2011-11-15T11:18:41-06:00 2010-12-31 DELOITTE TAX LLP 1111 BAGBY STREET SUITE 4500 HOUSTON TX 77002 990 2010-01-01 370662580 ST MARY'S HOSPITAL CENTRALIA ILLINOIS STMA 6184368000 477 N LINDBERGH BLVD ST LOUIS MO 63141 JUNE L PICKETT 6184368000 2011-11-15 1 NANCY Z EVETTS 7139822000 2010 2016-02-24 21:20:13Z WILLIAM THOMPSON 477 N LINDBERGH BLVD ST LOUIS MO 63141 105888529 0 0928 X WWW.SSMHC.CO X 1939 IL SEE SCHEDULE O 12 6 983 109 0 0 1277287 1288026 98934627 102425307 468322 621545 1434286 1357903 102114522 105692781 0 131139 0 0 46366859 48853846 0 0 0 48897234 48671268 95264093 97656253 6850429 8036528 66661243 71161935 65121741 65474674 1539502 5687261 X THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. 0 0 80867108 131139 102425307 SEE SCHEDULE O 80867108 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 983 1 0 0 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X KAY TINSLEY 6184366536 400 N PLEASANT AVENUE CENTRALIA IL 628013056 X VERLE BESANT 1.00 X 0 0 0 SR M RAMONA DOMBROWSKI CSSF 1.00 X 0 0 0 D BRUCE GEARY CPA CMA 1.00 X 0 0 0 PHILIP GUSTAFSON 1.00 X 0 534331 102866 SAJJAN K NEMANI MD 1.00 X 0 0 0 SR MARY JEAN RYAN FSM 1.00 X 0 0 0 JAMES SANGER 1.00 X 0 914911 40252 WILLIAM P THOMPSON 1.00 X X 0 1188452 605422 SR M CLARETTE STRYZEWSKI CSSF 1.00 X 0 0 0 JITENDRA K TRIVEDI MD 1.00 X 0 313199 144868 BRUCE MERRELL 40.00 X X 0 359239 132374 MIKE WARREN 1.00 X 0 363807 238908 BRUCE FLANIGAN 1.00 X 0 94602 14216 KRIS A ZIMMER 1.00 X 0 723982 180212 JUNE L PICKETT 1.00 X 0 220736 179387 CARISSA HIBBERT 20.00 X 48257 0 16464 KAY TINSLEY 20.00 X 191972 0 74072 VIRGINIA TELFORD 40.00 X 203958 0 13703 MARK CLARK 20.00 X 170723 0 54312 DELAND EVISCHI 20.00 X 168087 0 50882 JULIE LONG 20.00 X 0 157359 36320 MICHELLE DARNELL 20.00 X 0 160500 60449 THOMAS BLYTHE 20.00 X 0 162471 49844 GREG SIMS 5.00 X 0 176005 53932 JAMES RUETER 40.00 X 196297 0 47303 JEFFREY RAPP 20.00 X 128259 0 38405 PATRICIA NEUDECKER 40.00 X 127165 0 31014 RAJENDRA SHROFF 40.00 X 141215 0 26610 DENA FISCHER 40.00 X 121239 0 26882 1497172 5369594 2218697 18 0 1 0 MIDWEST EMERGENCY DEPT SRVCX 320 EAST HWY 50 OFALLON IL 622690000 ER PHYSICIANS 2918406 CENTRALIA ANESTHESIOLOGY 4227 LINCOLNSHIRE DRIVE MT VERNON IL 628640000 ANETHESIOLOGY SERVICES 1842431 MID AMERICA RADIOLOGY SC 152 LEMAY FERRY ROAD ST LOUIS MO 631660000 RADIOLOGY SERVICES 560472 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 PET SCANS 447768 ANSARI RADIATION ONCOLOGY 606 SABLE DRIVE CENTRALIA IL 62801 MD READING/INTERPRETATIONS 391111 19 56771 1226635 4620 1288026 PATIENT SERVICE REV 621110 102210287 102210287 ANESTHESIA SERVICES 621110 215020 215020 102425307 449785 449785 581492 196917 384575 384575 384575 170591 -1169 170591 1169 171760 171760 CAFETERIA 722210 391751 391751 PRINT SERVICES 561000 172643 172643 MEDICAL RECORDS 561000 85694 85694 323240 323240 973328 105692781 102425307 0 1979448 131139 131139 1640088 1640088 33830248 25965447 7864801 1843140 1413009 430131 9070858 6757520 2313338 2469512 1817407 652105 149941 149941 57943 57943 11855676 10206307 1649369 321463 321463 16294965 15889127 405838 4440396 4440396 2380489 2204653 175836 215162 134457 80705 74922 63522 11400 1113761 1113761 3167188 2889031 278157 638169 638169 BAD DEBT 5115411 5115411 0 MEDICAID PROVIDER TAX 2669260 2669260 0 MISCELLANEOUS EXPENSES 99189 13248 85941 LICENSES AND TAXES 77333 43413 33920 97656253 80867108 16789145 0 19103748 5207274 13416900 14998910 1493940 1700632 215754 446909 35121433 11208397 24650728 23913036 4094302 21651750 2312490 3685871 930934 66661243 71161935 6021449 5569584 14410253 12305202 38404000 38980000 6286039 8619888 65121741 65474674 X 1487469 5526952 52033 160309 1539502 5687261 66661243 71161935 X 8036528 -3888769 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3442 0 0 0 3442 0 1259000 1259000 20961585 4454955 16506630 11094259 6318756 4775503 1806589 434686 1371903 23913036 SSM CENTRAL INVESTMENT POOL 21639125 F BENEFICIAL INTEREST IN FOUNDATION 12625 F 21651750 THIRD PARTY PAYOR 2224957 DUE TO AFFILIATES 513490 DEFERRED COMPENSATION 121652 ASSET RETIREMENT OBLIGATION 947540 PENSION FUNDING LIABILITY 3594328 OTHER LONG TERM LIABILITIES 847400 CASH OVERDRAFT 370521 8619888 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS' FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH CARE (SSMHC). SSMHC 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 2010 OR 2009. 1 1 1 X 1 X 0.0 1 1 1 0 1 1 5636158 936055 4700103 0.05080 20718113 14340511 6377602 0.06890 26354271 15276566 11077705 0.11970 386889 461 386428 0.00420 121367 121367 0.00130 6559747 4121670 2438077 0.02630 110408 110408 0.00120 7178411 4122131 3056280 0.03300 33532682 19398697 14133985 0.15270 132 132 0.00000 26259 26259 0.00030 2193 46 2147 0.00000 28171 334 27837 0.00030 176775 176775 0.00190 233530 380 233150 0.00250 1 1556771 31799129 33475536 -1676407 X 1 0 1 1 ST MARY'S HOSPITAL

400 N PLEASANT AVENUE CENTRALIA IL 62801

X X X NA 1 3 CENTRALIA FAMILY HEALTH CENTER

1441 W BROADWAY CENTRALIA IL 62801

PRIMARY CARE CLINIC SALEM FAMILY HEALTH CENTER

1250 W WHITTAKER STREET SALEM IL 62881

PRIMARY CARE CLINIC CARLYLE FAMILY HEALTH CENTER

811 FAIRFAX ST CARLYLE IL 62231

PRIMARY CARE CLINIC PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5115411. ELIGIBILITY GUIDELINES FOR DISCOUNTED CARE SCHEDULE H, PART I, LINE 3B ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS USES FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS.THE APPLICABLE PERCENTAGE VARIES BASED ON HOW MUCH THE APPLICANT'S INCOME EXCEEDS FPG GUIDELINES. THE FOLLOWING SCHEDULE IS USED TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE:APPLICANT'S INCOME IS CHARITY CARE PERCENTAGELESS THAN OR EQUAL TO 2 TIMES FPG 100%MORE THAN 2 TIMES, LESS THAN 2.5 TIMES FPG 80%MORE THAN 2.5 TIMES, LESS THAN 3 TIMES FPG 60%MORE THAN 3 TIMES, LESS THAN 3.5 TIMES FPG 40%MORE THAN 3.5 TIMES, LESS THAN 4 TIMES FPG 20%4 OR MORE TIMES FPG 0% OTHER CRITERIA FOR FREE OR DISCOUNTED CARE SCHEDULE H, PART I, LINE 3C AN EXCEPTION TO THE SLIDING SCALE IS PROVIDED FOR A PATIENT'S BALANCE DUE IF THE AMOUNT IS TOO LARGE TO BE REASONABLY PAID THROUGH AN INSTALLMENT PLAN OVER FOUR YEARS GIVEN THE FAMILY INCOME AND EXPENSES. TO FURTHER STREAMLINE AND AUTOMATE THE FINANCIAL ASSISTANCE PROCESS, ST. MARY'S HOSPITAL BUSINESS OFFICE PERSONNEL WILL AUTOMATICALLY CONSIDER 100% OF THE PATIENT ACCOUNT AS CHARITY IF THE COMMERCIAL SOFTWARE SYSTEM (SEARCHAMERICA) INDICATES THAT THE PATIENT IS LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). THIS PROCESS IS CALLED "PRESUMPTIVE ELIGIBILITY". PREPARATION OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, QUESTION 6 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS PART OF THE INTEGRATED HEALTH SYSTEM KNOWN AS SSM HEALTH CARE. IN AN EFFORT TO STRENGTHEN ITS COMMUNITY BENEFIT PROGRAM, SSM HEALTH CARE PLANS FOR, MEASURES, AND COMMUNICATES IN AN ANNUAL REPORT CHARITY CARE PROVIDED TO PERSONS WHO ARE LOW INCOME, THE UNPAID COSTS OF PUBLIC PROGRAMS AND OTHER ACTIVITIES THAT RESPOND TO COMMUNITY NEED, IMPROVE COMMUNITY HEALTH, OR REACH OUT TO LOW INCOME AND VULNERABLE PERSONS. ST MARY'S HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT IS PROVIDED TO THE COMMUNITY AND CAN BE FOUND AT WWW.SMGSI.COM. SSM HEALTH CARE'S 2010 ANNUAL COMMUNITY BENEFIT REPORT FOR THE SYSTEM CAN BE FOUND AT WWW.SSMHC.COM. DESCRIPTION OF COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7 CHARITY CARE COSTING METHODOLOGY: THE COST OF CHARITY CARE IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES. A COST TO CHARGE RATIO CALCULATED USING THE IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGE, WAS USED TO COMPUTE CHARITY CARE AT COST. THIS IS THE RATIO OF TOTAL ADJUSTED OPERATING EXPENSE TO TOTAL GROSS PATIENT REVENUE. THE GROSS REVENUE AMOUNT IS A GROSS AMOUNT PRIOR TO CONTRACTUAL ADJUSTMENTS AND BAD DEBTS. BOTH GROSS REVENUE AND COST ARE BASED ON CHARGES AT DATE/TIME OF SERVICE.UNREIMBURSED MEDICAID COSTING METHODOLOGY: THE COST OF UNREIMBURSED MEDICAID IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES. A COST TO CHARGE RATIO CALCULATED UTILIZING IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGE, WAS USED TO COMPUTE UNREIMBURSED MEDICAID COSTS. THIS IS THE RATIO OF TOTAL ADJUSTED OPERATING EXPENSE TO TOTAL GROSS PATIENT REVENUE. THE GROSS REVENUE AMOUNT IS A GROSS AMOUNT PRIOR TO CONTRACTUAL ADJUSTMENTS AND BAD DEBTS. BOTH GROSS REVENUE AND COST ARE BASED ON CHARGES AT DATE/TIME OF SERVICE. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS COSTING METHODOLOGY: THE COSTS FOR THESE PROGRAMS WERE DERIVED FROM THE ACTUAL COSTS INCURRED IN THESE AREAS. THE EXPENDITURES ARE DETERMINED BASED ON ACTUAL INVOICES OR DOLLAR AMOUNTS SPENT AND CHARGED TO THESE DEPARTMENTS.HEALTH PROFESSIONAL EDUCATION COSTING METHODOLOGY: THE EXPENSES FOR HEALTH PROFESSION EDUCATION WERE TAKEN FROM THE DEPARTMENT'S INCOME AND EXPENSE STATEMENT, DERIVED FROM THE ACCOUNTING SYSTEM. AMOUNTS PAID FROM RESIDENT DEPARTMENTS WERE ALSO INCLUDED.RESEARCH COSTING METHODOLOGY: RESEARCH EXPENSES WERE TAKEN FROM THE INCOME AND EXPENSE STATEMENT FOR THE RESEARCH DEPARTMENTS, DERIVED FROM THE ACCOUNTING SYSTEM.CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS COSTING METHODOLOGY: CONTRIBUTION EXPENDITURES ARE BASED ON ACTUAL INVOICES THAT WERE CAPTURED AND REPORTED FOR THIS PROGRAM. DESCRIPTION OF COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: COMMUNITY BUILDING & COMMUNITY SUPPORT: CONDUCTED MENTAL HEALTH SEMINARS FOR POSTAL WORKERS; DONATED COMPUTERS TO THE AFTER SCHOOL PROGRAM AND CONDUCTED EMERGENCY PREPAREDNESS TRAINING FOR THE HOSPITAL AND COMMUNITY BEYOND WHAT IS CONSIDERED NORMAL OPERATING PROCEDURE. SEVERAL HOSPITAL EMPLOYEES SERVE ON LOCAL EMS BOARDS. COMMUNITY BUILDING & WORKFORCE DEVELOPMENT: CONDUCTED RECRUITMENT ACTIVITIES TO DRAW PHYSICIANS TO PROVIDE SERVICES FOR MEDICALLY UNDERSERVED AREA. THE HOSPITAL ALSO PARTNERED WITH LOCAL COLLEGES, UNIVERSITIES AND COMMUNITY WORKFORCE DEVELOPMENT AGENCIES TO RECRUIT EMPLOYEES AND INCREASE HEALTHCARE WORKER TRAININGS TO RELIEVE SHORTAGE AREAS. COMMUNITY BUILDING & COMMUNITY HEALTH IMPROVEMENT ADVOCACY: PARTICIPATE IN NUMEROUS AREA EVENTS TO PROMOTE COMMUNITY HEALTH INCLUDING THE FOLLOWING: WORKING CLOSELY WITH ILLINOIS DEPARTMENT OF PUBLIC HEALTH AT THE LOCAL AND STATE LEVEL TO ADVOCATE FOR WOMEN'S HEALTH, AGING PROGRAMS, IMMUNIZATION PROGRAMS AND OUTREACH TO THE POOR AND VULNERABLE. EMPLOYEES ARE MEMBERS OF REGIONAL AND LOCAL ADVOCACY GROUPS, COMMUNITY AWARENESS GROUPS, AND COALITIONS THAT WORK ON REGIONAL AND LOCAL PUBLIC AND COMMUNITY HEALTH ISSUES. HOSPITAL EMPLOYEES WERE PART OF THE IPLAN (ILLINOIS PUBLIC HEALTH LOCAL ASSESSMENT OF NEEDS) PROCESS WHICH IS COMPLETED EVERY FIVE YEARS. IN ADDITION TO THESE, ST. MARY'S HOSPITAL ALSO SERVES AS THE LEAD AGENCY FOR 21 COUNTIES FOR THE ILLINOIS BREAST & CERVICAL CANCER PROGRAM WHICH IS PART OF THE FEDERAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM RUN BY CDC OFFICE OF WOMEN'S HEALTH. BAD DEBT EXPENSE & COSTING METHODOLOGY SCHEDULE H, PART III, SECTION A, LINE 4 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS PART OF THE SSM HEALTH CARE CONSOLIDATED AUDIT. THE FOOTNOTE THAT REFERENCES BAD DEBT EXPENSE IN THE DECEMBER 31, 2010 CONSOLIDATED AUDIT IS AS FOLLOW:"IN LINE WITH ITS MISSION, SSMHC PROVIDES SERVICES TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY FOR THOSE SERVICES. FOR SOME OF ITS PATIENT SERVICES, SSMHC RECEIVES NO PAYMENT OR PAYMENT THAT IS LESS THAN THE FULL COST OF PROVIDING THE SERVICES.SSMHC VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR ALL OR PART OF THEIR HEALTH CARE EXPENSES AS DETERMINED BY SSMHC'S CRITERIA FOR FINANCIAL ASSISTANCE. BECAUSE SSMHC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUES.IN SOME CASES, SSMHC DOES NOT RECEIVE THE AMOUNT BILLED FOR PATIENT SERVICES EVEN THOUGH IT DID NOT RECEIVE INFORMATION NECESSARY TO DETERMINE IF THE PATIENTS MET THE CRITERIA FOR FINANCIAL ASSISTANCE. BAD DEBTS EXPENSE IS THE ESTIMATED AMOUNT OF PATIENT SERVICE REVENUES THAT SSMHC WILL NOT COLLECT."BAD DEBT COSTING METHODOLOGY: BAD DEBT EXPENSE REPORTED IN THE 2010 ANNUAL LICENSING SURVEY OF MISSOURI HOSPITALS WAS USED, MULTIPLIED BY THE COST TO CHARGE RATIO USING IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES.BAD DEBT EXPENSE REPORTED ON LINE 2 FOR THE YEAR ENDED DECEMBER 31, 2010 WAS $4,401,953 AT CHARGES AND $1,556,771 AT COST.ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS DID NOT MAKE AN ESTIMATE OF THE ORGANIZATION'S BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. DESCRIPTION OF MEDICARE COSTS INCLUDED IN COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B, LINE 8 THE COST OF PROVIDING CARE TO MEDICARE ELIGIBLE PATIENTS IS GREATER THAN THE REIMBURSEMENT THAT MEDICARE ALLOWS ON THE MEDICARE COST REPORT. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS CONSIDERS THIS SHORTFALL AS A COMPONENT OF COMMUNITY BENEFIT BECAUSE THE REIMBURSEMENT IS NOT NEGOTIATED AND SERVICES ARE PROVIDED REGARDLESS OF THE PATIENTS' ABILITY TO PAY. THE MEDICARE COSTS REPORTED ON LINE 6 WERE OBTAINED FROM THE 2010 MEDICARE COST REPORT. COLLECTION PRACTICES SCHEDULE H, PART III, SECTION C, LINE 9B ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS HAS ESTABLISHED WRITTEN CREDIT AND COLLECTION POLICY AND PROCEDURES. THE BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES OF SSM HEALTH CARE, 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 FAIR 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 CHARITY CARE AND FINANCIAL ASSISTANCE. ONCE THE PATIENT'S RESPONSIBILITY PORTION IS DETERMINED WE SEND THE PATIENT A MINIMUM OF THREE STATEMENTS AND MAKE AT LEAST 1 PHONE CALL OVER A 90 DAY PERIOD THEN, IF NO PAYMENT IS RECEIVED, THE ACCOUNT IS SENT TO A COLLECTION AGENCY. 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 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS' COLLECTION AND CHARITY POLICIES. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS DEFINES ITS PRIMARY SERVICE AREA AS A NINE COUNTY REGION INCLUDING THE ILLINOIS COUNTIES OF CLAY, CLINTON, FAYETTE, FRANKLIN, HAMILTON, JEFFERSON, MARION, WASHINGTON, AND WAYNE WITH AN APPROXIMATE POPULATION OF 231,475 IN 2010. OF THIS POPULATION 16.1% ARE BELOW THE FEDERAL POVERTY GUIDELINES.ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS DELIVERS HOSPITAL SERVICES IN INPATIENT, AMBULATORY SURGERY, OUTPATIENT, AND EMERGENCY ROOM SETTINGS. KEY SERVICE LINES INCLUDE CARDIOLOGY, ONCOLOGY, BEHAVIORAL HEALTH, PSYCHIATRICS, PHYSICAL THERAPY, OBSTETRICS, HYPERBARIC OXYGEN CHAMBER, WOUND CARE, ORTHOPEDICS, AND GENERAL SURGERY. ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS' SURGERY CENTERS ARE EQUIPPED WITH THE LATEST INNOVATIONS IN TECHNOLOGY ENSURING OUR PATIENTS HAVE ACCESS TO THE MOST ADVANCED TREATMENT WHILE STAYING CLOSE TO HOME. TO PROVIDE COMPLETE NEUROLOGICAL CARE, OUR SPECIALISTS ARE SUPPORTED BY BOARD CERTIFIED NEURORADIOLOGISTS, A FULL SERVICE REHABILITATION UNIT, A HOME HEALTH DEPARTMENT, 24-HOUR MRI SERVICE, NEURODIAGNOSTIC EQUIPMENT, AND CARDIAC CATHETERIZATION LABORATORIES NEEDS ASSESSMENT PROCESS SCHEDULE H, PART VI, LINE 2 THE ANNUAL STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLANNING PROCESS HAS INCLUDED AN ASSESSMENT OF THE COMMUNITY'S NEEDS TO INCLUDE THE IDENTIFICATION OF SPECIFIC AND MEASUREABLE HEALTHY COMMUNITIES' INITIATIVES. HEALTHY COMMUNITIES' INITIATIVES DEMONSTRATE THE LEADERSHIP ROLE THAT ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS TAKING IN IDENTIFYING, COMMUNICATING AND DEVELOPING RESPONSES TO HEALTH RELATED NEEDS IN THE COMMUNITY. AS OF JANUARY 2010, THE PRIMARY FOCUS OF SSM HEALTH CARE'S HEALTHY COMMUNITIES (HCIS) HAS BEEN ON ONE OF THE TOP-THREE CHRONIC DISEASES IN EACH ENTITY'S/NETWORK'S RESPECTIVE MARKET (E.G., CHF, DIABETES, ASTHMA) AS IDENTIFIED THROUGH, AMONG OTHER DATA SOURCES, COMMUNITY NEEDS ASSESSMENTS, CONSUMER/PUBLIC HEALTH STUDIES AND STATE/LOCAL HEALTH DEPARTMENT INFORMATION.COMMUNITY HEALTH IMPROVEMENT, WHICH WE PURSUE AS A SYSTEM PRIMARILY THROUGH HCIS UNDERTAKEN AT THE ENTITY LEVEL, IS FUNDAMENTAL TO OUR MISSION, VALUES, AND VISION. OVER THE YEARS MANY PEOPLE HAVE BENEFITED FROM OUR HCIS AND MUCH GOOD HAS COME FROM THEM. IN AN EFFORT TO BEST RESPOND TO COMMUNITY NEEDS, HCIS WILL REFOCUS ITS EFFORTS TOWARD A NEW APPROACH TO COMMUNITY HEALTH, AS OUTLINED HERE.CHRONIC DISEASE IS RAMPANT THROUGHOUT THE U.S. WHERE ROUGHLY HALF OF ALL ADULTS AND 10% OF CHILDREN/ADOLESCENTS LIVE WITH AT LEAST ONE CHRONIC DISEASE. OF THESE AN ESTIMATED 13 MILLION LACK HEALTH INSURANCE AND THEREBY HAVE POORER ACCESS TO PREVENTIVE AND PRIMARY CARE SERVICES THAN THEIR INSURED COUNTERPARTS AND EXPERIENCE WORSE HEALTH-RELATED OUTCOMES, INCLUDING PREMATURE DEATH.IN RESPONSE TO THIS GROWING NATIONAL HEALTH CRISIS, SYSTEM MANAGEMENT HAS SET THE EXPECTATION THAT ALL SSM OPERATING ENTITIES, WORKING INDIVIDUALLY OR COLLECTIVELY AS NETWORKS, IN COLLABORATION WITH COMMUNITY PARTNERS, WILL DEVELOP HCIS FOCUSED ON THE CHRONIC DISEASE SELECTED THAT ADDRESSES THREE PILLARS THAT STRETCH ACROSS THE CARE CONTINUUM: - PREVENTION THROUGH COMMUNITY EDUCATION IN PARTNERSHIP WITH COMMUNITY HEALTH ORGANIZATIONS, LOCAL HEALTH AGENCIES, CHURCHES, CIVIC CENTERS, SCHOOLS, INSURANCE COMPANIES AND OTHER COMMUNITY PARTNERS. - ACCESS TO PRIMARY CARE SERVICES AND NECESSARY MEDICATIONS IN CONJUNCTION WITH COMMUNITY HEALTH ORGANIZATIONS, LOCAL HEALTH AGENCIES AND CLINICS, EMPLOYED COMMUNITY PHYSICIANS AND PHARMACEUTICAL COMPANIES. - INPATIENT CARE INCLUDING PATIENT EDUCATION, COMPREHENSIVE DISCHARGE PLANNING, MEDICATION RECONCILIATION, COORDINATION OF CARE ACROSS SETTINGS AND POST-DISCHARGE FOLLOW-UP.INITIALLY, THE STRATEGIC GOAL WILL BE TO REDUCE THE 30-DAY HOSPITAL READMISSION RATE FOR THE CHRONIC DISEASE SELECTED. ST MARY'S HOSPITAL HAS TAKEN A COMPREHENSIVE APPROACH BY WORKING ON THE TOP FOUR CHRONIC DISEASES AT THE SAME TIME: HEART FAILURE, COPD, ACUTE MI AND PNEUMONIA. AS WE DEVELOP OUR COMMUNITY PARTNERSHIPS AND BEGIN TO IMPACT THE WHOLE CARE CONTINUUM, ADDITIONAL GOALS CAN BE ADDED THAT ADDRESS KEY INDICATORS OF COMMUNITY/POPULATION HEALTH (E.G., PREVALENCE AND INCIDENCE RATES, SCREENING RATES, HOSPITAL ADMISSION RATES, BEHAVIORAL AND LIFESTYLE FACTORS, HEALTHY PEOPLE 2020 GOALS). ST. MARY'S HOSPITAL HAS ESTABLISHED SPECIFIC STRATEGIES, INDICATORS ACTION PLANS AND MEASURES OF SUCCESS TO TRACK PROGRESS. THESE ARE ALL REPORTED THROUGH THE ANNUAL STRATEGIC AND OPERATIONAL PLANS AS WELL AS AT THE DEPARTMENTAL LEVEL. IN ADDITION TO THE HEALTHY COMMUNITIES INITIATIVES, EACH SSM HEALTH CARE HOSPITAL WILL CONDUCT A SEPARATE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ONCE EVERY THREE YEARS. TO SUPPORT THE COMPLETION OF A CHNA IN ACCORDANCE WITH ESTABLISHED GUIDELINES, A SIX-STEP PROCESS WAS DEVELOPED. THE PROCESS DEFINES AN APPROACH THAT CAN BE USED TO ASSESS THE HEALTH NEEDS OF THE COMMUNITIES SERVED BY SSM HEALTH CARE AND DEVELOP STRATEGIES FOR MEETING THOSE NEEDS. THE PROCESS INCLUDES: - DEVELOP A PLAN TO ADDRESS HEALTH REFORM MANDATES TO INCLUDE DEFINING HOW THE ASSESSMENT AND BY WHOM THE ASSESSMENT WILL BE COMPLETED; IDENTIFYING THE STAKEHOLDERS INVOLVED; AND THE TIME FRAME FOR COMPLETION - PERFORM DATA COLLECTION INCLUDING IDENTIFYING THE GEOGRAPHIC AREA SERVED, ACCESSING SECONDARY DATA SOURCES AND COORDINATING INTERVIEWS, SURVEY AND/OR FOCUS GROUPS FOR PRIMARY DATA COLLECTION - PERFORM DATA ANALYSIS BY EVALUATING QUANTITATIVE AND QUALITATIVE DATE TO IDENTIFY AND PRIORITIZE HEALTH NEEDS AND OPPORTUNITIES - CREATE A PLAN WITH GOALS, STRATEGIES, ACTIONS, DUE DATES, AND RESOURCE REQUIREMENTS WHICH INCLUDES INPUT FROM CONSTITUENTS - OBTAIN APPROVAL FROM SYSTEM MANAGEMENT TO BE ADOPTED IN 2012 AND INCORPORATE THE CHNA INITIATIVES INTO THE STRATEGIC PLAN TO INCLUDE APPOINTING RESPONSIBILITY FOR IMPLEMENTING THE PLAN AND ASSIGNING A STEERING COMMITTEE TO MONITOR PROGRESS AS APPROPRIATE - COORDINATE COMMUNICATION TO THE PUBLIC, BOARDS, STAFF AND OTHER STAKEHOLDERS PROGRESS IN ADDRESSING TOP PRIORITIES IMPACTING COMMUNITY HEALTHUTILIZING THIS PLAN, ST. MARY'S HOSPITAL HAS BEGUN THE FIRST TWO STEPS AND ANTICIPATES HAVING THE CHNA COMPLETED IN THE SECOND QUARTER OF 2012. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 ALL SSMHC FACILITIES WILL STRIVE TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES TO ALL PERSONS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. ALL BILLING AND COLLECTION POLICIES REFLECT THE MISSION AND VALUES OF SSMHC, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. SSMHC FACILITIES OFFER DISCOUNTS FOR HOSPITAL SERVICES TO ALL UNINSURED PERSONS. SELF-PAY DISCOUNTS APPLY TO EVERYONE WHO DOES NOT HAVE HEALTH INSURANCE, NO MATTER THEIR ABILITY TO PAY.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 FLYERS 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. PROMOTION OF COMMUNITY HEALTH/FURTHERANCE OF EXEMPT PURPOSE SCHEDULE H, PART VI, LINE 5 SSM HEALTH CARE'S MISSION STATEMENT IS "THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD."ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS PARTICIPATES IN A WIDE ARRAY OF COMMUNITY PROGRAMS THROUGHOUT THE AREA TO FURTHER ITS EXEMPT PURPOSE OF PROMOTING THE HEALTH OF THE COMMUNITY. THE THREE STRATEGIC PRIORITIES OF THE ST MARY'S HOSPITAL COMMUNITY BENEFITS PLAN ARE: BUILDING LOCAL CAPACITY, IMPROVING HEALTH OUTCOMES, AND REDUCING SOCIAL ISOLATION. GOALS AND OBJECTIVES ARE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. HEALTHY COMMUNITIES INITIATIVES CREATE OPPORTUNITIES FOR EACH RESIDENT TO MEET HIS/HER POTENTIAL PHYSICALLY, MENTALLY, SOCIALLY, EMOTIONALLY, AND SPIRITUALLY. THE INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. ST. MARY'S HOSPITAL'S HEALTHY COMMUNITIES INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS' 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. FOCUSING ON A BROAD DEFINITION OF HEALTH, ST MARY'S HOSPITAL CLINICS AND PROGRAMS PROVIDE MEDICAL AND MENTAL HEALTH SERVICES, HEALTH EDUCATION, HEALTH MANAGEMENT, PREVENTION, REFERRALS, INSURANCE ENROLLMENT AND IN-HOME PRIMARY CARE SERVICES AND SUPPORT, WHILE FOSTERING COLLABORATION AND INCORPORATING HEALTHY COMMUNITIES STRATEGIES. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE BOTH COMMUNITY HEALTH AND HEALTHY COMMUNITIES. ST MARY'S HOSPITAL AND SSM HEALTH CARE ADVOCATE FOR VULNERABLE POPULATIONS BY DEVELOPING RELATIONSHIPS WITH POLICY MAKERS AND THROUGH TARGETED EDUCATION EFFORTS. ALL PROJECTS INCLUDE MEASURABLE OBJECTIVES WITH A SPECIFIC TIME FRAME AND HAVE ACTIVITIES THAT WILL FAVORABLY AFFECT HEALTH STATUS INDICATORS. PROJECTS TO ACCOMPLISH HEALTH STATUS OBJECTIVES MAY INCLUDE: DISEASE PREVENTION PROGRAMS; HEALTH EDUCATION PROGRAMS; HEALTH CARE PROGRAMS FOR INDIVIDUALS WITH SPECIAL HEALTH CONCERNS; AND OTHER PROJECTS THAT IMPROVE COMMUNITY HEALTH STATUS. PROJECTS TO ADDRESS THE HEALTH PROBLEMS OF MINORITIES, THE POOR, AND OTHER MEDICALLY UNDERSERVED POPULATIONS MAY INCLUDE: IMPROVING ACCESSIBILITY AND CONTINUITY OF CARE; WORKING TO REDUCE DISPARITIES IN HEALTH STATUS; AND SPONSORING EFFORTS TO INCREASE THE NUMBER OF MINORITIES, THE POOR, AND UNDERSERVED WHO ENTER HEALTH PROFESSIONS AND WORK IN MEDICALLY UNDERSERVED COMMUNITIES. PROJECTS DESIGNED TO CONTAIN THE GROWTH OF COMMUNITY HEALTH CARE COSTS MAY INCLUDE: IMPROVING EFFICIENCY OF SERVICES; IMPROVING CASE MANAGEMENT AND CONTINUITY OF CARE; SPONSORING HEALTH PROMOTION, DISEASE PREVENTION, AND SELF CARE ACTIVITIES; CONTAINING HEALTH CARE COSTS; AND REDUCING REDUNDANCIES. THROUGH OUR COMMUNITY HEALTH NEEDS ASSESSMENT WE IDENTIFY VARIOUS UNMET COMMUNITY HEALTH NEEDS. OUR PRIMARY RESPONSIBILITY IS TO ADDRESS THOSE THAT WE CAN IMPACT THE MOST, THAT IS, THOSE ALIGNED WITH OUR CORE COMPETENCIES. WE COMMUNICATE THE NEEDS IDENTIFIED IN THE ASSESSMENT TO THE COMMUNITY THROUGH A VARIETY OF MEDIA, DEVELOP A PLAN FOR HOW TO ADDRESS THOSE NEEDS THAT WE CAN IMPACT, AND IMPLEMENT STRATEGIES TO ADDRESS THESE NEEDS. ONE OF THE CLEAREST EXAMPLES OF HOW ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS MEETS COMMUNITY NEED IS THROUGH OUR LITTLE EGYPT BREAST AND CERVICAL CANCER PROGRAM. OUR HOSPITAL HAS BEEN A LEAD AGENCY FOR THIS ILLINOIS PUBLIC HEALTH PROGRAM SINCE 1998 AND SERVES AS PAYER OF LAST RESORT FOR BREAST AND CERVICAL CANCER SCREENINGS FOR WOMEN WHO ARE UNINSURED. PARTNERING WITH SEVERAL SUSAN G. KOMEN RACE FOR THE CURE AFFILIATE AGENCIES ALSO ALLOWS OUR HOSPITAL TO PROVIDE ADDITIONAL EDUCATION AND SCREENINGS TO WOMEN WHO ARE UNDERINSURED OR COULD NOT OTHERWISE AFFORD THESE SCREENINGS. IN ADDITION TO THESE BREAST AND CERVICAL CANCER SCREENINGS, WE ALSO PROVIDES FREE SCREENINGS FOR PROSTATE CANCER, SKIN CANCER AND COLORECTAL CANCER AT VARIOUS LOCATIONS AND TIMES EACH YEAR. AMERICAN CANCER SOCIETY'S LOOK GOOD/FEEL BETTER PROGRAMS ARE OFFERED QUARTERLY AND CANCER SUPPORT GROUPS ARE OFFERED AT SEVERAL LOCATIONS EACH MONTH. THE FELICIAN WELLNESS CENTER (FWC) IS THE OUTCOME OF COLLABORATION BETWEEN THE CENTRALIA RECREATION COMPLEX, ST. MARY'S HOSPITAL AND THE FELICIAN SERVICES, INC. WORKING TOGETHER SINCE SEPTEMBER 2009, THE THREE AGENCIES ACHIEVE THEIR COMMON GOALS THROUGH RESPONSIBLE LEADERSHIP AND A SHARED VISION OF IMPROVING THE MIND, BODY, SPIRIT AND ENVIRONMENT OF THE COMMUNITIES IN THEIR COMBINED SERVICE REGION. THE FELICIAN WELLNESS CENTER DEVELOPS PROGRAMS AND SERVICES THAT CREATE OPPORTUNITIES FOR EACH RESIDENT TO MEET HIS/HER POTENTIAL PHYSICALLY, MENTALLY, SOCIALLY, EMOTIONALLY, AND SPIRITUALLY. THE INITIATIVES BUILD ON THE STRENGTHS OF ITS PEOPLE AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. HEALTHY COMMUNITIES INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING.THE HEALTHY COMMUNITIES CHRONIC DISEASE INITIATIVE IS ONE COMPONENT THAT FOCUSES ON AN IMPORTANT COMMUNITY HEALTH NEED, CHRONIC DISEASE, AND IS DIRECTED TO IMPROVE INPATIENT CARE, ACCESS TO CARE, AND PREVENTION/SCREENING FOR SELECT CHRONIC DISEASES THAT SIGNIFICANTLY IMPACT OUR COMMUNITIES. IN 2010, SSM REALIGNED THEIR HEALTHY COMMUNITIES INITIATIVES TO BETTER FIT IN WITH THE SSM STRATEGIC, FINANCIAL AND HUMAN RESOURCE PLAN. GUIDANCE WAS GIVEN FOR HEALTHY COMMUNITIES CHAMPIONS TO DEVELOP CHRONIC DISEASE MANAGEMENT PROGRAMS SPECIFIC TO EACH ENTITY'S COMMUNITY NEEDS ASSESSMENT. ST. MARY'S HOSPITAL QUICKLY DISCOVERED THAT CHF WAS OUR MAIN DISEASE THAT CAUSED READMISSIONS. IN ORDER TO REDUCE CHF READMISSIONS AND DELIVER OUTSTANDING PATIENT CARE WE HAVE RN HEALTH COACHES WHO FOLLOW PATIENTS ADMITTED WITH CHF, AMI, COPD AND PNEUMONIA DURING THE ADMISSION, AND FOR THE 30 DAY PERIOD FOLLOWING DISCHARGE. THE RN HEALTH COACHES HAVE EXPERIENCE IN TEACHING AND HANDLING THE MYRIAD ISSUES ASSOCIATED WITH CHRONIC DISEASE PATIENTS. 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. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: - OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, - HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, - HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY - ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, - PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS A 501(C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE. ALONG WITH GOOD SAMARITAN REGIONAL HEALTH CENTER IN MOUNT VERNON, ILLINOIS, IT IS PART OF A JOINT OPERATING AGREEMENT BETWEEN SSM HEALTH CARE 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. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART IV, LINE 7 THE SSM HEALTH CARE ANNUAL CONSOLIDATED COMMUNITY BENEFIT REPORT IS FILED IN ILLINOIS, MISSOURI, OKLAHOMA, AND WISCONSIN. 1 ILINOIS HOSPITAL RESEARCH AND EDUCATIONAL FOUNDATION 1151 EAST WARRENVILLE RD NAPERVILLE IL 60566 237421930 501(C)(3) 80622 TO ASSIST ILLINOIS HOSPITALS IN PROVIDING HEALTH CARE SERVICES LINCOLN FOUNDATION FOR BUSINESS EXCELLENCE 1415 W DIEHL ROAD NAPERVILLE IL 60563 363952696 501(C)(3) 10375 TO SUPPORT CONTINUOUS QUALITY IMPROVEMENT INITIATIVES AMERICAN HEART ASSOCIATION 2850 DAIRY DRIVE SUITE 300 MADISON WI 53718 135613797 501(C)(3) 7500 GENERAL PROGRAM SUPPORT JOHN & ELEANOR MITCHELL FOUNDATION PO BOX 923 MT VERNON IL 62864 376053100 501(C)(3) 7562 TO SUPPORT THE OPERATIONS OF THE FOUNDATION 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: COMPLETED GRANT/CONTRIBUTION REQUESTS ARE FORWARDED TO THE MARKETING DEPARTMENT FOR INITIAL APPROVAL. THE MARKETING DEPARTMENT MAINTAINS A LOG OF ALL CONTRIBUTION REQUESTS. THE DEPARTMENT EVALUATES THE REQUEST AND FORWARDS REQUESTS RECOMMENDED FOR APPROVAL TO THE HOSPITAL PRESIDENT AND/OR THE ADMINISTRATIVE COUNCIL FOR FINAL APPROVAL. MOST GRANTS/CONTRIBUTIONS ARE MADE TO 501(C)(3) ORGANIZATIONS OR LOCAL CIVIC AND EDUCATIONAL ORGANIZATIONS. 0 1 0 0 0 0 0 0 0 PHILIP GUSTAFSON 0 505622 0 0 0 28709 0 75722 0 27144 0 637197 0 0 JAMES SANGER 0 681794 0 0 0 233117 0 22569 0 17683 0 955163 0 0 WILLIAM P THOMPSON 0 830800 0 0 0 357652 0 585557 0 19865 0 1793874 0 0 JITENDRA K TRIVEDI MD 0 308803 0 0 0 4396 0 115217 0 29651 0 458067 0 0 BRUCE MERRELL 0 301044 0 0 0 58195 0 107696 0 24678 0 491613 0 0 MIKE WARREN 0 303837 0 0 0 59970 0 211678 0 27230 0 602715 0 0 KRIS A ZIMMER 0 638080 0 0 0 85902 0 154088 0 26124 0 904194 0 0 JUNE L PICKETT 0 207597 0 0 0 13139 0 163178 0 16209 0 400123 0 0 KAY TINSLEY 182000 0 0 0 9972 0 52389 0 21683 0 266044 0 0 0 VIRGINIA TELFORD 150276 0 0 0 53682 0 2528 0 11175 0 217661 0 0 0 MARK CLARK 162372 0 0 0 8351 0 27756 0 26556 0 225035 0 0 0 DELAND EVISCHI 150335 0 0 0 17752 0 24963 0 25919 0 218969 0 0 0 JULIE LONG 0 150122 0 0 0 7237 0 33630 0 2690 0 193679 0 0 MICHELLE DARNELL 0 152285 0 0 0 8215 0 34895 0 25554 0 220949 0 0 THOMAS BLYTHE 0 154799 0 0 0 7672 0 23776 0 26068 0 212315 0 0 GREG SIMS 0 164285 0 0 0 11720 0 33421 0 20511 0 229937 0 0 JAMES RUETER 173622 0 0 0 22675 0 41516 0 5787 0 243600 0 0 0 JEFFREY RAPP 127343 0 0 0 916 0 11840 0 26565 0 166664 0 0 0 PATRICIA NEUDECKER 126117 0 0 0 1048 0 6480 0 24534 0 158179 0 0 0 RAJENDRA SHROFF 140565 0 0 0 650 0 11385 0 15225 0 167825 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION TO CEO/EXECUTIVE DIRECTOR THE ORGANIZATION'S CEO IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) WRITTEN EMPLOYMENT CONTRACT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A: SEVERANCE PLAN: SSMHC 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 SSMHC. PART I, LINE 4B: SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS PENSION RESTORATION PLAN: SSM HEALTH CARE (SSMHC) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMHC 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 SSMHC'S 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 SSMHC OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMHC. NO REPORTABLE INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN DURING 2010. CAPITAL ACCUMULATION PLAN: SSMHC 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 SSMHC 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 2008 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF TWO 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 DISTRIBUTIONS FROM THIS PLAN IN 2010. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUALS' TAXABLE COMPENSATION. JAMES M SANGER $ 116,523 KRIS A ZIMMER $ 42,738 WILLIAM P THOMPSON $ 37,749 VIRGINIA TELFORD $ 24,638 BRUCE MERRELL $ 21,440 WAYNE GROTE $ 8,978 JUNE PICKETT $ 7,123 MICHAEL WARREN $ 7,357 MICHELLE DARNELL $ 6,522 GREG SIMS $ 6,410 MARK CLARK $ 6,325 THOMAS BLYTHE $ 6,211 KAY TINSLEY $ 6,085 JULIE LONG $ 5,556 ORGANIZATION MISSION STATEMENT FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION 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. PROGRAM SERVICE STATEMENT FORM 990, PART III, LINE 4A, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION: SINCE IT WAS FOUNDED IN 1872 BY FIVE CATHOLIC SISTERS, SSM HEALTH CARE (SSMHC) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. SPONSORED BY THE FRANCISCAN SISTERS OF MARY AND HEADQUARTERED IN ST LOUIS, SSMHC OPERATES 16 HOSPITAL LOCATIONS, TWO SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES IN FOUR STATES (WISCONSIN, OKLAHOMA, ILLINOIS AND MISSOURI). THE HEALTH SYSTEM EMPLOYS APPROXIMATELY 22,000 PEOPLE AND IS AFFILIATED WITH MORE THAN 5,000 PHYSICIANS. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMHC STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTH CARE TO PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. DESCRIBE THE ORGANIZATION'S APPROACH TO PROVIDING COMMUNITY BENEFIT: THE BOARD OF ST. MARY'S HOSPITAL, ADMINISTRATIVE COUNCIL, PHYSICIANS, EMPLOYEES, AND COMMUNITY ARE ALL INVOLVED IN PROVIDING ON-GOING FEEDBACK, MONITORING AND INFORMING THE DIRECTION OF POLICIES AND CONTENT OF COMMUNITY BENEFIT ACTIVITIES. THE THREE STRATEGIC PRIORITIES OF THE ST MARY'S HOSPITAL COMMUNITY BENEFITS PLAN ARE: BUILDING LOCAL CAPACITY, IMPROVING HEALTH OUTCOMES, AND REDUCING SOCIAL ISOLATION. GOALS AND OBJECTIVES ARE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. IN AN EFFORT TO STRENGTHEN ITS COMMUNITY BENEFIT PROGRAM, ST. MARY'S HOSPITAL HAS A COMMUNITY BENEFIT PLAN WHICH DETAILS THE PLANNING, MEASUREMENT AND COMMUNICATION OF THEIR COMMUNITY BENEFITS. COMMUNITY BENEFIT IS DEFINED AS SEEKING OUT AND SERVING THOSE WHO NEED HELP CONSISTENT WITH THE MISSION OF ST MARY'S HOSPITAL AS WELL AS THE BROADER COMMUNITY TO ENSURE OPTIMAL HEALTH STATUS IN OUR SERVICE REGION. THESE WIDE ARRAYS OF SERVICES INCLUDE, BUT ARE NOT LIMITED TO, LEADERSHIP AND COLLABORATIVE ACTIVITIES IN EDUCATION, ADVOCACY AND HEALTH PROMOTION. DESCRIBE THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICIES OR PROGRAMS (E.G., CHARITY CARE, DISCOUNTING) FOR LOW-INCOME PERSONS AND HOW THEY ARE COMMUNICATED TO THE PUBLIC. ST. MARY'S HOSPITAL STRIVES TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES TO ALL PERSONS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. ALL BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. WE OFFER DISCOUNTS FOR HOSPITAL SERVICES TO ALL UNINSURED PERSONS. SELF-PAY DISCOUNTS APPLY TO EVERYONE WHO DOES NOT HAVE HEALTH INSURANCE, REGARDLESS OF ABILITY TO PAY. OUR CHARITY CARE POLICIES ARE APPLIED FAIRLY AND CONSISTENTLY. EACH PERSON IS TREATED AS AN INDIVIDUAL WITH SPECIFIC NEEDS FOR ASSISTANCE WITHOUT REGARD TO PAYMENT. WE EMBRACE OUR RESPONSIBILITY TO SERVE OUR COMMUNITIES BY UTILIZING SOUND BUSINESS PRACTICES. CHARITY CARE IS PROVIDED TO PATIENTS BASED ON A SLIDING SCALE FOR HOUSEHOLD INCOMES UP TO FOUR TIMES THE FEDERAL POVERTY LEVEL. PATIENTS WHOSE HOUSEHOLD INCOME IS NO MORE THAN TWO TIMES THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FREE HOSPITAL SERVICES. IN ADDITION, AN EXCEPTION TO THE SLIDING SCALE IS PROVIDED FOR A PATIENT'S BALANCE DUE IF THE AMOUNT IS TOO LARGE TO BE REASONABLY PAID THROUGH AN INSTALLMENT PLAN OVER FOUR YEARS GIVEN THE FAMILY INCOME AND EXPENSES. THESE POLICIES ARE COMMUNICATED BY OUR STAFF PROVIDING 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 - WHOM TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELING. THE FOLLOWING TYPES OF NOTICES TO THE PUBLIC ARE ALSO 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. ALL APPLICATIONS 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. ORGANIZATION DESCRIPTION FOR TAX EXEMPTION: ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS A MEDICARE-DEPENDENT HOSPITAL: - 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 GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS THE THREE STRATEGIC PRIORITIES OF ST. MARY'S HOSPITAL'S COMMUNITY BENEFITS PLAN ARE: BUILDING LOCAL CAPACITY, IMPROVING HEALTH OUTCOMES, AND REDUCING SOCIAL ISOLATION. GOALS AND OBJECTIVES ARE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. HEALTHY COMMUNITIES INITIATIVES CREATE OPPORTUNITIES FOR EACH RESIDENT TO MEET HIS/HER POTENTIAL PHYSICALLY, MENTALLY, SOCIALLY, EMOTIONALLY, AND SPIRITUALLY. THE INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. SMGS HEALTHY COMMUNITIES INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. ST MARY'S HOSPITAL 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. FOCUSING ON A BROAD DEFINITION OF HEALTH, ST MARY'S HOSPITAL CLINICS AND PROGRAMS PROVIDE MEDICAL AND MENTAL HEALTH SERVICES, HEALTH EDUCATION, HEALTH MANAGEMENT, PREVENTION, REFERRALS, INSURANCE ENROLLMENT AND IN-HOME PRIMARY CARE SERVICES AND SUPPORT, WHILE FOSTERING COLLABORATION AND INCORPORATING HEALTHY COMMUNITIES STRATEGIES. ST MARY'S HOSPITAL PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE BOTH COMMUNITY HEALTH AND HEALTHY COMMUNITIES. ST MARY'S HOSPITAL AND SSM HEALTH CARE ADVOCATE FOR VULNERABLE POPULATIONS BY DEVELOPING RELATIONSHIPS WITH POLICY MAKERS AND THROUGH TARGETED EDUCATION EFFORTS. ALL PROJECTS INCLUDE MEASURABLE OBJECTIVES WITH A SPECIFIC TIME FRAME AND HAVE ACTIVITIES THAT WILL FAVORABLY AFFECT HEALTH STATUS INDICATORS. PROJECTS TO ACCOMPLISH HEALTH STATUS OBJECTIVES MAY INCLUDE: DISEASE PREVENTION PROGRAMS; HEALTH EDUCATION PROGRAMS; HEALTH CARE PROGRAMS FOR INDIVIDUALS WITH SPECIAL HEALTH CONCERNS; AND OTHER PROJECTS THAT IMPROVE COMMUNITY HEALTH STATUS. PROJECTS TO ADDRESS THE HEALTH PROBLEMS OF MINORITIES, THE POOR, AND OTHER MEDICALLY UNDERSERVED POPULATIONS MAY INCLUDE: IMPROVING ACCESSIBILITY AND CONTINUITY OF CARE; WORKING TO REDUCE DISPARITIES IN HEALTH STATUS; AND SPONSORING EFFORTS TO INCREASE THE NUMBER OF MINORITIES, THE POOR, AND UNDERSERVED WHO ENTER HEALTH PROFESSIONS AND WORK IN MEDICALLY UNDERSERVED COMMUNITIES. PROJECTS DESIGNED TO CONTAIN THE GROWTH OF COMMUNITY HEALTH CARE COSTS MAY INCLUDE: IMPROVING EFFICIENCY OF SERVICES; IMPROVING CASE MANAGEMENT AND CONTINUITY OF CARE; SPONSORING HEALTH PROMOTION, DISEASE PREVENTION, AND SELF CARE ACTIVITIES; CONTAINING HEALTH CARE COSTS; AND REDUCING REDUNDANCIES. THROUGH OUR COMMUNITY HEALTH NEEDS ASSESSMENT WE IDENTIFY VARIOUS UNMET COMMUNITY HEALTH NEEDS. OUR PRIMARY RESPONSIBILITY IS TO ADDRESS THOSE THAT WE CAN IMPACT THE MOST, THAT IS, THOSE ALIGNED WITH OUR CORE COMPETENCIES. WE COMMUNICATE THE NEEDS IDENTIFIED IN THE ASSESSMENT TO THE COMMUNITY THROUGH A VARIETY OF MEDIA, DEVELOP A PLAN FOR HOW TO ADDRESS THOSE NEEDS THAT WE CAN IMPACT, AND IMPLEMENT STRATEGIES TO ADDRESS THESE NEEDS. THE HEALTHY COMMUNITIES CHRONIC DISEASE INITIATIVE IS ONE COMPONENT THAT FOCUSES ON AN IMPORTANT COMMUNITY HEALTH NEED, CHRONIC DISEASE, AND IS DIRECTED TO IMPROVE INPATIENT CARE, ACCESS TO CARE, AND PREVENTION/SCREENING FOR SELECT CHRONIC DISEASES THAT SIGNIFICANTLY IMPACT OUR COMMUNITIES. ONE OF THE CLEAREST EXAMPLES OF HOW ST. MARY'S HOSPITAL MEETS COMMUNITY NEED IS THROUGH OUR LITTLE EGYPT BREAST AND CERVICAL CANCER PROGRAM. OUR HOSPITAL HAS BEEN A LEAD AGENCY FOR THIS ILLINOIS PUBLIC HEALTH PROGRAM SINCE 1998 AND SERVES AS PAYER OF LAST RESORT FOR BREAST AND CERVICAL CANCER SCREENINGS FOR WOMEN WHO ARE UNINSURED. PARTNERING WITH SEVERAL SUSAN G. KOMEN FOR THE CURE AFFILIATE AGENCIES ALSO ALLOWS OUR HOSPITAL TO PROVIDE ADDITIONAL EDUCATION AND SCREENINGS TO WOMEN WHO ARE UNDERINSURED OR COULD NOT OTHERWISE AFFORD THESE SCREENINGS. IN ADDITION TO THESE BREAST AND CERVICAL CANCER SCREENINGS, SMH ALSO PROVIDES FREE SCREENINGS FOR PROSTATE CANCER, SKIN CANCER AND COLORECTAL CANCER AT VARIOUS LOCATIONS AND TIMES EACH YEAR. AMERICAN CANCER SOCIETY'S LOOK GOOD/FEEL BETTER PROGRAMS ARE OFFERED QUARTERLY AND CANCER SUPPORT GROUPS ARE OFFERED AT SEVERAL LOCATIONS EACH MONTH. 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. 4. SSMHC'S 2010 COMMUNITY BENEFIT REPORT CAN BE FOUND AT WWW.SSMHC.COM. QUANTIFIABLE COMMUNITY BENEFIT THE FOLLOWING IS A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE INCLUDED AS COMMUNITY BENEFIT ACTIVITIES. TRADITIONAL CHARITY CARE $ 4,700,103 UNPAID COST OF MEDICAID $ 6,377,602 UNPAID COST OF MEDICARE $ 1,676,407 COST OF BAD DEBTS $ 1,556,771 COMMUNITY BENEFIT PROGRAMS $ 3,056,280 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $17,367,163 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE CORPORATION IS SSM REGIONAL HEALTH SERVICES. SSM REGIONAL HEALTH SERVICES IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS AND SSM REGIONAL HEALTH SERVICES ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND ELECT AND REMOVE DIRECTORS EXCEPT EX OFFICIO DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE 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 APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION E. TO APPROVE THE AMENDMENTS TO THE CERTIFICATE OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS, TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS, AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OF THE 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 MEMBER, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF THE MEMBER OF THE MEMBER AS DETERMINED BY THE MEMBER OF THE MEMBER Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OF THE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE 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. FORM 990, PART VI, SECTION B, LINE 11 ACCOUNTING/FINANCE PERSONNEL AT EACH SSMHC (SSM HEALTH CARE SYSTEM) ENTITY, IN CONJUNCTION WITH CORPORATE FINANCE PERSONNEL, PREPARE A CHECKLIST CONTAINING INFORMATION AND SUPPORTING SCHEDULES THAT ARE USED TO PREPARE THE FORM 990. THIS CHECKLIST IS THEN REVIEWED BY A SUPERVISOR/MANAGER AND SENT TO THE CORPORATE OFFICE FOR FINAL REVIEW AND COORDINATION OF THE SYSTEM LEVEL FORM 990 INFORMATION. THE INFORMATION IS SUBMITTED TO AN OUTSIDE TAX CONSULTING FIRM WHO PREPARES AND SIGNS THE FORM 990 FROM THE SSMHC INFORMATION. PRIOR TO FINALIZING THE RETURN, A DRAFT IS SENT TO PERSONNEL AT SSMHC FOR REVIEW AND APPROVAL. UPON SSMHC APPROVAL, THE OUTSIDE PREPARER FORWARDS THE COMPLETED FORM 990 FOR THE APPROPRIATE SIGNATURES AND FILING ACTION. A COMPLETE COPY OF THE RETURN IS PROVIDED TO THE BOARD AT THE NEXT SCHEDULED BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY TO 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 ON LINE. 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, SECTION B, LINE 15 ALL SSMHC EXECUTIVE SALARY/COMPENSATION INFORMATION IS BASED ON COMPARATIVE DATA WITH SIMILAR POSITIONS IN THE MARKET. THE COMPENSATION REVIEW PROCESS IS PERFORMED BY EXTERNAL INDEPENDENT COMPENSATION CONSULTANTS. THE SAME COMPARATIVE PROCESS IS PERFORMED INTERNALLY FOR EMPLOYEES. THE SALARY DATA AND POTENTIAL ADJUSTMENTS, FOR THE CEO OF THE SYSTEM, THE PRESIDENT/COO AND THE SENIOR VICE PRESIDENTS ARE PRESENTED TO THE SSMHC BOARD OF DIRECTORS BY THE SAME INDEPENDENT COMPENSATION CONSULTANTS TO APPROVE, DISAPPROVE, MODIFY. FORM 990, PART VI, SECTION C, LINE 19 THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENT FOR THE SSM HEALTH CARE SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH CARE'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE ILLINOIS SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. AVG HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED: FORM 990, PART VII: ALL INDIVIDUALS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED TO THE FILING ORGANIZATION ARE EMPLOYED AND COMPENSATED BY A RELATED ORGANIZATION. IN ADDITION, ALL COMPENSATED REPORTABLE INDIVIDUALS LISTED ON FORM 990, PART VII WORK A MINIMUM OF 40 HOURS PER WEEK FOR SSMHC RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 97,210. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 12,624. TRANSFERS TO AFFILIATES -3,998,603. TOTAL TO FORM 990, PART XI, LINE 5: -3,888,769. SSM HEALTH CARE CORPORATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 466029223 HEALTH CARE MO 501(C)(3) LINE 11A, I FRANCISCAN SISTERS OF MARY 0 SSM EMPLOYEE HEALTH CARE FUND 477 N LINDBERGH BLVD ST LOUIS MO 63141 431328934 BENEFIT PLANS MO 501(C)(9) SSM HEALTH CARE CORPORATION 0 SSMHCS LIABILITY TRUST I 477 N LINDBERGH BLVD ST LOUIS MO 63141 436331003 INSURANCE MO 501(C)(3) LINE 11A, I SSM HEALTH CARE CORPORATION 0 SSM CONSOLIDATED HEALTH SERVICES 477 N LINDBERGH BLVD ST LOUIS MO 63141 431473657 HEALTH CARE MO 501(C)(3) LINE 11A, I SSM HEALTH CARE CORPORATION 0 SSM POLICY INSTITUTE 477 N LINDBERGH BLVD ST LOUIS MO 63141 431788151 HEALTH CARE MO 501(C)(4) SSM HEALTH CARE CORPORATION 0 SSM PORTFOLIO MANAGEMENT CO 477 N LINDBERGH BLVD ST LOUIS MO 63141 431825256 MANAGEMENT MO 501(C)(3) LINE 11A, I SSM HEALTH CARE CORPORATION 0 SSM HEALTH CARE ST LOUIS 477 N LINDBERGH BLVD ST LOUIS MO 63141 431343281 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 477 N LINDBERGH BLVD ST LOUIS MO 63141 430738490 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE ST LOUIS 0 GLENNON HOSPITAL GUILD 477 N LINDBERGH BLVD ST LOUIS MO 63141 431030299 FUNDRAISING MO 501(C)(3) LINE 9 SSM CARDINAL GLENNON HOSPITAL 0 CARDINAL GLENNON CHILDREN'S FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431754347 FUNDRAISING MO 501(C)(3) LINE 7 SSM CARDINAL GLENNON HOSPITAL 0 SSM DEPAUL HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431776109 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM ST JOSEPH FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431591556 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 ST CLARE HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431273310 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM ST MARY'S HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431552945 FUNDRAISING OK 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM HEALTH CARE OF OKLAHOMA INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 730657693 HEALTH CARE OK 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 ST ANTHONY HOSPITAL FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 736104300 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF OKLAHOMA 0 SSM HEALTH CARE OF WISCONSIN INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 430688874 HEALTH CARE WI 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 DELLS MEDICAL BUILDING INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 391613292 MOB WI 501(C)(2) SSM HEALTH CARE OF WISCONSIN 0 ST MARY'S FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 431940686 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 ST CLARE HEALTH CARE FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 431940683 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 HOME HEALTH UNITED INC 4639 HAMMERSLEY ROAD MADISON WI 53713 391539827 HEALTH CARE WI 501(C)(3) LINE 9 SSM HEALTH CARE OF WISCONSIN 0 HOME CARE UNITED INC 4639 HAMMERSLEY ROAD MADISON WI 53713 391776340 HEALTH CARE WI 501(C)(3) LINE 9 SSM HEALTH CARE OF WISCONSIN 0 HHU XTRA CARE INC 4639 HAMMERSLEY ROAD MADISON WI 53713 391705111 HEALTH CARE WI 501(C)(3) LINE 9 SSM HEALTH CARE OF WISCONSIN 0 SSM REGIONAL HEALTH SERVICES 477 N LINDBERGH BLVD ST LOUIS MO 63141 440579850 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 ST FRANCIS HOSPITAL FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431099253 FUNDRAISING MO 501(C)(3) LINE 7 SSM REGIONAL HEALTH SERVICES 0 ST MARY'S HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431575307 FUNDRAISING MO 501(C)(3) LINE 11B, II SSM REGIONAL HEALTH SERVICES 0 GOOD SAMARITAN REGIONAL HEALTH CENTER 477 N LINDBERGH BLVD ST LOUIS MO 63141 430653587 HEALTH CARE IL 501(C)(3) LINE 3 SSM REGIONAL HEALTH SERVICES 0 ST MARY'S - 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