2011-05-10T10:49:10-05:00 2010-06-30 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2009-07-01 420733472 St Anthony Regional Hospital and Nursing Home STAN 7127928246 311 South Clark St PO Box 628 Carroll IA 51401 Edward H Smith Jr 7127945230 2011-05-03 6123974000 2009 2016-02-24 21:20:13Z Gary P Riedmann 311 Clark St PO Box 628 Carroll IA 51401 62386673 0 X www.stanthonyhospital.org X 1905 IA Consistently providing high quality healthcare services to meet patient and community needs. 9 7 733 437 -1725 -1725 813912 678649 53538840 52491546 -1177385 1307070 -394703 -326877 52780664 54150388 3500 0 26666832 26355471 0 0 24866812 25670975 51533644 52029946 1247020 2120442 110642994 113486595 28926100 26907443 81716894 86579152 St. Anthony Regional Hospital is a Catholic healthcare organization sponsored by the Franciscan Sisters of Perpetual Adoration and is a regional leader in providing consistently high quality healthcare services responsive to patient and community needs. 0 0 47123923 52491546 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, 2010, St. Anthony Regional Hospital and Nursing Home provided health care services to approximately 2,454 inpatients, 68,611 outpatients and and 23,986 clinic visits. St. Anthony Regional Hospital provided services for 1,839 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 for continuationSt. Anthony Regional Hospital provides services of cardiac rehabilitation, dialysis, hospice care, laboratory, observation, chemotherapy, pathology, radiology, respiratory therapy, physical therapy, occupational therapy, speech therapy, diabetes, and surgery services. St. Anthony Regional Hospital's largest patient service area is physical therapy. In the year ended June 30, 2010, St. Anthony serviced 9,944 patients in physical therapy, 8,667 in laboratory, and 7,664 in radiology. The activities pursued by St. Anthony Regional Hospital and Nursing Home in the provision of health care services are consistent with its tax exempt purpose. 2561010 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. 49684933 1 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 80 0 1 733 1 1 1 0 0 0 0 0 0 0 0 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA X Edward H Smith Jr 7127925246 311 S Clark St Carroll IA 51401 Gary McMinimee 0.30 X 0 0 0 Arthur A Neu 0.30 X X 0 0 0 Sr Romana Klaubauf 0.30 X 0 0 0 Jedd Hagen MD 40.00 X 128500 0 0 Tom Gronstal 0.30 X 0 0 0 Sr Helen Elsbernd 0.30 X 0 0 0 Sr Rita Heires 0.30 X 0 0 0 Fred Dolezal 0.30 X X 0 0 0 Sr Patricia Ann Shepler 0.30 X X 0 0 0 Gary P Riedmann 40.00 X 348750 0 62678 Edward H Smith Jr 40.00 X 180441 0 10162 Nelson H Lo 40.00 X 317429 0 15125 Dominick C Ervelli 40.00 X 189185 0 12411 John L Knorr 40.00 X 184572 0 6389 David C Peterson 40.00 X 175971 0 10017 Michael D Carabine 40.00 X 178378 0 10332 1703226 0 127114 21 0 1 0 Acute Care Inc PO Box 4130 Des Moines IA 50333 Physician Coverage Emergency Room 1005025 Shared Service Systems 1725 S 20th St Omaha NE 681083889 Laundry Service Fees 711217 Shared Medical Services Inc (ZBL Imagin PO Box 330 Cottage Grove WI 53527 Imaging Services 430110 Siouxland Community Blood Bank 1019 Jones Street Sioux City IA 51102 Blood Service Fees 220657 Horty Elving Associates 505 E Grant St Minneapolis MN 554041490 Architect Fees 210684 11 623265 55384 678649 Patient Service Rev 621400 32740512 32740512 Medicare/Medicaid Pmts 621400 18954605 18954605 Radiation Oncology Ser 621400 522383 522383 Cafeteria Sales 621400 275771 275771 Income from Partnershi 900004 -1725 -1725 52491546 850427 850427 1213751 1540628 -326877 -326877 -326877 7145898 6402 6613772 81885 532126 -75483 456643 456643 54150388 52217500 -1725 1255964 3500 3500 642439 128500 513939 21343101 20737574 605527 218415 205830 12585 2601888 2466520 135368 1549628 1468403 81225 34791 34791 163329 163329 3394787 2953014 441773 184581 63431 121150 1428936 1328021 100915 350749 350749 556432 556432 268590 228010 40580 1054783 1054783 5064447 5064447 327154 278177 48977 Medical Supplies 9610704 9610704 Bad Debts 1910005 1910005 Repair and Maintenance 1318554 1274754 43800 Miscellaneous 3133 2079 1054 52029946 49684933 2345013 0 1594616 2520011 9533253 9187773 171 116 1245977 1114879 138850 149831 111542763 46468287 66485524 65074476 23412770 27762657 4365411 3231168 3866422 4445684 110642994 113486595 5455726 5081712 21926641 20406268 544264 215755 999469 1203708 28926100 26907443 X 81300014 86016220 416880 562932 81716894 86579152 110642994 113486595 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8047 8047 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: St. Anthony Regional Hospital is a member of the Iowa Hospital Association. A percentage of the membership dues paid to IHA is related to lobbying activities. 362632 265297 55307 2500 680736 207355 196019 -33742 7000 362632 0.85000 0.15000 0.00000 0 1 1 616301 616301 79419425 25207825 54211600 27236585 19891095 7345490 4270452 1369367 2901085 65074476 Deferred Compensation 1203708 1203708 54150388 52029946 2120442 2792617 -50801 2741816 4862258 58706892 2792617 1763887 4556504 54150388 0 54150388 53844634 0 53844634 -1814688 -1814688 52029946 Part V, Line 4: Description of Intended Use of Endowment Funds: 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: 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, 2010 and 2009. The Hospital is engaged in certain activities that result in unrelated business income. Part XI, Line 8: Change in beneficial interest of net assets of Foundation 146,051 Transfer to St. Anthony Foundation for Op. Cash Requirements (198,577) Income from Partnerships 1,725 Part XII, Line 2d: Rental expenses 1,540,628 Realized loss on sale of assets 75,483 Change in beneficial interest of net assets of Foundation 146,051 Income from Partnerships 1,725 Part XIII, Line 4b: Rental expenses (1,540,628) Transfer to St. Anthony Foundation for Op. Cash Requirements (198,577) Realized loss on sale of assets (75,483) 1 1 X 1 X 1 X 1 1 1 0 1 1 560000 560000 0.01120 3806634 2678835 1127799 0.02250 4366634 2678835 1687799 0.03370 115672 49410 66262 0.00130 235281 5000 230281 0.00460 4522672 2676440 1846232 0.03680 185018 60405 124613 0.00250 5058643 2791255 2267388 0.04520 9425277 5470090 3955187 0.07890 14944 14944 0.00030 41697 7048 34649 0.00070 4453 4453 0.00010 2596 2596 0.00010 63690 7048 56642 0.00120 1 899844 13934487 17260177 -3325690 X 1 1 St Anthony Regional Hospital

311 S Clark Street PO Box 628 Carroll IA 51401

X X X St Anthony Regional Hospice

318 South Maple St Carroll IA 51401

X HOSPICE St Anthony Regional Hospital

311 S Clark Street PO Box 628 Carroll IA 51401

X DIALYSIS St Anthony Regional Home Health Agengy

311 S Clark Street PO Box 628 Carroll IA 51401

X HOME HEALTH St Anthony Regional Hospital

311 S Clark Street PO Box 628 Carroll IA 51401

X PSYCH Wall Lake Medical Clinic

311 First St Wall Lake IA 51466

RHC Part I, Line 3c: The patients 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 less than or equal to the FPG as follows, 201% - 250% for a 75% discount, 251%-300% for 50% discount, and 301%-399% for a 25% discount. Part I, Line 6a: Part I, Line 7: The cost-to-charge ratio method was used when calculating the amounts reported on Part I, Line 7, with the exception of Line 7g, Subsidized Health Services. Subsidized Health Services are reported using the departmental costs from the 2010 Medicare cost report. Part I, Line 7g: St. Anthony Regional Hospital has eight physician clinics that are included in subsidized health services where the costs exceed the reimbursements. Part I, Line 7f: Bad debt expense of 1,910,005 was subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f).Part III, Line 3: St. Anthony Regional Hospital works with those qualifying for charity care along every step of the process including accepting application 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 the necessary information it is impossible to know their reason for not cooperating and therefore know whether they may have qualified 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 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 historical bad debt written off. The bad debt at cost amount is calculated with the same cost to charge ratio used for the charity care at cost, times the estimated bad debt charges. Part III, Line 8: The amount of the Medicare short fall on line 7 should be included in 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 form 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 quality 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 povery 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 V: In addition to the facilities listed, St. Anthony Regional Hospital has a long term care attached nursing home and alzheimers unit. St. Anthony Regional Hospital also has 8 physican medical clinics. Part VI, Line 2: The hospital and county perform 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 their daily work 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 survey was placed in the Carroll County website and hard copies were placed in the courthouse and public library. There was a link to the web and survey on the St. Anthony Hospital web site. The goal was to recieve 300 surveys and just under 300 were received. The survey data results were reviewed and top areas of concern identified for the county. The community partners were invited to a meeting to review needs and assigned the to work groups. These needs will be assigned to committees and assessed over the next 3 years and action plans will be developed. Reports will be sent to the state to report progress and action. Part VI, Line 3: The financal 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 population of 10,000, which is in Carroll County with a population of approximatedly 21,500. St. Anthony Regional Hospital also serves portions of 6 surrounding counties within a radius of 50 miles. St. Anthony Regional Hospital operates 5 satellite physician clinics in the service area, in addition to the 3 physician clinics included in the Hospital. Part VI, Line 5: The hospital CEO and CFO participate in the Carroll Area Development board that is active in workforce development. The hospital emergency room director attends regional meetings on disaster readiness and we also provide emergency medical equipment to the community. The CEO is a board member of the Iowa Hospital Association board of directors. There are managers of the hospital that serve on the area community college advisory boards local health boards. Part VI, Line 6: St. Anthony Regional Hospital has demonstrated a commitment to promoting heatlh care to further its exempt purpose providing quality health care in the community and surrounding countries for one hundred and five years. The majority of the hospital's board members are from local businesses and reside in the community and are committed to promoting health care in the community. The hospital's medical staff consists of 28 active staff, 5 associate staff in the community and over 100 courtesy staff from outside community. St. Anthony Regional Hospital is a regional hospital provider and is committed to providing health care to the community. IA X X X X 0 1 0 0 0 0 0 1 0 Gary P Riedmann 297440 0 32718 0 18592 0 59428 0 3250 0 411428 0 0 0 Edward H Smith Jr 173000 0 6500 0 941 0 5486 0 4676 0 190603 0 0 0 Nelson H Lo 315242 0 0 0 2187 0 9199 0 5926 0 332554 0 0 0 Dominick C Ervelli 187917 0 0 0 1268 0 5835 0 6576 0 201596 0 0 0 John L Knorr 182486 0 0 0 2086 0 5501 0 888 0 190961 0 0 0 David C Peterson 173346 0 0 0 2625 0 5341 0 4676 0 185988 0 0 0 Michael D Carabine 171951 0 0 0 6427 0 5018 0 5314 0 188710 0 0 0 Part I, Line 4a Part I, Line 4b: St. Anthony Regional Hospital and Nursing Home had an IRC Section 457(f) Deferred Compensation Plan. The following participants of the plan received payments during the year: Gary P. Riedmann: $0 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 percentage of 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. Carroll County Iowa 426004323 NoneAvail 2003-09-29 10000000 Construction of Hospital Addition 0 0 Carroll County Iowa 426004323 144813AB8 2006-11-22 6672573 Construction of Hospital Addition 0 0 City of Carroll Iowa 426004322 145181CK7 2006-11-22 5402508 Construction of Hospital Addition 0 0 10445730 35220 10410510 10410510 2006 0 0 1 1 6969080 119276 6849804 6849804 2009 0 0 1 1 5637865 96573 5541292 5541292 2009 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 Citi Group 2.000000000000 1 0 0 0 0 0 1 Citi Group 2.000000000000 1 0 0 Mid-Iowa Insurance Fred Dolezal: Vice President 301876 Insurance: Mid-Iowa Insurance provided insurance services for St. Anthony Regional Hospital 0 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 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 sized organizations. The executive committee then determines the annual compensation for the CEO, other officers, and key employees for total board approval. Form 990, Part VI, Section C, line 19 St. Anthony Regional Hospital 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 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 VII: Jedd Hagen, board member, is a pathologist at St. Anthony Regional Hospital. Gary P. Riedmann, CEO, and Edward H. Smith, Jr., CFO, hold positions at both St. Anthony Regional Hospital and St. Anthony Foundation. On average, 40 hours per week are spent completing work within these roles. Form 990, Part XI, Line 2c The Board of Directors is responsible for overseeing the audit of the financial statements as well as the selection of the independent accountants used to complete the audit. This process remains consistent with prior years. Schedule R, Part V, Line 2: Transactions between related organizations are computed using the cost method to determine value. St Anthony Foundation 311 S Clark Street PO Box 628 Carroll IA 51401 421419695 Fundraising IA 501(C)(3) 11, Type I St Anthony Regional Hospital and Nursing Home Franciscan Sisters of Perpetual Adoration 912 Market St La Crosse WI 546014782 390806386 Religious Order WI 501(C)(3) 1 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 St Anthony Foundation C 623265 St Anthony Foundation O 198577