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Nonprofiteer
← ST ANTHONY SHAWNEE HOSPITAL INC

Form 990 for tax year 2022

Filed by ST ANTHONY SHAWNEE HOSPITAL INC.

Totals

Total revenue
$163,622,250
Total expenses
$167,289,324
Contributions and grants received
$300
Grants paid
$110,887
Program service revenue
$162,795,083
Investment income
$0
Other revenue
$826,867
Total assets, end of year
$194,926,189
Total liabilities, end of year
$66,477,855
Net assets or fund balances, end of year
$128,448,334
Program services expenses (Part IX)
$158,562,246
Management and general expenses
$8,727,078
Fundraising expenses
$0
Program service expenses (Part III)
$158,562,246

Program services were 94.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1f · All other contributions, gifts and grants

    $300

  • 2a · Program service revenue: NET PATIENT REVENUE

    total $157,785,793 · related or exempt $157,785,793

  • 2b · Program service revenue: 340 PHARMACY REVENUE

    total $4,349,815 · related or exempt $4,349,815

  • 2f · All other program service revenue

    total $659,475 · related or exempt $659,475 · unrelated business $0 · excluded $0

  • 6a · Gross rents

    real property $14,387

  • 6c · Rental income or loss

    real property $14,387 · personal property $0

  • 6d · Net rental income or loss

    total $14,387 · excluded $14,387

  • 7c · Gain or loss

    securities $0 · other assets $0

  • 10a · Gross sales of inventory

    $123,364

  • 10c · Net income from sales of inventory

    total $123,364 · excluded $123,364

  • 11a · Other revenue: CAFETERIA REVENUE

    total $596,543 · excluded $596,543

  • 11b · Other revenue: JOINT VENTURE INCOME

    total $92,573 · excluded $92,573

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $689,116

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $110,887 · program services $110,887

  • 5 · Compensation of officers, directors and key employees

    total $1,224,908 · program services $1,182,036 · management and general $42,872

  • 7 · Other salaries and wages

    total $50,814,693 · program services $49,036,179 · management and general $1,778,514

  • 8 · Pension plan contributions

    total $2,154,898 · program services $2,079,477 · management and general $75,421

  • 9 · Other employee benefits

    total $9,047,624 · program services $8,730,957 · management and general $316,667

  • 10 · Payroll taxes

    total $3,682,425 · program services $3,553,540 · management and general $128,885

  • 11a · Fees: management

    total $70,849 · program services $70,849

  • 11b · Fees: legal

    total $11,958 · management and general $11,958

  • 11d · Fees: lobbying

    total $12,091 · management and general $12,091

  • 11g · Fees: other

    total $38,060,321 · program services $35,056,838 · management and general $3,003,483 · fundraising $0

  • 12 · Advertising and promotion

    total $188,037 · management and general $188,037

  • 13 · Office expenses

    total $6,016,344 · program services $6,016,344

  • 14 · Information technology

    total $3,822,520 · program services $3,822,520

  • 16 · Occupancy

    total $5,988,755 · program services $6,084,502 · management and general -$95,747

  • 17 · Travel

    total $74,530 · program services $40,071 · management and general $34,459

  • 19 · Conferences, conventions and meetings

    total $10,828 · program services $8,078 · management and general $2,750

  • 20 · Interest

    total $2,582,613 · program services $2,582,613

  • 22 · Depreciation, depletion and amortization

    total $5,065,333 · program services $5,065,333

  • 23 · Insurance

    total $2,314,783 · program services $2,314,783

  • 24a · Other expenses: Medical supplies

    total $27,755,859 · program services $27,755,859

  • 24b · Other expenses: Medicaid Provider Tax

    total $4,109,893 · program services $4,109,893

  • 24c · Other expenses: Internal management fees

    total $3,227,688 · management and general $3,227,688

  • 24d · Other expenses: Licenses and taxes

    total $941,487 · program services $941,487

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $146,690 · end of year $195,343

  • 4 · Accounts receivable

    beginning of year $27,378,193 · end of year $27,365,267

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $3,561,147 · end of year $4,265,175

  • 9 · Prepaid expenses and deferred charges

    beginning of year $1,317,747 · end of year $2,080,445

  • 10a · Land, buildings and equipment: cost or other basis

    $130,222,295

  • 10b · Land, buildings and equipment: accumulated depreciation

    $54,148,864

  • 10c · Land, buildings and equipment, net

    beginning of year $72,980,137 · end of year $76,073,431

  • 12 · Investments: other securities

    beginning of year $391,718 · end of year $350,373

  • 13 · Investments: program-related

    beginning of year $0

  • 14 · Intangible assets

    beginning of year $21,972,988 · end of year $21,950,557

  • 15 · Other assets

    beginning of year $61,775,994 · end of year $62,645,598

  • 17 · Accounts payable and accrued expenses

    beginning of year $9,961,076 · end of year $10,197,834

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $47,448,130 · end of year $56,280,021

  • 27 · Net assets without donor restrictions

    beginning of year $132,115,408 · end of year $128,448,334

Mission and programs · 2022

Mission

THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.

Activities or mission (Part I)

TO POSITIVELY IMPACT HUMAN LIFE THROUGH EXCEPTIONAL HEALTH CARE. OUR CORE VALUES ARE THE FOLLOWING: COMPASSIONATE CARE, CLINICAL EXCELLENCE, PEOPLE FIRST, RESOURCE STEWARDSHIP, AND COMMUNITY OUTREACH.

  • Please see Schedule O for a complete description of program service accomplishments.

    Expenses $158,562,246 · Grants $110,887 · Revenue $162,795,083

As filed on the 2022 return.

Listed in Part VII

  • Joe Hodges

    Director, Chair, Regional President - SSM Health Care of Oklahoma

    Total calculated
    $1,674,892
    From this org
    $0
    From related orgs
    $1,095,255
    Other
    $579,637
    Hours/week
    1 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $642,969 related
    Bonus
    $0 + $367,335 related
    Other
    $0 + $84,951 related
    Deferred
    $0 + $538,438 related
    Nontaxable benefits
    $0 + $41,199 related
    Filer's total
    $0 + $1,674,892 related

  • Paige Bass

    Director, Chair

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Brooks Richardson

    Director

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Duke Ligon

    Director

    Total calculated
    $0
    Hours/week
    1 + 2 related

  • Iftikhar Ahmad MD

    Director

    Total calculated
    $0
    Hours/week
    1 + 2 related

  • Natalie Shirley

    Director

    Total calculated
    $0
    Hours/week
    1 + 2 related

  • Steve Smoot

    VICE PRESIDENT, COO of SSM Health

    Total calculated
    $2,904,291
    From this org
    $0
    From related orgs
    $1,870,292
    Other
    $1,033,999
    Hours/week
    1 + 65 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,084,584 related
    Bonus
    $0 + $672,081 related
    Other
    $0 + $113,627 related
    Deferred
    $0 + $995,370 related
    Nontaxable benefits
    $0 + $38,629 related
    Filer's total
    $0 + $2,904,291 related

  • Teresa Rose

    Director

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Angi Mohr

    Hospital President, SSM Health St. Anthony Hospital - Shawnee

    Total calculated
    $612,293
    From this org
    $440,869
    From related orgs
    $0
    Other
    $171,424
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $334,314
    Bonus
    $96,502
    Other
    $10,053
    Deferred
    $137,072
    Nontaxable benefits
    $34,352
    Filer's total
    $612,293

  • Douglas Long

    Secretary, General Counsel at SSM Health

    Total calculated
    $2,040,754
    From this org
    $0
    From related orgs
    $1,354,027
    Other
    $686,727
    Hours/week
    1 + 72.2 related

    Schedule J breakdown matched by us

    Base
    $0 + $724,576 related
    Bonus
    $0 + $460,492 related
    Other
    $0 + $168,959 related
    Deferred
    $0 + $664,054 related
    Nontaxable benefits
    $0 + $22,673 related
    Filer's total
    $0 + $2,040,753 related

  • Ramona Carey

    Asst Secretary

    Total calculated
    $101,043
    From this org
    $0
    From related orgs
    $70,520
    Other
    $30,523
    Hours/week
    1 + 41 related

  • Randy Combs

    Treasurer, Chief Financial Officer at SSM Health

    Total calculated
    $2,850,791
    From this org
    $0
    From related orgs
    $1,879,738
    Other
    $971,053
    Hours/week
    1 + 69 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,144,254 related
    Bonus
    $0 + $475,226 related
    Other
    $0 + $260,259 related
    Deferred
    $0 + $938,234 related
    Nontaxable benefits
    $0 + $32,819 related
    Filer's total
    $0 + $2,850,792 related

  • Shasta Manuel

    System VP Finance - Oklahoma

    Total calculated
    $681,005
    From this org
    $0
    From related orgs
    $492,700
    Other
    $188,305
    Hours/week
    10 + 32 related

    Schedule J breakdown matched by us

    Base
    $0 + $356,556 related
    Bonus
    $0 + $99,950 related
    Other
    $0 + $36,194 related
    Deferred
    $0 + $148,868 related
    Nontaxable benefits
    $0 + $39,438 related
    Filer's total
    $0 + $681,005 related

  • Cathy Broome

    VP - Patient Care Services/CNO

    Total calculated
    $279,011
    From this org
    $219,644
    From related orgs
    $0
    Other
    $59,367
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $188,256
    Bonus
    $29,651
    Other
    $1,737
    Deferred
    $47,242
    Nontaxable benefits
    $12,125
    Filer's total
    $279,011

  • Darin Farrell

    VP - Hospital Operations

    Total calculated
    $333,603
    From this org
    $241,306
    From related orgs
    $0
    Other
    $92,297
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $205,890
    Bonus
    $34,733
    Other
    $684
    Deferred
    $53,490
    Nontaxable benefits
    $38,807
    Filer's total
    $333,604

  • Christine DiEnna

    Physician

    Total calculated
    $626,118
    From this org
    $579,649
    From related orgs
    $0
    Other
    $46,469
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $393,477
    Bonus
    $185,278
    Other
    $893
    Deferred
    $14,331
    Nontaxable benefits
    $32,138
    Filer's total
    $626,118

  • David Hadley

    Physician

    Total calculated
    $498,114
    From this org
    $439,947
    From related orgs
    $0
    Other
    $58,167
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $313,983
    Bonus
    $123,392
    Other
    $2,573
    Deferred
    $17,540
    Nontaxable benefits
    $40,627
    Filer's total
    $498,114

  • Gaynell Anderson

    Physician

    Total calculated
    $473,696
    From this org
    $423,505
    From related orgs
    $0
    Other
    $50,191
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $309,464
    Bonus
    $112,683
    Other
    $1,358
    Deferred
    $14,267
    Nontaxable benefits
    $35,924
    Filer's total
    $473,695

  • Kenneth Darvin

    Physician

    Total calculated
    $487,561
    From this org
    $437,492
    From related orgs
    $0
    Other
    $50,069
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $314,510
    Bonus
    $121,624
    Other
    $1,358
    Deferred
    $8,700
    Nontaxable benefits
    $41,369
    Filer's total
    $487,561

  • Venkata Damera

    Physician

    Total calculated
    $752,217
    From this org
    $693,389
    From related orgs
    $0
    Other
    $58,828
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $503,767
    Bonus
    $188,734
    Other
    $888
    Deferred
    $17,699
    Nontaxable benefits
    $41,129
    Filer's total
    $752,217

  • Kris Zimmer

    Former Officer

    Total calculated
    $135,402
    From this org
    $0
    From related orgs
    $135,402
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $135,402 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $135,402 related

  • Laura Kaiser

    Former Officer

    Total calculated
    $8,384,492
    From this org
    $0
    From related orgs
    $5,770,684
    Other
    $2,613,808
    Hours/week
    0 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,929,589 related
    Bonus
    $0 + $1,636,383 related
    Other
    $0 + $2,204,713 related
    Deferred
    $0 + $2,594,363 related
    Nontaxable benefits
    $0 + $19,444 related
    Filer's total
    $0 + $8,384,492 related

  • Randy Kamm

    Former Key Employee

    Total calculated
    $214,757
    From this org
    $0
    From related orgs
    $155,525
    Other
    $59,232
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $154,783 related
    Bonus
    $0
    Other
    $0 + $742 related
    Deferred
    $0 + $24,615 related
    Nontaxable benefits
    $0 + $34,617 related
    Filer's total
    $0 + $214,758 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
The organization's top management official (Hospital President) has compensation that is determined by a related organization. The related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the SSM Health President.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
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 2022. 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 2022: Joe Hodges $139,252 Randall Combs $251.115 Douglas Long $159,815 Shasta Manuel $35,825 Angi Mohr $17,285 Cathy Broome $8,889 Laura Kaiser $708,350 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2022. All distributions received from the plan in the current year were included in the individual's taxable compensation. Joe Hodges $79,749 Shasta Manuel $34,306 Angi Mohr $8,020 Laura Kaiser $1,488,789

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

  • OKLAHOMA BAPTIST UNIVERSITY

    $81,000

    HIGHER EDUCATION SUPPORT

  • CITIZEN POTAWATOMI NATION

    $29,059

    HOUSING, EDUCATION, HEALTH CARE, VETERANS AND CAREER SERVICES

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • SSM St Joseph Endoscopy Center LLC

    N/A · Surgery Services · MO

    Directly controlled by NA

  • St Clare Imaging Services LLC

    N/A · Diag. Services · WI

    Directly controlled by NA

  • Mt Vernon Radiation Therapy Center LLC

    N/A · Radiation Therapy · IL

    Directly controlled by NA

  • Sleep & Neurology Center of Southern Illinois LLC

    N/A · Diag. Services · IL

    Directly controlled by NA

  • CHOWSMGSI Office Building LLC

    N/A · MOB · IL

    Directly controlled by NA

  • Oza Cancer Center LLC

    N/A · MOB · IL

    Directly controlled by NA

  • Shawnee Real Estate Holdings LLC

    N/A · MOB · OK

    Directly controlled by NA

  • Dean Clinic & St Mary's Hospital Accountable Care Organization LLC

    N/A · Accountable Care Organization · WI

    Directly controlled by NA

  • Wisconsin Integrated Information Technology and Telemedicine Systems LLC

    N/A · Information Technology Services · WI

    Directly controlled by NA

  • Wingra Building Group

    N/A · MOB · WI

    Directly controlled by NA

  • Janesville Riverview Clinic Building Partnership

    N/A · MOB · WI

    Directly controlled by NA

  • 1110 N Classen Blvd LLC

    N/A · MOB · OK

    Directly controlled by NA

  • SSM St Clare Surgical Center LLC

    N/A · Surgery Services · MO

    Directly controlled by NA

  • Windmill LLP

    N/A · Investments · MO

    Directly controlled by NA

  • Navitus Health Solutions LLC

    N/A · Pharmacy Benefits · WI

    Directly controlled by NA

  • SSM Select Rehab St Louis LLC

    N/A · Health Care · DE

    Directly controlled by NA

  • Epiphany Rx LLC

    N/A · Pharmacy Benefits · DE

    Directly controlled by NA

  • Bain Capital Global Direct Lending 2021 (L Offshore) LP

    N/A · Investments · DE

    Directly controlled by NA

  • Bloom Tree Long-Only Fund QP LP fka Bloom Tree Ponderosa Funds QP LP

    N/A · Investments · DE

    Directly controlled by NA

  • Carlyle Property Investors LP

    N/A · Investments · DE

    Directly controlled by NA

  • NECICF II AIV2-B LP

    N/A · Investments · DE

    Directly controlled by NA

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • SSM Managed Care Organization LLC

    C Corporation · Health Promotion · MO

    Directly controlled by NA

  • FPP INC & Subs

    C Corporation · Health Care · MO

    Directly controlled by NA

  • Diversified Health Services Corp

    C Corporation · Medical Equipment · MO

    Directly controlled by NA

  • SSM Properties Inc

    C Corporation · Property Services · MO

    Directly controlled by NA

  • HealthFirst Physician Management Services

    C Corporation · Medical Services · OK

    Directly controlled by NA

  • SSMHC Liability Trust II

    C Corporation · Insurance · MO

    Directly controlled by NA

  • SSM Medical Group Inc

    C Corporation · Physician Offices · MO

    Directly controlled by NA

  • SSMHC Insurance Company

    C Corporation · Insurance · CJ

    Directly controlled by NA

  • Physicians Services Corp of Southern Illinois Inc

    C Corporation · Health Care · IL

    Directly controlled by NA

  • Dean Health Systems Inc

    C Corporation · Physician Offices · WI

    Directly controlled by NA

  • Dean Health Insurance Inc

    C Corporation · Insurance · WI

    Directly controlled by NA

  • Dean Retail Services Inc

    C Corporation · Property Services · WI

    Directly controlled by NA

  • Oza Oncology Inc

    S Corporation · Physician Offices · IL

    Directly controlled by NA

  • SSM Health Janesville Campus Condominium Association Inc

    C Corporation · Condo association · WI

    Directly controlled by NA

  • SSM Health Pharmacy LLC

    C Corporation · Pharmacy · MO

    Directly controlled by NA

  • Navitus Holdings LLC

    C Corporation · Pharmacy · WI

    Directly controlled by NA

  • MS Community JV LLC

    C Corporation · Insurance · DE

    Directly controlled by NA

  • Quality Drug Corporation

    C Corporation · Pharmacy benefits · CA

    Directly controlled by NA

  • St Mary's Hospital Campus Condominium Owners Association Inc

    C Corporation · Condo association · WI

    Directly controlled by NA

  • Partners Group PMC Private Credit LP

    C Corporation · Investment · CJ

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2022
Filed
16 November 2023
IRS schema version
2022v5.0
Source object
202323199349329897

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