COMMUNITY HEALTHCARE FOUNDATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTHCARE FOUNDATION INC (EIN 83-0289853)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-12
- IRS object ID
- 202221329349305407
- Schema version
- 2021v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-12T14:05:29-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 470526649 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANA F COLE & COMPANY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 E 20TH AVE | AddressLine1Txt |
| City | TORRINGTON | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830289853 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION IN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3075324507 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2000 CAMPBELL DRIVE | AddressLine1Txt |
| City | TORRINGTON | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82240 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAROL CLARK | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 0307532418 | PhoneNum |
| Signature | 2022-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CAROL | PersonFirstNm |
| Person Last | CLARK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KIM S LONG | PreparerPersonNm |
| PTIN | P01326523 | PTIN |
| Phone | 3075324511 | PhoneNum |
| Preparation | 2022-05-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JESSICA WIEDMAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4543 ROAD 62 | AddressLine1Txt |
| City | TORRINGTON | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $105,600 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Activity Or Mission | THE PRIMARY EXEMPT PURPOSE IS TO RECEIVE AND ADMINISTER FUNDS FOR SCIENTIFIC, EDUCATIONAL, AND CHARITABLE PURPOSES TO SUPPORT AND BENEFIT THE SICK, ILL, AGED, AND INFIRMED AND TO IMPROVE THE HEALTH CARE SERVICES AVAILABLE TO THESE PEOPLE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $15,576 | PYContributionsGrantsAmt |
| CY Contributions Grants | $52,170 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,317 | PYInvestmentIncomeAmt |
| CY Investment Income | $19,776 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$2,932 | PYOtherRevenueAmt |
| CY Other Revenue | $9,664 | CYOtherRevenueAmt |
| PY Total Revenue | $19,961 | PYTotalRevenueAmt |
| CY Total Revenue | $81,610 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $20,463 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $133,935 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $934 | PYOtherExpensesAmt |
| CY Other Expenses | $1,480 | CYOtherExpensesAmt |
| PY Total Expenses | $21,397 | PYTotalExpensesAmt |
| CY Total Expenses | $135,415 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,436 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$53,805 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $564,113 | TotalAssetsBOYAmt |
| Total Assets EOY | $510,308 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $564,113 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $510,308 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE PRIMARY EXEMPT PURPOSE IS TO RECEIVE AND ADMINISTER FUNDS FOR SCIENTIFIC, EDUCATIONAL, AND CHARITABLE PURPOSES TO SUPPORT AND BENEFIT THE SICK, ILL, AGED, AND INFIRMED AND TO IMPROVE THE HEALTH CARE SERVICES AVAILABLE TO THESE PEOPLE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $125,000 | ExpenseAmt |
| Grant | $125,000 | GrantAmt |
| Desc | PROVIDE COMMUNITY HOSPITAL WITH INFUSION SUITE | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,000 | ExpenseAmt |
| Grant | $5,000 | GrantAmt |
| Desc | PROVIDE EDUCATIONAL ASSISTANCE IN THE FORM OF SCHOLARSHIPS TO STUDENTS FURTHERING THEIR EDUCATION IN MEDICAL RELATED FIELDS | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,768 | ExpenseAmt |
| Grant | $3,768 | GrantAmt |
| Desc | PROVIDED FIRST AID KITS AND AEDS IN PUBLIC PLACES | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $961 | ExpenseAmt |
| Grant | $167 | GrantAmt |
| Desc | OTHER SERVICES | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $961 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $167 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $134,729 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAROL CLARK | PersonNm |
| Phone | 3075324507 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 122 HILLCREST DR | AddressLine1Txt |
| City | TORRINGTON | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| ASHLEE ARRANTS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ANNA BARNES | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CAROL CLARK | ||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| T J EWALD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WHEATON KREMKE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BRETT MALM | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LEANN MATTIS | ||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| HEATHER OJEDA | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TAYLOR SCHMICK | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KENDRA STEINMETZ | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JACKIE VANMARK | ||||||
| VICE PRESIDE | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JENNELLE WERNER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JESSICA WIEDMAN | ||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $26,918 | GovernmentGrantsAmt |
| All Other Contributions | $25,252 | AllOtherContributionsAmt |
| Total Contributions | $52,170 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,613 | TotalRevenueColumnAmt |
| Exclusion | $12,613 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $13,583 | SecuritiesAmt |
| Other | $4,818 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,238 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,345 | SecuritiesAmt |
| Other | $4,818 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,163 | TotalRevenueColumnAmt |
| Exclusion | $7,163 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $22,406 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $12,752 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,654 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CASH BACK REWARDS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $10 | TotalRevenueColumnAmt |
| Exclusion | $10 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $10 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $81,610 | TotalRevenueColumnAmt |
| Exclusion | $19,786 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,768 | TotalAmt |
| Program Services | $128,768 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,167 | TotalAmt |
| Program Services | $5,167 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269 | TotalAmt |
| Program Services | $269 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475 | TotalAmt |
| Program Services | $475 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| BOARD EXPENSES | $581 | $581 | |
| FOREIGNTAX PAID | $55 | $55 | |
| CORPORATION LICENSES | $50 | $50 | |
| GIFT CARD PRIZE | $50 | $50 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,415 | TotalAmt |
| Program Services | $134,729 | ProgramServicesAmt |
| Management And General | $686 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $442,119 | BOYAmt |
| EOY | $369,984 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,994 | BOYAmt |
| EOY | $140,324 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,113 | BOYAmt |
| EOY | $510,308 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $356,613 | BOYAmt |
| EOY | $283,948 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,500 | BOYAmt |
| EOY | $226,360 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,113 | BOYAmt |
| EOY | $510,308 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,113 | BOYAmt |
| EOY | $510,308 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$53,805 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,334 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,153 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,724 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,576 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $52,170 | CurrentTaxYearAmt |
| Total | $85,957 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,334 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,153 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,724 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,576 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $52,170 | CurrentTaxYearAmt |
| Total | $85,957 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $85,957 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,021 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,751 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,738 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,653 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,902 | CurrentTaxYearAmt |
| Total | $32,065 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,345 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,397 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,608 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $445 | CurrentTaxYearAmt |
| Total | $36,810 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $154,832 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $22,406 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.55520 | PublicSupportCY170Pct |
| Public Support PY170 | 0.37490 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 10 | FormAndLineReferenceDesc |
| Explanation | 36,810 | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,000 | BeginningYearBalanceAmt |
| End Year Balance | $150,000 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,000 | BeginningYearBalanceAmt |
| End Year Balance | $150,000 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,000 | BeginningYearBalanceAmt |
| End Year Balance | $150,000 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,000 | BeginningYearBalanceAmt |
| End Year Balance | $150,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,000 | BeginningYearBalanceAmt |
| End Year Balance | $150,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | SUMMER NIGHT OU | Event1Nm |
| Gross Receipts Event1 | $22,406 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $22,406 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $2,206 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $325 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $4,978 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $1,800 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $3,443 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $22,406 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $22,406 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $2,206 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $325 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $4,978 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $1,800 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,443 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $12,752 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $9,654 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2000 CAMPBELL DR | AddressLine1Txt |
| City | TORRINGTON | CityNm |
| State Abbreviation | WY | StateAbbreviationCd |
| ZIP | 82240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash Grant | $125,000 | CashGrantAmt |
| Purpose Of Grant | INFUSION SUITE | PurposeOfGrantTxt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc |
|---|---|---|---|
| SCHOLARSHIPS | 5 | $5,000 | COST |
| SNACKS FOR HEALTHCARE WOR | 30 | $167 | COST |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | APPLICANTS MUST SHOW, IN THEIR APPLICATION FOR SUPPORT, THAT GRANT FUNDS WILL BE USED FOR EDUCATION COSTS IN A MEDICAL RELATED FIELD OR TO PURCHASE EQUIPMENT TO BE USED FOR HEALTH CARE OR SUPPLEMENT HEALTH CARE SERVICES IN GOSHEN COUNTY, WYOMING. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE PRIMARY EXEMPT PURPOSE IS TO RECEIVE AND ADMINISTER FUNDS FOR SCIENTIFIC, EDUCATIONAL, AND CHARITABLE PURPOSES TO SUPPORT AND BENEFIT THE SICK, ILL, AGED, AND INFIRMED AND TO IMPROVE THE HEALTH CARE SERVICES AVAILABLE TO THESE PEOPLE. |
| FORM 990, PAGE 2, PART III, LINE 4D | OTHER SERVICES |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 REVIEWED BY BOARD TREASURER |
| FORM 990, PAGE 6, PART VI, LINE 19 | PROVIDED UPON WRITTEN REQUEST |