SKY LAKES MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- SKY LAKES MEDICAL CENTER FOUNDATION INC (EIN 93-0946020)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-14
- IRS object ID
- 201912269349302161
- Schema version
- 2017v2.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-14T16:12:26-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | 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 | 805 SW BROADWAY STE 1200 | AddressLine1Txt |
| City | PORTLAND | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97205 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930946020 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SKY LAKES MEDICAL CENTER FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SKYL | BusinessNameControlTxt |
| Phone | 5412744768 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD RICO | PersonNm |
| Person Title | AUTHORIZED SIGNER | PersonTitleTxt |
| Phone | 5412744768 | PhoneNum |
| Signature | 2019-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY CAMPOS | PreparerPersonNm |
| PTIN | P00448102 | PTIN |
| Phone | 5032421447 | PhoneNum |
| Preparation | 2019-08-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 12.129.4.210 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-13 | IPDt |
| IP Tm | 09:57:37 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 04AC3BC5301D88D6367FF888E970AED671A35C09 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL STEWART | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,266,737 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SKYLAKES.ORG/FOUNDATION/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $922,215 | PYContributionsGrantsAmt |
| CY Contributions Grants | $473,368 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,277,768 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,227,273 | CYInvestmentIncomeAmt |
| PY Other Revenue | $35,229 | PYOtherRevenueAmt |
| CY Other Revenue | $14,499 | CYOtherRevenueAmt |
| PY Total Revenue | $2,235,212 | PYTotalRevenueAmt |
| CY Total Revenue | $1,715,140 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,100,082 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,812,707 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $241,282 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $142,804 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $75,000 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $286,111 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $434,432 | PYOtherExpensesAmt |
| CY Other Expenses | $541,721 | CYOtherExpensesAmt |
| PY Total Expenses | $1,775,796 | PYTotalExpensesAmt |
| CY Total Expenses | $2,572,232 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $459,416 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$857,092 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,812,438 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,310,753 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,041,926 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,909,854 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $21,770,512 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $22,400,899 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,550,000 | ExpenseAmt |
| Grant | $1,550,000 | GrantAmt |
| Desc | SKY LAKES MEDICAL CENTER - THESE FUNDS WERE UTILIZED TO PURCHASE SPECIFIC EQUIPMENT FOR CONSTRUCTION AND OTHER PROJECTS AND PROGRAMS OF THE MEDICAL CENTER. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $143,000 | ExpenseAmt |
| Grant | $143,000 | GrantAmt |
| Desc | SKY LAKES MEDICAL CENTER PROGRAM OPERATIONS/REIMBURSEMENT - CHILD ABUSE RESPONSE AND EVALUATION SERVICES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $240,136 | ExpenseAmt |
| Grant | $119,707 | GrantAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,933,136 | 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 | Yes (1) | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| DAF Excess Business Holdings | 0 | DAFExcessBusinessHoldingsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAUREN JESPERSEN | PersonNm |
| Phone | 5412744768 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 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 |
|---|---|---|---|---|---|---|---|
| CLARK PEDERSON | |||||||
| CHAIR | 3.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TOM SCHIESS | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAUL STEWART | |||||||
| BOARD MEMBER | 1.00 | 50.00 | Yes (X) | $0 | $750,563 | $46,800 | |
| HOLLY MONTJOY | |||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RON WENDT | |||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN BELL | |||||||
| BOARD MEMBER | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | |
| DOUG MCINNIS | |||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| HEIDI NEEL BIGGS | |||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JEAN PHILLIPS | |||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WENDY WARREN | |||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DWIGHT SMITH | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AMY BOIVIN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIN COX | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RAY HOLLIDAY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS KANDRA | |||||||
| BOARD MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID KING | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARTY LEDGERWOOD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SARAH NEVUE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER SCANLAN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAUREN JESPERSEN | |||||||
| SECRETARY/DIRECTOR | 40.00 | Yes (X) | $107,118 | $0 | $5,507 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $107,118 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $750,563 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $52,307 | 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 | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $13,440 | FundraisingAmt |
| Government Grants | $38,311 | GovernmentGrantsAmt |
| All Other Contributions | $421,617 | AllOtherContributionsAmt |
| Total Contributions | $473,368 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $557,468 | TotalRevenueColumnAmt |
| Exclusion | $557,468 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,207,456 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,537,651 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $669,805 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $669,805 | TotalRevenueColumnAmt |
| Exclusion | $669,805 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $28,125 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $13,440 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $13,946 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,179 | TotalRevenueColumnAmt |
| Exclusion | $14,179 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $320 | TotalRevenueColumnAmt |
| Exclusion | $320 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $320 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,715,140 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,241,772 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,693,000 | TotalAmt |
| Program Services | $1,693,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,707 | TotalAmt |
| Program Services | $119,707 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,285 | TotalAmt |
| Program Services | $22,057 | ProgramServicesAmt |
| Management And General | $44,114 | ManagementAndGeneralAmt |
| Fundraising | $44,114 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,472 | TotalAmt |
| Program Services | $694 | ProgramServicesAmt |
| Management And General | $1,389 | ManagementAndGeneralAmt |
| Fundraising | $1,389 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,227 | TotalAmt |
| Program Services | $1,045 | ProgramServicesAmt |
| Management And General | $2,091 | ManagementAndGeneralAmt |
| Fundraising | $2,091 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,525 | TotalAmt |
| Program Services | $2,705 | ProgramServicesAmt |
| Management And General | $5,410 | ManagementAndGeneralAmt |
| Fundraising | $5,410 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,295 | TotalAmt |
| Program Services | $2,059 | ProgramServicesAmt |
| Management And General | $4,118 | ManagementAndGeneralAmt |
| Fundraising | $4,118 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,280 | TotalAmt |
| Program Services | $1,656 | ProgramServicesAmt |
| Management And General | $3,312 | ManagementAndGeneralAmt |
| Fundraising | $3,312 | FundraisingAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,000 | TotalAmt |
| Fundraising | $75,000 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,874 | TotalAmt |
| Management And General | $141,874 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,615 | TotalAmt |
| Program Services | $5,523 | ProgramServicesAmt |
| Management And General | $11,046 | ManagementAndGeneralAmt |
| Fundraising | $11,046 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,772 | TotalAmt |
| Program Services | $16,454 | ProgramServicesAmt |
| Management And General | $3,159 | ManagementAndGeneralAmt |
| Fundraising | $3,159 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,272 | TotalAmt |
| Program Services | $16,254 | ProgramServicesAmt |
| Management And General | $32,509 | ManagementAndGeneralAmt |
| Fundraising | $32,509 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,230 | TotalAmt |
| Program Services | $7,046 | ProgramServicesAmt |
| Management And General | $14,092 | ManagementAndGeneralAmt |
| Fundraising | $14,092 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PROTECTED BIKE LANE | $209,000 | $41,800 | $83,600 | $83,600 |
| SOBERING FACILITY | $14,110 | $2,822 | $5,644 | $5,644 |
| HUGH CURRIN HOUSE | $1,568 | $314 | $627 | $627 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,572,232 | TotalAmt |
| Program Services | $1,933,136 | ProgramServicesAmt |
| Management And General | $352,985 | ManagementAndGeneralAmt |
| Fundraising | $286,111 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,635 | BOYAmt |
| EOY | $93,274 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $896,221 | BOYAmt |
| EOY | $705,877 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $774,572 | BOYAmt |
| EOY | $750,000 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,999,010 | BOYAmt |
| EOY | $22,761,602 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,812,438 | BOYAmt |
| EOY | $24,310,753 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,041,926 | BOYAmt |
| EOY | $1,909,854 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,041,926 | BOYAmt |
| EOY | $1,909,854 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,096,523 | BOYAmt |
| EOY | $15,280,106 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,673,989 | BOYAmt |
| EOY | $7,120,793 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,770,512 | BOYAmt |
| EOY | $22,400,899 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,812,438 | BOYAmt |
| EOY | $24,310,753 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$857,092 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,487,479 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SKY LAKES MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930508781 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $1,693,000 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $1,693,000 | 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
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 9 | DonorAdvisedFundsHeldCnt |
| Funds And Other Accounts Held | 33 | FundsAndOtherAccountsHeldCnt |
| Donor Advised Funds Contri | $92,315 | DonorAdvisedFundsContriAmt |
| Funds And Other Accounts Contri | $409,352 | FundsAndOtherAccountsContriAmt |
| Donor Advised Funds Grants | $94,389 | DonorAdvisedFundsGrantsAmt |
| Funds And Other Accounts Grants | $299,478 | FundsAndOtherAccountsGrantsAmt |
| Donor Advised Funds Vl EOY | $557,752 | DonorAdvisedFundsVlEOYAmt |
| Funds And Other Accounts Vl EOY | $21,943,110 | FundsAndOtherAccountsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (1) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (1) | DisclosedForCharitablePrpsInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,795,751 | BeginningYearBalanceAmt |
| Contributions | $189,824 | ContributionsAmt |
| Investment Earnings Or Losses | $561,415 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $209,418 | GrantsOrScholarshipsAmt |
| Other Expenditures | $174 | OtherExpendituresAmt |
| End Year Balance | $4,337,398 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $16,327,034 | BeginningYearBalanceAmt |
| Contributions | $207,062 | ContributionsAmt |
| Investment Earnings Or Losses | $649,810 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $203,150 | GrantsOrScholarshipsAmt |
| Other Expenditures | $13,185,005 | OtherExpendituresAmt |
| End Year Balance | $3,795,751 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $14,772,429 | BeginningYearBalanceAmt |
| Contributions | $831,608 | ContributionsAmt |
| Investment Earnings Or Losses | $1,640,023 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $21,511 | GrantsOrScholarshipsAmt |
| Other Expenditures | $587,712 | OtherExpendituresAmt |
| Administrative Expenses | $307,803 | AdministrativeExpensesAmt |
| End Year Balance | $16,327,034 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $15,555,625 | BeginningYearBalanceAmt |
| Contributions | $128,097 | ContributionsAmt |
| Investment Earnings Or Losses | $189,989 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $15,940 | GrantsOrScholarshipsAmt |
| Other Expenditures | $878,284 | OtherExpendituresAmt |
| Administrative Expenses | $207,058 | AdministrativeExpensesAmt |
| End Year Balance | $14,772,429 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $14,589,830 | BeginningYearBalanceAmt |
| Contributions | $170,459 | ContributionsAmt |
| Investment Earnings Or Losses | $1,968,108 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $62,666 | GrantsOrScholarshipsAmt |
| Other Expenditures | $896,032 | OtherExpendituresAmt |
| Administrative Expenses | $214,074 | AdministrativeExpensesAmt |
| End Year Balance | $15,555,625 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO SLMC | Desc |
| Amt | $1,909,854 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,909,854 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2018 OR 2017. 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, 2018 AND 2017, 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. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCHANT MCINTYRE & ASSOCIATES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1440 G ST NW | AddressLine1Txt |
| City | WASHINGTON | CityNm |
| State Abbreviation | DC | StateAbbreviationCd |
| ZIP | 20005 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | SOLICITATION OF GOVERNMENT GRANTS | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $75,000 | RetainedByContractorAmt |
| Net To Organization | $0 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $75,000 | TotalRetainedByContractorsAmt |
| Licensed States | OR | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $41,565 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $13,440 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $28,125 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $800 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $13,146 | RentFacilityCostsEvent1Amt |
| Gross Receipts Total | $41,565 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $13,440 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $28,125 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $800 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $13,146 | RentFcltyCostsTotalEventsAmt |
| Direct Expense Summary Events | $13,946 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $14,179 | NetIncomeSummaryAmt |
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 | SKY LAKES MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 930508781 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $1,693,000 | CashGrantAmt |
| Purpose Of Grant | PURCHASE OF EQUIPMENT AND PROGRAM OPERATING COSTS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|
| ACADEMIC SCHOLARSHIPS | 58 | $93,100 | |||
| PATIENT ASSISTANCE | 669 | $8,229 | $18,378 | PURCHASE PRICE | MEDICAL SUPPLIES |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | 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 | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAUL STEWART | PersonNm |
| Title | BOARD MEMBER | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $475,563 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $275,000 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $31,500 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $15,300 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $797,363 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHERN OREGON EMERGENCY CARE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611595709 | EIN |
| Primary Activities | PHYSICIAN SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OR | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SKY LAKES MEDICAL CENTER | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | SKY LAKES MEDICAL CENTER | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KLAMATH MEDICAL BUSINESS CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020731372 | EIN |
| Primary Activities | REAL AND PERSONAL PROPERTY RENTAL | PrimaryActivitiesTxt |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | N/A | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST PHYSICIAN SERVICES LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1Txt |
| City | KLAMATH FALLS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 870696029 | EIN |
| Primary Activities | PHYSICIAN SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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