SAMUEL U RODGERS HEALTH CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SAMUEL U RODGERS HEALTH CENTER INC (EIN 43-0899356)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-07-31
IRS object ID
201322129349300312
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-07-31T10:07:09-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1
CityKansas CityCity
StateMOState
ZIP Code641062246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN430899356EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Samuel U Rodgers Health Center IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% BOB THEISInCareOfName
Name ControlSAMUNameControl
Phone8164744920Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1825 Euclid AvenueAddressLine1
CityKansas CityCity
StateMOState
ZIP Code64124ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHILDA FUENTESName
TitleCEOTitle
Date Signed2013-08-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJim StillName
Phone8162216300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonHilda FuentesNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1825 Euclid AvenueAddressLine1
CityKansas CityCity
StateMOState
ZIP Code64124ZIPCode
FieldValueIRS element (for citing)
Gross Receipts21259059GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.rodgershealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1968YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionTHE CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE FOR ALL.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members17NbrIndependentVotingMembers
Total Nbr Employees269TotalNbrEmployees
Total Nbr Volunteers166TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year21684654ContributionsGrantsPriorYear
Contributions Grants Current Year12151541ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6867922ProgramServiceRevenuePriorYear
Program Service Revenue CY7413466ProgramServiceRevenueCY
Investment Income Prior Year38585InvestmentIncomePriorYear
Investment Income Current Year76539InvestmentIncomeCurrentYear
Other Revenue Prior Year61974OtherRevenuePriorYear
Other Revenue Current Year510449OtherRevenueCurrentYear
Total Revenue Prior Year28653135TotalRevenuePriorYear
Total Revenue Current Year20151995TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year11547110GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10142543SalariesEtcPriorYear
Salaries Etc Current Year10897182SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year83015TotalFundrsngExpCurrentYear
Other Expense Prior Year5621098OtherExpensePriorYear
Other Expenses Current Year6710049OtherExpensesCurrentYear
Total Expenses Prior Year27310751TotalExpensesPriorYear
Total Expenses Current Year17607231TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1342384RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2544764RevenuesLessExpensesCY
Total Assets BOY29899731TotalAssetsBOY
Total Assets EOY32575409TotalAssetsEOY
Total Liabilities BOY1677241TotalLiabilitiesBOY
Total Liabilities EOY1537379TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY28222490NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY31038030NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE FOR ALL.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangetrueSignificantChange
Expense13537194Expense
Revenue7413466Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense13537194TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArttrueCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109653NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees269NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members17NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledMOStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBOB THEISNamePerson
Telephone Number8168894802TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1825 EUCLID AVENUEAddressLine1
CityKansas CityCity
StateMOState
ZIP Code64124ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Ralph C Johnson MS CPA
Director/Chairperson1.0XX
Steven Israellite
Director/Vice Chairperson1.0XX000
Harry S Jonas MD
Director1.0X000
Joseph L Hiersteiner
Director/Treasurer1.0XX000
Ursula Copeland MSW
Director/Secretary1.0XX000
Farah Abdi
Director1.0X
Charles Houseworth
Director1.0X
Mona Lee Perry
Director1.0X
Manuel Solano MD
Director1.0X
Nhoung Tran
Director1.0X
ROBERT BROOKS
Director1.0X
JERRY STOLOV
Director1.0X
Maime Hughes
Emeritus (Non-Voting Director)1.0X
JOE VALENCIANO
DIRECTOR/VICE CHAIRPERSON1.0XX000
BRADLEY SANCHEZ HOUSETON
DIRECTOR1.0X
RANDALL FERGUSON
DIRECTOR1.0X
KATRENA ARMSTRONG
DIRECTOR1.0X
CATHY WALLACE
DIRECTOR1.0X
Ruth Terrell
CHIEF MKTG AND DEVEL. OFFICER40.0X11459212034
Hilda Fuentes
Chief Executive Officer40.0X18870613269
Ralph Caro
Chief Operating Officer40.0X11843511505
Daniel T Purdom MD
Chief Health Officer40.0X16668016065
Helen K Darby RN
Chief Clinical Officer40.0X1134497680
Bob Theis CPA
Chief Financial Officer40.0X10696610843
Sudha Chaudhuri MD
Physician24.015448512902X
Cindy Ruttan MD
Psychiatrist40.014460113167X
GREGORY BUHLER DO
PHYSICIAN40.014787317157X
MICHAEL WELLS DO
PHYSICIAN40.013976512471X
KHURSHEED ZIA MD
PSYCHIATRIST40.013387318842X
Charlene Mason-Dozier DDS
Former Chief Dental Officer40.012360610919X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1653031TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation156854TotalOtherCompensation
Number Individuals GT100 K19NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
WORKSMART MD
MEDICAL BILLING335116
PHARMACY SYSTEMS
PHARMACY MANAGEMENT323438
ALEXANDER OPEN SYSTEMS
MIS CONTRACT MGMT273003
CASEY ASSOCIATES INC
DOCUMENT MANAGEMENT124500
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Federated Campaigns175640FederatedCampaigns
Fundraising Events65207FundraisingEvents
Government Grants10624757GovernmentGrants
All Other Contributions1285937AllOtherContributions
Noncash Contributions152167NoncashContributions
Total Contributions12151541TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient Service RevenueDescription
Business Code621400BusinessCode
Total Revenue Column7413466TotalRevenueColumn
Related Or Exempt Function Income7413466RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue7413466TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column24142TotalRevenueColumn
Exclusion$24,142ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1060394Securities
Other5230Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1013227Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities47167Securities
Other5230Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column52397TotalRevenueColumn
Exclusion$52,397ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events23873GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events65207CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses93837FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-69964TotalRevenueColumn
Exclusion-$69,964ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Other Income90009939812$39,812
EHR INCENTIVES900099510000$510,000
RECOVERY OF LOSS ON IMPAIRMENT90009930601$30,601
FieldValueIRS element (for citing)
Total Other Revenue580413TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20151995TotalRevenueColumn
Related Or Exempt Function Income7413466RelatedOrExemptFunctionIncome
Exclusion$586,988ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total782816Total
Program Services614041ProgramServices
Management And General168775ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7578365Total
Program Services6433423ProgramServices
Management And General1079942ManagementAndGeneral
Fundraising65000Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total255240Total
Program Services199275ProgramServices
Management And General55965ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1549291Total
Program Services1428375ProgramServices
Management And General109484ManagementAndGeneral
Fundraising11432Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total731470Total
Program Services628654ProgramServices
Management And General96233ManagementAndGeneral
Fundraising6583Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total55615Total
Management And General55615ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total87375Total
Management And General87375ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1830262Total
Program Services1140210ProgramServices
Management And General690052ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total212742Total
Program Services207838ProgramServices
Management And General4904ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total536921Total
Program Services448491ProgramServices
Management And General88430ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total259039Total
Program Services106088ProgramServices
Management And General152951ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total465703Total
Program Services328462ProgramServices
Management And General137241ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total69198Total
Program Services58492ProgramServices
Management And General10706ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total22611Total
Program Services10864ProgramServices
Management And General11747ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total227Total
Program Services227ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1565663Total
Program Services594766ProgramServices
Management And General970897ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total78975Total
Management And General78975ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt Expense494526494526
Repairs & Maintenance15275011147841272
MEDICAL SUPPLIES639639639639
Dues & Subscriptions1203563651783839

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total118447Total
Program Services55828ProgramServices
Management And General62619ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17607231Total
Program Services13537194ProgramServices
Management And General3987022ManagementAndGeneral
Fundraising83015Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY118401BOY
EOY267813EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1260024BOY
EOY1357631EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY728728BOY
EOY688620EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY500347BOY
EOY615231EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY54286BOY
EOY47306EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY125969BOY
EOY140053EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis29906483LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4507336LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4102624BOY
EOY25399147EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1057904BOY
EOY1259543EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY78946EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY21951448BOY
EOY2721119EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY29899731BOY
EOY32575409EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1386508BOY
EOY1307581EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY270457BOY
EOY229798EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY20276BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1677241BOY
EOY1537379EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8551409BOY
EOY30768895EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY19671081BOY
EOY269135EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY28222490BOY
EOY31038030EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY29899731BOY
EOY32575409EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2544764ReconcilationRevenueExpenses
Reconcilation Other Changes270776ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Collect Used For Loan Or Exch PrgrmsXCollectUsedForLoanOrExchPrgrms
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1485793OtherCostOrOtherBasis
Book Value1485793BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis22031549OtherCostOrOtherBasis
Depreciation1588571Depreciation
Book Value20442978BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis262984OtherCostOrOtherBasis
Depreciation79200Depreciation
Book Value183784BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis6116706OtherCostOrOtherBasis
Depreciation2839565Depreciation
Book Value3277141BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9451OtherCostOrOtherBasis
Book Value9451BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings25399147TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
EST AMTS DUE FROM 3RD PARTIES2400000
OTHER A/R8546
SUR LEGACY FUND43438
INT IN NET ASSETS OF SURHCF269135
FieldValueIRS element (for citing)
Total Book Value Other Assets2721119TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Total Revenue20151995TotalRevenue
Total Expenses17607231TotalExpenses
Excess Or Deficit For Year2544764ExcessOrDeficitForYear
Net Unrealized GL On Investments119051NetUnrealizedGLOnInvestments
Other$151,725OtherAmount
Total Adjustments270776TotalAdjustments
Excess Or Deficit Per FS2815540ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt20364883TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments119051NetUnrealizedGainsInvestments
Other Revenues93837OtherRevenues
Revenue Not Rptd F990212888RevenueNotRptdF990
Revenue Subtotal20151995RevenueSubtotal
Total Revenue Per Form99020151995TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17701068TotExpensesEtcAuditedFinclStmt
Other Expenses Included93837OtherExpensesIncluded
Expenses Not Rptd F99093837ExpensesNotRptdF990
Expenses Subtotal17607231ExpensesSubtotal
Total Expenses Per Form99017607231TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
COLLECTIONS OF ARTSCHEDULE D, PART III, LINE 4Paintings by Rita Blitt were installed at the Health Center in April 2012. These paintings are part of the Rita Blitt Museum Without Walls exhibition. The Rita Blitt Museum Without Walls was developed in 2012 to list and illustrate exhibitions that are available for loan to galleries and museums, to map the numerous public places throughout the world that one can visit to view Blitts artwork, to share educational curriculum and films relating to her practice, and to showcase works in her portfolio. The exhibition featured in the On View section will change on a monthly basis. Blitt has indefinitely loaned collections of her art to non-profit organizations through the Rita Blitt Foundation, whose mission is to share, educate, and inspire through the artworks of Blitt.
UNCERTAIN TAX POSITIONS DISCLOSURESCHEDULE D, PART X, LINE 2MANAGEMENT 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.
RECONCILIATION OF CHANGE IN NET ASSETSSCHEDULE D, PART XI, LINE 8CHANGE IN INTEREST OF SURHCF $ 151,275
RECONCILIATION OF REVENUES PER AUDITED FINANCIAL STATEMENTSSCHEDULE D, PART XII, LINE 2DFUNDRAISING EVENT EXPENSES $ 93,837
RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTSSCHEDULE D, PART XIII, LINE 2DFUNDRAISING EVENT EXPENSES $ 93,837

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1NEW BEGINNINGNameOfEvent1
Gross Receipts Event189080GrossReceiptsEvent1
Charitable Contributions Event165207CharitableContributionsEvent1
Gross Revenue Event123873GrossRevenueEvent1
Rent Facility Costs Event110156RentFacilityCostsEvent1
Food And Beverage Event125740FoodAndBeverageEvent1
Entertainment Event17940EntertainmentEvent1
Other Direct Expenses Event150001OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total89080GrossReceiptsTotal
Charitable Contributions Total65207CharitableContributionsTotal
Gross Revenue Total Events23873GrossRevenueTotalEvents
Rent Facility Costs Total Events10156RentFacilityCostsTotalEvents
Food And Beverage Total Events25740FoodAndBeverageTotalEvents
Entertainment Total Events7940EntertainmentTotalEvents
Other Direct Expenses Total Events50001OtherDirectExpensesTotalEvents
Direct Expense Summary Events93837DirectExpenseSummaryEvents
Net Income Summary-69964NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Hilda Fuentes
1721991623727079045365201975
Daniel T Purdom MD
166410027086407425182745
Charlene Mason-Dozier DDS
123404020262814638134525
Sudha Chaudhuri MD
154364012179874915167387
Cindy Ruttan MD
144331027069836184157768
GREGORY BUHLER DO
1476030270480012357165030
MICHAEL WELLS DO
139495027071065365152236
KHURSHEED ZIA MD
1336030270700011842152715

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990107793NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionDENTAL EQUIPMENTDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99044374NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierNUMBER OF CONTRIBUTIONSIdentifier
Return ReferenceSCHEDULE M, PART I, COLUMN BReturnReference
ExplanationTHE AMOUNTS IN COLUMN B REPRESENT THE NUMBER OF CONTRIBUTIONS MADE.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CHANGES TO PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 3The Health Center completed construction of a new facility and moved from its previous Downtown Campus at 825 Euclid to the new facility with the same address. A legacy park was constructed at the previous location.
PROGRAM SERVICE ACCOMPLISHMENTFORM 990, PART III, LINE 4AThe Health Center is located in a community that is a vital part of the metropolitan area's multicultural fabric. Located northeast of the Vine District, the Health Center is accessible to neighborhood residents including individuals and families residing in nearby public housing family developments. The Health Centers goal is the same as its mission which is to provide high quality, compassionate health care to all. Comprehensive care is delivered to people throughout the Kansas City metropolitan area and rural Lafayette county and surrounding area in Missouri. Our outpatient primary care services include: - Adult & Senior Services - Behavioral Health - Children's & Adolescents Health - Women's Health - Dental Health - Podiatry On-site ancillary and supportive services include: - Laboratory - Imaging - Radiology - Pharmacy - Interpreters - Patient Transportation A full range of outreach services complete the array of primary care services. They include: - Education and screening for breast and cervical cancer - Counseling and treatment for alcohol, tobacco and other drug abuse - WIC and nutrition education services (serving 3,200 individuals monthly) - Missouri HealthNet enrollment - Community outreach and health education Today's constantly changing health care system has added a special challenge to the Health Center's ability to care for the medically underserved people in our service area: - The Kansas City area is home to an increasing number of financially indigent and uninsured patients who are ineligible for public support programs; - Many of the Health Center's patients are medically uninsured while third party reimbursement remains flat. The Health Center's patient base is extraordinarily diverse. Because we are located near one of the largest refugee resettlement facilities in the Midwest, our Health Center is a point of entry to primary care services for immigrants from war-torn nations. More than twenty percent of the 1.8 million residents of the Kansas City metropolitan area are uninsured or are on Medicaid. About 27% of our patients are best served in a language other than English. To ensure these patients receive high quality care, the Health Center employs a cadre of interpreters who speak 12 languages. Among patients served, 31 percent are Hispanic/Latino, 32 percent Caucasian, 20 percent African American, 10 percent representing other ethnicities and 7 percent are Asian/Pacific Islander. Children represent 38 percent of our patient base. Thus, protecting children from childhood diseases is a vital part of our mission. Unchecked, the ravages of childhood illnesses such as Measles, Mumps, and Rubella can cause permanent disability or even death. In 2011 SURHC - Provided health care for 19,047 individuals through over 69,500 visits - Launched a dental practice at J.A. Rogers Elementary School to provide oral health care services for low-income children - Provided $2.9 million in indigent care. 2012 -Provided health care for 21,114 individuals through over 77,000 visits - Launched a dental practice at the Clay County location to expand the Health Centers presence at that location - Provided $4.4 million in indigent care.
FORM 990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11AAN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING THE 990. ANY QUESTIONS AND CONCERNS THE FINANCE COMMITTEE HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CDuty to Disclose: If an Interested Person has a Position or Financial Interest in any business or other entity with which the Health Center is considering entering into an arrangement or transaction, the Interested Person must disclose the existence of the conflict to the Health Center's Board of Directors ("Board"). Determining Whether a Conflict of Interest Exists: The Board of Directors will make the determination. Procedures for Addressing the Conflict of Interest: - Prior to any discussion and vote on whether a conflict of interest exists, an Interested Person may make a presentation to the Board or the Executive Committee regarding the Interested Person's Position or Financial Interest. After such presentation, the Interested Person will leave the meeting during the discussion of, and the vote on, the Proposed Transaction. - The Board or the Executive Committee will undertake appropriate due diligence and inform itself of all material information reasonably available to it and explore all reasonable alternatives to the Proposed Transaction that would not involve the conflict of interest. - If a more advantageous transaction or arrangement is not reasonably possible under circumstances not producing a conflict of interest, the Board or the Executive Committee will determine by a majority vote of the Disinterested Directors whether the Proposed Transaction is (i) in the Health Center's best interest, (ii) for the Health Center's own benefit, and (iii) fair and reasonable to the Health Center. In conformity with this determination, the Board or the Executive Committee will make its decision as to whether the Health Center may enter into the Proposed Transaction. Violations of the Conflicts of Interest Policy: If the Board or the Executive Committee determines that the Covered Person has in fact failed to disclose a Position or a Financial Interest, the Board or the Executive Committee will take appropriate disciplinary and corrective action. Documentation in Minutes: With respect to the determination of whether a conflict of interest exists, the name of the Interested Person who disclosed or was otherwise found to have a Position or Financial Interest in connection with an actual or potential conflict of interest; the nature of the Position or Financial Interest; any action taken to determine whether a conflict of interest was present; and the Board or the Executive Committee's decision as to whether a conflict of interest in fact existed. Annual Statements: Each Covered Person will annually sign a statement that affirms such person: - Has received a copy of this Policy; - Has read and understands the Policy; - Has agreed to comply with the Policy; and - Understand the Health Center is exempt from federal income tax and to maintain its federal tax exemption the Health Center must engage primarily in activities that accomplish one or more of its tax-exempt purposes. In addition, each Covered Person will annually complete, sign and promptly return to the Board or the Executive Committee a Questionnaire and Disclosure Statement substantially in the form attached hereto. A Covered Person need not disclose Compensation paid to the Covered Person by Health Center pursuant to a resolution of the Board. Periodic Reviews: The periodic reviews as required by the policy will, at a minimum, include the following subjects: - Whether the Health Center Compensation arrangements are reasonable, based on competent survey information, and are the result of arm's-length bargaining; and - Whether transactions and arrangements with other entities and individuals conform to the Health Center's policies, are properly recorded, reflect reasonable payments for goods and services, further the Health Center's tax-exempt purposes and do not result in private inurnment, impermissible private benefit, or in an excess benefit transaction.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINE 15AThe last evaluation for the CEO was in April 2012. This evaluation was done by the Health Center's Board of Directors. The Chairperson of the Board will lead the assessment process. The chair shall select a Performance and Compensation Committee and its chair. The CEO will complete a self-assessment. This allows the Board and CEO to compare one another's perception of the CEO's performance. The Chairperson of the Performance and Compensation Committee will have each board member complete the Assessment form individually and compile results. Distribution of the assessment form: The Committee Chairperson will distribute the CEO Self-Assessment and the Board's Assessment of the CEO well enough in advance to allow ample time for completion. The Committee Chairperson will set a deadline for completing the Board's Assessment of the CEO. Analysis of the results: The responses for each question will be added together and the average response computed. Next, the average responses for each question will be added together and the average response for the assessment as a whole should be calculated. The results will be shared with the Board for discussion and analysis in closed session. Review of the results with the CEO: The CEO and the Board will meet in a closed executive session or a special meeting to review and discuss the results. Based on the results, the Board and CEO will develop a written performance plan and performance goals for the CEO describing areas of focus and improvement for the next year. The performance assessment will be used as a basis for determining compensation. An independent committee, using comparability data will conduct compensation analysis. Such deliberations and decisions regarding compensation shall be documented and substantiated. This compensation review methodology shall be used for all Chief Officer Positions. Solicit the CEO's feedback: The Board will obtain the CEO's feedback regarding the assessment process. Feedback will include understanding the CEO's agreement or disagreement with the Board's assessment; whether the format was appropriate, whether the Board and the CEO believed that the form used captured all of the necessary elements, and which areas could be improved in the next assessment. Other officers and key employees: On a regular basis, human resources will conduct salary surveys to ensure current job pay ranges and median pay for certain benchmarked positions remain competitive in the marketplace and consistent with the company's compensation philosophy. An independent committee using comparability data will conduct compensation analysis. Such deliberations and decisions regarding compensation should be documented and substantiated.
AVAILABILITY OF DOCUMENTSFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5NET UNREALIZED GAINS/(LOSSES) $ 119,051 CHANGE IN INTEREST OF SURHCF $ 151,725 --------- $ 270,776
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Ralph C. Johnson, MS, CPA TITLE:Director/Chairperson HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Manuel Solano, M.D. TITLE:Director HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Maime Hughes TITLE:Emeritus (Non-Voting Director) HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Hilda Fuentes TITLE:Chief Executive Officer HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Ralph Caro TITLE:Chief Operating Officer HOURS:1

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Samuel U Rodgers Health Ctr FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1825 Euclid AvenueAddressLine1
CityKansas CityCity
StateMOState
ZIP Code64124ZIPCode
FieldValueIRS element (for citing)
EIN200751739EIN
Primary ActivitiesSUPPORT ORGPrimaryActivities
Legal Domicile StateMOLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SURHCBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgtrueControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1Samuel U Rodgers Health Center FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeRTransactionType
Amount Involved19550543AmountInvolved
Method Of Amt DeterminationCOSTMethodOfAmtDetermination

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