CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION (EIN 83-0236858)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-10-17
IRS object ID
201802909349300215
Schema version
2017v2.3
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

FieldValueIRS element (for citing)
Return2018-10-17T09:36:14-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN841483675PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1RLR LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1POBOX 483AddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82003ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN830236858EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE REGIONAL MEDICAL CENTERBusinessNameLine1Txt
Business Name Line2FOUNDATIONBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlCHEYBusinessNameControlTxt
Phone3076337667PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1214 EAST 23RD STREETAddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSCOTT FOXPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone3076337667PhoneNum
Signature2018-10-16SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonROBERT B DICKERSONPreparerPersonNm
PTINP00432362PTIN
Phone3076315598PhoneNum
Preparation2018-10-16PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address64.88.174.3IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-10-17IPDt
IP Tm10:36:14IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id2E43059154C00348335E2B334E7609A734C56DCEAtSubmissionCreationDeviceId
At Submission Filing Device IdBD0945D10C998F31F514FA7FA1CFC8B5F5DE0028AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSCOTT FOXPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1214 EAST 23RD STREETAddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,627,848GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressGIVE.CHEYENNEREGIONAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1977FormationYr
Legal Domicile StateWYLegalDomicileStateCd
Activity Or MissionTHE FOUNDATION INFORMS, DEVELOPS AND STEWARDS RESOURCES TO ENABLE THE CHEYENNE REGIONAL HEALTH SYSTEM TO PROVIDE THE BEST POSSIBLE HEALTH CARE.ActivityOrMissionDesc
Voting Members Governing Body20VotingMembersGoverningBodyCnt
Voting Members Independent20VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers150TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$1,687,853PYContributionsGrantsAmt
CY Contributions Grants$1,542,990CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income-$64,949PYInvestmentIncomeAmt
CY Investment Income$570,026CYInvestmentIncomeAmt
CY Other Revenue$5,418CYOtherRevenueAmt
PY Total Revenue$1,622,904PYTotalRevenueAmt
CY Total Revenue$2,118,434CYTotalRevenueAmt
CY Grants And Similar Paid$467,850CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$343,994PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$349,050CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$35,427CYTotalFundraisingExpenseAmt
PY Other Expenses$1,658,758PYOtherExpensesAmt
CY Other Expenses$1,199,953CYOtherExpensesAmt
PY Total Expenses$2,002,752PYTotalExpensesAmt
CY Total Expenses$2,016,853CYTotalExpensesAmt
PY Revenues Less Expenses-$379,848PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$101,581CYRevenuesLessExpensesAmt
Total Assets BOY$16,040,310TotalAssetsBOYAmt
Total Assets EOY$17,964,731TotalAssetsEOYAmt
Total Liabilities BOY$144,233TotalLiabilitiesBOYAmt
Total Liabilities EOY$407,788TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,896,077NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$17,556,943NetAssetsOrFundBalancesEOYAmt
MissionTHE FOUNDATION INFORMS, DEVELOPS AND STEWARDS RESOURCES TO ENABLE THE CHEYENNE REGIONAL HEALTH SYSTEM TO PROVIDE THE BEST POSSIBLE HEALTH CARE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,032,448ExpenseAmt
Grant$467,850GrantAmt
DescPURCHASE OF MEDICAL EQUIPMENT FOR AND SUPPORT FOR PROGRAMS AND SERVICES AT CHEYENNE REGIONAL HEALTH SYSTEM. THIS INCLUDES EQUIPMENT PURCHASED FOR VARIOUS DEPARTMENTS ACROSS THE HEALTH SYSTEM AS WELL AS PROGRAM AND SERVICE SUPPORT FOR THE DAVIS HOSPICE CENTER, THE CHEYENNE REGIONAL CANCER CENTER AND OTHER SERVICE LINES.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$369,303ExpenseAmt
DescSUPPORT FOR THE CHEYENNE REGIONAL INJURY PREVENTION PROGRAM. THIS INCLUDES PROGRAMS AND SERVICES PROVIDED AS PART OF THE "SAFE COMMUNITIES- AND "SAFE KIDS" PROGRAMS. GOALS OF THESE PROGRAMS INCLUDE REDUCTION IN FATALITIES FOR UNRESTRAINED VEHICLE OCCUPANTS AND TO EDUCATE AND PROTECT FAMILIES ACROSS WYOMING BY ADDRESSING THE PRIMARY CAUSES OF INJURY TO CHILDREN & ADOLESCENTS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$1,401,751TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members20GoverningBodyVotingMembersCnt
Independent Voting Member20IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3076337667PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1214 E 23RD STREETAddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
DR HARMON DAVIS
CHAIR2.00Yes (X)Yes (X)$0$0$0
DAVID COOK
VICE CHAIR2.00Yes (X)Yes (X)$0$0$0
SUE MECCA
TREASURER2.00Yes (X)Yes (X)$0$0$0
FRAN NALER
SECRETARY2.00Yes (X)Yes (X)$0$0$0
PJ BARRETT
DIRECTOR1.00Yes (X)$0$0$0
DR RICK DAVIS
DIRECTOR1.00Yes (X)$0$0$0
KATHY EMMONS
DIRECTOR1.00Yes (X)$0$0$0
TIGHE FAGAN
DIRECTOR1.00Yes (X)$0$0$0
JOHN GROSS
DIRECTOR1.00Yes (X)$0$0$0
JEAN HALPERN
DIRECTOR1.00Yes (X)$0$0$0
BILL HARRIS
DIRECTOR1.00Yes (X)$0$0$0
DR MARK HOWSHAR
DIRECTOR1.00Yes (X)$0$0$0
BOB JENSEN
DIRECTOR1.00Yes (X)$0$0$0
STEPHEN FOSTER
DIRECTOR1.00Yes (X)$0$0$0
DR DAVID LIND
DIRECTOR1.00Yes (X)$0$0$0
PATRICK MADIGAN
DIRECTOR1.00Yes (X)$0$0$0
YVONNE MCGEE
DIRECTOR1.00Yes (X)$0$0$0
STEPHANIE MEISNER
DIRECTOR1.00Yes (X)$0$0$0
CAROL MERRELL
DIRECTOR1.00Yes (X)$0$0$0
JOHN METZKE
DIRECTOR1.00Yes (X)$0$0$0
GARY NEW
DIRECTOR1.00Yes (X)$0$0$0
ERNIE SHRINER
DIRECTOR1.00Yes (X)$0$0$0
DR SANDRA SURBRUGG
DIRECTOR1.00Yes (X)$0$0$0
PAM WINTER
DIRECTOR1.00Yes (X)$0$0$0
LARRY WOLFE
DIRECTOR1.00Yes (X)$0$0$0
SCOTT FOX
EXECUTIVE DI40.00Yes (X)$0$113,854$5,127
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$113,854TotReportableCompRltdOrgAmt
Total Other Compensation$5,127TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Fundraising$77,742FundraisingAmt
Related Organizations$511,982RelatedOrganizationsAmt
Government Grants$301,753GovernmentGrantsAmt
All Other Contributions$651,513AllOtherContributionsAmt
Total Contributions$1,542,990TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$226,897TotalRevenueColumnAmt
Exclusion$226,897ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$2,816,961SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,473,832SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$343,129SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$343,129TotalRevenueColumnAmt
Exclusion$343,129ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$35,582FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$77,742ContriRptFundraisingEventAmt
Fundraising Direct Expenses$35,582FundraisingDirectExpensesAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescINCREASE IN LIFE INSURANCEDesc
Total Revenue Column$5,418TotalRevenueColumnAmt
Exclusion$5,418ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$5,418OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,118,434TotalRevenueColumnAmt
Exclusion$575,444ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$467,850TotalAmt
Program Services$467,850ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$113,854TotalAmt
Management And General$113,854ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$210,900TotalAmt
Management And General$210,900ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$24,296TotalAmt
Management And General$24,296ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$8,750TotalAmt
Management And General$8,750ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$63,255TotalAmt
Management And General$63,255ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$14,813TotalAmt
Management And General$14,813ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$54,160TotalAmt
Management And General$18,733ManagementAndGeneralAmt
Fundraising$35,427FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$17,216TotalAmt
Management And General$17,216ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,013TotalAmt
Management And General$2,013ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$868TotalAmt
Management And General$868ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
OTHER PROGRAM COSTS$933,901$933,901
CONTRACTED SERVICES$51,145$51,145
CUSTOMER RELATIONS$18,408$18,408
MISCELLANEOUS$13,380$13,380

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$22,044TotalAmt
Management And General$22,044ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,016,853TotalAmt
Program Services$1,401,751ProgramServicesAmt
Management And General$579,675ManagementAndGeneralAmt
Fundraising$35,427FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$842,989BOYAmt
EOY$887,837EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$142,961BOYAmt
EOY$143,395EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$189,825BOYAmt
EOY$103,939EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$43,407LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$38,198LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,077BOYAmt
EOY$5,209EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$14,829,521BOYAmt
EOY$16,789,997EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$28,937BOYAmt
EOY$34,354EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$16,040,310BOYAmt
EOY$17,964,731EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$37,241BOYAmt
EOY$8,912EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$94,839BOYAmt
EOY$128,876EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$12,153BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
EOY$270,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$144,233BOYAmt
EOY$407,788EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,732,318BOYAmt
EOY$7,389,108EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,955,390BOYAmt
EOY$6,888,157EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,208,369BOYAmt
EOY$3,279,678EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,896,077BOYAmt
EOY$17,556,943EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,040,310BOYAmt
EOY$17,964,731EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$101,581ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,559,285NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,893,255CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,975,813CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,743,011CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,687,853CurrentTaxYearMinus1YearAmt
Current Tax Year$1,542,990CurrentTaxYearAmt
Total$9,842,922TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,893,255CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,975,813CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,743,011CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,687,853CurrentTaxYearMinus1YearAmt
Current Tax Year$1,542,990CurrentTaxYearAmt
Total$9,842,922TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$9,842,922PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$248,565CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$207,741CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$254,481CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$233,136CurrentTaxYearMinus1YearAmt
Current Tax Year$226,897CurrentTaxYearAmt
Total$1,170,820TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year$5,418CurrentTaxYearAmt
Total$5,418TotalAmt
FieldValueIRS element (for citing)
Total Support$11,019,160TotalSupportAmt
Public Support CY1700.89330PublicSupportCY170Pct
Public Support PY1700.91130PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,208,369BeginningYearBalanceAmt
Contributions$11,000ContributionsAmt
Investment Earnings Or Losses$87,456InvestmentEarningsOrLossesAmt
Other Expenditures$15,637OtherExpendituresAmt
Administrative Expenses$11,510AdministrativeExpensesAmt
End Year Balance$3,279,678EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,159,645BeginningYearBalanceAmt
Contributions$10,000ContributionsAmt
Investment Earnings Or Losses$54,276InvestmentEarningsOrLossesAmt
Other Expenditures$4,735OtherExpendituresAmt
Administrative Expenses$10,817AdministrativeExpensesAmt
End Year Balance$3,208,369EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,191,481BeginningYearBalanceAmt
Contributions$25,000ContributionsAmt
Investment Earnings Or Losses-$1,437InvestmentEarningsOrLossesAmt
Other Expenditures$33,839OtherExpendituresAmt
Administrative Expenses$21,560AdministrativeExpensesAmt
End Year Balance$3,159,645EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,204,957BeginningYearBalanceAmt
Investment Earnings Or Losses$5,992InvestmentEarningsOrLossesAmt
Other Expenditures$19,468OtherExpendituresAmt
End Year Balance$3,191,481EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,192,426BeginningYearBalanceAmt
Contributions$19,336ContributionsAmt
Investment Earnings Or Losses$110,737InvestmentEarningsOrLossesAmt
Other Expenditures$117,542OtherExpendituresAmt
End Year Balance$3,204,957EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,019OtherCostOrOtherBasisAmt
Depreciation$7,860DepreciationAmt
Book Value$5,159BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$30,388OtherCostOrOtherBasisAmt
Depreciation$30,338DepreciationAmt
Book Value$50BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,209TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescPLEDGES PAYABLEDesc
Amt$270,000Amt
FieldValueIRS element (for citing)
Total Liability$270,000TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$3,614,464TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$1,559,285NetUnrealizedGainsInvstAmt
Revenue Not Reported$1,559,285RevenueNotReportedAmt
Revenue Subtotal$2,055,179RevenueSubtotalAmt
Investment Expenses Not Incld$63,255InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$63,255RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$2,118,434TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$1,953,598TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$1,953,598ExpensesSubtotalAmt
Investment Expenses Not Incld2$63,255InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$63,255ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$2,016,853TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 3, PART XFormAndLineReferenceDesc
ExplanationTHE FOUNDATION IS AN ORGANIZATION EXEMPT FROM INCOME TAX UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE AND IS GENERALLY NOT SUBJECT TO FEDERAL INCOME TAXES. CONTRIBUTIONS TO THE FOUNDATION ARE DEDUCTIBLE FOR TAX PURPOSES BY THE DONOR, SUBJECT TO THE NORMAL LIMITATIONS IMPOSED BY THE TAXING AUTHORITIES. HOWEVER, THE FOUNDATION IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS, IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE BASIC FINANCIAL STATEMENTS TAKEN AS A WHOLE. IN ACCORDANCE WITH ASC (ACCOUNTING STANDARDS CODIFICATION) 740 INCOME TAXES (FORMERLY FASB INTERPRETATION 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES) THE FOUNDATION CURRENTLY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF SUCH POSITIONS ARE PROBABLE OF BEING SUSTAINED. THE FOUNDATION'S TAX YEARS SUBJECT TO EXAMINATION BY THE U.S. FEDERAL, STATE AND LOCAL TAX AUTHORITIES ARE FOR THE FISCAL YEARS ENDING DECEMBER 31, 2013-2017.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1WESTERN CONNECTEvent1Nm
Gross Receipts Event1$54,030GrossReceiptsEvent1Amt
Charitable Contri Event1$30,433CharitableContriEvent1Amt
Gross Revenue Event1$23,597GrossRevenueEvent1Amt
Rent Facility Costs Event1$7,383RentFacilityCostsEvent1Amt
Other Direct Expenses Event1$16,214OtherDirectExpensesEvent1Amt
Event2TREE OF REMEMBREvent2Nm
Gross Receipts Event2$22,323GrossReceiptsEvent2Amt
Charitable Contri Event2$22,323CharitableContriEvent2Amt
Other Events Total3OtherEventsTotalCnt
Gross Receipts Other Events$36,971GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$24,986CharitableContriOtherEventsAmt
Gross Revenue Other Events$11,985GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$11,985OthDirectExpnssOtherEventsAmt
Gross Receipts Total$113,324GrossReceiptsTotalAmt
Charitable Contributions Tot$77,742CharitableContributionsTotAmt
Gross Revenue Total Events$35,582GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$7,383RentFcltyCostsTotalEventsAmt
Oth Direct Expnss Total Events$28,199OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$35,582DirectExpenseSummaryEventsAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedfalseGrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE REGIONAL MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1214 EAST 23RD STREETAddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd
FieldValueIRS element (for citing)
Recipient EIN836000194RecipientEIN
Cash Grant$467,850CashGrantAmt
Valuation Method UsedFMVValuationMethodUsedDesc
Purpose Of GrantSUPPORTPurposeOfGrantTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 1, PART I, LINE 6NUMBER OF VOLUNTEERS INCLUDE THE MEMBERS OF THE BOARD OF DIRECTORS (ALL VOLUNTEER), VOLUNTEERS SUPPORTING MAJOR EVENTS (SUCH AS THE ANNUAL GALA), AND VOLUNTEERS SUPPORTING OTHER EVENTS/ACTIVITIES THROUGHOUT THE YEAR.
FORM 990, PAGE 6, PART VI, LINE 11BTHE 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 12CORGANIZATION 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 15ATHE 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 15BALL 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 19ALL GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE REGIONAL MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1214 EAST 23RD STREETAddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd
FieldValueIRS element (for citing)
EIN836000194EIN
Primary ActivitiesHOSPITALPrimaryActivitiesTxt
Legal Domicile StateWYLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
CHEYENNE REGIONAL MEDICAL CENTER
C$511,982FMV
CHEYENNE REGIONAL MEDICAL CENTER
B$467,850FMV

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