SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION (EIN 48-0862732)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201823199349302037
- Schema version
- 2017v2.3
- 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 G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T08:32:18-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1Txt |
| City | Kansas City | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 641062246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | 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 FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % EMILY DOYON | InCareOfNm |
| 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 | JONATHAN IMMORDINO | PersonNm |
| Person Title | INTERIM CFO | PersonTitleTxt |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Michael J Engle | PreparerPersonNm |
| PTIN | P00482834 | PTIN |
| Phone | 8162216300 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.126.162 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 43372220183195000000 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 93D6BCA2088F39FB1F732088889462DF184CBBA1 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B63AEF58A3948584CFC9994E7E12F4E53EEB27F2 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES KIRKBRIDE | 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 | $1,178,512 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SBAMH.ORG/ABOUT_US/FOUNDATION/OVERVIEW | 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 | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $551,300 | PYContributionsGrantsAmt |
| CY Contributions Grants | $156,059 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $29,818 | PYInvestmentIncomeAmt |
| CY Investment Income | $117,295 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,683 | PYOtherRevenueAmt |
| CY Other Revenue | $22,448 | CYOtherRevenueAmt |
| PY Total Revenue | $583,801 | PYTotalRevenueAmt |
| CY Total Revenue | $295,802 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $357,220 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $175,286 | 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 | $55,077 | PYOtherExpensesAmt |
| CY Other Expenses | $70,895 | CYOtherExpensesAmt |
| PY Total Expenses | $412,297 | PYTotalExpensesAmt |
| CY Total Expenses | $246,181 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $171,504 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $49,621 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,404,112 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,538,334 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $279,496 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $174,537 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,124,616 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,363,797 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $175,286 | ExpenseAmt |
| Grant | $175,286 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | IN 2017, DONOR SUPPORT OF NURSE NAVIGATION 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 | $175,286 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | Yes (true) | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | EMILY DOYON | PersonNm |
| Phone | 3163224559 | 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 (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| EMILY CONNELL | |||||||
| SECRETARY/TREASUER | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BARBARA DANKERT | |||||||
| VICE PRESIDENT | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KATIE BANKS-TODD | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JOY KISTLER | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| TOM MCKIBBAN | |||||||
| PRESIDENT | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| RYAN MURRY | |||||||
| PAST PRESIDENT | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JUSTIN PARSONS | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JEREMY SUNDGREN | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| GLENN BUCHHOLZ | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DAN DAVIS | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| ANITA MILLS | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| STEVE FUNK | |||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| EUGENE KABERLINE | |||||||
| CFO | 1.0 | 40.0 | Yes (X) | $0 | $204,287 | $10,126 | |
| JIM KIRKBRIDE | |||||||
| CEO | 1.0 | 40.0 | Yes (X) | $0 | $277,109 | $30,270 | |
| KERI MYERS | |||||||
| DIRECTOR OF FUND DEVELOPMENT | 40.0 | 0.0 | Yes (X) | $0 | $40,719 | $11,769 | |
| CHASE LOCKE | |||||||
| EXECUTIVE DIRECTOR FOUNDATION | 40.0 | 0.0 | Yes (X) | $0 | $54,935 | $7,817 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $577,050 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $59,982 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $90,716 | FundraisingAmt |
| All Other Contributions | $65,343 | AllOtherContributionsAmt |
| Total Contributions | $156,059 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,349 | TotalRevenueColumnAmt |
| Exclusion | $42,349 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $924,884 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $849,938 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $74,946 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,946 | TotalRevenueColumnAmt |
| Exclusion | $74,946 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $55,220 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $90,716 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $32,772 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,448 | TotalRevenueColumnAmt |
| Exclusion | $22,448 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $295,802 | TotalRevenueColumnAmt |
| Exclusion | $139,743 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,286 | TotalAmt |
| Program Services | $175,286 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,092 | TotalAmt |
| Management And General | $9,092 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,974 | TotalAmt |
| Management And General | $32,974 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| DONOR APPRECIATION EXPENSE | $6,555 | $6,555 |
| WELLNESS PROGRAM | $22,274 | $22,274 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,181 | TotalAmt |
| Program Services | $175,286 | ProgramServicesAmt |
| Management And General | $70,895 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $496,071 | BOYAmt |
| EOY | $235,629 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,862 | BOYAmt |
| EOY | $23,522 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $5,500 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,842,179 | BOYAmt |
| EOY | $2,273,683 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,404,112 | BOYAmt |
| EOY | $2,538,334 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $279,496 | BOYAmt |
| EOY | $174,537 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $279,496 | BOYAmt |
| EOY | $174,537 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,374,193 | BOYAmt |
| EOY | $1,556,827 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $347,420 | BOYAmt |
| EOY | $403,967 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,003 | BOYAmt |
| EOY | $403,003 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,124,616 | BOYAmt |
| EOY | $2,363,797 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,404,112 | BOYAmt |
| EOY | $2,538,334 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $49,621 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $189,560 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 (true) | GoverningDocumentListedInd |
| Support | $175,286 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $175,286 | SupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (true) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | false | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 1 | DonorAdvisedFundsHeldCnt |
| Donor Advised Funds Contri | $350 | DonorAdvisedFundsContriAmt |
| Donor Advised Funds Vl EOY | $175,350 | DonorAdvisedFundsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (true) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (true) | DisclosedForCharitablePrpsInd |
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,570,557 | BeginningYearBalanceAmt |
| Contributions | $94,805 | ContributionsAmt |
| Investment Earnings Or Losses | -$15,692 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $73,371 | OtherExpendituresAmt |
| Administrative Expenses | $7,400 | AdministrativeExpensesAmt |
| End Year Balance | $1,568,899 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,479,284 | BeginningYearBalanceAmt |
| Contributions | $46,819 | ContributionsAmt |
| Investment Earnings Or Losses | $108,550 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $56,867 | OtherExpendituresAmt |
| Administrative Expenses | $7,229 | AdministrativeExpensesAmt |
| End Year Balance | $1,570,557 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,291,319 | BeginningYearBalanceAmt |
| Contributions | $144,789 | ContributionsAmt |
| Investment Earnings Or Losses | $113,425 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $63,912 | OtherExpendituresAmt |
| Administrative Expenses | $6,337 | AdministrativeExpensesAmt |
| End Year Balance | $1,479,284 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.75990 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.18820 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.05190 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Rev Etc Audited Fincl Stmt | $670,995 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $189,560 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $152,861 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $32,772 | OtherRevenueAmt |
| Revenue Not Reported | $375,193 | RevenueNotReportedAmt |
| Revenue Subtotal | $295,802 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $295,802 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $431,814 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $152,861 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $32,772 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $185,633 | ExpensesNotReportedAmt |
| Expenses Subtotal | $246,181 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $246,181 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, 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. |
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | FUNDRAISING EVENT EXPENSES $ 32,772 |
| SCHEDULE D, PART XII, LINE 2D | FUNDRAISING EVENT EXPENSES $ 32,772 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $145,936 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $90,716 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $55,220 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $4,443 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $160 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $20,170 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $1,135 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $6,864 | OtherDirectExpensesEvent1Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $145,936 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $90,716 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $55,220 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $4,443 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $160 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $20,170 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $1,135 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,864 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $32,772 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $22,448 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | 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 | $175,286 | 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 | SCHEDULE I, 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EUGENE KABERLINE | ||||||||||||||
| CFO | $0 | $171,665 | $0 | $13,201 | $0 | $19,421 | $0 | $7,281 | $0 | $2,845 | $0 | $214,413 | $0 | $0 |
| JIM KIRKBRIDE | ||||||||||||||
| CEO | $0 | $254,772 | $0 | $19,201 | $0 | $3,136 | $0 | $10,800 | $0 | $19,470 | $0 | $307,379 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 4A | THE FOLLOWING PERSONS RECEIVED SEVERANCE PAYMENTS: EUGENE KABERLINE $19,421 |
| SCHEDULE J, PART VII, SCHEDULE J, PART I, LINE 3 & PART II | THE COMPENSATION BEING REPORTED FOR EUGENE KABERLINE, JIM KIRKBRIDE, KERI MYERS, AND CHASE LOCKE BY A RELATED ORGANIZATION IS FROM SUSAN B. ALLEN MEMORIAL HOSPITAL. SUSAN B. ALLEN MEMORIAL HOSPITAL USES A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH MR. KABERLINE, MR. KIRKBRIDE, MS. MYERS, AND MR. LOCKE'S COMPENSATION. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 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 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. |
| FORM 990, PART VI, SECTION A, LINE 2 | Eugene Kaberline, Jim Kirkbride, Keri Myers and Chase Locke have a business relationship. |
| 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 OF 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 THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND COMMENT. ANY QUESTIONS OR CONCERNS THE BOARD OF DIRECTORS HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT ARE NEEDED ARE MADE. THE FINAL 990 WITH ALL REQUIRED SCHEDULES ARE APPROVED BY THE BOARD OF DIRECTORS AND FILED. IF THE 990 IS FILED PRIOR TO BOARD APPROVAL AND CHANGES ARE NEEDED AN AMENDED RETURN IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | AT THE TIME OF HIRE OR ELECTION IN THE CASE OF BOARD MEMBERS, AND ANNUALLY THEREAFTER, EXECUTIVE DIRECTOR OF THE FOUNDATION, OR THEIR DESIGNEE SHALL PROVIDE TO THE BOARD AND EXECUTIVE OFFICERS, 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 FOUNDATION'S CORPORATE COMPLIANCE PLAN. A REPORT SHALL BE MADE TO THE BOARD OF DIRECTORS OF ITEMS DISCLOSED. EACH MEMBER OF THE BOARD OF DIRECTORS 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 C, LINE 19 | THE GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN B ALLEN MEMORIAL HOSPITAL | ||||||||||
| 720 WEST CENTRAL | EL DORADO | KS | 67042 | 480581968 | HOSPITAL | KS | 501(C)(3) | 3 | NA | false |
| SBAMH EMPLOYEE GROUP BENEFIT TRUST | ||||||||||
| 720 WEST CENTRAL | EL DORADO | KS | 67024 | 481105047 | VEBA | KS | 501(C)(9) | SBA HOSPITAL | Yes (true) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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