2020-08-13T09:33:17-05:00 2019-09-30 481066439 BT&CO PA 4301 SW HUNTOON ST TOPEKA KS 66604 990 2018-10-01 480980926 STORMONT-VAIL FOUNDATION C/O CORPORATE FINANCE STOR 7853545623 1500 SW 10TH AVENUE TOPEKA KS 66604 KENNETH L STONE TREASURER 7853545623 2020-08-04 1 CHERYL G HAYWARD P00016097 7852343427 2020-08-04 24.249.117.85 2020-08-04 16:13:38 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4096715517D5AF429C08871C7EC6C0E5F3952FA8 2018 2020-09-23 17:36:50Z AMY BURNS 1500 SW 10TH AVENUE TOPEKA KS 66604 7044125 0 X WWW.STORMONTVAIL.ORG/FOUNDATION X 1984 KS SEE CONTINUATION ON SCHEDULE O: TO PROVIDE VOLUNTARY GIFT SUPPORT FOR STORMONT-VAIL HEALTHCARE, INC. PATIENT CARE SERVICES AND COMMUNITY HEALTH EDUCATION PROGRAMS, IN SUPPORT OF HEALTHCARE'S MISSION OF "WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY." 27 22 0 22 0 0 1984108 2801849 0 0 1073261 895979 171962 161459 3229331 3859287 456277 420605 0 0 0 0 0 0 390910 1674780 1523720 2131057 1944325 1098274 1914962 25193999 26717909 223451 185212 24970548 26532697 X TO PROVIDE VOLUNTARY GIFT SUPPORT FOR STORMONT-VAIL HEALTHCARE, INC. PATIENT CARE SERVICES AND COMMUNITY HEALTH EDUCATION PROGRAMS, IN SUPPORT OF HEALTHCARE'S MISSION OF "WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY." 0 0 489063 FACILITIES:CONSISTENT WITH ITS MISSION, THE FOUNDATION PROVIDES STORMONT-VAIL HEALTHCARE WITH FUNDING FOR MEDICAL FACILITIES AND EQUIPMENT NEEDED TO IMPROVE THE HEALTH OF THE COMMUNITY. 169445 PATIENT CARE AND OTHER:A MAJORITY OF PROGRAM SERVICE EXPENDITURES IN THIS CATEGORY IS FOR DISCHARGE ASSISTANCE TO STORMONT-VAIL HEALTHCARE PATIENTS WHO HAVE CRITICAL NEEDS AT THE TIME OF DISCHARGE FROM THE HOSPITAL OR TREATMENT IN OUR CLINICS. TIMELY FUNDING IS PROVIDED FOR ITEMS SUCH AS CLOTHING, PRESCRIPTION DRUGS, TRANSPORTATION NEEDS, ETC. WHERE THE PATIENTS HAVE NO OTHER SOURCES OF FUNDING. 175250 175250 SCHOLARSHIPS:IN COOPERATION WITH BAKER UNIVERSITY AND THE KANSAS BOARD OF REGENTS, THE FOUNDATION PROVIDES SCHOLARSHIPS TO DESERVING NURSING STUDENTS ATTENDING THE BAKER UNIVERSITY SCHOOL OF NURSING AT STORMONT-VAIL. IN ADDITION TO BAKER UNIVERSITY, SCHOLARSHIPS ARE PROVIDED TO STUDENTS ATTENDING SOME OTHER POST SECONDARY ALLIED HEALTH EDUCATION PROGRAMS INCLUDING PROGRAMS AT KANSAS STATE UNIVERSITY, WASHBURN UNIVERSITY OF TOPEKA, THE UNIVERSITY OF KANSAS, FORT HAYS STATE UNIVERSITY AND POTENTIALLY OTHERS. EDUCATION:THE FOUNDATION COOPERATES WITH STORMONT-VAIL HEALTHCARE TO FUND EMPLOYEES' ATTENDANCE AT SELECT CONFERENCES, WORKSHOPS AND PROGRAMS IN ORDER TO GAIN KNOWLEDGE AND SKILLS, AND TO SHARE THAT KNOWLEDGE WITH PEERS,FURTHER ENHANCING PATIENT CARE AND IMPROVING THE HEALTH OF OUR COMMUNITY 438675 245355 OTHER COMMUNITY SUPPORT:THE FOUNDATION MAKES GRANTS/SPONSORSHIPS TO OTHER COMMUNITY CHARITIES ON BEHALF OF THE STORMONT-VAIL HEALTHCARE SYSTEM. 438675 245355 1272433 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 X 27 22 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KS X KENNETH L STONE 7853545620 1500 SW 10TH AVENUE TOPEKA KS 66604 KEN STONE SVF TREAS./DIR 4.00 40.00 X X 0 167281 27858 PAMELA JOHNSON BETTS TRUSTEE 1.00 X 0 0 0 TARA DIMICK TRUSTEE 1.00 X 0 0 0 NATALIE HAAG TRUSTEE 1.00 X 0 0 0 JEFF MARTIN TRUSTEE 1.00 X 0 0 0 KENT PALMBERG MD TRUSTEE 1.00 X 0 0 0 ANGELA SHARP TRUSTEE 1.00 X 0 0 0 ANDY TOMPKINS EDD VICE CHAIRPERSON 1.00 X X 0 0 0 DAN RICHARDSON DVM TRUSTEE 1.00 X 0 0 0 MIKE MORSE TRUSTEE 1.00 X 0 0 0 MIRANDA CARMONA JD CHAIRPERSON 1.00 X X 0 0 0 AMANDA KIEFER TRUSTEE 1.00 X 0 0 0 LYN RANTZ EDD TRUSTEE 1.00 X 0 0 0 ERROL WILLIAMS TRUSTEE 1.00 X 0 0 0 ANNE WILSON SECRETARY 1.00 X X 0 0 0 MICK URBAN TRUSTEE 1.00 X 0 0 0 DOUG WOLFF TRUSTEE 1.00 X 0 0 0 AMY BURNS PRESIDENT 40.00 X X 0 133970 29710 KEVIN HAHN DVM PAST CHAIRPERSON 1.00 X X 0 0 0 RANDY AUSTIN TRUSTEE 1.00 X 0 0 0 HEATHER BIRKBECK TRUSTEE 1.00 X 0 0 0 JOE GIGOUS TRUSTEE 1.00 X 0 0 0 CLINT PATTY TRUSTEE 1.00 X 0 0 0 MICHELLE SCHIERLING MD TRUSTEE 1.00 X 0 242663 12700 DAINA WILLIAMS TRUSTEE 1.00 X 0 0 0 ROBERT KENAGY MD PRESIDENT & CEO STORMONT 1.00 X 0 648166 115421 RANDY PETERSON FORMER PRESIDENT & CEO STORMONT 1.00 50.00 X 0 945425 170952 0 2137505 356641 0 1 1 0 0 943489 1858360 2801849 806874 806874 3202385 3113280 89105 89105 89105 233017 71558 161459 161459 3859287 0 0 1057438 420605 420605 10775 10775 10397 10397 198 66 132 50192 2346 19652 28194 10682 5341 5341 8137 8069 68 2067 2067 SHARED PAYROLL 507431 34121 204510 268800 DESIGNATED DISBURSEMENT 489063 489063 OTHER ASSISTANCE 169445 169445 SERVICES/PROGRAMS - INT 84012 84012 181321 72841 20105 88375 1944325 1272433 280982 390910 1001 865091 729456 397231 1196621 3183 21315 46497 45209 3355 1288 10515403 10946144 3448820 4561969 10095550 9125481 25193999 26717909 170266 135990 53185 49222 223451 185212 X 3408135 5282137 6062432 6143587 15499981 15106973 24970548 26532697 25193999 26717909 X 1914962 37083 -389896 X X 0 1 X 1 0 X 1794478 2109119 1510227 1984108 2801849 10199781 1794478 2109119 1510227 1984108 2801849 10199781 624722 9575059 890562 759759 705517 734479 806874 3897191 14096972 0.67920 0.66030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11170857 291418 244077 133464 11572888 10598986 174172 663934 266235 11170857 9238188 398800 1121354 159356 10598986 8173826 449885 719815 105338 9238188 8136401 402037 -223447 141165 8173826 0.18440 0.69990 0.11570 0 0 46497 45209 1288 1288 OTHER INVESTMENTS 4561969 F 4561969 ACCRUED INVESTMENT INCOME 3998 CHARITABLE REMAINDER TRUST 480000 BENEFICIAL INTEREST IN TRUST 8641483 9125481 DUE TO SVH 41622 CHARITABLE GIFT ANNUNITIES 7600 49222 3496077 37083 -389896 -352813 3848890 10397 10397 3859287 1933928 0 1933928 10397 10397 1944325 PART V, LINE 4: ENDOWMENT FUNDS ARE USED IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE GIFT IS ADDED TO THE FUND. ALL ENDOWMENTS ACCEPTED SUPPORT THE MISSION OF THE STORMONT-VAIL FOUNDATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -389,896. BIG HEARTS GOLF TOURNAMENT 233017 233017 26835 17497 26229 997 233017 233017 26835 17497 26229 997 71558 161459 1 AMERICAN CANCER SOCIETY 1315 SW ARROWHEAD RD TOPEKA KS 66604 131788491 501(C)(3) 17500 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE AMERICAN HEART ASSOCIATION 5375 SW 7TH ST TOPEKA KS 66606 135613797 501(C)(3) 25000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE MARCH OF DIMES FOUNDATION 4400 COLLEGE BLVD STE 180 OVERLAND PARK KS 66211 131846366 501(C)(3) 10000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE MEALS ON WHEELS OF EASTERN KANSAS 2701 SW EAST CIRCLE DRIVE SOUTH TOPEKA KS 66606 480792685 501(C)(3) 10000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE RACE AGAINST BREAST CANCER INC PO BOX 4458 TOPEKA KS 66604 481154057 501(C)(3) 10000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE MIDLAND CARE CONNECTION INC 200 SW FRAZIER CIRCLE TOPEKA KS 66606 480883888 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE JAYHAWK AREA COUNCIL BOY SCOUTS OF AMERICA 1020 SE MONROE ST TOPEKA KS 66612 480543748 501(C)(3) 7500 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE BAKER UNIVERSITY PO BOX 65 BALDWIN CITY KS 66006 480543766 501(C)(3) 88125 FUND NURSING SCHOLARSHIPS KANSAS CHILDREN'S DISCOVERY CENTER 4400 SW 10TH AVE TOPEKA KS 66604 371534978 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE SUNFLOWER STATE GAMES 501 SE JEFFERSON ST STE 22 TOPEKA KS 66607 481080635 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE VALEO BEHAVIORAL HEALTH CARE 330 SW OAKLEY TOPEKA KS 66606 480730326 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE FAMILY SERVICE & GUIDANCE CENTER 325 SW FRAZIER AVE TOPEKA KS 66606 480637039 501(C)(3) 10000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE POWERCAT HEALTH PARTNERSHIP 1800 COLLEGE AVE MANHATTAN KS 66503 237326834 501(C)(3) 7500 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE YWCA 225 SW 12TH ST TOPEKA KS 66612 480556758 501(C)(3) 10000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE KANSAS BOARD OF REGENTS SCHOLARSHIPS 1000 SW JACKSON ST STE 520 TOPEKA KS 66612 77375 FUND NURSING SCHOLARSHIPS WASHBURN UNIVERSITY 1700 SW COLLEGE TOPEKA KS 66621 5000 FUND NURSING SCHOLARSHIPS TOPEKA POLICE DEPT CITIZENS ACADEMY AMBASSADORS 320 S KANSAS AVE TOPEKA KS 66603 455288274 501(C)(3) 20000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE BOYS AND GIRLS CLUB OF TOPEKA 500 SE 27TH ST TOPEKA KS 66605 480636732 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE KANSAS PEDIATRIC FOUNDATION PO BOX 860481 SHAWNEE KS 66286 480892759 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE TOPEKA JUMP 3033 SW MACVICAR TOPEKA KS 66611 455339806 501(C)(3) 5000 COMMUNITY CHARITABLE SUPPORT ON BEHALF OF STORMONT-VAIL HEALTHCARE 20 0 PART I, LINE 2: FOR SCHOLARSHIPS REPORTED IN PART II OF THIS SCHEDULE, THE FOUNDATION PROVIDES SCHOLARSHIP FUNDING TO BAKER UNIVERSITY FOR SCHOLARSHIPS GRANTED TO STUDENTS OF THE SCHOOL OF NURSING PROGRAM WHICH OFFERS A BACHELOR OF SCIENCE IN NURSING DEGREE. THE SCHOOL OF NURSING IS OWNED BY STORMONT-VAIL HEALTHCARE, INC. BAKER UNIVERSITY CONFERS DEGREES AND MANAGES ADMISSIONS, SCHOLARSHIPS, AND ACADEMIC AFFAIRS. THE FOUNDATION RECEIVED DETAILED REPORTS LISTING SCHOLARSHIP RECIPIENTS. X X 0 1 0 0 0 0 0 0 0 KEN STONE SVF TREAS./DIR 0 166264 0 0 0 1017 0 8559 0 19299 0 195139 0 0 AMY BURNS PRESIDENT 0 133668 0 0 0 302 0 0 0 29710 0 163680 0 0 MICHELLE SCHIERLING MD TRUSTEE 0 233576 0 8643 0 444 0 12191 0 509 0 255363 0 0 ROBERT KENAGY MD PRESIDENT & CEO STORMONT 0 624122 0 0 0 24044 0 82847 0 32574 0 763587 0 0 RANDY PETERSON FORMER PRESIDENT & CEO STORMONT 0 921281 0 100 0 24044 0 136001 0 34951 0 1116377 0 0 FORM 990, PART VI, SECTION A, LINE 6 STORMONT-VAIL HEALTHCARE, INC. IS THE SOLE VOTING MEMBER OF THE STORMONT-VAIL FOUNDATION. STORMONT-VAIL HEALTHCARE, INC. IS A 501(C)(3) EXEMPT NON-PROFIT HEALTH CARE PROVIDER WITH NUMEROUS LOCATIONS IN AND THROUGHOUT TOPEKA AND NORTHEAST KANSAS. FORM 990, PART VI, SECTION A, LINE 7A THE TRUSTEES ARE ELECTED BY THE VOTING MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B THE PRESIDENT AND THE TREASURER FURNISH A DRAFT OF FORM 990 TO THE FOUNDATION'S FINANCE COMMITTEE FOR A MEETING AT WHICH THE REPORT IS DISCUSSED. THE FINANCE COMMITTEE'S FEEDBACK IS CONSIDERED AND FURTHER DISCUSSED WITH THE PAID PREPARER AS THE BASIS OF MODIFICATIONS, AS APPROPRIATE, IN THE FINAL VERSION OF FORM 990 FOR FILING. THE FINAL, FILED VERSION IS MADE AVAILABLE TO THE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE BOARD'S FOUNDATION RELATIONS COMMITTEE REVIEWS CONFLICTS OF INTEREST AND CONFIDENTIALITY STATEMENTS, AND CODE OF CONDUCT CERTIFICATIONS FOR ALL BOARD MEMBERS AND OFFICERS. FORM 990, PART VI, SECTION B, LINE 15 ALTHOUGH THE PRESIDENT AND EXECUTIVE DIRECTOR OF THE STORMONT-VAIL FOUNDATION IS NOT AN EMPLOYEE OF THE STORMONT-VAIL FOUNDATION, THE COMPENSATION OF THAT POSITION IS DETERMINED AS FOLLOWS: THE COMPENSATION COMMITTEE OF STORMONT-VAIL HEALTHCARE (COMPRISED OF THE TWO SENIOR VICE PRESIDENTS, ALL THE VICE PRESIDENTS, AND THE DIRECTORS OF COMPENSATION/BENEFITS AND FINANCE) REVIEW NATIONAL SURVEY DATA FOR THIS POSITION AND PROPOSE A PAY RANGE FOR THE POSITION. THE PRESIDENT AND CEO OF STORMONT-VAIL ALONG WITH THE CHAIR OF THE STORMONT-VAIL FOUNDATION BOARD REVIEWS THE FOUNDATION PRESIDENT AND EXECUTIVE DIRECTOR'S PERFORMANCE AND COMPENSATION IS DETERMINED BY THAT REVIEW. COMPENSATION FOR OTHER PERSONS, WHOSE COMPENSATION IS DISCLOSED IN THIS FORM 990 AND SCHEDULE J, IS DETERMINED BY STORMONT-VAIL HEALTHCARE, INC. BOARD OF DIRECTORS, OFFICERS, MANAGEMENT AND/OR IN ACCORDANCE WITH ESTABLISHED POLICIES AND PRACTICES OF HEALTHCARE. ADDITIONAL INFORMATION MAY BE AVAILABLE ON SCHEDULE O FOR STORMONT-VAIL HEALTHCARE, INC.'S FORM 990. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. THE FOUNDATION INCLUDES A COPY OF ITS AUDITED FINANCIAL STATEMENTS WITH ITS ANNUAL FORM SC FILED WITH THE KANSAS SECRETARY OF STATE. A CONDENSED BALANCE SHEET AND REVENUE AND EXPENSE STATEMENT IS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -389,896. PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. STORMONT-VAIL HEALTHCARE INC 1500 SW 10TH ST TOPEKA KS 666041353 480543789 PROVIDES HEALTH AND MEDICAL SERVICES KS 501(C)(3) 170(B)(1)(A)(III) STORMONT-VAIL HEALTHCARE 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 STORMONT-VAIL HEALTHCARE INC C 943489 STORMONT-VAIL HEALTHCARE INC O 507431 STORMONT-VAIL HEALTHCARE INC R 489063