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        <BusinessNameLine1>Blue Envelope Health Fund</BusinessNameLine1>
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        <State>WY</State>
        <ZIPCode>82602</ZIPCode>
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      <DateSigned>2013-11-15</DateSigned>
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          <City>Casper</City>
          <State>WY</State>
          <ZIPCode>82601</ZIPCode>
        </AddressUS>
        <AmountOfCashGrant>10000</AmountOfCashGrant>
        <AmountOfNonCashAssistance>0</AmountOfNonCashAssistance>
        <PurposeOfGrant>General Operations</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>United Way</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>1701 East E Street</AddressLine1>
          <City>Casper</City>
          <State>WY</State>
          <ZIPCode>82601</ZIPCode>
        </AddressUS>
        <AmountOfCashGrant>25000</AmountOfCashGrant>
        <AmountOfNonCashAssistance>0</AmountOfNonCashAssistance>
        <PurposeOfGrant>Asbestos Abatement - Senior Housing</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>Mercer Family Resource Center</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>535 W Yellowstone Hwy</AddressLine1>
          <City>Casper</City>
          <State>WY</State>
          <ZIPCode>82601</ZIPCode>
        </AddressUS>
        <AmountOfCashGrant>34000</AmountOfCashGrant>
        <AmountOfNonCashAssistance>0</AmountOfNonCashAssistance>
        <PurposeOfGrant>General Operations</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>Central Wyo Counseling Center</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>1430 Wilkins Circle</AddressLine1>
          <City>Casper</City>
          <State>WY</State>
          <ZIPCode>82601</ZIPCode>
        </AddressUS>
        <AmountOfCashGrant>25000</AmountOfCashGrant>
        <AmountOfNonCashAssistance>0</AmountOfNonCashAssistance>
        <PurposeOfGrant>Assist with program expenses</PurposeOfGrant>
      </RecipientTable>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>Camp Hope</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>3920 West 45th Street</AddressLine1>
          <City>Casper</City>
          <State>WY</State>
          <ZIPCode>82604</ZIPCode>
        </AddressUS>
        <AmountOfCashGrant>10000</AmountOfCashGrant>
        <AmountOfNonCashAssistance>0</AmountOfNonCashAssistance>
        <PurposeOfGrant>Camp Operations</PurposeOfGrant>
      </RecipientTable>
      <TotalNbrOf501C3AndGovtGrants>7</TotalNbrOf501C3AndGovtGrants>
      <TotalNbrOfOtherOrganizations>0</TotalNbrOfOtherOrganizations>
    </IRS990ScheduleI>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="12000229" softwareVersion="2012v2.0">
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 19</Identifier>
        <ReturnReference>Form 990, Part VI, Line 19: Other Organization Documents Publicly Available</ReturnReference>
        <Explanation>No documents available to the public.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Line 11b</Identifier>
        <ReturnReference>Form 990, Part VI, Line 11b: Form 990 Review Process</ReturnReference>
        <Explanation>No review was or will be conducted.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
  </ReturnData>
</Return>