2024-11-07T09:02:53-06:00 2023-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-08-01 932800795 AMBERWELL ATCHISON SUPPORT ORGANIZATION INC AMBE 2025858442 800 RAVEN HILL DR ATCHISON KS 66002 CHASE DUDZINSKI CFO 2025858442 2024-11-05 1 1 WENDY R COOLEY CPA P01523804 4023302660 2024-11-02 2023 2024-10-15 13:58:12Z X LARRY MEARS 800 RAVEN HILL DR ATCHISON KS 66002 20026 0 X AMBERWELLHEALTH.ORG X 2023 KS SUPPORT AND BENEFIT AMBERWELL ATCHISON ASSOCIATION. 5 5 0 5 0 0 0 0 20026 0 20026 0 0 0 0 0 10000 10000 10026 8398482 0 8398482 NONE 0 0 10000 AMBERWELL ATCHISON SUPPORT ORGANIZATION WAS FORMED DURING 2023 AS A SUPPORTING ORGANIZATION OF AMBERWELL ATCHISON ASSOCIATION FOR THE NEW MARKET TAX CREDITS FOR THE PURPOSES OF SUPPORTING HOSPITAL OPERATIONS. THIS AGREEMENT ENABLED THE HOSPITAL TO ENTER INTO SEVERAL FEDERAL AND STATE QUALIFIED LOW-INCOME COMMUNITY INVESTMENT (QLICI) FINANCIAL AGREEMENTS IN ORDER TO FINANCE CONSTRUCTION PROJECTS. 10000 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 0 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 5 5 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X CHASE DUDZINSKI 2025858442 800 RAVEN HILL DRIVE ATCHISON KS 66002 LARRY MEARS CHAIR 1.00 1.00 X X 0 0 0 JERRY HENRY VICE CHAIR 1.00 1.00 X X 0 0 0 LORIN AFFIELD SECRETARY 1.00 1.00 X X 0 0 0 SUSAN MYERS DIRECTOR 1.00 0.00 X 0 0 0 REED BERGER DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY PERRY CEO 1.00 41.00 X 0 434522 16004 CHASE DUDZINSKI CFO 1.00 41.00 X 0 250652 29813 0 685174 45817 0 0 1 0 0 20026 20026 20026 0 0 20026 LOAN ORIGINATION 10000 10000 10000 10000 0 0 0 562182 0 7836300 0 8398482 0 0 X 0 8398482 0 8398482 0 8398482 X 10026 8388456 X X 0 1 X 1 0 X X 1 AMBERWELL ATCHISON ASSOCIATION 480561974 3 1 0 10000 1 0 10000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 X 20026 0 20026 0 20026 10000 0 10000 0 10000 PART X, LINE 2: THE SUPPORT ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE SUPPORT ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023, THE SUPPORT ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 0 0 0 0 0 0 0 0 0 JEFFREY PERRY CEO 0 361022 0 73500 0 0 0 9900 0 6454 0 450876 0 0 CHASE DUDZINSKI CFO 0 244568 0 6084 0 0 0 7672 0 22491 0 280815 0 0 PART I, LINE 3 COMPENSATION FOR JEFFREY PERRY, CEO, 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. FORM 990, PART VI, SECTION A, LINE 7A THREE OF THE DIRECTORS OF THE CORPORATION SHALL BE DIRECTORS, OFFICERS, OR EMPLOYEES OF AMBERWELL ATCHISON ASSOCIATION. ANNUALLY, AMBERWELL ATCHISON ASSOCIATION'S BOARD OF DIRECTORS SHALL ELECT THE AMBERWELL DESIGNATED DIRECTORS BY VOTE. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED ELECTRONICALLY TO THE BOARD OF DIRECTORS TO REVIEW PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF THE ELECTION OR HIRE AND ANNUALLY THEREAFTER, THE GOVERNING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES 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 B, LINE 15 THE COMPENSATION FOR THE CEO AND CFO IS DETERMINED BY AMBERWELL ATCHISON ASSOCIATION, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DID NOT MAKE ANY OF THE ABOVE FORMS AVAILABLE. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 8,388,456. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. AMBERWELL ATCHISON ASSOCIATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480561974 HOSPITAL KS 501(C)(3) LINE 3 N/A 0 AMBERWELL HEALTH FOUNDATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480955489 SUPPORT AMBERWELL ATCHISON ASSOCIATION KS 501(C)(3) LINE 12B, II AMBERWELL ATCHISON ASSOCIATION 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0