GOOD SAMARITAN REGIONAL HEALTH CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN REGIONAL HEALTH CENTER (EIN 43-0653587)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-03
- IRS object ID
- 202113079349302321
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-03T17:30:48-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 430653587 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Regional Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 3149947800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 Woodfield Lane | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Randy Combs | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Signature | 2021-11-03 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Randy | PersonFirstNm |
| Person Last | Combs | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jeremy Bradford | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 Woodfield Lane | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $199,879,239 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | https://www.ssmhealth.com/locations/good-samaritan-hospital-mt-vernon | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1204 | TotalEmployeeCnt |
| Total Volunteers | 88 | TotalVolunteersCnt |
| Total Gross UBI | $1,812,229 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $27,670 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,755,932 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $185,240,500 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $184,144,411 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,451,803 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,062,898 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,151,813 | PYOtherRevenueAmt |
| CY Other Revenue | $3,065,435 | CYOtherRevenueAmt |
| PY Total Revenue | $189,871,786 | PYTotalRevenueAmt |
| CY Total Revenue | $199,028,676 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,250 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $12,750 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $77,149,650 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $81,681,113 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $66,982 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $102,134,324 | PYOtherExpensesAmt |
| CY Other Expenses | $110,801,043 | CYOtherExpensesAmt |
| PY Total Expenses | $179,287,224 | PYTotalExpensesAmt |
| CY Total Expenses | $192,494,906 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $10,584,562 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,533,770 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $279,838,809 | TotalAssetsBOYAmt |
| Total Assets EOY | $321,958,296 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $186,295,175 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $215,987,563 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $93,543,634 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $105,970,733 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Through our exceptional health care services, we reveal the healing presence of God. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $173,439,565 | ExpenseAmt |
| Grant | $12,750 | GrantAmt |
| Revenue | $184,829,415 | RevenueAmt |
| Desc | See Schedule O for a complete description of program service accomplishments. | Desc |
| Total Program Service Expenses | $173,439,565 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1204 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Stover | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6184367545 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 North Pleasant Ave | AddressLine1Txt |
| City | Centralia | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (34 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Candace Jennings | ||||||||||
| Director, Chairperson, Regional President-St. Louis/Southern Illinois | 1.0 | 46.0 | Yes (X) | Yes (X) | $0 | $1,170,577 | $342,361 | |||
| Elizabeth Franczyk MD | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Kimberly McMillan | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Patricia Williams | ||||||||||
| Director | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||||
| Rev Ron Johnson | ||||||||||
| Director | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||||
| Robert Brown | ||||||||||
| Director | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||||
| Ryan Willis MD | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Sajjan K Nemani MD | ||||||||||
| Director, Physician at SSM Health | 1.0 | 43.0 | Yes (X) | $0 | $484,420 | $0 | ||||
| Sr M Clarette Stryzewski CSSF | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Sr M Ramona Dombrowski CSSF | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Stacy Tate | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Yagnesh Oza MD | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Douglas Long | ||||||||||
| Secretary, General Counsel at SSM Health | 1.0 | 68.2 | Yes (X) | $0 | $1,201,821 | $399,352 | ||||
| Jeremy Bradford | ||||||||||
| Hospital President, SSM Health Good Samaritan Hospital | 40.0 | 0 | Yes (X) | $348,032 | $0 | $127,926 | ||||
| John Snodsmith | ||||||||||
| Regional VP, Finance | 10.0 | 34.0 | Yes (X) | $0 | $192,891 | $45,208 | ||||
| Karen Rewerts | ||||||||||
| VP - Financial Operations | 1.0 | 51.0 | Yes (X) | $0 | $790,849 | $178,749 | ||||
| Kris Zimmer | ||||||||||
| Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health | 1.0 | 67.0 | Yes (X) | $0 | $1,717,045 | $73,075 | ||||
| Rachel Hall | ||||||||||
| Assistant Secretary | 10.0 | 34.0 | Yes (X) | $0 | $93,828 | $27,636 | ||||
| Randy Combs | ||||||||||
| Treasurer, Chief Financial Officer at SSM Health | 1.0 | 64.0 | Yes (X) | $0 | $403,263 | $84,602 | ||||
| Brenda Alexander | ||||||||||
| Pt Yr System VP - Human Resources | 20.0 | 20.0 | $0 | $256,994 | $25,547 | Yes (X) | ||||
| Corey Black MD | ||||||||||
| Pt Yr Chief Medical Officer - Southern Illinois | 20.0 | 20.0 | $262,514 | $262,514 | $56,190 | Yes (X) | ||||
| George Daneker MD | ||||||||||
| Interim Chief Medical Officer - Southern Illinois | 20.0 | 20.0 | $0 | $451,603 | $59,993 | Yes (X) | ||||
| Hollie Colle | ||||||||||
| Director - Administrative Services/Operations | 20.0 | 20.0 | $88,526 | $88,526 | $46,432 | Yes (X) | ||||
| Julie Long | ||||||||||
| VP - Strategic Planning | 20.0 | 20.0 | $0 | $275,109 | $61,440 | Yes (X) | ||||
| Lisa Dimarco | ||||||||||
| Regional VP, Patient Care Services/CNO | 20.0 | 20.0 | $179,443 | $119,628 | $96,265 | Yes (X) | ||||
| Faisal Rashid | ||||||||||
| Physician | 40.0 | 0 | $349,357 | $232,905 | $49,528 | Yes (X) | ||||
| Hailemariam Wolde | ||||||||||
| Physician | 40.0 | 0 | $320,191 | $0 | $23,476 | Yes (X) | ||||
| John Flick | ||||||||||
| Physician | 40.0 | 0 | $332,701 | $110,900 | $39,880 | Yes (X) | ||||
| Qing Luo | ||||||||||
| Physician | 40.0 | 0 | $330,568 | $0 | $24,490 | Yes (X) | ||||
| Shamlan Sheikh | ||||||||||
| Physician | 40.0 | 0 | $337,885 | $0 | $54,143 | Yes (X) | ||||
| Kerry Swanson | ||||||||||
| Former Officer | 0.0 | 40.0 | $0 | $918,478 | $35,971 | Yes (X) | ||||
| Laura Kaiser | ||||||||||
| Former Officer | 0.0 | 46.0 | $0 | $3,454,725 | $1,724,577 | Yes (X) | ||||
| Matt Kinsella | ||||||||||
| Former Officer | 0.0 | 40.0 | $0 | $403,374 | $129,930 | Yes (X) | ||||
| Paula Friedman | ||||||||||
| Former Officer | 0.0 | 0.0 | $0 | $507,002 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,549,217 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $13,136,452 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $3,706,771 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 101 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AMN Healthcare Inc | |||||
| 12400 High Bluff Drive | San Diego | CA | 92130 | Staffing services | $1,657,129 |
| Sodexo Operations LLC | |||||
| 4880 Paysphere Circle | Chicago | IL | 60674 | Dietary services | $1,107,147 |
| Pediatric Group LLC | |||||
| 3412 Office Park Dr | Marion | IL | 62959 | Medical services | $875,000 |
| Total Renal Care Inc | |||||
| PO Box 8500-1607 | Philadelphia | PA | 19178 | Medical services | $542,827 |
| Intuitive Surgical Inc | |||||
| 950 Kifer Rd | Sunnyvale | CA | 94086 | Surgical services | $498,361 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 27 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $23,288 | RelatedOrganizationsAmt |
| Government Grants | $7,732,644 | GovernmentGrantsAmt |
| Total Contributions | $7,755,932 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $184,144,411 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $184,144,411 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $184,144,411 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,212,193 | TotalRevenueColumnAmt |
| Exclusion | $1,212,193 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $400,183 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $755,167 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$354,984 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$354,984 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$210,358 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$144,626 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,946,101 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $95,396 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,946,101 | SecuritiesAmt |
| Other | -$95,396 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,850,705 | TotalRevenueColumnAmt |
| Exclusion | $2,850,705 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $608,926 | $608,926 | ||
| RETAIL PHARMACY | 446110 | $2,012,403 | $2,012,403 | ||
| PHYSICIAN OFFICE REVENUE | 621111 | $695,188 | $10,184 | $685,004 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $103,902 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $103,902 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,420,419 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $199,028,676 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $184,829,415 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,812,229 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,631,100 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,500 | TotalAmt |
| Program Services | $10,500 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,250 | TotalAmt |
| Program Services | $2,250 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,115,511 | TotalAmt |
| Program Services | $1,076,757 | ProgramServicesAmt |
| Management And General | $38,754 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,878,310 | TotalAmt |
| Program Services | $52,006,527 | ProgramServicesAmt |
| Management And General | $1,871,783 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,281,225 | TotalAmt |
| Program Services | $6,063,009 | ProgramServicesAmt |
| Management And General | $218,216 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,508,757 | TotalAmt |
| Program Services | $15,935,227 | ProgramServicesAmt |
| Management And General | $573,530 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,897,310 | TotalAmt |
| Program Services | $3,761,914 | ProgramServicesAmt |
| Management And General | $135,396 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,272 | TotalAmt |
| Program Services | $443,272 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,936 | TotalAmt |
| Management And General | $180,936 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,752 | TotalAmt |
| Management And General | $4,752 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,488 | TotalAmt |
| Management And General | $16,488 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,429,111 | TotalAmt |
| Program Services | $17,104,840 | ProgramServicesAmt |
| Management And General | $6,272,040 | ManagementAndGeneralAmt |
| Fundraising | $52,231 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,865 | TotalAmt |
| Management And General | $3,865 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,717,232 | TotalAmt |
| Program Services | $5,377,392 | ProgramServicesAmt |
| Management And General | $339,840 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,514,359 | TotalAmt |
| Program Services | $9,435,462 | ProgramServicesAmt |
| Management And General | $67,957 | ManagementAndGeneralAmt |
| Fundraising | $10,940 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,819,554 | TotalAmt |
| Program Services | $4,611,169 | ProgramServicesAmt |
| Management And General | $207,969 | ManagementAndGeneralAmt |
| Fundraising | $416 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $225,447 | TotalAmt |
| Program Services | $214,521 | ProgramServicesAmt |
| Management And General | $7,531 | ManagementAndGeneralAmt |
| Fundraising | $3,395 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,096 | TotalAmt |
| Program Services | $13,603 | ProgramServicesAmt |
| Management And General | $493 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,460,129 | TotalAmt |
| Program Services | $6,460,129 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,377,391 | TotalAmt |
| Program Services | $12,377,391 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,472,131 | TotalAmt |
| Program Services | $1,472,131 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $31,233,502 | $31,233,502 | |
| Medicaid Provider Tax | $5,649,545 | $5,649,545 | |
| Internal management fees | $9,048,809 | $9,048,809 | |
| Licenses and taxes | $190,424 | $190,424 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,494,906 | TotalAmt |
| Program Services | $173,439,565 | ProgramServicesAmt |
| Management And General | $18,988,359 | ManagementAndGeneralAmt |
| Fundraising | $66,982 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,409,496 | BOYAmt |
| EOY | $935,945 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,008,049 | BOYAmt |
| EOY | $24,465,441 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,972 | BOYAmt |
| EOY | $68,702 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,323,383 | BOYAmt |
| EOY | $4,338,755 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,664,691 | BOYAmt |
| EOY | $1,976,341 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $269,343,698 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $118,978,533 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $161,464,247 | BOYAmt |
| EOY | $150,365,165 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,828,265 | BOYAmt |
| EOY | $96,764,725 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,921,401 | BOYAmt |
| EOY | $5,354,529 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,000,603 | BOYAmt |
| EOY | $2,998,936 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,086,702 | BOYAmt |
| EOY | $34,689,757 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $279,838,809 | BOYAmt |
| EOY | $321,958,296 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,661,101 | BOYAmt |
| EOY | $12,742,427 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,097,980 | BOYAmt |
| EOY | $7,983,451 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,536,094 | BOYAmt |
| EOY | $195,261,685 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $186,295,175 | BOYAmt |
| EOY | $215,987,563 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,988,427 | BOYAmt |
| EOY | $104,584,082 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $555,207 | BOYAmt |
| EOY | $1,386,651 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,543,634 | BOYAmt |
| EOY | $105,970,733 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $279,838,809 | BOYAmt |
| EOY | $321,958,296 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,533,770 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $5,130,501 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $762,828 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $16,488 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $16,488 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAID DUES TO VARIOUS STATE AND NATIONAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $25,000 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $25,000 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| End Year Balance | $0 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| End Year Balance | $0 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| End Year Balance | $0 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| End Year Balance | $0 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.0 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.0 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.0 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $590,251 | OtherCostOrOtherBasisAmt |
| Book Value | $590,251 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $187,429,645 | OtherCostOrOtherBasisAmt |
| Depreciation | $63,168,397 | DepreciationAmt |
| Book Value | $124,261,248 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,623,357 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,214,417 | DepreciationAmt |
| Book Value | $12,408,940 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $54,393,319 | OtherCostOrOtherBasisAmt |
| Depreciation | $43,144,728 | DepreciationAmt |
| Book Value | $11,248,591 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,307,126 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,450,991 | DepreciationAmt |
| Book Value | $1,856,135 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $150,365,165 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Centralized investment program | Desc |
| Book Value | $96,764,725 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $96,764,725 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATES | $31,314,536 |
| Other assets | $14,710 |
| Pension revaluation asset | $1,678,827 |
| Operating right-of-use assets | $1,681,684 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $34,689,757 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD-PARTY PAYORS | $18,807,363 |
| RABBI TRUST LIABILITIES | $279,337 |
| ASSET RETIREMENT OBLIGATIONS | $27,756 |
| ALLOCATED TAX-EXEMPT DEBT (ISSUED BY SSM HEALTH) | $154,000,000 |
| CAPITAL LEASE OBLIGATION | $11,126,908 |
| DUE TO AFFILIATES | $7,913,973 |
| Third-party patient loans | $1,410,175 |
| Operating lease obligations | $1,696,173 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $195,261,685 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part V, Line 4 Intended uses of endowment funds | THE PURPOSE OF THE ENDOWMENT IS TO PROVIDE SCHOLARSHIPS TO EMPLOYEES AND STUDENTS IN THE HEALTH CARE FIELD. |
| Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | GOOD SAMARITAN REGIONAL HEALTH 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,154,766 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,154,766 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0112 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,127,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,424,395 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,703,408 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1076 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,614,621 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,268,759 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,345,862 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $46,897,190 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,693,154 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,204,036 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1257 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $174,160 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $174,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0009 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $341,732 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $341,732 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0018 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,902 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,902 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0004 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $584,794 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $584,794 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $47,481,984 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,693,154 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,788,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1288 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,494,593 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $49,807,355 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $67,542,284 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$17,734,929 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|
| SLEEP & NEUROLOGY CENTER OF S ILLINOIS INC | ||
| SLEEP AND NEUROLOGY SERVICES | 0.501 | 0.499 |
| MT VERNON RADIATION THERAPY CENTER LLC | ||
| RADIATION THERAPY SERVICES | 0.51 | 0.49 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SSM Health Good Samaritan Hospital - Mt Vernon | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 GOOD SAMARITAN WAY | AddressLine1Txt |
| City | MT VERNON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62864 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://www.ssmhealth.com/locations/good-samaritan-hospital-mt-vernon | WebsiteAddressTxt |
| State License | 0005850 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | A | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.ssmhealth.com/resources/about/community-health | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.ssmhealth.com/resources/about/community-health | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Good Samaritan Hospital - Mt. Vernon. 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 Good Samaritan Hospital - Mt. Vernon. The CHNA was conducted in partnership with SSM Health St. Mary's Hospital - Centralia. |
| Schedule H, Part V, Section B, Line 11 Facility A, 1 | Facility A, 1 - SSM Health Good Samaritan Hospital - Mt. Vernon. 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 Good Samaritan Hospital - Mt. Vernon (continued). During 2020, the following activities were performed to help address the issues identified in the CHNA: - 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. United Way staffers and volunteers from Mt Vernon Festivals and the Mt Vernon Rotary Club assisted on-site. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| MT VERNON RADIATION THERAPY CENTER | ||||
| 4117 VETERANS MEMORIAL DRIVE | MT VERNON | IL | 62864 | RADIATION THERAPY |
| SLEEP & NEUROLOGY CENTER OF S ILLINOIS | ||||
| 13 CUSAMANO PROF PLAZA | MT VERNON | IL | 62864 | SLEEP/NEURO DIAGNOSTIC TESTING |
| Oza Oncology Inc | ||||
| 4117 Veterans Memorial Drive | Mt Vernon | IL | 62864 | Physician Office |
| SSM Health Express Clinic | ||||
| 602 S 42nd Street | Mt Vernon | IL | 62864 | Express clinic |
| SSM Health Medical Group | ||||
| 2 Good Samaritan Way | Mt Vernon | IL | 62864 | Outpatient clinic |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Good Samaritan Hospital - Mt Vernon 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 Good Samaritan Hospital - Mt Vernon 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 Hospital embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Hospital'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 Good Samaritan Hospital - Mt Vernon's collection and financial assistance policies. |
| Schedule H, Part V, Section B, Line 16a FAP website | A - SSM Health Good Samaritan Hospital - Mt. Vernon: 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 Good Samaritan Hospital - Mt. Vernon: 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 Good Samaritan Hospital - Mt. Vernon: 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 Good Samaritan Hospital - Mt. Vernon 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, Good Samaritan Regional Health Center 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 Good Samaritan Hospital promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote both population health and healthy communities. Our "Connections" program has free monthly educational luncheons focusing on topics such as arthritis and exercise, diabetes, stroke prevention, and other wellness promotion topics. We also hold a monthly Stress Management class which is free to the public and sponsored as a result of community needs. SSM Health Good Samaritan Hospital - Mt. Vernon 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 | Good Samaritan Regional Health Center is a 501(c)(3) organization and is a member of the integrated health care system known as SSM Health. Along with St Mary's Hospital, Centralia, Illinois, it is part of a joint operating agreement between SSM Health based in St Louis, Missouri as managing partner, 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | John R and Eleanor R Mitchell Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 923 | AddressLine1Txt |
| City | Mount Vernon | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62864 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 376053100 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $7,500 | CashGrantAmt |
| Purpose Of Grant | Support organization's programs and operations | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S GRANTS WERE MADE TO ORGANIZATIONS TAX EXEMPT UNDER IRC SECTION 501(c)(3). THESE ORGANIZATIONS HAVE DEVELOPED INTERNAL CONTROL PROCEDURES FOR THE USE OF GRANT FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Candace Jennings | ||||||||||||||
| Director, Chairperson, Regional President-St. Louis/Southern Illinois | $0 | $668,869 | $0 | $398,415 | $0 | $103,293 | $0 | $315,729 | $0 | $26,632 | $0 | $1,512,938 | $0 | $479,468 |
| Sajjan K Nemani MD | ||||||||||||||
| Director, Physician at SSM Health | $0 | $484,420 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $484,420 | $0 | $0 |
| Kerry Swanson | ||||||||||||||
| Former Officer | $0 | $206,595 | $0 | $191,770 | $0 | $520,113 | $0 | $1,315 | $0 | $34,656 | $0 | $954,449 | $0 | $367,686 |
| Matt Kinsella | ||||||||||||||
| Former Officer | $0 | $333,432 | $0 | $40,672 | $0 | $29,270 | $0 | $90,617 | $0 | $39,313 | $0 | $533,304 | $0 | $40,920 |
| Laura Kaiser | ||||||||||||||
| Former Officer | $0 | $1,605,981 | $0 | $1,659,602 | $0 | $189,142 | $0 | $1,696,604 | $0 | $27,973 | $0 | $5,179,302 | $0 | $1,659,576 |
| 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 |
| Karen Rewerts | ||||||||||||||
| VP - Financial Operations | $0 | $555,842 | $0 | $109,440 | $0 | $125,567 | $0 | $146,048 | $0 | $32,701 | $0 | $969,598 | $0 | $168,566 |
| John Snodsmith | ||||||||||||||
| Regional VP, Finance | $0 | $161,458 | $0 | $0 | $0 | $31,433 | $0 | $27,748 | $0 | $17,460 | $0 | $238,099 | $0 | $0 |
| 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 |
| Jeremy Bradford | ||||||||||||||
| Hospital President, SSM Health Good Samaritan Hospital | $289,792 | $0 | $57,591 | $0 | $649 | $0 | $82,198 | $0 | $45,728 | $0 | $475,958 | $0 | $61,190 | $0 |
| Lisa Dimarco | ||||||||||||||
| Regional VP, Patient Care Services/CNO | $154,952 | $103,301 | $21,692 | $14,461 | $2,799 | $1,866 | $38,787 | $25,858 | $18,972 | $12,648 | $237,202 | $158,134 | $21,616 | $14,410 |
| Julie Long | ||||||||||||||
| VP - Strategic Planning | $0 | $222,992 | $0 | $36,018 | $0 | $16,099 | $0 | $57,123 | $0 | $4,317 | $0 | $336,549 | $0 | $51,381 |
| Brenda Alexander | ||||||||||||||
| Pt Yr System VP - Human Resources | $0 | $84,653 | $0 | $29,554 | $0 | $142,787 | $0 | $13,980 | $0 | $11,567 | $0 | $282,541 | $0 | $98,123 |
| Corey Black MD | ||||||||||||||
| Pt Yr Chief Medical Officer - Southern Illinois | $172,087 | $172,087 | $35,557 | $35,557 | $54,870 | $54,870 | $18,275 | $18,275 | $9,820 | $9,820 | $290,609 | $290,609 | $71,344 | $71,344 |
| George Daneker MD | ||||||||||||||
| Interim Chief Medical Officer - Southern Illinois | $0 | $356,185 | $0 | $0 | $0 | $95,418 | $0 | $37,676 | $0 | $22,317 | $0 | $511,596 | $0 | $22,918 |
| Hollie Colle | ||||||||||||||
| Director - Administrative Services/Operations | $72,718 | $72,718 | $0 | $0 | $15,808 | $15,808 | $1,638 | $1,638 | $21,578 | $21,578 | $111,742 | $111,742 | $0 | $0 |
| John Flick | ||||||||||||||
| Physician | $313,576 | $104,524 | $18,280 | $6,094 | $845 | $282 | $3,206 | $1,069 | $26,704 | $8,901 | $362,611 | $120,870 | $0 | $0 |
| Faisal Rashid | ||||||||||||||
| Physician | $343,273 | $228,849 | $0 | $0 | $6,084 | $4,056 | $2,466 | $1,644 | $27,251 | $18,167 | $379,074 | $252,716 | $0 | $0 |
| Shamlan Sheikh | ||||||||||||||
| Physician | $323,548 | $0 | $13,500 | $0 | $837 | $0 | $4,235 | $0 | $49,908 | $0 | $392,028 | $0 | $0 | $0 |
| Qing Luo | ||||||||||||||
| Physician | $302,517 | $0 | $27,500 | $0 | $551 | $0 | $3,891 | $0 | $20,599 | $0 | $355,058 | $0 | $0 | $0 |
| Hailemariam Wolde | ||||||||||||||
| Physician | $299,558 | $0 | $19,000 | $0 | $1,633 | $0 | $4,220 | $0 | $19,256 | $0 | $343,667 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 1a Tax indemnification and gross-up payments | The following individuals listed on Part VII, Section A received a tax indemnification/gross up payment in 2020. These payments were included in their taxable compensation. Faisal Rashid |
| 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: Jeremy Bradford $23,200 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 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 $54,000 Karen Rewerts $43,291 Faisal Rashid $5,086 Kerry Swanson $2,812 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | ENTITY MORE THAN 35% OWNED BY SAJJAN K NEMANI, MD, DIRECTOR | RelationshipDescriptionTxt |
| Transaction | $11,050 | TransactionAmt |
| Transaction | FEES FOR MEDICAL SERVICES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Good Samaritan Regional Health Center: SSM Health Good Samaritan Hospital - Mt. Vernon, operating in partnership with the Felician Sisters, is a 134-bed tertiary care hospital. Good Samaritan delivers hospital services in inpatient, ambulatory surgery, outpatient, and emergency room settings. Our services include the heart center, cancer care, orthopedic medicine, surgery, obstetrics, neurology, physical rehabilitation, sleep medicine, emergency care, women's health, and behavioral health. Good Samaritan Hospital is one of the few hospitals in the region to offer a full-service cardiology program, including interventional cardiology and open heart surgery. It has one of the largest heart programs in Southern Illinois and is the regional heart center for emergency departments in the area. The Breast Imaging Center at Good Samaritan Regional Health Center is accredited by the American College of Radiology as a Breast Imaging Center of Excellence, indicating top-tier safety, quality and efficiencies are provided at our Women's Imaging Center. In 2015, the hospital launched a new pediatric emergency and NICU telemedicine program in conjunction with the physicians at SSM Health Cardinal Glennon Children's Hospital. Good Samaritan Regional Health Center 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: The following are the types of programs and services that could be quantified as uncompensated care: Traditional Charity Care $ 2,154,766 Unpaid Cost of Medicaid Services $ 20,703,408 Unpaid Cost of Medicare Services $ 17,734,929 Unpaid Cost of Other Government Programs $ 1,345,862 Total Quantifiable Uncompensated Care $ 41,938,965 |
| Form 990, Part V, Line 1a | 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. GOOD SAMARITAN REGIONAL HEALTH CENTER, 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 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 MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | All other revenue - Total Revenue: 103902, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 103902; |
| Form 990, Part IX, Line 11g Other Fees | Medical and other professional fees - Total Expense: 23429111, Program Service Expense: 17104840, Management and General Expenses: 6272040, Fundraising Expenses: 52231; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in beneficial interest in foundation - 1201442; Transfers to affiliates - -438614; |
| Form 990, Part I Doing Business As | Good Samaritan Regional Health Center currently conducts business under the following registered names: 1) SSM Health Good Samaritan Hospital - Mt Vernon 2) Good Samaritan Hospitalist Providers 3) Good Samaritan Plaza Pharmacy 4) SSM Health Breast Care 5) SSM Health Child Care Center 6) Good Samaritan Child Development Center 7) SSM Health Cancer Care 8) SSM Health Pharmacy 9) SSM Health School of Medical Laboratory |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (50 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| St Mary's Hospital Centralia Illinois | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 370662580 | 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 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (16 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | UBI Code VUBICodeVAmt | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Good Samaritan Regional Health Center | Related | $606,639 | $2,691,601 | false | $0 | Yes (true) | 0.51 |
| Sleep & Neurology Center of Southern Illinois LLC | ||||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 208468195 | Diag. Services | IL | Good Samaritan Regional Health Center | Related | $120,706 | $362,977 | false | $0 | false | 0.501 |
| 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 | ||||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (19 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | NA | C Corporation | false | CJ | ||
| Physicians Services Corp of Southern Illinois Inc | |||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 364161526 | Health Care | IL | NA | C Corporation | false | 1.00 | |
| 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 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Mt Vernon Radiology Therapy Center LLC | ||
| S | $100,529 | Cash |
| Sleep & Neurology Center of Southern Illinois LLC | ||
| S | $85,312 | Cash |
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | ||
| A | $237,285 | Cash |
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | ||
| Q | $59,786,764 | Cash |
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | ||
| P | $14,205,229 | Cash |