2013-05-15T13:00:29-05:00 2012-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2011-07-01 830230808 Wyoming Medical Center Foundation WYOM 3075772188 1233 East Second Street Casper WY 82601 Karen Zaback 3075772188 2013-05-15 1 Lisa Chaffee CPA P00193453 6122536500 2013-05-08 2011 2016-02-24 21:20:13Z Karen Zaback 1233 East Second Street Casper WY 82601 1434537 0 X www.wyomingmedicalcenterfoundation.org X 1976 WY To support the mission of the Wyoming Medical Center and the health of the community. 14 13 0 47 0 0 1504334 391008 274773 449289 37414 55206 92464 22982 1908985 918485 1535438 23142 0 0 452930 432352 0 0 0 674162 443560 2662530 899054 -753545 19431 5031680 5278328 98776 35209 4932904 5243119 X The Foundation's mission is to visibily improve the health of the community by providing financial and educational support in partnership with Wyoming Medical Center. 0 0 351524 2970 449289 Masterson Place, the Foundation's "home away from home", provides out of town patients and families a comfortable place to stay while receiving medical care in Casper. Each night, the facility averages 13 residents for a reasonable rate of $40. Masterson Place serves all needs including heart, cancer, neurological and trauma patients and families. Basic services include transportation to and from the facility, laundry and linen services, a small entertainment area as well as a reading library. The staff offers comfort to guests and their families as well as assistance in accessing medical and social services. Approximately 10,000 guests were served and $2,970 worth of room subsidy during the year ended June 30, 2012. 138295 Community Programs and support of Wyoming Medical Center: the Foundation assisted Wyoming Medical Center with public and community related efforts outside usual operational expenses for medical, civic, charitable, scientific, and educational purposes. The Foundation is holding funds for a capital campaign for Wyoming Medical Center construct a new tower, but no funds were distributed this year. It also raises funds for the Life Flight program, which is the only one in Wyoming, to purchase uniforms and specialized equipment when needed. The Foundation oversees the funds for the Prevent Alcohol Related Trauma in Youth (P.A.R.T.Y.) program, which educates the community about the risks of alcohol related trauma. The Foundation also supports many other community related programs. 62829 10972 Angels Program: The goal of the Angels Program is to offer support and services to cancer patients and their families around the state while they are going through treatment in Casper. We provide awareness and mammograms as well as women's exams for the uninsured and patients in need. The Angels Program has a group of 35 volunteers that provide meals and one-on-one support to patients and their families. We provide a library, art therapy, wigs, prosthesis, gas cards, grocery cards, utility payments, housekeeping, lodging and food vouchers so that patients can concentrate on healing and spending time with loved ones rather than worrying about day to day problems. The Angels Program is currently meeting the needs of at least 300 families. 113486 9200 Safe Kids of Central Wyoming is dedicated to the prevention of unintentional injury to children through education, advocacy, enforcement and environmental changes. Serving Central Wyoming, the coalition is comprised of almost 50 individuals who represent law enforcement, safety and health advocates, parents and grandparents, education professionals, child advocate groups, city and county officals. Every year, a Safe Kids Day is held where more than 1,000 participants enjoy a day of fun and learning in an interactive environment. More than 300 helmets are distributed, 250 car seats are checked with more than 100 distributed, over 100 life jackets are distributed to children and families on an annual basis. Monthly car seat checks, bike rodeos, booster seat demonstrations in elementary schools, seat belt campaigns at the junior and senior high levels are routine calendar items. Involvement to prevent drunk driving is continual in an effort to protect children and their families. 113486 9200 666134 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 10 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 14 13 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Nathan Stutte 3075772767 1233 East 2nd St Casper WY 86201 X Miriam Temme 1.50 X X 0 0 0 Karen Zaback 0.50 X X 0 0 0 Jessica Oden 0.50 X X 0 0 0 Bob Barnard 0.50 X 0 0 0 Patricia Cloud 0.50 X 0 0 0 Vickie Diamond 1.00 X 0 572431 26288 Dick Dresang 0.50 X 0 0 0 Cheryl Graff 0.50 X 0 0 0 Susie McMurry 1.00 X 0 0 0 John Purviance 0.50 X 0 0 0 Dax Collins 0.50 X 0 0 0 Marie Hill 0.50 X 0 0 0 Deanne Sramek 0.50 X 0 0 0 Kyle Thompson 0.50 X 0 0 0 Shawn Bassham 40.00 X 130005 0 14837 Pam Walker 40.00 X 54288 0 0 184293 572431 41125 1 0 1 0 0 391008 391008 Masterson Place Rev 721000 274289 274289 Income from Affiliate 900099 175000 175000 449289 18974 18974 508702 472470 36232 36232 36232 66564 43582 22982 22982 918485 449289 0 78188 23142 23142 145094 101566 43528 287258 162106 125152 860 860 7530 7530 14985 14985 565 475 90 30847 26067 4780 65990 51173 14817 2512 62 2450 78978 73908 5070 31616 27642 3974 3562 3162 400 72895 72895 13556 12534 1022 Community Programs 54906 54906 64758 56496 8262 899054 666134 232920 0 909536 1123700 1158633 757352 5483 20139 1957449 671517 1353611 1285932 1390709 1455805 199919 621611 13789 13789 5031680 5278328 4008 98776 31201 98776 35209 X 2592648 3039653 1776825 1640035 563431 563431 4932904 5243119 5031680 5278328 X 19431 290784 X 0 1 1 X 0 X X X 0 0 0 Wyoming Medical Center 830279242 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1511270 10478 10478 1511270 1111270 400000 93488 93488 1511270 1111270 42331 42331 1111270 0.62720 0.37280 0.00000 0 0 340885 340885 1337947 446509 891438 278617 225008 53609 1285932 Investment in Hospital Foundation Ventures, Inc. 621611 C 621611 Due to Wyoming Medical Center 31201 31201 918485 899054 19431 -39107 329891 290784 310215 2060588 -39107 1312628 1273521 787067 131418 131418 918485 1228056 329002 329002 899054 0 899054 Description of Intended Use of Endowment Funds: Part V, Line 4: The Foundation has an endowment on which the investment earnings are available to be used for Foundation general operating expenses. Description of Uncertain Tax Positions Under FIN 48: Part X: The Foundation is organized as a Wyoming nonprofit corporation and has been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Foundation undergoes annual analysis of its various tax positions, assessing the likelihood of these positions being upheld with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. The Foundation believes that it is compliant with all IRS tax regulations and as of June 30, 2012 has not recorded a tax liability for a tax uncertainty. The Foundation will recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if incurred. Part XI, Line 8 - Other Adjustments: Change in Valuation of Bad Debt Expense from Pledges -144,924. Change in Valuation of Discount on Pledges 53,123. Change in Value of Subsidiary Hospital Foundation Ventures Inc. 421,692. Total to Schedule D, Part XI, Line 8: 329,891. Part XII, Line 2d - Other Adjustments: Net Assets Released from Restrictions on Financial Statements 430,516. Subsidiary Hospital Foundation Ventures, Inc. Revenues 882,112. Part XII, Line 4b - Other Adjustments: Fundraising Expenses Reported in Expenses on Financial Statements -43,582. Subsidiary Hospital Foundation Ventures, Inc. Distribution 175,000. Part XIII, Line 2d - Other Adjustments: Subsidiary Hospital Foundation Ventures, Inc. Expenses 285,420. Fundraising Expenses Reported in Revenue on Form 990 43,582. Wine with a View 66564 66564 19854 23728 66564 66564 19854 23728 43582 22982 1 Car Seats 100 5000 FMV Provided car seats to those in need. Helmets 300 3000 FMV Provided helmets to children. Life Jackets 100 1200 FMV Provided life jackets to children. Mammograms 118 10031 Travel for Children's Medical Appointments 8 941 Masterson Place Rooms 74 2970 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Grant requests are submitted to the Foundation. The Foundation's program committee reviews the requests to see if the request qualifies, and if so, analyzes the amount requested and establishes a decision to be presented to the Board of Directors for approval. The estimates for car seats, helmets, and life jackets are a best guess of the number of each item given out at various events and to walk-ins at our office. The mammograms are an average of the number of patients billed for over 12 months. The cancer patient assistance and travel for children's medical appointments are the number of checks we cut to those needing assistance. The Masterson Place rooms are the total paid by the Foundation divided by the $40 per night rate. 1 0 0 0 0 0 0 0 0 Vickie Diamond 0 472459 0 90000 0 9972 0 26288 0 5620 0 604339 0 0 Part I, Line 4a Shawn Bassham: Severance pay of $22,295.20 and severance cobra premiums of $6,631.82 Supplemental Information Part III For the purposes of determining compensation, the filing organization relied on a related organization to establish compensation of the CEO of Wyoming Medical Center. The related organization used the following practices for establishing compensation for such individuals: compensation committee, written employment contract, compensation survey or study, and approval by the board or compensation committee. Form 990, Part VI, Section A, line 1 The Executive Committee of the Board may act on behalf of the Board to make decisions based on motions made at regular Board meetings. This committee is comprised of the Board Chair, Board Vice Chair and Board Treasurer. Form 990, Part VI, Section A, line 7a The Foundation's Board includes the CEO of Wyoming Medical Center, the current President of the Blue Envelope Health Fund, and the current President of the Wyoming Medical Center Auxiliary. The Foundation's Board must have eight community representatives as approved and appointed by the Wyoming Medical Center. Form 990, Part VI, Section B, line 11 A public accounting firm was contracted to prepare the Form 990. The Secretary/Treasurer will review the Form 990 with the Executive Director and the Finance Officer. The Form 990 will be presented to the Board for approval and upon approval, will be filed with the IRS. Form 990, Part VI, Section B, line 12c The Foundation monitors voting Board Members by requiring each Member to submit a conflict of interest form at the beginning of every fiscal year or when joining the Board. The Executive Director reviews the conflict forms. When voting on projects where an individual board member has a conflict, they will abstain from voting. The Executive Director and staff must disclose any conflicts within the confines of the Wyoming Medical Center policies as employees. Form 990, Part VI, Section B, line 15a The Executive Director is reviewed under the Wyoming Medical Center Director and Manager process that includes a 360 evaluation, a Wyoming Medical Center evaluation form and the percentage raise is based on this score. Additionally, the Executive Director's performance and compensation is reviewed by the Executive Committee led by the Board Chair regarding the goals set at the beginning of the fiscal year. A predetermined bonus (10% of salary) is prorated based on the accomplishments within the strategic plan and the Executive Director's goals for the year. Every 12-18 months, Wyoming Medical Center will conduct a market survey to determine if there are potential market adjustments based on similar jobs and if there are any market increases. This process was undertaken in August 2011 for the Executive Director Shawn Bassham. Form 990, Part VI, Section C, line 19 The Foundation makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part VII: In addition to the hours served at the Wyoming Medical Center Foundation, Vickie Diamond served 45 hours per week at the Wyoming Medical Center, a related organization. The Executive Director is employed by a related organization, Wyoming Medical Center. The salary for this position is reimbursed by the Wyoming Medical Center Foundation. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -39,107. Change in Valuation of Bad Debt Expense from Pledges -144,924. Change in Valuation of Discount on Pledges 53,123. Change in Value of Subsidiary Hospital Foundation Ventures Inc. 421,692. Total to Form 990, Part XI, Line 5: 290,784. Wyoming Medical Center 1233 East Second St Casper WY 82601 830279242 Medical Services WY 501(c)(3) Line 3 N/A 0 Hospital Foundation Ventures Inc 1233 East 2nd St Casper WY 82601 830282249 Business Investment WY Wyoming Medical Center Foundation C 882112 755711 1.00000 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1 Hospital Foundation Ventures Inc R 175000 Actual Amount