Show Your Work is a 7-part series from the Health Trust on how we operate, how we make decisions, and why we think the community deserves more than our word for it.
We started with a $250 million endowment. It’s grown to $308 million. $80 million spent. $58 million grown. That math surprises people. It shouldn’t, but it does. The misunderstanding behind the surprise is worth addressing directly.
The Trust is a permanent endowment. Not a spending account. Not a five-year fund. A structure designed to generate returns in perpetuity, distribute a portion of those returns each year, and preserve the principal for future generations.
The goal is not to spend down. That is worth explaining, because the counterargument is reasonable: if Natrona County has urgent health needs right now, why not deploy every available dollar toward them today? The answer is that the problems the Trust exists to address are not going to be solved in a decade. Chronic disease, behavioral health crises, housing instability, and poverty are generational conditions. They took generations to build. A foundation that spends itself down in 10 or 15 years funds programs for 10 or 15 years and then disappears. A permanent endowment can address community challenges forever, and the organizations it funds can plan, hire, and grow in ways that are simply not possible when long-term funding is uncertain. The math also favors patience. $308 million generating returns in perpetuity will put substantially more money into Natrona County over 50 years than $308 million spent down over a decade ever could. Permanence is not a hedge against urgency. It is the most effective response to it.
Where the money went
Since 2020, the Trust has distributed approximately $80 million in total. Of that, $66.7 million went directly to the work: $46.4 million to Banner Wyoming Medical Center as required, and $20.3 million into the community through grants, programs, and advocacy. The remaining $13.3 million funded operations, and that category deserves a closer look than it usually gets. Staff salaries go to people who live here. Service contracts and other services go to local businesses. In 2025, operational costs also increased because the Trust engaged an independent monitor to oversee compliance with the terms of the Banner Health acquisition. The monitor reviews Banner Wyoming Medical Center’s use of the annual distribution and verifies that the hospital is meeting the community benefit commitments it made when the acquisition was completed. That oversight exists to protect the community’s interests, and its cost reflects the seriousness with which the Trust takes that responsibility.
Beyond the operating budget, in 2022 the Trust purchased and began renovations on a building at 421 S. Center Street in downtown Casper. That purchase put Trust dollars into local real estate, used local contractors, and created the Collective Space, a free community meeting room available to any Natrona County nonprofit or community organization. As an owned asset in a growing downtown corridor, the building will appreciate in value over time, strengthening the Trust’s long-term financial position while continuing to serve the community directly. That is not overhead in the traditional sense. It is a long-term investment in the community.
How the endowment grew
Here is how the numbers work. Since 2020, the portfolio has generated approximately $129 million in total investment returns. Of that, roughly $80 million funded all spending: the Banner distribution, grants, programs, and operations. The remainder produced the growth from $250 million to $308 million. The endowment grew because the portfolio earned more than it distributed, which is how a well-managed permanent endowment is supposed to work.
That growth was not linear. In 2022, the portfolio declined by nearly $33 million in a difficult market. The Trust did not cut grants or reduce programming in response, because the structure was built to absorb that kind of volatility without disrupting community investments. By the end of 2023, the portfolio had fully recovered.
Endowment (2025)
$308M
Total spent since 2020
$80M
Mission spending
$66.7M
Banner + grants + programs
Endowment growth
+$58M
* 2020 reflects Oct–Dec only (partial year). All figures in millions.
The IRS requires private foundations to distribute at least 5% of assets annually. That requirement is calibrated to allow endowments to survive long-term without depleting principal. The Trust has distributed beyond the minimum in recent years, putting more into the community while maintaining the endowment’s purchasing power for decades ahead.
Natrona County’s health challenges will not be solved in a single grant cycle. They require sustained, reliable investment over time. The endowment exists to make that possible. Growing it during a period of active spending is not evidence of hoarding. It is evidence that the structure is working.
The Trust started as a $250 million organization. With disciplined management, it will be a $500 million organization when people in Natrona County who are children today are running its grantees. That is the point.
Want to learn more about our endowment and investments? Check out our new FAQs and financial documents on our website.
