Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
VITALOGY FOUNDATION
 
Employer identification number
20-1030462
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) CCFA
9 LAKE BELLEVUE DR STE 203
BELLEVUE,WA98005 		13-6193105 501(C)(3) 16,450       SUPPORTS CCFA'S MISSION TO CURE CROHN'S DISEASE AND ULCERATIVE COLITIS AND TO INCREASE QUALITY OF LIFE OF THOSE AFFECTED
(2) CCFA
9 LAKE BELLEVUE DR STE 203
BELLEVUE,WA98005 		13-6193105 501(C)(3) 25,000       SUPPORTS CCFA'S CAMP OASIS SCHOLARSHIP FUND
(3) DESC
515 THIRD AVE
SEATTLE,WA98104 		91-1275815 501(C)(3) 25,546       DONATION TO THE GENERAL FUND
(4) DOCTORS WITHOUT BORDERS
333 7TH AVE 2ND FLR
NEW YORK,NY10001 		13-3433452 501(C)(3) 10,000       DONATION TO THE GENERAL FUND
(5) EB RESEARCH PARTNERSHIP
1725 YORK AVE STE 29G
NEW YORK,NY10128 		27-2417202 501(C)(3) 19,400       TO FUND RESEARCH AIMED AT TREATING AND ULTIMATELY CURING EB
(6) FRED HUTCHINSON RESEARCH CENTER
PO BOX 19024 MAIL STOP J5200
SEATTLE,WA98109 		23-7156071 501(C)(3) 35,546       TO SUPPORT BRAIN CANCER RESEARCH
(7) GLOBAL POVERTY PROJECT INC
594 BROADWAY SUITE 207
NEW YORK,NY10012 		42-1772557 501(C)(3) 8,500       DONATION TO THE GENERAL FUND
(8) HEDGEBROOK
216 1ST AVE S STE 251
SEATTLE,WA98104 		80-0012629 501(C)(3) 6,000       TO SUPPORT SONGWRITERS RESIDENCY PROGRAM
(9) HOLLAND PROJECT
140 VESTA STREET
RENO,NV89502 		71-1017805 501(C)(3) 11,000       DONATION TO THE GENERAL FUND
(10) KEXP
113 DEXTER AVE N
SEATTLE,WA98109 		91-2061474 501(C)(3) 24,000       TO HELP SUPPORT "BREAKING NEW GROUND TOGETHER: THE CAMPAIGN FOR KEXP'S NEW HOME"
(11) MARY'S PLACE
1830 9TH AVE
SEATTLE,WA98101 		27-2087950 501(C)(3) 10,000       DONATION TO THE GENERAL FUND
(12) MONTANA SKATEPARK ASSOCIATION
618 S HIGGINS AVE
MISSOULA,MT59801 		82-0583110 501(C)(3) 60,000       TO HELP CREATE A PUBLIC, CONCRETE SKATEPARK IN STEVENSVILLE, MT
(13) OCEANIC SOCIETY
PO BOX 437
ROSS,CA94957 		94-3105570 501(C)(3) 10,000       DONATION TO THE GENERAL FUND
(14) REVOLUTION PER MINUTE
1475 15TH ST
SAN FRANCISCO,CA94103 		72-1600331 501(C)(3) 10,000       DONATION TO THE GENERAL FUND
(15) ROBIN HOOD FOUNDATION
826 BROADWAY 9TH FLOOR
NEW YORK,NY10003 		13-3441066 501(C)(3) 20,000       TO HELP SUPPORT NEW YORKERS IN NEED
(16) ROCK SCHOOL
10903 NE 53RD ST
KIRKLAND,WA98033 		46-0494902 501(C)(3) 10,000       TO COVER TEACHING ARTIST FEES TO PROVIDE SCHOLARSHIPS FOR YOUTH
(17) SEATTLE CHILDREN'S HOSPITAL FOUNDATION
PO BOX 5371 M/S S-200
SEATTLE,WA98145 		91-1156519 501(C)(3) 50,000       DONATION TO THE GENERAL FUND
(18) SEATTLE'S UNION GOSPEL MISSION
PO BOX 202
SEATTLE,WA98111 		91-0595029 501(C)(3) 10,000       DONATION TO THE GENERAL FUND
(19) SPRUCE STREET SCHOOL
914 VIRGINIA ST
SEATTLE,WA98101 		91-0963223 501(C)(3) 5,000       DONATION TO THE GENERAL FUND
(20) SPRUCE STREET SCHOOL
914 VIRGINIA ST
SEATTLE,WA98101 		91-0963223 501(C)(3) 10,000       DONATION TO THE ANNUAL FUND THAT SUPPORTS ART, MUSIC, PE, ELECTIVES, AND FINANCIAL AID
(21) STRONGHOLD SOCIETY
2022 E 134TH WAY
THORNTON,CO80241 		27-3621140 501(C)(3) 50,000       TO HELP FUND THE CONSTRUCTION AT THE PINE RIDGE SKATEPARK AS WELL AS THE WOUNDED KNEE SKATEPARK
(22) SUSAN G KOMEN 3-DAY
820 W JACKSON BLVD SUITE 800
CHICAGO,IL60607 		75-1835298 501(C)(3) 6,000       TO HELP FUND BREAST CANCER RESEARCH AND TREATMENT
(23) THE ACTOR'S GANG
9070 VENICE BLVD
CULVER CITY,CA90232 		95-4226223 501(C)(3) 25,000       DONATION TO THE GENERAL FUND
(24) TREEHOUSE
2100 24TH AVE S STE 200
SEATTLE,WA98122 		91-1425676 501(C)(3) 25,000       DONATION TO THE GENERAL FUND
(25) TREEHOUSE
2100 24TH AVE S STE 200
SEATTLE,WA98122 		91-1425676 501(C)(3) 4,818       TO HELP SUPPORT KIDS IN FOSTER CARE GRADUATE FROM HIGH SCHOOL.
(26) WAR CHILD US
AVANT BUILDING STE 900 200 DELAWARE
AVE
BUFFALO,NY14202 		20-0994157 501(C)(3) 25,000       DONATION TO THE GENERAL FUND
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
23
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015
Page 2

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
non-cash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of non-cash assistance
(1) HOUSING AND LIVING COSTS 1 0 6,000 BOOK VALUE BASIC LIVING COSTS TO AID REFUGEE FAMILY IN SETTLING INTO NEW HOME IN THE US
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
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.
Schedule I (Form 990) 2015



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