FURP.ORG / PUBLIC DATA EXPLORER

NATRONA COLLECTIVE HEALTH TRUST: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NATRONA COLLECTIVE HEALTH TRUST (EIN 83-0230808)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201241369349306414
Schema version
2010v3.4
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)
Timestamp2012-05-15T15:18:34-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17th AV S PO Box 2545AddressLine1
CityFargoCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN830230808EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Wyoming Medical Center FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWYOMNameControl
Phone3075772188Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11233 East Second StreetAddressLine1
CityCasperCity
StateWYState
ZIP Code82601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMiriam TemmeName
TitleBoard ChairTitle
Phone3075772188Phone
Date Signed2012-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLisa Chaffee CPAName
Phone7012398500Phone
Date Prepared2012-05-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMiriam TemmeNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11233 East Second StreetAddressLine1
CityCasperCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2104422GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.wyomingmedicalcenterfoundation.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1976YearFormation
State Legal DomicileWYStateLegalDomicile
Activity Or Mission DescriptionTo support the mission of the Wyoming Medical Center and the health of the community.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers75TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1182567ContributionsGrantsPriorYear
Contributions Grants Current Year1504334ContributionsGrantsCurrentYear
Program Service Revenue Prior Year404830ProgramServiceRevenuePriorYear
Program Service Revenue CY274773ProgramServiceRevenueCY
Investment Income Prior Year31883InvestmentIncomePriorYear
Investment Income Current Year37414InvestmentIncomeCurrentYear
Other Revenue Prior Year194139OtherRevenuePriorYear
Other Revenue Current Year92464OtherRevenueCurrentYear
Total Revenue Prior Year1813419TotalRevenuePriorYear
Total Revenue Current Year1908985TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year62695GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1535438GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year442087SalariesEtcPriorYear
Salaries Etc Current Year452930SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year20386TotalFundrsngExpCurrentYear
Other Expense Prior Year688991OtherExpensePriorYear
Other Expenses Current Year674162OtherExpensesCurrentYear
Total Expenses Prior Year1193773TotalExpensesPriorYear
Total Expenses Current Year2662530TotalExpensesCurrentYear
Revenues Less Expenses Prior Year619646RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-753545RevenuesLessExpensesCY
Total Assets BOY7230990TotalAssetsBOY
Total Assets EOY5031680TotalAssetsEOY
Total Liabilities BOY58065TotalLiabilitiesBOY
Total Liabilities EOY98776TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7172925NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4932904NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe Foundation's mission is to visibily improve the health of the community by providing financial and educational support in partnership with Wyoming Medical Center.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense280653Expense
Grants5980Grants
Revenue274773Revenue
DescriptionMasterson 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 20 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 20,000 guests were served and $15,000 worth of room subsidy during the year ended June 30, 2011.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1777799Expense
Grants1500000Grants
DescriptionCommunity 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 running a Capital Campaign to raise funds for Wyoming Medical Center to expand the Emergency Department and construct a new tower. It also raises money to support the Wyoming Medical Center Life Flight program, which is the only one in Wyoming, to purchase equipment and staff uniforms. 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.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense77167Expense
Grants16258Grants
DescriptionCancer Resource Center/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 25 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.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense78161Expense
Grants13200Grants
DescriptionSafe Kids of Central Wyoming is dedicated to the prevention of unintentional injury to children through education, advocacy, enforcement and envioronmental 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 700 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.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp78161TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt13200TotalOfOtherProgramServiceGrnt
Total Program Service Expense2213780TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Olympia IrelandBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3075772971TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11139 East 2nd StAddressLine1
CityCasperCity
StateWYState
ZIP Code86201ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Miriam Temme
Board Chair1.50XX000
Karen Zaback
Vice Chair0.50XX000
Jessica Oden
Secretary/Treasurer0.50XX000
Bob Barnard
Board Member0.50X000
Patricia Cloud
Board Member0.50X000
Vickie Diamond
Board Member/CEO WMC1.00X052546827207
Dick Dresang
Board Member0.50X000
Cheryl Graff
Board Member0.50X000
Susie McMurry
Board Member1.00X000
John Purviance
Board Member0.50X000
Sue Hoag
Board Member0.50X000
Michele Ryan
Board Member0.50X000
Deanne Sramek
Board Member0.50X000
Bill Sullivan
Board Member0.50X000
Gary Trapkus
Board Member0.50X000
Kyle Thompson
Board Member0.50X000
Diane Adami
Board Member0.50X000
Pam Walker
Board Member (thru Oct 2010)0.50X000
Shawn Bassham
Executive Director40.00X9059600
FieldValueIRS element (for citing)
Total Reportable Comp From Org90596TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs525468TotalReportableCompFrmRltdOrgs
Total Other Compensation27207TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations5976RelatedOrganizations
All Other Contributions1498358AllOtherContributions
Total Contributions1504334TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionMasterson Place RevDescription
Business Code721000BusinessCode
Total Revenue Column274773TotalRevenueColumn
Related Or Exempt Function Income274773RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue274773TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column19847TotalRevenueColumn
Exclusion$19,847ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities122077Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities104510Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities17567Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column17567TotalRevenueColumn
Exclusion$17,567ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events183391GrossIncomeFundraisingEvents
Fundraising Direct Expenses90927FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column92464TotalRevenueColumn
Exclusion$92,464ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1908985TotalRevenueColumn
Related Or Exempt Function Income274773RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$129,878ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1500000Total
Program Services1500000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total35438Total
Program Services35438ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total115936Total
Program Services81155ProgramServices
Management And General34781ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total336994Total
Program Services99142ProgramServices
Management And General237852ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total13784Total
Management And General13784ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6841Total
Management And General6841ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total17819Total
Program Services2219ProgramServices
Management And General15600ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total30519Total
Program Services12732ProgramServices
Management And General17787ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2607Total
Management And General2607ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total61425Total
Program Services61425ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total19136Total
Program Services6224ProgramServices
Management And General12912ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total6441Total
Management And General6441ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total74086Total
Management And General74086ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total9561Total
Program Services9561ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraising
Community Programs397689397689
Capital campaign2038620386
Bad debt expense424424
Dues & subscriptions0

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13444Total
Program Services7771ProgramServices
Management And General5673ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2662530Total
Program Services2213780ProgramServices
Management And General428364ManagementAndGeneral
Fundraising20386Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1443849BOY
EOY909536EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1544207BOY
EOY1158633EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY200936BOY
EOY5483EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1952232LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec598621LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1368031BOY
EOY1353611EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2390260BOY
EOY1390709EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY269918BOY
EOY199919EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY13789BOY
EOY13789EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7230990BOY
EOY5031680EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY10503BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY47562BOY
EOY98776EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY58065BOY
EOY98776EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4252343BOY
EOY2592648EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2757151BOY
EOY1776825EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY163431BOY
EOY563431EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7172925BOY
EOY4932904EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7230990BOY
EOY5031680EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-753545ReconcilationRevenueExpenses
Reconcilation Other Changes-1486476ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1Wyoming Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
EIN830279242EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Amount$1,500,000Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts1500000SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1111270BeginningOfYearBalance
Contributions400000Contributions
Investment Earnings Or Losses93488InvestmentEarningsOrLosses
Other Expenditures93488OtherExpenditures
End Of Year Balance1511270EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1111270BeginningOfYearBalance
Investment Earnings Or Losses42331InvestmentEarningsOrLosses
Other Expenditures42331OtherExpenditures
End Of Year Balance1111270EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.62720BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.37280PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis340885OtherCostOrOtherBasis
Book Value340885BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1337947OtherCostOrOtherBasis
Depreciation390453Depreciation
Book Value947494BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis190079OtherCostOrOtherBasis
Depreciation139888Depreciation
Book Value50191BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis83321OtherCostOrOtherBasis
Depreciation68280Depreciation
Book Value15041BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1353611TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue to Wyoming Medical CenterDescription
Amount$98,776Amount
FieldValueIRS element (for citing)
Total Of Amounts98776TotalOfAmounts
Total Revenue1908985TotalRevenue
Total Expenses2662530TotalExpenses
Excess Or Deficit For Year-753545ExcessOrDeficitForYear
Net Unrealized GL On Investments163399NetUnrealizedGLOnInvestments
Other-$1,649,875OtherAmount
Total Adjustments-1486476TotalAdjustments
Excess Or Deficit Per FS-2240021ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2854340TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments163399NetUnrealizedGainsInvestments
Other Revenues2275443OtherRevenues
Revenue Not Rptd F9902438842RevenueNotRptdF990
Revenue Subtotal415498RevenueSubtotal
Other Revenues Not Included1493487OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1493487RevenueNotRptdOnFinStmt
Total Revenue Per Form9901908985TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2891523TotExpensesEtcAuditedFinclStmt
Other Expenses Included228993OtherExpensesIncluded
Expenses Not Rptd F990228993ExpensesNotRptdF990
Expenses Subtotal2662530ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902662530TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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 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, 2011 has not recorded a tax liability for a tax uncertainty.
Part XI, Line 8 - Other Adjustments:Bad Debt Expense from Pledges -66,058. Change in Value of Hospital Foundation Ventures Inc. 163,461. Adjustment in Reporting Methodology for Hospital Foundation Ventures, Inc. -1,747,278.
Part XII, Line 2d - Other Adjustments:Net Assets Released from Restrictions on Financial Statements 1,973,916.
Part XII, Line 4b - Other Adjustments:Contributions Reported as Changes in Restricted Net Assets on Financial Stmt 1,442,625. Fundraising Expenses Reported in Expenses on Financial Statements -90,927. Contributions Reported as Change in Discount on Pledges on Financial Stmt 141,789.
Part XIII, Line 2d - Other Adjustments:Fundraising Expenses Reported in Revenue on Form 990 90,927.
Part XI: The prior period adjustment reflects the adjustment necessary to correct the variance between the prior year net assets from the audited financial statements and the Form 990.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Masterson Place GolfNameOfEvent1
Gross Receipts Event131175GrossReceiptsEvent1
Gross Revenue Event131175GrossRevenueEvent1
Cash Prizes Event11338CashPrizesEvent1
Non Cash Prizes Event18234NonCashPrizesEvent1
Rent Facility Costs Event111080RentFacilityCostsEvent1
Food And Beverage Event13637FoodAndBeverageEvent1
Other Direct Expenses Event17292OtherDirectExpensesEvent1
Name Of Event2Connoisseur's DelightNameOfEvent2
Gross Receipts Event249105GrossReceiptsEvent2
Gross Revenue Event249105GrossRevenueEvent2
Rent Facility Costs Event2903RentFacilityCostsEvent2
Food And Beverage Event211052FoodAndBeverageEvent2
Entertainment Event26970EntertainmentEvent2
Other Direct Expenses Event29141OtherDirectExpensesEvent2
Total Number Of Other Events5TotalNumberOfOtherEvents
Gross Receipts Other Events103111GrossReceiptsOtherEvents
Gross Revenue Other Events103111GrossRevenueOtherEvents
Cash Prizes Other Events10232CashPrizesOtherEvents
Rent Facility Costs Other Events2851RentFacilityCostsOtherEvents
Entertainment Other Events3900EntertainmentOtherEvents
Other Direct Expenses Other Events14297OtherDirectExpensesOtherEvents
Gross Receipts Total183391GrossReceiptsTotal
Gross Revenue Total Events183391GrossRevenueTotalEvents
Cash Prizes Total Events11570CashPrizesTotalEvents
Non Cash Prizes Total Events8234NonCashPrizesTotalEvents
Rent Facility Costs Total Events14834RentFacilityCostsTotalEvents
Food And Beverage Total Events14689FoodAndBeverageTotalEvents
Entertainment Total Events10870EntertainmentTotalEvents
Other Direct Expenses Total Events30730OtherDirectExpensesTotalEvents
Direct Expense Summary Events90927DirectExpenseSummaryEvents
Net Income Summary92464NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Wyoming Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11233 East 2nd StreetAddressLine1
CityCasperCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient830279242EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant1500000AmountOfCashGrant
Purpose Of GrantCapital CampaignPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII (7 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistanceAmount Of Cash GrantAmountOfCashGrant
Car Seats1005000FMVProvided car seats to those in need.
Helmets7007000FMVProvided helmets to children.
Life Jackets1001200FMVProvided life jackets to children.
Mammograms1028591
Cancer Patient Assistance151764
Travel for Children's Medical Appointments295903
Masterson Place Rooms1505980

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule 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 mammorgrams 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 lace rooms are the total paid by the Foundation divided by the $40 per night rate.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonVickie DiamondNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs433541CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs82000BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs9927OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs27207DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs4310NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs556985TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationFor 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 1The 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 7aThe 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 11A 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.
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 12c
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 B, line 15a
The Foundation makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.Form 990, Part VI, Section C, line 19
In addition to the hours served at the Wyoming Medical Center Foundation, Susan McMurray and Vickie Diamond also served 5 and 45 hours per week respectively, at the Wyoming Medical Center, a related organization.Form 990, Part VII:
Changes in Net Assets or Fund Balances:Net unrealized gains on investments: 163,399. Bad Debt Expense from Pledges -66,058. Change in Value of Hospital Foundation Ventures Inc. 163,461. Adjustment in Reporting Methodology for Hospital Foundation Ventures, Inc. -1,747,278. Total to Form 990, Part XI, Line 5: -1,486,476.Form 990, Part XI, line 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Wyoming Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11233 East Second StAddressLine1
CityCasperCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
EIN830279242EIN
Primary ActivitiesMedical ServicesPrimaryActivities
Legal Domicile StateWYLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity StatusLine 3PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Hospital Foundation Ventures IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11233 East 2nd StAddressLine1
CityCasperCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
EIN830282249EIN
Primary ActivityBusiness InvestmentPrimaryActivity
Legal Domicile StateWYLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Wyoming Medical Center FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income357682ShareOfTotalIncome
Share Of EOY Assets410110ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1Hospital Foundation Ventures IncBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeRTransactionType
Amount Involved234000AmountInvolved
Method Of Amt DeterminationActual AmountMethodOfAmtDetermination