SUSAN B ALLEN MEMORIAL HOSPITAL: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: SUSAN B ALLEN MEMORIAL HOSPITAL (EIN 48-0581968)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-09-27
IRS object ID: 201732709349300308
Schema version: 2016v3.1
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-09-27T09:05:47-05:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BKD LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1201 Walnut Suite 1700	AddressLine1Txt
City	Kansas City	CityNm
State Abbreviation	MO	StateAbbreviationCd
ZIP	641062246	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	480581968	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SUSAN B ALLEN MEMORIAL HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
In Care Of	% GENE KABERLINE	InCareOfNm
Business Name Control	SUSA	BusinessNameControlTxt
Phone	3163213300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	720 WEST CENTRAL	AddressLine1Txt
City	EL DORADO	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	67042	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	GENE KABERLINE	PersonNm
Person Title	CFO	PersonTitleTxt
Signature	2017-11-15	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Michael J Engle	PreparerPersonNm
PTIN	P00482834	PTIN
Phone	8162216300	PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	64.22.227.161	IPv4AddressTxt

Field	Value	IRS element (for citing)
Federal Original Submission Id	43372220172705000000	FederalOriginalSubmissionId
Federal Original Submission Id	2017-09-27	FederalOriginalSubmissionIdDt
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	6E878FA6C29EFF3721DC18DF9D0E8A9BE12011F9	AtSubmissionCreationDeviceId
At Submission Filing Device Id	60B107EC4821460DA499CE214EC088A36685104E	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	JIM KIRKBRIDE	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	720 WEST CENTRAL	AddressLine1Txt
City	EL DORADO	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	67042	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$55,289,042	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.SBAMH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1930	FormationYr
Legal Domicile State	KS	LegalDomicileStateCd
Activity Or Mission	THE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSSIONAL HEALTH CARE TO THE PEOPLE WE SERVE.	ActivityOrMissionDesc
Voting Members Governing Body	12	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	505	TotalEmployeeCnt
Total Volunteers	120	TotalVolunteersCnt
Total Gross UBI	-$1,725	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$1,725	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$416,788	PYContributionsGrantsAmt
CY Contributions Grants	$481,353	CYContributionsGrantsAmt
PY Program Service Revenue	$52,660,093	PYProgramServiceRevenueAmt
CY Program Service Revenue	$53,214,439	CYProgramServiceRevenueAmt
PY Investment Income	$1,119,031	PYInvestmentIncomeAmt
CY Investment Income	$514,685	CYInvestmentIncomeAmt
PY Other Revenue	$148,216	PYOtherRevenueAmt
CY Other Revenue	$270,429	CYOtherRevenueAmt
PY Total Revenue	$54,344,128	PYTotalRevenueAmt
CY Total Revenue	$54,480,906	CYTotalRevenueAmt
PY Grants And Similar Paid	$24,180	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$19,465	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$26,135,674	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$25,699,354	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$28,125,533	PYOtherExpensesAmt
CY Other Expenses	$27,753,821	CYOtherExpensesAmt
PY Total Expenses	$54,285,387	PYTotalExpensesAmt
CY Total Expenses	$53,472,640	CYTotalExpensesAmt
PY Revenues Less Expenses	$58,741	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,008,266	CYRevenuesLessExpensesAmt
Total Assets BOY	$81,259,407	TotalAssetsBOYAmt
Total Assets EOY	$82,969,876	TotalAssetsEOYAmt
Total Liabilities BOY	$18,737,315	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$18,733,255	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$62,522,092	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$64,236,621	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$42,519,020	ExpenseAmt
Grant	$19,465	GrantAmt
Revenue	$53,214,439	RevenueAmt
Desc	SEE SCHEDULE O	Desc
Total Program Service Expenses	$42,519,020	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	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
Temp Or Permanent Endowments	Yes (true)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	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	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	Yes (true)	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	Yes (true)	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
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 With Officer Ent	Yes (true)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	Yes (true)	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	Yes (true)	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	75	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	505	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
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
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	12	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	Yes (true)	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	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	KS	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	GENE KABERLINE	PersonNm
Phone	3163224559	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	720 WEST CENTRAL	AddressLine1Txt
City	EL DORADO	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	67042	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
CAMI BAKER
SECRETARY/TREASURER	1.0	0.0	Yes (X)	Yes (X)	$0	$0	$0
MICHAEL CLIFTON
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
CATHY COOPER MD
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
ED GARD
CHAIRMAN	1.0	0.0	Yes (X)	Yes (X)	$0	$0	$0
VINCE HAINES
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
BRANDI LANE
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
SUZIE LOCKE
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
AMY SEEBER MD
TRUSTEE	1.0	0.0	Yes (X)		$7,569	$0	$0
MARK UTECH
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
MIKE WHEELER
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
ROD ZIEGLER
TRUSTEE	1.0	0.0	Yes (X)		$0	$0	$0
Greg Joyce
Trustee	1.0	0.0	Yes (X)		$0	$0	$0
JIM KIRKBRIDE
PRESIDENT & CEO	40.0	0.0		Yes (X)	$223,830	$0	$16,783
EUGENE KABERLINE
VICE PRESIDENT & CFO	40.0	0.0		Yes (X)	$128,255	$0	$1,076
PATRICK AUMAN
INTERIM-CEO	40.0	0.0		Yes (X)	$65,722	$0	$0
ROBERT FISHER
INTERIM-CFO	40.0	0.0		Yes (X)	$61,289	$0	$0
ROBIN CRAWFORD
VICE PRESIDENT & CFO	40.0	1.0		Yes (X)	$69,052	$0	$3,024
CECILIA GOEBEL
CHIEF NURSING OFFICER	40.0	0.0		Yes (X)	$148,632	$0	$27,548
PAIGE DODSON
CHIEF MEDICAL OFFICER	40.0	0.0		Yes (X)	$218,264	$0	$9,345
GAY KIMBLE
CHIEF HR OFFICER	40.0	0.0		Yes (X)	$112,883	$0	$25,651
FRANCIA BIRD
CHIEF QUALITY OFFICER	40.0	0.0		Yes (X)	$87,591	$0	$25,025
MARK ROOKER
CIO & COO	40.0	0.0		Yes (X)	$113,182	$0	$22,252
Gerard Librodo MD
PHYSICIAN OF ORTHOPEDICS	40.0	0.0			$654,779	$0	$13,658	Yes (X)
LAWRENCE SHANK
ORTHOPEDIC SURGEON	40.0	0.0			$221,038	$0	$3,069	Yes (X)
JASON BRUNTON
HOSPITALIST	40.0	0.0			$231,783	$0	$12,415	Yes (X)
DR VIKRANT AZAD
ORTHO SURGEON	40.0	0.0			$173,181	$0	$6,243	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$2,517,050	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$166,089	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	21	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
FRESENIUS MEDICAL CARE
5215 n oconnor blvd suite 1100	IRVING	TX	75039	KIDNEY DIALYSIS	$907,600
PRISM HEALTHCARE PARTNERS LTD
190 S LA SALLE STREET STE 2900	CHICAGO	IL	60603	MEDICAL services	$417,000
MIDAMERICA ANESTHESIA PROFESSIONALS
700 W CENTRAL SUITE 107	EL DORADO	KS	67042	MEDICAL SERVICES	$226,193
CASCADE HEALTH SERVICES
1045 SWIFT AVENUE	N KANSAS CITY	MO	64116	MEDICAL SERVICES	$190,344
DR CHINWE ANTHONIA OKONKWO
700 W CENTRAL SBA MEDICAL CLINIC W	EL DORADO	KS	67042	MEDICAL SERVICES	$177,509

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	12	CntrctRcvdGreaterThan100KCnt
Related Organizations	$357,220	RelatedOrganizationsAmt
All Other Contributions	$124,133	AllOtherContributionsAmt
Total Contributions	$481,353	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Service Revenue	621110	$53,096,062	$53,096,062
Meals on Wheels	624200	$116,337	$116,337
Screening Program	623990	$2,040	$2,040

Field	Value	IRS element (for citing)
Total Program Service Revenue	$53,214,439	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$532,181	TotalRevenueColumnAmt
Exclusion	$532,181	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$127,907	TotalRevenueColumnAmt
Exclusion	$127,907	ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$322	TotalRevenueColumnAmt
Exclusion	$322	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$553,703	RealAmt
Personal	$57,330	PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$559,313	RealAmt
Personal	$103,420	PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$5,610	RealAmt
Personal	-$46,090	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$51,700	TotalRevenueColumnAmt
Exclusion	-$51,700	ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$2,202	SecuritiesAmt
Other	$143,201	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	-$2,202	SecuritiesAmt
Other	-$143,201	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$145,403	TotalRevenueColumnAmt
Exclusion	-$145,403	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$0	FundraisingGrossIncomeAmt
Fundraising Direct Expenses	$0	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gaming Gross Income	$0	GamingGrossIncomeAmt
Gaming Direct Expenses	$0	GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$0	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$0	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Cafeteria	722210	$176,895	$176,895
PARTNERSHIP INCOME		-$1,725		-$1,725
MISCELLANEOUS INCOME	900099	$146,637	$146,637

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$146,637	TotalRevenueColumnAmt
Exclusion	$146,637	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$321,807	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$54,480,906	TotalRevenueColumnAmt
Related Or Exempt Func Income	$53,214,439	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$1,725	UnrelatedBusinessRevenueAmt
Exclusion	$786,839	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$19,465	TotalAmt
Program Services	$19,465	ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,366,973	TotalAmt
Management And General	$1,366,973	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$12,182	TotalAmt
Program Services	$12,182	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$18,819,312	TotalAmt
Program Services	$14,111,438	ProgramServicesAmt
Management And General	$4,707,874	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$465,073	TotalAmt
Program Services	$348,805	ProgramServicesAmt
Management And General	$116,268	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,647,366	TotalAmt
Program Services	$2,735,525	ProgramServicesAmt
Management And General	$911,841	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,388,448	TotalAmt
Program Services	$1,041,336	ProgramServicesAmt
Management And General	$347,112	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$7,076,908	TotalAmt
Program Services	$5,307,681	ProgramServicesAmt
Management And General	$1,769,227	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$219,316	TotalAmt
Program Services	$164,487	ProgramServicesAmt
Management And General	$54,829	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$693,064	TotalAmt
Program Services	$519,798	ProgramServicesAmt
Management And General	$173,266	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$555,001	TotalAmt
Program Services	$416,251	ProgramServicesAmt
Management And General	$138,750	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$236,940	TotalAmt
Program Services	$177,705	ProgramServicesAmt
Management And General	$59,235	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$363,773	TotalAmt
Program Services	$295,456	ProgramServicesAmt
Management And General	$68,317	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,888,456	TotalAmt
Program Services	$2,916,342	ProgramServicesAmt
Management And General	$972,114	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$241,087	TotalAmt
Program Services	$180,815	ProgramServicesAmt
Management And General	$60,272	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Bad Debt	$4,405,411	$4,405,411
Medical Supplies	$9,005,523	$9,005,523
Repairs & Maint.	$233,243	$174,932	$58,311
Recruiting & Retention	$236,133	$177,100	$59,033

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$598,966	TotalAmt
Program Services	$508,768	ProgramServicesAmt
Management And General	$90,198	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$53,472,640	TotalAmt
Program Services	$42,519,020	ProgramServicesAmt
Management And General	$10,953,620	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$857,874	BOYAmt
EOY	$759,552	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$9,272,381	BOYAmt
EOY	$11,674,239	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,486,417	BOYAmt
EOY	$1,766,090	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,802,533	BOYAmt
EOY	$1,446,452	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$88,726,710	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$47,480,123	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$42,784,648	BOYAmt
EOY	$41,246,587	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$22,778,774	BOYAmt
EOY	$23,327,546	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$1,879,425	BOYAmt
EOY	$2,124,616	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$120,252	BOYAmt
EOY	$381,944	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$277,103	BOYAmt
EOY	$242,850	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$81,259,407	BOYAmt
EOY	$82,969,876	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$3,992,153	BOYAmt
EOY	$6,452,778	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$14,745,162	BOYAmt
EOY	$12,280,477	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$18,737,315	BOYAmt
EOY	$18,733,255	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$59,049,986	BOYAmt
EOY	$60,596,483	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$277,731	BOYAmt
EOY	$347,420	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,194,375	BOYAmt
EOY	$3,292,718	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$62,522,092	BOYAmt
EOY	$64,236,621	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$81,259,407	BOYAmt
EOY	$82,969,876	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,008,266	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$658,668	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$47,595	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

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 C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbyingGrp
Total Direct Lobbying		TotalDirectLobbyingGrp
Total Lobbying Expend		TotalLobbyingExpendGrp
Other Exempt Purpose Expend		OtherExemptPurposeExpendGrp
Total Exempt Purpose Expend		TotalExemptPurposeExpendGrp
Lobbying Nontaxable Amount		LobbyingNontaxableAmountGrp
Grassroots Nontaxable		GrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non Tx		TotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non Tx		TotLbbyExpendMnsLbbyngNonTxGrp
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (true)	GrantsOtherOrganizationsInd
Grants Other Organizations	$11,407	GrantsOtherOrganizationsAmt
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	false	OtherActivitiesInd
Total Lobbying Expenditures	$11,407	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1F	FormAndLineReferenceDesc
Explanation	A PORTION OF THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HEALTH ASSOCIATION DUES ARE ATTRIBUTED TO LOBBYING EXPENSES.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,568,899	BeginningYearBalanceAmt
Contributions	$220,239	ContributionsAmt
Investment Earnings Or Losses	$105,714	InvestmentEarningsOrLossesAmt
Administrative Expenses	$7,610	AdministrativeExpensesAmt
End Year Balance	$1,887,242	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,570,557	BeginningYearBalanceAmt
Contributions	$94,805	ContributionsAmt
Investment Earnings Or Losses	-$15,692	InvestmentEarningsOrLossesAmt
Other Expenditures	$73,371	OtherExpendituresAmt
Administrative Expenses	$7,400	AdministrativeExpensesAmt
End Year Balance	$1,568,899	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,479,284	BeginningYearBalanceAmt
Contributions	$46,819	ContributionsAmt
Investment Earnings Or Losses	$108,550	InvestmentEarningsOrLossesAmt
Other Expenditures	$56,867	OtherExpendituresAmt
Administrative Expenses	$7,229	AdministrativeExpensesAmt
End Year Balance	$1,570,557	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,291,319	BeginningYearBalanceAmt
Contributions	$144,789	ContributionsAmt
Investment Earnings Or Losses	$113,425	InvestmentEarningsOrLossesAmt
Other Expenditures	$63,912	OtherExpendituresAmt
Administrative Expenses	$6,337	AdministrativeExpensesAmt
End Year Balance	$1,479,284	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,170,060	BeginningYearBalanceAmt
Contributions	$92,514	ContributionsAmt
Investment Earnings Or Losses	$82,010	InvestmentEarningsOrLossesAmt
Other Expenditures	$47,398	OtherExpendituresAmt
Administrative Expenses	$5,867	AdministrativeExpensesAmt
End Year Balance	$1,291,319	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.74710	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.21350	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.03940	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (true)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (true)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,104,215	OtherCostOrOtherBasisAmt
Book Value	$4,104,215	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$44,322,756	OtherCostOrOtherBasisAmt
Depreciation	$20,258,698	DepreciationAmt
Book Value	$24,064,058	BookValueAmt

Field	Value	IRS element (for citing)
Leasehold Improvements		LeaseholdImprovementsGrp

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$38,827,859	OtherCostOrOtherBasisAmt
Depreciation	$26,056,434	DepreciationAmt
Book Value	$12,771,425	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,471,880	OtherCostOrOtherBasisAmt
Depreciation	$1,164,991	DepreciationAmt
Book Value	$306,889	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$41,246,587	TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt	$51,361,360	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$658,668	NetUnrealizedGainsInvstAmt
Other Revenue	$627,197	OtherRevenueAmt
Revenue Not Reported	$1,285,865	RevenueNotReportedAmt
Revenue Subtotal	$50,075,495	RevenueSubtotalAmt
Other Revenues Not Included	$4,405,411	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$4,405,411	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$54,480,906	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$49,570,174	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$502,945	OtherExpensesIncludedAmt
Expenses Not Reported	$502,945	ExpensesNotReportedAmt
Expenses Subtotal	$49,067,229	ExpensesSubtotalAmt
Other Expenses Not Included	$4,405,411	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$4,405,411	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$53,472,640	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4	THE ENDOWNMENT FUNDS ARE HELD BY SUSAN B. ALLEN MEMORIAL HOSPITAL FOUNDATION, A RELATED TAX EXEMPT ORGANIZATION. THE EARNINGS FROM THE ENDWOMENT FUNDS ARE USED TO FUND THE PURCHASE OF EQUIPMENT AND PROGRAM SUPPORT FOR SUSAN B. ALLEN MEMORIAL HOSPITAL.
SCHEDULE D, PART X, LINE 2	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 2D	RELATED ORGANIZATION REVENUE $ 933,465 ELIMINATIONS $ (959,129) RECLASS OF RENTAL EXPENSES $ 662,733 PARTNERSHIP INCOME $ 1,725 ARRA MEANINGFUL USE $ (11,597) ---------- $ 627,197
SCHEDULE D, PART XI, LINE 4b	BAD DEBT EXPENSE $ 4,405,411
SCHEDULE D, PART XII, LINE 2D	RELATED ORGANIZATION EXPENSE $ 209,029 ELIMINATIONS $ (357,220) RECLASS OF RENTAL EXPENSES $ 662,733 ARRA MEANINGFUL USE $ (11,597) ---------- $ 502,945
SCHEDULE D, PART XII, LINE 4B	BAD DEBT EXPENSE $ 4,405,411

Schedule F IRS990ScheduleF

Field	Value	IRS element (for citing)
Grant Records Maintained	false	GrantRecordsMaintainedInd

Account Activities Outside US AccountActivitiesOutsideUSGrp

Field	Value	IRS element (for citing)
Region	Central America and the Caribbean	RegionTxt
Type Of Activities Conducted	Investments	TypeOfActivitiesConductedTxt
Region Total Expenditures	$855,179	RegionTotalExpendituresAmt

Field	Value	IRS element (for citing)
Subtotal Spent	$855,179	SubtotalSpentAmt
Total Spent	$855,179	TotalSpentAmt
Transfer To Foreign Corp	false	TransferToForeignCorpInd
Interest In Foreign Trust	false	InterestInForeignTrustInd
Foreign Corp Ownership	Yes (true)	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	Yes (true)	PassiveForeignInvestmestCoInd
Foreign Partnership	false	ForeignPartnershipInd
Boycott Countries	false	BoycottCountriesInd

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	false	FPGReferenceDiscountedCareInd
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	false	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$761,324	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$455,163	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$306,161	NetCommunityBenefitExpnsAmt
Total Expense	0.00630	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,501,076	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,523,112	DirectOffsettingRevenueAmt
Net Community Benefit Expns	-$22,036	NetCommunityBenefitExpnsAmt

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,262,400	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,978,275	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$284,125	NetCommunityBenefitExpnsAmt
Total Expense	0.00630	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$162,968	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$43,175	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$119,793	NetCommunityBenefitExpnsAmt
Total Expense	0.00250	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,500	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$2,500	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$165,468	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$43,175	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$122,293	NetCommunityBenefitExpnsAmt
Total Expense	0.00260	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,427,868	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,021,450	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$406,418	NetCommunityBenefitExpnsAmt
Total Expense	0.00890	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,405,411	BadDebtExpenseAmt
Bad Debt Expense Attributable	$678,000	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$13,408,875	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$17,703,127	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$4,294,252	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SUSAN B ALLEN MEMORIAL HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	720 WEST CENTRAL	AddressLine1Txt
City	EL DORADO	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	67042	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.sbamh.org	WebsiteAddressTxt
State License	H-008-002	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	SUSAN B ALLEN MEMORIAL HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	16	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	false	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	false	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, SECTION C	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V, SECTION C	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	0.	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	SEE PART V, SECTION C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE PART V, SECTION C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	SEE PART V, SECTION C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5	Based on data acquired from the 2013 CHNA, Health & Wellness community partners were invited to give input during the 2016 CHNA data collection process and participated in the town hall meeting that followed where gaps in significant needs were identified and prioritized. These partners included but were not limited to: Butler County Health dept, South Central Kansas Mental Health, local school districts, Department of Aging, Members of SBA Medical Staff, Allied Health, Butler Community College School of Nursing, United Way, YMCA, large business owners, clergy, department of human services, etc.
SCHEDULE H, PART V, SECTION B, LINE 7A & 10A	WWW.SBAMH.ORG/ABOUT_US/COMMUNITY_HEALTH_NEEDS_ASSESSMENT
SCHEDULE H, PART V, SECTION B, LINE 11	SBA has adopted a "Population Health" philosophy where Health & Wellness services are developed and delivered to all citizens in our service area. The 2016 CHNA identified three (3) major underserved areas of significant need; mental health/allied health, community awareness/education and child/adult obesity management. SBA has filled vacant Board of Trustee positions based on these gaps and recently hired a community advocate to coordinate with local partners to develop strategies to best deliver the results of the 2016 CHNA to the community. SBA has discussed the need to improve access to dental care with several local dentists. Thus far, the discussion have focused on a hospital based dental clinic where dental hygienists and dentists could practice preventative and routine dental care for the underserved in partnership with the hospital. Initially, there was a dental room planned in the Cancer Center hallway construction project but after further review, it was determined to be too small to accommodate all the needed equipment. Current discussion include offering space in the ENT office that is underutilized and more than adequate for this service. Our next planning meeting will be later this fall.
SCHEDULE H, PART V, SECTION B, LINE 16	www.sbamh.org/patients_info/billing_information

Field	Value	IRS element (for citing)
Facility	4	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
SBA MEMORIAL HOSPITAL HOME HEALTH
720 W CENTRAL	EL DORADO	KS	67042	home health agency
SUSAN B ALLEN MEMORIAL HOSPITAL DME
720 W CENTRAL	EL DORADO	KS	67042	DURABLE MEDICAL EQUIPMENT PROVIDER
SBA MEMORIAL HOSPITAL DIALYSIS
720 W CENTRAL	EL DORADO	KS	67042	HEMODIALYSIS
SBA MEMORIAL HOSPITAL MEDICAL CLINIC
720 W CENTRAL	EL DORADO	KS	67042	MEDICAL OFFICE BUILDING

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3C	The Hospital also uses medical indigency, asset level, and residency as factors to determine eligibility.
Schedule H, Part I, Line 7, Column F	THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALDULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $4,405,411.
Schedule H, Part I, Line 7	THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES.
SCHEDULE H, PART III, SECTION A, LINE 2	NON-MEDICARE/MEDICAID ACCOUNT AGING OVER 180 DAY RESERVES AT 100%. MEDICARE/MEDICAID ACCOUNT AGING OVER 365 DAY RESERVED AT 100%.
SCHEDULE H, PART III, SECTION A, LINE 3	ESTIMATED BASED ON US CENSUS BUREAU INDIVIDUALS BELOW POVERTY LEVEL OF 15.4%.
SCHEDULE H, PART III, SECTION A, LINE 4	THE BAD DEBT FOOTNOTE IS ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION B, LINE 8	SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART III, SECTION C, LINE 9B	THE FINANCIAL ASSISTANCE POLICY IS OFFERED AT TIME OF REGISTRATION. NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN MULTIPLE FORMS.
SCHEDULE H, PART VI, LINE 2	IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS COMPLETED IN 2016 AS REQUIRED BY 501(R) THE ORGANIZATION HAS A STRATEGIC PLANNING COMMITTEE OF THE BOARD WHO THROUGH A CONSULTANT CONDUCTS A NEEDS SURVEY OF OUR SERVICE AREA.
SCHEDULE H, PART VI, LINE 3	ON ADMISSION, PATIENTS ARE GIVEN A BROCHURE DESCRIBING INFORMATION ABOUT THE KANSAS HEALTHWAVE PROGRAM. IT ALSO INCLUDES INFORMATION ABOUT COVENTRY ONE HEALTH INSURANCE AND VALUE BLUE, BOTH ARE LOW COST OR NOCOST INSURANCE PLANS. THE BROCHURE GIVES INFORMATION ABOUT OUR CHARITY CARE PROGRAM. OUR CHARITY CARE PROGRAM INFORMATION IS GIVEN TO OUR MEDICAL STAFF PHYSICIANS FOR DISTRIBUTION TO PATIENTS IN THEIR OFFICES. ALL OF THE BILLING STATEMENTS LIST THAT WE HAVE A CHARITY CARE PROGRAM AND THE WEBSITE URL. THE CHARITY CARE APPLICATION WITH COVER LETTER IS MAILED ALONG WITH THE FIRST STATEMENT SENT TO SELFPAY PATIENTS. THE GUIDELINES ARE INCLUDED WITH THE SECOND STATEMENT AFTER A REVIEW OF THE ACCOUNT INDICATES A NEED FOR FINANCIAL ASSISTANCE. PATIENT ACCOUNT REPRESENTATIVES REVIEW OUR CHARITY CARE PROGRAM WITH PATIENTS WHEN MAKING CALLS. WE ALSO REFER PATIENTS TO THE MIDLAND GROUP TO DETERMINE ELIGIBILITY FOR MEDICAID, OTHER ASSISTANCE PROGRAMS AND OUR CHARITY CARE PROGRAM. THE MIDLAND GROUP ASSISTS PATIENTS IN THE APPLICATION PROCESS TO SEE IF THEY ARE ELIGIBLE FOR STATE ASSISTANCE PROGRAMS. KANSAS MEDICAL ASSISTANCE PROGRAM (KMAP) HEALTHWAVE BROCHURES AND APPLICATIONS ARE PROVIDED TO PATIENTS WHO MAY MEET THE FINANCIAL GUIDELINES OF THE KMAP.
SCHEDULE H, PART VI, LINE 4	THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF 6 COMMUNITIES WITHIN BUTLER COUNTY WHICH LIE WITHIN A 15 MILE RADIUS OF THE HOSPITAL. THE POPULATION OF THESE COMMUNITIES IS APPROXIMATELY 37,500 OF WHICH 26% ARE AGE 55 OR OLDER. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF 13 SMALLER COMMUNITIES LOCATED IN BUTLER, GREENWOOD, ELK, MARION AND COWLEY COUNTIES WITH A COMBINED POPULATION OF JUST OVER 15,000 RESIDENTS OF WHICH 32% ARE AGE 55 OR OLDER. WHILE PART OF THE SERVICE AREA IS IN THE WICHITA METROPOLITAN STATISTICAL AREA, MUCH OF THE SERVICE AREA IS RURAL.
SCHEDULE H, PART VI, LINE 5	WE PARTICIPATE IN THE BUTLER COUNTY SENIOR FAIR PROVIDING HEALTH INFORMATION ON VARIOUS HEALTH ISSUES. WE PARTICIPATE IN THE FRONTIER REFINING EMPLOYEE HEALTH FAIR PROVIDING INFORMATION ABOUT VARIOUS HEALTH ISSUES AND OFFER HEALTH TESTING AND SCREENINGS. WE PARTICIPATE IN THE BUTLER COMMUNITY COLLEGE WOMEN'S FAIR PROVIDING INFORMATION ABOUT VARIOUSD IN THE BUTLER COMMUNITY COLLEGE-ANDOVER/SHERWIN WILLIAMS WELLNESS FAIR PROVIDING INFORMATION ABOUT VARIOUS HEALTH ISSUES AND OFFER HEALTH TESTING AND SCREENINGS. WE ARE A SPONSOR OF THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE IN EL DORADO, KANSAS AND IN EUREKA, KANSAS. WE PROVIDED A PHARMACIST FOR POISON PREVENTION AND SAFETY TO EL DORADO KINDERGARTEN AND 1ST GRADERS. WE PROVIDED MEETING SPACE FOR SEVERAL COMMUNITY HEALTH GROUPS INCLUDING BUTLER COUNTY DIABETES SUPPORT GROUP, THE AMERICAN CANCER SOCIETY, AND THE BUTLER COUNTY MULTIPLE SCLEROSIS SUPPORT GROUP. WE PROVIDE LOW COST SCREENING PROGRAMS FOR CARDIAC HEALTH, OSTEOPOROSIS, HYPERTENSION AND DIABETES. WE PROVIDE FREE INFLUENZA VACCINATIONS TO MEMBERS OF THE COMMUNITY. WE HAVE A VOLUNTEER BOARD OF 12 MEMBERS THAT COME FROM THROUGHOUT OUR SERVICE AREA.
FORM 990 DISCLOSURE REQUIRED UNDER REV. PROC. 2015-21	Susan B. Allen Memorial Hospital discovered in November of 2016 that they did not fully comply with 501(r) during a portion of the 2016 calendar year. The client believed they were in compliance until it was discovered during the preparation of their 12/31/2015 tax return. They inadvertently did not include the full version of the Financial Assistance Policy on their website. SBAMH corrected this in November of 2016 by adding the full version of the Financial Assistance Policy on their website. SBAMH also added a translated version of the Financial Assistance Policy on their website in December of 2016 even though it is not required. SBAMH does have someone visiting the homes of people that have not completed the Financial Application Policy, but are presumed to qualify, to encourage them to complete the application. It was discovered in July of 2017 from an IRS letter that the listing of covered and non-covered providers was not posted on the website and the CHNA posted on the website did not include managements action plan. These items were corrected upon receiving the letter.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
ADULT DIABETES EDUCATION PROGRAM	2	$1,504	BOOK	EDUCATION
PUBLIC INFLUENZA VACCINATIONS	918	$17,961	BOOK	VACCINATIONS

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE I, PART I, LINE 2	FormAndLineReferenceDesc
Explanation	THE PUBLIC INFLUENZA VACCINATIONS ARE GIVEN TO ALL WHO SHOW UP AT THE TWO CLINICY. THE ADULT DIABETES EDUCATION PROGRAM GRANTS ARE GIVEN TO THOSE WHO APPLY AND MEET THE FINANCIAL NEED CRITERIA.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	false	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	Yes (true)	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JIM KIRKBRIDE
PRESIDENT & CEO	$191,965	$0	$30,000	$0	$1,865	$0	$1,711	$0	$15,072	$0	$240,613	$0	$0	$0
Gerard Librodo MD
PHYSICIAN OF ORTHOPEDICS	$460,983	$0	$192,716	$0	$1,080	$0	$2,880	$0	$10,778	$0	$668,437	$0	$0	$0
LAWRENCE SHANK
ORTHOPEDIC SURGEON	$220,255	$0	$0	$0	$783	$0	$2,207	$0	$862	$0	$224,107	$0	$0	$0
JASON BRUNTON
HOSPITALIST	$230,786	$0	$0	$0	$997	$0	$2,327	$0	$10,088	$0	$244,198	$0	$0	$0
DR VIKRANT AZAD
ORTHO SURGEON	$173,181	$0	$0	$0	$0	$0	$22	$0	$6,221	$0	$179,424	$0	$0	$0
CECILIA GOEBEL
CHIEF NURSING OFFICER	$147,027	$0	$0	$0	$1,605	$0	$6,688	$0	$20,860	$0	$176,180	$0	$0	$0
PAIGE DODSON
CHIEF MEDICAL OFFICER	$191,528		$25,000		$1,736		$1,907		$7,438		$227,609		$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE J, PART I, LINE 6A	FormAndLineReferenceDesc
Explanation	MANAGEMENT INCENTIVE PLAN BASED ON CRITERIA OF CONTRIBUTION MARGIN PERCENTAGE AFTER MEETING ACCREDITATION STANDARDS AND QUALITY STANDARDS.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
BUTLER COUNTY KANSAS
A	486035405	12343PAA3	2012-04-30	$14,500,000	SEE PART VI	false	false	false
BUTLER COUNTY KANSAS
B	486035405		2014-12-16	$6,500,000	SEE PART VI	false	false	false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Bond DefeasedBondDefeasedAmt	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Capitalized InterestCapitalizedInterestAmt	Refunding EscrowRefundingEscrowAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Credit EnhancementCreditEnhancementAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	UnspentUnspentAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$7,500,364	$0	$14,500,655	$0	$24	$0	$0	$0	$0	$3,607,315	$10,893,316	$0	2013	Yes (true)	Yes (true)	Yes (true)	Yes (true)
B	$1,220,145	$0	$6,502,044	$0	$0	$0	$110,354	$0	$0	$5,302,497	$0	$1,089,193	2017	false	false	false	Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedPropertyInd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Any Research AgreementsAnyResearchAgreementsInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Change In Use Bond Financed PropChangeInUseBondFinancedPropInd	Remedial Action TakenRemedialActionTakenInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	false	false	false	false	0	false	false	false	Yes (true)
B	false	false	false	false	0	false	false	false	Yes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Business Name Line1GICProviderName/BusinessNameLine1Txt	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Rebate Not Due YetRebateNotDueYetInd
0
A	false	Yes (true)	false	false	false	0	false	Yes (true)
0
B	false		false	false	false	0	false	Yes (true)	Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (true)
B	Yes (true)

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line A, Column (f)	Improve and equip hospital facilities; Refund Series 1998Z Bonds (issued 12/22/1998); Refund Series 2002Q Bonds (issued 12/17/2002).
PART I, LINE B, COLUMN (F)	RENOVATIONS TO AND EQUIPMENT FOR HOSPITAL FACILITIES.
Part II, Line 3, Column A	Amount does not equal issue price due to investment earnings earned in the project fund during the project period.
Part II, Line 3, Column B	Amount does not equal issue price due to investment earnings earned in the project fund during the project period.
Part II, Line 11, Column A	This amount was expended to redeem the refunded bonds on May 1, 2012 and December 15, 2012.
Part II, Line 12, Column B	Amount represents $1,089,193 of Bond proceeds remaining in the project fund as of the fiscal year end.
Part II, Line 13 and Line 16, Column B	The project was completed after the fiscal year end. The Institution is in the process of completing the Final Allocation for the Bonds.
Part II, Line 15, Column A	The bond issue constitutes an "advance refunding issue" under U.S. Treasury Regs 1.150-1(d), but no bond that is part of the bond issue is an "advance refunding bond" under I.R.C. 149(d). The bonds were issued as a "draw-down loan" within meaning of U.S. Treasury Regs 1.150(1)(c)(4)(i). The first draw/advance on the bonds was made April 30, 2012 (i.e., the issue date of the bond issue), in part, to refund and redeem a prior series of 1998Z bonds on May 1, 2013; the second draw/advance on the Bonds was made December 14, 2012, in part, to refund and redeem a prior series of 2002Q bonds on December 15, 2012. Therefore, there are no advance refunding bonds, because no bond proceeds were used to pay debt service on a prior series of bonds more than 90 days after the issue date of that bond.
Part III, Column A	The bonds were issued for three separate purposes: (1) to currently refund a prior series of 1998Z bonds (issued December 22, 1998), (2) to currently refund a period series of 2002Q bonds (issued December 17, 2002) and (3) to finance new-money projects. In accordance with the Instructions for Schedule K (Form 990), the organization is completing this Part III (Private Business Use) only with respect to the portion of the bonds financing the new-money projects, because both prior series of refunded bonds were issued prior to January 1, 2003.
Part IV, Line 2c, Column A	Arbitrage Computation completed as of 1/1/2014.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	SEE SCHEDULE L PART V	PersonNm

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE L, PART IV	FormAndLineReferenceDesc
Explanation	(A) KACEY CARLSON (B) DAUGHTER OF EDWIN GARD, TRUSTEE/VICE CHAIRPERSON OF SUSAN B. ALLEN MEMORIAL HOSPITAL. (C) $12,182 (D) KACEY CARLSON IS AN EMPLOYEE AT SUSAN B. ALLEN MEMORIAL HOSPITAL. (E) NO	ExplanationTxt

Schedule M IRS990ScheduleM

Works Of Art WorksOfArtGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$2,000	NoncashContributionsRptF990Amt
Method Of Determining Revenues	ACCRUED	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Art Historical Treasures		ArtHistoricalTreasuresGrp
Art Fractional Interest		ArtFractionalInterestGrp
Books And Publications		BooksAndPublicationsGrp
Clothing And Household Goods		ClothingAndHouseholdGoodsGrp
Cars And Other Vehicles		CarsAndOtherVehiclesGrp
Boats And Planes		BoatsAndPlanesGrp
Intellectual Property		IntellectualPropertyGrp
Securities Publicly Traded		SecuritiesPubliclyTradedGrp
Securities Closely Held Stock		SecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust Intrsts		SecurPrtnrshpTrustIntrstsGrp
Securities Miscellaneous		SecuritiesMiscellaneousGrp
Qualified Contrib Hist Struct		QualifiedContribHistStructGrp
Qualified Contrib Other		QualifiedContribOtherGrp
Real Estate Residential		RealEstateResidentialGrp
Real Estate Commercial		RealEstateCommercialGrp
Real Estate Other		RealEstateOtherGrp
Collectibles		CollectiblesGrp
Food Inventory		FoodInventoryGrp
Drugs And Medical Supplies		DrugsAndMedicalSuppliesGrp
Taxidermy		TaxidermyGrp
Historical Artifacts		HistoricalArtifactsGrp
Scientific Specimens		ScientificSpecimensGrp
Archaeological Artifacts		ArchaeologicalArtifactsGrp
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	false	ReviewProcessUnusualNCGiftsInd
Third Parties Used	false	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Sch. M, Part I, Line 1, Column B	FormAndLineReferenceDesc
Explanation	The amount in column B represents the number of items contributed.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 4A	COMMUNITY SERVICES - SUSAN B. ALLEN MEMORIAL HOSPITAL OFFERS A NUMBER OF PROGRAMS AND SERVICES IN OUR COMMUNITY AT MINIMAL OR NO COST IN ORDER TO PROMOTE HEALTH AND WELLNESS. ACTUAL COSTS FOR THESE SERVICES ARE NOT SEPARATELY IDENTIFIABLE, AND ARE INCLUDED AS PART OF THE PATIENT SERVICES COST. 1. PARTICIPATED IN THE BUTLER COUNTY SENIOR FAIR, HELD IN EL DORADO, DISPLAYING AND PROVIDING INFORMATION REGARDING OUR DIABETES EDUCATION PROGRAM (INCLUDING BLOOD GLUCOSE SCREENINGS), HOME HEALTH SERVICES (INCLUDING BALANCE SCREENING, BLOOD PRESSURE TESTING, 02 SATURATIONS), HOME MEDICAL EQUIPMENT SERVICES, OSTEOPOROSIS INFORMATION (INCLUDING SCREENING), NUTRITION SERVICES, ENT INFORMATION (INCLUDING AUDIOLOGY TESTING), AND PHYSICAL REHABILITATION AT NOCHARGE. 2. PARTICIPATED IN THE FRONTIER REFINING EMPLOYEE HEALTH FAIR PROVIDING INFORMATION ON DIABETIC FOOT CARE, CARDIAC HEALTH, DIETARY EDUCATION, ORTHOPAEDIC ISSUES, PHYSICAL THERAPY ISSUES, HEARING SCREENINGS, BONE DENSITY TESTING AND BLOOD WORK (INCLUDING LIPID, PSA AND HEMOGLOBIN A1C TESTING). 3. BEGAN SERVING AS A PROJECT SEARCH HOST SITE. PROJECT SEARCH IS A HIGH SCHOOL TO WORK TRANSITION PROGRAM SERVING STUDENTS WITH DISABILITIES BETWEEN THE AGES OF 18-21. 4. PROVIDED A REGISTERED PHARMACIST TO THE EL DORADO SCHOOL DISTRICT FOR POISON PREVENTION AND SAFETY TALKS FOR ALL KINDERGARTEN AND FIRST GRADE STUDENTS AT THE ELEMENTARY SCHOOLS IN TOWN (APPROXIMATELY 300 STUDENTS). 5. PROVIDED A NUMBER OF DIRECTORS AND STAFF TO SPEAK AT LOCAL SCHOOL DISTRICT CAREER FAIR EVENTS INCLUDING PHYSICAL REHABILITATION, DIAGNOSTIC IMAGING, ATHLETIC TRAINING, AND ORTHOPEDIC SURGERY. 6. ADMINISTRATIVE PERSONNEL (4) ARE SUPPORTING THE EL DORADO VISION 2020 PROGRAM, PROVIDING MENTORING AT A LOCAL SCHOOL ONE HOUR PER WEEK. 7. PROVIDED OVER 200 FREE DARI (MOTION ANALYSIS) SCREENINGS FOR HIGH SCHOOL AND COMMUNITY COLLEGE ATHLETES. 8. SPONSORED THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE IN EL DORADO WITH A $1,000 SPONSORSHIP. THE HOSPITAL ALSO SUPPORTED THE GREENWOOD COUNTY (EUREKA, KANSAS) RELAY FOR LIFE WITH A $500 SPONSORSHIP. 9. MADE AVAILABLE A "SPEAKERS BUREAU" TO OUR COMMUNITY. HOSPITAL PERSONNEL SPOKE TO VARIOUS CIVIC GROUPS AND ORGANIZATIONS ON NUMEROUS OCCASIONS. 10. HOSPITAL EMPLOYEES DONATED OVER $15,305 IN SUPPORT OF THE EL DORADO UNITED WAY PROGRAM. 11. THE HOSPITAL DONATED $2,500 IN GIFT CARDS TO RESIDENTS OF EUREKA, KANSAS FOLLOWING A TORNADO EVENT IN THEIR COMMUNITY IN JULY. GIFT CARDS FROM A HOME/LUMBER SUPPLY BUSINESS WERE DISTRIBUTED TO RESIDENTS IDENTIFIED BY THE AMERICAN RED CROSS AND LOCAL LAW ENFORCEMENT. 12. PROVIDED MEETING ROOM SPACE FOR OTHER ORGANIZATIONS SERVING THE COMMUNITY, SUCH AS THE BUTLER COUNTY DIABETES SUPPORT GROUP, THE AMERICAN CANCER SOCIETY, THE ARC OF BUTLER (SPECIAL NEEDS AND DISABILITIES), BUTLER COUNTY ALZHEIMER'S SUPPORT GROUP, AND THE BUTLER COUNTY MULTIPLE SCLEROSIS SUPPORT GROUP. 13. PROVIDED FACILITIES AND MEALS FOR A BUTLER/GREENWOOD COUNTY MEDICAL SOCIETY MEETING. 14. STAFF MEMBERS FROM THE EMERGENCY DEPARTMENT (CHEST PAIN CENTER), RESPIRATORY CARE DEPARTMENT, AND PHYSICAL REHABILITATION DEPARTMENT ATTENDED THE BUTLER COMMUNITY COLLEGE "CAMP MED" PROGRAM FOR YOUTH FROM THROUGHOUT BUTLER COUNTY. 15. PROVIDE PERSONNEL AND FACILITIES FOR LOCAL EMERGENCY PLANNING COMMITTEE MEETINGS. 16. PROVIDE ONCE-A-MONTH FREE CHILDBIRTH EDUCATION CLASSES FOR NEW MOMS AND SIGNIFICANT OTHERS, REGARDLESS OF WHERE THEY WILL BE DELIVERING. OBSTETRICS STAFF PROVIDE EDUCATION AND INFORMATION ABOUT LABOR AND DELIVERY, COMFORT MEASURES, PAIN MANAGEMENT, NEWBORN CARE, RECOVERY AND DISCHARGE. 17. PROVIDED A LOW-COST SCREENING PROGRAM FOR CARDIAC HEALTH, OSTEOPOROSIS, HYPERTENSION, AND DIABETES TWO TIMES DURING THE YEAR IN FOR THE COMMUNITY HERE AT SUSAN B. ALLEN. 18. PROVIDED FREE OSTEOPOROSIS SCREENINGS IN THE PHYSICAL REHABILITATION DEPARTMENT ONE-HALF DAY EACH MONTH. 19. PROVIDE FREE HEARING SCREENINGS IN THE EL DORADO EAR, NOSE AND THROAT OFFICES ONE-HALF DAY EACH WEEK. 20. PARTNERED WITH USD 490 AND THE EL DORADO YMCA TO CREATE A MIDDLE SCHOOL AFTER-SCHOOL PROGRAM PROVIDING HEALTHY ACTIVITY, NUTRITION EDUCATION AND HEALTY LIFESTYLE EDUCATION TO STUDENTS AT NO COST. 21. PROVIDED A FREE INFLUENZA VACCINATION PROGRAM FOR MEMBERS OF OUR COMMUNITY. LARGE CLINICS WERE HELD FOR THE GENERAL PUBLIC - 1 IN EL DORADO AND 1 IN AUGUSTA - AS WELL AS SMALLER CLINICS LOCATED HERE AT THE HOSPITAL. IN TOTAL, 1,240 DOSES WERE GIVEN TO COMMUNITY MEMBERS AT NO COST. 22. ADMINISTRATIVE AND MANAGEMENT STAFF SERVE ON A VARIETY OF BOARDS AND COMMITTEES, INCLUDING THE EL DORADO YMCA, CHAMBER OF COMMERCE, EL DORADO INC., KANSAS HOSPITAL ASSOCIATION BOARD OF DIRECTORS EXECUTIVE COMMITTEE, CLINICAL LABORATORY MANAGERS ASSOCIATION - WHEATLAND CHAPTER, MEDICAL LABORATORY TECHNOLOGY PROGRAM ADVISORY COMMITTEE FOR SEWARD, BARTON COMMUNITY, AND MANHATTAN TECHNICAL COLLEGES, WICHITA STATE UNIVERSITY CLINICAL SCIENCE PROGRAM ADVISORY COMMITTEE, STATE OF KANSAS LABORATORY EMERGENCY PREPAREDNESS COMMITTEE, QUALITY CARE SERVICES, ASSOCIATION OF PROFESSIONAL INFECTION CONTROL AND EPIDEMIOLOGY, CENTRAL PLAINS EXPO, KANSAS SPORTS CONCUSSION PARTNERSHIP COMMITTEE, AMERICAN CANCER SOCIETY RELAY FOR LIFE, BLUESTEM COMMUNITY CREDIT UNION, EMPAC, BUTLER COMMUNITY COLLEGE NURSING ADVISORY BOARD, ASSOCIATION OF FUNDRAISING PROFESSIONALS BOARD, WICHITA STATE UNIVERSITY INSTITUTIONAL REVIEW BOARD, EL DORADO MINISTERIAL ALLIANCE, EL DORADO ARC OF BUTLER BOARD, THE KANSAS DIABETES ADVISORY COUNCIL, SOUTH CENTRAL KANSAS REGIONAL HOSPITAL EMERGENCY PLANNING GROUP, AND THE LOCAL EMERGENCY PLANNING COMMITTEE. 23. SPONSORED THE EL DORADO YMCA STRONG KIDS CAMPAIGN WITH A $1,000 DONATION. 24. ACT AS A CLINICAL SITE FOR TRAINING OF HEALTHCARE PROFESSIONALS INCLUDING MEDICAL STUDENTS, NURSING STUDENTS, RADIOLOGY, LAB, MEDICAL TECHNOLOGISTS, RESPIRATORY THERAPISTS, DIETITIANS, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS, ATHLETIC TRAINING STUDENTS, CRNA STUDENTS, PHYSICIAN ASSISTANT STUDENTS, APRN STUDENTS, AND PHARMACY STUDENTS. 25. SPONSORED THE BUTLER COUNTY 4-H PROGRAM WITH A $700 DONATION DURING THE ANNUAL LIVESTOCK AUCTION. 26. MADE AVAILABLE SCHOLARSHIP MONEY FOR PATIENTS TO GO THROUGH THE SBA ADULT DIABETES EDUCATION PROGRAM. IN ADDITION TO THE ACTUAL CLASS COSTS, ADDITIONAL LAB WORK WAS ALSO WRITTEN OFF FOR THESE PATIENTS. IN TOTAL, $2,123 WAS PROVIDED FOR FOUR PATIENTS WHO ATTENDED THE CLASS.
FORM 990, PART VI, SECTION A, LINE 2	CATHY N COOPER MD AND MICHAEL K WHEELER HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11B	AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE HOSPITAL'S OFFICERS AND THE ACCOUNTING STAFF. ANY QUESTIONS OR CONCERNS THE HOSPITAL'S OFFICERS OR ACCOUNTING STAFF HAVE ARE ADDRESSED AND ANY CLARIFICATION OR CORRECTIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PRESENTED TO THE BOARD OF TRUSTEES FOR THEIR REVIEW AND COMMENT. ANY QUESTIONS OR CONCERNS THE BOARD OF TRUSTEES HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT ARE NEEDED ARE MADE. THE FINAL 990 WITH ALL REQUIRED SCHEDULES ARE APPROVED BY THE BOARD OF TRUSTEES AND FILED. IF THE 990 IS FILED PRIOR TO BOARD APPROVAL AND CHANGES ARE NEEDED AN AMENDED RETURN IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C	AT THE TIME OF HIRE OR ELECTION IN THE CASE OF BOARD MEMBERS, AND ANNUALLY THEREAFTER, THE PRESIDENT AND CEO OR THEIR DESIGNEE SHALL PROVIDE TO THE BOARD, EXECUTIVE OFFICERS AND DEPARTMENT DIRECTORS, A COPY OF THE CONFLICT OF INTEREST POLICY AND THE CONFLICT OF INTEREST DISCLOSURE STATEMENT WHICH WILL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WITH RESPECT IT IS BELIEVED A CONFLICT MAY ARISE. THE ANNUAL REVIEW AND MONITORING IS A PART OF THE HOSPITAL'S CORPORATE COMPLIANCE PLAN. A REPORT SHALL BE MADE TO THE BOARD OF TRUSTEES OF ITEMS DISCLOSED. EACH MEMBER OF THE BOARD OF TRUSTEES OR MANAGEMENT SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL POTENTIAL CONFLICTS OF INTEREST WHICH MAY EXIST OR APPEAR TO EXIST.
FORM 990, PART VI, SECTION B, LINE 15A & 15B	THE HOSPITAL PARTICIPATES IN AN EXTERNAL SALARY SURVEY FOR ALL EXECUTIVE POSITIONS. THE PRESIDENT AND CEO REVIEWS THE SURVEY RESULTS, AND PRESENTS THEM TO THE COMPENSATION COMMITTEE OF THE BOARD WITH RECOMMENDATIONS FOR THE VICE PRESIDENTS. THE COMPENSATION COMMITTEE OF THE BOARD MAKES RECOMMENDATIONS TO THE FULL BOARD FOR APPROVAL. IN ADDITION, THE COMPENSATION COMMITTEE MAKES A RECOMMENDATION FOR THE PRESIDENT AND CEO SALARY TO THE FULL BOARD FOR APPROVAL. THE REVIEW IS DONE ANNUALLY BY THE COMPENSATION COMMITTEE AND THE BOARD.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART VII	AMY SEEBER IS COMPENSATED BY THE HOSPITAL FOR HER SERVICES PROVIDING A PHYSICIAN INTERPRETATION OF ELECTROCARDIOGRAMS.
FORM 990, PART XI, LINE 9	CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS $ (76,658) CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 245,191 Contributed personnel services from affiliate $ (122,664) Partnership Income $ 1,725 ---------- $ 47,595

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
720 WEST CENTRAL	EL DORADO	KS	67042	480862732	SUPPORT ORG	KS	501(C)(3)	12A	SBA HOSPITAL	Yes (true)
SBAMH EMPLOYEE GROUP BENEFIT TRUST
720 WEST CENTRAL	EL DORADO	KS	67042	481105047	VEBA	KS	501(C)(9)		SBA HOSPITAL	Yes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	FS ALLEN	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	720 WEST CENTRAL	AddressLine1Txt
City	EL DORADO	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	67042	ZIPCd

Field	Value	IRS element (for citing)
EIN	486103710	EIN
Primary Activities	GRANTOR TRUST	PrimaryActivitiesTxt
Legal Domicile State	KS	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Entity Type	TRUST	EntityTypeTxt
Share Of Total Income	-$76,391	ShareOfTotalIncomeAmt
Share Of EOY Assets	$2,811,055	ShareOfEOYAssetsAmt
Ownership	1.00000	OwnershipPct
Controlled Organization	Yes (true)	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	false	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	false	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (true)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	false	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (true)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
C	$357,220	cash
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
L	$122,664	FMV
SBAMH EMPLOYEE GROUP BENEFIT TRUST
R	$3,278,934	cash
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
S	$77,724	FMV