CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- CHEYENNE REGIONAL MEDICAL CENTER FOUNDATION (EIN 83-0236858)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-11
- IRS object ID
- 201543159349301849
- Schema version
- 2014v5.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-11T11:26:10-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 1620 CENTRAL AVE STE 304 | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | 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 | 2015-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT B DICKERSON | PreparerPersonNm |
| PTIN | P00432362 | PTIN |
| Phone | 3076315598 | PhoneNum |
| Preparation | 2015-11-02 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | 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 | $3,300,479 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHEYENNEGIVING.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Activity Or Mission | TO ASSIST IN THE DEVELOPMENT, GROWTH, AND OPERATION OF THE CHEYENNE REGIONAL MEDICAL CENTER. | ActivityOrMissionDesc |
| Voting Members Governing Body | 24 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 24 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,893,255 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,736,646 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $690,159 | PYInvestmentIncomeAmt |
| CY Investment Income | $324,666 | CYInvestmentIncomeAmt |
| CY Other Revenue | $152,074 | CYOtherRevenueAmt |
| PY Total Revenue | $2,583,414 | PYTotalRevenueAmt |
| CY Total Revenue | $3,213,386 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $271,475 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $410,654 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,674,994 | PYOtherExpensesAmt |
| CY Other Expenses | $2,077,751 | CYOtherExpensesAmt |
| PY Total Expenses | $2,946,469 | PYTotalExpensesAmt |
| CY Total Expenses | $2,488,405 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$363,055 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $724,981 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,194,649 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,169,652 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $53,818 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $356,737 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,140,831 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,812,915 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO ASSIST IN THE DEVELOPMENT, GROWTH, AND OPERATION OF THE CHEYENNE REGIONAL MEDICAL CENTER. | MissionDesc |
| Significant New Program Srvc | Yes (true) | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,404,797 | ExpenseAmt |
| Desc | PURCHASE OF MEDICAL EQUIPMENT AND RELATED EXPENSES IN SUPPORT OF THE CHEYENNE REGIONAL MEDICAL CENTER DEVELOPMENT | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $151,694 | ExpenseAmt |
| Desc | INJURY PREVENTION/SAFE KIDS PROGRAM EXPENSES | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ONGOING SUPPORT FOR THE DAVIS HOSPICE CENTER, CHEYENNE REGIONAL CANCER CENTER, AND WOMEN AND INFANT PROGRAM AND SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,556,491 | 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 |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | 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 | false | 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 With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | 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 | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 24 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 24 | 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 E 23RD STREET | AddressLine1Txt |
| City | CHEYENNE | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82001 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| CARMALEE ROSE | ||||||
| CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| NATALIE WINEGAR | ||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| FRAN NALER | ||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BUD DAVIS | ||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARK ANDERSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN BALSER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID COOK | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RICK DAVIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BILL DUBOIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LAURIE FARKAS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JACQUELINE FERRALL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARCIA GRAHAM | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN GROSS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARGO KARSTEN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BILL LARSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID LIND | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| FRANK MAGAZINE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CAROL MERRELL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CAREN MURRAY | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MONA LEE PEARL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARIAN SCHULZ ORR | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ERNIE SHRINER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DALE STEENBERGEN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SANDRA SURBRUGG | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE STONE | ||||||
| EXEC DIRECTO | 40.00 | Yes (X) | $0 | $143,367 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $143,367 | TotReportableCompRltdOrgAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $311,797 | GovernmentGrantsAmt |
| All Other Contributions | $2,424,849 | AllOtherContributionsAmt |
| Noncash Contributions | $6,907 | NoncashContributionsAmt |
| Total Contributions | $2,736,646 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $207,741 | TotalRevenueColumnAmt |
| Exclusion | $207,741 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $116,925 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $116,925 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $116,925 | TotalRevenueColumnAmt |
| Exclusion | $116,925 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $239,167 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $87,093 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $152,074 | TotalRevenueColumnAmt |
| Exclusion | $152,074 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,213,386 | TotalRevenueColumnAmt |
| Exclusion | $476,740 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,367 | TotalAmt |
| Management And General | $143,367 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,982 | TotalAmt |
| Management And General | $239,982 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,305 | TotalAmt |
| Management And General | $27,305 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,200 | TotalAmt |
| Management And General | $7,200 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,603 | TotalAmt |
| Management And General | $111,603 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,240 | TotalAmt |
| Management And General | $49,240 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,013 | TotalAmt |
| Management And General | $5,013 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $695 | TotalAmt |
| Management And General | $695 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,576 | TotalAmt |
| Management And General | $1,576 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$1,137 | TotalAmt |
| Management And General | -$1,137 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRIBUTIONS TO CRMC | $1,040,832 | $832,665 | $208,167 |
| OTHER PROGRAM COSTS | $723,826 | $723,826 | |
| CONTRACTED SERVICES | $73,846 | $73,846 | |
| CUSTOMER RELATIONS | $16,306 | $16,306 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,751 | TotalAmt |
| Management And General | $48,751 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,488,405 | TotalAmt |
| Program Services | $1,556,491 | ProgramServicesAmt |
| Management And General | $931,914 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,126,291 | BOYAmt |
| EOY | $836,508 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $827,658 | BOYAmt |
| EOY | $510,964 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $43,407 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $35,595 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,388 | BOYAmt |
| EOY | $7,812 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,202,564 | BOYAmt |
| EOY | $14,784,485 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,748 | BOYAmt |
| EOY | $29,883 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,194,649 | BOYAmt |
| EOY | $16,169,652 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,818 | BOYAmt |
| EOY | $19,249 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $268,388 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $69,100 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,818 | BOYAmt |
| EOY | $356,737 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,793,696 | BOYAmt |
| EOY | $5,452,855 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,142,178 | BOYAmt |
| EOY | $7,168,579 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,204,957 | BOYAmt |
| EOY | $3,191,481 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,140,831 | BOYAmt |
| EOY | $15,812,915 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,194,649 | BOYAmt |
| EOY | $16,169,652 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $724,981 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$59,804 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $6,907 | DonatedServicesAndUseFcltsAmt |
| 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 | false | FSAuditedInd |
| 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 | $1,510,272 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,364,163 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,019,504 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,893,255 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,736,646 | CurrentTaxYearAmt |
| Total | $11,523,840 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,510,272 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,364,163 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,019,504 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,893,255 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,736,646 | CurrentTaxYearAmt |
| Total | $11,523,840 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $11,523,840 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $293,676 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $279,447 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $254,942 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $248,565 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $207,741 | CurrentTaxYearAmt |
| Total | $1,284,371 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $239,167 | CurrentTaxYearAmt |
| Total | $239,167 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $13,047,378 | TotalSupportAmt |
| Public Support CY170 | 0.88320 | PublicSupportCY170Pct |
| Public Support PY170 | 0.88110 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 | $3,204,957 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $5,992 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $19,468 | OtherExpendituresAmt |
| End Year Balance | $3,191,481 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,192,426 | BeginningYearBalanceAmt |
| Contributions | $19,336 | ContributionsAmt |
| Investment Earnings Or Losses | $110,737 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $117,542 | OtherExpendituresAmt |
| End Year Balance | $3,204,957 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,258,002 | BeginningYearBalanceAmt |
| Contributions | $5,901 | ContributionsAmt |
| Investment Earnings Or Losses | $62,459 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $133,936 | OtherExpendituresAmt |
| End Year Balance | $3,192,426 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,333,005 | BeginningYearBalanceAmt |
| Contributions | $234 | ContributionsAmt |
| Investment Earnings Or Losses | -$22,282 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $52,955 | OtherExpendituresAmt |
| End Year Balance | $3,258,002 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,139,767 | BeginningYearBalanceAmt |
| Contributions | $1,600 | ContributionsAmt |
| Investment Earnings Or Losses | $353,583 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $161,945 | OtherExpendituresAmt |
| End Year Balance | $3,333,005 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,407 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,595 | DepreciationAmt |
| Book Value | $7,812 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,812 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE FOUNDATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXPEMT FROM INCOME TAXES UNDER SECTION 501(C)(3) FOR THE INTERNAL REVENUE CODE; THEREFORE, NO PROVISION FOR INCOME TAXES IS NECESSARY. THE FOUNDATION HAS BEEN CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION AS DEFINED IN CODE SECTION 509(A) AND QUALIFIES FOR DEDUCTIBLE CONTRIBUTIONS AS PROVIDED IN SECTION 170(B)(1) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS REQUIRED TO FILE FEDERAL FORM 990- RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, WHICH IS AN INFORMATION RETURN ONLY. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DENIM N DIAMOND | Event1Nm |
| Gross Receipts Event1 | $216,481 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $216,481 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $78,910 | OtherDirectExpensesEvent1Amt |
| Event2 | TREE OF REMEMBR | Event2Nm |
| Gross Receipts Event2 | $22,686 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $22,686 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $8,183 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $239,167 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $239,167 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $87,093 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $87,093 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $152,074 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 2 | INJURY PREVENTION/SAFE KIDS PROGRAM EXPENSES AND ONGOING SUPPORT OF DAVIS HOSPICE CENTER PROGRAM AND SERVICES |
| 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 FINANCE COMMITTEE HAS APPROVED THE FORM 990, IT IS SIGNED AND FILED WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ORGANIZATION BYLAWS REQUIRE ALL DIRECTORS/STAFF/COMMITTEE MEMBERS TO NOTIFY THE BOARD AS SOON AS A POSSIBLE CONFLICT OF INTEREST ARISES AND THEY MUST ALSO SIGN A CONFLICT OF INTEREST FORM ANNUALLY. |
| 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 |
| FORM 990, PAGE 6, PART VI, LINE 15B | ALL EMPLOYEE SALARIES ARE SET BY THE CHEYENNE REGIONAL MEDICAL CENTER. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL GOVERNMENT 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
| 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 | Yes (true) | 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 | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| C | $567,309 | FMV |
| CHEYENNE REGIONAL MEDICAL CENTER | ||
| B | $1,040,832 | FMV |
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