2019-05-14T05:45:13-05:00 2018-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2017-07-01 420733472 St Anthony Regional Hospital and Nursing Home STAN 7127945246 311 South Clark Street PO Box 628 Carroll IA 51401 John Munson CFO 7127945246 2019-05-10 1 Kristina Rasmussen P00143920 6123974000 167.219.56.46 2019-05-10 04:29:38 US P 7976E27EA537A2528AFD4534CEC7185AB37FE28A 0E4C15207DC127BDB52450F77D4060F40C3F1AE4 2017 2019-02-21 02:37:17Z Edward H Smith Jr 311 South Clark Street PO Box 628 Carroll IA 51401 105986952 0 0928 X www.stanthonyhospital.org X 1905 IA Consistently providing high quality healthcare services to meet patient and community needs. 10 8 886 529 0 0 1356314 1190686 75621692 74775520 5654894 5721853 -487317 -602038 82145583 81086021 6000 6000 0 0 39674142 41357009 0 0 0 36686520 35569316 76366662 76932325 5778921 4153696 155354796 165256320 23604911 28352996 131749885 136903324 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, the Franciscan Sisters of Perpetual Adoration. 0 0 69337194 6000 74775520 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, 2018, St. Anthony Regional Hospital and Nursing Home provided health care services to approximately 2,533 inpatients, 76,412 outpatients, and 44,717 clinic visits. St. Anthony Regional Hospital provided services for 1,512 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, medcial oncology, radiation therapy, and surgical services. St. Anthony's largest patient service area is laboratory. In the year ended June 30, 2018, St. Anthony serviced 17,909 patients in laboratory, 7,370 in emergency room, 6,779 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. 3294089 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. 72631283 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 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 1 147 0 1 886 1 1 1 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 John R Munson 7127945115 311 South Clark St Carroll IA 514010628 Tom Gronstal Chairman 0.30 0.00 X X 0 0 0 Nick Badding Vice-Chairman 0.30 0.00 X X 0 0 0 Sr Romona Klaubauf Secretary 0.30 0.00 X X 0 0 0 Peggy White Treasurer 0.30 0.30 X X 0 0 0 Fred Dolezal Board Member 0.30 0.00 X 0 0 0 Howard J Drees Board Member 0.30 0.00 X 0 0 0 Sr Theresa Keller Board Member 0.30 0.00 X 0 0 0 Sr Maris Kerwin Board Member 0.30 0.00 X 0 0 0 Wayne Seaman Board Member 0.30 0.00 X 0 0 0 Sr Donna Venteicher Board Member 0.30 0.00 X 0 0 0 Edward H Smith Jr CEO/President 40.00 0.30 X 358983 0 45275 John Munson CFO/Vice President 40.00 0.30 X 172723 0 23384 Richard C Sazama MD Physician 40.00 0.00 X 428290 0 15200 Nelson H Lo MD Physician 40.00 0.00 X 378257 0 32273 Maria Hernandez-Zacharias Physician 40.00 0.00 X 350868 0 31468 Randal O Hess MD Physician 40.00 0.00 X 462273 0 18104 Charles H Svensson MD Physician 40.00 0.00 X 272573 0 12070 2423967 0 177774 44 0 1 0 Acute Care Inc PO Box 3288 Des Moines IA 50316 Emergency Physician 1317371 Medical Oncology 1221 Pleasant St Des Moines IA 50309 Oncology Services 548424 Barton Associates Inc PO Box 417844 Boston MA 022417844 Contract Labor 532634 Grape Tree Medical Staffing Inc 703 16th St Spirit Lake IA 51360 Contract Labor 433366 Shared Medical Servies Inc 209 Limestone Pass Cottage Grove WI 53527 Imaging Service 351810 21 1190686 1190686 Patient Svc Revenue 621400 38177622 38177622 Medicare/Medicaid Pmts 621400 36171932 36171932 Cafeteria Sales 621400 425966 425966 74775520 1376942 1376942 1068621 1670659 -602038 -602038 -602038 27564533 10650 23229082 1190 4335451 9460 4344911 4344911 81086021 74349554 0 5545781 X 5000 5000 1000 1000 525002 525002 33405790 32452775 953015 746171 675340 70831 4365055 4174539 190516 2314991 2229474 85517 143512 143512 195310 195310 277775 277775 7440897 6290617 1150280 336153 13740 322413 2059548 1871229 188319 491224 491224 1959435 1950000 9435 359612 300268 59344 546456 546456 5732274 5732274 324189 324189 Medical Supplies 13734957 13734957 Repair and Maintenance 1967974 1838201 129773 76932325 72631283 4301042 0 569137 432608 15441457 12586021 31 119 1984980 2139347 570479 478091 149142106 79702767 65128979 69439339 58084112 65345127 452709 1012503 13122912 13823165 155354796 165256320 8281162 5821246 13034768 20396337 1044082 729649 1244899 1405764 23604911 28352996 X 126371872 130985923 5278013 5817401 100000 100000 131749885 136903324 155354796 165256320 X 4153696 1912892 -913149 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 9496 9496 0 Part II-B, Line 1: St. Anthony Hospital is a member of the Iowa Hospital Association, A percentage of the membership dues paid to IHA is related to lobbying activities. 13393000 202723 2011722 9750 855039 14742656 12173907 143951 1764112 9750 679220 13393000 11720664 357317 138893 9500 33467 12173907 9950534 1706686 510919 3500 443975 11720664 7852058 1626938 1547970 4000 1072432 9950534 0.45000 0.55000 0 1 1 693934 693934 93534438 46482507 47051931 39179349 30916454 8262895 15734385 2303806 13430579 69439339 Deferred Compensation Investments 1405764 Beneficial Interest in Net Assets of the Foundation 12417401 13823165 Deferred Compensation 1405764 1405764 X 84921725 1912892 539388 2452280 82469445 277775 -1661199 -1383424 81086021 78563369 1908819 1908819 76654550 277775 277775 76932325 Part V, Line 4: All restricted endowed funds held at the St. Anthony Foundation are used for the benefit of St. Anthony Regional Hospital for pastoral care and 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 for 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, 2018 and 2017. The Hospital is engaged in certain activities that result in unrelated business income recorded within other revenue in the consolidated statements of activities. Part XI, Line 2d - Other Adjustments: Change in beneficial interest of Net Assets of Foundation 539,388. Part XI, Line 4b - Other Adjustments: Rental Expenses -1,670,659. Realized Gain on Sale of Assets 9,460. Part XII, Line 2d - Other Adjustments: Rental Expenses 1,670,659. Realized Gain on Sale of Assets -9,460. Transfer to Foundation - Reimbursed Expenses 247,620. 1 1 1 X 1 X 399.000000000000 1 1 1 0 1 1 533540 0 533540 0.00690 9382784 6587710 2795074 0.03630 9916324 6587710 3328614 0.04320 186573 13942 172631 0.00220 424926 5000 419926 0.00550 13286054 8586933 4699121 0.06110 171255 47347 123908 0.00160 14068808 8653222 5415586 0.07040 23985132 15240932 8744200 0.11360 13117 0 13117 0.00020 13117 13117 0.00020 1 1436722 0 22573125 28035769 -5462644 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 15 1 0 1 1 X See Part V, Section C X 1 15 1 https://www.stanthonyhospital.org/webres/File/legal/CHNA13Final.pdf 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 6/30/16, St. Anthony Regional Hospital conducted a CHNA assessment. A total of 20 individuals were interviewed, including internal stakeholders - those affiliated or employed by St. Anthony Regional Hospital and Nursing Home - and external stakeholders from across the area. The interviews were conducted using a structured questionnaire with key stakeholders being asked to discuss community health needs and availability of services and recommendations for improving community health. All interviews were reviewed and comments analyzed to identify the most frequently mentioned community health issues. The interviews were conducted during the months of May and June 2016. St. Anthony Regional Hospital Part V, Section B, Line 6b: St. Anthony Regional Hospital and Nursing Home contracted with Community Health Advisors, LLC 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/CHNA13Final.pdf St. Anthony Regional Hospital Part V, Section B, Line 11: The following significant health needs were identified in the St. Anthony Regional Hospital and Nursing Home service area.- Access to care related to Cost and Use of Insurance- Cancer- Treatment and Prevention- Chronic Disease Management- Health Education- Mental Health Services- Nutrition and Exercise- Obesity and Diabetes- Substance Abuse - Tobacco and Alcohol- Transportation- VaccinationsSt. Anthony Regional Hospital and Nursing Home has worked to meet these identified health needs this year in the following ways:Access to Care Related to cost and use of Insurance:- Distributed copies of outreach and education materials on the St. Anthony Cares financial assistance program.- The certified financial counselors helped people in the community sign up in health exchanges. - We distributed Spanish materials to help non-English speaking population.Cancer - Treatment and Prevention:- We continued public awareness campaign aimed at cancer screening.- We Provided 1441 mammograms and 124 CT lung scans.- The expanded and remodeled radiation oncology department procedures increased.Chronic Disease Management:- The Health Coach helped patients access information and treat chronic diseases.- The St. Anthony Care Clinic offered diabetes education, wound care and health coaching.- The Healthy Bodies exercise continued to help at risk patients.Health Education:- We have provided community education by local physicians and professional staff to address community health education with the following programs:Managing Diabetes, Women's Heart Health, No Symptoms Required, Pain Management Anatomy of a Bicycle, Girls Night Out, Advanced Care Planning Conversations, My Heart is Fluttering is it Love or Should I See a Doctor, Making the Most of a Health Heart, Cancer the Emperor of All Maladies, Change for Life, Eat Well, Move More, Live Longer, Feeding Your Young Child, Healthy Active Children, Talking about Men's Health, Menopause Education, and Women's Incontinence. Mental Health:- We have contracted with mental health providers to provide coverage and continue to provide adult and adolescent care on an inpatient and outpatient basis. Inpatients days have increased 16.7% and outpatient visits have increased 14.4% from 2017 to 2018.- We have continued to support Carroll County Supervisors and area schools' efforts to increase access to mental health in area.Nutrition, Exercise, Obesity and Diabetes:- The Health Coach and Chronic Care Clinic provide services to manage diet, diabetes and weight loss.- The Chronic Care Clinic provides diabetes education and healthy bodies exercise program and St. Anthony partnered with Elderbridge Agency to host stepping classes and active body classes.- We continued to promote support groups for anyone affected by diabetes, along with family and any others in a supporting role. - We continued to work with local employers to promote wellness programs and work with community partners and health providers to try to decrease BMI and increase activity levels of Carroll County residents.- We increased Carroll County Health rankings in the state of Iowa from 15th to 14th, and Health Factor has improved from 11th to 10th out of 99 counties.- The Physical Therapy department offers active bodies classes and Parkinson exercise classes that have been well attended.Substance Abuse - Tobacco and Alcohol:- We maintained routine screening for tobacco use for outpatient and clinic patients.- Referrals, as appropriate, made for assistance with tobacco cessation.- We maintained routine screening for alcohol use for all patients admitted to the hospital.Vaccinations:- Collaborated with Public Health departments to promote and administer vaccines.- Designed a public education message on the importance of flu vaccine.Transportation:The objective was to address challenges related to public transportation for medical care in the service area. The Public Health Department is addressing the transportation needs by maintaining a list of available taxi services and raising funds to support taxi vouchers for elderly patients. However, given the challenge of enduring adequate transportation in a rural area, this need was not addressed by St. Anthony due to lack of infrastructure and expertise. A fund raiser was held in Feb 2018 for travel vouchers to be distributed to local social workers and facilities as needed. St. Anthony Regional Hospital Part V, Section B, Line 13h: Additional eligibility criteria for financial assistance include Medicaid/Medicare coverage, and State regulations. Part V, line 16a, FAP website: www.stanthonyhospital.org/webres/File/patients/Financial%20Assistance/Financial_Assistance_Policy.pdf Part V, line 16b, FAP Application website: www.stanthonyhospital.org/webres/File/patients/Financial%20Assistance/St_Anthony_CARES_Financial_Application.pdf Part V, line 16c, FAP Plain Language Summary website: www.stanthonyhospital.org/webres/File/patients/Financial%20Assistance/Plain_Language_Summary.pdf 6 1 - St Anthony Regional Hospice 311 South Clark St Carroll IA 51401 Hospice Services 2 - St Anthony Regional Hospital 311 South Clark St Carroll IA 51401 Dialysis Services 3 - St Anthony Regional Home Hlth Agency 311 South Clark St Carroll IA 51401 Home Health Services 4 - St Anthony Regional Hospital 311 South Clark St Carroll IA 51401 Psychiatric Services 5 - Wall Lake Medical Clinic 311 West First St Wall Lake IA 51466 Rural Health Clinic 6 - St Anthony Nursing Home 311 South Clark St Carroll IA 51401 Nursing Home 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 vehicle. 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. 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 2018 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 workforce development. The hospital emergency room director attended regional meetings on disaster readiness. 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 they 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: The financial statements for St. Anthony Regional Hospital do not include a footnote regarding bad debts, however the bad debt expense from the financial statement is a percent of revenue that is an estimate of the historical bad debt written off. Part III, Line 8: The amount of Medicare short fall on line 7 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 the 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 and 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 Prefered Medical Deposits (PMD). Accounts at PMD with no activity after 60 days are turned over to our 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: The Hospital and county performs a community needs assessment every three years to identify specific health concerns of the county. Meetings are held with community partners to identify needs from the daily work and with clients, students, educators, health care, volunteer services, case management, behavior medicine, and others in the county. A survey was developed to gather county resident's identified needs. The primary data collection included a web based community survey. The survey was posted on the hospital website. Similar versions of the survey were distributed by the Carroll County Public Health Department and Manning Regional Health Care Center. There were over 250 people who participated in the survey. The needs assessment was completed and adopted by the St. Anthony Hospital Board of Directors. The implementation strategy was developed and implemented based on the assessment of the survey. The hospital coordinated efforts with the Carroll County Public Health Department to ensure that community benefit resources address needs to improve the health of residents of the service area. The Carroll County Public Health Department provides emergency preparedness, blood pressure clinics, care for your self program, disease management, health opportunities for parents, immunizations, senior health, assistant to obstetrics patients, and TB testing to the community. 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 care 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: The Hospital is located in the city of Carroll in West Central Iowa, Carroll County with a population of 20,562. St. Anthony Hospital also serves portions of 6 surrounding counties with a radius of 50 miles. St. Anthony Hospital operates 6 satellite physician clinics in the service area, in addition to 2 physician clinics in the hospital. The six counties of Audubon, Carroll, Calhoun, Crawford, Green, and Sac comprise the hospital's primary service area. The estimated population of St. Anthony's six county area was 72,685 in 2014. The estimated 2014 median house hold income for all counties in the service area is less than the median Iowa household income of $52,716, as well as the national median income of $53,482. The majority of the population in the St. Anthony, six county service area is White/ Caucasian. Crawford County has a significant Hispanic population, with more than one-quarter of the population being Hispanic. The majority of the service area is comprised of English speaking residents. The exception is Crawford County where nearly one-quarter of the population speaks a language other than English in the home, nearly all of them being Spanish speaking. 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 one hundred and eleven years. The majority of the Hospital's board members are from local businesses and reside in the community. The Hospital's medical staff consists of 34 active staff, 8 associate staff in the community, and 69 courtesy staff from outside 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 Edward H Smith Jr CEO/President 297497 0 38696 0 22790 0 25671 0 19604 0 404258 0 0 0 John Munson CFO/Vice President 166195 0 5047 0 1481 0 5280 0 18104 0 196107 0 0 0 Richard C Sazama MD Physician 417394 0 0 0 10896 0 12600 0 2600 0 443490 0 0 0 Nelson H Lo MD Physician 378257 0 0 0 0 0 11569 0 20704 0 410530 0 0 0 Maria Hernandez-Zacharias Physician 341557 0 0 0 9311 0 10500 0 20968 0 382336 0 0 0 Randal O Hess MD Physician 445220 0 0 0 17053 0 0 0 18104 0 480377 0 0 0 Charles H Svensson MD Physician 268434 0 0 0 4139 0 0 0 12070 0 284643 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. No payments were made from the non-qualified compensation plan during the year. Part I, Line 7 In their roles as executives employed by St. Anthony Regional Hospital, 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 2410000 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 Schedule K, Supplemental Information: The two 2006 issues were paid off 1/2/2018. Part IV, Line 2c The rebate computation was performed on 11/19/2012 for the 2006 bonds outstanding. Drees Co Entity more than 35% controlled by H. Drees (Board Member) and family. 2167762 Plumbing/Heating Services 0 Badding Construction Entity more than 35% controlled by N. Badding (Officer) and family. 4920063 Construction Services 0 Form 990, Part VI, Section A, line 2 Sister Romana Klaubauf, Sister Theresa Keller, Sister Maris Kerwin, and Sister Donna Venticher have a business relationship through their membership in The Franciscan Sisters of Perpetual Adoration. Form 990, Part VI, Section A, line 6 The members of the St. Anthony Regional Hospital 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 members have 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 The Franciscan Sisters of Perpetual Adoration, as members of the St. Anthony Regional Hospital, elect and approve the board of directors for St. Anthony Regional Hospital. 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 are subject to the approval of the Franciscan Sisters of Perpetual Adoration. Form 990, Part VI, Section B, line 11b St. Anthony Regional Hospital gathers the necessary information for the completion of the Form 990 within the finance department and with assistance from 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 mails its consolidated 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 discloses financial statements to bondholders, the IHA, and the Iowa Attorney General's office. St. Anthony Regional Hospital'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 2,149,020. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,149,020. Patient Service Fees: Program service expenses 1,183,632. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,183,632. Contract Labor: Program service expenses 1,878,878. Management and general expenses 998. Fundraising expenses 0. Total expenses 1,879,876. Laundry Fees: Program service expenses 324,733. Management and general expenses 0. Fundraising expenses 0. Total expenses 324,733. Consulting Fees: Program service expenses 57,219. Management and general expenses 27,821. Fundraising expenses 0. Total expenses 85,040. Professional Fees: Program service expenses 578,634. Management and general expenses 984,144. Fundraising expenses 0. Total expenses 1,562,778. Recruiting Fees: Program service expenses 118,501. Management and general expenses 137,317. Fundraising expenses 0. Total expenses 255,818. Form 990, Part XI, line 9: Transfer to Foundation - Reimbursed Expenses -247,620. Change in beneficial interest of Net Assets of Foundation 539,388. Income From Joint Venture -1,204,917. St Anthony Foundation 311 South Clark PO Box 628 Carroll IA 51401 421419695 Fundraising IA 501(c)(3) 12a St Anthony Regional Hospital and Nursing Home 1 Franciscan Sisters of Perpetual Adoration 912 Market Street La Crosse WI 546014782 390806386 Religious Order WI 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 1190686 FMV St Anthony Foundation P 247620 FMV