2011-08-15T13:10:51-05:00 2010-09-30 Moss Adams LLP 805 SW Broadway 1200 Portland OR 97205 990 2009-10-01 930946020 Sky Lakes Medical Center Foundation SKYL 5412744768 2865 Daggett Avenue Klamath Falls OR 97601 Paul Stewart 5412744768 2011-08-11 1 Wendy Campos 5032421447 2009 2016-02-24 21:20:13Z Paul Stewart 2865 Daggett Avenue Klamath Falls OR 97601 5385760 0 X WWW.SKYLAKES.ORG/FOUNDATION.HTML X 1986 OR To advance the vision and mission of Sky Lakes Medical Center through philanthropy; The Foundation's work is fundraising and stewardship. 18 17 0 8 0 0 510970 507117 0 -4702286 635035 40364 44312 -4150952 1186464 774191 839173 0 129002 140334 0 67590 105363 53723 1008556 1033230 -5159508 153234 14129530 15096638 98361 337283 14031169 14759355 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. 0 0 326719 299335 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. 341613 341613 SKY LAKES MEDICAL CENTER CARES PROGRAM/OPERATIONS REIMBURSEMENT - CHILD ABUSE RESPONSE AND EVALUATION SERVICES. 198225 198225 SCHOLARSHIP FUNDS; OTHER SMALL PROJECTS. 866557 1 1 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 18 17 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 OR CA X SALLY-ANN PALCOVICH 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 X clark pEDERSON 3.00 X X 0 0 0 KErMIT HOUSER 1.00 X X 0 0 0 CINDY BALIN 1.00 X 0 0 0 JOHN BELL 1.00 X 0 0 0 CHRIS KANDRA 5.00 X 0 0 0 lINDA TURNER 1.00 X 0 0 0 jEAN PHILLIPS 1.00 X 0 0 0 bERNARD SIMONSEN 2.00 X 0 0 0 grEGORY SINDMACK MD 1.00 X 0 0 0 lISA VAUGHN 1.00 X 0 0 0 ROD WENDT 1.00 X 0 0 0 WENDY WARREN MD 1.00 X 0 0 0 LINDA WEIDER 1.00 X 0 0 0 HEIDI WRIGHT 1.00 X 0 0 0 DOUG MCINNIS 1.00 X 0 0 0 TOm Schiess 1.00 X 0 0 0 SUSAN FRESCHI 1.00 X 0 0 0 pAUL STEWART 5.00 X X 0 423169 25933 0 423169 25933 0 0 1 0 0 16870 180731 309516 15218 507117 236956 236956 4565882 4167803 398079 398079 398079 47389 16870 31493 15896 15896 OTHER REVENUE 900099 28416 28416 28416 1186464 0 0 679347 640948 640948 198225 198225 113714 20098 46808 46808 4855 971 1942 1942 12990 2598 5196 5196 8775 1755 3510 3510 75094 37547 37547 5740 1148 2296 2296 1645 329 658 658 1340 268 536 536 MISCELLANEOUS 1397 217 590 590 EVENT EXP-NETTED W/ REV -31493 -31493 1033230 866557 99083 67590 2517 21123 1340875 1099805 2004812 1972584 15524 10663463 11897339 102339 105787 14129530 15096638 48552 284025 49809 53258 98361 337283 X 9372677 9842594 4658492 4916761 14031169 14759355 14129530 15096638 X 0 1 1 X 0 X X 0 0 0 SKY LAKES MEDICAL CENTER 930508781 3 1 1 1 640948 1 640948 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9 44 42917 171838 20325 235911 239937 14519417 1 1 11694819 86864 1209992 37029 390645 224575 12339426 14291129 164841 -2183225 10388 341106 226432 11694819 0.84000 0.00000 0.00000 0 0 0 SPLIT INTEREST AGREEMENT LIABILITY 53258 53258 Part V, Line 4: Description of Intended Use of Endowment Funds: 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. Lake of the Woods Run 5723 5723 237 2647 CARES Annual Dinner 58266 16870 41396 10101 500 18008 1 270 270 64259 16870 47389 10101 737 20655 31493 15896 1 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 2 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 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 pAUL STEWART 0 303169 0 0 0 120000 0 12250 0 13683 0 449102 0 0 South Valley Wealth Management (SVWM) CLARK PEDERSON IS THE FOUNDATION'S BOARD CHAIR AND IS A VP AT SVWM 11995 THE FOUNDATION PAYS BROKERAGE FEES TO SVWM 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 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. SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930508781 HEALTHCARE OR 501(c)(3) 3 N/A 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0