2014-11-17T11:26:22-06:00 2013-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-01-01 480581968 Susan B Allen Memorial Hospital % ROBIN CRAWFORD SUSA 3163213300 720 West Central Suite El Dorado KS 67042 GAYLE ARNETT PRESIDENT/CEO 3163213300 2014-11-15 true Kevin Ensminger CPA P01310558 3163213300 2013 2015-11-30 17:44:51Z GAYLE ARNETT 720 WEST CENTRAL EL DORADO KS 67042 58538204 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 11 527 109 -273 -273 83257 214313 55751138 50554380 775473 1159354 184569 209683 56794437 52137730 27680 46493 0 0 24699097 27610507 0 0 0 27194778 25261280 51921555 52918280 4872882 -780550 80310217 79674990 19661640 17206729 60648577 62468261 X TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. false false 42585014 46493 50554107 See Schedule O 42585014 true true false true false false false false false true true false false false false false true false false false true false false false false false true true false true true true false false false false false false true false false false false false true true true true false true 66 0 true 527 true true true false false false false false false false false false X 12 11 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 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 X 0 0 0 MATTHEW J CROSS TRUSTEE 1.0 X 0 0 0 MARK D UTECH TRUSTEE 1.0 X 0 0 0 JOSEPH N SUNDGREN TRUSTEE/TREASURER/SECRETARY 1.0 X X 0 0 0 JACQUELINE A VIETTI TRUSTEE 1.0 X 0 0 0 MICHAEL K WHEELER TRUSTEE 1.0 X 0 0 0 KENNETH ZIEGLER TRUSTEE 1.0 X 0 0 0 CAMI R BAKER TRUSTEE 1.0 X 0 0 0 MICHAEL CLIFTON TRUSTEE 1.0 X 0 0 0 AMY SEEBER TRUSTEE 1.0 X 6060 0 0 GAYLE ARNETT PRESIDENT & CEO 40.0 1.0 X 270968 0 40024 CECILIA GOEBEL VICE PRESIDENT & CNO 40.0 X 135934 0 31235 DAVID SHAW VICE PRESIDENT & COO 40.0 X 132328 0 31267 ROBIN CRAWFORD VICE PRESIDENT & CFO 40.0 1.0 X 182476 0 25776 GERARD M LIBRODO MD PHYSICIAN OF ORTHOPEDICS 40.0 X 610315 0 22450 CHARLES E STAFFORD ROC - PHYSICIST 40.0 X 179037 0 18486 EVE SHANK ENT PHYSICIAN 40.0 X 148760 0 7612 RUBEN GARCIA HOSPITALIST PHYSICIAN 28.0 X 228464 0 25431 CASANA BRUNTON HOSPITALIST PHYSICIAN 28.0 X 200370 0 16252 2094712 0 218533 19 false true false FRESENIUS MEDICAL CARE KIDNEY DIALYSIS 877803 AFFILIATED MED SERVICES LAB INC LAB SERVICES 166307 SCHNEIDER ELECTRIC ELECTRIC & MECHANIC 1725733 EMERGENCY MANAGEMENT MIDWEST PHYSICIAN SERVICES 484946 HUTTON CONSTRUCTION CONSTRUCTION SVCS 1288032 12 206427 7886 214313 Patient Service Revenue 621110 49164908 49164908 Meals on Wheels 624200 92996 92996 Screening Program 623990 2830 2830 ARRA Meaningful Use 621110 1293646 1293646 50554380 526985 526985 530 530 809 809 613973 82864 602425 128795 11548 -45931 -34383 -34383 6300633 460 5629313 39941 671320 -39481 631839 631839 0 0 0 Cafeteria 722210 213392 213392 PARTNERSHIP INCOME 900099 -273 -273 Miscellaneous 900099 30138 30138 30138 30138 243257 52137730 50554380 -273 1369310 2000 2000 44493 44493 0 0 850008 850008 0 19657796 14743347 4914449 2305921 1729441 576480 3365415 2524061 841354 1431367 1073525 357842 0 0 0 0 0 0 5297855 3973391 1324464 0 210737 158053 52684 730154 547617 182537 0 0 686843 515132 171711 254620 190965 63655 0 0 388457 315505 72952 0 3013643 2260232 753411 264189 198142 66047 Bad Debt 4781107 4781107 Medical Supplies 8984412 8984412 Repairs & Maint. 302303 226727 75576 Recruiting & Retention 120383 90287 30096 226577 226577 52918280 42585014 10333266 0 229946 42162 1917188 0 0 0 8700088 8748906 0 0 0 0 0 0 1517828 1518113 1960439 2015516 83314448 39794239 40985656 43520209 22375399 21791687 2049460 1663599 313935 148740 0 0 260278 226058 80310217 79674990 5448689 4692372 0 0 0 0 14212951 12514357 0 0 0 0 0 0 0 0 0 0 19661640 17206729 X 55894764 57302295 1288732 1483326 3465081 3682640 60648577 62468261 80310217 79674990 X -780550 852325 1747909 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 9198 false false false 9198 false 1291319 144789 113425 63912 6337 1479284 1170060 92514 82010 47398 5867 1291319 1165992 43432 13396 47095 5665 1170060 1138533 38000 112893 118334 5100 1165992 1029973 40000 113597 45037 1138533 0.86060 0.12130 0.01810 false true true 4050478 4050478 43831690 16883540 26948150 34102922 22071260 12031662 1329358 839439 489919 43520209 48940441 852325 731493 1583818 47356623 4781107 4781107 52137730 48868393 731220 731220 48137173 4781107 4781107 52918280 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 Central America and the Caribbean Investments 1181557 1181557 1181557 false false true true false false true true true X true X true true true false true true 936254 936254 0.01940 5385852 3450436 1935416 0.04020 6322106 3450436 2871670 0.05960 44493 44493 0.00090 44493 44493 0.00090 6366599 3450436 2916163 0.06050 false 4781107 13044410 20123360 -7078950 X true true 1 1 SUSAN B ALLEN MEMORIAL HOSPITAL 720 WEST CENTRAL EL DORADO KS 67042 X X X SUSAN B ALLEN MEMORIAL HOSPITAL 1 true X X X X X X X X X 13 true false true X SEE PART V, SECTION C X X X X X false false true true 200. true 200. true X X X X X true true X X X X X X true false X X X true X false false 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. 4 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 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. true ADULT DIABETES EDUCATION PROGRAM 16 10363 BOOK EDUCATION PUBLIC INFLUENZA VACCINATIONS 2171 34130 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 266192 0 0 0 4776 0 18903 0 21121 0 310992 0 0 0 CECILIA GOEBEL VICE PRESIDENT & CNO 134735 0 0 0 1199 0 10652 0 20584 0 167170 0 0 0 DAVID SHAW VICE PRESIDENT & COO 131314 0 0 0 1014 0 10262 0 21005 0 163595 0 0 0 ROBIN CRAWFORD VICE PRESIDENT & CFO 181378 0 0 0 1098 0 6983 0 18793 0 208252 0 0 0 GERARD M LIBRODO MD PHYSICIAN OF ORTHOPEDICS 609235 0 0 0 1080 0 13500 0 8950 0 632765 0 0 0 CHARLES E STAFFORD ROC - PHYSICIST 177781 0 0 0 1256 0 9478 0 9008 0 197523 0 0 0 EVE SHANK ENT PHYSICIAN 148615 0 0 0 145 0 1296 0 6316 0 156372 0 0 0 RUBEN GARCIA HOSPITALIST PHYSICIAN 225970 0 0 0 2495 0 6976 0 18455 0 253895 0 0 0 CASANA BRUNTON HOSPITALIST PHYSICIAN 200060 0 0 0 309 0 8834 0 7419 0 216623 0 0 0 SCHEDULE J, PART I, LINE 1A 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. A BUTLER COUNTY KANSAS 486035394 12343PAA3 2012-04-30 14500000 SEE PART VI false false false A 2015643 0 14500655 0 24 0 0 0 0 3607315 10893316 0 2013 true true true true A false false false false 0 false false false true A false true false false 0 false 0 false true A 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 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. 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) $3,824,314 (D) CONTRIBUTIONS TO BENEFIT PLAN (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, 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 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 202334 3416203 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 3824314 cash