2011-11-14T16:51:52-06:00 2010-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2010-01-01 480581968 Susan B Allen Memorial Hospital SUSA 3163213300 720 West Central El Dorado KS 67042 GAYLE ARNETT 3163213300 2011-11-15 true Michael J Engle 8162216300 2010 2016-02-24 21:20:13Z GAYLE ARNETT 720 WEST CENTRAL EL DORADO KS 67042 58710855 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 11 485 105 -1242 -1242 104973 246870 45684484 44907639 -398958 1130124 301402 249195 45691901 46533828 38534 38448 0 0 23450245 21921008 0 0 0 22401050 23029838 45889829 44989294 -197928 1544534 76415251 77429716 27638255 25387830 48776996 52041886 X TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. false false 34480916 38448 44906397 See Schedule O 34480916 true true false true false false false false true true false false false false true true false false false true false false false false false true false true true true false false false true false false false true false false false false false true false false false false true 45 0 true 485 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 X VINCE E HAINES 1.0 X X 0 0 0 EDWIN A GARD 1.0 X X 0 0 0 CATHY N COOPER MD 1.0 X 0 0 0 MATTHEW J CROSS 1.0 X 0 0 0 MARK D UTECH 1.0 X X 0 0 0 PHILLIP S OLSEN 1.0 X 0 0 0 JOSEPH N SUNDGREN 1.0 X 0 0 0 JACQUELINE A VIETTI 1.0 X 0 0 0 MICHAEL K WHEELER 1.0 X 0 0 0 KENNETH ZIEGLER 1.0 X 0 0 0 CAMI R BAKER 1.0 X 0 0 0 MICHAEL CLIFTON 1.0 X 0 0 0 GAYLE ARNETT 40.0 X 225786 0 37794 CECILIA GOEBEL 40.0 X 116488 0 29466 DAVID SHAW 40.0 X 123214 0 22034 ROBIN CRAWFORD 40.0 X 156208 0 25377 GERARD M LIBRODO MD 40.0 X 400275 0 19545 CHARLES E STAFFORD 40.0 X 173706 0 18650 SUSAN E LARSON 40.0 X 120824 0 24609 ANTHONY J HOSS 40.0 X 112875 0 15180 CATHRYN J YEUBANKS 40.0 X 108515 0 22903 1537891 0 215558 9 false true false FRESENIUS MEDICAL CARE KIDNEY DIALYSIS 527162 AFFILIATED MED SERVICES LAB INC LAB SERVICES 157822 ACUTE CARE ER PHYSISICANS 483055 3 163990 68249 14631 246870 Patient Service Revenue 621110 44803397 44803397 Meals on Wheels 624200 97036 97036 Screening Program 623990 7206 7206 44907639 555957 555957 12737 12737 637 637 610344 7868 540271 9110 70073 -1242 68831 -1242 70073 11414057 775019 11068278 559368 345779 215651 561430 561430 0 0 0 Cafeteria 722210 155082 155082 Miscellaneous 900004 24645 24645 179727 46533828 44907639 -1242 1380561 6300 6300 32148 32148 0 0 736367 736367 0 16571263 12428447 4142816 786080 589560 196520 2611263 1958447 652816 1216035 912026 304009 0 30673 30673 218594 218594 0 0 51238 51238 3588979 2917113 671866 170579 127934 42645 8164619 6123464 2041155 0 0 727771 545828 181943 180747 135560 45187 0 0 1085724 881825 203899 0 3474339 2605754 868585 196403 147302 49101 Bad Debt 4669338 4669338 MEDICAID PROVIDER ASSESSMENT 186968 186968 Repairs & Maint. 184281 138211 46070 Recruiting & Retention 54784 41088 13696 _ 44801 33603 11198 44989294 34480916 10508378 0 21055 206543 2932231 2458204 7128109 7162325 135000 63333 1526692 1324544 1209503 1671446 73457062 33797095 41603780 39659967 19622559 22673745 1168560 1329680 178169 204367 889593 675562 76415251 77429716 6138255 4987830 21500000 20400000 27638255 25387830 X 44237646 47188571 1052824 1175945 3486526 3677370 48776996 52041886 76415251 77429716 X 1544534 1720356 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 7929 false false false 7929 false 1138533 38000 112893 118334 5100 1165992 1029973 40000 113597 45037 1138533 1138441 58722 -130655 36535 1029973 0.85222 0.13116 0.01662 false true true 3340210 3340210 43721676 14173061 29548615 25206488 18909479 6297009 1188688 714555 474133 39659967 0 0 46533828 44989294 1544534 557936 1162420 1720356 3264890 47641145 557936 549381 1107317 46533828 46533828 45538675 549381 549381 44989294 44989294 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 TRUSTS $ 152,844 CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 161,121 CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS & LOSSES $ 848,455 ----------- $ 1,162,420 RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII, LINE 2D RECLASS OF RENTAL EXPENSES $ 549,381 RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XIII, LINE 2D RECLASS OF RENTAL EXPENSES $ 549,381 Central America and the Caribbean 0 0 Investments 1950000 0 0 0 0 1950000 1950000 true false false true false false true true true X true X true true true false true true 1217371 1217371 0.02710 3207155 1034086 2173069 0.04830 4424526 1034086 3390440 0.07540 29706 29706 0.00070 29706 29706 0.00070 4454232 1034086 3420146 0.07610 false 4669338 10885878 14139286 -3253408 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 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 $4,669,338. 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 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. MEDICARE SHORTFALL 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. COLLECTION PRACTICES 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. NEEDS ASSESSMENT: SCHEDULE H, PART VI, LINE 2 We have a strategic planning committee of the Board who through a consultant conducts a needs survey of our service area. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: 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. COMMUNITY INFORMATION: 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. PROMOTION OF COMMUNITY HEALTH: SCHEDULE H, PART VI, LINE 5 We participate in the Butler County Senior Fair providing health information on various health issues. We participate in the Frontier Refining Employee Health Fair providing information about various health issues and offer health testing and screenings. We participate in the Butler Community College Women's Fair providing information about 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, the Butler County Tobacco Coalition 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 X ADULT DIABETES EDUCATION PROGRAM 14 6198 BOOK EDUCATION PUBLIC INFLUENZA VACCINATIONS 1800 25950 BOOK VACCINATIONS PROCEDURE FOR MONITORING THE USE OF GRANTS 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 222131 0 0 0 3655 0 17095 0 20699 0 263580 0 0 0 ROBIN CRAWFORD 155110 0 0 0 1098 0 6400 0 18977 0 181585 0 0 0 GERARD M LIBRODO MD 399324 0 0 0 951 0 10412 0 9133 0 419820 0 0 0 CHARLES E STAFFORD 172932 0 0 0 774 0 8773 0 9877 0 192356 0 0 0 HEALTH OR SOCIAL CLUB DUES OR INITITION FEES SCHEDULE J, PART I, LINE 1A DAVID SHAW, CECILIA GOEBEL, GERARD M LIBRODO, MD, ANTHONY J HOSS, SUSAN LARSON, CATHRYN YEUBANKS, ROBIN CRAWFORD, AND GAYLE ARNETT RECEIVED PAYMENT OF HEALTH OR SOCIAL CLUB OR INITIATION FEES THAT WERE REPORTED IN THEIR W-2. GENERAL M LIBRODO MD SALARY ADVANCE X 95000 63333 false true true 63333 SEE SCHEDULE L PART V BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS 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) $127,625 (D) RENT (E) NO 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, HOME HEALTH SERVICES, 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, STRESS MANAGEMENT/MENTAL HEALTH, DIETARY EDUCATION, BONE DENSITY TESTING AND BLOOD DRAWS. 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, A SPEAKER DISCUSSING DIABETES RELATED ISSUES, AND PROVIDED $250 IN SPONSORSHIP FOR REFRESHMENTS. 5. SPONSORED THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE IN EL DORADO WITH A $1,000 SPONSORSHIP. IN ADDITION, HOSPITAL AFFILIATED TEAMS RAISED OVER $14,900 FOR THE EVENT. 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 400 STUDENTS). 7. ADMINISTRATIVE PERSONNEL 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 $19,050 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 BUTLER COUNTY TOBACCO COALITION, AND THE BUTLER COUNTY MULTIPLE SCLEROSIS SUPPORT GROUP. 11. 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. 12. PROVIDED A LOW-COST SCREENING PROGRAM FOR CARDIAC HEALTH, OSTEOPOROSIS, HYPERTENSION, AND DIABETES TWO TIMES DURING THE YEAR IN EL DORADO AND ONE TIME IN AUGUSTA FOR THE GENERAL PUBLIC. 13. PROVIDED FREE OSTEOPOROSIS SCREENINGS IN THE PHYSICAL REHABILITATION DEPARTMENT ONE-HALF DAY EACH MONTH. 14. PROVIDED LOW-COST SCREENING PROGRAMS FOR CARDIAC HEALTH AND HYPERTENSION THREE TIMES DURING THE YEAR, SCREENINGS FOR DIABETES TWO 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. 15. 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. ALSO, CLINICS WERE HELD AT SCHOOL DISTRICTS AND BUSINESSES THROUGHOUT BUTLER COUNTY. IN TOTAL, 1,800 DOSES WERE GIVEN TO COMMUNITY MEMBERS AT NO COST. 16. 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, BLUESTEM CHAPTER OF THE AMERICAN RED CROSS, EMPAC, BUTLER COUNTY COOPERATIVE EDUCATION ADVISORY BOARD, 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 EXAINAR, 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. 17. SPONSORED, IN THE AMOUNT OF $500, AND HELPED ADMINISTER THE AUGUSTA LOOP THE LAKE RUN IN CONJUNCTION WITH THE ANNUAL AUGUSTA HOMECOMING FESTIVAL. 18. SPONSORED, IN THE AMOUNT OF $250, AND PROVIDED CERTIFIED ATHLETIC TRAINERS TO OFFER GENERAL ATHLETIC STRETCHING ADVICE AT THE AUGUSTA CHAMBER OF COMMERCE ANNUAL GOLF TOURNAMENT. 19. SPONSORED THE EL DORADO YMCA STRONG KIDS CAMPAIGN WITH A $1,000 DONATION. 20. 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, CRNA STUDENTS, PHYSICIAN ASSISTANT STUDENTS, AND PHARMACY STUDENTS. 21. SPONSORED THE BUTLER COUNTY 4-H PROGRAM WITH A $1,050 DONATION DURING THE ANNUAL LIVESTOCK AUCTION. 22. 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, $6,198 WAS PROVIDED FOR FOURTEEN PATIENTS WHO ATTENDED THE CLASS. ATTACHMENT OF AUDITED FINANCIAL STATEMENTS FORM 990, PART IV, LINE 20B PER THE IRS' FORM 990 INSTRUCTIONS, AN ORGANIZATION OPERATING ONE OR MORE HOSPITALS AT ANY TIME DURING THE YEAR MUST ATTACH A COPY OF ITS AUDITED FINANCIAL STATEMENTS TO THE TAX RETURN IF ITS TAX YEAR BEGAN AFTER MARCH 23, 2010. SUSAN B. ALLEN MEMORIAL HOSPITAL'S AUDITED FINANCIAL STATEMENTS ARE NOT ATTACHED BECAUSE ITS TAX YEAR BEGAN ON JANUARY 1, 2010. 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. 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. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED GAINS ON INVESTMENTS $ 557,936 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS $ 152,844 CHANGE IN INTEREST IN THE NET ASSETS OF SBAMHF $ 161,121 CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS & LOSSES $ 848,455 ----------- $ 1,720,356 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 SUSAN B ALLEN MEMORIAL HOSPITAL FDN 720 WEST CENTRAL EL DORADO KS 67042 480862732 SUPPORT ORG KS 501(C)(3) 11A NA FS ALLEN 720 WEST CENTRAL EL DORADO KS 67042 486103710 GRANTOR TRUST KS NA TRUST 151696 3436390 1.00000 false false true false false false false false false false false false true true false false false false