2016-01-28T14:30:17-06:00 2014-09-30 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990 2013-10-01 930946020 SKY LAKES MEDICAL CENTER FOUNDATION SKYL 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 PAUL STEWART PRESIDENT/CEO 5412744768 2016-01-25 1 WENDY CAMPOS P00448102 5032421447 2016-01-25 2013 2016-04-25 22:37:26Z PAUL STEWART 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 8881554 0 X SEE SCHEDULE O X 1986 OR TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 17 15 0 40 0 0 501431 751709 0 0 1698430 1547986 21519 33512 2221380 2333207 2132874 1236604 0 0 141674 145534 0 0 50833 209518 185894 2484066 1568032 -262686 765175 17622280 19463709 745271 1427789 16877009 18035920 X TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 0 0 836906 728762 SKY LAKES MEDICAL CENTER - THESE FUNDS WERE UTILIZED TO PURCHASE SPECIFIC EQUIPMENT FOR CONSTRUCTION AND OTHER PROJECTS AND PROGRAMS OF THE MEDICAL CENTER. 457630 457630 SKY LAKES MEDICAL CENTER PROGRAM OPERATIONS/REIMBURSEMENT - CHILD ABUSE RESPONSE AND EVALUATION SERVICES. 24992 24992 PATIENT ASSISTANCE PROGRAMS ARE PRIMARILY FOR THE CANCER TREATMENT CENTER OWNED BY SKY LAKES MEDICAL CENTER AND THE PATIENT ASSISTANCE PROGRAM. BOTH 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 FOR PATIENT BENEFIT THROUGH THE PATIENT ASSISTANCE PROGRAM WHICH IS CONTROLLED 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. 25220 25220 SCHOLARSHIPS, FUNDS FOR SMALLER PROJECTS, AND PROGRAMS WITHIN SKY LAKES MEDICAL CENTER AND SEVERAL SMALL ENTITIES AND PROGRAMS TO FURTHER THE MISSION OF THE FOUNDATION. 25220 25220 1344748 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 1 1 0 0 0 0 0 X 17 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 CA OR X SALLY-ANN PALCOVICH 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 CLARK PEDERSON CHAIR 3.00 1.00 X X 0 0 0 TOM SCHIESS VICE CHAIR 1.00 X X 0 0 0 JOHN BELL BOARD MEMBER 1.00 3.00 X 0 0 0 AMY BOIVIN BOARD MEMBER 1.00 X 0 0 0 MARTY LEDGERWOOD BOARD MEMBER 1.00 X 0 0 0 KERMIT HOUSER BOARD MEMBER 1.00 1.00 X 0 0 0 CHRIS KANDRA BOARD MEMBER 3.00 X 0 0 0 DAVID KING BOARD MEMBER 1.00 X 0 0 0 DOUGLAS MCINNIS DVM BOARD MEMBER 1.00 1.00 X 0 0 0 JEAN PHILLIPS BOARD MEMBER 1.00 1.00 X 0 0 0 JENNIFER SCANLAN BOARD MEMBER 1.00 X 0 0 0 PAUL STEWART BOARD MEMBER 1.00 50.00 X 0 566702 41986 THERESA TUCKER DDS BOARD MEMBER 1.00 X 0 0 0 WENDY WARREN MD BOARD MEMBER 1.00 1.00 X 0 0 0 ROD WENDT BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN PATTEE MD BOARD MEMBER 1.00 1.00 X 0 22550 0 HEIDI WRIGHT BOARD MEMBER 1.00 X 0 0 0 SALLY ANN PALCOVICH SECRETARY/DEVELOP OFFICE DIRECTOR 40.00 X 95930 0 14506 95930 589252 56492 0 0 1 0 0 6680 126736 618293 11451 751709 1127770 1127770 6954745 6534529 420216 420216 420216 31755 6680 13818 17937 17937 OTHER REVENUE 900099 15575 15575 15575 2333207 0 0 1581498 1206385 1206385 30219 30219 112235 22447 44894 44894 24214 4842 9686 9686 9085 1817 3634 3634 178 36 71 71 7000 1400 2800 2800 101987 101987 4463 4463 1348 270 539 539 4290 588 2526 1176 510 102 204 204 OPERATIONS 75818 75818 MEMBERSHIP AND DUES 4118 824 1647 1647 EVENT EXP-NET W/ REVENU -13818 -13818 1568032 1344748 172451 50833 78743 13974 90196 119376 1928701 1438345 15524640 17892014 17622280 19463709 745271 1427789 745271 1427789 X 12688149 13489731 4188860 4546189 16877009 18035920 17622280 19463709 765175 393736 0 X 0 1 X 1 0 X X X 0 0 0 SKY LAKES MEDICAL CENTER 930508781 3 1 1 1 1216501 1 1216501 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8 37 30971 2597787 22245 2616599 281257 16608184 1 1 14589830 170459 -420216 580298 0 214074 13545701 13956740 12716 2126606 10509 1214051 281672 14589830 11698651 20361 2760201 12270 220861 289342 13956740 12339426 98175 -202310 32407 256108 248125 11698651 11694819 86864 1209992 37029 390645 224575 12339426 1.00000 0.00000 0.00000 0 0 0 X PART V, LINE 4: CONTINUED GROWTH OF FUNDS WHICH ALLOWS FOR LARGER EXPENDITURES OF INVESTMENT AND OTHER INCOME TO BE SPENT WITHOUT EXPENDING ANY OF THE INITIAL GIFTED FUNDS OR DESIGNATED FUNDS TO REMAIN AS ENDOWED FUNDS. PART X, LINE 2: FIN 48 (ASC 740) UNCERTAIN TAX POSITION FOOTNOTE - THE FOUNDATION HAD NO UNRECOGNIZED TAX BENEFITS AT SEPTEMBER 30, 2014 OR 2013, THE FOUNDATION RECOGNIZES INTEREST ACCRUED AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AS AN ADMINISTRATIVE EXPENSE. DURING THE YEARS ENDED SEPTEMBER 30, 2014 AND 2013, THE FOUNDATION RECOGNIZED NO INTEREST AND PENALTIES. THE FOUNDATION FILES AN EXEMPT ORGANIZATION INFORMATION RETURN IN THE U.S. FEDERAL JURISDICTION. CARES ANNUAL EVENT 38435 6680 31755 900 4610 8308 38435 6680 31755 900 4610 8308 13818 17937 1 SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 501(C)(3) 1206385 PURCHASE EQUIPMENT, PROGRAM OPERATING COSTS 1 0 SCHOLARSHIPS - PAID TO SCHOOLS ON BEHALF OF STUDENTS 18 18200 PATIENT FINANCIAL ASSISTANCE 85 12019 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 347702 0 219000 0 0 0 26173 0 15813 0 608688 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR. MEMBERS OF THE BOARD OF DIRECTORS ARE E-MAILED A COPY OF FORM 990 FOR REVIEW 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. FORM 990, PAGE 1, ITEM J - WEBSITE: WWW.SKYLAKES.ORG/ABOUT-US/FOUNDATION/11883/CONTENT.ASPX SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 HEALTHCARE OR 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0