Klamath Medical Service Bureau in Klamath Falls, Oregon (OR)
Table of contents:
- Overview
- Detailed Reports
- Analysis of Revenue and Expenses
- Balance Sheets
- Capital Gains and Losses for Tax on Investment Income
- Excise Tax Based on Investment Income
- Statements Regarding Activities
- Statements Regarding Activities for Which Form 4720 May Be Required
- Minimum Investment Return
- Distributable Amount
- Undistributed Income
- Private Operating Foundations
- Supplementary Information
- Analysis of Income-Producing Activities
- Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
- Other organizations in Oregon
| Klamath Medical Service Bureau | |
| Employer Identification Number (EIN) | 931123593 |
| Name of Organization | Klamath Medical Service Bureau |
| Address | 11144 Siskin Ln, Klamath Falls, OR 97601-8640 |
| Subsection | Charitable Organization |
| Deductibility | Contributions are deductible |
| Foundation | Private non-operating foundation |
| Organization | Corporation |
| Exempt Organization Status | Unconditional Exemption |
| Tax Period | 12/2013 |
| Assets | $1,000,000 to $4,999,999 |
| Income | $1,000,000 to $4,999,999 |
| Filing Requirement | 990 - Not required to file (all other) |
| Asset Amount | $2,960,573 |
| Amount of Income | $1,431,494 |
| Form 990 Revenue Amount | $206,426 |
Non-representatives - add comments:
Revenue for 2013
Assets at the end of 2013
Expenses for 2013
| Analysis of Revenue and Expenses (for 2013) | ||||
| Revenue and expenses per books | Net investment income | Adjusted net income | Disbursements for charitable purposes (cash basis only) | |
|---|---|---|---|---|
| Total revenue | $295,920 | $295,920 | $0 | |
| Contributions, gifts, grants, etc., received | $0 | |||
| Interest on savings and temporary cash investments | $1 | |||
| Dividends and interest from securities | $114,371 | |||
| Gross rents | $0 | |||
| Gross sales price for all assets | $1,316,032 | |||
| Gross profit from sales of goods | $0 | |||
| Other income | $1,090 | |||
| Other | $180,458 | |||
| Total expenses and disbursements | $230,373 | $35,326 | $0 | $194,027 |
| Compensation of officers, directors, trustees, etc. | $19,383 | |||
| Pension plans, employee benefits | $0 | |||
| Legal fees | $0 | |||
| Accounting fees | $4,720 | |||
| Interest | $0 | |||
| Depreciation | $0 | |||
| Occupancy | $0 | |||
| Travel, conferences, and meetings | $725 | |||
| Printing and publications | $0 | |||
| Total operating and administrative expenses | $59,395 | $35,326 | $23,049 | |
| Contributions, gifts, grants paid | $170,978 | |||
| Excess of revenue over expenses and disbursements | $65,547 | |||
| Net investment income | $260,594 | |||
| Adjusted net income | $0 | |||
| Balance Sheets | ||||||
| 2011 | 2012 | 2013 | ||||
|---|---|---|---|---|---|---|
| Book Value | Fair Market Value | Book Value | Fair Market Value | Book Value | Fair Market Value | |
| Total assets | $2,911,823 | $3,188,572 | $2,894,813 | $3,277,211 | $2,960,573 | $3,594,900 |
| Cash - non-interest-bearing | $0 | $0 | $0 | |||
| Investments-U.S. and state government obligations | $403,282 | $415,325 | $312,973 | |||
| Investments-corporate stock | $1,842,065 | $1,830,114 | $1,964,257 | |||
| Investments-corporate bonds | $564,209 | $490,845 | $584,361 | |||
| Investments-mortgage loans | $0 | $0 | $0 | |||
| Investments-other | $0 | $0 | $0 | |||
| Other assets | $0 | $0 | ||||
| Total liabilities | $1,104 | $1,098 | $1,311 | |||
| Mortgages and other notes payable | $0 | $0 | $0 | |||
| Other liabilities | $1,098 | $1,311 | ||||
| Total liabilities and net assets/fund balances | $2,910,719 | $2,893,715 | $2,959,262 | |||
| Capital Gains and Losses for Tax on Investment Income | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| Capital gain net income | $128,229 | $92,363 | $180,458 |
| Net capital loss | $0 | $0 | $0 |
| Excise Tax Based on Investment Income | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| Domestic foundations that meet the section 4940(e) requirements (for Reduced Tax on Net Investment Income) | No | No | No |
| Tax based on investment income | $3,448 | $1,716 | $2,606 |
| Total credits and payments | $870 | $4,500 | $1,720 |
| Current year estimated tax payments and previous year's overpayment credited to current year | $870 | $3,480 | $1,720 |
| Exempt foreign organizations-tax withheld at source | $0 | $0 | $0 |
| Tax paid with application for extension of time to file (Form 8868) | $0 | $1,020 | $0 |
| Backup withholding erroneously withheld | $0 | $0 | $0 |
| Any penalty for underpayment of estimated tax | $6 | $0 | $0 |
| Tax due | $0 | $886 | |
| Overpayment | $2,784 | $0 | |
| Amount to be credited to next year's estimated tax | $0 | $1,720 | $0 |
| Statements Regarding Activities | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign? | No | No | No |
| Has the foundation engaged in any activities that have not previously been reported to the IRS? | No | No | |
| Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments? | No | No | |
| Has the foundation filed a tax return on Form 990-T for this year? | No | No | |
| Was there a liquidation, termination, dissolution, or substantial contraction during the year? | No | No | No |
| Has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate) of each state? | Yes | Yes | |
| Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for current calendar year or the taxable year beginning in this year? | No | No | No |
| Did any persons become substantial contributors during the tax year? | No | No | |
| Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? | No | No | |
| Did the foundation comply with the public inspection requirements for its annual returns and exemption application? | Yes | Yes | |
| Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 | No | No | |
| Statements Regarding Activities for Which Form 4720 May Be Required | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| During the year did the foundation (either directly or indirectly): | |||
| Engage in the sale or exchange, or leasing of property with a disqualified person? | No | No | No |
| Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? | No | No | No |
| Furnish goods, services, or facilities to (or accept them from) a disqualified person? | No | No | No |
| Pay compensation to, or pay or reimburse the expenses of, a disqualified person? | No | No | No |
| Transfer any income or assets to a disqualified person (or make any of either available for the benefit or use of a disqualified person)? | No | No | No |
| Agree to pay money or property to a government official? | No | No | No |
| Did any of the acts fail to qualify under the exceptions described in Regulations section 53.4941(d)-3 or in a current notice regarding disaster assistance? | No | No | |
| Did the foundation engage in a prior year in any of the acts, other than excepted acts, that were not corrected before the first day of the tax year beginning in this year? | No | No | |
| At the end of this tax year, did the foundation have any undistributed income for tax year(s) beginning before this year? | No | No | No |
| Are there any years listed above for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed income? | No | No | |
| Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? | No | No | No |
| Did the foundation have excess business holdings in this year as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? | No | No | No |
| Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? | No | No | No |
| Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in this year? | No | No | |
| During the year did the foundation pay or incur any amount to: | |||
| Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? | No | No | No |
| Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive? | No | No | No |
| Provide a grant to an individual for travel, study, or other similar purposes? | No | No | No |
| Provide a grant to an organization other than a charitable, etc., organization described in section 509(a)(1), (2), or (3), or section 4940(d)(2)? | No | No | No |
| Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals? | No | No | No |
| Did any of the transactions fail to qualify under the exceptions described in Regulations section 53.4945 or in a current notice regarding disaster assistance? | No | No | |
| Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? | No | No | |
| Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? | No | No | |
| Minimum Investment Return | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes | $3,404,454 | $3,297,939 | $3,394,426 |
| Net value of noncharitable-use assets | $3,248,470 | $3,343,510 | |
| Minimum investment return | $167,669 | $162,424 | $167,176 |
| Distributable Amount | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| Distributable amount | $164,221 | $160,708 | $164,570 |
| Undistributed Income | |||
| 2011 | 2012 | 2013 | |
|---|---|---|---|
| Distributable amount for this year | $164,221 | $160,708 | $164,570 |
| Undistributed income for this year. This amount must be distributed in the next year | $0 | $0 | $0 |
| Private Operating Foundations (for 2010 - 2013) | |||||
| 2013 | 2012 | 2011 | 2010 | Total | |
|---|---|---|---|---|---|
| The lesser of the adjusted net income or the minimum investment return | $0 | $0 | $0 | $0 | $0 |
| Qualifying distributions made directly for active conduct of exempt activities | $0 | $0 | $0 | $0 | $0 |
| Value of all assets | $0 | $0 | $0 | $0 | $0 |
| Value of assets qualifying under section 4942(j)(3)(B)(i) | $0 | $0 | $0 | $0 | $0 |
| 2/3 of minimum investment return | $0 | $0 | $0 | $0 | $0 |
| Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) | $0 | $0 | $0 | $0 | $0 |
| Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii) | $0 | $0 | $0 | $0 | $0 |
| Gross investment income | $0 | $0 | $0 | $0 | $0 |
| Supplementary Information (for 2013) | |
| Grants approved for future payment | $0 |
| Analysis of Income-Producing Activities (for 2013) | ||
| Amount | Related or exempt function income | |
|---|---|---|
| Program service revenue | ||
| Fees and contracts from government agencies | $0 | $0 |
| Membership dues and assessments | $0 | $0 |
| Interest on savings and temporary cash investments | $1 | $0 |
| Dividends and interest from securities | $114,371 | $0 |
| Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (for 2013) | |
| Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? | |
| Transfers from the reporting foundation to a noncharitable exempt organization of: | |
| Cash | No |
| Other assets | No |
| Other transactions: | |
| Sales of assets to a noncharitable exempt organization | No |
| Purchases of assets from a noncharitable exempt organization | No |
| Rental of facilities, equipment, or other assets | No |
| Reimbursement arrangements | No |
| Loans or loan guarantees | No |
| Performance of services or membership or fundraising solicitations | No |
| Sharing of facilities, equipment, mailing lists, other assets, or paid employees | No |
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| Other organizations in Oregon | |||||
| Id | Name | Address | State | Established | Total Income |
|---|---|---|---|---|---|
| 1 | Klamath Falls Gospel Mission | PO BOX 87, Klamath Falls, OR 97601-0378 | OR | 1959-07 | $1,462,102 |
| 2 | Loyal Order Of Moose International, 1106 Klamath Falls Lodge | 1577 Oak Ave, Klamatic Falls, OR 97601-5942 | OR | 1935-08 | $46,257 |
| 3 | Klamath Family Head Start | 1940 S 6th St, Klamath Falls, OR 97601-3370 | OR | 1980-08 | $3,262,535 |
| 4 | Klamath Forest Protective Association | 3200 Delap Rd, Klamath Falls, OR 97601-5211 | OR | 1941-11 | $258,335 |
| 5 | Klamath Health Partners Inc | 2074 S 6th St, Klamath Falls, OR 97601-3372 | OR | 1998-03 | $7,335,779 |
| 6 | Klamath Hospice Inc | 4745 S 6th St, Klamath Falls, OR 97603-4958 | OR | 1982-05 | $2,617,608 |
| 7 | Klamath Humane Society Inc | PO BOX 482, Klamath Falls, OR 97601-0027 | OR | 1972-04 | $454,222 |
| 8 | Klamath Ice Sports Inc | 5075 Fox Sparrow Dr, Klamath Falls, OR 97601-8658 | OR | 2000-02 | $294,213 |
| 9 | Klamath Kid Center Inc | 3801 Altamont Dr, Klamath Falls, OR 97603-7217 | OR | 1986-11 | $314,032 |
| 10 | Klamath Lake Counties Food Bank | PO BOX 317, Klamath Falls, OR 97601-0013 | OR | 1985-01 | $2,338,654 |
| 11 | Klamath Medical Service Bureau | 11144 Siskin Ln, Klamath Falls, OR 97601-8640 | OR | $1,431,494 | |
| 12 | Klamath Off-Project Water Users Inc | PO BOX 249, Beatty, OR 97621-0249 | OR | 2006-07 | $500 |
| 13 | Klamath Outdoor Science School | PO BOX 721, Klamath Falls, OR 97601-0039 | OR | 2004-11 | $57,713 |
| 14 | Klamath River Inter-Tribal Fish And Water Commission | PO BOX 436, Chiloquin, OR 97624-0436 | OR | 2000-03 | $792,209 |
| 15 | Klamath Siskiyou Wildlands Center | PO BOX 102, Ashland, OR 97520-0004 | OR | 2000-03 | $737,698 |
| 16 | Klamath Water Foundation | 4615 Reeder Road, Klamth Falls, OR 97603 | OR | 2004-05 | $14 |
| 17 | Klamath Watershed Partnership | 205 Riverside Dr Ste C, Klamath Falls, OR 97601-4203 | OR | 1997-08 | $491,456 |
| 18 | Klamath Wingwatchers Inc | Po Box 251, Klamath Falls, OR 97601 | OR | 1991-10 | $0 |
| 19 | Klamath Youth Soccer League Inc | 4500 Foothills Blvd, Klamath Falls, OR 97603-4074 | OR | 2005-03 | $19,049 |
| 20 | Klamath-Lake Community Action Services | 2300 Clairmont Drive, Klamath Falls, OR 97601-1136 | OR | 2005-10 | $2,711,375 |
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