2022-04-20T13:20:45-05:00 2020-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990 2020-07-01 830230808 WYOMING MEDICAL CENTER FOUNDATION WYOM 3075772973 1233 EAST SECOND STREET CASPER WY 82601 BETH WORTHEN BOARD CHAIR 3075772973 2022-04-20 1 BETH WORTHEN 999009999 WENDY CAMPOS P00448102 5032421447 2022-04-20 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z BETH WORTHEN 1233 EAST SECOND STREET CASPER WY 82601 252228875 0 X WWW.WYOMINGMEDICALCENTERFOUNDATION.ORG X 1976 WY TO ENHANCE EXCELLENCE IN HEALTHCARE DELIVERY AT WYOMING MEDICAL CENTER. 9 9 0 21 0 0 1031644 250236599 0 0 66802 1917993 -2970 -14648 1095476 252139944 652309 2068979 0 0 0 39447 0 16542 16542 398597 297819 1050906 2422787 44570 249717157 8140660 277113966 192183 138416 7948477 276975550 X OUR MISSION IS TO SUPPORT THE DELIVERY AND ACCESSIBILITY OF HIGH-QUALITY, EFFICIENT HEALTH AND WELL-BEING OF RESIDENTS OF NATRONA COUNTY, WYOMING, AND THE OVERALL PHYSICAL AND MENTAL HEALTH AND WELL-BEING OF RESIDENTS OF NATRONA COUNTY, WYOMING. 0 1 2311809 2068979 THROUGHOUT THE FISCAL YEAR, WYOMING MEDICAL CENTER FOUNDATION ("WMC FOUNDATION") HAS RAISED FUNDS TO SUPPORT VARIOUS PROJECTS FOR ITS SUPPORTED ORGANIZATION, WYOMING MEDICAL CENTER ("WMC"). 2311809 1 1 0 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 4 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 0 0 1 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X JEANNE EHLEBRACHT 3075777837 1233 EAST SECOND STREET CASPER WY 82601 X MICHELE CHULICK WMC EMPLOYEE BOARD MEMBER THROUGH SEPT 2020 2.00 55.00 X 0 2287035 57671 CORRINE ARROSS WMC EMPLOYEE BOARD MEMBER THROUGH SEPT 2020 2.00 40.00 X 0 141978 21702 BETH WORTHEN CHAIR 10.00 X X 0 0 0 JUDY AURELIUS CHAIR THROUGH SEPT 2020 2.00 X X 0 0 0 JESSICA ODEN VICE CHAIR 5.00 X X 0 0 0 KYLE THOMPSON VICE CHAIR THROUGH SEPT 2020 2.00 X X 0 0 0 JOHN MASTERSON TREASURER 2.00 X X 0 0 0 DEBBIE REID TREASURER THROUGH SEPT 2020 2.00 X X 0 0 0 JAMES ANDERSON MD BOARD MEMBER 2.00 X 0 0 0 BOB BARNARD BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 SCOTT BROWNELL BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 SERENA COBB BOARD MEMBER 2.00 X 0 0 0 DAX COLLINS BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 MARK DOWELL MD BOARD MEMBER 2.00 X 0 0 0 JENNIFER GLADSON BOARD MEMBER 2.00 X 0 0 0 J PAUL JONES MD BOARD MEMBER 2.00 X 0 0 0 RYAN KLINGER BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 SUSIE MCMURRY BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 PAM MILLER BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 ERIC NELSON BOARD MEMBER 2.00 X 0 0 0 BRIAN STACK BOARD MEMBER THROUGH SEPT 2020 2.00 X 0 0 0 0 2429013 79373 0 0 1 0 0 167211162 83025437 167211162 250236599 1038523 1038523 74283 88931 -14648 -14648 -14648 879470 0 879470 879470 879470 252139944 0 0 1903345 2068979 2068979 39447 2576 36871 43507 41334 2173 9792 9792 16542 16542 55392 55392 876 876 8264 8264 139826 139826 10219 10219 LICENSES & FEES 16892 16892 PROGRAM EXPENSES 10752 10752 REPAIRS & MAINTENANCE 1199 1199 FOOD & BEVERAGE 669 669 431 431 2422787 2311809 94436 16542 824430 1122918 93456610 126286 109499 0 3730883 4396 17799 4744957 427963 4456820 4316994 2640884 172551027 74055 1794447 13789 13789 8140660 277113966 7940 61207 184243 77209 192183 138416 X 6954387 25767053 994090 251208497 7948477 276975550 8140660 277113966 249717157 19309916 0 X 0 1 X 1 0 X X 1 WYOMING MEDICAL CENTER 830279242 3 1 2328351 0 1 2328351 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 13789 X 0 1310525 147428 147428 1310525 1917041 143285 749801 1310525 2310525 134910 528394 1917041 2310525 133519 133519 2310525 2535525 213140 438140 2310525 0.59140 0.40860 0.00000 0 0 369000 369000 4138982 382244 3756738 236975 45719 191256 4316994 DUE TO WYOMING MEDICAL CENTER 77209 77209 X 104272237 19309916 -167122231 -147812315 252084552 55392 55392 252139944 2456326 88931 88931 2367395 55392 55392 2422787 PART X, LINE 2: THE FOUNDATION IS ORGANIZED AS A WYOMING NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE FOUNDATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. THE FOUNDATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. THE FOUNDATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE FOUNDATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 88,931. EQUITY TRANSFER FROM WMC -167,211,162. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 88,931. PART III, LINE 4: THE FOUNDATION HOLDS A STATUE THAT IS MAINTAINED IN A MAIN HALLWAY OF WYOMING MEDICAL CENTER. THE FOUNDATION WILL HAVE TO RETURN THE STATUE TO ITS OWNER UPON REQUEST. X 1 R-DESIGNS INC 752 NICKLAUS DR SUITE D PLANO TX 75025 CONTRACT WORK FOR CAPITAL CAMPAIGN 0 0 16542 -16542 16542 -16542 WY 0 WYOMING MEDICAL CENTER 1233 EAST SECOND STREET CASPER WY 82601 830279242 501(C)(3) 2068979 WOMEN OF VISION AND WEST TOWER DONATIONS 1 0 PART I, LINE 2: GRANTS TO OTHER ORGANIZATIONS ARE LIMITED TO THE ORGANIZATION'S SUPPORTED ORGANIZATION, WYOMING MEDICAL CENTER, IN SUPPORT OF ITS CHARITABLE PURPOSE. BOTH ORGANIZATIONS ARE UNDER COMMON MANAGEMENT, WHO ENSURE THAT ALL GRANTED FUNDS ARE USED FOR APPROPRIATE PURPOSES. 0 0 0 0 0 0 0 0 0 MICHELE CHULICK WMC EMPLOYEE BOARD MEMBER THROUGH SEPT 2020 0 572084 0 190000 0 1524951 0 31356 0 26315 0 2344706 0 0 CORRINE ARROSS WMC EMPLOYEE BOARD MEMBER THROUGH SEPT 2020 0 131607 0 10138 0 233 0 7174 0 14528 0 163680 0 0 X 1 167211162 FAIR MARKET VALUE 0 0 1 0 FORM 990, PART III, LINE 3 ON AUGUST 19, 2020, THE HOSPITAL ENTERED INTO A MEMBERSHIP SUBSTITUTION AGREEMENT ("THE AGREEMENT") WITH BANNER HEALTH, AN ARIZONA NONPROFIT CORPORATION ("BANNER"). AS PART OF THE AGREEMENT BANNER BECOME THE SOLE MEMBER OF THE HOSPITAL ON OCTOBER 1, 2020. IN CONNECTION WITH THE CLOSING OF THE AGREEMENT AS OF SEPTEMBER 30, 2020, THE FOUNDATION RECEIVED CERTAIN PROCEEDS FROM THE HOSPITAL AND BANNER, WHICH THE FOUNDATION WILL INVEST, MAINTAIN AND EXPEND IN FURTHERANCE OF ITS CHARITABLE PURPOSES, INCLUDING FOR THE BENEFIT OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 1 THE FOUNDATION'S EXECUTIVE COMMITTEE INCLUDES THE FOUNDATION BOARD PRESIDENT, VICE PRESIDENT, TREASURER, AND SECRETARY. THE EXECUTIVE DIRECTOR OF THE FOUNDATION SERVES AS A NON-VOTING, EX-OFFICIO MEMBER. THE EXECUTIVE COMMITTEE ACTS ON BEHALF OF THE BOARD OF DIRECTORS WHEN THE BOARD IS NOT IN SESSION BUT IS ACCOUNTABLE TO THE BOARD FOR ITS ACTIONS. THESE ACTIONS MUST BE APPROVED BY A VOTE BY THE BOARD OF DIRECTORS AT THE NEXT BOARD MEETING FOLLOWING THE ACTION. FORM 990, PART VI, SECTION A, LINE 4 ON AUGUST 19, 2020, THE HOSPITAL ENTERED INTO A MEMBERSHIP SUBSTITUTION AGREEMENT ("THE AGREEMENT") WITH BANNER HEALTH, AN ARIZONA NONPROFIT CORPORATION ("BANNER"). AS PART OF THE AGREEMENT BANNER BECOME THE SOLE MEMBER OF THE HOSPITAL ON OCTOBER 1, 2020. IN CONNECTION WITH THE CLOSING OF THE AGREEMENT AS OF SEPTEMBER 30, 2020, THE FOUNDATION RECEIVED CERTAIN PROCEEDS FROM THE HOSPITAL AND BANNER, WHICH THE FOUNDATION WILL INVEST, MAINTAIN AND EXPEND IN FURTHERANCE OF ITS CHARITABLE PURPOSES, INCLUDING FOR THE BENEFIT OF THE HOSPITAL. IN CONNECTION WITH THE CLOSING OF THE TRANSACTION, THE FOUNDATION'S ARTICLES OF INCORPORATION WERE AMENDED TO PROVIDE THAT THE FOUNDATION WILL MORE BROADLY SUPPORT HEALTH NEEDS WITHIN THE COMMUNITY. FROM CONTRIBUTIONS RECEIVED AND THE EARNINGS THEREON, THE FOUNDATION WILL BE OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES TO SUPPORT THE DELIVERY AND ACCESSIBILITY OF HIGH-QUALITY, EFFICIENT HEALTH AND WELLBEING OF RESIDENTS OF NATRONA COUNTY, WYOMING, AND THE OVERALL PHYSICAL AND MENTAL HEALTH AND WELLBEING OF RESIDENTS OF NATRONA COUNTY, WYOMING. FORM 990, PART VI, SECTION A, LINE 7A THE FOUNDATION'S BOARD INCLUDES THE CEO OF WYOMING MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B A PUBLIC ACCOUNTING FIRM WAS CONTRACTED TO PREPARE THE FORM 990. THE FORM 990 WAS REVIEWED BY THE FOUNDATION'S BOARD SECRETARY/TREASURER AND BOARD CHAIR. THE FORM 990 WAS PRESENTED TO THE BOARD FOR APPROVAL AND, UPON APPROVAL, WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION MONITORS VOTING BOARD MEMBERS BY REQUIRING EACH MEMBER TO SUBMIT A CONFLICT OF INTEREST FORM AT THE BEGINNING OF EVERY FISCAL YEAR OR WHEN JOINING THE BOARD. THE EXECUTIVE DIRECTOR REVIEWS THE CONFLICT FORMS. IF IT'S UNCLEAR WHETHER A CONFLICT EXISTS, THE BOARD OF DIRECTORS MAKES THE DETERMINATION. WHEN VOTING ON PROJECTS WHERE AN INDIVIDUAL BOARD MEMBER HAS A CONFLICT, THEY WILL ABSTAIN FROM VOTING. THE EXECUTIVE DIRECTOR AND STAFF MUST DISCLOSE ANY CONFLICTS WITHIN THE CONFINES OF THE WYOMING MEDICAL CENTER POLICIES AS EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR IS COMPENSATED BY WYOMING MEDICAL CENTER, AND THE COMPENSATION IS DETERMINED BY WYOMING MEDICAL CENTER'S HUMAN RESOURCES DEPARTMENT BY UTILIZING COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 18 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: THE RELATED ORGANIZATION, WYOMING MEDICAL CENTER ("WMC"), COMPENSATES THOSE INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A. WYOMING MEDICAL CENTER FOUNDATION ("WMC FOUNDATION") DOES NOT REIMBURSE WMC FOR THESE SERVICES. THE COMPENSATION REPORTED FOR MICHELE CHULICK AND CORRINE ARROSS REPRESENTS COMPENSATION FOR THEIR SERVICES SOLELY TO WMC. WYOMING MEDICAL CENTER 1233 EAST SECOND STREET CASPER WY 82601 830279242 MEDICAL SERVICES WY 501(C)(3) LINE 3 N/A 0 WYMEDCO CARE INC 1233 EAST SECOND STREET CASPER WY 82601 830279267 SUPPORT IN THE NONPROFIT MISSION OF WMC WY 501(C)(3) LINE 12A, I WYOMING MEDICAL CENTER 0 CENTRAL WYOMING OUTPATIENT SURGERY CENTER LLC 1201 EAST 3RD STREET CASPER WY 82601 830331130 MEDICAL SERVICES WY N/A 0 0 NORTH PLATTE PATHOLOGY LLC 111 SOUTH JEFFERSON STREET CASPER WY 82601 453676843 MEDICAL SERVICES WY N/A 0 0 WYMEDCO VENTURES INC 1233 EAST SECOND STREET CASPER WY 82601 830281137 MEDICAL SERVICES WY N/A C 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 1 0 0 1 AT THE TIME OF FILING, AS A RESULT OF THE ACCOUNTING PERIOD CHANGE AND THE SHORT TAX YEAR, THE 2020 FORM 990 DID NOT QUALIFY FOR ELECTRONIC SUBMISSION. PER IRS.GOV, IN THE CASE OF A SHORT YEAR, THE INSTRUCTIONS STATED THAT THE IRS WOULD CONTINUE TO ACCEPT PAPER FILINGS AS ITS SYSTEMS WEREN'T YET ABLE TO RECEIVE THESE FORMS ELECTRONICALLY. THE RETURN WAS ORIGINALLY MAILED TO THE IRS AND FILED TIMELY ON MAY 6, 2021. THE ORGANIZATION RECEIVED A LETTER DATED NOVEMBER 1, 2021 REJECTING ITS SUBMISSION. WE RESPONDED TO THE LETTER AND RESUBMITTED A COPY OF THE ORIGINALLY FILED RETURN WHICH WAS AGAIN RETURNED WITH A LETTER DATED MARCH 18, 2022. UPON A DISCUSSION WITH AN IRS AGENT AND THEIR RECOMMENDATION TO ATTEMPT TO SUBMIT ELECTRONICALLY AND VERIFYING WITH OUR TAX SOFTWARE PROVIDER, WE SUBMITTED THE RETURN WHICH WAS REJECTED SINCE "FINAL RETURN/TERMINATED OR "INITIAL RETURN" CHECKBOXES WERE NOT CHECKED AND THE EIN IN THE RETURN HAD NOT BEEN ESTABLISHED AS AN EXEMPT ORGANIZATION RETURN FILER IN THE E-FILE DATABASE. DUE TO THE ACCOUNTING PERIOD CHANGE AS WELL AS THE CONVERSION FROM A PUBLIC CHARITY TO PRIVATE FOUNDATION THIS REQUIRED A MANUAL CHANGE IN THE IRS SYSTEMS. WE RECEIVED CONFIRMATION TODAY THAT THIS HAS BEEN TEMPORARILY CHANGED/UPDATED TO ACCEPT THIS SUBMISSION. WE KINDLY REQUEST THAT YOU ACCEPT THIS RETURN AS FILED TIMELY.