2021-11-03T17:32:58-05:00 2020-12-31 990 2020-01-01 370662580 St Mary's Hospital Centralia Illinois STMA 6184368000 10101 Woodfield Lane St Louis MO 63132 Randy Combs Treasurer 2021-11-03 Randy Combs 999009999 2020 2022-09-23 18:48:47Z Damon Harbison 10101 Woodfield Lane St Louis MO 63132 113780996 false 0928 X https://www.ssmhealth.com/locations/st-marys-hospital-centralia X 1947 MO TO 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. 12 10 784 63 0 0 1571169 10558099 109628361 102674665 485760 -7718 358193 317039 112043483 113542085 31264 5000 0 47803618 49915425 0 23491 48378079 48468555 96212961 98388980 15830522 15153105 70785650 101261497 66237829 82030674 4547821 19230823 THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. false false 86522385 5000 102674665 PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS. 86522385 true true false true false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true X 0 0 784 true false false false false false false false false false false false false X 12 10 false false false false true true true true false false false false true true true true true false false false X Mark Stover 6184367545 400 N Pleasant Avenue Centralia IL 62801 Candace Jennings Director, Chairperson, Regional President-St. Louis/Southern Illinois 1.0 46.0 X X 0 1170577 342361 Elizabeth Franczyk MD Director 1.0 3.0 X 0 0 0 Kimberly McMillan Director 1.0 3.0 X 0 0 0 Patricia Williams Director 1.0 4.0 X 0 0 0 Rev Ron Johnson Director 1.0 4.0 X 0 0 0 Robert Brown Director 1.0 4.0 X 0 0 0 Ryan Willis MD Director 1.0 3.0 X 0 0 0 Sajjan K Nemani MD Director, Physician at SSM Health 1.0 43.0 X 0 484420 0 Sr M Clarette Stryzewski CSSF Director 1.0 3.0 X 0 0 0 Sr M Ramona Dombrowski CSSF Director 1.0 3.0 X 0 0 0 Stacy Tate Director 1.0 3.0 X 0 0 0 Yagnesh Oza MD Director 1.0 3.0 X 0 0 0 Damon Harbison Hospital President, SSM Health St. Mary's Hospital - Centralia 40.0 1.0 X 323008 0 119153 Douglas Long Secretary, General Counsel at SSM Health 1.0 68.2 X 0 1201821 399352 John Snodsmith Regional VP, Finance 10.0 34.0 X 0 192891 45208 Karen Rewerts VP-Financial Operations 1.0 51.0 X 0 790849 178749 Kris Zimmer Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health 1.0 67.0 X 0 1717045 73075 Rachel Hall Assistant Secretary 5.0 39.0 X 0 93828 27636 Randy Combs Treasurer, Chief Financial Officer at SSM Health 1.0 64.0 X 0 403263 84602 Brenda Alexander Pt Yr System VP - Human Resources 20.0 20.0 X 0 256994 25547 Corey Black MD Pt Yr Chief Medical Officer - Southern Illinois 20.0 20.0 X 262514 262514 56190 George Daneker MD Interim Chief Medical Officer - Southern Illinois 20.0 20.0 X 0 451603 59993 Hollie Colle Director - Administrative Services/Operations 20.0 20.0 X 88526 88526 46432 Julie Long VP - Strategic Planning 20.0 20.0 X 0 275109 61440 Lisa Dimarco Regional VP, Patient Care Services/CNO 20.0 20.0 X 119628 179443 96265 Marla Smith Director - Nursing 40.0 0 X 165924 0 29160 Susie Robbins ER Nurse Director 40.0 0 X 174421 0 6518 Tara Rapp Pharmacist 40.0 0 X 150158 0 5174 Todd Davis Clinical Pharmacist 40.0 0 X 153174 0 37503 Tracy Fiscus Administrative Director - Nursing 40.0 0 X 196167 0 37172 Kerry Swanson Former Officer 0.0 40.0 X 0 918478 35971 Laura Kaiser Former Officer 0.0 46.0 X 0 3454725 1724577 Matt Kinsella Former Officer 0.0 40.0 X 0 403374 129930 Paula Friedman Former Officer 0.0 0.0 X 0 507002 0 1633520 12852462 3622008 55 true true false ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS 2700 TURNBERRY DRIVE MARION IL 62959 MEDICAL SERVICES 2835378 SHORES BUILDERS 1154 SCHWARTZ ROAD CENTRALIA IL 62801 Construction services 2147525 MIDWEST EMERGENCY DEPARTMENT PO BOX 8882 FORT WORTH TX 76124 MEDICAL SERVICES 866353 FELICIAN SERVICES 3800 W PETERSON AVE CHICAGO IL 60659 MANAGEMENT SERVICES 767280 SODEXO OPERATIONS LLC 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 DIETARY SERVICES 589552 15 669291 9888808 15650 10558099 NET PATIENT SERVICE REVENUE 622110 102674665 102674665 0 0 0 0 102674665 40216 40216 226745 185711 41034 0 41034 41034 5266 53200 5266 -53200 -47934 -47934 CAFETERIA REVENUE 722210 236085 236085 MGMT FEES TO RELATED ORG 541611 36000 36000 MEDICAL RECORDS 561000 3920 3920 0 0 0 0 276005 113542085 102674665 0 309321 X 5000 5000 1002646 926015 76631 32384714 29909592 2475122 3562910 3290601 272309 10567672 9759998 807674 2397483 2214246 183237 396602 357514 39088 20264 20264 3017 3017 14696 14696 16892436 9668194 7213224 11018 22099 22099 3640478 3475709 164769 4414814 4358417 45457 10940 1926311 1755843 170468 90751 74287 14931 1533 9559 2625 6934 1499512 1499512 4511409 4511409 469612 469612 Medical supplies 10361368 10361368 Medicaid Provider Tax 3718814 3718814 Internal management fees 296136 296136 Licenses and taxes 163629 163629 17048 0 17048 0 98388980 86522385 11843104 23491 4953243 154424 17222751 15660371 0 0 0 0 2296356 2348049 533075 533255 85327099 44329344 41039436 40997755 0 1089542 1053204 1051132 910981 2600115 39603458 70785650 101261497 9019230 7603680 87095 3328744 0 0 45818000 46538000 11313504 24560250 66237829 82030674 X 3409442 18408464 1138379 822359 4547821 19230823 70785650 101261497 X 15153105 8848 -478951 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 14696 14696 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The organization paid dues to various state and national associations and a portion of these dues was allocated to lobbying activities. 1259000 1259000 48269221 21191758 27077463 14961 5820 9141 32446380 22461891 9984489 3337537 669875 2667662 40997755 Due from Affiliates 39428803 Operating right-of-use assets 174655 39603458 DUE TO AFFILIATES DEFERRED COMPENSATION 259667 ASSET RETIREMENT OBLIGATION 1037834 PENSION FUNDING LIABILITY 7878699 OTHER LONG-TERM LIABILITIES 891000 THIRD PARTY PAYORS 13761007 Third-party patient loans 557388 Operating lease obligations 174655 24560250 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote ST 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 2020 OR 2019. true true X true X true X true true false true true 978840 978840 0.0099 28593828 25807552 2786276 0.0283 1683049 1508251 174798 0.0018 0 0 31255717 27315803 3939914 0.0400 157095 157095 0.0016 189246 189246 0.0019 0 0.0 0 0.0 38153 38153 0.0004 0 0 384494 0 384494 0.0039 0 0 31640211 27315803 4324408 0.0440 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 4776240 24120729 29042987 -4922258 X true true 1 1 SSM Health St Mary's Hospital - Centralia 400 N PLEASANT AVENUE CENTRALIA IL 62801 https://www.ssmhealth.com/locations/st-marys-hospital-centralia 0002642 X X X A A 1 false false true X X X X X X X X X 18 true true false true X https://www.ssmhealth.com/resources/about/community-health X true 18 true https://www.ssmhealth.com/resources/about/community-health false true X 200.0 400.0 X X X X X true true X X X true X https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance X https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance X https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE 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, 1 Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. The hospital utilized primary and secondary data to account for input from persons who represent the broad interests of the community served. Over 100 surveys were received by the hospital from community leaders in area counties and medical staff. In addition to the surveys, the hospital gathered and reviewed data from sources such as the Community Commons, IPLAN (Illinois Project for Local Assessment of Needs) of Jefferson, Marion, and other surrounding counties, and the Illinois Department of Public Health. Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. SSM Health St. Mary's Hospital - Centralia conducted its 2018 CHNA in cooperation with SSM Health Good Samaritan Hospital - Mt. Vernon. Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. The hospital identified various health needs in the 2018 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: - Mental health - Substance abuse - Nutrition Mental health The hospital serves a high-risk population that frequently experiences the adverse effects of poor mental health. The hospital is the only facility in the region with inpatient and outpatient mental health services and has committed itself to improving population health in this area. Additionally, statistics show: - Marion and Jefferson Counties have a rate of suicide nearly 50% higher than the state of Illinois average per 100,000 - Victims of child abuse and neglect are 12 times more likely to commit suicide than the general population - 70% of self-harm that did not result in suicide is the result of drug or other poisoning - 39% suicides result from firearm injuries - Suicide rates are 2.3 times higher among Caucasians than African Americans - Annual average suicide rates for males increase with age. Women's rates plateau and drop off after age 54 The hospital's action plan includes the following initiatives to improve mental health in the community served: - Recruiting licensed clinical social workers (LCSWs), psychiatric RNs and APNs to promote more availability to care and treatment - Developing and implementing a telepsychiatry program - Evaluate and implement ACE screening tool for identification of abuse and neglect - Develop and implement treatment protocols for abuse and neglect to begin the healing process - Provide information and support to educators, hospitals, medical staff and others on being "trauma informed" to support children of abuse Substance Abuse The hospital serves a high-risk population that frequently experiences the adverse effects of poor mental health and substance abuse. The hospital is the only facility in the region with inpatient and outpatient mental health services and has committed itself to improving population health in this area. Additionally, statistics show: - Liquor store access per 100,000 population is 40% higher in Marion and Jefferson Counties than that of the State of Illinois - Liquor store access per 100,000 population has increased 10% from 2015 to 2016 - 36.7% higher population with a lack of social and economic support vs. State - Access to mental health providers is 22.6% lower in Marion and Jefferson Counties vs. U.S. average and 13% lower than the State of Illinois - Greater than 20% rise in depression among adolescents from 2010 to 2014, 62% of whom did not receive treatment - 55% of adults with mental health needs did not receive treatment - 40.2% higher population who are current smokers vs. State - 95% of individuals aged 12 and older with alcohol abuse or dependence did not receive treatment - 88% of individuals aged 12 and older with illicit drug abuse or dependence did not receive treatment - 3.8% of adolescents reported non-medical use of pain relievers in Illinois in 2013-2014 The hospital's action plan includes the following initiatives to address substance abuse in the community served: - Implementing a telepsychiatry program - Expansion of LCSW counselling services - Reduce the stigma associated with mental health through community and education outreach - Prevent drug overdoses by providing greater prevention programs and education - Implement trauma-informed programs for teachers - Partner with educators for Social-Emotional Learning programs - Improve parenting skills and services starting with prenatal classes - Community education and awareness - Implement local intervention programs by developing and implementing local suboxone and/or Vivitrol clinics for treatment (closest current clinic is more than 65 miles away) - Make reversal agents widely available to first responders, community outreach and other organizations Nutrition Nutrition is the intake of food, considered in relation to the body's dietary needs. Good nutrition - an adequate, well balanced diet combined with regular physical activity - is the cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity. Poor nutrition contributes to many diseases, including obesity, heart disease, and some cancers. Poor nutrition is making our nation sick. Additionally, statistics show: - 25-30% of population with low food access - 62.5% of children are eligible for free/reduced price lunches - Nearly 30% of Medicare beneficiaries have diabetes - 31% of adults are obese - 24% with no leisure time physical activity - 87% with inadequate fruit/vegetable consumption - 22.5 - 24.8% of adults reporting no leisure time physical activity - 10,500 people in Marion and Jefferson Counties with food insecurity according to Feed America (2016) - 25 - 30% of population living in low income census tract with low access to a supermarket or large grocery store The hospital's action plan includes the following initiatives to improve nutrition in the community served: - Increase access to healthy food options through food banks - Provide support to the Central Illinois Food Bank for distribution of fresh fruits, vegetables, protein and dairy in the "food deserts" in Mount Vernon area - Improve knowledge and skills of parents and others to prepare healthy foods - Build a demonstration kitchen and broadcast cooking programs on the internet - Develop vegetable and fruit gardens in collaboration with local churches, schools and others - Develop fitness and activity programs - Update Nutrition, Exercise Training Program at the Felician Wellness Center in Centralia and replicate to Mt. Vernon The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs and address additional community needs within its efforts. The following community needs were identified but have not been prioritized due to the hospital's limited resources at this time (additional descriptions available in the 2018 CHNA): - Obesity - Cancer - Diabetes - Heart disease - Access to care - Health education - Prevention Schedule H, Part V, Section B, Line 11 Facility A, 2 Facility A, 2 - SSM Health St. Mary's Hospital - Centralia (continued). During 2020, the following activities were performed to help address the issues identified in the CHNA: Mobile Markets were envisioned by educators at the University of Illinois Extension who partnered closely with SSM Health in the past. After huddling with SSM Health's Mission Integration leaders in Southern Illinois, the idea was turned into a reality. A monthly mobile market was held in both Centralia and Mt. Vernon, where families lined up in their vehicles in a socioeconomically challenged part of town and headed for a tent staffed by volunteers who provided them with a delivery of produce, dairy products, recipes, exercise tips, and other health information. This partnership between the University of Illinois Extension, SSM Health, the United Way of South-Central Illinois and the USDA was a creative way to care for our neighbors struggling with food insecurity. Each family received a 20-pound box of produce (including items such as potatoes, onions, chopped romaine, baby carrots, oranges, apples, etc.) and a seven-pound dairy box (including various cheeses, yogurt, cottage cheese and butter, in addition to a gallon of milk). The bulk of the food was provided by a USDA grant and administered by Cusumano & Sons, Inc, a produce wholesaler. 4 CENTRALIA WORK SAFETY INSTITUTE 1441 W BROADWAY CENTRALIA IL 62801 REHABILITATION FACILITY SALEM WORK SAFETY INSTITUTE 1250 W WHITTAKER STREET SALEM IL 62881 REHABILITATION FACILITY SSM Health Medical Group 1054 Martin Luther King Suite 125 Centralia IL 62801 Outpatient clinic SSM Health Express Clinic 1003 E McCord Street Centralia IL 62801 Express clinic Schedule H, Part I, Line 3c Discounted Care Exceptions Patients 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 organization SSM Health Care Corporation, 46-6029223 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The 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 amount AS 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 Methodology FOR 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 footnote SSM 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, 2020 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE 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 assistance SSM 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 website A - 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 website A - 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 website A - 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 assessment SSM 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 assistance Each 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 information SSM Health St. Mary's Hospital - Centralia, in partnership with SSM Health Good Samaritan Hospital - Mount Vernon, defines its primary service area as Marion County, Jefferson County, and parts of Franklin County in Illinois. The hospitals are located in Mount Vernon and Centralia, Illinois. The estimated population of the area served is 165,223. Of this population, the poverty level is 18.0% and 62.4% of children are eligible for free or reduced lunch. Additionally, only 15.7% of individuals have a bachelor's degree of higher level of education. There are disproportionately high rates of disability in the community as well, with 18% of Marion and Jefferson counties affected compared to only 10.9% throughout Illinois. Furthermore, rates of access to a primary care physician are nearly half of the state's average, and nearly 28% of the population reports a lack of social or economic support. Additional information concerning the service area can be found on pages 6 through 8, and 21 through 23 of the 2018 CHNA. Schedule H, Part VI, Line 5 Promotion of community health SSM 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 system St. 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 report IL true true false false false false false false false Candace Jennings Director, Chairperson, Regional President-St. Louis/Southern Illinois 0 668869 0 398415 0 103293 0 315729 0 26632 0 1512938 0 479468 Sajjan K Nemani MD Director, Physician at SSM Health 0 484420 0 0 0 0 0 0 0 0 0 484420 0 0 Kerry Swanson Former Officer 0 206595 0 191770 0 520113 0 1315 0 34656 0 954449 0 367686 Matt Kinsella Former Officer 0 333432 0 40672 0 29270 0 90617 0 39313 0 533304 0 40920 Laura Kaiser Former Officer 0 1605981 0 1659602 0 189142 0 1696604 0 27973 0 5179302 0 1659576 Paula Friedman Former Officer 0 0 0 249317 0 257685 0 0 0 0 0 507002 0 258551 Kris Zimmer Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health 0 370664 0 803048 0 543333 0 56137 0 16938 0 1790120 0 1162526 Douglas Long Secretary, General Counsel at SSM Health 0 645435 0 469242 0 87144 0 374673 0 24679 0 1601173 0 547438 Karen Rewerts VP-Financial Operations 0 555842 0 109440 0 125567 0 146048 0 32701 0 969598 0 168566 John Snodsmith Regional VP, Finance 0 161458 0 0 0 31433 0 27748 0 17460 0 238099 0 0 Damon Harbison Hospital President, SSM Health St. Mary's Hospital - Centralia 255706 0 57308 0 9994 0 71526 0 47627 0 442161 0 66731 0 Randy Combs Treasurer, Chief Financial Officer at SSM Health 0 216927 0 100000 0 86336 0 82693 0 1909 0 487865 0 84600 Lisa Dimarco Regional VP, Patient Care Services/CNO 103301 154952 14461 21692 1866 2799 25858 38787 12648 18972 158134 237202 14410 21616 Julie Long VP - Strategic Planning 0 222992 0 36018 0 16099 0 57123 0 4317 0 336549 0 51381 Brenda Alexander Pt Yr System VP - Human Resources 0 84653 0 29554 0 142787 0 13980 0 11567 0 282541 0 98123 Corey Black MD Pt Yr Chief Medical Officer - Southern Illinois 172087 172087 35557 35557 54870 54870 18275 18275 9820 9820 290609 290609 71344 71344 George Daneker MD Interim Chief Medical Officer - Southern Illinois 0 356185 0 0 0 95418 0 37676 0 22317 0 511596 0 22918 Hollie Colle Director - Administrative Services/Operations 72718 72718 0 0 15808 15808 1638 1638 21578 21578 111742 111742 0 0 Tracy Fiscus Administrative Director - Nursing 166095 0 0 0 30072 0 2602 0 34570 0 233339 0 0 0 Marla Smith Director - Nursing 133757 0 0 0 32167 0 2061 0 27099 0 195084 0 0 0 Todd Davis Clinical Pharmacist 152671 0 0 0 503 0 2354 0 35149 0 190677 0 0 0 Tara Rapp Pharmacist 149996 0 0 0 162 0 2252 0 2922 0 155332 0 0 0 Susie Robbins ER Nurse Director 140313 0 0 0 34108 0 2120 0 4398 0 180939 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The 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 payment SSM 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. Brenda Alexander $73,846 Corey Black, MD $37,019 Paula Friedman $257,685 Kerry Swanson $338,461 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Pension 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: Damon Harbison $20,600 Kris Zimmer $54,000 Karen Rewerts $45,600 John Snodsmith $10,000 Lisa Dimarco $20,800 Julie Long $15,600 Brenda Alexander $12,800 Corey Black $30,800 Laura Kaiser $314,000 Matt Kinsella $27,200 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. Candace Jennings $81,053 Damon Harbison $9,422 Kris Zimmer $493,428 Randy Combs $84,600 Douglas Long $78,000 Karen Rewerts $59,124 Julie Long $15,362 Brenda Alexander $68,569 Corey Black, MD $71,574 George Daneker, MD $22,918 Kerry Swanson $175,918 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: Candace Jennings $9,258 Kris Zimmer $26,226 Karen Rewerts $43,291 Kerry Swanson $2,812 Form 990, Part III, Line 4a Description of Program Service Briefly 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 $ 978,840 Unpaid Cost of Medicaid Services $ 2,786,276 Unpaid Cost of Medicare Services $ 4,922,258 Unpaid Cost of Other Government Programs $ 174,798 Total Quantifiable Uncompensated Care $ 8,862,172 Form 990, Part V, Line 1a Common Paymaster ALL 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 compensation The organization's top management official, regional 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. Form 990, Part VI, Line 15b Process for determining compensation The organization's top management official, regional 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. Form 990, Part VI, Line 6 Classes of members or stockholders THE 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 body THE 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 stockholders THE 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 body The 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 body The 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 policy BOARD 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 public THE 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 IX, Line 11g Other Fees Medical and other professional fees - Total Expense: 16892436, Program Service Expense: 9668194, Management and General Expenses: 7213224, Fundraising Expenses: 11018; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in beneficial interest in foundation - -34543; Transfers to affiliates - -444408; SSM Health Care Corporation 10101 Woodfield Lane St Louis MO 63132 466029223 Health Care MO 501(c)(3) Type I SSM Health Ministries false SSMHC Liability Trust I 10101 Woodfield Lane St Louis MO 63132 436331003 Insurance MO 501(c)(3) Type I SSM Health Care Corporation false SSM Consolidated Health Services 10101 Woodfield Lane St Louis MO 63132 431473657 Health Care MO 501(c)(3) 10 SSM Health Care Corporation false SSM Policy Institute 10101 Woodfield Lane St Louis MO 63132 431788151 Health Care MO 501(c)(4) SSM Health Care Corporation false SSM Health Care Portfolio Management Co 10101 Woodfield Lane St Louis MO 63132 431825256 Management MO 501(c)(3) Type I SSM Health Care Corporation false SSM Cardinal Glennon Children's Hospital 10101 Woodfield Lane St Louis MO 63132 430738490 Health Care MO 501(c)(3) 3 SSM Health Care St Louis false Cardinal Glennon Children's Foundation 10101 Woodfield Lane St Louis MO 63132 431754347 Fundraising MO 501(c)(3) 7 SSM Cardinal Glennon Children's Hospital false SSM Health Foundation - St Louis 10101 Woodfield Lane St Louis MO 63132 431552945 Fundraising MO 501(c)(3) 7 SSM Health Care St Louis false SSM Health Care of Oklahoma Inc 10101 Woodfield Lane St Louis MO 63132 730657693 Health Care OK 501(c)(3) 3 SSM Health Care Corporation false The St Anthony Hospital Foundation Inc 10101 Woodfield Lane St Louis MO 63132 736104300 Fundraising OK 501(c)(3) 7 SSM Health Care of Oklahoma false SSM Health Care of Wisconsin Inc 10101 Woodfield Lane St Louis MO 63132 430688874 Health Care WI 501(c)(3) 3 SSM Health Care Corporation false Dells Medical Building Inc 10101 Woodfield Lane St Louis MO 63132 391613292 MOB WI 501(c)(2) SSM Health Care of Wisconsin false St Mary's Foundation Inc 10101 Woodfield Lane St Louis MO 63132 431940686 Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin false St Clare Health Care Foundation Inc 10101 Woodfield Lane St Louis MO 63132 431940683 Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin false Home Health United Inc 2802 Walton Commons Lane Madison WI 53718 391539827 Health Care WI 501(c)(3) 10 SSM Health Care of Wisconsin false Home Care United Inc 2802 Walton Commons Lane Madison WI 53718 391776340 Health Care WI 501(c)(3) 10 SSM Health Care of Wisconsin false HHU Xtra Care Inc 2802 Walton Commons Lane Madison WI 53718 391705111 Health Care WI 501(c)(3) 10 SSM Health Care of Wisconsin false SSM Health at Home Foundation of Wisconsin Inc 2802 Walton Commons Lane Madison WI 53718 391839309 Fundraising WI 501(c)(3) Type I Home Health United Inc false SSM Regional Health Services 10101 Woodfield Lane St Louis MO 63132 440579850 Health Care MO 501(c)(3) 3 SSM Health Care Corporation false St Mary's Health Center Jefferson City Missouri Foundation 10101 Woodfield Lane St Louis MO 63132 431575307 Fundraising MO 501(c)(3) Type I SSM Regional Health Services false Good Samaritan Regional Health Center 10101 Woodfield Lane St Louis MO 63132 430653587 Health Care IL 501(c)(3) 3 SSM Regional Health Services false St Mary's - Good Samaritan Inc 10101 Woodfield Lane St Louis MO 63132 364170833 Health Care IL 501(c)(3) Type I SSM Regional Health Services false Good Samaritan Regional Health Center Foundation 10101 Woodfield Lane St Louis MO 63132 262884795 Fundraising IL 501(c)(3) 7 St Mary's-Good Samaritan Inc false St Mary's Hospital Foundation 10101 Woodfield Lane St Louis MO 63132 364636691 Fundraising IL 501(c)(3) 7 St Mary's-Good Samaritan Inc false St Mary's Hospital Auxiliary 400 N Pleasant Centralia IL 62801 237126345 Fundraising IL 501(c)(3) 10 St Mary's Hospital Foundation false SSM Health Businesses 10101 Woodfield Lane St Louis MO 63132 431333488 Health Care MO 501(c)(3) 10 SSM Health Care Corporation false SSM Health Care St Louis 10101 Woodfield Lane St Louis MO 63132 431343281 Health Care MO 501(c)(3) 3 SSM Health Care Corporation false Centralia Medical Services Bldg Assoc 10101 Woodfield Lane St Louis MO 63132 237408025 MOB IL 501(c)(3) Type I SSM Regional Health Services false St Mary's Janesville Foundation Inc 10101 Woodfield Lane St Louis MO 63132 273439133 Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin false SSM Health Ministries 3221 McKelvey Road Suite 107 Bridgeton MO 63044 431012492 Religious Organization MO 501(c)(3) 1 NA false Lee Dewey Corporation 10101 Woodfield Lane St Louis MO 63132 731279603 MOB OK 501(c)(3) Type I SSM Health Care of Oklahoma false SSM Hospice & Home Care Foundation 10101 Woodfield Lane St Louis MO 63132 300012246 Fundraising MO 501(c)(3) 7 SSM Health Businesses false St Mary's Hospital Auxiliary 100 St Marys Medical Plaza Jefferson City MO 65101 436049878 Fundraising MO 501(c)(3) Type II NA false Good Samaritan Hospital Auxiliary 1 Good Samaritan Way Mount Vernon IL 62864 237049599 Fundraising IL 501(c)(3) Type III-FI NA false St Anthony Shawnee Hospital Inc 1000 N Lee Ave Oklahoma City OK 73102 455055149 Health Care OK 501(c)(3) 3 SSM Health Care of Oklahoma false SSM Audrain Health Care Inc 10101 Woodfield Lane St Louis MO 63132 431550298 Health Care MO 501(c)(3) 3 SSM Regional Health Services false Audrain Medical Center Foundation Inc 620 E Monroe St Mexico MO 65265 431265060 Fundraising MO 501(c)(3) Type I NA false SSM-SLUH Inc 10101 Woodfield Lane St Louis MO 63132 474196634 Health Care MO 501(c)(3) 3 SSM Health Care St Louis false SSM Health Plan 1277 Deming Way Madison WI 53717 831979548 Insurance MO 501(c)(4) SSM Health Businesses false Agnesian Healthcare Inc 430 E Division St Fond du Lac WI 54935 390807236 Health Care WI 501(c)(3) 3 SSM Health Care of Wisconsin false Ripon Medical Center Inc 845 Parkside Street Ripon WI 54971 391101287 Health Care WI 501(c)(3) 3 Agnesian Healthcare Inc false Waupun Memorial Hospital Inc 620 West Brown Street Waupun WI 53963 390806265 Health Care WI 501(c)(3) 3 Agnesian Healthcare Inc false St Francis Home of Fond du Lac Wisconsin Inc 33 Everett Street Fond du Lac WI 54935 391029998 Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc false Sister Servants of Christ the King Villa Loretto N8114 County WW Mount Calvary WI 53057 391022770 Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc false Villa Rosa Inc N8120 County WW Mount Calvary WI 53057 421670962 Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc false The Christian Home and Rehabilitation Center Incorporated 331 Bly Street Waupun WI 53963 390884514 Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc false The Monroe Clinic Inc 515 22nd Avenue Monroe WI 53566 390808509 Health Care WI 501(c)(3) 3 SSM Health Care of Wisconsin false Monroe Clinic and Hospital Foundation Inc 515 22nd Avenue Monroe WI 53566 205769038 Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin false Agnesian Healthcare Foundation Inc 430 E Division St Fond du Lac WI 54935 391684956 Fundraising WI 501(c)(3) Type I SSM Health Care of Wisconsin false Shared Magnetic Resonance Imaging Facility Inc 1104 John Nolen Drive Madison WI 53713 391534744 Health Care WI 501(c)(3) Type I SSM Health Care of Wisconsin false SSM St Joseph Endoscopy Center LLC 10101 Woodfield Lane St Louis MO 63132 270046559 Surgery Services MO NA N/A St Clare Imaging Services LLC 707 14th Street Suite A Baraboo WI 53913 200122365 Diag. Services WI NA N/A Mt Vernon Radiation Therapy Center LLC 10101 Woodfield Lane St Louis MO 63132 201382620 Radiation Therapy IL NA N/A Sleep & Neurology Center of Southern Illinois LLC 10101 Woodfield Lane St Louis MO 63132 208468195 Diag. Services IL NA N/A CHOWSMGSI Office Building LLC 10101 Woodfield Lane St Louis MO 63132 371383861 MOB IL NA N/A Oza Cancer Center LLC 10101 Woodfield Lane St Louis MO 63132 201382727 MOB IL NA N/A Shawnee Real Estate Holdings LLC 1000 N Lee Ave Oklahoma City OK 73102 455458304 MOB OK NA N/A Dean Clinic & St Mary's Hospital Accountable Care Organization LLC 1808 West Beltline Highway Madison WI 53713 452995500 Accountable Care Organization WI NA N/A Wisconsin Integrated Information Technology and Telemedicine Systems LLC 1808 West Beltline Highway Madison WI 53713 392016715 Information Technology Services WI NA N/A Dean Health Holdings LLC 1277 Deming Way Madison WI 53717 261594709 Support Services WI NA N/A Wingra Building Group 1808 West Beltline Highway Madison WI 53713 390237060 MOB WI NA N/A Janesville Riverview Clinic Building Partnership 1808 West Beltline Highway Madison WI 53713 396220698 MOB WI NA N/A 1110 N Classen Blvd LLC 1110 N Classen Boulevard Oklahoma City OK 73106 731158158 MOB OK NA N/A SSM St Clare Surgical Center LLC 10101 Woodfield Lane St Louis MO 63132 261439695 Surgery Services MO NA N/A Windmill LLP 50 Village View Lane Chesterfield MO 63017 431804651 Investments MO NA N/A Navitus Holdings LLC 1808 West Beltline Highway Madison WI 53713 800968174 Pharmacy Benefits WI NA N/A SSM Managed Care Organization LLC 10101 Woodfield Lane St Louis MO 63132 431708511 Health Promotion MO NA C Corporation false FPP INC & Subs 10101 Woodfield Lane St Louis MO 63132 431465174 Health Care MO NA C Corporation false Diversified Health Services Corp 10101 Woodfield Lane St Louis MO 63132 431369305 Medical Equipment MO NA C Corporation false SSM Properties Inc 10101 Woodfield Lane St Louis MO 63132 431462486 Property Services MO NA C Corporation false HealthFirst Physician Management Services 10101 Woodfield Lane St Louis MO 63132 731534336 Medical Services OK NA C Corporation false SSMHC Liability Trust II 10101 Woodfield Lane St Louis MO 63132 816128118 Insurance MO NA C Corporation false SSM Medical Group Inc 10101 Woodfield Lane St Louis MO 63132 431664107 Physician Offices MO NA C Corporation false SSMHC Insurance Company 10101 Woodfield Lane St Louis MO 63132 030310431 Insurance CJ NA C Corporation false Physicians Services Corp of Southern Illinois Inc 10101 Woodfield Lane St Louis MO 63132 364161526 Health Care IL NA C Corporation false Dean Health Systems Inc 1808 West Beltline Highway Madison WI 53713 391128616 Physician Offices WI NA C Corporation false Dean Health Insurance Inc PO Box 56099 Madison WI 53705 391830837 Insurance WI NA C Corporation false Dean Health Plan Inc PO Box 56099 Madison WI 53705 391535024 Insurance WI NA C Corporation false Dean Retail Services Inc 1808 West Beltline Highway Madison WI 53713 391717636 Property Services WI NA C Corporation false Oza Oncology Inc 4117 Veterans Memorial Drive Mt Vernon IL 62804 371343746 Physician Offices IL NA S Corporation false SSM Health Janesville Campus Condominium Association Inc 1808 West Beltline Highway Madison WI 53713 832038674 Condo association WI NA C Corporation false SSM Health Pharmacy LLC 10101 Woodfield Lane St Louis MO 63132 264031708 Pharmacy MO NA C Corporation false Dane County Cytology Center Inc 2000 Engel Street Suite 201 Madison WI 53713 391414219 Medical Services WI NA C Corporation false SSM Health Insurance Company 1277 Deming Way Madison WI 53717 834718249 Insurance MO NA C Corporation false St Mary's Hospital Campus Condominium Owners Association Inc 707 South Mills Street Madison WI 53715 000000000 Condo association WI NA C Corporation false false true true false false false false false false true true false true true true false false false false