CENTRALIA MEDICAL SERVICES: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CENTRALIA MEDICAL SERVICES (EIN 23-7408025)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-04
- IRS object ID
- 202133089349303208
- Schema version
- 2020v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-04T14:01:25-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237408025 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Centralia Medical Services Building Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 6184368000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 Woodfield Ln | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Randy Combs | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Signature | 2021-11-04 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Randy | PersonFirstNm |
| Person Last | Combs | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jeremy Fotheringham | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 Woodfield Ln | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $273,918 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ssmhealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | Rental of office space to Physicians to facilitate patient and hospital accessibility. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $305,676 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $273,918 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$4,486 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $301,190 | PYTotalRevenueAmt |
| CY Total Revenue | $273,918 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $360,043 | PYOtherExpensesAmt |
| CY Other Expenses | $343,036 | CYOtherExpensesAmt |
| PY Total Expenses | $360,043 | PYTotalExpensesAmt |
| CY Total Expenses | $343,036 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$58,853 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$69,118 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,045,480 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,165,906 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,024,960 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,214,504 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,020,520 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $951,402 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Through our exceptional health care services, we reveal the healing presence of God. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $333,134 | ExpenseAmt |
| Revenue | $273,918 | RevenueAmt |
| Desc | CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION PROMOTED HEALTH CARE PROGRAMS IN THE COMMUNITY BY PROVIDING OFFICE SPACE TO PHYSICIANS, an MRI suite, and a convenient care location. These services increase THE AVAILABILITY OF DOCTORS FOR MEDICAL EMERGENCIES AND provide added CONVENIENCE FOR THE PATIENT IN HOSPITAL ACCESSIBILITY. | Desc |
| Total Program Service Expenses | $333,134 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | false | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | 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 | Kelly Marhanka | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6184367565 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 N Pleasant Ave | AddressLine1Txt |
| City | Centralia | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 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 |
|---|---|---|---|---|---|---|---|---|
| Candace Jennings | ||||||||
| Director, Chairperson, Regional President-St. Louis/Southern Illinois | 1.0 | 46.0 | Yes (X) | Yes (X) | $0 | $1,170,577 | $342,361 | |
| Elizabeth Franczyk MD | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Kimberly McMillan | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Patricia Williams | ||||||||
| Director | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||
| Rev Ron Johnson | ||||||||
| Director | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||
| Robert Brown | ||||||||
| Director | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||
| Ryan Willis MD | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Sajjan K Nemani MD | ||||||||
| Director, Physician at SSM Health | 1.0 | 43.0 | Yes (X) | $0 | $484,420 | $0 | ||
| Sr M Clarette Stryzewski CSSF | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Sr M Ramona Dombrowski CSSF | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Stacy Tate | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Yagnesh Oza MD | ||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||
| Douglas Long | ||||||||
| Secretary, General Counsel at SSM Health | 1.0 | 68.2 | Yes (X) | $0 | $1,201,821 | $399,352 | ||
| John Snodsmith | ||||||||
| Regional VP, Finance | 1.0 | 43.0 | Yes (X) | $0 | $192,891 | $45,208 | ||
| Karen Rewerts | ||||||||
| VP - Financial Operations | 1.0 | 51.0 | Yes (X) | $0 | $790,849 | $178,749 | ||
| Kris Zimmer | ||||||||
| Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health | 1.0 | 67.0 | Yes (X) | $0 | $1,717,045 | $73,075 | ||
| Rachel Hall | ||||||||
| Assistant Secretary | 1.0 | 43.0 | Yes (X) | $0 | $93,828 | $27,636 | ||
| Randy Combs | ||||||||
| Treasurer, Chief Financial Officer at SSM Health | 1.0 | 64.0 | Yes (X) | $0 | $403,263 | $84,602 | ||
| Kerry Swanson | ||||||||
| Former Officer | 0.0 | 40.0 | $0 | $918,478 | $35,971 | Yes (X) | ||
| Laura Kaiser | ||||||||
| Former Officer | 0.0 | 46.0 | $0 | $3,454,725 | $1,724,577 | Yes (X) | ||
| Matt Kinsella | ||||||||
| Former Officer | 0.0 | 40.0 | $0 | $403,374 | $129,930 | Yes (X) | ||
| Paula Friedman | ||||||||
| Former Officer | 0.0 | 0.0 | $0 | $507,002 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $11,338,273 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $3,041,461 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Rental Income | Desc |
| Business | 531120 | BusinessCd |
| Total Revenue Column | $273,918 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $273,918 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $273,918 | TotalProgramServiceRevenueAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $273,918 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $273,918 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,161 | TotalAmt |
| Program Services | $5,923 | ProgramServicesAmt |
| Management And General | $1,238 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,864 | TotalAmt |
| Program Services | $6,864 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,473 | TotalAmt |
| Program Services | $179,209 | ProgramServicesAmt |
| Management And General | $264 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,311 | TotalAmt |
| Program Services | $136,311 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,627 | TotalAmt |
| Program Services | $3,627 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Parking lot lease | $1,200 | $1,200 | |
| Internal management fees | $8,400 | $8,400 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,036 | TotalAmt |
| Program Services | $333,134 | ProgramServicesAmt |
| Management And General | $9,902 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,070,451 | BOYAmt |
| EOY | $1,291,354 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,548 | BOYAmt |
| EOY | $40,421 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,596 | BOYAmt |
| EOY | $3,596 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,552,170 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,816,892 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,869,993 | BOYAmt |
| EOY | $1,735,278 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,892 | BOYAmt |
| EOY | $95,257 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,045,480 | BOYAmt |
| EOY | $3,165,906 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $339,859 | BOYAmt |
| EOY | $120,304 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,685,101 | BOYAmt |
| EOY | $2,094,200 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,024,960 | BOYAmt |
| EOY | $2,214,504 | 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 | $1,020,520 | BOYAmt |
| EOY | $951,402 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,020,520 | BOYAmt |
| EOY | $951,402 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,045,480 | BOYAmt |
| EOY | $3,165,906 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$69,118 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HOSPITAL CENTRALIA ILLINOIS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370662580 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (true) | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part I, Line 12g(iii) ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS | FormAndLineReferenceDesc |
| Explanation | CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION IS A TYPE II SUPPORTING ORGANIZATION THAT IS OPERATED EXCLUSIVELY TO SUPPORT THE OPERATIONS OF ST. MARY'S HOSPITAL, A RELATED TAX-EXEMPT ORGANIZATION. THE AMOUNT OF SUPPORT PROVIDED TO ST. MARY'S HOSPITAL ON SCHEDULE A, PART I, LINE 11(H)(V) AND LINE 11(H)(VI) DOES NOT INCLUDE EXPENSES PAID ON BEHALF OF BUT NOT DIRECTLY TO ST. MARY'S HOSPITAL. THESE EXPENSES TOTALED $333,134 DURING THE YEAR ENDED DECEMBER 31, 2020. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $67,481 | OtherCostOrOtherBasisAmt |
| Book Value | $67,481 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,332,927 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,704,295 | DepreciationAmt |
| Book Value | $1,628,632 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,612 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,213 | DepreciationAmt |
| Book Value | $10,399 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $131,150 | OtherCostOrOtherBasisAmt |
| Depreciation | $102,384 | DepreciationAmt |
| Book Value | $28,766 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,735,278 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Asset Retirement Obligation | $55,091 |
| Due to Affiliates | $2,039,109 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,094,200 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | Centralia Medical Services Building Association's financial information is included in the consolidated audited financial statements of a related organization, SSM Health (SSMH). SSMH evaluates its uncertain tax positions on an annual basis. A tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. There have been no uncertain tax positions recorded in 2020 or 2019. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Candace Jennings | ||||||||||||||
| Director, Chairperson, Regional President-St. Louis/Southern Illinois | $0 | $668,869 | $0 | $398,415 | $0 | $103,293 | $0 | $315,729 | $0 | $26,632 | $0 | $1,512,938 | $0 | $479,468 |
| Sajjan K Nemani MD | ||||||||||||||
| Director, Physician at SSM Health | $0 | $484,420 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $484,420 | $0 | $0 |
| Kerry Swanson | ||||||||||||||
| Former Officer | $0 | $206,595 | $0 | $191,770 | $0 | $520,113 | $0 | $1,315 | $0 | $34,656 | $0 | $954,449 | $0 | $367,686 |
| Matt Kinsella | ||||||||||||||
| Former Officer | $0 | $333,432 | $0 | $40,672 | $0 | $29,270 | $0 | $90,617 | $0 | $39,313 | $0 | $533,304 | $0 | $40,920 |
| Laura Kaiser | ||||||||||||||
| Former Officer | $0 | $1,605,981 | $0 | $1,659,602 | $0 | $189,142 | $0 | $1,696,604 | $0 | $27,973 | $0 | $5,179,302 | $0 | $1,659,576 |
| Paula Friedman | ||||||||||||||
| Former Officer | $0 | $0 | $0 | $249,317 | $0 | $257,685 | $0 | $0 | $0 | $0 | $0 | $507,002 | $0 | $258,551 |
| Kris Zimmer | ||||||||||||||
| Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health | $0 | $370,664 | $0 | $803,048 | $0 | $543,333 | $0 | $56,137 | $0 | $16,938 | $0 | $1,790,120 | $0 | $1,162,526 |
| Douglas Long | ||||||||||||||
| Secretary, General Counsel at SSM Health | $0 | $645,435 | $0 | $469,242 | $0 | $87,144 | $0 | $374,673 | $0 | $24,679 | $0 | $1,601,173 | $0 | $547,438 |
| Karen Rewerts | ||||||||||||||
| VP - Financial Operations | $0 | $555,842 | $0 | $109,440 | $0 | $125,567 | $0 | $146,048 | $0 | $32,701 | $0 | $969,598 | $0 | $168,566 |
| John Snodsmith | ||||||||||||||
| Regional VP, Finance | $0 | $161,458 | $0 | $0 | $0 | $31,433 | $0 | $27,748 | $0 | $17,460 | $0 | $238,099 | $0 | $0 |
| Randy Combs | ||||||||||||||
| Treasurer, Chief Financial Officer at SSM Health | $0 | $216,927 | $0 | $100,000 | $0 | $86,336 | $0 | $82,693 | $0 | $1,909 | $0 | $487,865 | $0 | $84,600 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | The organization's top management official, Regional President, is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the SSM Health Board of Directors. |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | SSM Health has adopted a severance policy to provide a financial transition in the event of involuntary termination without cause for executive level positions. The amount of the compensation is based on the position held and length of service with SSMH. The following individuals listed in Part VII of the Form 990 received payments under the plan in the current year: Paula Friedman $257,685 Kerry Swanson $338,461 |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | Pension Restoration Plan: SSM Health (SSMH) provides this supplemental defined benefit nonqualified retirement plan to any employee who is a participant in the SSMH qualified defined benefit plan who earns over the Internal Revenue Service compensation limit. The plan "restores" the benefits to these employees that would have been provided under the SSMH qualified plan if the regulations did not impose compensation limits. An individual can take a distribution from the plan at (1) age 65 or older if the individual is still employed by SSMH or (2) age 55 or older if the individual is no longer employed by SSMH. No individuals listed on Part VII of Form 990 received distributions from the plan in 2020. Capital Accumulation Plan: SSMH provides this supplemental nonqualified retirement plan to executive level employees. The organization contributed a percentage of the employee's base salary into their choice of a select list of investments. The deposits and earnings of the plan are owned by SSMH and are tax-deferred until a distribution is made to the employee. In addition, the plan has special safeguards in place to protect the funds from contingencies, other than insolvency. For contributions made to the plan in 2014 or after, the distribution will occur after the completion of four plan years for all executives that are still actively employed on the distribution date. Any active participant 65 years or older will receive the contribution in the current year. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2020: Kris Zimmer $54,000 Karen Rewerts $45,600 John Snodsmith $10,000 Laura Kaiser $314,000 Matt Kinsella $27,200 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2020. All distributions received from the plan in the current year were included in the individual's taxable compensation. Candace Jennings $81,053 Kris Zimmer $493,428 Randy Combs $84,600 Douglas Long $78,000 Karen Rewerts $59,124 During 2020, the following individuals participated in a nonqualified retirement plan from the organization or a related organization. The amounts reported below represent the change in accrued benefit for each individual and also include amounts accrued under the pension restoration plan: Candace Jennings $9,258 Kris Zimmer $26,226 Karen Rewerts $43,291 Kerry Swanson $2,812 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1a | ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223. |
| Form 990, Part VI, Line 15a Process for determining compensation | A 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 15b Process for determining compensation | A 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 stockholders | The sole corporate member of the corporation is SSM Regional Health Services. SSM Regional Health Services is a nonprofit 501(c)(3) organization. Both Centralia Medical Services Building Association and SSM Regional Health Services are part of the integrated health care system known as SSM Health, which operates hospitals, two skilled nursing facilities and home health agencies in four states. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | The member has the power to appoint additional, successor or replacement members and elect and remove directors. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | The member has the following powers: A. To establish and change the mission, philosophy and values of the corporation B. To appoint additional, successor or replacement members C. To appoint and remove the appointed directors and the ex officio directors D. To appoint and remove the chief executive officer of any operating division of the corporation E. To approve the amendments to the articles of incorporation of the corporation as provided therein F. To approve amendments to the bylaws of the corporation G. To approve the merger, consolidation or dissolution of the corporation H. To approve the formation of a controlled subsidiary or a remotely controlled subsidiary I. To approve the sale of all or substantially all of the assets of the corporation J. To approve the acquisition or disposition by the corporation of another legal entity or an interest in another legal entity K. To authorize or approve the acquisition or disposition by the corporation of real property or any interest in real property L. To establish centralized employee benefits, insurance, investment, financing, corporate responsibility, performance assessment and improvement and other operational and support programs, to require the participation of the corporation in such programs, and to authorize the opening and closing of bank accounts and investment accounts in the name of the corporation in connection with such programs M. To approve the strategic, financial and human resources plan of the corporation N. To appoint the auditor and corporate counsel for the corporation O. To authorize and approve borrowing money and entering into financial guaranties by the corporation, including actions relating to the formation, joining, operation, withdrawal from and termination of a credit group or an obligation group and the granting of security interests in the property of the corporation P. To require the corporation to transfer assets, including but not limited to cash, to the member of the corporate member or to any entity exempt from federal income tax as an organization described in section 501(c)(3) of the internal revenue code of 1986, as amended, or the corresponding provision of any future united states internal revenue law, which is controlled by the member of the corporate member, to the extent necessary to accomplish the mission, goals and objectives of the member of the corporate member as determined by the member of the corporate member Q. To approve the transfer of assets by the corporation to any entity other than the member of the corporate member, other than transfers made in the ordinary course of operations of the corporation which will not require corporate member approval; and R. To determine the extent to which and the manner in which the powers described in this section which are reserved to the corporate member with respect to the corporation are to be included in the governing documents of any controlled subsidiary, remotely controlled subsidiary or non-controlled subsidiary and exercised with respect to any controlled subsidiary, any remotely controlled subsidiary or any non-controlled subsidiary. |
| Form 990, Part VI, 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, Line 11b Review of form 990 by governing body | The Form 990 is prepared by the Tax Department of the parent organization, SSM Health Care Corporation (SSM). The Form 990 is reviewed by certain members of Senior Management. Any questions are addressed to the Tax Director of SSM prior to filing the Form 990 with the Internal Revenue Service. A copy of the Form 990 is provided to the Board of Directors at the next regularly scheduled board meeting. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Board members are required to complete a conflict of interest disclosure statement annually. The President and Secretary of the Board oversee compliance with this requirement. All Board members with an identified conflict of interest abstain from Board discussions and votes when applicable. Employees with purchasing authority and/or ability to influence purchasing decisions are assigned the conflict of interest disclosure course (COI) which must be completed 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 public | The year-end audited consolidated financial statements and unaudited quarterly consolidated financial statements for the SSM Health System are made available to the public on SSM Health's Website. The organization's articles of incorporation are available on the Illinois secretary of state's website. Copies of the form 990 and the organization's conflict of interest policy are available upon request. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (50 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SSM Health Care Corporation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 466029223 | Health Care | MO | 501(c)(3) | Type I | SSM Health Ministries | false |
| SSMHC Liability Trust I | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 436331003 | Insurance | MO | 501(c)(3) | Type I | SSM Health Care Corporation | false |
| SSM Consolidated Health Services | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431473657 | Health Care | MO | 501(c)(3) | 10 | SSM Health Care Corporation | false |
| SSM Policy Institute | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431788151 | Health Care | MO | 501(c)(4) | SSM Health Care Corporation | false | |
| SSM Health Care Portfolio Management Co | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431825256 | Management | MO | 501(c)(3) | Type I | SSM Health Care Corporation | false |
| SSM Cardinal Glennon Children's Hospital | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 430738490 | Health Care | MO | 501(c)(3) | 3 | SSM Health Care St Louis | false |
| Cardinal Glennon Children's Foundation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431754347 | Fundraising | MO | 501(c)(3) | 7 | SSM Cardinal Glennon Children's Hospital | false |
| SSM Health Foundation - St Louis | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431552945 | Fundraising | MO | 501(c)(3) | 7 | SSM Health Care St Louis | false |
| SSM Health Care of Oklahoma Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 730657693 | Health Care | OK | 501(c)(3) | 3 | SSM Health Care Corporation | false |
| The St Anthony Hospital Foundation Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 736104300 | Fundraising | OK | 501(c)(3) | 7 | SSM Health Care of Oklahoma | false |
| SSM Health Care of Wisconsin Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 430688874 | Health Care | WI | 501(c)(3) | 3 | SSM Health Care Corporation | false |
| Dells Medical Building Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 391613292 | MOB | WI | 501(c)(2) | SSM Health Care of Wisconsin | false | |
| St Mary's Foundation Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431940686 | Fundraising | WI | 501(c)(3) | 7 | SSM Health Care of Wisconsin | false |
| St Clare Health Care Foundation Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431940683 | Fundraising | WI | 501(c)(3) | 7 | SSM Health Care of Wisconsin | false |
| Home Health United Inc | ||||||||||
| 2802 Walton Commons Lane | Madison | WI | 53718 | 391539827 | Health Care | WI | 501(c)(3) | 10 | SSM Health Care of Wisconsin | false |
| Home Care United Inc | ||||||||||
| 2802 Walton Commons Lane | Madison | WI | 53718 | 391776340 | Health Care | WI | 501(c)(3) | 10 | SSM Health Care of Wisconsin | false |
| HHU Xtra Care Inc | ||||||||||
| 2802 Walton Commons Lane | Madison | WI | 53718 | 391705111 | Health Care | WI | 501(c)(3) | 10 | SSM Health Care of Wisconsin | false |
| SSM Health at Home Foundation of Wisconsin Inc | ||||||||||
| 2802 Walton Commons Lane | Madison | WI | 53718 | 391839309 | Fundraising | WI | 501(c)(3) | Type I | Home Health United Inc | false |
| SSM Regional Health Services | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 440579850 | Health Care | MO | 501(c)(3) | 3 | SSM Health Care Corporation | false |
| St Mary's Health Center Jefferson City Missouri Foundation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431575307 | Fundraising | MO | 501(c)(3) | Type I | SSM Regional Health Services | false |
| Good Samaritan Regional Health Center | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 430653587 | Health Care | IL | 501(c)(3) | 3 | SSM Regional Health Services | false |
| St Mary's Hospital Centralia Illinois | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 370662580 | Health Care | IL | 501(c)(3) | 3 | SSM Regional Health Services | false |
| St Mary's - Good Samaritan Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 364170833 | Health Care | IL | 501(c)(3) | Type I | SSM Regional Health Services | false |
| Good Samaritan Regional Health Center Foundation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 262884795 | Fundraising | IL | 501(c)(3) | 7 | St Mary's-Good Samaritan Inc | false |
| St Mary's Hospital Foundation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 364636691 | Fundraising | IL | 501(c)(3) | 7 | St Mary's-Good Samaritan Inc | false |
| St Mary's Hospital Auxiliary | ||||||||||
| 400 N Pleasant | Centralia | IL | 62801 | 237126345 | Fundraising | IL | 501(c)(3) | 10 | St Mary's Hospital Foundation | false |
| SSM Health Businesses | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431333488 | Health Care | MO | 501(c)(3) | 10 | SSM Health Care Corporation | false |
| SSM Health Care St Louis | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431343281 | Health Care | MO | 501(c)(3) | 3 | SSM Health Care Corporation | false |
| St Mary's Janesville Foundation Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 273439133 | Fundraising | WI | 501(c)(3) | 7 | SSM Health Care of Wisconsin | false |
| SSM Health Ministries | ||||||||||
| 3221 McKelvey Road Suite 107 | Bridgeton | MO | 63044 | 431012492 | Religious Organization | MO | 501(c)(3) | 1 | NA | false |
| Lee Dewey Corporation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 731279603 | MOB | OK | 501(c)(3) | Type I | SSM Health Care of Oklahoma | false |
| SSM Hospice & Home Care Foundation | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 300012246 | Fundraising | MO | 501(c)(3) | 7 | SSM Health Businesses | false |
| St Mary's Hospital Auxiliary | ||||||||||
| 100 St Marys Medical Plaza | Jefferson City | MO | 65101 | 436049878 | Fundraising | MO | 501(c)(3) | Type II | NA | false |
| Good Samaritan Hospital Auxiliary | ||||||||||
| 1 Good Samaritan Way | Mount Vernon | IL | 62864 | 237049599 | Fundraising | IL | 501(c)(3) | Type III-FI | NA | false |
| St Anthony Shawnee Hospital Inc | ||||||||||
| 1000 N Lee Ave | Oklahoma City | OK | 73102 | 455055149 | Health Care | OK | 501(c)(3) | 3 | SSM Health Care of Oklahoma | false |
| SSM Audrain Health Care Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431550298 | Health Care | MO | 501(c)(3) | 3 | SSM Regional Health Services | false |
| Audrain Medical Center Foundation Inc | ||||||||||
| 620 E Monroe St | Mexico | MO | 65265 | 431265060 | Fundraising | MO | 501(c)(3) | Type I | NA | false |
| SSM-SLUH Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 474196634 | Health Care | MO | 501(c)(3) | 3 | SSM Health Care St Louis | false |
| SSM Health Plan | ||||||||||
| 1277 Deming Way | Madison | WI | 53717 | 831979548 | Insurance | MO | 501(c)(4) | SSM Health Businesses | false | |
| Agnesian Healthcare Inc | ||||||||||
| 430 E Division St | Fond du Lac | WI | 54935 | 390807236 | Health Care | WI | 501(c)(3) | 3 | SSM Health Care of Wisconsin | false |
| Ripon Medical Center Inc | ||||||||||
| 845 Parkside Street | Ripon | WI | 54971 | 391101287 | Health Care | WI | 501(c)(3) | 3 | Agnesian Healthcare Inc | false |
| Waupun Memorial Hospital Inc | ||||||||||
| 620 West Brown Street | Waupun | WI | 53963 | 390806265 | Health Care | WI | 501(c)(3) | 3 | Agnesian Healthcare Inc | false |
| St Francis Home of Fond du Lac Wisconsin Inc | ||||||||||
| 33 Everett Street | Fond du Lac | WI | 54935 | 391029998 | Health Care | WI | 501(c)(3) | 10 | Agnesian Healthcare Inc | false |
| Sister Servants of Christ the King Villa Loretto | ||||||||||
| N8114 County WW | Mount Calvary | WI | 53057 | 391022770 | Health Care | WI | 501(c)(3) | 10 | Agnesian Healthcare Inc | false |
| Villa Rosa Inc | ||||||||||
| N8120 County WW | Mount Calvary | WI | 53057 | 421670962 | Health Care | WI | 501(c)(3) | 10 | Agnesian Healthcare Inc | false |
| The Christian Home and Rehabilitation Center Incorporated | ||||||||||
| 331 Bly Street | Waupun | WI | 53963 | 390884514 | Health Care | WI | 501(c)(3) | 10 | Agnesian Healthcare Inc | false |
| The Monroe Clinic Inc | ||||||||||
| 515 22nd Avenue | Monroe | WI | 53566 | 390808509 | Health Care | WI | 501(c)(3) | 3 | SSM Health Care of Wisconsin | false |
| Monroe Clinic and Hospital Foundation Inc | ||||||||||
| 515 22nd Avenue | Monroe | WI | 53566 | 205769038 | Fundraising | WI | 501(c)(3) | 7 | SSM Health Care of Wisconsin | false |
| Agnesian Healthcare Foundation Inc | ||||||||||
| 430 E Division St | Fond du Lac | WI | 54935 | 391684956 | Fundraising | WI | 501(c)(3) | Type I | SSM Health Care of Wisconsin | false |
| Shared Magnetic Resonance Imaging Facility Inc | ||||||||||
| 1104 John Nolen Drive | Madison | WI | 53713 | 391534744 | Health Care | WI | 501(c)(3) | Type I | SSM Health Care of Wisconsin | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (16 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt |
|---|---|---|---|---|---|---|---|---|
| SSM St Joseph Endoscopy Center LLC | ||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 270046559 | Surgery Services | MO | NA | N/A |
| St Clare Imaging Services LLC | ||||||||
| 707 14th Street Suite A | Baraboo | WI | 53913 | 200122365 | Diag. Services | WI | NA | N/A |
| Mt Vernon Radiation Therapy Center LLC | ||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 201382620 | Radiation Therapy | IL | NA | N/A |
| Sleep & Neurology Center of Southern Illinois LLC | ||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 208468195 | Diag. Services | IL | NA | N/A |
| CHOWSMGSI Office Building LLC | ||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 371383861 | MOB | IL | NA | N/A |
| Oza Cancer Center LLC | ||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 201382727 | MOB | IL | NA | N/A |
| Shawnee Real Estate Holdings LLC | ||||||||
| 1000 N Lee Ave | Oklahoma City | OK | 73102 | 455458304 | MOB | OK | NA | N/A |
| Dean Clinic & St Mary's Hospital Accountable Care Organization LLC | ||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 452995500 | Accountable Care Organization | WI | NA | N/A |
| Wisconsin Integrated Information Technology and Telemedicine Systems LLC | ||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 392016715 | Information Technology Services | WI | NA | N/A |
| Dean Health Holdings LLC | ||||||||
| 1277 Deming Way | Madison | WI | 53717 | 261594709 | Support Services | WI | NA | N/A |
| Wingra Building Group | ||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 390237060 | MOB | WI | NA | N/A |
| Janesville Riverview Clinic Building Partnership | ||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 396220698 | MOB | WI | NA | N/A |
| 1110 N Classen Blvd LLC | ||||||||
| 1110 N Classen Boulevard | Oklahoma City | OK | 73106 | 731158158 | MOB | OK | NA | N/A |
| SSM St Clare Surgical Center LLC | ||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 261439695 | Surgery Services | MO | NA | N/A |
| Windmill LLP | ||||||||
| 50 Village View Lane | Chesterfield | MO | 63017 | 431804651 | Investments | MO | NA | N/A |
| Navitus Holdings LLC | ||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 800968174 | Pharmacy Benefits | WI | NA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (19 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|
| SSM Managed Care Organization LLC | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431708511 | Health Promotion | MO | NA | C Corporation | false | |
| FPP INC & Subs | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431465174 | Health Care | MO | NA | C Corporation | false | |
| Diversified Health Services Corp | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431369305 | Medical Equipment | MO | NA | C Corporation | false | |
| SSM Properties Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431462486 | Property Services | MO | NA | C Corporation | false | |
| HealthFirst Physician Management Services | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 731534336 | Medical Services | OK | NA | C Corporation | false | |
| SSMHC Liability Trust II | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 816128118 | Insurance | MO | NA | C Corporation | false | |
| SSM Medical Group Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431664107 | Physician Offices | MO | NA | C Corporation | false | |
| SSMHC Insurance Company | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 030310431 | Insurance | NA | C Corporation | false | CJ | |
| Physicians Services Corp of Southern Illinois Inc | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 364161526 | Health Care | IL | NA | C Corporation | false | |
| Dean Health Systems Inc | ||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 391128616 | Physician Offices | WI | NA | C Corporation | false | |
| Dean Health Insurance Inc | ||||||||||
| PO Box 56099 | Madison | WI | 53705 | 391830837 | Insurance | WI | NA | C Corporation | false | |
| Dean Health Plan Inc | ||||||||||
| PO Box 56099 | Madison | WI | 53705 | 391535024 | Insurance | WI | NA | C Corporation | false | |
| Dean Retail Services Inc | ||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 391717636 | Property Services | WI | NA | C Corporation | false | |
| Oza Oncology Inc | ||||||||||
| 4117 Veterans Memorial Drive | Mt Vernon | IL | 62804 | 371343746 | Physician Offices | IL | NA | S Corporation | false | |
| SSM Health Janesville Campus Condominium Association Inc | ||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 832038674 | Condo association | WI | NA | C Corporation | false | |
| SSM Health Pharmacy LLC | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 264031708 | Pharmacy | MO | NA | C Corporation | false | |
| Dane County Cytology Center Inc | ||||||||||
| 2000 Engel Street Suite 201 | Madison | WI | 53713 | 391414219 | Medical Services | WI | NA | C Corporation | false | |
| SSM Health Insurance Company | ||||||||||
| 1277 Deming Way | Madison | WI | 53717 | 834718249 | Insurance | MO | NA | C Corporation | false | |
| St Mary's Hospital Campus Condominium Owners Association Inc | ||||||||||
| 707 South Mills Street | Madison | WI | 53715 | 000000000 | Condo association | WI | NA | C Corporation | false | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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