2014-05-09T16:17:19-05:00 2013-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2012-07-01 420733472 St Anthony Regional Hospital and Nursing Home STAN 7127945246 311 South Clark Street PO Box 628 Carroll IA 51401 John Munson 7127945246 2014-05-07 1 Kristina Rasmussen P00143920 6123974000 2012 2015-11-30 17:44:51Z Edward H Smith Jr 311 South Clark Street PO Box 628 Carroll IA 51401 83193962 0 0928 X www.stanthonyhospital.org X 1905 IA Consistently providing high quality healthcare services to meet patient and community needs. 10 9 757 444 2023 0 149934 158567 64337847 59012017 2835658 2694001 -423758 -564197 66899681 61300388 3000 5000 0 0 30026394 31241575 0 0 0 30280643 28379234 60310037 59625809 6589644 1674579 126551178 132472507 23117178 21650597 103434000 110821910 X St. Anthony Regional Hospital is a catholic healthcare organization sponsored by the Franciscan Sisters of Perpetual Adoration and a regional leader in providing consistently high quality healthcare services responsive to patient and community needs. 0 0 53881995 5000 58653462 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, 2013, St. Anthony Regional Hospital and Nursing Home provided heath care services to approximately 2,556 inpatients, 69,552 outpatients, and 27,820 clinic visits. St. Anthony Regional Hospital provided services for 1,788 acute care inpatients, and provided psychiatric, swing bed, and nursing home services for the remainder of the 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, phyiscial therapy, occupational therapy, speech therapy, diabetes and surgical services. St. Anthony's largest patient service area is physical therapy. In the year ended June 30, 2013, St. Anthony serviced 10,012 in physical therapy, 7,083 in laboratory, and 7,918 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. 2238651 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. 56120646 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 1 102 0 1 757 1 1 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 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 51401 Gary McMinimee 0.30 0.00 X X 0 0 0 Fred Dolezal 0.30 0.30 X X 0 0 0 Sr Helen Elsbernd 0.30 0.30 X X 0 0 0 Tom Gronstal 0.30 0.00 X X 0 0 0 Urban Knobbe 0.30 0.30 X 0 0 0 Wayne Seaman 0.30 0.30 X 0 0 0 Sr Rita Heires 0.30 0.00 X 0 0 0 Sr Romana Klaubauf 0.30 0.00 X 0 0 0 Art Neu 0.30 0.00 X 0 0 0 Sr Theresa Keller 0.30 0.00 X 0 0 0 Gary P Reidmann End 012013 20.00 0.30 X 1066189 0 46133 Edward H Smith Jr 40.00 0.30 X 233761 0 23435 John Munson 40.00 0.30 X 145956 0 11460 Nelson H Lo MD 40.00 0.00 X 344763 0 21686 Robert J Langenfeld MD 40.00 0.00 X 219201 0 16055 Tina F Schechinger MD 40.00 0.00 X 225226 0 8595 Dominick C Ervelli MD 40.00 0.00 X 202693 0 21772 Brian L Pratt MD 40.00 0.00 X 199641 0 16982 2637430 0 166118 25 0 1 0 Dell Marketing LP PO Box 677654 Dallas TX 752676021 Computer Consulting Services 690683 Deloitte & Touche LLP PO Box 7247-6446 Philadelphia PA 191706446 Accounting Services 240113 Dr Jedd Hagen 2313 Skyline Dr Carroll IA 51401 Pathology Services 129000 3 157993 574 158567 Patient Svc Revenue 621400 33584732 33584732 Medicare/Medicaid Pmts 621400 24940480 24940480 Cafeteria Sales 621400 356532 356532 Radiation Oncology Svc 621400 128250 128250 Inc. from Partnership 900004 2023 2023 59012017 923593 923593 1226922 1791119 -564197 -564197 -564197 21821833 51030 19987994 114461 1833839 -63431 1770408 1770408 61300388 58653462 2023 2486336 5000 5000 695887 695887 24933292 23929285 1004007 257957 226113 31844 3529127 3334802 194325 1825312 1733319 91993 43176 43176 253814 253814 3770932 3106425 664507 240448 52688 187760 1796273 1605571 190702 296184 296184 1915363 1915043 320 295655 249759 45896 783628 783628 6448994 6448994 323893 281255 42638 Medical Supplies 10863847 10863847 0 0 Repair and Maintenance 1346264 1288270 57994 0 Miscellaneous expenses 763 463 300 0 59625809 56120646 3505163 0 1129952 585093 12434526 10543350 3 108830 1509025 1467853 330280 232605 114514199 50869700 65242669 63644499 37152099 44042782 1149432 384432 7603192 11463063 126551178 132472507 5275477 5089358 17160848 15657317 42309 30102 638544 873820 23117178 21650597 X 101551358 107088750 1782642 3633160 100000 100000 103434000 110821910 126551178 132472507 X 1674579 4088350 1624981 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8144 8144 0 Explanation of Lobbying Activities: Part II-B, Line 1: St. Anthony Hospital is a member of Iowa Hospital Association. A percentage of the membership dues paid to IHA is related to lobbying activities. 4622373 3018705 739105 2500 6612 8371071 995357 3662163 -30442 3500 1205 4622373 680736 190774 129468 3500 2121 995357 362632 265297 55307 2500 680736 207355 196019 -33742 7000 362632 0.53000 0.47000 0 1 1 632934 632934 80205902 29420477 50785425 30357914 19716385 10641529 3317449 1732838 1584611 63644499 Deferred Compensation Investments 873820 Beneficial interest in Net Assets of the Foundation 8233160 Investment in Joint Venture 2162323 Other 193760 11463063 Deferred Compensation 873820 873820 X 69091782 4088350 3703044 7791394 61300388 0 61300388 61703872 0 61703872 -2078063 -2078063 59625809 Description of Intended Use of Endowment Funds: 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. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: 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, 2013 and 2012. The Hospital is engaged in certain activities that result in unrelated business income. Part XI, Line 2d - Other Adjustments: Rental expenses 1,791,118. Realized gain on sale of assets 63,431. Change in beneficial interest of net assets of Foundation 1,850,518. Income from Partnerships -2,023. Part XII, Line 4b - Other Adjustments: Rental expenses -1,791,118. Transfer to St. Anthony Foundation for Op. Cash Requirements -223,514. Realized gain on sale of assets -63,431. 1 1 X 1 X 1 X 1 1 1 0 1 1 916288 0 916288 0.01540 4128034 2200612 1927422 0.03230 5044322 2200612 2843710 0.04770 188654 45694 142960 0.00240 306150 5500 300650 0.00500 6534970 3666223 2868747 0.04810 229118 89059 140059 0.00230 7258892 3806476 3452416 0.05780 12303214 6007088 6296126 0.10550 8810 8810 0.00010 27276 24730 2546 0.00000 4368 4368 0.00010 40454 24730 15724 0.00020 1 1092167 17135724 21607799 -4472075 X 1 1 1 1 St Anthony Regional Hospital

311 South Clark St Box 628 Carroll IA 51401

www.stanthonyhospital.org X X X St Anthony Regional Hospital 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 399.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 5 St Anthony Regional Hospice

311 South Clark St Carroll IA 51401

Hospice services St Anthony Regional Hospital

311 South Clark St Carroll IA 51401

Dialysis Services St Anthony Regional Home Health Agency

311 South Clark St Carroll IA 51401

Home Health Services St Anthony Regional Hospital

311 South Clark St Carroll IA 51401

Psychiatric Services Wall Lake Medical Cllinic

311 First St Wall Lake IA 51466

Rural Health Clinic Part I, Line 3c: The family or household income must be less than or equal to 200% of the FPG to qualify for free care. For discounted care, the family or household income must be equal to the FPG as follows: 201% - 250% of FPG for a 75% discount, 251% - 300% of FCG for a 50% discount, and 301% - 399% of FPG for a 25% discount. Part I, Line 7: The cost to charge ratio was used when calculating the amounts reported in Part I, line 7, with the exception of line 7g, subsidized heath services. Subsidized heath services are reported using departmental cost from the 2013 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. Included is a list of services and costs by clinics included in the subsidized health services calculation:OP Mental Health - $638,338Home Health Services - $525,614OP Diabetic Clinic - $449,403Medical Clinics - $4,433,258Public Health Services - $319,700Cardiac Rehabilitation Services - $168,657 Part I, L7 Col(f): Bad debt expense of $1,563,718 was subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, Column f. Part II: The hospital CEO and VP participate 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 ratios from the Medicare report.Part III, Line 9: 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. St. Anthony Regional Hospital Part V, Section B, Line 3: In 2012, St. Anthony Regional Hospital conducted a CHNA assessment. A total of 24 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 issues, as well as the social determinants of health. Interviewees were asked about issues related to access to particular health services, prevalence and treatment of chronic health conditions, compliance with care treatment plans, health disparities, and other issues. All interviews were reviewed and comments analyzed to identify the most frequently mentioned community health issues. The interviews were conducted during the months of March through May 2013. St. Anthony Regional Hospital Part V, Section B, Line 6i: The CHNA and Implementation Strategy are available at www.stanthonyhospital.org. Both of these documents were approved by the Board of Directors during the fiscal year ended June 30, 2013. St. Anthony Regional Hospital Part V, Section B, Line 7: The hospital facility did not address all the significant needs identified in its most recently conducted CHNA. Alcohol Use:The objective to reduce alcohol use among residents is not being addressed because New Opportunities, a non-profit agency in Carroll, Iowa, is addressing the use of alcohol among residents.Unintentional Injury and Motor Vehicle Accident Deaths:The objective to reduce the number of accidental injuries and motor vehicle deaths among area residents is not being addressed because local law enforcement agencies are addressing this issue among area residents. St. Anthony Regional Hospital Part V, Section B, Line 20d: 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 the federal poverty guidelines are eligible for a discount of 25%. All individuals that earn less 200% of the federal poverty guidelines pay 0% of gross charges. Part VI, Line 2: In addition to the Community Health Needs Assessment that was conducted in 2012, other area assessments were taken into account. The Hospital and county are involved in other coalitions that periodically assess community needs. Meetings were held with community partners to identify needs from their daily work and with clients, students, educators, health care, volunteer services, case management, behavior medicine, and others in the county. Surveys were developed and placed on the county website and hard copies were placed in the courthouse and public library. Survey data results were reviewed and areas of concern were identified for the county. Needs identified are assigned to committees and assessed over a three year period as action plans are developed and executed. Reports are sent to the state to monitor progress and action. 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 with a county population of 25,000. St. Anthony Hospital also serves portions of 6 surrounding counties within 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. 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 seven years. The majority of the hospital's board members are from local business and reside in the community. The hospital's medical staff consists of 30 active staff, 8 associate staff in the community, and 115 courtesy staff from outside the community. St. Anthony Regional Hospital is a regional provider and is committed to providing quality health care to the community. Reports Filed With States Part VI, Line 7 IA X X X X X 0 1 0 0 0 0 0 1 0 Gary P Reidmann End 012013 132025 0 23888 0 910276 0 45133 0 1000 0 1112322 0 907625 0 Edward H Smith Jr 219260 0 10779 0 3722 0 10025 0 13410 0 257196 0 0 0 John Munson 137706 0 7081 0 1169 0 0 0 11460 0 157416 0 0 0 Nelson H Lo MD 341128 0 1109 0 2526 0 6976 0 14710 0 366449 0 0 0 Robert J Langenfeld MD 213285 0 0 0 5916 0 4350 0 11705 0 235256 0 0 0 Tina F Schechinger MD 204321 0 600 0 20305 0 0 0 8595 0 233821 0 0 0 Dominick C Ervelli MD 199920 0 1270 0 1503 0 4212 0 17560 0 224465 0 0 0 Brian L Pratt MD 181525 0 1444 0 16672 0 3810 0 13172 0 216623 0 0 0 Part I, Line 4b St. Anthony Hospital and Nursing Home has an IRC Section 457F Deferred Compensation Plan. The following participant of the plan received a payment during the year, which was related to plan contributions accumulated over 20 years: Gary P. Reidmann: $907,625 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 Iowa 426004323 2003-09-29 10000000 Construction of Hospital Addition 0 0 0 B Carroll County Iowa 426004323 144813AB8 2006-11-22 6672573 Construction of Hospital Addition 0 0 0 C City of Carroll Iowa 426004322 145181CK7 2006-11-22 5402508 Construction of Hospital Addition 0 0 0 A 9392683 10445730 35220 10410510 2006 0 0 1 1 B 6969080 133451 6835629 2009 0 0 1 1 C 1770000 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 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 1 0 0 1 Citi Group 1.900000000000 1 0 0 C 0 0 0 1 0 0 1 Citi Group 1.900000000000 1 0 0 A 0 B 0 C 0 Schedule K Supplental 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 filed 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 earnings and (for column C) to a small excess amount (less than $1,000) that was used to pay principal on the bonds. Part IV, column A, lines 2b and 2c: Shortly before this return was due to be filed, it came to St. Anthony's attention that a misinterpretation of documents associated with the Series 2003 bonds led to a failure to prepare a timely rebate analysis with respect to these bonds. That oversight is being rectified, but had not been finalized at the time this return was filed. At this date, St. Anthony does not know whether any rebate payment was due on the 2003 bonds. Part IV, Line 2c: The rebate computation was performed on 11/19/2012 for the 2006 bonds outstanding. Mid Iowa Insurance Fred Dolezal - VP 313321 Insurance 0 Mid Iowa Insurance: Fred Dolezal Vice President, Insurance services for St. Anthony Regional Hospital and Nursing Home. 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 operations. The form was prepared by the St. Anthony Regional Hospital's 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 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." Board members are required to disclose the facts surrounding any possible conflict of interest throughout the year. 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 size 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer to St. Anthony Foundation for Op. cash requirements -223,514. Change in beneficial interest of net assets of Foundation 1,850,518. Income from Partnership -2,023. St Anthony Foundation 311 South Clark Street PO Box 628 Carroll IA 51401 421419695 Fundraising IA 501(c)(3) Line 11, Type I: 509 St Anthony Regional Hospital 1 Franciscan Sisters of Perpetual Adoration 912 Market Street La Crosse WI 546014782 390806386 Religious Order WI 501(c)(3) Line 1: 170(b)(1)(a) 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 157993 FMV St Anthony Foundation P 223514 FMV St Anthony Foundation R 2000000 FMV