2021-08-12T18:17:49-05:00 2020-09-30 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990 2019-10-01 930946020 SKY LAKES MEDICAL CENTER FOUNDATION SKYL 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 RICHARD RICO AUTHORIZED SIGNER 5412744768 2021-08-12 1 WENDY CAMPOS P00448102 5032421447 2021-08-11 2019 2022-09-23 18:48:47Z PAUL STEWART 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 9869484 0 X WWW.SKYLAKES.ORG/FOUNDATION/ X 1986 OR TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 18 17 0 17 0 0 467376 1418490 0 0 1829325 1264956 39836 8864 2336537 2692310 1295562 1239596 0 0 204285 201025 90000 15000 111947 1924187 1385580 3514034 2841201 -1177497 -148891 22564682 21035357 2346700 137240 20217982 20898117 TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 0 0 1013381 1013381 SKY LAKES MEDICAL CENTER - THESE FUNDS WERE UTILIZED TO PURCHASE SPECIFIC EQUIPMENT FOR CONSTRUCTION AND OTHER PROJECTS AND PROGRAMS OF THE MEDICAL CENTER. 150104 150104 SKY LAKES MEDICAL CENTER PROGRAM OPERATIONS/REIMBURSEMENT - CHILD ABUSE RESPONSE AND EVALUATION SERVICES. 1324905 76111 PATIENT ASSISTANCE PROGRAMS BENEFIT OUR PATIENTS BY PAYING FOR ITEMS OF COMFORT FOR CANCER PATIENTS DURING THEIR TREATMENT AND FINANCIAL ASSISTANCE FOR CANCER PATIENTS WHEN NEEDED UNDER THE DIRECTION OF THE DIRECTOR OF THE CANCER TREATMENT CENTER AND A CANCER COMMITTEE. PATIENT ASSISTANCE IS ALSO USED BY THE RESOURCE MANAGEMENT DEPARTMENT IN SKY LAKES MEDICAL CENTER FOR ITEMS THAT CANNOT BE PURCHASED BY PATIENTS OR THEIR FAMILIES BUT ARE A NECESSITY FOR TREATMENT OR TRAVEL FOR TREATMENT. SCHOLARSHIPS ARE PROVIDED FOR HEALTHCARE PROFESSIONS AND PLAY AN IMPORTANT ROLE IN SUPPORTING THE HOSPITAL IN ATTRACTING AND RETAINING EXCEPTIONAL CLINICAL STAFF. 2488390 1 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 CA OR X LAUREN JESPERSEN 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 MARTY LEDGERWOOD CHAIR 3.00 0.00 X X 0 0 0 TOM SCHIESS VICE CHAIR 1.00 0.00 X X 0 0 0 PAUL STEWART BOARD MEMBER 1.00 50.00 X 0 895918 47462 ROBERT JACKMAN BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN BELL BOARD MEMBER 1.00 3.00 X 0 0 0 DOUG MCINNIS BOARD MEMBER 1.00 1.00 X 0 0 0 HEIDI NEEL BIGGS BOARD MEMBER 1.00 1.00 X 0 0 0 KAREN HOGGARTH BOARD MEMBER 1.00 0.00 X 0 0 0 JEAN PHILLIPS BOARD MEMBER 1.00 1.00 X 0 0 0 WENDY WARREN BOARD MEMBER 1.00 1.00 X 0 0 0 ROD WENDT BOARD MEMBER 1.00 1.00 X 0 0 0 AMY BOIVIN BOARD MEMBER 1.00 0.00 X 0 0 0 ERIN COX BOARD MEMBER 1.00 0.00 X 0 0 0 RAY HOLLIDAY BOARD MEMBER 1.00 0.00 X 0 0 0 CHRIS KANDRA BOARD MEMBER 3.00 0.00 X 0 0 0 DAVID KING BOARD MEMBER 1.00 0.00 X 0 0 0 SARAH NEVUE BOARD MEMBER 1.00 0.00 X 0 0 0 JENNIFER SCANLAN BOARD MEMBER 1.00 0.00 X 0 0 0 LAUREN JESPERSEN SECRETARY/DIRECTOR 40.00 0.00 X 115954 0 2496 115954 895918 49958 0 0 1 0 0 126673 1291817 31513 1418490 1158983 1158983 7260753 7154780 105973 105973 105973 31258 22394 8864 8864 2692310 0 0 1273820 1163485 1163485 76111 76111 120225 24045 48090 48090 48347 9669 19339 19339 2125 425 850 850 16218 3244 6487 6487 14110 2822 5644 5644 7500 1500 3000 3000 4580 4580 8655 8655 15000 15000 130682 130682 18017 18017 1682 336 673 673 1140 228 456 456 31020 6204 12408 12408 CHC CAPITAL PROJECT 925000 925000 SOBERING FACILITY 162181 162181 HEALTHY KLAMATH 50152 50152 KLAMATH COMMONS PARK 29472 29472 15499 15499 2841201 2488390 240864 111947 403098 230346 693896 299055 750000 750000 20717688 19755956 22564682 21035357 118253 109069 2228447 28171 2346700 137240 X 14421141 14680792 5796841 6217325 20217982 20898117 22564682 21035357 -148891 828837 189 0 X 0 1 X 1 0 X X X 1 SKY LAKES MEDICAL CENTER 930508781 3 1 1163485 0 1 1163485 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6 30 1700 969268 29111 4093556 700357 20200670 1 1 4567616 1700 538586 29111 -714 5079505 4337398 33078 237779 40455 184 4567616 3795751 189824 561415 209418 174 4337398 16327034 207062 649810 203150 13185005 3795751 14766429 831608 1640023 21511 587712 301803 16327034 0.00000 0.00000 1.00000 0 0 0 DUE TO SLMC 28171 28171 X PART V, LINE 4: ENDOWMENTS ARE HELD BY SKY LAKES MEDICAL CENTER FOUNDATION FOR THE BENEFIT OF SKY LAKES MEDICAL CENTER, A RELATED ORGANIZATION. PART X, LINE 2: FIN 48 (ASC 740) UNCERTAIN TAX POSITION FOOTNOTE - THE MEDICAL CENTER AND FOUNDATION ARE TAX-EXEMPT ORGANIZATIONS AND ARE NOT SUBJECT TO STATE OR FEDERAL INCOME TAXES, EXCEPT ON UNRELATED BUSINESS INCOME, IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER AND FOUNDATION HAD NO UNRECOGNIZED TAX BENEFITS AT SEPTEMBER 30, 2020 OR 2019. THE MEDICAL CENTER AND FOUNDATION RECOGNIZE INTEREST ACCRUED AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AS AN ADMINISTRATIVE EXPENSE. DURING THE YEARS ENDED SEPTEMBER 30, 2020 AND 2019, THE MEDICAL CENTER AND FOUNDATION RECOGNIZED NO INTEREST AND PENALTIES. THE MEDICAL CENTER FILES AN EXEMPT ORGANIZATION INFORMATION RETURN AND AN UNRELATED BUSINESS INCOME TAX RETURN IN THE U.S. FEDERAL JURISDICTION AND AN UNRELATED BUSINESS INCOME TAX RETURN WITH THE OREGON DEPARTMENT OF REVENUE. THE FOUNDATION FILES AN EXEMPT ORGANIZATION INFORMATION RETURN IN THE U.S. FEDERAL JURISDICTION. CHARITABLE ART SHOW 31258 31258 2288 20106 31258 31258 2288 20106 22394 8864 1 SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 501(C)(3) 1163485 PURCHASE OF EQUIPMENT AND PROGRAM OPERATING COSTS 1 0 ACADEMIC SCHOLARSHIPS 38 39000 PATIENT ASSISTANCE 1265 5960 31151 PURCHASE PRICE MEDICAL SUPPLIES PART I, LINE 2: FUNDS ARE SET UP AND TRACKED ON A FUND BY FUND BASIS. THE DIRECTOR AND ACCOUNTANT BOTH MONITOR THAT FUNDS ARE CORRECTLY CREDITED AND THAT FUNDS ARE SPENT AS ALLOWED BY THE RULES FOR THAT FUND, WHETHER THOSE RULES ARE ESTABLISHED BY THE DONOR, THE BOARD, GRANT APPLICATIONS OR SPECIFIC PEOPLE ENTRUSTED WITH SPENDING THE FUNDS. 0 0 0 0 0 0 0 0 0 PAUL STEWART BOARD MEMBER 0 554230 0 341688 0 0 0 32162 0 15300 0 943380 0 0 X 1 15243 FMV X DISASTER SUPPLIES 3 16270 FMV 0 0 0 PART I, COLUMN (B): REPORTED BASED ON THE NUMBER OF CONTRIBUTIONS RECEIVED FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND CFO AND CONTROLLER BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE DUTY OF THE BOARD OF DIRECTORS OF SKY LAKES MEDICAL CENTER FOUNDATION TO SAFEGUARD THE TAX EXEMPT STATUS OF THE FOUNDATION, AND AS SUCH THE BOARD WILL TAKE SERIOUSLY ANY CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER OR POTENTIAL BOARD MEMBER. ALL BOARD MEMBERS AND POTENTIAL MEMBERS MUST DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. AN UPDATED STATEMENT OF SUCH POTENTIAL CONFLICTS SHALL BE SUBMITTED YEARLY BY ALL BOARD MEMBERS FOR REVIEW AT THE BOARD'S ANNUAL MEETING. AFTER DISCLOSURE OF THE POTENTIAL CONFLICT OF INTEREST AND AFTER ANY DISCUSSION WITH THE INTERESTED PARTY, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE MINUTES OF THE BOARD AND ALL COMMITTEES OF THE BOARD SHALL CONTAIN 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST; 2) THE NATURE OF THE FINANCIAL INTEREST; 3) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR THE DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT; 4) THE CONTENT OF THE DISCUSSION INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 5) ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT; AND, 6) THE BOARD OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ALL MADE AVAILABLE TO THE PUBLIC UPON REQUEST. SOUTHERN OREGON EMERGENCY CARE LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 611595709 PHYSICIAN SERVICES OR 0 0 SKY LAKES MEDICAL CENTER SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 HEALTHCARE OR 501(C)(3) LINE 3 N/A 0 KLAMATH CARE SERVICES INC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946018 SUPPORT MEDICAL CENTER (INACTIVE) OR 501(C)(3) LINE 12C, III-FI SKY LAKES MEDICAL CENTER 0 KLAMATH MEDICAL BUSINESS CENTER LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 020731372 REAL AND PERSONAL PROPERTY RENTAL OR N/A N/A 0 0 WEST PHYSICIAN SERVICES LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 870696029 PHYSICIAN SERVICES OR N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0