2021-10-12T19:44:31-05:00 2020-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2020-01-01 201030462 VITALOGY FOUNDATION VITA 6153299902 CO FBMM INC PO BOX 340020 NASHVILLE TN 372030020 JAMIE CHEEK VICE PRESIDENT 6153299902 2021-09-29 1 JAMIE CHEEK 999009999 KATHRYN J OKIMOTO P00746598 4254544919 2021-09-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STONE C GOSSARD C/O FBMM INC PO BOX 340020 NASHVILLE TN 372030020 1452025 0 X N/A X 2004 WA THE VITALOGY FOUNDATION IS A PUBLIC NON-PROFIT ORGANIZATION THAT WAS FOUNDED IN 2006 BY THE MEMBERS OF PEARL JAM AND THEIR MANAGER. THE FOUNDATION SUPPORTS THE EFFORTS OF NON-PROFIT ORGANIZATIONS DOING COMMENDABLE WORK IN THE FIELDS OF COMMUNITY HEALTH, THE ENVIRONMENT, ARTS & EDUCATION AND SOCIAL CHANGE. 5 5 4 7 50024 31093 1247990 1363549 0 0 18514 14131 -5336 48456 1261168 1426136 1404881 1306572 0 0 89451 105325 0 0 18582 146913 299719 1641245 1711616 -380077 -285480 1961842 1664191 17285 7435 1944557 1656756 THE FOUNDATION SUPPORTS THE EFFORTS OF NON-PROFIT ORGANIZATIONS DOING COMMENDABLE WORK IN THE FIELDS OF COMMUNITY HEALTH, THE ENVIRONMENT, ARTS & EDUCATION AND SOCIAL CHANGE. 0 0 1306572 1306572 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. 1306572 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 4 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 5 5 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X JAMIE CHEEK CO FBMM INC 6153299902 PO BOX 340020 NASHVILLE TN 372030020 X JEFFREY A AMENT PRESIDENT 1.00 20.00 X X 0 0 0 MICHAEL D MCCREADY VICE PRESIDENT 1.00 20.00 X X 0 0 0 EDDIE J VEDDER VICE PRESIDENT 1.00 20.00 X X 0 0 0 KELLY CURTIS SECRETARY (PART YEAR) 1.00 20.00 X X 0 0 0 STONE GOSSARD TREASURER 1.00 20.00 X X 0 0 0 MATTHEW D CAMERON DIRECTOR 1.00 0.00 X 0 0 0 JAMIE CHEEK VICE PRESIDENT, SECRETARY 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 WILLIAMSWORKS PO BOX 8442 MISSOULA MT 59807 STRATEGIC CONSULTING 225325 1 8261 1355288 1965 1363549 14131 14131 1965 8261 3533 -1568 -1568 72380 22356 50024 50024 1426136 0 50024 12563 X 1306572 1306572 88620 88620 9192 9192 7513 7513 17907 14778 3129 10814 10814 992 992 257456 242980 14476 2414 1437 977 4964 4964 4304 4304 600 600 268 268 1711616 1306572 386462 18582 439685 202687 903893 759940 618264 701514 0 50 1961842 1664191 17285 7435 17285 7435 X 1405203 989750 539354 667006 1944557 1656756 1961842 1664191 X -285480 222 888 -3431 X 0 0 0 X 2465361 253384 3927994 1247990 1363549 9258278 2465361 253384 3927994 1247990 1363549 9258278 70977 9187301 1026 1048 5742 18514 14131 40461 18414 31093 49507 145 145 9348391 0.98280 0.98250 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REFUND - 2019 AMOUNT: $ 145. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED AUCTION 10226 8261 1965 3533 10226 8261 1965 3533 3533 -1568 1 ALLIANCE FOR GLOBAL JUSTICE 225 EAST 26TH ST SUITE 1 TUCSON AZ 85713 522094677 501(C)(3) 15000 THE MOVEMENT FOR BLACK LIVES AMERICAN FOUNDATION FOR SUICIDE PREVENTION 199 WATER STREET 11TH FLOOR NEW YORK NY 10038 133393329 501(C)(3) 15000 GENERAL OPERATING SUPPORT & COVID-19 RESPONSE EFFORTS ARTS CORPS 4408 DELRIDGE WAY SW STE 110 SEATTLE WA 98106 912044679 501(C)(3) 10000 ARTS CORPS FESTA AND GENERAL SUPPORT BUILDING CHANGES 1200 12TH AVENUE SOUTH SUITE 1200 SEATTLE WA 98144 911410450 501(C)(3) 100000 WA STATE STUDENT AND YOUTH HOMELESSNESS COVID-19 RESPONSE FUND CHANGE THE REF INC 5944 CORAL RIDGE DR CORAL SPRINGS FL 33076 824538977 501(C)(3) 10000 GENERAL FUNDS CHILDREN'S CANCER ASSOCIATION 1200 NORTHWEST NAITO PARKWAY SUITE 140 PORTLAND OR 97209 931181662 501(C)(3) 24311 MYMUSICRX FOR HOSPITALIZED KIDS & TEENS CROHN'S & COLITIS FOUNDATION INC 733 THIRD AVENUE SUITE 510 NEW YORK NY 10017 136193105 501(C)(3) 25000 IBD VENTURES CONSERVATION NW 1829 10TH AVE W SUITE B SEATTLE WA 98119 943091547 501(C)(3) 25000 WILDERNESS PROTECTION FOR THE WILD CREST OF THE KETTLE RIVER RANGE DOHENY STATE BEACH INTERPRETIVE ASSOCIATION 25300 DANA POINT HARBOR DR DANA POINT CA 92629 953736287 501(C)(3) 25000 DOHENY STATE BEACH FOUNDATION SUPPORT DOLORES C HUERTA FOUNDATION PO BOX 2087 BAKERSFIELD CA 93303 912145992 501(C)(3) 10000 VECINOS EMERGENCY RELIEF DOWNTOWN EMERGENCY SERVICE CENTER 515 THIRD AVE SEATTLE WA 98104 911275815 501(C)(3) 18120 GENERAL FUNDS EVERYTOWN FOR GUN SAFETY SUPPORT FUND INC PO BOX 4184 NEW YORK NY 10163 261598353 501(C)(3) 20000 $10,000 TO SUPPORT THE WORK OF MOMS DEMAND ACTION; $10,000 GENERAL FUNDS FARESTART 700 VIRGINIA STREET SEATTLE WA 98101 911546757 501(C)(3) 25000 COVID-19 RESPONSE & RECOVERY FOOD LIFELINE 815 S 96TH STREET SEATTLE WA 98108 911090450 501(C)(3) 50000 HOLIDAY MEALS CAMPAIGN GLOBAL POVERTY PROJECT 594 BROADWAY SUITE 207 NEW YORK NY 10012 421772557 501(C)(3) 94500 $70,000 FOR CURTIS SCHOLARSHIP PROGRAM MANAGER SALARY FOR 2020; $14,500 IN-KIND DONATION FOR WILLIAMSWORKS DELIVERABLES; $10,000 FOR JUST VOTE CAMPAIGN GLOBALGIVING 1110 VERMONT AVENUE NW SUITE 550 WASHINGTON DC 20005 300108263 501(C)(3) 100000 WIRES WILDLIFE RESCUE HOPEWELL FUND 1201 CONNECTICUT AVE NW STE 300 WASHINGTON DC 20036 473681860 501(C)(3) 10000 2020 GALVANIZE USA KEYSTONE RESEARCH CENTER 412 N 3RD ST HARRISBURG PA 17101 251776998 501(C)(3) 15000 THE VOTER PROJECT FUND LATINO COMMUNITY FUND INC 50 HURT PLAZA SE SUITE 1434 ATLANTA GA 30303 820911954 501(C)(3) 25000 OPERATIONAL SUPPORT LCF GEORGIA LIVING UNITED FOR CHANGE IN ARIZONA 5716 N 19TH AVE PHOENIX AZ 85015 271398645 501(C)(3) 10000 ARIZONA CENTER FOR EMPOWERMENT MAKE THE ROAD STATES INC 301 GROVE STREET BROOKLYN NY 11237 843988830 501(C)(3) 20000 MRPA 2020 MARYS PLACE SEATTLE 1830 9TH AVE SEATTLE WA 98101 272087950 501(C)(3) 18120 GENERAL FUNDS MUSICARES FOUNDATION INC 3030 OLYMPIC BLVD SANTA MONICA CA 90404 954470909 501(C)(3) 15000 COVID-19 RELIEF FUND NORTHWEST CREDIT UNION FOUNDATION 18000 INTERNATIONAL BLVD STE 350 SEATAC WA 98188 911649328 501(C)(3) 15000 EMERGENCY LOAN PROGRAM ONE TAIL AT A TIME 3303 W AINSLIE ST STE 3 CHICAGO IL 60625 262125306 501(C)(3) 10000 ELLIS VETERINARY CLINIC PATH WITH ART 312 2ND AVE S SEATTLE WA 98104 260599518 501(C)(3) 10000 EVOLVING CREATIVE CONNECTIONS PENNFUTURE 610 NORTH THIRD STREET HARRISBURG PA 17101 311607866 501(C)(3) 15000 DEMOCRACY FOR ALL PEOPLE FOR THE AMERICAN WAY 1101 15TH ST NW STE 600 WASHINGTON DC 20005 521366721 501(C)(3) 25000 GENERAL SUPPORT PODER IN ACTION 5877 W INDIAN SCHOOL RD PHOENIX AZ 85031 462284158 501(C)(3) 10000 PIA LEADERSHIP DEVELOPMENT PROGRAM PUBLIC DEFENDER ASSOCIATION 110 PREFONTAINE PL S502 SEATTLE WA 98104 910852323 501(C)(3) 100000 CO-LEAD PROGRAM REAL CHANGE HOMELESS EMPOWERMENT PROJECT 219 1ST AVE S STE 220 SEATTLE WA 98104 911817387 501(C)(3) 38120 $10,000 TO SUPPORT VENDORS WHO ARE IMPACTED BY CORONAVIRUS & $28,119.50 FOR GENERAL OPERATING SUPPORT REAL FOOD AMERICA 4922 OAKCREST DR FAIRFAX VA 22030 823635712 501(C)(3) 10000 GENERAL FUNDS RURAL ARIZONA ENGAGEMENT 345 E CENTRAL AVE STE 4 CASA GRANDE AZ 85128 833114207 501(C)(3) 10000 CIVIC ENGAGEMENT AND CAPACITY BUILDING SEATTLE CENTER FOUNDATION 305 HARRISON ST SEATTLE WA 98109 911003385 501(C)(3) 10000 GENERAL FUNDS SEATTLE-AFRICAN SISTER CITIES COMMITTEE 6535 SEWARD PARK AVE S SEATTLE WA 98118 943088256 501(C)(3) 10000 AMERICAN HISTORY TRAVELING MUSEUM: THE UNSPOKEN TRUTHS SPRUCE STREET SCHOOL 914 VIRGINIA ST SEATTLE WA 98101 910963223 501(C)(3) 10000 ANNUAL FUND 2019-2020 TEEN CANCER AMERICA 11835 WEST OLYMPIC BLVD NO 2 LOS ANGELES CA 90064 460825676 501(C)(3) 100000 GENERAL FUNDS THE APOLLO THEATER FOUNDATION 253 WEST 125TH STREET NEW YORK NY 10027 133630066 501(C)(3) 125000 DIGITAL LEARNING THE SAN ONOFRE FOUNDATION 3030 AVENIDA DEL PRESIDENTE SAN CLEMENTE CA 92672 260254696 501(C)(3) 7500 GENERAL FUNDS TOWN HALL ASSOCIATION 720 SENECA STEET STE A SEATTLE WA 98101 911910904 501(C)(3) 10000 THE CAMPAIGN FOR TOWN HALL TREEHOUSE 2100 24TH AVE S SUITE 200 SEATTLE WA 98144 911425676 501(C)(3) 7140 LEVELING THE PLAYING FIELD FOR YOUTH IN FOSTER CARE VIOLENCE POLICY CENTER 1025 CONNECTICUT AVE NW SUITE 1210 WASHINGTON DC 20036 521571442 501(C)(3) 10000 WORKING TO REDUCE GUN VIOLENCE IN THE US WAR CHILD USA INC 200 DELAWARE AVE STE 900 BUFFALO NY 14202 200994157 501(C)(3) 15000 WAR CHILD USA'S COVID RESPONSE WELD SEATTLE PO BOX 77570 SEATTLE WA 77570 813922645 501(C)(3) 15000 1426 PROJECT WILD LOVE PRESERVE 8202 NE STATE HWY 104 KINGSTON WA 98346 273729450 501(C)(3) 20000 GENERAL FUNDS YOUTHCARE 2500 NE 54TH STREET SEATTLE WA 98105 910917079 501(C)(3) 5262 GENERAL FUNDS 46 0 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 GRANTS MADE TO DATE BY YEAR THAT INCLUDES TRACKING ON UPDATES RECEIVED BY GRANTEES. FORM 990, PART VI, SECTION A, LINE 2 ALL MEMBERS OF THE BOARD HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE CPA FIRM, REVIEWED BY OUTSIDE CONSULTANTS KNOWLEDGEABLE ABOUT THE ORGANIZATION, AND PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS. 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. FORM 990, PART IX, LINE 11G PHILANTHROPIC CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 225,325. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 225,325. PARTNERSHIP CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,770. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,770. GENERAL OPERATING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,885. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,885. SELLER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 14,476. TOTAL EXPENSES 14,476. FORM 990, PART XI, LINE 9: ACCRUAL TO CASH ADJUSTMENT -3,431. 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 MONKEYWRENCH INC PO BOX 340020 NASHVILLE TN 372030020 331062443 MUSICAL RECORDINGS WA N/A S 0 PEARL JAM TOURING INC PO BOX 340020 NASHVILLE TN 372030020 911531093 MUSICAL ENTERTAINMENT NV N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0