FURP.ORG / PUBLIC DATA EXPLORER

NATRONA COLLECTIVE HEALTH TRUST: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NATRONA COLLECTIVE HEALTH TRUST (EIN 83-0230808)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201121339349304022
Schema version
2009v1.7
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)
Timestamp2011-05-13T14:25:27-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

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)
NameSHAWN BASSHAMName
TitleDIRECTORTitle
Phone3075772188Phone
Date Signed2011-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSHAWN BASSHAMNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11233 EAST SECOND STREETAddressLine1
CityCASPERCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1883747GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
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 Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers75TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2177085ContributionsGrantsPriorYear
Contributions Grants Current Year1182567ContributionsGrantsCurrentYear
Program Service Revenue Prior Year717442ProgramServiceRevenuePriorYear
Program Service Revenue CY404830ProgramServiceRevenueCY
Investment Income Prior Year81818InvestmentIncomePriorYear
Investment Income Current Year31883InvestmentIncomeCurrentYear
Other Revenue Prior Year65202OtherRevenuePriorYear
Other Revenue Current Year194139OtherRevenueCurrentYear
Total Revenue Prior Year3041547TotalRevenuePriorYear
Total Revenue Current Year1813419TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year73212GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY62695GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year432564SalariesEtcPriorYear
Salaries Etc Current Year442087SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year71593TotalFundrsngExpCurrentYear
Other Expense Prior Year561539OtherExpensePriorYear
Other Expenses Current Year688991OtherExpensesCurrentYear
Total Expenses Prior Year1067315TotalExpensesPriorYear
Total Expenses Current Year1193773TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1974232RevenuesLessExpensesPriorYear
Revenues Less Expenses CY619646RevenuesLessExpensesCY
Total Assets BOY5170268TotalAssetsBOY
Total Assets EOY7230990TotalAssetsEOY
Total Liabilities BOY118915TotalLiabilitiesBOY
Total Liabilities EOY58065TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5051353NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7172925NetAssetsOrFundBalancesEOY
Mission DescriptionTHE FOUNDATION'S MISSION IS TO VISIBLY 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
Expense395170Expense
Revenue269781Revenue
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 19 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 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 $8,000 worth of room subsidy DURING THE YEAR ENDED JUNE 30, 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense225832Expense
Grants62695Grants
Revenue135049Revenue
DescriptionCommunity Programs and support of wyoming medical center: the foundation assisted wyoming medical center with public and community related efforts outisde usual operational expenses for medical, civic, charitable, scientific, and educational purposes.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense73867Expense
DescriptionCANCER RESOURCE CENTER/ANGELS PROGRAM: THE ANGELS PROGRAM'S GOAL 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 WOMENS EXAMS FOR THE UNINSURED AND PATIENTS IN NEED. THE ANGELS PROGRAM HAS A GROUP OF 22 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 LOVE 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)
Expense3261Expense
DescriptionSafe 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 officials. 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 800 helmets are distributed, 400 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 Exp3261TotalOfOtherProgramServiceExp
Total Program Service Expense698130TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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 Individuals0GrantsToIndividuals
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 Entity0RelatedOrgControlledEntity
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
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
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 Line1PAM SCHOENEWALDBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3075772914TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11139 EAST SECOND STAddressLine1
CityCASPERCity
StateWYState
ZIP Code82601ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOHN MASTERSON
BOARD CHAIR1.50XX000
MIRIAM TEMME
Vice Chair0.50XX000
TIM KUGLER
SECRETARY/TREASURER0.50XX000
BOB BARNARD
BOARD MEMBER0.50X000
SUSAN BURK
BOARD MEMBER0.50X000
VICKIE DIAMOND
BOARD MEMBER/CEO WMC1.00X040206927880
DICK DRESANG
BOARD MEMBER0.50X000
PATTI LEGLER
BOARD MEMBER0.50X000
SUSIE MCMURRY
BOARD MEMBER1.00X000
JOHN PURVIANCE
BOARD MEMBER0.50X000
RICK REIMANN
BOARD MEMBER0.50X000
MICHELE RYAN
BOARD MEMBER0.50X000
DEANNE SRAMEK
BOARD MEMBER0.50X000
BILL SULLIVAN
BOARD MEMBER0.50X000
GARY TRAPKUS
BOARD MEMBER0.50X000
PAM WALKER
BOARD MEMBER0.50X000
Sue Hoag
Board MemBER0.50X000
Carol Bryden
Board Member0.50X000
SHAWN BASSHAM
EXECUTIVE DIRECTOR40.00X84184012035
FieldValueIRS element (for citing)
Total Reportable Comp From Org84184TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs402069TotalReportableCompFrmRltdOrgs
Total Other Compensation39915TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations10000RelatedOrganizations
All Other Contributions1172567AllOtherContributions
Total Contributions1182567TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MASTERSON PLACE REV721000269781269781
JOINT VENTURE REVENUE900099135049135049
FieldValueIRS element (for citing)
Total Program Service Revenue404830TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column31883TotalRevenueColumn
Exclusion$31,883ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events264467GrossIncomeFundraisingEvents
Fundraising Direct Expenses70328FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column194139TotalRevenueColumn
Exclusion$194,139ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1813419TotalRevenueColumn
Related Or Exempt Function Income404830RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$226,022ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total62695Total
Program Services62695ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total96219Total
Program Services67353ProgramServices
Management And General28866ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total345868Total
Program Services160294ProgramServices
Management And General185574ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total12319Total
Management And General12319ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total9794Total
Management And General9794ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total12978Total
Program Services1099ProgramServices
Management And General11879ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total42162Total
Program Services27272ProgramServices
Management And General14890ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2350Total
Management And General2350ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total65410Total
Program Services65410ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total13579Total
Program Services3075ProgramServices
Management And General10504ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2768Total
Management And General2768ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total78839Total
Program Services60745ProgramServices
Management And General18094ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total11074Total
Program Services11074ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
COMMUNITY PROGRAMS225832225832
BAD DEBT EXPENSE117549200117349
CAPITAL CAMPAIGN EXP7159371593
MISCELLANEOUS EXPENSES16759126214138
DUES AND SUBSCRIPTIONS59854605525

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1193773Total
Program Services698130ProgramServices
Management And General424050ManagementAndGeneral
Fundraising71593Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1023958BOY
EOY1443849EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1451515BOY
EOY1544207EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY290575BOY
EOY200936EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1892570LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec524539LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1359730BOY
EOY1368031EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY731019BOY
EOY2390260EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY299682BOY
EOY269918EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY13789BOY
EOY13789EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5170268BOY
EOY7230990EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY28499BOY
EOY10503EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY90416BOY
EOY47562EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY118915BOY
EOY58065EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2835013BOY
EOY4252343EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2052909BOY
EOY2757151EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY163431BOY
EOY163431EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5051353BOY
EOY7172925EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5170268BOY
EOY7230990EOY
FieldValueIRS element (for citing)
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
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$50,964Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts50964SumOfAmounts

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 Balance979459BeginningOfYearBalance
End Of Year Balance979459EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1111270BeginningOfYearBalance
Investment Earnings Or Losses-131811InvestmentEarningsOrLosses
End Of Year Balance979459EndOfYearBalance
FieldValueIRS element (for citing)
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 Basis1303173OtherCostOrOtherBasis
Depreciation334010Depreciation
Book Value969163BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis248512OtherCostOrOtherBasis
Depreciation190529Depreciation
Book Value57983BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1368031TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO WYOMING MEDICAL CENTERDescription
Amount$47,562Amount
FieldValueIRS element (for citing)
Total Of Amounts47562TotalOfAmounts

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CONNOISSEUR'S DELIGHTNameOfEvent1
Gross Receipts Event152542GrossReceiptsEvent1
Gross Revenue Event152542GrossRevenueEvent1
Other Direct Expenses Event114560OtherDirectExpensesEvent1
Name Of Event2Springtime in ParisNameOfEvent2
Gross Receipts Event244161GrossReceiptsEvent2
Gross Revenue Event244161GrossRevenueEvent2
Other Direct Expenses Event212938OtherDirectExpensesEvent2
Total Number Of Other Events6TotalNumberOfOtherEvents
Gross Receipts Other Events167764GrossReceiptsOtherEvents
Gross Revenue Other Events167764GrossRevenueOtherEvents
Other Direct Expenses Other Events42830OtherDirectExpensesOtherEvents
Gross Receipts Total264467GrossReceiptsTotal
Gross Revenue Total Events264467GrossRevenueTotalEvents
Other Direct Expenses Total Events70328OtherDirectExpensesTotalEvents
Direct Expense Summary Events70328DirectExpenseSummaryEvents
Net Income Summary194139NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
WYOMING MEDICAL CENTER
1223 EAST SECOND STCASPERWY82601830279242501(C)(3)50964Car Seats and Capital Project
WYOMING DEPARTMENT OF HEALTHDr Chynoweth
6101 YELLOWSTONE RD 510CHEYENNEWY82002830208667N/A7500EDUCATIONAL LOAN REPAYMENT

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.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

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1VICKIE DIAMONDBusinessNameLine1
FieldValueIRS element (for citing)
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs348549CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs44000BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs9520OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs26300DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs1580NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs429949TotalCompensationRelatedOrgs
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 (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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 BOOKKEEPER. 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 12cTHE 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. 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 15aTHE EXECUTIVE DIRECTOR IS REVIEWED UNDER THE WYOMING MEDICAL CENTER'S 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 2010 FOR THE EXECUTIVE DIRECTOR S. BASSHAM.
Form 990, Part VI, Section C, line 19THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, LINE 1AVickie Diamond work approximately 41 hours per week as follows: Wyoming Medical Center 40 hours Wyoming medical center foundation 1 hour Susie mcmurray worked approximately 6 hours per week as follows: Wyoming medical center 5 hours Wyoming medical center foundation 1 hourEXPLANATION FOR HOURS WORKED

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 STREETAddressLine1
CityCASPERCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
EIN830279242EIN
Primary ActivitiesMEDICAL SERVICESPrimaryActivities
Legal Domicile StateWYLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA

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 SECOND STAddressLine1
CityCASPERCity
StateWYState
ZIP Code82601ZIPCode
FieldValueIRS element (for citing)
EIN830282249EIN
Primary ActivityBUSINESS INVESTMENTPrimaryActivity
Legal Domicile StateWYLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income318299ShareOfTotalIncome
Share Of EOY Assets270458ShareOfEOYAssets
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 Involved322386AmountInvolved