SUSAN B ALLEN MEMORIAL HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- SUSAN B ALLEN MEMORIAL HOSPITAL (EIN 48-0581968)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201413219349305016
- Schema version
- 2013v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T11:26:22-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480581968 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susan B Allen Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % ROBIN CRAWFORD | InCareOfNm |
| Business Name Control | SUSA | BusinessNameControlTxt |
| Phone | 3163213300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 West Central | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | El Dorado | City |
| State | KS | State |
| ZIP Code | 67042 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GAYLE ARNETT | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 3163213300 | PhoneNum |
| Signature | 2014-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin Ensminger CPA | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 3163213300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GAYLE ARNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1 |
| City | EL DORADO | City |
| State | KS | State |
| ZIP Code | 67042 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $58,538,204 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.sbamh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1930 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 527 | TotalEmployeeCnt |
| Total Volunteers | 109 | TotalVolunteersCnt |
| Total Gross UBI | -$273 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$273 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $83,257 | PYContributionsGrantsAmt |
| CY Contributions Grants | $214,313 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $55,751,138 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $50,554,380 | CYProgramServiceRevenueAmt |
| PY Investment Income | $775,473 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,159,354 | CYInvestmentIncomeAmt |
| PY Other Revenue | $184,569 | PYOtherRevenueAmt |
| CY Other Revenue | $209,683 | CYOtherRevenueAmt |
| PY Total Revenue | $56,794,437 | PYTotalRevenueAmt |
| CY Total Revenue | $52,137,730 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $27,680 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $46,493 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,699,097 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $27,610,507 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,194,778 | PYOtherExpensesAmt |
| CY Other Expenses | $25,261,280 | CYOtherExpensesAmt |
| PY Total Expenses | $51,921,555 | PYTotalExpensesAmt |
| CY Total Expenses | $52,918,280 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,872,882 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$780,550 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $80,310,217 | TotalAssetsBOYAmt |
| Total Assets EOY | $79,674,990 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,661,640 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,206,729 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $60,648,577 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $62,468,261 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $42,585,014 | ExpenseAmt |
| Grant | $46,493 | GrantAmt |
| Revenue | $50,554,107 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $42,585,014 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | Yes (true) | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (true) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 66 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 527 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBIN CRAWFORD | PersonNm |
| Phone | 3163224559 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1 |
| City | EL DORADO | City |
| State | KS | State |
| ZIP Code | 67042 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| VINCE E HAINES | ||||||||
| TRUSTEE/CHAIRPERSON | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| EDWIN A GARD | ||||||||
| TRUSTEE/VICE CHAIRPERSON | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | 1.0 | |
| CATHY N COOPER MD | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| MATTHEW J CROSS | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| MARK D UTECH | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH N SUNDGREN | ||||||||
| TRUSTEE/TREASURER/SECRETARY | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JACQUELINE A VIETTI | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL K WHEELER | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| KENNETH ZIEGLER | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| CAMI R BAKER | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL CLIFTON | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| AMY SEEBER | ||||||||
| TRUSTEE | 1.0 | Yes (X) | $6,060 | $0 | $0 | |||
| GAYLE ARNETT | ||||||||
| PRESIDENT & CEO | 40.0 | Yes (X) | $270,968 | $0 | $40,024 | 1.0 | ||
| CECILIA GOEBEL | ||||||||
| VICE PRESIDENT & CNO | 40.0 | Yes (X) | $135,934 | $0 | $31,235 | |||
| DAVID SHAW | ||||||||
| VICE PRESIDENT & COO | 40.0 | Yes (X) | $132,328 | $0 | $31,267 | |||
| ROBIN CRAWFORD | ||||||||
| VICE PRESIDENT & CFO | 40.0 | Yes (X) | $182,476 | $0 | $25,776 | 1.0 | ||
| GERARD M LIBRODO MD | ||||||||
| PHYSICIAN OF ORTHOPEDICS | 40.0 | $610,315 | $0 | $22,450 | Yes (X) | |||
| CHARLES E STAFFORD | ||||||||
| ROC - PHYSICIST | 40.0 | $179,037 | $0 | $18,486 | Yes (X) | |||
| EVE SHANK | ||||||||
| ENT PHYSICIAN | 40.0 | $148,760 | $0 | $7,612 | Yes (X) | |||
| RUBEN GARCIA | ||||||||
| HOSPITALIST PHYSICIAN | 28.0 | $228,464 | $0 | $25,431 | Yes (X) | |||
| CASANA BRUNTON | ||||||||
| HOSPITALIST PHYSICIAN | 28.0 | $200,370 | $0 | $16,252 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,094,712 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $218,533 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| ServicesServicesDesc | CompensationCompensationAmt |
|---|---|
| FRESENIUS MEDICAL CARE | |
| KIDNEY DIALYSIS | $877,803 |
| AFFILIATED MED SERVICES LAB INC | |
| LAB SERVICES | $166,307 |
| SCHNEIDER ELECTRIC | |
| ELECTRIC & MECHANIC | $1,725,733 |
| EMERGENCY MANAGEMENT MIDWEST | |
| PHYSICIAN SERVICES | $484,946 |
| HUTTON CONSTRUCTION | |
| CONSTRUCTION SVCS | $1,288,032 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $206,427 | RelatedOrganizationsAmt |
| All Other Contributions | $7,886 | AllOtherContributionsAmt |
| Total Contributions | $214,313 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621110 | $49,164,908 | $49,164,908 |
| Meals on Wheels | 624200 | $92,996 | $92,996 |
| Screening Program | 623990 | $2,830 | $2,830 |
| ARRA Meaningful Use | 621110 | $1,293,646 | $1,293,646 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $50,554,380 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $526,985 | TotalRevenueColumnAmt |
| Exclusion | $526,985 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $530 | TotalRevenueColumnAmt |
| Exclusion | $530 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $809 | TotalRevenueColumnAmt |
| Exclusion | $809 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $613,973 | RealAmt |
| Personal | $82,864 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $602,425 | RealAmt |
| Personal | $128,795 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $11,548 | RealAmt |
| Personal | -$45,931 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$34,383 | TotalRevenueColumnAmt |
| Exclusion | -$34,383 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,300,633 | SecuritiesAmt |
| Other | $460 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,629,313 | SecuritiesAmt |
| Other | $39,941 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $671,320 | SecuritiesAmt |
| Other | -$39,481 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $631,839 | TotalRevenueColumnAmt |
| Exclusion | $631,839 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Cafeteria | 722210 | $213,392 | $213,392 | |
| PARTNERSHIP INCOME | 900099 | -$273 | -$273 | |
| Miscellaneous | 900099 | $30,138 | $30,138 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,138 | TotalRevenueColumnAmt |
| Exclusion | $30,138 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $243,257 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,137,730 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $50,554,380 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$273 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,369,310 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,000 | TotalAmt |
| Program Services | $2,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,493 | TotalAmt |
| Program Services | $44,493 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $850,008 | TotalAmt |
| Management And General | $850,008 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,657,796 | TotalAmt |
| Program Services | $14,743,347 | ProgramServicesAmt |
| Management And General | $4,914,449 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,305,921 | TotalAmt |
| Program Services | $1,729,441 | ProgramServicesAmt |
| Management And General | $576,480 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,365,415 | TotalAmt |
| Program Services | $2,524,061 | ProgramServicesAmt |
| Management And General | $841,354 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,431,367 | TotalAmt |
| Program Services | $1,073,525 | ProgramServicesAmt |
| Management And General | $357,842 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,297,855 | TotalAmt |
| Program Services | $3,973,391 | ProgramServicesAmt |
| Management And General | $1,324,464 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,737 | TotalAmt |
| Program Services | $158,053 | ProgramServicesAmt |
| Management And General | $52,684 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $730,154 | TotalAmt |
| Program Services | $547,617 | ProgramServicesAmt |
| Management And General | $182,537 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $686,843 | TotalAmt |
| Program Services | $515,132 | ProgramServicesAmt |
| Management And General | $171,711 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,620 | TotalAmt |
| Program Services | $190,965 | ProgramServicesAmt |
| Management And General | $63,655 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $388,457 | TotalAmt |
| Program Services | $315,505 | ProgramServicesAmt |
| Management And General | $72,952 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,013,643 | TotalAmt |
| Program Services | $2,260,232 | ProgramServicesAmt |
| Management And General | $753,411 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,189 | TotalAmt |
| Program Services | $198,142 | ProgramServicesAmt |
| Management And General | $66,047 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad Debt | $4,781,107 | $4,781,107 | |
| Medical Supplies | $8,984,412 | $8,984,412 | |
| Repairs & Maint. | $302,303 | $226,727 | $75,576 |
| Recruiting & Retention | $120,383 | $90,287 | $30,096 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $226,577 | TotalAmt |
| Program Services | $226,577 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,918,280 | TotalAmt |
| Program Services | $42,585,014 | ProgramServicesAmt |
| Management And General | $10,333,266 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,946 | BOYAmt |
| EOY | $42,162 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,917,188 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,700,088 | BOYAmt |
| EOY | $8,748,906 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,517,828 | BOYAmt |
| EOY | $1,518,113 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,960,439 | BOYAmt |
| EOY | $2,015,516 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $83,314,448 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $39,794,239 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,985,656 | BOYAmt |
| EOY | $43,520,209 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,375,399 | BOYAmt |
| EOY | $21,791,687 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,049,460 | BOYAmt |
| EOY | $1,663,599 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $313,935 | BOYAmt |
| EOY | $148,740 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $260,278 | BOYAmt |
| EOY | $226,058 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,310,217 | BOYAmt |
| EOY | $79,674,990 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,448,689 | BOYAmt |
| EOY | $4,692,372 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,212,951 | BOYAmt |
| EOY | $12,514,357 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,661,640 | BOYAmt |
| EOY | $17,206,729 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,894,764 | BOYAmt |
| EOY | $57,302,295 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,288,732 | BOYAmt |
| EOY | $1,483,326 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,465,081 | BOYAmt |
| EOY | $3,682,640 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,648,577 | BOYAmt |
| EOY | $62,468,261 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,310,217 | BOYAmt |
| EOY | $79,674,990 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$780,550 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $852,325 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,747,909 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $9,198 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $9,198 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,291,319 | BeginningYearBalanceAmt |
| Contributions | $144,789 | ContributionsAmt |
| Investment Earnings Or Losses | $113,425 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $63,912 | OtherExpendituresAmt |
| Administrative Expenses | $6,337 | AdministrativeExpensesAmt |
| End Year Balance | $1,479,284 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,170,060 | BeginningYearBalanceAmt |
| Contributions | $92,514 | ContributionsAmt |
| Investment Earnings Or Losses | $82,010 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $47,398 | OtherExpendituresAmt |
| Administrative Expenses | $5,867 | AdministrativeExpensesAmt |
| End Year Balance | $1,291,319 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,165,992 | BeginningYearBalanceAmt |
| Contributions | $43,432 | ContributionsAmt |
| Investment Earnings Or Losses | $13,396 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $47,095 | OtherExpendituresAmt |
| Administrative Expenses | $5,665 | AdministrativeExpensesAmt |
| End Year Balance | $1,170,060 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,138,533 | BeginningYearBalanceAmt |
| Contributions | $38,000 | ContributionsAmt |
| Investment Earnings Or Losses | $112,893 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $118,334 | OtherExpendituresAmt |
| Administrative Expenses | $5,100 | AdministrativeExpensesAmt |
| End Year Balance | $1,165,992 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,029,973 | BeginningYearBalanceAmt |
| Contributions | $40,000 | ContributionsAmt |
| Investment Earnings Or Losses | $113,597 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $45,037 | OtherExpendituresAmt |
| End Year Balance | $1,138,533 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.86060 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.12130 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.01810 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,050,478 | OtherCostOrOtherBasisAmt |
| Book Value | $4,050,478 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,831,690 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,883,540 | DepreciationAmt |
| Book Value | $26,948,150 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,102,922 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,071,260 | DepreciationAmt |
| Book Value | $12,031,662 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,329,358 | OtherCostOrOtherBasisAmt |
| Depreciation | $839,439 | DepreciationAmt |
| Book Value | $489,919 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $43,520,209 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $48,940,441 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $852,325 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $731,493 | OtherRevenueAmt |
| Revenue Not Reported | $1,583,818 | RevenueNotReportedAmt |
| Revenue Subtotal | $47,356,623 | RevenueSubtotalAmt |
| Other Revenues Not Included | $4,781,107 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $4,781,107 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $52,137,730 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $48,868,393 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $731,220 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $731,220 | ExpensesNotReportedAmt |
| Expenses Subtotal | $48,137,173 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $4,781,107 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $4,781,107 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $52,918,280 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART V, LINE 4 | THE ENDOWNMENT FUNDS ARE HELD BY SUSAN B. ALLEN MEMORIAL HOSPITAL FOUNDATION, A RELATED TAX EXEMPT ORGANIZATION. THE EARNINGS FROM THE ENDWOMENT FUNDS ARE USED TO FUND THE PURCHASE OF EQUIPMENT AND PROGRAM SUPPORT FOR SUSAN B. ALLEN MEMORIAL HOSPITAL. |
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | RECLASS OF RENTAL EXPENSES $ 731,220 PARTNERSHIP INCOME $ 273 --------- $ 731,493 |
| SCHEDULE D, PART XI, LINE 4B | BAD DEBT EXPENSE $4,781,107 |
| SCHEDULE D, PART XII, LINE 2D | RECLASS OF RENTAL EXPENSES $ 731,220 |
| SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $4,781,107 |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | RegionTxt |
| Type Of Activities Conducted | Investments | TypeOfActivitiesConductedTxt |
| Region Total Expenditures | $1,181,557 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $1,181,557 | SubtotalSpentAmt |
| Total Spent | $1,181,557 | TotalSpentAmt |
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | Yes (true) | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | Yes (true) | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $936,254 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $936,254 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01940 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,385,852 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,450,436 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,935,416 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04020 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,322,106 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,450,436 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,871,670 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05960 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,493 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,493 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,493 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,493 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,366,599 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,450,436 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,916,163 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,781,107 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $13,044,410 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $20,123,360 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,078,950 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1 |
| City | EL DORADO | City |
| State | KS | State |
| ZIP Code | 67042 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 3 | 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 5A | http://www.sbamh.org/about_us/community_health_needs_assessment |
| PART V, SECTION B, LINE 7 | DURING 2013, THE TWO HIGH PRIORITY ITEMS NOT ADDRESSED ARE DECREASING CANCER RATES AND FIGHTING SUBSTANCE ABUSE. THESE WERE NOT ADDRESSED BECAUSE SBAMH DID NOT HAVE ENOUGH RESOURCES TO DEVELOP DURING 2013. NONE OF THE LOW PRIORITY ITEMS WERE ADDRESSED. SOME OF THE ITEMS SBAMH DID NOT HAVE ENOUGH RESOURCES TO DEVELOP DURING 2013 AND OTHERS WERE NOT IN OUR SCOPE OF SERVICES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| SBA MEMORIAL HOSPITAL HOME HEALTH | ||||
| 620 WEST CENTRAL | EL DORADO | KS | 67042 | HOME HEALTH AGENCY |
| SUSAN B ALLEN MEMORIAL HOSPITAL DME | ||||
| 620 WEST CENTRAL | EL DORADO | KS | 67042 | DURABLE MEDICAL EQUIPMENT PROVIDER |
| SBA MEMORIAL HOSPITAL DIALYSIS | ||||
| 701 WEST CENTRAL | EL DORADO | KS | 67042 | HEMODIALYSIS |
| SBA MEMORIAL HOSPITAL MEDICAL CLINIC | ||||
| 700 WEST CENTRAL | EL DORADO | KS | 67042 | MEDICAL OFFICE BUILDING |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $4,781,107. |
| 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, 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, 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, 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, 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 no cost insurance plans. The Brochure gives information about our charity care program. Our charity care program information is given to our medical staff physicians for distribution to patients in their offices. 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 participated in the Butler Community College-ANDOVER/SHERWIN WILLIAMS WELLNESS Fair providing information about various health issues and offer health testing and screenings. WE ARE A SPONSOR OF THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE IN EL DORADO, KANSAS AND IN EUREKA, KANSAS. WE PROVIDED A PHARMACIST FOR POISON PREVENTION AND SAFETY TO EL DORADO KINDERGARTEN AND 1ST GRADERS. WE PROVIDED MEETING SPACE FOR SEVERAL COMMUNITY HEALTH GROUPS INCLUDING BUTLER COUNTY DIABETES SUPPORT GROUP, THE AMERICAN CANCER SOCIETY, AND THE BUTLER COUNTY MULTIPLE SCLEROSIS SUPPORT GROUP. WE PROVIDE LOW COST SCREENING PROGRAMS FOR CARDIAC HEALTH, OSTEOPOROSIS, HYPERTENSION AND DIABETES. WE PROVIDE FREE INFLUENZA VACCINATIONS TO MEMBERS OF THE COMMUNITY. WE HAVE A VOLUNTEER BOARD OF 12 MEMBERS THAT COME FROM THROUGHOUT OUR SERVICE AREA. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|
| ADULT DIABETES EDUCATION PROGRAM | 16 | $10,363 | BOOK | EDUCATION |
| PUBLIC INFLUENZA VACCINATIONS | 2171 | $34,130 | BOOK | VACCINATIONS |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | THE PUBLIC INFLUENZA VACCINATIONS ARE GIVEN TO ALL WHO SHOW UP AT THE TWO CLINICS. THE ADULT DIABETES EDUCATION PROGRAM GRANTS ARE GIVEN TO THOSE WHO APPLY AND MEET THE FINANCIAL NEED CRITERIA. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GAYLE ARNETT | ||||||||||||||
| PRESIDENT & CEO | $266,192 | $0 | $0 | $0 | $4,776 | $0 | $18,903 | $0 | $21,121 | $0 | $310,992 | $0 | $0 | $0 |
| CECILIA GOEBEL | ||||||||||||||
| VICE PRESIDENT & CNO | $134,735 | $0 | $0 | $0 | $1,199 | $0 | $10,652 | $0 | $20,584 | $0 | $167,170 | $0 | $0 | $0 |
| DAVID SHAW | ||||||||||||||
| VICE PRESIDENT & COO | $131,314 | $0 | $0 | $0 | $1,014 | $0 | $10,262 | $0 | $21,005 | $0 | $163,595 | $0 | $0 | $0 |
| ROBIN CRAWFORD | ||||||||||||||
| VICE PRESIDENT & CFO | $181,378 | $0 | $0 | $0 | $1,098 | $0 | $6,983 | $0 | $18,793 | $0 | $208,252 | $0 | $0 | $0 |
| GERARD M LIBRODO MD | ||||||||||||||
| PHYSICIAN OF ORTHOPEDICS | $609,235 | $0 | $0 | $0 | $1,080 | $0 | $13,500 | $0 | $8,950 | $0 | $632,765 | $0 | $0 | $0 |
| CHARLES E STAFFORD | ||||||||||||||
| ROC - PHYSICIST | $177,781 | $0 | $0 | $0 | $1,256 | $0 | $9,478 | $0 | $9,008 | $0 | $197,523 | $0 | $0 | $0 |
| EVE SHANK | ||||||||||||||
| ENT PHYSICIAN | $148,615 | $0 | $0 | $0 | $145 | $0 | $1,296 | $0 | $6,316 | $0 | $156,372 | $0 | $0 | $0 |
| RUBEN GARCIA | ||||||||||||||
| HOSPITALIST PHYSICIAN | $225,970 | $0 | $0 | $0 | $2,495 | $0 | $6,976 | $0 | $18,455 | $0 | $253,895 | $0 | $0 | $0 |
| CASANA BRUNTON | ||||||||||||||
| HOSPITALIST PHYSICIAN | $200,060 | $0 | $0 | $0 | $309 | $0 | $8,834 | $0 | $7,419 | $0 | $216,623 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | DAVID SHAW, CECILIA GOEBEL, GERARD M LIBRODO, MD, RUBEN GARCIA, MD, CASANA BRUNTON, MD, ROBIN CRAWFORD, CHARLES STAFFORD,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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BUTLER COUNTY KANSAS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 486035394 | BondIssuerEIN |
| CUSIP | 12343PAA3 | CUSIPNum |
| Bond Issued | 2012-04-30 | BondIssuedDt |
| Issue Price | $14,500,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $2,015,643 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $14,500,655 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $24 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $0 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $3,607,315 | CapitalExpendituresAmt |
| Other Spent Proceeds | $10,893,316 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | Yes (true) | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0 | PrivateBusUseByOthersPct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| No Rebate Due | Yes (true) | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE A, COLUMN (F) | IMPROVE AND EQUIP HOSPITAL FACILITIES; REFUND SERIES 1998Z BONDS ISSUED 12/22/1998); REFUND SERIES 2002Q BONDS (ISSUED 12/17/2002). |
| PART II, LINE 3 | AMOUNT DOES NOT EQUAL ISSUE PRICE DUE TO INVESTMENT EARNINGS EARNED IN THE PROJECT FUND DURING THE PROJECT PERIOD. |
| PART II, LINE 11 | THIS AMOUNT WAS EXPENDED TO REDEEM THE REFUNDED BONDS ON MAY 1, 2012 AND DECEMBER 15, 2012. |
| PART II, LINE 15 | 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 | THE BONDS WERE ISSUED FOR THREE SEPARATE PURPOSES: (1) TO CURRENTLY REFUND A PRIOR SERIES OF 1998Z BONDS (ISSUED DECEMBER 17, 1998), (2) TO CURRENTLY REFUND A PERIOD SERIES OF 2002Q BONDS (ISSUED DECEMBER 22, 2002) AND (3) TO FINANCE NEW-MONEY PROJECTS. IN ACCORDANCE WITH THE INSTRUCTIONS FOR SCHEDULE K (FORM 990), THE ORGANIZATION IS COMPLETING THIS PART III (PRIVATE BUSINESS USE) ONLY WITH RESPECT TO THE PORTION OF THE BONDS FINANCING THE NEW-MONEY PROJECTS, BECAUSE BOTH PRIOR SERIES OF REFUNDED BONDS WERE ISSUED PRIOR TO JANUARY 1, 2003. |
| PART III, LINE 9 | BUTLER COUNTY, KANSAS, AS ISSUER OF THE BONDS, HAS ADOPTED POST-ISSUANCE TAX-EXEMPT BOND COMPLIANCE PROCEDURES AND HAS PROVIDED A COPY OF THIS DOCUMENT TO THE ORGANIZATION. UNDER THE BOND DOCUMENTS, THE ORGANIZATION IS OBLIGATED TO CARRY OUT THESE POST-ISSUANCE TAX-EXEMPT BOND COMPLIANCE PROCEDURES TO ENSURE COMPLIANCE WITH THE TAX-EXEMPT BOND REQUIREMENTS. THESE PROCEDURES INCLUDED PROVISIONS RELATING TO TIMELY REMEDIATING ANY NON-QUALIFIED BONDS IN ACCORDANCE WITH U.S. TREAS. REGS 1.141-12 AND 1.145-2; COMPLIANCE WITH ARBITRAGE REQUIREMENTS UNDER I.R.C. 148; AND TIMELY IDENTIFYING AND CORRECTING VIOLATIONS OF FEDERAL TAX LAW THROUGH "VCAP' IF SELF-REMEDICATION IS NOT AVAILABLE. IN ADDITION, THE HOSPITAL, PLANS TO ADOPT ITS OWN SEPARATE WRITTEN PROCEDURES BY THE 2014 FISCAL YEAR END. |
| PART IV, LINE 2C | ARBITRAGE COMPUTATION COMPLETED AS OF 1/1/2014. |
| PART IV, LINE 7 | SEE THE SUPPLEMENTAL INFORMATION PROVIDED ABOVE UNDER PART III, LINE 9. |
| PART V | SEE THE SUPPLEMENTAL INFORMATION PROVIDED ABOVE UNDER PART III, LINE 9. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| SEE SCHEDULE L PART V |
| SEE SCHEDULE L PART V |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | (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) $3,824,314 (D) CONTRIBUTIONS TO BENEFIT PLAN (E) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | Community Services - Susan B. Allen Memorial Hospital offers a number of programs and services in our community at minimal or no cost in order to promote health and wellness. Actual costs for these services are not separately identifiable, and are included as part of the patient services cost. 1. Participated in the Butler County Senior Fair, held in El Dorado, displaying and providing information regarding our Diabetes Education Program (including blood glucose screenings), Home Health Services (including balance screening, blood pressure testing, 02 saturations), Home Medical Equipment Services, Osteoporosis information (including screening), 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, bone density testing and blood work (including lipid, PSA and Hemoglobin A1c testing). 3. Participated in the Butler Community College Women's Fair by providing free osteoporosis screening and information about early heart attack care, and stroke prevention information. 4. Co-sponsored a Community Health Needs Assessment along with South Central Mental Health and the Butler County Health Department. Made results available community-wide through the Hospital's website. 5. 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. 6. Provided a Registered Pharmacist to USD 490 for Poison Prevention and Safety talks for all kindergarten and first grade students at the elementary schools in town (approximately 300 students). 7. Administrative personnel (4) are supporting the El Dorado Vision 2020 program, providing mentoring at a local school one hour per week. 8. Made available a "Speakers Bureau" to our community. Hospital personnel spoke to various civic groups and organizations on numerous occasions. 9. Hospital employees donated over $18,900 in support of the El Dorado United Way program. 10. 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. 11. Provided items including bandages, gauze pads and gloves to USD 402 School District allowing them to place "Crisis Kits" in each classroom in the District's six schools. 12. Provided facilities and meals for a Butler/Greenwood County Medical Society meeting. 13. 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. 14. Provide personnel and facilities for Local Emergency Planning Committee meetings. 15. Provided a low-cost screening program for cardiac health, osteoporosis, hypertension, and diabetes two times during the year for the community here at Susan B. Allen. 16. Provided free osteoporosis screenings in the Physical Rehabilitation department one-half day each month. 17. 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. 18. 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. 19. 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, 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 ARC of Butler Board, Community Garden Project Committee, the Kansas Diabetes Advisory Council, and the Local Emergency Planning Committee. 20. Sponsored the El Dorado YMCA Strong Kids Campaign with a $1,000 donation. 21. Act as a clinical site for training of healthcare professionals including medical students, nursing students, radiology, lab, respiratory therapists, dietitians, physical, occupational and speech therapists, athletic training students, CRNA students, physician assistant students, and pharmacy students. 22. Sponsored the Butler County 4-H program with a $500 donation during the annual livestock auction. 23. 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, $10,363.00 was provided for sixteen 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. VINCE E HAINES AND JACQUELINE A VIETTI 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 & 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, LINES 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, 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 $ 204,021 CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 208,132 CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS & LOSSES $1,335,483 PARTNERSHIP INCOME $ 273 ---------- $1,747,909 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACTED EXPENSES TOTAL FEES:4356793 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:941062 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN B ALLEN MEMORIAL HOSPITAL FDN | ||||||||||
| 720 WEST CENTRAL | EL DORADO | KS | 67042 | 480862732 | SUPPORT ORG | KS | 501(C)(3) | 11A | SBA HOSPITAL | Yes (true) |
| SBAMH EMPLOYEE GROUP BENEFIT TRUST | ||||||||||
| 720 WEST CENTRAL | EL DORADO | KS | 67042 | 481105047 | VEBA | KS | 501(C)(9) | SBA HOSPITAL | Yes (true) | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FS ALLEN | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1 |
| City | EL DORADO | City |
| State | KS | State |
| ZIP Code | 67042 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 486103710 | EIN |
| Primary Activities | GRANTOR TRUST | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | TRUST | EntityTypeTxt |
| Share Of Total Income | $202,334 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $3,416,203 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SBAMH EMPLOYEE GROUP BENEFIT TRUST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | r | TransactionTypeTxt |
| Involved | $3,824,314 | InvolvedAmt |
| Method Of Amount Determination | cash | MethodOfAmountDeterminationTxt |