2024-05-07T13:41:27-05:00 2023-06-30 930623286 ALDRICH CPAS AND ADVISORS LLP 1903 WRIGHT PLACE 180 CARLSBAD CA 92008 990 2022-07-01 931084126 PEACE HARBOR HOSPITAL FOUNDATION PEAC 5419026589 400 9TH ST FLORENCE OR 97439 LAUREL FERGUSON PRESIDENT 5419026589 2024-03-29 1 LAUREL FERGUSON 999009999 0 DEBRA D SMITH CPA P00646873 7604318440 2024-03-29 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GEORGE HENRY 400 9TH ST FLORENCE OR 97439 219947 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/PEACE-HARBOR X 1987 OR IMPROVE THE HEALTH & LIVES OF COMMUNITY MEMBERS BY RAISING FUNDS & PROVIDING CHARITABLE SUPPORT. 10 9 0 30 0 0 1086744 161894 0 0 142174 58053 4134 0 1233052 219947 565044 501183 0 0 0 0 0 0 0 13336 18290 578380 519473 654672 -299526 4914763 4722786 110882 93257 4803881 4629529 TO IMPROVE THE HEALTH AND LIVES OF COMMUNITY MEMBERS BY PROVIDING CHARITABLE SUPPORT TO PEACEHEALTH PEACE HARBOR MEDICAL CENTER (THE HOSPITAL) SO THAT COMPASSIONATE, AFFORDABLE AND HIGH-QUALITY MEDICAL CARE MAY BE OFFERED TO ALL IN THIS REGION. 0 0 501183 501183 TRANSFERS TO PEACEHEALTH PEACE HARBOR MEDICAL CENTER TO SUPPORT THEIR PROGRAM SERVICES. 501183 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X X SACRED HEART MEDICAL CENTER FOUNDATION 5412227100 123 INTERNATIONAL WAY SPRINGFIELD OR 97477 SALLY WANTZ VICE PRESIDENT 1.00 X X 0 0 0 LAUREL FERGUSON SECRETARY/TREASURER 1.00 X X 0 0 0 PAULA BURNETTE PRESIDENT 1.00 X X 0 0 0 JASON HAWKINS DIRECTOR, CAO PEACEHARBOR HOSPITAL 1.00 40.00 X 0 327667 52307 RONALD MOORE DIRECTOR 1.00 X 0 0 0 NORMA KAY WOOD DIRECTOR 1.00 X 0 0 0 MONICA KOSMAN DIRECTOR 1.00 X 0 0 0 GEORGE HENRY DIRECTOR 1.00 X 0 0 0 BEVERLY SCOTT DIRECTOR 1.00 X 0 0 0 HEATHER MCARTHUR DIRECTOR 1.00 X 0 0 0 DAVID RIGSBY - START 12023 EXECUTIVE DIRECTOR 40.00 X 0 0 0 0 327667 52307 0 0 1 0 0 161894 1000 161894 55644 55644 2409 0 2409 2409 2409 219947 0 0 58053 501183 501183 16685 16685 605 605 IN KIND EXPENSES 1000 0 1000 0 519473 501183 18290 0 1297358 50050 558405 1827329 339078 3236 780500 780500 780500 1705963 1825227 233459 236444 4914763 4722786 110882 93257 110882 93257 X 1564614 1537213 3239267 3092316 4803881 4629529 4914763 4722786 X -299526 104564 20610 X 0 1 X 1 0 X 266289 128476 616335 1086744 161894 2259738 266289 128476 616335 1086744 161894 2259738 1139754 1119984 15811 23189 21411 30818 55644 146873 4134 4134 3677 3677 2414422 0.46390 0.49970 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1063750 10223 58836 1132809 1203163 -139413 1063750 380466 822697 1203163 338879 41587 380466 372024 -33145 338879 1.00000 0 0 780500 780500 780500 INVESTMENTS IN LIFE INSURANCE POLICIES 236444 236444 LIFE ESTATE OBLIGATIONS 93257 93257 X 869129 104564 540693 20610 665867 203262 16685 16685 219947 1043481 540693 540693 502788 16685 16685 519473 PART X, LINE 2: FOR THE YEARS ENDED JUNE 30, 2023 AND 2022, MANAGEMENT OF THE FOUNDATION BELIEVES THAT THERE HAS BEEN NO ACTIVITY THAT WOULD JEOPARDIZE THE TAX POSITION, BEING A TAX EXEMPT ORGANIZATION, AND THAT IT IS MORE LIKELY THAN NOT, BASED ON THE TECHNICAL MERITS, THAT THIS POSITION WOULD BE SUSTAINED UPON EXAMINATION. THE FOUNDATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE. THERE WERE NONE FOR THE YEARS ENDED JUNE 30, 2023 AND 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF LIFE ESTATE OBLIGATIONS AND REAL ESTATE 17,625. CHANGE IN VALUE OF BENEFICIAL INTERESTS AND LIFE INSURANCE POLICIES 2,985. 1 PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939497 501(C)(3) 501183 0 SUPPORT FOR PEACEHEALTH PEACE HARBOR MEDICAL CENTER. 1 0 PART I, LINE 2: GRANT REQUESTS FROM DONOR RESTRICTED FUNDS ARE SUBMITTED BY HOSPITAL ADMINISTRATION, INCLUDING AN INDICATION FROM WHICH FOUNDATION FUND MONEY IS BEING REQUESTED, AND ACCOMPANIED BY RECEIPTS, INVOICES AND OTHER VERIFICATION OF THE PROPOSED USE OF FUNDS (REIMBURSEMENT). FOUNDATION STAFF REVIEW THE REQUEST FOR COMPLIANCE WITH DONOR RESTRICTIONS AND COMPLIANCE WITH EXPENDITURE DOCUMENTATION PROCEDURES. IF THIS INFORMATION IS IN ORDER, THEN A TRANSFER IS INITIATED BY THE FOUNDATION TO THE HOSPITAL. THE FOUNDATION BOARD APPROVES THE TRANSFERS AT ITS QUARTERLY BOARD MEETINGS. REQUESTS FOR THE USE OF UNRESTRICTED FUNDS FOLLOWS THE SAME PROCESS, BUT THE FOUNDATION BOARD MOST APPROVE THE REQUESTS BEFORE THE TRANSFERS ARE INITIATED. X X X X 1 1 0 1 0 0 0 0 0 0 0 JASON HAWKINS DIRECTOR, CAO PEACEHARBOR HOSPITAL 0 277862 0 49805 0 0 0 26417 0 25890 0 379974 0 0 PART I, LINE 1A PEACEHEALTH (A RELATED ORGANIZATION) HAS POLICES REGARDING THE ELIGIBILITY OF EXECUTIVES FOR THESE ITEMS. FOR EXAMPLE TRAVEL FOR COMPANIONS AND HOUSING ALLOWANCES ARE RELATED TO RELOCATION BENEFITS OR FIRST CLASS TRAVEL FOR FLIGHTS EXCEEDING SIX HOURS IN DURATION. THESE BENEFITS WERE REPORTED AND TREATED AS TAXABLE. PART I, LINE 3 THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES. EMPLOYEES ARE 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 ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THE RANGES OF PAY RATES ARE REVIEWED ON AN ANNUAL BASIS. PART I, LINE 4B PEACEHEALTH (A RELATED ORGANIZATION) HAS POLICES REGARDING THE ELIGIBILITY OF EXECUTIVES FOR THESE ITEMS. BOARD MEMBERS LISTED ON SCHEDULE J ARE EMPLOYEES OF PEACEHEALTH A RELATED ENTITY AND PEACEHEALTH'S CEO, EXECUTIVE VICE PRESIDENT, SENIOR VICE PRESIDENT, CERTAIN PHYSICIANS AND OTHER HIGHLY COMPENSATED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN VARIOUS NONQUALIFIED RETIREMENT PLANS. CONTRIBUTIONS TO THESE PLANS AND RELATED INVESTMENT RETURNS ARE DISCLOSED ON SCHEDULE J AS DEFERRED COMPENSATION AND AS BONUS COMPENSATION WHEN PAID TO THE INDIVIDUAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT CPA FIRM AND IS PRESENTED TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REMINDED TO RECUSE THEMSELVES FROM VOTING ON ITEMS THAT INVOLVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT HAVE ANY PAID EMPLOYEES. EMPLOYEES ARE 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 ESTABLISHES THE INDIVIDUAL RATE OF PAY WITHIN THE PAY RANGE BASED ON RELEVANT EXPERIENCE/SKILLS/COMPETENCE TO DO THE JOB. THE RANGES OF PAY RATES ARE REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST VIA MAIL OR E-MAIL. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF LIFE ESTATE OBLIGATIONS 17,625. CHANGE IN VALUE OF BENEFICIAL INTERESTS & LIFE INSURANCE POLICIES 2,985. PEACEHEALTH 1115 SE 164TH AVE SUITE 332 VANCOUVER WA 98683 910939479 HEALTHCARE WA 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0