2023-11-07T10:13:11-06:00 2022-12-31 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2022-01-01 480581968 SUSAN B ALLEN MEMORIAL HOSPITAL SUSA 3163213300 720 WEST CENTRAL EL DORADO KS 67042 LEONARD HERNANDEZ PRESIDENT & CEO 3163213300 2023-10-20 1 LEONARD HERNANDEZ 999009999 0 ABIGAIL L CAMPBELL P01296738 8656730844 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MELISSA HALL 720 WEST CENTRAL EL DORADO KS 67042 39519090 0 X WWW.SBAMH.ORG X 1930 KS THE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. 12 12 345 22 -1132 0 1923077 1845007 38201881 37010909 1581576 -350876 950288 927848 42656822 39432888 0 0 0 0 19651937 20510643 0 0 0 21465181 22370233 41117118 42880876 1539704 -3447988 55505865 48132777 10120603 7992188 45385262 40140589 X TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. 0 0 34831171 37801551 SEE SCHEDULE O 34831171 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 85 0 1 345 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KS X CINDI STRACK 3163224544 720 WEST CENTRAL EL DORADO KS 67042 SUZIE LOCKE CHAIR 1.00 X X 0 0 0 GREG JOYCE OD VICE CHAIR 1.00 X X 0 0 0 BRANDI LANE SECRETARY/TREASURER 1.00 X X 0 0 0 CAMI BAKER TRUSTEE 1.00 X 0 0 0 MIKE BELLESINE TRUSTEE 1.00 X 0 0 0 GLENN BUCHOLZ TRUSTEE 1.00 X 0 0 0 MICHAEL CLIFTON TRUSTEE 1.00 X 0 0 0 VINCE HAINES TRUSTEE 1.00 X 0 0 0 RICHARD KUHNS MD TRUSTEE 1.00 X 0 0 0 MICHAEL RAUSCH MD TRUSTEE 1.00 X 0 0 0 RYAN MURRAY TRUSTEE 1.00 X 0 0 0 JEREMY SUNDGREN TRUSTEE 1.00 X 0 0 0 LEONARD HERNANDEZ CHIEF EXECUTIVE OFFICER 40.00 1.00 X 241745 0 12568 CINDI STRACK CHIEF FINANCIAL OFFICER 40.00 X 146056 0 12568 MELISSA HALL CHIEF OPERATING OFFICER 40.00 X 141241 0 84 CECILIA GOEBEL CHIEF NURSING OFFICER 40.00 X 146508 0 8903 SHANE FEJFAR PHYSICIAN 40.00 X 587467 0 10474 NICHOLAS POSGE PODIATRIST 40.00 X 243472 0 12568 IRAM SIRAJUDDIN PHYSICIAN 40.00 X 240018 0 8656 CHARLES STAFFORD PHYSICIAN 40.00 X 195880 0 84 HANNAH CAVE NURSE PRACTITIONER 40.00 X 148644 0 5286 2091031 0 71191 22 0 1 0 TRAJECTORY RCS LLC 10111 E 21ST B WICHITA KS 67206 REVENUE CYCLE SERVICES 960099 PHILIPS HEALTHCARE PO BOX 100355 ATLANTA GA 30384 EQUIPMENT MAINTENANCE SUPPORT 388505 MERITAIN HEALTH PO BOX 860093 MINNEAPOLIS MN 55486 INSURANCE 327416 AFFILIATED MEDICAL SERVICES PO BOX 12127 WICHITA KS 67277 LABORATORY SERVICES 216646 VARIAN MEDICAL SYSTEMS 70140 NETWORK PLACE CHICAGO IL 60673 EQUIPMENT MAINTENANCE SUPPORT 210760 14 35201 1783569 26237 1845007 PATIENT SERVICE REVENUE 621110 36913157 36913157 MEALS ON WHEELS 624200 97752 97752 37010909 -264674 -264674 576 576 716670 0 716670 716670 716670 86202 -86202 -86202 -86202 CAFETERIA SALES 621110 137762 137762 MISCELLANEOUS 621110 73972 73972 PARTNERSHIP INCOME 621110 -1132 -1132 210602 39432888 37801551 -1132 -212538 X 709672 709672 17521071 13648812 3872259 778 638 140 1182593 969726 212867 1096529 899154 197375 5821 5821 143528 143528 75240 75240 5856129 4561890 1294239 14434 11244 3190 961331 748871 212460 161276 125634 35642 69209 51907 17302 2337348 1706264 631084 623149 485429 137720 SUPPLIES - MEDICAL 5035108 5035108 BAD DEBT 4266428 4266428 REPAIRS AND MAINTENANCE 1409198 1097757 311441 PROVIDER ASSESSMENT 553571 553571 858463 668738 189725 42880876 34831171 8049705 0 4645092 783115 7421525 8411188 749089 716662 743765 717840 87273716 61494451 27920249 25779265 9344924 7410409 3990126 3542517 29120 11004 661975 760777 55505865 48132777 7389134 5974612 2731469 2017576 10120603 7992188 X 40656557 36221316 4728705 3919273 45385262 40140589 55505865 48132777 X -3447988 -1797817 1132 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 7083 7083 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: SUSAN B. ALLEN MEMORIAL HOSPITAL PAYS MEMBERSHIP DUES TO THE KANSAS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES IS DESIGNATED FOR LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. 3402966 256312 -562645 4437 3092196 3050761 359705 7500 3402966 2531526 263800 324572 69137 3050761 1963579 5300 562647 2531526 2141962 9966 -178045 10304 1963579 0.80740 0.14750 0.04510 0 1 1 3836424 3836424 46607696 27419437 19188259 35508685 32838344 2670341 1320911 1236670 84241 25779265 OTHER SECURITIES 3542517 C 3542517 X 33333319 -1797817 -1797817 35131136 36456 4265296 4301752 39432888 38577992 0 38577992 36456 4266428 4302884 42880876 PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND A SIMILAR PROVISION OF STATE LAW. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION HAVE NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2022. AT DECEMBER 31, 2022, TAX RETURNS FOR YEARS 2019 THROUGH 2021 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,266,428. FLOW THRU PARTNERSHIP INCOME/LOSS -1,132. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,266,428. SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUNDS ARE HELD BY SUSAN B. ALLEN MEMORIAL HOSPITAL FOUNDATION, A RELATED TAX EXEMPT ORGANIZATION. THE EARNINGS FROM THE ENDOWMENT FUNDS ARE USED TO FUND THE PURCHASE OF EQUIPMENT AND PROGRAM SUPPORT FOR SUSAN B. ALLEN MEMORIAL HOSPITAL. 1 1 1 X 0 1 1 1 0 1 1 1310804 1310804 0.03390 4830840 2462989 2367851 0.06130 6141644 2462989 3678655 0.09520 6141644 2462989 3678655 0.09520 1 4266428 2161054 7760656 9657195 -1896539 X 1 1 1 1 SUSAN B ALLEN MEMORIAL HOSPITAL 720 WEST CENTRAL EL DORADO KS 67042 WWW.SBAMH.ORG H-008-002 X X X SUSAN B ALLEN MEMORIAL HOSPITAL 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 0.000000000000 X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X 1 X 0 0 SUSAN. B ALLEN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: BASED ON DATA ACQUIRED FROM THE 2022 CHNA, HEALTH AND WELLNESS COMMUNITY PARTNERS WERE INVITED TO GIVE INPUT DURING THE 2022 CHNA DATA COLLECTION PROCESS. THESE PARTNERS INCLUDED BUT WERE NOT LIMITED TO: BUTLER COUNTY HEALTH DEPARTMENT, SOUTH CENTRAL KANSAS MENTAL HEALTH, LOCAL SCHOOL DISTRICTS, DEPARTMENT OF AGING, MEMBERS OF SBAMH MEDICAL STAFF, ALLIED HEALTH, BUTLER COMMUNITY COLLEGE SCHOOL OF NURSING, UNITED WAY, YMCA, LARGE BUSINESS OWNERS, CLERGY, GENERAL PUBLIC, ETC. SUSAN. B ALLEN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: SBAMH HAS ADOPTED A "POPULATION HEALTH" PHILOSOPHY WHERE HEALTH AND WELLNESS SERVICES ARE DEVELOPED AND DELIVERED TO ALL CITIZENS IN OUR SERVICE AREA. THE 2022 CHNA IDENTIFIED SIX (6) MAJOR UNDERSERVED AREAS OF SIGNIFICANT NEED: MENTAL HEALTH SERVICES, HEALTH EDUCATION, SENIOR NUTRITION SERVICES, HEALTH PROMOTION, ACCESS TO HEALTH CARE, AND HEALTH CARE SERVICES NEEDED BUT NOT AVAILABLE IN BUTLER COUNTY. SCHEDULE H, PART V, SECTION B, LINE 7A & 10A WWW.SBAMH.ORG/ABOUT_US/COMMUNITY_HEALTH_NEEDS_ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 16 WWW.SBAMH.ORG/PATIENTS_INFO/BILLING_INFORMATION 5 1 - SBA MEMORIAL HOSPITAL HOME HEALTH 720 W CENTRAL EL DORADO KS 67042 HOME HEALTH AGENCY 2 - SBA MEMORIAL HOSPITAL MEDICAL CLINIC 720 W CENTRAL EL DORADO KS 67042 MEDICAL OFFICE BUILDING 3 - SUSAN B ALLEN MEMORIAL HOSPITAL DME 720 W CENTRAL EL DORADO KS 67042 DURABLE MEDICAL EQUIPMENT PROVIDER 4 - EL DORADO URGENT CARE 2710 W CENTRAL AVE SUITE A EL DORADO KS 67042 URGENT CARE CLINIC 5 - AUGUSTA IMMEDIATE CARE 401 W 7TH AVE AUGUSTA KS 67010 IMMEDIATE CARE CLINIC PART I, LINE 3C: THE HOSPITAL ALSO USES MEDICAL INDIGENCY, ASSET LEVEL, AND RESIDENCY AS FACTORS TO DETERMINE ELIGIBILITY. 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 COSTS TO PATIENT CARE CHARGES. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE WAS $4,266,428. PART III, LINE 2: NON-MEDICARE AND NON-MEDICAID ACCOUNTS RESERVE AT 100% AT THE POINT OF AGING OVER 189 DAYS. MEDICARE AND MEDICAID ACCOUNTS RESERVE AT 100% AFTER 365 DAYS. PART III, LINE 3: THIS AMOUNT IS ESTIMATED BASED ON THE U.S. CENSUS BUREAU RATE OF INDIVIDUALS BELOW POVERTY LEVEL - 10.1%. PART III, LINE 4: THE BAD DEBT FOOTNOTE IS ON PAGE 14 OF THE AUDITED FINANCIAL STATEMENTS. 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. PART III, LINE 9B: THE FINANCIAL ASSISTANCE POLICY IS OFFERED AT TIME OF REGISTRATION. NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN MULTIPLE FORMS. PART VI, LINE 2: IN ADDITIONS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS COMPLETE IN 2022 AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), THE ORGANIZATION HAS A STRATEGIC PLANNING COMMITTEE. 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 ALSO GIVES INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. OUR FINANCIAL ASSISTANCE PROGRAM INFORMATION IS GIVEN TO OUR MEDICAL STAFF PHYSICIANS FOR DISTRIBUTION TO PATIENTS IN THEIR OFFICES. ALL OF THE BILLING STATEMENTS LIST THAT WE HAVE A FINANCIAL ASSISTANCE PROGRAM AND THE WEBSITE URL FOR THE APPLICATION. THE FINANCIAL ASSISTANCE APPLICATION WITH COVER LETTER IS MAILED ALONG WITH THE FIRST STATEMENT SENT TO SELF-PAY PATIENTS. THE GUIDELINES ARE INCLUDED WITH THE SECOND STATEMENT AFTER A REVIEW OF THE ACCOUNT INDICATES A NEED FOR FINANCIAL ASSISTANCE. PATIENT ACCOUNT REPRESENTATIVES REVIEW OUR FINANCIAL ASSISTANCE PROGRAM WITH PATIENTS WHEN MAKING CALLS. OUR STAFF HELP PATIENTS DETERMINE ELIGIBILITY FOR MEDICAID, OTHER ASSISTANCE PROGRAMS, AND OUR FINANCIAL CARE PROGRAM. THEY ALSO ASSIST 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. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICES 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 CONSIST 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 PART VI, LINE 5: SBAMH PARTICIPATES OR PROVIDES SUPPORT TO: - PROVIDING LOW COST SCREENING PROGRAMS FOR CARDIAC HEALTH, OSTEOPOROSIS AND HYPERTENSION.- PROVIDING FREE INFLUENZA VACCINATIONS TO UNINSURED MEMBERS OF THE COMMUNITY THROUGH A PARTNERSHIP WITH THE BUTLER COUNTY HEALTH DEPARTMENT.- EL DORADO CHAMBER OF COMMERCE, EL DORADO INC., KIWANIS AND ANDOVER CHAMBER.- BCC-BG PRODUCTS VETERANS SPORTS COMPLEX.- VOLUNTEER RECOGNITION PROGRAM- BLOOD DRIVE- SBAMH HAS A VOLUNTEER BOARD OF 12 MEMBERS THAT COME FROM THROUGHOUT OUR SERVICE AREA. 1 X X X X 0 0 0 0 0 1 0 0 0 LEONARD HERNANDEZ CHIEF EXECUTIVE OFFICER 210018 0 21002 0 10725 0 0 0 12568 0 254313 0 0 0 CINDI STRACK CHIEF FINANCIAL OFFICER 141965 0 2765 0 1326 0 0 0 12568 0 158624 0 0 0 CECILIA GOEBEL CHIEF NURSING OFFICER 141315 0 2829 0 2364 0 0 0 8903 0 155411 0 0 0 SHANE FEJFAR PHYSICIAN 572500 0 0 0 14967 0 0 0 10474 0 597941 0 0 0 NICHOLAS POSGE PODIATRIST 243225 0 0 0 247 0 0 0 12568 0 256040 0 0 0 IRAM SIRAJUDDIN PHYSICIAN 239993 0 0 0 25 0 0 0 8656 0 248674 0 0 0 CHARLES STAFFORD PHYSICIAN 191711 0 3493 0 676 0 0 0 84 0 195964 0 0 0 HANNAH CAVE NURSE PRACTITIONER 128738 0 19762 0 144 0 0 0 5286 0 153930 0 0 0 SCHEDULE J, PART I, LINE 6A MANAGEMENT INCENTIVE PLAN BASED ON CRITERIA OF CONTRIBUTION MARGIN PERCENTAGE AFTER MEETING ACCREDITATION STANDARDS AND QUALITY STANDARDS. A BUTLER COUNTY KANSAS 486035405 12343PAA3 2012-04-30 14500000 0 0 0 B BUTLER COUNTY KANSAS 486035405 2014-12-16 6500000 SEE PART VI 0 0 0 A 14500655 14500655 24 3607315 10983316 2013 1 1 1 1 B 5079463 6503000 110354 6392646 2017 0 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 1 B 1 PART I, LINE A, COLUMN (F) IMPROVE AND EQUIP HOSPITAL FACILITIES; REFUND SERIES 1998Z BONDS (ISSUED 12/22/1998); REFUND SERIES 2002Q BONDS (ISSUED 12/17/2002). PART I, LINE B, COLUMN (F) RENOVATIONS TO AND EQUIPMENT FOR HOSPITAL FACILITIES. PART II, LINE 3, COLUMN A PART II, LINE 3, COLUMN B PART II, LINE 11, COLUMN A PART II, LINE 15, COLUMN A THE BOND ISSUE CONSTITUTES AN "ADVANCE REFUNDING ISSUE" UNDER U.S. TREASURY REGS 1.150-1(D), BUT NO BOND THAT IS PART OF THE BOND ISSUE IS AN "ADVANCE REFUNDING BOND" UNDER I.R.C. 149(D). THE BONDS WERE ISSUED AS A "DRAW-DOWN LOAN" WITHIN MEANING OF U.S. TREASURY REGS 1.150(1)(C)(4)(I). THE FIRST DRAW/ADVANCE ON THE BONDS WAS MADE APRIL 30, 2012 (I.E., THE ISSUE DATE OF THE BOND ISSUE), IN PART, TO REFUND AND REDEEM A PRIOR SERIES OF 1998Z BONDS ON MAY 1, 2012; THE SECOND DRAW/ADVANCE ON THE BONDS WAS MADE DECEMBER 14, 2012, IN PART, TO REFUND AND REDEEM A PRIOR SERIES 2002Q BONDS ON DECEMBER 15, 2012. THEREFORE, THERE ARE NO ADVANCE REFUNDING BONDS, BECAUSE NO BOND PROCEEDS WERE USED TO PAY DEBT SERVICE ON A PRIOR SERIES OF BONDS MORE THAN 90 DAYS AFTER THE ISSUE DATE OF THAT BOND. PART III, COLUMN A PART III HAS BEEN COMPLETED FOR THE PROJECTS ORIGINALLY FINANCED AFTER JANUARY 1, 2003. PART IV, LINE 2C, COLUMN A ARBITRAGE COMPUTATION COMPLETED AS OF 1/1/2014. PART IV, LINE 2C, COLUMN B ARBITRAGE COMPUTATION COMPLETED AS OF 8/1/2017. FORM 990, PART III, LINE 4A SUSAN B. ALLEN MEMORIAL HOSPITAL (SBAMH) 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 COSTS. - HOSTED VETERANS TO EAT A NUTRITIONAL MEAL IN OUR SBA CAFE FOR FREE. - PARTICIPATED IN EL DORADO'S TRICK OR TREAT DOWN MAIN STREET EVENT IN THE COMMUNITY. - HOSTED WELLNESS SCREENINGS FOR EMPLOYEES OF BUTLER RURAL ELECTRIC AND BUTLER COUNTY/BUTLER VITALITY. THIS INCLUDES BLOOD PRESSURE, WEIGHT, BMI, LIPID PROFILES, HEMOGLOBIN A1C DIABETES TESTING, AND PSA SCREENINGS. PARTICIPATION WAS FROM MED/SURG UNIT, LABORATORY, REGISTRATION, MARKETING, MAINTENANCE, AND INFECTION DISEASE DEPARTMENTS. - SERVED AS A PROJECT SEARCH HOST SITE FOR A PROGRAM IN PARTNERSHIP WITH BUTLER COMMUNITY COLLEGE, PROJECT SEARCH IS A HIGH SCHOOL TO WORK TRANSITION PROGRAM SERVICING STUDENTS WITH DISABILITIES. THE STUDENTS WORK ONSITE TO LEARN EMPLOYABILITY AND JOB SKILLS. - SBA AUXILIARY HAS 156 TOTAL MEMBERS WITH 50-60 BEING ACTIVE THROUGHOUT 2022. - HOSTED 11 VENDOR EVENTS FOR OUR STAFF AND COMMUNITY. THESE VENDOR SALES RESULTED IN 281 VOLUNTEER HOURS INVESTED BACK TO SBA AND COMMUNITY. - AWARDED $5,000 IN SCHOLARSHIP CHECKS TO 5 AREA COLLEGE STUDENTS GOING INTO THE MEDICAL FIELD. - $208,417 TOTAL SCHOLARSHIPS AWARDED TO AREA COLLEGE STUDENTS GOING INTO THE MEDIAL FIELD. - SEWING SAINTS GROUP MADE AND DELIVERED TO HOSPITAL PATIENTS 856 BABY BONNETS, BABY MITTS, MANY STUFFER TOYS, CHEMO CAPS AND FABRIC MASKS. - DONATED SWADDLERS AND ONESIES FOR NEWBORN BABIES. - DONATED AN LED "TAKE A NUMBER" SYSTEM FOR ADMISSIONS. - 310 CANCER CENTER PATIENTS RECEIVED NUTRITIONAL MEALS FORM OUR MATT CROSS FUND FOR CARE DURING TREATMENTS. -1 PATIENT RECEIVED PRESCRIPTION ASSISTANCE THROUGH OUR SBA PHARMACY AND PARTNERSHIP WITH TRUECARE PHARMACY. - 45 PATIENTS RECEIVED GAS CARDS FROM OUR TRANSPORTATION FUND TO BE ABLE TO DRIVE TO AND FROM THEIR CANCER CENTER VISITS. - PROVIDED 313 FREE INFLUENZA VACCINATIONS FOR ALL SBA STAFF AND VOLUNTEERS. - PROVIDED A NUMBER OF DIRECTORS AND STAFF TO SPEAK AT LOCAL SCHOOL DISTRICTS REGARDING HEALTH AND WELLNESS; PHYSICAL REHAB, ALLERGY/IMMUNOLOGY, RADIATION ONCOLOGY, PODIATRY. STAFF ALSO PROVIDED A POISON PREVENTION PRESENTATION AT ALL THE EL DORADO ELEMENTARY SCHOOLS. - 189 KIDS WERE INVOLVED IN A WELLNESS PROGRAM SUPPORTED BY THE MARY K CONNELL FUND FOR WELLNESS AND YMCA WORKING ON WELLNESS INITIATIVE. IN THIS PROGRAM, WE ENGAGE WITH GROUPS OF TEACHERS OR SCHOOL STAFF MEMBERS TO WORK ON IMPLEMENTING HEALTHIER LIFESTYLE CHOICES THROUGH NUTRITIONAL EDUCATION, FITNESS TRAINING AND HEALTH CHOICES. THE PROGRAM INCLUDES: - WALKING/RIDING YOUR BIKE TO SCHOOL - 29 KIDS PARTICIPATED IN THIS PROGRAM TO ENCOURAGE ELEMENTARY AGED STUDENTS TO WALK OR RIDE THEIR BIKE TO SCHOOL. PROGRAM INCLUDED PRIZES (IN 2022, 71 WERE GIVEN OUT). EACH PRIZE REPRESENTS A WEEK OF WALKING OR RIDING THEIR BIKE TO SCHOOL. - FIFTH GRADE WELLNESS CLASSES - 150 KIDS PARTICIPATED IN PARTNERSHIP WITH EL DORADO ELEMENTARY SCHOOLS AND THE YMCA, WE ATTENDED 6 WEEKS OF PHYSICAL EDUCATION CLASSES AT 3 SCHOOLS (GRANDVIEW, BLACKMORE, SKELLY). PARTICIPANTS RECEIVED A WATER BOTTLE AND TRACKING BOOKLET WITH A CELEBRATION LUNCH AT THE END.-PROVIDED CPR, ACLS AND PALS COURSES . - STAFF VOLUNTEERS TO VISITED COMMUNITY MEMBERS AT THE NURSING CARE FACILITY TO PROVIDE FREE NAIL TRIMMING FOR SENIOR CITIZENS. - 70 MEALS ON WHEELS VOLUNTEERS DONATED THEIR TIME TO DELIVER NUTRITIONAL MEALS TO ROUGHLY 100 HOMEBOUND OLDER ADULTS AND PEOPLE WITH DISABILITIES. MEALS ON WHEELS IS A PROGRAM THAT DELIVERS MEALS TO INDIVIDUALS AT HOME WHO ARE UNABLE TO PURCHASE OR PREPARE THEIR OWN MEALS. THE NAME IS OFTEN USED GENERICALLY TO REFER TO HOME-DELIVERED MEALS PROGRAMS, NOT ALL OF WHICH ARE ACTUALLY NAMED "MEALS ON WHEELS." - PARTICIPATED IN CHAMPS, WHICH STANDS FOR CHOOSING HEALTHY APPETIZING MEAL PLAN SOLUTIONS FOR SENIORS. THIS IS OFFERED THROUGH THE OLDER AMERICANS ACT. A FEDERALLY FUNDED PROGRAM AND THROUGH THE NUTRITION PROGRAM/AAA. AN ESTIMATED 150 OLDER ADULTS RECEIVED ONE NUTRITIOUS MEAL SEVEN DAYS A WEEK THROUGH THE SBA CAFE. - HOSTED AND PROVIDED FREE CHILDBIRTH EDUCATIONAL CLASSES FOR NEW MOMS AND FAMILY MEMBERS REGARDLESS OF WHERE THEY WERE DELIVERING. OBSTETRICS STAFF PROVIDED EDUCATION AND INFORMATION ABOUT LABOR/DELIVERY, COMFORT MEASURES, PAIN MANAGEMENT, NEWBORN CARE, RECOVERY/DISCHARGE. 32 PEOPLE ATTENDED THE 7 TOTAL CLASSES OFFERED DURING 2022. - PROVIDED BREASTFEEDING EDUCATION FOR NEW MOMS POST-DELIVERY. - ADMINISTRATIVE AND MANAGEMENT STAFF SERVED ON A VARIETY OF BOARDS AND COMMITTEES: PROJECT SEARCH, ACT 1 PLAYERS, GIRL SCOUT TROOP, HARRY HYNES MEMORIAL HOSPICE, EL DORADO CHAMBER OF COMMERCE, KIWANIS, ROTARY, AMERICAN HOSPITAL ASSOCIATION INSTITUTE FOR DIVERSITY & HEALTH EQUITY BOARD, BLUE CROSS BLUE SHIELD OF KANSAS BOARD, EL DORADO INC. BOARD, SOROPTIMIST INTERNATIONAL OF EL DORADO. - MADE AVAILABLE A SPEAKER BUREAU TO OUR COMMUNITY, HOSPITAL STAFF OFFERS AND SPEAKS TO VARIOUS CIVIC GROUPS/ORGANIZATIONS. - EMPLOYEE APPRECIATION TEAM AND EMPLOYEES DONATED VARIOUS ITEMS TO NONPROFITS IN OUR COMMUNITY IN NEED. - HOSPITAL EMPLOYEES PARTICIPATED IN AND DONATED OVER 5,000 IN SUPPORT OF THE EL DORADO UNITED WAY PROGRAM TO HELP SUPPORT OTHER NONPROFITS. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE HOSPITAL'S OFFICERS AND THE ACCOUNTING DIRECTOR. ANY QUESTIONS OR CONCERNS THE HOSPITAL'S OFFICERS OR ACCOUNT DIRECTOR HAVE ARE ADDRESSED AND ANY CLARIFICATION OR CORRECTIONS MADE AS NEEDED. FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF HIRE OR ELECTION IN THE CASE OF BOARD MEMBERS, AND ANNUALLY THEREAFTER, THE PRESIDENT AND CEO OR THEIR DESIGNEE SHALL PROVIDE TO THE BOARD, EXECUTIVE OFFICERS AND DEPARTMENT DIRECTORS, A COPY OF THE CONFLICT OF INTEREST POLICY AND THE CONFLICT OF INTEREST DISCLOSURE STATEMENT WHICH WILL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WITH RESPECT IT IS BELIEVED A CONFLICT MAY ARISE. THE ANNUAL REVIEW AND MONITORING IS A PART OF THE HOSPITAL'S COMPLIANCE PLAN. A REPORT SHALL BE MADE TO THE BOARD OF TRUSTEES OF ITEMS DISCLOSED. EACH MEMBER OF THE BOARD OF TRUSTEES OR MANAGEMENT SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL POTENTIAL CONFLICTS OF INTEREST WHICH MAY EXIST OR APPEAR TO EXIST. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL PARTICIPATES IN AN EXTERNAL SALARY SURVEY FOR ALL EXECUTIVE POSITIONS. THE PRESIDENT AND CEO AND CHIEF HUMAN RESOURCES OFFICER REVIEWS THE SURVEY RESULTS AND PRESENTS THEM TO THE COMPENSATION COMMITTEE OF THE BOARD WITH RECOMMENDATIONS FOR THE EXECUTIVE AND VICE PRESIDENT POSITIONS. 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 AND CEO SALARY TO THE FULL BOARD FOR APPROVAL. THE REVIEW IS DONE ANNUALLY BY THE COMPENSATION COMMITTEE AND THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,874,278. MANAGEMENT AND GENERAL EXPENSES 531,745. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,406,023. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,687,612. MANAGEMENT AND GENERAL EXPENSES 762,494. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,450,106. FORM 990, PART XI, LINE 9: PASS THRU GAIN/LOSS 1,132. SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION 720 WEST CENTRAL EL DORADO KS 67042 480862732 SUPPORT ORG KS 501(C)(3) LINE 12A, I SBA HOSPITAL 1 FS ALLEN 720 WEST CENTRAL EL DORADO KS 67042 486103710 GRANTOR TRUST KS N/A T 702178 2573634 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION C 35201 CASH