2011-05-13T14:25:27-05:00 2010-06-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-07-01 830230808 WYOMING MEDICAL CENTER FOUNDATION WYOM 3075772188 1233 EAST SECOND STREET CASPER WY 82601 SHAWN BASSHAM 3075772188 2011-05-13 1 6123764500 2009 2016-02-24 21:20:13Z SHAWN BASSHAM 1233 EAST SECOND STREET CASPER WY 82601 1883747 0 X WWW.wyomingmedicalcenterfoundation.ORG X 1976 WY TO SUPPORT THE MISSION OF THE WYOMING MEDICAL CENTER AND THE HEALTH OF THE COMMUNITY. 18 18 0 75 0 0 2177085 1182567 717442 404830 81818 31883 65202 194139 3041547 1813419 73212 62695 0 432564 442087 0 71593 561539 688991 1067315 1193773 1974232 619646 5170268 7230990 118915 58065 5051353 7172925 THE FOUNDATION'S MISSION IS TO VISIBLY IMPROVE THE HEALTH OF THE COMMUNITY BY PROVIDING FINANCIAL AND EDUCATIONAL SUPPORT IN PARTNERSHIP WITH WYOMING MEDICAL CENTER. 0 0 395170 269781 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 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. 225832 62695 135049 Community 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. 73867 CANCER 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. 3261 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 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. 3261 698130 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 18 18 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X PAM SCHOENEWALD 3075772914 1139 EAST SECOND ST CASPER WY 82601 JOHN MASTERSON 1.50 X X 0 0 0 MIRIAM TEMME 0.50 X X 0 0 0 TIM KUGLER 0.50 X X 0 0 0 BOB BARNARD 0.50 X 0 0 0 SUSAN BURK 0.50 X 0 0 0 VICKIE DIAMOND 1.00 X 0 402069 27880 DICK DRESANG 0.50 X 0 0 0 PATTI LEGLER 0.50 X 0 0 0 SUSIE MCMURRY 1.00 X 0 0 0 JOHN PURVIANCE 0.50 X 0 0 0 RICK REIMANN 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 PAM WALKER 0.50 X 0 0 0 Sue Hoag 0.50 X 0 0 0 Carol Bryden 0.50 X 0 0 0 SHAWN BASSHAM 40.00 X 84184 0 12035 84184 402069 39915 0 0 1 0 0 10000 1172567 1182567 MASTERSON PLACE REV 721000 269781 269781 JOINT VENTURE REVENUE 900099 135049 135049 404830 31883 31883 264467 70328 194139 194139 1813419 404830 0 226022 62695 62695 96219 67353 28866 345868 160294 185574 12319 12319 9794 9794 12978 1099 11879 42162 27272 14890 2350 2350 65410 65410 13579 3075 10504 2768 2768 78839 60745 18094 11074 11074 COMMUNITY PROGRAMS 225832 225832 BAD DEBT EXPENSE 117549 200 117349 CAPITAL CAMPAIGN EXP 71593 71593 MISCELLANEOUS EXPENSES 16759 12621 4138 DUES AND SUBSCRIPTIONS 5985 460 5525 1193773 698130 424050 71593 1023958 1443849 1451515 1544207 290575 200936 1892570 524539 1359730 1368031 731019 2390260 299682 269918 13789 13789 5170268 7230990 28499 10503 90416 47562 118915 58065 X 2835013 4252343 2052909 2757151 163431 163431 5051353 7172925 5170268 7230990 X 0 1 1 X 0 X X X 0 0 0 WYOMING MEDICAL CENTER 830279242 3 1 1 1 50964 1 50964 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 979459 979459 1111270 -131811 979459 0 0 340885 340885 1303173 334010 969163 248512 190529 57983 1368031 DUE TO WYOMING MEDICAL CENTER 47562 47562 CONNOISSEUR'S DELIGHT 52542 52542 14560 Springtime in Paris 44161 44161 12938 6 167764 167764 42830 264467 264467 70328 70328 194139 1 WYOMING MEDICAL CENTER 1223 EAST SECOND ST CASPER WY 82601 830279242 501(C)(3) 50964 Car Seats and Capital Project WYOMING DEPARTMENT OF HEALTHDr Chynoweth 6101 YELLOWSTONE RD 510 CHEYENNE WY 82002 830208667 N/A 7500 EDUCATIONAL LOAN REPAYMENT 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. 0 0 0 0 0 0 0 0 0 VICKIE DIAMOND 0 348549 0 44000 0 9520 0 26300 0 1580 0 429949 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 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 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 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. 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'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 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, LINE 1A EXPLANATION FOR HOURS WORKED Vickie 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 hour WYOMING MEDICAL CENTER 1233 EAST SECOND STREET CASPER WY 82601 830279242 MEDICAL SERVICES WY 501(C)(3) 3 N/A HOSPITAL FOUNDATION VENTURES INC 1233 EAST SECOND ST CASPER WY 82601 830282249 BUSINESS INVESTMENT WY N/A C 318299 270458 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 322386