 6153299902 2012 2016-03-07 17:11:31Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 247331 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 707154 245320 0 0 1489 2011 0 0 708643 247331 296138 373880 0 0 0 0 0 0 5136 68036 60533 364174 434413 344469 -187082 812697 625615 0 0 812697 625615 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. 0 0 386721 373880 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. 386721 1 0 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 1.00 X X 0 0 0 MICHAEL D MCCREADY 1.00 X X 0 0 0 EDDIE J VEDDER 1.00 X X 0 0 0 KELLY CURTIS 1.00 X X 0 0 0 STONE C GOSSARD 1.00 X X 0 0 0 MATTHEW D CAMERON 1.00 X 0 0 0 0 0 0 0 0 0 0 0 245320 245320 2011 2011 247331 0 0 2011 299180 299180 22700 22700 52000 52000 2262 2262 2700 2700 39363 12841 21386 5136 13786 13786 2422 2422 434413 386721 42556 5136 431237 17144 381460 608471 812697 625615 0 0 X 812697 625615 812697 625615 812697 625615 -187082 0 X 0 0 0 X 422118 341986 344950 707154 245320 2061528 422118 341986 344950 707154 245320 2061528 2061528 8761 2969 2710 1489 2011 17940 2079468 0.99140 0.98590 X 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 52000 0 0 0 0 0 0 52000 0 52000 CENTRAL AMERICA AND THE CARIBBEAN RELIEF FUND 52000 CASH PAYMENT 1 0 0 0 0 0 0 0 MONITORING GRANTS TO OUTSIDE ORGANIZATIONS SCHEDULE F - PART 1 - LINE 2 MONITORING GRANTS TO OUTSIDE ORGANIZATIONS SCHEDULE F - PART 1 - LINE 2 1 ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 5500 N/A N/A GENERAL SUPPORT FUND CROHN'S & COLITIS FOUNDATION OF AMERICA 9 LAKE BELLEVUE SUITE 203 BELLEVUE WA 98005 136193105 501(C)(3) 27680 N/A N/A GENERAL SUPPORT FUND CONSERVATION INTERNATIONAL 2011 CRYSTAL DRIVE SUITE 500 ARLINGTON VA 22202 521497470 501(C)(3) 25000 N/A N/A GENERAL SUPPORT FUND DOWNTOWN EMERGENCY SERVICE CENTER (DESC) 515 THIRD AVENUE SEATTLE WA 98104 911275815 501(C)(3) 20000 N/A N/A GENERAL SUPPORT FUND FOOD FOR THOUGHT BY THE SEA 1000 OCEAN AVENUE ASBURY PARK NJ 07712 264286096 501(C)(3) 12500 N/A N/A GENERAL SUPPORT FUND HEDGEBROOK 2197 MILLMAN ROAD LANGLEY WA 98260 800012629 501(C)(3) 7000 N/A N/A GENERAL SUPPORT FUND MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH 801 BROADWAY SUITE 701 SEATTLE WA 98122 912054035 501(C)(3) 10000 N/A N/A GENERAL SUPPORT FUND ROCK SCHOOL 10903 NE 53RD STREET KIRKLAND WA 98033 460494902 501(C)(3) 10000 N/A N/A GENERAL SUPPORT FUND SPRUCE STREET SCHOOL 914 VIRGINIA STREET SEATTLE WA 98101 910963223 501(C)(3) 15000 N/A N/A GENERAL SUPPORT FUND THE ACTORS GANG 9070 VENICE BLVD CULVER CITY CA 90232 954226223 501(C)(3) 50000 N/A N/A GENERAL SUPPORT FUND THE COASTAL HABITAT FOR HUMANITY 200 HIGHWAY 71 SPRING LAKE HEIGHTS NJ 07762 223285769 501(C)(3) 12500 N/A N/A GENERAL SUPPORT FUND UJA FEDERATION OF NEW YORK 130 EAST 59TH STREET NEW YORK NY 10022 510172429 501(C)(3) 5500 N/A N/A GENERAL SUPPORT FUND WILD LOVE PERSERVE 12239 10TH AVENUE SOUTH SEATTLE WA 98168 273729450 501(C)(3) 7000 N/A N/A GENERAL SUPPORT FUND WOUNDED WARRIOR PROJECT 4899 BELFORT ROAD SUITE 300 JACKSONVILLE FL 32256 202370934 501(C)(3) 10000 N/A N/A GENERAL SUPPORT FUND 14 0 DIRECT CASH ASSISTANCE TO AN INDIGENT INDIVIDUAL FOR FOOD, CLOTHING, SHELTER, AND TUITION ASSISTANCE. 1 5277 17423 FMV NON-CASH ASSISTANCE IS COMPRISED OF COLLEGE TUITION AND EXPENSES FOR BOOKS / SUPPLIES. PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 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