INCLINE VILLAGE COMMUNITY HOSPITAL FOUNDATION: Form 990, tax year 2020
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- Organization
- INCLINE VILLAGE COMMUNITY HOSPITAL FOUNDATION (EIN 20-0752156)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-03-21
- IRS object ID
- 202220809349300977
- Schema version
- 2020v4.2
- 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 | 2022-03-21T13:11:08-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SECOND STREET SUITE 900 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94105 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200752156 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INCLINE VILLAGE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INCL | BusinessNameControlTxt |
| Phone | 7758334100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 880 ALDER AVENUE | AddressLine1Txt |
| City | INCLINE VILLAGE | CityNm |
| State Abbreviation | NV | StateAbbreviationCd |
| ZIP | 89451 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KARLI EPSTEIN | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 7758334100 | PhoneNum |
| Signature | 2022-03-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KARLI | PersonFirstNm |
| Person Last | EPSTEIN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TRACY S PAGLIA | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 4159561500 | PhoneNum |
| Preparation | 2022-03-17 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KARLI EPSTEIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 880 ALDER AVENUE | AddressLine1Txt |
| City | INCLINE VILLAGE | CityNm |
| State Abbreviation | NV | StateAbbreviationCd |
| ZIP | 89451 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,046,482 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.TFHD.COM/IVCH/IVCH-FOUNDATION | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | NV | LegalDomicileStateCd |
| Activity Or Mission | ASSIST INCLINE VILLAGE COMMUNITY HOSPITAL TO DELIVER QUALITY EMERGENCY & PRIMARY HEALTH CARE SERVICES | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,360,187 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,046,482 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,360,187 | PYTotalRevenueAmt |
| CY Total Revenue | $1,046,482 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $612,209 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $206,586 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,858 | PYOtherExpensesAmt |
| CY Other Expenses | $903 | CYOtherExpensesAmt |
| PY Total Expenses | $615,067 | PYTotalExpensesAmt |
| CY Total Expenses | $207,489 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $745,120 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $838,993 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,241,580 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,081,101 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,250 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,222,330 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,081,101 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR MISSION IS TO ASSIST THE INCLINE VILLAGE COMMUNITY HOSPITAL IN DELIVERING THE HIGHEST QUALITY EMERGENCY AND PRIMARY HEALTH CARE SERVICES BY PROCURING FINANCIAL RESOURCES, IMPROVING COMMUNITY AWARENESS AND INVOLVING COMMUNITY RESIDENTS AND VISITORS IN DEVELOPING A LONG-TERM VISION FOR COMPREHENSIVE HEALTH CARE IN THE COMMUNITIES OF THE NORTH SHORE OF LAKE TAHOE, INCLUDING KINGS BEACH, CRYSTAL BAY AND INCLINE VILLAGE | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $76,517 | ExpenseAmt |
| Grant | $76,517 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION PROVIDED SUPPORT FOR THE EDUCATION AND TREATMENT OF BEHAVIORAL HEALTH. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $59,375 | ExpenseAmt |
| Grant | $59,375 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION PROVIDED SUPPORT IN THE TREATMENT AND PREVENTION OF COVID-19 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $45,534 | ExpenseAmt |
| Grant | $45,534 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION PROVIDED SUPPORT TO ENHANCE EMERGENCY SERVICES IN THE COMMUNITY | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $25,160 | ExpenseAmt |
| Grant | $25,160 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION PROVIDED SUPPORT FOR VARIOUS OTHER EXPENSES TO ASSIST THE INCLINE VILLAGE COMMUNITY HOSPITAL IN DELIVERING OPTIMAL HEALTH CARE SERVICES IN NORTH LAKE TAHOE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $25,160 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $25,160 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $206,586 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (1) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAYE CHASSEUR CONTROLLER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5305823489 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10121 PINE AVENUE | AddressLine1Txt |
| City | TRUCKEE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96160 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| HARRY WEIS | ||||||||
| DIRECTOR & TFHD CEO | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $684,337 | $60,098 | |
| JUDY NEWLAND | ||||||||
| COO, TFHD | 0.50 | 40.00 | Yes (X) | $0 | $439,345 | $62,112 | ||
| CRYSTAL BETTS | ||||||||
| CFO, TFHD | 0.50 | 39.00 | Yes (X) | $0 | $446,705 | $53,598 | ||
| JAYE CHASSEUR | ||||||||
| CONTROLLER, TFHD | 0.50 | 39.00 | $0 | $194,451 | $28,576 | Yes (X) | ||
| KARLI EPSTEIN | ||||||||
| EXECUTIVE DIRECTOR | 16.00 | 24.00 | Yes (X) | $0 | $142,675 | $33,180 | ||
| WARREN KOCMOND | ||||||||
| PRESIDENT | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WALTER L BINDER | ||||||||
| VICE PRESIDENT | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NAN HEALY | ||||||||
| SECRETARY | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KEVIN HANNA | ||||||||
| TREASURER | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GARY FINCH | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDSAY HARDIE | ||||||||
| DIRECTOR THRU 01/21 | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SHANE JOHNSON MD | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ROGER KAHN | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SUSANNA KINTZ | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DONALD M MASON MD | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| EARL NEMSER | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MYLES RINER | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JONATHAN SMITH OD | ||||||||
| DIRECTOR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,907,513 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $237,564 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,750 | GovernmentGrantsAmt |
| All Other Contributions | $1,039,732 | AllOtherContributionsAmt |
| Total Contributions | $1,046,482 | TotalContributionsAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,046,482 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,586 | TotalAmt |
| Program Services | $206,586 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $903 | TotalAmt |
| Management And General | $903 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,489 | TotalAmt |
| Program Services | $206,586 | ProgramServicesAmt |
| Management And General | $903 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $867,096 | BOYAmt |
| EOY | $1,468,827 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,928 | BOYAmt |
| EOY | $507,190 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,750 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,806 | BOYAmt |
| EOY | $105,084 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,241,580 | BOYAmt |
| EOY | $2,081,101 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,250 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,250 | BOYAmt |
| EOY | $0 | 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 | $940,300 | BOYAmt |
| EOY | $1,734,202 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,030 | BOYAmt |
| EOY | $346,899 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,222,330 | BOYAmt |
| EOY | $2,081,101 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,241,580 | BOYAmt |
| EOY | $2,081,101 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $838,993 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $19,778 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAHOE FOREST HOSPITAL DISTRICT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 946004062 | EIN |
| Organization Type | 6 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $206,586 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $206,586 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $64,806 | BeginningYearBalanceAmt |
| Contributions | $20,500 | ContributionsAmt |
| Investment Earnings Or Losses | $19,778 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $105,084 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $52,432 | BeginningYearBalanceAmt |
| Contributions | $11,100 | ContributionsAmt |
| Investment Earnings Or Losses | $1,274 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $64,806 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $41,610 | BeginningYearBalanceAmt |
| Contributions | $8,500 | ContributionsAmt |
| Investment Earnings Or Losses | $2,322 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $52,432 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $32,162 | BeginningYearBalanceAmt |
| Contributions | $5,500 | ContributionsAmt |
| Investment Earnings Or Losses | $3,948 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $41,610 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $29,209 | ContributionsAmt |
| Investment Earnings Or Losses | $2,953 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $32,162 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.62090 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.37910 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ENDOWMENT: BENEFICIAL INTEREST IN TRUST | Desc |
| Book Value | $105,084 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $105,084 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,246,202 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $179,942 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $19,778 | OtherRevenueAmt |
| Revenue Not Reported | $199,720 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,046,482 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,046,482 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $387,431 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $179,942 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $179,942 | ExpensesNotReportedAmt |
| Expenses Subtotal | $207,489 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $207,489 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE PURPOSE OF THE ENDOWMENT AND IMPROVEMENT FUNDS IS TO PROVIDE SUPPORT TO OR FOR THE BENEFIT OF THE FOUNDATION AND ITS ACTIVITIES IN PURSUIT OF ITS MISSION TO DELIVER OPTIMAL HEALTH CARE SERVICES IN THE COMMUNITIES SERVED BY INCLINE VILLAGE COMMUNITY HOSPITAL. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST IN TRUST 19,778. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAHOE FOREST HOSPITAL DISTRICT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 759 | AddressLine1Txt |
| City | TRUCKEE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96160 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 946004062 | RecipientEIN |
| IRC Section | 115(1) | IRCSectionDesc |
| Cash Grant | $206,586 | CashGrantAmt |
| Purpose Of Grant | TO SUPPORT AND ENHANCE HEALTHCARE IN THE DISTRICT'S SERVICE AREA | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FOUNDATION EXISTS TO SUPPORT AND ENHANCE HEALTHCARE IN THE INCLINE VILLAGE COMMUNITY HOSPITAL'S SERVICE AREA. ACCORDINGLY, THE FOUNDATION'S ASSISTANCE REPRESENTS PAYMENTS DIRECTLY MADE TO THE DISTRICT IN FURTHERANCE OF THESE PURPOSES. THE BOARD OF DIRECTORS FROM THE FOUNDATION AND THE DISTRICT PERFORM MONITORING PROCEDURES TO ENSURE THAT THE ASSISTANCE PROVIDED BY THE FOUNDATION IS USED TO SUPPORT AND ENHANCE HEALTHCARE IN INCLINE VILLAGE COMMUNITY HOSPITAL'S SERVICE AREA. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HARRY WEIS | ||||||||||||||
| DIRECTOR & TFHD CEO | $0 | $581,651 | $0 | $83,486 | $0 | $19,200 | $0 | $38,969 | $0 | $21,129 | $0 | $744,435 | $0 | $0 |
| JUDY NEWLAND | ||||||||||||||
| COO, TFHD | $0 | $439,345 | $0 | $0 | $0 | $0 | $0 | $38,969 | $0 | $23,143 | $0 | $501,457 | $0 | $0 |
| CRYSTAL BETTS | ||||||||||||||
| CFO, TFHD | $0 | $373,194 | $0 | $67,617 | $0 | $5,894 | $0 | $32,469 | $0 | $21,129 | $0 | $500,303 | $0 | $0 |
| JAYE CHASSEUR | ||||||||||||||
| CONTROLLER, TFHD | $0 | $192,713 | $0 | $0 | $0 | $1,738 | $0 | $17,112 | $0 | $11,464 | $0 | $223,027 | $0 | $0 |
| KARLI EPSTEIN | ||||||||||||||
| EXECUTIVE DIRECTOR | $0 | $141,963 | $0 | $0 | $0 | $712 | $0 | $10,348 | $0 | $22,832 | $0 | $175,855 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE FOUNDATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. |
| PART I, LINE 6 | CURRENT EMPLOYEES OF THE RELATED ORGANIZATION, TAHOE FOREST HOSPITAL DISTRICT (DISTRICT) WHO MEET THE PLAN CRITERIA ARE ELIGIBLE TO PARTICIPATE IN A GAIN SHARING PROGRAM. CERTAIN PROGRAM METRICS MUST BE ACHIEVED IN ORDER FOR THE GAIN SHARING POOL TO BE ACTIVE FOR THE FISCAL YEAR. THE POOL OF GAIN SHARING FUNDS IS CALCULATED AS A PERCENTAGE OF AUDITED NET INCOME OF THE DISTRICT, TIERED FOR DIFFERENT LEVELS OF NET INCOME OF THE DISTRICT OVERALL. ELIGIBLE EMPLOYEES, WHICH MAY INCLUDE OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES OF THE DISTRICT THAT ALSO SERVE THE FOUNDATION THAT ARE EMPLOYED BY THE DISTRICT RECEIVE A PRO-RATA SHARE OF THE GAIN SHARING POOL BY ALLOCATING THE EMPLOYEE'S SALARY AGAINST THE TOTAL SALARY OF ALL ELIGIBLE EMPLOYEES. THE FOUNDATION DOES NOT INCUR ANY EXPENSES UNDER THIS PLAN. |
| PART I, LINE 7 | CERTAIN KEY PERSONNEL OF THE RELATED ORGANIZATION, TAHOE FOREST HOSPITAL DISTRICT (DISTRICT) THAT SERVE THE FOUNDATION ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION PLAN WHICH AWARDS A PERCENTAGE OF BASE COMPENSATION FOR THE FISCAL YEAR. ELIGIBLE EMPLOYEES OF THE DISTRICT INCLUDE OFFICERS, KEY PERSONNEL, AND OTHER EMPLOYEES AT THE DISCRETION OF THE CEO THAT MAY ALSO SERVE THE FOUNDATION. FOR THE INCENTIVE COMPENSATION TO BE AWARDED, CERTAIN FINANCIAL TARGETS AND ACHIEVEMENT OF ANNUAL GOALS AND STRATEGIC OBJECTIVES MUST BE MET. THE CEO MAY USE DISCRETION OVER THE INCENTIVE COMPENSATION AWARDED, BUT ALL PAYOUTS UNDER THE PLAN ARE DETERMINED AFTER ACCEPTANCE OF THE DISTRICT'S AUDITED FINANCIAL STATEMENT BY THE BOARD OF DIRECTORS. THE FOUNDATION DOES NOT INCUR ANY EXPENSES UNDER THIS PLAN. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE FOUNDATION IS TAHOE FOREST HOSPITAL DISTRICT. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE FOUNDATION'S BOARD OF DIRECTORS ARE ELECTED BY THE SOLE MEMBER, TAHOE FOREST HOSPITAL DISTRICT. |
| FORM 990, PART VI, SECTION A, LINE 7B | AMENDMENTS TO THE BYLAWS AND CHANGES TO THE NUMBER OF DIRECTORS MUST BE APPROVED BY THE SOLE MEMBER, TAHOE FOREST HOSPITAL DISTRICT. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR. THE EXECUTIVE DIRECTOR ALSO REVIEWS THE FORM 990 WITH THE CHAIRMAN OR TREASURER OF THE BOARD AND THE FOUNDATION'S ACCOUNTANT IN PERSON, VIA EMAIL, OR THROUGH A BOARD MEETING. A COPY OF FORM 990 IS DISTRIBUTED TO THE REMAINDER OF THE BOARD VIA EMAIL OR THROUGH A BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE FOUNDATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL PERSONS HOLDING POSITIONS OF RESPONSIBILITY AND TRUST ON BEHALF OF INCLINE VILLAGE COMMUNITY HOSPITAL FOUNDATION, INCLUDING, BUT NOT LIMITED TO MEMBERS OF THE BOARD OF DIRECTORS, VOLUNTEER COMMITTEE MEMBERS, AND TAHOE FOREST HOSPITAL DISTRICT STAFF (BOARD/STAFF/VOLUNTEERS). COVERED PERSONS ARE REQUIRED TO ANNUALLY COMPLETE A DISCLOSURE STATEMENT FOR POTENTIAL RELATIONSHIPS AS WELL AS DISCLOSING ANY INTEREST THAT MAY IMPACT THE DECISION-MAKING PROCESS WHENEVER THERE IS ANY DOUBT ABOUT WHETHER DISCLOSURE IS REQUIRED. IF A COVERED PERSON HAS AN INTEREST IN A PROPOSED TRANSACTION WITH THE FOUNDATION, HE OR SHE MUST MAKE FULL DISCLOSURE OF SUCH INTEREST BEFORE ANY DISCUSSION OR NEGOTIATION OF THE TRANSACTION AND ABSTAIN FROM DECISION-TAKING ACTIONS. IF A CONFLICT, OR THE POTENTIAL APPEARANCE OF A CONFLICT, EXISTS, THE BOARD MEMBER MUST RECUSE THEMSELVES BY NOT INFLUENCING, ATTEMPTING TO INFLUENCE, OR PARTICIPATING IN THAT DISCUSSION AND/OR VOTE MADE BY REMAINING MEMBERS THAT DO NOT HAVE AN INTEREST. |
| FORM 990, PART VI, SECTION C, LINE 19 | ANY INTERESTED PARTIES WHO DESIRE TO OBTAIN A COPY OF ANY OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS CAN CONTACT THE OFFICE AND REQUEST A PAPER COPY. ANY DOCUMENTS REQUESTED ARE PRINTED AND HANDED TO THE INTERESTED PARTY AT THE OFFICE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN TRUST 19,778. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| TAHOE FOREST HOSPITAL DISTRICT | |||||||||||
| PO BOX 759 | TRUCKEE | CA | 96160 | 946004062 | HEALTHCARE | CA | N/A | 0 | |||
| TAHOE FOREST HEALTH SYSTEM FOUNDATION | |||||||||||
| PO BOX 2508 | TRUCKEE | CA | 96160 | 943047869 | HEALTHCARE | CA | 0 | 501(C)(3) | LINE 12A, I | TAHOE FOREST HOSPITAL DISTRICT | |
| TAHOE INSTITUTE FOR RURAL HEALTH RESEARCH | |||||||||||
| PO BOX 759 | TRUCKEE | CA | 96160 | 352372175 | IMPROVE AFFORDABILITY OF HIGH QUALITY HEALTHCARE | CA | 0 | 501(C)(3) | LINE 12A, I | TAHOE FOREST HOSPITAL DISTRICT | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE TRUCKEE SURGERY CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10770 DONNER PASS ROAD SUITE 201 | AddressLine1Txt |
| City | TRUCKEE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96161 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273943102 | EIN |
| Primary Activities | AMBULATORY SURGERY CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAHOE FOREST HOSPITAL DISTRICT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| TAHOE FOREST HOSPITAL DISTRICT | ||
| B | $202,402 | FMV |
| TAHOE FOREST HOSPITAL DISTRICT | ||
| O | $132,008 | FMV |
| TAHOE FOREST HOSPITAL DISTRICT | ||
| Q | $179,942 | FMV |
Comments