SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
LA PINE COMMUNITY HEALTH CENTER
 
Employer identification number

26-3084386
Return Reference Explanation
FORM 990, PAGE 1, PART I, LINE 6 SERVES ON THE BOARD.
FORM 990, PAGE 2, PART III, LINE 2 BECAME A TESTING SITE FOR COVID-19
FORM 990, PAGE 2, PART III, LINE 3 CLOSED SUNRIVER SITE.
FORM 990, PAGE 6, PART VI, LINE 8B NO COMMITTEE HAS AUTHORITY TO ACT ON BEHALF OF THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 11B THE BOARD RECEIVES IT ELECTRONICALLY PRIOR TO THE BOARD MEETING FOR THEM TO REVIEW. THE DOCUMENT IS REVIEWED BY THE CEO DURING THE BOARD MEETING. ANY QUESTIONS ARE ANSWERED AT THE BOARD MEETING AND IF NECESSARY THE APPROPRIATE CHANGES ARE MADE. THE BOARD VOTES ON THE APPROVAL OF THE FROM 990 AT THE MEETING.
FORM 990, PAGE 6, PART VI, LINE 12C THE POLICY IS REVIEWED ANNUALLY WITH THE BOARD MEMBERS, DIRECTORS, MANAGERS AND KEY EMPLOYEES. THE DISCLOSURE STATEMENT AND CONFLICT OF INTEREST ARE SIGNED BY EACH PERSON.
FORM 990, PAGE 6, PART VI, LINE 15A INFORMATION FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS IS ASSESSED AND THE SALARIES ARE BASED ON SURVEYS OF COMMUNITY HEALTH CENTERS IN REGION.
FORM 990, PAGE 6, PART VI, LINE 15B INFORMATION FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS IS ASSESSED AND THE SALARIES ARE BASED ON SURVEYS OF COMMUNITY HEALTH CENTERS IN REGION.
FORM 990, PAGE 6, PART VI, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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