CLARK FORK VALLEY HOSPITAL FOUNDATION INC: Form 990EZ, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CLARK FORK VALLEY HOSPITAL FOUNDATION INC (EIN 81-0304386)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-05-14
- IRS object ID
- 201441349349203879
- Schema version
- 2013v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-05-14T16:02:31-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 810497523 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JORDAHL & SLITER PLLC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8600 | AddressLine1 |
| City | KALISPELL | City |
| State | MT | State |
| ZIP Code | 599041600 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810304386 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAR | BusinessNameControlTxt |
| Phone | 4068264858 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 768 | AddressLine1 |
| City | PLAINS | City |
| State | MT | State |
| ZIP Code | 59859 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DACY HOLLAND | PersonNm |
| Person Title | VICE PRESIDENT | PersonTitleTxt |
| Phone | 4068254858 | PhoneNum |
| Signature | 2014-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JUSTIN P SLITER | PreparerPersonNm |
| PTIN | P00188996 | PTIN |
| Phone | 4067521040 | PhoneNum |
| Preparation | 2014-05-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Website Address | N/A | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $26,428 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $14,787 | ContributionsGiftsGrantsEtcAmt |
| Investment Income | $128 | InvestmentIncomeAmt |
| Fundraising Gross Income | $11,513 | FundraisingGrossIncomeAmt |
| Special Events Direct Expenses | $2,667 | SpecialEventsDirectExpensesAmt |
| Special Events Net Income Loss | $8,846 | SpecialEventsNetIncomeLossAmt |
| Total Revenue | $23,761 | TotalRevenueAmt |
| Grants And Similar Amounts Paid | $10,749 | GrantsAndSimilarAmountsPaidAmt |
| Fees And Other Pymt To Ind Cntrct | $1,750 | FeesAndOtherPymtToIndCntrctAmt |
| Printing Publications Postage | $18 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $412 | OtherExpensesTotalAmt |
| Total Expenses | $12,929 | TotalExpensesAmt |
| Excess Or Deficit For Year | $10,832 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $46,169 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $57,001 | NetAssetsOrFundBalancesEOYAmt |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,169 | BOYAmt |
| EOY | $57,001 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,169 | BOYAmt |
| EOY | $57,001 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,169 | BOYAmt |
| EOY | $57,001 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | THE FOUNDATION IS A SOLE SUPPORT ORGANIZATION TOTALLY COMMITTED TO SUPPORTING THE FUNCTION AND PURPOSE OF CLARK FORK VALLEY HOSPITAL. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp (4 entries)
| Description Program Srvc AccomDescriptionProgramSrvcAccomTxt | Grants And AllocationsGrantsAndAllocationsAmt | Program Service ExpensesProgramServiceExpensesAmt |
|---|---|---|
| THE FOUNDATION DONATED OVER $10,000 FOR NEW KITCHEN AND DINING EQUIMENT FOR THE HOSPITAL. THE FOUNDATION ALSO CONDUCTED EVENTS TO RAISE AWARENESS OF THE HOSPITAL AND ITS FUNCTION WITHIN THE COMMUNITY. | $8,465 | $8,465 |
| THE FOUNDATION WORKED TO RAISE AWARENESS OF THE IMPACT OF RURAL HEALTHCARE AMONG THE COMMUNITY AND PHILANTHROPIC SUPPORT AMONG EMPLOYEES. | $0 | $0 |
| OVERSAW THE OPERATION OF THE HOSPITAL GIFT SHOP, MEMENTOS, AND ADDED A SPECIALTY COFFEE SHOP. | $2,284 | $2,284 |
| EXPANDED THE BOARD SIZE TO INLCUDE MORE MEMBERS THUS EXPANDING REACH AND AWARENESS INTO THE COMMUNITY. | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $10,749 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (10 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| DAPHNE BOLES | ||||
| PRESIDENT | 1.00 | $0 | $0 | $0 |
| DAWN LYNCH | ||||
| SECRETARY TREASURER | 1.00 | $0 | $0 | $0 |
| THOMAS OLDING | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| JANICE BLAKE | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| BETTY BOEHLER | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| DACY HOLLAND | ||||
| VICE PRESIDENT | 1.00 | $0 | $0 | $0 |
| JOHN DRYE | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| MARIE HARTMAN | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| KAY NYGAARD | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| DEBBIE MEYER | ||||
| DIRECTOR | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 768 | AddressLine1 |
| City | PLAINS | City |
| State | MT | State |
| ZIP Code | 59859 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4068254858 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Certification | Yes (X) | CertificationInd |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810475376 | EIN |
| Organization Type | 501(C)(3) | OrganizationTypeDesc |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $10,749 | SupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $10,749 | SupportSumAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME | DESCRIPTION: INTEREST INCOME. AMOUNT: 128. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: EQUIPMENT PURCHASES & OPERATIONS. GRANTEE NAME: CLARK FORK VALLEY HOSPITAL. GRANTEE ADDRESS: 10 KRUGER ROAD PLAINS, MT 59859. GRANTEE RELATIONSHIP: SUPPORTED ORGANIZATION. AMOUNT GIVEN: 10,749. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: MEMBERSHIPS AND DUES. AMOUNT: 412. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. | DeclarationDesc |