2023-05-12T11:38:07-05:00 2022-06-30 861065772 Deloitte Tax LLP 111 Monument Circle Suite 4200 Indianapolis IN 46204 990 2021-07-01 420733472 St Anthony Regional Hospital and Nursing Home STAN 7127945246 311 South Clark Street PO Box 628 Carroll IA 51401 Eric Salmonson CFO/ Vice President 7127945246 2023-05-12 1 Eric Salmonson 999009999 Shawna M Jansons P01222873 3174648600 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Allen Anderson 311 South Clark Street PO Box 628 Carroll IA 51401 118216610 0 0928 X www.stanthonyhospital.org X 1905 IA Consistently providing high quality healthcare services to meet patient and community needs. 10 8 889 500 0 0 4728644 4159569 82380729 82538190 9139978 5073147 -20535 229515 96228816 92000421 6500 0 0 0 42365265 44444231 0 0 0 42955147 47902230 85326912 92346461 10901904 -346040 221133827 193905686 50037293 40040787 171096534 153864899 X St. Anthony Regional Hospital is inspired by faith and committed to excellence. We are dedicated to improving the health of the people we serve. We will lead in providing high quality, high value healthcare services responsive to the needs of our patients and the region. We are committed to the health ministry of our sponsors, St. Anthony Ministries. 0 0 62216685 68897878 St. Anthony Regional Hospital is a 99 bed acute care facility and St. Anthony Nursing Home has 79 beds in Carroll, IA. In the year ended June 30, 2022, St. Anthony Regional Hospital and Nursing Home provided health care services to approximately 2,140 inpatients, 72,232 outpatients, and 42,140 clinic visits. St. Anthony Regional Hospital provided services for 1,570 acute care inpatients, and provided psychiatric, swing bed, and nursing home services for the remainder of inpatients. Outpatient services were provided to patients through ancillary departments, emergency room, and clinics.See Schedule O.St. Anthony Hospital provides services of cardiac rehabilitation, dialysis, hospice care, laboratory, observation, chemotherapy, pathology, radiology, respiratory therapy, physical therapy, occupational therapy, speech therapy, diabetes, medical oncology, radiation therapy, and surgical services. St. Anthony's largest patient service area is physical therapy. In the year ended June 30, 2022, St. Anthony serviced 9,415 patients in physical therapy, 7,053 in emergency room, and 6,870 in radiology. The activities pursued by St. Anthony Regional Hospital and Nursing Home in the provision of health care services are consistent with its exempt purpose. 25252689 16784121 As part of its mission, St. Anthony Regional Hospital provides medical care to individuals who are unable to pay for services, incurs costs in excess of reimbursement for services to Medicaid beneficiaries, and carries out other activities and programs free of charge to support the community in which it operates. Community benefit projects include community health education, health care support services, behavioral health services, community health improvement advocacy, and other traditional charity care. 87469374 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 158 0 1 889 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA X Eric Salmonson 7127945424 311 South Clark St Carroll IA 514010628 Howard Drees Treasurer 0.30 0.00 X X 0 0 0 Nick Badding Chairman 0.30 0.00 X X 0 0 0 Peggy White Vice Chairman 0.30 0.30 X X 0 0 0 Sr Theresa Keller Secretary 0.30 0.00 X X 0 0 0 Deb Auen Board Member 0.30 0.30 X 0 0 0 Jeff Scharfenkamp Board Member 0.30 0.00 X 0 0 0 Karl Eischeid DDS Board Member 0.30 0.00 X 0 0 0 Sr Donna Venteicher Board Member 0.30 0.00 X 0 0 0 Sr Michelle Pettit Board Member (Beg 7/21) 0.30 0.00 X 0 0 0 Sr Rose Elsbernd Board Member 0.30 0.00 X 0 0 0 Edward H Smith Jr CEO/President 40.00 0.30 X 410078 0 46702 John Munson CFO/Vice President (End 5/22) 40.00 0.30 X 213456 0 36598 Allen Anderson CEO/President (Start 6/22) 40.00 0.30 X 0 0 0 Eric Salmonson CFO/Vice President (Start 3/22) 40.00 0.30 X 0 0 0 Randall Hess MD Physician 40.00 0.00 X 505730 0 43962 Nelson Lo MD Physician 40.00 0.00 X 457142 0 34849 Amy Canuso MD Physician 40.00 0.00 X 429143 0 41703 Charles Svensson MD Physician 40.00 0.00 X 337544 0 28685 Kevin Bohac CRNA (Beg 7/21) 40.00 0.00 X 295125 0 37745 2648218 0 270244 62 0 1 0 Acute Care Inc PO Box 3288 Des Moines IA 50316 Emergency Physician Services 1593188 Capital Orthopaedics & Sports Medicine P 12499 University Ave Suite 210 Clive IA 503258288 Orthopedic Physician Services 1302222 Medical Oncology and Hematology DBA Miss 1221 Pleasant St Des Moines IA 50309 Oncology Physician Services 1012103 Pathology Laboratory PO Box 569 Des Moines IA 503020569 Laboratory Services 347010 Mid Iowa Anesthesia Inc 3621 Woodland St Ames IA 50010 Contract Labor 336538 21 1015760 3143809 4159569 Patient SVC Revenue 621400 42341464 42341464 Medicare/Medicaid Pmts 621400 39842521 39842521 Cafeteria Sales 621400 354205 354205 82538190 1709099 1709099 3382504 3152989 229515 229515 229515 26427248 23063200 3364048 3364048 3364048 92000421 82183985 0 5656867 X 758935 758935 35665486 34375142 1290344 838019 752507 85512 4674318 4451356 222962 2507473 2395706 111767 65088 65088 203027 203027 8100 8100 470871 470871 10860161 9905913 954248 317473 27885 289588 2200228 2021099 179129 545056 545056 2886533 2878243 8290 313940 241168 72772 710583 710583 6877569 6877569 430612 430612 Medical Supplies 19024696 19024696 Rental & Maintenance 2988293 2831839 156454 92346461 87469374 4877087 0 12327185 2832165 11040296 10241127 187 189 2508791 2759179 687480 910980 170202721 100229662 73248490 69973059 97357760 81131772 5828199 4254372 18135439 21802843 221133827 193905686 18653827 10256390 29048823 27896801 635570 412127 1699073 1475469 50037293 40040787 X 158644732 137522089 12451802 16342810 171096534 153864899 221133827 193905686 X -346040 -20481544 3595949 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8100 8100 0 Part II-B, Line 1: St. Anthony Regional Hospital and Nursing Home is a member of the Iowa Hospital Association and the Catholic Health Organization. A percentage of dues are paid for lobbying activities. 23500033 255947 -2620802 43550 -2835 21094463 19046674 868052 6253780 15900 2652573 23500033 18596647 98672 1108234 14850 742029 19046674 14742656 2531749 1454273 15000 117031 18596647 13393000 202723 2011722 9750 855039 14742656 0.05000 0.95000 0 1 1 693934 693934 116848353 61930982 54917371 46096489 35254408 10842081 6563945 3044272 3519673 69973059 Deferred Compensation Investments 1475469 Beneficial Interest in Net Assets of the Foundation 20327374 21802843 Deferred Compensation 1475469 1475469 X 78101346 -20481544 3891008 -16590536 94691882 470871 -3162332 -2691461 92000421 95332981 3457391 3457391 91875590 470871 470871 92346461 Part V, Line 4: All restricted endowed funds held at the St. Anthony Foundation are used for the benefit of St. Anthony Regional Hospital and Nursing Home and for scholarships. Part X, Line 2: The Internal Revenue Service has determined that the Hospital is an organization exempt from income tax under the Internal Revenue Code; and accordingly, no provision for income taxes is recorded in the consolidated statement of activities. Accounting for income taxes provides that 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. The Hospital recorded no liabilities for unrecognized tax benefits as of June 30, 2022 and 2021. Part XI, Line 2d - Other Adjustments: Change in beneficial interest of Net Assets of St. Anthony Foundation 3,891,008. Part XI, Line 4b - Other Adjustments: Rental Expense -3,152,989. Realized Loss on Sale of Assets -9,343. Part XII, Line 2d - Other Adjustments: Rental Expense 3,152,989. Realized Loss on Sale of Assets 9,343. Transfer to Foundation 295,059. 1 1 X 1 X 1 X 399.000000000000 1 1 0 1 1 597723 597723 0.00700 10604385 7619773 2984612 0.03500 11202108 7619773 3582335 0.04200 179733 4970 174763 0.00200 414102 414102 0.00490 13279111 9100280 4178831 0.04900 177635 59098 118537 0.00140 14050581 9164348 4886233 0.05730 25252689 16784121 8468568 0.09930 12708 12708 0.00010 12708 12708 0.00010 1 890217 0 25428021 29384488 -3956467 X 1 1 1 1 St Anthony Regional Hospital 311 South Clark St PO Box 628 Carroll IA 514010628 www.stanthonyhospital.org 14009OH X X X St Anthony Regional Hospital 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X See Part V, Section C X 1 21 1 See Part V, Section C 0 1 X 200.000000000000 399.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X X 1 X 0 0 St. Anthony Regional Hospital Part V, Section B, Line 5: In the year ended 6/30/22, St. Anthony Regional Hospital conducted a CHNA assessment. Interviews with community stakeholders throughout the region provided an understanding of the community's health needs from the organizations and agencies that have a deep understanding of the populations in the greatest need. St. Anthony provided Tripp Umbach with a list of community stakeholders to interview. Interviews were conducted with a public health expert and representatives of underserved populations. St. Anthony Regional Hospital Part V, Section B, Line 6b: St. Anthony Regional Hospital and Nursing Home contracted with Tripp Umbach for assistance with the Community Health Needs Assessment. St. Anthony Regional Hospital Part V, Section B, Line 7d: https://www.stanthonyhospital.org/webres/File/legal/CHNA%20August%202022.pdf St. Anthony Regional Hospital Part V, Section B, Line 11: The following significant health needs and action items were identified and all were addressed in the St. Anthony Regional Hospital and Nursing Home CHNA:Mental HealthGoal 1. Decrease depression among children, youth, and adults.Strategy 1.1 Provided depression screening in primary care settings, with systems in place to ensure accurate diagnoses, effective treatment and appropriate follow-up.Strategy 1.2 Implemented Collaborative Care for the Management of Depressive Disorders.Strategy 1.3 Integrated behavioral health and primary care services.Goal 2. Reduce Suicide RiskStrategy 2.1 Train healthcare providers, educators and community volunteers in Mental Health First Aid.Strategy 2.2 Implemented the "Zero Suicide in Healthcare" framework (organizational assessment, training, consultation).Goal 3. Promote mental health and social cohesion in community settingsStrategy 3.1 Iowa "Connections Matter" Initiative (Connections Matter in Health Care component).Strategy 3.2 Supported group-based parent education and support.CancerGoal 1. Increase Cancer Screenings Strategy 1.1 Implemented Prostate Specific Antigen (PSA) Screening Campaign.Strategy 1.2 Implemented Multicomponent Interventions to Increase Cancer Screening: Increased community demand (education, incentives, reminders, media): Increased community access (barriers addressed); Increased Provider Delivery (reminders, incentives, feedback).Goal 2. Reduce Cancer MortalitiesStrategy 2.1 Provided anticoagulation therapy (aspirin) to prostate cancer patients.Strategy 2.2 Vaccinated cancer patients against infectious diseases, including influenza and pneumonia.Strategy 2.3 Implemented risk assessment for breast cancer in primary care settings and provide tailored recommendations based on individual risk (including use of chemoprevention).Strategy 2.4 Educated patients (and the families of adolescent patients) about the importance of the HPV vaccine.Goal 3: Increase patient access and retention through support servicesStrategy 3.1 Incorporated Patient Navigators into Cancer Center care team.Strategy 3.2 Provided psychosocial care for patients with cancer and their families.Obesity/Live Healthy Goal 1. Increase daily physical activity among children, youth and adultsStrategy 1.1 Used Point of Decision Prompts for Physical Activity in healthcare and community settings.Strategy 1.2 Provided Exercise "Prescriptions" in primary care and other healthcare settings.Strategy 1.3 Promoted community-based Social Support for Physical Activity (walking groups, ...). Goal 2. Increase consumption of fruits and vegetables.Strategy 2.1 Developed school-based fruit and vegetable gardens and garden-based nutrition education.Strategy 2.2 Provided fruit and vegetable incentives for low-income patients (vouchers, coupons, etc.). Goal 3. Increase diabetes prevention and management.Strategy 3.1 Used Text Message-Based Health Interventions.Strategy 3.2 Promoted use Type-2 Diabetes Self-Management Mobile App.Substance UseGoal 1. Reduce Risky and under-age alcohol useStrategy 1.1 Implemented CDC Risky Alcohol-Use Screening and Brief Interventions in Primary Care Settings (for youth and adults).Strategy 1.2 Supported universal school-based alcohol prevention programs (lesson plans, prevention education, alcohol-free fundraising policies, peer support, life skills training, etc.).Strategy 1.3 Promoted enhanced enforcement to prevent underage access to alcohol (responsible beverage sales training, decoys/shoulder taps, social host ordinances, etc.).Goal 2. Reduce Alcohol-Impaired DrivingStrategy 2.1 Implemented media campaign against alcohol-impaired driving.Strategy 2.2 Implemented "Every 15 Minutes" program in local high schools.Goal 3. Reduce of tobacco products Strategy 3.1 Implemented cell phone-based tobacco cessation program.Strategy 3.2 Implemented social media and media campaigns against use of tobacco products.Strategy 3.3 Expanded promotion of Quit Line to reach at-risk populations.Strategy 3.4 Promoted smoke-free workplaces, shared public spaces and multi-unit housing.Strategy 3.5 Reduced or eliminated co-payments for tobacco cessation services.No actions were taken during the tax year related to the most recent CHNAbecause the CHNA was adopted at the end of the tax year. St. Anthony Regional Hospital Part V, Section B, Line 13h: Additional eligibility criteria for financial assistance include Medicaid/Medicare coverage, and State regulations. St. Anthony Regional Hospital: Part V, Section B, Line 10: https://www.stanthonyhospital.org/webres/File/legal/St%20Anthony%20Implementation%20Strategy%202023%20FINAL_approved_4_25_23%20AB.pdfThe following disclosure is in accordance with Section 7 of Rev. Proc. 2015-21 in regards to St. Anthony Regional Hospital not timely conducting and adopting its implementation strategy and making it widely available to the public. During the preparation of the Form 990 for the tax period ending June 30, 2022, it was discovered that the previously mentioned document had not been timely adopted and approved by the board. The error was identified in April 2023 and corrective action was taken immediately upon discovery. The required document was approved by the board on April 25, 2023 and posted at the appropriate link on May 4, 2023, prior to the filing of the 2021 Form 990. This error was minor and inadvertent and due to reasonable cause. St. Anthony Regional Hospital is not aware of any patients that were adversely impacted due to the error. Part V, line 16a, FAP website: https://www.stanthonyhospital.org/patients-visitors/patients/financial-assistance/ Part V, line 16b, FAP Application website: https://www.stanthonyhospital.org/patients-visitors/patients/financial-assistance/ Part V, line 16c, FAP Plain Language Summary website: https://www.stanthonyhospital.org/patients-visitors/patients/financial-assistance/ 6 1 - St Anthony Nursing Home 311 South Clark St Carroll IA 51401 Nursing Home 2 - St Anthony Regional Hospital 311 South Clark St Carroll IA 51401 Psychiatric Services 3 - St Anthony Regional Hospital 311 South Clark St Carroll IA 51401 Dialysis Services 4 - St Anthony Regional Home Hlth Agency 311 South Clark St Carroll IA 51401 Home Health Services 5 - St Anthony Regional Hospice 311 South Clark St Carroll IA 51401 Hospice Services 6 - Wall Lake Medical Clinic 311 West First St Wall Lake IA 51466 Rural Health Clinic Part I, Line 3c: In addition to FPG, the Hospital will consider the extent to which the patient's household has assets that could be used to meet his or her financial obligation. Assets may include, but are not limited to, cash, savings and checking account, certificates of deposit, stocks and bonds, individual retirement accounts (IRAs), trust funds, real estate (excluding the patient's home) and motor vehicles. The hospital will take into account any liabilities that are the responsibility of the patient's household. To relieve stress related to financial burdens, families with a medical catastrophe with self-pay balances greater than 20 percent of their annual household income in one calendar year may be eligible for substantial discounts.St. Anthony's Regional Hospital and Nursing Home also uses asset level, medical indigency, insurance status, Medicaid/Medicare coverage, and state regulations as factors in determining eligibility for free and discounted care. Part I, Line 7: The cost to charge ratio was used when calculating the amounts reported in Part 1, line 7, with the exception of line 7g, subsidized health services. Subsidized health services are reported using departmental cost from the 2022 cost report. Part I, Line 7g: St. Anthony Regional Hospital has eight physician clinics that are included in subsidized health services where cost exceeds the reimbursements. Part II, Community Building Activities: The Hospital CEO participates in the Carroll Area Development board that is active in economic development. The CEO is a board member of the Iowa Hospital Association Board of Directors. There are managers of the Hospital that serve on local health advisory boards. Part III, Line 2: St. Anthony Regional Hospital reports bad debt in accordance with generally accepted accounting principles (GAAP). Bad debt at cost is calculated with the same cost to charge ratio used for the charity care at cost multiplied by the estimated debt charges. Part III, Line 3: St. Anthony Regional Hospital works with those qualifying for charity care along every step of the process including accepting applications for financial assistance after previous attempts to work with the patient fail. Every effort is made to work with the patient to provide financial assistance when appropriate. While there are people who do not cooperate with the Hospital regarding payment plans, financial assistance or with those trying to help get on government programs. For individuals not providing necessary information it is impossible to know the reason for not cooperating and therefore know whether the will qualify for charity care. St. Anthony Regional Hospital is unable to reasonably determine whether any amount of bad debt could have been classified as charity care if individuals do not provide the necessary information to evaluate their situation to determine qualification with the charity care policy. Part III, Line 4: St. Anthony Regional Hospital's audited financial statements include a footnote for the provision for bad debts on Page 11 in the section entitled 'Net Patient Service Revenue'. Part III, Line 8: The amount of Medicare short fall on line 6 should be included in the community benefit because Medicare pays less than the cost for rendering services. The Medicare allowable costs are taken from the Medicare cost report and determined based on the cost to charge ratio from the Medicare report. Part III, Line 9b: The policy states that St. Anthony Regional Hospital offers charity care to all patients who meet criteria for financial aid and want assistance. Patients who do not have insurance may qualify for St. Anthony Cares based on annual income and family size. Patients with insurance may also qualify for St. Anthony Cares for bills not covered by insurance. Charity information is available upon admission an disclosed in monthly billing statements. An application is completed by the patient and based on income and family size the amount of charity is determined based on the federal poverty guidelines. Patients receive statements and make payment arrangements with Preferred Medical Deposits (PMD). Accounts at PMD with no activity after 60 days are turned over to a collection agency, Avadyne Health. Reasonable efforts will be extended to patients to make them aware of the Care. It includes the following action: - Providing written notice on their billing statement from the payment processor that financial assistant is available. - Making a determination regarding Financial Assistance eligibility if the patient submits a complete CARES application during the application period. - Notify the patient who submits an incomplete CARES application about how to complete it properly, and giving the patient a reasonable opportunity to do so. The Hospital must provide this notification in writing and must provide contact information for resources in assisting the patient with completing the CARES application. Providing a Plain Language Summary identifying the ECAs that the Hospital may take if needed, and stating a deadline after which ECAs may be initiated that is no earlier than 30 days after the date when the written notice is provided. Part VI, Line 2: An internal working group was charged, along with Tripp Umbach, to help identify the needs of those living in the hospital's service area. The information presented in the community health needs assessment represents a comprehensive community-wide process where St. Anthony Regional Hospital continued to connect with public and private organizations, such as health-related professionals, human service organizations, non-profits, civic organizations, and childcare facilities, to evaluate the community's health and social needs. The needs assessment took a deep dive into existing resources integrating helpful information to achieve health equality in the community. An independent review of existing data, including in-depth interviews with local stakeholders, resulted in the identification and confirmation of crucial community health needs. Part VI, Line 3: The financial counselor from the organization informs and educates patients about eligibility of federal, state and local government programs and charity policies. The charity care policy is made available to patients in the admissions office and provided in the admission packets. If patients have questions they can stop in the business office and discuss them with the financial counselor. Part VI, Line 4: St. Anthony serves a predominantly rural population over a large geographic area comprising six counties in West Central Iowa. These counties include Audubon, Calhoun, Carroll, Crawford, Greene, and Sac. The population in the St. Anthony service area is primarily White/Caucasian and comprised of residents proficient in the English language. The majority of the six counties' 71,382 residents are white and non-Hispanic and are older than 55 as of 2019. Part VI, Line 5: St. Anthony Regional Hospital has demonstrated a commitment to promoting health care to further its exempt purpose of providing quality health care in the community and surrounding counties for more than one hundred and fifteen years. The majority of the Hospital's board members are from local businesses and reside in the community. St. Anthony Regional Hospital is a regional provider and is committed to providing quality care to the community. Part VI, Line 7, Reports Filed With States IA X X X X 0 1 0 0 0 0 0 1 0 Randall Hess MD Physician 474315 0 26555 0 4860 0 15277 0 28685 0 549692 0 0 0 Nelson Lo MD Physician 457142 0 0 0 0 0 13335 0 21514 0 491991 0 0 0 Amy Canuso MD Physician 283870 0 141683 0 3590 0 13018 0 28685 0 470846 0 0 0 Edward H Smith Jr CEO/President 220445 0 37970 0 151663 0 11629 0 35073 0 456780 0 0 0 Charles Svensson MD Physician 326629 0 2950 0 7965 0 0 0 28685 0 366229 0 0 0 Kevin Bohac CRNA (Beg 7/21) 247880 0 45729 0 1516 0 9060 0 28685 0 332870 0 0 0 John Munson CFO/Vice President (End 5/22) 196199 0 15524 0 1733 0 6625 0 29973 0 250054 0 0 0 Part I, Line 4b St. Anthony Regional Hospital and Nursing Home has a non qualified deferred compensation plan that complies with section 457(f) of the Internal Revenue Code and the short-term deferral provisions of section 409A of the code. The plan is to be an unfunded plan maintained primarily for the purpose of providing deferred compensation benefits for a select group of management or highly compensated employees. The CEO, Ed Smith, was paid out $117,912.93 from his 457(f) plan. Part I, Line 7 In their roles as executives employed by St. Anthony Regional Hospital and Nursing Home, the executives are eligible for incentive payouts. The incentive award will be a percentage of the base pay compensation for the CEO, CFO, and other executives. The ultimate payout includes a reduction/increase multiplier depending on whether the organization reached specified performance metrics identified by the Board of Directors. A City of Carroll IA 426004322 000000000 2012-11-26 4820000 Refund Bonds Issued 12/20/2001 0 0 0 A 4338000 4820000 50000 4770000 2009 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Badding Construction Entity more than 35% controlled by Nick Badding, board Chairman, and family 464847 Construction Services 0 Drees Co Entity more than 35% controlled by Howard J. Drees, Treasurer, and family. 208491 Construction and Plumbing and Heating Services. 0 Form 990, Part VI, Section A, line 2 Sister Rose Elsbernd, Sister Theresa Keller, Sister Michele Pettit, and Sister Donna Venteicher have a business relationship through their membership in the Franciscan Sisters of Perpetual Adoration. Form 990, Part VI, Section A, line 6 The former members of the St. Anthony Regional Hospital and Nursing Home are the sisters of the religious community known as the Congregation of the Sisters of the Third Order of the St. Francis of Perpetual Adoration (FSPA). The FSPA has formed St. Anthony Ministries to assume canonical sponsorship and membership of St. Anthony Regional Hospital and Nursing Home, performed previously by the FSPA. St. Anthony Ministries has the power to elect the board of directors, amend the articles of incorporation and bylaws of the organizations and dissolve the organization. Form 990, Part VI, Section A, line 7a St. Anthony Ministries, as the sole member of St. Anthony Regional Hospital and Nursing Home, elects and approves the Board of Directors for St. Anthony Regional Hospital and Nursing Home. Form 990, Part VI, Section A, line 7b All decisions, including dissolution of the organization, made by the Board of Directors of St. Anthony Regional Hospital and Nursing Home are subject to the approval of St. Anthony Ministries. Form 990, Part VI, Section B, line 11b St. Anthony Regional Hospital and Nursing Home gathers the necessary information for the completion of the Form 990 within the finance department and with assistance form the human resources and operation departments. The form was prepared by an independent accounting firm. Drafts of the form were reviewed by the CFO and the Audit committee. After the internal reviews were complete, the final version of the form 990 was given to each member of the Board of Directors prior to filing the return. Form 990, Part VI, Section B, line 12c The Officers and Board Members annually disclose in writing, "any interest which would be inconsistent with the expeditious, proper, and impartial performance of duties." Defining disclosable conflict or duality of interest as any matter in which the corporations are "interested which affects the financial interest or employment of such member, a member of his/her family by blood or marriage, or any business enterprise in which he/she or such family member is employed or has a financial interest." Officers and Board members are required to disclose the facts surrounding any possible conflict of interest throughout the year. If a conflict of interest is disclosed by an Officer or Board Member, during a board meeting the Officer or Board Member will not participate in any discussions or deliberations regarding the matter and would abstain from any voting decisions on this matter during the meeting. All conflict of interests that are disclosed will be reported in the minutes of the board meetings. Form 990, Part VI, Section B, line 15 At the direction of the Board of Directors the CEO gathers compensation information (salary and benefits) from various sources including Iowa Hospital Association and benefit consultants for like-sized organizations. The Executive Committee then determines the annual compensation for the CEO, other officers, and any key employees for the total board approval. The compensation process for the CEO is completed in August annually. The other officers compensation is completed in March annually. Form 990, Part VI, Section C, line 19 The St. Anthony Regional Hospital and Nursing Home mails its audited financial statements to financial institutions, governmental institutions, board members, and the Iowa Hospital Association. The Form 990 is available at guidestar.org. St. Anthony Regional Hospital and Nursing Home discloses financial statements to bondholders, the IHA, and the Iowa Attorney General's office. St. Anthony Regional Hospital and Nursing Home's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, line 11g Physician Fees: Program service expenses 4,170,914. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,170,914. Patient Service Fees: Program service expenses 784,612. Management and general expenses 0. Fundraising expenses 0. Total expenses 784,612. Contract Labor: Program service expenses 3,180,853. Management and general expenses 18,520. Fundraising expenses 0. Total expenses 3,199,373. Laundry Fees: Program service expenses 283,982. Management and general expenses 0. Fundraising expenses 0. Total expenses 283,982. Consulting Fees: Program service expenses 57,174. Management and general expenses 25,468. Fundraising expenses 0. Total expenses 82,642. Professional Fees: Program service expenses 1,218,654. Management and general expenses 683,453. Fundraising expenses 0. Total expenses 1,902,107. Recruiting: Program service expenses 209,724. Management and general expenses 226,807. Fundraising expenses 0. Total expenses 436,531. Form 990, Part XI, line 9: Transfer to Foundation - Reimbursed Expenses -295,059. Change in beneficial interest of Net Assets of St. Anthony Foundation 3,891,008. St Anthony Foundation 311 South Clark St PO Box 628 Carroll IA 51401 421419695 Fundraising IA 501(c)(3) 12A, I St Anthony Regional Hospital and Nursing Home 1 St Anthony Ministries 311 South Clark St PO Box 628 Carroll IA 51401 000000000 Religious Order IA 501(c)(3) 1 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 St Anthony Foundation C 1015760 FMV St Anthony Foundation P 295059 FMV