CLARK FORK VALLEY HOSPITAL FOUNDATION INC: Form 990EZ, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- CLARK FORK VALLEY HOSPITAL FOUNDATION INC (EIN 81-0304386)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-08-15
- IRS object ID
- 201142279349201354
- Schema version
- 2010v3.4
- 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) |
|---|---|---|
| Timestamp | 2011-08-15T10:17:54-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JORDAHL & SLITER PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810304386 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CLAR | NameControl |
| Phone | 4068264858 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAWN LYNCH | Name |
| Title | SECRETARY TREASURER | Title |
| Phone | 4068254858 | Phone |
| Date Signed | 2011-08-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JUSTIN P SLITER | Name |
| Phone | 4067521040 | Phone |
| Date Prepared | 2011-08-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Web Site | N/A | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 39736 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 27162 | ContributionsGiftsGrantsEtc |
| Fundraising Gross Income | 12354 | FundraisingGrossIncome |
| Special Events Direct Expenses | 2574 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | 9780 | SpecialEventsNetIncomeLoss |
| Other Revenue Total | 220 | OtherRevenueTotal |
| Total Revenue | 37162 | TotalRevenue |
| Grants And Similar Amounts Paid | 6976 | GrantsAndSimilarAmountsPaid |
| Fees And Oth Pymt To Ind Contractors | 3672 | FeesAndOthPymtToIndContractors |
| Other Expenses Total | 1439 | OtherExpensesTotal |
| Total Expenses | 12087 | TotalExpenses |
| Excess Or Deficit For Year | 25075 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 19388 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | 0 | OtherChangesInNetAssets |
| Net Assets Or Fund Balances EOY | 44463 | NetAssetsOrFundBalancesEOY |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19388 | BOY |
| EOY | 44463 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19388 | BOY |
| EOY | 44463 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19388 | BOY |
| EOY | 44463 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Primary Exempt Purpose | THE FOUNDATION IS A SOLE SUPPORT ORGANIZATION TOTALLY COMMITTED TO SUPPORTING THE FUNCTION AND PURPOSE OF CLARK FORK VALLEY HOSPITAL. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | THE FOUNDATION CONDUCTED A SUCCESSFUL GOLF TOURNAMENT TO RAISE ALMOST $10,000 IN FUNDS TO SUPPORT THE CLARK FORK VALLEY HOSPITAL. THE FOUNDATION ALSO CONDUCTS EVENTS TO RAISE AWARENESS OF THE HOSPITAL AND ITS FUNCTION WITHIN THE COMMUNITY. | DescriptionProgramServiceAccom |
| Grants And Allocations | 6976 | GrantsAndAllocations |
| Program Service Expenses | 11108 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 11108 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc |
|---|---|---|---|---|---|---|---|
| NICHOLAS LAWYER | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | PRESIDENT | 0.50 | 0 | 0 |
| DAWN LYNCH | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | SECRETARY TREASURER | 0.50 | 0 | 0 |
| LINDA SHROCK | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | DIRECTOR | 0.50 | 0 | 0 |
| WADE REHBEIN | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | DIRECTOR | 0.50 | 0 | 0 |
| BETTY BOEHLER | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | DIRECTOR | 0.50 | 0 | 0 |
| DAPHNE BOLES | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | DIRECTOR | 0.50 | 0 | 0 |
| SHARON NICHOLS | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | DIRECTOR | 0.50 | 0 | 0 |
| GREG HANSON MD | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | PRESIDENT/CEO - CFVH (EX OFFI | 0.50 | 0 | 0 |
| BARRY FOWLER | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | EXECUTIVE DIRECTOR (EX OFFICI | 10.00 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | 0 | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | 0 | OrganizationHadUBI |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtc |
| Direct Indirect Political Expend | 0 | DirectIndirectPoliticalExpend |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficers |
| Tax Imposed Under IRC4911 | 0 | TaxImposedUnderIRC4911 |
| Tax Imposed Under IRC4912 | 0 | TaxImposedUnderIRC4912 |
| Tax Imposed Under IRC4955 | 0 | TaxImposedUnderIRC4955 |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTrans |
| Amount Of Tax Imposed On Org Mgr | 0 | AmountOfTaxImposedOnOrgMgr |
| Amount Of Tax Reimbursed By Org | 0 | AmountOfTaxReimbursedByOrg |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARRY FOWLER EXEC DIRECTOR | BusinessNameLine1 |
Address US AddressUS
| 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) |
|---|---|---|
| Telephone Number | 4068254858 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Foreign Office | 0 | ForeignOffice |
| Maintain Any Donor Advised Funds | 0 | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | 0 | DoesOrgHaveHospital |
| Tanning Services Provided | 0 | TanningServicesProvided |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction With Control Entity | 0 | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | 0 | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | 0 | EngageInLobbyingActivities |
| Operating School | 0 | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | 0 | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | 1 | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| 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 | CLARK FORK VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810475376 | EIN |
| Type Of Organization | 501(C)(3) | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Amount | $6,976 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 6976 | 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 O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER REVENUE | FORM 990-EZ, PART I, LINE 8 | DESCRIPTION: INTEREST INCOME. AMOUNT: 220. |
| GRANTS AND SIMILAR AMOUNTS PAID | FORM 990-EZ, PART I, LINE 10 | ACTIVITY CLASSIFICATION: EQUIPMENT PURCHASES & OPERATIONS. GRANTEE NAME: CLARK FORK VALLEY HOSPITAL. GRANTEE ADDRESS: 10 KRUGER ROAD PLAINS, MT 59859. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 99/99/99. AMOUNT GIVEN: 6,976. |
| OTHER EXPENSES | FORM 990-EZ, PART I, LINE 16 | DESCRIPTION: BANK FEES. AMOUNT: 50. DESCRIPTION: CONFERENCES. AMOUNT: 1,047. DESCRIPTION: MEMBERSHIPS AND DUES. AMOUNT: 157. DESCRIPTION: MISCELLANEOUS. AMOUNT: 185. TOTAL TO FORM 990-EZ, LINE 16: 1,439. |
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. | Declaration |