2011-11-14T16:30:47-06:00 2010-12-31 DELOITTE TAX LLP 1111 BAGBY STREET SUITE 4500 HOUSTON TX 770022591 990 2010-01-01 736104300 THE ST ANTHONY HOSPITAL FOUNDATIONINC STAN 3149947800 477 N LINDBERGH ST LOUIS MO 63141 JUNE L PICKETT 3149947800 2011-11-14 1 NANCY Z EVETTS 7139822000 2010 2016-02-24 21:20:13Z SHERYL RICE RHODES 826 NW 11TH ST OKLAHOMA CITY OK 73106 2777809 0 0928 X WWW.GIVETOSAINTS.COM X 1963 OK 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. 31 31 0 100 0 0 795181 1312533 0 0 -394531 1381241 152827 -35200 553477 2658574 1336059 1624152 0 0 373053 429255 0 0 500247 271501 292894 1980613 2346301 -1427136 312273 23214542 25502192 904027 1399318 22310515 24102874 X THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. 0 0 1624152 1624152 SEE SCHEDULE O 1624152 1 1 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 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 31 31 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OK X TONI CRUZ 4052707500 PO BOX 205 OKLAHOMA CITY OK 73101 X 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 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 STEVE MASON 1.00 X 0 0 0 MICHAEL J 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 T ROONEY 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 SEAN TRAUSCHKE 1.00 X X 0 0 0 DAVID HARLOW 1.00 X 0 0 0 BLAKE ARNOLD 1.00 X 0 0 0 CHESTER BEAM MD 1.00 X 0 0 0 TOM KELLY 1.00 X 0 0 0 MARY H TOLBERT 1.00 X 0 0 0 JUNE L PICKETT 1.00 X 0 220736 179387 SHERYL RICE RHODES 40.00 X 0 169310 40284 SHASTA MANUEL 1.00 X 0 264460 45943 0 654506 265614 0 0 1 0 0 263984 10450 1038099 157790 1312533 744034 744034 637207 637207 637207 637207 84035 263984 119235 -35200 -35200 2658574 0 0 1346041 1523060 1523060 101092 101092 162986 32597 130389 238419 22333 216086 27850 3620 24230 24000 24000 40873 40873 68726 68726 8779 8779 39391 5121 34270 3114 3114 2804 2804 3069 338 2731 MISCELLANEOUS EXPENSES 83059 0 21490 61569 DONOR CULTIVATION 19079 0 0 19079 2346301 1624152 221902 500247 248603 122615 774048 607009 359435 229303 133201 130132 21834138 24302421 224552 340015 23214542 25502192 358730 980164 545297 0 419154 904027 1399318 X 11102338 12395756 11132604 11631545 75573 75573 22310515 24102874 23214542 25502192 X 312273 1480086 X 0 1 1 X 0 X 1429870 2101220 1133515 795181 1312533 6772319 1429870 2101220 1133515 795181 1312533 6772319 888132 5884187 852658 1098793 1109776 792035 744035 4597297 11369616 1364783 0.51750 0.51070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 75573 14500 14500 75573 75573 13499 13168 331 75573 75573 75573 1.00000 0 1 1 124100 124100 63515 62092 1423 171820 167211 4609 130132 SSM CENTRAL INVESTMENT POOL 24302421 F 24302421 GIFT ANNUITY LIABILITY 419154 419154 2658574 2346301 312273 1432284 47802 1480086 1792359 4090858 1432284 1432284 2658574 0 2658574 2298499 -47802 -47802 2346301 0 2346301 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION'S PERMANENT ENDOWMENT FUNDS ARE HELD FOR THE PURPOSE OF PROVIDING SCHOLARSHIPS TO NURSING STUDENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2010 OR 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: ACTUARIAL GAIN ON GIFT ANNUITY LIABILITY 47,802. PART XIII, LINE 2D - OTHER ADJUSTMENTS: ACTUARIAL GAIN ON GIFT ANNUITY LIABILITY -47,802. BALL/AUCTION 348019 263984 84035 119235 348019 263984 84035 119235 119235 -35200 1 SSM HEALTH CARE OF OKLAHOMA INC PO BOX 205 OKLAHOMA CITY OK 73101 730657693 501(C)(3) 1523060 TO SUPPORT THE OPERATIONS AND CAPITAL NEEDS OF THE RELATED HOSPITALS 1 NURSING SCHOLARSHIPS 14 14500 FREE PRESCRIPTION MEDICATION TO THE NEEDY 914 86086 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 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 INSURE 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. PAYMENTS FROM THE TREE OF LIFE FUND REPRESENT NON-CASH ITEMS PROVIDED TO CANCER PATIENTS AND THEIR FAMILIES TO ASSIST THESE INDIVIDUALS DURING THEIR TREATMENT. THE NON-CASH ITEMS REPRESENT SPECIFIC ITEMS REQUESTED BY THE INDIVIDUALS AND ARE RELATED TO THEIR TREATMENT. 0 1 0 0 0 0 0 0 0 JUNE L PICKETT 0 207649 0 0 0 13087 0 163178 0 16209 0 400123 0 0 SHERYL RICE RHODES 0 162708 0 0 0 6602 0 35891 0 4393 0 209594 0 0 SHASTA MANUEL 0 255517 0 0 0 8943 0 23689 0 22254 0 310403 0 0 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) 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 2010. 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 2010. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUALS' TAXABLE COMPENSATION. JUNE PICKETT $7,123 SHERYL RICE RHODES $5,043 X 4 55550 COST OR SELLING PRICE X 4902 COST OR SELLING PRICE X 10 16696 COST OR SELLING PRICE X 2 180 COST OR SELLING PRICE X 3 2900 COST OR SELLING PRINCE X HOTEL/VACATION PACKAGES 6 11768 COST OR SELLING PRICE X GIFT CERTIFICATES/GIFT CARDS 22 3708 COST OR SELLING PRICE X PRIVATE PILOT LICENSE INSTRUCTION 1 11000 COST OR SELLING PRICE X FISH TANK SUPPLIES/MAINTENANCE 6 17883 COST OR SELLING PRICE X HEALTH/BEAUTY TREATMENTS 8 5106 COST OR SELLING PRICE X BAND PERFORMANCE 1 5000 COST OR SELLING PRICE X OTHER MISCELLANEOUS 28 23097 COST OR SELLING PRICE 0 1 0 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. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, QUESTION 4A 2010 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. FRANCIS, ST. ANTHONY HOSPITAL IS A FAITH-BASED, NONPROFIT, 615 BED ACUTE CARE HOSPITAL SERVING PATIENTS FROM ACROSS THE STATE OF OKLAHOMA. ST ANTHONY HOSPITAL 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 16 HOSPITAL LOCATIONS, TWO SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES IN FOUR STATES. THE HEALTH SYSTEM EMPLOYEES APPROXIMATELY 22,000 PEOPLE AND IS AFFILIATED WITH MORE THAN 5,000 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 HOSPITAL FOUNDATION WAS ESTABLISHED IN 1963 AS A NON-PROFIT 501(C)3 ORGANIZATION. ITS PURPOSE, THEN AND TODAY, IS 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. THE FOUNDATION CONTINUES THE MISSION OF THE HOSPITAL'S FOUNDING SISTERS BY SEEKING AND RECEIVING CHARITABLE DONATIONS FROM GRATEFUL PATIENTS AND THEIR FAMILIES, PHYSICIANS, SAINTS EMPLOYEES, BUSINESSES, CORPORATIONS, PRIVATE FOUNDATIONS, COMMUNITY ORGANIZATIONS AND COMMUNITY MEMBERS. THESE DONATIONS SUPPORT CAPITAL IMPROVEMENTS, NEW TECHNOLOGY, PATIENT CARE AREAS SUCH AS CARDIOLOGY AND ONCOLOGY AND MISSION FUNDS, SUCH AS THE SISTERS FUND, THAT PROVIDES FREE PRESCRIPTION MEDICATIONS TO THE NEEDY. B. SUMMARIZE FOUNDATION'S APPROACH TO PROVIDING COMMUNITY BENEFIT. ST. ANTHONY HOSPITAL FOUNDATION BENEFITS THE COMMUNITY BY SUPPORTING PROGRAMS, CAPITAL NEEDS AND PROJECTS THAT IMPROVE HEALTH CARE SERVICES PROVIDED BY ST. ANTHONY HOSPITAL, BONE AND JOINT HOSPITAL AT ST. ANTHONY AND OTHER SSM HEALTH CARE OF OKLAHOMA HOSPITALS, HEALTHPLEXES AND CLINICS. 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. 2. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS CAMPUS AND FACILITY IMPROVEMENTS DONATIONS SUPPORTED THE EXPANSION AND DEVELOPMENT OF THE ST. ANTHONY MIDTOWN CAMPUS TO CREATE A MORE WELCOMING, VISITOR-FRIENDLY ENVIRONMENT WITH STATE-OF-THE-ART EQUIPMENT AND TECHNOLOGY TO ENHANCE HEALING AND PROMOTE WELL-BEING FOR PATIENTS, STAFF AND VISITORS. IMPROVEMENTS ASSISTED BY DONATIONS IN 2010 INCLUDED PROVIDING NEW FURNITURE AND FURNISHINGS FOR THE RENOVATION OF ST. ANTHONY'S BEHAVIORAL MEDICINE CENTER (LARGEST BEHAVIORAL MEDICINE CENTER IN THE STATE THAT SERVES CHILDREN, ADOLESCENTS AND ADULTS), CONSTRUCTION OF THE RAPP FOUNDATION CONFERENCE CENTER (FOR EDUCATIONAL MEETINGS FOR PATIENT SUPPORT GROUPS, PHYSICIANS, STAFF AND COMMUNITY ORGANIZATIONS), EQUIPMENT AND RENOVATIONS TO JOYFUL BEGINNINGS (WOMEN'S AND CHILDREN'S UNIT) AND IMPROVEMENTS TO ST. ANTHONY NORTH, THE MIDTOWN CAMPUS, LABORATORY AND WOUND CARE CLINIC. PATIENT CARE SUPPORT TO BRING STATE-OF-THE-ART, EXCEPTIONAL HEALTHCARE TO PATIENTS, THE FOUNDATION HELPED FUND NEW EQUIPMENT AND TECHNOLOGY. THE GUEST SERVICES FUND, CREATED IN MEMORY OF SISTER CLARA HEITMAN, ASSISTED OUT-OF-TOWN PATIENT FAMILIES WITH HOUSING AND MEALS WHILE THEIR LOVED ONES WERE IN THE HOSPITAL. THE CARDIOLOGY FUND AIDED THE EXPANSION OF LIFE-SAVING PROGRAMS FOR PATIENTS SUFFERING FROM HEART DISEASE. ORTHOPEDIC RESEARCH WAS MADE POSSIBLE THROUGH THE BONE & JOINT HOSPITAL FUND. THE SISTERS FUND PROVIDED $86,086 IN FREE PRESCRIPTION MEDICATIONS TO SAINTS PATIENTS WHO MUST CHOOSE BETWEEN PAYING FOR RENT, BUYING FOOD OR BUYING THEIR MEDICATIONS. TO HELP OUR MEDICAL STAFF MEET EXTRAORDINARY MEDICAL CHALLENGES WITH EASE, THE FOUNDATION PROVIDED NURSING SCHOLARSHIPS, NURSING EDUCATION EQUIPMENT AND CONTINUING EDUCATION FOR PHYSICIANS. SUPPORT OF COMMUNITY NONPROFIT ORGANIZATIONS CONTRIBUTIONS IN 2010 TO COMMUNITY NONPROFIT ORGANIZATIONS INCLUDED: $500 FOR SPONSORSHIP TO THE LIBRARY ENDOWMENT TRUST, $500 SPONSORSHIP TO THE OKLAHOMA CITY PUBLIC SCHOOL FOUNDATION AND $500 SPONSORSHIP 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 16 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. AVG HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED: 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,432,284. ACTUARIAL GAIN ON GIFT ANNUITY LIABILITY 47,802. TOTAL TO FORM 990, PART XI, LINE 5: 1,480,086. SSM HEALTH CARE CORPORATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 466029223 HEALTH CARE MO 501(C)(3) LINE 11A, I FRANSISCAN 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 SSMHCS 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 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 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 GLENNON HOSPITAL GUILD 477 N LINDBERGH BLVD ST LOUIS MO 63141 431030299 FUNDRAISING MO 501(C)(3) LINE 9 SSM CARDIAL GLENNON HOSPITAL 0 CARDINAL GLENNON CHILDREN'S FOUNDATION 477 N LINDBERGH BLVD ST LOUIS MO 63141 431754347 FUNDRAISING MO 501(C)(3) LINE 7 SSM CARDIAL GLENNON 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 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 OK 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 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 ST ANTHONY HOSPITAL FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 736104300 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF OKLAHOMA 0 SSM HEALTH CARE OF WISCONSIN INC 477 N LINDBERGH BLVD ST LOUIS MO 63141 430688874 HEALTH CARE WI 501(C)(3) LINE 3 SSSM 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 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 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 0 SSM HEALTH BUSINESSES 477 N LINDBERGH BLVD ST LOUIS MO 63141 431333488 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 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 CENTRALIA MEDICAL SERVICES BLDG ASSOC 477 N LINDBERGH ST LOUIS MO 63141 237408025 HEALTH CARE IL 501(C)(3) LINE 11B, II SSM REGIONAL HEALTH SERVICES 0 ST MARY'S JANESVILLE FOUNDATION INC 2901 LANDMARK PL STE 300 MADISON WI 53713 273439133 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 FRANCISCAN SISTERS OF MARY 1100 BELLEVUE AVE ST LOUIS MO 63117 431012492 RELIGIOUS ORGANIZATION MO 501(C)(3) LINE 1 N/A 0 HEALTH CARE FOR KIDS 4055 LINDELL BLVD ST LOUIS MO 63108 431620093 HEALTH CARE MO 501(C)(3) LINE 3 SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 0 SSM SJ ENDOSCOPY 477 N LINDBERGH BLVD ST LOUIS MO 63141 270046559 SURGERY SERVICES MO N/A SSMCDI IMAGING 5775 WAYZATA BOULEVARD SUITE 400 ST LOUIS PARK MN 55416 263791858 IMAGING SERVICES MO N/A SSM SELECT REHAB 4716 OLD GETTYSBURG ROAD MECHANICSBURG PA 17055 263694972 HEALTH CARE MO N/A SA MT AMB SRUG 110 N LEE OKLAHOMA CITY OK 73103 731528341 SURGERY SERVICES OK N/A ST ANTHONY HOSPITAL CARDIOVASCULAR SERVICES 477 N LINDBERGH BLVD ST LOUIS MO 63141 760825755 HEALTH CARE OK N/A B& J MB OFF BUILD 1000 N LEE OKLAHOMA CITY OK 73103 731533449 MOB OK N/A B&J MANAGEMENT 1000 N LEE STREET OKLAHOMA CITY OK 73102 364645813 MANAGEMENT OK N/A WIITTS LLC 2901 LANDMARK PLACE SUITE 300 MADISON WI 53713 392016715 MED. INF. SYSTEMS WI N/A SHARED IMAGING SERVICES 915 17TH STREET PRAIRIE DU SAC WI 53578 391971378 DIAG. SERVICES WI N/A ST CLARE IMAGING SERVICES 707 14TH STREET SUITE A BARABOO WI 53913 200122365 DIAG. SERVICES WI N/A MEADOW RIDGE 1402 PANKRATZ STREET SUITE 110 MADISON WI 53704 391991403 ASST. LIVING WI N/A DEAN HEALTH HOLD 1277 DEMING WAY MADISON WI 53717 261594709 IT SERVICES WI N/A MV RAD THERAPY 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 605 N 12TH STREET MOUNT VERNON IL 62864 371383861 MOB MO N/A COMP CANCER CARE 477 N LINDBERGH BLVD ST LOUIS MO 63141 201382727 MOB IL N/A 1110 N CLASSEN BLVD LLC 110 N CLASSEN OKLAHOMA CITY OK 73106 731158158 MOB OK N/A M&C REALTY 1603 WENTVILLE PARKWAY STE 121 WENTZVILLE MO 63385 621851447 MOB MO N/A SURG CNTR MW CITY 8121 NATIONAL AVE SUITE 108 MIDWEST CITY OK 73110 232697171 SURGERY SERVICES OK N/A SSM WELLBRIDGE 6140 GREENWOOD PLAZA BLVD GREENWOOD VILLAGE CO 80111 431794814 FITNESS CENTER MO N/A MIA OF ST CHARLES 132 NORTH KANSAS ST ROOM 212 EDWARDSVILLE IL 62025 422125740 DIAG. SERVICES MO N/A MEADOW RIDGE MEMORY 1402 PANKRATZ ST SUITE 110 MADISON WI 53704 203163929 HEALTH CARE WI N/A SSM BER-EK IMAGING 477 N LINDBERGH BLVD ST LOUIS MO 63141 205039552 IMAGING SERVICES MO N/A HPI-OKC LLC 14024 QUAIL POINTE DRIVE OKLAHOMA CITY OK 73134 205144487 HEALTH CARE OK N/A VASCULAR INSTITUTE DP 12266 DEPAUL DR SUITE 315 BRIDGETON MO 63044 205511708 VASCULAR CLINIC MO N/A SSM SC SURG CNTR 15305 DALLAS PKWY STE 1600 ADDISON TX 75001 261439695 SURGERY SERVICES MO N/A ST ANTHONY CARDIO SERVICES INSTITUTE 477 N LINDBERGH BLVD ST LOUIS MO 63141 260646402 MANAGEMENT OK N/A SSM RX EXPRESS LLC 727 N BALLAS RD ST LOUIS MO 63141 431465174 PHARMACY MO N/A N/A SSM MANAGED CARE ORGANIZATION LLC 477 N LINBERGH BLVD ST LOUIS MO 63141 431708511 HEALTH PROMOTION MO N/A C FPP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431465174 HEALTH CARE MO N/A C DIVERSIFIED HEALTH SERVICES CORP 477 N LINBERGH BLVD ST LOUIS MO 63141 431369305 MEDICAL EQUIPMENT MO N/A C SSM CARDIO AND THORACIC SERVICES INC 477 N LINBERGH BLVD ST LOUIS MO 63141 260286559 HEALTH CARE MO N/A C SSM PROPERTIES INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431462486 PROPERTY SERVICES MO N/A C SSM DEPAUL MEDICAL GROUP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431715106 HEALTH CARE MO N/A C SSM ST CHARLES CLINIC MED GROUP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 430626408 PHYSICIAN OFFICES MO N/A C HEALTH FIRST PHYS MANAGEMENT 477 N LINBERGH BLVD ST LOUIS MO 63141 731534336 MEDICAL SERVICES MO N/A C SSMHCS LIABILITY TRUST II 477 N LINBERGH BLVD ST LOUIS MO 63141 816128118 INSURANCE MO N/A C SSM NEUROSCIENCES INC 477 N LINBERGH BLVD ST LOUIS MO 63141 263413981 HEALTH CARE MO N/A C SSM MEDICAL GROUP INC 477 N LINBERGH BLVD ST LOUIS MO 63141 431664107 PHYSICIAN OFFICES MO N/A C SSMHC INSURANCE COMPANY 477 N LINBERGH BLVD ST LOUIS MO 63141 030310431 INSURANCE CA N/A C SSM ORTHOPEDIC INC 477 N LINBERGH BLVD ST LOUIS MO 63141 271557033 HEALTH CARE MO N/A C SSM CANCER CARE INC 477 N LINBERGH BLVD ST LOUIS MO 63141 271557324 HEALTH CARE MO N/A C SSM ST JOSEPH SURGERY CENTER 477 N LINDBERGH BLVD ST LOUIS MO 63141 431822767 HEALTH CARE MO N/A C ST MARY'S DEAN VENTURES INC 1808 WEST BELTLINE HIGHWAY MADISON WI 53713 391628491 HEALTH CARE WI N/A C SHARED MRI FACILITY INC 1104 JOHN NOLEN DRIVE MADISON WI 53713 391534744 HEALTH CARE WI N/A C 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1