2013-05-15T19:04:13-05:00 2012-06-30 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-07-01 721545902 PEACEHEALTH ST JOSEPH MEDICAL CENTER FOUNDATION PEAC 3607886866 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 MARK MCCAMPBELL 3607566865 2013-05-15 1 SARA ELIZABETH J HYRE P00235495 4254544919 2013-05-15 2011 2016-02-24 21:20:13Z MARK MCCAMPBELL 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 3744146 0 X WWW.THEHOSPITALFOUNDATION.ORG X 2003 WA TO RAISE CONTRIBUTIONS AND ESTABLISH ENDOWMENTS TO SUPPORT PEACEHEALTH ST. JOSEPH MEDICAL CENTER ACTIVITIES. 25 24 0 41 0 0 1730933 3358922 0 0 46148 48410 -25495 -120523 1751586 3286809 756239 2371286 0 0 0 0 0 0 206493 215108 257686 971347 2628972 780239 657837 6011504 5178621 159679 378797 5851825 4799824 X PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOUNDATION EXISTS TO ACQUIRE AND RECOGNIZE CHARITABLE GIFTS AND BEQUESTS THAT ASSIST PEACEHEALTH ST. JOSEPH MEDICAL CENTER IN FULFILLING ITS MISSION, ADHERING TO ITS CORE VALUES AND PROVIDING MEDICAL SERVICES TO THE WHATCOM REGION. THE FOUNDATION WILL:- PROVIDE INDIVIDUALS AND INSTITUTIONS WITH AN OPPORTUNITY TO EXTENDTHE GIFT OF HEALTH TO CITIZENS IN NORTHWEST WASHINGTON STATE.- SUPPORT THE APPLICATION OF INNOVATIVE PATIENT CARE SERVICES TOIMPROVE THE HEALTH CARE SERVICES OF THIS AREA.- ACHIEVE FOR THE MEDICAL CENTER A HIGHER LEVEL OF MUTUALUNDERSTANDING AND INVOLVEMENT WITH THE COMMUNITIES IT SERVES.- PHILANTHROPIC OPPORTUNITIES SHOULD ENHANCE THE ABILITY OF ST. JOSEPHMEDICAL CENTER TO PROVIDE HEALING AND COMPASSIONATE HEALTHCARE RESPECTING EVERY PERSON'S HUMAN DIGNITY. 0 0 71183 71183 PURSUING PERFECTIONS PROJECT - A COMMUNITY WIDE TEAM OF PATIENTS, PHYSICIANS AND HOSPITAL STAFF WORKING TOGETHER TO IDENTIFY HOW TO IMPROVE CARE TO DIABETIC AND CONGESTIVE HEART FAILURE PATIENTS AND THEIR FAMILIES THROUGH THE DEVELOPMENT OF A SHARE CARE PLAN, CREATION OF CARE TEAMS AND THE REDESIGN OF SERVICES IN HOSPITALS AND CLINICS. 2174194 2174194 SUPPORT OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOR EDUCATION, PATIENT SUPPORT, NURSING SUPPORT, RESEARCH, CAPITAL EXPENDITURES, SCHOLARSHIPS AND CHARITY CARE. THE FOUNDATION RECEIVES FROM PEACEHEALTH ST. JOSEPH MEDICAL CENTER AND PEACEHEALTH CORPORATION DONATED USE OF FACILITIES AND SERVICES, WHICH INCLUDE SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES, AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $619,888 OF SUCH ITEMS HAS BEEN REFLECTED IN THE FINANCIAL STATEMENTS AS A PART OF IN-KIND CONTRIBUTIONS AND EXPENSES, BUT HAS BEEN REMOVED FROM THE FORM 990 AS PER THE INSTRUCTIONS. 125909 125909 THE WHATCOM HOSPICE FOUNDATION TRANSFERS. THE WHATCOM HOSPICE FOUNDATION'S MISSION IS TO SUPPORT THE HOSPICE PROGRAM OF PEACEHEALTH ST. JOSEPH MEDICAL CENTER. 2371286 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 3 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 25 24 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 0 WA X NICOLE POYNER 3607886540 809 E CHESTNUT ST BELLINGHAM WA 98225 X JOHN HUNTLEY 2.00 X X 0 0 0 FRANK IMHOF 2.00 X X 0 0 0 NANCY STEIGER 2.00 X X 0 508923 21254 MARION ROBIN FOOTE 2.00 X X 0 0 0 DR SHAUN SULLIVAN 2.00 X X 0 0 0 CHARLES ARIZ MD 2.00 X 0 0 0 MICHAEL BRADBURN 2.00 X 0 0 0 BRAD DEHANN 2.00 X 0 0 0 AMY ESARY 2.00 X 0 0 0 ROSEMARIE FRANCIS 2.00 X 0 0 0 DON HAGGEN 2.00 X 0 0 0 WILLIAM HALL MD 2.00 X 0 0 0 DENNY HOLMSTROM 2.00 X 0 0 0 KATIE JANSEN 2.00 X 0 0 0 LYNNETTE JENSEN 2.00 X 0 0 0 SIMON JOHNSON 2.00 X 0 0 0 JEFFREY KAUFMAN 2.00 X 0 0 0 ANITA WISEMAN 1.00 X 0 0 0 JAN JURGENSEN 1.00 X 0 0 0 CHET KENOYER 2.00 X 0 0 0 MIKE PERRY 2.00 X 0 0 0 SARAH ROTHENBUHLER 2.00 X 0 0 0 DIANE STROUT 2.00 X 0 0 0 HOLLY STUDLEY 2.00 X 0 0 0 CHRISTINE THOMPSON 2.00 X 0 0 0 FRANK ZURLINE 2.00 X 0 0 0 MARK MCCAMPBELL 40.00 X 0 214908 15511 KEVIN PENDERGAST 2.00 X 0 77040 1031 0 800871 37796 0 0 1 0 0 286389 212506 2860027 289781 3358922 47828 47828 10749 0 10749 10749 10749 303272 302690 582 582 582 23375 286389 154647 -131272 -131272 3286809 0 0 -72113 2306636 2306636 64650 64650 2270 2270 217731 48923 168808 INDIRECT SPECIAL EVENT 20058 20058 BAD DEBT EXPENSE 17627 17627 2628972 2371286 51193 206493 2451024 2910203 2332180 1089079 922656 909824 164111 174866 141533 94649 6011504 5178621 68335 378797 91344 159679 378797 X 1473342 1545487 4015103 2884061 363380 370276 5851825 4799824 6011504 5178621 X 657837 -1709838 X 0 1 1 X 0 X 2758140 2111682 1295391 1730933 3358922 11255068 2758140 2111682 1295391 1730933 3358922 11255068 3567657 7687411 200985 106465 50603 44176 58577 460806 69788 69788 11785662 0.65230 0.66520 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1125630 154645 -2293 4000 822 1273160 989556 67276 69561 763 1125630 880911 52598 56047 989556 473753 422870 -4812 10900 880911 0.66000 0.29000 0.05000 0 0 0 3286809 2628972 657837 -39026 -1670812 -1709838 -1052001 2159589 -27389 619888 -1719719 -1127220 3286809 0 3286809 3211587 619888 619888 2591699 37273 37273 2628972 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED FOR CAPITAL, SCHOLARSHIPS, AND ACCESS CARE (CHARITY CARE). PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN SPLIT INTEREST VALUE 11,637. ADJUSTMENT FOR PLEDGE TO BE COLLECTED DIRECTLY BY PEACEHEALTH ST. JOSEPH MEDICAL CENTER -1,682,449. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,670,812. PART XII, LINE 2D - OTHER ADJUSTMENTS: INDIRECT SPECIAL EVENTS EXPENSE NETTED WITH REVENUE ON FS -20,058. CONTRIBUTED SERVICES AND USE OF FACILITIES NETTED WITH REVENUE ON FS -14,945. INVESTMENT FEE -2,270. ADJUSTMENT FOR PLEDGE TO BE COLLECTED DIRECTLY BY PEACEHEALTH ST. JOSEPH MEDICAL CENTER -1,682,446. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INDIRECT SPECIAL EVENTS EXPENSE NETTED WITH REVENUE ON FS 20,058. CONTRIBUTED SERVICES AND USE OF FACILITIES NETTED WITH REVENUE ON FS 14,945. INVESTMENT FEE 2,270. SCHEDULE D, PART XI, LINE 2A: NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS -39,026 CHANGE IN SPLIT INTEREST VALUE 11,637 TOTAL -27,389 GALA 309764 286389 23375 9813 50342 11619 82873 309764 286389 23375 9813 50342 11619 82873 154647 -131272 1 HINET PO BOX 5365 BELLINGHAM WA 98225 911993455 501(C)(3) 67390 SHARED CARE PLAN, PURSUING PERFECTION FUNDS PEACEHEALTH ST JOSEPH MEDICAL CENTER 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 910565889 501(C)(3) 2023584 36532 FMV VARIOUS GIKS FOR PATIENTS, PAINTINGS AND ARTWORK PROGRAM AND EVENT EXPENSES WESTERN WASHINGTON UNIVERSITY FOUNDATION (CRITICAL JUNCTURES INSTITUTE) 625 CORNWALL AVENUE BELLINGHAM WA 98225 GOVERNMENT-UNI 36340 SHARED CARE PLAN, PURSUING PERFECTION FUNDS WHATCOM HOSPICE FOUNDATION 800 E CHESTNUT SUITE 1-A BELLINGHAM WA 98225 943146369 501(C)(3) 119200 HOSPICE PROGRAM AND HOSPICE HOUSE SUPPORT PEACEHEALTH (SYSTEM OFFICE) 1115 SE 164TH AVE 2ND FLOOR VANCOUVER WA 98683 910939479 501(C)(3) 23590 PROGRAM EXPENSES 5 PROGRAM GRANT SUPPORT 2 64650 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION RECEIVES BACKUP DOCUMENTATION (USUALLY IN THE FORM OF AN INVOICE) FROM THE GRANTEE SHOWING FUNDS WERE USED FOR THEIR INTENDED PURPOSE. 0 1 0 0 0 0 0 0 0 NANCY STEIGER 0 403919 0 97804 0 7200 0 3755 0 17499 0 530177 0 0 MARK MCCAMPBELL 0 184995 0 27723 0 2190 0 0 0 15511 0 230419 0 0 PART I, LINE 4B THERE IS A 457(F) PLAN FOR SENIOR VPS, PRESIDENT AND CHIEF MISSION OFFICER. NANCY STEIGER IS A PARTICIPANT IN THIS PLAN AND SHE RECEIVED PAYMENT OF $3,755 DURING THE REPORTING YEAR. X 2 6416 FMV X SUPPLIES 1 212506 COST OR SELLING PRICE X AUCTION ITEMS 14 66159 FMV X PIANO 1 4700 FMV 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS IS BASED ON THE NUMBER OF CONTRIBUTORS DURING THE YEAR. FORM 990, PART I, LINE 6: THERE ARE 26 VOLUNTEERS THAT SERVE AS BOARD MEMBERS, AND 15 VOLUNTEERS THAT HELP WITH FOUNDATION COMMITTEES AND CLERICAL DUTIES IN THE OFFICE OF DEVELOPMENT, SUPPORTING BOTH PEACEHEALTH ST. JOSEPH MEDICAL CENTER FOUNDATION AND WHATCOM HOSPICE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A SEE BELOW DESCRIPTION TO FORM 990, PART VI, SECTION A, LINE 7B. FORM 990, PART VI, SECTION A, LINE 7B AS STATED IN THE ARTICLES OF INCORPORATION "THE FOUNDATION SHALL BE ORGANIZED AND OPERATED EXCLUSIVELY FOR THE PURPOSE OF SUPPORTING PEACEHEALTH ST. JOSEPH MEDICAL CENTER, A PART OF PEACEHEALTH WHATCOM REGION, LOCATED IN BELLINGHAM, WASHINGTON, IN FURTHERANCE OF THE HEALTHCARE MISSION OF ITS OWNER, PEACEHEALTH". THE FOLLOWING ACTIONS OF THE BOARD REQUIRE APPROVAL FROM PEACEHEALTH. 1) THE FOUNDATION SHALL NOT HAVE POWER TO GUARANTEE PAYMENT OR PERFORMANCE BY THIRD PARTIES WITHOUT THE PRIOR WRITTEN CONSENT OF THE PRESIDENT OF PEACEHEALTH OR HIS/HER DELEGATE. 2) THE FOUNDATION SHALL HAVE NO POWER TO MERGE OR CONSOLIDATE WITH OTHER ORGANIZATIONS OR TO CREATE OR ACQUIRE OTHER ORGANIZATIONS OR TO VOLUNTARILY DISSOLVE AND WIND UP ITS AFFAIRS OR TO ENTER INTO ANY ASSIGNMENT OF INCOME OR ASSETS FOR THE BENEFIT OF CREDITORS OR TO SEEK THE PROTECTION OF DEBTOR RELIEF LAWS, WITHOUT HAVING OBTAINED THE PRIOR WRITTEN CONSENT OF THE PRESIDENT OF PEACEHEALTH. 3) WRITTEN CONSENT MUST BE OBTAINED BY THE PRESIDENT OF PEACEHEALTH, OR HIS OR HER DELEGATE, TO THE EXACT LANGUAGE OF ANY PROPOSED CHANGE IN ARTICLES AND BYLAWS. THIS CONSENT SHALL HAVE BEEN FIRST OBTAINED PRIOR TO ANY CHANGE TO THE ARTICLES OF INCORPORATION OR BYLAWS BECOMING EFFECTIVE. 4) ALL PROPOSED NOMINATIONS (OF DIRECTORS) MUST BE APPROVED BY PEACEHEALTH. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE REVIEWS THE FORM 990. ADDITIONALLY, AN ELECTRONIC COPY WITHOUT DONOR NAMES IS PROVIDED TO ALL OTHER BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, DIRECTORS, AGENTS, AND EMPLOYEES ARE REQUIRED TO SIGN ANNUALLY, OUR IN-DEPTH CONFLICT OF INTEREST DISCLOSURE POLICY WHICH AFFIRMS THEY HAVE READ, UNDERSTOOD AND AGREED WITH THE CONFLICT OF INTEREST POLICY AND HAVE ANSWERED ALL QUESTIONS ON THE DISCLOSURE FULLY AND HONESTLY. THE OFFICERS, DIRECTORS, AGENTS, AND EMPLOYEES ARE COVERED UNDER THE POLICY. EACH BOARD MEMBER IS REQUIRED TO SIGN A COPY WHICH IS REVIEWED BY THE EXECUTIVE DIRECTOR. IT MUST BE SIGNED BEFORE THEY ATTEND ANY BOARD OR COMMITTEE MEETINGS. BEFORE AN ITEM IS PUT ON AN AGENDA, THE BOARD/COMMITTEE WILL REVIEW AND ASCERTAIN IF THERE WILL BE ANY CONFLICTS ON THE BOARD AND IF SO, THE BOARD MEMBER IS CONTACTED AND TOLD ABOUT THE SUBJECT OF DISCUSSION. THE BOARD/COMMITTEE DECIDES IF IT IS IN FACT A CONFLICT AND IF SO, THE BOARD MEMBER IS ASKED TO EXCUSE THEMSELVES FROM THE ROOM DURING DISCUSSION AND VOTING BY THE EXECUTIVE DIRECTOR OR COMMITTEE CHAIR. FORM 990, PART VI, SECTION B, LINE 15A THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER 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 CHIEF DEVELOPMENT OFFICER AT TIME OF HIRE WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HUMAN RESOURCES AND THE ADMINISTRATIVE DIRECTOR OF HUMAN RESOURCES 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 IN THE FOUNDATION OFFICE UPON REQUEST. FORM 990, PART VI, LINE 16B: THE FOUNDATION FOLLOWS THE JOINT VENTURE POLICY OF THE PARENT ORGANIZATION, PEACEHEALTH. FORM 990, PART VII, SECTION A: THE ORGANIZATION MADE REASONABLE EFFORTS TO OBTAIN THE INFORMATION REQUIRED FOR PART VII BY DISTRIBUTING A QUESTIONNAIRE TO EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE LISTED IN PART VII. THE QUESTIONNAIRE INCLUDED THE NAME, TITLE, DATE, AND SIGNATURE OF EACH PERSON REPORTING INFORMATION AND CONTAINS PERTINENT INSTRUCTIONS AND DEFINITIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -39,026. CHANGE IN SPLIT INTEREST VALUE 11,637. ADJUSTMENT FOR PLEDGE TO BE COLLECTED DIRECTLY BY PEACEHEALTH ST. JOSEPH MEDICAL CENTER -1,682,449. TOTAL TO FORM 990, PART XI, LINE 5: -1,709,838. PEACEHEALTH 1115 SE 164TH AVE VANCOUVER WA 98683 910939479 HOSPITAL WA 501(C)(3) 3 - HOSPITAL PEACEHEALTH 0 VISITING NURSE FOUNDATION 800 E CHESTNUT ST BELLINGHAM WA 98225 943146369 SUPPORT WHATCOM HOSPICE, A PROGRAM OF ST JOSEPH HOSPITAL WA 501(C)(3) 11D - TYPE III PEACEHEALTH 0 PEACEHEALTH KETCHIKAN MEDICAL CENTER FOUNDATION 3100 TONGASS AVE KETCHIKAN AK 99901 651225184 SUPPORT KETCHIKAN GENERAL HOSPITAL AK 501(C)(3) 7 - 509(A)(1) 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 - 509(A)(1) 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 JOHN MEDICAL CENTER FOUNDATION 1615 DELAWARE LONGVIEW WA 98632 911538852 SUPPORT ST. JOHN MEDICAL CENTER WA 501(C)(3) 7 - 509(A)(1) PEACEHEALTH 0 HEALTH VENTURES PO BOX 10905 EUGENE OR 97440 911350776 HEALTHCARE JOINT VENTURES WA 501(C)(3) 7 - 509(A)(1) PEACEHEALTH 0 PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION PO BOX 1600 VANCOUVER WA 98668 911231436 SUPPORT SW WASHINGTON MEDICAL CENTER WA 501(C)(3) 7 - 509(A)(1) PEACEHEALTH 0 CHARITABLE ANNUITY TRUSTS (6) INVESTMENT & CHARITABLE GIVING WA N/A T 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0