2024-08-12T11:18:49-05:00 2023-09-30 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1400 PORTLAND OR 97205 990 2022-10-01 930946020 SKY LAKES MEDICAL CENTER FOUNDATION SKYL 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 RICHARD RICO VP/CFO 5412744768 2024-08-07 1 1 WENDY CAMPOS P00448102 5032421447 2024-08-07 2022 2024-08-08 14:25:15Z DAVID CAUBLE 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 10375917 0 X WWW.SKYLAKES.ORG/FOUNDATION/ X 1986 OR TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 16 15 0 16 0 0 1824151 1212440 0 0 701412 1034170 -7640 -10340 2517923 2236270 1772733 1691438 0 0 241633 154680 0 0 39368 507366 330926 2521732 2177044 -3809 59226 21463408 24209640 483399 254962 20980009 23954678 TO ADVANCE THE VISION AND MISSION OF SKY LAKES MEDICAL CENTER THROUGH PHILANTHROPY; THE FOUNDATION'S WORK IS FUNDRAISING AND STEWARDSHIP. 0 0 1438112 1438112 SKY LAKES MEDICAL CENTER - FUNDS UTILIZED TO PURCHASE SPECIFIC EQUIPMENT FOR CONSTRUCTION AND OTHER PROJECTS AND PROGRAMS OF THE MEDICAL CENTER. 531636 253326 OTHER PROGRAMS INCLUDING: (1) PATIENT ASSISTANCE PROGRAMS FOR ITEMS OF COMFORT DURING TREATMENT AND FINANCIAL ASSISTANCE 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 FOR ITEMS THAT CANNOT BE PURCHASED BY PATIENTS OR THEIR FAMILIES BUT ARE A NECESSITY FOR TREATMENT OR TRAVEL. (2) SCHOLARSHIPS PROVIDED FOR HEALTHCARE PROFESSIONALS AND PLAY AN IMPORTANT ROLE IN SUPPORTING THE HOSPITAL IN ATTRACTING AND RETAINING EXCEPTIONAL CLINICAL STAFF. (3) CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES). 1969748 1 1 0 0 0 1 0 0 0 1 0 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 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 CA OR X LAUREN JESPERSEN 5412744768 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 CAUBLE DAVID - BOARD MBR SECRETARY TILL 10/30/22, SLMC CEO 1.00 40.00 X X 0 649728 36370 LEDGERWOOD MARTY CHAIR 1.00 0.00 X X 0 0 0 SCHIESS TOM VICE CHAIR 1.00 0.00 X X 0 0 0 BELL JOHN BOARD MEMBER 1.00 3.00 X 0 0 0 BOIVIN AMY BOARD MEMBER 1.00 0.00 X 0 0 0 HOLLIDAY RAY BOARD MEMBER 1.00 0.00 X 0 0 0 KANDRA CHRIS BOARD MEMBER 1.00 0.00 X 0 0 0 MCINNIS DOUG DVM BOARD MEMBER 1.00 1.00 X 0 0 0 MOISA RADU BOARD MEMBER 1.00 1.00 X 0 0 0 NEEL BIGGS HEIDI BOARD MEMBER 1.00 1.00 X 0 0 0 SCANLAN JENNIFER BOARD MEMBER 1.00 0.00 X 0 0 0 WARREN WENDY MD BOARD MEMBER 1.00 1.00 X 0 0 0 WENDT ROD BOARD MEMBER 1.00 1.00 X 0 0 0 MONTJOY HOLLY BOARD MEMBER 1.00 0.00 X 0 0 0 SMITH ANDREW BOARD MEMBER 1.00 0.00 X 0 0 0 MCCREADIE G SCOTT MD BOARD MEMBER 1.00 1.00 X 0 484814 40207 STORK DAVID BOARD MEMBER 1.00 1.00 X 0 0 0 JESPERSEN LAUREN DIRECTOR 40.00 0.00 X 114363 0 6841 114363 1134542 83418 0 0 1 0 0 35203 652312 524925 1212440 384895 384895 8778582 8129307 649275 649275 649275 0 35203 10340 -10340 -10340 2236270 0 0 1023830 1574037 1574037 117401 117401 134225 134225 196 196 8087 8087 1810 1810 10362 10362 2600 520 1040 1040 9700 1940 3880 3880 128560 128560 47035 9407 18814 18814 1859 371 744 744 10385 2077 4154 4154 26840 5368 10736 10736 EULANA PARK PROJECT 77309 77309 MOORE PARK PROJECT 59821 59821 COMMUNITY ART PROJECTS 41805 41805 -74988 -74988 2177044 1969748 167928 39368 224582 843326 116215 141114 750000 750000 20372611 22475200 21463408 24209640 120559 128896 362840 126066 483399 254962 X 13070640 14403663 7909369 9551015 20980009 23954678 21463408 24209640 59226 2915443 0 X 0 1 X 1 0 X X X 1 SKY LAKES MEDICAL CENTER 930508781 3 1 1438112 0 1 1438112 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8 31 148605 1103024 111316 1712482 7550481 16404226 1 1 6328288 140000 1223786 141593 7550481 6981087 674284 -1322860 4223 6328288 5079505 220491 1757202 39000 37111 6981087 4567616 1700 538586 29111 -714 5079505 4337398 33078 237779 40455 184 4567616 0.00000 0.00000 1.00000 0 0 0 DUE TO SLMC 126066 126066 X 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: 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, 2023 OR 2022. 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, 2023 AND 2022, 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. GOLF TOURNAMENT 35203 35203 0 248 780 6170 3142 35203 35203 248 780 6170 3142 10340 -10340 1 SKY LAKES MEDICAL CENTER 2865 DAGGETT AVE KLAMATH FALLS OR 97601 930508781 501(C)(3) 1438112 0 ANNUAL SUPPORT OF HOSPITAL KLAMATH GROWN PO BOX 1305 KLAMATH FALLS OR 97601 881543151 501(C)(3) 62250 0 COMMUNITY SUPPORT INTEGRAL YOUTH SERVICES 115 NORTH 10TH STREET KLAMATH FALLS OR 97601 930981933 501(C)(3) 20000 0 COMMUNITY SUPPORT REFUGE CHURCH MALIN 1761 WASHBURN WAY KLAMATH FALLS OR 97603 930726979 501(C)(3) 11934 0 COMMUNITY SUPPORT BAPTIST CHURCH ON HOMEDALE 3052 HOMEDALE RD KLAMATH FALLS OR 97603 930805898 501(C)(3) 11600 0 COMMUNITY SUPPORT OSU EXTENSION OFFICE - KLAMATH COUNTY 6923 WASHBURN WAY KLAMATH FALLS OR 97603 611730890 GOVERNMENT 10211 0 COMMUNITY SUPPORT CROSSPOINT 5000 HOSANA WAY KLAMATH FALLS OR 97603 931001159 501(C)(3) 7930 0 COMMUNITY SUPPORT ABIDING PLACE MINISTRIES 71410 E HIGHWAY 140 BLY OR 97622 824722888 501(C)(3) 7000 0 COMMUNITY SUPPORT 8 0 CASCADE HEALTH ALLIANCE BENEVOLENT FUND 56 71987 INVOICE MEDICAL BILLS SKY LAKES CANCER TREATMENT CENTER 50 25612 COST TO PURCHASE GAS VOUCHERS & OTHER SUPPORT EMPLOYEE HELP FUND 17 9109 INVOICE GENERAL SUPPORT SKY LAKES WELLNESS CENTER 285 5693 COST TO PURCHASE GIFT CARDS INCENTIVIZING PARTICIPATION SKY LAKES VOLUNTEERS 18 5000 COST TO PURCHASE NURSING SCHOOL STUDENT SUPPLIES 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 CAUBLE DAVID - BOARD MBR SECRETARY TILL 10/30/22, SLMC CEO 0 648728 0 648728 0 1000 0 18300 0 18070 0 1334826 0 0 MCCREADIE G SCOTT MD BOARD MEMBER 0 461622 0 23192 0 0 0 18526 0 21681 0 525021 0 0 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. 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 SKY LAKES MEDICAL CENTER 0 KLAMATH MEDICAL BUSINESS CENTER LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 020731372 REAL AND PERSONAL PROPERTY RENTAL OR N/A 0 0 WEST PHYSICIAN SERVICES LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 870696029 PHYSICIAN SERVICES OR N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0