DELLS MEDICAL BUILDING INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
DELLS MEDICAL BUILDING INC (EIN 39-1613292)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202233199349310008
Schema version
2021v4.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-15T11:33:14-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391613292EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Dells Medical Building IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELLBusinessNameControlTxt
Phone6083561423PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110101 Woodfield LnAddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63132ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBarb PottsPersonNm
Person TitleVP-FinancePersonTitleTxt
Phone3149947800PhoneNum
Signature2022-11-15SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstBarbaraPersonFirstNm
Person LastPottsPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Laura WalczakBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line110101 Woodfield LnAddressLine1Txt
CitySt LouisCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63132ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$880,213GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website Addresswww.ssmhealth.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1988FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionProvide convenient medical office space to physicians to enhance health care accessibility for patients.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$879,963PYProgramServiceRevenueAmt
CY Program Service Revenue$879,963CYProgramServiceRevenueAmt
PY Investment Income$313PYInvestmentIncomeAmt
CY Investment Income$250CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$880,276PYTotalRevenueAmt
CY Total Revenue$880,213CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$450,443PYOtherExpensesAmt
CY Other Expenses$433,581CYOtherExpensesAmt
PY Total Expenses$450,443PYTotalExpensesAmt
CY Total Expenses$433,581CYTotalExpensesAmt
PY Revenues Less Expenses$429,833PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$446,632CYRevenuesLessExpensesAmt
Total Assets BOY$7,144,980TotalAssetsBOYAmt
Total Assets EOY$7,481,305TotalAssetsEOYAmt
Total Liabilities BOY$110,307TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,034,673NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$7,481,305NetAssetsOrFundBalancesEOYAmt
MissionThrough our exceptional health care services, we reveal the healing presence of God.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescDELLS MEDICAL BUILDING, INC'S (DMBI) LEASING ACTIVITIES ARE A VITAL COMPONENT OF ST CLARE HOSPITAL'S MEDICAL STAFF DEVELOPMENT EFFORTS. BY PROVIDING QUALITY OFFICE SPACE IN THE HOSPITAL'S SERVICE AREA CONVENIENT TO MEMBERS OF THE PUBLIC, DMBI IS SUPPORTING ITS EFFORTS IN RECRUITING AND RETAINING QUALIFIED PHYSICIANS TO THESE LOCALITIES.Desc
Total Program Service Expenses$0TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Troy WalkerBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6083561423PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1707 14th StreetAddressLine1Txt
CityBarabooCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53913ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Laura Walczak
Director, President, Hospital President - St. Clare1.041.0Yes (X)Yes (X)$0$357,959$19,323
Scott Wysocki
Director, VP-Operations1.040.0Yes (X)$0$190,407$70,228
Troy Walker
Director, Director of Finance-WI1.040.0Yes (X)$0$165,925$41,743
Douglas Long
Secretary, General Counsel at SSM Health1.068.2Yes (X)$0$1,201,678$483,601
Randy Combs
Treasurer, Chief Financial Officer at SSM Health1.066.0Yes (X)$0$1,290,602$485,851
Steve Smoot
Vice President, Chief Operations Officer at SSM Health1.053.0Yes (X)$0$1,532,078$917,946
Thomas Kirschbaum
Assistant Secretary, General Counsel - WI1.042.0Yes (X)$0$454,287$183,535
Kris Zimmer
Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health0.00.0$0$219,379$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,412,315TotReportableCompRltdOrgAmt
Total Other Compensation$2,202,228TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescRent IncomeDesc
Business531120BusinessCd
Total Revenue Column$879,963TotalRevenueColumnAmt
Related Or Exempt Func Income$879,963RelatedOrExemptFuncIncomeAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$879,963TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$250TotalRevenueColumnAmt
Exclusion$250ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$880,213TotalRevenueColumnAmt
Related Or Exempt Func Income$879,963RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$250ExclusionAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,587TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$63,025TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$289,725TotalAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmt
Internal management fees$42,000
Space rental$37,244

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$433,581TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,378,428BOYAmt
EOY$3,040,339EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$51,556BOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,052,729LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$6,627,458LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,714,996BOYAmt
EOY$4,425,271EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$15,695EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,144,980BOYAmt
EOY$7,481,305EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$96,376BOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,931BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$110,307BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$7,034,673BOYAmt
EOY$7,481,305EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,034,673BOYAmt
EOY$7,481,305EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,144,980BOYAmt
EOY$7,481,305EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$446,632ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$380,000OtherCostOrOtherBasisAmt
Book Value$380,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,341,256OtherCostOrOtherBasisAmt
Depreciation$6,375,656DepreciationAmt
Book Value$3,965,600BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$140,573OtherCostOrOtherBasisAmt
Depreciation$140,113DepreciationAmt
Book Value$460BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$190,900OtherCostOrOtherBasisAmt
Depreciation$111,689DepreciationAmt
Book Value$79,211BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,425,271TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDue to AffiliatesDesc
FieldValueIRS element (for citing)
Total Liability$0TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationDells Medical Building, Inc.'s financial information is included in the consolidated audited financial statements of a related organization, SSM Health (SSMH). SSMH evaluates its uncertain tax positions on an annual basis. A tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolution of any related appeals or litigation processes, based on the technical merits. There have been no uncertain tax positions recorded in 2021 or 2020.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Laura Walczak
Director, President, Hospital President - St. Clare$0$230,064$0$34,366$0$93,529$0$6,825$0$12,498$0$377,282$0$94,923
Scott Wysocki
Director, VP-Operations$0$163,902$0$16,604$0$9,901$0$41,927$0$28,301$0$260,635$0$27,952
Troy Walker
Director, Director of Finance-WI$0$151,061$0$8,000$0$6,864$0$4,930$0$36,813$0$207,668$0$6,031
Kris Zimmer
Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health$0$0$0$219,008$0$372$0$0$0$0$0$219,379$0$372
Steve Smoot
Vice President, Chief Operations Officer at SSM Health$0$1,014,744$0$506,986$0$10,347$0$877,981$0$39,965$0$2,450,024$0$506,986
Douglas Long
Secretary, General Counsel at SSM Health$0$683,805$0$374,673$0$143,200$0$460,492$0$23,109$0$1,685,279$0$374,673
Randy Combs
Treasurer, Chief Financial Officer at SSM Health$0$940,014$0$182,693$0$167,895$0$478,907$0$6,945$0$1,776,454$0$82,693
Thomas Kirschbaum
Assistant Secretary, General Counsel - WI$0$368,861$0$62,127$0$23,299$0$145,570$0$37,965$0$637,822$0$79,849

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationThe organization's top management official, president, is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the SSM Health Board of Directors.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planPension Restoration Plan: SSM Health (SSMH) provides this supplemental defined benefit nonqualified retirement plan to any employee who is a participant in the SSMH qualified defined benefit plan who earns over the Internal Revenue Service compensation limit. The plan "restores" the benefits to these employees that would have been provided under the SSMH qualified plan if the regulations did not impose compensation limits. An individual can take a distribution from the plan at (1) age 65 or older if the individual is still employed by SSMH or (2) age 55 or older if the individual is no longer employed by SSMH. No individuals listed on Part VII of Form 990 received distributions from the plan in 2021. 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 2021: Steve Smoot - $197,200 Thomas Kirschbaum - $17.722 Troy Walker - $6,031 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2021. All distributions received from the plan in the current year were included in the individual's taxable compensation. Kris Zimmer $372

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part V, Line 1aALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223.
Form 990, Part VI, Line 15aA related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 15bA related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 6 Classes of members or stockholdersThe sole member of the corporation is SSM Health Care of Wisconsin. SSM Health Care of Wisconsin is a nonprofit 501(c)(3) organization that currently operates three hospitals and two nursing homes in Wisconsin. Both Dells Medical Building, Inc. and SSM Health Care of Wisconsin are part of the integrated health care system known as SSM Health, which operates in four states and operates 20 hospital locations.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyDirectors are elected by a majority vote of all outstanding shares.
Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing bodyThe organization does not have any committees with authority to act on behalf of the governing body.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyThe Form 990 is prepared by the Tax Department of the parent organization, SSM Health Care Corporation (SSM). The Form 990 is reviewed by certain members of Senior Management. Any questions are addressed to the Tax Director of SSM prior to filing the Form 990 with the Internal Revenue Service. A copy of the Form 990 is provided to the Board of Directors at the next regularly scheduled board meeting.
Form 990, Part VI, Line 12c Conflict of interest policyBoard 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 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, Line 19 Required documents available to the publicThe year-end audited consolidated financial statements and unaudited quarterly consolidated financial statements for the SSM Health System are made available to the public on SSM Health's website. The organization's articles of incorporation are available upon request to the Wisconsin Department of Financial Institution's office. Copies of the Form 990 and the organization's conflict of interest policy are available to the public upon request.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (53 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
SSM Health Care Corporation
10101 Woodfield LaneSt LouisMO63132466029223Health CareMO501(c)(3)Type ISSM Health Ministriesfalse
SSMHC Liability Trust I
10101 Woodfield LaneSt LouisMO63132436331003InsuranceMO501(c)(3)Type ISSM Health Care Corporationfalse
SSM Consolidated Health Services
10101 Woodfield LaneSt LouisMO63132431473657Health CareMO501(c)(3)10SSM Health Care Corporationfalse
SSM Policy Institute
10101 Woodfield LaneSt LouisMO63132431788151Health CareMO501(c)(4)SSM Health Care Corporationfalse
SSM Health Care Portfolio Management Co
10101 Woodfield LaneSt LouisMO63132431825256ManagementMO501(c)(3)Type ISSM Health Care Corporationfalse
SSM Cardinal Glennon Children's Hospital
10101 Woodfield LaneSt LouisMO63132430738490Health CareMO501(c)(3)3SSM Health Care St Louisfalse
Cardinal Glennon Children's Foundation
10101 Woodfield LaneSt LouisMO63132431754347FundraisingMO501(c)(3)7SSM Cardinal Glennon Children's Hospitalfalse
SSM Health Foundation - St Louis
10101 Woodfield LaneSt LouisMO63132431552945FundraisingMO501(c)(3)7SSM Health Care St Louisfalse
SSM Health Care of Oklahoma Inc
10101 Woodfield LaneSt LouisMO63132730657693Health CareOK501(c)(3)3SSM Health Care Corporationfalse
The St Anthony Hospital Foundation Inc
10101 Woodfield LaneSt LouisMO63132736104300FundraisingOK501(c)(3)7SSM Health Care of Oklahomafalse
SSM Health Care of Wisconsin Inc
10101 Woodfield LaneSt LouisMO63132430688874Health CareWI501(c)(3)3SSM Health Care Corporationfalse
Dells Medical Building Inc
10101 Woodfield LaneSt LouisMO63132391613292MOBWI501(c)(2)SSM Health Care of Wisconsinfalse
St Mary's Foundation Inc
10101 Woodfield LaneSt LouisMO63132431940686FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
St Clare Health Care Foundation Inc
10101 Woodfield LaneSt LouisMO63132431940683FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
Home Health United Inc
2802 Walton Commons LaneMadisonWI53718391539827Health CareWI501(c)(3)10SSM Health Care of Wisconsinfalse
Home Care United Inc
2802 Walton Commons LaneMadisonWI53718391776340Health CareWI501(c)(3)10SSM Health Care of Wisconsinfalse
HHU Xtra Care Inc
2802 Walton Commons LaneMadisonWI53718391705111Health CareWI501(c)(3)10SSM Health Care of Wisconsinfalse
SSM Health at Home Foundation of Wisconsin Inc
2802 Walton Commons LaneMadisonWI53718391839309FundraisingWI501(c)(3)Type IHome Health United Incfalse
SSM Regional Health Services
10101 Woodfield LaneSt LouisMO63132440579850Health CareMO501(c)(3)3SSM Health Care Corporationfalse
St Mary's Health Center Jefferson City Missouri Foundation
10101 Woodfield LaneSt LouisMO63132431575307FundraisingMO501(c)(3)Type ISSM Regional Health Servicesfalse
Good Samaritan Regional Health Center
10101 Woodfield LaneSt LouisMO63132430653587Health CareIL501(c)(3)3SSM Regional Health Servicesfalse
St Mary's Hospital Centralia Illinois
10101 Woodfield LaneSt LouisMO63132370662580Health CareIL501(c)(3)3SSM Regional Health Servicesfalse
St Mary's - Good Samaritan Inc
10101 Woodfield LaneSt LouisMO63132364170833Health CareIL501(c)(3)Type ISSM Regional Health Servicesfalse
Good Samaritan Regional Health Center Foundation
10101 Woodfield LaneSt LouisMO63132262884795FundraisingIL501(c)(3)7St Mary's-Good Samaritan Incfalse
St Mary's Hospital Foundation
10101 Woodfield LaneSt LouisMO63132364636691FundraisingIL501(c)(3)7St Mary's-Good Samaritan Incfalse
St Mary's Hospital Auxiliary
400 N PleasantCentraliaIL62801237126345FundraisingIL501(c)(3)10St Mary's Hospital Foundationfalse
SSM Health Businesses
10101 Woodfield LaneSt LouisMO63132431333488Health CareMO501(c)(3)10SSM Health Care Corporationfalse
SSM Health Care St Louis
10101 Woodfield LaneSt LouisMO63132431343281Health CareMO501(c)(3)3SSM Health Care Corporationfalse
Centralia Medical Services Bldg Assoc
10101 Woodfield LaneSt LouisMO63132237408025MOBIL501(c)(3)Type ISSM Regional Health Servicesfalse
St Mary's Janesville Foundation Inc
10101 Woodfield LaneSt LouisMO63132273439133FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
SSM Health Ministries
3221 McKelvey Road Suite 107BridgetonMO63044431012492Religious OrganizationMO501(c)(3)1NAfalse
Lee Dewey Corporation
10101 Woodfield LaneSt LouisMO63132731279603MOBOK501(c)(3)Type ISSM Health Care of Oklahomafalse
SSM Hospice & Home Care Foundation
10101 Woodfield LaneSt LouisMO63132300012246FundraisingMO501(c)(3)7SSM Health Businessesfalse
St Mary's Hospital Auxiliary
100 St Marys Medical PlazaJefferson CityMO65101436049878FundraisingMO501(c)(3)Type IINAfalse
Good Samaritan Hospital Auxiliary
1 Good Samaritan WayMount VernonIL62864237049599FundraisingIL501(c)(3)Type III-FINAfalse
St Anthony Shawnee Hospital Inc
1000 N Lee AveOklahoma CityOK73102455055149Health CareOK501(c)(3)3SSM Health Care of Oklahomafalse
SSM Audrain Health Care Inc
10101 Woodfield LaneSt LouisMO63132431550298Health CareMO501(c)(3)3SSM Regional Health Servicesfalse
Audrain Medical Center Foundation Inc
620 E Monroe StMexicoMO65265431265060FundraisingMO501(c)(3)Type INAfalse
SSM-SLUH Inc
10101 Woodfield LaneSt LouisMO63132474196634Health CareMO501(c)(3)3SSM Health Care St Louisfalse
SSM Health Plan
1277 Deming WayMadisonWI53717831979548InsuranceMO501(c)(4)SSM Health Businessesfalse
Agnesian Healthcare Inc
430 E Division StFond du LacWI54935390807236Health CareWI501(c)(3)3SSM Health Care of Wisconsinfalse
Ripon Medical Center Inc
845 Parkside StreetRiponWI54971391101287Health CareWI501(c)(3)3Agnesian Healthcare Incfalse
Waupun Memorial Hospital Inc
620 West Brown StreetWaupunWI53963390806265Health CareWI501(c)(3)3Agnesian Healthcare Incfalse
St Francis Home of Fond du Lac Wisconsin Inc
33 Everett StreetFond du LacWI54935391029998Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
Sister Servants of Christ the King Villa Loretto
N8114 County WWMount CalvaryWI53057391022770Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
Villa Rosa Inc
N8120 County WWMount CalvaryWI53057421670962Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
The Christian Home and Rehabilitation Center Incorporated
331 Bly StreetWaupunWI53963390884514Health CareWI501(c)(3)10Agnesian Healthcare Incfalse
The Monroe Clinic Inc
515 22nd AvenueMonroeWI53566390808509Health CareWI501(c)(3)3SSM Health Care of Wisconsinfalse
Monroe Clinic and Hospital Foundation Inc
515 22nd AvenueMonroeWI53566205769038FundraisingWI501(c)(3)7SSM Health Care of Wisconsinfalse
Agnesian Healthcare Foundation Inc
430 E Division StFond du LacWI54935391684956FundraisingWI501(c)(3)Type ISSM Health Care of Wisconsinfalse
Shared Magnetic Resonance Imaging Facility Inc
1104 John Nolen DriveMadisonWI53713391534744Health CareWI501(c)(3)Type ISSM Health Care of Wisconsinfalse
SSM Health Cardinal Glennon Transport
10101 Woodfield LaneSt LouisMO63132863519607Health CareMO501(c)(3)Type ISSM Cardinal Glennon Children's Hospitalfalse
SSM Health Foundation
10101 Woodfield LaneSt LouisMO63132874109859FundraisingMO501(c)(3)Type ISSM Health Care Corporationfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (18 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
SSM St Joseph Endoscopy Center LLC
10101 Woodfield LaneSt LouisMO63132270046559Surgery ServicesMONAN/A
St Clare Imaging Services LLC
707 14th Street Suite ABarabooWI53913200122365Diag. ServicesWINAN/A
Mt Vernon Radiation Therapy Center LLC
10101 Woodfield LaneSt LouisMO63132201382620Radiation TherapyILNAN/A
Sleep & Neurology Center of Southern Illinois LLC
10101 Woodfield LaneSt LouisMO63132208468195Diag. ServicesILNAN/A
CHOWSMGSI Office Building LLC
10101 Woodfield LaneSt LouisMO63132371383861MOBILNAN/A
Oza Cancer Center LLC
10101 Woodfield LaneSt LouisMO63132201382727MOBILNAN/A
Shawnee Real Estate Holdings LLC
1000 N Lee AveOklahoma CityOK73102455458304MOBOKNAN/A
Dean Clinic & St Mary's Hospital Accountable Care Organization LLC
1808 West Beltline HighwayMadisonWI53713452995500Accountable Care OrganizationWINAN/A
Wisconsin Integrated Information Technology and Telemedicine Systems LLC
1808 West Beltline HighwayMadisonWI53713392016715Information Technology ServicesWINAN/A
Dean Health Holdings LLC
1277 Deming WayMadisonWI53717261594709Support ServicesWINAN/A
Wingra Building Group
1808 West Beltline HighwayMadisonWI53713390237060MOBWINAN/A
Janesville Riverview Clinic Building Partnership
1808 West Beltline HighwayMadisonWI53713396220698MOBWINAN/A
1110 N Classen Blvd LLC
1110 N Classen BoulevardOklahoma CityOK73106731158158MOBOKNAN/A
SSM St Clare Surgical Center LLC
10101 Woodfield LaneSt LouisMO63132261439695Surgery ServicesMONAN/A
Windmill LLP
50 Village View LaneChesterfieldMO63017431804651InvestmentsMONAN/A
Navitus Health Solutions LLC
361 Integrity DriveMadisonWI53717043608530Pharmacy BenefitsWINAN/A
SSM Select Rehab St Louis LLC
4714 Gettysburg RoadMechanicsburgPA17055263694972Health CareDENAN/A
Epiphany Rx LLC
361 Integrity DriveMadisonWI53717364855405Pharmacy BenefitsDENAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (21 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
SSM Managed Care Organization LLC
10101 Woodfield LaneSt LouisMO63132431708511Health PromotionMONAC Corporationfalse
FPP INC & Subs
10101 Woodfield LaneSt LouisMO63132431465174Health CareMONAC Corporationfalse
Diversified Health Services Corp
10101 Woodfield LaneSt LouisMO63132431369305Medical EquipmentMONAC Corporationfalse
SSM Properties Inc
10101 Woodfield LaneSt LouisMO63132431462486Property ServicesMONAC Corporationfalse
HealthFirst Physician Management Services
10101 Woodfield LaneSt LouisMO63132731534336Medical ServicesOKNAC Corporationfalse
SSMHC Liability Trust II
10101 Woodfield LaneSt LouisMO63132816128118InsuranceMONAC Corporationfalse
SSM Medical Group Inc
10101 Woodfield LaneSt LouisMO63132431664107Physician OfficesMONAC Corporationfalse
SSMHC Insurance Company
030310431InsuranceNAC CorporationfalsePO Box 1051 GTGrand CaymanCJKY11102CJ
Physicians Services Corp of Southern Illinois Inc
10101 Woodfield LaneSt LouisMO63132364161526Health CareILNAC Corporationfalse
Dean Health Systems Inc
1808 West Beltline HighwayMadisonWI53713391128616Physician OfficesWINAC Corporationfalse
Dean Health Insurance Inc
PO Box 56099MadisonWI53705391830837InsuranceWINAC Corporationfalse
Dean Health Plan Inc
PO Box 56099MadisonWI53705391535024InsuranceWINAC Corporationfalse
Dean Retail Services Inc
1808 West Beltline HighwayMadisonWI53713391717636Property ServicesWINAC Corporationfalse
Oza Oncology Inc
4117 Veterans Memorial DriveMt VernonIL62804371343746Physician OfficesILNAS Corporationfalse
SSM Health Janesville Campus Condominium Association Inc
1808 West Beltline HighwayMadisonWI53713832038674Condo associationWINAC Corporationfalse
SSM Health Pharmacy LLC
10101 Woodfield LaneSt LouisMO63132264031708PharmacyMONAC Corporationfalse
SSM Health Insurance Company
1277 Deming WayMadisonWI53717834718249InsuranceMONAC Corporationfalse
Navitus Holdings LLC
1808 West Beltline HighwayMadisonWI53713800968174PharmacyWINAC Corporationfalse
MS Community JV LLC
401 Carlson Parkway CP330MinnetonkaMN55305873240022InsuranceDENAC Corporationfalse
Quality Drug Corporation
239 BroadwayLaguna BeachCA92651330644268Pharmacy benefitsCANAC Corporationfalse
St Mary's Hospital Campus Condominium Owners Association Inc
707 South Mills StreetMadisonWI53715000000000Condo associationWINAC Corporationfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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