STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

SUSAN B ALLEN MEMORIAL HOSPITAL: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
SUSAN B ALLEN MEMORIAL HOSPITAL (EIN 48-0581968)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-14
IRS object ID
201613199349305736
Schema version
2015v2.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-14T12:49:40-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1Txt
CityKansas CityCityNm
State AbbreviationMOStateAbbreviationCd
ZIP641062246ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480581968EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SUSAN B ALLEN MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% GENE KABERLINEInCareOfNm
Business Name ControlSUSABusinessNameControlTxt
Phone3163213300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1Txt
CityEL DORADOCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67042ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGENE KABERLINEPersonNm
Person TitleCFOPersonTitleTxt
Signature2016-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKevin Ensminger CPAPreparerPersonNm
PTINP01310558PTIN
Phone8162216300PhoneNum
Preparation2016-11-15PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJIM KIRKBRIDEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1Txt
CityEL DORADOCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67042ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$67,174,859GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SBAMH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1930FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionTHE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSSIONAL HEALTH CARE TO THE PEOPLE WE SERVE.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee475TotalEmployeeCnt
Total Volunteers116TotalVolunteersCnt
Total Gross UBI-$26,199TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$26,199NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$793,112PYContributionsGrantsAmt
CY Contributions Grants$416,788CYContributionsGrantsAmt
PY Program Service Revenue$55,468,770PYProgramServiceRevenueAmt
CY Program Service Revenue$52,660,093CYProgramServiceRevenueAmt
PY Investment Income$1,136,569PYInvestmentIncomeAmt
CY Investment Income$1,119,031CYInvestmentIncomeAmt
PY Other Revenue$9,916PYOtherRevenueAmt
CY Other Revenue$148,216CYOtherRevenueAmt
PY Total Revenue$57,408,367PYTotalRevenueAmt
CY Total Revenue$54,344,128CYTotalRevenueAmt
PY Grants And Similar Paid$41,786PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$24,180CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$27,095,512PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$26,135,674CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$28,513,706PYOtherExpensesAmt
CY Other Expenses$28,125,533CYOtherExpensesAmt
PY Total Expenses$55,651,004PYTotalExpensesAmt
CY Total Expenses$54,285,387CYTotalExpensesAmt
PY Revenues Less Expenses$1,757,363PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$58,741CYRevenuesLessExpensesAmt
Total Assets BOY$82,532,498TotalAssetsBOYAmt
Total Assets EOY$81,259,407TotalAssetsEOYAmt
Total Liabilities BOY$18,062,183TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,737,315TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$64,470,315NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$62,522,092NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$44,024,543ExpenseAmt
Grant$24,180GrantAmt
Revenue$52,633,894RevenueAmt
DescSEE SCHEDULE ODesc
Total Program Service Expenses$44,024,543TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document63IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee475EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldKSStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGENE KABERLINEPersonNm
Phone3163224559PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1Txt
CityEL DORADOCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67042ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
VINCE E HAINES
TRUSTEE/CHAIRPERSON1.00.0Yes (X)Yes (X)$0$0$0
EDWIN A GARD
TRUSTEE/VICE CHAIRPERSON1.00.0Yes (X)Yes (X)$0$0$0
CATHY N COOPER MD
TRUSTEE1.00.0Yes (X)$0$0$0
MATTHEW J CROSS
TRUSTEE1.00.0Yes (X)$0$0$0
MARK D UTECH
TRUSTEE1.00.0Yes (X)$0$0$0
JOSEPH N SUNDGREN
TRUSTEE/TREASURER/SECRETARY1.00.0Yes (X)Yes (X)$0$0$0
JACQUELINE A VIETTI
TRUSTEE1.01.0Yes (X)$0$0$0
MICHAEL K WHEELER
TRUSTEE1.00.0Yes (X)$0$0$0
KENNETH ZIEGLER
TRUSTEE1.00.0Yes (X)$0$0$0
CAMI R BAKER
TRUSTEE1.00.0Yes (X)$0$0$0
MICHAEL CLIFTON
TRUSTEE1.00.0Yes (X)$0$0$0
AMY SEEBER
TRUSTEE1.00.0Yes (X)$5,574$0$0
GAYLE ARNETT
PRESIDENT & CEO40.01.0Yes (X)$133,574$0$27,302
CECILIA GOEBEL
VICE PRESIDENT & CNO40.00.0Yes (X)$131,577$0$31,904
DAVID SHAW
VICE PRESIDENT & COO40.00.0Yes (X)$221,441$0$21,972
ROBIN CRAWFORD
VICE PRESIDENT & CFO40.01.0Yes (X)$153,224$0$28,221
Patrick Auman
INTERIM PRESIDENT & CEO40.01.0Yes (X)$193,308$0$0
EVE SHANK
ENT PHYSICIAN40.00.0$344,488$0$20,922Yes (X)
GERARD M LIBRODO MD
physician of orthepedics40.00.0$653,056$0$13,150Yes (X)
JASON BRUNTON
HOSPITALIST40.00.0$216,400$0$11,630Yes (X)
LAWRENCE SHANK
ORTHOPEDIC SURGEON40.00.0$462,215$0$3,876Yes (X)
RUBEN GARCIA
HOSPITALIST PHYSICIAN40.00.0$238,462$0$18,197Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,753,319TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$177,174TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K15IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
FRESENIUS MEDICAL CARE
5215 n oconnor blvd suite 1100IRVINGTX75039KIDNEY DIALYSIS$950,810
PRISM HEALTHCARE PARTNERS LTD
190 S LA SALLE STREET STE 2900CHICAGOIL60603MEDICAL services$249,001
PATRICK A AUMAN
1519 TANNEHILL DRHOUSTONTX77008MANAGERIAL SERVICES$193,309
AFFILIATED MEDICAL SERVICES LAB I
PO BOX 12127WICHITAKS67277MEDICAL SERVICES$172,278
MONITORING CONCEPTS LLC
7225 S 85TH AVE STE 200TULSAOK74133MEDICAL SERVICES$133,135
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt
Related Organizations$403,077RelatedOrganizationsAmt
All Other Contributions$13,711AllOtherContributionsAmt
Total Contributions$416,788TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Service Revenue621110$52,145,653$52,145,653
Meals on Wheels624200$100,360$100,360
Screening Program623990$2,545$2,545
ARRA Meaningful Use621110$411,535$411,535
FieldValueIRS element (for citing)
Total Program Service Revenue$52,660,093TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$549,802TotalRevenueColumnAmt
Exclusion$549,802ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$194TotalRevenueColumnAmt
Exclusion$194ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$349TotalRevenueColumnAmt
Exclusion$349ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$548,420RealAmt
Personal$52,920PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$525,896RealAmt
Personal$119,307PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$22,524RealAmt
Personal-$66,387PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$43,863TotalRevenueColumnAmt
Exclusion-$43,863ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$12,729,613SecuritiesAmt
Other$24,950OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$12,151,657SecuritiesAmt
Other$33,871OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$577,956SecuritiesAmt
Other-$8,921OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$569,035TotalRevenueColumnAmt
Exclusion$569,035ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Cafeteria722210$197,267$197,267
PARTNERSHIP INCOME900099-$26,199-$26,199
MISCELLANEOUS900099$20,662$20,662

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,662TotalRevenueColumnAmt
Exclusion$20,662ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$191,730OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$54,344,128TotalRevenueColumnAmt
Related Or Exempt Func Income$52,660,093RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue-$26,199UnrelatedBusinessRevenueAmt
Exclusion$1,293,446ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$24,180TotalAmt
Program Services$24,180ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$948,096TotalAmt
Management And General$948,096ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$41,671TotalAmt
Program Services$41,671ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$19,385,056TotalAmt
Program Services$14,528,374ProgramServicesAmt
Management And General$4,856,682ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$370,313TotalAmt
Program Services$277,735ProgramServicesAmt
Management And General$92,578ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,973,403TotalAmt
Program Services$2,980,052ProgramServicesAmt
Management And General$993,351ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,417,135TotalAmt
Program Services$1,062,851ProgramServicesAmt
Management And General$354,284ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,484,951TotalAmt
Program Services$4,113,713ProgramServicesAmt
Management And General$1,371,238ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$282,440TotalAmt
Program Services$211,830ProgramServicesAmt
Management And General$70,610ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$436,650TotalAmt
Program Services$327,488ProgramServicesAmt
Management And General$109,162ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$729,809TotalAmt
Program Services$547,357ProgramServicesAmt
Management And General$182,452ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$259,589TotalAmt
Program Services$194,692ProgramServicesAmt
Management And General$64,897ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$444,296TotalAmt
Program Services$360,857ProgramServicesAmt
Management And General$83,439ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,091,259TotalAmt
Program Services$3,068,444ProgramServicesAmt
Management And General$1,022,815ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$298,315TotalAmt
Program Services$223,736ProgramServicesAmt
Management And General$74,579ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Bad Debt$5,993,751$5,993,751
Medical Supplies$9,731,253$9,731,253
Repairs & Maint.$13,303$9,977$3,326
Recruiting & Retention$133,340$100,005$33,335

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$226,577TotalAmt
Program Services$226,577ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$54,285,387TotalAmt
Program Services$44,024,543ProgramServicesAmt
Management And General$10,260,844ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$192BOYAmt
EOY$857,874EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,466,258BOYAmt
EOY$9,272,381EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,476,140BOYAmt
EOY$1,486,417EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,805,378BOYAmt
EOY$1,802,533EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$86,950,150LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$44,165,502LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$43,142,296BOYAmt
EOY$42,784,648EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$23,126,090BOYAmt
EOY$22,778,774EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$2,154,070BOYAmt
EOY$1,879,425EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$50,719BOYAmt
EOY$120,252EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$311,355BOYAmt
EOY$277,103EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$82,532,498BOYAmt
EOY$81,259,407EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,834,890BOYAmt
EOY$3,992,153EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,227,293BOYAmt
EOY$14,745,162EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$18,062,183BOYAmt
EOY$18,737,315EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$59,665,473BOYAmt
EOY$59,049,986EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,305,818BOYAmt
EOY$277,731EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,499,024BOYAmt
EOY$3,194,375EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$64,470,315BOYAmt
EOY$62,522,092EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$82,532,498BOYAmt
EOY$81,259,407EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$58,741ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,320,949NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$686,015OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$7,716GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$7,716TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1FFormAndLineReferenceDesc
ExplanationA PORTION OF THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HEALTH ASSOCIATION DUES ARE ATTRIBUTED TO LOBBYING EXPENSES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

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

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,165,992BeginningYearBalanceAmt
Contributions$43,432ContributionsAmt
Investment Earnings Or Losses$13,396InvestmentEarningsOrLossesAmt
Other Expenditures$47,095OtherExpendituresAmt
Administrative Expenses$5,665AdministrativeExpensesAmt
End Year Balance$1,170,060EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.83890BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.14530PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.01580TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,189,689OtherCostOrOtherBasisAmt
Book Value$4,189,689BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$44,259,170OtherCostOrOtherBasisAmt
Depreciation$19,123,736DepreciationAmt
Book Value$25,135,434BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$37,180,380OtherCostOrOtherBasisAmt
Depreciation$23,986,344DepreciationAmt
Book Value$13,194,036BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,320,911OtherCostOrOtherBasisAmt
Depreciation$1,055,422DepreciationAmt
Book Value$265,489BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$42,784,648TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$47,499,450TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$1,320,949NetUnrealizedGainsInvstAmt
Other Revenue$470,022OtherRevenueAmt
Revenue Not Reported-$850,927RevenueNotReportedAmt
Revenue Subtotal$48,350,377RevenueSubtotalAmt
Other Revenues Not Included$5,993,751OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$5,993,751RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$54,344,128TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$49,109,044TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$817,408OtherExpensesIncludedAmt
Expenses Not Reported$817,408ExpensesNotReportedAmt
Expenses Subtotal$48,291,636ExpensesSubtotalAmt
Other Expenses Not Included$5,993,751OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$5,993,751ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$54,285,387TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4THE 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 2MANAGEMENT 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 2DRELATED ORGANIZATION REVENUE $ 201,697 ELIMINATIONS $ (403,077) RECLASS OF RENTAL EXPENSES $ 645,203 PARTNERSHIP INCOME $ 26,199 ---------- $ 470,022
SCHEDULE D, PART XI, LINE 4bBAD DEBT EXPENSE $ 5,993,751
SCHEDULE D, PART XII, LINE 2DRELATED ORGANIZATION EXPENSE $ 172,205 RECLASS OF RENTAL EXPENSES $ 645,203 ---------- $ 817,408
SCHEDULE D, PART XII, LINE 4BBAD DEBT EXPENSE $ 5,993,751

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

FieldValueIRS element (for citing)
RegionCentral America and the CaribbeanRegionTxt
Type Of Activities ConductedInvestmentsTypeOfActivitiesConductedTxt
Region Total Expenditures$840,927RegionTotalExpendituresAmt
FieldValueIRS element (for citing)
Subtotal Spent$840,927SubtotalSpentAmt
Total Spent$840,927TotalSpentAmt
Transfer To Foreign CorpfalseTransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipYes (true)ForeignCorpOwnershipInd
Passive Foreign Investmest CoYes (true)PassiveForeignInvestmestCoInd
Foreign PartnershipfalseForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,049,138TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$403,163DirectOffsettingRevenueAmt
Net Community Benefit Expns$645,975NetCommunityBenefitExpnsAmt
Total Expense0.01320TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,906,383TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,556,541DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,348,842NetCommunityBenefitExpnsAmt
Total Expense0.02760TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,955,521TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,959,704DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,994,817NetCommunityBenefitExpnsAmt
Total Expense0.04080TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$155,629TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$45,370DirectOffsettingRevenueAmt
Net Community Benefit Expns$110,259NetCommunityBenefitExpnsAmt
Total Expense0.00230TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$155,629TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$45,370DirectOffsettingRevenueAmt
Net Community Benefit Expns$110,259NetCommunityBenefitExpnsAmt
Total Expense0.00230TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,111,150TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,005,074DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,105,076NetCommunityBenefitExpnsAmt
Total Expense0.04310TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$5,993,751BadDebtExpenseAmt
Bad Debt Expense Attributable$923,038BadDebtExpenseAttributableAmt
Reimbursed By Medicare$13,693,796ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$17,741,682CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$4,047,886MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SUSAN B ALLEN MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1Txt
CityEL DORADOCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67042ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.sbamh.orgWebsiteAddressTxt
State LicenseH-008-002StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SUSAN B ALLEN MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Includes Publicity MeasuresfalseIncludesPublicityMeasuresInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesYes (true)CollectionActivitiesInd
Reporting To Credit AgencyYes (X)ReportingToCreditAgencyInd
Engaged Legal Judicial ProcessYes (X)EngagedLegalJudicialProcessInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, SECTION B, LINE 5IN THE TOWN HALL MEETINGS, SBAMH TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED AND WHO HAD SPECIAL KNOWLEDGE IN PUBLIC HEALTH. THIS INCLUDED LEADERS IN HEALTH CARE ORGANIZATIONS; EDUCATION OFFICIALS AND STAFF; COMMUNITY LEADERS; PRESS; FOUNDATIONS; PHYSICIANS; HOUSING ADMINISTRATORS; REPRESENTATIVES FROM BUSINESS; THE HOSPITAL ORGANIZATION'S BOARD MEMBERS; PUBLIC SAFETY OFFICIALS; DIRECTORS OR STAFF OF HEALTH AND HUMAN SERVICE ORGANIZATIONS; STAFF FROM STATE AND AREA AGENCIES ON AGING; POLITICAL, APPOINTED AND ELECTED OFFICIALS; CIVIC OR SERVICE CLUBS; CHAMBER OF COMMERCE; AND CONSUMER ADVOCATES.
PART V, SECTION B, LINE 6BTHE BUTLER COUNTY HEALTH DEPARTMENT SOUTH CENTRAL MENTAL HEALTH CENTER
PART V, SECTION B, LINE 7A & 10aHTTP://WWW.SBAMH.ORG/ABOUT_US/COMMUNITY_HEALTH_NEEDS_ASSESSMENT
PART V, SECTION B, LINE 11Our Executive Team, with Board approval, has built a new Hospital department to go live effective 1/1/2017 named Community Health, which will include a Director (RN) who will coordinate and strategize needs identified in our CHNA. This includes overall community health, a wellness program for community members (12 week program including pre-lab work/fitness, YMCA membership, training with a nutritional therapies, weekly boot camps at the YMCA and post-lab/fitness evaluation), nutritional therapy (education for families over obesity/diabetes) and intends to eventually lead this department into nurse navigation for the community.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
SBA MEMORIAL HOSPITAL HOME HEALTH
720 W CENTRALEL DORADOKS67042home health agency
SUSAN B ALLEN MEMORIAL HOSPITAL DME
720 W CENTRALEL DORADOKS67042DURABLE MEDICAL EQUIPMENT PROVIDER
SBA MEMORIAL HOSPITAL DIALYSIS
720 W CENTRALEL DORADOKS67042HEMODIALYSIS
SBA MEMORIAL HOSPITAL MEDICAL CLINIC
720 W CENTRALEL DORADOKS67042MEDICAL OFFICE BUILDING

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7, COLUMN FTHE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $5,993,751.
SCHEDULE H, PART I, LINE 7THE 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 2AN ACCOUNTS RECEIVABLE AGING ANALYSIS IS PERFORMED AND UNCOLLECTIBLE PERCENTAGES ARE ASSIGNED TO THE AGING CATEGORIES BASED UPON THE ESTIMATED COLLECTABILITY OF EACH GROUP.
SCHEDULE H, PART III, SECTION A, LINE 3ESTIMATED BASED ON US CENSUS BUREAU INDIVIDUALS BELOW POVERTY LEVEL OF 15.4%.
SCHEDULE H, PART III, SECTION A, LINE 4A COST TO CHARGE RATIO IS USED TO DETERMINE THE AMOUNT ON LINE 2. THE HOSPITAL DOES NOT HAVE A FOOTNOTE ON THE AUDITED FINANCIALS THAT DESCRIBES BAD DEBT. THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.
SCHEDULE H, PART III, SECTION B, LINE 8SERVING 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 B, LINE 9BTHE HOSPITAL SENDS A 30 DAY LETTER TO NOTIFY THE PATIENT OF THE NEED FOR COLLECTION. DURING THIS TIME, A COLLECTION STAFF REVIEWS/SCREENS THE ACCOUNT FOR POSSIBLE FINANCIAL ASSISTANCE. IF THERE IS ANY INDICATION THAT THE PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE COLLECTION STAFF SPEAKS WITH THE PATIENT ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND MAILS AN APPLICATION WITH INFORMATION DOCUMENTS.
SCHEDULE H, PART VI, LINE 2IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS COMPLETED IN 2013 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 3ON 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 ARE PROGRAM INFORMATION IS GIVEN TO OUR MEDICAL STAFF PHYSICIANS FOR DISTRIBUTION TO PATIENTS IN THEIR OFFICES. THE CHARITY CARE GUIDELINES (THE GUIDELINES) ARE 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. INHOUSE COLLECTORS REVIEW OUR CHARITY CARE PROGRAM WITH PATIENTS WHEN MAKING CALLS. THE GUIDELINES ARE TAKEN TO THE PATIENT'S ROOM AND REVIEWED WITH THEM WHILE THEY ARE INHOUSE. 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 4THE 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 5WE 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 BUTLLER 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

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

Grant TypeGrantTypeTxtRecipientRecipientCntNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDesc
ADULT DIABETES EDUCATION PROGRAM4$2,123BOOKEDUCATION
PUBLIC INFLUENZA VACCINATIONS1240$22,057BOOKVACCINATIONS

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE PUBLIC INFLUENZA VACCINATIONS ARE GIVEN TO ALL WHO SHOW UP AT THE TWO CLINICs. THE ADULT DIABETES EDUCATION PROGRAM GRANTS ARE GIVEN TO THOSE WHO APPLY AND MEET THE FINANCIAL NEED CRITERIA.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GAYLE ARNETT
PRESIDENT & CEO$130,304$0$0$0$3,270$0$19,770$0$7,532$0$160,876$0$0$0
CECILIA GOEBEL
VICE PRESIDENT & CNO$130,249$0$0$0$1,328$0$10,649$0$21,255$0$163,481$0$0$0
DAVID SHAW
VICE PRESIDENT & COO$220,598$0$0$0$843$0$10,420$0$11,552$0$243,413$0$0$0
ROBIN CRAWFORD
VICE PRESIDENT & CFO$152,126$0$0$0$1,098$0$9,090$0$19,131$0$181,445$0$0$0
Patrick Auman
INTERIM PRESIDENT & CEO$193,212$0$0$0$96$0$0$0$0$0$193,308$0$0$0
EVE SHANK
ENT PHYSICIAN$342,726$0$0$0$1,762$0$2,640$0$18,282$0$365,410$0$0$0
GERARD M LIBRODO MD
physician of orthepedics$651,829$0$0$0$1,227$0$2,980$0$10,170$0$666,206$0$0$0
JASON BRUNTON
HOSPITALIST$215,823$0$0$0$577$0$1,885$0$9,745$0$228,030$0$0$0
LAWRENCE SHANK
ORTHOPEDIC SURGEON$460,845$0$0$0$1,370$0$2,650$0$1,226$0$466,091$0$0$0
RUBEN GARCIA
HOSPITALIST PHYSICIAN$236,049$0$0$0$2,413$0$0$0$18,197$0$256,659$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART I, LINE 1AFormAndLineReferenceDesc
ExplanationEVE SHANK, MD, JASON BRUNTON, MD, RUBEN GARCIA, MD, GERARD LIBRODO, MD, ROBIN CRAWFORD, CECILIA GOEBEL, DAVID SHAW, AND GAYLE ARNETT RECEIVED PAYMENT OF HEALTH OR SOCIAL CLUB OR INITIATION FEES THAT WERE REPORTED IN THEIR W-2.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
BUTLER COUNTY KANSAS
A48603540512343PAA32012-04-30$14,500,000SEE PART VIfalsefalsefalse
BUTLER COUNTY KANSAS
B4860354052014-12-16$6,500,000SEE PART VIfalsefalsefalse

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$5,621,139$0$14,500,655$0$24$0$0$0$0$3,607,315$10,893,316$02013Yes (true)Yes (true)Yes (true)Yes (true)
B$633,699$0$6,500,000$0$0$0$110,354$0$0$5,302,497$0$1,087,359falsefalsefalseYes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
Afalsefalsefalsefalse0falsefalsefalseYes (true)
Bfalsefalsefalsefalse0falsefalsefalseYes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1TxtGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsIndRebate Not Due YetRebateNotDueYetInd
0
AfalseYes (true)falsefalsefalse0falseYes (true)
0
Bfalsefalsefalsefalse0falseYes (true)Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 AAmount does not equal issue price due to investment earnings earned in the project fund during the project period.
Part II, Line 3, Column BThe bonds were issued as a "draw-down loan" within the meaning of U.S. Treasury Regs 1.150(1)(c)(4)(i). As of the fiscal year end, all proceeds of the Bonds had been drawn. Amount does not equal issue price due to investment earnings earned in the project fund during the project period.
Part II, Line 11, Column AThis amount was expended to redeem the refunded bonds on May 1, 2012 and December 15, 2012.
Part II, Line 12, Column BAmount represents Bond proceeds remaining in the project fund as of the fiscal year end.
Part II, Line 13 and Line 16, Column BThe project was not completed as of the fiscal year end.
Part II, Line 15, Column AThe 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,
Part III, Column AThe 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
Part III, Column BAs of the fiscal year end, the project was not complete and a final allocation has not been made. As a result, the measurement period for the
Part III, Line 9, Part IV, Line 7, and Part VIt was determined that the Institution adopted post issuance tax-exempt
Part IV, Line 2c, Column A

Schedule L IRS990ScheduleL

FieldValueIRS element (for citing)
Total Balance Due$0TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

SEE SCHEDULE L PART V
SEE SCHEDULE L PART V

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART IVFormAndLineReferenceDesc
Explanation(A) MARGARET GARD (B) WIFE OF EDWIN GARD, TRUSTEE/VICE CHAIRPERSON OF SUSAN B. ALLEN MEMORIAL HOSPITAL. (C) $10,072 (D) MARGARET GARD IS AN EMPLOYEE AT SUSAN B. ALLEN MEMORIAL HOSPITAL. (E) NO (A) KACEY CARLSON (B) DAUGHTER OF EDWIN GARD, TRUSTEE/VICE CHAIRPERSON OF SUSAN B. ALLEN MEMORIAL HOSPITAL. (C) $31,599 (D) KACEY CARLSON IS AN EMPLOYEE AT SUSAN B. ALLEN MEMORIAL HOSPITAL. (E) NOExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4ACommunity 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), and Early Heart Attack and Stroke Care information at no charge. 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. Participated in the Augusta School District Wellness Fair by providing lab services, free osteoporosis screenings, and provided free educational sessions aimed at early heart attack care and stroke prevention, concussion protocol, and diabetes information. 4. Participated in the El Dorado School District KidzFest event where parents and children of the school district were invited to learn of services available to children. Staff from the Emergency Department/Chest Pain Center attended and spoke with children and their parents about the positive effects of exercise and good nutrition on heart health. 5. 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). 6. 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. 7. Provided Clinical Dietitians to speak on nutrition and diet, and Emergency Department / Chest Pain Center staff to speak on cardiac and stroke issues, to Intrust Bank employees during their quarterly wellness activity events. 8. Administrative personnel (4) are supporting the El Dorado Vision 2020 program, providing mentoring at a local school one hour per week. 9. Purchased and donated the Anatomy in Clay education program to the Augusta School District for use in the anatomy and physiology classes at the Augusta High School. The system was provided in an effort to improve the health care curriculum program. 10. 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. 11. Made available a "Speakers Bureau" to our community. Hospital personnel spoke to various civic groups and organizations on numerous occasions. 12. Hospital employees donated over $20,236 in support of the El Dorado United Way program. 13. Hosted an educational session regarding the Economic Impact of Healthcare in the State of Kansas for local business and government leaders. Kansas Hospital Association President, Tom Bell, presented the program. 14. 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. 15. Provided facilities and meals for a Butler/Greenwood County Medical Society meeting. 16. 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. 17. Provide personnel and facilities for Local Emergency Planning Committee meetings. 18. 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. 19. 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. 20. Provided free osteoporosis screenings in the Physical Rehabilitation department one-half day each month. 21. Provide free hearing screenings in the El Dorado Ear, Nose and Throat offices one-half day each week. 22. Provided low-cost screening programs for cardiac health, hypertension and diabetes four times during the year, a low-cost thyroid screening test two times, free bone-density testing three times, and free community education on living wills, advanced directives, and durable medical power of attorney at the YMCA. 23. 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. 24. 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, 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. 25. Sponsored the El Dorado YMCA Strong Kids Campaign with a $1,000 donation. 26. 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. 27. Sponsored the Butler County 4-H program with a $600 donation during the annual livestock auction. 28. 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, $2,123.00 was provided for four patients who attended the class.
FORM 990, PART VI, SECTION A, LINE 2CATHY N COOPER MD AND MICHAEL K WHEELER HAVE A BUSINESS RELATIONSHIP. Joseph N Sundgren AND MICHAEL K WHEELER HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11BAN 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 12CAT 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 & 15BTHE HOSPITAL PARTICIPATES IN AN EXTERNAL SALARY SURVEY FOR ALL EXECUTIVE POSITIONS. THE PRESIDENT & 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 & 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 19THE GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART VIIAMY SEEBER IS COMPENSATED BY THE HOSPITAL FOR HER SERVICES PROVIDING A PHYSICIAN INTERPRETATION OF ELECTROCARDIOGRAMS.
FORM 990, PART XI, LINE 9CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS $ (338,629) CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ (274,645) Contributed personnel services from affiliate $ ( 98,940) Partnership Income $ 26,199 ---------- $ (686,015)
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACTED EXPENSES TOTAL FEES:4723177
FORM 990 PART IX LINE 11GDESCRIPTION:PROFESSIONAL FEES TOTAL FEES:761774

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
720 WEST CENTRALEL DORADOKS67042480862732SUPPORT ORGKS501(C)(3)11ASBA HOSPITALYes (true)
SBAMH EMPLOYEE GROUP BENEFIT TRUST
720 WEST CENTRALEL DORADOKS67042481105047VEBAKS501(C)(9)SBA HOSPITALYes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1FS ALLENBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1Txt
CityEL DORADOCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67042ZIPCd
FieldValueIRS element (for citing)
EIN486103710EIN
Primary ActivitiesGRANTOR TRUSTPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeTRUSTEntityTypeTxt
Share Of Total Income-$311,345ShareOfTotalIncomeAmt
Share Of EOY Assets$2,887,446ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
C$403,077cash
SUSAN B ALLEN MEMORIAL HOSPITAL FDN
L$98,940FMV
SBAMH EMPLOYEE GROUP BENEFIT TRUST
R$3,381,390cash