Hospice of the Northwest Foundation Form 990 Public Disclosure Copy

Transcription

1 Hospie of the rthwest Foundtion 07 Form 990 Puli Dislosure Copy

2 ETENDED TO NOVEMBER, 08 OMB -007 Return of Orgniztion Exempt From Inome Tx Form 990 Under setion 0(), 7, or 97()() of the Internl Revenue Code (exept privte foundtions) 07 Deprtment of the Tresury Do not enter soil seurity numers on this form s it my e mde puli. Open to Puli Internl Revenue Servie Go to for instrutions nd the ltest informtion. Inspetion A For the 07 lendr yer, or tx yer eginning nd ending B Chek if C Nme of orgniztion D Employer identifition numer pplile: Address hnge Nme hnge SKAGIT HOSPICE FOUNDATION Doing usiness s HOSPICE OF THE NORTHWEST FOUNDAT Initil return Numer nd street (or P.O. ox if mil is not delivered to street ddress) Room/suite E Telephone numer Finl return/ 7 FREEWAY DR. A terminted City or town, stte or provine, ountry, nd ZIP or foreign postl ode G Gross reeipts,0,. Amended return MOUNT VERNON, WA 987 H() Is this group return Applition F Nme nd ddress of prinipl offier: WENDY ROHRBACHER for suordintes? ~~ pending SAME AS C ABOVE H() Are ll suordintes inluded? I Tx-exempt sttus: 0()() 0() ( ) (insert no.) 97()() or 7 If "," tth list. (see instrutions) J Wesite: H() Group exemption numer K Form of orgniztion: Corportion Trust Assoition Other L Yer of formtion: 000 M Stte of legl domiile: WA Prt I Summry Briefly desrie the orgniztion s mission or most signifint tivities: FUNDING DIGNITY AND COMPASSION EVERY MOMENT OF LIFE Ativities & Governne Revenue Expenses Net Assets or Fund Blnes Sign Here Chek this ox if the orgniztion disontinued its opertions or disposed of more thn % of its net ssets. Numer of voting memers of the governing ody (Prt VI, line ) Numer of independent voting memers of the governing ody (Prt VI, line ) ~~~~~~~~~~~~~~ Totl numer of individuls employed in lendr yer 07 (Prt V, line ) ~~~~~~~~~~~~~~~~ Net unrelted usiness txle inome from Form 990-T, line Professionl fundrising fees (Prt I, olumn (A), line e) ~~~~~~~~~~~~~~ Totl fundrising expenses (Prt I, olumn (D), line ) 79,97. true, orret, nd omplete. Delrtion of preprer (other thn offier) is sed on ll informtion of whih preprer hs ny knowledge. Signture of offier WENDY ROHRBACHER, EECUTIVE DIRECTOR Type or print nme nd title ~~~~~~~~~~~~~~~~~~~~ Totl numer of volunteers (estimte if neessry) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 Totl unrelted usiness revenue from Prt VIII, olumn (C), line ~~~~~~~~~~~~~~~~~~~~ Contriutions nd grnts (Prt VIII, line h) ~~~~~~~~~~~~~~~~~~~~~ Progrm servie revenue (Prt VIII, line g) ~~~~~~~~~~~~~~~~~~~~~ Investment inome (Prt VIII, olumn (A), lines,, nd 7d) ~~~~~~~~~~~~~ Other revenue (Prt VIII, olumn (A), lines, d, 8, 9, 0, nd e) ~~~~~~~~ Totl revenue - dd lines 8 through (must equl Prt VIII, olumn (A), line ) Grnts nd similr mounts pid (Prt I, olumn (A), lines -) Benefits pid to or for memers (Prt I, olumn (A), line ) ~~~~~~~~~~~ ~~~~~~~~~~~~~ Slries, other ompenstion, employee enefits (Prt I, olumn (A), lines -0) ~~~ = = 7 7 Prior Yer Current Yer,9., ,7.,8. 8,7.,.,70. 7,. 8,9. 0, Other expenses (Prt I, olumn (A), lines -d, f-e) ~~~~~~~~~~~~~ 0,.,. 8 Totl expenses. Add lines -7 (must equl Prt I, olumn (A), line ) ~~~~~~~ 88,90., Revenue less expenses. Sutrt line 8 from line -,97. 7,7. Beginning of Current Yer End of Yer 0 Totl ssets (Prt, line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~,88,90.,,7. Totl liilities (Prt, line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~,08.,9. Net ssets or fund lnes. Sutrt line from line 0,870,89.,9,8. Prt II Signture Blok Under penlties of perjury, I delre tht I hve exmined this return, inluding ompnying shedules nd sttements, nd to the est of my knowledge nd elief, it is Print/Type preprer s nme Preprer s signture Dte Chek PTIN if Pid BETHANY ANDREW-CPA self-employed P08 Preprer Firm s nme LARSON GROSS PLLC Firm s EIN 9-7 Use Only Firm s ddress RIMLAND DR., STE 9 9BELLINGHAM, WA 98 Phone no. (0) 7-80 My the IRS disuss this return with the preprer shown ove? (see instrutions) LHA For Pperwork Redution At tie, see the seprte instrutions. Form 990 (07) Dte

3 Form 990 (07) SKAGIT HOSPICE FOUNDATION Prt III Sttement of Progrm Servie Aomplishments Chek if Shedule O ontins response or note to ny line in this Prt III Briefly desrie the orgniztion s mission: TO FUND THE PROGRAM AND SERVICES OF HOSPICE OF THE NORTHWEST TO ENSURE DIGNIFIED AND COMPASSIONATE CARE IS AVAILABLE TO ANYONE COPING WITH A LIFE-LIMITING DIAGNOSIS. Pge Did the orgniztion undertke ny signifint progrm servies during the yer whih were not listed on the prior Form 990 or 990-EZ? If "," desrie these new servies on Shedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion ese onduting, or mke signifint hnges in how it onduts, ny progrm servies? ~~~~~~ If "," desrie these hnges on Shedule O. Desrie the orgniztion s progrm servie omplishments for eh of its three lrgest progrm servies, s mesured y expenses. Setion 0()() nd 0()() orgniztions re required to report the mount of grnts nd llotions to others, the totl expenses, nd revenue, if ny, for eh progrm servie reported. ( Code: ) ( Expenses,0. inluding grnts of 0,807. ) ( Revenue,7. ) ENGAGES IN ACTIVE DEVELOPMENT OF PROGRAMS AND RAISING OF FUNDS FOR HOSPICE SERVICES IN SKAGIT, ISLAND, SAN JUAN, AND NORTH SNOHOMISH COUNTIES, WA. THE FOUNDATION ALSO PROVIDES EDUCATION AND OUTREACH IN THE COMMUNITY ABOUT HOSPICE AND END OF LIFE ISSUES. ( Code: ) ( Expenses inluding grnts of ) ( Revenue ) ( Code: ) ( Expenses inluding grnts of ) ( Revenue ) d e Other progrm servies (Desrie in Shedule O.) ( Expenses inluding grnts of ) ( Revenue ) Totl progrm servie expenses ,0. Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

4 Form 990 (07) SKAGIT HOSPICE FOUNDATION Prt IV Cheklist of Required Shedules d e f Is the orgniztion desried in setion 0()() or 97()() (other thn privte foundtion)? If "," omplete Shedule A~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion required to omplete Shedule B, Shedule of Contriutors? ~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion engge in diret or indiret politil mpign tivities on ehlf of or in opposition to ndidtes for puli offie? If "," omplete Shedule C, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Did the orgniztion engge in loying tivities, or hve setion 0(h) eletion in effet during the tx yer? If "," omplete Shedule C, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion setion 0()(), 0()(), or 0()() orgniztion tht reeives memership dues, ssessments, or similr mounts s defined in Revenue Proedure 98-9? If "," omplete Shedule C, Prt III ~~~~~~~~~~~~~~ Did the orgniztion mintin ny donor dvised funds or ny similr funds or ounts for whih donors hve the right to provide dvie on the distriution or investment of mounts in suh funds or ounts? If "," omplete Shedule D, Prt I Did the orgniztion reeive or hold onservtion esement, inluding esements to preserve open spe, the environment, histori lnd res, or histori strutures? If "," omplete Shedule D, Prt II~~~~~~~~~~~~~~ Did the orgniztion mintin olletions of works of rt, historil tresures, or other similr ssets? If "," omplete Shedule D, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report n mount in Prt, line, for esrow or ustodil ount liility, serve s ustodin for mounts not listed in Prt ; or provide redit ounseling, det mngement, redit repir, or det negotition servies? If "," omplete Shedule D, Prt IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion, diretly or through relted orgniztion, hold ssets in temporrily restrited endowments, permnent endowments, or qusi-endowments? If "," omplete Shedule D, Prt V ~~~~~~~~~~~~~~~~~~~~~~~~ If the orgniztion s nswer to ny of the following questions is "," then omplete Shedule D, Prts VI, VII, VIII, I, or s pplile. Did the orgniztion report n mount for lnd, uildings, nd equipment in Prt, line 0? If "," omplete Shedule D, Prt VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report n mount for investments - other seurities in Prt, line tht is % or more of its totl ssets reported in Prt, line? If "," omplete Shedule D, Prt VII ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report n mount for investments - progrm relted in Prt, line tht is % or more of its totl ssets reported in Prt, line? If "," omplete Shedule D, Prt VIII ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report n mount for other ssets in Prt, line tht is % or more of its totl ssets reported in Prt, line? If "," omplete Shedule D, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report n mount for other liilities in Prt, line? If "," omplete Shedule D, Prt ~~~~~~ Did the orgniztion s seprte or onsolidted finnil sttements for the tx yer inlude footnote tht ddresses the orgniztion s liility for unertin tx positions under FIN 8 (ASC 70)? If "," omplete Shedule D, Prt ~~~~ Did the orgniztion otin seprte, independent udited finnil sttements for the tx yer? If "," omplete Shedule D, Prts I nd II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion inluded in onsolidted, independent udited finnil sttements for the tx yer? If "," nd if the orgniztion nswered "" to line, then ompleting Shedule D, Prts I nd II is optionl ~~~~~ Is the orgniztion shool desried in setion 70()()(A)(ii)? If "," omplete Shedule E ~~~~~~~~~~~~~~ Did the orgniztion mintin n offie, employees, or gents outside of the United Sttes? ~~~~~~~~~~~~~~~~ Did the orgniztion hve ggregte revenues or expenses of more thn 0,000 from grntmking, fundrising, usiness, investment, nd progrm servie tivities outside the United Sttes, or ggregte foreign investments vlued t 00,000 or more? If "," omplete Shedule F, Prts I nd IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report on Prt I, olumn (A), line, more thn,000 of grnts or other ssistne to or for ny foreign orgniztion? If "," omplete Shedule F, Prts II nd IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report on Prt I, olumn (A), line, more thn,000 of ggregte grnts or other ssistne to or for foreign individuls? If "," omplete Shedule F, Prts III nd IV ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report totl of more thn,000 of expenses for professionl fundrising servies on Prt I, olumn (A), lines nd e? If "," omplete Shedule G, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report more thn,000 totl of fundrising event gross inome nd ontriutions on Prt VIII, lines nd 8? If "," omplete Shedule G, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report more thn,000 of gross inome from gming tivities on Prt VIII, line 9? If "," omplete Shedule G, Prt III d e f 7 8 Pge 9 Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

5 Form 990 (07) SKAGIT HOSPICE FOUNDATION Prt IV Cheklist of Required Shedules (ontinued) d Setion 0()(), 0()(), nd 0()(9) orgniztions. Did the orgniztion engge in n exess enefit trnstion with disqulified person during the yer? If "," omplete Shedule L, Prt I ~~~~~~~~~~~~~~~~ Did the orgniztion operte one or more hospitl filities? If "," omplete Shedule H ~~~~~~~~~~~~~~~~ If "" to line 0, did the orgniztion tth opy of its udited finnil sttements to this return? ~~~~~~~~~~ Did the orgniztion report more thn,000 of grnts or other ssistne to ny domesti orgniztion or domesti government on Prt I, olumn (A), line? If "," omplete Shedule I, Prts I nd II ~~~~~~~~~~~~~~ Did the orgniztion report more thn,000 of grnts or other ssistne to or for domesti individuls on Prt I, olumn (A), line? If "," omplete Shedule I, Prts I nd III ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion nswer "" to Prt VII, Setion A, line,, or out ompenstion of the orgniztion s urrent nd former offiers, diretors, trustees, key employees, nd highest ompensted employees? If "," omplete Shedule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion hve tx-exempt ond issue with n outstnding prinipl mount of more thn 00,000 s of the lst dy of the yer, tht ws issued fter Deemer, 00? If "," nswer lines through d nd omplete Shedule K. If "", go to line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion invest ny proeeds of tx-exempt onds eyond temporry period exeption? ~~~~~~~~~~~ Did the orgniztion mintin n esrow ount other thn refunding esrow t ny time during the yer to defese ny tx-exempt onds? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion t s n "on ehlf of" issuer for onds outstnding t ny time during the yer? ~~~~~~~~~~~ Is the orgniztion wre tht it engged in n exess enefit trnstion with disqulified person in prior yer, nd tht the trnstion hs not een reported on ny of the orgniztion s prior Forms 990 or 990-EZ? If "," omplete Shedule L, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion report ny mount on Prt, line,, or for reeivles from or pyles to ny urrent or former offiers, diretors, trustees, key employees, highest ompensted employees, or disqulified persons? If "," omplete Shedule L, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion provide grnt or other ssistne to n offier, diretor, trustee, key employee, sustntil ontriutor or employee thereof, grnt seletion ommittee memer, or to % ontrolled entity or fmily memer of ny of these persons? If "," omplete Shedule L, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion prty to usiness trnstion with one of the following prties (see Shedule L, Prt IV instrutions for pplile filing thresholds, onditions, nd exeptions): A urrent or former offier, diretor, trustee, or key employee? If "," omplete Shedule L, Prt IV ~~~~~~~~~~~ A fmily memer of urrent or former offier, diretor, trustee, or key employee? If "," omplete Shedule L, Prt IV ~~ An entity of whih urrent or former offier, diretor, trustee, or key employee (or fmily memer thereof) ws n offier, diretor, trustee, or diret or indiret owner? If "," omplete Shedule L, Prt IV~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion reeive more thn,000 in non-sh ontriutions? If "," omplete Shedule M ~~~~~~~~~ Did the orgniztion reeive ontriutions of rt, historil tresures, or other similr ssets, or qulified onservtion ontriutions? If "," omplete Shedule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion liquidte, terminte, or dissolve nd ese opertions? If "," omplete Shedule N, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion sell, exhnge, dispose of, or trnsfer more thn % of its net ssets? If "," omplete Shedule N, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion own 00% of n entity disregrded s seprte from the orgniztion under Regultions setions nd ? If "," omplete Shedule R, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion relted to ny tx-exempt or txle entity? If "," omplete Shedule R, Prt II, III, or IV, nd Prt V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion hve ontrolled entity within the mening of setion ()()? ~~~~~~~~~~~~~~~~~~ If "" to line, did the orgniztion reeive ny pyment from or engge in ny trnstion with ontrolled entity within the mening of setion ()()? If "," omplete Shedule R, Prt V, line ~~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Did the orgniztion mke ny trnsfers to n exempt non-hritle relted orgniztion? If "," omplete Shedule R, Prt V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion ondut more thn % of its tivities through n entity tht is not relted orgniztion nd tht is treted s prtnership for federl inome tx purposes? If "," omplete Shedule R, Prt VI ~~~~~~~~ Did the orgniztion omplete Shedule O nd provide explntions in Shedule O for Prt VI, lines nd 9? te. All Form 990 filers re required to omplete Shedule O 0 0 d Pge 8 Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

6 Form 990 (07) SKAGIT HOSPICE FOUNDATION Pge Prt V Sttements Regrding Other IRS Filings nd Tx Compline Chek if Shedule O ontins response or note to ny line in this Prt V Enter the numer reported in Box of Form 09. Enter -0- if not pplile ~~~~~~~~~~~ Enter the numer of Forms W-G inluded in line. Enter -0- if not pplile ~~~~~~~~~~ Did the orgniztion omply with kup withholding rules for reportle pyments to vendors nd reportle gming If t lest one is reported on line, did the orgniztion file ll required federl employment tx returns? ~~~~~~~~~~ te. If the sum of lines nd is greter thn 0, you my e required to e-file (see instrutions) ~~~~~~~~~~~ 7 Orgniztions tht my reeive dedutile ontriutions under setion 70(). Did the orgniztion reeive pyment in exess of 7 mde prtly s ontriution nd prtly for goods nd servies provided to the pyor? d e f g h Sponsoring orgniztions mintining donor dvised funds. Did donor dvised fund mintined y the Sponsoring orgniztions mintining donor dvised funds. Setion 0()(7) orgniztions. Enter: Setion 0()() orgniztions. Enter: Setion 97()() non-exempt hritle trusts. Is the orgniztion filing Form 990 in lieu of Form 0? (gmling) winnings to prize winners? Enter the numer of employees reported on Form W-, Trnsmittl of Wge nd Tx Sttements, filed for the lendr yer ending with or within the yer overed y this return ~~~~~~~~~~ Did the orgniztion hve unrelted usiness gross inome of,000 or more during the yer? ~~~~~~~~~~~~~~ If "," hs it filed Form 990-T for this yer? If "," to line, provide n explntion in Shedule O ~~~~~~~~~~ At ny time during the lendr yer, did the orgniztion hve n interest in, or signture or other uthority over, finnil ount in foreign ountry (suh s nk ount, seurities ount, or other finnil ount)?~~~~~~~ If "," enter the nme of the foreign ountry: J See instrutions for filing requirements for FinCEN Form, Report of Foreign Bnk nd Finnil Aounts (FBAR). Ws the orgniztion prty to prohiited tx shelter trnstion t ny time during the tx yer? ~~~~~~~~~~~~ Did ny txle prty notify the orgniztion tht it ws or is prty to prohiited tx shelter trnstion? ~~~~~~~~~ If "," to line or, did the orgniztion file Form 888-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Does the orgniztion hve nnul gross reeipts tht re normlly greter thn 00,000, nd did the orgniztion soliit ny ontriutions tht were not tx dedutile s hritle ontriutions? If "," did the orgniztion inlude with every soliittion n express sttement tht suh ontriutions or gifts were not tx dedutile? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," did the orgniztion notify the donor of the vlue of the goods or servies provided? Setion 0()(9) qulified nonprofit helth insurne issuers. te. See the instrutions for dditionl informtion the orgniztion must report on Shedule O. Did the orgniztion reeive ny pyments for indoor tnning servies during the tx yer? ~~~~~~~~~~~~~~~~ If "," hs it filed Form 70 to report these pyments? If "," provide n explntion in Shedule O ~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion sell, exhnge, or otherwise dispose of tngile personl property for whih it ws required to file Form 88? ~~~~~~~~~~~~~~~ If "," indite the numer of Forms 88 filed during the yer ~~~~~~~~~~~~~~~~ Did the orgniztion reeive ny funds, diretly or indiretly, to py premiums on personl enefit ontrt? Did the orgniztion, during the yer, py premiums, diretly or indiretly, on personl enefit ontrt? 7d 0 0 ~~~~~~~ ~~~~~~~~~ If the orgniztion reeived ontriution of qulified intelletul property, did the orgniztion file Form 8899 s required? ~ If the orgniztion reeived ontriution of rs, ots, irplnes, or other vehiles, did the orgniztion file Form 098-C? sponsoring orgniztion hve exess usiness holdings t ny time during the yer? ~~~~~~~~~~~~~~~~~~~ Did the sponsoring orgniztion mke ny txle distriutions under setion 9? Did the sponsoring orgniztion mke distriution to donor, donor dvisor, or relted person? Initition fees nd pitl ontriutions inluded on Prt VIII, line ~~~~~~~~~~~~~~~ Gross reeipts, inluded on Form 990, Prt VIII, line, for puli use of lu filities ~~~~~~ Gross inome from memers or shreholders ~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross inome from other soures (Do not net mounts due or pid to other soures ginst mounts due or reeived from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," enter the mount of tx-exempt interest reeived or rued during the yer ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Is the orgniztion liensed to issue qulified helth plns in more thn one stte? ~~~~~~~~~~~~~~~~~~~~~ Enter the mount of reserves the orgniztion is required to mintin y the sttes in whih the orgniztion is liensed to issue qulified helth plns ~~~~~~~~~~~~~~~~~~~~~~ Enter the mount of reserves on hnd~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e 7f 7g 7h Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

7 Form 990 (07) SKAGIT HOSPICE FOUNDATION Pge Prt VI Governne, Mngement, nd Dislosure For eh "" response to lines through 7 elow, nd for "" response to line 8, 8, or 0 elow, desrie the irumstnes, proesses, or hnges in Shedule O. See instrutions. Chek if Shedule O ontins response or note to ny line in this Prt VI Setion A. Governing Body nd Mngement Enter the numer of voting memers of the governing ody t the end of the tx yer ~~~~~~ If there re mteril differenes in voting rights mong memers of the governing ody, or if the governing 8 9 Is there ny offier, diretor, trustee, or key employee listed in Prt VII, Setion A, who nnot e rehed t the orgniztion s miling ddress? If "," provide the nmes nd ddresses in Shedule O Setion B. Poliies (This Setion B requests informtion out poliies not required y the Internl Revenue Code.) exempt sttus with respet to suh rrngements? Setion C. Dislosure 7 List the sttes with whih opy of this Form 990 is required to e filed JWA 8 9 ody delegted rod uthority to n exeutive ommittee or similr ommittee, explin in Shedule O. Enter the numer of voting memers inluded in line, ove, who re independent ~~~~~~ Did ny offier, diretor, trustee, or key employee hve fmily reltionship or usiness reltionship with ny other offier, diretor, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion delegte ontrol over mngement duties ustomrily performed y or under the diret supervision of offiers, diretors, or trustees, or key employees to mngement ompny or other person? ~~~~~~~~~~~~~~ Did the orgniztion mke ny signifint hnges to its governing douments sine the prior Form 990 ws filed? ~~~~~ Did the orgniztion eome wre during the yer of signifint diversion of the orgniztion s ssets? ~~~~~~~~~ Did the orgniztion hve memers or stokholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 Did the orgniztion hve memers, stokholders, or other persons who hd the power to elet or ppoint one or more memers of the governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Are ny governne deisions of the orgniztion reserved to (or sujet to pprovl y) memers, stokholders, or persons other thn the governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion ontemporneously doument the meetings held or written tions undertken during the yer y the following: The governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Eh ommittee with uthority to t on ehlf of the governing ody? Desrie in Shedule O the proess, if ny, used y the orgniztion to review this Form 990. Did the orgniztion hve written onflit of interest poliy? If "," go to line ~~~~~~~~~~~~~~~~~~~~ Were offiers, diretors, or trustees, nd key employees required to dislose nnully interests tht ould give rise to onflits? ~~~~~~ Did the orgniztion regulrly nd onsistently monitor nd enfore ompline with the poliy? If "," desrie in Shedule O how this ws done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ for puli inspetion. Indite how you mde these ville. Chek ll tht pply. Own wesite Another s wesite Upon request Other (explin in Shedule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Did the orgniztion hve lol hpters, rnhes, or ffilites? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," did the orgniztion hve written poliies nd proedures governing the tivities of suh hpters, ffilites, nd rnhes to ensure their opertions re onsistent with the orgniztion s exempt purposes? ~~~~~~~~~~~~~ Hs the orgniztion provided omplete opy of this Form 990 to ll memers of its governing ody efore filing the form? Did the orgniztion hve written whistlelower poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion hve written doument retention nd destrution poliy? ~~~~~~~~~~~~~~~~~~~~~~ Did the proess for determining ompenstion of the following persons inlude review nd pprovl y independent persons, omprility dt, nd ontemporneous sustntition of the deliertion nd deision? The orgniztion s CEO, Exeutive Diretor, or top mngement offiil Other offiers or key employees of the orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "" to line or, desrie the proess in Shedule O (see instrutions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the orgniztion invest in, ontriute ssets to, or prtiipte in joint venture or similr rrngement with txle entity during the yer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," did the orgniztion follow written poliy or proedure requiring the orgniztion to evlute its prtiiption in joint venture rrngements under pplile federl tx lw, nd tke steps to sfegurd the orgniztion s Setion 0 requires n orgniztion to mke its Forms 0 (or 0 if pplile), 990, nd 990-T (Setion 0()()s only) ville Desrie in Shedule O whether (nd if so, how) the orgniztion mde its governing douments, onflit of interest poliy, nd finnil sttements ville to the puli during the tx yer. 0 Stte the nme, ddress, nd telephone numer of the person who possesses the orgniztion s ooks nd reords: WENDY ROHRBACHER, EECUTIVE DIRECTOR FREEWAY DR., NO. A, MOUNT VERNON, WA Form 990 (07) SKAGIT HOSPICE FOUNDATION

8 Form 990 (07) SKAGIT HOSPICE FOUNDATION Pge 7 Prt VII Compenstion of Offiers, Diretors, Trustees, Key Employees, Highest Compensted Employees, nd Independent Contrtors Chek if Shedule O ontins response or note to ny line in this Prt VII Setion A. Offiers, Diretors, Trustees, Key Employees, nd Highest Compensted Employees Complete this tle for ll persons required to e listed. Report ompenstion for the lendr yer ending with or within the orgniztion s tx yer. List ll of the orgniztion s urrent offiers, diretors, trustees (whether individuls or orgniztions), regrdless of mount of ompenstion. Enter -0- in olumns (D), (E), nd (F) if no ompenstion ws pid. List ll of the orgniztion s urrent key employees, if ny. See instrutions for definition of "key employee." List the orgniztion s five urrent highest ompensted employees (other thn n offier, diretor, trustee, or key employee) who reeived reportle ompenstion (Box of Form W- nd/or Box 7 of Form 099-MISC) of more thn 00,000 from the orgniztion nd ny relted orgniztions. List ll of the orgniztion s former offiers, key employees, nd highest ompensted employees who reeived more thn 00,000 of reportle ompenstion from the orgniztion nd ny relted orgniztions. List ll of the orgniztion s former diretors or trustees tht reeived, in the pity s former diretor or trustee of the orgniztion, more thn 0,000 of reportle ompenstion from the orgniztion nd ny relted orgniztions. List persons in the following order: individul trustees or diretors; institutionl trustees; offiers; key employees; highest ompensted employees; nd former suh persons. Chek this ox if neither the orgniztion nor ny relted orgniztion ompensted ny urrent offier, diretor, or trustee. (A) (B) (C) (D) (E) (F) Nme nd Title Averge hours per week (list ny hours for relted orgniztions elow line) Position (do not hek more thn one ox, unless person is oth n offier nd diretor/trustee) Individul trustee or diretor Institutionl trustee Offier Key employee Highest ompensted employee Former Reportle ompenstion from the orgniztion (W-/099-MISC) Reportle ompenstion from relted orgniztions (W-/099-MISC) Estimted mount of other ompenstion from the orgniztion nd relted orgniztions () SEAN BARTLETT.00 TREASURER () TED BROCKMAN.00 TRUSTEE () DIANNE GODDARD.00 TRUSTEE () KATHLEEN PETRZELKA.00 SECRETARY () DANNY PICKERING.00 VICE PRESIDENT () PATRICIA SLATER.00 PRESIDENT (7) KATHERINE REINECKE.00 TRUSTEE (8) GINA DAVIS-GILLESPIE.00 TRUSTEE (9) LORI HALVERSON.00 TRUSTEE (0) DOUG NOBLET.00 TRUSTEE () HUGH PIERCE.00 TRUSTEE () MARY RYAN.00 TRUSTEE () WENDY ROHRBACHER 0.00 EECUTIVE DIRECTOR 0.,90. 8, Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

9 Form 990 (07) SKAGIT HOSPICE FOUNDATION Pge 8 Prt VII Setion A. Offiers, Diretors, Trustees, Key Employees, nd Highest Compensted Employees (ontinued) (A) (B) (C) (D) (E) (F) Nme nd title Averge Position (do not hek more thn one Reportle Reportle Estimted hours per ox, unless person is oth n ompenstion ompenstion mount of week offier nd diretor/trustee) from from relted other (list ny the orgniztions ompenstion hours for orgniztion (W-/099-MISC) from the relted (W-/099-MISC) orgniztion orgniztions nd relted elow orgniztions line) Individul trustee or diretor Institutionl trustee Offier Key employee Highest ompensted employee Former d Su-totl~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl from ontinution sheets to Prt VII, Setion A ~~~~~~~~~~ Totl (dd lines nd ) Did the orgniztion list ny former offier, diretor, or trustee, key employee, or highest ompensted employee on line? If "," omplete Shedule J for suh individul ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did ny person listed on line reeive or rue ompenstion from ny unrelted orgniztion or individul for servies rendered to the orgniztion? If "," omplete Shedule J for suh person Setion B. Independent Contrtors Totl numer of individuls (inluding ut not limited to those listed ove) who reeived more thn 00,000 of reportle ompenstion from the orgniztion For ny individul listed on line, is the sum of reportle ompenstion nd other ompenstion from the orgniztion nd relted orgniztions greter thn 0,000? If "," omplete Shedule J for suh individul~~~~~~~~~~~~~ Complete this tle for your five highest ompensted independent ontrtors tht reeived more thn 00,000 of ompenstion from the orgniztion. Report ompenstion for the lendr yer ending with or within the orgniztion s tx yer. 0.,90. 8, ,90. 8,7. (A) (B) (C) Nme nd usiness ddress NONE Desription of servies Compenstion 0 Totl numer of independent ontrtors (inluding ut not limited to those listed ove) who reeived more thn 00,000 of ompenstion from the orgniztion 0 Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

10 Form 990 (07) SKAGIT HOSPICE FOUNDATION Prt VIII Sttement of Revenue Contriutions, Gifts, Grnts nd Other Similr Amounts Progrm Servie Revenue Other Revenue d e f g nsh ontriutions inluded in lines -f: h d e f g d d 9 0 d e f Totl. Add lines -f Business Code Totl. Add lines -f Misellneous Revenue Business Code MISCELLANENOUS Government grnts (ontriutions) All other ontriutions, gifts, grnts, nd similr mounts not inluded ove ~~ Pge 9 Chek if Shedule O ontins response or note to ny line in this Prt VIII (A) (B) (C) (D) Totl revenue Relted or Unrelted Revenue exluded exempt funtion usiness from tx under setions revenue revenue - Federted mpigns Memership dues ~~~~~~ ~~~~~~~~ Fundrising events ~~~~~~~~ Relted orgniztions ~~~~~~ All other progrm servie revenue ~~~~~ Investment inome (inluding dividends, interest, nd other similr mounts) ~~~~~~~~~~~~~~~~~ Inome from investment of tx-exempt ond proeeds Roylties Gross rents ~~~~~~~ Less: rentl expenses~~~ Rentl inome or (loss) ~~ Net rentl inome or (loss) 7 Gross mount from sles of ssets other thn inventory Less: ost or other sis nd sles expenses ~~~ Gin or (loss) ~~~~~~~ (i) Rel (ii) Personl (i) Seurities 7,08. (ii) Other Net gin or (loss) 8 Gross inome from fundrising events (not inluding 0,8. of ontriutions reported on line ). See Prt IV, line 8 ~~~~~~~~~~~~~ Less: diret expenses~~~~~~~~~~ Net inome or (loss) from fundrising events Gross inome from gming tivities. See Prt IV, line 9 ~~~~~~~~~~~~~ Less: diret expenses ~~~~~~~~~ Net inome or (loss) from gming tivities Gross sles of inventory, less returns nd llownes ~~~~~~~~~~~~~ Less: ost of goods sold 8,.,7. ~~~~~~~~ 0,8. 9,9.,0.,9. 9,89. Net inome or (loss) from sles of inventory,7. 0,. 0,.,7.,7.,00.,00. d All other revenue ~~~~~~~~~~~~~ e Totl. Add lines -d ~~~~~~~~~~~~~~~ 7. Totl revenue. See instrutions. 7,.,7. 0., Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

11 Form 990 (07) SKAGIT HOSPICE FOUNDATION Prt I Sttement of Funtionl Expenses Setion 0()() nd 0()() orgniztions must omplete ll olumns. All other orgniztions must omplete olumn (A). Chek if Shedule O ontins response or note to ny line in this Prt I Do not inlude mounts reported on lines, (A) (B) (C) (D) 7, 8, 9, nd 0 of Prt VIII. Totl expenses Progrm servie Mngement nd Fundrising expenses generl expenses expenses Grnts nd other ssistne to domesti orgniztions nd domesti governments. See Prt IV, line ~ 0,807. 0, d e f g d Grnts nd other ssistne to domesti individuls. See Prt IV, line ~~~~~~~ Grnts nd other ssistne to foreign orgniztions, foreign governments, nd foreign individuls. See Prt IV, lines nd ~~~ Benefits pid to or for memers ~~~~~~~ Compenstion of urrent offiers, diretors, trustees, nd key employees ~~~~~~~~ Compenstion not inluded ove, to disqulified persons (s defined under setion 98(f)()) nd persons desried in setion 98()()(B) ~~~ Other slries nd wges ~~~~~~~~~~ Pension pln ruls nd ontriutions (inlude setion 0(k) nd 0() employer ontriutions) Other employee enefits ~~~~~~~~~~ Pyroll txes ~~~~~~~~~~~~~~~~ Fees for servies (non-employees): Mngement ~~~~~~~~~~~~~~~~ Legl ~~~~~~~~~~~~~~~~~~~~ Aounting ~~~~~~~~~~~~~~~~~ Loying ~~~~~~~~~~~~~~~~~~ Professionl fundrising servies. See Prt IV, line 7 Investment mngement fees ~~~~~~~~ Other. (If line g mount exeeds 0% of line, olumn (A) mount, list line g expenses on Sh O.) Advertising nd promotion ~~~~~~~~~ Offie expenses~~~~~~~~~~~~~~~ Informtion tehnology ~~~~~~~~~~~ Roylties ~~~~~~~~~~~~~~~~~~ Oupny ~~~~~~~~~~~~~~~~~ Trvel ~~~~~~~~~~~~~~~~~~~ Pyments of trvel or entertinment expenses for ny federl, stte, or lol puli offiils Conferenes, onventions, nd meetings ~~ Interest ~~~~~~~~~~~~~~~~~~ Pyments to ffilites ~~~~~~~~~~~~ Depreition, depletion, nd mortiztion ~~ Insurne ~~~~~~~~~~~~~~~~~ Other expenses. Itemize expenses not overed ove. (List misellneous expenses in line e. If line e mount exeeds 0% of line, olumn (A) mount, list line e expenses on Shedule O.) e All other expenses Totl funtionl expenses. Add lines through e Joint osts. Complete this line only if the orgniztion reported in olumn (B) joint osts from omined edutionl mpign nd fundrising soliittion. Chek here if following SOP 98- (ASC 98-70),.,.,70.,70. Pge 0,.,0. 7, ,908.,908. IN KIND GIFTS,0.,0. DIRECT MAILING COSTS 9,8. 9,8. NEWSLETTERS 9,. 8,7. 9. SUPPLIES,79.,79. 8,0.,7.,.,070.,0.,0. 79, Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

12 Form 990 (07) SKAGIT HOSPICE FOUNDATION Pge Prt Blne Sheet Net Assets or Fund Blnes Liilities Assets Chek if Shedule O ontins response or note to ny line in this Prt (A) (B) Beginning of yer End of yer Csh - non-interest-ering ~~~~~~~~~~~~~~~~~~~~~~~~~,99.,. Svings nd temporry sh investments ~~~~~~~~~~~~~~~~~~ Pledges nd grnts reeivle, net ~~~~~~~~~~~~~~~~~~~~~,07.,0. Aounts reeivle, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Lons nd other reeivles from urrent nd former offiers, diretors, trustees, key employees, nd highest ompensted employees. Complete Prt II of Shedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lons nd other reeivles from other disqulified persons (s defined under setion 98(f)()), persons desried in setion 98()()(B), nd ontriuting employers nd sponsoring orgniztions of setion 0()(9) voluntry 7 employees enefiiry orgniztions (see instr). Complete Prt II of Sh L ~~ tes nd lons reeivle, net ~~~~~~~~~~~~~~~~~~~~~~~ 7 8 Inventories for sle or use ~~~~~~~~~~~~~~~~~~~~~~~~~~ 8 9 Prepid expenses nd deferred hrges ~~~~~~~~~~~~~~~~~~ 87. 9,7. 0 Lnd, uildings, nd equipment: ost or other sis. Complete Prt VI of Shedule D ~~~ 0,. Less: umulted depreition ~~~~~~ 0,98.,. 0. Investments - pulily trded seurities ~~~~~~~~~~~~~~~~~~~,7,7.,0,0. Investments - other seurities. See Prt IV, line ~~~~~~~~~~~~~~ Investments - progrm-relted. See Prt IV, line ~~~~~~~~~~~~~ Intngile ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other ssets. See Prt IV, line ~~~~~~~~~~~~~~~~~~~~~~ Totl ssets. Add lines through (must equl line ),88,90.,,7. 7 Aounts pyle nd rued expenses ~~~~~~~~~~~~~~~~~~,08. 7, Grnts pyle ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tx-exempt ond liilities ~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Esrow or ustodil ount liility. Complete Prt IV of Shedule D ~~~~ Lons nd other pyles to urrent nd former offiers, diretors, trustees, key employees, highest ompensted employees, nd disqulified persons. Complete Prt II of Shedule L ~~~~~~~~~~~~~~~~~~~~~~~ Seured mortgges nd notes pyle to unrelted third prties ~~~~~~ Unseured notes nd lons pyle to unrelted third prties ~~~~~~~~ Other liilities (inluding federl inome tx, pyles to relted third prties, nd other liilities not inluded on lines 7-). Complete Prt of Shedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl liilities. Add lines 7 through,08. Orgniztions tht follow SFAS 7 (ASC 98), hek here nd,9. omplete lines 7 through 9, nd lines nd. 7 Unrestrited net ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~,89,97. 7,0,. 8 Temporrily restrited net ssets ~~~~~~~~~~~~~~~~~~~~~~ 0, ,0. 9 Permnently restrited net ssets ~~~~~~~~~~~~~~~~~~~~~ 9 Orgniztions tht do not follow SFAS 7 (ASC 98), hek here nd omplete lines 0 through. 0 Cpitl stok or trust prinipl, or urrent funds ~~~~~~~~~~~~~~~ Pid-in or pitl surplus, or lnd, uilding, or equipment fund ~~~~~~~~ 0 Retined ernings, endowment, umulted inome, or other funds ~~~~ Totl net ssets or fund lnes ~~~~~~~~~~~~~~~~~~~~~~,870,89.,9,8. Totl liilities nd net ssets/fund lnes,88,90.,,7. Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

13 Form 990 (07) SKAGIT HOSPICE FOUNDATION Pge Prt I Reonilition of Net Assets Chek if Shedule O ontins response or note to ny line in this Prt I Totl revenue (must equl Prt VIII, olumn (A), line ) Totl expenses (must equl Prt I, olumn (A), line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Revenue less expenses. Sutrt line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fund lnes t eginning of yer (must equl Prt, line, olumn (A)) ~~~~~~~~~~ Net unrelized gins (losses) on investments Donted servies nd use of filities Investment expenses Prior period djustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other hnges in net ssets or fund lnes (explin in Shedule O) ~~~~~~~~~~~~~~~~~~~ 0 Net ssets or fund lnes t end of yer. Comine lines through 9 (must equl Prt, line, olumn (B)) 0,9,8. Prt II Finnil Sttements nd Reporting Chek if Shedule O ontins response or note to ny line in this Prt II Aounting method used to prepre the Form 990: Csh Arul Other If the orgniztion hnged its method of ounting from prior yer or heked "Other," explin in Shedule O. Were the orgniztion s finnil sttements ompiled or reviewed y n independent ountnt? ~~~~~~~~~~~~ If "," hek ox elow to indite whether the finnil sttements for the yer were ompiled or reviewed on seprte sis, onsolidted sis, or oth: Seprte sis Consolidted sis Both onsolidted nd seprte sis Were the orgniztion s finnil sttements udited y n independent ountnt? ~~~~~~~~~~~~~~~~~~~ If "," hek ox elow to indite whether the finnil sttements for the yer were udited on seprte sis, onsolidted sis, or oth: Seprte sis Consolidted sis Both onsolidted nd seprte sis If "" to line or, does the orgniztion hve ommittee tht ssumes responsiility for oversight of the udit, review, or ompiltion of its finnil sttements nd seletion of n independent ountnt?~~~~~~~~~~~~~~~ If the orgniztion hnged either its oversight proess or seletion proess during the tx yer, explin in Shedule O. As result of federl wrd, ws the orgniztion required to undergo n udit or udits s set forth in the Single Audit At nd OMB Cirulr A-? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," did the orgniztion undergo the required udit or udits? If the orgniztion did not undergo the required udit or udits, explin why in Shedule O nd desrie ny steps tken to undergo suh udits ,.,070. 7,7.,870,89. 7,8. 0. Form 990 (07) SKAGIT HOSPICE FOUNDATION 07

14 SCHEDULE A (Form 990 or 990-EZ) Deprtment of the Tresury Internl Revenue Servie Complete if the orgniztion is setion 0()() orgniztion or setion 97()() nonexempt hritle trust. Atth to Form 990 or Form 990-EZ. Go to for instrutions nd the ltest informtion. OMB -007 Open to Puli Inspetion Nme of the orgniztion Employer identifition numer SKAGIT HOSPICE FOUNDATION Prt I Reson for Puli Chrity Sttus (All orgniztions must omplete this prt.) See instrutions. The orgniztion is not privte foundtion euse it is: (For lines through, hek only one ox.) d e f A hurh, onvention of hurhes, or ssoition of hurhes desried in setion 70()()(A)(i). A shool desried in setion 70()()(A)(ii). (Atth Shedule E (Form 990 or 990-EZ).) A hospitl or oopertive hospitl servie orgniztion desried in setion 70()()(A)(iii). A medil reserh orgniztion operted in onjuntion with hospitl desried in setion 70()()(A)(iii). Enter the hospitl s nme, ity, nd stte: An orgniztion operted for the enefit of ollege or university owned or operted y governmentl unit desried in setion 70()()(A)(iv). (Complete Prt II.) A federl, stte, or lol government or governmentl unit desried in setion 70()()(A)(v). An orgniztion tht normlly reeives sustntil prt of its support from governmentl unit or from the generl puli desried in setion 70()()(A)(vi). (Complete Prt II.) A ommunity trust desried in setion 70()()(A)(vi). (Complete Prt II.) An griulturl reserh orgniztion desried in setion 70()()(A)(ix) operted in onjuntion with lnd-grnt ollege or university or non-lnd-grnt ollege of griulture (see instrutions). Enter the nme, ity, nd stte of the ollege or university: An orgniztion tht normlly reeives: () more thn /% of its support from ontriutions, memership fees, nd gross reeipts from tivities relted to its exempt funtions - sujet to ertin exeptions, nd () no more thn /% of its support from gross investment inome nd unrelted usiness txle inome (less setion tx) from usinesses quired y the orgniztion fter June 0, 97. See setion 09()(). (Complete Prt III.) Puli Chrity Sttus nd Puli Support An orgniztion orgnized nd operted exlusively to test for puli sfety. See setion 09()(). An orgniztion orgnized nd operted exlusively for the enefit of, to perform the funtions of, or to rry out the purposes of one or more pulily supported orgniztions desried in setion 09()() or setion 09()(). See setion 09()(). Chek the ox in lines through d tht desries the type of supporting orgniztion nd omplete lines e, f, nd g. Type I. A supporting orgniztion operted, supervised, or ontrolled y its supported orgniztion(s), typilly y giving the supported orgniztion(s) the power to regulrly ppoint or elet mjority of the diretors or trustees of the supporting orgniztion. You must omplete Prt IV, Setions A nd B. Type II. A supporting orgniztion supervised or ontrolled in onnetion with its supported orgniztion(s), y hving ontrol or mngement of the supporting orgniztion vested in the sme persons tht ontrol or mnge the supported orgniztion(s). You must omplete Prt IV, Setions A nd C. Type III funtionlly integrted. A supporting orgniztion operted in onnetion with, nd funtionlly integrted with, its supported orgniztion(s) (see instrutions). You must omplete Prt IV, Setions A, D, nd E. Type III non-funtionlly integrted. A supporting orgniztion operted in onnetion with its supported orgniztion(s) tht is not funtionlly integrted. The orgniztion generlly must stisfy distriution requirement nd n ttentiveness requirement (see instrutions). You must omplete Prt IV, Setions A nd D, nd Prt V. Chek this ox if the orgniztion reeived written determintion from the IRS tht it is Type I, Type II, Type III funtionlly integrted, or Type III non-funtionlly integrted supporting orgniztion. Enter the numer of supported orgniztions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 07 g Provide the following informtion out the supported orgniztion(s). (i) Nme of supported (ii) EIN (iii) Type of orgniztion (iv) Is the orgniztion listed (v) Amount of monetry (vi) Amount of other in your governing doument? orgniztion (desried on lines -0 support (see instrutions) support (see instrutions) ove (see instrutions)) SKAGIT HOSPICE SERVICES, LLC ,807. Totl 0, LHA For Pperwork Redution At tie, see the Instrutions for Form 990 or 990-EZ Shedule A (Form 990 or 990-EZ) SKAGIT HOSPICE FOUNDATION 07

15 Shedule A (Form 990 or 990-EZ) 07 SKAGIT HOSPICE FOUNDATION Pge Prt II Support Shedule for Orgniztions Desried in Setions 70()()(A)(iv) nd 70()()(A)(vi) (Complete only if you heked the ox on line, 7, or 8 of Prt I or if the orgniztion filed to qulify under Prt III. If the orgniztion fils to qulify under the tests listed elow, plese omplete Prt III.) Setion A. Puli Support Clendr yer (or fisl yer eginning in) Totl. Add lines through ~~~ Puli support. Sutrt line from line. Clendr yer (or fisl yer eginning in) ssets (Explin in Prt VI.) ~~~~ Totl support. Add lines 7 through 0 () 0 () 0 () 0 0 (e) 07 (f) Totl () 0 () 0 () 0 0 (e) 07 (f) Totl First five yers. If the Form 990 is for the orgniztion s first, seond, third, fourth, or fifth tx yer s setion 0()() orgniztion, hek this ox nd stop here Setion C. Computtion of Puli Support Perentge /% support test If the orgniztion did not hek the ox on line, nd line is /% or more, hek this ox nd 7 0% -fts-nd-irumstnes test If the orgniztion did not hek ox on line,, or, nd line is 0% or more, 8 Gifts, grnts, ontriutions, nd memership fees reeived. (Do not inlude ny "unusul grnts.") ~~ Tx revenues levied for the orgniztion s enefit nd either pid to or expended on its ehlf ~~~~ The vlue of servies or filities furnished y governmentl unit to the orgniztion without hrge ~ The portion of totl ontriutions y eh person (other thn governmentl unit or pulily supported orgniztion) inluded on line tht exeeds % of the mount shown on line, olumn (f) ~~~~~~~~~~~~ Setion B. Totl Support Amounts from line ~~~~~~~ Gross inome from interest, dividends, pyments reeived on seurities lons, rents, roylties, nd inome from similr soures ~ Net inome from unrelted usiness tivities, whether or not the usiness is regulrly rried on ~ Other inome. Do not inlude gin or loss from the sle of pitl Gross reeipts from relted tivities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ Puli support perentge for 07 (line, olumn (f) divided y line, olumn (f)) ~~~~~~~~~~~~ Puli support perentge from 0 Shedule A, Prt II, line ~~~~~~~~~~~~~~~~~~~~~ stop here. The orgniztion qulifies s pulily supported orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ /% support test - 0. If the orgniztion did not hek ox on line or, nd line is /% or more, hek this ox nd stop here. The orgniztion qulifies s pulily supported orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ nd if the orgniztion meets the "fts-nd-irumstnes" test, hek this ox nd stop here. Explin in Prt VI how the orgniztion meets the "fts-nd-irumstnes" test. The orgniztion qulifies s pulily supported orgniztion ~~~~~~~~~~~~~~~ 0% -fts-nd-irumstnes test - 0. If the orgniztion did not hek ox on line,,, or 7, nd line is 0% or more, nd if the orgniztion meets the "fts-nd-irumstnes" test, hek this ox nd stop here. Explin in Prt VI how the orgniztion meets the "fts-nd-irumstnes" test. The orgniztion qulifies s pulily supported orgniztion ~~~~~~~~ Privte foundtion. If the orgniztion did not hek ox on line,,, 7, or 7, hek this ox nd see instrutions Shedule A (Form 990 or 990-EZ) 07 % % SKAGIT HOSPICE FOUNDATION 07

16 Shedule A (Form 990 or 990-EZ) 07 SKAGIT HOSPICE FOUNDATION Prt III Support Shedule for Orgniztions Desried in Setion 09()() Clendr yer (or fisl yer eginning in) The vlue of servies or filities furnished y governmentl unit to the orgniztion without hrge ~ Totl. Add lines through ~~~ 7 Amounts inluded on lines,, nd reeived from disqulified persons Amounts inluded on lines nd reeived from other thn disqulified persons tht exeed the greter of,000 or % of the mount on line for the yer ~~~~~~ Add lines 7 nd 7 ~~~~~~~ 8 Puli support. (Sutrt line 7 from line.) Clendr yer (or fisl yer eginning in) 9 Amounts from line ~~~~~~~ 0 Gross inome from interest, dividends, pyments reeived on seurities lons, rents, roylties, nd inome from similr soures ~ Unrelted usiness txle inome (less setion txes) from usinesses quired fter June 0, 97 ~~~~ () 0 () 0 () 0 0 (e) 07 (f) Totl () 0 () 0 () 0 0 (e) 07 (f) Totl First five yers. If the Form 990 is for the orgniztion s first, seond, third, fourth, or fifth tx yer s setion 0()() orgniztion, hek this ox nd stop here Setion C. Computtion of Puli Support Perentge Puli support perentge from 0 Shedule A, Prt III, line Setion D. Computtion of Investment Inome Perentge 7 8 Pge Puli support perentge for 07 (line 8, olumn (f) divided y line, olumn (f)) ~~~~~~~~~~~~ % 9 /% support tests If the orgniztion did not hek the ox on line, nd line is more thn /%, nd line 7 is not 0 (Complete only if you heked the ox on line 0 of Prt I or if the orgniztion filed to qulify under Prt II. If the orgniztion fils to qulify under the tests listed elow, plese omplete Prt II.) Setion A. Puli Support Gifts, grnts, ontriutions, nd memership fees reeived. (Do not inlude ny "unusul grnts.") ~~ Gross reeipts from dmissions, merhndise sold or servies performed, or filities furnished in ny tivity tht is relted to the orgniztion s tx-exempt purpose Gross reeipts from tivities tht re not n unrelted trde or usiness under setion ~~~~~ Tx revenues levied for the orgniztion s enefit nd either pid to or expended on its ehlf ~~~~ Setion B. Totl Support Add lines 0 nd 0 ~~~~~~ Net inome from unrelted usiness tivities not inluded in line 0, whether or not the usiness is regulrly rried on ~~~~~~~ Other inome. Do not inlude gin or loss from the sle of pitl ssets (Explin in Prt VI.) ~~~~ Totl support. (Add lines 9, 0,, nd.) Investment inome perentge for 07 (line 0, olumn (f) divided y line, olumn (f)) Investment inome perentge from 0 Shedule A, Prt III, line 7 ~~~~~~~~~~~~~~~~~~ ~~~~~~~~ 7 % more thn /%, hek this ox nd stop here. The orgniztion qulifies s pulily supported orgniztion ~~~~~~~~~~ /% support tests - 0. If the orgniztion did not hek ox on line or line 9, nd line is more thn /%, nd line 8 is not more thn /%, hek this ox nd stop here. The orgniztion qulifies s pulily supported orgniztion ~~~~ Privte foundtion. If the orgniztion did not hek ox on line, 9, or 9, hek this ox nd see instrutions Shedule A (Form 990 or 990-EZ) SKAGIT HOSPICE FOUNDATION 07 8 % %