CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION (EIN 83-0236858)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-07
- IRS object ID
- 202203119349301685
- Schema version
- 2021v4.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-07T11:27:44-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 841483675 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RLR LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | POBOX 483 | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830236858 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHEY | BusinessNameControlTxt |
| Phone | 3076337667 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 EAST 23RD STREET | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SCOTT FOX | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 3076337667 | PhoneNum |
| Signature | 2022-10-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SCOTT | PersonFirstNm |
| Person Last | FOX | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT B DICKERSON | PreparerPersonNm |
| PTIN | P00432362 | PTIN |
| Phone | 3076315598 | PhoneNum |
| Preparation | 2022-10-27 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SCOTT FOX | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 EAST 23RD STREET | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,256,407 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | GIVE.CHEYENNEREGIONAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Activity Or Mission | THE FOUNDATION INFORMS, DEVELOPS AND STEWARDS RESOURCES IN SUPPORT OF THE CHEYENNE REGIONAL HEALTH SYSTEM'S MISSION TO INSPIRE GREAT HEALTH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 25 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 25 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,247,297 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,251,637 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $291,913 | PYInvestmentIncomeAmt |
| CY Investment Income | $943,772 | CYInvestmentIncomeAmt |
| PY Other Revenue | $276,408 | PYOtherRevenueAmt |
| CY Other Revenue | $325,102 | CYOtherRevenueAmt |
| PY Total Revenue | $2,815,618 | PYTotalRevenueAmt |
| CY Total Revenue | $2,520,511 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,056,066 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,486,685 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $372,853 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $402,039 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $161,937 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $231,286 | PYOtherExpensesAmt |
| CY Other Expenses | $287,817 | CYOtherExpensesAmt |
| PY Total Expenses | $2,660,205 | PYTotalExpensesAmt |
| CY Total Expenses | $2,176,541 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $155,413 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $343,970 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,385,047 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,884,628 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,492,501 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,761,965 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $21,892,546 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,122,663 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE FOUNDATION INFORMS, DEVELOPS AND STEWARDS RESOURCES IN SUPPORT OF THE CHEYENNE REGIONAL HEALTH SYSTEM'S MISSION TO INSPIRE GREAT HEALTH. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,412,870 | ExpenseAmt |
| Grant | $1,129,019 | GrantAmt |
| Desc | PURCHASE OF MEDICAL EQUIPMENT AND RELATED EXPENSES IN SUPPORT OF THE CHEYENNE REGIONAL HEALTH SYSTEM. IN 2020 (PAID IN 2021) & 2021, THIS INCLUDED EQUIPMENT PURCHASES FOR THE INTENSIVE CARE UNIT (ICU) RENOVATION (ANNUAL CAMPAIGN), AND ALSO INCLUDED EQUIPMENT & PROGRAMS FOR VARIOUS DEPARTMENTS ACROSS THE HEALTH SYSTEM. IN CY2021, SEVENTY-ONE (71) NEW GRANTS WERE APPROVED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $273,619 | ExpenseAmt |
| Grant | $273,619 | GrantAmt |
| Desc | ONGOING SUPPORT OF CHEYENNE REGIONAL CANCER CENTER AND DAVIS HOSPICE CENTER PROGRAM AND SERVICES. THIS INCLUDES CONTINUED STEWARDSHIP OF PLEDGES MADE DURING THE CANCER CENTER CAPITAL CAMPAIGN. IT ALSO INCLUDES STEWARDSHIP OF THE DAVIS HOSPICE CENTER PROGRAMS SUCH AS THE "TREE OF REMEMBRANCE" HELD ANNUALLY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $84,047 | ExpenseAmt |
| Grant | $84,047 | GrantAmt |
| Desc | SUPPORT FOR THE CHEYENNE REGIONAL INJURY PREVENTION PROGRAM. THIS INCLUDES PROGRAMS AND SERVICES PROVIDED AS PART OF THE "SAFE KIDS OF LARAMIE COUNTY" PROGRAM. GOALS OF THIS PROGRAM INCLUDE REDUCTION IN FATALITIES FOR UNRESTRAINED VEHICLE OCCUPANTS AND TO EDUCATE AND PROTECT FAMILIES IN SOUTHEAST WYOMING BY ADDRESSING THE PRIMARY CAUSES OF INJURY TO CHILDREN & ADOLESCENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,770,536 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (true) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 25 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 25 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3076337667 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 EAST 23RD STREET | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SCOTT FOX | ||||||||
| EXECUTIVE DI | 40.00 | Yes (X) | $0 | $133,882 | $6,257 | |||
| SUE MECCA | ||||||||
| CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SANDRA SURBRUGG MD | ||||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DAVID COOK | ||||||||
| PAST CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GREG VAUGHN | ||||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MEGAN ROMANO JD | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| HARMON DAVIS II MD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| FRAN NALER | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| PJ BARRETT | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| SAM BASS RN | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| MARK HOWSHAR MD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| BOB JENSEN | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| DAVID LIND MD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| CAROL MERRELL | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| GARY NEW | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| STEVE NEWTON EDD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ANN NORWOOD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| CARMALEE ROSE | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| PAM WINTER | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JJ CHEN MD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ALEXANDRA FARKAS | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| PHYLLIS SHERARD PHD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| BARBARA STAFFORD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| LEW RONEY | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| LINDA FINNERTY | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ADAM WADDELL | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| VICTORIA FRY JD | ||||||||
| DIR MAJ GIFT | $0 | $102,376 | $11,053 | 40.00 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $236,258 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $17,310 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $155,316 | FundraisingAmt |
| Related Organizations | $581,983 | RelatedOrganizationsAmt |
| All Other Contributions | $514,338 | AllOtherContributionsAmt |
| Noncash Contributions | $653,882 | NoncashContributionsAmt |
| Total Contributions | $1,251,637 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $379,953 | TotalRevenueColumnAmt |
| Exclusion | $379,953 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,127,638 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $563,819 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $563,819 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $563,819 | TotalRevenueColumnAmt |
| Exclusion | $563,819 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $497,179 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $155,316 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $172,077 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $325,102 | TotalRevenueColumnAmt |
| Exclusion | $325,102 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,520,511 | TotalRevenueColumnAmt |
| Exclusion | $1,268,874 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,486,685 | TotalAmt |
| Program Services | $1,486,685 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,882 | TotalAmt |
| Program Services | $40,165 | ProgramServicesAmt |
| Management And General | $66,941 | ManagementAndGeneralAmt |
| Fundraising | $26,776 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,980 | TotalAmt |
| Program Services | $101,903 | ProgramServicesAmt |
| Management And General | $45,217 | ManagementAndGeneralAmt |
| Fundraising | $92,860 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,177 | TotalAmt |
| Program Services | $10,707 | ProgramServicesAmt |
| Management And General | $8,453 | ManagementAndGeneralAmt |
| Fundraising | $9,017 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,700 | TotalAmt |
| Management And General | $9,700 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,445 | TotalAmt |
| Management And General | $89,445 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,937 | TotalAmt |
| Program Services | $14,468 | ProgramServicesAmt |
| Fundraising | $14,469 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,843 | TotalAmt |
| Program Services | $4,880 | ProgramServicesAmt |
| Management And General | $3,853 | ManagementAndGeneralAmt |
| Fundraising | $4,110 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,918 | TotalAmt |
| Program Services | $7,189 | ProgramServicesAmt |
| Management And General | $5,675 | ManagementAndGeneralAmt |
| Fundraising | $6,054 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $309 | TotalAmt |
| Program Services | $117 | ProgramServicesAmt |
| Management And General | $93 | ManagementAndGeneralAmt |
| Fundraising | $99 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $868 | TotalAmt |
| Program Services | $330 | ProgramServicesAmt |
| Management And General | $260 | ManagementAndGeneralAmt |
| Fundraising | $278 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| CONTRACTED SERVICES | $68,838 | $68,838 | ||
| CUSTOMER RELATIONS | $17,723 | $17,723 | ||
| MEALS | $9,093 | $2,907 | $3,279 | $2,907 |
| BOOKS AND EDUCATION | $8,810 | $8,810 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,333 | TotalAmt |
| Program Services | $5,814 | ProgramServicesAmt |
| Management And General | $11,152 | ManagementAndGeneralAmt |
| Fundraising | $5,367 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,176,541 | TotalAmt |
| Program Services | $1,770,536 | ProgramServicesAmt |
| Management And General | $244,068 | ManagementAndGeneralAmt |
| Fundraising | $161,937 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,142,169 | BOYAmt |
| EOY | $1,067,384 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,381 | BOYAmt |
| EOY | $200,054 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,738 | BOYAmt |
| EOY | $5,302 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $43,407 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $41,669 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,606 | BOYAmt |
| EOY | $1,738 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,065,845 | BOYAmt |
| EOY | $24,566,117 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,308 | BOYAmt |
| EOY | $44,033 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,385,047 | BOYAmt |
| EOY | $25,884,628 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,255 | BOYAmt |
| EOY | $39,989 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,048,246 | BOYAmt |
| EOY | $1,243,976 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,000 | BOYAmt |
| EOY | $478,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,492,501 | BOYAmt |
| EOY | $1,761,965 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,916,903 | BOYAmt |
| EOY | $12,163,313 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,975,643 | BOYAmt |
| EOY | $11,959,350 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,892,546 | BOYAmt |
| EOY | $24,122,663 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,385,047 | BOYAmt |
| EOY | $25,884,628 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $343,970 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,886,147 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,542,990 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,843,014 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,104,745 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,247,297 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,251,637 | CurrentTaxYearAmt |
| Total | $7,989,683 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,542,990 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,843,014 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,104,745 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,247,297 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,251,637 | CurrentTaxYearAmt |
| Total | $7,989,683 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,176,958 | SubstantialContributorsTotAmt |
| Public Support Total170 | $6,812,725 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $226,897 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $265,526 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $306,721 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $291,913 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $379,953 | CurrentTaxYearAmt |
| Total | $1,471,010 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,418 | CurrentTaxYearMinus4YearsAmt |
| Total | $5,418 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $9,466,111 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $1,273,127 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.71970 | PublicSupportCY170Pct |
| Public Support PY170 | 0.75300 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 10 | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME 5,418 | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,119,418 | BeginningYearBalanceAmt |
| Contributions | $148,827 | ContributionsAmt |
| Investment Earnings Or Losses | $40,706 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $11,598 | AdministrativeExpensesAmt |
| End Year Balance | $4,297,353 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,531,714 | BeginningYearBalanceAmt |
| Contributions | $523,150 | ContributionsAmt |
| Investment Earnings Or Losses | $64,554 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,119,418 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,409,128 | BeginningYearBalanceAmt |
| Contributions | $15,200 | ContributionsAmt |
| Investment Earnings Or Losses | $117,227 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $9,841 | AdministrativeExpensesAmt |
| End Year Balance | $3,531,714 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,279,678 | BeginningYearBalanceAmt |
| Contributions | $266,594 | ContributionsAmt |
| Investment Earnings Or Losses | -$108,826 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,429 | OtherExpendituresAmt |
| Administrative Expenses | $23,889 | AdministrativeExpensesAmt |
| End Year Balance | $3,409,128 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,208,369 | BeginningYearBalanceAmt |
| Contributions | $11,000 | ContributionsAmt |
| Investment Earnings Or Losses | $87,456 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $15,637 | OtherExpendituresAmt |
| Administrative Expenses | $11,510 | AdministrativeExpensesAmt |
| End Year Balance | $3,279,678 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,019 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,282 | DepreciationAmt |
| Book Value | $1,737 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,388 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,387 | DepreciationAmt |
| Book Value | $1 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,738 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PLEDGES PAYABLE | Desc |
| Amt | $478,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $478,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,408,715 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,886,147 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $1,886,147 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,522,568 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $89,445 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$91,502 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$2,057 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,520,511 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,178,598 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $2,178,598 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $89,445 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | -$91,502 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | -$2,057 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,176,541 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 2, PART V, LINE 4 | THE FOUNDATION ENDOWMENTS ARE INTENDED TO SUPPORT THE ONGOING SUPPORT OF SERVICES AT CHEYENNE REGIONAL MEDICAL CENTER IN THE AREAS OF ONCOLOGY/CANCER SERVICES, CARDIAC SERVICES, NURSING EDUCATION (THROUGH SCHOLARSHIPS), AND HOSPICE PROGRAMS AND SERVICES (INCLUDING OPERATION OF THE DAVIS HOSPICE CENTER). ADDITIONALLY, THE FOUNDATION HAS A GENERAL ENDOWMENT TO SUPPORT "THE AREA OF GREATEST NEED." |
| SCHEDULE D, PAGE 3, PART X | THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PRESENTED IN THESE FINANCIAL STATEMENTS. DUE TO THE FOUNDATION'S NON-PROFIT QUALIFICATION, DONORS MAY BE ENTITLED TO A CHARITABLE DEDUCTION FOR AMOUNTS CONTRIBUTED TO THE FOUNDATION. THERE ARE NO UNRELATED BUSINESS ACTIVITIES SUBJECT TO INCOME TAXES. THE TAX RETURNS FOR DECEMBER 31, 2021, 2020 AND 2019 REMAIN OPEN FOR EXAMINATION. |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | DIRECT EXPENSES -110,523 IN-KIND DONATIONS 71,899 IN-KIND DONATIONS - FUNDRAISING -52,878 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | DIRECT EXPENSES -110,523 IN-KIND DONATIONS 71,899 IN-KIND DONATIONS - FUNDRAISING -52,878 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DENIM & DIAMOND | Event1Nm |
| Gross Receipts Event1 | $420,707 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $136,597 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $284,110 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $34,159 | NonCashPrizesEvent1Amt |
| Other Direct Expenses Event1 | $85,635 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF CLASSIC | Event2Nm |
| Gross Receipts Event2 | $81,459 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $1,300 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $80,159 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $1,300 | NonCashPrizesEvent2Amt |
| Other Direct Expenses Event2 | $27,387 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 6 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $150,329 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $17,419 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $132,910 | GrossRevenueOtherEventsAmt |
| Cash Prizes Other Events | $2,000 | CashPrizesOtherEventsAmt |
| Non Cash Prizes Other Events | $17,419 | NonCashPrizesOtherEventsAmt |
| Oth Direct Expnss Other Events | $4,177 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $652,495 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $155,316 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $497,179 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $2,000 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $52,878 | NonCashPrizesTotalEventsAmt |
| Oth Direct Expnss Total Events | $117,199 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $172,077 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $325,102 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 EAST 23RD STREET | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 836000194 | RecipientEIN |
| IRC Section | GOV | IRCSectionDesc |
| Cash Grant | $1,467,664 | CashGrantAmt |
| Non Cash Assistance | $19,021 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | DONATED GOODS | NonCashAssistanceDesc |
| Purpose Of Grant | SUPPORT | PurposeOfGrantTxt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | DONATED GOODS | 195 | $71,899 | FMV |
| Yes (X) | CRMC IN-KIND | 12 | $581,983 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PAGE 2, PART II | FormAndLineReferenceDesc |
| Explanation | WE ARE REPORTING THE NUMBER OF TRANSACTIONS FOR DONATED GOODS. WE ARE REPORTING 12 MONTHS OF EXPENSES PAID FOR BY CHEYENNE REGIONAL MEDICAL CENTER. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | NUMBER OF VOLUNTEERS INCLUDE THE MEMBERS OF THE BOARD OF DIRECTORS (ALL VOLUNTEER), VOLUNTEERS SUPPORTING MAJOR EVENTS,AND VOLUNTEERS SUPPORTING OTHER EVENTS/ACTIVITIES THROUGHOUT THE YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE EXECUTIVE DIRECTOR REVIEWS THE FORM 990. IT IS THEN REVIEWED BY THE FINANCE COMMITTEE. ONCE THE BOARD FINANCE COMMITTEE HAS APPROVED THE FORM 990, IT IS SIGNED AND DISTRIBUTED TO THE FULL BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ORGANIZATION BYLAWS REQUIRE ALL DIRECTORS/STAFF/COMMITTEE MEMBERS MUST REVIEW THE CONFLICT OF INTEREST POLICY AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. SHOULD THE INFORMATION CHANGE MATERIALLY DURING THE YEAR, THEY ARE REQUIRED TO DISCLOSE SUCH CHANGES AND REVISE THEIR ANNUAL DISCLOSURE STATEMENT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION FOR THE EXECUTIVE DIRECTOR IS SET BY CHEYENNE REGIONAL MEDICAL CENTER AS THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF THE MEDICAL CENTER IN ACCORDANCE WITH THE MEMORANDUM OF UNDERSTANDING BETWEEN CRMC AND THE FOUNDATION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | ALL EMPLOYEE SALARIES ARE SET BY THE CHEYENNE REGIONAL MEDICAL CENTER IN ACCORDANCE WITH THE MEMORANDUM OF UNDERSTANDING BETWEEN CRMC AND THE FOUNDATION. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | DIRECT EXPENSES 110,523 IN-KIND DONATIONS -71,899 IN-KIND DONATIONS - FUNDRAISING 52,878 DIRECT EXPENSES -110,523 IN-KIND DONATIONS 71,899 IN-KIND DONATIONS - FUNDRAISING -52,878 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 EAST 23RD STREET | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 836000194 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| S | $174,641 | FMV |
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| B | $1,467,664 | FMV |
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| O | $402,040 | FMV |
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| N | $5,302 | FMV |
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| R | $19,021 | FMV |
Comments