Skip to content
Nonprofiteer
← CHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION

Form 990 for tax year 2022

Filed by CHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION.

Totals

Total revenue
$73,499
Total expenses
$66,624
Contributions and grants received
$51,047
Grants paid
$49,994
Program service revenue
$0
Investment income
$24,218
Other revenue
-$1,766
Total assets, end of year
$1,721,875
Total liabilities, end of year
$2,500
Net assets or fund balances, end of year
$1,719,375
Program services expenses (Part IX)
$49,994
Management and general expenses
$0
Fundraising expenses
$16,630
Program service expenses (Part III)
$49,994

Program services were 75.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1c · Fundraising events

    $44,184

  • 1d · Related organizations

    $5,000

  • 1f · All other contributions, gifts and grants

    $1,863

  • 3 · Investment income

    total $11,327 · excluded $11,327

  • 7a · Gross sales of assets other than inventory

    securities $12,891

  • 7b · Less cost or other basis and sales expenses

    securities $0

  • 7c · Gain or loss

    securities $12,891

  • 7d · Net gain or loss

    total $12,891 · excluded $12,891

  • 8a · Fundraising events: gross income

    $4,196

  • 8a · Fundraising events: contributions included on line 1c

    $44,184

  • 8b · Fundraising events: direct expenses

    $5,962

  • 8c · Net income from fundraising events

    total -$1,766 · excluded -$1,766

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $35,666 · program services $35,666

  • 2 · Grants to domestic individuals

    total $14,328 · program services $14,328

  • 11c · Fees: accounting

    total $2,500 · fundraising $2,500

  • 16 · Occupancy

    total $4,008 · fundraising $4,008

  • 19 · Conferences, conventions and meetings

    total $990 · fundraising $990

  • 22 · Depreciation, depletion and amortization

    total $3,008 · fundraising $3,008

  • 24a · Other expenses: MISCELLANEOUS FUNDRAISI

    total $6,055 · fundraising $6,055

  • 24b · Other expenses: DUES

    total $69 · fundraising $69

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $1,111,821 · end of year $1,104,971

  • 10a · Land, buildings and equipment: cost or other basis

    $202,590

  • 10b · Land, buildings and equipment: accumulated depreciation

    $64,578

  • 10c · Land, buildings and equipment, net

    beginning of year $141,020 · end of year $138,012

  • 11 · Investments: publicly traded securities

    beginning of year $606,800 · end of year $478,892

  • 17 · Accounts payable and accrued expenses

    beginning of year $0 · end of year $2,500

  • 27 · Net assets without donor restrictions

    beginning of year $1,612,177 · end of year $1,473,611

  • 28 · Net assets with donor restrictions

    beginning of year $247,464 · end of year $245,764

Mission and programs · 2022

Mission

TO ASSURE THERE IS, AND ALWAYS WILL BE, A STRONG FINANCIAL FOUNDATION SUPPORTING OUR HEALTH CARE COMMUNITY.

Activities or mission (Part I)

TO SUPPORT SIDNEY REGIONAL MEDICAL CENTER.

  • PROVIDE SUPPORT TO CHEYENNE COUNTY HOSPITAL ASSOCIATION, D/B/A SIDNEY REGIONAL MEDICAL CENTER, TO FURTHER THEIR QUEST TO PROVIDE THE MOST UP-TO-DATE FACILITIES, EQUIPMENT AND SERVICE.

    Expenses $35,666 · Grants $35,666

  • PROVIDE FUNDING TO SUPPORT SCHOLARSHIPS AND INTERN PROGRAMS FOR INDIVIDUALS CURRENTLY STUDYING IN THE HEALTH CARE FIELD.

    Expenses $14,328 · Grants $14,328

  • PROVIDE FUNDING TO ASSIST WITH DENTAL PROCEDURES FOR THOSE IN NEED.

As filed on the 2022 return.

Listed in Part VII

  • Bill Butkus

    PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • Kurt Kaiser

    VICE PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • Sean Doyle

    TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Julie Shoemaker

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Stan Belieu

    MEMBER

    Total calculated
    $0
    Hours/week
    1 + 4 related

  • Sheri Ehler

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Vickie Smith

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Nanci McCaslin

    MEMBER

    Total calculated
    $0
    Hours/week
    1 + 4 related

  • Shane Cochran

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Dr James Popovich

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Nicky Radcliffe

    MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Kelly Utley

    EXECUTIVE DIRECTOR

    Total calculated
    $291,844
    From this org
    $0
    From related orgs
    $242,387
    Other
    $49,457
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $217,643 related
    Bonus
    $0 + $22,705 related
    Other
    $0 + $2,039 related
    Deferred
    $0 + $27,000 related
    Nontaxable benefits
    $0 + $22,457 related
    Filer's total
    $0 + $291,844 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
KELLY UTLEY, THE EXECUTIVE DIRECTOR OF THE FOUNDATION, IS AN EMPLOYEE OF CHEYENNE COUNTY HOSPITAL ASSOCIATION, D/B/A SIDNEY REGIONAL MEDICAL CENTER, A RELATED ENTITY. THE BOARD OF DIRECTORS OF THE MEDICAL CENTER REVIEWS MARKET COMPENSATION DATA FOR ALL HOSPITAL STAFF AND THE CEO OF THE MEDICAL CENTER APPROVES THE COMPENSATION FOR THE EXECUTIVE DIRECTOR.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
15 November 2023
IRS schema version
2022v5.0
Source object
202303199349305715

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

The source document this was parsed from is served over the API, which is where bulk and document access live.