TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) VERLE BESANT DIRECTOR	1.00	X		0	0	0
(2) SR M RAMONA DOMBROWSKI CSSF DIRECTOR	1.00	X		0	0	0
(3) D BRUCE GEARY CPA CMA DIRECTOR	1.00	X		0	0	0
(4) PHILIP GUSTAFSON DIRECTOR	1.00	X		0	534,331	102,866
(5) SAJJAN K NEMANI MD DIRECTOR	1.00	X		0	0	0
(6) SR MARY JEAN RYAN FSM DIRECTOR	1.00	X		0	0	0
(7) JAMES SANGER DIRECTOR	1.00	X		0	914,911	40,252
(8) WILLIAM P THOMPSON DIRECTOR & PRESIDENT	1.00	X	X	0	1,188,452	605,422
(9) SR M CLARETTE STRYZEWSKI CSSF DIRECTOR	1.00	X		0	0	0
(10) JITENDRA K TRIVEDI MD DIRECTOR	1.00	X		0	313,199	144,868
(11) BRUCE MERRELL DIRECTOR	40.00	X	X	0	359,239	132,374
(12) MIKE WARREN DIRECTOR	1.00	X		0	363,807	238,908
(13) BRUCE FLANIGAN PART YEAR DIRECTOR	1.00	X		0	94,602	14,216
(14) KRIS A ZIMMER TREASURER	1.00		X	0	723,982	180,212
(15) JUNE L PICKETT SECRETARY	1.00		X	0	220,736	179,387
(16) CARISSA HIBBERT ASST SECRETARY	20.00		X	48,257	0	16,464
(17) KAY TINSLEY VP FISCAL SERVICES	20.00		X	191,972	0	74,072

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(F) Estimated amount of other compensation from the organization and related organizations
(18) VIRGINIA TELFORD VP NURSING	40.00	X		203,958	0	13,703
(19) MARK CLARK VP OPERATIONS	20.00	X		170,723	0	54,312
(20) DELAND EVISCHI VP BUSINESS DEVELOPMENT	20.00	X		168,087	0	50,882
(21) JULIE LONG VP PLANNING & MARKETING	20.00	X		0	157,359	36,320
(22) MICHELLE DARNELL VP SYSTEMS IMPROVEMENT	20.00	X		0	160,500	60,449
(23) THOMAS BLYTHE VP HUMAN RESOURCES	20.00	X		0	162,471	49,844
(24) GREG SIMS VP MEDICAL GROUP	5.00	X		0	176,005	53,932
(25) JAMES RUETER CRNA	40.00		X	196,297	0	47,303
(26) JEFFREY RAPP PHARMACIST	20.00		X	128,259	0	38,405
(27) PATRICIA NEUDECKER PT DIRECTOR	40.00		X	127,165	0	31,014
(28) RAJENDRA SHROFF PHYSICIAN	40.00		X	141,215	0	26,610
(29) DENA FISCHER DIRECTOR MARKETING	40.00		X	121,239	0	26,882

(A) Name and business address	(B) Description of services	(C) Compensation
MIDWEST EMERGENCY DEPT SRVCX 320 EAST HWY 50 OFALLON,IL622690000	ER PHYSICIANS	2,918,406
CENTRALIA ANESTHESIOLOGY 4227 LINCOLNSHIRE DRIVE MT VERNON,IL628640000	ANETHESIOLOGY SERVICES	1,842,431
MID AMERICA RADIOLOGY SC 152 LEMAY FERRY ROAD ST LOUIS,MO631660000	RADIOLOGY SERVICES	560,472
ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO,IL606936485	PET SCANS	447,768
ANSARI RADIATION ONCOLOGY 606 SABLE DRIVE CENTRALIA,IL62801	MD READING/INTERPRETATIONS	391,111
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 19

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	131,139	131,139
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,640,088		1,640,088
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	33,830,248	25,965,447	7,864,801
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	1,843,140	1,413,009	430,131
9	Other employee benefits .......	9,070,858	6,757,520	2,313,338
10	Payroll taxes ...........	2,469,512	1,817,407	652,105
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	149,941		149,941
c	Accounting ...........	57,943		57,943
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........	11,855,676	10,206,307	1,649,369
12	Advertising and promotion ....	321,463		321,463
13	Office expenses .......	16,294,965	15,889,127	405,838
14	Information technology ......	4,440,396	4,440,396
15	Royalties ..
16	Occupancy ...........	2,380,489	2,204,653	175,836
17	Travel ............	215,162	134,457	80,705
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	74,922	63,522	11,400
20	Interest ...........	1,113,761	1,113,761
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	3,167,188	2,889,031	278,157
23	Insurance ..............	638,169		638,169
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	BAD DEBT	5,115,411	5,115,411	0
b	MEDICAID PROVIDER TAX	2,669,260	2,669,260	0
c	MISCELLANEOUS EXPENSES	99,189	13,248	85,941
d	LICENSES AND TAXES	77,333	43,413	33,920
e
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	97,656,253	80,867,108	16,789,145	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........		1
2	Savings and temporary cash investments .......	19,103,748	2	5,207,274
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	13,416,900	4	14,998,910
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	1,493,940	8	1,700,632
9	Prepaid expenses and deferred charges ............	215,754	9	446,909
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	35,121,433
b	Less: accumulated depreciation. .....	10b	11,208,397	24,650,728	10c	23,913,036
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	4,094,302	12	21,651,750
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14	2,312,490
15	Other assets. See Part IV, line 11 ...........	3,685,871	15	930,934
16	Total assets. Add lines 1 through 15 (must equal line 34)...	66,661,243	16	71,161,935
	17	Accounts payable and accrued expenses .	6,021,449	17	5,569,584
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	14,410,253	20	12,305,202
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	38,404,000	23	38,980,000
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	6,286,039	25	8,619,888
26	Total liabilities. Add lines 17 through 25.....	65,121,741	26	65,474,674
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	1,487,469	27	5,526,952
28	Temporarily restricted net assets .....	52,033	28	160,309
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	1,539,502	33	5,687,261
34	Total liabilities and net assets/fund balances .....	66,661,243	34	71,161,935

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization ST MARY'S HOSPITAL CENTRALIA ILLINOIS
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization ST MARY'S HOSPITAL CENTRALIA ILLINOIS
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Yes

3,442

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Total. lines 1c through 1i ...................................

3,442

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,259,000		1,259,000
b	Buildings ................	20,961,585	4,454,955	16,506,630
c	Leasehold improvements ............
d	Equipment ................	11,094,259	6,318,756	4,775,503
e	Other .................	1,806,589	434,686	1,371,903
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				23,913,036

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) SSM CENTRAL INVESTMENT POOL	21,639,125	F
(B) BENEFICIAL INTEREST IN FOUNDATION	12,625	F







Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)	21,651,750

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
THIRD PARTY PAYOR		2,224,957
DUE TO AFFILIATES		513,490
DEFERRED COMPENSATION		121,652
ASSET RETIREMENT OBLIGATION		947,540
PENSION FUNDING LIABILITY		3,594,328
OTHER LONG TERM LIABILITIES		847,400
CASH OVERDRAFT		370,521


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		8,619,888
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X:	ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS' FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH CARE (SSMHC). SSMHC 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 2010 OR 2009.

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other 0 %

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	5,636,158	936,055	4,700,103	5.080 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	20,718,113	14,340,511	6,377,602	6.890 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	26,354,271	15,276,566	11,077,705	11.970 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	386,889	461	386,428	0.420 %
f Health professions education (from Worksheet 5) ..	121,367		121,367	0.130 %
g Subsidized health services (from Worksheet 6) ..	6,559,747	4,121,670	2,438,077	2.630 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	110,408		110,408	0.120 %
jTotal Other Benefits ...	7,178,411	4,122,131	3,056,280	3.300 %
kTotal. Add lines 7d and 7j. ..	33,532,682	19,398,697	14,133,985	15.270 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	132		132	0 %
2	Economic development
3	Community support	26,259		26,259	0.030 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	2,193	46	2,147	0 %
7	Community health improvement advocacy	28,171	334	27,837	0.030 %
8	Workforce development	176,775		176,775	0.190 %
9	Other
10	Total	233,530	380	233,150	0.250 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

1,556,771

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

31,799,129

Enter Medicare allowable costs of care relating to payments on line 5.....

33,475,536

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-1,676,407

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	ST MARY'S HOSPITAL 400 N PLEASANT AVENUE CENTRALIA,IL62801	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:NA

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?3
Name and address		Type of Facility (Describe)
1	CENTRALIA FAMILY HEALTH CENTER 1441 W BROADWAY CENTRALIA,IL62801	PRIMARY CARE CLINIC
2	CENTRALIA FAMILY HEALTH CENTER 1441 W BROADWAY CENTRALIA,IL62801	PRIMARY CARE CLINIC
3	CENTRALIA FAMILY HEALTH CENTER 1441 W BROADWAY CENTRALIA,IL62801	PRIMARY CARE CLINIC
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
		PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5115411.
ELIGIBILITY GUIDELINES FOR DISCOUNTED CARE	SCHEDULE H, PART I, LINE 3B	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS USES FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS.THE APPLICABLE PERCENTAGE VARIES BASED ON HOW MUCH THE APPLICANT'S INCOME EXCEEDS FPG GUIDELINES. THE FOLLOWING SCHEDULE IS USED TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE:APPLICANT'S INCOME IS CHARITY CARE PERCENTAGELESS THAN OR EQUAL TO 2 TIMES FPG 100%MORE THAN 2 TIMES, LESS THAN 2.5 TIMES FPG 80%MORE THAN 2.5 TIMES, LESS THAN 3 TIMES FPG 60%MORE THAN 3 TIMES, LESS THAN 3.5 TIMES FPG 40%MORE THAN 3.5 TIMES, LESS THAN 4 TIMES FPG 20%4 OR MORE TIMES FPG 0%
OTHER CRITERIA FOR FREE OR DISCOUNTED CARE	SCHEDULE H, PART I, LINE 3C	AN EXCEPTION TO THE SLIDING SCALE IS PROVIDED FOR A PATIENT'S BALANCE DUE IF THE AMOUNT IS TOO LARGE TO BE REASONABLY PAID THROUGH AN INSTALLMENT PLAN OVER FOUR YEARS GIVEN THE FAMILY INCOME AND EXPENSES. TO FURTHER STREAMLINE AND AUTOMATE THE FINANCIAL ASSISTANCE PROCESS, ST. MARY'S HOSPITAL BUSINESS OFFICE PERSONNEL WILL AUTOMATICALLY CONSIDER 100% OF THE PATIENT ACCOUNT AS CHARITY IF THE COMMERCIAL SOFTWARE SYSTEM (SEARCHAMERICA) INDICATES THAT THE PATIENT IS LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). THIS PROCESS IS CALLED "PRESUMPTIVE ELIGIBILITY".
PREPARATION OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART I, QUESTION 6	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS PART OF THE INTEGRATED HEALTH SYSTEM KNOWN AS SSM HEALTH CARE. IN AN EFFORT TO STRENGTHEN ITS COMMUNITY BENEFIT PROGRAM, SSM HEALTH CARE PLANS FOR, MEASURES, AND COMMUNICATES IN AN ANNUAL REPORT CHARITY CARE PROVIDED TO PERSONS WHO ARE LOW INCOME, THE UNPAID COSTS OF PUBLIC PROGRAMS AND OTHER ACTIVITIES THAT RESPOND TO COMMUNITY NEED, IMPROVE COMMUNITY HEALTH, OR REACH OUT TO LOW INCOME AND VULNERABLE PERSONS. ST MARY'S HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT IS PROVIDED TO THE COMMUNITY AND CAN BE FOUND AT WWW.SMGSI.COM. SSM HEALTH CARE'S 2010 ANNUAL COMMUNITY BENEFIT REPORT FOR THE SYSTEM CAN BE FOUND AT WWW.SSMHC.COM.
DESCRIPTION OF COSTING METHODOLOGY	SCHEDULE H, PART I, LINE 7	CHARITY CARE COSTING METHODOLOGY: THE COST OF CHARITY CARE IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES. A COST TO CHARGE RATIO CALCULATED USING THE IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGE, WAS USED TO COMPUTE CHARITY CARE AT COST. THIS IS THE RATIO OF TOTAL ADJUSTED OPERATING EXPENSE TO TOTAL GROSS PATIENT REVENUE. THE GROSS REVENUE AMOUNT IS A GROSS AMOUNT PRIOR TO CONTRACTUAL ADJUSTMENTS AND BAD DEBTS. BOTH GROSS REVENUE AND COST ARE BASED ON CHARGES AT DATE/TIME OF SERVICE.UNREIMBURSED MEDICAID COSTING METHODOLOGY: THE COST OF UNREIMBURSED MEDICAID IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES. A COST TO CHARGE RATIO CALCULATED UTILIZING IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGE, WAS USED TO COMPUTE UNREIMBURSED MEDICAID COSTS. THIS IS THE RATIO OF TOTAL ADJUSTED OPERATING EXPENSE TO TOTAL GROSS PATIENT REVENUE. THE GROSS REVENUE AMOUNT IS A GROSS AMOUNT PRIOR TO CONTRACTUAL ADJUSTMENTS AND BAD DEBTS. BOTH GROSS REVENUE AND COST ARE BASED ON CHARGES AT DATE/TIME OF SERVICE. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS COSTING METHODOLOGY: THE COSTS FOR THESE PROGRAMS WERE DERIVED FROM THE ACTUAL COSTS INCURRED IN THESE AREAS. THE EXPENDITURES ARE DETERMINED BASED ON ACTUAL INVOICES OR DOLLAR AMOUNTS SPENT AND CHARGED TO THESE DEPARTMENTS.HEALTH PROFESSIONAL EDUCATION COSTING METHODOLOGY: THE EXPENSES FOR HEALTH PROFESSION EDUCATION WERE TAKEN FROM THE DEPARTMENT'S INCOME AND EXPENSE STATEMENT, DERIVED FROM THE ACCOUNTING SYSTEM. AMOUNTS PAID FROM RESIDENT DEPARTMENTS WERE ALSO INCLUDED.RESEARCH COSTING METHODOLOGY: RESEARCH EXPENSES WERE TAKEN FROM THE INCOME AND EXPENSE STATEMENT FOR THE RESEARCH DEPARTMENTS, DERIVED FROM THE ACCOUNTING SYSTEM.CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS COSTING METHODOLOGY: CONTRIBUTION EXPENDITURES ARE BASED ON ACTUAL INVOICES THAT WERE CAPTURED AND REPORTED FOR THIS PROGRAM.
DESCRIPTION OF COMMUNITY BUILDING ACTIVITIES	SCHEDULE H, PART II	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: COMMUNITY BUILDING & COMMUNITY SUPPORT: CONDUCTED MENTAL HEALTH SEMINARS FOR POSTAL WORKERS; DONATED COMPUTERS TO THE AFTER SCHOOL PROGRAM AND CONDUCTED EMERGENCY PREPAREDNESS TRAINING FOR THE HOSPITAL AND COMMUNITY BEYOND WHAT IS CONSIDERED NORMAL OPERATING PROCEDURE. SEVERAL HOSPITAL EMPLOYEES SERVE ON LOCAL EMS BOARDS. COMMUNITY BUILDING & WORKFORCE DEVELOPMENT: CONDUCTED RECRUITMENT ACTIVITIES TO DRAW PHYSICIANS TO PROVIDE SERVICES FOR MEDICALLY UNDERSERVED AREA. THE HOSPITAL ALSO PARTNERED WITH LOCAL COLLEGES, UNIVERSITIES AND COMMUNITY WORKFORCE DEVELOPMENT AGENCIES TO RECRUIT EMPLOYEES AND INCREASE HEALTHCARE WORKER TRAININGS TO RELIEVE SHORTAGE AREAS. COMMUNITY BUILDING & COMMUNITY HEALTH IMPROVEMENT ADVOCACY: PARTICIPATE IN NUMEROUS AREA EVENTS TO PROMOTE COMMUNITY HEALTH INCLUDING THE FOLLOWING: WORKING CLOSELY WITH ILLINOIS DEPARTMENT OF PUBLIC HEALTH AT THE LOCAL AND STATE LEVEL TO ADVOCATE FOR WOMEN'S HEALTH, AGING PROGRAMS, IMMUNIZATION PROGRAMS AND OUTREACH TO THE POOR AND VULNERABLE. EMPLOYEES ARE MEMBERS OF REGIONAL AND LOCAL ADVOCACY GROUPS, COMMUNITY AWARENESS GROUPS, AND COALITIONS THAT WORK ON REGIONAL AND LOCAL PUBLIC AND COMMUNITY HEALTH ISSUES. HOSPITAL EMPLOYEES WERE PART OF THE IPLAN (ILLINOIS PUBLIC HEALTH LOCAL ASSESSMENT OF NEEDS) PROCESS WHICH IS COMPLETED EVERY FIVE YEARS. IN ADDITION TO THESE, ST. MARY'S HOSPITAL ALSO SERVES AS THE LEAD AGENCY FOR 21 COUNTIES FOR THE ILLINOIS BREAST & CERVICAL CANCER PROGRAM WHICH IS PART OF THE FEDERAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM RUN BY CDC OFFICE OF WOMEN'S HEALTH.
BAD DEBT EXPENSE & COSTING METHODOLOGY	SCHEDULE H, PART III, SECTION A, LINE 4	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS PART OF THE SSM HEALTH CARE CONSOLIDATED AUDIT. THE FOOTNOTE THAT REFERENCES BAD DEBT EXPENSE IN THE DECEMBER 31, 2010 CONSOLIDATED AUDIT IS AS FOLLOW:"IN LINE WITH ITS MISSION, SSMHC PROVIDES SERVICES TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY FOR THOSE SERVICES. FOR SOME OF ITS PATIENT SERVICES, SSMHC RECEIVES NO PAYMENT OR PAYMENT THAT IS LESS THAN THE FULL COST OF PROVIDING THE SERVICES.SSMHC VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO ARE UNABLE TO PAY FOR ALL OR PART OF THEIR HEALTH CARE EXPENSES AS DETERMINED BY SSMHC'S CRITERIA FOR FINANCIAL ASSISTANCE. BECAUSE SSMHC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUES.IN SOME CASES, SSMHC DOES NOT RECEIVE THE AMOUNT BILLED FOR PATIENT SERVICES EVEN THOUGH IT DID NOT RECEIVE INFORMATION NECESSARY TO DETERMINE IF THE PATIENTS MET THE CRITERIA FOR FINANCIAL ASSISTANCE. BAD DEBTS EXPENSE IS THE ESTIMATED AMOUNT OF PATIENT SERVICE REVENUES THAT SSMHC WILL NOT COLLECT."BAD DEBT COSTING METHODOLOGY: BAD DEBT EXPENSE REPORTED IN THE 2010 ANNUAL LICENSING SURVEY OF MISSOURI HOSPITALS WAS USED, MULTIPLIED BY THE COST TO CHARGE RATIO USING IRS WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES.BAD DEBT EXPENSE REPORTED ON LINE 2 FOR THE YEAR ENDED DECEMBER 31, 2010 WAS $4,401,953 AT CHARGES AND $1,556,771 AT COST.ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS DID NOT MAKE AN ESTIMATE OF THE ORGANIZATION'S BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.
DESCRIPTION OF MEDICARE COSTS INCLUDED IN COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B, LINE 8	THE COST OF PROVIDING CARE TO MEDICARE ELIGIBLE PATIENTS IS GREATER THAN THE REIMBURSEMENT THAT MEDICARE ALLOWS ON THE MEDICARE COST REPORT. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS CONSIDERS THIS SHORTFALL AS A COMPONENT OF COMMUNITY BENEFIT BECAUSE THE REIMBURSEMENT IS NOT NEGOTIATED AND SERVICES ARE PROVIDED REGARDLESS OF THE PATIENTS' ABILITY TO PAY. THE MEDICARE COSTS REPORTED ON LINE 6 WERE OBTAINED FROM THE 2010 MEDICARE COST REPORT.
COLLECTION PRACTICES	SCHEDULE H, PART III, SECTION C, LINE 9B	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS HAS ESTABLISHED WRITTEN CREDIT AND COLLECTION POLICY AND PROCEDURES. THE BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES OF SSM HEALTH CARE, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. THE HOSPITAL EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH IT PARTICIPATES BY ESTABLISHING SOUND BUSINESS PRACTICES. THE HOSPITAL'S BILLING AND COLLECTION PRACTICES WILL BE FAIR AND CONSISTENTLY APPLIED. ALL STAFF AND VENDORS ARE EXPECTED TO TREAT ALL PATIENTS CONSISTENTLY AND FAIRLY REGARDLESS OF THEIR ABILITY TO PAY. THEY RESPOND TO PATIENTS IN A PROMPT AND COURTEOUS MANNER REGARDING ANY QUESTIONS ABOUT THEIR BILLS AND PROVIDE NOTIFICATION OF THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE. ONCE THE PATIENT'S RESPONSIBILITY PORTION IS DETERMINED WE SEND THE PATIENT A MINIMUM OF THREE STATEMENTS AND MAKE AT LEAST 1 PHONE CALL OVER A 90 DAY PERIOD THEN, IF NO PAYMENT IS RECEIVED, THE ACCOUNT IS SENT TO A COLLECTION AGENCY. ALL OUTSIDE COLLECTION AGENCIES MUST COMPLY WITH STATE AND FEDERAL LAWS, COMPLY WITH THE ASSOCIATION OF CREDIT AND COLLECTION PROFESSIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY AND COMPLY WITH ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS' COLLECTION AND CHARITY POLICIES.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, LINE 4	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS DEFINES ITS PRIMARY SERVICE AREA AS A NINE COUNTY REGION INCLUDING THE ILLINOIS COUNTIES OF CLAY, CLINTON, FAYETTE, FRANKLIN, HAMILTON, JEFFERSON, MARION, WASHINGTON, AND WAYNE WITH AN APPROXIMATE POPULATION OF 231,475 IN 2010. OF THIS POPULATION 16.1% ARE BELOW THE FEDERAL POVERTY GUIDELINES.ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS DELIVERS HOSPITAL SERVICES IN INPATIENT, AMBULATORY SURGERY, OUTPATIENT, AND EMERGENCY ROOM SETTINGS. KEY SERVICE LINES INCLUDE CARDIOLOGY, ONCOLOGY, BEHAVIORAL HEALTH, PSYCHIATRICS, PHYSICAL THERAPY, OBSTETRICS, HYPERBARIC OXYGEN CHAMBER, WOUND CARE, ORTHOPEDICS, AND GENERAL SURGERY. ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS' SURGERY CENTERS ARE EQUIPPED WITH THE LATEST INNOVATIONS IN TECHNOLOGY ENSURING OUR PATIENTS HAVE ACCESS TO THE MOST ADVANCED TREATMENT WHILE STAYING CLOSE TO HOME. TO PROVIDE COMPLETE NEUROLOGICAL CARE, OUR SPECIALISTS ARE SUPPORTED BY BOARD CERTIFIED NEURORADIOLOGISTS, A FULL SERVICE REHABILITATION UNIT, A HOME HEALTH DEPARTMENT, 24-HOUR MRI SERVICE, NEURODIAGNOSTIC EQUIPMENT, AND CARDIAC CATHETERIZATION LABORATORIES
NEEDS ASSESSMENT PROCESS	SCHEDULE H, PART VI, LINE 2	THE ANNUAL STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLANNING PROCESS HAS INCLUDED AN ASSESSMENT OF THE COMMUNITY'S NEEDS TO INCLUDE THE IDENTIFICATION OF SPECIFIC AND MEASUREABLE HEALTHY COMMUNITIES' INITIATIVES. HEALTHY COMMUNITIES' INITIATIVES DEMONSTRATE THE LEADERSHIP ROLE THAT ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS TAKING IN IDENTIFYING, COMMUNICATING AND DEVELOPING RESPONSES TO HEALTH RELATED NEEDS IN THE COMMUNITY. AS OF JANUARY 2010, THE PRIMARY FOCUS OF SSM HEALTH CARE'S HEALTHY COMMUNITIES (HCIS) HAS BEEN ON ONE OF THE TOP-THREE CHRONIC DISEASES IN EACH ENTITY'S/NETWORK'S RESPECTIVE MARKET (E.G., CHF, DIABETES, ASTHMA) AS IDENTIFIED THROUGH, AMONG OTHER DATA SOURCES, COMMUNITY NEEDS ASSESSMENTS, CONSUMER/PUBLIC HEALTH STUDIES AND STATE/LOCAL HEALTH DEPARTMENT INFORMATION.COMMUNITY HEALTH IMPROVEMENT, WHICH WE PURSUE AS A SYSTEM PRIMARILY THROUGH HCIS UNDERTAKEN AT THE ENTITY LEVEL, IS FUNDAMENTAL TO OUR MISSION, VALUES, AND VISION. OVER THE YEARS MANY PEOPLE HAVE BENEFITED FROM OUR HCIS AND MUCH GOOD HAS COME FROM THEM. IN AN EFFORT TO BEST RESPOND TO COMMUNITY NEEDS, HCIS WILL REFOCUS ITS EFFORTS TOWARD A NEW APPROACH TO COMMUNITY HEALTH, AS OUTLINED HERE.CHRONIC DISEASE IS RAMPANT THROUGHOUT THE U.S. WHERE ROUGHLY HALF OF ALL ADULTS AND 10% OF CHILDREN/ADOLESCENTS LIVE WITH AT LEAST ONE CHRONIC DISEASE. OF THESE AN ESTIMATED 13 MILLION LACK HEALTH INSURANCE AND THEREBY HAVE POORER ACCESS TO PREVENTIVE AND PRIMARY CARE SERVICES THAN THEIR INSURED COUNTERPARTS AND EXPERIENCE WORSE HEALTH-RELATED OUTCOMES, INCLUDING PREMATURE DEATH.IN RESPONSE TO THIS GROWING NATIONAL HEALTH CRISIS, SYSTEM MANAGEMENT HAS SET THE EXPECTATION THAT ALL SSM OPERATING ENTITIES, WORKING INDIVIDUALLY OR COLLECTIVELY AS NETWORKS, IN COLLABORATION WITH COMMUNITY PARTNERS, WILL DEVELOP HCIS FOCUSED ON THE CHRONIC DISEASE SELECTED THAT ADDRESSES THREE PILLARS THAT STRETCH ACROSS THE CARE CONTINUUM: - PREVENTION THROUGH COMMUNITY EDUCATION IN PARTNERSHIP WITH COMMUNITY HEALTH ORGANIZATIONS, LOCAL HEALTH AGENCIES, CHURCHES, CIVIC CENTERS, SCHOOLS, INSURANCE COMPANIES AND OTHER COMMUNITY PARTNERS. - ACCESS TO PRIMARY CARE SERVICES AND NECESSARY MEDICATIONS IN CONJUNCTION WITH COMMUNITY HEALTH ORGANIZATIONS, LOCAL HEALTH AGENCIES AND CLINICS, EMPLOYED COMMUNITY PHYSICIANS AND PHARMACEUTICAL COMPANIES. - INPATIENT CARE INCLUDING PATIENT EDUCATION, COMPREHENSIVE DISCHARGE PLANNING, MEDICATION RECONCILIATION, COORDINATION OF CARE ACROSS SETTINGS AND POST-DISCHARGE FOLLOW-UP.INITIALLY, THE STRATEGIC GOAL WILL BE TO REDUCE THE 30-DAY HOSPITAL READMISSION RATE FOR THE CHRONIC DISEASE SELECTED. ST MARY'S HOSPITAL HAS TAKEN A COMPREHENSIVE APPROACH BY WORKING ON THE TOP FOUR CHRONIC DISEASES AT THE SAME TIME: HEART FAILURE, COPD, ACUTE MI AND PNEUMONIA. AS WE DEVELOP OUR COMMUNITY PARTNERSHIPS AND BEGIN TO IMPACT THE WHOLE CARE CONTINUUM, ADDITIONAL GOALS CAN BE ADDED THAT ADDRESS KEY INDICATORS OF COMMUNITY/POPULATION HEALTH (E.G., PREVALENCE AND INCIDENCE RATES, SCREENING RATES, HOSPITAL ADMISSION RATES, BEHAVIORAL AND LIFESTYLE FACTORS, HEALTHY PEOPLE 2020 GOALS). ST. MARY'S HOSPITAL HAS ESTABLISHED SPECIFIC STRATEGIES, INDICATORS ACTION PLANS AND MEASURES OF SUCCESS TO TRACK PROGRESS. THESE ARE ALL REPORTED THROUGH THE ANNUAL STRATEGIC AND OPERATIONAL PLANS AS WELL AS AT THE DEPARTMENTAL LEVEL. IN ADDITION TO THE HEALTHY COMMUNITIES INITIATIVES, EACH SSM HEALTH CARE HOSPITAL WILL CONDUCT A SEPARATE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ONCE EVERY THREE YEARS. TO SUPPORT THE COMPLETION OF A CHNA IN ACCORDANCE WITH ESTABLISHED GUIDELINES, A SIX-STEP PROCESS WAS DEVELOPED. THE PROCESS DEFINES AN APPROACH THAT CAN BE USED TO ASSESS THE HEALTH NEEDS OF THE COMMUNITIES SERVED BY SSM HEALTH CARE AND DEVELOP STRATEGIES FOR MEETING THOSE NEEDS. THE PROCESS INCLUDES: - DEVELOP A PLAN TO ADDRESS HEALTH REFORM MANDATES TO INCLUDE DEFINING HOW THE ASSESSMENT AND BY WHOM THE ASSESSMENT WILL BE COMPLETED; IDENTIFYING THE STAKEHOLDERS INVOLVED; AND THE TIME FRAME FOR COMPLETION - PERFORM DATA COLLECTION INCLUDING IDENTIFYING THE GEOGRAPHIC AREA SERVED, ACCESSING SECONDARY DATA SOURCES AND COORDINATING INTERVIEWS, SURVEY AND/OR FOCUS GROUPS FOR PRIMARY DATA COLLECTION - PERFORM DATA ANALYSIS BY EVALUATING QUANTITATIVE AND QUALITATIVE DATE TO IDENTIFY AND PRIORITIZE HEALTH NEEDS AND OPPORTUNITIES - CREATE A PLAN WITH GOALS, STRATEGIES, ACTIONS, DUE DATES, AND RESOURCE REQUIREMENTS WHICH INCLUDES INPUT FROM CONSTITUENTS - OBTAIN APPROVAL FROM SYSTEM MANAGEMENT TO BE ADOPTED IN 2012 AND INCORPORATE THE CHNA INITIATIVES INTO THE STRATEGIC PLAN TO INCLUDE APPOINTING RESPONSIBILITY FOR IMPLEMENTING THE PLAN AND ASSIGNING A STEERING COMMITTEE TO MONITOR PROGRESS AS APPROPRIATE - COORDINATE COMMUNICATION TO THE PUBLIC, BOARDS, STAFF AND OTHER STAKEHOLDERS PROGRESS IN ADDRESSING TOP PRIORITIES IMPACTING COMMUNITY HEALTHUTILIZING THIS PLAN, ST. MARY'S HOSPITAL HAS BEGUN THE FIRST TWO STEPS AND ANTICIPATES HAVING THE CHNA COMPLETED IN THE SECOND QUARTER OF 2012.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, LINE 3	ALL SSMHC 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 REFLECT THE MISSION AND VALUES OF SSMHC, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. SSMHC 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.EACH ENTITY PROVIDING MEDICAL SERVICE 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 COMMUNICATION 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 CULTURALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES ARE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY.THEY 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 - WHO TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELING.THE FOLLOWING TYPES OF NOTICES TO THE PUBLIC ARE PROVIDED: - SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS. - BROCHURES OR FLYERS PROVIDED 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. - 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 IS ALSO PROVIDED TO PUBLIC AGENCIES.
PROMOTION OF COMMUNITY HEALTH/FURTHERANCE OF EXEMPT PURPOSE	SCHEDULE H, PART VI, LINE 5	SSM HEALTH CARE'S MISSION STATEMENT IS "THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD."ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS PARTICIPATES IN A WIDE ARRAY OF COMMUNITY PROGRAMS THROUGHOUT THE AREA TO FURTHER ITS EXEMPT PURPOSE OF PROMOTING THE HEALTH OF THE COMMUNITY. THE THREE STRATEGIC PRIORITIES OF THE ST MARY'S HOSPITAL COMMUNITY BENEFITS PLAN ARE: BUILDING LOCAL CAPACITY, IMPROVING HEALTH OUTCOMES, AND REDUCING SOCIAL ISOLATION. GOALS AND OBJECTIVES ARE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. HEALTHY COMMUNITIES INITIATIVES CREATE OPPORTUNITIES FOR EACH RESIDENT TO MEET HIS/HER POTENTIAL PHYSICALLY, MENTALLY, SOCIALLY, EMOTIONALLY, AND SPIRITUALLY. THE INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. ST. MARY'S HOSPITAL'S HEALTHY COMMUNITIES INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS' COMMUNITY HEALTH PROGRAMS PROVIDE COMPASSIONATE AND COMPETENT CARE WHILE THEY PROMOTE HEALTH IMPROVEMENT BY REACHING DIRECTLY INTO THE COMMUNITY TO ENSURE THAT LOW-INCOME AND UNDER-SERVED PERSONS CAN ACCESS HEALTH CARE SERVICES. FOCUSING ON A BROAD DEFINITION OF HEALTH, ST MARY'S HOSPITAL CLINICS AND PROGRAMS PROVIDE MEDICAL AND MENTAL HEALTH SERVICES, HEALTH EDUCATION, HEALTH MANAGEMENT, PREVENTION, REFERRALS, INSURANCE ENROLLMENT AND IN-HOME PRIMARY CARE SERVICES AND SUPPORT, WHILE FOSTERING COLLABORATION AND INCORPORATING HEALTHY COMMUNITIES STRATEGIES. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE BOTH COMMUNITY HEALTH AND HEALTHY COMMUNITIES. ST MARY'S HOSPITAL AND SSM HEALTH CARE ADVOCATE FOR VULNERABLE POPULATIONS BY DEVELOPING RELATIONSHIPS WITH POLICY MAKERS AND THROUGH TARGETED EDUCATION EFFORTS. ALL PROJECTS INCLUDE MEASURABLE OBJECTIVES WITH A SPECIFIC TIME FRAME AND HAVE ACTIVITIES THAT WILL FAVORABLY AFFECT HEALTH STATUS INDICATORS. PROJECTS TO ACCOMPLISH HEALTH STATUS OBJECTIVES MAY INCLUDE: DISEASE PREVENTION PROGRAMS; HEALTH EDUCATION PROGRAMS; HEALTH CARE PROGRAMS FOR INDIVIDUALS WITH SPECIAL HEALTH CONCERNS; AND OTHER PROJECTS THAT IMPROVE COMMUNITY HEALTH STATUS. PROJECTS TO ADDRESS THE HEALTH PROBLEMS OF MINORITIES, THE POOR, AND OTHER MEDICALLY UNDERSERVED POPULATIONS MAY INCLUDE: IMPROVING ACCESSIBILITY AND CONTINUITY OF CARE; WORKING TO REDUCE DISPARITIES IN HEALTH STATUS; AND SPONSORING EFFORTS TO INCREASE THE NUMBER OF MINORITIES, THE POOR, AND UNDERSERVED WHO ENTER HEALTH PROFESSIONS AND WORK IN MEDICALLY UNDERSERVED COMMUNITIES. PROJECTS DESIGNED TO CONTAIN THE GROWTH OF COMMUNITY HEALTH CARE COSTS MAY INCLUDE: IMPROVING EFFICIENCY OF SERVICES; IMPROVING CASE MANAGEMENT AND CONTINUITY OF CARE; SPONSORING HEALTH PROMOTION, DISEASE PREVENTION, AND SELF CARE ACTIVITIES; CONTAINING HEALTH CARE COSTS; AND REDUCING REDUNDANCIES. THROUGH OUR COMMUNITY HEALTH NEEDS ASSESSMENT WE IDENTIFY VARIOUS UNMET COMMUNITY HEALTH NEEDS. OUR PRIMARY RESPONSIBILITY IS TO ADDRESS THOSE THAT WE CAN IMPACT THE MOST, THAT IS, THOSE ALIGNED WITH OUR CORE COMPETENCIES. WE COMMUNICATE THE NEEDS IDENTIFIED IN THE ASSESSMENT TO THE COMMUNITY THROUGH A VARIETY OF MEDIA, DEVELOP A PLAN FOR HOW TO ADDRESS THOSE NEEDS THAT WE CAN IMPACT, AND IMPLEMENT STRATEGIES TO ADDRESS THESE NEEDS. ONE OF THE CLEAREST EXAMPLES OF HOW ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS MEETS COMMUNITY NEED IS THROUGH OUR LITTLE EGYPT BREAST AND CERVICAL CANCER PROGRAM. OUR HOSPITAL HAS BEEN A LEAD AGENCY FOR THIS ILLINOIS PUBLIC HEALTH PROGRAM SINCE 1998 AND SERVES AS PAYER OF LAST RESORT FOR BREAST AND CERVICAL CANCER SCREENINGS FOR WOMEN WHO ARE UNINSURED. PARTNERING WITH SEVERAL SUSAN G. KOMEN RACE FOR THE CURE AFFILIATE AGENCIES ALSO ALLOWS OUR HOSPITAL TO PROVIDE ADDITIONAL EDUCATION AND SCREENINGS TO WOMEN WHO ARE UNDERINSURED OR COULD NOT OTHERWISE AFFORD THESE SCREENINGS. IN ADDITION TO THESE BREAST AND CERVICAL CANCER SCREENINGS, WE ALSO PROVIDES FREE SCREENINGS FOR PROSTATE CANCER, SKIN CANCER AND COLORECTAL CANCER AT VARIOUS LOCATIONS AND TIMES EACH YEAR. AMERICAN CANCER SOCIETY'S LOOK GOOD/FEEL BETTER PROGRAMS ARE OFFERED QUARTERLY AND CANCER SUPPORT GROUPS ARE OFFERED AT SEVERAL LOCATIONS EACH MONTH. THE FELICIAN WELLNESS CENTER (FWC) IS THE OUTCOME OF COLLABORATION BETWEEN THE CENTRALIA RECREATION COMPLEX, ST. MARY'S HOSPITAL AND THE FELICIAN SERVICES, INC. WORKING TOGETHER SINCE SEPTEMBER 2009, THE THREE AGENCIES ACHIEVE THEIR COMMON GOALS THROUGH RESPONSIBLE LEADERSHIP AND A SHARED VISION OF IMPROVING THE MIND, BODY, SPIRIT AND ENVIRONMENT OF THE COMMUNITIES IN THEIR COMBINED SERVICE REGION. THE FELICIAN WELLNESS CENTER DEVELOPS PROGRAMS AND SERVICES THAT CREATE OPPORTUNITIES FOR EACH RESIDENT TO MEET HIS/HER POTENTIAL PHYSICALLY, MENTALLY, SOCIALLY, EMOTIONALLY, AND SPIRITUALLY. THE INITIATIVES BUILD ON THE STRENGTHS OF ITS PEOPLE AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. HEALTHY COMMUNITIES INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING.THE HEALTHY COMMUNITIES CHRONIC DISEASE INITIATIVE IS ONE COMPONENT THAT FOCUSES ON AN IMPORTANT COMMUNITY HEALTH NEED, CHRONIC DISEASE, AND IS DIRECTED TO IMPROVE INPATIENT CARE, ACCESS TO CARE, AND PREVENTION/SCREENING FOR SELECT CHRONIC DISEASES THAT SIGNIFICANTLY IMPACT OUR COMMUNITIES. IN 2010, SSM REALIGNED THEIR HEALTHY COMMUNITIES INITIATIVES TO BETTER FIT IN WITH THE SSM STRATEGIC, FINANCIAL AND HUMAN RESOURCE PLAN. GUIDANCE WAS GIVEN FOR HEALTHY COMMUNITIES CHAMPIONS TO DEVELOP CHRONIC DISEASE MANAGEMENT PROGRAMS SPECIFIC TO EACH ENTITY'S COMMUNITY NEEDS ASSESSMENT. ST. MARY'S HOSPITAL QUICKLY DISCOVERED THAT CHF WAS OUR MAIN DISEASE THAT CAUSED READMISSIONS. IN ORDER TO REDUCE CHF READMISSIONS AND DELIVER OUTSTANDING PATIENT CARE WE HAVE RN HEALTH COACHES WHO FOLLOW PATIENTS ADMITTED WITH CHF, AMI, COPD AND PNEUMONIA DURING THE ADMISSION, AND FOR THE 30 DAY PERIOD FOLLOWING DISCHARGE. THE RN HEALTH COACHES HAVE EXPERIENCE IN TEACHING AND HANDLING THE MYRIAD ISSUES ASSOCIATED WITH CHRONIC DISEASE PATIENTS. OUR "CONNECTIONS" PROGRAM HAS FREE MONTHLY EDUCATIONAL LUNCHEONS FOCUSING ON TOPICS SUCH AS ARTHRITIS AND EXERCISE, DIABETES, STROKE PREVENTION, AND OTHER WELLNESS PROMOTION TOPICS. WE ALSO HOLD A MONTHLY STRESS MANAGEMENT CLASS WHICH IS FREE TO THE PUBLIC AND SPONSORED AS A RESULT OF COMMUNITY NEEDS. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: - OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, - HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, - HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY - ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, - PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS
AFFILIATED HEALTH CARE SYSTEM	SCHEDULE H, PART VI, LINE 6	ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS A 501(C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE. ALONG WITH GOOD SAMARITAN REGIONAL HEALTH CENTER IN MOUNT VERNON, ILLINOIS, IT IS PART OF A JOINT OPERATING AGREEMENT BETWEEN SSM HEALTH CARE BASED IN ST LOUIS, MISSOURI AS MANAGING PARTNER, AND FELICIAN SISTERS, INC. OF CHICAGO. TOGETHER THE HOSPITALS ARE PURSUING A VISION TO CREATE A COMPREHENSIVE, REGIONAL HEALTH CARE ENTERPRISE COVERING A NINE COUNTY AREA IN SOUTH CENTRAL ILLINOIS.
STATE FILING OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART IV, LINE 7	THE SSM HEALTH CARE ANNUAL CONSOLIDATED COMMUNITY BENEFIT REPORT IS FILED IN ILLINOIS, MISSOURI, OKLAHOMA, AND WISCONSIN.

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number
37-0662580

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) ILINOIS HOSPITAL RESEARCH AND EDUCATIONAL FOUNDATION1151 EAST WARRENVILLE RD NAPERVILLE,IL60566	23-7421930	501(C)(3)	80,622	TO ASSIST ILLINOIS HOSPITALS IN PROVIDING HEALTH CARE SERVICES
(2) LINCOLN FOUNDATION FOR BUSINESS EXCELLENCE1415 W DIEHL ROAD NAPERVILLE,IL60563	36-3952696	501(C)(3)	10,375	TO SUPPORT CONTINUOUS QUALITY IMPROVEMENT INITIATIVES
(3) AMERICAN HEART ASSOCIATION2850 DAIRY DRIVE SUITE 300 MADISON,WI53718	13-5613797	501(C)(3)	7,500	GENERAL PROGRAM SUPPORT
(4) JOHN & ELEANOR MITCHELL FOUNDATIONPO BOX 923 MT VERNON,IL62864	37-6053100	501(C)(3)	7,562	TO SUPPORT THE OPERATIONS OF THE FOUNDATION

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	PART I, LINE 2:	SCHEDULE I, PART I, LINE 2: COMPLETED GRANT/CONTRIBUTION REQUESTS ARE FORWARDED TO THE MARKETING DEPARTMENT FOR INITIAL APPROVAL. THE MARKETING DEPARTMENT MAINTAINS A LOG OF ALL CONTRIBUTION REQUESTS. THE DEPARTMENT EVALUATES THE REQUEST AND FORWARDS REQUESTS RECOMMENDED FOR APPROVAL TO THE HOSPITAL PRESIDENT AND/OR THE ADMINISTRATIVE COUNCIL FOR FINAL APPROVAL. MOST GRANTS/CONTRIBUTIONS ARE MADE TO 501(C)(3) ORGANIZATIONS OR LOCAL CIVIC AND EDUCATIONAL ORGANIZATIONS.

Schedule I (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) PHILIP GUSTAFSON	(i) (ii)	0 505,622	0 0	0 28,709	0 75,722	0 27,144	0 637,197	0 0
(2) JAMES SANGER	(i) (ii)	0 681,794	0 0	0 233,117	0 22,569	0 17,683	0 955,163	0 0
(3) WILLIAM P THOMPSON	(i) (ii)	0 830,800	0 0	0 357,652	0 585,557	0 19,865	0 1,793,874	0 0
(4) JITENDRA K TRIVEDI MD	(i) (ii)	0 308,803	0 0	0 4,396	0 115,217	0 29,651	0 458,067	0 0
(5) BRUCE MERRELL	(i) (ii)	0 301,044	0 0	0 58,195	0 107,696	0 24,678	0 491,613	0 0
(6) MIKE WARREN	(i) (ii)	0 303,837	0 0	0 59,970	0 211,678	0 27,230	0 602,715	0 0
(7) KRIS A ZIMMER	(i) (ii)	0 638,080	0 0	0 85,902	0 154,088	0 26,124	0 904,194	0 0
(8) JUNE L PICKETT	(i) (ii)	0 207,597	0 0	0 13,139	0 163,178	0 16,209	0 400,123	0 0
(9) KAY TINSLEY	(i) (ii)	182,000 0	0 0	9,972 0	52,389 0	21,683 0	266,044 0	0 0
(10) VIRGINIA TELFORD	(i) (ii)	150,276 0	0 0	53,682 0	2,528 0	11,175 0	217,661 0	0 0
(11) MARK CLARK	(i) (ii)	162,372 0	0 0	8,351 0	27,756 0	26,556 0	225,035 0	0 0
(12) DELAND EVISCHI	(i) (ii)	150,335 0	0 0	17,752 0	24,963 0	25,919 0	218,969 0	0 0
(13) JULIE LONG	(i) (ii)	0 150,122	0 0	0 7,237	0 33,630	0 2,690	0 193,679	0 0
(14) MICHELLE DARNELL	(i) (ii)	0 152,285	0 0	0 8,215	0 34,895	0 25,554	0 220,949	0 0
(15) THOMAS BLYTHE	(i) (ii)	0 154,799	0 0	0 7,672	0 23,776	0 26,068	0 212,315	0 0
(16) GREG SIMS	(i) (ii)	0 164,285	0 0	0 11,720	0 33,421	0 20,511	0 229,937	0 0
(17) JAMES RUETER	(i) (ii)	173,622 0	0 0	22,675 0	41,516 0	5,787 0	243,600 0	0 0
(18) JEFFREY RAPP	(i) (ii)	127,343 0	0 0	916 0	11,840 0	26,565 0	166,664 0	0 0
(19) PATRICIA NEUDECKER	(i) (ii)	126,117 0	0 0	1,048 0	6,480 0	24,534 0	158,179 0	0 0
(20) RAJENDRA SHROFF	(i) (ii)	140,565 0	0 0	650 0	11,385 0	15,225 0	167,825 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
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. JAMES M SANGER $ 116,523 KRIS A ZIMMER $ 42,738 WILLIAM P THOMPSON $ 37,749 VIRGINIA TELFORD $ 24,638 BRUCE MERRELL $ 21,440 WAYNE GROTE $ 8,978 JUNE PICKETT $ 7,123 MICHAEL WARREN $ 7,357 MICHELLE DARNELL $ 6,522 GREG SIMS $ 6,410 MARK CLARK $ 6,325 THOMAS BLYTHE $ 6,211 KAY TINSLEY $ 6,085 JULIE LONG $ 5,556

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Identifier	Return Reference	Explanation
ORGANIZATION MISSION STATEMENT	FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING & PROVIDING REGIONAL, COST EFFECTIVE QUALITY HEALTH SERVICES FOR EVERYONE, WITH A SPECIAL CONCERN FOR THE POOR AND VULNERABLE.
PROGRAM SERVICE STATEMENT	FORM 990, PART III, LINE 4A, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION: SINCE IT WAS FOUNDED IN 1872 BY FIVE CATHOLIC SISTERS, SSM HEALTH CARE (SSMHC) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. SPONSORED BY THE FRANCISCAN SISTERS OF MARY AND HEADQUARTERED IN ST LOUIS, SSMHC OPERATES 16 HOSPITAL LOCATIONS, TWO SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES IN FOUR STATES (WISCONSIN, OKLAHOMA, ILLINOIS AND MISSOURI). THE HEALTH SYSTEM EMPLOYS 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 AND COMPASSIONATE HEALTH CARE TO PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. DESCRIBE THE ORGANIZATION'S APPROACH TO PROVIDING COMMUNITY BENEFIT: THE BOARD OF ST. MARY'S HOSPITAL, ADMINISTRATIVE COUNCIL, PHYSICIANS, EMPLOYEES, AND COMMUNITY ARE ALL INVOLVED IN PROVIDING ON-GOING FEEDBACK, MONITORING AND INFORMING THE DIRECTION OF POLICIES AND CONTENT OF COMMUNITY BENEFIT ACTIVITIES. THE THREE STRATEGIC PRIORITIES OF THE ST MARY'S HOSPITAL COMMUNITY BENEFITS PLAN ARE: BUILDING LOCAL CAPACITY, IMPROVING HEALTH OUTCOMES, AND REDUCING SOCIAL ISOLATION. GOALS AND OBJECTIVES ARE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. IN AN EFFORT TO STRENGTHEN ITS COMMUNITY BENEFIT PROGRAM, ST. MARY'S HOSPITAL HAS A COMMUNITY BENEFIT PLAN WHICH DETAILS THE PLANNING, MEASUREMENT AND COMMUNICATION OF THEIR COMMUNITY BENEFITS. COMMUNITY BENEFIT IS DEFINED AS SEEKING OUT AND SERVING THOSE WHO NEED HELP CONSISTENT WITH THE MISSION OF ST MARY'S HOSPITAL AS WELL AS THE BROADER COMMUNITY TO ENSURE OPTIMAL HEALTH STATUS IN OUR SERVICE REGION. THESE WIDE ARRAYS OF SERVICES INCLUDE, BUT ARE NOT LIMITED TO, LEADERSHIP AND COLLABORATIVE ACTIVITIES IN EDUCATION, ADVOCACY AND HEALTH PROMOTION. DESCRIBE THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICIES OR PROGRAMS (E.G., CHARITY CARE, DISCOUNTING) FOR LOW-INCOME PERSONS AND HOW THEY ARE COMMUNICATED TO THE PUBLIC. ST. MARY'S HOSPITAL STRIVES TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES TO ALL PERSONS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. ALL BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. WE OFFER DISCOUNTS FOR HOSPITAL SERVICES TO ALL UNINSURED PERSONS. SELF-PAY DISCOUNTS APPLY TO EVERYONE WHO DOES NOT HAVE HEALTH INSURANCE, REGARDLESS OF ABILITY TO PAY. OUR CHARITY CARE POLICIES ARE APPLIED FAIRLY AND CONSISTENTLY. EACH PERSON IS TREATED AS AN INDIVIDUAL WITH SPECIFIC NEEDS FOR ASSISTANCE WITHOUT REGARD TO PAYMENT. WE EMBRACE OUR RESPONSIBILITY TO SERVE OUR COMMUNITIES BY UTILIZING 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 AMOUNT IS TOO LARGE TO BE REASONABLY PAID THROUGH AN INSTALLMENT PLAN OVER FOUR YEARS GIVEN THE FAMILY INCOME AND EXPENSES. THESE POLICIES ARE COMMUNICATED BY OUR STAFF PROVIDING 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 ARE ALSO PROVIDED: - SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS. - BROCHURES OR FLIERS PROVIDED 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 - APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION. ALL APPLICATIONS CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES IS ALSO PROVIDED TO PUBLIC AGENCIES. ORGANIZATION DESCRIPTION FOR TAX EXEMPTION: ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS IS A MEDICARE-DEPENDENT HOSPITAL: - OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; - HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA; - HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY; - ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS; - PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS.
		DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS THE THREE STRATEGIC PRIORITIES OF ST. MARY'S HOSPITAL'S COMMUNITY BENEFITS PLAN ARE: BUILDING LOCAL CAPACITY, IMPROVING HEALTH OUTCOMES, AND REDUCING SOCIAL ISOLATION. GOALS AND OBJECTIVES ARE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. HEALTHY COMMUNITIES INITIATIVES CREATE OPPORTUNITIES FOR EACH RESIDENT TO MEET HIS/HER POTENTIAL PHYSICALLY, MENTALLY, SOCIALLY, EMOTIONALLY, AND SPIRITUALLY. THE INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. SMGS HEALTHY COMMUNITIES INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. ST MARY'S HOSPITAL COMMUNITY HEALTH PROGRAMS PROVIDE COMPASSIONATE AND COMPETENT CARE WHILE THEY PROMOTE HEALTH IMPROVEMENT BY REACHING DIRECTLY INTO THE COMMUNITY TO ENSURE THAT LOW-INCOME AND UNDER-SERVED PERSONS CAN ACCESS HEALTH CARE SERVICES. FOCUSING ON A BROAD DEFINITION OF HEALTH, ST MARY'S HOSPITAL CLINICS AND PROGRAMS PROVIDE MEDICAL AND MENTAL HEALTH SERVICES, HEALTH EDUCATION, HEALTH MANAGEMENT, PREVENTION, REFERRALS, INSURANCE ENROLLMENT AND IN-HOME PRIMARY CARE SERVICES AND SUPPORT, WHILE FOSTERING COLLABORATION AND INCORPORATING HEALTHY COMMUNITIES STRATEGIES. ST MARY'S HOSPITAL PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE BOTH COMMUNITY HEALTH AND HEALTHY COMMUNITIES. ST MARY'S HOSPITAL AND SSM HEALTH CARE ADVOCATE FOR VULNERABLE POPULATIONS BY DEVELOPING RELATIONSHIPS WITH POLICY MAKERS AND THROUGH TARGETED EDUCATION EFFORTS. ALL PROJECTS INCLUDE MEASURABLE OBJECTIVES WITH A SPECIFIC TIME FRAME AND HAVE ACTIVITIES THAT WILL FAVORABLY AFFECT HEALTH STATUS INDICATORS. PROJECTS TO ACCOMPLISH HEALTH STATUS OBJECTIVES MAY INCLUDE: DISEASE PREVENTION PROGRAMS; HEALTH EDUCATION PROGRAMS; HEALTH CARE PROGRAMS FOR INDIVIDUALS WITH SPECIAL HEALTH CONCERNS; AND OTHER PROJECTS THAT IMPROVE COMMUNITY HEALTH STATUS. PROJECTS TO ADDRESS THE HEALTH PROBLEMS OF MINORITIES, THE POOR, AND OTHER MEDICALLY UNDERSERVED POPULATIONS MAY INCLUDE: IMPROVING ACCESSIBILITY AND CONTINUITY OF CARE; WORKING TO REDUCE DISPARITIES IN HEALTH STATUS; AND SPONSORING EFFORTS TO INCREASE THE NUMBER OF MINORITIES, THE POOR, AND UNDERSERVED WHO ENTER HEALTH PROFESSIONS AND WORK IN MEDICALLY UNDERSERVED COMMUNITIES. PROJECTS DESIGNED TO CONTAIN THE GROWTH OF COMMUNITY HEALTH CARE COSTS MAY INCLUDE: IMPROVING EFFICIENCY OF SERVICES; IMPROVING CASE MANAGEMENT AND CONTINUITY OF CARE; SPONSORING HEALTH PROMOTION, DISEASE PREVENTION, AND SELF CARE ACTIVITIES; CONTAINING HEALTH CARE COSTS; AND REDUCING REDUNDANCIES. THROUGH OUR COMMUNITY HEALTH NEEDS ASSESSMENT WE IDENTIFY VARIOUS UNMET COMMUNITY HEALTH NEEDS. OUR PRIMARY RESPONSIBILITY IS TO ADDRESS THOSE THAT WE CAN IMPACT THE MOST, THAT IS, THOSE ALIGNED WITH OUR CORE COMPETENCIES. WE COMMUNICATE THE NEEDS IDENTIFIED IN THE ASSESSMENT TO THE COMMUNITY THROUGH A VARIETY OF MEDIA, DEVELOP A PLAN FOR HOW TO ADDRESS THOSE NEEDS THAT WE CAN IMPACT, AND IMPLEMENT STRATEGIES TO ADDRESS THESE NEEDS. THE HEALTHY COMMUNITIES CHRONIC DISEASE INITIATIVE IS ONE COMPONENT THAT FOCUSES ON AN IMPORTANT COMMUNITY HEALTH NEED, CHRONIC DISEASE, AND IS DIRECTED TO IMPROVE INPATIENT CARE, ACCESS TO CARE, AND PREVENTION/SCREENING FOR SELECT CHRONIC DISEASES THAT SIGNIFICANTLY IMPACT OUR COMMUNITIES. ONE OF THE CLEAREST EXAMPLES OF HOW ST. MARY'S HOSPITAL MEETS COMMUNITY NEED IS THROUGH OUR LITTLE EGYPT BREAST AND CERVICAL CANCER PROGRAM. OUR HOSPITAL HAS BEEN A LEAD AGENCY FOR THIS ILLINOIS PUBLIC HEALTH PROGRAM SINCE 1998 AND SERVES AS PAYER OF LAST RESORT FOR BREAST AND CERVICAL CANCER SCREENINGS FOR WOMEN WHO ARE UNINSURED. PARTNERING WITH SEVERAL SUSAN G. KOMEN FOR THE CURE AFFILIATE AGENCIES ALSO ALLOWS OUR HOSPITAL TO PROVIDE ADDITIONAL EDUCATION AND SCREENINGS TO WOMEN WHO ARE UNDERINSURED OR COULD NOT OTHERWISE AFFORD THESE SCREENINGS. IN ADDITION TO THESE BREAST AND CERVICAL CANCER SCREENINGS, SMH ALSO PROVIDES FREE SCREENINGS FOR PROSTATE CANCER, SKIN CANCER AND COLORECTAL CANCER AT VARIOUS LOCATIONS AND TIMES EACH YEAR. AMERICAN CANCER SOCIETY'S LOOK GOOD/FEEL BETTER PROGRAMS ARE OFFERED QUARTERLY AND CANCER SUPPORT GROUPS ARE OFFERED AT SEVERAL LOCATIONS EACH MONTH. OUR "CONNECTIONS" PROGRAM HAS FREE MONTHLY EDUCATIONAL LUNCHEONS FOCUSING ON TOPICS SUCH AS ARTHRITIS AND EXERCISE, DIABETES, STROKE PREVENTION, AND OTHER WELLNESS PROMOTION TOPICS. WE ALSO HOLD A MONTHLY STRESS MANAGEMENT CLASS WHICH IS FREE TO THE PUBLIC AND SPONSORED AS A RESULT OF COMMUNITY NEEDS. 4. SSMHC'S 2010 COMMUNITY BENEFIT REPORT CAN BE FOUND AT WWW.SSMHC.COM. QUANTIFIABLE COMMUNITY BENEFIT THE FOLLOWING IS A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE INCLUDED AS COMMUNITY BENEFIT ACTIVITIES. TRADITIONAL CHARITY CARE $ 4,700,103 UNPAID COST OF MEDICAID $ 6,377,602 UNPAID COST OF MEDICARE $ 1,676,407 COST OF BAD DEBTS $ 1,556,771 COMMUNITY BENEFIT PROGRAMS $ 3,056,280 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $17,367,163
FORM 990, PART VI, SECTION A, LINE 6		THE SOLE CORPORATE MEMBER OF THE CORPORATION IS SSM REGIONAL HEALTH SERVICES. SSM REGIONAL HEALTH SERVICES IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS AND SSM REGIONAL HEALTH SERVICES ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE.
FORM 990, PART VI, SECTION A, LINE 7A		THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND ELECT AND REMOVE DIRECTORS EXCEPT EX OFFICIO DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B		THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION B. TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS C. TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION E. TO APPROVE THE AMENDMENTS TO THE CERTIFICATE OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY L. 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 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 M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OF THE MEMBER OR TO ANY ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY THE MEMBER OF THE MEMBER, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF THE MEMBER OF THE MEMBER AS DETERMINED BY THE MEMBER OF THE MEMBER Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OF THE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE MEMBER WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY.
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 IS PROVIDED TO THE BOARD AT THE NEXT SCHEDULED BOARD 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	ALL 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 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 ILLINOIS 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: 97,210. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 12,624. TRANSFERS TO AFFILIATES -3,998,603. TOTAL TO FORM 990, PART XI, LINE 5: -3,888,769.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL CENTRALIA ILLINOIS

Employer identification number

37-0662580

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) SSM HEALTH CARE CORPORATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 46-6029223	HEALTH CARE	MO	501(C)(3)	LINE 11A, I	FRANCISCAN SISTERS OF MARY		No
(2) SSM EMPLOYEE HEALTH CARE FUND 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1328934	BENEFIT PLANS	MO	501(C)(9)		SSM HEALTH CARE CORPORATION		No
(3) SSMHCS LIABILITY TRUST I 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-6331003	INSURANCE	MO	501(C)(3)	LINE 11A, I	SSM HEALTH CARE CORPORATION		No
(4) SSM CONSOLIDATED HEALTH SERVICES 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1473657	HEALTH CARE	MO	501(C)(3)	LINE 11A, I	SSM HEALTH CARE CORPORATION		No
(5) SSM POLICY INSTITUTE 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1788151	HEALTH CARE	MO	501(C)(4)		SSM HEALTH CARE CORPORATION		No
(6) SSM PORTFOLIO MANAGEMENT CO 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1825256	MANAGEMENT	MO	501(C)(3)	LINE 11A, I	SSM HEALTH CARE CORPORATION		No
(7) SSM HEALTH CARE ST LOUIS 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1343281	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(8) SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-0738490	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS		No
(9) GLENNON HOSPITAL GUILD 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1030299	FUNDRAISING	MO	501(C)(3)	LINE 9	SSM CARDINAL GLENNON HOSPITAL		No
(10) CARDINAL GLENNON CHILDREN'S FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1754347	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM CARDINAL GLENNON HOSPITAL		No
(11) SSM DEPAUL HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1776109	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(12) SSM ST JOSEPH FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1591556	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(13) ST CLARE HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1273310	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(14) SSM ST MARY'S HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1552945	FUNDRAISING	OK	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(15) SSM HEALTH CARE OF OKLAHOMA INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 73-0657693	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(16) ST ANTHONY HOSPITAL FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 73-6104300	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF OKLAHOMA		No
(17) SSM HEALTH CARE OF WISCONSIN INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-0688874	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(18) DELLS MEDICAL BUILDING INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 39-1613292	MOB	WI	501(C)(2)		SSM HEALTH CARE OF WISCONSIN		No
(19) ST MARY'S FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1940686	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN		No
(20) ST CLARE HEALTH CARE FOUNDATION INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1940683	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN		No
(21) HOME HEALTH UNITED INC 4639 HAMMERSLEY ROAD MADISON,WI53713 39-1539827	HEALTH CARE	WI	501(C)(3)	LINE 9	SSM HEALTH CARE OF WISCONSIN		No
(22) HOME CARE UNITED INC 4639 HAMMERSLEY ROAD MADISON,WI53713 39-1776340	HEALTH CARE	WI	501(C)(3)	LINE 9	SSM HEALTH CARE OF WISCONSIN		No
(23) HHU XTRA CARE INC 4639 HAMMERSLEY ROAD MADISON,WI53713 39-1705111	HEALTH CARE	WI	501(C)(3)	LINE 9	SSM HEALTH CARE OF WISCONSIN		No
(24) SSM REGIONAL HEALTH SERVICES 477 N LINDBERGH BLVD ST LOUIS,MO63141 44-0579850	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(25) ST FRANCIS HOSPITAL FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1099253	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM REGIONAL HEALTH SERVICES		No
(26) ST MARY'S HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1575307	FUNDRAISING	MO	501(C)(3)	LINE 11B, II	SSM REGIONAL HEALTH SERVICES		No
(27) GOOD SAMARITAN REGIONAL HEALTH CENTER 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-0653587	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES		No
(28) ST MARY'S - GOOD SAMARITAN INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 36-4170833	HEALTH CARE	IL	501(C)(3)	LINE 11A, I	SSM REGIONAL HEALTH SERVICES		No
(29) GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 26-2884795	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S - GOOD SAMARITAN		No
(30) ST MARY'S HOSPITAL FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 36-4636691	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S - GOOD SAMARITAN		No
(31) SSM HEALTH BUSINESSES 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1333488	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(32) SSM HOSPICE & HOME CARE FOUNDATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 30-0012246	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH BUSINESSES		No
(33) CENTRALIA MEDICAL SERVICES BLDG ASSOC 477 N LINDBERGH ST LOUIS,MO63141 23-7408025	HEALTH CARE	IL	501(C)(3)	LINE 11B, II	SSM REGIONAL HEALTH SERVICES		No
(34) ST MARY'S JANESVILLE FOUNDATION INC 2901 LANDMARK PL STE 300 MADISON,WI53713 27-3439133	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN		No
(35) FRANCISCAN SISTERS OF MARY 1100 BELLEVUE AVE ST LOUIS,MO63117 43-1012492	RELIGIOUS ORGANIZATION	MO	501(C)(3)	LINE 1	N/A		No
(36) LEE DEWEY CORPORATION 477 N LINDBERGH BLVD ST LOUIS,MO63141 73-1279603	MOB	OK	501(C)(3)	LINE 11A, I	SSM HEALTH CARE OF OKLAHOMA		No
(37) HEALTH CARE FOR KIDS 4055 LINDELL BLVD ST LOUIS,MO63108 43-1620093	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM CARDINAL GLENNON CHILDREN'S HOSPITAL		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SSM SJ ENDOSCOPY 477 N LINDBERGH BLVD ST LOUIS,MO63141 27-0046559	SURGERY SERVICES	MO	N/A
(2) SSMCDI IMAGING 5775 WAYZATA BOULEVARD SUITE 400 ST LOUIS PARK,MN55416 26-3791858	IMAGING SERVICES	MO	N/A
(3) SSM SELECT REHAB 4716 OLD GETTYSBURG ROAD MECHANICSBURG,PA17055 26-3694972	HEALTH CARE	MO	N/A
(4) SA MT AMB SRUG 110 N LEE OKLAHOMA CITY,OK73103 73-1528341	SURGERY SERVICES	OK	N/A
(5) ST ANTHONY HOSPITAL CARDIOVASCULAR SERVICES 477 N LINDBERGH BLVD ST LOUIS,MO63141 76-0828314	HEALTH CARE	OK	N/A
(6) B&J MB OFF BUILD 1000 N LEE OKLAHOMA CITY,OK73103 73-1533449	MOB	OK	N/A
(7) B&J MANAGEMENT 1000 N LEE STREET OKLAHOMA CITY,OK73102 36-4645813	MANAGEMENT	OK	N/A
(8) WIITTS LLC 2901 LANDMARK PLACE SUITE 300 MADISON,WI53713 39-2016715	MED. INF. SYSTEMS	WI	N/A
(9) SHARED IMAGING SERVICES 915 17TH STREET PRAIRIE DU SAC,WI53578 39-1971378	DIAG. SERVICES	WI	N/A
(10) ST CLARE IMAGING SERVICES 707 14TH STREET SUITE A BARABOO,WI53913 20-0122365	DIAG. SERVICES	WI	N/A
(11) MEADOW RIDGE 1402 PANKRATZ STREET SUITE 110 MADISON,WI53704 39-1991403	ASST. LIVING	WI	N/A
(12) DEAN HEALTH HOLD 1277 DEMING WAY MADISON,WI53717 26-1594709	IT SERVICES	WI	N/A
(13) MV RAD THERAPY 477 N LINDBERGH BLVD ST LOUIS,MO63141 20-1382620	RADIATION THERAPY	IL	N/A
(14) SLEEPNEURO SO IL 477 N LINDBERGH BLVD ST LOUIS,MO63141 20-8468195	DIAG. SERVICES	IL	N/A
(15) SMHC SURG CO-MGMT 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 20-8929305	MANAGEMENT	MO	N/A
(16) SMHC CARD CO-MGMT 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 20-8929381	MANAGEMENT	MO	N/A
(17) SMHC MUSC CO-MGMT 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 20-8929237	MANAGEMENT	MO	N/A
(18) CHOWSMGSI 605 N 12TH STREET MOUNT VERNON,IL62864 37-1383861	MOB	MO	N/A
(19) COMP CANCER CARE 477 N LINDBERGH BLVD ST LOUIS,MO63141 20-1382727	MOB	IL	N/A
(20) 1110 N CLASSEN BLVD LLC 110 N CLASSEN OKLAHOMA CITY,OK73106 73-1158158	MOB	OK	N/A
(21) M&C REALTY 1603 WENTZVILLE PARKWAY STE 121 WENTZVILLE,MO63385 62-1851447	MOB	MO	N/A
(22) SURG CNTR MW CITY 8121 NATIONAL AVE SUITE 108 MIDWEST CITY,OK73110 23-2697171	SURGERY SERVICES	OK	N/A
(23) SSM WELLBRIDGE 6140 GREENWOOD PLAZA BLVD GREENWOOD VILLAGE,CO80111 43-1794814	FITNESS CENTER	MO	N/A
(24) MIA OF ST CHARLES 132 NORTH KANSAS ST ROOM 212 EDWARDSVILLE,IL62025 42-2125740	DIAG. SERVICES	MO	N/A
(25) MEADOW RIDGE MEMORY 1402 PANKRATZ ST SUITE 110 MADISON,WI53704 20-3163929	HEALTH CARE	WI	N/A
(26) SSM BER-EK IMAGING 477 N LINDBERGH BLVD ST LOUIS,MO63141 20-5039552	IMAGING SERVICES	MO	N/A
(27) HPI-OKC LLC 14024 QUAIL POINTE DRIVE OKLAHOMA CITY,OK73134 20-5144487	HEALTH CARE	OK	N/A
(28) VASCULAR INSTITUTE DP 12266 DEPAUL DR SUITE 315 BRIDGETON,MO63044 20-5511708	VASCULAR CLINIC	MO	N/A
(29) SSM SC SURG CNTR 15305 DALLAS PKWY STE 1600 ADDISON,TX75001 26-1439695	SURGERY SERVICES	MO	N/A
(30) ST ANTHONY CARDIO SERVICES INSTITUTE 477 N LINDBERGH BLVD ST LOUIS,MO63141 26-0646402	MANAGEMENT	OK	N/A
(31) SSM RX EXPRESS LLC 727 N BALLAS RD ST LOUIS,MO63141 43-1465174	PHARMACY	MO	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) SSM MANAGED CARE ORGANIZATION LLC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1708511	HEALTH PROMOTION	MO	N/A	C
(2) FPP INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1465174	HEALTH CARE	MO	N/A	C
(3) DIVERSIFIED HEALTH SERVICES CORP 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1369305	MEDICAL EQUIPMENT	MO	N/A	C
(4) SSM CARDIO AND THORACIC SERVICES INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 26-0286559	HEALTH CARE	MO	N/A	C
(5) SSM PROPERTIES INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1462486	PROPERTY SERVICES	MO	N/A	C
(6) SSM DEPAUL MEDICAL GROUP INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1715106	HEALTH CARE	MO	N/A	C
(7) SSM ST CHARLES CLINIC MED GROUP INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-0626408	PHYSICIAN OFFICES	MO	N/A	C
(8) HEALTH FIRST PHYS MANAGEMENT 477 N LINDBERGH BLVD ST LOUIS,MO63141 73-1534336	MEDICAL SERVICES	MO	N/A	C
(9) SSMHCS LIABILITY TRUST II 477 N LINDBERGH BLVD ST LOUIS,MO63141 81-6128118	INSURANCE	MO	N/A	C
(10) SSM NEUROSCIENCES INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 26-3413981	HEALTH CARE	MO	N/A	C
(11) SSM MEDICAL GROUP INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1664107	PHYSICIAN OFFICES	MO	N/A	C
(12) SSMHC INSURANCE COMPANY 477 N LINDBERGH BLVD ST LOUIS,MO63141 03-0310431	INSURANCE	CA	N/A	C
(13) SSM ORTHOPEDIC INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 27-1557033	HEALTH CARE	MO	N/A	C
(14) SSM CANCER CARE INC 477 N LINDBERGH BLVD ST LOUIS,MO63141 27-1557324	HEALTH CARE	MO	N/A	C
(15) SSM ST JOSEPH SURGERY CENTER 477 N LINDBERGH BLVD ST LOUIS,MO63141 43-1822767	HEALTH CARE	MO	N/A	C
(16) ST MARY'S DEAN VENTURES INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1628491	HEALTH CARE	WI	N/A	C
(17) SHARED MRI FACILITY INC 1104 JOHN NOLEN DRIVE MADISON,WI53713 39-1534744	HEALTH CARE	WI	N/A	C

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) SSM EMPLOYEE HEALTH CARE FUND	O	10,248,162	COST OF SERVICES
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	6
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	983
6	Total number of volunteers (estimate if necessary) ....	6	109
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,277,287	1,288,026
9	Program service revenue (Part VIII, line 2g) .........	98,934,627	102,425,307
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	468,322	621,545
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,434,286	1,357,903
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	102,114,522	105,692,781
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	131,139
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	46,366,859	48,853,846
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	48,897,234	48,671,268
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	95,264,093	97,656,253
19	Revenue less expenses. Subtract line 18 from line 12......	6,850,429	8,036,528
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	66,661,243	71,161,935
21	Total liabilities (Part X, line 26)............	65,121,741	65,474,674
22	Net assets or fund balances. Subtract line 21 from line 20 .....	1,539,502	5,687,261

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 80,867,108 including grants of $ 131,139 ) (Revenue $ 102,425,307 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 80,867,108

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,497,172	5,369,594	2,218,697

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		56,771
e	Government grants (contributions)1e		1,226,635

f	All other contributions, gifts, grants, and similar amounts not included above1f		4,620
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,288,026
			Business Code
2a	PATIENT SERVICE REV		621,110	102,210,287	102,210,287
b	ANESTHESIA SERVICES		621,110	215,020	215,020
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			102,425,307
3	Investment income (including dividends, interest
	and other similar amounts).....			449,785			449,785
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents	581,492
b	Less: rental expenses	196,917
c	Rental income or (loss)	384,575
d	Net rental income or (loss).......			384,575			384,575
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	170,591
b	Less: cost or other basis and sales expenses		-1,169
c	Gain or (loss)	170,591	1,169
d	Net gain or (loss)..........			171,760			171,760
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	CAFETERIA		722,210	391,751			391,751
b	PRINT SERVICES		561,000	172,643			172,643
c	MEDICAL RECORDS		561,000	85,694			85,694
d	All other revenue ....			323,240			323,240
e	Total. Add lines 11a–11d ......			973,328
12	Total revenue. See Instructions....			105,692,781	102,425,307	0	1,979,448


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........				1
2	Savings and temporary cash investments .......			19,103,748	2	5,207,274
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			13,416,900	4	14,998,910
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			1,493,940	8	1,700,632
9	Prepaid expenses and deferred charges ............			215,754	9	446,909
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	35,121,433
b	Less: accumulated depreciation. .....	10b	11,208,397	24,650,728	10c	23,913,036
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			4,094,302	12	21,651,750
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14	2,312,490
15	Other assets. See Part IV, line 11 ...........			3,685,871	15	930,934
16	Total assets. Add lines 1 through 15 (must equal line 34)...			66,661,243	16	71,161,935
17	Accounts payable and accrued expenses .			6,021,449	17	5,569,584
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			14,410,253	20	12,305,202
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			38,404,000	23	38,980,000
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			6,286,039	25	8,619,888
26	Total liabilities. Add lines 17 through 25.....			65,121,741	26	65,474,674
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			1,487,469	27	5,526,952
28	Temporarily restricted net assets .....			52,033	28	160,309
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			1,539,502	33	5,687,261
34	Total liabilities and net assets/fund balances .....			66,661,243	34	71,161,935