2024-11-15T14:22:59-06:00 2023-12-31 990 2023-01-01 431940686 ST MARY'S FOUNDATION INC STMA 6082585600 700 SOUTH PARK STREET MADISON WI 53715 STEPHANIE KING VP FINANCE 6082585600 2024-11-15 0 2023 2024-10-15 13:58:12Z X STEPHANIE KING 700 SOUTH PARK STREET MADISON WI 53715 4457123 0 0928 X HTTPS://WWW.SSMHEALTH.COM/DONATES/ST-MARYS-FOUNDA X 2000 WI TO ACTIVELY BUILD AND SUSTAIN COMMUNITY SUPPORT FOR THE HEALTH CARE AND WELLNESS INITIATIVES OF SSM HEALTH ST. MARY'S HOSPITAL - MADISON AND SSM HEALTH ST. MARY'S CARE CENTER. 23 20 0 18 0 0 2221257 3439805 0 0 745651 1001994 -6424 -12680 2960484 4429119 3306115 1494259 0 0 460002 427900 0 0 87482 193550 146763 3959667 2068922 -999183 2360197 26276717 31887058 439953 426386 25836764 31460672 X THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. 0 0 1431584 1431584 PROVIDED FUNDING TO SUPPORT THE HEALTH CARE AND WELLNESS INITIATIVES OF SSM HEALTH ST MARY'S HOSPITAL - MADISON AND SSM HEALTH ST MARY'S CARE CENTER. SEE SCHEDULE O FOR A DESCRIPTION OF SIGNIFICANT PROGRAM SERVICE ACCOMPLISHMENTS. 62675 62675 PROVIDED EMERGENCY ASSISTANCE SUCH AS HOUSING, UTILITIES, EDUCATION, AND CHILD CARE. 1494259 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 23 20 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 WI X DINA BOYLE 6082298382 700 SOUTH PARK STREET MADISON WI 53715 ERIC THORNTON DIRECTOR, HOSPITAL PRESIDENT 1.00 40.00 X X 0 411975 155575 TIMOTHY CRUMMY MD PT YR DIRECTOR & CHAIRPERSON 1.00 0.00 X X 0 0 0 KIMBERLY SHAUL DIRECTOR & SECRETARY 1.00 0.00 X X 0 0 0 KELLYE GOLDEN DIRECTOR & VICE CHAIR 1.00 0.00 X X 0 0 0 JOE MCNEIL DIRECTOR & TREASURER 1.00 0.00 X X 0 0 0 JEFFREY TUBBS DIRECTOR 1.00 0.00 X X 0 0 0 DAN HOUNCHELL DIRECTOR, VP-PRODUCT MANAGEMENT, HEALTH PLANS 1.00 0.00 X 0 0 0 FRANK BYRNE MD DIRECTOR 1.00 0.00 X 0 0 0 JEANNIE CULLEN SCHULTZ DIRECTOR 1.00 0.00 X 0 0 0 LAURA ZACH DIRECTOR 1.00 0.00 X 0 0 0 SARAH GROESSL MD DIRECTOR, PHYSICIAN WITH DEAN MEDICAL GROUP 1.00 0.00 X 0 0 0 JESSICA FLESCH BUYE DIRECTOR 1.00 0.00 X 0 0 0 TIM O'BRIEN DIRECTOR 1.00 0.00 X 0 0 0 PAUL CUTA DIRECTOR 1.00 0.00 X 0 0 0 ERIC HELSHER DIRECTOR 1.00 0.00 X 0 0 0 JEFF MACK DIRECTOR 1.00 0.00 X 0 0 0 DAVE SHAW DIRECTOR 1.00 0.00 X 0 0 0 SEBASTAIN GERACI DIRECTOR 1.00 0.00 X 0 0 0 CHRIS ROE DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL FOLEY MD DIRECTOR 1.00 0.00 X 0 0 0 SARAH KUEMMEL DIRECTOR 1.00 0.00 X 0 205770 17737 SEAN BAXTER DIRECTOR 1.00 0.00 X 0 0 0 DINA BOYLE EXECUTIVE DIRECTOR 40.00 0.00 X 0 149150 54664 DOUGLAS LONG ASSISTANT SECRETARY, GENERAL COUNSEL AT SSM HEALTH 1.00 72.20 X 0 1425239 777013 ADAM TIERNEY DIRECTOR, HOSPITAL PRESIDENT (FORMER) 1.00 40.00 X 0 402714 67946 KYLE NONDORF DIRECTOR, HOSPITAL PRESIDENT (FORMER) 1.00 40.00 X 0 708825 264501 0 3303673 1337436 0 1 1 0 0 91817 3347988 2606 3439805 521001 521001 480993 0 480993 480993 480993 15324 91817 28004 -12680 -12680 4429119 0 0 989314 1475635 1475635 18624 18624 396823 396823 31077 31077 51594 51594 1860 1860 47256 15595 31661 5459 1818 3641 878 292 586 11569 11569 DIRECT DONOR BENEFIT 22420 22420 BANK CHARGES 5727 5727 2068922 1494259 487181 87482 -130753 2913172 1498055 2057418 24594261 26590050 315154 326418 26276717 31887058 439953 426386 439953 426386 X 13313632 15827840 12523132 15632832 25836764 31460672 26276717 31887058 X 2360197 2556841 706870 X 0 1 X 1 0 X 865066 1409532 2096133 2221257 3455129 10047117 865066 1409532 2096133 2221257 3455129 10047117 10047117 676528 418639 475959 523281 521001 2615408 23521 23521 12686046 0.79200 0.57240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18115453 1072126 3096723 645636 21638666 21921928 448811 -3101932 62200 1091154 18115453 19131744 54777 2686880 55400 -103927 21921928 17148630 326694 2822221 64800 1101001 19131744 14130530 79430 3288046 67394 281982 17148630 0 1 0 0 SSM COMPREHENSIVE INVESTMENT PROGRAM 26590050 F 26590050 CHARITABLE GIFT ANNUITY LIABILITY 375020 DUE TO AFFILIATES 51366 426386 X PART X, LINE 2: ST MARY'S FOUNDATION, INC'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNVERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2023 OR 2022. GOLF EVENT 107141 91817 15324 3041 19814 5149 107141 91817 15324 3041 19814 5149 28004 -12680 0 SSM HEALTH CARE OF WISCONSIN INC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 430688874 501(C)(3) 62675 2829 BOOK FUNDRAISING EVENT GIK ITEMS HOSPITAL SUPPORT 1 CARE ASSISTANCE 16 18624 SCHEDULE I, PART I, LINE 2 - PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE PROCEDURE FOR MONITORING USE OF GRANT FUNDS HAS BEEN ESTABLISHED BY THE FOUNDATION. FOR EXPENSES OUTLINED IN A FUNDING REQUEST THAT HAS BEEN PRE-APPROVED BY THE FOUNDATION. THE ISSUANCE OF GRANTS OCCURS AFTER RELATED ORGANIZATION PROVIDES DOCUMENTATION OF ACTUAL EXPENSES INCURRED AND PAID. ALL GRANTS TO DOMESTIC ORGANIZATIONS WERE MADE TO A RELATED ORGANIZATION. AMOUNTS PAID FOR SCHOLARSHIPS ARE SENT DIRECTLY TO THE EDUCATIONAL INSTITUTION AND CARE ASSISTANCE FUNDS ARE PAID TO THE SERVICE PROVIDER. X 1 0 0 1 0 0 0 0 0 0 0 DOUGLAS LONG ASSISTANT SECRETARY, GENERAL COUNSEL 0 759270 0 495539 0 170430 0 753634 0 23379 0 2202252 0 495539 KYLE NONDORF DIRECTOR, HOSPITAL PRESIDENT (FORMER 0 530447 0 148664 0 29714 0 220743 0 43758 0 973326 0 161317 ERIC THORNTON DIRECTOR, HOSPITAL PRESIDENT 0 338368 0 57599 0 16008 0 116256 0 39319 0 567550 0 64170 ADAM TIERNEY DIRECTOR, HOSPITAL PRESIDENT (FORMER 0 399892 0 0 0 2822 0 24918 0 43028 0 470660 0 0 SARAH KUEMMEL DIRECTOR 0 204036 0 0 0 1734 0 14608 0 3129 0 223507 0 0 DINA BOYLE EXECUTIVE DIRECTOR 0 134559 0 13804 0 787 0 18920 0 35744 0 203814 0 13804 PART I, LINE 1A AN INDIVIDUAL LISTED ON PART VII, SECTION A, RECEIVED TAX INDEMNIFICATION/GROSS UP PAYMENTS IN 2023, WHICH WAS INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 1B THE FOUNDATION'S TOP MANAGEMENT OFFICIAL (EXECUTIVE DIRECTOR) 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 4B 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 THE SSMH 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 INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2023. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2023: KYLE NONDORF $53,282 DOUGLAS LONG $161,286 SARAH GROESSL $2,883 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. KYLE NONDORF $28,586 X FUNDRAISING EVENT PRIZES 4 2706 COST 0 1 0 FORM 990, PART III, LINE 4 - PROGRAM SERVICE ACCOMPLISHMENTS ST. MARY'S HOSPITAL FOUNDATION (IL) IRS FORM 990, SUPPLEMENT PART III BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION. SINCE IT WAS FOUNDED IN 1872 BY CATHOLIC SISTERS, SSM HEALTH (SSMH) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. SSMH IS A CATHOLIC, NOT-FOR-PROFIT HEALTH SYSTEM SERVING THE COMPREHENSIVE HEALTH NEEDS OF COMMUNITIES ACROSS THE MIDWEST THROUGH ONE OF THE LARGEST INTEGRATED DELIVERY SYSTEMS IN THE NATION. WITH CARE DELIVERY SITES IN ILLINOIS, MISSOURI, OKLAHOMA, AND WISCONSIN, SSMH INCLUDES 23 ACUTE CARE HOSPITALS, ONE CHILDREN'S HOSPITAL, MORE THAN 300 PHYSICIAN OFFICES AND OTHER OUTPATIENT AND VIRTUAL CARE SERVICES, 10 POST-ACUTE FACILITIES, COMPREHENSIVE HOME CARE AND HOSPICE SERVICES, A PHARMACY BENEFIT COMPANY, A HEALTH INSURANCE COMPANY, AND AN ACCOUNTABLE CARE ORGANIZATION. THE HEALTH SYSTEM EMPLOYS NEARLY 40,000 PEOPLE AND IS AFFILIATED WITH 11,000 PHYSICIANS MAKING IT ONE OF THE LARGEST EMPLOYERS IN EVERY COMMUNITY IT SERVES. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMH STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL HEALTH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. DESCRIBE THE EXEMPT PURPOSE ACHIEVEMENTS. DURING 2023, THE FOUNDATION BOARD OF DIRECTORS UNDERWENT A STRATEGIC PLANNING PROCESS. WITH THE VISION OF A VIBRANT COMMUNITY WHERE ALL HEALTH CARE NEEDS ARE MET, THE FOUNDATION'S MISSION IS TO INSPIRE FINANCIAL AND SPIRITUAL SUPPORT OF ST. MARY'S HOSPITAL'S MISSION BY BUILDING PERSONAL RELATIONSHIPS AND COMMUNITY ENGAGEMENT. FOUNDATION SUPPORT IS GENERATED BY ORGANIZATIONS AND INDIVIDUALS WHO PROVIDE ANNUAL GENEROSITY THROUGH THE FORM OF ANNUAL GIFTS, SPECIAL AND SIGNATURE GIFTS IN SUPPORT OF SPECIAL PROJECTS AND ENDOWMENT, AND THE ULTIMATE GIFT ARRANGED THROUGH BEQUESTS AND OTHER PLANNED GIFT VEHICLES. ADDITIONAL REVENUE IS GENERATED THROUGH AN ANNUAL GOLF TOURNAMENT. THE FOUNDATION'S VISION IS CARRIED OUT BY BUILDING RELATIONS WITH INDIVIDUALS, ORGANIZATIONS, AND FOUNDATIONS CAPABLE OF MAKING GIFTS, CREATING OPPORTUNITIES TO INFORM PROSPECTIVE SUPPORTERS ABOUT THE HOSPITAL'S WORK, INVOLVING THEM IN THE MISSION, AND GRACIOUSLY RECOGNIZING THE SUPPORT GIVEN. OVER THE PAST YEAR, THE FOUNDATION PROVIDED FUNDING FOR PATIENT IMPACT: PATIENT EDUCATION RESOURCES, PET THERAPY AND PHYSICAL THERAPY EQUIPMENT; AND COMMUNITY HEALTH: PATIENT TRANSPORTATION TO / FROM MEDICAL APPOINTMENTS, CHILDREN'S BICYCLE HELMETS. FUNDRAISING EFFORTS HAVE ALSO CENTERED AROUND SUPPORT FOR EMPLOYEE PROFESSIONAL DEVELOPMENT AND EDUCATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATION MEMBER IS SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH CARE OF WISCONSIN, INC. IS A NONPROFIT 501(C)(3) ORGANIZATION THAT OPERATES THREE HOSPITALS AND TWO SKILLED NURSING FACILITIES. BOTH THE FOUNDATION AND SSM HEALTH CARE OF WISCONSIN, INC. ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE RIGHT TO APPOINT THE BOARD OF DIRECTORS, EXCEPT FOR ANY DIRECTOR WHO SERVES EX OFFICIO, AND TO REMOVE THE DIRECTORS WITH OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE PHILOSOPHY OF THE CORPORATION B. TO APPOINT THE BOARD OF DIRECTORS, EXCEPT FOR ANY DIRECTOR WHO SERVES EX OFFICIO, AND TO REMOVE THE DIRECTORS WITH OR WITHOUT CAUSE C. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN D. TO APPROVE THE BYLAWS OF THE CORPORATION AND ANY AMENDMENTS THERETO E. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION F. TO APPROVE THE SALE, CONVEYANCE, ASSIGNMENT, TRANSFER, ALIENATION, PLEDGE, ENCUMBRANCE, MORTGAGE OR LEASE OF REAL PROPERTY OR ANY INTEREST THEREIN OF THE CORPORATION IN ACCORDANCE WITH THE POLICIES APPROVED BY THE MEMBER FROM TIME TO TIME G. TO APPROVE (I) THE ACQUISITION OF REAL PROPERTY OR ANY INTEREST THEREIN OR (II) THE ACQUISITION OF STOCK OF A CORPORATION IF, AFTER THE ACQUISITION, THE CORPORATION WILL OWN A MAJORITY OF THE VOTING STOCK OF SUCH CORPORATION, IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER FROM TIME TO TIME H. TO APPROVE THE SALE, TRANSFER OR OTHER DISPOSITION ("DISPOSITION") OF THE VOTING STOCK OF A CORPORATION IF BEFORE THE DISPOSITION THE CORPORATION OWNED A MAJORITY OF THE VOTING STOCK OF THE CORPORATION AND AFTER SUCH DISPOSITION THE CORPORATION WOULD NOT OWN A MAJORITY OF THE VOTING STOCK OF THE CORPORATION, IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER FROM TIME TO TIME I. TO APPROVE ANY BORROWING OR GUARANTEES OF THE CORPORATION IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER FROM TIME TO TIME J. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENTS 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 K. TO APPROVE THE ACCEPTANCE OF ANY GIFT OR CONTRIBUTION WHICH, IN CONNECTION THEREWITH, WOULD IMPOSE A CONTINUING OBLIGATION UPON THE CORPORATION, INCLUDING, WITHOUT LIMITATION, THE OBLIGATION TO PROVIDE HEALTH CARE SERVICES, PAY AN ANNUITY OR UNDERTAK ANY OTHER OBLIGATIONS, EXCEPT AS OTHERWISE DETERMINED BY THE MEMBER PURSUANT TO POLICIES ADOPTED BY THE MEMBER FROM TIME TO TIME; AND L. TO APPROVE OR REJECT PROPOSALS FOR EXPENDITURES OR CONTRIBUTIONS IN ACCORDANCE WITH THE BYLAWS IN THE EVENT THE PRESIDENT OF ST MARY'S HOSPITAL AND THE BOARD OF DIRECTORS DO NOT AGREE WITH RESPECT TO THE APPROVAL OF SUCH PROPOSAL. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION (SSM). THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGMENT. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SSM PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. 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 OF THE BOARD OVERSEE COMPLIANCE WITH THIS REQUIREMENT. ALL BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAIN FROM BOARD DISCUSSIONS AND VOTES WHEN APPLICABLE. EMPLOYEES WITH PURCHASING AUTHORITY AND/OR ABILITY TO INFLUENCE PURCHASING DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ONLINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON (WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR END. FORM 990, PART VI, SECTION C, LINE 19 THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLE OF INCORPORATION ARE AVAILABLE UPON REQUEST TO THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTION'S OFFICE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: ACTUARIAL LOSS ON GIFT ANNUITIES FUND BALANCE TRANSFERS 706,870. SSM HEALTH CARE ST LOUIS 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431343281 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE CORPORATION 0 CENTRALIA MEDICAL SERVICES BLDG ASSOC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 237408025 MOB IL 501(C)(3) LINE 12A, I SSM REGIONAL HEALTH SERVICES 0 ST MARY'S JANESVILLE FOUNDATION INC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 273439133 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 SSM HEALTH MINISTRIES 3221 MCKELVEY ROAD SUITE 107 BRIDGETON MO 63044 431012492 RELIGIOUS ORGANIZATION MO 501(C)(3) LINE 1 N/A 0 LEE DEWEY CORPORATION 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 731279603 MOB OK 501(C)(3) LINE 12A, I SSM HEALTH CARE OF OKLAHOMA 0 ST MARY'S HOSPITAL AUXILIARY 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY MO 65101 436049878 FUNDRAISING MO 501(C)(3) LINE 12B, II N/A 0 GOOD SAMARITAN HOSPITAL AUXILIARY 1 GOOD SAMARITAN WAY MOUNT VERNON IL 62864 237049599 FUNDRAISING IL 501(C)(3) LINE 12C, 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 AUDRAIN HEALTH CARE INC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431550298 HEALTH CARE MO 501(C)(3) LINE 3 SSM REGIONAL HEALTH SERVICES 0 SSM-SLUH INC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 474196634 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE ST LOUIS 0 AGNESIAN HEALTHCARE INC 430 E DIVISION ST FOND DU LAC WI 54935 390807236 HEALTH CARE WI 501(C)(3) LINE 3 SSM HEALTH CARE OF WISCONSIN 0 RIPON MEDICAL CENTER INC 845 PARKSIDE STREET RIPON WI 54971 391101287 HEALTH CARE WI 501(C)(3) LINE 3 AGNESIAN HEALTHCARE INC 0 WAUPUN MEMORIAL HOSPITAL INC 620 WEST BROWN STREET WAUPUN WI 53963 390806265 HEALTH CARE WI 501(C)(3) LINE 3 AGNESIAN HEALTHCARE INC 0 ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC 33 EVERETT STREET FOND DU LAC WI 54935 391029998 HEALTH CARE WI 501(C)(3) LINE 10 AGNESIAN HEALTHCARE INC 0 SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO N8114 COUNTY WW MOUNT CALVARY WI 53057 391022770 HEALTH CARE WI 501(C)(3) LINE 10 AGNESIAN HEALTHCARE INC 0 VILLA ROSA INC N8120 COUNTY WW MOUNT CALVARY WI 53057 421670962 HEALTH CARE WI 501(C)(3) LINE 10 AGNESIAN HEALTHCARE INC 0 THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED 331 BLY STREET WAUPUN WI 53963 390884514 HEALTH CARE WI 501(C)(3) LINE 10 AGNESIAN HEALTHCARE INC 0 THE MONROE CLINIC INC 515 22ND AVENUE MONROE WI 53566 390808509 HEALTH CARE WI 501(C)(3) LINE 3 SSM HEALTH CARE OF WISCONSIN 0 MONROE CLINIC AND HOSPITAL FOUNDATION INC 515 22ND AVENUE MONROE WI 53566 205769038 FUNDRAISING WI 501(C)(3) LINE 7 SSM HEALTH CARE OF WISCONSIN 0 AGNESIAN HEALTHCARE FOUNDATION INC 430 E DIVISION ST FOND DU LAC WI 54935 391684956 FUNDRAISING WI 501(C)(3) LINE 12A, I SSM HEALTH CARE OF WISCONSIN 0 SHARED MAGNETIC RESONANCE IMAGING FACILITY INC 1104 JOHN NOLEN DRIVE MADISON WI 53713 391534744 HEALTH CARE WI 501(C)(3) LINE 12A, I SSM HEALTH CARE OF WISCONSIN 0 SSM HEALTH CARDINAL GLENNON TRANSPORT 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 863519607 HEALTH CARE MO 501(C)(3) LINE 12A, I SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 0 SSM HEALTH FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 874109859 FUNDRAISING MO 501(C)(3) LINE 12A, I SSM HEALTH CARE CORPORATION 0 SSM HEALTH CARE GROUP 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 880988603 HEALTH CARE MO 501(C)(3) LINE 10 SSM HEALTH CARE ST LOUIS 0 THE SARAH COMMUNITY 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431784657 HEALTH CARE MO 501(C)(3) LINE 10 SSM HEALTH BUSINESSES 0 VISITING NURSE ASSOCIATION OF GREATER ST LOUIS 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 430567000 HEALTH CARE MO 501(C)(3) LINE 7 SSM HEALTH BUSINESSES 0 SSM HEALTH BUSINESSES 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431333488 HEALTH CARE MO 501(C)(3) LINE 10 SSM HEALTH CARE CORPORATION 0 SSM HEALTH CARE ST LOUIS 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431343281 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE 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