2013-11-15T11:25:45-06:00 2012-12-31 861065772 DELOITTE TAX LLP 1111 BAGBY STREET SUITE 4500 HOUSTON TX 770022591 990 2012-01-01 736104300 THE ST ANTHONY HOSPITAL FOUNDATION INC STAN 3149947800 477 N LINDBERGH ST LOUIS MO 63141 JUNE L PICKETT 3149947800 2013-11-15 1 BROOKE KITCHEN P00849302 7139822000 2012 2016-02-25 16:41:14Z SHERRY RICE RHODES 826 NW 11ST ST OKLAHOMA CITY OK 73106 3366062 0 0928 X WWW.GIVETOSAINTS.COM X 1963 OK TO SUPPORT PATIENTS IN SSM HEALTH CARE OF OKLAHOMA HOSPITALS, HEALTHPLEXES AND CLINICS 30 30 0 100 0 0 1247642 1995137 0 0 1710529 1292462 4913 0 2963084 3287599 2502096 1234116 0 0 442712 472159 0 0 599144 275613 243096 3220421 1949371 -257337 1338228 22502656 25111957 680680 676270 21821976 24435687 X THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. 0 0 1234116 1234116 PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS. 1234116 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 9 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 X 30 30 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OK X LEAH HODGES 4052727499 PO BOX 205 OKLAHOMA CITY OK 73101 MINNIE BAJAJ 1.00 X 0 0 0 JERRY BENDORF 1.00 X X 0 0 0 CARLEEN BURGER 1.00 X 0 0 0 MIKE COLLISON 1.00 X 0 0 0 MELINDA COX 1.00 X 0 0 0 PAUL W DUDMAN 1.00 X 0 0 0 JAMIE FARHA 1.00 X X 0 0 0 JOAN FRATES 1.00 X X 0 0 0 SUSIE FULLER 1.00 X 0 0 0 SHEILA HEIM 1.00 X 0 0 0 RICHARD HORTON 1.00 X 0 0 0 LAUREN HUMPHREY 1.00 X 0 0 0 ERIC JOINER 1.00 X 0 0 0 JENEE NAIFEH LISTER 1.00 X 0 0 0 JUDY M LOVE 1.00 X 0 0 0 DEBBIE LUCAS 1.00 X 0 0 0 MICHAEL MILLIGAN 1.00 X 0 0 0 LEE ANN NORDIN 1.00 X 0 0 0 VINCENT ORZA 1.00 X 0 0 0 JAMES PICKEL 1.00 X 0 0 0 MYRLA PIERSON 1.00 X 0 0 0 CHARLOTTE RICHELS 1.00 X 0 0 0 PATRICK ROONEY 1.00 X 0 0 0 BECKY ROTEN 1.00 X 0 0 0 AVIS SCARAMUCCI 1.00 X 0 0 0 DAVID SCHNEIDER 1.00 X 0 0 0 STEPHANIE SINGER 1.00 X 0 0 0 LINDA STEWART 1.00 X 0 0 0 SEAN TRAUSCHKE 1.00 X X 0 0 0 LORI TYLER 1.00 X 0 0 0 JUNE L PICKETT 1.00 40.00 X 0 240525 353818 SHERRY RICE RHODES 40.00 X 0 191445 61743 SHASTA MANUEL 1.00 40.00 X 0 326790 73375 0 758760 488936 0 0 1 0 0 467895 1527242 104816 1995137 656142 656142 636320 0 636320 636320 636320 78463 467895 78463 0 3287599 0 0 1292462 1093282 1093282 140834 140834 175000 17500 157500 268472 24650 243822 28687 3156 25531 13810 13810 49726 49726 11492 11492 41529 41529 5138 5138 1075 118 957 FUNDRAISING EXPENSES 94195 0 0 94195 DONOR CULTIVATION 24118 0 0 24118 MISCELLANEOUS EXPENSE 2013 0 2013 0 1949371 1234116 116111 599144 35041 32365 476507 1019624 600 359435 232751 127760 126684 21625245 23667557 238103 265127 22502656 25111957 321379 334178 359301 342092 680680 676270 X 11307061 12850464 10439342 11509650 75573 75573 21821976 24435687 22502656 25111957 X 1338228 1360136 -84653 X 0 1 X 1 0 X 1133515 795181 1312533 1194800 1995137 6431166 1133515 795181 1312533 1194800 1995137 6431166 648343 5782823 1109776 792035 744035 663512 656142 3965500 10396666 812749 0.55620 0.53690 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 75573 3331 3331 75573 75573 7000 7000 75573 75573 14500 14500 75573 75573 13499 13168 331 75573 75573 75573 1.00000 0 1 1 124100 124100 63515 63515 0 171820 169236 2584 126684 SSM COMPREHENSIVE INVESTMENT PROGRAM 23667557 F 23667557 GIFT ANNUITY LIABILITY 342092 342092 X 4594893 1360136 -52842 1307294 3287599 0 3287599 1981182 31811 31811 1949371 0 1949371 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION'S PERMANENT ENDOWMENT FUNDS ARE HELD FOR THE PURPOSE OF PROVIDING SCHOLOARSHIPS TO NURSING STUDENTS DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2012 OR 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PLEDGES -52,842. PART XII, LINE 2D - OTHER ADJUSTMENTS: ACTUARIAL LOSS ON GIFT ANNUITY LIABILITY 31,811. SAINTS BALL 546358 467895 78463 31891 42446 3200 926 546358 467895 78463 31891 42446 3200 926 78463 0 1 SSM HEALTH CARE OF OKLAHOMA INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 730657693 501(C)(3) 1093282 TO SUPPORT THE OPERATIONS AND CAPITAL NEEDS OF THE RELATED HOSPITALS 1 0 FREE PRESCRIPTION MEDICATION TO THE NEEDY 908 123584 SCHOLARSHIPS 10 17250 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION'S GRANTS TO ORGANIZATIONS WERE MADE TO A RELATED ORGANIZATION THAT IS TAX EXEMPT UNDER SECTION 501(C)(3). THIS ORGANIZATION HAS DEVELOPED INTERNAL CONTROL PROCEDURES FOR THE USE OF GRANT FUNDS. APPROVED GRANT APPLICATIONS FOR GRANTS TO INDIVIDUALS ARE FORWARDED TO THE FOUNDATION AND THE FOUNDATION PAYS THE REQUESTED EXPENDITURE. TO MONITOR THE USE OF ALL GRANTS, THE FOUNDATION PRESIDENT REVIEWS ALL REQUESTS FOR GRANTS FROM ALL DESIGNATED FUNDS INCLUDING THE TREE OF LIFE FUND AND THE SISTER'S FUND TO ENSURE REQUESTS MEET THE CRITERIA ESTABLISHED FOR THESE FUNDS. PAYMENTS FROM THE SISTER'S FUND FOR PHARMACEUTICALS ARE MADE DIRECTLY TO THE PHARMACY AFTER THE PHARMACEUTICALS HAVE BEEN PROVIDED AND NOT TO THE INDIVIDUAL RECEIVING ASSISTANCE. 0 1 0 0 0 0 0 0 0 JUNE L PICKETT 0 220007 0 0 0 20518 0 331433 0 22385 0 594343 0 8280 SHERRY RICE RHODES 0 171837 0 0 0 19608 0 55218 0 6525 0 253188 0 5156 SHASTA MANUEL 0 307486 0 0 0 19304 0 44625 0 28750 0 400165 0 10400 SUPPLEMENTAL INFORMATION PART III PART I LINE 3: COMPENSATION TO CEO/EXECUTIVE DIRECTOR THE ORGANIZATION'S CEO 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 BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A: SEVERANCE PLAN: SSMHC 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 SSMHC. PART I, LINE 4B: SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS PENSION RESTORATION PLAN: SSM HEALTH CARE (SSMHC) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMHC 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 SSMHC'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 SSMHC OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMHC. NO REPORTABLE INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN DURING 2012. CAPITAL ACCUMULATION PLAN: SSMHC 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 SSMHC 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 2012. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. SHASTA MANUEL $10,411 JUNE PICKETT $8,289 SHERRY RICE RHODES $5,162 X 25564 COST OR SELLING PRICE X 4 3125 COST OR SELLING PRICE X VIDEOS & MEMORABILIA 3 30800 COST OR SELLING PRICE X GIFT CARDS 18 9150 COST OR SELLING PRICE X HEALTHY/BEAUTY 7 2961 COST OR SELLING PRICE X JEWELRY 7 5413 COST OR SELLING PRICE X ENTERTAINMENT 25 27803 COST OR SELLING PRICE 0 1 1 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE AMOUNTS IN COLUMN B REPRESENT THE NUMBER OF CONTRIBUTIONS RECEIVED BY THE ORGANIZATION, NOT THE ACTUAL NUMBER OF ITEMS CONTRIBUTED. THIRD PARTY USE: PART I, LINE 32B: STOCK DONATIONS ARE SOLD BY A BANK/INVESTMENT COMPANY USED BY THE SSM COMPREHENSIVE INVESTMENT PROGRAM. ORGANIZATION MISSION STATEMENT FORM 990, PART I, LINE 1 TO PROMOTE, RECEIVE, INVEST, AND DISBURSE GIFTS IN SUPPORT OF PATIENTS IN ST. ANTHONY HOSPITAL, BONE AND JOINT HOSPITAL AT ST. ANTHONY, AND OTHER SSM HEALTH CARE OF OKLAHOMA HOSPITALS, HEALTHPLEXES, AND CLINICS. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: FORM 990, PART III, QUESTION 4A 2012 COMMUNITY BENEFIT REPORT THE COMMUNITY BENEFIT CONTRIBUTION OF ST. ANTHONY FOUNDATION INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. A. DESCRIBE THE ORGANIZATION'S MISSION AND PRIMARY EXEMPT PURPOSE. FOUNDED IN 1898 BY TWO CATHOLIC SISTERS OF ST. ANTHONY FRANCIS, ST. ANTHONY HOSPITAL IS A FAITH-BASED, FULL-CARE 601-BED REGIONAL REFERRAL MEDICAL CENTER LOCATED IN OKLAHOMA CITY. THE FIRST HOSPITAL IN OKLAHOMA TERRITORY, ST. ANTHONY REMAINS TRUE TODAY TO ITS FOUNDERS' MISSION OF PROVIDING COMPASSIONATE, EXCEPTIONAL HEALTHCARE TO OKLAHOMANS, INCLUDING THE POOR, VULNERABLE AND OFTEN-FORGOTTEN. ST. ANTHONY IS STRENGTHENING HEALTHCARE IN RURAL OKLAHOMA THROUGH ITS SAINTS 1ST PARTNERSHIPS WITH 19 HOSPITALS LOCATED IN WESTERN OKLAHOMA AND THROUGH ITS TELEMEDICINE PROGRAMS. ST. ANTHONY HOSPITAL IS PART OF SSM HEALTH CARE OF OKLAHOMA COMPRISED OF ST. ANTHONY HOSPITAL, BONE AND JOINT HOSPITAL AT ST. ANTHONY, ST. ANTHONY SHAWNEE HOSPITAL, ST. ANTHONY NORTH, ST. ANTHONY SOUTH, ST. ANTHONY EAST HEALTHPLEX AND ST. ANTHONY SOUTH HEALTHPLEX, NUMEROUS CLINICS AND PARTNERSHIPS WITH 19 SAINTS 1ST HOSPITALS LOCATED IN RURAL OKLAHOMA. ST ANTHONY IS PART OF THE INTEGRATED HEALTH CARE SYSTEM SPONSORED BY SSM HEALTH CARE (SSMHC). SPONSORED BY THE FRANCISCAN SISTERS OF MARY AND HEADQUARTERED IN ST LOUIS, MISSOURI, SSMHC OPERATES 18 HOSPITAL LOCATIONS, TWO SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES IN FOUR STATES. THE HEALTH SYSTEM EMPLOYS APPROXIMATELY 25,600 PEOPLE AND IS AFFILIATED WITH MORE THAN 6,600 PHYSICIANS. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMHC STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL HEALTH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. ST. ANTHONY FOUNDATION, ESTABLISHED IN 1963, IS A SEPARATE 501(C)(3) NONPROFIT ORGANIZATION, DIRECTED BY A DEDICATED VOLUNTEER BOARD OF DIRECTORS. IT CONTINUES THE MISSION OF THE SISTERS BY SEEKING PHILANTHROPIC DONATIONS FROM GRATEFUL PATIENTS AND THEIR FAMILIES, PHYSICIANS, SAINTS EMPLOYEES, BUSINESSES, CORPORATIONS, PRIVATE FOUNDATIONS, COMMUNITY ORGANIZATIONS AND COMMUNITY MEMBERS TO BENEFIT PATIENT CARE AT SSM OF OKLAHOMA ENTITIES. B. SUMMARIZE THE FOUNDATION'S APPROACH TO PROVIDING COMMUNITY BENEFIT. AS A NONPROFIT, FAITH-BASED HOSPITAL, DONATIONS HELP GIVE PATIENTS THE VERY BEST CARE BY FUNDING NEW EQUIPMENT AND TECHNOLOGY, IMPROVING PATIENT CARE AREAS, TRAINING OUR HEALTH CARE PROFESSIONALS AND ENSURING ALL OF OUR PATIENTS RECEIVE EXCEPTIONAL COMPASSIONATE HEALTH CARE. OUR GIVING PRIORITIES ARE ALIGNED WITH THE STRATEGIC GOALS OF ST. ANTHONY HOSPITAL, ENSURING THAT MONIES DONATED TO ST. ANTHONY FOUNDATION ARE USED TO SUPPORT CRITICAL MEDICAL SERVICES. OUR CURRENT GIVING PRIORITIES ARE: AREA OF GREATEST NEED - FUNDS PROVIDE ST. ANTHONY THE FLEXIBILITY TO SUPPORT PROGRAMS AND SERVICES MOST NEEDED. CAMPUS DEVELOPMENT - DONATIONS HELP FUND NEW CONSTRUCTION AND IMPROVEMENTS FOR PATIENT CARE INCLUDING THE NEW SAINTS PAVILION THAT WILL HOUSE AN EMERGENCY DEPARTMENT, ADDITIONAL TRAUMA ROOMS, CRITICAL CARE UNITS AND PATIENT ROOMS TO CARE FOR OUR GROWING NUMBER OF CRITICALLY ILL PATIENTS. CANCER CARE: DONATIONS ENABLE ST. ANTHONY TO CONTINUE ITS LEADERSHIP IN CANCER CARE THROUGH THE FRANK C. LOVE CANCER INSTITUTE. THE TREE OF LIFE FUND PROVIDES COMFORTS, MEDICATIONS AND OTHER ASSISTANCE TO CANCER PATIENTS. EQUIPMENT AND TECHNOLOGY: FUNDS HELP PURCHASE CRITICALLY NEEDED EQUIPMENT AND NEW TECHNOLOGY TO CONTINUE TO PROVIDE THE HIGHEST QUALITY CARE AND ENHANCE CLINICAL OUTCOMES FOR OUR PATIENTS. CARDIAC CARE: DONATIONS WILL ENABLE ST. ANTHONY'S HEART AND VASCULAR INSTITUTE TO CONTINUE ITS LEADERSHIP IN CARDIAC AND VASCULAR CARE, INCLUDING THE ACQUISITION OF ADVANCED TECHNOLOGY AND PATIENT SERVICES. ORTHOPEDICS: CONTRIBUTIONS WILL ENABLE BONE AND JOINT HOSPITAL AT ST. ANTHONY TO CONTINUE ITS LEADERSHIP IN THE DIAGNOSIS AND TREATMENT OF ALL TYPES OF ARTHRITIC, ORTHOPEDIC AND SPINAL BONE CONDITIONS, INCLUDING STATE-OF-THE-ART IMAGING SERVICES AND MINIMALLY INVASIVE KNEE AND HIP REPLACEMENT SURGERY. 2. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS DONATIONS SUPPORT CAMPUS AND HOSPITAL IMPROVEMENTS, ADD NEW TECHNOLOGY AND EQUIPMENT, SUPPORT PATIENT CARE AREAS, PROVIDE CONTINUING EDUCATION OPPORTUNITIES TO MEDICAL STAFF AND PROVIDE PATIENT ASSISTANCE SUCH AS THE SISTERS FUND THAT PROVIDES PRESCRIPTION MEDICATIONS TO THE NEEDY. RECENT ACCOMPLISHMENTS MADE POSSIBLE WITH DONATIONS TO THE FOUNDATION INCLUDE BUT ARE NOT LIMITED TO: - HELPING PURCHASE SURGICAL EQUIPMENT. - BUYING FURNITURE AND FURNISHINGS FOR OUR BEHAVIORAL MEDICINE CENTER TO PROVIDE A MORE WELCOMING AND HEALING ENVIRONMENT FOR OUR CHILDREN & ADOLESCENT PATIENTS. - PROVIDING EQUIPMENT FOR JOYFUL BEGINNINGS TO CARE FOR MEDICALLY FRAGILE BABIES. - FUNDING A NO-COST MULTIDISCIPLINARY PILOT WEIGHT LOSS CLINIC TO LOWER OBESITY BY PROVIDING EDUCATION AND TRAINING FOR ADULTS ON HOW TO LIVE A HEALTHY LIFESTYLE AND BE AN EXAMPLE FOR THEIR CHILDREN. - TRAINING AND CONTINUING EDUCATION FOR MEDICAL RESIDENTS, PHYSICIANS AND NURSES TO HELP OUR MEDICAL STAFF MEET EXTRAORDINARY MEDICAL CHALLENGES WITH EASE. - EXPANDING, AND IMPROVING HOSPITAL CAMPUS AND FACILITIES TO CREATE PREMIER HEALTH FACILITIES THAT ENHANCE HEALING AND PROMOTE WELL-BEING FOR PATIENTS, STAFF AND VISITORS. - PROVIDING MORE THAN $120,000 IN PRESCRIPTION MEDICATIONS TO NEEDY PATIENTS. - SUPPORTING ORTHOPEDIC RESEARCH THROUGH THE BONE & JOINT HOSPITAL FUND. - ASSISTING OUT-OF-TOWN PATIENT FAMILIES WITH HOUSING WHILE THEIR LOVED ONES WERE IN THE HOSPITAL THROUGH THE GUEST SERVICES FUND, CREATED IN MEMORY OF SISTER CLARA HEITMAN. SUPPORT OF COMMUNITY NONPROFIT ORGANIZATIONS LIMITED FUNDS ARE PROVIDED TO OTHER NONPROFIT COMMUNITY ORGANIZATIONS THROUGH EVENT SPONSORSHIPS. EACH FUNDING REQUEST IS REVIEWED TO DETERMINE BENEFIT TO THE COMMUNITY, CONNECTION TO HOSPITAL GOALS OR LEADERSHIP. CONTRIBUTIONS IN 2012 TO COMMUNITY NONPROFIT ORGANIZATIONS INCLUDED: $500 FOR SPONSORSHIP: TO THE LIBRARY ENDOWMENT TRUST, THE FOUNDATION FOR OKLAHOMA CITY PUBLIC SCHOOLS AND TO THE GIRL SCOUTS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE FOUNDATION IS SSM HEALTH CARE OF OKLAHOMA. SSM HEALTH CARE OF OKLAHOMA IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH THE FOUNDATION AND SSM HEALTH CARE OF OKLAHOMA ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE, WHICH OPERATES IN FOUR STATES AND OWNS, MANAGES AND IS AFFILIATED WITH 18 HOSPITALS AND 2 NURSING HOMES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE POWER TO APPOINT SUCCESSOR, ADDITIONAL OR REPLACEMENT MEMBERS, PROVIDED THAT ANY SUCCESSOR, ADDITIONAL OR REPLACEMENT MEMBER SHALL BE A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND ELECT AND REMOVE DIRECTORS WITH OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER RESERVES THE POWER TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF THE FOUNDATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE FOUNDATION IN CONNECTION WITH SUCH PROGRAMS. FORM 990, PART VI, SECTION B, LINE 11 ACCOUNTING/FINANCE PERSONNEL AT EACH SSMHC (SSM HEALTH CARE SYSTEM) ENTITY, IN CONJUNCTION WITH CORPORATE 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 CORPORATE OFFICE FOR FINAL REVIEW AND COORDINATION OF THE SYSTEM LEVEL FORM 990 INFORMATION. THE INFORMATION IS SUBMITTED TO AN OUTSIDE TAX CONSULTING FIRM WHO PREPARES AND SIGNS THE FORM 990 FROM THE SSMHC INFORMATION. PRIOR TO FINALIZING THE RETURN, A DRAFT IS SENT TO PERSONNEL AT SSMHC FOR REVIEW AND APPROVAL. UPON SSMHC APPROVAL, THE OUTSIDE PREPARER FORWARDS THE COMPLETED FORM 990 FOR THE APPROPRIATE SIGNATURES AND FILING ACTION. A COMPLETE COPY OF THE RETURN WILL BE PRESENTED TO THE BOARD AT THEIR NEXT REGULARLY SCHEDULED MEETING. FORM 990, PART VI, SECTION B, LINE 12C 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 DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ON LINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON (WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR END. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT'S SALARY IS DETERMINED BY AN OUTSIDE CONSULTANT WHO USES THIRD PARTY SALARY SURVEY INFORMATION TO DETERMINE SALARY RECOMMENDATIONS. THE REGIONAL PRESIDENT OF SSM HEALTH CARE CORPORATION, THE PARENT ORGANIZATION, MAKES A RECOMMENDATION TO THE SSM HEALTH CARE CORPORATION PRESIDENT WHO GRANTS FINAL APPROVAL OF SALARY. FORM 990, PART VI, SECTION C, LINE 19 THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENT FOR THE SSM HEALTH CARE SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH CARE'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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: ACTURIAL LOSS ON GIFT ANNUITY LIABILITY -31,811. LOSS ON UNCOLLECTIBLE PLEDGES -52,842. SSM HEALTH CARE CORPORATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 466029223 HEALTH CARE MO 501(C)(3) LINE 11A, I FRANCISCAN SISTERS OF MARY 0 SSM EMPLOYEE HEALTH CARE FUND 477 N LINDBERGH BLVD ST LOUIS MO 63141 431328934 BENEFIT PLANS MO 501(C)(9) SSM HEALTH CARE CORPORATION 0 SSMHC LIABILITY TRUST I 477 N LINDBERGH BLVD ST LOUIS MO 63141 436331003 INSURANCE MO 501(C)(3) LINE 11A, I SSM HEALTH CARE CORPORATION 0 SSM CONSOLIDATED HEALTH SERVICES 477 N LINDBERGH BLVD ST LOUIS MO 63141 431473657 HEALTH CARE MO 501(C)(3) LINE 11A, I SSM HEALTH CARE CORPORATION 0 SSM POLICY INSTITUTE 477 N LINDBERGH BLVD ST LOUIS MO 63141 431788151 HEALTH CARE MO 501(C)(4) SSM HEALTH CARE CORPORATION 0 SSM PORTFOLIO MANAGEMENT CO 477 N LINDBERGH BLVD ST LOUIS MO 63141 431825256 MANAGEMENT MO 501(C)(3) LINE 11A, I SSM HEALTH CARE CORPORATION 0 SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 477 N LINDBERGH BLVD ST LOUIS MO 63141 430738490 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE ST LOUIS 0 CARDINAL GLENNON CHILDREN'S FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431754347 FUNDRAISING MO 501(C)(3) LINE 7 SSM CARDINAL GLENNONCHILDREN'S HOSPITAL 0 SSM DEPAUL HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431776109 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM ST JOSEPH FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431591556 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM ST CLARE HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431273310 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM ST MARY'S HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431552945 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH CARE ST LOUIS 0 SSM HEALTH CARE OF OKLAHOMA INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 730657693 HEALTH CARE OK 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 SSM HEALTH CARE OF WISCONSIN INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 430688874 HEALTH CARE WI 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 DELLS MEDICAL BUILDING INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 391613292 MOB WI 501(C)(2) SSM HEALTH CARE OF WISCONSIN 0 ST MARY'S FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 431940686 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 ST CLARE HEALTH CARE FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 431940683 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 HOME HEALTH UNITED INC 4639 HAMMERSLEY ROAD MADISON WI 53713 391539827 HEALTH CARE WI 501(C)(3) LINE 9 SSM HEALTH CARE OF WISCONSIN 0 HOME CARE UNITED INC 4639 HAMMERSLEY ROAD MADISON WI 53713 391776340 HEALTH CARE WI 501(C)(3) LINE 9 SSM HEALTH CARE OF WISCONSIN 0 HHU XTRA CARE INC 4639 HAMMERSLEY ROAD MADISON WI 53713 391705111 HEALTH CARE WI 501(C)(3) LINE 9 SSM HEALTH CARE OF WISCONSIN 0 SSM REGIONAL HEALTH SERVICES 477 N LINDBERGH BLVD ST LOUIS MO 63141 440579850 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 ST FRANCIS HOSPITAL FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431099253 FUNDRAISING MO 501(C)(3) LINE 7 SSM REGIONAL HEALTH SERVICES 0 ST MARY'S HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431575307 FUNDRAISING MO 501(C)(3) LINE 11B, II SSM REGIONAL HEALTH SERVICES 0 GOOD SAMARITAN REGIONAL HEALTH CENTER 477 N LINDBERGH BLVD ST LOUIS MO 63141 430653587 HEALTH CARE IL 501(C)(3) LINE 3 SSM REGIONAL HEALTH SERVICES 0 ST MARY'S HOSPITAL CENTRALIA ILLINOIS 477 N LINDBERGH BLVD ST LOUIS MO 63141 370662580 HEALTH CARE IL 501(C)(3) LINE 3 SSM REGIONAL HEALTH SERVICES 0 ST MARY'S - GOOD SAMARITAN INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 364170833 HEALTH CARE IL 501(C)(3) LINE 11A, I SSM REGIONAL HEALTH SERVICES 0 GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 262884795 FUNDRAISING IL 501(C)(3) LINE 7 ST MARY'S-GOOD SAMARITAN INC 0 ST MARY'S HOSPITAL FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 364636691 FUNDRAISING IL 501(C)(3) LINE 7 ST MARY'S-GOOD SAMARITAN INC 0 SSM HEALTH BUSINESSES 477 N LINDBERGH BLVD ST LOUIS MO 63141 431333488 HEALTH CARE MO 501(C)(3) LINE 9 SSM HEALTH CARE CORPORATION 0 SSM HEALTH CARE ST LOUIS 477 N LINDBERGH BLVD ST LOUIS MO 63141 431343281 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 CENTRALIA MEDICAL SERVICES BLDG ASSOC 477 N LINDBERGH BLVD ST LOUIS MO 63141 237408025 MOB IL 501(C)(3) LINE 11A, I SSM REGIONAL HEALTH SERVICES 0 ST MARY'S JANESVILLE FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 273439133 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 FRANCISCAN SISTERS OF MARY 3221 MCKELVEY ROAD SUITE 107 BRIDGETON MO 63044 431012492 RELIGIOUS ORGANIZATION MO 501(C)(3) LINE 1 N/A 0 LEE DEWEY CORPORATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 731279603 MOB OK 501(C)(3) LINE 11A, I SSM HEALTH CARE OF OKLAHOMA 0 SSM HOSPICE & HOME CARE FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 300012246 FUNDRAISING MO 501(C)(3) LINE 7 SSM HEALTH BUSINESSES 0 ST MARY'S HOSPITAL AUXILIARY 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY MO 65101 436049878 FUNDRAISING MO 501(C)(3) LINE 11B, II N/A 0 GOOD SAMARITAN HOSPITAL AUXILIARY 605 NORTH 12TH STREET MT VERNON IL 62864 237049599 FUNDRAISING IL 501(C)(3) LINE 11C, III-FI N/A 0 ST ANTHONY SHAWNEE HOSPITAL INC 1000 N LEE AVE OKLAHOMA CITY OK 73102 455055149 HEALTH CARE OK 501(C)(3) LINE 3 SSM HEALTH CARE OF OKLAHOMA 0 SSM SJ ENDOSCOPY 477 N LINDBERGH BLVD ST LOUIS MO 63141 270046559 SURGERY SERVICES MO N/A ST CLARE IMAGING SERVICES 707 14TH STREET SUITE A BARABOO WI 53913 200122365 DIAG. SERVICES WI N/A MT VERNON RADIATION THERAPY CENTER 477 N LINDBERGH BLVD ST LOUIS MO 63141 201382620 RADIATION THERAPY IL N/A SLEEPNEURO SO IL 477 N LINDBERGH BLVD ST LOUIS MO 63141 208468195 DIAG. SERVICES IL N/A SMHC SURG CO-MGMT 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY MO 65101 208929305 MANAGEMENT MO N/A SMHC CARD CO-MGMT 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY MO 65101 208929381 MANAGEMENT MO N/A SMHC MUSC CO-MGMT 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY MO 65101 208929237 MANAGEMENT MO N/A CHOWSMGSI 477 N LINDBERGH BLVD ST LOUIS MO 63141 371383861 MOB IL N/A COMP CANCER CARE 477 N LINDBERGH BLVD ST LOUIS MO 63141 201382727 MOB IL N/A SHAWNEE REAL ESTATE HOLDINGS LLC 1000 N LEE AVE OKLAHOMA CITY OK 73102 455458304 MOB OK N/A SSM RX EXPRESS 477 N LINDBERGH BLVD ST LOUIS MO 63141 264031708 PHARMACY MO N/A SSM MANAGED CARE ORGANIZATION LLC 477 N LINBERGH BLVD ST LOUIS MO 63141 431708511 HEALTH PROMOTION MO N/A C 0 FPP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431465174 HEALTH CARE MO N/A C 0 DIVERSIFIED HEALTH SERVICES CORP 477 N LINBERGH BLVD ST LOUIS MO 63141 431369305 MEDICAL EQUIPMENT MO N/A C 0 SSM CARDIO AND THORACIC SERVICES INC 477 N LINBERGH BLVD ST LOUIS MO 63141 260286559 HEALTH CARE MO N/A C 0 SSM PROPERTIES INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431462486 PROPERTY SERVICES MO N/A C 0 SSM DEPAUL MEDICAL GROUP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431715106 HEALTH CARE MO N/A C 0 SSM ST CHARLES CLINIC MED GROUP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 430626408 PHYSICIAN OFFICES MO N/A C 0 HEALTH FIRST PHYS MANAGEMENT 477 N LINBERGH BLVD ST LOUIS MO 63141 731534336 MEDICAL SERVICES OK N/A C 0 SSMHCS LIABILITY TRUST II 477 N LINBERGH BLVD ST LOUIS MO 63141 816128118 INSURANCE MO N/A C 0 SSM NEUROSCIENCES INC 477 N LINBERGH BLVD ST LOUIS MO 63141 263413981 HEALTH CARE MO N/A C 0 SSM MEDICAL GROUP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431664107 PHYSICIAN OFFICES MO N/A C 0 SSMHC INSURANCE COMPANY 477 N LINBERGH BLVD ST LOUIS MO 63141 030310431 INSURANCE CA N/A C 0 SSM ORTHOPEDIC INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 271557033 HEALTH CARE MO N/A C 0 SSM CANCER CARE 477 N LINDBERGH BLVD ST LOUIS MO 63141 271557324 HEATH CARE MO N/A C 0 PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS 477 N LINDBERGH BLVD ST LOUIS MO 63141 364161526 HEATH CARE IL N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1