CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION (EIN 83-0236858)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-14
IRS object ID
201643199349304939
Schema version
2015v2.1
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)
Return2016-11-14T11:39:14-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

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 Line11620 CENTRAL AVE STE 304AddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

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
Signature2016-11-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonROBERT B DICKERSONPreparerPersonNm
PTINP00432362PTIN
Phone3076315598PhoneNum
Preparation2016-11-10PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSCOTT FOXPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1214 E 23RD STAddressLine1Txt
CityCHEYENNECityNm
State AbbreviationWYStateAbbreviationCd
ZIP82001ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,015,342GrossReceiptsAmt
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 Body19VotingMembersGoverningBodyCnt
Voting Members Independent19VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers150TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$2,736,646PYContributionsGrantsAmt
CY Contributions Grants$1,743,011CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$324,666PYInvestmentIncomeAmt
CY Investment Income$261,033CYInvestmentIncomeAmt
PY Other Revenue$152,074PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$3,213,386PYTotalRevenueAmt
CY Total Revenue$2,004,044CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$410,654PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$328,244CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$17,507CYTotalFundraisingExpenseAmt
PY Other Expenses$2,077,751PYOtherExpensesAmt
CY Other Expenses$1,273,747CYOtherExpensesAmt
PY Total Expenses$2,488,405PYTotalExpensesAmt
CY Total Expenses$1,601,991CYTotalExpensesAmt
PY Revenues Less Expenses$724,981PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$402,053CYRevenuesLessExpensesAmt
Total Assets BOY$16,169,652TotalAssetsBOYAmt
Total Assets EOY$15,463,040TotalAssetsEOYAmt
Total Liabilities BOY$356,736TotalLiabilitiesBOYAmt
Total Liabilities EOY$151,978TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,812,916NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$15,311,062NetAssetsOrFundBalancesEOYAmt
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$188,993ExpenseAmt
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$686,116ExpenseAmt
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$875,109TotalProgramServiceExpensesAmt
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 LiabilitiesfalseReportOtherLiabilitiesInd
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 OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
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
Backup Wthld CompliancefalseBackupWthldComplianceInd
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 Members19GoverningBodyVotingMembersCnt
Independent Voting Member19IndependentVotingMemberCnt
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 (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
CARMALEE ROSE
CHAIR2.00Yes (X)Yes (X)$0$0$0
NATALIE WINEGAR
VICE CHAIR2.00Yes (X)Yes (X)$0$0$0
FRAN NALER
TREASURER2.00Yes (X)Yes (X)$0$0$0
DR HARMON DAVIS
SECRETARY2.00Yes (X)Yes (X)$0$0$0
JOHN BALSER
DIRECTOR1.00Yes (X)$0$0$0
DAVID COOK
DIRECTOR1.00Yes (X)$0$0$0
DR RICK DAVIS
DIRECTOR1.00Yes (X)$0$0$0
WILLIAM DUBOIS
DIRECTOR1.00Yes (X)$0$0$0
LAURIE FARKAS
DIRECTOR1.00Yes (X)$0$0$0
JACQUELINE FERRALL
DIRECTOR1.00Yes (X)$0$0$0
MARCIA GRAHAM
DIRECTOR1.00Yes (X)$0$0$0
JOHN GROSS
DIRECTOR1.00Yes (X)$0$0$0
DR MARGO KARSTEN
DIRECTOR1.00Yes (X)$0$0$0
PATRICK MADIGAN
DIRECTOR1.00Yes (X)$0$0$0
DR DAVID LIND
DIRECTOR1.00Yes (X)$0$0$0
FRANK MAGAZINE
DIRECTOR1.00Yes (X)$0$0$0
CAROL MERRELL
DIRECTOR1.00Yes (X)$0$0$0
CAREN MURRAY
DIRECTOR1.00Yes (X)$0$0$0
MONA LEE PEARL
DIRECTOR1.00Yes (X)$0$0$0
MARIAN SCHULZ ORR
DIRECTOR1.00Yes (X)$0$0$0
ERNIE SHRINER
DIRECTOR1.00Yes (X)$0$0$0
DR SANDRA SURBRUGG
DIRECTOR1.00Yes (X)$0$0$0
STEVE STONE
EX - EXEC DI40.00Yes (X)$0$156,083$23,933
SCOTT FOX
EXECUTIVE DI40.00Yes (X)$0$31,866$1,651
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$187,949TotReportableCompRltdOrgAmt
Total Other Compensation$25,584TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Fundraising$268,903FundraisingAmt
All Other Contributions$1,474,108AllOtherContributionsAmt
Total Contributions$1,743,011TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$254,481TotalRevenueColumnAmt
Exclusion$254,481ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$17,850SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$11,298SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$6,552SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,552TotalRevenueColumnAmt
Related Or Exempt Func Income$6,552RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Contri Rpt Fundraising Event$268,903ContriRptFundraisingEventAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,004,044TotalRevenueColumnAmt
Related Or Exempt Func Income$6,552RelatedOrExemptFuncIncomeAmt
Exclusion$254,481ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$187,949TotalAmt
Management And General$187,949ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$115,108TotalAmt
Management And General$115,108ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$25,187TotalAmt
Management And General$25,187ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,240TotalAmt
Management And General$7,240ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$70,345TotalAmt
Management And General$70,345ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$63,848TotalAmt
Management And General$46,341ManagementAndGeneralAmt
Fundraising$17,507FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$15,394TotalAmt
Management And General$15,394ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$297TotalAmt
Management And General$297ManagementAndGeneralAmt

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$768,841$768,841
CONTRIBUTIONS TO CRMC$245,024$106,268$138,756
CONTRACTED SERVICES$30,960$30,960
MISCELLANEOUS$27,300$27,300

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$43,630TotalAmt
Management And General$43,630ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,601,991TotalAmt
Program Services$875,109ProgramServicesAmt
Management And General$709,375ManagementAndGeneralAmt
Fundraising$17,507FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$836,508BOYAmt
EOY$717,940EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$104,965EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$510,964BOYAmt
EOY$336,665EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$43,407LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$36,463LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,812BOYAmt
EOY$6,944EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$14,784,485BOYAmt
EOY$14,266,494EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$29,883BOYAmt
EOY$30,032EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$16,169,652BOYAmt
EOY$15,463,040EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$19,248BOYAmt
EOY$39,360EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$268,388BOYAmt
EOY$76,654EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$69,100BOYAmt
EOY$35,964EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$356,736BOYAmt
EOY$151,978EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,452,856BOYAmt
EOY$4,864,274EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,168,579BOYAmt
EOY$7,287,143EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,191,481BOYAmt
EOY$3,159,645EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,812,916BOYAmt
EOY$15,311,062EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,169,652BOYAmt
EOY$15,463,040EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$402,053ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$903,907NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
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$1,364,163CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,019,504CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,893,255CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,975,813CurrentTaxYearMinus1YearAmt
Current Tax Year$1,743,011CurrentTaxYearAmt
Total$11,995,746TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,364,163CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,019,504CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,893,255CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,975,813CurrentTaxYearMinus1YearAmt
Current Tax Year$1,743,011CurrentTaxYearAmt
Total$11,995,746TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$11,995,746PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$279,447CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$254,942CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$248,565CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$207,741CurrentTaxYearMinus1YearAmt
Current Tax Year$254,481CurrentTaxYearAmt
Total$1,245,176TotalAmt
FieldValueIRS element (for citing)
Total Support$13,240,922TotalSupportAmt
Public Support CY1700.90600PublicSupportCY170Pct
Public Support PY1700.88320PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,258,002BeginningYearBalanceAmt
Contributions$5,901ContributionsAmt
Investment Earnings Or Losses$62,459InvestmentEarningsOrLossesAmt
Other Expenditures$133,936OtherExpendituresAmt
End Year Balance$3,192,426EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,333,005BeginningYearBalanceAmt
Contributions$234ContributionsAmt
Investment Earnings Or Losses-$22,282InvestmentEarningsOrLossesAmt
Other Expenditures$52,955OtherExpendituresAmt
End Year Balance$3,258,002EndYearBalanceAmt
FieldValueIRS element (for citing)
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,019OtherCostOrOtherBasisAmt
Depreciation$6,075DepreciationAmt
Book Value$6,944BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$30,388OtherCostOrOtherBasisAmt
Depreciation$30,388DepreciationAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,944TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$1,047,299TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$903,907NetUnrealizedGainsInvstAmt
Other Revenue$17,507OtherRevenueAmt
Revenue Not Reported-$886,400RevenueNotReportedAmt
Revenue Subtotal$1,933,699RevenueSubtotalAmt
Investment Expenses Not Incld$70,345InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$70,345RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$2,004,044TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$1,549,153TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$17,507OtherExpensesIncludedAmt
Expenses Not Reported$17,507ExpensesNotReportedAmt
Expenses Subtotal$1,531,646ExpensesSubtotalAmt
Investment Expenses Not Incld2$70,345InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$70,345ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$1,601,991TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 3, PART XTHE 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 FOUNDATIONS TAX YEARS SUBJECT TO EXAMINATION BY THE U.S. FEDERAL, STATE AND LOCAL TAX AUTHORITIES ARE FOR THE FISCAL YEARS ENDING DECEMBER 31, 2012-2015, RESPECTIVELY.
SCHEDULE D, PAGE 4, PART XI, LINE 2DRECLASS DIRECT BENEFIT TO DONOR 17,507
SCHEDULE D, PAGE 4, PART XII, LINE 2DRECLASS DIRECT BENEFIT TO DONOR 17,507

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1DENIM N DIAMONDEvent1Nm
Gross Receipts Event1$268,903GrossReceiptsEvent1Amt
Charitable Contri Event1$268,903CharitableContriEvent1Amt
Gross Receipts Total$268,903GrossReceiptsTotalAmt
Charitable Contributions Tot$268,903CharitableContributionsTotAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonSTEVE STONEPersonNm
TitleEX - EXEC DIRECTORTitleTxt
Compensation Based On Rltd Orgs$156,083CompensationBasedOnRltdOrgsAmt
Deferred Comp Rltd Orgs$23,933DeferredCompRltdOrgsAmt
Total Compensation Rltd Orgs$180,016TotalCompensationRltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 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.
FORM 990, PART XI, LINE 9RECLASS DIRECT BENEFIT TO DONOR 17,507 RECLASS DIRECT BENEFIT TO DONOR -17,507

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$469,509FMV
CHEYENNE REGIONAL MEDICAL CENTER
B$245,024FMV

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