2025-11-17T18:58:51-06:00 2024-12-31 990 2024-01-01 364636691 ST MARY'S HOSPITAL FOUNDATION STMA 6184366455 400 N PLEASANT CENTRALIA IL 62801 STEPHANIE KING VP FINANCE 6184366455 2025-11-17 0 2024 2025-03-06 01:10:19Z KATHLEEN ZIBBY-DAMRON 400 N PLEASANT CENTRALIA IL 62801 382214 0 0928 X WWW.GIVETOSSMHEALTH.ORG/FOUNDATIONS/ILLINOIS/SSM- X 2008 IL TO PROVIDE SUPPORT TO SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA IN SUPPORT OF THEIR MISSION TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING REGIONAL QUALITY HEALTH SERVICES FOR EVERYONE. 12 9 0 10 0 0 250039 188120 127575 110031 15456 74229 -22 969 393048 373349 47489 363437 0 0 93573 83786 0 0 108722 24442 24936 165504 472159 227544 -98810 1113515 1067527 5240 35001 1108275 1032526 X THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. 0 0 363437 363437 110031 PROVIDED SUPPORT TO VARIOUS PROGRAMS AND EQUIPMENT PURCHASES FOR SSM HEALTH ST MARY'S HOSPITAL - CENTRALIA. PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS. 363437 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 12 9 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 IL X NIKKI PAYNE 5572034447 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 DAMON HARBISON TRUSTEE & HOSPITAL PRESIDENT 1.00 50.00 X X 0 575496 220573 MARYANN LANGENFELD MD TRUSTEE 1.00 0.00 X 0 0 0 RAJENDRA SHROFF MD TRUSTEE & PHYSICIAN 1.00 50.00 X 0 139833 39815 GREGG WINN TRUSTEE 1.00 0.00 X 0 0 0 JACK GRAHAM TRUSTEE 1.00 0.00 X 0 0 0 KEITH KESSLER TRUSTEE 1.00 0.00 X 0 0 0 KIM MCMILLAN TRUSTEE & CHAIRPERSON 1.00 0.00 X X 0 0 0 PATTY WILLIAMS TRUSTEE 1.00 0.00 X 0 0 0 REV RON JOHNSON TRUSTEE 1.00 0.00 X 0 0 0 SUSAN ROBBINS TRUSTEE 1.00 0.00 X 0 0 0 WES MONKEN TRUSTEE 1.00 0.00 X 0 0 0 JEREMY FOTHERINGHAM TRUSTEE & REGIONAL PRESIDENT 1.00 50.00 X 0 1310180 630158 DOUGLAS LONG ASST SECRETARY & GENERAL COUNSEL 1.00 50.00 X 0 1587150 700771 JOHN SNODSMITH REGIONAL VP FINANCE 1.00 50.00 X 0 320127 90119 KATHLEEN ZIBBY-DAMRON EXECUTIVE DIRECTOR 20.00 20.00 X 0 168593 38295 KAREN REWERTS FORMER OFFICER & SYSTEM VP FINANCE 0.00 50.00 X 0 845480 234843 MATT KINSELLA FORMER OFFICER 0.00 50.00 X 0 561331 175077 0 5508190 2129651 0 1 1 0 0 38276 149844 188120 110031 110031 110031 18904 18904 55325 0 55325 55325 55325 9234 38276 8565 669 669 600 300 300 300 373349 110031 0 75198 363437 363437 75637 75637 8149 8149 17498 17498 5918 5918 162 162 144 144 BANK FEES 586 586 OTHER EXPENSES 428 428 TAXES 200 200 472159 363437 0 108722 633549 140073 350130 827421 129836 100033 1113515 1067527 5240 35001 5240 35001 X 415646 596341 692629 436185 1108275 1032526 1113515 1067527 -98810 23061 0 X 0 1 X 1 0 X 427279 185174 248093 260951 188120 1309617 427279 185174 248093 260951 188120 1309617 351432 958185 56 3137 5932 6435 18904 34464 20641 13667 42821 9234 86363 1430444 110031 0.66990 0.94380 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 OTHER LIABILITIES 35001 35001 X PART X, LINE 2: ST. MARY'S HOSPITAL FOUNDATION'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 UNCERTAIN 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 2024 OR 2023. GOLF TOURNAMENT 47510 38276 9234 440 3514 2500 1455 656 47510 38276 9234 440 3514 2500 1455 656 8565 669 1 ST MARY'S HOSPITAL CENTRALIA ILLINOIS 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 370662580 501(C)(3) 362837 0 SUPPORT HOSPITAL OPERATIONS PT TRANSPORTATION 1 0 PART I, LINE 2: GRANTS TO ORGANIZATIONS ARE MADE TO A RELATED ORGANIZATION THAT IS TAX EXEMPT UNDER SECTION 501(C)(3). THE ORGANIZATION HAS DEVELOPED INTERNAL CONTROL PROCEDURES FOR THE USE OF GRANT FUNDS. X 1 1 0 1 0 0 0 0 0 0 0 DOUGLAS LONG ASST SECRETARY & GENERAL COUNSEL 0 813979 0 583198 0 189973 0 676547 0 24224 0 2287921 0 583198 JEREMY FOTHERINGHAM TRUSTEE & REGIONAL PRESIDENT 0 837601 0 470869 0 1710 0 589116 0 41042 0 1940338 0 470869 KAREN REWERTS FORMER OFFICER & SYSTEM VP FINANCE 0 601026 0 176014 0 68440 0 198391 0 36452 0 1080323 0 229400 DAMON HARBISON TRUSTEE & HOSPITAL PRESIDENT 0 420997 0 122672 0 31827 0 166694 0 53879 0 796069 0 148571 MATT KINSELLA FORMER OFFICER 0 417285 0 101437 0 42609 0 132986 0 42091 0 736408 0 121251 JOHN SNODSMITH REGIONAL VP FINANCE 0 264636 0 40328 0 15163 0 59973 0 30146 0 410246 0 40328 KATHLEEN ZIBBY-DAMRON EXECUTIVE DIRECTOR 0 152824 0 15073 0 696 0 21365 0 16930 0 206888 0 15073 RAJENDRA SHROFF MD TRUSTEE & PHYSICIAN 0 139645 0 0 0 188 0 8702 0 31113 0 179648 0 0 PART I, LINE 1A AN INDIVIDUAL LISTED ON PART VII OF THE FORM 990 RECEIVED A TAX INDEMNIFICATION/GROSS-UP PAYMENT IN 2024. THE PAYMENT WAS INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE ORGANIZATION'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. SCHEDULE J, 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 2024. 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 DISTRIBUTIONS FROM THIS PLAN IN 2024. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. DAMON HARBISON $30,371 JOHN SNODSMITH $14,284 MATT KINSELLA $41,165 KAREN REWERTS $60,917 FORM 990 PART III, LINE 4 - PROGRAM SERVICE ACCOMPLISHMENTS 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. 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: NUTRITIONAL SNACKS FOR ONCOLOGY PATIENTS UNDERGOING TREATMENT; COMMUNITY HEALTH: PATIENT TRANSPORTATION TO / FROM MEDICAL APPOINTMENTS, CHILDREN'S BICYCLE HELMETS, AND FOR PROFESSIONAL DEVELOPMENT / EXCELLENCE: HEART MATH FUNDING PROVIDED FOR EMPLOYEE EDUCATION. FORM 990, PART V, LINE 1A ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-3069223. FORM 990, PART VI, SECTION A, LINE 2 FOREST LANGENFELD, TRUSTEE, AND DR MARYANN LANGENFELD, TRUSTEE - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS ST MARY'S-GOOD SAMARITAN, INC., A NONPROFIT 501(C)(3) ORGANIZATION. ST MARY'S-GOOD SAMARITAN, INC. AND THE FOUNDATION ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE POWER TO APPOINT THE BOARD OF TRUSTEES EXCEPT FOR ANY TRUSTEE WHO SERVES EX OFFICIO, AND TO REMOVE APPOINTED TRUSTEES WITH OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED TO THE MEMBER: A. TO ESTABLISH AND CHANGE THE PHILOSOPHY OF THE FOUNDATION B. TO APPOINT THE BOARD OF TRUSTEES, EXCEPT FOR ANY TRUSTEE WHO SERVES EX OFFICIO, AND TO REMOVE THE APPOINTED TRUSTEES WITH OR WITHOUT CAUSE C. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE FOUNDATION AS PROVIDED IN THE BYLAWS D. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE FOUNDATION E. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE FOUNDATION F. TO APPROVE THE SALE, CONVEYANCE, ASSIGNMENT, TRANSFER, ALIENATION, PLEDGE, ENCUMBRANCE, MORTGAGE OR LEASE OF REAL PROPERTY OR ANY INTEREST THEREIN OF THE FOUNDATION 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 FOUNDATION WILL OWN A MAJORITY OF THE VOTING STOCK OF SUCH CORPORATION, IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER H. TO APPROVE THE SALE, TRANSFER OR OTHER DISPOSITION OF THE VOTING STOCK OF A CORPORATION IF BEFORE THE DISPOSITION THE FOUNDATION OWNED A MAJORITY OF THE VOTING STOCK OF THE CORPORATION AND AFTER SUCH DISPOSITION THE FOUNDATION WOULD NOT OWN A MAJORITY OF THE VOTING STOCK OF THE CORPORATION, IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER I. TO APPROVE ANY BORROWINGS OR GUARANTEES OF THE FOUNDATION IN ACCORDANCE WITH POLICIES APPROVED BY THE MEMBER J. TO APPROVE THE ACCEPTANCE OF ANY GIFT OR CONTRIBUTION WHICH, IN CONNECTION THEREWITH, WOULD IMPOSE A CONTINUING OBLIGATION UPON THE FOUNDATION, INCLUDING, WITHOUT LIMITATION, THE OBLIGATION TO PROVIDE HEALTH CARE SERVICES, PAY AN ANNUITY OR OTHERWISE, EXCEPT AS OTHERWISE DETERMINED BY THE MEMBER PURSUANT TO POLICIES ADOPTED BY THE MEMBER FROM TIME TO TIME K. TO APPROVE OR REJECT PROPOSALS FOR EXPENDITURES OR CONTRIBUTIONS IN ACCORDANCE WITH ARTICLE IX OF THE BYLAWS IN THE EVENT THE PRESIDENT OF THE MEMBER AND THE BOARD OF TRUSTEES DO NOT AGREE WITH RESPECT TO THE APPROVAL OF SUCH PROPOSAL L. TO APPROVE THE ANNUAL OPERATING BUDGET OF THE FOUNDATION AND M. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, 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 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 MANAGEMENT. 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 ON LINE. 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 ARTICLES OF INCORPORATION ARE AVAILABLE ON THE ILLINOIS SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. 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