SUSAN B ALLEN MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SUSAN B ALLEN MEMORIAL HOSPITAL (EIN 48-0581968)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201223209349303637
- Schema version
- 2011v1.3
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T10:51:54-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480581968 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susan B Allen Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % ROBIN CRAWFORD | InCareOfName |
| Name Control | SUSA | NameControl |
| Phone | 3163213300 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GAYLE ARNETT | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 3163213300 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | GAYLE ARNETT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 53205849 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.sbamh.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1930 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 453 | TotalNbrEmployees |
| Total Nbr Volunteers | 109 | TotalNbrVolunteers |
| Total Gross UBI | -23286 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -23286 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 246870 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 103664 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 44907639 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 47784002 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1130124 | InvestmentIncomePriorYear |
| Investment Income Current Year | 788652 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 249195 | OtherRevenuePriorYear |
| Other Revenue Current Year | 278220 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 46533828 | TotalRevenuePriorYear |
| Total Revenue Current Year | 48954538 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 38448 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 32885 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21921008 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 22554499 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 23029838 | OtherExpensePriorYear |
| Other Expenses Current Year | 23207134 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 44989294 | TotalExpensesPriorYear |
| Total Expenses Current Year | 45794518 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1544534 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3160020 | RevenuesLessExpensesCY |
| Total Assets BOY | 77429716 | TotalAssetsBOY |
| Total Assets EOY | 78893986 | TotalAssetsEOY |
| Total Liabilities BOY | 25387830 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 24908677 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 52041886 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 53985309 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 36969977 | Expense |
| Grants | 32885 | Grants |
| Revenue | 47760716 | Revenue |
| Description | See Schedule O | Description |
| Total Program Service Expense | 36969977 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | true | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 46 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 453 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | KS | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ROBIN CRAWFORD | NamePerson |
| Telephone Number | 3163224559 | TelephoneNumber |
Address US AddressUS
| 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) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| VINCE E HAINES | |||||||
| TRUSTEE/CHAIRPERSON | 1.0 | X | X | 0 | 0 | 0 | |
| EDWIN A GARD | |||||||
| TRUSTEE/VICE CHAIRPERSON | 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 | 4980 | 0 | 0 | ||
| GAYLE ARNETT | |||||||
| PRESIDENT & CEO | 40.0 | X | 241624 | 0 | 39422 | ||
| CECILIA GOEBEL | |||||||
| VICE PRESIDENT & CNO | 40.0 | X | 125572 | 0 | 30848 | ||
| DAVID SHAW | |||||||
| VICE PRESIDENT & COO | 40.0 | X | 126422 | 0 | 25750 | ||
| ROBIN CRAWFORD | |||||||
| VICE PRESIDENT & CFO | 40.0 | X | 162300 | 0 | 26393 | ||
| GERARD M LIBRODO MD | |||||||
| PHYSICIAN OF ORTHOPEDICS | 40.0 | 437218 | 0 | 20091 | X | ||
| CHARLES E STAFFORD | |||||||
| ROC - PHYSICIST | 40.0 | 176120 | 0 | 19376 | X | ||
| SUSAN E LARSON | |||||||
| PHARMACY DIRECTOR | 40.0 | 124355 | 0 | 25815 | X | ||
| ANTHONY J HOSS | |||||||
| ULTRA SOUND TECHNICIAN | 40.0 | 111721 | 0 | 15310 | X | ||
| CATHRYN J YEUBANKS | |||||||
| PHARMACIST | 40.0 | 110406 | 0 | 24344 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1620718 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 227349 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| FRESENIUS MEDICAL CARE | |
| KIDNEY DIALYSIS | 882321 |
| AFFILIATED MED SERVICES LAB INC | |
| LAB SERVICES | 144435 |
| ACUTE CARE | |
| ER PHYSISICANS | 505335 |
| EMERGENCY MANAGMENT MIDWEST | |
| PHYSICIAN SERVICES | 152386 |
| SUPERIOR LINEN SERVICE | |
| LAUNDRY SERVICES | 133042 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Related Organizations | 99164 | RelatedOrganizations |
| All Other Contributions | 4500 | AllOtherContributions |
| Total Contributions | 103664 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenue | 621110 | 47675325 | 47675325 |
| Meals on Wheels | 624200 | 97544 | 97544 |
| Screening Program | 623990 | 11133 | 11133 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 47784002 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 600300 | TotalRevenueColumn |
| Exclusion | $600,300 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8563 | TotalRevenueColumn |
| Exclusion | $8,563 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 690 | TotalRevenueColumn |
| Exclusion | $690 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 614546 | Real |
| Personal | 123030 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 508760 | Real |
| Personal | 146316 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 105786 | Real |
| Personal | -23286 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82500 | TotalRevenueColumn |
| Unrelated Business Revenue | -23286 | UnrelatedBusinessRevenue |
| Exclusion | $105,786 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3774264 | Securities |
| Other | 1760 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3585032 | Securities |
| Other | 11203 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 189232 | Securities |
| Other | -9443 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 179789 | TotalRevenueColumn |
| Exclusion | $179,789 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria | 722210 | 174607 | $174,607 |
| MISCELLANEOUS | 900099 | 20423 | $20,423 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20423 | TotalRevenueColumn |
| Exclusion | $20,423 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 195030 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48954538 | TotalRevenueColumn |
| Related Or Exempt Function Income | 47784002 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -23286 | UnrelatedBusinessRevenue |
| Exclusion | $1,090,158 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3250 | Total |
| Program Services | 3250 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29635 | Total |
| Program Services | 29635 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 778527 | Total |
| Management And General | 778527 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16902741 | Total |
| Program Services | 12677056 | ProgramServices |
| Management And General | 4225685 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 851000 | Total |
| Program Services | 638250 | ProgramServices |
| Management And General | 212750 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2781975 | Total |
| Program Services | 2086481 | ProgramServices |
| Management And General | 695494 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1240256 | Total |
| Program Services | 930192 | ProgramServices |
| Management And General | 310064 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4465583 | Total |
| Program Services | 3349187 | ProgramServices |
| Management And General | 1116396 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 172728 | Total |
| Program Services | 129546 | ProgramServices |
| Management And General | 43182 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 646141 | Total |
| Program Services | 484606 | ProgramServices |
| Management And General | 161535 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 728803 | Total |
| Program Services | 546602 | ProgramServices |
| Management And General | 182201 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 184901 | Total |
| Program Services | 138676 | ProgramServices |
| Management And General | 46225 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1036762 | Total |
| Program Services | 842058 | ProgramServices |
| Management And General | 194704 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2870756 | Total |
| Program Services | 2153067 | ProgramServices |
| Management And General | 717689 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192407 | Total |
| Program Services | 144305 | ProgramServices |
| Management And General | 48102 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt | 4481466 | 4481466 | |
| MEDICAL SUPPLIES | 7872661 | 7872661 | |
| Repairs & Maint. | 163496 | 122622 | 40874 |
| Recruiting & Retention | 150794 | 113096 | 37699 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 240635 | Total |
| Program Services | 227221 | ProgramServices |
| Management And General | 13414 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45794518 | Total |
| Program Services | 36969977 | ProgramServices |
| Management And General | 8824541 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 206543 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2458204 | BOY |
| EOY | 3091452 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7162325 | BOY |
| EOY | 9220410 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63333 | BOY |
| EOY | 31667 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1324544 | BOY |
| EOY | 1470005 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1671446 | BOY |
| EOY | 2253566 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 74566111 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 36325265 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39659967 | BOY |
| EOY | 38240846 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22673745 | BOY |
| EOY | 22170961 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1329680 | BOY |
| EOY | 1382366 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 204367 | BOY |
| EOY | 451409 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 675562 | BOY |
| EOY | 581304 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77429716 | BOY |
| EOY | 78893986 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4987830 | BOY |
| EOY | 5658677 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20400000 | BOY |
| EOY | 19250000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25387830 | BOY |
| EOY | 24908677 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47188571 | BOY |
| EOY | 49427865 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1175945 | BOY |
| EOY | 1215631 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3677370 | BOY |
| EOY | 3341813 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52041886 | BOY |
| EOY | 53985309 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77429716 | BOY |
| EOY | 78893986 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3160020 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1216597 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $7,945 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 7945 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1165992 | BeginningOfYearBalance |
| Contributions | 37767 | Contributions |
| Investment Earnings Or Losses | 13396 | InvestmentEarningsOrLosses |
| Other Expenditures | 47095 | OtherExpenditures |
| Administrative Expenses | 5665 | AdministrativeExpenses |
| End Of Year Balance | 1164395 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1138533 | BeginningOfYearBalance |
| Contributions | 38000 | Contributions |
| Investment Earnings Or Losses | 112893 | InvestmentEarningsOrLosses |
| Other Expenditures | 118334 | OtherExpenditures |
| Administrative Expenses | 5100 | AdministrativeExpenses |
| End Of Year Balance | 1165992 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1029973 | BeginningOfYearBalance |
| Contributions | 40000 | Contributions |
| Investment Earnings Or Losses | 113597 | InvestmentEarningsOrLosses |
| Other Expenditures | 45037 | OtherExpenditures |
| End Of Year Balance | 1138533 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1138441 | BeginningOfYearBalance |
| Contributions | 58722 | Contributions |
| Investment Earnings Or Losses | -130655 | InvestmentEarningsOrLosses |
| Other Expenditures | 36535 | OtherExpenditures |
| End Of Year Balance | 1029973 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.84570 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.14180 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.01250 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | true | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | true | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3340210 | OtherCostOrOtherBasis |
| Book Value | 3340210 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 43810382 | OtherCostOrOtherBasis |
| Depreciation | 15161028 | Depreciation |
| Book Value | 28649354 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26308228 | OtherCostOrOtherBasis |
| Depreciation | 20439343 | Depreciation |
| Book Value | 5868885 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1107291 | OtherCostOrOtherBasis |
| Depreciation | 724894 | Depreciation |
| Book Value | 382397 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38240846 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Total Revenue | 48954538 | TotalRevenue |
| Total Expenses | 45794518 | TotalExpenses |
| Excess Or Deficit For Year | 3160020 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -661603 | NetUnrealizedGLOnInvestments |
| Other | -$554,995 | OtherAmount |
| Total Adjustments | -1216598 | TotalAdjustments |
| Excess Or Deficit Per FS | 1943422 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 48948011 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -661603 | NetUnrealizedGainsInvestments |
| Other Revenues | 655076 | OtherRevenues |
| Revenue Not Rptd F990 | -6527 | RevenueNotRptdF990 |
| Revenue Subtotal | 48954538 | RevenueSubtotal |
| Total Revenue Per Form990 | 48954538 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 46449594 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 655076 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 655076 | ExpensesNotRptdF990 |
| Expenses Subtotal | 45794518 | ExpensesSubtotal |
| Total Expenses Per Form990 | 45794518 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| INTENDED USE OF ENDOWMENT FUNDS | 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. |
| UNCERTAIN TAX POSITIONS DISCLOSURE | 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. |
| RECONCILIATION OF NET ASSETS | SCHEDULE D, PART XI, LINE 8 | CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST $ (348,557) CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 52,686 CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS & LOSSES $ (259,124) ----------- $ (554,995) |
| RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS | SCHEDULE D, PART XII, LINE 2D | RECLASS OF RENTAL EXPENSES $ 655,076 |
| RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS | SCHEDULE D, PART XIII, LINE 2D | RECLASS OF RENTAL EXPENSES $ 655,076 |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | Region |
| Type Of Activities Conducted | Investments | TypeOfActivitiesConducted |
| Total Expenditures | 301357 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Amount Spent | 301357 | SubtotalAmountSpent |
| Total Amount Spent | 301357 | TotalAmountSpent |
| Transfer To Foreign Corp | true | TransferToForeignCorp |
| Interest In Foreign Trust | false | InterestInForeignTrust |
| Own Foreign Corp | true | OwnForeignCorp |
| Passive Foreign Invest Co | true | PassiveForeignInvestCo |
| Foreign Partnership | false | ForeignPartnership |
| Boycott Countries | false | BoycottCountries |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1073716 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1073716 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02340 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2853479 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2677309 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 176170 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00380 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3927195 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2677309 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1249886 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02720 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30080 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30080 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30080 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30080 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3957275 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2677309 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1279966 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02790 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $4,481,466 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 12226883 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 17143219 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4916336 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| 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 | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
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) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Uninsured Discount | X | UninsuredDiscount |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 $4,481,466. | |
| 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. | |
| BAD DEBT EXPENSE | 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 4 |
| MEDICARE SHORTFALL | 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 8 |
| COLLECTION PRACTICES | 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 III, LINE 9B |
| NEEDS ASSESSMENT: | We have a strategic planning committee of the Board who through a consultant conducts a needs survey of our service area. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: | 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 3 |
| COMMUNITY INFORMATION: | 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 4 |
| PROMOTION OF COMMUNITY HEALTH: | We participate in the Butler County Senior Fair providing health information on various health issues. We participate in the Frontier Refining Employee Health Fair providing information about various health issues and offer health testing and screenings. We participate in the Butler Community College Women's Fair providing information about 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 Butller County Diabetes Support Group, The American Cancer Society, and the Butler County Multiple Sclerosis Support Group. We provide low cost screening programs for cardiac health, osteoporosis, hypertension and diabetes. We provide free influenza vaccinations to members of the community. WE HAVE A VOLUNTEER BOARD OF 12 MEMBERS THAT COME FROM THROUGHOUT OUR SERVICE AREA. | SCHEDULE H, PART VI, LINE 5 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance |
|---|---|---|---|---|
| ADULT DIABETES EDUCATION PROGRAM | 16 | 6198 | BOOK | EDUCATION |
| PUBLIC INFLUENZA VACCINATIONS | 1418 | 23437 | BOOK | VACCINATIONS |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING THE USE OF GRANTS | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GAYLE ARNETT | |||||||||||||
| 237817 | 0 | 0 | 0 | 3807 | 0 | 17780 | 0 | 21642 | 0 | 281046 | 0 | 0 | 0 |
| CECILIA GOEBEL | |||||||||||||
| 124561 | 0 | 0 | 0 | 1011 | 0 | 9599 | 0 | 21249 | 0 | 156420 | 0 | 0 | 0 |
| DAVID SHAW | |||||||||||||
| 125596 | 0 | 0 | 0 | 826 | 0 | 9737 | 3 | 16013 | 0 | 152172 | 3 | 0 | 0 |
| ROBIN CRAWFORD | |||||||||||||
| 161202 | 0 | 0 | 0 | 1098 | 0 | 6457 | 0 | 19936 | 0 | 188693 | 0 | 0 | 0 |
| GERARD M LIBRODO MD | |||||||||||||
| 436267 | 0 | 0 | 0 | 951 | 0 | 10765 | 0 | 9326 | 0 | 457309 | 0 | 0 | 0 |
| CHARLES E STAFFORD | |||||||||||||
| 175288 | 0 | 0 | 0 | 832 | 0 | 8831 | 0 | 10545 | 0 | 195496 | 0 | 0 | 0 |
| SUSAN E LARSON | |||||||||||||
| 123257 | 0 | 0 | 0 | 1098 | 0 | 5090 | 0 | 20725 | 0 | 150170 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | HEALTH OR SOCIAL CLUB DUES OR INITITION FEES | Identifier |
| Return Reference | SCHEDULE J, PART I, LINE 1A | ReturnReference |
| Explanation | DAVID SHAW, CECILIA GOEBEL, GERARD M LIBRODO, MD, ANTHONY J HOSS, SUSAN LARSON, CATHRYN YEUBANKS, ROBIN CRAWFORD,CHARLES STAFFORD,AND GAYLE ARNETT RECEIVED PAYMENT OF HEALTH OR SOCIAL CLUB OR INITIATION FEES THAT WERE REPORTED IN THEIR W-2. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | GENERAL M LIBRODO MD | NamePerson |
| Purpose Of Loan | SALARY ADVANCE | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $95,000 | OriginalPrincipalAmount |
| Balance Due | 31667 | BalanceDue |
| Default | false | Default |
| Approved By Board | true | ApprovedByBoard |
| Written Agreement | true | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 31667 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SEE SCHEDULE L PART V | NamePerson |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS | Identifier |
| Return Reference | SCHEDULE L, PART IV | ReturnReference |
| 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) $127,625 (D) RENT (E) NO | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICE ACCOMPLISHMENTS | 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), Home Medical Equipment Services, Osteoporosis information (and screening) and senior psychiatric services 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 weight management, diabetes related issues including diabetes related footwear. 4. Participated in the Butler Community College - Andover / Sherwin Williams Wellness Fair, providing free osteoporosis screening, and provided $250 in sponsorship for refreshments. 5. Participated in the Augusta Unified School District-wide employee wellness fair, providing osteoporosis screenings and speakers on multiple topics at no charge. 6. Participated in the Walnut River Festival, a community event aimed at youth and parents, by providing nutrition and breastfeeding education. 7. 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. 8. 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 400 students). 9. Administrative personnel (4) are supporting the El Dorado Vision 2020 program, providing mentoring at a local school one hour per week. 10. Made available a "Speakers Bureau" to our community. Hospital personnel spoke to various civic groups and organizations on numerous occasions. 11. Hospital employees donated over $19,775 in support of the El Dorado United Way program. 12. Provided meeting room space for other organizations serving the community, such as the Butler County Diabetes Support Group, the American Cancer Society, the ARC of Butler (special needs and disabilities), Quality Care Services (child and adult food program), and the Butler County Multiple Sclerosis Support Group. 13. Provide equipment, personnel and facilities for Local Emergency Planning Committee training. Also have an employee who was appointed to the Governor's Commission on Emergency Planning and Response at the State level. 14. Teamed with Butler County Emergency Management and the Butler County Health Department to submit and receive a grant to provide up to 300 NOAA Weather Alert Radios for citizens of Butler County who meet certain criteria. 15. Provided a low-cost screening program for cardiac health, osteoporosis, hypertension, and diabetes two times during the year in El Dorado and twice in Augusta for the general public. 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 three 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, 1,418 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., Partners in Education Foundation, USD 490 Facilities Committee, American Cancer Society Relay for Life, Bluestem Community Credit Union, EMPAC, Butler Community College Nursing Advisory Board, Society for Social Worker Leadership in Healthcare Board, Prevention of Elder Abuse, Neglect and Exploitation Planning Committee, Violence Against Women Planning Committee, Sexual Abuse Nurse Examiner Planning Committee, Walnut Valley Aids Coalition, Salvation Army Board, Crime Stoppers Board, Butler County History Center and WWII Museum Board, 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 $1,250 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, $6,643.00 was provided for sixteen patients who attended the class. |
| BUSINESS OR FAMILY RELATIONSHIP | 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. |
| 990 REVIEW PROCESS | 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. |
| CONFLICT OF INTEREST POLICY | 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. |
| COMPENSATION REVIEW | 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 LAST REVIEW WAS DONE IN 2010 BY THE COMPENSATION COMMITTEE AND THE BOARD. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, LINE 19 | THE GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| COMPENSATION OF TRUSTEE | FORM 990, PART VII | AMY SEEBER IS COMPENSATED BY THE HOSPITAL FOR HER SERVICES PROVIDING A PHYSICIAN INTERPRETATION OF ELECTROCARDIOGRAMS. |
| RECONCILIATION OF NET ASSETS | FORM 990, PART XI, LINE 5 | UNREALIZED GAINS ON INVESTMENTS $ (661,602) CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS $ (348,557) CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 52,686 CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS & LOSSES $ (259,124) ----------- $ (1,216,597) |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:GAYLE ARNETT TITLE:PRESIDENT & CEO HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ROBIN CRAWFORD TITLE:VICE PRESIDENT & CFO HOURS:1 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL FDN | BusinessNameLine1 |
Address US AddressUS
| 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 | 480862732 | EIN |
| Primary Activities | SUPPORT ORG | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
| Exempt Code Section | 501(C)3 | ExemptCodeSection |
| Public Charity Status | 11D | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FS ALLEN | BusinessNameLine1 |
Address US AddressUS
| 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 Activity | GRANTOR TRUST | PrimaryActivity |
| Legal Domicile State | KS | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | TRUST | TypeOfEntity |
| Share Of Total Income | -343654 | ShareOfTotalIncome |
| Share Of EOY Assets | 3092736 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |