2024-11-15T14:20:38-06:00 2023-12-31 990EZ 2023-01-01 364170833 ST MARY'S - GOOD SAMARITAN INC STMA 6184368000 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 BARBARA POTTS VP FINANCE 6184368000 2024-11-15 0 2023 2024-10-15 13:58:12Z X X X WWW.SSMHEALTH.COM X X 56207 X 56207 56207 5 5 56202 46386 0 102588 X 46386 102588 46386 102588 0 0 46386 102588 X TO IMPROVE ACCESS TO HEAL TH CARE AND IMPROVE HEAL TH IN OUR COMMUNITIES. SINCE IT WAS FOUNDED IN 1872 BY CATHOLIC SISTERS, SSM HEAL TH (SSMH) HAS EXISTED TO MEET THE HEAL TH NEEDS OF THE COMMUNITIES IT SERVES. SSMH IS A CATHOLIC, NOT-FOR PROFIT HEAL TH SYSTEM SERVING THE COMPREHENSIVE HEAL TH 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 HEAL TH 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 HEAL TH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. ST. MARY'S - GOOD SAMARITAN, INC. IS COMMITTED TO THE PURPOSE OF ENABLING ITS ENTITIES, SSM HEAL TH ST MARY'S HOSPITAL - CENTRALIA AND SSM HEAL TH GOOD SAMARITAN HOSPITAL - MT. VERNON TO PROVIDE ACCESS TO QUALITY HEAL TH CARE SERVICES TO ALL PERSONS ON THE SOUTHERN ILLINOIS REGION REGARDLESS OF THEIR ABILITY TO PAY. THROUGH ITS GOVERNANCE, OPERATION AND ADMINISTRATION, ST MARY'S - GOOD SAMARITAN, INC. HELPS TO MEET THE COMMUNITY NEEDS IDENTIFIED BY EACH HOSPITAL IN AN ECONOMIC AND EFFICIENT MANNER. THE LEADERS OF ST. MARY'S -GOOD SAMARITAN, INC. PARTICIPATE IN COMMUNITY ORGANIZATIONS WHICH ENABLE THEM TO IDENTIFY COMMUNITY NEEDS. ALL SSMH FACILITIES WILL STRIVE TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES TO ALL PERSONS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. ALL BILLING AND COLLECTION POLICIES AND PRACTICES WILL REFLECT THE MISSION AND VALUES OF SSMH, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. SSMH FACILITIES OFFER DISCOUNTS FOR HOSPITAL SERVICES TO ALL UNINSURED PERSONS. SELF-PAY DISCOUNTS APPLY TO EVERYONE WHO DOES NOT HAVE HEALTH INSURANCE, NO MATTER THEIR ABILITY TO PAY. SSMH WILL APPLY ITS CHARITY CARE POLICIES FAIRLY AND CONSISTENTLY. EACH PERSON WILL BE TREATED AS AN INDIVIDUAL WITH SPECIFIC NEEDS FOR ASSISTANCE WITHOUT REGARD TO PAYMENT. SSMH EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH WE PARTICIPATE BY ESTABLISHING SOUND BUSINESS PRACTICES. CHARITY CARE IS PROVIDED TO PATIENTS BASED ON A SLIDING SCALE FOR HOUSEHOLD INCOMES UP TO FOUR TIMES THE FEDERAL POVERTY LEVEL. PATIENTS WHOSE HOUSEHOLD INCOME IS NO MORE THAN TWO TIMES THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FREE HOSPITAL SERVICES. IN ADDITION, AN EXCEPTION TO THE SLIDING SCALE IS PROVIDED FOR A PATIENT'S BALANCE DUE IF THE AMOUNTIS TOO LARGE TO BE REASONABLY PAID THROUGH AN INSTALLMENT PLAN OVER FOUR YEARS GIVEN THE FAMILY INCOME AND EXPENSES. EACH ENTITY PROVIDING MEDICAL SERVICES SHALL PROVIDE INFORMATION TO THE PUBLIC REGARDING ITS CHARITY CARE POLICIES AND THE QUALIFICATION REQUIREMENTS FOR EACH OF ITS FACILITIES. WHEN STANDARD SYSTEM NOTICES AND COMMUNICATIONS REGARDING CHARITY CARE ARE AVAILABLE, THESE MUST BE USED. MODIFICATIONS TO THE STANDARD MAY BE MADE TO COMPLY WITH STATE AND LOCAL LAWS, AS WELL AS REFLECT CUL TU RALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES WILL BE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY WILL PROVIDE INFORMATION ABOUT: THE PATIENT'S RESPONSIBILITY FOR PAYMENT, THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND ENTITY CHARITY CARE AND PAYMENT ARRANGEMENTS, THE ENTITY'S CHARITY POLICY AND APPLICATION PROCESS, AND WHOM TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELING. THE FOLLOWING TYPES OF NOTICES TO THE PUBLIC SHALL BE PROVIDED: SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS, BROCHURES OR FLIERS AT TIME OF REGISTRATION AND AVAILABLE IN THE FINANCIAL COUNSELING AREAS, NOTICES SENT WITH OR ON PATIENT BILLS OR COMMUNICATIONS SENT TO PATIENTS AND GUARANTORS RELATED TO MEDICAL SERVICES AND APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION. THE APPLICATION FOR CHARITY CARE, TOGETHER WITH ANY INSTRUCTIONS, MUST CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES WILL ALSO BE PROVIDED TO PUBLIC AGENCIES. ST MARY'S - GOOD SAMARITAN, INC. SUPPORTS TWO SSMH HOSPITALS THAT: EACH OPERATE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, HAVE AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, HAVE A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY, ENGAGE IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, AND PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEAL TH CARE PROGRAMS. ADDITIONAL INFORMATION REGARDING SSMH'S 2022 COMMUNITY BENEFIT REPORT CAN BE FOUND AT WWW.SSMHEALTH.COM. 0 5 5 X JEAN BENOIT-HOULE MD DIRECTOR 1.00 0 0 0 MATTHEW FLANIGAN DIRECTOR 1.00 0 0 0 DAMON HARBISON DIRECTOR 1.00 0 0 0 MONICA HEINZMAN DIRECTOR 1.00 0 0 0 TENA HOYT DIRECTOR 1.00 0 0 0 ERICA IBENDAHL MD DIRECTOR 1.00 0 0 0 JEREMY MIDURA CSSF DIRECTOR 1.00 0 0 0 SUDEEP NAIR MD DIRECTOR 1.00 0 0 0 SUZIE SCHMIDT DIRECTOR 1.00 0 0 0 RAJENDRA SHROFF MD DIRECTOR 1.00 0 0 0 WILLIAMS PATRICIA DIRECTOR 1.00 0 0 0 JEREMY FOTHERINGHAM DIRECTOR, CHAIRPERSON & PRESIDENT 1.00 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MARK STOVER 400 N PLEASANT CENTRALIA IL 62801 6184367545 0 0 0 0 0 0 0 0 0 0 NONE NONE 1 X X 3 ST MARY'S HOSPITAL CENTRALIA IL 370662580 3 1 0 0 GOOD SAMARITAN REGIONAL HEALTH CENTER 430653587 3 1 0 0 CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION 237408025 3 1 0 0 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 30 - FINANCIAL SUPPORT ST. MARY'S - GOOD SAMARITAN, INC. IS A TYPE I SUPPORTING ORGANIZATION THAT IS OPERA TED EXCLUSIVELY TO SUPPORT THE OPERATIONS OF ST. MARY'S HOSPITAL, GOOD SAMARITAN REGIONAL HEAL TH CENTER, AND CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION, RELATED TAX-EXEMPT ORGANIZATIONS. THE AMOUNTS OF SUPPORT PROVIDED TO THESE ORGANIZATIONS ON SCHEDULE A, PART I, LINE 11(H)(V) AND LINE 11 (H)(VI) DO NOT INCLUDE EXPENSES PAID ON BEHALF OF BUT NOT DIRECTLY TO THESE ORGANIZATIONS. SCHEDULE A, PART IV, SECTION A, LINE 2 -SUPPORTED ORG. WITHOUT IRS STATUS 5 ST. MARY'S - GOOD SAMARITAN, INC. IS A SUPPORTING ORGANIZATION THAT PROVIDES SUPPORT TO ST. MARY'S HOSPITAL CENTRALIA, ILLINOIS AND GOOD SAMARITAN REGIONAL HEAL TH CENTER, BOTH TAX EXEMPT HOSPITALS. THROUGH ITS SUPPORT OF THESE TWO HOSPITALS, ST. MARY'S - GOOD SAMARITAN, INC. ALSO PROVIDES SUPPORT TO CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION, A SUPPORTING ORGANIZATION OF TO ST. MARY'S HOSPITAL CENTRALIA, ILLINOIS. CENTRALIA MEDICAL SERVICES BUILDING ASSOCIATION PROVIDES OFFICE SPACE TO PHYSICIANS, AN MRI SUITE, AND A CONVENIENT CARE LOCATION TO INCREASE THE AVAILABILITY OF DOCTORS FOR MEDICAL EMERGENCIES AND PROVIDE ADDITIONAL PATIENT ACCESSIBILITY. FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: MISC EXPENSE. AMOUNT: 5. FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS DESCRIPTION: DUE FROM AFFILIATES. BEG. OF YEAR AMOUNT: 46,386. END OF YEAR AMOUNT: 102,588. THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.