SKY LAKES MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- SKY LAKES MEDICAL CENTER FOUNDATION INC (EIN 93-0946020)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-15
- IRS object ID
- 201142279349302624
- Schema version
- 2009v1.7
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-15T13:10:51-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 SW Broadway 1200 | AddressLine1 |
| City | Portland | City |
| State | OR | State |
| ZIP Code | 97205 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930946020 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sky Lakes Medical Center Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SKYL | NameControl |
| Phone | 5412744768 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 Daggett Avenue | AddressLine1 |
| City | Klamath Falls | City |
| State | OR | State |
| ZIP Code | 97601 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Paul Stewart | Name |
| Title | President/CEO | Title |
| Phone | 5412744768 | Phone |
| Date Signed | 2011-08-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Wendy Campos | Name |
| Phone | 5032421447 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Paul Stewart | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 Daggett Avenue | AddressLine1 |
| City | Klamath Falls | City |
| State | OR | State |
| ZIP Code | 97601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5385760 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.SKYLAKES.ORG/FOUNDATION.HTML | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | To advance the vision and mission of Sky Lakes Medical Center through philanthropy; The Foundation's work is fundraising and stewardship. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 17 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 8 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 510970 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 507117 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -4702286 | InvestmentIncomePriorYear |
| Investment Income Current Year | 635035 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 40364 | OtherRevenuePriorYear |
| Other Revenue Current Year | 44312 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | -4150952 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1186464 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 774191 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 839173 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 129002 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 140334 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 67590 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 105363 | OtherExpensePriorYear |
| Other Expenses Current Year | 53723 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1008556 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1033230 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -5159508 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 153234 | RevenuesLessExpensesCY |
| Total Assets BOY | 14129530 | TotalAssetsBOY |
| Total Assets EOY | 15096638 | TotalAssetsEOY |
| Total Liabilities BOY | 98361 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 337283 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14031169 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 14759355 | NetAssetsOrFundBalancesEOY |
| Mission Description | Sky Lakes Medical Center will continually strive to reduce the burden of illness, injury and disability, and to improve the health, self-reliance and well-being of the people we serve. We will demonstrate that we are competent and caring in all we do. We shall endeavor to be so successful in this effort that we will become a preeminent healthcare center. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 326719 | Expense |
| Grants | 299335 | Grants |
| Description | SKY LAKES MEDICAL CENTER - THESE FUNDS WERE UTILIZED TO PURCHASE SPECIFIC EQUIPMENT, FOR CONSTRUCTION AND OTHER BUILDING PROJECTS, AND FOR PROGRAMS FOR THE MEDICAL CENTER. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 341613 | Expense |
| Grants | 341613 | Grants |
| Description | SKY LAKES MEDICAL CENTER CARES PROGRAM/OPERATIONS REIMBURSEMENT - CHILD ABUSE RESPONSE AND EVALUATION SERVICES. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 198225 | Expense |
| Grants | 198225 | Grants |
| Description | SCHOLARSHIP FUNDS; OTHER SMALL PROJECTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 866557 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 1 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 17 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 0 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SALLY-ANN PALCOVICH | NamePerson |
| Telephone Number | 5412744768 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1 |
| City | KLAMATH FALLS | City |
| State | OR | State |
| ZIP Code | 97601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| clark pEDERSON | ||||||
| CHAIR | 3.00 | X | X | 0 | 0 | 0 |
| KErMIT HOUSER | ||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| CINDY BALIN | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| JOHN BELL | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| CHRIS KANDRA | ||||||
| BOARD MEMBER | 5.00 | X | 0 | 0 | 0 | |
| lINDA TURNER | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| jEAN PHILLIPS | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| bERNARD SIMONSEN | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| grEGORY SINDMACK MD | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| lISA VAUGHN | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| ROD WENDT | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| WENDY WARREN MD | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| LINDA WEIDER | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| HEIDI WRIGHT | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| DOUG MCINNIS | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| TOm Schiess | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| SUSAN FRESCHI | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| pAUL STEWART | ||||||
| pRESIDENT/CEO | 5.00 | X | X | 0 | 423169 | 25933 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 423169 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 25933 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 16870 | FundraisingEvents |
| Government Grants | 180731 | GovernmentGrants |
| All Other Contributions | 309516 | AllOtherContributions |
| Noncash Contributions | 15218 | NoncashContributions |
| Total Contributions | 507117 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 236956 | TotalRevenueColumn |
| Exclusion | $236,956 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4565882 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4167803 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 398079 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 398079 | TotalRevenueColumn |
| Exclusion | $398,079 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 47389 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 16870 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 31493 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15896 | TotalRevenueColumn |
| Exclusion | $15,896 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 28416 | TotalRevenueColumn |
| Exclusion | $28,416 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 28416 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1186464 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $679,347 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 640948 | Total |
| Program Services | 640948 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 198225 | Total |
| Program Services | 198225 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113714 | Total |
| Program Services | 20098 | ProgramServices |
| Management And General | 46808 | ManagementAndGeneral |
| Fundraising | 46808 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4855 | Total |
| Program Services | 971 | ProgramServices |
| Management And General | 1942 | ManagementAndGeneral |
| Fundraising | 1942 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12990 | Total |
| Program Services | 2598 | ProgramServices |
| Management And General | 5196 | ManagementAndGeneral |
| Fundraising | 5196 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8775 | Total |
| Program Services | 1755 | ProgramServices |
| Management And General | 3510 | ManagementAndGeneral |
| Fundraising | 3510 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75094 | Total |
| Management And General | 37547 | ManagementAndGeneral |
| Fundraising | 37547 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5740 | Total |
| Program Services | 1148 | ProgramServices |
| Management And General | 2296 | ManagementAndGeneral |
| Fundraising | 2296 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1645 | Total |
| Program Services | 329 | ProgramServices |
| Management And General | 658 | ManagementAndGeneral |
| Fundraising | 658 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1340 | Total |
| Program Services | 268 | ProgramServices |
| Management And General | 536 | ManagementAndGeneral |
| Fundraising | 536 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MISCELLANEOUS | 1397 | 217 | 590 | 590 |
| EVENT EXP-NETTED W/ REV | -31493 | -31493 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1033230 | Total |
| Program Services | 866557 | ProgramServices |
| Management And General | 99083 | ManagementAndGeneral |
| Fundraising | 67590 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2517 | BOY |
| EOY | 21123 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1340875 | BOY |
| EOY | 1099805 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2004812 | BOY |
| EOY | 1972584 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15524 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10663463 | BOY |
| EOY | 11897339 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 102339 | BOY |
| EOY | 105787 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14129530 | BOY |
| EOY | 15096638 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48552 | BOY |
| EOY | 284025 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49809 | BOY |
| EOY | 53258 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98361 | BOY |
| EOY | 337283 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9372677 | BOY |
| EOY | 9842594 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4658492 | BOY |
| EOY | 4916761 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14031169 | BOY |
| EOY | 14759355 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14129530 | BOY |
| EOY | 15096638 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SKY LAKES MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930508781 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $640,948 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 640948 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number DA Fs Held | 9 | NumberDAFsHeld |
| Number Funds Held | 44 | NumberFundsHeld |
| Donor Advised Contributions | 42917 | DonorAdvisedContributions |
| Contrib To Funds And Other Accounts | 171838 | ContribToFundsAndOtherAccounts |
| Grants Paid From Donor Funds | 20325 | GrantsPaidFromDonorFunds |
| Grants Funds And Other Accounts | 235911 | GrantsFundsAndOtherAccounts |
| Aggregate DAF Value | 239937 | AggregateDAFValue |
| Aggregate Fund Value | 14519417 | AggregateFundValue |
| Disclosed Orgs Legal Control | 1 | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | 1 | DisclosedForCharitablePurposes |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 11694819 | BeginningOfYearBalance |
| Contributions | 86864 | Contributions |
| Investment Earnings Or Losses | 1209992 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 37029 | GrantsOrScholarships |
| Other Expenditures | 390645 | OtherExpenditures |
| Administrative Expenses | 224575 | AdministrativeExpenses |
| End Of Year Balance | 12339426 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 14291129 | BeginningOfYearBalance |
| Contributions | 164841 | Contributions |
| Investment Earnings Or Losses | -2183225 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 10388 | GrantsOrScholarships |
| Other Expenditures | 341106 | OtherExpenditures |
| Administrative Expenses | 226432 | AdministrativeExpenses |
| End Of Year Balance | 11694819 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.84000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SPLIT INTEREST AGREEMENT LIABILITY | Description |
| Amount | $53,258 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 53258 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part V, Line 4: | Identifier |
| Return Reference | Description of Intended Use of Endowment Funds: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Lake of the Woods Run | NameOfEvent1 |
| Gross Receipts Event1 | 5723 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 5723 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 237 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 2647 | OtherDirectExpensesEvent1 |
| Name Of Event2 | CARES Annual Dinner | NameOfEvent2 |
| Gross Receipts Event2 | 58266 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 16870 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 41396 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 10101 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 500 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 18008 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 270 | GrossReceiptsOtherEvents |
| Gross Revenue Other Events | 270 | GrossRevenueOtherEvents |
| Gross Receipts Total | 64259 | GrossReceiptsTotal |
| Charitable Contributions Total | 16870 | CharitableContributionsTotal |
| Gross Revenue Total Events | 47389 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 10101 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 737 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 20655 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 31493 | DirectExpenseSummaryEvents |
| Net Income Summary | 15896 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|---|
| SKY LAKES MEDICAL CENTER | ||||||||||
| 2865 DAGGETT AVENUE | KLAMATH FALLS | OR | 97601 | 930508781 | 501(C)(3) HOSPITAL | 284117 | 15218 | FMV | Medical Office & Computer Equipment | Operations Support |
| SKY LAKES MEDICAL CENTER CARES PROGRAM | ||||||||||
| 2865 DAGGETT AVENUE | KLAMATH FALLS | OR | 97601 | 930508781 | 501(C)(3) HOSPITAL | 341613 | Programs Support | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII (3 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| Scholarships - paid to schools on behalf of students | 23 | 18750 |
| Patient Financial Assistance including CTC | 126 | 38991 |
| Continuing Education Costs Physicians (In house presentations and conferences) | 21 | 19010 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | pAUL STEWART | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 303169 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 120000 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 12250 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 13683 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 449102 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Valley Wealth Management (SVWM) | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | CLARK PEDERSON IS THE FOUNDATION'S BOARD CHAIR AND IS A VP AT SVWM | Relationship |
| Amount Of Transaction | 11995 | AmountOfTransaction |
| Description Of Transaction | THE FOUNDATION PAYS BROKERAGE FEES TO SVWM | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 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 | The Board of Directors monitors the policy throughout the year and meets quarterly to monitor and enforce compliance with the policy. |
| 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
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SKY LAKES MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2865 DAGGETT AVENUE | AddressLine1 |
| City | KLAMATH FALLS | City |
| State | OR | State |
| ZIP Code | 97601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930508781 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | OR | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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