TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) MARK BAIRD...................................................................... SVP AND CFO	1.00 ................. 39.00	X	X	1,288,249	46,819
(2) RANDY COMBS...................................................................... CFO AT SSM HEALTH	1.00 ................. 40.00	X		1,290,602	485,852
(3) RICK CORCORAN...................................................................... DIRECTOR THRU NOV 2021	1.00 ................. 0.00	X		0	0
(4) DAVID DOCHERTY...................................................................... DIR, PRES AT HEALTH PLANS	10.00 ................. 30.00	X	X	527,114	216,954
(5) DAVID ELLENBOGEN...................................................................... SVP SEC & GENERAL COUNSEL	1.00 ................. 40.00	X	X	683,704	90,914
(6) MATT HANLEY...................................................................... CCO, SSM HEALTH THRU NOV 2021	1.00 ................. 40.00	X		1,200,046	718,286
(7) DON IMHOLZ...................................................................... DIRECTOR THRU NOV 2021	1.00 ................. 0.00	X		0	0
(8) CANDACE JENNINGS...................................................................... REGIONAL PRES, THRU JUNE 2021	1.00 ................. 40.00	X		768,695	18,648
(9) TIM JOHNSON...................................................................... VP-MEDICAL GROUP OPERATIONS	1.00 ................. 40.00	X		592,955	252,062
(10) MATT KINSELLA...................................................................... REGIONAL VP FINANCE-WISCONSIN	1.00 ................. 40.00	X		413,770	176,323
(11) DOUGLAS LONG...................................................................... GEN COUNSEL, THRU NOV 2021	1.00 ................. 40.00	X		1,201,678	483,601
(12) LES MCPHEARSON...................................................................... PRESIDENT, DHP (THRU NOV 2021)	1.00 ................. 40.00	X	X	793,963	161,387
(13) JOHN NAYLOR...................................................................... PRESIDENT & CEO AT MEDICA	1.00 ................. 40.00	X	X	2,863,360	43,901
(14) JOHN PHELAN...................................................................... DIRECTOR THRU NOV 2021	1.00 ................. 0.00	X		690,483	35,384
(15) MARY QUIST...................................................................... SVP FIN & CORP CONTROLLER	1.00 ................. 40.00	X		694,530	51,694
(16) KAREN REWERTS...................................................................... VP-FINANCIAL OPERATIONS	1.00 ................. 50.00	X		736,547	251,796
(17) EVANS RICHARDSON...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

SSM HEALTH PLAN

Employer identification number

83-1979548

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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 can 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" on 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 education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, 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)

Revenue included on 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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on 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	Net investment earnings, gains, and 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 current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..		0

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)ACCRUED INVESTMENT INCOME				704
(2)PREMIUMS IN THE COURSE OF COLLECTIONS				59,527
(3)RECEIVABLES FROM AFFILIATES				1,844,914
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				1,905,145

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	587,336
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	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 XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	SSM HEALTH PLAN'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2021 OR 2020.

Return Reference

Explanation

PART X, LINE 2:

SSM HEALTH PLAN'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2021 OR 2020.

Schedule D (Form 990) 2021

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

SSM HEALTH PLAN

Employer identification number

83-1979548

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 on 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 on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

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 on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

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

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

Yes

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

Yes

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(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)
1JOHN NAYLOR PRESIDENT & CEO AT MEDICA	(i) (ii)	0 ------------- 1,043,892	0 ------------- 1,597,510	0 ------------- 221,958	0 ------------- 20,012	0 ------------- 23,889	0 ------------- 2,907,261	0 ------------- 0
2MATT HANLEY CCO, SSM HEALTH THRU NOV 2021	(i) (ii)	0 ------------- 767,127	0 ------------- 426,143	0 ------------- 6,776	0 ------------- 681,835	0 ------------- 36,451	0 ------------- 1,918,332	0 ------------- 426,143
3RANDY COMBS CFO AT SSM HEALTH	(i) (ii)	0 ------------- 940,014	0 ------------- 182,693	0 ------------- 167,895	0 ------------- 478,907	0 ------------- 6,945	0 ------------- 1,776,454	0 ------------- 82,693
4DOUGLAS LONG GEN COUNSEL, THRU NOV 2021	(i) (ii)	0 ------------- 683,805	0 ------------- 374,673	0 ------------- 143,200	0 ------------- 460,492	0 ------------- 23,109	0 ------------- 1,685,279	0 ------------- 374,673
5MARK BAIRD SVP AND CFO	(i) (ii)	0 ------------- 489,477	0 ------------- 693,738	0 ------------- 105,034	0 ------------- 22,275	0 ------------- 24,544	0 ------------- 1,335,068	0 ------------- 0
6JEREMY FOTHERINGHAM DIRECTOR THRU NOV 2021	(i) (ii)	0 ------------- 624,103	0 ------------- 50,000	0 ------------- 84,666	0 ------------- 382,896	0 ------------- 35,287	0 ------------- 1,176,952	0 ------------- 0
7KAREN REWERTS VP-FINANCIAL OPERATIONS	(i) (ii)	0 ------------- 572,568	0 ------------- 96,173	0 ------------- 67,806	0 ------------- 219,658	0 ------------- 32,138	0 ------------- 988,343	0 ------------- 159,077
8LES MCPHEARSON PRESIDENT, DHP (THRU NOV 2021)	(i) (ii)	0 ------------- 561,978	0 ------------- 227,271	0 ------------- 4,714	0 ------------- 117,496	0 ------------- 43,891	0 ------------- 955,350	0 ------------- 85,185
9TIM JOHNSON VP-MEDICAL GROUP OPERATIONS	(i) (ii)	0 ------------- 499,194	0 ------------- 92,051	0 ------------- 1,710	0 ------------- 216,780	0 ------------- 35,282	0 ------------- 845,017	0 ------------- 92,051
10CANDACE JENNINGS REGIONAL PRES, THRU JUNE 2021	(i) (ii)	0 ------------- 354,947	0 ------------- 408,824	0 ------------- 4,924	0 ------------- 4,685	0 ------------- 13,963	0 ------------- 787,343	0 ------------- 307,508
11DAVID ELLENBOGEN SVP SEC & GENERAL COUNSEL	(i) (ii)	0 ------------- 509,159	0 ------------- 120,133	0 ------------- 54,412	0 ------------- 66,025	0 ------------- 24,889	0 ------------- 774,618	0 ------------- 0
12MARY QUIST SVP FIN & CORP CONTROLLER	(i) (ii)	0 ------------- 327,656	0 ------------- 306,704	0 ------------- 60,170	0 ------------- 22,275	0 ------------- 29,419	0 ------------- 746,224	0 ------------- 0
13DAVID DOCHERTY DIR, PRES AT HEALTH PLANS	(i) (ii)	0 ------------- 303,770	0 ------------- 222,155	0 ------------- 1,189	0 ------------- 176,990	0 ------------- 39,964	0 ------------- 744,068	0 ------------- 112,706
14JOHN PHELAN DIRECTOR THRU NOV 2021	(i) (ii)	0 ------------- 685,648	0 ------------- 0	0 ------------- 4,835	0 ------------- 8,700	0 ------------- 26,684	0 ------------- 725,867	0 ------------- 0
15RANDY RUPLINGER CFO - HEALTH PLANS	(i) (ii)	0 ------------- 291,047	0 ------------- 216,613	0 ------------- 1,527	0 ------------- 172,380	0 ------------- 40,528	0 ------------- 722,095	0 ------------- 109,107
16MATT KINSELLA REGIONAL VP FINANCE-WISCONSIN	(i) (ii)	0 ------------- 339,271	0 ------------- 62,880	0 ------------- 11,619	0 ------------- 138,111	0 ------------- 38,212	0 ------------- 590,093	0 ------------- 66,793
17MINDY PHILLIPS DIRECTOR THRU NOV 2021	(i) (ii)	0 ------------- 307,064	0 ------------- 51,059	0 ------------- 20,233	0 ------------- 120,896	0 ------------- 22,454	0 ------------- 521,706	0 ------------- 70,656
18DEAN SUTTON VP & GEN COUNSEL - HP	(i) (ii)	0 ------------- 209,263	0 ------------- 78,163	0 ------------- 1,090	0 ------------- 13,656	0 ------------- 38,532	0 ------------- 340,704	0 ------------- 43,909
19KRIS ZIMMER FORMER CFO AT SSM HEALTH	(i) (ii)	0 ------------- 0	0 ------------- 219,008	0 ------------- 372	0 ------------- 0	0 ------------- 0	0 ------------- 219,380	0 ------------- 372

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS ARE COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4B	PENSION RESTORATION PLAN: SSM HEALTH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2021. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2021: DAVID DOCHERTY $32,943 MATT HANLEY $150,807 TIM JOHNSON $47,262 MATT KINSELLA $31,550 LES MCPHEARSON $109,131 KAREN REWERTS $52,238 RANDY RUPLINGER $31,959 DEAN SUTTON $10,222 JEREMY FOTHERINGHAM $110,880 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2021. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. MATT KINSELLA $10,849 KAREN REWERTS $59,124 MINDY PHILLIPS $19,506
PART I, LINE 6	MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATION'S OPERATING EARNINGS.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

SSM HEALTH PLAN

Employer identification number

83-1979548

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 4	EFFECTIVE DECEMBER 1, 2021 SSM HEALTH PLAN'S (THE CORPORATION'S ) BYLAWS WERE AMENDED TO REFLECT MS COMMUNITY NFP JV, LLC AS THE SOLE MEMBER OF THE CORPORATION. THE CORPORATION'S BYLAWS WERE ALSO AMENDED TO REFLECT CHANGES TO CERTAIN POWERS RESERVED FOR AND EXERCISED BY THE MEMBER CONSISTENT WITH THE PROVISIONS OF THE MEMBER'S LIMITED LIABILITY COMPANY AGREEMENT, AND TO REVISE THE TERM LENGTHS AND NUMBER OF DIRECTORS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE CORPORATION IS MS COMMUNITY NFP JV, LLC, A DELAWARE LIMITED LIABILITY COMPANY. BOTH SSM HEALTH PLAN AND MS COMMUNITY NFP JV, LLC ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS MEDICA HEALTH.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND APPOINT AND REMOVE DIRECTORS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B	CERTAIN POWERS WITH RESPECT TO THE CORPORATION ARE RESERVED TO THE MEMBER AND SHALL BE EXERCISED BY THE MEMBER CONSISTENT WITH THE PROVISIONS OF THE MEMBER'S LIMITED LIABILITY COMPANY AGREEMENT. THE MEMBER MAY EXERCISE ANY OF ITS RESERVED POWERS THROUGH AUTHORITY DELEGATED TO THE OFFICERS OR MANAGEMENT OF THE MEMBER OR THE BOARD OR OFFICERS OF THE CORPORATION PURSUANT TO CORPORATE RESOLUTIONS AND POLICIES WHICH MAY BE ADOPTED BY THE MEMBER, PROVIDED THAT THE EXERCISE OF THE RESERVED POWERS REMAINS THE ULTIMATE RESPONSIBILITY OF THE MEMBER. THE POWERS OF THE MEMBER WITH RESPECT TO THE CORPORATION INCLUDE, AMONG OTHER DUTIES, THE POWER TO APPROVE ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS; TO APPOINT AND REMOVE THE DIRECTORS/OFFICERS; TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; AND TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OR TO ANY OTHER 501(C)(3) EXEMPT ENTITY, WHICH IS CONTROLLED BY THE MEMBER, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF THE MEMBER AS DETERMINED BY THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 8B	THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11B	MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND FINANCE DIRECTOR REVIEW THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY WILL BE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY OF THE BOARD OVERSEE COMPLIANCE WITH THIS REQUIREMENT. ALL BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAIN FROM BOARD DISCUSSIONS AND VOTES WHEN APPLICABLE. EMPLOYEES WITH PURCHASING AUTHORITY AND/OR ABILITY TO INFLUENCE PURCHASING DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ON LINE. 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	A RELATED ORGANIZATION UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
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 SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,334,906. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,334,906.
FORM 990, PART XI, LINE 9:	PAID IN CAPITAL 7,500,000. CHANGE IN NONADMITTED ASSETS -37,895.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

SSM HEALTH PLAN

Employer identification number

83-1979548

Part I

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

(a) Name, address, and EIN (if applicable) 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 entity?
(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)AGNESIAN HEALTHCARE FOUNDATION INC 430 E DIVISION ST FOND DU LAC,WI54935 39-1684956	FUNDRAISING	WI	501(C)(3)	12	SSM HEALTH C		No
(2)AGNESIAN HEALTHCARE INC 430 E DIVISION ST FOND DU LAC,WI54935 39-0807236	HEALTH CARE	WI	501(C)(3)	3	SSM HEALTH C		No
(3)AUDRAIN MEDICAL CENTER FOUNDATION INC 620 E MONROE ST MEXICO,MO65265 43-1265060	FUNDRAISING	MO	501(C)(3)	12	N/A		No
(4)CARDINAL GLENNON CHILDREN'S FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1754347	FUNDRAISING	MO	501(C)(3)	7	SSM CARDINAL		No
(5)CENTRALIA MEDICAL SERVICES BLDG ASSOC 10101 WOODFIELD LANE ST LOUIS,IL63132 23-7408025	MOB	IL	501(C)(3)	12	SSM REGIONAL		No
(6)DELLS MEDICAL BUILDING INC 10101 WOODFIELD LANE ST LOUIS,WI63132 39-1613292	MOB	WI	501(C)(2)	N/A	SSM HEALTH C		No
(7)GOOD SAMARITAN HOSPITAL AUXILIARY 1 GOOD SAMARITAN WAY MOUNT VERNON,IL62864 23-7049599	FUNDRAISING	IL	501(C)(3)	12	N/A		No
(8)GOOD SAMARITAN REGIONAL HEALTH CENTER 10101 WOODFIELD LANE ST LOUIS,IL63132 43-0653587	HEALTH CARE	IL	501(C)(3)	3	SSM REGIONAL		No
(9)GOOD SAMARITAN REGIONAL HEALTH CENTER FO 10101 WOODFIELD LANE ST LOUIS,IL63132 26-2884795	FUNDRAISING	IL	501(C)(3)	7	ST MARY'S-GO		No
(10)HHU XTRA CARE INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1705111	HEALTH CARE	WI	501(C)(3)	10	SSM HEALTH C		No
(11)HOME CARE UNITED INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1776340	HEALTH CARE	WI	501(C)(3)	10	SSM HEALTH C		No
(12)HOME HEALTH UNITED INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1539827	HEALTH CARE	WI	501(C)(3)	10	SSM HEALTH C		No
(13)LEE DEWEY CORPORATION 10101 WOODFIELD LANE ST LOUIS,OK63132 73-1279603	MOB	OK	501(C)(3)	12	SSM HEALTH C		No
(14)MONROE CLINIC AND HOSPITAL FOUNDATION I 515 22ND AVENUE MONROE,WI53566 20-5769038	FUNDRAISING	WI	501(C)(3)	7	SSM HEALTH C		No
(15)RIPON MEDICAL CENTER INC 845 PARKSIDE STREET RIPON,WI54971 39-1101287	HEALTH CARE	WI	501(C)(3)	3	AGNESIAN HEA		No
(16)SHARED MAGNETIC RESONANCE IMAGING FACILI 1104 JOHN NOLEN DRIVE MADISON,WI53713 39-1534744	HEALTH CARE	WI	501(C)(3)	12	SSM HEALTH C		No
(17)SISTER SERVANTS OF CHRIST THE KING VILLA N8114 COUNTY WW MOUNT CALVARY,WI53057 39-1022770	HEALTH CARE	WI	501(C)(3)	10	AGNESIAN HEA		No
(18)SSM AUDRAIN HEALTH CARE INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1550298	HEALTH CARE	MO	501(C)(3)	3	SSM REGIONAL		No
(19)SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0738490	HEALTH CARE	MO	501(C)(3)	3	SSM HEALTH C		No
(20)SSM CONSOLIDATED HEALTH SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1473657	HEALTH CARE	MO	501(C)(3)	10	SSM HEALTH C		No
(21)SSM HEALTH AT HOME FOUNDATION OF WISCONS 2802 WALTON COMMONS LANE MADISON,WI53718 39-1839309	FUNDRAISING	WI	501(C)(3)	12	HOME HEALTH		No
(22)SSM HEALTH BUSINESSES 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1333488	HEALTH CARE	MO	501(C)(3)	10	SSM HEALTH C		No
(23)SSM HEALTH CARDINAL GLENNON TRANSPORT 10101 WOODFIELD LANE ST LOUIS,MO63132 86-3519607	HEALTH CARE	MO	501(C)(3)	12	SSM CARDINAL		No
(24)SSM HEALTH CARE CORPORATION 10101 WOODFIELD LANE ST LOUIS,MO63132 46-6029223	HEALTH CARE	MO	501(C)(3)	12	SSM HEALTH M		No
(25)SSM HEALTH CARE OF OKLAHOMA INC 10101 WOODFIELD LANE ST LOUIS,OK63132 73-0657693	HEALTH CARE	OK	501(C)(3)	3	SSM HEALTH C		No
(26)SSM HEALTH CARE OF WISCONSIN INC 10101 WOODFIELD LANE ST LOUIS,WI63132 43-0688874	HEALTH CARE	WI	501(C)(3)	3	SSM HEALTH C		No
(27)SSM HEALTH CARE PORTFOLIO MANAGEMENT CO 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1825256	MANAGEMENT	MO	501(C)(3)	12	SSM HEALTH C		No
(28)SSM HEALTH CARE ST LOUIS 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1343281	HEALTH CARE	MO	501(C)(3)	3	SSM HEALTH C		No
(29)SSM HEALTH FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 87-4109859	FUNDRAISING	MO	501(C)(3)	12	SSM HEALTH C		No
(30)SSM HEALTH FOUNDATION - ST LOUIS 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1552945	FUNDRAISING	MO	501(C)(3)	7	SSM HEALTH C		No
(31)SSM HEALTH MINISTRIES 3221 MCKELVEY ROAD SUITE 107 BRIDGETON,MO63044 43-1012492	RELIGIOUS ORG	MO	501(C)(3)	1	N/A		No
(32)SSM HEALTH PLAN 1277 DEMING WAY MADISON,MO53717 83-1979548	INSURANCE	MO	501(C)(4)	N/A	SSM HEALTH B		No
(33)SSM HOSPICE & HOME CARE FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 30-0012246	FUNDRAISING	MO	501(C)(3)	7	SSM HEALTH B		No
(34)SSM POLICY INSTITUTE 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1788151	HEALTH CARE	MO	501(C)(4)	N/A	SSM HEALTH C		No
(35)SSM REGIONAL HEALTH SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 44-0579850	HEALTH CARE	MO	501(C)(3)	3	SSM HEALTH C		No
(36)SSMHC LIABILITY TRUST I 10101 WOODFIELD LANE ST LOUIS,MO63132 43-6331003	INSURANCE	MO	501(C)(3)	12	SSM HEALTH C		No
(37)SSM-SLUH INC 10101 WOODFIELD LANE ST LOUIS,MO63132 47-4196634	HEALTH CARE	MO	501(C)(3)	3	SSM HEALTH C		No
(38)ST ANTHONY SHAWNEE HOSPITAL INC 1000 N LEE AVE OKLAHOMA CITY,OK73102 45-5055149	HEALTH CARE	OK	501(C)(3)	3	SSM HEALTH C		No
(39)ST MARY'S JANESVILLE FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,WI63132 27-3439133	FUNDRAISING	WI	501(C)(3)	7	SSM HEALTH C		No
(40)ST CLARE HEALTH CARE FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,WI63132 43-1940683	FUNDRAISING	WI	501(C)(3)	7	SSM HEALTH C		No
(41)ST FRANCIS HOME OF FOND DU LAC WISCONS 33 EVERETT STREET FOND DU LAC,WI54935 39-1029998	HEALTH CARE	WI	501(C)(3)	10	AGNESIAN HEA		No
(42)ST MARY'S - GOOD SAMARITAN INC 10101 WOODFIELD LANE ST LOUIS,IL63132 36-4170833	HEALTH CARE	IL	501(C)(3)	12	SSM REGIONAL		No
(43)ST MARY'S FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,WI63132 43-1940686	FUNDRAISING	WI	501(C)(3)	7	SSM HEALTH C		No
(44)ST MARY'S HEALTH CENTER JEFFERSON CITY 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1575307	FUNDRAISING	MO	501(C)(3)	12	SSM REGIONAL		No
(45)ST MARY'S HOSPITAL AUXILIARY 400 N PLEASANT CENTRALIA,IL62801 23-7126345	FUNDRAISING	IL	501(C)(3)	10	ST MARY'S HO		No
(46)ST MARY'S HOSPITAL FOUNDATION 10101 WOODFIELD LANE ST LOUIS,IL63132 36-4636691	FUNDRAISING	IL	501(C)(3)	7	ST MARY'S-GO		No
(47)ST MARY'S HOSPITAL CENTRALIA ILLINOIS 10101 WOODFIELD LANE ST LOUIS,IL63132 37-0662580	HEALTH CARE	IL	501(C)(3)	3	SSM REGIONAL		No
(48)THE CHRISTIAN HOME AND REHABILITATION CE 331 BLY STREET WAUPUN,WI53963 39-0884514	HEALTH CARE	WI	501(C)(3)	10	AGNESIAN HEA		No
(49)THE MONROE CLINIC INC 515 22ND AVENUE MONROE,WI53566 39-0808509	HEALTH CARE	WI	501(C)(3)	3	SSM HEALTH C		No
(50)THE ST ANTHONY HOSPITAL FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,OK63132 73-6104300	FUNDRAISING	OK	501(C)(3)	7	SSM HEALTH C		No
(51)VILLA ROSA INC N8120 COUNTY WW MOUNT CALVARY,WI53057 42-1670962	HEALTH CARE	WI	501(C)(3)	10	AGNESIAN HEA		No
(52)WAUPUN MEMORIAL HOSPITAL INC 620 WEST BROWN STREET WAUPUN,WI53963 39-0806265	HEALTH CARE	WI	501(C)(3)	3	AGNESIAN HEA		No
(53)ST MARY'S HOSPITAL AUXILIARY 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 43-6049878	FUNDRAISING	MO	501(C)(3)	12	N/A		No
(54)MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA,MN55305 41-1812461	FOUNDATION	MN	501(C)(3)	12	MH COMPANY		No
(55)MEDICA COMMUNITY HEALTH PLAN 401 CARLSON PARKWAY MINNETONKA,MN55305 41-1843804	HEALTH CARE	MN	501(C)(3)	N/A	MH COMPANY		No
(56)MEDICA HOLDING COMPANY 401 CARLSON PARKWAY MINNETONKA,MN55305 01-0571840	HOLDING CO	MN	501(C)(3)	N/A	N/A		No
(57)MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA,MN55305 41-1242261	HEALTH CARE	MN	501(C)(4)		MH COMPANY		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) SSM ST JOSEPH ENDOSCOPY CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-0046559	SURGERY SERVICES	MO	MHC	EXCLUDED				No			No
(2) ST CLARE IMAGING SERVICES LLC 707 14TH STREET SUITE A BARABOO,WI53913 20-0122365	DIAG. SERVICES	WI	MHC	EXCLUDED				No			No
(3) MT VERNON RADIATION THERAPY CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-1382620	RADIATION THERAPY	IL	MHC	EXCLUDED				No			No
(4) SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-8468195	DIAG. SERVICES	IL	MHC	EXCLUDED				No			No
(5) CHOWSMGSI OFFICE BUILDING LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 37-1383861	MOB	IL	MHC	EXCLUDED				No			No
(6) OZA CANCER CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-1382727	MOB	IL	MHC	EXCLUDED				No			No
(7) SHAWNEE REAL ESTATE HOLDINGS LLC 1000 N LEE AVE OKLAHOMA CITY,OK73102 45-5458304	MOB	OK	MHC	EXCLUDED				No			No
(8) DEAN CLINIC & ST MARY'S HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 45-2995500	ACCOUNTABLE CARE	WI	MHC	EXCLUDED				No			No
(9) WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-2016715	INFORMATION TECHN	WI	MHC	EXCLUDED				No			No
(10) DEAN HEALTH HOLDINGS LLC 1277 DEMING WAY MADISON,WI53717 26-1594709	SUPPORT SERVICES	WI	MHC	EXCLUDED				No			No
(11) WINGRA BUILDING GROUP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-0237060	MOB	WI	MHC	EXCLUDED				No			No
(12) JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-6220698	MOB	WI	MHC	EXCLUDED				No			No
(13) 1110 N CLASSEN BLVD LLC 1110 N CLASSEN BOULEVARD OKLAHOMA CITY,OK73106 73-1158158	MOB	OK	MHC	EXCLUDED				No			No
(14) SSM ST CLARE SURGICAL CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-1439695	SURGERY SERVICES	MO	MHC	EXCLUDED				No			No
(15) WINDMILL LLP 50 VILLAGE VIEW LANE CHESTERFIELD,MO63017 43-1804651	INVESTMENTS	MO	MHC	EXCLUDED				No			No
(16) NAVITUS HEALTH SOLUTIONS LLC 361 INTEGRITY DRIVE MADISON,WI53717 04-3608530	PHARMACY BENEFITS	WI	MHC	EXCLUDED				No			No
(17) SSM SELECT REHAB ST LOUIS LLC 4714 GETTYSBURG ROAD MECHANICSBURG,PA17055 26-3694972	HEALTH CARE	DE	MHC	EXCLUDED				No			No
(18) EPIPHANY RX LLC 361 INTEGRITY DRIVE MADISON,WI53717 36-4855405	PHARMACY BENEFITS	DE	MHC	EXCLUDED				No			No
(19) MS COMMUNITY NFP JV LLC (MFCJVN) 401 CARLSON PARKWAY MINNETONKA,MN55305 87-3268926	HOLDING COMPANY	MN	MHC	EXCLUDED				No			No

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)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) SSM MANAGED CARE ORGANIZATION LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1708511	HEALTH PROMOTION	MO	MHC	C					No
(2) FPP INC & SUBS 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1465174	HEALTH CARE	MO	MHC	C					No
(3) DIVERSIFIED HEALTH SERVICES CORP 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1369305	MEDICAL EQUIPMENT	MO	MHC	C					No
(4) SSM PROPERTIES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1462486	PROPERTY SERVICES	MO	MHC	C					No
(5) HEALTHFIRST PHYSICIAN MANAGEMENT SERVICE 10101 WOODFIELD LANE ST LOUIS,MO63132 73-1534336	MEDICAL SERVICES	OK	MHC	C					No
(6) SSMHC LIABILITY TRUST II 10101 WOODFIELD LANE ST LOUIS,MO63132 81-6128118	INSURANCE	MO	MHC	C					No
(7) SSM MEDICAL GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1664107	PHYSICIAN OFFICES	MO	MHC	C					No
(8) SSMHC INSURANCE COMPANY PO BOX 1051 GT GRAND CAYMAN KY1-1102 CJ 03-0310431	INSURANCE	CJ	MHC	C					No
(9) PHYSICIANS SERVICES CORP OF SOUTHERN IL 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4161526	HEALTH CARE	IL	MHC	C					No
(10) DEAN HEALTH SYSTEMS INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1128616	PHYSICIAN OFFICES	WI	MHC	C					No
(11) DEAN HEALTH INSURANCE INC PO BOX 56099 MADISON,WI53705 39-1830837	INSURANCE	WI	MHC	C					No
(12) DEAN HEALTH PLAN INC PO BOX 56099 MADISON,WI53705 39-1535024	INSURANCE	WI	MHC	C					No
(13) DEAN RETAIL SERVICES INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1717636	PROPERTY SERVICES	WI	MHC	C					No
(14) OZA ONCOLOGY INC 4117 VETERANS MEMORIAL DRIVE MT VERNON,IL62804 37-1343746	PHYSICIAN OFFICES	IL	MHC	S					No
(15) SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 83-2038674	CONDO ASSOCIATION	WI	MHC	C					No
(16) SSM HEALTH PHARMACY LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-4031708	PHARMACY	MO	MHC	C					No
(17) SSM HEALTH INSURANCE COMPANY 1277 DEMING WAY MADISON,WI53717 83-4718249	INSURANCE	MO	MHC	C					No
(18) NAVITUS HOLDINGS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 80-0968174	PHARMACY	WI	MHC	C					No
(19) MS COMMUNITY JV LLC 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 87-3240022	INSURANCE	DE	MHC	C					No
(20) QUALITY DRUG CORPORATION 239 BROADWAY LAGUNA BEACH,CA92651 33-0644268	PHARMACY BENEFITS	CA	MHC	C					No
(21) ST MARY'S HOSPITAL CAMPUS CONDOMINIUM O 707 SOUTH MILLS STREET MADISON,WI53715 000000000	CONDO ASSOCIATION	WI	MHC	C					No
(22) MEDICA INSURANCE COMPANY 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 41-1490988	INSURANCE	MN	MAS	C					No
(23) MEDICA SLEF-INSURED 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 41-1479417	3RD PARTY ADMIN	MN	MAS	C					No
(24) MEDICA AFFILIATED SERVICES 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 41-1716415	HOLDING CO	MN	MH COMPANY	C					No
(25) MEDICA HEALTH MANAGEMENT 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 20-8005519	HEALTH MGMT	MN	MAS	C					No
(26) MMSI INC 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 41-1547003	HEALTH INSURANCE	MN	MAS	C					No
(27) MEDICA SERVICES COMPANY LLC 401 CARLSON PARKWAY MINNETONKA,MN55305 85-2902940	ADMIN SERVICES	MN	MAS	C					No
(28) MEDICA REGIONAL INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA,MN55305 85-4111612	HEALTH INSURANCE	MN	MAS	C					No

Schedule R (Form 990) 2021

Page 3

Part V

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

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

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, or (iv) rent from a controlled entity .....................

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

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

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

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

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

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

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

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related 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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

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

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O.TO OPERATE A HEALTH MAINTENANCE ORGANIZATION (HMO) TO SERVE PRIMARILY MEDICAID AND MEDICARE ADVANTAGE BENEFICIARIES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	5
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	0	9,174,081
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	14,964	-38,236
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	14,964	9,135,845
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	0	4,714,973
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–24e)....	11,679,155	11,049,804
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	11,679,155	15,764,777
19	Revenue less expenses. Subtract line 18 from line 12.......	-11,664,191	-6,628,932
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	6,906,016	8,646,843
21	Total liabilities (Part X, line 26).............	1,600,245	2,507,890
22	Net assets or fund balances. Subtract line 21 from line 20.....	5,305,771	6,138,953

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 10,117,348 including grants of $ 0 ) (Revenue $ 9,174,081 )
	SSM HEALTH PLAN WILL OPERATE A HEALTH MAINTENANCE ORGANIZATION(HMO) THAT WILL FOCUS ITS ACTIVITIES PRIMARILY ON SERVING MEDICARE ADVANTAGE BENEFICIARIES, SUBJECT TO REGULATORY APPROVALS.

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 expenses10,117,348

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) JEREMY FOTHERINGHAM........................................................................ DIRECTOR THRU NOV 2021	1.00 .......................40.00	X			0	758,769	418,183
(19) MINDY PHILLIPS........................................................................ DIRECTOR THRU NOV 2021	1.00 .......................40.00	X			0	378,356	143,350
(20) RANDY RUPLINGER........................................................................ CFO - HEALTH PLANS	1.00 .......................0.00		X		0	509,187	212,908
(21) DEAN SUTTON........................................................................ VP & GEN COUNSEL - HP	1.00 .......................40.00		X		0	288,516	52,188
(22) KRIS ZIMMER........................................................................ FORMER CFO AT SSM HEALTH	0.00 .......................0.00			X	0	219,380	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	15,899,904	3,860,250

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

f	All other contributions, gifts, grants, and similar amounts not included above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	PREMIUM REVENUE	524114	9,174,081	9,174,081
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		9,174,081

3 Investment income (including dividends, interest, and othersimilar amounts) ......			-38,236			-38,236
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			9,135,845	9,174,081	0	-38,236

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
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........	3,370,531		3,370,531
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	966,359		966,359
10	Payroll taxes ...........	378,083		378,083
11	Fees for services (non-employees):
a	Management ......	6,842		6,842
b	Legal .........	6,078		6,078
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	3,895		3,895
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	9,334,906	9,334,906
12	Advertising and promotion ....	732,086		732,086
13	Office expenses .......	74,099	74,099
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	10,594	10,594
17	Travel ............	34,126	34,126
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	8,356	8,356
20	Interest ...........	451	451
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	197,029	197,029
23	Insurance ...	1,746	1,746
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	OTHER EXPENSES	526,613	343,058	183,555
b	BOOKS/SUBSCRIPTIONS	47,487	47,487
c	LICENSES	45,577	45,577
d	TAXES	19,919	19,919
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	15,764,777	10,117,348	5,647,429	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,961,043	1	5,801,789
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			0	4	0
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			0	8	0
9	Prepaid expenses and deferred charges ......			0	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	0
b	Less: accumulated depreciation	10b	0	0	10c	0
11	Investments—publicly traded securities .			939,929	11	939,909
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			5,044	15	1,905,145
16	Total assets. Add lines 1 through 15 (must equal line 33)...			6,906,016	16	8,646,843

17	Accounts payable and accrued expenses .....	1,506,597	17	1,828,422
18	Grants payable ...	0	18	0
19	Deferred revenue .........	82,705	19	92,132
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	10,943	25	587,336
26	Total liabilities. Add lines 17 through 25..	1,600,245	26	2,507,890

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	5,305,771	31	6,138,953
32	Total net assets or fund balances ...........	5,305,771	32	6,138,953
33	Total liabilities and net assets/fund balances ........	6,906,016	33	8,646,843