2015-11-13T11:43:40-06:00 2014-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2014-01-01 480581968 SUSAN B ALLEN MEMORIAL HOSPITAL % ROBIN CRAWFORD SUSA 3163213300 720 WEST CENTRAL EL DORADO KS 67042 patrick auman Interim PRESIDENT/CEO 3163213300 2015-11-16 true Kevin Ensminger CPA P01310558 8162216300 2015-11-16 2014 2016-04-25 22:37:26Z PATRICK AUMAN 720 WEST CENTRAL EL DORADO KS 67042 63897137 false X WWW.SBAMH.ORG X 1930 KS THE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. 12 10 508 116 -7298 -7298 214313 793112 50554380 55468770 1159354 1136569 209683 9916 52137730 57408367 46493 41786 0 0 27610507 27095512 0 0 0 25261280 28513706 52918280 55651004 -780550 1757363 79674990 82532498 17206729 18062183 62468261 64470315 X TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. false false 45392812 41786 55461472 SEE SCHEDULE O 45392812 true true false true false false false false false true true false false false false false false true false false true false false false false false true true false true true true false false false false false false false false false true false false false false false true true true true false true 57 0 true 508 true true true false false false false false false false false false X 12 10 true false false false false false false true true false false true true true true true true true true false KS X ROBIN CRAWFORD 3163224559 720 WEST CENTRAL EL DORADO KS 67042 VINCE E HAINES TRUSTEE/CHAIRPERSON 1.0 0.0 X X 0 0 0 EDWIN A GARD TRUSTEE/VICE CHAIRPERSON 1.0 1.0 X X 0 0 0 CATHY N COOPER MD TRUSTEE 1.0 0.0 X 0 0 0 MATTHEW J CROSS TRUSTEE 1.0 0.0 X 0 0 0 MARK D UTECH TRUSTEE 1.0 0.0 X 0 0 0 JOSEPH N SUNDGREN TRUSTEE/TREASURER/SECRETARY 1.0 0.0 X X 0 0 0 JACQUELINE A VIETTI TRUSTEE 1.0 0.0 X 0 0 0 MICHAEL K WHEELER TRUSTEE 1.0 0.0 X 0 0 0 KENNETH ZIEGLER TRUSTEE 1.0 0.0 X 0 0 0 CAMI R BAKER TRUSTEE 1.0 0.0 X 0 0 0 MICHAEL CLIFTON TRUSTEE 1.0 0.0 X 0 0 0 AMY SEEBER TRUSTEE 1.0 0.0 X 6180 0 0 GAYLE ARNETT PRESIDENT & CEO 40.0 1.0 X 255688 0 40915 CECILIA GOEBEL VICE PRESIDENT & CNO 40.0 0.0 X 137578 0 31001 DAVID SHAW VICE PRESIDENT & COO 40.0 0.0 X 136707 0 24672 ROBIN CRAWFORD VICE PRESIDENT & CFO 40.0 1.0 X 175430 0 27659 GERARD M LIBRODO MD PHYSICIAN OF ORTHOPEDICS 40.0 0.0 X 617918 0 12278 lawrence shank orthopedic surgeon 40.0 0.0 X 506215 0 3357 EVE SHANK ENT PHYSICIAN 40.0 0.0 X 386720 0 20295 RUBEN GARCIA HOSPITALIST PHYSICIAN 40.0 0.0 X 238810 0 18211 JASON BRUNTON HOSPITALIST 40.0 0.0 X 238458 0 10759 2699704 0 189147 18 false true false FRESENIUS MEDICAL CARE KIDNEY DIALYSIS 847445 AFFILIATED MED SERVICES LAB INC LAB SERVICES 187550 LYTLE CONSTRUCTION INC CONSTRUCTION 229584 EMERGENCY MANAGEMENT MIDWEST PHYSICIAN SERVICES 571207 HUTTON CONSTRUCTION CONSTRUCTION SVCS 224068 13 784901 8211 793112 Patient Service Revenue 621110 54457550 54457550 Meals on Wheels 624200 89384 89384 Screening Program 623990 5865 5865 ARRA Meaningful Use 621110 915971 915971 55468770 582902 582902 1 1 724 724 588364 72280 743213 131372 -154849 -59092 -213941 -213941 6167447 404 5604506 9679 562941 -9275 553666 553666 0 0 0 Cafeteria 722210 209266 209266 PARTNERSHIP INCOME 900099 -7298 -7298 MISCELLANEOUS 900099 21165 21165 21165 21165 223133 57408367 55468770 -7298 1153783 3000 3000 38786 38786 0 0 835830 835830 35134 35134 20026617 15015814 5010803 886431 664823 221608 3875531 2906648 968883 1435969 1076977 358992 0 0 0 0 0 0 5037552 3778164 1259388 0 188243 141182 47061 694199 520649 173550 0 0 720205 540154 180051 293308 219981 73327 0 0 404211 328300 75911 0 3613513 2710135 903378 301884 226413 75471 Bad Debt 7197138 7197138 Medical Supplies 9541127 9541127 Repairs & Maint. 188735 141551 47184 Recruiting & Retention 107019 80264 26755 226572 226572 55651004 45392812 10258192 0 42162 192 0 0 0 0 8748906 10466258 0 0 0 0 0 0 1518113 1476140 2015516 1805378 85051745 41909449 43520209 43142296 21791687 23126090 1663599 2154070 148740 50719 0 0 226058 311355 79674990 82532498 4692372 4834890 0 0 0 0 12514357 13227293 0 0 0 0 0 0 0 0 0 0 17206729 18062183 X 57302295 59665473 1483326 1305818 3682640 3499024 62468261 64470315 79674990 82532498 X 1757363 -54913 299604 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 9722 false false false 9722 false PART II-B, LINE 1F A PORTION OF THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HEALTH ASSOCIATION DUES ARE ATTRIBUTED TO LOBBYING EXPENSES. 1479284 46819 108550 56867 7229 1570557 1291319 144789 113425 63912 6337 1479284 1170060 92514 82010 47398 5867 1291319 1165992 43432 13396 47095 5665 1170060 1138533 38000 112893 118334 5100 1165992 0.85030 0.12350 0.02620 false true true 4189689 4189689 44169713 17999699 26170014 35362268 22963602 12398666 1330075 946148 383927 43142296 51572649 -54913 1416333 1361420 50211229 7197138 7197138 57408367 49372429 918563 918563 48453866 7197138 7197138 55651004 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 $ 1,319,351 ELIMINATIONS $ (784,901) RECLASS OF RENTAL EXPENSES $ 874,585 PARTNERSHIP INCOME $ 7,298 ---------- $ 1,416,333 SCHEDULE D, PART XI, LINE 4b BAD DEBT EXPENSE $7,197,138 SCHEDULE D, PART XII, LINE 2D RELATED ORGANIZATION EXPENSE $ 43,978 RECLASS OF RENTAL EXPENSES $ 874,585 ---------- $ 918,563 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $7,197,138 Central America and the Caribbean Investments 1141592 1141592 1141592 false false true true false false true true true X true X true true false true true 897838 530909 366929 0.00760 6113618 3717291 2396326 0.04950 7011456 4248200 2763255 0.05710 24867 5865 19002 0.00040 24867 5865 19002 0.00040 7036323 4254065 2782257 0.05750 false 7197138 1108553 12459362 18494927 -6035565 X true true 1 1 SUSAN B ALLEN MEMORIAL HOSPITAL 720 WEST CENTRAL EL DORADO KS 67042 www.sbamh.org H-008-002 X X X SUSAN B ALLEN MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 13 true false true true X SEE PART V, SECTION C X true 13 false true false true X 200. 200. true true X false true true X X X X X true X false false PART V, SECTION B, LINE 5 IN 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 6B THE BUTLER COUNTY HEALTH DEPARTMENT SOUTH CENTRAL MENTAL HEALTH CENTER PART V, SECTION B, LINE 7A HTTP://WWW.SBAMH.ORG/ABOUT_US/COMMUNITY_HEALTH_NEEDS_ASSESSMENT PART V, SECTION B, LINE 11 HIGH PRIORITY ITEMS: 1. DECREASE CANCER RATES - THIS WAS NOT ADDRESSED BECAUSE SBAMH DOES NOT HAVE ENOUGH RESOURCES TO DEVELOP. 2. IMPROVE/ENCOURAGE FITNESS - ALL THREE TACTICS THAT WERE ADDRESSED IN 2013 WERE CONTINUED TO BE DONE IN 2014. 3. OFFER MORE HEALTH FOOD CHOICES - Tactic 1 was addressed in 2103 and continued to be done in 2014. Tactic 2 was explored in 2014 and it was determined that it was not feasible because the grocery stores were not willing to make the financial commitment needed to accomplish the implementation of the Nuval system. Tactic 3 was explored and it was determined that the Hospital alone would not be able to accomplish this. It would take the corporation of the City, County and the community as a whole to do this. 4. FIGHT SUBSTANCE ABUSE - Tactic 1 was addressed in 2014 with a presentation to the Hospital medical staff about KTRACS. Tactic 2 was not addressed do to not enough resources to develop. 5. PROVIDE LOW INCOME ACCESS TO HEALTH COVERAGE - All 3 tactics that were addressed in 2013 were continued to be done in 2014. 6. IMPROVE IMMUNIZATIONS IN BABIES UNDER 24 MONTHS OF AGE - Was addressed in 2013 and continued to done in 2014. LOW PRIORITY ITEMS None of the low priority items have been addressed. Some were not addressed because SBAMH did not have the resources and others were not within the SBAMHs scope of service. 4 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 SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $7,197,138. 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 AN 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 3 ESTIMATED BASED ON US CENSUS BUREAU INDIVIDUALS BELOW POVERTY LEVEL OF 15.4%. SCHEDULE H, PART III, SECTION A, LINE 4 A 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 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 B, LINE 9B THE 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 2 IN 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 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 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 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 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. true ADULT DIABETES EDUCATION PROGRAM 12 6385 BOOK EDUCATION PUBLIC INFLUENZA VACCINATIONS 2077 32401 BOOK VACCINATIONS SCHEDULE I, PART I, LINE 2 THE 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. X true true X X false false false false false false false false false GAYLE ARNETT PRESIDENT & CEO 250908 0 0 0 4780 0 19770 0 21145 0 296603 0 0 0 CECILIA GOEBEL VICE PRESIDENT & CNO 136297 0 0 0 1281 0 10649 0 20352 0 168579 0 0 0 DAVID SHAW VICE PRESIDENT & COO 135631 0 0 0 1076 0 10420 0 14252 0 161379 0 0 0 ROBIN CRAWFORD VICE PRESIDENT & CFO 174332 0 0 0 1098 0 9090 0 18569 0 203089 0 0 0 GERARD M LIBRODO MD PHYSICIAN OF ORTHOPEDICS 617040 0 0 0 878 0 3279 0 8999 0 630196 0 0 0 lawrence shank orthopedic surgeon 505495 0 0 0 720 0 2600 0 757 0 509572 0 0 0 EVE SHANK ENT PHYSICIAN 385696 0 0 0 1024 0 2084 0 18211 0 407015 0 0 0 RUBEN GARCIA HOSPITALIST PHYSICIAN 236270 0 0 0 2540 0 0 0 18211 0 257021 0 0 0 JASON BRUNTON HOSPITALIST 237881 0 0 0 577 0 1783 0 8976 0 249217 0 0 0 SCHEDULE J, PART I, LINE 1A EVE SHANK, MD, JASON BRUNTON, MD, RUBEN GARCIA, 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. A BUTLER COUNTY KANSAS 486035405 12343PAA3 2012-04-30 14500000 SEE PART VI false false false B BUTLER COUNTY KANSAS 486035405 2014-12-16 6500000 SEE PART VI false false false A 3793472 0 14500655 0 24 0 0 0 0 3607315 10893316 0 2013 true true true true B 0 0 6500000 0 0 0 110354 0 0 1608477 0 4781169 false false false true A false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true B false false false false 0 false false false true A false true false false 0 false 0 false true B false true false false 0 false 0 false true A true B true 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 The total proceeds to be received from the sale of the Bonds will be $6,500,000. The bonds were issued as a "draw-down loan" within the meaning of U.S. Treas. Regs 1.150(1)(c)(4)(i). As of the fiscal year end, only $2,500,000 of Bond proceeds had been drawn. However, all remaining proceeds will be drawn as of December 15, 2015. 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 $781,169 of Bond proceeds in the Project Fund as of the fiscal year end plus $4,000,000 of remaining Bond proceeds to be drawn by December 15, 2015. Part II, Line 15, Column A The bond issue constitutes an "advance refunding issue" under U.S. Treas. 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 the meaning of U.S. Treas. 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 was no advance refunding, 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 the January 1, 2003. refunded bonds were issued prior to the January 1, 2003. Part III, Column B As 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 project has not started and the Institution has marked "no" to all questions in Part III. Part III, Line 9, Part IV, Line 7, and Part V It was determined that the Institution adopted post issuance tax-exempt compliance procedures as of March 30, 2012. Part IV, Line 2c, Column A Arbitrage Computation completed as of 1/1/2014. SEE SCHEDULE L PART V SEE SCHEDULE L PART V SCHEDULE L, PART IV (A) EL DORADO CLINIC, PA (EDC) (B) CATHY N COOPER, MD, IS AN OFFICER OF EDC AND A DIRECTOR OF SUSAN B. ALLEN MEMORIAL HOSPITAL. (C) $140,411 (D) RENT (E) NO (A) SBAMH EMPLOYEE GROUP BENEFIT TRUST (B) GAYLE ARNETT, DAVID SHAW AND ROBIN CRAWFORD ARE OFFICERS OF SBAMH AND TRUSTEES OF SBAMH EMPLOYEE GROUP BENEFIT TRUST. (C) $3,360,639 (D) CONTRIBUTIONS TO BENEFIT PLAN (E) NO (A) MARGARET GARD (B) WIFE OF EDWIN GARD, TRUSTEE/VICE CHAIRPERSON OF SUSAN B. ALLEN MEMORIAL HOSPITAL. (C) $17,162 (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) $17,972 (D) KACEY CARLSON IS AN EMPLOYEE AT SUSAN B. ALLEN MEMORIAL HOSPITAL. (E) NO 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), 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 $24,200 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, 1,500 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 $500 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, $6,385.00 was provided for twelve patients who attended the class. FORM 990, PART VI, SECTION A, LINE 2 JOSEPH N SUNDGREN AND MICHAEL K WHEELER HAVE A BUSINESS RELATIONSHIP. 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 & 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 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 $ (198,166) CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 490,472 Partnership Income $ 7,298 ---------- $ 299,604 SUSAN B ALLEN MEMORIAL HOSPITAL FDN 720 WEST CENTRAL EL DORADO KS 67042 480862732 SUPPORT ORG KS 501(C)(3) 11A SBA HOSPITAL true SBAMH EMPLOYEE GROUP BENEFIT TRUST 720 WEST CENTRAL EL DORADO KS 67042 481105047 VEBA KS 501(C)(9) SBA HOSPITAL true FS ALLEN 720 WEST CENTRAL EL DORADO KS 67042 486103710 GRANTOR TRUST KS NA TRUST -197183 3219020 1.00000 true false false true false false false false false false false false false false true true false false true false SBAMH EMPLOYEE GROUP BENEFIT TRUST r 3360639 cash