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ST MARYS HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
ST MARYS HOSPITAL (EIN 37-0662580)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202243199349315499
Schema version
2021v4.2
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)
Return2022-11-15T13:37:31-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN370662580EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1St Mary's Hospital Centralia IllinoisBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTMABusinessNameControlTxt
Phone6184368000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110101 Woodfield LaneAddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63132ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRandy CombsPersonNm
Person TitleTreasurerPersonTitleTxt
Phone3149947800PhoneNum
Signature2022-11-15SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstBarbaraPersonFirstNm
Person LastPottsPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1SSM Health St Mary's Hospital - CentraliaBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Damon HarbisonBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line110101 Woodfield LaneAddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63132ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$120,465,670GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttps://www.ssmhealth.com/locations/st-marys-hospital-centraliaWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1947FormationYr
Legal Domicile StateMOLegalDomicileStateCd
Activity Or MissionTO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING & PROVIDING REGIONAL, COST EFFECTIVE QUALITY HEALTH SERVICES FOR EVERYONE, WITH A SPECIAL CONCERN FOR THE POOR AND VULNERABLE.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee753TotalEmployeeCnt
Total Volunteers49TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$10,558,099PYContributionsGrantsAmt
CY Contributions Grants$6,944,849CYContributionsGrantsAmt
PY Program Service Revenue$102,674,665PYProgramServiceRevenueAmt
CY Program Service Revenue$113,041,526CYProgramServiceRevenueAmt
PY Investment Income-$7,718PYInvestmentIncomeAmt
CY Investment Income-$50,423CYInvestmentIncomeAmt
PY Other Revenue$317,039PYOtherRevenueAmt
CY Other Revenue$289,790CYOtherRevenueAmt
PY Total Revenue$113,542,085PYTotalRevenueAmt
CY Total Revenue$120,225,742CYTotalRevenueAmt
PY Grants And Similar Paid$5,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$12,617CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$49,915,425PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$46,888,094CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$16,955CYTotalFundraisingExpenseAmt
PY Other Expenses$48,468,555PYOtherExpensesAmt
CY Other Expenses$55,581,129CYOtherExpensesAmt
PY Total Expenses$98,388,980PYTotalExpensesAmt
CY Total Expenses$102,481,840CYTotalExpensesAmt
PY Revenues Less Expenses$15,153,105PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$17,743,902CYRevenuesLessExpensesAmt
Total Assets BOY$101,261,497TotalAssetsBOYAmt
Total Assets EOY$116,545,110TotalAssetsEOYAmt
Total Liabilities BOY$82,030,674TotalLiabilitiesBOYAmt
Total Liabilities EOY$79,763,713TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$19,230,823NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$36,781,397NetAssetsOrFundBalancesEOYAmt
MissionTHROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$88,694,962ExpenseAmt
Grant$12,617GrantAmt
Revenue$113,041,526RevenueAmt
DescPLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.Desc
Total Program Service Expenses$88,694,962TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee753EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mark StoverBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6184367545PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1400 N Pleasant AvenueAddressLine1Txt
CityCentraliaCityNm
State AbbreviationILStateAbbreviationCd
ZIP62801ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Candace Jennings
Pt Yr Director, Pt Yr Chairperson, Pt Yr Regional President-St. Louis/Southern Illinois1.045.0Yes (X)Yes (X)$0$768,694$18,648
Damon Harbison
Director, Hospital President40.03.0Yes (X)Yes (X)$0$325,010$165,902
Sr M Clarette Stryzewski CSSF
Director, Chairperson1.03.0Yes (X)Yes (X)$0$0$0
Erica Ibendahl MD
Director, SSM Health Medical Group Physician1.043.0Yes (X)$0$668,241$53,990
Jeremy Bradford
Director, Hospital President-SSM Health Good Samaritan Hospital1.042.0Yes (X)$0$354,690$178,557
Matthew Flanigan
Director1.03.0Yes (X)$0$0$0
Michael Baumgartner
Director, Regional President-Southern Illinois1.044.2Yes (X)$0$625,557$220,270
Patty Williams
Director1.04.0Yes (X)$0$0$0
Ryan Willis MD
Director1.03.0Yes (X)$0$0$0
Sajjan K Nemani MD
Director1.043.0Yes (X)$0$489,281$0
Sr M Ramona Dombrowski CSSF
Director1.03.0Yes (X)$0$0$0
Stacy Tate
Director1.03.0Yes (X)$0$0$0
Sudeep Nair MD
Director, SSM Health Medical Group Physician1.043.0Yes (X)$0$554,989$57,910
Douglas Long
Secretary, General Counsel at SSM Health1.068.2Yes (X)$0$1,201,678$483,601
John Snodsmith
Regional VP, Finance10.035.0Yes (X)$0$265,033$83,277
Rachel Hall
Assistant Secretary1.043.0Yes (X)$0$84,975$27,568
Randy Combs
Treasurer, Chief Financial Officer at SSM Health1.066.0Yes (X)$0$1,290,602$485,851
George Daneker MD
Interim Chief Medical Officer - Southern Illinois20.020.0$0$430,473$88,663Yes (X)
Hollie Colle
Director - Administrative Services/Operations20.020.0$153,768$0$29,016Yes (X)
Julie Long
VP - Strategic Planning20.020.0$0$397,612$117,256Yes (X)
Lisa Dimarco
Regional VP, Patient Care Services/CNO20.020.0$0$382,937$79,689Yes (X)
Jeff Rapp
Clinical Pharmacy Manager40.00$164,104$0$46,882Yes (X)
Kendra Bowen
Physician Assistant40.00$184,275$0$6,509Yes (X)
Khalil Rabie
Regional Director - Pharmacy Services40.00$191,483$0$38,495Yes (X)
Tracie Foster
Nurse Practitioner40.00$191,434$0$43,588Yes (X)
Tracy Fiscus
Administrative Director - Nursing40.00$159,428$0$37,829Yes (X)
Corey Black MD
Former Key Employee0.00.0$0$251,512$1,521Yes (X)
Karen Rewerts
Former Officer, VP-Financial Operations0.043.0$0$736,547$251,796Yes (X)
Kerry Swanson
Former Officer0.00.0$0$501,061$28,261Yes (X)
Kris Zimmer
Former Officer0.00.0$0$219,379$0Yes (X)
Laura Kaiser
Former Officer, CEO at SSM Health0.046.0$0$3,489,979$2,214,336Yes (X)
Matt Kinsella
Former Officer0.040.0$0$413,770$176,323Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,044,491TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$13,452,020TotReportableCompRltdOrgAmt
Total Other Compensation$4,935,739TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K54IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS
2700 TURNBERRY DRIVEMARIONIL62959MEDICAL SERVICES$3,091,414
SHORES BUILDERS
1154 SCHWARTZ ROADCENTRALIAIL62801Construction services$825,312
FELICIAN SERVICES
3800 W PETERSON AVECHICAGOIL60659MANAGEMENT SERVICES$790,298
MIDWEST EMERGENCY DEPARTMENT
PO BOX 8882FORT WORTHTX76124MEDICAL SERVICES$727,451
SODEXO OPERATIONS LLC
4880 PAYSPHERE CIRCLECHICAGOIL60674DIETARY SERVICES$650,700
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt
Related Organizations$343,916RelatedOrganizationsAmt
Government Grants$6,600,933GovernmentGrantsAmt
Total Contributions$6,944,849TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE622110$106,134,811$106,134,811
ANESTHESIA SERVICES622110$6,084,490$6,084,490
340B PHARMACY REVENUE446110$426,202$426,202

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$396,023TotalRevenueColumnAmt
Related Or Exempt Func Income$396,023RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$113,041,526TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$226,745RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$189,505RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$37,240RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$37,240TotalRevenueColumnAmt
Exclusion$37,240ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$50,423OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other-$50,423OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$50,423TotalRevenueColumnAmt
Exclusion-$50,423ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA REVENUE722210$216,550$216,550
MGMT FEES TO RELATED ORG541611$36,000$36,000

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$252,550OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$120,225,742TotalRevenueColumnAmt
Related Or Exempt Func Income$113,041,526RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$239,367ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$12,617TotalAmt
Program Services$12,617ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$182,784TotalAmt
Program Services$168,733ProgramServicesAmt
Management And General$14,051ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$32,185,453TotalAmt
Program Services$29,711,360ProgramServicesAmt
Management And General$2,474,093ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,423,447TotalAmt
Program Services$2,237,157ProgramServicesAmt
Management And General$186,290ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$9,750,379TotalAmt
Program Services$9,000,868ProgramServicesAmt
Management And General$749,511ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,346,031TotalAmt
Program Services$2,165,692ProgramServicesAmt
Management And General$180,339ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$306,321TotalAmt
Program Services$213,653ProgramServicesAmt
Management And General$92,668ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$88,152TotalAmt
Management And General$88,152ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$3,700TotalAmt
Management And General$3,700ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$3,961TotalAmt
Management And General$3,961ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$15,249,601TotalAmt
Program Services$13,010,126ProgramServicesAmt
Management And General$2,233,816ManagementAndGeneralAmt
Fundraising$5,659FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$31,036TotalAmt
Management And General$31,036ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,998,957TotalAmt
Program Services$3,240,939ProgramServicesAmt
Management And General$758,018ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,918,171TotalAmt
Program Services$3,872,410ProgramServicesAmt
Management And General$34,973ManagementAndGeneralAmt
Fundraising$10,788FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,608,940TotalAmt
Program Services$1,605,028ProgramServicesAmt
Management And General$3,912ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$109,562TotalAmt
Program Services$98,726ProgramServicesAmt
Management And General$10,328ManagementAndGeneralAmt
Fundraising$508FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$32,655TotalAmt
Program Services$19,821ProgramServicesAmt
Management And General$12,834ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,810,046TotalAmt
Program Services$3,810,046ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,743,725TotalAmt
Program Services$4,743,725ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$374,114TotalAmt
Program Services$374,114ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical supplies$10,344,084$10,344,084
Internal management fees$6,892,241$6,892,241
Medicaid Provider Tax$3,998,599$3,998,599
Licenses and taxes$67,264$67,264

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$102,481,840TotalAmt
Program Services$88,694,962ProgramServicesAmt
Management And General$13,769,923ManagementAndGeneralAmt
Fundraising$16,955FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$154,424BOYAmt
EOY$122,585EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$15,660,371BOYAmt
EOY$18,647,278EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,348,049BOYAmt
EOY$2,170,972EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$533,255BOYAmt
EOY$585,318EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$87,797,045LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$48,261,139LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$40,997,755BOYAmt
EOY$39,535,906EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$1,053,204BOYAmt
EOY$1,051,114EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$910,981BOYAmt
EOY$774,984EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$39,603,458BOYAmt
EOY$53,656,953EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$101,261,497BOYAmt
EOY$116,545,110EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,603,680BOYAmt
EOY$9,860,714EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$3,328,744BOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$46,538,000BOYAmt
EOY$49,566,000EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$24,560,250BOYAmt
EOY$20,336,999EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$82,030,674BOYAmt
EOY$79,763,713EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$18,408,464BOYAmt
EOY$36,023,838EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$822,359BOYAmt
EOY$757,559EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$19,230,823BOYAmt
EOY$36,781,397EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$101,261,497BOYAmt
EOY$116,545,110EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$17,743,902ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$193,328OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$3,961OtherActivitiesAmt
Total Lobbying Expenditures$3,961TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYFormAndLineReferenceDesc
ExplanationThe organization paid dues to various state and national associations and a portion of these dues was allocated to lobbying activities.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,259,000OtherCostOrOtherBasisAmt
Book Value$1,259,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$51,453,387OtherCostOrOtherBasisAmt
Depreciation$23,413,144DepreciationAmt
Book Value$28,040,243BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$33,689,280OtherCostOrOtherBasisAmt
Depreciation$24,175,774DepreciationAmt
Book Value$9,513,506BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,395,378OtherCostOrOtherBasisAmt
Depreciation$672,221DepreciationAmt
Book Value$723,157BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$39,535,906TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
Due from Affiliates$53,645,176
Operating right-of-use assets$11,777
FieldValueIRS element (for citing)
Total Book Value Other Assets$53,656,953TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDescAmtAmt
DEFERRED COMPENSATION$103,167
ASSET RETIREMENT OBLIGATION$1,060,912
PENSION FUNDING LIABILITY$7,646,520
OTHER LONG-TERM LIABILITIES$540,000
THIRD PARTY PAYORS$10,616,442
Third-party patient loans$358,181
Operating lease obligations$11,777
FieldValueIRS element (for citing)
Total Liability$20,336,999TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationST MARY'S HOSPITAL, CENTRALIA, ILLINOIS' FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2021 OR 2020.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$718,779TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$718,779NetCommunityBenefitExpnsAmt
Total Expense0.0070TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$29,236,390TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$29,755,069DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,964,920TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,118,543DirectOffsettingRevenueAmt
Net Community Benefit Expns$846,377NetCommunityBenefitExpnsAmt
Total Expense0.0083TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$31,920,089TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$30,873,612DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,565,156NetCommunityBenefitExpnsAmt
Total Expense0.0153TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$123,667TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$123,667NetCommunityBenefitExpnsAmt
Total Expense0.0012TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$319,226TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$319,226NetCommunityBenefitExpnsAmt
Total Expense0.0031TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$16,956TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$16,956NetCommunityBenefitExpnsAmt
Total Expense0.0002TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$459,849TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$459,849NetCommunityBenefitExpnsAmt
Total Expense0.0045TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$32,379,938TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$30,873,612DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,025,005NetCommunityBenefitExpnsAmt
Total Expense0.0198TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$4,590,056BadDebtExpenseAmt
Reimbursed By Medicare$23,733,020ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$33,176,832CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$9,443,812MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SSM Health St Mary's Hospital - CentraliaBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1400 N PLEASANT AVENUEAddressLine1Txt
CityCENTRALIACityNm
State AbbreviationILStateAbbreviationCd
ZIP62801ZIPCd
FieldValueIRS element (for citing)
Website Addresshttps://www.ssmhealth.com/locations/st-marys-hospital-centraliaWebsiteAddressTxt
State License0002642StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting GroupAFacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ABusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted21CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttps://www.ssmhealth.com/resources/about/community-health/community-health-needs-assessmentsOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt22ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttps://www.ssmhealth.com/resources/about/community-health/community-health-needs-assessmentsStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.0FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttps://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistanceFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttps://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistanceFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttps://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistanceFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3ETHE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.
Schedule H, Part V, Section B, Line 5 Facility A, 1Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. In conducting this assessment, the SSM Health Community Health team sought input from the community through a community wide health survey, hosted focus groups, and conducted key informant interviews. No groups in the community were excluded from participating in the assessment. Secondary data was collected from various organizations, such as the U.S. Census, Centers for Disease Control and Prevention, County Health Rankings, SparkMap, broadstreet.io, and the Illinois Department of Public Health. Each of these sources of primary data (community input) was analyzed along aside secondary data. No written comments were received on the SSM Health Southern Illinois 2019- 2021 Community Health Needs Assessment. Community Health Survey From March 15, 2021, to May 24, 2021, individuals within the community were invited to complete a thirty nine question community health survey. The online survey was promoted through social media, press releases, county and city chambers of commerce, e mail invitations to SSM Health physicians, staff, and volunteer boards as well as email invitations to public officials, community organizations, and churches. Paper surveys were available at the hospital entrances and local public libraries. 577 residents of the 23 zip codes of the defined communities completed surveys; 3 of the 577 surveys were completed using a paper survey. Focus Groups Focus groups were moderated, conducted, and analyzed by the company, Stefanie Santos McLeese: PR and Brand Strategy. As part of the broader Community Health Needs Assessment (CHNA) data gathering process, three audiences were identified as priorities for further investigation, either due to statistical under representation in the 2021 CHNA survey or general urgency as indicated in survey results. One group was assigned to represent each of these audiences. When possible, CHNA initiatives focus on the collection of health needs from a representative mix of first person perspectives. However, certain groups may be more reluctant or simply less likely to share their direct feedback for a variety of reasons. In cases like these, it can be appropriate to engage individuals with direct contact with these populations to provide the necessary story, point of view, and context, helping to ensure the CHNA incorporates the needs of these groups. The SSM Health community health team conducted a rigorous, best practice network recruit for each of the three groups, beginning with known stakeholders with appropriate context before branching out to recruit stakeholders suggested as ideal for representing the populations in question by those known stakeholders. Group Emphasis and Participant Summary -Individuals experiencing housing instability or homelessness : seven participants representing local community services organizations; two of these participants had personally experienced housing instability -Black community members : three church leaders serving predominantly Black congregations -Individuals experiencing mental health difficulties: nine participants representing local community service organizations which on focus mental health services Key Informant Interviews The Community Health team interviewed 28 key community members health care administrations, social service organization leaders, law enforcement, educational leaders, civic organizational leaders, and key community leaders to gather input on the health needs, strengths, concerns, and areas of improvement needed in our community. Several of the interviews involved more than one person from the organization. Interviews were conducted in person or via virtual video meeting software depending on the individual's preferences. All interviews were recorded and transcribed via auto transcription software.
Schedule H, Part V, Section B, Line 6a Facility A, 1Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. SSM Health St. Mary's Hospital - Centralia conducted its 2021 CHNA in cooperation with SSM Health Good Samaritan Hospital - Mt. Vernon.
Schedule H, Part V, Section B, Line 11 Facility A, 1Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Substance abuse - Mental health - Nutrition, weight, and exercise Substance abuse According to the CDC's National Center for Health Statistics provisional, drug overdose deaths have increased from 78,056 in 2019/2020 to 100,306 in 2020/2021. In Illinois, the overall age adjusted drug overdose mortality rate in 2019 was 21.9 per 100,000 population. Illinois has also been ranked 24 th in the country for overall drug overdose fatality rate. According to the CDC's Center for Vitals statistics, mortality rates due to poisoning were 26 per 100,000 population for Marion County and 22 per 100,000 for Jefferson County. Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Cigarette smoking causes more than 480,000 deaths annually, including 41,000 deaths from secondhand smoke. For every American who dies because of smoking, at least 30 are living with a serious smoking related illness. According to CDC's Behavioral Risk Factor Surveillance Survey, over 15% of residents in Illinois were current smokers in 2019. Additionally, in 2019, 22.7% of Illinois high school youth reported currently using any tobacco product, including e cigarettes. Among Illinois high school youth, 4.7% reported currently smoking cigarettes. The percent of adults who regularly smoke in both Marion and Jefferson County is approximately 20%, higher than the state average. The hospital has the following strategies addressing Substance abuse in its community: - Provide opportunities for proper drug disposal for OTC and controlled substances - install comprehensive medication collection kiosks, pending DEA approval, at each hospital - create and distribute education regarding at home drug disposal best practices - distribute "at-home" disposal kids to high risk populations - Provide education on opioid misuse and provide naloxone to community members - apply for a State of Illinois naloxone standing order for SSM Health pharmacy and ensure listing on state and national websites - Identify eligible organizations willing to participate in the Illinois Drug Overdose Prevention Program (DOPP) - Promote Narcan pick-up availability at specified community-based locations - Provide education opportunities on Narcan administration and disperse Narcan for households to have on-hand in an emergency - Provide prevention and cessation education on tobacco and vaping use - Initiate the implementation of CATCH my Breath program in local schools - Provide resources and educational opportunities for tobacco and vaping cessation in the community - Provide incentive opportunities for local schools to participate in smoking prevention education Goals for the substance abuse health priority are: - decrease incidence of improper drug use - decrease incidence of prescription drug dependence - reduce emergency hospital visits due to drug-related incidents - decrease rate of opioid overdose - reduce prevalence of tobacco related health disparities Mental health Marion and Jefferson Counties are ranked among the lowest quartile of adults reporting poor mental health days, with an average of over 5 poor mental health days per month. According to United Health Foundation's US Health Rankings, over 14% of Illinois residents have been diagnosed with a depressive disorder. The rate of suicide in Illinois is 11.3 per 100,000 population. Additionally, the rate of suicide in Marion county is 26 per 100,000 population, and Jefferson county is 15 per 100,000 population. Both rates of suicide are higher than the average rate of suicide in the state. The hospital's action plan includes the following initiatives to address mental health in the region served: - Provide educational opportunities for community members - Offer Question, Persuade, Refer (QPR) Gatekeeper Training - Implement Adult and Youth Mental Health First Aid trainings - Provide resources to increase knowledge of accessible mental health services - Increase distribution of community Mental Health Resource Guide - Begin distributing the National Suicide Prevention Lifeline to community members and partnering organizations - Enhance collaborative efforts with community partners - Develop relationships with new and existing community partners - Sponsor community events and initiatives hosted by partners - Provide educational opportunities on trauma informed care - Provide CME opportunities to SSM Health and community clinicians on trauma informed care - Provide general education workshops on trauma informed community building and resilience Expected outcomes of these strategies include the following: - reduce number of reported mentally unhealthy days - increase percentage of individuals receiving treatment for chronic mental illness - reduce prevalence of untreated depression/anxiety - decrease suicide rate - decrease emergency department visits for nonfatal intentional injury Nutrition, weight and exercise Obesity is a serious chronic disease that continues to increase in the United States and can lead to other serious illnesses like type II diabetes, heart disease, and cancer. In Jefferson and Marion counties, over 30% of adults living in the community are obese (BMI=30+), which is slightly lower than the state average percentage of adults with obesity, at 32%. Community representatives who participated in the Community Health Needs Assessment have identified obesity as a significant need to be addressed in the area. Access to nutritious food and opportunities for physical activity plays a vital role in reducing the prevalence of obesity and chronic disease. Within the Jefferson and Marion county areas, 14% of the population experience food insecurity, or a lack of resources to feed all members of their household. Additionally, the rate of available fitness and recreation facilities per 100,000 population is approximately 15 in both Jefferson and Marion County. The rate in Illinois for Recreation and Fitness facilities is only 12.5 per 100,000 population. Many times, these facilities have a cost for membership, which can also pose a barrier to many community members. Costs for fitness center memberships typically range from $10 to $100 each month. The hospital has outlined the strategies below to improve community health related to nutrition, weight and exercise: - promote access to nutritious food for those experiencing food insecurity - provide support for mobile markets and to local community food pantries - identify locations for little food pantry box installation - support existing and establish additional community gardens and the training of master gardeners - provide opportunities for education and engagement regarding nutrition, weight and exercise - fund scholarships for identified vulnerable populations to participate in Felician wellness centers' next (nutrition, exercise, and physical activity) program - provide evidence-based chronic disease/diabetes self-management cources - provide support in offering accessible community fitness courses - build partnerships with outside organizations to build community programs - partner with local schools to promote the USDA's team nutrition program - develop relationships with new and existing community partners - sponsor community events and initiatives hosted by partners Long-term, the hospital hopes for these outcomes: - reduce percentage of adults with obesity - reduce percentage of individuals with Type II diabetes - reduce percentage of individuals with chronic disease - decrease population who experience food insecurity - reduce obesity-related disability - improve quality of life The hospital has no plans to discontinue other community benefit efforts to address other needs noted in its 2021 CHNA.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
SSM Health Medical Group
1054 Martin Luther KingCentraliaIL62801Outpatient clinic
SSM Health Medical Group
432 N Pleasant AveCentraliaIL62801Outpatient clinic
SSM Health Medical Group
1050 Martin Luther King Suite 104CentraliaIL62801Outpatient clinic
SSM Health Medical Group
402 N Pleasant AveCentraliaIL62801Outpatient clinic

Supplemental Information Detail SupplementalInformationDetail (17 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 3c Discounted Care ExceptionsPatients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called "presumptive eligibility."
Schedule H, Part I, Line 6a Community benefit report prepared by related organizationSSM Health Care Corporation, 46-6029223
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistanceThe amounts reported on Form 990, Schedule H, Part I, Line 7a, 7b, and 7c were determined using the cost to charge ratio derived from worksheet 2 in the schedule h instructions. Form 990, schedule h, part I, Lines 7e, 7f, 7g, 7h, and 7i are reported at cost as reported in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountAS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.
Schedule H, Part III, Line 3 Bad Debt Expense MethodologyFOR FINANCIAL STATEMENT PURPOSES, SSM Health HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORTON HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnoteSSM Health St. Mary's Hospital - Centralia is part of the SSM Health consolidated audit. THE FOOTNOTE THAT REFERENCES THE TREATMENT OF UNCOLLECTIBLE ACCOUNTS AND IMPLICIT PRICE CONCESSIONS IN THE DECEMBER 31, 2021 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13, 14 AND 15 OF THE ATTACHED FINANCIAL STATEMENTS.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costsTHE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistanceSSM Health St. Mary's Hospital - Centralia has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable, The Health Center embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Health Center's billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after 120 days. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSM prior to engaging in ECAs. SSM will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make "reasonable efforts" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with SSM Health St. Mary's Hospital - Centralia's collection and financial assistance policies.
Schedule H, Part V, Section B, Line 16a FAP websiteA - SSM Health St. Mary's Hospital - Centralia: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application websiteA - SSM Health St. Mary's Hospital - Centralia: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary websiteA - SSM Health St. Mary's Hospital - Centralia: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessmentSSM Health (SSMH) participates in Community Benefit according to our vision, Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSMH's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSMH's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical health issues in the community. All hospital CHNAs are completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistanceEach entity providing medical service shall provide information to the public regarding its charity care policies and the qualification requirements for each of its facilities. When standard system notices and communication regarding charity care are available, these must be used. Modifications to the standard may be made to comply with state and local laws, as well as reflect culturally sensitive terminology for the policy. All notices are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They provide information about: * The patient's responsibility for payment, * The availability of financial assistance from public programs and entity charity care and payment arrangements, * The entity's charity policy and application process, and * Who to contact to get additional information or financial counseling. The following types of notices to the public are provided: * Signs in the emergency department, outpatient and inpatient registration and public waiting areas. * Brochures or fliers provided at time of registration and available in the financial counseling areas. * Notices sent with or on patient bills or communications sent to patients and guarantors related to medical services. * Applications provided to uninsured patients at the time of registration. The application for charity care, together with any instructions, must clearly state the policies regarding charity care, including excluded services, eligibility criteria and documentation requirements. Information about the entity's charity policies is also provided to public agencies.
Schedule H, Part VI, Line 4 Community informationSSM Health St. Mary's Hospital - Centralia, in partnership with SSM Health Good Samaritan Hospital - Mount Vernon, defines its primary service area as Marion and Jefferson Counties in Illinois. There are 23 zip codes that are located within or partially within the community. This area had an estimated population of 81,171 people in 2020 and accounts for 54% of the total patients served by the hospitals. The secondary service area is another 84,000 people and 17% of inpatient-care patients served. The median age in the community is 41.0 years old, which is older than the U.S. median age of 38.1 years. The population has also decreased about 3.7% in the last 10 years. In the area served, the poverty level is 18.0%, significantly more than the 13% rates for both Illinois and the U.S. as a whole. Median family income is $60,361, compared to $83,279 for Illinois and $77,263 for the nation. Life expectancy also falls behind State and U.S. rates for this area. Additional information concerning the service area can be found starting on page 6 of the 2021 CHNA.
Schedule H, Part VI, Line 5 Promotion of community healthSSM Health St. Mary's Hospital - Centralia participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. In response to the global coronavirus pandemic, St. Mary's Hospital, Centralia, Illinois worked relentlessly to respond to community needs by developing and implementing strategies to address social needs of those served, providing screening & testing services, personal protective equipment and education throughout the community, as well as treatment for those who presented with COVID-19. SSM Health St. Mary's Hospital - Centralia advocates for vulnerable populations by developing relationships with policy makers and through targeted education efforts. All projects include measurable objectives with a specific time frame and have activities that will favorably affect health status indicators. Projects to accomplish health status objectives may include: disease prevention programs; health education programs; health care programs for individuals with special health concerns; and other projects that improve community health status. Projects to address the health problems of minorities, the poor, and other medically underserved populations may include: improving accessibility and continuity of care; working to reduce disparities in health status; and sponsoring efforts to increase the number of minorities, the poor, and underserved who enter health professions and work in medically underserved communities. Projects designed to contain the growth of community health care costs may include: improving efficiency of services; improving case management and continuity of care; sponsoring health promotion, disease prevention, and self- care activities; containing health care costs; and reducing redundancies. St. Mary's Hospital, Centralia, Illinois also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Has a governing body in which independent persons representative of the community comprise a majority * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.
Schedule H, Part VI, Line 6 Affiliated health care systemSt. Mary's Hospital, Centralia, Illinois is a 501(c)(3) organization and is a member of the integrated health care system known as SSM Health. Along with Good Samaritan Regional Health Center, it is part of a joint operating agreement between SSM Health based in St Louis, Missouri, and Felician Sisters, Inc. of Chicago. Together the hospitals are pursuing a vision to create a comprehensive, regional health care enterprise covering a nine county area in South Central Illinois.
Schedule H, Part VI, Line 7 State filing of community benefit reportIL

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Damon Harbison
Director, Hospital President$0$268,967$0$44,494$0$11,549$0$117,791$0$48,111$0$490,912$0$55,894
Candace Jennings
Pt Yr Director, Pt Yr Chairperson, Pt Yr Regional President-St. Louis/Southern Illinois$0$354,946$0$408,824$0$4,924$0$4,685$0$13,963$0$787,342$0$307,508
Michael Baumgartner
Director, Regional President-Southern Illinois$0$394,313$0$138,473$0$92,771$0$207,274$0$12,996$0$845,827$0$138,473
Jeremy Bradford
Director, Hospital President-SSM Health Good Samaritan Hospital$0$303,220$0$50,448$0$1,022$0$133,167$0$45,390$0$533,247$0$50,448
Erica Ibendahl MD
Director, SSM Health Medical Group Physician$0$645,904$0$21,311$0$1,026$0$3,012$0$50,978$0$722,231$0$0
Sudeep Nair MD
Director, SSM Health Medical Group Physician$0$544,503$0$7,648$0$2,838$0$8,700$0$49,210$0$612,899$0$0
Sajjan K Nemani MD
Director$0$489,281$0$0$0$0$0$0$0$0$0$489,281$0$0
Matt Kinsella
Former Officer$0$339,271$0$62,880$0$11,619$0$138,111$0$38,212$0$590,093$0$66,793
Kerry Swanson
Former Officer$0$0$0$19,047$0$482,014$0$0$0$28,261$0$529,322$0$0
Karen Rewerts
Former Officer, VP-Financial Operations$0$572,568$0$96,173$0$67,806$0$219,658$0$32,138$0$988,343$0$159,077
Laura Kaiser
Former Officer, CEO at SSM Health$0$1,734,729$0$1,374,054$0$381,195$0$2,194,966$0$19,371$0$5,704,315$0$1,747,726
Kris Zimmer
Former Officer$0$0$0$219,008$0$372$0$0$0$0$0$219,379$0$372
Douglas Long
Secretary, General Counsel at SSM Health$0$683,805$0$374,673$0$143,200$0$460,492$0$23,109$0$1,685,279$0$374,673
John Snodsmith
Regional VP, Finance$0$251,039$0$13,365$0$629$0$57,340$0$25,937$0$348,310$0$13,365
Randy Combs
Treasurer, Chief Financial Officer at SSM Health$0$940,014$0$182,693$0$167,895$0$478,907$0$6,945$0$1,776,454$0$82,693
Corey Black MD
Former Key Employee$0$0$0$0$0$251,512$0$0$0$1,521$0$253,033$0$0
Lisa Dimarco
Regional VP, Patient Care Services/CNO$0$266,151$0$36,875$0$79,911$0$48,539$0$31,150$0$462,626$0$89,005
Julie Long
VP - Strategic Planning$0$290,479$0$38,124$0$69,009$0$111,762$0$5,494$0$514,868$0$53,371
George Daneker MD
Interim Chief Medical Officer - Southern Illinois$0$375,401$0$32,449$0$22,623$0$67,314$0$21,349$0$519,136$0$32,449
Hollie Colle
Director - Administrative Services/Operations$150,424$0$3,000$0$344$0$3,176$0$25,840$0$182,784$0$0$0
Khalil Rabie
Regional Director - Pharmacy Services$188,448$0$3,000$0$35$0$5,915$0$32,580$0$229,977$0$0$0
Tracie Foster
Nurse Practitioner$130,603$0$60,460$0$371$0$0$0$43,588$0$235,022$0$0$0
Kendra Bowen
Physician Assistant$119,105$0$64,932$0$238$0$3,795$0$2,713$0$190,784$0$0$0
Jeff Rapp
Clinical Pharmacy Manager$163,563$0$0$0$541$0$4,288$0$42,594$0$210,986$0$0$0
Tracy Fiscus
Administrative Director - Nursing$154,115$0$3,000$0$2,313$0$4,892$0$32,937$0$197,257$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 1a Tax indemnification and gross-up paymentsThe following individuals listed on Part VII, Section A received a tax indemnification/gross up payment in 2021. These payments were included in their taxable compensation. Hollie Colle Khalil Rabie Tracie Foster Kendra Bowen Jeff Rapp Tracy Fiscus
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationThe organization's top management official (Hospital President) has compensation that is determined by a related organization. The related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the SSM Health President.
Schedule J, Part I, Line 4a Severance or change-of-control paymentSSM HEALTH HAS ADOPTED A SEVERANCE POLICY TO PROVIDE A FINANCIAL TRANSITION IN THE EVENT OF INVOLUNTARY TERMINATION WITHOUT CAUSE FOR EXECUTIVE LEVEL POSITIONS. THE AMOUNT OF THE COMPENSATION IS BASED ON THE POSITION HELD AND LENGTH OF SERVICE WITH SSMH. THE FOLLOWING INDIVIDUALS LISTED IN PART VII OF THE FORM 990 RECEIVED PAYMENTS UNDER THE PLAN IN THE CURRENT YEAR. Corey Black, MD $251,512 Kerry Swanson $482,014
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planPension Restoration Plan: SSM Health (SSMH) provides this supplemental defined benefit nonqualified retirement plan to any employee who is a participant in the SSMH qualified defined benefit plan who earns over the Internal Revenue Service compensation limit. The plan "restores" the benefits to these employees that would have been provided under the SSMH qualified plan if the regulations did not impose compensation limits. An individual can take a distribution from the plan at (1) age 65 or older if the individual is still employed by SSMH or (2) age 55 or older if the individual is no longer employed by SSMH. No individuals listed on Part VII of Form 990 received distributions from the plan in 2021. Capital Accumulation Plan: SSMH provides this supplemental nonqualified retirement plan to executive level employees. The organization contributed a percentage of the employee's base salary into their choice of a select list of investments. The deposits and earnings of the plan are owned by SSMH and are tax-deferred until a distribution is made to the employee. In addition, the plan has special safeguards in place to protect the funds from contingencies, other than insolvency. For contributions made to the plan in 2014 or after, the distribution will occur after the completion of four plan years for all executives that are still actively employed on the distribution date. Any active participant 65 years or older will receive the contribution in the current year. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2021: Damon Harbison $10,945 Lisa Dimarco $52,130 Julie Long $15,247 Laura Kaiser $373,672 Matt Kinsella $10,849 Kris Zimmer $372 Karen Rewerts $62,904 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2021. All distributions received from the plan in the current year were included in the individual's taxable compensation. Jeremy Bradford $27,810 Damon Harbison $24,915 John Snodsmith $10,785 Julie Long $25,749 Laura Kaiser $549,883 Matt Kinsella $31,550 Karen Rewerts $52,238

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, Line 4a Description of Program ServiceBriefly describe the organization's mission: Since it was founded in 1872 by Catholic sisters, SSM Health (SSMH) has existed to meet the health needs of the communities it serves. SSMH is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through one of the largest integrated delivery systems in the nation. With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSMH includes 23 acute care hospitals, one children's hospital, more than 300 physician offices and other outpatient and virtual care services, 10 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company, and an Accountable Care Organization. The health system employs nearly 40,000 people and is affiliated with 11,000 physicians making it one of the largest employers in every community it serves. In the tradition of its founding sisters, SSMH strives to fulfill its mission by providing exceptional health care to everyone who comes to its hospitals, regardless of their ability to pay. About St. Mary's Hospital, Centralia, Illinois: SSM Health St. Mary's Hospital - Centralia, operating in partnership with the Felician Sisters, is a 125-bed hospital with a strong history of over 100 years of community engagement. St. Mary's Hospital delivers hospital services in inpatient, ambulatory surgery, outpatient, and emergency room settings. Key service lines include behavioral health, cancer, maternity, occupational medicine, weight management services, wound care, and many more. The hospital's surgery centers are equipped with the latest innovations in technology ensuring our patients have access to the most advanced treatment while staying close to home. To provide complete neurological care, our specialists are supported by board certified neuroradiologists, a full-service rehabilitation unit, a home health department, 24-hour MRI service, neurodiagnostic equipment, and cardiac catheterization laboratories. SSM Health St. Mary's Hospital - Centralia also operates the Little Egypt Breast and Cervical Cancer Program and has been a Lead Agency for this Illinois Public Health Program since 1998. The program often serves as a last resort for breast and cervical cancer screenings and education for women who are uninsured. For seven consecutive years, Healthgrades has presented St. Mary's Hospital the Outstanding Patient Experience and Critical Care Excellence awards. In 2014, Quest by Premier Inc. recognized St. Mary's Hospital-Centralia with the Citation of Merit Award for High-Value Healthcare. In 2016, SSM Health announced a $20 million renovation plan for St. Mary's Hospital-Centralia, which will include interior and exterior upgrades, including expansion of the surgery department and improvements to the emergency department. St. Mary's Hospital, Centralia, Illinois also furthers its exempt purpose with the following activities: - Operates an emergency room that is open to all persons regardless of ability to pay - Has an open medical staff with privileges available to all qualified physicians in the area - Has a governing body in which independent persons representative of the community comprise a majority - Engages in the training and education of health care professionals - Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs - All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system. Quantifiable Uncompensated Care: This section includes a list of the types of programs and services that could be quantified as uncompensated care: Traditional Charity Care $ 718,779 Unpaid Cost of Medicare Services $ 9,443,812 Unpaid Cost of Other Government Programs $ 846,377 Total Quantifiable Uncompensated Care $ 11,008,968
Form 990, Part V, Line 1a Common PaymasterALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223.
Form 990, Part VI, Line 15a Process for determining compensationA related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 15b Process for determining compensationA related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 6 Classes of members or stockholdersTHE CORPORATION SHALL HAVE TWO (2) MEMBERS: THE CORPORATE MEMBER, WHICH SHALL BE SSM REGIONAL HEALTH SERVICES, A MISSOURI NONPROFIT CORPORATION, AND THE MANAGING MEMBER, WHICH SHALL BE ST. MARY'S - GOOD SAMARITAN, INC., AN ILLINOIS NOT-FOR-PROFIT CORPORATION. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS, SSM REGIONAL HEALTH SERVICES, AND ST. MARY'S - GOOD SAMARITAN, INC., ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyTHE CORPORATE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND ELECT AND REMOVE DIRECTORS EXCEPT EX OFFICIO DIRECTORS.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersTHE CORPORATE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION B. TO APPOINT ADDITIONAL SUCCESSOR OR REPLACEMENT MEMBERS C. TO ELECT AND REMOVE THE DIRECTORS D. TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION E. TO APPROVE THE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS, TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS, AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTEREST IN THE PROPERTY OF THE CORPORATION P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OF THE CORPORATE MEMBER OR TO ANY ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY THE MEMBER OF THE CORPORATE MEMBER, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS, AND OBJECTIVE OF THE MEMBER OF THE CORPORATE MEMBER AS DETERMINED BY THE MEMBER OF THE CORPORATE MEMBER Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OF THE CORPORATE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE CORPORATE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE CORPORATE MEMBER WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY. THE MANAGING MEMBER HAS THE FOLLOWING POWERS: CERTAIN POWERS ARE RESERVED TO THE MANAGING MEMBER, INCLUDING THE AUTHORITY TO TAKE SUCH ACTIONS ON BEHALF OF THE CORPORATION AS ARE VESTED IN THE MANAGING MEMBER UNDER THE JOINT OPERATING AGREEMENT (JOA), SUBJECT TO THE LIMITATIONS OF APPLICABLE LAW. THE MANNER TO WHICH THE MANAGING MEMBER EXERCISES SUCH RESERVED POWERS SHALL BE DETERMINED PURSUANT TO THE PROVISIONS OF THE JOA AND THE BYLAWS OF THE MANAGING MEMBERS. IN ADDITION, THE MANAGING MEMBER SHALL PARTICIPATE IN THE ELECTION OF THE DIRECTORS TO THE EXTENT OUTLINED IN THE ORGANIZATION'S BYLAWS.
Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing bodyThe organization does not have any committees with authority to act on behalf of the governing body.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyThe Form 990 is prepared by the Tax Department of the parent organization, SSM Health Care Corporation (SSM). The Form 990 is reviewed by certain members of Senior Management. Any questions are addressed to the Tax Director of SSM prior to filing the Form 990 with the Internal Revenue Service. A copy of the Form 990 is provided to the Board of Directors at the next regularly scheduled board meeting.
Form 990, Part VI, Line 12c Conflict of interest policyBOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY OF THE BOARD OVERSEE COMPLIANCE WITH THIS REQUIREMENT. ALL BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAIN FROM BOARD DISCUSSIONS AND VOTES WHEN APPLICABLE. EMPLOYEES WITH PURCHASING AUTHORITY AND/OR ABILITY TO INFLUENCE PURCHASING DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ONLINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON (WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR-END.
Form 990, Part VI, Line 19 Required documents available to the publicTHE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE ILLINOIS SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
Form 990, Part VIII, Line 2f Other Program Service RevenueALL OTHER PROGRAM SERVICE REVENUE - Total Revenue: 396023, Related or Exempt Function Revenue: 396023, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other FeesMedical and other professional fees - Total Expense: 15249601, Program Service Expense: 13010126, Management and General Expenses: 2233816, Fundraising Expenses: 5659;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesChange in beneficial interest in foundation - -2090; Fund balance transfers - -191238;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (52 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
SSM Health Care Corporation
10101 Woodfield LaneSt LouisMO63132466029223Health CareMO501(c)(3)Type ISSM Health Ministriesfalse
SSMHC Liability Trust I
10101 Woodfield LaneSt LouisMO63132436331003InsuranceMO501(c)(3)Type ISSM Health Care Corporationfalse
SSM Consolidated Health Services
10101 Woodfield LaneSt LouisMO63132431473657Health CareMO501(c)(3)10SSM Health Care Corporationfalse
SSM Policy Institute
10101 Woodfield LaneSt LouisMO63132431788151Health CareMO501(c)(4)SSM Health Care Corporationfalse
SSM Health Care Portfolio Management Co
10101 Woodfield LaneSt LouisMO63132431825256ManagementMO501(c)(3)Type ISSM Health Care Corporationfalse
SSM Cardinal Glennon Children's Hospital
10101 Woodfield LaneSt LouisMO63132430738490Health CareMO501(c)(3)3SSM Health Care St Louisfalse
Cardinal Glennon Children's Foundation
10101 Woodfield LaneSt LouisMO63132431754347FundraisingMO501(c)(3)7SSM Cardinal Glennon Children's Hospitalfalse
SSM Health Foundation - St Louis
10101 Woodfield LaneSt LouisMO63132431552945FundraisingMO501(c)(3)7SSM Health Care St Louisfalse
SSM Health Care of Oklahoma Inc
10101 Woodfield LaneSt LouisMO63132730657693Health CareOK501(c)(3)3SSM Health Care Corporationfalse
The St Anthony Hospital Foundation Inc
10101 Woodfield LaneSt LouisMO63132736104300FundraisingOK501(c)(3)7SSM Health Care of Oklahomafalse
SSM Health Care of Wisconsin Inc
10101 Woodfield LaneSt LouisMO63132430688874Health CareWI501(c)(3)3SSM Health Care Corporationfalse
Dells Medical Building Inc
10101 Woodfield LaneSt LouisMO63132391613292MOBWI501(c)(2)SSM Health Care of Wisconsinfalse
St Mary's Foundation Inc
10101 Woodfield LaneSt LouisMO63132431940686FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
St Clare Health Care Foundation Inc
10101 Woodfield LaneSt LouisMO63132431940683FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
Home Health United Inc
2802 Walton Commons LaneMadisonWI53718391539827Health CareWI501(c)(3)10SSM Health Care of Wisconsinfalse
Home Care United Inc
2802 Walton Commons LaneMadisonWI53718391776340Health CareWI501(c)(3)10SSM Health Care of Wisconsinfalse
HHU Xtra Care Inc
2802 Walton Commons LaneMadisonWI53718391705111Health CareWI501(c)(3)10SSM Health Care of Wisconsinfalse
SSM Health at Home Foundation of Wisconsin Inc
2802 Walton Commons LaneMadisonWI53718391839309FundraisingWI501(c)(3)Type IHome Health United Incfalse
SSM Regional Health Services
10101 Woodfield LaneSt LouisMO63132440579850Health CareMO501(c)(3)3SSM Health Care Corporationfalse
St Mary's Health Center Jefferson City Missouri Foundation
10101 Woodfield LaneSt LouisMO63132431575307FundraisingMO501(c)(3)Type ISSM Regional Health Servicesfalse
Good Samaritan Regional Health Center
10101 Woodfield LaneSt LouisMO63132430653587Health CareIL501(c)(3)3SSM Regional Health Servicesfalse
St Mary's - Good Samaritan Inc
10101 Woodfield LaneSt LouisMO63132364170833Health CareIL501(c)(3)Type ISSM Regional Health Servicesfalse
Good Samaritan Regional Health Center Foundation
10101 Woodfield LaneSt LouisMO63132262884795FundraisingIL501(c)(3)7St Mary's-Good Samaritan Incfalse
St Mary's Hospital Foundation
10101 Woodfield LaneSt LouisMO63132364636691FundraisingIL501(c)(3)7St Mary's-Good Samaritan Incfalse
St Mary's Hospital Auxiliary
400 N PleasantCentraliaIL62801237126345FundraisingIL501(c)(3)10St Mary's Hospital Foundationfalse
SSM Health Businesses
10101 Woodfield LaneSt LouisMO63132431333488Health CareMO501(c)(3)10SSM Health Care Corporationfalse
SSM Health Care St Louis
10101 Woodfield LaneSt LouisMO63132431343281Health CareMO501(c)(3)3SSM Health Care Corporationfalse
Centralia Medical Services Bldg Assoc
10101 Woodfield LaneSt LouisMO63132237408025MOBIL501(c)(3)Type ISSM Regional Health Servicesfalse
St Mary's Janesville Foundation Inc
10101 Woodfield LaneSt LouisMO63132273439133FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
SSM Health Ministries
3221 McKelvey Road Suite 107BridgetonMO63044431012492Religious OrganizationMO501(c)(3)1NAfalse
Lee Dewey Corporation
10101 Woodfield LaneSt LouisMO63132731279603MOBOK501(c)(3)Type ISSM Health Care of Oklahomafalse
SSM Hospice & Home Care Foundation
10101 Woodfield LaneSt LouisMO63132300012246FundraisingMO501(c)(3)7SSM Health Businessesfalse
St Mary's Hospital Auxiliary
100 St Marys Medical PlazaJefferson CityMO65101436049878FundraisingMO501(c)(3)Type IINAfalse
Good Samaritan Hospital Auxiliary
1 Good Samaritan WayMount VernonIL62864237049599FundraisingIL501(c)(3)Type III-FINAfalse
St Anthony Shawnee Hospital Inc
1000 N Lee AveOklahoma CityOK73102455055149Health CareOK501(c)(3)3SSM Health Care of Oklahomafalse
SSM Audrain Health Care Inc
10101 Woodfield LaneSt LouisMO63132431550298Health CareMO501(c)(3)3SSM Regional Health Servicesfalse
Audrain Medical Center Foundation Inc
620 E Monroe StMexicoMO65265431265060FundraisingMO501(c)(3)Type INAfalse
SSM-SLUH Inc
10101 Woodfield LaneSt LouisMO63132474196634Health CareMO501(c)(3)3SSM Health Care St Louisfalse
SSM Health Plan
1277 Deming WayMadisonWI53717831979548InsuranceMO501(c)(4)SSM Health Businessesfalse
Agnesian Healthcare Inc
430 E Division StFond du LacWI54935390807236Health CareWI501(c)(3)3SSM Health Care of Wisconsinfalse
Ripon Medical Center Inc
845 Parkside StreetRiponWI54971391101287Health CareWI501(c)(3)3Agnesian Healthcare Incfalse
Waupun Memorial Hospital Inc
620 West Brown StreetWaupunWI53963390806265Health CareWI501(c)(3)3Agnesian Healthcare Incfalse
St Francis Home of Fond du Lac Wisconsin Inc
33 Everett StreetFond du LacWI54935391029998Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
Sister Servants of Christ the King Villa Loretto
N8114 County WWMount CalvaryWI53057391022770Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
Villa Rosa Inc
N8120 County WWMount CalvaryWI53057421670962Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
The Christian Home and Rehabilitation Center Incorporated
331 Bly StreetWaupunWI53963390884514Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
The Monroe Clinic Inc
515 22nd AvenueMonroeWI53566390808509Health CareWI501(c)(3)3SSM Health Care of Wisconsinfalse
Monroe Clinic and Hospital Foundation Inc
515 22nd AvenueMonroeWI53566205769038FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
Agnesian Healthcare Foundation Inc
430 E Division StFond du LacWI54935391684956FundraisingWI501(c)(3)Type ISSM Health Care of Wisconsinfalse
Shared Magnetic Resonance Imaging Facility Inc
1104 John Nolen DriveMadisonWI53713391534744Health CareWI501(c)(3)Type ISSM Health Care of Wisconsinfalse
SSM Health Cardinal Glennon Transport
10101 Woodfield LaneSt LouisMO63132863519607Health CareMO501(c)(3)Type ISSM Cardinal Glennon Children's Hospitalfalse
SSM Health Foundation
10101 Woodfield LaneSt LouisMO63132874109859FundraisingMO501(c)(3)Type ISSM Health Care Corporationfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (18 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
SSM St Joseph Endoscopy Center LLC
10101 Woodfield LaneSt LouisMO63132270046559Surgery ServicesMONAN/A
St Clare Imaging Services LLC
707 14th Street Suite ABarabooWI53913200122365Diag. ServicesWINAN/A
Mt Vernon Radiation Therapy Center LLC
10101 Woodfield LaneSt LouisMO63132201382620Radiation TherapyILNAN/A
Sleep & Neurology Center of Southern Illinois LLC
10101 Woodfield LaneSt LouisMO63132208468195Diag. ServicesILNAN/A
CHOWSMGSI Office Building LLC
10101 Woodfield LaneSt LouisMO63132371383861MOBILNAN/A
Oza Cancer Center LLC
10101 Woodfield LaneSt LouisMO63132201382727MOBILNAN/A
Shawnee Real Estate Holdings LLC
1000 N Lee AveOklahoma CityOK73102455458304MOBOKNAN/A
Dean Clinic & St Mary's Hospital Accountable Care Organization LLC
1808 West Beltline HighwayMadisonWI53713452995500Accountable Care OrganizationWINAN/A
Wisconsin Integrated Information Technology and Telemedicine Systems LLC
1808 West Beltline HighwayMadisonWI53713392016715Information Technology ServicesWINAN/A
Dean Health Holdings LLC
1277 Deming WayMadisonWI53717261594709Support ServicesWINAN/A
Wingra Building Group
1808 West Beltline HighwayMadisonWI53713390237060MOBWINAN/A
Janesville Riverview Clinic Building Partnership
1808 West Beltline HighwayMadisonWI53713396220698MOBWINAN/A
1110 N Classen Blvd LLC
1110 N Classen BoulevardOklahoma CityOK73106731158158MOBOKNAN/A
SSM St Clare Surgical Center LLC
10101 Woodfield LaneSt LouisMO63132261439695Surgery ServicesMONAN/A
Windmill LLP
50 Village View LaneChesterfieldMO63017431804651InvestmentsMONAN/A
Navitus Health Solutions LLC
361 Integrity DriveMadisonWI53717043608530Pharmacy BenefitsWINAN/A
SSM Select Rehab St Louis LLC
4714 Gettysburg RoadMechanicsburgPA17055263694972Health CareDENAN/A
Epiphany Rx LLC
361 Integrity DriveMadisonWI53717364855405Pharmacy BenefitsDENAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (21 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
SSM Managed Care Organization LLC
10101 Woodfield LaneSt LouisMO63132431708511Health PromotionMONAC Corporationfalse
FPP INC & Subs
10101 Woodfield LaneSt LouisMO63132431465174Health CareMONAC Corporationfalse
Diversified Health Services Corp
10101 Woodfield LaneSt LouisMO63132431369305Medical EquipmentMONAC Corporationfalse
SSM Properties Inc
10101 Woodfield LaneSt LouisMO63132431462486Property ServicesMONAC Corporationfalse
HealthFirst Physician Management Services
10101 Woodfield LaneSt LouisMO63132731534336Medical ServicesOKNAC Corporationfalse
SSMHC Liability Trust II
10101 Woodfield LaneSt LouisMO63132816128118InsuranceMONAC Corporationfalse
SSM Medical Group Inc
10101 Woodfield LaneSt LouisMO63132431664107Physician OfficesMONAC Corporationfalse
SSMHC Insurance Company
030310431InsuranceNAC CorporationfalsePO Box 1051 GTGrand CaymanCJKY11102CJ
Physicians Services Corp of Southern Illinois Inc
10101 Woodfield LaneSt LouisMO63132364161526Health CareILNAC Corporationfalse
Dean Health Systems Inc
1808 West Beltline HighwayMadisonWI53713391128616Physician OfficesWINAC Corporationfalse
Dean Health Insurance Inc
PO Box 56099MadisonWI53705391830837InsuranceWINAC Corporationfalse
Dean Health Plan Inc
PO Box 56099MadisonWI53705391535024InsuranceWINAC Corporationfalse
Dean Retail Services Inc
1808 West Beltline HighwayMadisonWI53713391717636Property ServicesWINAC Corporationfalse
Oza Oncology Inc
4117 Veterans Memorial DriveMt VernonIL62804371343746Physician OfficesILNAS Corporationfalse
SSM Health Janesville Campus Condominium Association Inc
1808 West Beltline HighwayMadisonWI53713832038674Condo associationWINAC Corporationfalse
SSM Health Pharmacy LLC
10101 Woodfield LaneSt LouisMO63132264031708PharmacyMONAC Corporationfalse
SSM Health Insurance Company
1277 Deming WayMadisonWI53717834718249InsuranceMONAC Corporationfalse
Navitus Holdings LLC
1808 West Beltline HighwayMadisonWI53713800968174PharmacyWINAC Corporationfalse
MS Community JV LLC
401 Carlson Parkway CP330MinnetonkaMN55305873240022InsuranceDENAC Corporationfalse
Quality Drug Corporation
239 BroadwayLaguna BeachCA92651330644268Pharmacy benefitsCANAC Corporationfalse
St Mary's Hospital Campus Condominium Owners Association Inc
707 South Mills StreetMadisonWI53715000000000Condo associationWINAC Corporationfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd