2017-05-15T00:00:00-05:00 2016-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2015-07-01 420733472 St Anthony Regional Hospital and Nursing Home STAN 7127945246 311 South Clark Street PO Box 628 Carroll IA 51401 John Munson CFO 7127945246 2017-05-17 1 Kristina Rasmussen P00143920 6123974000 2015 2021-01-29 14:40:06Z Edward H Smith Jr 311 South Clark Street PO Box 628 Carroll IA 51401 94658784 0 0928 X www.stanthonyhospital.org X 1905 IA Consistently providing high quality healthcare services to meet patient and community needs. 11 11 791 515 2177 0 467616 170296 68320240 73302323 4959424 1074479 -403520 -489405 73343760 74057693 0 6500 0 0 34097214 36193177 0 0 0 31962469 34959121 66059683 71158798 7284077 2898895 145455995 145239794 21348840 21354065 124107155 123885729 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 64314514 6500 73302323 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, 2016, St. Anthony Regional Hospital and Nursing Home provided health care services to approximately 2,543 inpatients, 80,718 outpatients, and 39,105 clinic visits. St. Anthony Regional Hospital provided services for 1,578 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 and surgical services. St. Anthony's largest patient service area is laboratory. In the year ended June 30, 2016, St. Anthony serviced 17,527 patients in laboratory, 7,533 in emergency room, and 7,935 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. 2732845 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. 67047359 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 0 0 0 0 0 0 1 1 1 0 0 1 132 0 1 791 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 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 Fred Dolezal Chairman 0.30 0.00 X X 0 0 0 Tom Gronstal Vice-Chairman 0.30 0.00 X X 0 0 0 Sr Ramona Klaubauf Secretary 0.30 0.00 X X 0 0 0 Wayne Seaman Treasurer 0.30 0.30 X X 0 0 0 Nick Badding 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 Josh Smith Board Member (Start 7/15) 0.30 0.00 X 0 0 0 Sr Donna Venticher Board Member 0.30 0.00 X 0 0 0 Peggy White Board Member 0.30 0.00 X 0 0 0 Edward H Smith Jr CEO/President 40.00 0.30 X 355462 0 35258 John Munson CFO/Vice President 40.00 0.30 X 165547 0 18412 Richard C Sazama MD Physician 40.00 0.00 X 428889 0 10254 Nelson H Lo MD Physician 40.00 0.00 X 362841 0 26862 Jwong H Ling Physician 40.00 0.00 X 343274 0 0 Tina F Schechinger MD Physician 40.00 0.00 X 260976 0 20689 David C Pederson Anesthesist 40.00 0.00 X 253181 0 17548 2170170 0 129023 31 0 1 0 Medical Oncology 1221 Pleasant St Des Moines IA 50309 Oncology Services 226114 Park Place International LLC 7227 Chagrin Rd Chagrin Falls OH 44023 Computer Services 182462 Deloitte and Touche LLP PO Box 844708 Dallas TX 752844708 Accounting Services 149252 Dorsey & Whitney LLP 801 Grand Ste 4100 Des Moines IA 502098002 Legal Services 146296 Dr Jed Hagen 2313 Skyline Dr Carroll IA 51401 Pathology Services 128750 8 170296 170296 Patient Svc Revenue 621400 42213975 42213975 Medicare/Medicaid Pmts 621400 30702400 30702400 Cafeteria Sales 621400 383771 383771 Inc. from Partnership 900004 2177 2177 73302323 1396867 1396867 1017181 1506586 -489405 -489405 -489405 18736037 36080 18990206 104299 -254169 -68219 -322388 -322388 74057693 72916375 2177 968845 5000 5000 1500 1500 514715 514715 28805269 27879880 925389 639172 575332 63840 4207434 4000491 206943 2026587 1940055 86532 66827 66827 179557 179557 267705 267705 6874486 5883298 991188 305299 33619 271680 1870970 1682938 188032 432352 432352 2034609 2022909 11700 323494 260965 62529 600756 600756 6115734 6115734 362776 362776 Medical Supplies 13223396 13223396 Repair and Maintenance 1620482 1505229 115253 Joint Venture Expenses 680214 521129 159085 Community Event Support 464 464 71158798 67047359 4111439 0 1420467 1938636 11717203 12048209 13 17 2007239 1977648 409964 429459 132322552 69260562 61078620 63061990 53176378 51580897 413817 1729743 15232294 12473195 145455995 145239794 5629473 5986067 13391000 12881000 1264336 1418800 1064031 1068198 21348840 21354065 X 119540473 119178876 4466682 4606853 100000 100000 124107155 123885729 145455995 145239794 X 2898895 -1136294 -1984027 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7892 7892 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. 11720664 357317 138893 9500 33467 12173907 9950534 1706686 510919 3500 443975 11720664 7852058 1626938 1547970 4000 1072432 9950534 4622373 3018705 739105 2500 525625 7852058 995357 3662163 -30442 3500 1205 4622373 0.54000 0.46000 0 1 1 632934 632934 86476104 39414426 47061678 35979709 27775122 8204587 9233805 2071014 7162791 63061990 Deferred Compensation Investments 1068198 Beneficial Interest in Net Assets of the Foundation 11206853 Other 198144 12473195 Deferred Compensation 1068198 1068198 X 74366493 -1136294 140171 -996123 75362616 267705 -1572628 -1304923 74057693 72697437 1806344 1806344 70891093 267705 267705 71158798 Part V, Line 4: All restricted endowed funds held at 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 in the consolidated statements 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, 2016 and 2015. 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 140,171. Part XI, Line 4b - Other Adjustments: Rental Expenses -1,506,586. Realized Loss on Sale of Assets -68,219. Income from Partnerships 2,177. Part XII, Line 2d - Other Adjustments: Rental Expenses 1,506,586. Realized Loss on Sale of Assets 68,219. Transfer to Foundation - Reimbursed Expenses 231,539. 1 1 X 1 X 1 X 399.000000000000 1 1 0 1 1 481355 481355 0.00680 7494250 5763266 1730984 0.02430 0.00000 7975605 5763266 2212339 0.03110 213238 31395 181843 0.00260 254705 1750 252955 0.00360 10581652 7603754 2977898 0.04180 0.00000 195056 63301 131755 0.00190 11244651 7700200 3544451 0.04990 19220256 13463466 5756790 0.08100 11005 0 11005 0.00020 18346 17221 1125 0.00000 29351 17221 12130 0.00020 1 1221594 0 20117579 25278359 -5160780 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/images/sarpdf/CHNA.13/CHNA16Final.pdf 0 0 1 X 200.000000000000 399.000000000000 X X X X 1 1 X X 1 X www.stanthonyhospital.org/images/sarpdf/Financial_Assistance_Policy.pdf X www.stanthonyhospital.org/images/sarpdf/St_Anthony_CARES_Financial_Applicat X www.stanthonyhospital.org/images/sarpdf/Plain_Language_Summary 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: www.stanthonyhospital.org/images/sarpdf/CHNA.13/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 heath needs this year in the following ways:Access to Care Related to Cost and Use of Insurance:- Distributed 750 annually copies of outreach and education materials on the St. Anthony Cares financial assistance program.- The four 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 campaigns aimed at cancer screening.- We provided 1500 mammograms.- 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 program 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 and inpatient and outpatient basis. Inpatients days have increased 9.7% and outpatient visits have increased 7.3% from 2015 to 2016.- 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.- We continue to promote support groups for anyone affected by diabetes, along with family and any others in a supporting role.- We continue to work with local employers to promote wellness programs.Substance Abuse - Tobacco and Alcohol:- We have implemented routine screening for tobacco use for outpatient and clinic patients.- Referrals, as appropriated, made for assistance with tobacco cessation.- We have implemented 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. 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 22d: St. Anthony uses annual poverty guidelines to determine FAP eligibility. The maximum amount a FAP eligible patient would pay is 75% of gross charges. Individuals that earn 301-399% of federal poverty guidelines are eligible for a discout of 25%. All individuals that earn less than 200% of federal poverty guidelines pay 0% of gross charges. 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 accounts, certificates of deposit, stocks, bonds, IRA accounts, trust funds, real estate, and motor vehicles. The hospital will also take into account any liabilities that are the responsibility of the patient's household. To relieve the stress related to financial burdens, families with a medical catastrophe with self- pay balances greater than 20% of their annual 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 heath services. Subsidized heath services are reported using departmental cost from the 2016 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 them 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 the 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 then turned over to our collection agency Avadyne Health. 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 residents 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 intends to coordinate 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. 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 a 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 5 satellite physician clinics in the service area, in addition to 3 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 were 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 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 278355 0 55000 0 22107 0 20088 0 15170 0 390720 0 0 0 John Munson CFO/Vice President 152167 0 12057 0 1323 0 5042 0 13370 0 183959 0 0 0 Richard C Sazama MD Physician 417493 0 500 0 10896 0 7754 0 2500 0 439143 0 0 0 Nelson H Lo MD Physician 359036 0 1000 0 2805 0 10992 0 15870 0 389703 0 0 0 Jwong H Ling Physician 343274 0 0 0 0 0 0 0 0 0 343274 0 0 0 Tina F Schechinger MD Physician 235544 0 23336 0 2096 0 7319 0 13370 0 281665 0 0 0 David C Pederson Anesthesist 225215 0 23591 0 4375 0 7620 0 9928 0 270729 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. 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 Carroll County IA 426004323 144813AB8 2006-11-22 6672573 Construction of Hospital Addition 0 0 0 B City of Carroll IA 426004322 145181CK7 2006-11-22 5402508 Construction of Hospital Addition 0 0 0 A 6969080 133451 6835629 2009 0 0 1 1 B 2835000 5637070 107254 5529816 2009 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 1 Citi Group 1.900000000000 1 0 0 B 0 0 0 1 0 0 1 Citi Group 1.900000000000 1 0 0 A 0 B 0 Schedule K, Supplemental Information: The two 2006 issues actually comprise a single issue for tax purposes, but are reported separately herein because the two series were issued by two different issuers (each of which files a form 8038) and were accounted for separately. Differences between the issue price (Part 1) and total proceeds (Part II, Line 3 ) are due to investment earning and (for column B) to a small excess amount (less than $1,000) that was used to pay principal on bonds. Part IV, Line 2c. The rebate computation was performed on 11/19/2012 for the 2006 bonds outstanding. Form 990, Part VI, Section A, line 2 Sister Ramona 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 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 11 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. Form 990, Part VI, Section C, line 19 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 XI, line 9: Transfer to Foundation - Reimbursed Expenses -231,539. Change in beneficial interest of Net Assets of Foundation 140,171. Income From Partnership -2,177. Consolidation Joint Venture -1,890,482. St Anthony Foundation 311 South Clark St PO Box 628 Carroll IA 51401 421419695 Fundraising IA 501(c)(3) 11a 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 1 0 St Anthony Foundation C 170296 FMV St Anthony Foundation P 231539 FMV