2012-05-15T15:18:34-05:00 2011-06-30 Eide Bailly LLP 4310 17th AV S PO Box 2545 Fargo ND 581082545 990 2010-07-01 830230808 Wyoming Medical Center Foundation WYOM 3075772188 1233 East Second Street Casper WY 82601 Miriam Temme 3075772188 2012-05-15 1 Lisa Chaffee CPA 7012398500 2012-05-14 2010 2016-02-24 21:20:13Z Miriam Temme 1233 East Second Street Casper WY 82601 2104422 0 X www.wyomingmedicalcenterfoundation.org X 1976 WY To support the mission of the Wyoming Medical Center and the health of the community. 17 16 0 75 0 0 1182567 1504334 404830 274773 31883 37414 194139 92464 1813419 1908985 62695 1535438 0 0 442087 452930 0 0 20386 688991 674162 1193773 2662530 619646 -753545 7230990 5031680 58065 98776 7172925 4932904 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 280653 5980 274773 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 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. 1777799 1500000 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 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. 77167 16258 Cancer 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. 78161 13200 Safe 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. 78161 13200 2213780 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 17 16 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Olympia Ireland 3075772971 1139 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 525468 27207 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 Sue Hoag 0.50 X 0 0 0 Michele Ryan 0.50 X 0 0 0 Deanne Sramek 0.50 X 0 0 0 Bill Sullivan 0.50 X 0 0 0 Gary Trapkus 0.50 X 0 0 0 Kyle Thompson 0.50 X 0 0 0 Diane Adami 0.50 X 0 0 0 Pam Walker 0.50 X 0 0 0 Shawn Bassham 40.00 X 90596 0 0 90596 525468 27207 0 0 1 0 0 5976 1498358 1504334 Masterson Place Rev 721000 274773 274773 274773 19847 19847 122077 104510 17567 17567 17567 183391 90927 92464 92464 1908985 274773 0 129878 1500000 1500000 35438 35438 115936 81155 34781 336994 99142 237852 13784 13784 6841 6841 17819 2219 15600 30519 12732 17787 2607 2607 61425 61425 19136 6224 12912 6441 6441 74086 74086 9561 9561 Community Programs 397689 397689 Capital campaign 20386 20386 Bad debt expense 424 424 Dues & subscriptions 0 13444 7771 5673 2662530 2213780 428364 20386 1443849 909536 1544207 1158633 200936 5483 1952232 598621 1368031 1353611 2390260 1390709 269918 199919 13789 13789 7230990 5031680 10503 47562 98776 58065 98776 X 4252343 2592648 2757151 1776825 163431 563431 7172925 4932904 7230990 5031680 X -753545 -1486476 X 0 1 1 X 0 X X X 0 0 0 Wyoming Medical Center 830279242 3 1 1500000 1 1500000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1111270 400000 93488 93488 1511270 1111270 42331 42331 1111270 0.62720 0.37280 0 0 340885 340885 1337947 390453 947494 190079 139888 50191 83321 68280 15041 1353611 Due to Wyoming Medical Center 98776 98776 1908985 2662530 -753545 163399 -1649875 -1486476 -2240021 2854340 163399 2275443 2438842 415498 1493487 1493487 1908985 2891523 228993 228993 2662530 0 2662530 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. Masterson Place Golf 31175 31175 1338 8234 11080 3637 7292 Connoisseur's Delight 49105 49105 903 11052 6970 9141 5 103111 103111 10232 2851 3900 14297 183391 183391 11570 8234 14834 14689 10870 30730 90927 92464 1 Wyoming Medical Center 1233 East 2nd Street Casper WY 82601 830279242 501(c)(3) 1500000 Capital Campaign 1 Car Seats 100 5000 FMV Provided car seats to those in need. Helmets 700 7000 FMV Provided helmets to children. Life Jackets 100 1200 FMV Provided life jackets to children. Mammograms 102 8591 Cancer Patient Assistance 15 1764 Travel for Children's Medical Appointments 29 5903 Masterson Place Rooms 150 5980 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 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. 0 0 0 0 0 0 0 0 0 Vickie Diamond 0 433541 0 82000 0 9927 0 27207 0 4310 0 556985 0 0 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, Susan McMurray and Vickie Diamond also served 5 and 45 hours per week respectively, at the Wyoming Medical Center, a related organization. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: 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. 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 357682 410110 1.00000 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1 Hospital Foundation Ventures Inc R 234000 Actual Amount