SUSAN B ALLEN MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SUSAN B ALLEN MEMORIAL HOSPITAL (EIN 48-0581968)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-04
- IRS object ID
- 202243089349303019
- Schema version
- 2021v4.2
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-04T14:50:49-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621517792 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PYA P C | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 SUTHERLAND AVE | AddressLine1Txt |
| City | KNOXVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37919 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480581968 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUSA | BusinessNameControlTxt |
| Phone | 3163213300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1Txt |
| City | EL DORADO | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67042 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LEONARD HERNANDEZ | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 3163213300 | PhoneNum |
| Signature | 2022-11-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LEONARD | PersonFirstNm |
| Person Last | HERNANDEZ | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRY HAEFNER | PreparerPersonNm |
| PTIN | P01258953 | PTIN |
| Phone | 8656730844 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LEONARD HERNANDEZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1Txt |
| City | EL DORADO | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,718,166 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SBAMH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1930 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF SUSAN B. ALLEN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 371 | TotalEmployeeCnt |
| Total Volunteers | 78 | TotalVolunteersCnt |
| Total Gross UBI | -$2,695 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,241,117 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,923,077 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $36,747,548 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $38,201,881 | CYProgramServiceRevenueAmt |
| PY Investment Income | $570,158 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,581,576 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,741,200 | PYOtherRevenueAmt |
| CY Other Revenue | $950,288 | CYOtherRevenueAmt |
| PY Total Revenue | $46,300,023 | PYTotalRevenueAmt |
| CY Total Revenue | $42,656,822 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,179 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,205,709 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,651,937 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,190,706 | PYOtherExpensesAmt |
| CY Other Expenses | $21,465,181 | CYOtherExpensesAmt |
| PY Total Expenses | $43,401,594 | PYTotalExpensesAmt |
| CY Total Expenses | $41,117,118 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,898,429 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,539,704 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $57,597,268 | TotalAssetsBOYAmt |
| Total Assets EOY | $55,505,865 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,574,268 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,120,603 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $44,023,000 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $45,385,262 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $33,672,860 | ExpenseAmt |
| Revenue | $39,020,572 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $33,672,860 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 98 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 371 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CINDI STRACK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3163224544 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1Txt |
| City | EL DORADO | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67042 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CAMI BAKER | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL CLIFTON | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MIKE BELLESINE | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GLENN BUCHHOLZ | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| VINCE HAINES | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GREG JOYCE OD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD KUHNS MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRANDI LANE | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SUZIE LOCKE | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RYAN MURRY | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL RAUSCH MD | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JEREMY SUNDGREN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LEONARD HERNANDEZ | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $220,743 | $0 | $12,568 | 1.00 | ||
| CINDI STRACK | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $145,193 | $0 | $22,098 | |||
| MELISSA HALL | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $53,378 | $0 | $84 | |||
| CECILIA GOEBEL | ||||||||
| CHIEF NURSING OFFICER | 40.00 | Yes (X) | $146,080 | $0 | $11,363 | |||
| NICHOLAS POSGE | ||||||||
| PODIATRIST | 40.00 | $232,679 | $0 | $19,348 | Yes (X) | |||
| IRAM SIRAJUDDIN | ||||||||
| ALLERGY/IMMUNOLOGY PHYSICIAN | 40.00 | $240,271 | $0 | $10,096 | Yes (X) | |||
| CHARLES STAFFORD | ||||||||
| RADIATION ONCOLOGY PHYSICIST | 40.00 | $195,230 | $0 | $84 | Yes (X) | |||
| EDWARD DE YOUNG | ||||||||
| SURGERY COORDINATOR | 40.00 | $146,936 | $0 | $10,661 | Yes (X) | |||
| HANNAH CAVE | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $156,794 | $0 | $84 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,537,304 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $86,386 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| VIGILIAS LLC DBA FREESTATE CONNECT | |||||
| 4704 E OAKLAND ST | WICHITA | KS | 67218 | PHYSICIAN SERVICES | $1,110,425 |
| TRAJECTORY RCS LLC | |||||
| 10111 E 21ST B | WICHITA | KS | 67206 | REVENUE CYCLE SERVICES | $699,737 |
| QUALIVIS | |||||
| PO BOX 123847 | DALLAS | TX | 75312 | CONTRACT LABOR | $689,757 |
| PHILIPS HEALTHCARE | |||||
| PO BOX 100355 | ATLANTA | GA | 30384 | SERVICE CONTRACTS | $588,304 |
| AVEC HEALTH SOULUTIONS | |||||
| PO BOX 66936 | ST LOUIS | MO | 63166 | REVENUE CYCLE SERVICES | $512,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 20 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $115,459 | RelatedOrganizationsAmt |
| Government Grants | $1,783,292 | GovernmentGrantsAmt |
| All Other Contributions | $24,326 | AllOtherContributionsAmt |
| Total Contributions | $1,923,077 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $38,086,089 | $38,086,089 |
| MEALS ON WHEELS | 624200 | $115,792 | $115,792 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $38,201,881 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,642,920 | TotalRevenueColumnAmt |
| Exclusion | $1,642,920 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $430 | TotalRevenueColumnAmt |
| Exclusion | $430 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $739,357 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $739,357 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $739,357 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $739,357 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $61,344 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$61,344 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$61,344 | TotalRevenueColumnAmt |
| Exclusion | -$61,344 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA | $133,862 | $133,862 | ||
| MISCELLANEOUS | $79,334 | $79,334 | ||
| PARTNERSHIP INCOME | -$2,695 | -$2,695 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $210,501 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,656,822 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,020,572 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$2,695 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,715,868 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $512,016 | TotalAmt |
| Management And General | $512,016 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,281,153 | TotalAmt |
| Program Services | $13,187,734 | ProgramServicesAmt |
| Management And General | $3,093,419 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,689 | TotalAmt |
| Program Services | $7,038 | ProgramServicesAmt |
| Management And General | $1,651 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,681,028 | TotalAmt |
| Program Services | $1,361,633 | ProgramServicesAmt |
| Management And General | $319,395 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,169,051 | TotalAmt |
| Program Services | $946,931 | ProgramServicesAmt |
| Management And General | $222,120 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,478 | TotalAmt |
| Management And General | $25,478 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,714 | TotalAmt |
| Management And General | $115,714 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,191 | TotalAmt |
| Management And General | $47,191 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,251,764 | TotalAmt |
| Program Services | $4,817,255 | ProgramServicesAmt |
| Management And General | $1,434,509 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,740 | TotalAmt |
| Program Services | $5,964 | ProgramServicesAmt |
| Management And General | $1,776 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $837,901 | TotalAmt |
| Program Services | $645,639 | ProgramServicesAmt |
| Management And General | $192,262 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,273 | TotalAmt |
| Program Services | $152,007 | ProgramServicesAmt |
| Management And General | $45,266 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,896 | TotalAmt |
| Program Services | $55,422 | ProgramServicesAmt |
| Management And General | $18,474 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,676,560 | TotalAmt |
| Program Services | $1,873,592 | ProgramServicesAmt |
| Management And General | $802,968 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $519,891 | TotalAmt |
| Program Services | $400,599 | ProgramServicesAmt |
| Management And General | $119,292 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES - MEDICAL | $5,172,032 | $5,172,032 | |
| BAD DEBT | $3,165,797 | $3,165,797 | |
| REPAIRS AND MAINTENANCE | $1,266,158 | $975,630 | $290,528 |
| SUPPLIES - GENERAL | $495,714 | $381,969 | $113,745 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $612,072 | TotalAmt |
| Program Services | $523,618 | ProgramServicesAmt |
| Management And General | $88,454 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,117,118 | TotalAmt |
| Program Services | $33,672,860 | ProgramServicesAmt |
| Management And General | $7,444,258 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,987,341 | BOYAmt |
| EOY | $4,645,092 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,072,780 | BOYAmt |
| EOY | $7,421,525 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $776,409 | BOYAmt |
| EOY | $749,089 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $464,625 | BOYAmt |
| EOY | $743,765 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $88,865,846 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $60,945,597 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,565,466 | BOYAmt |
| EOY | $27,920,249 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,706,137 | BOYAmt |
| EOY | $9,344,924 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,397,607 | BOYAmt |
| EOY | $3,990,126 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,605 | BOYAmt |
| EOY | $29,120 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $508,298 | BOYAmt |
| EOY | $661,975 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,597,268 | BOYAmt |
| EOY | $55,505,865 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,104,823 | BOYAmt |
| EOY | $7,389,134 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,469,445 | BOYAmt |
| EOY | $2,731,469 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,574,268 | BOYAmt |
| EOY | $10,120,603 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,635,971 | BOYAmt |
| EOY | $40,656,557 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,387,029 | BOYAmt |
| EOY | $4,728,705 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,023,000 | BOYAmt |
| EOY | $45,385,262 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,597,268 | BOYAmt |
| EOY | $55,505,865 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,539,704 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$180,137 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,695 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,050,761 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $359,705 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $7,500 | AdministrativeExpensesAmt |
| End Year Balance | $3,402,966 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,531,526 | BeginningYearBalanceAmt |
| Contributions | $263,800 | ContributionsAmt |
| Investment Earnings Or Losses | $324,572 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $69,137 | AdministrativeExpensesAmt |
| End Year Balance | $3,050,761 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,963,579 | BeginningYearBalanceAmt |
| Contributions | $5,300 | ContributionsAmt |
| Investment Earnings Or Losses | $562,647 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,531,526 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,141,962 | BeginningYearBalanceAmt |
| Contributions | $9,966 | ContributionsAmt |
| Investment Earnings Or Losses | -$178,045 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $10,304 | AdministrativeExpensesAmt |
| End Year Balance | $1,963,579 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,887,242 | BeginningYearBalanceAmt |
| Contributions | $20,087 | ContributionsAmt |
| Investment Earnings Or Losses | $243,725 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $9,092 | AdministrativeExpensesAmt |
| End Year Balance | $2,141,962 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.80260 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.13254 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.06486 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,003,563 | OtherCostOrOtherBasisAmt |
| Book Value | $4,003,563 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,766,512 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,211,671 | DepreciationAmt |
| Book Value | $20,554,841 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,774,860 | OtherCostOrOtherBasisAmt |
| Depreciation | $33,509,922 | DepreciationAmt |
| Book Value | $3,264,938 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,320,911 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,224,004 | DepreciationAmt |
| Book Value | $96,907 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $27,920,249 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER SECURITIES | Desc |
| Book Value | $3,990,126 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,990,126 | TotalBookValueSecuritiesAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $39,313,583 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$180,137 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$180,137 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,493,720 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,163,102 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,163,102 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $42,656,822 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $37,951,321 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $37,951,321 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,165,797 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,165,797 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $41,117,118 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2021. AT DECEMBER 31, 2021, TAX RETURNS FOR YEARS 2018 THROUGH 2020 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 3,165,797. FLOW THRU PARTNERSHIP INCOME/LOSS -2,695. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 3,165,797. |
| 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,175,703 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,134,525 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $41,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,208,108 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,098,290 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $109,818 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,383,811 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,232,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $150,996 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,383,811 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,232,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $150,996 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,165,797 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $319,745 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,460,336 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,464,175 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,003,839 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1Txt |
| City | EL DORADO | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SBAMH.ORG | WebsiteAddressTxt |
| State License | H-008-002 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SUSAN. B ALLEN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: BASED ON DATA ACQUIRED FROM THE 2016 CHNA, HEALTH AND WELLNESS COMMUNITY PARTNERS WERE INVITED TO GIVE INPUT DURING THE 2019 CHNA DATA COLLECTION PROCESS AND PARTICIPATED IN THE TOWN HALL MEETING THAT FOLLOWED WHERE GAPS IN SIGNIFICANT NEEDS WERE IDENTIFIED AND PRIORITIZED. THESE PARTNERS INCLUDED BUT WERE NOT LIMITED TO: BUTLER COUNTY HEALTH DEPT, 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, DEPARTMENT OF HUMAN SERVICES, ETC. |
| SUSAN. B ALLEN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: SBAMH HAS ADOPTED A "POPULATION HEALTH" PHILOSOPHY WHERE HEALTH & WELLNESS SERVICES ARE DEVELOPED AND DELIVERED TO ALL CITIZENS IN OUR SERVICE AREA. THE 2019 CHNA IDENTIFIED THREE (3) MAJOR UNDERSERVED AREAS OF SIGNIFICANT NEED; MENTAL HEALTH/ALLIED HEALTH, POVERTY, AND SUBSTANCE ABUSE. |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 PERCENTAGE WAS 2.73%. |
| PART III, LINE 2: | NON-MEDICARE AND NON-MEDICAID ACCOUNTS RESERVE AT 100% AT THE POINT OF AGING OVER 180 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 15 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 ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS COMPLETED IN 2019 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 CHARITY CARE PROGRAM. OUR CHARITY CARE 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 CHARITY CARE PROGRAM AND THE WEBSITE URL FOR THE APPLICATION. THE CHARITY CARE 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 CHARITY CARE PROGRAM WITH PATIENTS WHEN MAKING CALLS. OUR STAFF HELP PATIENTS DETERMINE ELIGIBILITY FOR MEDICAID, OTHER ASSISTANCE PROGRAMS, AND OUR CHARITY 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 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. |
| 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 DRIVESBAMH HAS A VOLUNTEER BOARD OF 12 MEMBERS THAT COME FROM THROUGHOUT OUR SERVICE AREA. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LEONARD HERNANDEZ | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $210,018 | $0 | $0 | $0 | $10,725 | $0 | $0 | $0 | $12,568 | $0 | $233,311 | $0 | $0 | $0 |
| CINDI STRACK | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $141,526 | $0 | $0 | $0 | $3,667 | $0 | $0 | $0 | $22,098 | $0 | $167,291 | $0 | $0 | $0 |
| CECILIA GOEBEL | ||||||||||||||
| CHIEF NURSING OFFICER | $142,515 | $0 | $0 | $0 | $3,565 | $0 | $0 | $0 | $11,363 | $0 | $157,443 | $0 | $0 | $0 |
| NICHOLAS POSGE | ||||||||||||||
| PODIATRIST | $232,457 | $0 | $0 | $0 | $222 | $0 | $0 | $0 | $19,348 | $0 | $252,027 | $0 | $0 | $0 |
| IRAM SIRAJUDDIN | ||||||||||||||
| ALLERGY/IMMUNOLOGY PHYSICIAN | $239,043 | $0 | $0 | $0 | $1,228 | $0 | $0 | $0 | $10,096 | $0 | $250,367 | $0 | $0 | $0 |
| CHARLES STAFFORD | ||||||||||||||
| RADIATION ONCOLOGY PHYSICIST | $191,711 | $0 | $0 | $0 | $3,519 | $0 | $0 | $0 | $84 | $0 | $195,314 | $0 | $0 | $0 |
| EDWARD DE YOUNG | ||||||||||||||
| SURGERY COORDINATOR | $125,908 | $0 | $0 | $0 | $21,028 | $0 | $0 | $0 | $10,661 | $0 | $157,597 | $0 | $0 | $0 |
| HANNAH CAVE | ||||||||||||||
| PHYSICIAN ASSISTANT | $121,181 | $0 | $0 | $0 | $35,613 | $0 | $0 | $0 | $84 | $0 | $156,878 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 6A | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT INCENTIVE PLAN BASED ON CRITERIA OF CONTRIBUTION MARGIN PERCENTAGE AFTER MEEETING ACCREDITATION STANDARDS AND QUALITY STANDARDS. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| BUTLER COUNTY KANSAS | ||||||||
| A | 486035405 | 12343PAA3 | 2012-04-30 | $14,500,000 | SEE PART VI | 0 | 0 | 0 |
| BUTLER COUNTY KANSAS | ||||||||
| B | 486035405 | 2014-12-16 | $6,500,000 | SEE PART VI | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Capitalized InterestCapitalizedInterestAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $14,500,655 | $14,500,655 | $24 | $3,607,315 | $10,983,316 | 2013 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | |
| B | $4,394,673 | $6,503,000 | $6,392,646 | 2017 | 0 | 0 | Yes (1) | Yes (1) | $110,354 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE A, COLUMN (F) | IMPROVE AND EQUIP HOSPITAL FACILITIES; REFUND SERIES 1998Z BONDS (ISSUED 12/22/1998); REFUND SERIES 2002Q BONDS (ISSUED 12/17/2002). |
| PART 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | COMMUNITY SERVICES: 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 COST. - HOSTED VETERANS TO EAT A NUTRITIONAL MEAL IN OUR SBA CAFE FOR FREE. - OFFERED COVID-19 VACCINATION CLINICS. - PARTICIPATED IN EL DORADO'S TRICK OR TREAT DOWN MAIN STREET EVENT IN THE COMMUNITY. - RECEIVED THE EL DORADO CHAMBER OF COMMERCE BUSINESS OF THE MONTH - FOR PROVIDING HEALTHCARE, EDUCATIONAL AND WELLNESS TO OUR COMMUNITY. - HOSTED WELLNESS SCREENINGS FOR EMPLOYEES OF BUTLER RUAL ELECTRIC AND BUTLER COUNTY/BUTLER VITATLITY. THIS INCLUDED BLOOD PRESSURE, WEIGHT, BMI, LIPID PROFILES, HEMOGLOBAN A1C DIABETES TESTING, AND PSA SCREENINGS. PARTICIPATION WAS FROM OUR MED/SURG UNIT, LABORATORY, REGISTRATION/ADMISSION, MARKETING, MAINTENANCE, AND INFECTION DISEASE DEPARTMENTS. - SERVED AS PROJECT SEARCH HOST SITE 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. - HOSTED 2 AMERICAN RED CROSS BLOOD DRIVES FOR A TOTAL 35 UNITS OF BLOOD COLLECTED. - SBA AUXILIARY HAS 100 TOTAL MEMBERS WITH 50-60 BEING ACTIVE THROUGHOUT THE YEAR: - HOSTED 12 VENDOR EVENTS FOR OUR STAFF AND COMMUNITY. THESE VENDOR SALES RESULTED IN 133 VOLUNTEER HOURS INVESTED BACK TO SBA AND COMMUNITY. - AWARDED $9,000 IN SCHOLARSHIP CHECKS TO AREA COLLEGE STUDENTS GOING INTO THE MEDICAL FIELD. - $203,417 TOTAL SCHOLARSHIPS AWARDED IN SCHOLARSHIPS SINCE 1973, TO ASSIST COLLEGE STUDENTS IN THE HEALTHCARE FIELD. - SEWING SAINTS GROUP MADE A DELIVERED TO HOSPITAL PATIENTS: 201 BABY BONNETS, 201 BABY MITTS, MANY STUFFED TOYS, CHEMO CAPS AND FABRIC MASKS. THEY ALSO OFFERED 'ACTIVITY MATS' TO PATIENTS IN OUR REHABILITATION DEPARTMENT WHO NEEDED TO TAKE THEM HOME DURING COVID-19. - 195 CANCER CENTER PATIENTS RECEIVED NUTRITIONAL MEALS FROM OUR MATT CROSS FUND FOR CARE DURING TREATMENTS. - 4 TOTAL PATIENTS RECEIVED PRESCRIPTION ASSISTANCE THROUGH OUR SBA PHARMACY AND PARTNERSHIP WITH TRUECARE PHARMACY. - 46 TOTAL PATIENTS RECEIVED GAS CARDS TO BE ABLE TO DRIVE TO AND FROM THEIR CANCER CENTER VISITS - FROM OUR TRANSPORTATION ASSISTANCE FUND. - 100 SOCKS (WITH ENCOURAGING MESSAGES) WERE GIVEN AWAY TO CANCER CENTER PATIENTS DURING OCTOBER FOR OUR 'SOCK IT TO CANCER' CAMPAIGN TO HONOR AND SUPPORT BREAST CANCER AWARENESS MONTH. - PROVIDED FREE INFLUENZA VACCINATIONS FOR ALL SBA STAFF AND VOLUNTEERS. 305 FLU SHOTS WERE GIVEN TO SBA EMPLOYEES AND VOLUNTEERS. - PROVIDED FREE INFLUENZA VACCINATIONS FOR COMMUNITY MEMBERS WHO ARE UNINSURED. WITH OUR PARTNERSHIP WITH BUTLER COUNTY HEALTH DEPARTMENT, WE HELD 6 COMMUNITY CLINICS (EL DORADO, AUGUSTA, ANDOVER, ROSE HILL). A TOTAL OF 203 FLU SHOTS WERE ADMINISTERED TO THE UNINSURED. - INVOLVED WITH THE NONPROFIT - ICT STREET TEAM WHICH IS A NON-PROFIT THAT PROVIDES FREE MEDICAL SERVICES INCLUDING FREE MEDICATIONS TO THE HOMELESS. - 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 OF THE EL DORADO ELEMENTARY SCHOOLS. - 252 KIDS WERE INVOLVED IN WELLNESS PROGRAMS SUPPORTED BY THE MARY K CONNELL FUND FOR WELLNESS INITIATIVE EL DORADO 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. DIRECTORS AND STAFF FROM SBA AND THE YMCA LEAD THE GROUP DISCUSSIONS. THE PROGRAM BREAKDOWN IS AS FOLLOWS: - WALKING/RIDING YOUR BIKE TO SCHOOL - 50 KIDS PARTICIPATED - PROGRAM TO ENCOURAGE ELEMENTARY AGED STUDENTS TO WALK OR RIDE THEIR BIKES TO SCHOOL. PROGRAM ALSO INCLUDES PRIZES (IN 2021, 73 WERE GIVEN OUT). EACH PRIZE REPRESENTS A WEEK OF WALKING OR BIKE RIDING TO SCHOOL. - MIDDLE SCHOOL AFTER SCHOOL PROGRAM - 55 KIDS PARTICIPATED - IN PARTNERSHIP WITH THE YMCA, THIS PROGRAM PROVIDES A SAFE PLACE WITH POSITIVE ROLE MODELS AND LOTS OF PHYSICAL ACTIVITY. STUDENTS IN PROGRAM WHO WERE NOT PARTICIPATING IN SPORTS, RESULTED IN IMPROVED DISCIPLINE AT SCHOOL AND ANECDOTALLY FEWER POLICE REPORTS. - ENHANCED THE POWERUP PROGRAM - 60 KIDS PARTICIPATED - IN PARTNERSHIP WITH THE YMCA, THIS PROGRAM ENHANCES WELLNESS AND PHYSICAL ACTIVITY AFTERSCHOOL FOR ELEMENTARY AGED KIDS (1ST-5TH). THIS FREE PROGRAM WILL OFFER KIDS SOCIAL AND PHYSICAL ACTIVITIES WITH FRIENDS AND OFFER THE OPPORTUNITY TO TRY NEW ACTIVITIES ALL UNDER APPROPRIATE SUPERVISION. KIDS CAN EXPERIENCE DIFFERENT SPORTS/ACTIVITIES EACH WEEK INCLUDING FIELD DAYS, DODGEBALL, FLAG FOOTBALL, PICKLEBALL, SOCCER, SPIKE BALL, BASKETBALL AND MORE. - FIFTH GRADE WELLNESS CLASSES - 87 KIDS PARTICIPATED - IN PARTNERSHIP WITH EL DORADO ELEMENTARY SCHOOLS, AND THE YMCA, WE ATTEND 6 WEEKS OF PHYSICAL EDUCATION CLASSES AT EACH SCHOOL (GRANDVIEW -36, BLACKMORE -51, SKELLY -TBD). PARTICIPANTS RECEIVED A WATER BOTTLE, PEDOMETER AND TRACKING BOOKLET. ON COMPLETION OF THE PROGRAM, WE HOST A CELEBRATION LUNCH FOR EACH CLASS. - HOSTED THREE JOB FAIRS AND PROVIDED INFORMATION ON OUR POSITIONS AND INSTRUCTION OF ALL THE SERVICES SBA HAS FOR COMMUNITY. - PROVIDED CPR, ACLS AND PALS COURSES. - PARTICIPATED IN THE BUTLER COUNTY EMS/STEPPING OUT PROGRAM'S FALL PREVENTION COURSE - STAFF VOLUNTEERS TO VISIT COMMUNITY MEMBERS AT THE NURSING CARE FACILITY TO PROVIDE FREE NAIL TRIMMING FOR SENIOR CITIZENS. - HOSTED SOME COMMUNITY MEMBERS FOR SBA'S 90TH ANNIVERSARY. - SUPPORTED, SPONSORED AND VOLUNTEERED FOR THE EL DORADO 150TH CELEBRATION, YMCA GOLF TOURNAMENT, EL DORADO CHAMBER OF COMMERCE WOMEN IN BUSINESS, BUTLER COMMUNITY COLLEGE ATHLETICS GRIZZLY BACKER, EHS AFTER PROM, 5 COMMUNITY WELLNESS RUNS PUT ON BY OZ EVENTS. - 70 MEALS ON WHEELS VOLUNTEERS DONATE 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." - PARTICIPATE IN CHAMPSS, WHICH STANDS FOR CHOOSING HEALTHY APPETIZING MEAL PLAN SOLUTIONS FOR SENIORS, IS OFFERED THROUGH THE OLDER AMERICANS ACT, A FEDERALLY FUNDED PROGRAM, AND THROUGH THE NUTRITION PROGRAM/AAA. THROUGH THE PROGRAM, AN ESTIMATED 150 OLDER ADULTS RECEIVE ONE NUTRITIOUS MEAL SEVEN DAYS A WEEK THROUGH THE SBA CAFE. - HOSTED AND PROVIDED MONTHLY FREE CHILDBIRTH EDUCATIONAL CLASSES FOR NEW MOMS & FAMILY MEMBERS REGARDLESS OF WHERE THEY WILL BE DELIVERING. OBSTETRICS STAFF PROVIDE EDUCATION AND INFORMATION ABOUT LABOR/DELIVERY, COMFORT MEASURES, PAIN MANAGEMENT, NEWBORN CARE, RECOVERY/DISCHARGE. 29 PEOPLE ATTENDED - 12 TOTAL CLASSES OFFERED. PROVIDE BREASTFEEDING EDUCATION FOR NEW MOMS POST-DELIVERY. - PROVIDE FREE HEARING SCREENINGS IN THE EL DORADO AUDIOLOGY/EAR, NOSE AND THROAT OFFICES EACH WEEK. - ADMINISTRATIVE AND MANAGEMENT STAFF SERVE ON A VARIETY OF BOARDS AND COMMITTEES: PROJECT SEARCH, ACT 1 PLAYERS, GIRL SCOTT TROOP, HARRY HYNES MEMORIAL HOSPICE, EL DORADO CHAMBER OF COMMERCE BOARD, 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 SPEAKERS BUREAU TO OUR COMMUNITY, HOSPITAL STAFF OFFERS AND SPEAKS TO VARIOUS CIVIC GROUPS/ORGANIZATIONS. - EMPLOYEE APPRECIATION TEAM AND EMPLOYEES DONATE VARIOUS ITEMS TO NONPROFITS IN OUR COMMUNITY IN NEED. - HOSPITAL EMPLOYEES PARTICIPATE IN AND DONATED OVER XXXXX 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 1,906,891. MANAGEMENT AND GENERAL EXPENSES 567,845. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,474,736. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,910,364. MANAGEMENT AND GENERAL EXPENSES 866,664. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,777,028. |
| FORM 990, PART XI, LINE 9: | FLOW THRU PARTNERSHIP INCOME/LOSS 2,695. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1Txt |
| City | EL DORADO | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480862732 | EIN |
| Primary Activities | SUPPORT ORG | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SBA HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FS ALLEN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 WEST CENTRAL | AddressLine1Txt |
| City | EL DORADO | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 486103710 | EIN |
| Primary Activities | GRANTOR TRUST | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | T | EntityTypeTxt |
| Share Of Total Income | $481,154 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $3,558,571 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $115,459 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |