SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SUSAN B ALLEN MEMORIAL HOSPITAL FOUNDATION (EIN 48-0862732)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201223209349302407
Schema version
2011v1.3
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T10:18:50-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

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 Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN480862732EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Susan B Allen Memorial Hospital FoundationBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% ROBIN CRAWFORDInCareOfName
Name ControlSUSANameControl
Phone3163213300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1720 West CentralAddressLine1
CityEl DoradoCity
StateKSState
ZIP Code67042ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGAYLE ARNETTName
TitlePRESIDENT/CEOTitle
Phone3163213300Phone
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
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 PersonGAYLE ARNETTNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1
CityEL DORADOCity
StateKSState
ZIP Code67042ZIPCode
FieldValueIRS element (for citing)
Gross Receipts191338GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SBAMH.COM/DEVELOPMENT.CFMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionTO MAINTAIN AND IMPROVE THE SERVICES OF SUSAN B. ALLEN MEMORIAL HOSPITAL.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers11TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year211231ContributionsGrantsPriorYear
Contributions Grants Current Year112214ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year45738InvestmentIncomePriorYear
Investment Income Current Year40944InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year26524OtherRevenueCurrentYear
Total Revenue Prior Year256969TotalRevenuePriorYear
Total Revenue Current Year179682TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year163990GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY99164GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6273OtherExpensePriorYear
Other Expenses Current Year6060OtherExpensesCurrentYear
Total Expenses Prior Year170263TotalExpensesPriorYear
Total Expenses Current Year105224TotalExpensesCurrentYear
Revenues Less Expenses Prior Year86706RevenuesLessExpensesPriorYear
Revenues Less Expenses CY74458RevenuesLessExpensesCY
Total Assets BOY1328881TotalAssetsBOY
Total Assets EOY1381566TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1328881NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1381566NetAssetsOrFundBalancesEOY
Mission DescriptionTO MAINTAIN AND IMPROVE THE SERVICES OF SUSAN B. ALLEN MEMORIAL HOSPITAL.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense99164Expense
Grants99164Grants
Revenue0Revenue
DescriptionEQUIPMENT AND PROGRAM SUPPORT FOR SUSAN B. ALLEN MEMORIAL HOSPITAL.Description
Total Program Service Expense99164TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
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 OrganizationstrueGrantsToOrganizations
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 ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
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 Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
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 CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledKSStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonROBIN CRAWFORDNamePerson
Telephone Number3163224559TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1
CityEL DORADOCity
StateKSState
ZIP Code67042ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
PAULA GILLILAND
DIRECTOR1.0X000
BARBARA DANKERT
DIRECTOR1.0X000
DAN DAVIS
DIRECTOR1.0X000
MIKE MCGUIRE
DIRECTOR1.0X000
TOM MCKIBBAN
DIRECTOR1.0X000
RYAN MURRY
DIRECTOR1.0X000
JUSTIN PARSONS
DIRECTOR1.0X000
JEREMY SUNDGREN
DIRECTOR1.0X000
BILL KLOEBLEN
DIRECTOR1.0X000
ALISON ROBBINS
DIRECTOR1.0X000
LADONNA SNOOK
DIRECTOR1.0X000
ROBIN CRAWFORD
VICE PRESIDENT & CFO1.0016230026393X
GAYLE ARNETT
PRESIDENT & CEO1.0024162439422X
MARY LUEBBERT
DIRECTOR OF FUND DEVELOPMENT1.005733011566X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs461254TotalReportableCompFrmRltdOrgs
Total Other Compensation77381TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions112214AllOtherContributions
Total Contributions112214TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column40944TotalRevenueColumn
Exclusion$40,944ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events38180GrossIncomeFundraisingEvents
Fundraising Direct Expenses11656FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column26524TotalRevenueColumn
Exclusion$26,524ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column179682TotalRevenueColumn
Exclusion$67,468ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total99164Total
Program Services99164ProgramServices

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)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total350Total
Management And General350ManagementAndGeneral

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)
Total5663Total
Management And General5663ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total47Total
Management And General47ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total105224Total
Program Services99164ProgramServices
Management And General6060ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY68145BOY
EOY64903EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

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)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1260736BOY
EOY1316663EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1328881BOY
EOY1381566EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

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)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1045346BOY
EOY1054337EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY130600BOY
EOY161294EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY152935BOY
EOY165935EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1328881BOY
EOY1381566EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1328881BOY
EOY1381566EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses74458ReconcilationRevenueExpenses
Reconcilation Other Changes-21773ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 OtherXSupportingOrg509a3Type3Other
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1SUSAN B ALLEN MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
EIN480581968EIN
Type Of Organization03TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$99,164Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts99164SumOfAmounts

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

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1165992BeginningOfYearBalance
Contributions43432Contributions
Investment Earnings Or Losses13396InvestmentEarningsOrLosses
Other Expenditures47095OtherExpenditures
Administrative Expenses5665AdministrativeExpenses
End Of Year Balance1170060EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1138533BeginningOfYearBalance
Contributions38000Contributions
Investment Earnings Or Losses112893InvestmentEarningsOrLosses
Other Expenditures118334OtherExpenditures
Administrative Expenses5100AdministrativeExpenses
End Of Year Balance1165992EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1029973BeginningOfYearBalance
Contributions40000Contributions
Investment Earnings Or Losses113597InvestmentEarningsOrLosses
Other Expenditures45037OtherExpenditures
End Of Year Balance1138533EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1138441BeginningOfYearBalance
Contributions58722Contributions
Investment Earnings Or Losses-130655InvestmentEarningsOrLosses
Other Expenditures36535OtherExpenditures
End Of Year Balance1029973EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.84570BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.14180PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.01250TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements
EquipmentEquipment
Other Land BuildingsOtherLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Total Revenue179682TotalRevenue
Total Expenses105224TotalExpenses
Excess Or Deficit For Year74458ExcessOrDeficitForYear
Net Unrealized GL On Investments-21773NetUnrealizedGLOnInvestments
Total Adjustments-21773TotalAdjustments
Excess Or Deficit Per FS52685ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt169565TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-21773NetUnrealizedGainsInvestments
Other Revenues11656OtherRevenues
Revenue Not Rptd F990-10117RevenueNotRptdF990
Revenue Subtotal179682RevenueSubtotal
Total Revenue Per Form990179682TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt116880TotExpensesEtcAuditedFinclStmt
Other Expenses Included11656OtherExpensesIncluded
Expenses Not Rptd F99011656ExpensesNotRptdF990
Expenses Subtotal105224ExpensesSubtotal
Total Expenses Per Form990105224TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
INTENDED USE OF ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4EARNINGS FROM THE ENDOWMENT FUNDS ARE USED TO FUND THE PURCHASE OF EQUIPMENT AND PROGRAM SUPPORT FOR SUSAN B. ALLEN MEMORIAL HOSPITAL.
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 REVENUE PER AUDITED FINANCIAL STATEMENTSSCHEDULE D, PART XII, LINE 2DFUNDRAISING EVENT EXPENSES $ 11,656
RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTSSCHEDULE D, PART XIII, LINE 2DFUNDRAISING EVENT EXPENSES $ 11,656

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1MASQUERADE BALLNameOfEvent1
Gross Receipts Event138180GrossReceiptsEvent1
Gross Revenue Event138180GrossRevenueEvent1
Food And Beverage Event17628FoodAndBeverageEvent1
Entertainment Event11200EntertainmentEvent1
Other Direct Expenses Event15566OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Other Events0GrossReceiptsOtherEvents
Charitable Contrib Other Events0CharitableContribOtherEvents
Gross Revenue Other Events0GrossRevenueOtherEvents
Cash Prizes Other Events0CashPrizesOtherEvents
Non Cash Prizes Other Events0NonCashPrizesOtherEvents
Rent Facility Costs Other Events0RentFacilityCostsOtherEvents
Food And Beverage Other Events0FoodAndBeverageOtherEvents
Entertainment Other Events0EntertainmentOtherEvents
Other Direct Expenses Other Events0OtherDirectExpensesOtherEvents
Gross Receipts Total38180GrossReceiptsTotal
Charitable Contributions Total0CharitableContributionsTotal
Gross Revenue Total Events38180GrossRevenueTotalEvents
Cash Prizes Total Events0CashPrizesTotalEvents
Non Cash Prizes Total Events0NonCashPrizesTotalEvents
Rent Facility Costs Total Events0RentFacilityCostsTotalEvents
Food And Beverage Total Events7628FoodAndBeverageTotalEvents
Entertainment Total Events1200EntertainmentTotalEvents
Other Direct Expenses Total Events5566OtherDirectExpensesTotalEvents
Direct Expense Summary Events14394DirectExpenseSummaryEvents
Net Income Summary23786NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1SUSAN B ALLEN MEMORIAL HOSPITALBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1
CityEL DORADOCity
StateKSState
ZIP Code67042ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient480581968EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant99164AmountOfCashGrant
Purpose Of GrantFINANCIAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING OF GRANTSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationALL 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ROBIN CRAWFORD
0161202000109806457019936018869300
GAYLE ARNETT
02378170003807017780021642028104600

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierCOMPENSATION FROM RELATED ORGANIZATIONIdentifier
Return ReferenceFORM 990, PART VII; SCHEDULE J, PART I, LINE 3 & PART IIReturnReference
ExplanationTHE COMPENSATION BEING REPORTED FOR GAYLE ARNETT, ROBIN CRAWFORD AND MARY LUEBBERT 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 MS. ARNETT, MR. CRAWFORD, AND MS. LUBEBBERT'S COMPENSATION.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
MEMBERSFORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS TWO CLASSES OF MEMBERSHIP: THE HOSPITAL MEMBER, THE SUSAN B. ALLEN MEMORIAL HOSPITAL, A RELATED 501(C)(3) TAX EXEMPT ORGANIZATION, AND THE VOTING MEMBERS, CONSIST OF THOSE NATURAL PERSONS WHO HAVE BEEN ELECTED TO, ARE QUALIFIED AND ARE SERVING AS DIRECTORS OF THE CORPORATION.
DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL OF MEMBERSFORM 990, PART VI, SECTION A, LINE 7BTHE 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.
FORM 990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BAN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE FOUNDATION'S OFFICERS AND THE ACCOUNTING STAFF. ANY QUESTIONS OR CONCERNS THE FOUNDATION'S OFFICERS OR ACCOUNTING STAFF HAVE 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.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CAT THE TIME OF HIRE OR ELECTION IN THE CASE OF BOARD MEMBERS, AND ANNUALLY THEREAFTER, DIRECTOR OF FUND DEVELOPMENT 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.
AVAILABILITY OF DOCUMENTSFORM 990, PART VI, SECTION C, LINE 19THE GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
RECONCILIATION OF NET ASSETSFORM 990, PART XI, LINE 5UNREALIZED GAINS/(LOSSES) $ 74,415
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBIN CRAWFORD TITLE:VICE PRESIDENT & CFO HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:GAYLE ARNETT TITLE:PRESIDENT & CEO HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MARY LUEBBERT TITLE:DIRECTOR OF FUND DEVELOPMENT HOURS:40

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SUSAN B ALLEN MEMORIAL HOSPITALBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1720 WEST CENTRALAddressLine1
CityEL DORADOCity
StateKSState
ZIP Code67042ZIPCode
FieldValueIRS element (for citing)
EIN480581968EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateKSLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
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 OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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