BEAR LAKE VALLEY HEALTH CARE FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BEAR LAKE VALLEY HEALTH CARE FOUNDATION (EIN 82-0495884)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-07-13
- IRS object ID
- 202311949349301816
- Schema version
- 2021v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-07-13T17:23:04-04:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 820409588 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARY H TEUSCHER CPA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N 8TH ST | AddressLine1Txt |
| City | MONTPELIER | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 820495884 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEAR LAKE VALLEY HEALTH CARE FOUNDA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BEAR | BusinessNameControlTxt |
| Phone | 2088474450 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 SOUTH 5TH STREET | AddressLine1Txt |
| City | MONTPELIER | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83254 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHANE JOHNSON | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 2088474450 | PhoneNum |
| Signature | 2022-07-13 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TRACY | PersonFirstNm |
| Person Last | PARK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | GARY H TEUSCHER | PreparerPersonNm |
| PTIN | P01059377 | PTIN |
| Phone | 2088472601 | PhoneNum |
| Preparation | 2023-07-13 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CORIN EBORN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 351 N 4TH ST | AddressLine1Txt |
| City | MONTPELIER | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $837,233 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Legal Domicile State | ID | LegalDomicileStateCd |
| Activity Or Mission | THE FOUNDATION SUPPORTS THE DELIVERY OF HEALTH CARE TO THE RESIDENTS OF BEAR LAKE VALLEY. IT ALSO SUPPORTS THE FURTHERING OF HEALTH CARE EDUCATION AND ECONOMIC DEVELOPMENTS FOR THE VALLEY'S RESIDENTS BY SPONSORING HEALTH FAIRS, GRANTS TO THE HOSPITAL FOR MEDICAL EQUIPMENT, WELLNESS PROGRAMS AND ACTIVITIES, AND GRANTS TO VARIOUS ENTITIES TO HELP WITH ECONOMIC GROWTH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $50,591 | PYContributionsGrantsAmt |
| CY Contributions Grants | $380,001 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $38,967 | PYInvestmentIncomeAmt |
| CY Investment Income | $12,966 | CYInvestmentIncomeAmt |
| PY Other Revenue | $103,151 | PYOtherRevenueAmt |
| CY Other Revenue | $427,095 | CYOtherRevenueAmt |
| PY Total Revenue | $192,709 | PYTotalRevenueAmt |
| CY Total Revenue | $820,062 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $80,442 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,926,610 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,666 | PYOtherExpensesAmt |
| CY Other Expenses | $1,667 | CYOtherExpensesAmt |
| PY Total Expenses | $82,108 | PYTotalExpensesAmt |
| CY Total Expenses | $1,928,277 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $110,601 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,108,215 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,594,462 | TotalAssetsBOYAmt |
| Total Assets EOY | $436,637 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,660 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $486 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,592,802 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $436,151 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE FOUNDATION SUPPORTS THE DELIVERY OF HEALTH CARE TO THE RESIDENTS OF BEAR LAKE VALLEY. IT ALSO SUPPORTS THE FURTHERING OF HEALTH CARE EDUCATION AND ECONOMIC DEVELOPMENT FOR THE VALLEY'S RESIDENTS BY SPONSORING HEALTH FAIRS, GRANTS TO THE HOSPITAL FOR MEDICAL EQUIPMENT, WELLNESS PROGRAMS AND ACTIVITIES, AND GRANTS TO VARIOUS ENTITIES TO HELP WITH ECONOMIC GROWTH. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,906,751 | ExpenseAmt |
| Revenue | $470,213 | RevenueAmt |
| Desc | THE FOUNDATION RAISED MONEY TO HELP THE HOSPITAL TO BUY EQUIPMENT. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $19,859 | ExpenseAmt |
| Revenue | $366,222 | RevenueAmt |
| Desc | THE FOUNDATION SPONSORS HEALTH FAIRS AND OTHER PROGRAMS AND SERVICES TO THE PUBLIC. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,667 | ExpenseAmt |
| Grant | $1,667 | GrantAmt |
| Desc | DEPRECIATION ON BUILDING | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,667 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $1,667 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $1,928,277 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | Yes (true) | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHANE JOHNSON | PersonNm |
| Phone | 2088474450 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 SOUTH 5TH STREET | AddressLine1Txt |
| City | MONTPELIER | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|
| LINDA ARNELL | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| LOTT CROCKETT | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| KRISTIE DECLARK | |||||
| VICE PRESIDE | Yes (X) | $0 | $0 | $0 | |
| CORIN EBORN | |||||
| PRESIDENT | Yes (X) | $0 | $0 | $0 | |
| CASEY HUMPHREYS | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| WALKER PELTO | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| EMILY SCHWARTING | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | Yes (X) |
| LARRY VILA | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| ANDREA WOOLSTENHULME | |||||
| TREASURER | Yes (X) | $0 | $0 | $0 | |
| SHANE JOHNSON | |||||
| EXECUTIVE DI | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $380,001 | AllOtherContributionsAmt |
| Total Contributions | $380,001 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,966 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,966 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $366,222 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $17,171 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $349,051 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $90,212 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $12,168 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $78,044 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $78,044 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $820,062 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $91,010 | RelatedOrExemptFuncIncomeAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,906,751 | TotalAmt |
| Program Services | $1,906,751 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,859 | TotalAmt |
| Program Services | $19,859 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,667 | TotalAmt |
| Program Services | $1,667 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,928,277 | TotalAmt |
| Program Services | $1,928,277 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,337,376 | BOYAmt |
| EOY | $211,174 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,933 | BOYAmt |
| EOY | $20,001 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,547 | BOYAmt |
| EOY | $9,355 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $69,000 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,127 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,540 | BOYAmt |
| EOY | $37,873 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $198,066 | BOYAmt |
| EOY | $158,234 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,594,462 | BOYAmt |
| EOY | $436,637 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,660 | BOYAmt |
| EOY | $486 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,660 | BOYAmt |
| EOY | $486 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,592,802 | BOYAmt |
| EOY | $436,151 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,592,802 | BOYAmt |
| EOY | $436,151 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,594,462 | BOYAmt |
| EOY | $436,637 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,108,215 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$49,763 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $1,327 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $67,567 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $50,648 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $726,299 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $50,591 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $380,001 | CurrentTaxYearAmt |
| Total | $1,275,106 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $185,198 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $175,993 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $50,213 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $92,588 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $379,188 | CurrentTaxYearAmt |
| Total | $883,180 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $252,765 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $226,641 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $776,512 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $143,179 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $759,189 | CurrentTaxYearAmt |
| Total | $2,158,286 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $2,158,286 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,659 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,598 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,739 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $38,967 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,966 | CurrentTaxYearAmt |
| Total | $88,929 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,659 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,598 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,739 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $38,967 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,966 | CurrentTaxYearAmt |
| Total | $88,929 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $263,424 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $236,239 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $793,251 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $182,146 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $772,155 | CurrentTaxYearAmt |
| Total | $2,247,215 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.96040 | PublicSupportCY509Pct |
| Public Support PY509 | 0.94640 | PublicSupportPY509Pct |
| Investment Income CY | 0.04000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.05000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,127 | DepreciationAmt |
| Book Value | $37,873 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $37,873 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $820,062 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $820,062 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $820,062 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,928,277 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $1,928,277 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,928,277 | TotalExpensesPerForm990Amt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | SPECIAL EVENT | Event1Nm |
| Gross Receipts Event1 | $354,660 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $354,660 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $10,467 | OtherDirectExpensesEvent1Amt |
| Event2 | SNOWBALL DANCE | Event2Nm |
| Gross Receipts Event2 | $11,562 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $11,562 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $6,704 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $366,222 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $366,222 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $17,171 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $17,171 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $349,051 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteer Labor Bingo | false | VolunteerLaborBingoInd |
| Volunteer Labor Pull Tabs | false | VolunteerLaborPullTabsInd |
| Volunteer Labor Other Gaming | false | VolunteerLaborOtherGamingInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed | Yes (true) | LicensedInd |
| License Suspended Etc | false | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | false | GamingWithNonmembersInd |
| Member Of Other Entity | false | MemberOfOtherEntityInd |
| Individual With Books | SHANE JOHNSON | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 SOUTH 5TH STREET | AddressLine1Txt |
| City | MONTPELIER | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | false | CntrctWith3rdPrtyForGameRevInd |
| Charitable Distribution Rqr | false | CharitableDistributionRqrInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEAR LAKE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5TH STREET | AddressLine1Txt |
| City | MONTPELIER | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash Grant | $1,906,751 | CashGrantAmt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | GRANTS | GrantTypeTxt |
| Cash Grant | $19,859 | CashGrantAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE FOUNDATION SUPPORTS THE DELIVERY OF HEALTH CARE TO THE RESIDENTS OF BEAR LAKE VALLEY. IT ALSO SUPPORTS THE FURTHERING OF HEALTH CARE EDUCATION AND ECONOMIC DEVELOPMENT FOR THE VALLEY'S RESIDENTS BY SPONSORING HEALTH FAIRS, GRANTS TO THE HOSPITAL FOR MEDICAL EQUIPMENT, WELLNESS PROGRAMS AND ACTIVITIES, AND GRANTS TO VARIOUS ENTITIES TO HELP WITH ECONOMIC GROWTH. |
| FORM 990, PAGE 2, PART III, LINE 4D | DEPRECIATION ON BUILDING |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD REVIEWS THE FORM 990 BEFORE IT IS SIGNED. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
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