2012-11-07T13:13:56-06:00 2011-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVE SUITE 801 EVERETT WA 982013510 990 2011-01-01 911030686 ISLAND HOSPITAL FOUNDATION ISLA 3602994201 1211 24TH STREET ANACORTES WA 98221 WILLIAM RABEL 3602994201 2012-10-29 1 ROBERT GRANNUM P00355876 4252597227 2011 2016-02-25 16:41:14Z DIANNE KUHN 1211 24TH STREET ANACORTES WA 98221 996620 0 X WWW.ISLANDHOSPITALFOUNDATION.ORG X 1978 WA THE MISSION OF THE FOUNDATION IS TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH, IN AND AROUND ANACORTES, WASHINGTON. 19 19 0 60 0 0 2207577 830493 0 0 31696 35821 -59478 -94707 2179795 771607 799061 462836 0 0 121524 100074 0 0 55404 83210 109610 1003795 672520 1176000 99087 1985994 2028898 1091 3887 1984903 2025011 TO RAISE FUNDS TO SUPPORT ISLAND HOSPITAL AND ITS COMMITMENT TO COMMUNITY HEALTH IN AND AROUND ANACORTES, WASHINGTON. 0 0 150000 150000 FUND HOSPITAL RENOVATION AND EXPANSION COSTS NOT MET BY TAX REVENUE. 397906 312836 FACILITATE OPERATIONAL NEEDS OF COMMUNITY PROGRAMS AND SERVICES OF LOCAL PUBLIC HOSPITAL DISTRICT. 547906 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 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 19 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BERNADETTE MOLNAR 3602994247 1211 24TH ST ANACORTES WA 98221 X DIANNE KUHN 2.00 X X 0 0 0 JOHN PROSSER 2.00 X X 0 0 0 DAVE MARGESON 2.00 X X 0 0 0 SHELLIE BOGOSIAN 2.00 X X 0 0 0 MARV SHELBY 1.00 X 0 0 0 BRENDA GRAHAM-APTER 1.00 X 0 0 0 DR MARK BACKMAN 1.00 X 0 0 0 JERREL BARTO 1.00 X 0 0 0 LANI DONOHOE 1.00 X 0 0 0 CHRIS JENSEN 1.00 X 0 0 0 DIANA JORDAN-NEW 1.00 X 0 0 0 BETH PRINS 1.00 X 0 0 0 BILL RABEL 1.00 X 0 0 0 AARON RASMUSSEN 1.00 X 0 0 0 JIM ROE 1.00 X 0 0 0 DIANE RUSHER 1.00 X 0 0 0 STEVE RUTZ 1.00 X 0 0 0 ANNE SMITH 1.00 X 0 0 0 JERALD ZAVALNEY 1.00 X 0 0 0 0 0 0 0 0 0 0 0 242249 588244 70298 830493 35821 35821 130306 242249 225013 -94707 -94707 771607 0 0 -58886 462836 462836 78698 31479 19675 27544 21376 8550 5344 7482 7500 7500 11017 11017 11027 11027 11467 11467 11503 11503 34940 189 14373 20378 8449 8449 1146 1146 BANK FEES 6473 6473 BAD DEBT EXPENSE 3355 3355 MISCELLANEOUS 2733 2733 672520 547906 69210 55404 100 100 277750 53309 163270 150917 8290 30112 21797 343 1514787 1794117 1985994 2028898 1091 3887 1091 3887 X 1984903 2025011 1984903 2025011 1985994 2028898 X 99087 -58979 X X 1 0 1 X 0 X 1827632 305479 516446 427076 830493 3907126 1827632 305479 516446 427076 830493 3907126 763352 3143774 13461 5033 29458 31696 35821 115469 4022595 964491 0.78150 0.77150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1386988 33591 -17903 27692 1374984 252065 1129508 119052 62572 51065 1386988 250221 1844 252065 0.84890 0.14620 0.00490 0 0 0 EQUITY FUNDS 756321 C OTHER ASSETS 353578 C MONEY MARKET FUNDS 26238 C FIXED INCOME FUNDS 657980 C 1794117 771607 672520 99087 -58979 -58979 40108 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INCOME FROM THE ENDOWMENTS IS TO BE USED FOR TWO PURPOSES: HOSPITAL IDENTIFIED COMMUNITY HEALTH NEEDS AND TO PROVIDE FUNDS FOR THE BENEFIT OF THE BIRTHING CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AS A CHARITABLE FOUNDATION, ISLAND HOSPITAL FOUNDATION IS A NOT-FOR-PROFIT CORPORATION AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A). FOR THE 2011 FINANCIAL STATEMENTS, THE FOUNDATION HAS ACCOUNTED FOR UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND WAS REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2011, THE FOUNDATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL OR DISCLOSURE. GALA OF HOPE 194962 130804 64158 34060 5997 36784 2620 20178 GOLF CLASSIC 97574 56931 40643 19567 30947 17453 1 80019 54514 25505 25884 9391 4218 2600 15314 372555 242249 130306 79511 46335 41002 5220 52945 225013 -94707 1 ISLAND HOSPITAL SKAGIT COUNTY PUBLIC HOSPITAL DISTRICT NO 2 1211 24TH STREET ANACORTES WA 98221 910729255 SKAGIT COUNTY 462486 350 FAIR MARKET VALUE TOYS FOR PHYSICAL THERAPY & REHABILITATION SUPPORT OF HEALTH PROGRAMS AT HOSPITAL 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL GRANTS AND ASSISTANCE ARE ONLY PROVIDED TO THE SUPPORTED ORGANIZATION ISLAND HOSPITAL AND UTILIZED ONLY FOR THE PURPOSE OF THAT GRANT (I.E. HEALTH SCREENING PROGRAM, DIABETES CARE). ISLAND HOSPITAL IS RESPONSIBLE FOR ENSURING FUNDS TRANSFERRED FROM ISLAND HOSPITAL FOUNDATION ARE DESIGNATED AND UTILIZED ONLY FOR THE PURPOSE INSTRUCTED, AND THE FOUNDATION RECEIVES REPORTS SHOWING FUNDS WERE DISBURSED TO DEPARTMENTS AS INSTRUCTED. X 40 FMV X 1 500 FMV X 12 2270 FMV X CHRISTMAS DECORATIONS 28 15874 FMV X GIFT CERTIFICATES, TICKETS, PACKAGES, ETC. 97 40849 FMV X VARIOUS 19 10115 FMV 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): NUMBER OF CONTRIBUTORS IS THE ACTUAL NUMBER OF CONTRIBUTORS OF NON-CASH ITEMS, EXCLUDING CONTRIBUTORS OF SERVICES. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE BEFORE IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C 1. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, AND D. UNDERSTANDS IHF IS CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. 2. EACH VOTING MEMBER OF THE BOARD SHALL ANNUALLY SIGN A STATEMENT WHICH DECLARES WHETHER SUCH PERSON IS AN INDEPENDENT DIRECTOR. 3. IF AT ANY TIME DURING THE YEAR, THE INFORMATION IN THE ANNUAL STATEMENT CHANGES MATERIALLY, THE DIRECTOR SHALL DISCLOSE SUCH CHANGES AND REVISE THE ANNUAL DISCLOSURE FORM. 4. THE EXECUTIVE COMMITTEE SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY BY REVIEWING ANNUAL STATEMENTS AND TAKING SUCH OTHER ACTIONS AS ARE NECESSARY FOR EFFECTIVE OVERSIGHT. FORM 990, PART VI, SECTION C, LINE 19 ALL ORGANIZATIONAL, FINANCIAL, AND TAX DOCUMENTS, INCLUDING FORM 990, ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -58,979. FORM 990, PART XII, LINE 2C THE METHOD BY WHICH THE FOUNDATION ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT, REVIEW, OR COMPILATION OF ITS FINANCIAL STATEMENTS AND SELECTION OF ITS INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART VI, LINE 7A FOR THE BOARD SELECTION, THE PRESIDENT, VICE PRESIDENT, AND PAST PRESIDENT RECRUIT AND BRING IN CANDIDATES. THE ENTIRE BOARD THEN VOTES ON ELECTING CANDIDATES TO THE BOARD. FINANCIAL, BUDGETARY AND GOVERNING DECISIONS REQUIRE A MAJORITY VOTE OF THE BOARD TO BE ADOPTED BY THE ORGANIZATION.