2024-11-13T20:35:36-06:00 2023-12-31 910189318 MOSS ADAMS LLP 2707 COLBY AVENUE SUITE 801 EVERETT WA 98201 990 2023-01-01 911122992 GRAYS HARBOR COMMUNITY HOSPITAL FOUNDATION GRAY 3605375136 915 ANDERSON DRIVE ABERDEEN WA 98520 NIALL FOLEY CFO 3605375136 2024-11-13 1 0 WENDY CAMPOS P00448102 4252597227 2024-11-13 2023 2024-10-15 13:58:12Z SEE SCHEDULE O HARBOR REGIONAL HEALTH COMMUNITY HOSPITAL FOUNDATION NIALL FOLEY 915 ANDERSON DRIVE ABERDEEN WA 98520 373177 0 X WWW.GHCARES.ORG/FOUNDATION X 1981 WA SUPPORTING HARBOR REGIONAL HEALTH THROUGH ADVOCACY AND FUNDRAISING. 14 9 0 23 0 0 85834 146615 0 0 321491 226562 0 0 407325 373177 191563 288237 0 0 0 0 0 0 0 294 24513 191857 312750 215468 60427 7621942 8445768 314281 223914 7307661 8221854 SUPPORTING HARBOR REGIONAL HEALTH PROGRAMS, SERVICES, AND CAPITAL NEEDS THROUGH ADVOCACY AND FUNDRAISING. 0 0 288237 288237 0 THIS ORGANIZATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR HEALTH CARE SERVICES IN WASHINGTON STATE, BY PRIMARILY ACTING FOR THE BENEFIT OF HARBOR REGIONAL HEALTH, A WASHINGTON NONPROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER SEC 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1954, AND FOR THE BENEFIT OF HEALTH CARE NEEDS OF GRAYS HARBOR COUNTY BY (1) RECEIPT OF CONTRIBUTIONS ON BEHALF OF HARBOR REGIONAL HEALTH AND THE HEALTH CARE FACILITIES FOR THEIR TAX-EXEMPT PURPOSES, (2) BY MAKING DONATIONS TO HARBOR REGIONAL HEALTH AND THEIR HEALTH CARE FACILITIES FOR THEIR TAX-EXEMPT PURPOSES, AND (3) PROVIDING FUNDRAISING SERVICES FOR HARBOR REGIONAL HEALTH AND THE HEALTH CARE NEEDS OF GRAYS HARBOR COUNTY BY OTHERWISE RENDERING SUPPORT TO SAID HOSPITAL AND THE HEALTH CARE NEEDS OF GRAYS HARBOR CO. 288237 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X NIALL FOLEY 3605376143 1006 NORTH H STREET ABERDEEN WA 98520 DR JOHN EILAND BOARD MEMBER 1.00 40.00 X 0 676360 0 DR GREG MAY BOARD MEMBER 1.00 40.00 X 0 591309 0 TOM JENSEN BOARD MEMBER 1.00 40.00 X 0 439085 73789 MELANIE BRANDT BOARD MEMBER 1.00 40.00 X 0 130790 30840 CHRIS MAJORS BOARD MEMBER 4.00 36.00 X 0 102659 17966 CHRIS THOMAS VICE-CHAIR 1.00 1.00 X X 0 11520 0 SCOTT DILLEY TREASURER 1.00 1.00 X X 0 8448 0 LYNN CSERNOTTA BOARD MEMBER 1.00 1.00 X 0 7808 0 MILES LONGENBAUGH PRESIDENT 1.00 0.00 X X 0 0 0 STEPHEN RUPERT DDS SECRETARY 1.00 0.00 X X 0 0 0 REBECCA WALSH BOARD MEMBER 1.00 0.00 X 0 0 0 STAN WOODY BOARD MEMBER 1.00 0.00 X 0 0 0 MELANIE STURGEON BOARD MEMBER 1.00 0.00 X 0 0 0 DAVE HAVILAND BOARD MEMBER 1.00 0.00 X 0 0 0 0 1967979 122595 0 0 1 0 0 146615 2000 146615 159423 159423 67139 0 67139 67139 67139 373177 0 0 226562 288237 288237 3016 3016 16086 16086 3759 3759 1526 1526 126 126 312750 288237 24513 0 310808 452054 140359 0 0 2250 7170775 7991464 7621942 8445768 216 216 314065 223698 314281 223914 X 1982879 2897072 5324782 5324782 7307661 8221854 7621942 8445768 60427 853766 0 X 0 1 X 1 0 X 26542 19930 70364 85834 146615 349285 26542 19930 70364 85834 146615 349285 200592 148693 112664 126660 103710 118642 159423 621099 970384 0.15320 0.14360 X PURSUANT TO REGULATION 1.170A-9(F)(3), THE ORGANIZATION NORMALLY RECEIVES A SUBSTANTIAL PART OF ITS SUPPORT DIRECTLY OR INDIRECTLY FROM THE GENERAL PUBLIC AND IS ACTIVELY ENGAGED IN THE ATTRACTION OF PUBLIC SUPPORT. THE ORGANIZATION IS PUBLICLY SUPPORTED UNDER THE FACTS AND CIRCUMSTANCES TEST AS FOLLOWS:(I) TEN PERCENT-OF-SUPPORT LIMITATION: THE PERCENTAGE OF SUPPORT NORMALLY RECEIVED BY THE ORGANIZATION FROM CONTRIBUTIONS MADE BY GOVERNMENT UNITS, FROM CONTRIBUTIONS MADE DIRECTLY OR INDIRECTLY BY THE GENERAL PUBLIC, OR FROM A COMBINATION OF THESE SOURCES EQUALS AT LEAST 10 PERCENT.(II) ATTRACTION OF PUBLIC SUPPORT: THE ORGANIZATION'S EXEMPT PURPOSE IS TO SUPPORT GRAYS HARBOR COMMUNITY HOSPITAL (HOSPITAL) BY RAISING FUNDS AND PROVIDING THEM TO THE HOSPITAL FOR SPECIFIED PROGRAMS. THE HOSPITAL IS A PUBLIC CHARITY UNDER IRC 170(B)(1)(A)(III). THE FOUNDATION HAS BEEN WORKING WITH A VENDOR TO BRING IN A NEW CAMPAIGN. ONCE THAT IS IN PLACE, THEY PLAN TO CONDUCT A FUNDRAISING CAMPAIGN AND THEN MOVE ON TO ADDITIONAL CAPITAL CAMPAIGNS IN 2024. IN PRIOR YEARS THE ORGANIZATION HAD CONDUCTED A FUNDRAISING EVENT TO ATTRACT PUBLIC SUPPORT. DUE TO TURNOVER AT THE ORGANIZATION AND THE EFFECTS OF SOCIAL DISTANCING DUE TO COVID IT HAS NOT BEEN ABLE TO CONDUCT A FUNDRAISING EVENT. IT IS A GOAL TO BEGIN CONDUCTING AN ANNUAL FUNDRAISING EVENT IN 2024.(III) PERCENTAGE OF FINANCIAL SUPPORT: FOR THE YEAR-ENDED DECEMBER 31, 2023, PUBLIC SUPPORT EQUALED 15.32%, WHICH SATISFIED THE TEN PERCENT REQUIREMENT.(IV) SOURCES OF SUPPORT: THE ORGANIZATION RECEIVES SUPPORT FROM A REPRESENTATIVE NUMBER OF PERSONS AND ORGANIZATIONS INCLUDING, BUT NOT LIMITED TO, ESTATES, TRUSTS AND OTHER TAX-EXEMPT ORGANIZATIONS. (V) REPRESENTATIVE GOVERNING BODY: THE ORGANIZATION'S BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS HAVING SPECIFIC KNOWLEDGE OR EXPERTISE IN THE INDUSTRY INCLUDING EMPLOYEES OF THE RELATED HOSPITAL ORGANIZATION, PUBLIC OFFICIALS OF A PUBLIC HEALTH DISTRICT AND VOLUNTEERS FROM THE GENERAL PUBLIC. (VI) AVAILABILITY OF PUBLIC SERVICES: THE ORGANIZATION SUPPORTS THE GREATER PUBLIC AT LARGE BY SUPPORTING PROGRAMS OF GRAYS HARBOR COMMUNITY HOSPITAL WHICH PROVIDES HEALTH SERVICES TO THE COMMUNITY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5324782 288237 288237 5324782 5324782 191563 191563 5324782 5324782 48822 48822 5324782 5324782 174528 174528 5324782 5324782 248868 248868 5324782 0.00000 1.00000 0.00000 0 0 0 X PART V, LINE 4: INVEST THE FUNDS WITH AN INDEPENDENT BROKER AND USE THE UNRESTRICTED INTEREST EARNED FOR CAPITAL NEEDS OF GRAYS HARBOR COMMUNITY HOSPITAL. PART X, LINE 2: THE DISTRICT, AS A POLITICAL SUBDIVISION OF THE STATE OF WASHINGTON, IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 115 OF THE INTERNAL REVENUE CODE. 1 GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DRIVE ABERDEEN WA 98520 910568304 501(C)(3) 287267 0 TO PROVIDE SUPPORT TO THE HOSPITAL AS IT IS THE FOUNDATION'S EXEMPT PURPOSE. 1 0 PART I, LINE 2: THE FOUNDATION WAS ORGANIZED FOR THE SOLE PURPOSE OF PROVIDING GRANTS TO GRAYS HARBOR COMMUNITY HOSPITAL. ALL GRANTS PROVIDED TO GRAYS HARBOR COMMUNITY HOSPITAL ARE IN SUPPORT OF HOSPITAL PROGRAMS, SERVICES AND CAPITAL NEEDS. ANY SCHOLARSHIPS THAT ARE NOT ROUTED THROUGH GRAYS HARBOR COMMUNITY HOSPITAL ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTION ON A STUDENT'S BEHALF TO ENSURE FUNDS ARE USED APPROPRIATELY. 0 0 0 0 0 0 0 0 0 DR JOHN EILAND BOARD MEMBER 0 676360 0 0 0 0 0 0 0 0 0 676360 0 0 DR GREG MAY BOARD MEMBER 0 591309 0 0 0 0 0 0 0 0 0 591309 0 0 TOM JENSEN BOARD MEMBER 0 400862 0 0 0 38223 0 30000 0 43789 0 512874 0 0 MELANIE BRANDT BOARD MEMBER 0 130790 0 0 0 0 0 12752 0 18088 0 161630 0 0 PART I, LINE 3 COMPENSATION FOR THE EXECUTIVE DIRECTOR IS ANALYZED BY THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 HARBOR REGIONAL HEALTH IS THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990, INCLUDING SCHEDULE B, IS DISTRIBUTED TO ALL BOARD MEMBERS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY SIGN CONFLICT OF INTEREST QUESTIONNAIRES AND THESE ARE REVIEWED BY THE COMPLIANCE DEPARTMENT FOR ANY POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT ARISES THE BOARD MEMBER MUST EXCUSE THEMSELVES FROM DISCUSSION OF AND VOTING ON THE ISSUE. IF A BOARD MEMBER IS AN OWNER IN A COMPANY THAT IS CAUSING THE CONFLICT OF INTEREST A CONTACT OF THE COMPANY OTHER THAN THE BOARD MEMBER MUST REPRESENT THE COMPANY IN NEGOTIATIONS WITH THE HOSPITAL FOR CONTRACTS AT FAIR MARKET VALUE. ESSENTIALLY THE BOARD MEMBER CANNOT BE INVOLVED IN THE TRANSACTION IN ANY WAY. FORM 990, PART VI, SECTION B, LINE 15 THE OFFICER OF THE FILING ORGANIZATION IS PAID BY HARBOR REGIONAL HEALTH, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 18 HARBOR REGIONAL HEALTH COMMUNITY HOSPITAL FOUNDATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AND OTHER GOVERNANCE DOCUMENTS AVAILABLE UPON REQUEST. GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DRIVE ABERDEEN WA 98520 910568304 TO PROVIDE QUALITY HEALTHCARE SERVICES AND EDUCATION. WA 501(C)(3) LINE 3 GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 0 GRAYS HARBOR PUBLIC HOSPITAL DISTRICT #2 915 ANDERSON DRIVE ABERDEEN WA 98520 383941437 TO SUPPORT HEALTH CARE FOR THE GRAYS HARBOR COUNTY COMMUNITY WA 501(C)(3) LINE 6 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0