2012-10-06T13:19:45-05:00 2011-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2011-01-01 911893957 THE MAX FOUNDATION MAXF 4257788660 110 WEST DAYTON AVENUE NO 205 EDMONDS WA 98020 PATRICIA GARCIA-GONZALEZ 4257788660 2012-10-05 1 JANE M SEARING P00000565 4254544919 2012-10-05 2011 2016-02-24 21:20:13Z PATRICIA GARCIA-GONZALEZ 110 WEST DAYTON AVENUE NO 205 EDMONDS WA 98020 2110447 0 X WWW.THEMAXFOUNDATION.ORG X 1997 WA SERVE PEOPLE WORLDWIDE LIVING WITH BLOOD-RELATED CANCER AND RARE CANCERS. 5 4 11 400 0 0 190352 84917 1865047 2025530 0 0 0 0 2055399 2110447 132666 31174 0 0 868755 894493 0 0 62877 877726 924086 1879147 1849753 176252 260694 1058480 1318331 843 0 1057637 1318331 X THE MAX FOUNDATION IS DEDICATED TO IMPROVING THE LIVES OF PEOPLE LIVING WITH BLOOD-RELATED CANCER AND RARE CANCERS, FOCUSING ON UNDERSERVED POPULATIONS IN THE US AS WELL AS IN EMERGING COUNTRIES. THE ORGANIZATION FULFILLS ITS MISSION THROUGH THREE PRIMARY INITIATIVES: AN INTERNATIONAL 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 MATERIALS FOR PATIENTS AS WELL AS FOR HEALTHCARE PROVIDERS. 0 0 1649652 31174 2025530 IN 2011 THE FOUNDATION PROVIDED SERVICES TO PATIENTS AND THEIR FAMILIES:- ENROLLING AND ADMINSTRATING 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 MORE THAN 30,000 PATIENTS. - THROUGH A PATIENT HELPLINE, SERVING APPROXIMATELY 20,161 PATIENTS IN OVER 122 COUNTRIES WITH COUNSELING AND EMOTIONAL SUPPORT. - ADVOCACY SERVICES TO 5,088 PATIENTS IN 109 COUNTRIES AND INFORMATIONAL REFERRALS TO 4,469 PATIENTS IN PATIENT ASSISTANCE PROGRAMS. - WITH FINANCIAL AND ORGANIZATIONAL SUPPORT FOR THE ACTIVITIES OF PATIENT/FAMILY SUPPORT GROUPS THROUGHOUT THE WORLD. 1649652 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 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 11 1 0 1 IN MY AR 0 0 0 0 0 0 0 0 X 5 4 0 0 0 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 2.00 X X 0 0 0 JAMES LUMSDEN 2.00 X X 0 0 0 PATRICIA GARCIA-GONZALEZ 60.00 X X 152435 0 10729 152435 0 10729 1 0 1 0 0 84917 84917 PATIENT CARE 621500 2025530 2025530 2025530 2110447 2025530 0 0 X 3738 3738 500 500 26936 26936 163164 130532 16316 16316 46946 43490 1728 1728 530825 491747 19539 19539 90376 82412 3982 3982 63182 56864 3159 3159 11799 11799 11136 5568 1114 4454 53725 39312 14111 302 8811 8106 705 46967 43210 3757 86494 77845 8649 17823 17391 432 13542 12459 1083 3962 3962 MAXSTATION OPERATIONS 669827 609542 46888 13397 1849753 1649652 137224 62877 1044945 1272717 161016 119034 9903 41982 3632 3632 1058480 1318331 843 843 0 X 1056900 1318331 737 0 1057637 1318331 1058480 1318331 260694 0 X X 1 0 1 X 0 X 90188 37372 53242 190352 84917 456071 90188 37372 53242 190352 84917 456071 13515 442556 456071 8967557 0.97040 1.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 161016 119034 41982 41982 1 CENTRAL AMERICA AND THE CARIBBEAN 2 2 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 46593 EAST ASIA AND THE PACIFIC 4 13 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 241011 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 GRANTS GRANTS 500 NORTH AMERICA 1 2 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 31545 SUB-SAHARAN AFRICA 1 1 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 34983 SOUTH AMERICA 2 3 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 81882 MIDDLE EAST AND NORTH AFRICA 0 0 GRANTS GRANTS 1600 RUSSIA & THE NEWLY INDEPENDENT STATES 1 1 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 15057 SOUTH ASIA 3 18 PROGRAM SRVCS, GRANTS PATIENT SUPPORT ACTIVITIES 247332 11 22 3 18 14 40 453171 247332 700503 X DIAGNOSTIC TESTING CENTRAL AMERICA AND THE CARIBBEAN 3 800 WIRE TRANSFER GENERAL(EDUCATION, TREATMENT) EAST ASIA AND THE PACIFIC 3 900 WIRE TRANSFER TRANSPORTATION/HOUSING DURING TREATMENT EUROPE (INCLUDING ICELAND & GREENLAND) 1 500 WIRE TRANSFER GENERAL(EDUCATION, TREATMENT) NORTH AMERICA 1 150 WIRE TRANSFER DIAGNOSTIC TESTING RUSSIA & THE NEWLY INDEPENDENT STATES 36 3600 WIRE TRANSFER GENERAL(EDUCATION, TREATMENT) RUSSIA & THE NEWLY INDEPENDENT STATES 1 237 WIRE TRANSFER GENERAL(EDUCATION, TREATMENT) SOUTH AMERICA 2 400 WIRE TRANSFER GENERAL(EDUCATION, TREATMENT) SUB-SAHARAN AFRICA 1 250 WIRE TRANSFER 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. SCHEDULE F, PART III, COL (D): THE GRANT EXPENSES REPORTED ON SCHEDULE F, PART III ARE ON THE MODIFIED CASH BASIS OF ACCOUNTING. X X 0 0 0 0 0 0 0 0 0 PATRICIA GARCIA-GONZALEZ 147435 0 5000 0 0 0 0 0 10729 0 163164 0 0 0 INES GARCIA GONZALEZ SEE PART V 33600 SEE PART V 0 MERCEDES ARTEAGA SEE PART V 13346 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 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: MERCEDES ARTEGA(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 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 THE MAX - PROGRAM SERVICES MY THE MAX FOUNDATION C -119855 15764 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MAXSTATION MALAYSIA SDN BHD D 128904 CASH