2012-11-15T16:07:47-06:00 2011-12-31 271574632 FBMM TAX PLLC P O BOX 340020 NASHVILLE TN 372030020 990 2011-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 STONE C GOSSARD 6153299902 2012-11-14 1 ROGER W DUNAWAY III P00815324 6153299902 2011 2016-02-24 21:20:13Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 708643 0 X N/A X 2004 WA TO DISTRIBUTE FUNDS EXCLUSIVELY FOR EDUCATIONAL, CHARITABLE, RELIGIOUS, SCIENTIFIC AND/OR LITERARY PURPOSES, INCLUDING BUT NOT LIMITED TO THE MAKING OF GRANTS TO CHARITABLE ORGANIZATIONS FOR CHARITABLE PURPOSES. 6 6 0 6 0 0 344950 707154 0 0 2710 1489 0 0 347660 708643 295490 296138 0 0 0 0 0 0 5147 48804 68036 344294 364174 3366 344469 468228 812697 0 0 468228 812697 TO DISTRIBUTE FUNDS EXCLUSIVELY FOR EDUCATIONAL, CHARITABLE, RELIGIOUS, SCIENTIFIC AND/OR LITERARY PURPOSES, INCLUDING BUT NOT LIMITED TO THE MAKING OF GRANTS TO CHARITABLE ORGANIZATIONS FOR CHARITABLE PURPOSES. 0 0 309892 296138 0 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. 309892 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 707154 707154 1489 1489 708643 0 0 1489 295138 295138 1000 1000 2405 2405 4425 885 3540 25726 12863 7718 5145 12 6 4 2 FOREIGN TAXES PAID 35468 0 35468 0 364174 309892 49135 5147 18258 431237 449970 381460 468228 812697 0 0 X 468228 812697 468228 812697 468228 812697 344469 0 X 0 0 0 X 12402 422118 341986 344950 707154 1828610 12402 422118 341986 344950 707154 1828610 1828610 10233 8761 2969 2710 1489 26162 1854772 0.98590 0.98380 X 1 CANADA 0 1 FUNDRAISING 46358 HAITI 0 0 GRANTMAKING 20000 0 1 0 0 0 1 66358 0 66358 HAITI HAITI GENERAL FUND 20000 CASH PAYMENT 0 CASH 1 0 0 0 0 0 0 0 1 ADVOCACY FOR PATIENTS WITH CHRONIC ILLNESS INC 18 TIMBERLINE DRIVE FARMINGTON CT 06032 830415607 501(C)(3) 20000 0 N/A N/A GENERAL SUPPORT FUND AIR TRAFFIC CONTROL EDUCATION FUND INC 1475 15TH STREET SAN FRANCISCO CA 94103 721600331 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND ARKANSAS TAKE ACTION 125 ENGLEWOOD ROAD LITTLE ROCK AR 72207 261807968 501(C)(3) 50000 0 N/A N/A GENERAL SUPPORT FUND ARTS CORPS 4408 DELRIDGE WAY SW 110 SEATTLE WA 98106 912044679 501(C)(3) 5000 0 N/A N/A GENERAL SUPPORT FUND BLESSINGS IN A BACKPACK 1839 BROWNSBORO ROAD LOUISVILLE KY 40206 261964620 501(C)(3) 49280 0 N/A N/A GENERAL SUPPORT FUND DOWNTOWN EMERGENCY SERVICE CENTER 515 THIRD AVENUE SEATTLE WA 98104 911275815 501(C)(3) 20000 0 N/A N/A GENERAL SUPPORT FUND GULF RESTORATION NETWORK 338 BARONNE STREET SUITE 200 NEW ORLEANS LA 70112 721447742 501(C)(3) 20000 0 N/A N/A GULF OF MEXICO OIL SPILL RESPONSE PROGRAM MILWAUKEE RIVERKEEPER 1845 NORTH FARWELL AVENUE SUITE 100 100 MILWAUKEE WI 53202 391846305 501(C)(3) 24640 0 N/A N/A TO PROTECT MILWAUKEE RIVERS & SAFEGUARD WATER QUALITY PARTNERS IN HEALTH 888 COMMONWEALTH AVE 3RD FLOOR BOSTON MA 02215 043567502 501(C)(3) 20000 0 N/A N/A HAITI EMERGENCY RESPONSE PROGRAM GENERAL FUND STRONGHOLD SOCIETY 2022 EAST 134TH WAY THORNTON CO 80241 273621140 501(C)(3) 23578 0 N/A N/A TO BUILD WK4-DIRECTIONS SKATE PARK ON THE PINE RIDGE INDIAN RESERVATION TREEHOUSE 2100 24TH AVE SOUTH SUITE 200 SEATTLE WA 981444632 911425676 501(C)(3) 15000 0 N/A N/A GENERAL SUPPORT FUND WILD SALMON CENTER 721 NW NINTH AVENUE SUITE 300 PORTLAND OR 97209 943166095 501(C)(3) 10000 0 N/A N/A GENERAL SUPPORT FUND WISCONSIN VOICES INC 252 EAST HIGHLAND AVENUE SUITE 208 MILWAUKEE WI 53202 273183754 501(C)(3) 24640 0 N/A N/A GENERAL SUPPORT FUND 13 0 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. VITALOGY HEALTH FOUNDATION PO BOX 340020 NASHVILLE TN 372030020 912013250 GRANT MAKING WA 501(C)(3) PF N/A 0 PEARL JAM LLC PO BOX 340020 NASHVILLE TN 372030020 911695049 MUSICAL ENTERTAINMENT WA N/A 0 0 DEKERIVER LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 203277547 BUILDING RENTAL WA N/A 0 0 TEN CLUB LLC 1900 SOUTH CORGIAT DRIVE SEATTLE WA 98108 912094535 FAN CLUB MERCHANDISE WA N/A 0 0 MONKEYWRENCH FILMS LLC PO BOX 340020 NASHVILLE TN 372030020 264471983 FILM PRODUCTION CA N/A 0 0 PERMASEAL FILM PRODUCTION COMPANY LLC PO BOX 340020 NASHVILLE TN 372030020 264508356 FILM PRODUCTION WA N/A 0 0 MONKEYWRENCH INC PO BOX 340020 NASHVILLE TN 372030020 331062443 MUSICAL RECORDINGS WA N/A S PEARL JAM TOURING INC PO BOX 340020 NASHVILLE TN 372030020 911531093 MUSICAL ENTERTAINMENT NV N/A S 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0