2015-11-18T09:00:20-06:00 2014-12-31 861065772 Deloitte Tax LLP 1111 Bagby Street Suite 4500 Houston TX 77002 990 2014-01-01 455055149 St Anthony Shawnee Hospital Inc STAN 4053955626 10101 Woodfield Lane St Louis MO 63132 June L Pickett Secretary 2015-11-16 true Brooke Kitchen McNeil P00849302 7139822000 2014 2016-03-07 17:11:31Z William Thompson 10101 Woodfield Lane St Louis MO 63132 70724300 false 0928 X www.ssmhealth.com X 2012 OK TO POSITIVELY IMPACT HUMAN LIFE THROUGH EXCEPTIONAL HEALTH CARE. OUR CORE VALUES ARE THE FOLLOWING: COMPASSIONATE CARE, CLINICAL EXCELLENCE, PEOPLE FIRST, RESOURCE STEWARDSHIP, AND COMMUNITY OUTREACH. 15 11 674 48 0 0 36027 17110 71878172 69314842 0 -17767 969234 1145972 72883433 70460157 11600 50268 0 0 37496075 31706432 0 0 0 33123519 33680990 70631194 65437690 2252239 5022467 78147476 88959523 54848248 60637828 23299228 28321695 THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. false false 54900832 50268 69314842 Please see Schedule O for a complete description of program service accomplishments. 54900832 true false false true false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 0 0 674 true false false false false false false false false false false X 15 11 false false false false true true true true true false false false true true true true true false false true true OK X Jennifer Pierce 4053955626 1102 W McArthur Shawnee OK 74801 William Thompson Director & Vice Chair 1.00 55.00 X X 0 3248929 2256052 Sr Mary Jean Ryan FSM Director & Chairperson 1.00 9.00 X X 0 0 0 Joe Hodges Director & President 1.00 43.00 X X 0 713630 399333 MT Berry Director 1.00 2.00 X 0 0 0 Martha Burger Director 1.00 2.00 X 0 0 0 Mike Collison Director 1.00 2.00 X 0 0 0 David Harlow Director 1.00 2.00 X 0 0 0 Jenee Lister Director 1.00 3.00 X 0 0 0 Judith Love Director 1.00 3.00 X 0 0 0 John Richels Director 1.00 2.00 X 0 0 0 Kersey Winfree MD Director 1.00 43.00 X 0 505310 164600 Margaret Salyer Director 1.00 2.00 X 0 0 0 Georgette Toma MD Director 1.00 11.00 X 0 107700 0 Marion McMillan Director 1.00 1.00 X 0 0 0 Natalie Shirley Director 1.00 1.00 X 0 0 0 June Pickett Secretary 0.10 42.70 X 0 253530 146963 Kris Zimmer Treasurer 1.00 56.00 X 0 956951 412836 Ramona Carey Assistant Secretary 1.00 41.00 X 0 75328 88359 Paula Friedman Vice President 1.00 53.00 X 0 729173 396619 Shasta Manuel Regional VP Finance/CFO 10.00 31.00 X 0 363653 82462 Charles Skillings Hospital President 40.00 0 X 0 356189 104270 Angela Mohr Executive Vice President 40.00 0 X 165206 0 35366 David Heon Physician 40.00 0 X 314362 0 48636 Gaynell Anderson Physician 40.00 0 X 339566 0 37630 David Hadley Physician 40.00 0 X 317843 0 30169 Kenneth Darvin Physician 40.00 0 X 301654 0 45964 Lara Mashek Physician 40.00 0 X 250558 0 32509 1689189 7310393 4281768 18 false true false CLINICAL PARTNERS PA 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ANESTHESIA BILLING 1823857 SODEXO MANAGEMENT INC PO BOX 536922 ATLANTA GA 303536922 DIETARY AND ENVIRO SERVICES 1017020 SHAWNEE SURGICAL SERVICES LLC PO BOX 68 SHAWNEE OK 74802 SURGERY CENTOR DIRECTOR/MANAGEMENT FEES 585012 SLEEPELITE OF SHAWNEE LLC BMB 444 2150 S DOUGLAS BLVD STE C MIDWEST CITY OK 73130 SLEEP LAB STUDIES 472500 SODEXO INC AND AFFILIATES 500 ROSS ST 154-0455 PITTSBURG PA 152620001 DIETARY AND ENVIRO SERVICES 325777 20 X 10760 6350 17110 NET PATIENT REVENUE 621110 67179494 67179494 2135348 2135348 0 0 69314842 603578 80637 522941 0 522941 522941 17767 0 -17767 -17767 -17767 153060 165739 -12679 -12679 CAFETERIA REVENUE 722320 535772 535772 JOINT VENTURE INCOME 900099 99938 99938 0 0 0 0 635710 70460157 69314842 0 1128205 X 50268 50268 561108 561108 22494013 17925761 4568252 1298587 1019035 279552 5743074 4502741 1240333 1609650 1251917 357733 323000 323000 1695 1695 141168 141168 7684409 6082147 1602262 0 136 136 4576975 4461379 115596 1419424 1390022 29402 1108043 1063463 44580 91233 62012 29221 11791 1449 10342 2263128 2263128 4416353 4042395 373958 832920 832920 MEDICAL SUPPLIES 8564909 8564909 MEDICAID PROVIDER TAX 1953393 1953393 LICENSES AND TAXES 56134 53560 2574 MIscellaneous 236279 213253 23026 0 0 0 0 65437690 54900832 10536858 0 209723 558782 12221211 12538661 2079677 2473871 631226 848654 59756683 11891307 37783838 47865376 0 0 21933262 21933262 3288539 2740917 78147476 88959523 7508734 15008837 47339514 45628991 54848248 60637828 X 23299228 28321695 23299228 28321695 78147476 88959523 5022467 0 X false true X true false X false false false false false true 2662 false false false 2662 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL HOSPITAL ASSOCIATIONS AND PORTIONS OF THE DUES WERE ALLOCATED TO LOBBYING ACTIVITIES. 2000668 2000668 15286171 1336274 13949897 17432502 10555033 6877469 25037342 25037342 47865376 DUE TO AFFILIATES INTERCO LOANS PAYABLE 40780002 PENSION FUNDING LIABILITY 913132 CAPITAL LEASE OBLIGATION 3935857 45628991 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote ST. ANTHONY SHAWNEE HOSPITAL, INC.'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF SSM HEALTH (SSMH), A RELATED ORGANIZATION. SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS IN 2014 OR 2013. true true true X true X true true true false true false 423588 423588 0.0065 10739631 11359145 -619514 0.0 0 0.0 0 0 11163219 11359145 -195926 0.0065 30917 3620 27297 0.0004 0 0.0 0 0.0 0 0.0 193800 200 193600 0.0030 0 0 224717 3820 220897 0.0034 0 0 11387936 11362965 24971 0.0098 false 4647469 20309863 23108040 -2798177 X true true SHAWNEE SURGICAL REALTY LLC MEDICAL BUILDING 0.25 0.75 1 1 ST ANTHONY SHAWNEE HOSPITAL 1102 W MCARTHUR SHAWNEE OK 74801 WWW.SSMHEALTH.COM 2162 X X X ST ANTHONY SHAWNEE HOSPITAL 1 false false true X X X X X X X X X 12 true false false true X www.stanthonyshawnee.com/pages/chna.aspx X WWW.SSMHEALTH.COM/SYSTEM/EXCEPTIONAL-CARE/WHAT-WE-MEAN/CHNA/ X true 12 true http://www.stanthonyshawnee.com/Pages/CHNA.aspx false false true X 2.0 4.0 X X X X X true true X X X true X X X X X X X true X false X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - St Anthony Shawnee Hospital. The participation by a largely diverse group of community leaders who shared their time and expertise in regard to the health status of the community contributed to the overall strength of the CHNA. Community partners were identified that are knowledgeable about the state of Pottawatomie County, as well as the City of Shawnee. Those identified included: Pottawatomie County Health Department, the Oklahoma Department of Human Services, the United Way of Pottawatomie County, Gateway to Prevention and Recovery, Growthlines, and COEDD Area Agency on Aging. A complete list of organizations and individuals participating can be found in Appendix 1 of the CHNA. A list of interview questions used to gather information from the community partners can be found in Appendix 2 of the CHNA. After the completion of the data analysis, a web-based survey tool was utilized that allowed for ranking and prioritization of the identified needs. The survey was distributed to close to 100 participants through an email mechanism including participating community partners and representatives in the medical and nursing field, the faith community, case management, hospital/practice management, public health, school officials, as well as patient and family advocates. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St Anthony Shawnee Hospital. SSM Health's mission statement is "Through our exceptional health care services, we reveal the healing presence of God." The strategic priorities of the community benefit plan as identified in the most recent community health needs assessment (CHNA) are: obesity, heart disease, and prescription drug abuse. Our needs assessment was completed June 2012 and adopted as part of our strategic plan in November 2012 and adopted as part of our strategic plan. Goals and objectives were established to change behavior, provide metrics to measure change, and to impact the overall health of those we serve. All of the community benefit activities are designed to meet the needs identified in the CHNA. The St Anthony Shawnee 2012 - 2015 CHNA showed that in Pottawatomie County, 34% of the adult residents are identified as obese, with only 15% (1 in 7) reporting eating fruits and vegetables five times a day. This places Oklahoma at 51st in the nation. A myriad of social, economic, and environmental factors combine to discourage the efforts of monitoring calorie intake, choosing healthy foods, and increasing physical activity. The Nutritional Services Department of the hospital not only provides meals for hospitalized patients, but operates a full service cafe for employees and visitors. Increasing the availability of healthy options, with a focus on increasing fruits and vegetables in the diet, as well as educating employees, will not only affect their health but make an impact on their families as well. The Cafe, operated by the Nutritional Services Department, was instrumental in making an impact on the employees (and subsequently their families) through healthy options by increasing the visibility of fruits and vegetables in The Cafe, providing nutritional snacks at meetings, providing educational offerings on importance of fruits and vegetables, and implementing alternatives for fried foods. Marketing assisted with this initiative by providing information through the email and MyNews, as well as publishing the weekly menu with the healthier options highlighted. The following goals were established in 2014 to address obesity: * Goal: Increase the contribution and variety of fruits and vegetables sold in the cafe by 10%, the hospital will continue to monitor sales to determine the percentage increase in sales; healthy options in the cafe were increased * Goal: Decrease the number of admitted diabetic patients with a body mass index greater than 30, established a program to insure eligible patients receive counseling and instruction from a dietician The St Anthony Shawnee 2012 - 2015 CHNA indicated Heart Disease is the leading cause of death for Pottawatomie County, with 242.3/10,000 compared to the national average of 190.1. In addition, Oklahoma ranked 49th worst in the nation for lack of physical activity at 31% (as reported by the 2011 State of the State's Health Report). Heart Disease alone accounts for over $90 million a year in medical cost for Pottawatomie County and is the number one cause of death for all ages. Not only has the hospital provided medical care and treatment of patients with heart disease, there has been a focus on education to recognize symptoms of heart attack, as well as care for prevention of heart disease. St Anthony Shawnee Hospital will strive to increase educational initiatives and opportunities for heart disease awareness, In 2014, educational opportunities were the focus for the importance placed on "movement" as a positive term versus the sometimes negative connotation of "exercise" with emphasis in everyday life. This was seen in the February Heart Month awareness as well as the development of the first annual walk/run and educational expo for employees and the community. * Goal: sponsor the first ever employee/community walk/run, 65 registered participants in the 5K Harvest Health Hustle and 5 in the family walk * Goal: Reduce the readmissions rate for Congestive Heart Failure (CHF) patients, established a baseline percentage of 22% and developed a program for a follow-up clinic that will see patients within five business days of discharge to supplement current discharge phone calls The St Anthony Shawnee 2012 - 2015 CHNA indicated many societal and health factors have influenced the increase in the use and ease of availability of prescription pain medication. The ten-year trend for deaths due to drug overdose has been on a significant upward trend for the state of Oklahoma with a greater than 100% increase. According to the Oklahoma Bureau of Narcotics State Medical Examiner, three fourths of drug overdose deaths are attributable to prescription drugs. In Pottawatomie County, 17.9-21.0% of drug overdose deaths are attributable to prescription drug abuse ranking the County 25th in the state. While the specific numbers were not available for Pottawatomie County, it is interesting to note that the ten year trend for deaths due to drug overdose has been on a significant upward trend for the state of Oklahoma, with a greater than 100% increase. According to the Oklahoma Bureau of Narcotics: Oklahoma State Medical Examiner, three-fourths of these deaths are attributable to prescription drugs. St Anthony Shawnee Hospital has identified several avenues to impact the use of prescription pain medication, such as offering a variety of alternative methods for chronic and acute pain treatment. Having knowledgeable medical staff in regard to opiate use and alternative options further enhances the health benefits of the community. In addition, creating mechanisms to removed unused and expired drugs in a home creates a safer, healthier community. * Goal: After completion of training during the year on pain medications and alternative therapies, one-third of the physicians will indicate a change in their current practice, after completion of the Prescription Drug Abuse training 31% indicated they would make a change to current practice. * Goal: Decrease deaths in Pottawatomie County attributable to prescription drug abuse, established a baseline percentage of 800 To determine the community needs the hospital could address, the hospital used a point rating system to identify the top ten community needs. A full list of needs and points totals can be found in Appendix 4 of the CHNA. St. Anthony Shawnee's internal work group further refined the list to determine which of the top ten identified needs would develop into strategic action plans. This was done by using an internal rating scale that considered: the number of people in the PSA that are affected by the problem; how well the concern aligns with the hospital's mission and strategies, what resources are required to address the issue; and could the health need be measurably impacted. This process resulted in four needs being prioritized. Even though there was an extensive list of identified community health needs, there are existing that include services and agencies that work to meet those needs. See pages 25 and 26 of the CHNA for a list of existing community resources. 5 FAMILY HEALTHCARE ASSOCIATES 3204 MEDICAL PARK SHAWNEE OK 74804 PHYSICIAN - FAMILY HEALTH HEART CENTER AT ST ANTHONY SHAWNEE 3208 MEDICAL PARK DRIVE SHAWNEE OK 74804 CARDIOLOGIST URGENT CARE CLINIC 1900 GORDIN COOPER SHAWNEE OK 74804 URGENT CARE CLINIC MULTISPECIALTY CLINIC AT ST ANTHONY 3200 MEDICAL PARK SHAWNEE OK 74804 PHYSICIAN - SPECIALTY SURGERY CENTER AT ST ANTHONY SHAWNEE 1106 W MCARTHUR SHAWNEE OK 74804 OUTPATIENT SURGERY 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 St. Anthony Shawnee Hospital, Inc. 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 St Anthony Shawnee Hospital 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 Support - Coalition Building: Hospital representation at community coalition of Local Emergency Planning Committee for community health and safety which enhances health and advances knowledge. Hospital representation on the local United Way Board of Directors and participation in the United Way campaign. Hospital representation on the local YMCA Board of Directors. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Bad debt expense reported in the accounting system, adjusted for bad debt recoveries, was used, multiplied by the cost to charge ratio using IRS Worksheet 2, Ratio of patient costs to charges. Schedule H, Part III, Line 3 Bad Debt Expense Methodology St. Anthony Shawnee Hospital, Inc. 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 St. Anthony Shawnee Hospital, nc. is part of the SSM Health consolidated audit. The footnote that references bad debt expense in the December 31, 2014 consolidated audit is contained on page 16 and 17 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. St. Anthony Shawnee Hospital, Inc. 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 2014 Medicare cost report. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance St. Anthony Hospital Shawnee, Inc. 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 Health Center embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Health Center'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 St. Anthony Hospital Shawnee, Inc. collection and financial assistance policies. Schedule H, Part V, Section B, Line 16a FAP website - ST ANTHONY SHAWNEE HOSPITAL: Line 16a URL: WWW.SSMHEALTH.COM/SYSTEM/EXCEPTIONAL-CARE/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - ST ANTHONY SHAWNEE HOSPITAL: Line 16b URL: WWW.SSMHEALTH.COM/SYSTEM/EXCEPTIONAL-CARE/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST ANTHONY SHAWNEE HOSPITAL: Line 16c URL: WWW.SSMHEALTH.COM/SYSTEM/EXCEPTIONAL-CARE/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment 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 our 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). 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 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: 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 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. 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 St Anthony Shawnee Hospital is located in Shawnee, Oklahoma, in the northern section of Pottawatomie County. Pottawatomie County, with a population of 70,424 is considered the Primary Service area (PSA). The Pottawatomie County is predicted to experience a projected growth rate of 3.16% by 2016. This is only slightly higher than the projected growth rate for the state of Oklahoma, at 3%, and lower than the national projection of 4%. When comparing 2011 data and projections for 2016, it shows a negative growth rate for the 15 - 17 and 25 - 54 age groups. Estimates suggest that the largest growing segment of the population from 2011 to 2016 will be the 65+ cohort, with an estimated increase of 1.3% to reach 16% of the county's population by 2016. Additional detailed information concerning the demographic data of the St Anthony Shawnee service area can be found on pages 12 through 19 of the CHNA. St Anthony Shawnee Hospital is a 114 bed facility providing health care services for close to 50 years to Shawnee and the surrounding communities of Pottawatomie County. To address the healthcare needs, St Anthony Shawnee Hospital is comprised of two campus locations with acute care, newborn deliveries, Intensive Care, Emergency department, orthopedics, heart cath lab, diagnostic imaging, sleep lab, physical therapy, occupational therapy, speech therapy, cancer center and rehabilitation services. Schedule H, Part VI, Line 5 Promotion of community health St. Anthony Shawnee Hospital, Inc. 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, St. Anthony Shawnee 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. St. Anthony Hospital Shawnee, Inc. 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. St. Anthony Shawnee Hospital, Inc. 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 ST. ANTHONY SHAWNEE HOSPITAL IS A 501(C) (3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE. ALONG WITH SSM HEALTH CARE OF OKLAHOMA, INC. THE HOSPITAL IS PURSUING A VISION TO CREATE A COMPREHENSIVE, REGIONAL HEALTH CARE ENTERPRISE FOR THE CENTRAL OKLAHOMA REGION. Schedule H, Part VI, Line 7 State filing of community benefit report IL, MO, OK, WI true ST GREGORY'S UNIVERSITY 1900 W MacArthur Street Shawnee OK 74804 730685198 501(c)(3) 40000 0 NURSING PROGRAM 1 0 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds The organization's grants were made to organizations tax exempt under IRC Section 501(c)(3). These organizations have developed internal controls procedures for the use of grant funds. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The organization's grants were made to organizations tax exempt under IRC Section 501(c)(3). These organizations have developed internal controls procedures for the use of grant funds. X true true true true false false false false false false false William Thompson Director & Vice Chair 0 1807984 0 0 0 1440945 0 2228684 0 27368 0 5504981 0 90580 Joe Hodges Director & President 0 633413 0 0 0 80217 0 364886 0 34447 0 1112963 0 42700 Kersey Winfree MD Director 0 461752 0 0 0 43558 0 138540 0 26060 0 669910 0 14320 June Pickett Secretary 0 230695 0 0 0 22835 0 130612 0 16351 0 400493 0 8960 Kris Zimmer Treasurer 0 853676 0 0 0 103275 0 382451 0 30385 0 1369787 0 50610 Ramona Carey Assistant Secretary 0 72979 0 0 0 2349 0 71192 0 17167 0 163687 0 0 Paula Friedman Vice President 0 640295 0 0 0 88878 0 377167 0 19452 0 1125792 0 33950 Shasta Manuel Regional VP Finance/CFO 0 344482 0 0 0 19171 0 60675 0 21787 0 446115 0 12520 Charles Skillings Hospital President 0 319825 0 0 0 36364 0 77840 0 26430 0 460459 0 21350 Angela Mohr Executive Vice President 158165 0 0 0 7041 0 14196 0 21170 0 200572 0 5400 0 David Heon Physician 311200 0 0 0 3162 0 18465 0 30171 0 362998 0 0 0 Gaynell Anderson Physician 336643 0 0 0 2923 0 14684 0 22946 0 377196 0 0 0 David Hadley Physician 316584 0 0 0 1259 0 7449 0 22720 0 348012 0 0 0 Kenneth Darvin Physician 300100 0 0 0 1554 0 17043 0 28921 0 347618 0 0 0 Lara Mashek Physician 249934 0 0 0 624 0 10719 0 21790 0 283067 0 0 0 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 2014. The payment was included in their taxable compensation. Gaynell Anderson Kenneth Darvin Lara Mashek 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 (SSMH) President. Schedule J, Part I, Line 4a Severance or change-of-control payment SSMH has adopted a severance policy to provide a financial transition in the event of involuntary termination without cause for executive level positions. The amount of the compensation is based on the position held and length of service with SSMH. No reportable individuals listed on Part VII of Form 990 received payments from this plan during 2014. 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 2014. 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 2008 or after, the distribution will occur after the completion of two 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 2014. All distributions received from the plan in the current year were included in the individuals' taxable compensation. William Thompson $ 90,701 Kris Zimmer $ 50,811 Joe Hodges $ 42,757 Paula Friedman $ 39,621 Charles Skillings $ 21,378 Kersey Winfree, MD $ 17,589 Shasta Manuel $ 12,537 June Pickett $ 11,398 Angela Mohr $ 5,407 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 (SSM) has existed to meet the health needs of the communities it serves. SSM 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, SSM includes 18 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 approximately 30,000 people and is affiliated with more than 8,000 physicians making it one of the largest employers in every community it serves. SSM is sponsored by SSM Health Ministries, an independent 6-member body comprised of three Franciscan Sisters of Mary and three lay people who collectively hold certain reserved powers over SSM. In the tradition of its founding sisters, SSM strives to fulfill its mission by providing exceptional health care to everyone who comes to its hospitals, regardless of their ability to pay. About St. Anthony Shawnee Hospital: St. Anthony Shawnee Hospital is a 114-bed facility providing health care services for over 50 years to Shawnee and the surrounding communities of Pottawatomie County to address the healthcare needs. St Anthony Shawnee Hospital along with SSM Health Care of Oklahoma comprise the Oklahoma region of SSMH. St Anthony Shawnee Hospital is comprised of two campus locations with acute care, newborn deliveries, Intensive Care, Emergency department, orthopedics, heart cath lab, diagnostic imaging, sleep lab, physical therapy, occupational therapy, speech therapy, cancer center and rehabilitation services. According to the 2014 Hospital Consumer Assessment of Healthcare Providers and Systems, St. Anthony Shawnee Hospital scored above both the national average and average for Oklahoma hospitals in nine out of eleven patient satisfaction categories, demonstrating the hospital's continued commitment to high-quality care. The Women's Center at St. Anthony Shawnee Hospital has been recognized by the Immunization Action Coalition (IAC) for achieving one of the highest rankings in the nation for its work to immunize newborns against the hepatitis B virus. St. Anthony Shawnee Hospital is the only hospital in Oklahoma on the Immunization Action Coalition's Hepatitis B Honor Roll, with a coverage rate of 97 percent. 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 our 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). 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 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: 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 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 CHNA Community Benefit Programs: For more information on CHNA Community Benefit Programs provided by St. Anthony Shawnee Hospital, please see Schedule H, Part V. Organizational description for tax exemption: In addition to its CHNA community benefit activities, St. Anthony Hospital Shawnee, Inc. 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, St. Anthony Shawnee 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. St. Anthony Hospital Shawnee, Inc. 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. St Anthony Shawnee, along with three Catholic healthcare systems, is partnering with St Gregory University in Shawnee to establish a Catholic nursing program. The program will offer the traditional Bachelor of Nursing degree and a bridge program to the Bachelor of Science in Nursing, The program will provide new nurses with significant clinical experience and help meet the needs for current and future nurses. St. Anthony Hospital Shawnee, Inc. also furthers its exempt purpose with the following activities: * Operates a Level III Trauma 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. Form 990, Part III, Line 4b Description of Program Service (Continued) 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 policies provided by St. Anthony Shawnee Hospital, please see Schedule H. Quantifiable Community Benefit: This section includes a list of the types of programs and services that could be included as community benefit activities: Traditional Charity Care $ 423,588 Unpaid Cost of Medicare $ 2,798,177 Cost of Bad Debt $ 4,647,469 Community Benefit Programs $ 220,897 Total Quantifiable Community Benefit $ 8,090,131 Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE CORPORATE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF OKLAHOMA, INC. SSM HEALTH CARE OF OKLAHOMA, INC. IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH ST. ANTHONY SHAWNEE HOSPITAL, INC. AND SSM HEALTH CARE OF OKLAHOMA, INC. 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 AND REMOVE THE APPOINTED DIRECTORS AND THE EX-OFFICIO 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 APPOINTED DIRECTORS AND THE EX-OFFICIO DIRECTORS D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION E. TO APPROVE THE AMENDMENTS TO THE Certificate 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 AUTHORIZE OR 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 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 member, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS, AND OBJECTIVE OF THE MEMBER of the member AS DETERMINED BY THE MEMBER of the member. Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER of the member, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE 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 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 A CHECKLIST CONTAINING INFORMATION AND SUPPORTING SCHEDULES THAT ARE USED TO PREPARE THE FORM 990. THIS CHECKLIST IS THEN REVIEWED BY A SUPERVISOR/MANAGER AND SENT TO THE SYSTEM OFFICE FOR FINAL REVIEW AND COORDINATION OF THE SYSTEM LEVEL FORM 990 INFORMATION. SSMH PERSONNEL PREPARE THE FORM 990 AND SUBMIT THE COMPLETED FORM 990 TO AN OUTSIDE TAX CONSULTING FIRM WHO REVIEWS THE FORM 990 AND SIGNS AS PAID PREPARER. A COMPLETE COPT OF THE RETURN IS PROVIDED TO THE BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. Form 990, Part VI, Line 12c Conflict of interest policy BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY TO 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 DECISION ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ON LINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON (WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR END. Form 990, Part VI, Line 19 Required documents available to the public THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR SSM HEALTH ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE OKLAHOMA 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 VIII, Line 2f Other Program Service Revenue OTHER PROGRAM SERVICE REVENUE - Total Revenue: 2135348, Related or Exempt Function Revenue: 2135348, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Medical Physician, Practitioner, Psychiatrist, Resident, and Therapist - Total Expense: 1610011, Program Service Expense: 1609961, Management and General Expenses: 50, Fundraising Expenses: 0; Recruitment, Consulting, Administrative, and PBS Fees - Total Expense: 3950102, Program Service Expense: 2371264, Management and General Expenses: 1578838, Fundraising Expenses: 0; Medical Lab, Radiology, Transportation - Total Expense: 2124296, Program Service Expense: 2100922, Management and General Expenses: 23374, Fundraising Expenses: 0; SSM Health Care Corporation 10101 Woodfield Lane St Louis MO 63132 466029223 Health Care MO 501(c)(3 Type I SSM Health Ministries false SSMHC Liability Trust I 10101 Woodfield Lane St Louis MO 63132 436331003 Insurance MO 501(c)(3 Type I SSM Health Care Corporation false SSM Consolidated Health Services 10101 Woodfield Lane St Louis MO 63132 431473657 Health Care MO 501(c)(3 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 Dells Medical Building Inc 10101 Woodfield Lane St Louis MO 63132 391613292 MOB WI 501(c)(2 SSM Health Care of Wisconsin false St Mary's Foundation Inc 10101 Woodfield Lane St Louis MO 63132 431940686 Fundraising WI 501(c)(3 7 SSM Health Care of Wisconsin false St Clare Health Care Foundation Inc 10101 Woodfield Lane St Louis MO 63132 431940683 Fundraising WI 501(c)(3 7 SSM Health Care of Wisconsin false Home Health United Inc 2802 Walton Commons Lane Madison WI 53718 391539827 Health Care WI 501(c)(3 9 SSM Health Care of Wisconsin false Home Care United Inc 2802 Walton Commons Lane Madison WI 53718 391776340 Health Care WI 501(c)(3 9 SSM Health Care of Wisconsin false HHU Xtra Care Inc 2802 Walton Commons Lane Madison WI 53718 391705111 Health Care WI 501(c)(3 9 SSM Health Care of Wisconsin false Home Health United - VNS Foundation Inc 2802 Walton Commons Lane Madison WI 53718 391839309 Fundraising WI 501(c)(3 Type II NA 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 Good Samaritan Regional Health Center 10101 Woodfield Lane St Louis MO 63132 430653587 Health Care IL 501(c)(3 3 SSM Regional Health Services false St Mary's Hospital Centralia Illinois 10101 Woodfield Lane St Louis MO 63132 370662580 Health Care IL 501(c)(3 3 SSM Regional Health Services false St Mary's - Good Samaritan Inc 10101 Woodfield Lane St Louis MO 63132 364170833 Health Care IL 501(c)(3 Type I SSM Regional Health Services false Good Samaritan Regional Health Center Foundation 10101 Woodfield Lane St Louis MO 63132 262884795 Fundraising IL 501(c)(3 7 St Mary's - Good Samaritan Inc false St Mary's Hospital Foundation 10101 Woodfield Lane St Louis MO 63132 364636691 Fundraising IL 501(c)(3 7 St Mary's - Good Samaritan Inc false St Mary's Hospital Auxiliary 400 N Pleasant Centralia IL 62801 237126345 Fundraising IL 501(c)(3 9 St Mary's Hospital Foundation false SSM Health Businesses 10101 Woodfield Lane St Louis MO 63132 431333488 Health Care MO 501(c)(3 9 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 I SSM Regional Health Services false St Mary's Janesville Foundation Inc 2901 Landmark PL Ste 300 Madison WI 53713 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)(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 605 North 12th Street Mt Vernon IL 62864 237049599 Fundraising IL 501(c)(3 Type III-FI NA 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 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 SSM St Joseph Endoscopy Center LLC 10101 Woodfield Lane St Louis MO 63132 270046559 Surgery Services MO NA N/A St Clare Imaging Services 707 14th Street Suite A Baraboo WI 53913 200122365 Diag Services WI NA N/A Mt Vernon Radiation Therapy Center LLC 10101 Woodfield Lane St Louis MO 63132 201382620 Radiation Therapy IL NA N/A Sleep & Neurology Center of S Illinois LLC 10101 Woodfield Lane St Louis MO 63132 208468195 Diag Services IL NA N/A SMHC Surgical Co-Mgmt Company LLC 100 St Marys Medical Plaza Jefferson City MO 65101 208929305 Management MO NA N/A SMHC Cardiovascular Co-Mgmt Company LLC 100 St Marys Medical Plaza Jefferson City MO 65101 208929381 Management MO NA N/A SMHC Musculoskeletal Co-Mgmt Company LLC 100 St Marys Medical Plaza Jefferson City MO 65101 208929237 Management MO NA N/A ChowSMGSI Office Building LLC 10101 Woodfield Lane St Louis MO 63132 371383861 MOB IL NA N/A Center for Comprehensive Cancer Care LLC 10101 Woodfield Lane St Louis MO 63132 201382727 MOB IL NA N/A Shawnee Real Estate Holdings LLC 1000 N Lee Ave Oklahoma City OK 73102 455458304 MOB OK NA N/A SSM RX Express LLC 10101 Woodfield Lane St Louis MO 63132 264031708 Pharmacy MO NA N/A Dean Clinic & St Marys Hospital Accountable Care Organization LLC 1808 West Beltline Highway Madison WI 53713 452995500 Accountable Care Organization WI NA N/A Wisconsin Integrated Information Technology and Telemedicine Systems LLC 1808 West Beltline Highway Madison WI 53713 392016715 Information Technology Services WI NA N/A Dean Health Holdings LLC 1277 Deming Way Madison WI 53717 261594709 Support Services WI NA N/A Wingra Building Group 1808 West Beltline Highway Madison WI 53713 390237060 MOB WI NA N/A Janesville Riverview Clinic Building Partnership 1808 West Beltline Highway Madison WI 53713 396220698 MOB WI NA N/A 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 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 10101 Woodfield Lane St Louis MO 63132 364161526 Health Care IL NA C Corporation false Dean Health Systems Inc 1808 West Beltline Highway Madison WI 53713 391128616 Physician Offices WI NA C Corporation false Dean Health Insurance Inc PO Box 56099 Madison WI 53705 391830837 Insurance WI NA C Corporation false Dean Health Plan Inc PO Box 56099 Madison MO 53705 391535024 Insurance WI NA C Corporation false St Marys 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 Yagnesh V Oza MD Inc 4117 Veterans Memorial Drive Mt Vernon IL 62804 Physician Offices IL NA C Corporation false false false false false false false false false false false false false true true true true true true true