2011-05-06T10:26:47-05:00 2010-06-30 Clark Nuber PS 10900 NE 4th Street Suite 1700 Bellevue WA 98004 990 2009-07-01 721545902 ST JOSEPH HOSPITAL FOUNDATION STJO 3607886866 800 EAST CHESTNUT STREET No 1A BELLINGHAM WA 98225 MARK MCCAMPBELL 3607566865 2011-05-03 1 Sara Elizabeth J Hyre 4254544919 2009 2016-02-24 21:20:13Z MARK MCCAMPBELL 800 EAST CHESTNUT STREET No 1A BELLINGHAM WA 98225 1391835 0 X WWW.THEHOSPITALFOUNDATION.ORG X 2003 WA TO RAISE CONTRIBUTIONS AND ESTABLISH ENDOWMENTS TO SUPPORT ST. JOSEPH HOSPITAL ACTIVITIES. 27 25 0 30 0 0 2111682 1295391 0 93261 30579 -25904 4963 2179039 1330933 3240754 1130114 0 0 0 159591 125773 227304 3366527 1357418 -1187488 -26485 5398520 5530124 441235 542798 4957285 4987326 ST. JOSEPH HOSPITAL FOUNDATION EXISTS TO ACQUIRE AND RECOGNIZECHARITABLE GIFTS AND BEQUESTS THAT ASSIST ST. JOSEPH HOSPITAL INFULFILLING ITS MISSION, ADHERING TO ITS CORE VALUES AND PROVIDINGMEDICAL SERVICES TO THE WHATCOM REGION. ST. JOSEPH HOSPITAL 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 ST. JOSEPH HOSPITAL A HIGHER LEVEL OF MUTUALUNDERSTANDING AND INVOLVEMENT WITH THE COMMUNITIES IT SERVES.- PHILANTHROPIC OPPORTUNITIES SHOULD ENHANCE THE ABILITY OF ST. JOSEPHHOSPITAL TO PROVIDE HEALING AND COMPASSIONATE HEALTHCARE RESPECTINGEVERY PERSON'S HUMAN DIGNITY. 0 0 811136 811136 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. 318978 318978 SUPPORT OF ST. JOSEPH HOSPITAL FOR EDUCATION, PATIENT SUPPORT, NURSING SUPPORT, RESEARCH, CAPITAL EXPENDITURES, SCHOLARSHIPS AND CHARITY CARE. THE FOUNDATION RECEIVES FROM ST. JOSEPH HOSPITAL AND PEACEHEALTH CORPORATION DONATED FACILITIES AND SERVICES, WHICH INCLUDE SPACE RENTAL, PROPERTY AND EQUIPMENT, UTILITIES, EMPLOYEES, AND OTHER ITEMS. THE ESTIMATED FAIR MARKET VALUE OF $419,938 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. 1130114 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 27 25 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WA X NICOLE POYNER 3607886540 809 E CHESTNUT ST BELLINGHAM WA 98225 X DR PETER BUETOW 2.00 X 0 0 0 AMY ESARY 2.00 X 0 0 0 MARION ROBIN FOOTE 2.00 X X 0 0 0 ROSEMARIE FRANCIS 2.00 X 0 0 0 DON HAGGEN 2.00 X 0 0 0 DENNY HOLMSTROM 2.00 X 0 0 0 JOHN HUNTLEY 2.00 X X 0 0 0 FRANK IMHOF 2.00 X X 0 0 0 LYNNETTE JENSEN 2.00 X 0 0 0 SIMON JOHNSON 2.00 X 0 0 0 DR RICHARD JONES 2.00 X X 0 0 0 JEFFREY KAUFMAN 2.00 X 0 0 0 MARY KING 2.00 X 0 0 0 DR LEASA LOWY 2.00 X 0 164968 17279 GINNY MCEVOY 2.00 X 0 0 0 PATTY NELSON 2.00 X 0 0 0 DR RALPH RINNE 2.00 X 0 0 0 HARRY ROBINSON 2.00 X 0 0 0 JOANNE ROBINSON 2.00 X 0 0 0 SARAH ROTHENBUHLER 2.00 X 0 0 0 NANCY STEIGER 2.00 X 0 526144 23497 DR SHAUN SULLIVAN 2.00 X 0 0 0 DR IAN THOMPSON 2.00 X 0 0 0 CHRISTINE THOMPSON 2.00 X 0 0 0 MO WEST 2.00 X 0 0 0 DOUG WIGHT 2.00 X 0 0 0 FRANK ZURLINE 2.00 X 0 0 0 GLENN WELCH JUL-JAN 40.00 X 0 112802 1469 KEVIN PENDERGAST FEB-JUN 40.00 X 0 0 0 0 803914 42245 0 0 1 0 0 141274 204854 125000 824263 241581 1295391 33752 33752 16851 16851 16851 16851 24242 27415 -3173 -3173 -3173 21599 141274 33487 -11888 -11888 1330933 0 0 35542 1130114 1130114 207725 67713 140012 ALLOWANCE FOR BAD DEBT 16980 16980 DONOR RECOGNITION PANEL 2599 2599 1357418 1130114 67713 159591 261967 1533 1957069 2702901 2283750 2178110 760579 488328 134760 151752 395 7500 5398520 5530124 224 33711 178419 254942 262592 254145 441235 542798 X 848866 1129831 3756833 3499752 351586 357743 4957285 4987326 5398520 5530124 X 0 1 1 X 0 X 1773696 1173865 4658140 2111682 1295391 11012774 1773696 1173865 4658140 2111682 1295391 11012774 2628865 8383909 82208 140071 200985 106465 50603 580332 11593106 0.72320 0.71560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 880911 52598 56047 989556 473753 422870 -4812 10900 880911 0.64000 0.36000 0.00000 0 0 0 ANNUITY PAYABLE 254145 254145 1330933 1357418 -26485 77023 -20497 56526 30041 1807397 77023 419938 -20497 476464 1330933 0 1330933 1777356 419938 419938 1357418 0 1357418 Part V, Line 4: Description of Intended Use of Endowment Funds: ENDOWMENT FUNDS ARE USED FOR CAPITAL, SCHOLARSHIPS, AND ACCESS CARE (CHARITY CARE). Part XI, Line 8 - Other Adjustments: CHANGE IN SPLIT INTEREST VALUE: -20497. Part XII, Line 2d - Other Adjustments: CHANGE IN SPLIT INTEREST VALUE: -20497. GALA 162873 141274 21599 651 20078 850 11908 162873 141274 21599 651 20078 850 11908 33487 -11888 1 WHATCOM HEALTH INFORMATION NETWORK 625 CORNWALL AVE BELLINGHAM WA 98225 911993455 680535 PURSUING PERFECTION AND SHARED CARE PLAN PROJECT PEACEHEALTH - ST JOSEPH 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 910565889 501(C)(3) 259027 CAPITAL, ACCESS CARE, RESEARCH AND SCHOLARSHIPS WHATCOM HOSPICE FOUNDATION 800 E CHESTNUT SUITE 1-A BELLINGHAM WA 98225 943146369 501(C)(3) 66030 HOSPICE PROGRAM AND HOSPICE HOUSE SUPPORT CONGRAL NR LLC 922 - 11TH STREET 3 BELLINGHAM WA 98225 200137222 83125 WORK DONE ON SHARED CARE PLAN WEBSITE WWU FOUNDATION (CRITICAL JUNCTURES INSTITUTE) 625 CORNWALL AVE BELLINGHAM WA 98225 GOVERNMENT 41397 CRITICAL JUNCTURES SUPPORT 4 1 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. X X 0 0 0 0 0 0 0 0 0 DR LEASA LOWY 0 164968 0 0 0 0 0 1576 0 15703 0 182247 0 0 NANCY STEIGER 0 526144 0 0 0 0 0 18740 0 4757 0 549641 0 0 X 1 25953 FAIR MARKET VALUE X CEILING LIFT SYSTEM 1 10774 COST OR SELLING PRICE X SUPPLIES 320 204854 COST OR SELLING PRICE 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): CONTRIBUTIONS ARE COUNTED BY NUMBER RECEIVED. Form 990, Part VI, Section A, line 2 HARRY ROBINSON AND JOANNE ROBINSON HAVE A FAMILY RELATIONSHIP. 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 ST. JOSEPH HOSPITAL, 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. 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 AND RECOMMENDS APPROVAL FOR FILING TO THE FULL BOARD. A COPY OF THE FORM 990 IS PROVIDED BY EMAIL TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. Form 990, Part VI, Section B, line 12c BOARD MEMBERS 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 HARD 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 WE ASCERTAIN IF THERE WILL BE ANY CONFLICTS WITH OUR 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, THEY ARE 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 (CDO) 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 CDO AT TIME OF HIRE WAS DETERMINED THROUGH A DISCUSSION BETWEEN THE REGIONAL CEO, REGIONAL DIRECTOR OF HR AND THE ADMINISTRATIVE DIRECTOR OF H.R. 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 I, LINE 6 THERE ARE 25 VOLUNTEERS THAT SERVE AS BOARD MEMBERS, AND 5 VOLUNTEERS THAT HELP WITH CLERICAL DUTIES IN THE OFFICE OF DEVELOPMENT, SUPPORTING BOTH ST. JOSEPH HOSPITAL FOUNDATION AND WHATCOM HOSPICE FOUNDATION. REASONABLE EFFORTS STATEMENT 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 CONTAINED THE PERTINENT INSTRUCTIONS AND DEFINITIONS FOR PART VII, SECTION A, COLUMNS (E) AND (F). AT THE TIME OF THE FILING OF THIS RETURN, THE ORGANIZATION RECEIVED 22 COMPLETED QUESTIONNAIRES OUT OF 27 THAT WERE DISTRIBUTED. SEVERAL PHONE CALLS WERE MADE AND EMAILS SENT TO THE UNRESPONSIVE PERSONS IN AN EFFORT TO OBTAIN THE QUESTIONNAIRES, BUT TO DATE THE ORGANIZATION HAS RECEIVED NO RESPONSES FROM THESE PERSONS. PEACEHEALTH 14432 SE EASTGATE WAY STE 300 BELLEVUE WA 98007 910939479 HOSPITAL WA 501(c)(3) 3 - Hospital PEACEHEALTH 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 KETCHIKAN GENERAL HOSPITAL FOUNDATION 3100 TONGASS AVE KETCHIKAN AK 99901 651225184 SUPPORT KETCHIKAN GENERAL HOSPITAL AK 501(c)(3) 7 - 509(a)(1) PEACEHEALTH 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 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 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 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 HEALTH VENTURES PO BOX 10905 EUGENE OR 97440 911350776 HEALTHCARE JOINT VENTURES WA 501(c)(3) 7 - 509(a)(1) PEACEHEALTH 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0