2024-05-10T15:13:00-05:00 2023-06-30 135565207 KPMG LLP 1300 SW 5TH AVENUE SUITE 3800 PORTLAND OR 97201 990 2022-07-01 911231436 PEACEHEALTH SOUTHWEST MEDICAL CENTER FDN PEAC 3607291000 PO BOX 1600 VANCOUVER WA 986681600 DARRIN MONTALVO EXEC VP 3607291000 2024-05-07 1 DARRIN MONTALVO 999009999 0 DAVID M HIGHFILL P01517891 5032216500 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DARRIN MONTALVO 1115 SE 164TH AVE VANCOUVER WA 98683 9874054 0 X WWW.PEACEHEALTH.ORG/FOUNDATION/SW-WASHINGTON X 1983 WA THE FOUNDATION RAISES FUNDS TO SUPPORT THE PEACEHEALTH SOUTHWEST MEDICAL CENTER. 24 22 0 0 0 0 22605219 6928281 0 0 1258888 611484 1050 1650 23865157 7541415 2604655 9118462 0 0 935292 971669 0 0 0 1377132 1249917 4917079 11340048 18948078 -3798633 49855151 47383385 2628 0 49852523 47383385 PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION AIMS TO PROVIDE AN EFFICIENT MEANS OF COLLECTING AND DISTRIBUTING SUPPORT TO PEACEHEALTH (EIN: 91-0939479), SPECIFICALLY THE PEACEHEALTH SOUTHWEST MEDICAL CENTER. 0 0 10189296 9118462 0 PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION SUPPORTS PEACEHEALTH SOUTHWEST MEDICAL CENTER BY SOLICITING CONTRIBUTIONS IN SUPPORT OF THE MEDICAL CENTER'S OPERATIONS. PEACEHEALTH SOUTHWEST MEDICAL CENTER IS A HOSPITAL OWNED AND OPERATED BY PEACEHEALTH (EIN: 91-0939479) WHICH IS AN EXEMPT ORGANIZATION PURSUANT TO IRC 501(C)(3). 10189296 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 1 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 24 22 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WA X JEFF SEIRER 3607291000 1115 SE 164TH AVENUE VANCOUVER WA 98683 JOAN CAVANAGH DIRECTOR 2.00 0.00 X 0 0 0 LESLIE DURST DIRECTOR 2.00 0.00 X 0 0 0 SEAN GREGORY MD DIRECTOR 2.00 40.00 X 0 1044183 98179 MELANIE FAIN DIRECTOR 2.00 0.00 X 0 0 0 JO MARIE HANSEN DIRECTOR 2.00 0.00 X 0 0 0 JANET KEENEY DIRECTOR 2.00 0.00 X 0 0 0 DAVID HAYES MD DIRECTOR 2.00 0.00 X 0 0 0 PATTY KELLER DIRECTOR 2.00 0.00 X 0 0 0 JOE KORTUM DIRECTOR 2.00 0.00 X 0 0 0 GREG KUBICEK DIRECTOR 2.00 0.00 X 0 0 0 MARK MARTEL DIRECTOR 2.00 0.00 X 0 0 0 DAN MONAGHAN JR DIRECTOR 2.00 0.00 X 0 0 0 DAVID NIERENBERG DIRECTOR 2.00 0.00 X 0 0 0 RISA OLSEN SECRETARY 2.00 0.00 X X 0 0 0 SANDFORD PLANT DIRECTOR 2.00 0.00 X 0 0 0 RON PRILL DIRECTOR 2.00 0.00 X 0 0 0 JOHN REIERSGAARD DIRECTOR 2.00 0.00 X 0 0 0 DAVID RUIZ MD DIRECTOR 2.00 40.00 X 0 326794 50039 GREG SEIFERT TREASURER 2.00 0.00 X X 0 0 0 RICK TAKACH VICE PRESIDENT 2.00 0.00 X X 0 0 0 IVY TIMPE DIRECTOR 2.00 0.00 X 0 0 0 CANDACE YOUNG PHD PRESIDENT 2.00 0.00 X X 0 0 0 JANIS WYATT DIRECTOR 2.00 0.00 X 0 0 0 KATHY CORWIN DIRECTOR 2.00 0.00 X 0 0 0 KAREN SANTANGELO EXECUTIVE DIRECTOR 2.00 40.00 X 0 239712 47145 0 1610689 195363 0 0 1 0 0 6928281 10148 6928281 609777 609777 2334346 2332639 1707 1707 1707 MISCELLANEOUS REVENUE 900099 1650 1650 1650 7541415 0 0 613134 9118462 9118462 760998 119355 641643 38495 6038 32457 121475 19052 102423 50701 7952 42749 218876 34329 184547 6300 988 5312 131366 20604 110762 8765 1375 7390 15574 2443 13131 1365 214 1151 IN KIND EXPENSES 840197 840197 BAD DEBT ALLOWANCE 17000 17000 BANK FEES 2270 2270 8204 1287 6917 11340048 10189296 1150752 0 17314029 13170789 16560525 16909085 466152 466152 15450241 16742501 64204 94858 49855151 47383385 2628 0 2628 0 X 6597994 6838508 43254529 40544877 49852523 47383385 49855151 47383385 X -3798633 1416562 -87067 X 0 1 X 1 0 X 3560259 4555595 5996311 22605219 6928281 43645665 3560259 4555595 5996311 22605219 6928281 43645665 14188059 29457606 1074125 387334 1417183 1268397 609777 4756816 48402481 0.60860 0.74850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 24977625 51035 -28935 572950 24426775 18719257 9927266 -865523 2803375 24977625 15549608 252064 3098072 180487 18719257 15212988 833800 -158413 338767 15549608 15567914 423848 411177 1189951 15212988 0.12535 0.76143 0.11322 0 0 0 X PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO SUPPORT PEACEHEALTH, SPECIFICALLY THE PEACEHEALTH SOUTHWEST MEDICAL CENTER. PART X, LINE 2: THE CORPORATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT EXCEEDS 50% PROBABILITY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN ESTIMATE OCCURS. 1 PEACEHEALTH 1115 SE 164TH AVE VANCOUVER WA 98683 910939479 501(C)(3) 9108467 9995 BOOK QUILTS, MEALS, CLEANING AND HOSPITAL SUPPLIES HOSPITAL OPERATING ACTIVITIES 1 0 PART I, LINE 2: FOR TAX YEAR 2022, THE FOUNDATION MADE ALL OF ITS CONTRIBUTIONS TO PEACEHEALTH, SPECIFICALLY SOUTHWEST MEDICAL CENTER (SWMC). SWMC USES FUNDS FOR ITS OWN OPERATIONS OR DISBURSEMENTS AS DETERMINED BY THE COMMUNITY BENEFIT OPERATIONS OF PEACEHEALTH (EIN: 91-0939479), THE OWNER OF THE HOSPITAL. 0 1 0 0 0 0 0 0 0 SEAN GREGORY MD DIRECTOR 0 691875 0 352308 0 0 0 63230 0 34949 0 1142362 0 0 DAVID RUIZ MD DIRECTOR 0 325386 0 1060 0 348 0 20904 0 29135 0 376833 0 0 KAREN SANTANGELO EXECUTIVE DIRECTOR 0 215558 0 12673 0 11481 0 11993 0 35152 0 286857 0 0 PART I, LINE 3 THE ORGANIZATION WHICH CONTROLS PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION IS PEACEHEALTH (EIN: 91-0939479). PEACEHEALTH ESTABLISHES COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR USING: 1) INDEPENDENT COMPENSATION CONSULTANT 2) COMPENSATION SURVEY OR STUDY 3) APPROVAL BY THE BOARD ALL PERSONS PROVIDING SERVICES FOR PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION ARE EMPLOYEES OF AND COMPENSATED BY PEACEHEALTH. PART I, LINE 4B PEACEHEALTH (EIN: 91-0939479) ESTABLISHES, IMPLEMENTS, AND CONDUCTS THE COMPENSATION POLICIES AND PRACTICES OF PEACEHEALTH SOUTHWEST MEDICAL CENTER FOUNDATION. THE COMPENSATION POLICIES OF PEACEHEALTH ARE DISCLOSED BELOW. PEACEHEALTH'S CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, 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. THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN CALENDAR YEAR 2022 (DEFERRED/PAID): SEAN GREGORY: $33,576/$0 X 1 10148 FMV AT DATE OF CONTRIB. 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 PEACEHEALTH, A WASHINGTON NON-PROFIT CORPORATION, WHICH IS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, IS THE SOLE MEMBER CORPORATION OF SOUTHWEST MEDICAL CENTER FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER CORPORATION, PEACEHEALTH HAS THE RIGHT TO APPOINT ONE BOARD MEMBER. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER CORPORATION, PEACEHEALTH HAS CERTAIN ADDITIONAL RIGHTS, INCLUDING APPROVING DISSOLUTION AND APPROVING CHANGES TO SOUTHWEST MEDICAL CENTER FOUNDATION'S ARTICLES AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S ACCOUNTING DEPARTMENT WORKS CLOSELY WITH THE OUTSIDE ACCOUNTING FIRM IT ENGAGES (KPMG) TO PREPARE AND REVIEW THE RETURN. THE EVP / CFO AND LEGAL DEPARTMENT REVIEW A DRAFT OF THE FORM 990 AND PROVIDE COMMENTS. THE FINAL DRAFT IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO SOUTHWEST MEDICAL CENTER FOUNDATION BOARD MEMBERS AND OFFICERS AT LEAST ANNUALLY. RESPONSES ARE REVIEWED BY THE PEACEHEALTH ORGANIZATIONAL INTEGRITY DEPARTMENT AND ANY PERCEIVED OR REAL CONFLICTS OF CONCERN ARE DOCUMENTED IN A MANAGEMENT PLAN AND REVIEWED BY NETWORK AND BOARD LEADERSHIP. BOARD MEMBERS AND OFFICERS ARE OBLIGATED TO BRING ANY CHANGES IN STATUS VIS-A-VIS THE CONFLICT OF INTEREST POLICY TO THE BOARD'S ATTENTION FOR REVIEW AND DISPOSITION BETWEEN SURVEY PERIODS. IF PEACEHEALTH ORGANIZATIONAL INTEGRITY BELIEVES A DISCLOSURE POSES A POTENTIAL OR ACTUAL CONFLICT, IT MUST INDICATE TO THE COVERED PERSON HOW TO DISPOSE OF OR MANAGE THE CONFLICT. PEACEHEALTH ORGANIZATIONAL INTEGRITY INVOLVES LEADERS FROM OTHER DEPARTMENTS AS NEEDED TO REVIEW AND MANAGE DISCLOSED CONFLICTS OF INTEREST. IF PEACEHEALTH HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST OR OTHERWISE VIOLATED THIS POLICY OR REFUSED TO COOPERATE IN AN INVESTIGATION RELATED TO COMPLIANCE WITH THIS POLICY, IT MUST INFORM THE PERSON OF THE BASIS FOR THE BELIEF AND AFFORD AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF AFTER HEARING THE RESPONSE AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, PEACEHEALTH DETERMINES A PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT MAY TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION UP TO AND INCLUDING DISSOLUTION OF THE PERSON'S AFFILIATION WITH PEACEHEALTH. FORM 990, PART VI, SECTION B, LINE 15 SOUTHWEST MEDICAL CENTER FOUNDATION DOES NOT COMPENSATE EMPLOYEES. RATHER, ALL EMPLOYEES THAT SPEND TIME ON SOUTHWEST MEDICAL CENTER FOUNDATION OPERATIONS ARE COMPENSATED BY PEACEHEALTH. THE INDEPENDENT CHAIR OF THE PEACEHEALTH BOARD OF DIRECTORS REVIEWS AND RECOMMENDS, IN PARTNERSHIP WITH REPRESENTATIVES OF AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS, THE COMPENSATION OF PEACEHEALTH'S PRESIDENT/CHIEF EXECUTIVE OFFICER. FURTHERMORE, THE INDEPENDENT COMPENSATION CONSULTANT, WITH SUPPORT FROM MEMBERS OF THE HUMAN RESOURCES DEPARTMENT, DETERMINES COMPARABILITY DATA ACROSS VARIOUS INDUSTRY AND APPLICABLE FOR-PROFIT/NOT-FOR-PROFIT ORGANIZATIONS FOR PERIODICALLY INFORMING THE GOVERNANCE COMMITTEE OF THE BOARD ON THE MARKET COMPETITIVENESS OF THE PAY FOR PEACEHEALTH EXECUTIVES. DISCUSSIONS AND DECISIONS MADE DURING THE COMMITTEE MEETINGS ARE DOCUMENTED IN MEETING MINUTES. THE MOST RECENT COMPENSATION REVIEW WAS COMPLETED IN SEPTEMBER 2022, AND INCLUDED THE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, NETWORK CHIEF EXECUTIVES, MEDICAL GROUP CHIEF EXECUTIVE, AND OTHER SENIOR NETWORK ROLES (INCLUDING CFO, COO, CAO). FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON REQUEST. FORM 990, PART XI, LINE 9: PLEDGE WRITEOFF 10,328. CHANGE IN VALUE OF GIFT ANNUITY 25,061. CHANGE IN PRESENT VALUE DISCOUNT ON RECEIVABLES -122,456. PEACEHEALTH NETWORKS 1115 SE 164TH AVENUE VANCOUVER WA 98683 911230425 SUPPORT WA 501(C)(3) LINE 12B, II N/A 0 PEACEHEALTH 1115 SE 164TH AVENUE VANCOUVER WA 98683 910939479 MEDICAL SERVICES WA 501(C)(3) LINE 3 PH NETWORKS 0 HEALTH VENTURES 1115 SE 164TH AVENUE VANCOUVER WA 98683 911350776 HEALTHCARE JV WA 501(C)(3) LINE 12A, I PEACEHEALTH 0 KETCHIKAN MEDICAL SERVICES FOUNDATION 3100 TANGASS AVENUE KETHIKAN AK 99901 651225184 FUNDRAISING AK 501(C)(3) LINE 7 PEACEHEALTH 0 COTTAGE GROVE MEDICAL CENTER FOUNDATION 1515 VILLAGE DRIVE COTTAGE GROVE OR 97424 930688381 FUNDRAISING OR 501(C)(3) LINE 7 PEACEHEALTH 0 PEACE HARBOR MEDICAL CENTER FOUNDATION 400 NINTH STREET FLORENCE OR 97439 931084126 FUNDRAISING OR 501(C)(3) LINE 7 PEACEHEALTH 0 SACRED HEART MEDICAL CENTER FOUNDATION PO BOX 10905 EUGENE OR 97440 936026548 FUNDRAISING OR 501(C)(3) LINE 7 PEACEHEALTH 0 ST JOHN MEDICAL CENTER FOUNDATION PO BOX 3 LONGVIEW WA 98632 911538852 FUNDRAISING WA 501(C)(3) LINE 7 PEACEHEALTH 0 ST JOSEPH MEDICAL CENTER FOUNDATION 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 721545902 FUNDRAISING WA 501(C)(3) LINE 7 PEACEHEALTH 0 RB AMBULATORY SURGERY CENTER 3355 RIVERBEND DR SPRINGFIELD OR 97477 MEDICAL OR N/A 0 0 ARDON HEALTH HOLDINGS LLC 601 SW 2ND AVE 24TH FL PORTLAND OR 97204 821561337 PHARMACY DE N/A 0 0 CLARE REASSURANCE 1115 SE 164TH AVENUE VANCOUVER WA 98683 REINSURANCE CJ N/A C 0 LOWER COLUMBIA REGION POOLED INCOME FUND 1115 SE 164TH AVENUE VANCOUVER WA 98683 466157497 POOLED INCOME WA N/A T 0 OREGON REGION POOLED INCOME FUND 1115 SE 164TH AVENUE VANCOUVER WA 98683 466180599 POOLED INCOME WA N/A T 0 PEACEHEALTH AMBULATORY LLC 1115 SE 164TH AVENUE VANCOUVER WA 98683 862027568 MEDICAL WA N/A C 0 PEACEHEALTH CLINICALLY INTEGRATED NETWORK 1115 SE 164TH AVENUE VANCOUVER WA 98683 861975269 MEDICAL WA N/A C 0 PEACEHEALTH DIRECT CONTRACTING LLC 1115 SE 164TH AVENUE VANCOUVER WA 98683 861344009 MEDICAL WA N/A C 0 PEACEHEALTH NETWORKS ON DEMAND LLC 1115 SE 164TH AVENUE VANCOUVER WA 98683 832849989 MEDICAL CLINICS WA N/A C 0 POOLED INCOME FUND OF PEACEHEALTH #1 1115 SE 164TH AVENUE VANCOUVER WA 98683 276030191 POOLED INCOME WA N/A T 0 SIUSLAW REGION POOLED INCOME FUND 1115 SE 164TH AVENUE VANCOUVER WA 98683 466221760 POOLED INCOME WA N/A T 0 SOUTHWEST REGION POOLED INCOME FUND 1115 SE 164TH AVENUE VANCOUVER WA 98683 466168710 POOLED INCOME WA N/A T 0 WHATCOM REGION POOLED INCOME FUND 1115 SE 164TH AVENUE VANCOUVER WA 98683 466129451 POOLED INCOME WA N/A T 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0