2024-04-08T10:20:06-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2022-07-01 843157045 IMH QALICB IMHQ 3077422141 255 NORTH 30TH STREET LARAMIE WY 82072 JAMES BANDS CEO 3077422141 2024-03-01 1 JAMES BANDS XXX-XX-XXXX 1 SARAH HINTZ P00492291 3037795710 2024-03-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JAMES BANDS 255 NORTH 30TH STREET LARAMIE WY 82072 229500 0 X N/A X 2019 WY TO SUPPORT IVINSON MEMORIAL HOSPITAL. 3 2 0 2 0 0 0 0 229500 229500 0 0 0 0 229500 229500 0 0 0 0 0 0 0 0 0 950907 951958 950907 951958 -721407 -722458 14658290 13967912 16622810 16654890 -1964520 -2686978 TO SUPPORT IVINSON MEMORIAL HOSPITAL. 0 0 951958 0 229500 IMH QALICB WAS FORMED IN SEPTEMBER 2019 TO FACILITATE THE NEW MARKETS TAX CREDIT FINANCING FOR IVINSON MEMORIAL HOSPITAL TO CONSTRUCT A 26,000 SQUARE FOOT MEDICAL OFFICE BUILDING. 951958 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 X 3 2 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 WY X JAMES BANDS 3077422141 255 NORTH 30TH STREET LARAMIE WY 82072 JAMES BANDS PRESIDENT 2.00 38.00 X X 0 319104 46887 REBECCA MILLER TREASURER 0.30 0.00 X X 0 0 0 GUY WARPNESS SECRETARY 0.30 0.00 X X 0 0 0 0 319104 46887 0 0 1 0 0 ADMIN REVENUE 561000 229500 229500 229500 229500 229500 0 0 2625 2625 89967 89967 599488 599488 201880 201880 57998 57998 951958 951958 0 0 148634 205717 525000 435000 13438531 12839042 695981 207828 546152 488153 -27 0 14658290 13967912 45000 45000 16577810 16609890 16622810 16654890 X -1964520 -2686978 -1964520 -2686978 14658290 13967912 -722458 0 X X 0 1 X 1 0 X X X 1 IVINSON MEMORIAL HOSPITAL 300975387 3 1 951958 0 1 951958 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 0 PART IV, SECTION D, LINE 3: IVINSON MEMORIAL HOSPITAL HAS A SIGNIFICANT VOICE IN IMH QALICB'S INVESTMENTS AND ACTIVITIES THROUGH ITS CFO, WHO SERVES AS THE PRESIDENT OF IMH QALICB'S BOARD OF DIRECTORS AND HAS 1/3 OF THE TOTAL VOTING RIGHTS ON THE BOARD. PART IV, SECTION E, LINE 2A: IVINSON MEMORIAL HOSPITAL IS THE SOLE ORGANIZATION SUPPORTED BY IMH QALICB, WHICH WAS FORMED IN SEPTEMBER 2019 TO FACILITATE THE NEW MARKETS TAX CREDIT FINANCING FOR IVINSON MEMORIAL HOSPITAL TO CONSTRUCT A 26,000 SQUARE FOOT MEDICAL OFFICE BUILDING. 695981 207828 488153 488153 X PART X, LINE 2: IMH QALICB IS ORGANIZED AS A WYOMING NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). IMH QALICB IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, IMH QALICB IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT IS UNRELATED TO THEIR EXEMPT PURPOSE. IMH QALICB BELIEVES THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. IMH QALICB WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES WERE INCURRED. 0 0 0 0 0 0 0 0 0 JAMES BANDS PRESIDENT 0 290256 0 28848 0 0 0 14081 0 32806 0 365991 0 0 PART I, LINE 3 THE BOARD COMPENSATION COMMITTEE OF IVINSON MEMORIAL HOSPITAL REVIEWS THE CEO'S COMPENSATION ANNUALLY. THIS COMMITTEE UTILIZES DATA FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE DATA IS CREATED BASED ON COMPARABLE FACILITIES IN THE GEOGRAPHIC REGION. COMPENSATION REVIEWS WERE LAST CONDUCTED IN 2023. FORM 990, PART VI, SECTION A, LINE 7A AT ALL TIMES, ONE OF THE DIRECTORS MUST BE THE CFO OF IVINSON MEMORIAL HOSPITAL OR ANOTHER PERSON AS MAY BE DESIGNATED BY THE BOARD OF DIRECTORS OF IVINSON MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WHO HAVE BEEN GRANTED AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT CPA FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. PRIOR TO FILING, THE 990 WAS REVIEWED IN ITS ENTIRETY BY THE FINANCE COMMITTEE OF IVINSON MEMORIAL HOSPITAL'S BOARD AND BY IMH QALICB'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C IMH QALICB HAS A CONFLICT OF INTEREST POLICY THAT COVERS ALL BOARD MEMBERS, OFFICERS, DIRECTORS, MANAGERS, SUPERVISORS AND HIGHLY COMPENSATED EMPLOYEES. ALL COVERED INDIVIDUALS COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT UPON JOINING IMH QALICB AND ANNUALLY THEREAFTER. ALL COVERED INDIVIDUALS HAVE AN OBLIGATION TO DISCLOSE ALL INTERESTS, ACTIONS OR RELATIONSHIPS THAT CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OR THAT COULD CREATE SUCH. AFTER SUCH DISCLOSURE, THE INDIVIDUAL LEAVES THE MEETING WHILE THE BOARD, COMMITTEE OR SUPERVISOR DETERMINES WHETHER A CONFLICT EXISTS. IF A CONFLICT IS DEEMED TO EXIST, THE RELEVANT BODY EVALUATES WHETHER A MORE BENEFICIAL TRANSACTION IS AVAILABLE TO IMH QALICB. IF A MORE BENEFICIAL TRANSACTION IS NOT IDENTIFIED, THE RELEVANT BODY VOTES WHETHER TO ENTER THE TRANSACTION THAT INVOLVES THE CONFLICT OF INTEREST. THE INDIVIDUAL WITH THE CONFLICT DOES NOT PARTICIPATE IN THE VOTE. RECORDS ARE KEPT OF ALL SITUATIONS THAT INVOLVE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IF AN INDIVIDUAL FAILS TO DISCLOSE A CONFLICT OF INTEREST, THE INDIVIDUAL IS GIVEN THE OPPORTUNITY TO EXPLAIN, AFTER WHICH THE RELEVANT BODY DETERMINES APPROPRIATE DISCIPLINARY ACTION, IF ANY. FORM 990, PART VI, SECTION C, LINE 19 IMH QALICB'S GOVERNING DOCUMENTS, CONFLICT OR INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. IVINSON MEMORIAL HOSPITAL 255 NORTH 30TH STREET IVINSON WY 82072 300975387 HOSPITAL WY 501(C)(3) LINE 3 N/A 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 1 0 0 0 0