SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION: Form 990, tax year 2020
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- Organization
- SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION (EIN 48-0862732)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-03
- IRS object ID
- 202133079349300528
- Schema version
- 2020v4.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-03T08:45:28-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | 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 | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480862732 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION | BusinessNameLine2Txt |
| 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 AND CEO | PersonTitleTxt |
| Phone | 3163213300 | PhoneNum |
| Signature | 2021-11-02 | 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 | DEBORAH O ERNSBERGER | PreparerPersonNm |
| PTIN | P00364912 | PTIN |
| Phone | 8656730844 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | 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 | $182,580 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | SBAMHFOUNDATION.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | PHILANTHROPIC PRIORITIES AT THE SUSAN B. ALLEN MEMORIAL HOSPITAL FOUNDATION REFLECT A FOCUS ON FULFILLING THE NEEDS OF SUSAN B. ALLEN MEMORIAL HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $216,151 | PYContributionsGrantsAmt |
| CY Contributions Grants | $92,373 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $167,291 | PYInvestmentIncomeAmt |
| CY Investment Income | $74,035 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$11,508 | PYOtherRevenueAmt |
| CY Other Revenue | $15,728 | CYOtherRevenueAmt |
| PY Total Revenue | $371,934 | PYTotalRevenueAmt |
| CY Total Revenue | $182,136 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $116,669 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,765 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $39,540 | PYOtherExpensesAmt |
| CY Other Expenses | $15,180 | CYOtherExpensesAmt |
| PY Total Expenses | $156,209 | PYTotalExpensesAmt |
| CY Total Expenses | $25,945 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $215,725 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $156,191 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,017,525 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,406,804 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $49,808 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,197 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,967,717 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,397,607 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,765 | ExpenseAmt |
| Grant | $10,765 | GrantAmt |
| Revenue | $6,083 | RevenueAmt |
| Desc | IN 2020, DONOR SUPPORT OF NUMEROUS PROJECTS PROVIDED VALUABLE FUNDING TO ADVANCE OUR MISSION OF TAKING CARE OF THE COMMUNITY. SUSAN B. ALLEN IS PROUD TO CONTINUE TO OFFER NEW INITIATIVES TO CONTINUE TO PROVIDE EXCELLENT PATIENT CARE TO OUR COMMUNITY MEMBERS. | Desc |
| Total Program Service Expenses | $10,765 | 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 | Yes (1) | 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 | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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 (15 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 |
|---|---|---|---|---|---|---|---|
| STEVE FUNK | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAN DAVIS | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL DENTON | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| EMILY CONNELL | |||||||
| PAST PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATIE BANKS-TODD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL CLIFTON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | |
| BARBARA DANKERT | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOYCE DEMO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RYAN LIESS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ASHLYN LINDSKOG | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JUSTIN PARSONS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL SCHWANKE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HOLLY LANDON | |||||||
| EXECUTIVE DIRECTOR, SBAMH | 40.00 | Yes (X) | $0 | $90,100 | $8,965 | ||
| LEONARD HERNANDEZ | |||||||
| CHIEF EXECUTIVE OFFICER | 1.00 | Yes (X) | $0 | $65,831 | $2,166 | 40.00 | |
| CINDI STRACK | |||||||
| CHIEF FINANCIAL OFFICER | 1.00 | Yes (X) | $0 | $61,218 | $5,314 | 40.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $217,149 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $16,445 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $26,145 | FundraisingAmt |
| All Other Contributions | $66,228 | AllOtherContributionsAmt |
| Total Contributions | $92,373 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,866 | TotalRevenueColumnAmt |
| Exclusion | $47,866 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,169 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,169 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,169 | TotalRevenueColumnAmt |
| Exclusion | $26,169 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $10,089 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $26,145 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $444 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,645 | TotalRevenueColumnAmt |
| Exclusion | $9,645 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $6,083 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,083 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $6,083 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $182,136 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,083 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $83,680 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,765 | TotalAmt |
| Program Services | $10,765 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73 | TotalAmt |
| Management And General | $73 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,759 | TotalAmt |
| Management And General | $11,759 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| BANK FEES | $1,682 | $1,682 |
| BUSINESS EXPENSE | $326 | $326 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,340 | TotalAmt |
| Management And General | $1,340 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,945 | TotalAmt |
| Program Services | $10,765 | ProgramServicesAmt |
| Management And General | $15,180 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $343,083 | BOYAmt |
| EOY | $139,348 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,460 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,665,982 | BOYAmt |
| EOY | $3,267,456 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,017,525 | BOYAmt |
| EOY | $3,406,804 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,808 | BOYAmt |
| EOY | $9,197 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,808 | BOYAmt |
| EOY | $9,197 | 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 | $2,043,241 | BOYAmt |
| EOY | $2,273,317 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $924,476 | BOYAmt |
| EOY | $1,124,290 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,967,717 | BOYAmt |
| EOY | $3,397,607 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,017,525 | BOYAmt |
| EOY | $3,406,804 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $156,191 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $273,699 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN B ALLEN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480581968 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $10,765 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $10,765 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 1 | DonorAdvisedFundsHeldCnt |
| Donor Advised Funds Vl EOY | $103,311 | DonorAdvisedFundsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (1) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (1) | DisclosedForCharitablePrpsInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,531,526 | BeginningYearBalanceAmt |
| Contributions | $263,800 | ContributionsAmt |
| Investment Earnings Or Losses | $267,194 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $11,759 | AdministrativeExpensesAmt |
| End Year Balance | $3,050,761 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,963,579 | BeginningYearBalanceAmt |
| Contributions | $5,300 | ContributionsAmt |
| Investment Earnings Or Losses | $573,174 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $10,527 | AdministrativeExpensesAmt |
| End Year Balance | $2,531,526 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,568,899 | BeginningYearBalanceAmt |
| Contributions | $220,239 | ContributionsAmt |
| Investment Earnings Or Losses | $105,714 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $7,610 | AdministrativeExpensesAmt |
| End Year Balance | $1,887,242 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.79400 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.14800 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.05800 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $436,754 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $273,698 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$5,639 | OtherRevenueAmt |
| Revenue Not Reported | $268,059 | RevenueNotReportedAmt |
| Revenue Subtotal | $168,695 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $13,441 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $13,441 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $182,136 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,864 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$5,639 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$5,639 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,503 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $13,442 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $13,442 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $25,945 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | EARNINGS FROM THE ENDOWMENT FUNDS ARE USED TO FUND THE PURCHASE OF EQUIPMENT AND PROGRAM SUPPORT FOR SUSAN B. ALLEN MEMORIAL HOSPITAL. |
| 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, 2020 OR 2019. AT DECEMBER 31, 2020, TAX RETURNS FOR YEARS 2017 THROUGH 2019 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSE 444. OTHER ADJUSTMENT -6,083. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSE 444. OTHER ADJUSTMENT -6,083. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $36,234 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $26,145 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $10,089 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $444 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $36,234 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $26,145 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $10,089 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $444 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $444 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $9,645 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| 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) |
|---|---|---|
| Recipient EIN | 480581968 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $10,765 | CashGrantAmt |
| Purpose Of Grant | FINANCIAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ALL GRANT REQUESTS ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. ALL GRANTS ARE MADE TO SUSAN B. ALLEN MEMORIAL HOSPITAL, A RELATED 501(C)(3) ORGANIZATION. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 | THE SUSAN B. ALLEN MEMORIAL HOSPITAL FOUNDATION IS DEDICATED TO HELPING THE HOSPITAL FULFILL ITS MISSION OF PROVIDING COMPASSIONATE, PROFESSIONAL HEALTHCARE TO THE COMMUNITIES WE SERVE. ACTING AS THE FUNDRAISING ARM OF SUSAN B. ALLEN MEMORIAL HOSPITAL (SBAMH), THE FOUNDATION ACCEPTS CHARITABLE GIFTS TO BE USED FOR MAINTAINING AND IMPROVING THE PROGRAMS AND SERVICES AT THE HOSPITAL THAT WILL HAVE A POSITIVE IMPACT ON THE HEALTH OF OUR COMMUNITIES. THE FOUNDATION HAS PROVIDED SUPPORT BY: - PROVIDING MEALS AND SNACKS TO CANCER CENTER PATIENTS - PROVIDING PRESCRIPTION ASSISTANCE - PROVIDING TRANSPORTATION ASSISTANCE - PROVIDING COVID-19 SUPPORT |
| FORM 990, PART VI, SECTION A, LINE 6 | SUSAN B. ALLEN MEMORIAL HOSPITAL IS THE SOLE MEMBER OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER, SUSAN B. ALLEN MEMORIAL HOSPITAL, HAS THE RIGHT TO ELECT BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE HOSPITAL MEMBER HAS THE RIGHT TO APPROVE: AMENDMENT TO THE ARTICLES OF INCORPORATION OF THE CORPORATION; AMENDMENT OF THE BYLAWS OF THE CORPORATION; ANY MERGER, SALE OF SUBSTANTIALLY ALL OF THE ASSETS OR DISSOLUTION OF THE CORPORATION; INCURRING ANY DEBT BY THE CORPORATION; AND THE RIGHT TO ELECT OR REMOVE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY SUSAN B. ALLEN MEMORIAL HOSPITAL (SOLE MEMBER) ACCOUNTING/FOUNDATION STAFF, CFO AND CEO. ANY QUESTIONS OR CONCERNS HAD ARE ADDRESSED AND ANY CLARIFICATION OR CORRECTIONS MADE AS NEEDED. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH MEMBER OF THE BOARD OF DIRECTORS IS REQUIRED AT THE TIME OF HIRE OR ELECTION, AND ANNUALLY THEREAFTER, TO REVIEW THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES OF WHICH A CONFLICT OF INTEREST MAY ARISE. THE ANNUAL REVIEW AND MONITORING OF THE CONFLICT OF INTEREST POLICY IS A PART OF THE FOUNDATION'S CORPORATE COMPLIANCE PLAN. ANY POTENTIAL CONFLICTS DISCLOSED ON THE INTEREST DISCLOSURE STATEMENTS ARE REPORTED TO THE BOARD OF DIRECTORS. |
| 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. |
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 | 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 | 480581968 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 3 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | 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 | Yes (1) | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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