2014-08-15T16:02:42-05:00 2013-09-30 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990 2012-10-01 930946020 SKY LAKES MEDICAL CENTER FOUNDATION SKYL 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 PAUL STEWART 5412744768 2014-08-13 1 WENDY CAMPOS P00448102 5032421447 2012 2015-11-30 17:44:51Z PAUL STEWART 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 9054292 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. 18 15 0 40 0 0 561929 501431 0 0 208316 1698430 73214 21519 843459 2221380 702638 2132874 0 0 144937 141674 0 0 147756 161232 209518 1008807 2484066 -165348 -262686 17085537 17622280 374017 745271 16711520 16877009 X TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 0 0 1200000 1200000 SKY LAKES MEDICAL CENTER - THESE FUNDS WERE UTILIZED TO PURCHASE SPECIFIC EQUIPMENT FOR CONSTRUCTION AND OTHER PROJECTS AND PROGRAMS OF THE MEDICAL CENTER. 447812 447812 SKY LAKES MEDICAL CENTER PROGRAM OPERATIONS/REIMBURSEMENT - CHILD ABUSE RESPONSE AND EVALUATION SERVICES. 40414 40414 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. 483537 444648 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. 483537 444648 2171763 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 1 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 0 X 18 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 OR CA X SALLY-ANN PALCOVICH 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 CLARK PEDERSON 3.00 1.00 X X 0 0 0 TOM SCHIESS 1.00 X X 0 0 0 JOHN BELL 1.00 3.00 X 0 0 0 SUSAN FRESCHI 0.30 X 0 0 0 MARTY LEDGERWOOD 1.00 X 0 0 0 KERMIT HOUSER 1.00 1.00 X 0 0 0 CHRIS KANDRA 3.00 X 0 0 0 DAVID KING 1.00 X 0 0 0 DOUGLAS MCINNIS DVM 1.00 1.00 X 0 0 0 GRANT NISKANEN MD 1.00 1.00 X 0 188718 7356 JEAN PHILLIPS 1.00 X 0 0 0 BERNARD SIMONSEN 1.00 1.00 X 0 0 0 GREGORY SINDMACK MD 1.00 7.00 X 0 6000 0 JENNIFER SCANLAN 1.00 X 0 0 0 PAUL STEWART 1.00 50.00 X 0 530703 26888 THERESA TUCKER DDS 1.00 X 0 0 0 WENDY WARREN MD 1.00 1.00 X 0 0 0 ROD WENDT 1.00 1.00 X 0 0 0 JOHN PATTEE MD 1.00 30.00 X 0 22550 0 HEIDI WRIGHT 1.00 X 0 0 0 SALLY ANN PALCOVICH 40.00 X 95930 0 15818 95930 747971 50062 0 0 1 0 0 26496 9834 120541 344560 12999 501431 412786 412786 8101765 6816121 1285644 1285644 1285644 11345 26496 16791 -5446 -5446 OTHER REVENUE 900099 26965 26965 26965 2221380 0 0 1719949 2108577 2108577 24297 24297 110875 22175 44350 44350 22034 1504 10265 10265 8765 1753 3506 3506 273 55 109 109 9595 1919 3838 3838 67744 33872 33872 91276 45638 45638 49325 9865 19730 19730 2658 530 1064 1064 510 102 204 204 20 4 8 8 MEMBERSHIP AND DUES 4053 811 1621 1621 DONOR RECOGNITION 855 171 342 342 EVENT EXP-NET W/ REVENU -16791 -16791 2484066 2171763 164547 147756 40039 78743 135034 90196 1929404 1928701 14981060 15524640 17085537 17622280 374017 745271 374017 745271 X 11472988 12688149 5238532 4188860 16711520 16877009 17085537 17622280 -262686 428175 0 X 0 1 X 1 0 X X X 0 0 0 SKY LAKES MEDICAL CENTER 930508781 3 1 1 1 2108577 1 2108577 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12 39 68559 2597787 49746 2616599 268823 16608184 1 1 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 14291129 164841 -2183225 10388 341106 226432 11694819 1.00000 0.00000 0.00000 0 0 0 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. CARES ANNUAL EVENT 30846 26496 4350 931 700 3700 8052 LAKE OF THE WOODS RUN 6995 6995 43 237 3128 37841 26496 11345 974 937 3700 11180 16791 -5446 1 SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 501(C)(3) 2108577 PURCHASE EQUIPMENT, PROGRAM OPERATING COSTS 1 0 SCHOLARSHIPS - PAID TO SCHOOLS ON BEHALF OF STUDENTS 12 8950 PATIENT FINANCIAL ASSISTANCE INCLUDING CTC 55 8692 VARIOUS SERVICES RENDERED (TEACHING CLASSES, PIANO TUNING) 5 6655 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 GRANT NISKANEN MD 0 188718 0 0 0 0 0 7356 0 0 0 196074 0 0 PAUL STEWART 0 530703 0 0 0 0 0 12500 0 14388 0 557591 0 0 DA DAVIDSON & CO (DAD) CLARK PEDERSON IS THE FOUNDATION'S BOARD CHAIR AND IS A VP AT DAD 67740 THE FOUNDATION PAID BROKERAGE FEES TO DAD 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/SKY-LAKES-MEDICAL-CENTER-FOUNDATION/DEFAULT SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 HEALTHCARE OR 501(C)(3) 170(B)(1) (A)(I) N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0