SSM EMPLOYEE HEALTH CARE FUND: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SSM EMPLOYEE HEALTH CARE FUND (EIN 43-1328934)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201243209349308829
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T17:01:45-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11111 BAGBY STREET SUITE 4500AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code77002ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431328934EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SSM EMPLOYEE HEALTH CARE FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSSMENameControl
Phone3149977800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1477 N LINDBERGH BLVDAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63141ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKRIS A ZIMMERName
TitleTRUSTEETitle
Phone3149977800Phone
Date Signed2012-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSRIRAM SRINIVASANName
PTINP00654717PTIN
Phone7139822000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSUSAN E GOLDBERGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1477 N LINDBERGH BLVDAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63141ZIPCode
FieldValueIRS element (for citing)
Gross Receipts173530552GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteSWW.SSMHC.COMWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1984YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionPROVIDE SICK, ACCIDENT, AND OTHER QUALIFIED BENEFITS TO EMPLOYEES OF SSM HEALTH CAREActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year187421480ProgramServiceRevenuePriorYear
Program Service Revenue CY173510056ProgramServiceRevenueCY
Investment Income Prior Year22105InvestmentIncomePriorYear
Investment Income Current Year20496InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year187443585TotalRevenuePriorYear
Total Revenue Current Year173530552TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year184736815OtherExpensePriorYear
Other Expenses Current Year171734380OtherExpensesCurrentYear
Total Expenses Prior Year184736815TotalExpensesPriorYear
Total Expenses Current Year171734380TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2706770RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1796172RevenuesLessExpensesCY
Total Assets BOY41565194TotalAssetsBOY
Total Assets EOY42057332TotalAssetsEOY
Total Liabilities BOY19539901TotalLiabilitiesBOY
Total Liabilities EOY18260867TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY22025293NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY23796465NetAssetsOrFundBalancesEOY
Mission DescriptionTHROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionPROVIDE SICK, ACCIDENT, AND OTHER QUALIFIED BENEFITS FOR MEMBERS OF THE SSM HEALTH CARE SYSTEM (SSMHC). SSMHC IS AN INTEGRATED HEALTH CARE SYSTEM OPERATING 17 HOSPITAL LOCATIONS, TWO SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES IN FOUR STATES. SSMHC EMPLOYS APPROXIMATELY 24,000 PEOPLE AND IS AFFILIATED WITH MORE THAN 6,500 PHYSICIANS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Number Of8282 Filed0NumberOf8282Filed
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SUSAN E GOLDBERGBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3149947904TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1477 NORTH LINDBERGH BLVDAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63132ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (3 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
STEVEN M BARNEY
TRUSTEE1.00X067742738184
SUSAN E GOLDBERG
TRUSTEE1.00X0252923108729
KRIS A ZIMMER
TRUSTEE1.00X0708536189289
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1638886TotalReportableCompFrmRltdOrgs
Total Other Compensation336202TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
FMH CORESOURCE
13160 FOSTER STOVERLAND PARKKS62213CONTRACT ADMINISTRATOR2470826
OPTUM HEALTH NETWORK
PO BOX 78910MILWAUKEEWI53278INSURANCE SERVICES1920443
LIVE HEALTHIER
7735 OLD GEORGETOWN RD SUITE 100BETHESDAMD20814CONTRACT ADMINISTRATOR580712
MATRIA
PO BOX 403393ATLANTAGA30384CONTRACT ADMINISTRATOR550007
EXPRESS SCRIPT
21653 NETWORK PLACECHICAGOIL60673CONTRACT ADMINISTRATOR387960
FieldValueIRS element (for citing)
Number Of Contractors GT100 K13NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionINSURANCE FEESDescription
Business Code525100BusinessCode
Total Revenue Column173510056TotalRevenueColumn
Related Or Exempt Function Income173510056RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue173510056TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column20496TotalRevenueColumn
Exclusion$20,496ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column173530552TotalRevenueColumn
Related Or Exempt Function Income173510056RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$20,496ExclusionAmount

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
MEDICAL, DENTAL, VISION146899493
LIFE, LTD, AD&D, STD PR16374312
ADMINISTRATIVE6383582
REINSURANCE2076993

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total171734380Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY41360722BOY
EOY41960226EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY204472BOY
EOY97106EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY41565194BOY
EOY42057332EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY211021BOY
EOY755406EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY19328880BOY
EOY17505461EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY19539901BOY
EOY18260867EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY22025293BOY
EOY23796465EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22025293BOY
EOY23796465EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41565194BOY
EOY42057332EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1796172ReconcilationRevenueExpenses
Reconcilation Other Changes-25000ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FS0IncludedOnFS
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ESTIMATED HEALTH CARE CLAIMS$17,444,000
DUE TO AFFILIATES$61,461
FieldValueIRS element (for citing)
Total Of Amounts17505461TotalOfAmounts
Total Revenue173530552TotalRevenue
Total Expenses171734380TotalExpenses
Excess Or Deficit For Year1796172ExcessOrDeficitForYear
Other-$25,000OtherAmount
Total Adjustments-25000TotalAdjustments
Excess Or Deficit Per FS1771172ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt156901242TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal156901242RevenueSubtotal
Other Revenues Not Included16629310OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt16629310RevenueNotRptdOnFinStmt
Total Revenue Per Form990173530552TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt155360067TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal155360067ExpensesSubtotal
Other Expenses Not Included16374313OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt16374313ExpensesNotRptdOnFinStmt
Total Expenses Per Form990171734380TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE STATE AND FEDERAL TAXING AUTHORITIES. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011 AND 2010, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2007.
PART XI, LINE 8 - OTHER ADJUSTMENTS:FUND BALANCE TRANSFER -25,000.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INSURANCE PREMIUMS FOR LIFE AND DISABILITY INSURANCE 16,629,310.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:OPERATING EXPENSES FOR LIFE AND DISABILITY INSURANCE 16,374,313.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
STEVEN M BARNEY
0539974000137453016752021432071561100
SUSAN E GOLDBERG
023283800020085098090010639036165200
KRIS A ZIMMER
0661311000472250162685026604089782500

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceIdentifierIdentifierExplanationExplanation
PART I, LINE 4B
PART IIISUPPLEMENTAL INFORMATIONPART 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) WRITTEN EMPLOYMENT CONTRACT; (3) COMPENSATION SURVEY OR STUDY; (4) 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 2011. 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 2011. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUALS' TAXABLE COMPENSATION. STEVEN M. BARNEY $66,707

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11ACCOUNTING/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 IS PROVIDED TO THE TRUSTEES PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTRUSTEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. ANY TRUSTEE WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAINS FROM 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 15ALL SSMHC EXECUTIVE SALARY/COMPENSATION INFORMATION IS BASED ON COMPARATIVE DATA WITH SIMILAR POSITIONS IN THE MARKET. THE COMPENSATION REVIEW PROCESS IS PERFORMED BY EXTERNAL INDEPENDENT COMPENSATION CONSULTANTS. THE SAME COMPARATIVE PROCESS IS PERFORMED INTERNALLY FOR EMPLOYEES. THE SALARY DATA AND POTENTIAL ADJUSTMENTS, FOR THE CEO OF THE SYSTEM, THE PRESIDENT/COO AND THE SENIOR VICE PRESIDENTS ARE PRESENTED TO THE SSMHC BOARD OF DIRECTORS BY THE SAME INDEPENDENT COMPENSATION CONSULTANTS TO APPROVE, DISAPPROVE, MODIFY.
FORM 990, PART VI, SECTION C, LINE 19THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH CARE SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH CARE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART VII:ALL INDIVIDUALS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED TO THE FILING ORGANIZATION ARE EMPLOYED AND COMPENSATED BY A RELATED ORGANIZATION. IN ADDITION, ALL COMPENSATED REPORTABLE INDIVIDUALS LISTED ON FORM 990, PART VII WORK A MINIMUM OF 40 HOURS PER WEEK FOR SSMHC RELATED ORGANIZATIONS.AVG HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED:
FORM 990, PART XI, LINE 5:FUND BALANCE TRANSFER -25,000. TOTAL TO FORM 990, PART XI, LINE 5: -25,000.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (41 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
SSM HEALTH CARE CORPORATION
477 N LINDBERGH BLVDST LOUISMO63141466029223HEALTH CAREMO501(C)(3)LINE 11A, IFRANCISCAN SISTERS OF MARY0
SSMHC LIABILITY TRUST I
477 N LINDBERGH BLVDST LOUISMO63141436331003INSURANCEMO501(C)(3)LINE 11A, ISSM HEALTH CARE CORPORATION0
SSM CONSOLIDATED HEALTH SERVICES
477 N LINDBERGH BLVDST LOUISMO63141431473657HEALTH CAREMO501(C)(3)LINE 11A, ISSM HEALTH CARE CORPORATION0
SSM POLICY INSTITUTE
477 N LINDBERGH BLVDST LOUISMO63141431788151HEALTH CAREMO501(C)(4)SSM HEALTH CARE CORPORATION0
SSM PORTFOLIO MANAGEMENT CO
477 N LINDBERGH BLVDST LOUISMO63141431825256MANAGEMENTMO501(C)(3)LINE 11A, ISSM HEALTH CARE CORPORATION0
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
477 N LINDBERGH BLVDST LOUISMO63141430738490HEALTH CAREMO501(C)(3)LINE 3SSM HEALTH CARE ST LOUIS0
GLENNON HOSPITAL GUILD
477 N LINDBERGH BLVDST LOUISMO63141431030299FUNDRAISINGMO501(C)(3)LINE 9SSM CARDINAL GLENNON CHILDREN'S HOSPITAL0
CARDINAL GLENNON CHILDREN'S FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431754347FUNDRAISINGMO501(C)(3)LINE 7SSM CARDINAL GLENNON CHILDREN'S HOSPITAL0
SSM DEPAUL HEALTH CENTER FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431776109FUNDRAISINGMO501(C)(3)LINE 7SSM HEALTH CARE ST LOUIS0
SSM ST JOSEPH FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431591556FUNDRAISINGMO501(C)(3)LINE 7SSM HEALTH CARE ST LOUIS0
SSM ST CLARE HEALTH CENTER FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431273310FUNDRAISINGMO501(C)(3)LINE 7SSM HEALTH CARE ST LOUIS0
SSM ST MARY'S HEALTH CENTER FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431552945FUNDRAISINGMO501(C)(3)LINE 7SSM HEALTH CARE ST LOUIS0
SSM HEALTH CARE OF OKLAHOMA INC
477 N LINDBERGH BLVDST LOUISMO63141730657693HEALTH CAREOK501(C)(3)LINE 3SSM HEALTH CARE CORPORATION0
ST ANTHONY HOSPITAL FOUNDATION INC
477 N LINDBERGH BLVDST LOUISMO63141736104300FUNDRAISINGOK501(C)(3)LINE 7SSM HEALTH CARE OF OKLAHOMA0
SSM HEALTH CARE OF WISCONSIN INC
477 N LINDBERGH BLVDST LOUISMO63141430688874HEALTH CAREWI501(C)(3)LINE 3SSM HEALTH CARE CORPORATION0
DELLS MEDICAL BUILDING INC
477 N LINDBERGH BLVDST LOUISMO63141391613292MOBWI501(C)(2)SSM HEALTH CARE OF WISCONSIN0
ST MARY'S FOUNDATION INC
477 N LINDBERGH BLVDST LOUISMO63141431940686FUNDRAISINGWI501(C)(3)LINE 7SSM HEALTH CARE OF WISCONSIN0
ST CLARE HEALTH CARE FOUNDATION INC
477 N LINDBERGH BLVDST LOUISMO63141431940683FUNDRAISINGWI501(C)(3)LINE 7SSM HEALTH CARE OF WISCONSIN0
HOME HEALTH UNITED INC
4639 HAMMERSLEY ROADMADISONWI53713391539827HEALTH CAREWI501(C)(3)LINE 9SSM HEALTH CARE OF WISCONSIN0
HOME CARE UNITED INC
4639 HAMMERSLEY ROADMADISONWI53713391776340HEALTH CAREWI501(C)(3)LINE 9SSM HEALTH CARE OF WISCONSIN0
HHU XTRA CARE INC
4639 HAMMERSLEY ROADMADISONWI53713391705111HEALTH CAREWI501(C)(3)LINE 9SSM HEALTH CARE OF WISCONSIN0
SSM REGIONAL HEALTH SERVICES
477 N LINDBERGH BLVDST LOUISMO63141440579850HEALTH CAREMO501(C)(3)LINE 3SSM HEALTH CARE CORPORATION0
ST FRANCIS HOSPITAL FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431099253FUNDRAISINGMO501(C)(3)LINE 7SSM REGIONAL HEALTH SERVICES0
ST MARY'S HEALTH CENTER FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141431575307FUNDRAISINGMO501(C)(3)LINE 11B, IISSM REGIONAL HEALTH SERVICES0
GOOD SAMARITAN REGIONAL HEALTH CENTER
477 N LINDBERGH BLVDST LOUISMO63141430653587HEALTH CAREIL501(C)(3)LINE 3SSM REGIONAL HEALTH SERVICES0
ST MARY'S HOSPITAL CENTRALIA ILLINOIS
477 N LINDBERGH BLVDST LOUISMO63141370662580HEALTH CAREIL501(C)(3)LINE 3SSM REGIONAL HEALTH SERVICES0
ST MARY'S - GOOD SAMARITAN INC
477 N LINDBERGH BLVDST LOUISMO63141364170833HEALTH CAREIL501(C)(3)LINE 11A, ISSM REGIONAL HEALTH SERVICES0
GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141262884795FUNDRAISINGIL501(C)(3)LINE 7ST MARY'S-GOOD SAMARITAN INC0
ST MARY'S HOSPITAL FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141364636691FUNDRAISINGIL501(C)(3)LINE 7ST MARY'S-GOOD SAMARITAN INC0
SSM HEALTH BUSINESSES
477 N LINDBERGH BLVDST LOUISMO63141431333488HEALTH CAREMO501(C)(3)LINE 3SSM HEALTH CARE CORPORATION0
SSM HEALTH CARE ST LOUIS
477 N LINDBERGH BLVDST LOUISMO63141431343281HEALTH CAREMO501(C)(3)LINE 3SSM HEALTH CARE CORPORATION0
CENTRALIA MEDICAL SERVICES BLDG ASSOC
477 N LINDBERGH BLVDST LOUISMO63141237408025HEALTH CAREIL501(C)(3)LINE 11B, IISSM REGIONAL HEALTH SERVICES0
ST MARY'S JANESVILLE FOUNDATION INC
477 N LINDBERGH BLVDST LOUISMO63141273439133FUNDRAISINGWI501(C)(3)LINE 7SSM HEALTH CARE OF WISCONSIN0
FRANCISCAN SISTERS OF MARY
1100 BELLEVUE AVEST LOUISMO63117431012492RELIGIOUS ORGANIZATIONMO501(C)(3)LINE 10N/A
LEE DEWEY CORPORATION
477 N LINDBERGH BLVDST LOUISMO63141731279603MOBOK501(C)(3)LINE 11A, ISSM HEALTH CARE OF OKLAHOMA0
HEALTH CARE FOR KIDS
4055 LINDELL BLVDST LOUISMO63141431620093HEALTH CAREMO501(C)(3)LINE 3SSM CARDINAL GLENNON CHILDREN'S HOSPITAL0
SSM HOSPICE & HOME CARE FOUNDATION
477 N LINDBERGH BLVDST LOUISMO63141300012246FUNDRAISINGMO501(C)(3)LINE 7SSM HEALTH BUSINESSES0
ST MARY'S HOSPITAL AUXILIARY
100 ST MARYS MEDICAL PLAZAJEFFERSON CITYMO65101436049878FUNDRAISINGMO501(C)(3)LINE 11B, II0N/A
GOOD SAMARITAN HOSPITAL AUXILIARY
605 NORTH 12TH STREETMT VERNONIL62864237049599FUNDRAISINGIL501(C)(3)LINE 11C, III-FI0N/A
HHU-VNS FOUNDATION
4639 HAMMERSLEY ROADMADISONWI53713391839309FUNDRAISINGWI501(C)(3)LINE 7SSM HEALTH CARE OF WISCONSIN0
ST MARY'S HOSPITAL AUXILIARY
400 N PLEASANTCENTRALIAIL62801237126345FUNDRAISINGIL501(C)(3)LINE 9ST MARY'S HOSPITAL CENTRALIA ILLINOIS0

Form990 Schedule R Part III Form990ScheduleRPartIII (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
SSM SJ ENDOSCOPY
477 N LINDBERGH BLVDST LOUISMO63141270046559SURGERY SERVICESMON/A
SSMCDI IMAGING
3440 DEPAUL LN STE 100BRIDGETONMO63044263791858IMAGING SERVICESMON/A
SA MT AMB SURG
110 N LEEOKLAHOMA CITYOK73103731528341SURGERY SERVICESOKN/A
ST CLARE IMAGING SERVICES
707 14TH STREET SUITE ABARABOOWI53913200122365DIAG. SERVICESWIN/A
MT VERNON RADIATION THERAPY CENTER
477 N LINDBERGH BLVDST LOUISMO63141201382620RADIATION THERAPYILN/A
SLEEPNEURO SO IL
477 N LINDBERGH BLVDST LOUISMO63141208468195DIAG. SERVICESILN/A
SMHC SURG CO-MGMT
100 ST MARYS MEDICAL PLAZAJEFFERSON CITYMO65101208929305MANAGEMENTMON/A
SMHC CARD CO-MGMT
100 ST MARYS MEDICAL PLAZAJEFFERSON CITYMO65101208929381MANAGEMENTMON/A
SMHC MUSC CO-MGMT
100 ST MARYS MEDICAL PLAZAJEFFERSON CITYMO65101208929237MANAGEMENTMON/A
CHOWSMGSI
605 N 12TH STREETST LOUISMO63141371383861MOBILN/A
COMP CANCER CARE
477 N LINDBERGH BLVDST LOUISMO63141201382727MOBILN/A
MIA OF ST CHARLES
132 NORTH KANSAS ST ROOM 212ST CHARLESMO63301422125740DIAG. SERVICESMON/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (18 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
SSM MANAGED CARE ORGANIZATION LLC
477 N LINBERGH BLVDST LOUISMO63141431708511HEALTH PROMOTIONMON/AC
FPP INC
477 N LINBERGH BLVDST LOUISMO63141431465174HEALTH CAREMON/AC
DIVERSIFIED HEALTH SERVICES CORP
477 N LINBERGH BLVDST LOUISMO63141431369305MEDICAL EQUIPMENTMON/AC
SSM CARDIO AND THORACIC SERVICES INC
477 N LINBERGH BLVDST LOUISMO63141260286559HEALTH CAREMON/AC
SSM PROPERTIES INC
477 N LINBERGH BLVDST LOUISMO63141431462486PROPERTY SERVICESMON/AC
SSM DEPAUL MEDICAL GROUP INC
477 N LINBERGH BLVDST LOUISMO63141431715106HEALTH CAREMON/AC
SSM ST CHARLES CLINIC MED GROUP INC
477 N LINBERGH BLVDST LOUISMO63141430626408PHYSICIAN OFFICESMON/AC
HEALTH FIRST PHYS MANAGEMENT
477 N LINBERGH BLVDST LOUISOK63141731534336MEDICAL SERVICESOKN/AC
SSMHCS LIABILITY TRUST II
477 N LINBERGH BLVDST LOUISMO63141816128118INSURANCEMON/AC
SSM NEUROSCIENCES INC
477 N LINBERGH BLVDST LOUISMO63141263413981HEALTH CAREMON/AC
SSM MEDICAL GROUP INC
477 N LINBERGH BLVDST LOUISMO63141431664107PHYSICIAN OFFICESMON/AC
SSMHC INSURANCE COMPANY
477 N LINBERGH BLVDST LOUISMO63141030310431INSURANCECAN/AC
SSM ORTHOPEDIC INC
477 N LINBERGH BLVDST LOUISMO63141271557033HEALTH CAREMON/AC
SSM CANCER CARE INC
477 N LINBERGH BLVDST LOUISMO63141271557324HEALTH CAREMON/AC
SSM ST JOSEPH SURGERY CENTER
477 N LINDBERGH BLVDST LOUISMO63141431822767HEALTH CAREMON/AC
ST MARY'S DEAN VENTURES INC
1808 WEST BELTLINE HIGHWAYMADISONWI53713391628491HEALTH CAREWIN/AC
SHARED MRI FACILITY INC
1104 JOHN NOLEN DRIVEMADISONWI53713391534744HEALTH CAREWIN/AC
PHYSICIANS SERVICES
477 N LINBERGH BLVDST LOUISMO63141364161526HEALTH CAREILN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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