GOOD SAMARITAN REGIONAL HEALTH CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN REGIONAL HEALTH CENTER (EIN 43-0653587)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201703179349306405
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-13T15:01:05-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Crowe Horwath LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9600 Brownsboro Road Suite 400 | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 402411122 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 430653587 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Regional Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 6188991040 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 Woodfield Lane | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | June L Pickett | PersonNm |
| Person Title | Secretary | PersonTitleTxt |
| Signature | 2017-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rachel Spurlock | PreparerPersonNm |
| PTIN | P00520729 | PTIN |
| Phone | 5023263996 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laura Kaiser | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 Woodfield Lane | AddressLine1Txt |
| City | St Louis | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $183,524,835 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ssmhealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1988 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | To continue the healing ministry of Jesus Christ by improving & providing regional, cost effective quality health services for everyone, with a special concern for the poor and vulnerable. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1395 | TotalEmployeeCnt |
| Total Volunteers | 110 | TotalVolunteersCnt |
| Total Gross UBI | $3,017,223 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $967,522 | PYContributionsGrantsAmt |
| CY Contributions Grants | $391,258 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $164,499,251 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $179,714,358 | CYProgramServiceRevenueAmt |
| PY Investment Income | $62,635 | PYInvestmentIncomeAmt |
| CY Investment Income | $115,721 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,274,067 | PYOtherRevenueAmt |
| CY Other Revenue | $2,486,465 | CYOtherRevenueAmt |
| PY Total Revenue | $167,803,475 | PYTotalRevenueAmt |
| CY Total Revenue | $182,707,802 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $104,317 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $61,806 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $71,209,700 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $76,314,181 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $88,619,190 | PYOtherExpensesAmt |
| CY Other Expenses | $93,926,916 | CYOtherExpensesAmt |
| PY Total Expenses | $159,933,207 | PYTotalExpensesAmt |
| CY Total Expenses | $170,302,903 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,870,268 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $12,404,899 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $236,633,754 | TotalAssetsBOYAmt |
| Total Assets EOY | $281,186,934 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $165,276,998 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $209,973,840 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $71,356,756 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $71,213,094 | 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 | $144,465,105 | ExpenseAmt |
| Grant | $61,806 | GrantAmt |
| Revenue | $178,519,755 | RevenueAmt |
| Desc | See Schedule O for a complete description of program service accomplishments. | Desc |
| Total Program Service Expenses | $144,465,105 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | 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 | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | 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 | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1395 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (true) | 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 | Yes (true) | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Matthew Kinsella | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6188991040 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 North Pleasant Ave | AddressLine1Txt |
| City | Centralia | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (32 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Paula Friedman | ||||||||||
| Vice President, Senior VP-Strategic Development SSM Health | 1.0 | 54.0 | Yes (X) | Yes (X) | $0 | $940,690 | $388,689 | |||
| William Thompson | ||||||||||
| Chair, President/CEO of SSM Health | 1.0 | 56.0 | Yes (X) | Yes (X) | $0 | $1,732,435 | $242,602 | |||
| Robert Brown | ||||||||||
| Director | 1.0 | 3.5 | Yes (X) | $0 | $0 | $0 | ||||
| Sr M Ramona Dombrowski CSSF | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Christopher Howard | ||||||||||
| Pres-Hospital Operations of SSM Health | 1.0 | 55.0 | Yes (X) | $0 | $1,129,635 | $404,326 | ||||
| Rev Ron Johnson | ||||||||||
| Director | 1.0 | 3.5 | Yes (X) | $0 | $0 | $0 | ||||
| Kimberly McMillan | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Sajjan K Nemani MD | ||||||||||
| Director | 1.0 | 43.0 | Yes (X) | $9,350 | $214,131 | $0 | ||||
| Sr M Clarette Stryzewski CSSF | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Stacy Tate | ||||||||||
| Director | 1.0 | 3.5 | Yes (X) | $0 | $0 | $0 | ||||
| Elizabeth Franczyk MD | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Yagnesh Oza MD | ||||||||||
| Director | 1.0 | 43.0 | Yes (X) | $0 | $54,139 | $0 | ||||
| Patricia Williams | ||||||||||
| Director | 1.0 | 2.0 | Yes (X) | $0 | $0 | $0 | ||||
| Ryan Willis MD | ||||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | ||||
| Deland Evischi | ||||||||||
| Pt Yr Regional CFO | 20.0 | 22.0 | Yes (X) | $0 | $241,160 | $110,676 | ||||
| June Pickett | ||||||||||
| Secretary | 1.0 | 65.1 | Yes (X) | $0 | $281,543 | $35,564 | ||||
| Michael Warren | ||||||||||
| Hospital President | 40.0 | 0.5 | Yes (X) | $0 | $473,698 | $60,750 | ||||
| Kris Zimmer | ||||||||||
| Treasurer, Senior VP-Finance SSM Health | 1.0 | 57.0 | Yes (X) | $0 | $1,105,377 | $344,110 | ||||
| Rachel Ruettgers | ||||||||||
| Assistant Secretary | 20.0 | 22.0 | Yes (X) | $0 | $61,229 | $21,577 | ||||
| Matthew Kinsella | ||||||||||
| Regional CFO | 20.0 | 22.0 | Yes (X) | $0 | $119,410 | $19,155 | ||||
| Christina Adams | ||||||||||
| VP Nursing | 40.0 | 0 | $208,227 | $0 | $136,903 | Yes (X) | ||||
| Mark Clark | ||||||||||
| VP Operations | 20.0 | 20.0 | $0 | $209,163 | $111,651 | Yes (X) | ||||
| Michelle Darnell | ||||||||||
| VP Systems Improvement | 20.0 | 20.0 | $180,593 | $0 | $87,728 | Yes (X) | ||||
| Julie Long | ||||||||||
| System VP - Strategic Development | 20.0 | 20.0 | $0 | $193,220 | $67,091 | Yes (X) | ||||
| Brenda Alexander | ||||||||||
| System VP - Human Resources | 20.0 | 20.0 | $0 | $137,764 | $30,135 | Yes (X) | ||||
| Matthew Sojka MD | ||||||||||
| Reg Pres - PO & Ambulatory Network | 20.0 | 20.0 | $0 | $358,411 | $49,271 | Yes (X) | ||||
| John Flick | ||||||||||
| Physician | 40.0 | 0 | $389,750 | $0 | $44,635 | Yes (X) | ||||
| Faisal Rashid | ||||||||||
| Physician | 40.0 | 0 | $594,967 | $0 | $69,394 | Yes (X) | ||||
| Anthony Vacca | ||||||||||
| Physician | 40.0 | 0 | $614,462 | $0 | $139,060 | Yes (X) | ||||
| Thomas Smith | ||||||||||
| Physician | 40.0 | 0 | $336,819 | $0 | $13,278 | Yes (X) | ||||
| Thejeswi Pujar | ||||||||||
| Physician | 40.0 | 0 | $303,470 | $0 | $33,833 | Yes (X) | ||||
| Janice Becherer | ||||||||||
| Former Key Employee | 0.0 | 0 | $122,381 | $0 | $18,707 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,760,019 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,252,005 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,429,135 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 49 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Intuitive Surgical Inc | |||||
| 950 Kifer Rd | Sunnyvale | CA | 94086 | Surgical services | $1,082,244 |
| Bevis Construction | |||||
| 1300 Park Avenue | Mt Vernon | IL | 62864 | Construction services | $940,800 |
| Locumtenenscom | |||||
| 2655 Northwinds Parkway | Alpharetta | GA | 30009 | Staffing services | $737,345 |
| Jackson & Coker Holdings LLC | |||||
| 2655 Northwinds Parkway | Alpharetta | GA | 30009 | Physician staffing | $701,806 |
| SOUTHERN ILLINOIS ANESTHESIOLOGY | |||||
| 4117 LINCOLNSHIRE DRIVE | MT VERNON | IL | 62864 | MEDICAL SERVICES | $646,640 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 30 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Related Organizations | $353,576 | RelatedOrganizationsAmt |
| Government Grants | $37,682 | GovernmentGrantsAmt |
| Noncash Contributions | $3,977 | NoncashContributionsAmt |
| Total Contributions | $391,258 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $174,450,333 | $174,450,333 | |
| JOINT VENTURE REVENUE | 900099 | $2,489,698 | $1,295,095 | $1,194,603 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,774,327 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,774,327 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $179,714,358 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $112,984 | TotalRevenueColumnAmt |
| Exclusion | $112,984 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $556,630 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $817,033 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$260,403 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$260,403 | TotalRevenueColumnAmt |
| Exclusion | -$260,403 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,737 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $2,737 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,737 | TotalRevenueColumnAmt |
| Exclusion | $2,737 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $924,248 | $924,248 | |
| RETAIL PHARMACY | 446110 | $1,492,598 | $1,492,598 | |
| CHILD CARE | 624410 | $330,022 | $330,022 |
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 | $2,746,868 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $182,707,802 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $178,519,755 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $3,017,223 | UnrelatedBusinessRevenueAmt |
| Exclusion | $779,566 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,806 | TotalAmt |
| Program Services | $61,806 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,635,485 | TotalAmt |
| Program Services | $455,499 | ProgramServicesAmt |
| Management And General | $1,179,986 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,389,387 | TotalAmt |
| Program Services | $45,987,010 | ProgramServicesAmt |
| Management And General | $6,402,377 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,673,531 | TotalAmt |
| Program Services | $4,068,688 | ProgramServicesAmt |
| Management And General | $604,843 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,778,248 | TotalAmt |
| Program Services | $11,941,793 | ProgramServicesAmt |
| Management And General | $1,836,455 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,837,530 | TotalAmt |
| Program Services | $3,306,514 | ProgramServicesAmt |
| Management And General | $531,016 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,647,000 | TotalAmt |
| Management And General | $5,647,000 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $378,219 | TotalAmt |
| Management And General | $378,219 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,524 | TotalAmt |
| Management And General | $72,524 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,064,317 | TotalAmt |
| Program Services | $10,827,118 | ProgramServicesAmt |
| Management And General | $4,237,199 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,238 | TotalAmt |
| Management And General | $51,238 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,132,400 | TotalAmt |
| Program Services | $5,979,959 | ProgramServicesAmt |
| Management And General | $152,441 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,827,252 | TotalAmt |
| Program Services | $7,811,626 | ProgramServicesAmt |
| Management And General | $15,626 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,534,240 | TotalAmt |
| Program Services | $3,383,704 | ProgramServicesAmt |
| Management And General | $150,536 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,329 | TotalAmt |
| Program Services | $334,090 | ProgramServicesAmt |
| Management And General | $78,239 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,117 | TotalAmt |
| Program Services | $68,866 | ProgramServicesAmt |
| Management And General | $14,251 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,089,569 | TotalAmt |
| Program Services | $7,089,569 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,005,189 | TotalAmt |
| Program Services | $12,794,653 | ProgramServicesAmt |
| Management And General | $210,536 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,160,405 | TotalAmt |
| Management And General | $4,160,405 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $26,497,173 | $26,497,173 | |
| MEDICAID PROVIDER TAX | $3,766,179 | $3,766,179 | |
| LICENSES AND TAXES | $124,601 | $103,624 | $20,977 |
| BOND RELATED FEES | $93,930 | $93,930 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$12,766 | TotalAmt |
| Program Services | -$12,766 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,302,903 | TotalAmt |
| Program Services | $144,465,105 | ProgramServicesAmt |
| Management And General | $25,837,798 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,297,147 | BOYAmt |
| EOY | $33,509,710 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,646,382 | BOYAmt |
| EOY | $31,403,017 | 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) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,645,115 | BOYAmt |
| EOY | $3,990,942 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,349,164 | BOYAmt |
| EOY | $3,299,200 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $256,934,559 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $70,124,407 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,159,841 | BOYAmt |
| EOY | $186,810,152 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,545,086 | BOYAmt |
| EOY | $5,040,138 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,978,798 | BOYAmt |
| EOY | $2,978,798 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,012,221 | BOYAmt |
| EOY | $14,154,977 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $236,633,754 | BOYAmt |
| EOY | $281,186,934 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,893,405 | BOYAmt |
| EOY | $14,212,909 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,591,335 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,383,593 | BOYAmt |
| EOY | $193,169,596 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $165,276,998 | BOYAmt |
| EOY | $209,973,840 | EOYAmt |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,843,515 | BOYAmt |
| EOY | $70,768,348 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $513,241 | BOYAmt |
| EOY | $444,746 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,356,756 | BOYAmt |
| EOY | $71,213,094 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $236,633,754 | BOYAmt |
| EOY | $281,186,934 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $12,404,899 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$12,548,561 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $5,021 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $5,021 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | THE ORGANIZATION PAID DUES TO VARIOUS STATE AND NATIONAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES. |
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | THE ORGANIZATION PAID DUES TO VARIOUS STATE AND NATIONAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES. |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $632,759 | OtherCostOrOtherBasisAmt |
| Book Value | $632,759 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $183,936,553 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,105,571 | DepreciationAmt |
| Book Value | $151,830,982 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,424,638 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,505,283 | DepreciationAmt |
| Book Value | $13,919,355 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,500,977 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,164,194 | DepreciationAmt |
| Book Value | $14,336,783 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,439,632 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,349,359 | DepreciationAmt |
| Book Value | $6,090,273 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $186,810,152 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $2,897,357 |
| DUE FROM AFFILIATES | $10,241,103 |
| THIRD-PARTY PAYORS | $1,016,517 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,154,977 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (10 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD-PARTY PAYORS | $50,000 |
| RABBI TRUST LIABILITIES | $121,967 |
| ASSET RETIREMENT OBLIGATIONS | $24,960 |
| PENSION FUNDING LIABILITY | -$750,577 |
| ALLOCATED TAX-EXEMPT DEBT (ISSUED BY SSM HEALTH CARE) | $179,637,519 |
| CAPITAL LEASE OBLIGATION | $12,578,473 |
| DEFERRED REVENUE | |
| OTHER NOTES PAYABLE | |
| DUE TO AFFILIATES | $286,393 |
| Third-party patient loans | $1,220,861 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $193,169,596 | 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 | GOOD SAMARITAN REGIONAL HEALTH CENTER'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 2016 OR 2015. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | false | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,942,334 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,942,334 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0114 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,966,177 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,939,089 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,027,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,801,026 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,909,842 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $891,184 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0052 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $44,709,537 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,848,931 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,860,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1166 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $672,225 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $672,168 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0039 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $279,904 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $279,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0016 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,821 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,821 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $39 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $201,762 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $201,762 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0012 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $1,156,751 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,156,694 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0068 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $45,866,288 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,848,988 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $21,017,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1234 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $465 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $465 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,540 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,289 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,289 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,601 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,723 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,723 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $21,618 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $21,618 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $7,007,272 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $50,334,965 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $68,338,611 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$18,003,646 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (3 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|
| SLEEP & NEUROLOGY CENTER OF S ILLINOIS INC | ||
| SLEEP AND NEUROLOGY SERVICES | 0.501 | 0.499 |
| MT VERNON RADIATION THERAPY CENTER LLC | ||
| RADIATION THERAPY SERVICES | 0.51 | 0.49 |
| Oza Oncology Inc | ||
| Physician Office | 0.51 | 0.49 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SSM Health Good Samaritan Hospital - Mt Vernon | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 GOOD SAMARITAN WAY | AddressLine1Txt |
| City | MT VERNON | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62864 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.ssmhealthillinois.com/locations/good-samaritan-hospital-mt-vernon | WebsiteAddressTxt |
| State License | 0005850 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Facility Reporting Group | A | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.ssmhealthillinois.com/locations/good-samaritan-hospital-mt-vernon | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | https://www.ssmhealth.com/about/community-health-needs-assessments | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.ssmhealth.com/about/community-health-needs-assessments | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.ssmhealth.com/for-patients/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.ssmhealth.com/for-patients/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.ssmhealth.com/for-patients/financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility A, 1 | Facility A, 1 - SSM Health Good Samaritan Hospital - Mt. Vernon. Community feedback consisted of a perception survey distributed to 48 leaders in a four-county area who provide services or live in Jefferson County, Illinois. A list of participants can be found on page 21 of the CHNA. The survey was conducted during the second quarter of 2015. The surveys were distributed by the Director of Community Health Services covering topics including, but not limited to the potential needs initially identified in the statistical data. The top priorities were selected based upon tabulated data, community feedback and the resources available for SSM Health Good Samaritan Hospital - Mt. Vernon to make a significant impact. |
| Schedule H, Part V, Section B, Line 6a Facility A, 1 | Facility A, 1 - SSM Health Good Samaritan Hospital - Mt. Vernon. The CHNA was conducted in partnership with SSM Health St. Mary's Hospital - Centralia. |
| Schedule H, Part V, Section B, Line 11 Facility A, 1 | Facility A, 1 - SSM Health Good Samaritan Hospital - Mt. Vernon. SSM Health's mission statement is "Through our exceptional health care services, we reveal the healing presence of God." In 2015, in collaboration with our community partners, SSM Health Good Samaritan Hospital - Mt. Vernon conducted a Community Health Needs Assessment (CHNA) and developed a strategic implementation plan for the 2016-2018 cycle. The strategic priorities we will address over the next three years include: cancer, heart disease, and obesity. The SSM Health Illinois Regional Board approved this CHNA on December 17, 2015. SSM Health Good Samaritan Hospital - Mt. Vernon last conducted a CHNA in 2012. The SSM Health Good Samaritan Hospital - Mt. Vernon 2016 -2018 CHNA showed cancer as a significant barrier to exceptional quality of life within the community. Not only is the hospital's service area one of the most afflicted in terms of the number of people diagnosed on an annual basis, but the death rate due to the associated diagnosis is among the highest in the nation. The area's local economy is a contributing factor to this, being heavily reliant on industrial and agricultural processes, and tobacco use is also high. While SSM Health Good Samaritan Hospital - Mt. Vernon is not equipped to address of all the influencing factors, the hospital is able to assist in providing cancer treatment options and promoting healthy lifestyle practices that are highly conducive to preventing the development of cancer. The following goals were achieved in 2016 to address cancer issues: - Goal: Reduce the Jefferson County age-adjusted death rate due to cancer from 203.1 deaths per 100,000 persons reported in 2015 to 195.8 deaths per 1000,000 persons by 2018 (close the gap between county and national rate by 25%, the death rate due to cancer decreased to 196.0 per 100,000 in 2016. - Goal: Reduce the percentage of initial cancer diagnoses that are late stage (III and IV) for lung, prostate and colorectal cancer, from 58% in 2014 to less than 48% by 2018 (breast cancer with a late stage rate of less than 15%), the 2016 overall late stage initial cancer diagnosis rate was 26.3%. The SSM Health Good Samaritan Hospital - Mt. Vernon 2016 - 2018 CHNA showed heart disease as a top health concern for the community. Heart disease is affected by numerous lifestyle behaviors including smoking, uncontrolled blood pressure and cholesterol, diabetes, stress and depression, an unhealthy diet and lack of exercise. SSM Health and SSM Health Good Samaritan Hospital - Mt Vernon offer a wide scope of programs with the goal of creating healthy lifestyle behaviors and reducing the risk of heart disease in the community. The following goals were achieved in 2016 to address heart disease: - Goal: Reduce the age-adjusted death rate due to coronary heart disease in Jefferson County from 115.7 deaths per 100,000 persons reported in 2015 to 105.7 death per 100,000 persons (the national rate) by 2018, in 2016 the rate fell to 109.1 deaths per 100,000. - Goal: Reduce the 30-day all-cause readmission rate for SSM Health Good Samaritan Hospital - Mt. Vernon for patients with congestive heart failure (CHF), heart attack and open heart surgery to top quartile or better, the top quartile was achieved in 2016. The SSM Health Good Samaritan Hospital - Mt. Vernon 2016 - 2018 CHNA showed obesity is prevalent in all age groups and poses a threat to the overall health of service area communities. Good Samaritan will provide education and support to people struggling with obesity while working with community partners to prevent obesity in children and young adults and increase focus on preventing or treating obesity during Medicare wellness visits. The following goals were achieved in 2016 to address obesity: - Goal: Reduce the percentage of adults in Jefferson County who are considered overweight or obese from 64.9% reported in 2015 to less than 63.1%, the national norm, by 2018, the percentage of adults overweight or obese in Jefferson County fell to 61.1% in 2016. - Goal: Reduce the gap between the state and Jefferson County average of adults with diabetes by 50% to 10.35% per 100,000 by 2018, the gap decreased to just 11.1% with the last reported data. - Goal: Improve hemoglobin A1C control among SSM Health Medical Group patients with diabetes from 58.6% in 2014 to greater than 66.5% by 2018, A1C control among Medical Group patients was reported at an improved 63.1% in 2016. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| MT VERNON RADIATION THERAPY CENTER | ||||
| 4117 VETERANS MEMORIAL DRIVE | MT VERNON | IL | 62864 | RADIATION THERAPY |
| SLEEP & NEUROLOGY CENTER OF S ILLINOIS | ||||
| 13 CUSAMANO PROF PLAZA | MT VERNON | IL | 62864 | SLEEP/NEURO DIAGNOSTIC TESTING |
| Oza Oncology Inc | ||||
| 4117 Veterans Memorial Drive | Mount Vernon | IL | 62864 | Physician Office |
Supplemental Information Detail SupplementalInformationDetail (19 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3b Eligibility for Discounted Care | Services eligible under the financial assistance policy will be made available to the patient on a sliding fee scale, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. The basis for the amounts the hospital will charge patients qualifying for financial assistance is as follows: Patients whose family income is above 200% but not more than 400% of the FPL are eligible to receive discounted services at amounts no greater than the amounts generally billed to the hospital's commercially insured or Medicare patients. |
| Schedule H, Part I, Line 3c Discounted Care Exceptions | Patients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called "presumptive eligibility." |
| Schedule H, Part I, Line 6a Community Benefit Annual Report | Good Samaritan Regional Health Center is part of the integrated health system known as SSM Health. In an effort to strengthen its community benefit program, SSM Health plans for, measures, and communicates community benefits provided to persons who are low income, the unpaid costs of public programs and other activities that respond to community need, improve community health, or reach out to low income and vulnerable persons. |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | Financial Assistance Methodology: The cost of financial assistance is calculated in compliance with catholic health association (CHA) guidelines. A cost to charge ratio calculated using the IRS worksheet 2, ratio of patient care cost to charges, was used to compute financial assistance at cost. This is the ratio of total adjusted operating expense to total gross patient revenue. The gross revenue amount is a gross amount - prior to contractual adjustments and bad debts. Both gross revenue and costs are based on charges at date/time of service. Unreimbursed Medicaid Costing Methodology: The cost of unreimbursed Medicaid is calculated in compliance with Catholic Health Association (CHA) guidelines. A cost to charge ratio calculated utilizing IRS Worksheet 2, Ratio of patient care cost to charges, was used to compute unreimbursed Medicaid costs. This is the ratio of total adjusted operating expenses to total gross patient revenue. The gross revenue amount is gross amount - prior to contractual adjustments and bad debts. Both gross revenue and costs are based on charges at date/time of service. Community health improvement services and community benefit operations costing methodology: The costs for these programs were derived from the actual costs incurred in these areas. Subsidized health services costing methodology: The expenditures are determined based on actual invoices or dollar amounts spent and charged to these departments, reduced by any grant revenues restricted for these services, if any. Research costing methodology: Research expenses were taken from the income and expense statements for the research departments, derived from the accounting system. Cash and In-Kind contributions to community groups costing methodology: Contribution expenditures are based on actual invoices that were captured and reported for this program, derived from the accounting system. |
| Schedule H, Part II Community Building Activities | Good Samaritan Regional Health Center participates in a wide array of community and civic organizations in the promotion of health care and community building activities. Specific activities reported in Part II of Schedule H include the following: Community Building: Community support - hospital hosted the Jefferson County Ministerial Association meetings and participated in emergency preparedness drills, planning, and conferences. Community Building: Environmental improvements - extensive recycling efforts. Community Building: Coalition building - leadership and employees joined forces with the Jefferson County Care Network, the Shawnee Preparedness and Response Coalition, the Regional Opioid Prescription Drug Abuse & Heroin Addiction Summit, and the Southern Illinois Breastfeeding Coalition. Community Building: Community health improvement advocacy - guest speakers volunteered time with the Jefferson County Chamber of Commerce, Mt. Vernon Rotary West; staff planned and prepared for the 2016 American Heart Association Heart Walk. Community Building: Workforce development - Staff served as ILPEX examiners; CEO held a summit for the hospital and 5 surrounding critical access hospitals to provide education on accountable care organization options; several career fairs were attended by staff to educate youth and young adults on health care career options. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | BAD DEBT EXPENSE IS REPORTED BASED ON THE ORGANIZATION'S FINANCIAL STATEMENT REPORTING. |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | SSM Health Good Samaritan Hospital - Mt Vernon did not make an estimate of the organization's bad debt attributable to patients eligible under the organization's financial assistance policy. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | SSM Health Good Samaritan Hospital - Mt Vernon is part of the SSM Health consolidated audit. The footnote that references bad debt expense in the December 31, 2016 consolidated audit is contained on page 18 and 19 of the attached financial statements. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | The cost of providing care to Medicare eligible patients is greater than the reimbursement that Medicare allows on the Medicare cost report. SSM Health Good Samaritan Hospital - Mt Vernon considers this shortfall as a component of community benefit because the reimbursement is not negotiated and services are provided regardless of the patients' ability to pay. The Medicare costs reported on Line 6 were obtained from the 2016 Medicare cost report. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | SSM Health Good Samaritan Hospital - Mt Vernon has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable. The Hospital embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Hospital's billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after the expiration of the notification period. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSM prior to engaging in ECAs. SSM will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make "reasonable efforts" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with SSM Health Good Samaritan Hospital - Mt Vernon's collection and financial assistance policies. |
| Schedule H, Part V, Section B, Line 16a FAP website | A - SSM Health Good Samaritan Hospital - Mt. Vernon: Line 16a URL: https://www.ssmhealth.com/for-patients/financial-assistance; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | A - SSM Health Good Samaritan Hospital - Mt. Vernon: Line 16b URL: https://www.ssmhealth.com/for-patients/financial-assistance; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | A - SSM Health Good Samaritan Hospital - Mt. Vernon: Line 16c URL: https://www.ssmhealth.com/for-patients/financial-assistance; |
| Schedule H, Part VI, Line 2 Needs assessment | SSM Health (SSMH) participates in Community Benefit according to our vision, Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSMH's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSMH's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conduced every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). CBISA is the gathering, collecting, and reporting of all data relating to community benefit activities and programs across the System. A CBISA is conducted every year by each hospital according to the following steps: * Collect and enter data: Send out emails reminding staff to submit activities; enter data into Lyon; and run reports to share with leaders. * Finalize and report on prior year: Enter all prior year data into Lyon by January 31; and communicate final prior year figures to IRS, System Board, and the community. System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, all hospital CHNAs were completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | All SSMH facilities will strive to provide exceptional health care services to all persons in need regardless of their ability to pay. All billing and collection policies reflect the mission and values of SSMH, including our special concern for people who are poor and vulnerable. SSMH facilities offer discounts for hospital services to all uninsured persons. Self-pay discounts apply to everyone who does not have health insurance, no matter their ability to pay. SSMH applies its charity care policies fairly and consistently. Each person is treated as an individual with specific needs for assistance without regard to payment. SSMH embraces its responsibility to serve the communities in which we participate by establishing sound business practices. Charity care is provided to patients based on a sliding scale for household incomes up to four times the federal poverty level. Patients whose household income is no more than two times the federal poverty level are eligible for free hospital services. In addition, an exception to the sliding scale is provided for a patient's balance due if the amount is too large to be reasonably paid through an installment plan over four years given the family income and expenses. Each entity providing medical service shall provide information to the public regarding its charity care policies and the qualification requirements for each of its facilities. When standard system notices and communication regarding charity care are available, these must be used. Modifications to the standard may be made to comply with state and local laws, as well as reflect culturally sensitive terminology for the policy. All notices are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They provide information about: * The patient's responsibility for payment, * The availability of financial assistance from public programs and entity charity care and payment arrangements, * The entity's charity policy and application process, and * Who to contact to get additional information or financial counseling. The following types of notices to the public are provided: * Signs in the emergency department, outpatient and inpatient registration and public waiting areas. * Brochures or fliers provided at time of registration and available in the financial counseling areas. * Notices sent with or on patient bills or communications sent to patients and guarantors related to medical services. * Applications provided to uninsured patients at the time of registration. The application for charity care, together with any instructions, must clearly state the policies regarding charity care, including excluded services, eligibility criteria and documentation requirements. Information about the entity's charity policies is also provided to public agencies. |
| Schedule H, Part VI, Line 4 Community information | SSM Health Good Samaritan Hospital - Mt. Vernon defines its primary service area as the Jefferson County service area with a population of 38,849 in 2011. Of this population, 31.5% have an average household income under $25,000. Jefferson County has designated Health Professional Shortages in the areas of mental health, low income dental and primary medical care. Jefferson County has designated three townships to be medically underserved areas. The distribution of race/ethnicity in our community is white/Caucasian: 87%; black/African-American: 9%; Hispanic: 2%; other: 2%. The English language is spoken in 96% of the county's households. Approximately 14% of the population has a bachelor's degree or higher. Jefferson County is ranked 90th among 102 Illinois counties for overall health status. Additional information concerning the Jefferson County Service Area can be found on pages 6 and 14 through 18 of the 2015 CHNA. SSM Health Good Samaritan Hospital - Mt. Vernon delivers hospital services in inpatient, ambulatory surgery, outpatient, and emergency room settings. Our services include the heart center, cancer care, orthopedic medicine, surgery, obstetrics, neurology, physical rehabilitation, sleep disorders, emergency care, women's health, and behavioral health. SSM Health Good Samaritan Hospital - Mt. Vernon is one of the few hospitals in the region to offer a full service cardiology program, including interventional cardiology and open heart surgery. |
| Schedule H, Part VI, Line 5 Promotion of community health | SSM Health Good Samaritan Hospital - Mt. Vernon participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. Focusing on a broad definition of health, Good Samaritan's hospital, clinics and programs provide medical and mental health services, health education, health management, prevention, referrals, insurance enrollment and in-home primary care services and support, while fostering collaboration and incorporating Community Benefit strategies. Good Samaritan promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote both population health and healthy communities. Our "Connections" program has free monthly educational luncheons focusing on topics such as arthritis and exercise, diabetes, stroke prevention, and other wellness promotion topics. We also hold a monthly Stress Management class which is free to the public and sponsored as a result of community needs. SSM Health Good Samaritan Hospital - Mt. Vernon also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Has a governing body in which independent persons representative of the community comprise a majority * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system. |
| Schedule H, Part VI, Line 6 Affiliated health care system | Good Samaritan Regional Health Center is a 501(c)(3) organization and is a member of the integrated health care system known as SSM Health. Along with St Mary's Hospital, Centralia, Illinois, it is part of a joint operating agreement between SSM Health based in St Louis, Missouri as managing partner, and Felician Sisters, Inc. of Chicago. Together the hospitals are pursuing a vision to create a comprehensive, regional health care enterprise covering a nine county area in South Central Illinois. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | IL |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Jefferson County Development Corporation | |||||||
| 200 Potomac Blvd | Mt Vernon | IL | 62864 | 203563410 | 501(c)(3) | $7,500 | General support |
| John and Eleanor Mitchell Foundation | |||||||
| PO Box 923 | Mt Vernon | IL | 62864 | 376053100 | 501(c)(3) | $12,000 | General support |
| American Red Cross | |||||||
| 431 18th Street NW | Washington | DC | 20006 | 530196605 | 501(c)(3) | $5,000 | General support |
| Rend Lake College Foundation | |||||||
| 468 N Ken Gray Parkway | Ina | IL | 62846 | 371078407 | 501(c)(3) | $9,062 | General support |
| University of Illinois Foundation | |||||||
| 1305 West Green Street | Urbana | IL | 61801 | 376006007 | 501(c)(3) | $12,000 | General support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | COMPLETED GRANT AND CONTRIBUTION REQUESTS ARE FORWARDED TO THE MARKETING DEPARTMENT FOR INITIAL APPROVAL. THE MARKETING DEPARTMENT MAINTAINS A LOG OF ALL CONTRIBUTION REQUESTS. THE DEPARTMENT EVALUATES THE REQUESTS AND FORWARDS REQUESTS RECOMMENDED FOR APPROVAL TO THE HOSPITAL PRESIDENT AND/OR THE ADMINISTRATIVE COUNCIL FOR FINAL APPROVAL. MOST GRANTS AND CONTRIBUTIONS ARE MADE TO 501(C)(3) OR LOCAL CIVIC AND EDUCATIONAL ORGANIZATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Severance Payment | false | 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 (20 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Paula Friedman | ||||||||||||||
| Vice President, Senior VP-Strategic Development SSM Health | $0 | $705,000 | $0 | $114,197 | $0 | $121,493 | $0 | $368,230 | $0 | $20,459 | $0 | $1,329,379 | $0 | $114,197 |
| William Thompson | ||||||||||||||
| Chair, President/CEO of SSM Health | $0 | $1,010,243 | $0 | $384,123 | $0 | $338,069 | $0 | $221,076 | $0 | $21,526 | $0 | $1,975,037 | $0 | $460,221 |
| Christopher Howard | ||||||||||||||
| Pres-Hospital Operations of SSM Health | $0 | $872,531 | $0 | $157,325 | $0 | $99,779 | $0 | $369,852 | $0 | $34,474 | $0 | $1,533,961 | $0 | $157,325 |
| Sajjan K Nemani MD | ||||||||||||||
| Director | $9,350 | $214,131 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,350 | $214,131 | $0 | $0 |
| Deland Evischi | ||||||||||||||
| Pt Yr Regional CFO | $0 | $212,031 | $0 | $13,138 | $0 | $15,991 | $0 | $69,532 | $0 | $41,144 | $0 | $351,836 | $0 | $13,138 |
| June Pickett | ||||||||||||||
| Secretary | $0 | $229,851 | $0 | $19,802 | $0 | $31,890 | $0 | $10,977 | $0 | $24,587 | $0 | $317,107 | $0 | $19,802 |
| Michael Warren | ||||||||||||||
| Hospital President | $0 | $372,340 | $0 | $12,758 | $0 | $88,600 | $0 | $32,917 | $0 | $27,833 | $0 | $534,448 | $0 | $26,320 |
| Kris Zimmer | ||||||||||||||
| Treasurer, Senior VP-Finance SSM Health | $0 | $870,802 | $0 | $148,371 | $0 | $86,204 | $0 | $310,798 | $0 | $33,312 | $0 | $1,449,487 | $0 | $148,371 |
| Janice Becherer | ||||||||||||||
| Former Key Employee | $118,527 | $0 | $0 | $0 | $3,854 | $0 | $479 | $0 | $18,228 | $0 | $141,088 | $0 | $0 | $0 |
| Christina Adams | ||||||||||||||
| VP Nursing | $199,467 | $0 | $4,425 | $0 | $4,335 | $0 | $131,514 | $0 | $5,389 | $0 | $345,130 | $0 | $4,425 | $0 |
| Mark Clark | ||||||||||||||
| VP Operations | $0 | $195,497 | $0 | $10,587 | $0 | $3,079 | $0 | $77,576 | $0 | $34,075 | $0 | $320,814 | $0 | $10,587 |
| Michelle Darnell | ||||||||||||||
| VP Systems Improvement | $167,574 | $0 | $10,288 | $0 | $2,731 | $0 | $58,577 | $0 | $29,151 | $0 | $268,321 | $0 | $10,288 | $0 |
| Julie Long | ||||||||||||||
| System VP - Strategic Development | $0 | $179,716 | $0 | $10,748 | $0 | $2,756 | $0 | $62,191 | $0 | $4,900 | $0 | $260,311 | $0 | $10,748 |
| Brenda Alexander | ||||||||||||||
| System VP - Human Resources | $0 | $125,666 | $0 | $0 | $0 | $12,098 | $0 | $17,827 | $0 | $12,308 | $0 | $167,899 | $0 | $0 |
| Matthew Sojka MD | ||||||||||||||
| Reg Pres - PO & Ambulatory Network | $0 | $301,537 | $0 | $15,625 | $0 | $41,249 | $0 | $28,081 | $0 | $21,190 | $0 | $407,682 | $0 | $0 |
| John Flick | ||||||||||||||
| Physician | $364,390 | $0 | $0 | $0 | $25,360 | $0 | $10,576 | $0 | $34,059 | $0 | $434,385 | $0 | $0 | $0 |
| Faisal Rashid | ||||||||||||||
| Physician | $568,642 | $0 | $0 | $0 | $26,325 | $0 | $36,153 | $0 | $33,241 | $0 | $664,361 | $0 | $0 | $0 |
| Anthony Vacca | ||||||||||||||
| Physician | $547,241 | $0 | $0 | $0 | $67,221 | $0 | $112,803 | $0 | $26,257 | $0 | $753,522 | $0 | $0 | $0 |
| Thomas Smith | ||||||||||||||
| Physician | $299,945 | $0 | $0 | $0 | $36,874 | $0 | $5,550 | $0 | $7,728 | $0 | $350,097 | $0 | $0 | $0 |
| Thejeswi Pujar | ||||||||||||||
| Physician | $302,319 | $0 | $0 | $0 | $1,151 | $0 | $3,119 | $0 | $30,714 | $0 | $337,303 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 1a Tax indemnification and gross-up payments | The following individuals listed on Part VII, Section A received a tax indemnification/gross up payment in 2016. These payments were included in their taxable compensation. Faisal Rashid |
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | The organization's top management official, hospital 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 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 SSMH's qualified plan if the regulations did not impose compensation limits. An individual can take a distribution from the plan at (1) age 65 or older if the individual is still employed by SSMH or (2) age 55 or older if the individual is no longer employed by SSMH. No reportable individuals listed on Part VII of Form 990 received distributions from this plan during 2016. 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 distributions from this plan in 2016. All distributions received from the plan in the current year were included in the individuals' taxable compensation. William Thompson $294,066 June Pickett $18,727 Michael Warren $45,255 During 2016, 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: Paula Friedman $276,866 William Thompson $3,108 Christopher Howard $257,997 Deland Evischi $67,582 June Pickett ($11,000) Michael Warren ($2,751) Kris Zimmer $201,583 Rachel Ruettgers $711 Matthew Kinsella $2,711 Christina Adams $120,369 Mark Clark $66,448 Michelle Darnell $49,769 Julie Long $44,827 Brenda Alexander $5,657 Matthew Sojka, MD $3,175 John Flick $6,648 Faisal Rashid $32,178 Anthony Vacca $109,745 Thomas Smith $2,059 Thejeswi Pujar $1,754 Janice Becherer ($1,355) |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC | |||
| ENTITY MORE THAN 35% OWNED BY SAJJAN K NEMANI, MD, DIRECTOR | $98,348 | JOINT VENTURE | false |
| OZA ONCOLOGY INC | |||
| ENTITY MORE THAN 35% OWNED BY YAGNESH OZA, MD, DIRECTOR | $1,194,603 | JOINT VENTURE | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a Description of Program Service | Briefly describe the organization's mission: Since it was founded in 1872 by Catholic sisters, SSM Health (SSMH) has existed to meet the health needs of the communities it serves. SSMH is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through one of the largest integrated delivery systems in the nation. With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSMH includes 19 acute care hospitals, one children's hospital, more than 60 outpatient care sites, a pharmacy benefit company, an insurance company, two long-term care facilities, comprehensive home care and hospice services, a technology company, and two Accountable Care Organizations. The health system employs more than 31,000 people and is affiliated with more than 8,500 physicians making it one of the largest employers in every community it serves. SSMH is sponsored by SSM Health Ministries, an independent 8-member body comprised of three Franciscan Sisters of Mary and five lay people who collectively hold certain reserved powers over SSMH. In the tradition of its founding sisters, SSMH strives to fulfill its mission by providing exceptional health care to everyone who comes to its hospitals, regardless of their ability to pay. About Good Samaritan Regional Health Center: Good Samaritan Regional Health Center in Mt. Vernon, Illinois, operating in partnership with the Felician Sisters, is a 134-bed tertiary care hospital. Good Samaritan Regional Health Center delivers hospital services in inpatient, ambulatory surgery, outpatient, and emergency room settings. Our services include the heart center, cancer care, orthopedic medicine, surgery, obstetrics, neurology, physical rehabilitation, sleep medicine, emergency care, women's health, and behavioral health. Good Samaritan Regional Health Center is one of the few hospitals in the region to offer a full service cardiology program, including interventional cardiology and open heart surgery. It has one of the largest heart programs in Southern Illinois and is the regional heart center for emergency departments in the area. For three consecutive years, Healthgrades has presented SSM Health Good Samaritan Hospital with the Patient Safety Excellence Award. In 2014, Quest by Premier Inc. recognized SSM Health Good Samaritan Hospital with the Citation of Merit Award for Outstanding Patient Care. The Breast Imaging Center at Good Samaritan Regional Health Center is accredited by the American College of Radiology as a Breast Imaging Center of Excellence, indicating top-tier safety, quality and efficiencies are provided at our Women's Imaging Center. In 2015, the hospital launched a new pediatric emergency and NICU telemedicine program in conjunction with the physicians at SSM Health Cardinal Glennon Children's Hospital. Describe the organization's approach to providing community benefit: SSM Health (SSM) participates in Community Benefit according to our vision, Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSM's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always the goal. To fulfill this commitment, SSM's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). First, CHNA is the assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Kick-off meeting conducted and updated toolkit distributed; and periodic meetings scheduled to evaluate and monitor progress. Data collected and report made to Regional/ Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). Next, CBISA is the gathering, collecting, and reporting of all data relating to community benefit activities and programs across the System. A CBISA is conducted every year by each hospital according to the following steps: * Collect and enter data: Kick-off meeting conducted and updated toolkit distributed; new staff complete Lyon web-based course; and periodic meetings scheduled to evaluate and monitor progress. Emails sent reminding staff to submit activities; occurrences entered into Lyon; and reports are produced and shared with leaders. - Finalize and report on prior year: All prior year data entered into Lyon by January 31; and communicate final prior year figures to IRS, System Board, and the community. System Office staff and leaders oversee and monitor SSM's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, all hospital CHNAs were completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health. Description of Community Benefit Programs: For more information on Community Benefit Programs provided by Good Samaritan Regional Health Center, please see Schedule H, Part V. |
| Form 990, Part III, Line 4b Description of Program Service (Continued) | Organization description for tax exemption: In addition to its community benefit activities, Good Samaritan Regional Health Center participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. Focusing on a broad definition of health, Good Samaritan's hospital, clinics and programs provide medical and mental health services, health education, health management, prevention, referrals, insurance enrollment and in-home primary care services and support, while fostering collaboration and incorporating Community Benefit strategies. Good Samaritan promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote both community health and healthy communities. Good Samaritan Regional Health Center offers one of the most comprehensive diabetes programs in southern Illinois achieving the prestigious American Diabetes Association Recognition status. Diabetes self-management education is a proven way to reduce complications and costs of diabetes while improving quality of life. Sessions aare offered in group or individual sessions to learn diabetes from A-Z. Our "Connections" program has free monthly educational luncheons focusing on topics such as arthritis and exercise, diabetes, stroke prevention, and other wellness promotion topics. We also hold a monthly Stress Management class which is free to the public and sponsored as a result of community needs. Good Samaritan Regional Health Center also furthers its exempt purpose with the following activities: - Operates an emergency room that is open to all persons regardless of ability to pay, - Has an open medical staff with privileges available to all qualified physicians in the area, - Has a governing body in which independent persons representative of the community comprise a majority - Engages in the training and education of health care professionals, - Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs - All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system Describe the organization's financial assistance policies or programs (e.g., charity care, discounting) for low-income persons and how they are communicated to the public. For information on the financial assistance polices provided by Good Samaritan Regional Health Center, please see Schedule H. Quantifiable Uncompensated Care: This section includes a list of the types of programs and services that could be quantified as uncompensated care: Traditional Charity Care $ 1,942,334 Cost of Bad Debt $ 2,263,141 Unpaid Cost of Medicaid Services $ 17,027,088 Unpaid Cost of Medicare Services $ 18,003,646 Unpaid Cost of Other Government Programs $ 891,184 Total Quantifiable Uncompensated Care $ 40,127,393 |
| Form 990, Part V, Line 1a Common Paymaster | SSM HEALTH CARE CORPORATION, EIN 46-6029223, SERVES AS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, Good Samaritan Regional Health Center, EIN 43-0653587. THEREFORE, ALL APPLICABLE 1099 AND 1096 IRS TAX FILINGS ARE REPORTED BY SSM HEALTH CARE CORPORATION. |
| 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 Good Samaritan Regional Health Center and SSM Regional Health Services are part of the integrated health care system known as SSM Health. |
| 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 ELECT AND REMOVE THE 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 BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS, TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS, AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OF THE 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 OBJECTIVE 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 OR 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 11b Review of form 990 by governing body | ACCOUNTING/FINANCE PERSONNEL AT EACH SSMH (SSM HEALTH SYSTEM) ENTITY, IN CONJUNCTION WITH SYSTEM FINANCE PERSONNEL, PREPARE INFORMATION AND SUPPORTING SCHEDULES THAT ARE USED TO PREPARE THE FORM 990. THIS INFORMATION IS THEN REVIEWED BY A SUPERVISOR/MANAGER AND SENT TO THE SYSTEM OFFICE, WHERE SSMH PERSONNEL PREPARE THE FORM 990. THE RETURN IS THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM WHO SIGNS AS PAID PREPARER. THE RETURN IS PROVIDED TO ENTITY MANAGEMENT PERSONNEL FOR FINAL REVIEW PRIOR TO FILING. THE COMPLETE FORM 990 IS PROVIDED ELECTRONICALLY TO ALL BOARD MEMBERS 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 ONLINE. 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 MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
| Form 990, Part VII, Section A Compensation of Former Key Employees | Compensation of Former Key Employees reported on Form 990, Part VII, Section A, represents amounts paid from the organization to an individual still employed by the organization but no longer in the role of a key employee. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | All other program service revenue - Total Revenue: 2774327, Related or Exempt Function Revenue: 2774327, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in beneficial interest in foundation - -170089; Transfers to affiliates - -12378472; |
| Form 990, Part I Doing Business As | Good Samaritan Regional Health Center currently conducts business under the following registered names: 1) Good Samaritan Hospitalist Providers 2) Good Samaritan Plaza Pharmacy 3) SSM Health Breast Care 4) SSM Health Good Samaritan Hospital - Mt. Vernon 5) SSM Health Child Care Center |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (42 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 | FRANCISCAN SISTERS OF MARY | 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) | Type I | 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 HOSPITAL | false |
| SSM DEPAUL HEALTH CENTER FOUNDATION | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431776109 | FUNDRAISING | MO | 501(c)(3) | 7 | SSM HEALTH CARE ST LOUIS | false |
| SSM ST JOSEPH FOUNDATION | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431591556 | FUNDRAISING | MO | 501(c)(3) | 7 | SSM HEALTH CARE ST LOUIS | false |
| SSM ST CLARE HEALTH CENTER FOUNDATION | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431273310 | FUNDRAISING | MO | 501(c)(3) | 7 | SSM HEALTH CARE ST LOUIS | false |
| SSM ST MARY'S HEALTH CENTER FOUNDATION | ||||||||||
| 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 |
| 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 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 REGIONAL HEALTH SERVICES | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 440579850 | HEALTH CARE | MO | 501(c)(3) | 3 | SSM HEALTH CARE CORPORATION | false |
| ST FRANCIS HOSPITAL FOUNDATION | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431099253 | FUNDRAISING | MO | 501(c)(3) | 7 | SSM REGIONAL HEALTH SERVICES | false |
| ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431575307 | FUNDRAISING | MO | 501(c)(3) | Type II | SSM REGIONAL HEALTH SERVICES | 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 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 | 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 | 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 |
| CENTRALIA MEDICAL SERVICES BLDG ASSOC | ||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 237408025 | MOB | IL | 501(c)(3) | Type II | SSM REGIONAL HEALTH SERVICES | 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 |
| FRANCISCAN SISTERS OF MARY | ||||||||||
| 3221 MCKELVEY ROAD SUITE 107 | ST LOUIS | 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 AND 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 | MT 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 STREET | MEXICO | MO | 65265 | 431265060 | FUNDRAISING | MO | 501(c)(3) | Type I | SSM AUDRAIN HEALTH CARE INC | false |
| HOME HEALTH UNITED - VNS FOUNDATION INC | ||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391839309 | FUNDRAISING | WI | 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 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | UBI Code VUBICodeVAmt | OwnershipOwnershipPct | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM ST JOSEPH ENDOSCOPY CENTER LLC | ||||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 270046559 | SURGERY SERVICES | MO | NA | N/A | $0 | $0 | $0 | 0 | ||
| ST CLARE IMAGING SERVICES | ||||||||||||||
| 707 14TH STREET SUITE A | BARABOO | WI | 53913 | 200122365 | DIAG SERVICES | WI | NA | N/A | $0 | $0 | $0 | 0 | ||
| MT VERNON RADIATION THERAPY CENTER LLC | ||||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 201382620 | RADIATION THERAPY | IL | NA | Related | $1,044,144 | $1,840,997 | $0 | 0.51 | false | false |
| SLEEP & NEUROLOGY CENTER OF S ILLINOIS LLC | ||||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 208468195 | DIAG SERVICES | IL | NA | Related | $98,348 | $186,535 | $0 | 0.501 | false | false |
| CHOWSMGSI OFFICE BUILDING LLC | ||||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 371383861 | MOB | IL | NA | N/A | $0 | $0 | $0 | 0 | ||
| OZA CANCER CENTER LLC | ||||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 201382727 | MOB | IL | NA | N/A | $0 | $0 | $0 | 0 | ||
| SHAWNEE REAL ESTATE HOLDINGS LLC | ||||||||||||||
| 1000 N LEE AVE | OKLAHOMA CITY | OK | 73102 | 455458304 | MOB | OK | NA | N/A | $0 | $0 | $0 | 0 | ||
| SSM Health Pharmacy LLC | ||||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 264031708 | PHARMACY | MO | NA | N/A | $0 | $0 | $0 | 0 | ||
| 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 | $0 | $0 | $0 | 0 | ||
| WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC | ||||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 392016715 | INFORMATION TECHNOLOGY SERVICES | WI | NA | N/A | $0 | $0 | $0 | 0 | ||
| DEAN HEALTH HOLDINGS LLC | ||||||||||||||
| 1277 DEMING WAY | MADISON | WI | 53717 | 261594709 | SUPPORT SERVICES | WI | NA | N/A | $0 | $0 | $0 | 0 | ||
| WINGRA BUILDING GROUP | ||||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 390237060 | MOB | WI | NA | N/A | $0 | $0 | $0 | 0 | ||
| JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP | ||||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 396220698 | MOB | WI | NA | N/A | $0 | $0 | $0 | 0 | ||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (22 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 | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM MANAGED CARE ORGANIZATION LLC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431708511 | HEALTH PROMOTION | MO | NA | C Corporation | false | |||
| FPP INC | ||||||||||||
| 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 CARDIO AND THORACIC SERVICES INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 260286559 | HEALTH CARE | MO | NA | C Corporation | false | |||
| SSM PROPERTIES INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431462486 | PROPERTY SERVICES | MO | NA | C Corporation | false | |||
| SSM DEPAUL MEDICAL GROUP INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 431715106 | HEALTH CARE | MO | NA | C Corporation | false | |||
| SSM ST CHARLES CLINIC MED GROUP INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 430626408 | PHYSICIAN OFFICES | MO | NA | C Corporation | false | |||
| HEALTH FIRST PHYS MANAGEMENT SERVICES INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 731534336 | MEDICAL SERVICES | OK | NA | C Corporation | false | |||
| SSMHCS LIABILITY TRUST II | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 816128118 | INSURANCE | MO | NA | C Corporation | false | |||
| SSM NEUROSCIENCES INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 263413981 | HEALTH CARE | 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 | CA | NA | C Corporation | false | |||
| SSM ORTHOPEDIC INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 271557033 | HEALTH CARE | MO | NA | C Corporation | false | |||
| SSM CANCER CARE INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 271557324 | HEALTH CARE | MO | NA | C Corporation | false | |||
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | ||||||||||||
| 10101 WOODFIELD LANE | ST LOUIS | MO | 63132 | 364161526 | HEALTH CARE | IL | NA | C Corporation | Yes (true) | -$16,781,692 | $8,647,622 | 1 |
| 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 | |||
| ST MARY'S DEAN VENTURES INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 391628491 | PHYSICIAN OFFICES | WI | NA | C Corporation | false | |||
| DEAN RETAIL SERVICES INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 391717636 | PROPERTY SERVICES | WI | NA | C Corporation | false | |||
| NAVITUS HOLDINGS LLC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 800968174 | PHARMACY BENEFITS | WI | NA | C Corporation | false | |||
| OZA ONCOLOGY INC | ||||||||||||
| 4117 VETERANS MEMORIAL DRIVE | MT VERNON | IL | 62804 | 371343746 | PHYSICIAN OFFICES | IL | NA | C Corporation | Yes (true) | $1,194,603 | $1,499,170 | 0.51 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | Yes (true) | 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 | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Mt Vernon Radiology Therapy Center LLC | ||
| R | $114,750 | Cash |
| Physicians Services Corp of Southern Illinois Inc | ||
| R | $12,069,636 | Cash |
| Physicians Services Corp of Southern Illinois Inc | ||
| A | $373,896 | Contract |
| Oza Oncology Inc | ||
| R | $1,359,051 | Cash |
| Physicians Services Corp of Southern Illinois Inc | ||
| Q | $30,753,219 | Cash |
| Physicians Services Corp of Southern Illinois Inc | ||
| P | $9,628,842 | Cash |
Comments