2023-12-12T15:47:00-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 480955489 AMBERWELL HEALTH FOUNDATION AMBE 9133676653 800 RAVEN HILL DRIVE ATCHISON KS 66002 CHASE DUDZINSKI CHIEF FINANCIAL OFFICER 9133676653 2023-12-12 1 CHASE DUDZINSKI XXX-XX-XXXX 1 WENDY R COOLEY CPA P01523804 4023302660 2023-12-12 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X RICHARD BERGER 800 RAVEN HILL DRIVE ATCHISON KS 66002 6056156 0 X N/A X 1983 KS SUPPORT FOR AMBERWELL ATCHISON ASSOCIATION IN ITS MISSION AND TO SUPPORT THE HEALTH OF THE COMMUNITY. 4 4 0 5 -21594 0 0 0 10 0 161884 512835 -17478 33511 144416 546346 0 750000 0 0 0 0 0 0 0 21159 78653 21159 828653 123257 -282307 17491382 14260475 0 0 17491382 14260475 SUPPORT FOR AMBERWELL ATCHISON ASSOCIATION IN ITS MISSION AND TO SUPPORT THE HEALTH OF THE COMMUNITY. 0 0 750000 750000 INVEST THE FOUNDATION CORPUS, PROVIDE CAPITAL EXPENDITURE FUNDS ANNUALLY, AND UPON REQUEST AND APPROVAL, PROVIDE FUNDS FOR NEW PROJECTS. 750000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 1 0 1 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X CHASE DUDZINSKI 9133676653 800 RAVEN HILL DRIVE ATCHISON KS 66002 JEFF PERRY CEO 1.00 40.00 X 0 519608 18104 JIM FRASER CFO THRU 07/22 1.00 40.00 X 0 198128 21307 CHASE DUDZINSKI CFO 1.00 40.00 X 0 165681 23194 RICHARD N BERGER CHAIRPERSON 1.00 0.00 X X 0 0 0 KEVIN MCDERMED SECRETARY 1.00 0.00 X X 0 0 0 MARK WINDSOR TREASURER 1.00 0.00 X X 0 0 0 BILL THORNTON DIRECTOR 1.00 0.00 X 0 0 0 ANDREA BOCK-KUNZ MD DIRECTOR THRU 04/22 1.00 0.00 X 0 0 0 0 883417 62605 0 0 1 0 0 243377 243377 5779268 5509810 269458 269458 269458 RECOVERY OF INVESTMENT FUNDS 900099 55105 55105 PARTNERSHIP INCOME 525990 -21594 -21594 33511 546346 0 -21594 567940 750000 750000 1255 1255 77398 77398 828653 750000 78653 0 223266 127365 17005160 13821562 239680 288272 23276 23276 17491382 14260475 0 0 X 17491382 14260475 17491382 14260475 17491382 14260475 -282307 -2948600 0 X X 0 1 X 1 0 X X 1 AMBERWELL ATCHISON ASSOCIATION 480561974 3 1 250000 0 1 250000 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION C, LINE 1: JEFF PERRY SERVES AS A NON-VOTING MEMBER ON THE BOARD OF DIRECTORS FOR THE FOUNDATION AND IS CEO FOR AMBERWELL ATCHISON. HE IS ABLE TO MONITOR THE ACTIONS OF THE FOUNDATION AND SEE THAT THEY ARE MEETING THE NEEDS OF THE HOSPITAL. PART IV, SECTION A, LINE 6: THE FOUNDATION PROVIDED SUPPORT TO HIAWATHA HOSPITAL ASSOCIATION, INC. IN THE CURRENT YEAR. AMBERWELL ATCHISON ASSOCIATION, THE SUPPORTED ORGANIZATION, AND HIAWATHA HOSPITAL ASSOCIATION, INC. HAVE AN AFFILIATION AGREEMENT IN PLACE. THE SEPARATE HOSPITAL ORGANIZATION'S HAVE SIMILAR MISSIONS OF SUPPORTING THE HEALTH AND WELFARE OF THE RESIDENTS IN RURAL COMMUNITIES. 0 X PART X, LINE 2: THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 AMBERWELL ATCHISON ASSOCIATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480561974 501(C)(3) 250000 0 PROGRAM SUPPORT HIAWATHA HOSPITAL ASSOCIATION 300 UTAH STREET HIAWATHA KS 66434 480577658 501(C)(3) 500000 0 PROGRAM SUPPORT 2 0 PART I, LINE 2: THE FOUNDATION ONLY MAKES GRANTS TO AMBERWELL ATCHISON ASSOCIATION, THE SUPPORTED ORGANIZATION, OR OTHER AFFILIATED HEALTHCARE ORGANIZATIONS WITH SIMILAR MISSIONS. JEFF PERRY, NON-VOTING MEMBER OF THE FOUNDATION BOARD, SERVES AS THE CEO OF BOTH AMBERWELL ATCHISON ASSOCIATION AND HIAWATHA HOSPITAL ASSOCIATION AND IS ABLE TO MONITOR THE USE OF THE GRANT FUNDS THROUGH MANAGEMENT OVERSIGHT. 0 0 0 0 0 0 0 0 0 JEFF PERRY CEO 0 392938 0 126508 0 162 0 9150 0 8954 0 537712 0 0 JIM FRASER CFO THRU 07/22 0 198128 0 0 0 0 0 3266 0 18041 0 219435 0 0 CHASE DUDZINSKI CFO 0 145552 0 20000 0 129 0 3125 0 20069 0 188875 0 0 PART I, LINE 3 COMPENSATION FOR JEFF PERRY IS ESTABLISHED BY AMBERWELL ATCHISON ASSOCIATION, A RELATED ENTITY, USING THE FOLLOWING: INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION STUDY, FORM 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. JEFF SERVED AS A NON-VOTING MEMBER OF THE FOUNDATION AND CEO OF AMBERWELL ATCHISON. FORM 990, PART VI, SECTION A, LINE 2 MARK WINDSOR, RICHARD BERGER AND KEVIN MCDERMED HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE REVISED IN 2022 TO CHANGE THE NAME TO AMBERWELL HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 6 AMBERWELL HEALTH FOUNDATION HAS THREE CLASSES OF MEMBERS. LIFETIME MEMBERSHIPS CONSISTS OF INDIVIDUAL WHO HAVE AT ANY TIME CONTRIBUTED TO THE CORPORATION $1,000 TO $9,999. SUSTAINING MEMBERSHIP CONSISTS OF INDIVIDUALS WHO HAVE AT ANY TIME CONTRIBUTED TO THE CORPORATION $10,000 OR MORE. CORPORATE MEMBERSHIP CONSISTS OF THOSE BUSINESS ENTITIES WHO HAVE AT ANY TIME CONTRIBUTED TO THE CORPORATION $25,000 OR MORE. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS HAVE THE RIGHT TO ELECT THE MEMBERS OF THE BOARD OF DIRECTORS OF RIVERBEND REGIONAL HEALTHCARE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B IF THE BOARD RECOMMENDS THE REMOVAL OF A MEMBER FOR ENGAGING IN CONDUCT THAT IS IMMORAL, ILLEGAL, OR OTHERWISE CONTRARY OR DETRIMENTAL TO THE PURPOSE OF THE CORPORATION, THE ISSUE SHALL BE PUT TO A VOTE OF THE MEMBERSHIP. REMOVAL OF A MEMBER SHALL REQUIRE A VOTE OF 2/3 OF ALL MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF ELECTION AND ANNUALLY THEREAFTER, THE GOVERNING BOARD MEMBERS SHALL PROVIDE THE APPLICABLE CONFLICT OF INTEREST DISCLOSURES WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM THE VOTE OF THE CONFLICTED POSITION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMBERWELL ATCHISON ASSOCIATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480561974 HOSPITAL KS 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0