STRATEGY STUDIO / PUBLIC DATA EXPLORER

CHRISTIAN HOME AND REHABILITATION CENTER INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
CHRISTIAN HOME AND REHABILITATION CENTER INC (EIN 39-0884514)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-02
IRS object ID
202113069349302016
Schema version
2020v4.0
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)
Return2021-11-02T14:32:20-05:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390884514EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1The Christian Home & Rehabilitation CtrBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCHRIBusinessNameControlTxt
Phone9203249051PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1452 Fox Lake RoadAddressLine1Txt
CityWaupunCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53963ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRandy CombsPersonNm
Person TitleTreasurerPersonTitleTxt
Signature2021-11-02SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstRandyPersonFirstNm
Person LastCombsPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Chris ThornockBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1452 Fox Lake RoadAddressLine1Txt
CityWaupunCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53963ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$6,103,011GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresshttps://www.ssmhealth.com/locations/location-details/christian-home-rehab-center-waupunWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1977FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH, AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. THIS MISSION GUIDES EVERYTHING WE DO AS AN ORGANIZATION.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers31TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,804PYContributionsGrantsAmt
CY Contributions Grants$178,987CYContributionsGrantsAmt
PY Program Service Revenue$6,044,432PYProgramServiceRevenueAmt
CY Program Service Revenue$5,914,080CYProgramServiceRevenueAmt
PY Investment Income-$400,285PYInvestmentIncomeAmt
CY Investment Income$7,994CYInvestmentIncomeAmt
PY Other Revenue$7,358PYOtherRevenueAmt
CY Other Revenue$1,950CYOtherRevenueAmt
PY Total Revenue$5,656,309PYTotalRevenueAmt
CY Total Revenue$6,103,011CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$4,245,335PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,181,852CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,270,381PYOtherExpensesAmt
CY Other Expenses$4,069,147CYOtherExpensesAmt
PY Total Expenses$8,515,716PYTotalExpensesAmt
CY Total Expenses$9,250,999CYTotalExpensesAmt
PY Revenues Less Expenses-$2,859,407PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$3,147,988CYRevenuesLessExpensesAmt
Total Assets BOY$27,340,304TotalAssetsBOYAmt
Total Assets EOY$26,680,868TotalAssetsEOYAmt
Total Liabilities BOY$27,655,180TotalLiabilitiesBOYAmt
Total Liabilities EOY$30,109,497TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$314,876NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$3,428,629NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH, AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. THIS MISSION GUIDES EVERYTHING WE DO AS AN ORGANIZATION.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$8,577,676ExpenseAmt
Revenue$5,914,080RevenueAmt
DescTHE CHRISTIAN HOME PROVIDES SKILLED NURSING AND ASSISTED LIVING SERVICES TO ELDERLY RESIDENTS IN THE WAUPUN AREA TO MEET THE RESIDENTS PHYSICAL, EMOTIONAL, AND SPIRITUAL NEEDS.Desc
Total Program Service Expenses$8,577,676TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
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 AssetsfalseReportOtherAssetsInd
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 HospitalfalseOperateHospitalInd
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
Employee0EmployeeCnt
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 Members10GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
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 CommitteesYes (true)MinutesOfCommitteesInd
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 Line1Dennis BangartBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9209292300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 E Division StreetAddressLine1Txt
CityFond du lacCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54935ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Dave Kusek
Director, Chairperson1.03.0Yes (X)Yes (X)$0$0$0
Douglas Trost
Director, CEO and President1.046.0Yes (X)Yes (X)$0$309,759$84,584
Steve Franke
Director, Secretary/Treasurer1.03.0Yes (X)Yes (X)$0$0$0
Barb Senn
Director, Vice Chairperson1.03.0Yes (X)$0$0$0
Carol Hyland
Director1.03.0Yes (X)$0$0$0
Damond Boatwright
Director, Regional President - WI1.050.0Yes (X)$0$1,134,246$404,896
Jenny Knuth
Director1.03.0Yes (X)$0$0$0
Rick Vant Hoff
Director1.03.0Yes (X)$0$0$0
Sr Stephen Bloesl
Director1.03.0Yes (X)$0$0$0
Sue Buwalda
Director1.03.0Yes (X)$0$0$0
Douglas Long
Secretary, General Counsel at SSM Health1.068.2Yes (X)$0$1,201,821$399,352
Kris Zimmer
Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health1.067.0Yes (X)$0$1,717,045$73,075
Randy Combs
Treasurer, Chief Financial Officer at SSM Health1.064.0Yes (X)$0$403,263$84,602
Janel Konkel
Executive Director20.020.0$0$154,919$33,980Yes (X)
Paula Friedman
Former Officer0.00.0$0$507,002$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,428,055TotReportableCompRltdOrgAmt
Total Other Compensation$1,080,489TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
US FOODSERVICE INC
9399 W Higgins RoadRosemontIL60018DIETARY SERVICES$273,300
PRN Home Health and Therapy
1101 E South River StAppletonWI54915Therapy services$207,594
BROCKMAN ROOFING AND SIDING
N3940 Conrad StKaukaunaWI54130CONSTRUCTION/MAINTENANCE SERVICES$101,335
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$175,264GovernmentGrantsAmt
All Other Contributions$3,723AllOtherContributionsAmt
Total Contributions$178,987TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNet patient service revenueDesc
Business623110BusinessCd
Total Revenue Column$5,914,080TotalRevenueColumnAmt
Related Or Exempt Func Income$5,914,080RelatedOrExemptFuncIncomeAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$5,914,080TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$650TotalRevenueColumnAmt
Exclusion$650ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

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

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$7,344OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$7,344OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,344TotalRevenueColumnAmt
Exclusion$7,344ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCafeteria revenueDesc
Business722210BusinessCd
Total Revenue Column$1,950TotalRevenueColumnAmt
Exclusion$1,950ExclusionAmt

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$1,950OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,103,011TotalRevenueColumnAmt
Related Or Exempt Func Income$5,914,080RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$9,944ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,031,834TotalAmt
Program Services$3,658,189ProgramServicesAmt
Management And General$373,645ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$41,670TotalAmt
Program Services$37,808ProgramServicesAmt
Management And General$3,862ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$823,514TotalAmt
Program Services$747,196ProgramServicesAmt
Management And General$76,318ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$284,834TotalAmt
Program Services$258,437ProgramServicesAmt
Management And General$26,397ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$118TotalAmt
Management And General$118ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$608,057TotalAmt
Program Services$487,321ProgramServicesAmt
Management And General$120,736ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$484,185TotalAmt
Program Services$428,322ProgramServicesAmt
Management And General$55,863ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$15,938TotalAmt
Program Services$4,987ProgramServicesAmt
Management And General$10,951ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$246,223TotalAmt
Program Services$246,223ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$9,243TotalAmt
Program Services$7,310ProgramServicesAmt
Management And General$1,933ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$5,180TotalAmt
Program Services$1,680ProgramServicesAmt
Management And General$3,500ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$931,500TotalAmt
Program Services$931,500ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,447,623TotalAmt
Program Services$1,447,623ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$8,598TotalAmt
Program Services$8,598ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
Medical supplies$201,982$201,982
Medicaid Provider Tax$110,500$110,500

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$9,250,999TotalAmt
Program Services$8,577,676ProgramServicesAmt
Management And General$673,323ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$377,907BOYAmt
EOY$1,158,894EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$484,899BOYAmt
EOY$457,680EOYAmt

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$40,463BOYAmt
EOY$40,463EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$35,687BOYAmt
EOY$6,242EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$28,306,579LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,848,702LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$25,868,899BOYAmt
EOY$24,457,877EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$525,477BOYAmt
EOY$559,712EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$6,972BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$27,340,304BOYAmt
EOY$26,680,868EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$815,359BOYAmt
EOY$458,512EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$43,890BOYAmt
EOY$60,690EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

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$0BOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,795,931BOYAmt
EOY$29,590,295EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$27,655,180BOYAmt
EOY$30,109,497EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$840,353BOYAmt
EOY-$3,988,341EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$525,477BOYAmt
EOY$559,712EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$314,876BOYAmt
EOY-$3,428,629EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$27,340,304BOYAmt
EOY$26,680,868EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$3,147,988ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$34,235OtherChangesInNetAssetsAmt
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 RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$289,067CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$42,169CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$131,877CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,804CurrentTaxYearMinus1YearAmt
Current Tax Year$178,987CurrentTaxYearAmt
Total$646,904TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,324,050CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,414,008CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,767,966CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,044,432CurrentTaxYearMinus1YearAmt
Current Tax Year$5,914,080CurrentTaxYearAmt
Total$28,464,536TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$94,861CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$93,773CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$76,930CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,358CurrentTaxYearMinus1YearAmt
Current Tax Year$1,950CurrentTaxYearAmt
Total$274,872TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,707,978CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,549,950CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,976,773CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,056,594CurrentTaxYearMinus1YearAmt
Current Tax Year$6,095,017CurrentTaxYearAmt
Total$29,386,312TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$10,000CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$10,000TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$501,845CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$724,721CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,871CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$360,671CurrentTaxYearMinus1YearAmt
Current Tax Year$215,517CurrentTaxYearAmt
Total$1,809,625TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$511,845CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$724,721CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,871CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$360,671CurrentTaxYearMinus1YearAmt
Current Tax Year$215,517CurrentTaxYearAmt
Total$1,819,625TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$27,566,687PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,817CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,278CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,901CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,740CurrentTaxYearMinus1YearAmt
Current Tax Year$650CurrentTaxYearAmt
Total$9,386TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,817CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,278CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,901CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,740CurrentTaxYearMinus1YearAmt
Current Tax Year$650CurrentTaxYearAmt
Total$9,386TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,710,795CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,552,228CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,978,674CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,058,334CurrentTaxYearMinus1YearAmt
Current Tax Year$6,095,667CurrentTaxYearAmt
Total$29,395,698TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.9378PublicSupportCY509Pct
Public Support PY5090.9394PublicSupportPY509Pct
Investment Income CY0InvestmentIncomeCYPct
Investment Income PY0.0004InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

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 D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$502,134OtherCostOrOtherBasisAmt
Book Value$502,134BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$23,677,427OtherCostOrOtherBasisAmt
Depreciation$2,444,590DepreciationAmt
Book Value$21,232,837BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,217,830OtherCostOrOtherBasisAmt
Depreciation$121,097DepreciationAmt
Book Value$1,096,733BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,909,188OtherCostOrOtherBasisAmt
Depreciation$1,283,015DepreciationAmt
Book Value$1,626,173BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$24,457,877TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Due to affiliates$6,224,082
Allocated tax-exempt debt (SSM Health Care Corporation)$23,000,000
Third party payors$366,213
FieldValueIRS element (for citing)
Total Liability$29,590,295TotalLiabilityAmt
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
ExplanationTHE CHRISTIAN HOME & REHABILITATION CENTER'S 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 2020 OR 2019.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 (7 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
Douglas Trost
Director, CEO and President$0$269,976$0$37,162$0$2,621$0$44,544$0$40,040$0$394,343$0$37,162
Damond Boatwright
Director, Regional President - WI$0$665,011$0$362,963$0$106,272$0$398,144$0$6,752$0$1,539,142$0$467,525
Paula Friedman
Former Officer$0$0$0$249,317$0$257,685$0$0$0$0$0$507,002$0$258,551
Kris Zimmer
Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health$0$370,664$0$803,048$0$543,333$0$56,137$0$16,938$0$1,790,120$0$1,162,526
Douglas Long
Secretary, General Counsel at SSM Health$0$645,435$0$469,242$0$87,144$0$374,673$0$24,679$0$1,601,173$0$547,438
Randy Combs
Treasurer, Chief Financial Officer at SSM Health$0$216,927$0$100,000$0$86,336$0$82,693$0$1,909$0$487,865$0$84,600
Janel Konkel
Executive Director$0$135,441$0$9,139$0$10,339$0$10,003$0$23,977$0$188,899$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationThe organization's top management official (CEO and President) is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
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: Paula Friedman $257,685
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 2020. 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 2020: Douglas Trost $11,000 Damond Boatwright $77,160 Kris Zimmer $54,000 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2020. All distributions received from the plan in the current year were included in the individual's taxable compensation. Damond Boatwright $104,562 Kris Zimmer $493,428 Randy Combs $84,600 Douglas Long $78,000 During 2020, the following individuals participated in a nonqualified retirement plan from the organization or a related organization. The amounts reported below represent the change in accrued benefit for each individual and also include amounts accrued under the pension restoration plan: Kris Zimmer $26,226

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part V, Line 1aALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY A RELATED 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 sole member of the corporation is Agnesian Healthcare Inc. Agnesian Healthcare Inc is a nonprofit 501(C)(3) organization. Both The Christian Home & Rehabilitation Center and Agnesian Healthcare 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 member has the power to appoint additional, successor or replacement members and to appoint and remove the appointed directors and the ex officio directors.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersThe following powers are reserved for the member: a. to establish and change the mission, philosophy and values of the Corporation; b. to appoint additional, successor or replacement Members; c. to appoint and remove the Directors; d. to appoint and remove the President of the Corporation and the chief executive officer of any operating division of the Corporation; e. to approve 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 interests in the property of the Corporation; p. to require the Corporation to transfer assets, including but not limited to cash, to SSMHCC or to any other entity exempt from federal income tax as an organization described in ยง501(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 SSMHCC, to the extent necessary to accomplish the mission, goals and objectives of SSMHCC as determined by SSMHCC; q. to approve the transfer of assets by the Corporation to any entity other than SSMHCC, other than transfers made in the ordinary course of operations of the Corporation which will not require 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 SSMHCC 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.
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 policyA written conflict of interest and insider transaction policy exists which requires each director, principal officer, trustee or committee member to disclose on a annual basis to the designated authority a conflict of interest disclosure statement. The designated authority ensures that all statements are completed, reviews them for conflicts, and submits to the board for review any conflict of interest disclosure statements that disclose actual or potential conflicts.
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 Wisconsin Secretary of State's website. Copies of the Form 990 and the conflict of interest policy are available to the public upon request.
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesChange in beneficial interest in foundation - 34235;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (50 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 Hospital Centralia Illinois
10101 Woodfield LaneSt LouisMO63132370662580Health 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 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

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (16 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 Holdings LLC
1808 West Beltline HighwayMadisonWI53713800968174Pharmacy BenefitsWINAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (19 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndLegal 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
10101 Woodfield LaneSt LouisMO63132030310431InsuranceNAC CorporationfalseCJ
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
Dane County Cytology Center Inc
2000 Engel Street Suite 201MadisonWI53713391414219Medical ServicesWINAC Corporationfalse
SSM Health Insurance Company
1277 Deming WayMadisonWI53717834718249InsuranceMONAC 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 OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd