GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION (EIN 26-2884795)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-15
- IRS object ID
- 202433209349315773
- Schema version
- 2023v5.1
- 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 D
- Schedule G
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-15T13:39:44-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 262884795 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN REGIONAL HEALTH CENTER | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 6188991047 | PhoneNum |
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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHANIE KING | PersonNm |
| Person Title | VP FINANCE | PersonTitleTxt |
| Phone | 6188991047 | PhoneNum |
| Signature | 2024-11-15 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | STEPHANIE KING | PrincipalOfficerNm |
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) |
|---|---|---|
| Gross Receipts | $585,898 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | SSMHEALTH.COM/DONATE/GOOD-SAMARITAN-FOUNDATION-MT | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE SUPPORT TO SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON IN SUPPORT OF THEIR MISSION TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING REGIONAL QUALITY HEALTH SERVICES FOR EVERYONE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $282,459 | PYContributionsGrantsAmt |
| CY Contributions Grants | $297,713 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $82,699 | PYInvestmentIncomeAmt |
| CY Investment Income | $146,280 | CYInvestmentIncomeAmt |
| PY Other Revenue | $643 | PYOtherRevenueAmt |
| CY Other Revenue | $118,522 | CYOtherRevenueAmt |
| PY Total Revenue | $365,801 | PYTotalRevenueAmt |
| CY Total Revenue | $562,515 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $129,613 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $26,945 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $181,660 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $93,569 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $119,363 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $49,231 | PYOtherExpensesAmt |
| CY Other Expenses | $25,794 | CYOtherExpensesAmt |
| PY Total Expenses | $360,504 | PYTotalExpensesAmt |
| CY Total Expenses | $146,308 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,297 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $416,207 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,091,378 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,730,158 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,120 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,337 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,090,258 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,723,821 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THROUGH OUR EXCEPTIONAL HEALTHCARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $26,945 | ExpenseAmt |
| Grant | $26,945 | GrantAmt |
| Desc | PROVIDED PROGRAM AND CAPITAL SUPPORT TO THE HEALTHCARE INITIATIVES OF SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON. PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS. | Desc |
| Total Program Service Expenses | $26,945 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REBECCA LYONS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3149893072 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12800 CORPORATE HILL DRIVE | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63131 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| CAROL HAMERSKI | ||||||||
| TRUSTEE & SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL BAUMGARTNER | ||||||||
| HOSPITAL PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL BECK | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| HUNT BONAN | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| REX CUSUMANO | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| NORMA FAIRCHILD | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JOHNNY KAUSHAL | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL KROESCHEN | ||||||||
| CHAIRPERSON & TRUSTEE | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR NICHOLE LEMASTER | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR WES NEAL | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARCIA SCOTT | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRYAN STIREWALT | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DARLA WEXSTTEN | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM WILLIAMS | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUGLAS LONG | ||||||||
| ASST. SECRETARY, GENERAL COUNSEL AT SSM HEALTH | 1.00 | 72.20 | Yes (X) | $0 | $1,425,239 | $777,013 | ||
| JOHN SNODSMITH | ||||||||
| REGIONAL VP, FINANCE | 1.00 | 43.00 | Yes (X) | $0 | $292,287 | $99,350 | ||
| KAY ZIBBY-DAMRON | ||||||||
| EXECUTIVE DIRECTOR | 20.00 | 20.00 | Yes (X) | $0 | $162,164 | $37,460 | ||
| KAREN REWERTS | ||||||||
| FORMER OFFICER, VP-FINANCIAL OPERATIONS | 0.00 | 43.00 | $0 | $801,331 | $287,514 | Yes (X) | ||
| MATT KINSELLA | ||||||||
| FORMER OFFICER | 0.00 | 40.00 | $0 | $532,042 | $201,905 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,213,063 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,403,242 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $58,425 | FundraisingAmt |
| All Other Contributions | $239,288 | AllOtherContributionsAmt |
| Total Contributions | $297,713 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $83,837 | TotalRevenueColumnAmt |
| Exclusion | $83,837 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $62,443 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $62,443 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,443 | TotalRevenueColumnAmt |
| Exclusion | $62,443 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $12,865 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $58,425 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $22,688 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$9,823 | TotalRevenueColumnAmt |
| Exclusion | -$9,823 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $695 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $695 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| INTERCOMPANY REVENUE-S | 900099 | $125,845 | $125,845 |
| OTHER REVENUE | 900099 | $2,500 | $2,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $128,345 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $562,515 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $264,802 | 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 | $26,945 | TotalAmt |
| Program Services | $26,945 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,752 | TotalAmt |
| Fundraising | $86,752 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,817 | TotalAmt |
| Fundraising | $6,817 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,366 | TotalAmt |
| Fundraising | $16,366 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,147 | TotalAmt |
| Fundraising | $1,147 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,880 | TotalAmt |
| Fundraising | $1,880 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $302 | TotalAmt |
| Fundraising | $302 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,930 | TotalAmt |
| Fundraising | $1,930 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113 | TotalAmt |
| Fundraising | $113 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt |
|---|---|---|
| OTHER EXPENSES | $3,155 | $3,155 |
| BANK FEES | $726 | $726 |
| TAXES | $115 | $115 |
| LICENSES, DUES & SUBSCR | $60 | $60 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,308 | TotalAmt |
| Program Services | $26,945 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $119,363 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $408,309 | BOYAmt |
| EOY | $717,482 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,505,868 | BOYAmt |
| EOY | $1,669,626 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $167,061 | BOYAmt |
| EOY | $172,327 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,299 | BOYAmt |
| EOY | $753,882 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $416,841 | BOYAmt |
| EOY | $416,841 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,091,378 | BOYAmt |
| EOY | $3,730,158 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,120 | BOYAmt |
| EOY | $6,337 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,120 | BOYAmt |
| EOY | $6,337 | 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 | $1,392,328 | BOYAmt |
| EOY | $1,881,868 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,697,930 | BOYAmt |
| EOY | $1,841,953 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,090,258 | BOYAmt |
| EOY | $3,723,821 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,091,378 | BOYAmt |
| EOY | $3,730,158 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $416,207 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $217,356 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $251,254 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $953,679 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $417,612 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $282,459 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $297,713 | CurrentTaxYearAmt |
| Total | $2,202,717 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $251,254 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $953,679 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $417,612 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $282,459 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $297,713 | CurrentTaxYearAmt |
| Total | $2,202,717 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $2,202,717 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,534 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $16,881 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $32,720 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $57,592 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $83,837 | CurrentTaxYearAmt |
| Total | $210,564 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,580 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $20,890 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,925 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $19,620 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,560 | CurrentTaxYearAmt |
| Total | $92,575 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,505,856 | TotalSupportAmt |
| Public Support CY170 | 0.87900 | PublicSupportCY170Pct |
| Public Support PY170 | 0.61560 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $24,714 | BeginningYearBalanceAmt |
| Contributions | $1,000 | ContributionsAmt |
| Investment Earnings Or Losses | $3,734 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $29,448 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $27,995 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$3,281 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $24,714 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $25,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,995 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $27,995 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $25,000 | ContributionsAmt |
| End Year Balance | $25,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SSM COMPREHENSIVE INVESTMENT PROGRAM | Desc |
| Book Value | $753,882 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $753,882 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MINERAL RIGHTS | Desc |
| Book Value | $416,841 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $416,841 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $6,337 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,337 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE PURPOSE OF THE ENDOWMENT IS TO PROVIDE SCHOLARSHIPS TO EMPLOYEES AND STUDENTS IN THE HEALTH CARE FIELD. |
| PART X, LINE 2: | GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCDERTAIN 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 2023 OR 2022. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF EVENT | Event1Nm |
| Gross Receipts Event1 | $71,290 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $58,425 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $12,865 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $7,019 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $13,019 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $2,650 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $71,290 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $58,425 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $12,865 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $7,019 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $13,019 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,650 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $22,688 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$9,823 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HOSPITAL - MT VERNON | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 GOOD SAMARITAN WAY | AddressLine1Txt |
| City | MOUNT VERNON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62864 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 430653587 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $10,250 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | CHARITABLE SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS TO ORGANIZATIONS ARE MADE TO A RELATED ORGANIZATION AND ARE TAX EXEMPT UNDER SECTION 501(C)(3). THE ORGANIZATION HAS DEVELOPED INTERNAL CONTROL PROCEDURES FOR THE USE OF GRANT FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DOUGLAS LONG | ||||||||||||||
| ASST. SECRETARY, GENERAL COUNSEL AT | $0 | $759,270 | $0 | $495,539 | $0 | $170,430 | $0 | $753,634 | $0 | $23,379 | $0 | $2,202,252 | $0 | $495,539 |
| KAREN REWERTS | ||||||||||||||
| FORMER OFFICER, VP-FINANCIAL OPERATI | $0 | $589,021 | $0 | $154,022 | $0 | $58,288 | $0 | $253,200 | $0 | $34,314 | $0 | $1,088,845 | $0 | $205,965 |
| MATT KINSELLA | ||||||||||||||
| FORMER OFFICER | $0 | $405,421 | $0 | $105,716 | $0 | $20,905 | $0 | $160,100 | $0 | $41,805 | $0 | $733,947 | $0 | $114,535 |
| JOHN SNODSMITH | ||||||||||||||
| REGIONAL VP, FINANCE | $0 | $257,255 | $0 | $34,175 | $0 | $857 | $0 | $69,162 | $0 | $30,188 | $0 | $391,637 | $0 | $34,175 |
| KAY ZIBBY-DAMRON | ||||||||||||||
| EXECUTIVE DIRECTOR | $0 | $152,528 | $0 | $8,943 | $0 | $693 | $0 | $21,367 | $0 | $16,093 | $0 | $199,624 | $0 | $8,943 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J PART I, LINE 3 | ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION THE FOUNDATION'S TOP MANAGEMENT OFFICIAL (EXECUTIVE DIRECTOR) IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSUL TANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990 SCHEDULE J PART I, LINE 4B | SUPPLEMENTAL NONQUALIFIED RETIREMENT 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 2023. 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 2023: DOUGLAS LONG $161,286 JOHN SNODSMITH $11,873 MATTHEW KINSELLA $39,596 KAREN REWERTS $56,755 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. KAREN REWERTS $53,386 MATT KINSELLA $19,814 |
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 | GREEN HILLS GOLF CLUB | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | ENTITY MORE THAN 35% OWNED BY TOM WILLIAMS | RelationshipDescriptionTxt |
| Transaction | $13,019 | TransactionAmt |
| Transaction | PURCHASES OF SERVICES AND EVENT PRIZES | TransactionDesc |
| Sharing Of Revenues | Yes (1) | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A - PROGRAM SERVICE ACCOMPLISHMENTS | 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. DESCRIBE THE EXEMPT PURPOSE ACHIEVEMENTS. THE FOUNDATION RAISES FUNDS WITH A VISION TO PROVIDE LONG-TERM SUPPORT TO SSM HEALTH GOOD SAMARITAN HOSPITAL MOUNT VERNON'S HEALING MINISTRY. THIS SUPPORT IS GENERATED BY ORGANIZATIONS AND INDIVIDUALS WHO PROVIDE ANNUAL GIVING FROM INCOME, OCCASIONAL LARGE GIFTS IN SUPPORT OF SPECIAL PROJECTS, AND THE ULTIMATE GIFT ARRANGED THROUGH BEQUESTS AND OTHER PLANNED GIFT VEHICLES. THIS VISION IS CARRIED OUT BY BUILDING RELATIONS WITH INDIVIDUALS, ORGANIZATIONS, AND FOUNDATIONS CAPABLE OF MAKING GIFTS, CREATING OPPORTUNITIES TO INFORM PROSPECTIVE SUPPORTERS ABOUT THE HOSPITAL'S WORK, INVOLVING THEM IN THE MISSION, AND GRACIOUSLY RECOGNIZING THE SUPPORT WE ARE GIVEN. THROUGH GIFTS TO THE FOUNDATION, DONORS SUPPORT MEDICAL PROGRAMS, THE PURCHASE OF MEDICAL EQUIPMENT, BUILDING IMPROVEMENTS AND DEPARTMENTAL PROGRAMS AND COMMUNITY HEALTH INITIATIVES. DURING 2023, THE FOUNDATION APPROVED FUNDING REQUESTS TO PROVIDE ASSISTANCE TO HOSPICE PATIENTS, EQUIPMENT AND INTERN STIPEND TO THE MUSIC THERAPY DEPARTMENT, AND IS FUNDING MONTHLY TRANSPORTATION COSTS FOR PATIENTS WHO NEED ASSISTANCE GETTING TO MEDICAL APPOINTMENTS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE CORPORATE MEMBER OF THE FOUNDATION IS ST. MARY'S-GOOD SAMARITAN, INC., A NONPROFIT 501(C)(3) ORGANIZATION. BOTH THE FOUNDATION AND ST. MARY'S-GOOD SAMARITAN, INC. ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY THE MEMBER HAS THE POWER TO APPOINT THE BOARD OF TRUSTEES EXCEPT FOR ANY TRUSTEE WHO SERVES EX OFFICIO, AND TO REMOVE APPOINTED TRUSTEES WITH OR WITHOUT CAUSE. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE PHILOSOPHY OF THE FOUNDATION B. TO APPOINT THE BOARD OF TRUSTEES, EXCEPT FOR ANY TRUSTEE WHO SERVES EX OFFICIO, AND TO REMOVE THE APPOINTED TRUSTEES WITH OR WITHOUT CAUSE C. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE FOUNDATION AS PROVIDED THEREIN D. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE FOUNDATION E. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE FOUNDATION F.TO APPROVE THE SALE, CONVEYANCE, ASSIGNMENT, TRANSFER, ALIENATION, PLEDGE, ENCUMBRANCE, MORTGAGE OR LEASE OF REAL PROPERTY OR ANY INTEREST THEREIN OF THE FOUNDATION IN ACCORDANCE WITH THE POLICIES APPROVED BY THE MEMBER G.TO APPROVE I) THE ACQUISITION OF REAL PROPERTY OR ANY INTEREST THEREIN OR II) THE ACQUISITION OF STOCK OF A CORPORATION IF, AFTER THE ACQUISITION, THE FOUNDATION WILL OWN A MAJORITY OF THE VOTING STOCK OF SUCH CORPORATION, IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER H.TO APPROVE THE SALE, TRANSFER OR OTHER DISPOSITION OF THE VOTING STOCK OF A CORPORATION IF BEFORE THE DISPOSITION THE FOUNDATION OWNED A MAJORITY OF THE VOTING STOCK OF THE CORPORATION AND AFTER SUCH DISPOSITION THE FOUNDATION WOULD NOT OWN A MAJORITY OF THE VOTING STOCK OF THE CORPORATION, IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER I.TO APPROVE ANY BORROWINGS OR GUARANTEES OF THE FOUNDATION IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER J.TO APPROVE THE ACCEPTANCE OF ANY GIFT OR CONTRIBUTION WHICH, IN CONNECTION THEREWITH, WOULD IMPOSE A CONTINUING OBLIGATION UPON THE FOUNDATION, INCLUDING, WITHOUT LIMITATION, THE OBLIGATION TO PROVIDE HEAL TH CARE SERVICES, PAY AN ANNUITY OR UNDERTAKE ANY OTHER OBLIGATIONS, EXCEPT AS OTHERWISE DETERMINED BY THE MEMBER PURSUANT TO POLICIES ADOPTED BY THE MEMBER K.TO APPROVE OR REJECT PROPOSALS FOR EXPENDITURES OR CONTRIBUTIONS IN ACCORDANCE WITH ARTICLE IX OF THE BYLAWS IN THE EVENT THE PRESIDENT OF THE MEMBER AND THE BOARD OF TRUSTEES DO NOT AGREE WITH RESPECT TO THE APPROVAL OF SUCH PROPOSAL L.TO APPROVE THE ANNUAL OPERATING BUDGET OF THE FOUNDATION AND M.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 FOUNDATION IN SUCH PROGRAMS, AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE FOUNDATION IN CONNECTION WITH SUCH PROGRAMS. |
| FORM 990, PART VI, SECTION A, LINE 8B | DOCUMENTATION OF MEETINGS HELD BY COMMITTEES OF GOVERNING BODY THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | 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 PRIOR TO FILING. |
| 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 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. 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 C, LINE 19 | THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEAL TH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE ILLINOIS SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| 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 PRIOR TO FILING. |
| FORM 990, PART IX, LINE 11G | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 16,366. TOTAL EXPENSES 16,366. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (49 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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM HEALTH CARE ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431343281 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE CORPORATION | 0 | |
| CENTRALIA MEDICAL SERVICES BLDG ASSOC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 237408025 | MOB | IL | 501(C)(3) | LINE 12A, I | SSM REGIONAL HEALTH SERVICES | 0 | |
| ST MARY'S JANESVILLE FOUNDATION INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 273439133 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| SSM HEALTH MINISTRIES | |||||||||||
| 3221 MCKELVEY ROAD SUITE 107 | BRIDGETON | MO | 63044 | 431012492 | RELIGIOUS ORGANIZATION | MO | 501(C)(3) | LINE 1 | 0 | N/A | |
| LEE DEWEY CORPORATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 731279603 | MOB | OK | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF OKLAHOMA | 0 | |
| ST MARY'S HOSPITAL AUXILIARY | |||||||||||
| 100 ST MARYS MEDICAL PLAZA | JEFFERSON CITY | MO | 65101 | 436049878 | FUNDRAISING | MO | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| GOOD SAMARITAN HOSPITAL AUXILIARY | |||||||||||
| 1 GOOD SAMARITAN WAY | MOUNT VERNON | IL | 62864 | 237049599 | FUNDRAISING | IL | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| ST ANTHONY SHAWNEE HOSPITAL INC | |||||||||||
| 1000 N LEE AVE | OKLAHOMA CITY | OK | 73102 | 455055149 | HEALTH CARE | OK | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF OKLAHOMA | 0 | |
| SSM AUDRAIN HEALTH CARE INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431550298 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM REGIONAL HEALTH SERVICES | 0 | |
| SSM-SLUH INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 474196634 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE ST LOUIS | 0 | |
| AGNESIAN HEALTHCARE INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 390807236 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| RIPON MEDICAL CENTER INC | |||||||||||
| 845 PARKSIDE STREET | RIPON | WI | 54971 | 391101287 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | AGNESIAN HEALTHCARE INC | 0 | |
| WAUPUN MEMORIAL HOSPITAL INC | |||||||||||
| 620 WEST BROWN STREET | WAUPUN | WI | 53963 | 390806265 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | AGNESIAN HEALTHCARE INC | 0 | |
| ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC | |||||||||||
| 33 EVERETT STREET | FOND DU LAC | WI | 54935 | 391029998 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO | |||||||||||
| N8114 COUNTY WW | MOUNT CALVARY | WI | 53057 | 391022770 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| VILLA ROSA INC | |||||||||||
| N8120 COUNTY WW | MOUNT CALVARY | WI | 53057 | 421670962 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED | |||||||||||
| 331 BLY STREET | WAUPUN | WI | 53963 | 390884514 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| THE MONROE CLINIC INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 390808509 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| MONROE CLINIC AND HOSPITAL FOUNDATION INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 205769038 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| AGNESIAN HEALTHCARE FOUNDATION INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 391684956 | FUNDRAISING | WI | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF WISCONSIN | 0 | |
| SHARED MAGNETIC RESONANCE IMAGING FACILITY INC | |||||||||||
| 1104 JOHN NOLEN DRIVE | MADISON | WI | 53713 | 391534744 | HEALTH CARE | WI | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF WISCONSIN | 0 | |
| SSM HEALTH CARDINAL GLENNON TRANSPORT | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 863519607 | HEALTH CARE | MO | 501(C)(3) | LINE 12A, I | SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | 0 | |
| SSM HEALTH FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 874109859 | FUNDRAISING | MO | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE CORPORATION | 0 | |
| SSM HEALTH CARE GROUP | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 880988603 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH CARE ST LOUIS | 0 | |
| THE SARAH COMMUNITY | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431784657 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH BUSINESSES | 0 | |
| VISITING NURSE ASSOCIATION OF GREATER ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430567000 | HEALTH CARE | MO | 501(C)(3) | LINE 7 | SSM HEALTH BUSINESSES | 0 | |
| ST MARY'S JANESVILLE FOUNDATION INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 273439133 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| SSM HEALTH MINISTRIES | |||||||||||
| 3221 MCKELVEY ROAD SUITE 107 | BRIDGETON | MO | 63044 | 431012492 | RELIGIOUS ORGANIZATION | MO | 501(C)(3) | LINE 1 | 0 | N/A | |
| LEE DEWEY CORPORATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 731279603 | MOB | OK | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF OKLAHOMA | 0 | |
| ST MARY'S HOSPITAL AUXILIARY | |||||||||||
| 100 ST MARYS MEDICAL PLAZA | JEFFERSON CITY | MO | 65101 | 436049878 | FUNDRAISING | MO | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| GOOD SAMARITAN HOSPITAL AUXILIARY | |||||||||||
| 1 GOOD SAMARITAN WAY | MOUNT VERNON | IL | 62864 | 237049599 | FUNDRAISING | IL | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| ST ANTHONY SHAWNEE HOSPITAL INC | |||||||||||
| 1000 N LEE AVE | OKLAHOMA CITY | OK | 73102 | 455055149 | HEALTH CARE | OK | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF OKLAHOMA | 0 | |
| SSM AUDRAIN HEALTH CARE INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431550298 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM REGIONAL HEALTH SERVICES | 0 | |
| SSM-SLUH INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 474196634 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE ST LOUIS | 0 | |
| AGNESIAN HEALTHCARE INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 390807236 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| RIPON MEDICAL CENTER INC | |||||||||||
| 845 PARKSIDE STREET | RIPON | WI | 54971 | 391101287 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | AGNESIAN HEALTHCARE INC | 0 | |
| WAUPUN MEMORIAL HOSPITAL INC | |||||||||||
| 620 WEST BROWN STREET | WAUPUN | WI | 53963 | 390806265 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | AGNESIAN HEALTHCARE INC | 0 | |
| ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC | |||||||||||
| 33 EVERETT STREET | FOND DU LAC | WI | 54935 | 391029998 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO | |||||||||||
| N8114 COUNTY WW | MOUNT CALVARY | WI | 53057 | 391022770 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| VILLA ROSA INC | |||||||||||
| N8120 COUNTY WW | MOUNT CALVARY | WI | 53057 | 421670962 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED | |||||||||||
| 331 BLY STREET | WAUPUN | WI | 53963 | 390884514 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | 0 | |
| THE MONROE CLINIC INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 390808509 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| MONROE CLINIC AND HOSPITAL FOUNDATION INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 205769038 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | 0 | |
| AGNESIAN HEALTHCARE FOUNDATION INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 391684956 | FUNDRAISING | WI | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF WISCONSIN | 0 | |
| SHARED MAGNETIC RESONANCE IMAGING FACILITY INC | |||||||||||
| 1104 JOHN NOLEN DRIVE | MADISON | WI | 53713 | 391534744 | HEALTH CARE | WI | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF WISCONSIN | 0 | |
| SSM HEALTH CARDINAL GLENNON TRANSPORT | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 863519607 | HEALTH CARE | MO | 501(C)(3) | LINE 12A, I | SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | 0 | |
| SSM HEALTH FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 874109859 | FUNDRAISING | MO | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE CORPORATION | 0 | |
| SSM HEALTH CARE GROUP | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 880988603 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH CARE ST LOUIS | 0 | |
| THE SARAH COMMUNITY | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431784657 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH BUSINESSES | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (22 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| SSM ST JOSEPH ENDOSCOPY CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 270046559 | SURGERY SERVICES | MO | N/A | 0 | 0 |
| ST CLARE IMAGING SERVICES LLC | |||||||||
| 707 14TH STREET SUITE A | BARABOO | WI | 53913 | 200122365 | DIAG. SERVICES | WI | N/A | 0 | 0 |
| MT VERNON RADIATION THERAPY CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 201382620 | RADIATION THERAPY | IL | N/A | 0 | Yes (1) |
| SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 208468195 | DIAG. SERVICES | IL | N/A | 0 | 0 |
| CHOWSMGSI OFFICE BUILDING LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 371383861 | MOB | IL | N/A | 0 | 0 |
| OZA CANCER CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 201382727 | MOB | IL | N/A | 0 | 0 |
| SHAWNEE REAL ESTATE HOLDINGS LLC | |||||||||
| 1000 N LEE AVE | OKLAHOMA CITY | OK | 73102 | 455458304 | MOB | OK | N/A | 0 | 0 |
| DEAN CLINIC & ST MARY'S HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 452995500 | ACCOUNTABLE CARE ORGANIZATION | WI | N/A | 0 | 0 |
| WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 392016715 | INFORMATION TECHNOLOGY SERVICES | WI | N/A | 0 | 0 |
| WINGRA BUILDING GROUP | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 390237060 | MOB | WI | N/A | 0 | 0 |
| JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 396220698 | MOB | WI | N/A | 0 | 0 |
| 1110 N CLASSEN BLVD LLC | |||||||||
| 1110 N CLASSEN BOULEVARD | OKLAHOMA CITY | OK | 73106 | 731158158 | MOB | OK | N/A | 0 | Yes (1) |
| SSM ST CLARE SURGICAL CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 261439695 | SURGERY SERVICES | MO | N/A | 0 | 0 |
| WINDMILL LLP | |||||||||
| 50 VILLAGE VIEW LANE | CHESTERFIELD | MO | 63017 | 431804651 | INVESTMENTS | MO | N/A | 0 | 0 |
| NAVITUS HEALTH SOLUTIONS LLC | |||||||||
| 361 INTEGRITY DRIVE | MADISON | WI | 53717 | 043608530 | PHARMACY BENEFIT MANAGEMENT | WI | N/A | 0 | 0 |
| SSM SELECT REHAB ST LOUIS LLC | |||||||||
| 4714 GETTYSBURG ROAD | MECHANICSBURG | PA | 17055 | 263694972 | HEALTH CARE | DE | N/A | 0 | 0 |
| EPIPHANY RX LLC | |||||||||
| 361 INTEGRITY DRIVE | MADISON | WI | 53717 | 364855405 | PHARMACY BENEFIT MANAGEMENT | DE | N/A | 0 | 0 |
| RXPRECHECK LL | |||||||||
| 278 FRANKLIN RD | BRENTWOOD | TN | 37027 | 812842151 | PHARMACY BENEFIT MANAGEMENT | TN | N/A | 0 | 0 |
| ARCHIMEDES LLC | |||||||||
| 278 FRANKLIN RD | BRENTWOOD | TN | 37027 | 811158028 | PHARMACY BENEFIT MANAGEMENT | TN | N/A | 0 | 0 |
| BLOOM TREE LONG-ONLY FUND QP LP FKA BLOOM TREE PONDEROSA FUNDS QP LP | |||||||||
| 101 PARK AVENUE 33RD FL | NEW YORK | NY | 10178 | 823704522 | INVESTMENTS | DE | N/A | 0 | 0 |
| NECICF II AIV2-B LP | |||||||||
| 300 DELAWARE AVE STE 210 | WILMINGTON | DE | 19801 | 845058167 | INVESTMENTS | DE | N/A | 0 | 0 |
| BISON CAPITAL PARTNERS VI-A LP | |||||||||
| 233 WILSHIRE BLVD STE 425 | SANTA MONICA | CA | 90401 | 874006968 | INVESTMENTS | DE | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM MANAGED CARE ORGANIZATION LLC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431708511 | HEALTH PROMOTION | MO | N/A | C | 0 | |||
| FPP INC & SUBS | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431465174 | HEALTH CARE | MO | N/A | C | 0 | |||
| DIVERSIFIED HEALTH SERVICES CORP | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431369305 | MEDICAL EQUIPMENT | MO | N/A | C | 0 | |||
| SSM PROPERTIES INC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431462486 | PROPERTY SERVICES | MO | N/A | C | 0 | |||
| HEALTHFIRST PHYSICIAN MANAGEMENT SERVICES | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 731534336 | MEDICAL SERVICES | OK | N/A | C | 0 | |||
| SSMHC LIABILITY TRUST II | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 816128118 | INSURANCE | MO | N/A | C | 0 | |||
| SSM MEDICAL GROUP INC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431664107 | PHYSICIAN OFFICES | MO | N/A | C | 0 | |||
| SSMHC INSURANCE COMPANY | ||||||||||||
| 030310431 | INSURANCE | N/A | C | 0 | PO BOX 1051 GT | CJ | CJ | |||||
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 364161526 | HEALTH CARE | IL | N/A | C | 0 | |||
| DEAN HEALTH SYSTEMS INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 391128616 | PHYSICIAN OFFICES | WI | N/A | C | 0 | |||
| DEAN RETAIL SERVICES INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 391717636 | PROPERTY SERVICES | WI | N/A | C | 0 | |||
| SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 832038674 | CONDO ASSOCIATION | WI | N/A | C | 0 | |||
| SSM HEALTH PHARMACY LLC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 264031708 | PHARMACY | MO | N/A | C | 0 | |||
| NAVITUS HOLDINGS LLC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 800968174 | PHARMACY | WI | N/A | C | 0 | |||
| MS COMMUNITY JV LLC | ||||||||||||
| 401 CARLSON PARKWAY CP330 | MINNETONKA | MN | 55305 | 873240022 | INSURANCE | DE | N/A | C | 0 | |||
| QUALITY DRUG CORPORATION | ||||||||||||
| 239 BROADWAY | LAGUNA BEACH | CA | 92651 | 330644268 | PHARMACY BENEFITS | CA | N/A | C | 0 | |||
| ST MARY'S HOSPITAL CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC | ||||||||||||
| 707 SOUTH MILLS STREET | MADISON | WI | 53715 | 000000000 | CONDO ASSOCIATION | WI | N/A | C | 0 | |||
| PARTNERS GROUP PMC PRIVATE CREDIT LP | ||||||||||||
| 981439264 | INVESTMENT | N/A | C | 0 | C/O MAPLES CORPORATE SERVICES LTD | CJ | CJ | |||||
| OMNINHEALTH HOLDINGS | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 884144276 | HEALTH CARE CONSULTING | DE | N/A | C | 0 | |||
| PARTNERS GROUP PMC PRIVATE CREDIT LP | ||||||||||||
| 981439264 | INVESTMENT | C | 0 | C/O MAPLES CORPORATE SERVICES LTD | CJ | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments