2023-11-15T19:54:33+00:00 2022-12-31 264532849 Purk & Associates PC 1034 S Brentwood Boulevard Suite 20 00 St Louis MO 63117 990EZ 2022-01-01 364170833 St Mary's - Good Samaritan Inc STMA 6184368000 10101 Woodfield Ln St Louis MO 63132 Randy Combs Treasurer 3149947800 2023-11-16 true Barbara Potts 999009999 Douglas G Pleus P00013488 3148844022 2022 2023-04-26 12:10:37Z X X www.ssmhealth.com X X 55151 X 55151 0 0 0 0 55151 0 26192 26192 28959 17427 0 46386 X 17427 46386 17427 46386 0 0 17427 46386 X TO IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS. 26192 26192 Sr M Clarette Stryzewski CSSF Director, Chairperson 1.000 0 0 0 Damon Harbison Director, Hospital President-SSM Health St. Mary's Hospital 0 0 0 0 Patty Williams Director 1.000 0 0 0 Michael Baumgartner Director, Regional President-Southern Illinois 1.000 0 0 0 Sr M Ramona Dombrowski CSSF Director 1.000 0 0 0 Matthew Flanigan Director 1.000 0 0 0 Jeremy Bradford Director, Hospital President-SSM Health Good Samaritan Hospital 1.000 0 0 0 Erica Ibendahl MD Director, SSM Health Medical Group Physician 1.000 0 0 0 Sudeep Nair MD Director, SSM Health Medical Group Physician 1.000 0 0 0 Herb Williams Director 1.000 0 0 0 Douglas Long Secretary, General Counsel at SSM Health 1.000 0 0 0 John Snodsmith Regional VP, Finance 1.000 0 0 0 Randy Combs Treasurer, Chief Financial Officer at SSM Health 1.000 0 0 0 Rachel Hall Assistant Secretary 1.000 0 0 0 false false false false false 0 false false false false Mark Stover 400 N Pleasant Centralia IL 62801 6184367545 false false false false false false false false false false false true X X 3 ST MARY'S HOSPITAL CENTRALIA ILLINOIS 370662580 3 true 0 0 GOOD SAMARITAN REGIONAL HEALTH CENTER 430653587 3 true 0 0 CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION 237408025 9 true 0 0 3 0 0 true true false false false false false false false false false false false false false true false 30 FINANCIAL SUPPORT ST. MARY'S - GOOD SAMARITAN, INC. IS A TYPE I SUPPORTING ORGANIZATION THAT IS OPERATED EXCLUSIVELY TO SUPPORT THE OPERATIONS OF ST. MARY'S HOSPITAL, GOOD SAMARITAN REGIONAL HEALTH CENTER, AND CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION, RELATED TAX-EXEMPT ORGANIZATIONS. THE AMOUNTS OF SUPPORT PROVIDED TO THESE ORGANIZATIONS ON SCHEDULE A, PART I, LINE 11(H)(V) AND LINE 11(H)(VI) DO NOT INCLUDE EXPENSES PAID ON BEHALF OF BUT NOT DIRECTLY TO THESE ORGANIZATIONS. Schedule A, Part IV, Section A, Line 2 Supported Org. Without IRS Status 509(a)1 or (2) ST. MARY'S - GOOD SAMARITAN, INC. IS A SUPPORTING ORGANIZATION THAT PROVIDES SUPPORT TO ST. MARY'S HOSPITAL CENTRALIA, ILLINOIS AND GOOD SAMARITAN REGIONAL HEALTH CENTER, BOTH TAX EXEMPT HOSPITALS. THROUGH ITS SUPPORT OF THESE TWO HOSPITALS, ST. MARY'S - GOOD SAMARITAN, INC. ALSO PROVIDES SUPPORT TO CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION, A SUPPORTING ORGANIZATION OF TO ST. MARY'S HOSPITAL CENTRALIA, ILLINOIS. CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION PROVIDES OFFICE SPACE TO PHYSICIANS, AN MRI SUITE, AND A CONVENIENT CARE LOCATION TO INCREASE THE AVAILABILITY OF DOCTORS FOR MEDICAL EMERGENCIES AND PROVIDE ADDITIONAL PATIENT ACCESSIBILITY. Form 990-EZ, Part I, Line 16 Other Expenses SUPPLIES - -29; PROFESSIONAL LIABILITY INSURANCE - 25221; Consulting Fees - 1000; Form 990-EZ, Part II, Line 24b Other Assets DUE FROM AFFILIATES - BOY:17427,EOY:46386; Form 990-EZ, Part III, Exempt Purpose PRIMARY EXEMPT PURPOSE TO IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. Form 990-EZ, Part III, Program Services Details 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. ST. MARY'S - GOOD SAMARITAN, INC. IS COMMITTED TO THE PURPOSE OF ENABLING ITS ENTITIES, SSM HEALTH ST MARY'S HOSPITAL - CENTRALIA AND SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON TO PROVIDE ACCESS TO QUALITY HEALTH CARE SERVICES TO ALL PERSONS ON THE SOUTHERN ILLINOIS REGION REGARDLESS OF THEIR ABILITY TO PAY. THROUGH ITS GOVERNANCE, OPERATION AND ADMINISTRATION, ST MARY'S - GOOD SAMARITAN, INC. HELPS TO MEET THE COMMUNITY NEEDS IDENTIFIED BY EACH HOSPITAL IN AN ECONOMIC AND EFFICIENT MANNER. THE LEADERS OF ST. MARY'S - GOOD SAMARITAN, INC. PARTICIPATE IN COMMUNITY ORGANIZATIONS WHICH ENABLE THEM TO IDENTIFY COMMUNITY NEEDS. ALL SSMH 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 AND PRACTICES WILL REFLECT THE MISSION AND VALUES OF SSMH, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. SSMH 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. SSMH WILL APPLY ITS CHARITY CARE POLICIES FAIRLY AND CONSISTENTLY. EACH PERSON WILL BE TREATED AS AN INDIVIDUAL WITH SPECIFIC NEEDS FOR ASSISTANCE WITHOUT REGARD TO PAYMENT. SSMH EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH WE PARTICIPATE BY ESTABLISHING 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 AMOUNTIS TOO LARGE TO BE REASONABLY PAID THROUGH AN INSTALLMENT PLAN OVER FOUR YEARS GIVEN THE FAMILY INCOME AND EXPENSES. EACH ENTITY PROVIDING MEDICAL SERVICES 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 COMMUNICATIONS 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 WILL BE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY WILL 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 WHOM TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELING. THE FOLLOWING TYPES OF NOTICES TO THE PUBLIC SHALL BE PROVIDED: SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS, BROCHURES OR FLIERS 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 AND 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 WILL ALSO BE PROVIDED TO PUBLIC AGENCIES. ST MARY'S - GOOD SAMARITAN, INC. SUPPORTS TWO SSMH HOSPITALS THAT: EACH OPERATE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, HAVE AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, HAVE A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY, ENGAGE IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, AND PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. ADDITIONAL INFORMATION REGARDING SSMH'S 2022 COMMUNITY BENEFIT REPORT CAN BE FOUND AT WWW.SSMHEALTH.COM. 30 FINANCIAL SUPPORT ST. MARY'S - GOOD SAMARITAN, INC. IS A TYPE I SUPPORTING ORGANIZATION THAT IS OPERATED EXCLUSIVELY TO SUPPORT THE OPERATIONS OF ST. MARY'S HOSPITAL AND GOOD SAMARITAN REGIONAL HEALTH CENTER, RELATED TAX-EXEMPT ORGANIZATIONS. THE AMOUNTS OF SUPPORT PROVIDED TO ST MARY'S HOSPITAL AND GOOD SAMARITAN REGIONAL HEALTH CENTER ON SCHEDULE A, PART I, LINE 11(H)(VII) DO NOT INCLUDE EXPENSES PAID ON BEHALF OF BUT NOT DIRECTLY TO ST MARY'S HOSPITAL AND GOOD SAMARITAN REGIONAL HEALTH CENTER.