2022-11-04T14:50:49-05:00 2021-12-31 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2021-01-01 480581968 SUSAN B ALLEN MEMORIAL HOSPITAL SUSA 3163213300 720 WEST CENTRAL EL DORADO KS 67042 LEONARD HERNANDEZ PRESIDENT & CEO 3163213300 2022-11-04 1 LEONARD HERNANDEZ 999009999 TERRY HAEFNER P01258953 8656730844 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z LEONARD HERNANDEZ 720 WEST CENTRAL EL DORADO KS 67042 42718166 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 12 371 78 -2695 0 4241117 1923077 36747548 38201881 570158 1581576 4741200 950288 46300023 42656822 5179 0 0 0 19205709 19651937 0 0 0 24190706 21465181 43401594 41117118 2898429 1539704 57597268 55505865 13574268 10120603 44023000 45385262 X TO PROVIDE COMPASSIONATE, PROFESSIONAL HEALTH CARE TO THE PEOPLE WE SERVE. 0 0 33672860 39020572 SEE SCHEDULE O 33672860 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 98 0 1 371 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 CAMI BAKER CHAIR 1.00 X X 0 0 0 MICHAEL CLIFTON VICE CHAIR 1.00 X X 0 0 0 MIKE BELLESINE TRUSTEE 1.00 X 0 0 0 GLENN BUCHHOLZ TRUSTEE 1.00 X 0 0 0 VINCE HAINES TRUSTEE 1.00 X 0 0 0 GREG JOYCE OD TRUSTEE 1.00 X 0 0 0 RICHARD KUHNS MD TRUSTEE 1.00 X 0 0 0 BRANDI LANE TRUSTEE 1.00 X 0 0 0 SUZIE LOCKE TRUSTEE 1.00 X 0 0 0 RYAN MURRY TRUSTEE 1.00 X 0 0 0 MICHAEL RAUSCH MD 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 220743 0 12568 CINDI STRACK CHIEF FINANCIAL OFFICER 40.00 X 145193 0 22098 MELISSA HALL CHIEF OPERATING OFFICER 40.00 X 53378 0 84 CECILIA GOEBEL CHIEF NURSING OFFICER 40.00 X 146080 0 11363 NICHOLAS POSGE PODIATRIST 40.00 X 232679 0 19348 IRAM SIRAJUDDIN ALLERGY/IMMUNOLOGY PHYSICIAN 40.00 X 240271 0 10096 CHARLES STAFFORD RADIATION ONCOLOGY PHYSICIST 40.00 X 195230 0 84 EDWARD DE YOUNG SURGERY COORDINATOR 40.00 X 146936 0 10661 HANNAH CAVE PHYSICIAN ASSISTANT 40.00 X 156794 0 84 1537304 0 86386 19 0 1 0 VIGILIAS LLC DBA FREESTATE CONNECT 4704 E OAKLAND ST WICHITA KS 67218 PHYSICIAN SERVICES 1110425 TRAJECTORY RCS LLC 10111 E 21ST B WICHITA KS 67206 REVENUE CYCLE SERVICES 699737 QUALIVIS PO BOX 123847 DALLAS TX 75312 CONTRACT LABOR 689757 PHILIPS HEALTHCARE PO BOX 100355 ATLANTA GA 30384 SERVICE CONTRACTS 588304 AVEC HEALTH SOULUTIONS PO BOX 66936 ST LOUIS MO 63166 REVENUE CYCLE SERVICES 512500 20 115459 1783292 24326 1923077 PATIENT SERVICE REVENUE 621110 38086089 38086089 MEALS ON WHEELS 624200 115792 115792 38201881 1642920 1642920 430 430 739357 0 739357 739357 739357 61344 -61344 -61344 -61344 CAFETERIA 133862 133862 MISCELLANEOUS 79334 79334 PARTNERSHIP INCOME -2695 -2695 210501 42656822 39020572 -2695 1715868 X 512016 512016 16281153 13187734 3093419 8689 7038 1651 1681028 1361633 319395 1169051 946931 222120 25478 25478 115714 115714 47191 47191 6251764 4817255 1434509 7740 5964 1776 837901 645639 192262 197273 152007 45266 73896 55422 18474 2676560 1873592 802968 519891 400599 119292 SUPPLIES - MEDICAL 5172032 5172032 BAD DEBT 3165797 3165797 REPAIRS AND MAINTENANCE 1266158 975630 290528 SUPPLIES - GENERAL 495714 381969 113745 612072 523618 88454 41117118 33672860 7444258 0 6987341 4645092 6072780 7421525 776409 749089 464625 743765 88865846 60945597 30565466 27920249 8706137 9344924 3397607 3990126 118605 29120 508298 661975 57597268 55505865 10104823 7389134 3469445 2731469 13574268 10120603 X 39635971 40656557 4387029 4728705 44023000 45385262 57597268 55505865 X 1539704 -180137 2695 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3050761 0 359705 7500 3402966 2531526 263800 324572 69137 3050761 1963579 5300 562647 2531526 2141962 9966 -178045 10304 1963579 1887242 20087 243725 9092 2141962 0.80260 0.13254 0.06486 0 1 1 4003563 4003563 46766512 26211671 20554841 36774860 33509922 3264938 1320911 1224004 96907 27920249 OTHER SECURITIES 3990126 C 3990126 X 39313583 -180137 -180137 39493720 3163102 3163102 42656822 37951321 0 37951321 3165797 3165797 41117118 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. 1 1 1 X 0 1 1 1 0 1 1 1175703 1134525 41178 0.00110 4208108 4098290 109818 0.00290 5383811 5232815 150996 0.00400 5383811 5232815 150996 0.00400 1 3165797 319745 8460336 10464175 -2003839 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 19 1 0 0 1 X SEE PART V, SECTION C X 1 19 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 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 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 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. 1 X X X X 0 0 0 0 0 1 0 0 0 LEONARD HERNANDEZ CHIEF EXECUTIVE OFFICER 210018 0 0 0 10725 0 0 0 12568 0 233311 0 0 0 CINDI STRACK CHIEF FINANCIAL OFFICER 141526 0 0 0 3667 0 0 0 22098 0 167291 0 0 0 CECILIA GOEBEL CHIEF NURSING OFFICER 142515 0 0 0 3565 0 0 0 11363 0 157443 0 0 0 NICHOLAS POSGE PODIATRIST 232457 0 0 0 222 0 0 0 19348 0 252027 0 0 0 IRAM SIRAJUDDIN ALLERGY/IMMUNOLOGY PHYSICIAN 239043 0 0 0 1228 0 0 0 10096 0 250367 0 0 0 CHARLES STAFFORD RADIATION ONCOLOGY PHYSICIST 191711 0 0 0 3519 0 0 0 84 0 195314 0 0 0 EDWARD DE YOUNG SURGERY COORDINATOR 125908 0 0 0 21028 0 0 0 10661 0 157597 0 0 0 HANNAH CAVE PHYSICIAN ASSISTANT 121181 0 0 0 35613 0 0 0 84 0 156878 0 0 0 SCHEDULE J, PART I, LINE 6A MANAGEMENT INCENTIVE PLAN BASED ON CRITERIA OF CONTRIBUTION MARGIN PERCENTAGE AFTER MEEETING ACCREDITATION STANDARDS AND QUALITY STANDARDS. A BUTLER COUNTY KANSAS 486035405 12343PAA3 2012-04-30 14500000 SEE PART VI 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 4394673 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 1 B 0 0 0 1 0 0 0 0 1 A 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 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. 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 481154 3558571 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 115459 CASH