2014-05-14T16:30:47-05:00 2013-09-30 481066439 BERBERICH TRAHAN & CO PA 3630 SW BURLINGAME ROAD TOPEKA KS 666112050 990 2012-10-01 480980926 STORMONT-VAIL FOUNDATION CO CORPORATE FINANCE STOR 7853545623 1500 SW 10TH AVENUE TOPEKA KS 66604 KENNETH L STONE 7853545623 2014-05-12 1 CHERYL G HAYWARD P00016097 7852343427 2012 2015-11-30 17:44:51Z JANE MACKEY 1500 SW 10TH AVENUE TOPEKA KS 66604 5188902 0 X WWW.STORMONTVAIL.ORG 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." 25 22 0 0 0 0 1190081 1193816 0 0 446188 1110107 159279 246754 1795548 2550677 129975 132725 0 0 357855 391986 0 0 204932 711023 527376 1198853 1052087 596695 1498590 14231303 16379920 120889 241003 14110414 16138917 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 324713 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. 153733 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. SCHOLARSHIPS:IN COOPERATION WITH BAKER UNIVERSITY, 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. 132725 132725 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 132725 132725 611171 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 1 0 0 0 0 X 25 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 7853545623 1500 SW 10TH AVENUE TOPEKA KS 66604 KEN STONE 4.00 X X 0 146435 23789 KEVIN M CASSIDY DDS 1.00 X X 0 0 0 JARED HOLROYD 1.00 X 0 0 0 JIM BIRKBECK 1.00 X X 0 0 0 RICK JACKSON 1.00 X 0 0 0 OLGA SMITH 1.00 X 0 0 0 TOM MCBRIDE 1.00 X 0 0 0 SHELLE MCCOY 1.00 X 0 0 0 DARREL PAVELKA 1.00 X 0 0 0 DEBORAH ROSE 1.00 X 0 0 0 KENT CORNISH 1.00 X 0 0 0 STEVE TYLER 1.00 X 0 0 0 JANE MACKEY 40.00 X X 0 103906 11909 JUDY MOLER 1.00 X X 0 0 0 MIKE WORSWICK 1.00 X 0 0 0 MARY ANN DURALL 1.00 X 0 0 0 RICHARD ROSS 1.00 X 0 0 0 KEVIN HAN 1.00 X X 0 392805 8362 RANDY PETERSON 1.00 X 0 403259 8147 MAYNARD OLIVERIUS 1.00 X 0 1760487 7696 ROSALIND JENNINGS 1.00 X 0 0 0 MARK RUELLE 1.00 X 0 0 0 DONALD SCHEPKER 40.00 X 0 49987 0 0 2856879 59903 0 0 1 0 0 420000 773816 1193816 582990 582990 3077605 2550488 527117 527117 527117 334491 87737 246754 246754 2550677 0 0 1356861 132725 132725 391986 36196 168073 187717 9200 9200 25792 25792 37438 37438 34370 6048 12977 15345 7928 7928 1036 1036 6146 6146 188 188 DESIGNATED DISBURSEMENT 343933 343933 EDUCATION PROGRAMS 54024 51596 2428 DUES, BOOKS & SUBSCRIPT 4996 3184 1812 MISCELLANEOUS 2325 51 404 1870 1052087 611171 235984 204932 1001 1001 879813 726458 369970 551059 8643 8873 31746 31408 525 338 5840348 7331856 7131003 7760335 14231303 16379920 63330 83560 10920 4740 46639 152703 120889 241003 X 496468 1036526 2274293 2885275 11339653 12217116 14110414 16138917 14231303 16379920 X 1498590 -98280 628193 X X 0 1 X 1 0 X 2417106 1684773 751039 1311397 1193816 7358131 2417106 1684773 751039 1311397 1193816 7358131 2339037 5019094 293005 392335 419219 498607 582990 2186156 9544287 783436 0.52590 0.36350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6010736 396574 526228 82918 6850620 5070422 453835 712526 226047 6010736 5086119 228603 -102103 142197 5070422 4576716 265279 395325 151201 5086119 4202552 466673 45208 41016 96701 4576716 0.11280 0.70340 0.18380 0 0 31746 31408 338 338 ACCRUED INVESTMENT INCOME 12008 CHARITABLE REMAINDER TRUST 350000 BENEFICIAL INTEREST IN TRUST 7398327 7760335 DUE TO SVHC 147503 CHARITABLE GIFT ANNUNITIES 5200 152703 X 3090544 -98280 628193 529913 2560631 25792 -35746 -9954 2550677 1062041 35746 35746 1026295 25792 25792 1052087 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION'S POLICY IS TO EVALUATE UNCERTAIN TAX POSITIONS ANNUALLY. MANAGEMENT EVALUATED THE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT THE FOUNDATION HAD TAKEN NO UNCERTAIN TAX POSITION THAT REQUIRED ADJUSTMENT TO THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 628,193. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -35,746. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 35,746. BIG HEARTS GOLF TOURNAMENT 182966 182966 20024 13290 16153 2524 FRIENDS OF CARE LINE 123795 123795 3448 424 7125 1 27730 27730 17919 6830 334491 334491 23472 13290 34496 16479 87737 246754 1 BAKER UNIVERSITY PO BOX 65 BALDWIN CITY KS 66006 480543766 501(C)(3) 124625 FUND NURSING SCHOLARSHIPS PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 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 0 131770 0 14208 0 457 0 1792 0 21997 0 170224 0 0 KEVIN HAN 0 317756 0 71420 0 3629 0 2731 0 5631 0 401167 0 0 RANDY PETERSON 0 395674 0 0 0 7585 0 0 0 8147 0 411406 0 0 MAYNARD OLIVERIUS 0 1325156 0 425637 0 9694 0 1000 0 6696 0 1768183 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 11 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 628,193. 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 420000 STORMONT-VAIL HEALTHCARE INC O 355791 STORMONT-VAIL HEALTHCARE INC R 181627