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ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME (EIN 42-0733472)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201301349349300150
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-14T00:10:45-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line150 South Sixth Street Suite 2800AddressLine1
CityMinneapolisCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN420733472EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1St Anthony Regional Hospital and Nursing HomeBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTANNameControl
Phone7127928246Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1311 South Clark Street PO Box 628AddressLine1
CityCarrollCity
StateIAState
ZIP Code51401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJohn MunsonName
TitleChief Financial OfficerTitle
Phone7127928246Phone
Date Signed2013-05-02DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKristina RasmussenName
PTINP00143920PTIN
Phone6123974000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGary P RiedmannNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1311 South Clark Street PO Box 628AddressLine1
CityCarrollCity
StateIAState
ZIP Code51401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts91662379GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.stanthonyhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1905YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionConsistently providing high quality healthcare services to meet patient and community needs.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees739TotalNbrEmployees
Total Nbr Volunteers478TotalNbrVolunteers
Total Gross UBI217TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year925626ContributionsGrantsPriorYear
Contributions Grants Current Year149934ContributionsGrantsCurrentYear
Program Service Revenue Prior Year56792216ProgramServiceRevenuePriorYear
Program Service Revenue CY64337847ProgramServiceRevenueCY
Investment Income Prior Year2593343InvestmentIncomePriorYear
Investment Income Current Year2835658InvestmentIncomeCurrentYear
Other Revenue Prior Year-173036OtherRevenuePriorYear
Other Revenue Current Year-423758OtherRevenueCurrentYear
Total Revenue Prior Year60138149TotalRevenuePriorYear
Total Revenue Current Year66899681TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year26747098SalariesEtcPriorYear
Salaries Etc Current Year30026394SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year27439579OtherExpensePriorYear
Other Expenses Current Year30280643OtherExpensesCurrentYear
Total Expenses Prior Year54189677TotalExpensesPriorYear
Total Expenses Current Year60310037TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5948472RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6589644RevenuesLessExpensesCY
Total Assets BOY122380058TotalAssetsBOY
Total Assets EOY126551178TotalAssetsEOY
Total Liabilities BOY25845594TotalLiabilitiesBOY
Total Liabilities EOY23117178TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY96534464NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY103434000NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSt. 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense53815774Expense
Grants3000Grants
Revenue63981180Revenue
DescriptionSt. 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, 2012 St. Anthony Regional Hospital and Nursing Home provided heath care services to approximately 2,346 inpatients, 71,472 outpatients, and 27,065 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 Statement 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 physical therapy. In the year ended June 30, 2012, St. Anthony serviced 10,923 in physical therapy, 7,721 in laboratory, and 8,297 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense3254404Expense
DescriptionAs 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense57070178TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109698NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees739NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledIAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1John R MunsonBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7127945115TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1311 South Clark StAddressLine1
CityCarrollCity
StateIAState
ZIP Code51401ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Gary McMinimee
Chairman0.30XX000
Fred Dolezal
Vice-Chairman0.30XX000
Sr Helen Elsbernd
Secretary0.30XX000
Tom Gronstal
Treasurer0.30XX000
Urban Knobbe
Board Member0.30X000
Wayne Seaman
Board Member0.30X000
Sr Rita Heires
Board Member0.30X000
Sr Romana Klaubauf
Board Member0.30X000
Art Neu
Board Member0.30X000
Sr Theresa Keller
Board Member0.30X000
Gary P Riedmann
CEO President0.30X382661065950
Edward H Smith Jr
Vice President0.30X19087408912
John Munson
CFO0.30X581190386
Nelson H Lo
Physician40.00327136012812X
Robert J Langenfeld
Physician40.0021667808583X
Dominick C Ervelli
Physician40.00197559011455X
Brian L Pratt
Physician40.0019042909699X
David P Nystrom
Physician40.0019015309756X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1753609TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation127553TotalOtherCompensation
Number Individuals GT100 K21NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Dell Marketing LP
PO Box 416634BostonMA022416634Computer Consulting Services1096265
Shared Medical Services Inc
PO Box 330Cottage GroveWI53527Imaging Services319130
Deloitte & Touche LLP
PO Box 7247-6446PhiladelphiaPA191706446Accounting Fees203430
Dr Jed Hagen
2313 Skyline DrCarrollIA51401Pathology Services127000
Corepoint Health LLC
3010 Gaylord ParkwayFriscoTX75034Computer Services116000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Related Organizations149934RelatedOrganizations
Total Contributions149934TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
Patient Svc Revenue6214003861969838619698
Medicare/Medicaid Pmts6214002532983925329839
Cafeteria Sales621400356450$356,450
Radiation Oncology Svc6214003164331643
Inc. from Partnership900004217217
FieldValueIRS element (for citing)
Total Program Service Revenue64337847TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column843472TotalRevenueColumn
Exclusion$843,472ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1441920Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1865678Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-423758Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-423758TotalRevenueColumn
Exclusion-$423,758ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities24421777Securities
Other467429Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities22558029Securities
Other338991Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1863748Securities
Other128438Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1992186TotalRevenueColumn
Exclusion$1,992,186ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column66899681TotalRevenueColumn
Related Or Exempt Function Income63981180RelatedOrExemptFunctionIncome
Unrelated Business Revenue217UnrelatedBusinessRevenue
Exclusion$2,768,350ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total3000Total
Program Services3000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total614314Total
Management And General614314ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total24136602Total
Program Services23191551ProgramServices
Management And General945051ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total358199Total
Program Services308866ProgramServices
Management And General49333ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3159959Total
Program Services3081529ProgramServices
Management And General78430ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1757320Total
Program Services1712804ProgramServices
Management And General44516ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total34090Total
Management And General34090ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total244048Total
Management And General244048ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3826148Total
Program Services3072659ProgramServices
Management And General753489ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total252499Total
Program Services29150ProgramServices
Management And General223349ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2805677Total
Program Services2681949ProgramServices
Management And General123728ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total408411Total
Program Services408411ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1415436Total
Program Services1414873ProgramServices
Management And General563ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total246921Total
Program Services211736ProgramServices
Management And General35185ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total911332Total
Program Services911332ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5557985Total
Program Services5557985ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total321296Total
Program Services279498ProgramServices
Management And General41798ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Medical Supplies109266321092663200
Bad Debts2257123225712300
Repair and Maintenance10667291019185475440
Miscellaneous expenses6316189544210

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total60310037Total
Program Services57070178ProgramServices
Management And General3239859ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2280808BOY
EOY1129952EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8821955BOY
EOY12434526EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY3BOY
EOY3EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1405643BOY
EOY1509025EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY151835BOY
EOY330280EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis110693019LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec45450350LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY64877448BOY
EOY65242669EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY35118342BOY
EOY37152099EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4964399BOY
EOY1149432EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4759625BOY
EOY7603192EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY122380058BOY
EOY126551178EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5100620BOY
EOY5275477EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY18816606BOY
EOY17160848EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY449528BOY
EOY42309EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1478840BOY
EOY638544EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25845594BOY
EOY23117178EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY96166987BOY
EOY101551358EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY367477BOY
EOY1782642EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY100000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY96534464BOY
EOY103434000EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY122380058BOY
EOY126551178EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses6589644ReconcilationRevenueExpenses
Reconcilation Other Changes309892ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$8,178OtherActivitiesAmount
Total Lobbying Expenditures IIB8178TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationSt. Anthony Hospital is a member of Iowa Hospital Association. A percentage of the membership dues paid to IHA is related to lobbing activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance995357BeginningOfYearBalance
Contributions3662163Contributions
Investment Earnings Or Losses-30442InvestmentEarningsOrLosses
Grants Or Scholarships3500GrantsOrScholarships
Other Expenditures1205OtherExpenditures
End Of Year Balance4622373EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance680736BeginningOfYearBalance
Contributions190774Contributions
Investment Earnings Or Losses129468InvestmentEarningsOrLosses
Grants Or Scholarships3500GrantsOrScholarships
Other Expenditures2121OtherExpenditures
End Of Year Balance995357EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance362632BeginningOfYearBalance
Contributions265297Contributions
Investment Earnings Or Losses55307InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
End Of Year Balance680736EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance207355BeginningOfYearBalance
Contributions196019Contributions
Investment Earnings Or Losses-33742InvestmentEarningsOrLosses
Grants Or Scholarships7000GrantsOrScholarships
End Of Year Balance362632EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.56000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.44000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis756466OtherCostOrOtherBasis
Book Value756466BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis78690205OtherCostOrOtherBasis
Depreciation27584504Depreciation
Book Value51105701BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis27546437OtherCostOrOtherBasis
Depreciation16248355Depreciation
Book Value11298082BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3699911OtherCostOrOtherBasis
Depreciation1617491Depreciation
Book Value2082420BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings65242669TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Deferred Compensation Investments638544
Beneficial interest in net assets of the Foundation4382642
Investment in Joint Venture2304137
Other277869
FieldValueIRS element (for citing)
Total Book Value Other Assets7603192TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDeferred CompensationDescription
Amount$638,544Amount
FieldValueIRS element (for citing)
Total Of Amounts638544TotalOfAmounts
Total Revenue66899681TotalRevenue
Total Expenses60310037TotalExpenses
Excess Or Deficit For Year6589644ExcessOrDeficitForYear
Net Unrealized GL On Investments-998311NetUnrealizedGLOnInvestments
Other$1,308,203OtherAmount
Total Adjustments309892TotalAdjustments
Excess Or Deficit Per FS6899536ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt69152989TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-998312NetUnrealizedGainsInvestments
Other Revenues3251620OtherRevenues
Revenue Not Rptd F9902253308RevenueNotRptdF990
Revenue Subtotal66899681RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99066899681TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt62253453TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal62253453ExpensesSubtotal
Other Expenses Not Included-1943416OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt-1943416ExpensesNotRptdOnFinStmt
Total Expenses Per Form99060310037TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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: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, 2012 and 2011. The Hospital is engaged in certain activities that result in unrelated business income.
Part XI, Line 8 - Other Adjustments:Transfer to St. Anthony Foundation for Op. cash requirements -206,745. Change in beneficial interest of net assets of Foundation 1,515,165. Income from Partnerships -217. Total to Schedule D, Part XI, Line 8: 1,308,203.
Part XII, Line 2d - Other Adjustments:Rental expenses 1,865,678. Realized loss on sale of assets -128,438. Change in beneficial interest of net assets of Foundation 1,515,165. Income from Partnerships -217. Miscellaneous Adjustment -568.
Part XIII, Line 4b - Other Adjustments:Rental expenses -1,865,678. Transfer to St. Anthony Foundation for Op. Cash Requirements -206,744. Realized loss on sale of assets 128,438. Miscellaneous Adjustment 568.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense864628TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense864628NetCommunityBenefitExpense
Percent Of Total Expense0.01430PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4416675TotalCommunityBenefitExpense
Direct Offsetting Revenue2980111DirectOffsettingRevenue
Net Community Benefit Expense1436564NetCommunityBenefitExpense
Percent Of Total Expense0.02380PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5281303TotalCommunityBenefitExpense
Direct Offsetting Revenue2980111DirectOffsettingRevenue
Net Community Benefit Expense2301192NetCommunityBenefitExpense
Percent Of Total Expense0.03810PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense184289TotalCommunityBenefitExpense
Direct Offsetting Revenue49770DirectOffsettingRevenue
Net Community Benefit Expense134519NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense297538TotalCommunityBenefitExpense
Direct Offsetting Revenue5000DirectOffsettingRevenue
Net Community Benefit Expense292538NetCommunityBenefitExpense
Percent Of Total Expense0.00490PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense7579162TotalCommunityBenefitExpense
Direct Offsetting Revenue4977949DirectOffsettingRevenue
Net Community Benefit Expense2601213NetCommunityBenefitExpense
Percent Of Total Expense0.04310PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense224102TotalCommunityBenefitExpense
Direct Offsetting Revenue72899DirectOffsettingRevenue
Net Community Benefit Expense151203NetCommunityBenefitExpense
Percent Of Total Expense0.00250PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8285091TotalCommunityBenefitExpense
Direct Offsetting Revenue5105618DirectOffsettingRevenue
Net Community Benefit Expense3179473NetCommunityBenefitExpense
Percent Of Total Expense0.05270PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense13566394TotalCommunityBenefitExpense
Direct Offsetting Revenue8085729DirectOffsettingRevenue
Net Community Benefit Expense5480665NetCommunityBenefitExpense
Percent Of Total Expense0.09080PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense18085TotalCommunityBuildingExpense
Net Community Building Expense18085NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense21117TotalCommunityBuildingExpense
Direct Offsetting Revenue15603DirectOffsettingRevenue
Net Community Building Expense5514NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense5178TotalCommunityBuildingExpense
Net Community Building Expense5178NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense44380TotalCommunityBuildingExpense
Direct Offsetting Revenue15603DirectOffsettingRevenue
Net Community Building Expense28777NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,019,820BadDebtExpenseAmount
Amount Reimbursed By Medicare17501954AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare19262968CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1761014MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1St Anthony Regional HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1311 South Clark St Box 628AddressLine1
CityCarrollCity
StateIAState
ZIP Code51401ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1St Anthony Regional HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent399.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
St Anthony Regional Hospice
311 South Clark StreetCarrollIA51401Hospice services
St Anthony Regional Hospital
311 South Clark StreetCarrollIA51401Dialysis services
St Anthony Regional Home Health Agency
311 South Clark StreetCarrollIA51401Home Health Services
St Anthony Regional Hospital
311 South Clark StreetCarrollIA51401Psychiatric services
Wall Lake Medical Clinic
311 First StWall LakeIA51466Rural Health Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 health services. Subsidized health services are reported using departmental cost from the 2012 cost report.
Part I, Line 7g: St. Anthony Regional Hospital has eight physician clinics that are included in subsidized health services where the cost exceed the reimbursements.
Part I, L7 Col(f): Bad debt expense of 2,257,123 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 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. The bad debt at cost amount is calculated with the same cost to charge ratio used for the charity care at cost, time the estimated bad debt charges.
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 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 V, Section B, Line 19d: 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.St. Anthony Regional Hospital
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 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 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 survey was placed in the 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 receive 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 to work groups. These needs will be assigned to committees and assessed over the next three years and action plans will be developed. Reports will be sent to the state to report 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 population of 21,500. 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.
IAReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Gary P Riedmann
3003670713840109100553240106260448611000
Edward H Smith Jr
171055019421039800089120199786000
Nelson H Lo
3237210107802337000128120339948000
Robert J Langenfeld
204038066160602400085830225261000
Dominick C Ervelli
1947850134801426000114550209014000
Brian L Pratt
1722070159001663200096990200128000
David P Nystrom
1763730226301151700097560199909000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 4bSt. Anthony Hospital and Nursing Home had an IRC Section 457F Deferred Compensation Plan. The following participants of the plan received payments during the year: Gary P. Riedmann: $0
Part I, Line 7In 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.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancingCUSIP NumberCUSIPNumber
Carroll County Iowa
4260043232003-09-2910000000Construction of Hospital Addition000
Carroll County Iowa
4260043232006-11-226672573Construction of Hospital Addition000144813AB8
City of Carroll Iowa
4260043222006-11-225402508Construction of Hospital Addition000145181CK7

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetired
10445730352201041051020060011
6969080133451683562920090011
56370701072545529816200900111445000

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00000.000000.000000.000001
00000.000000.000000.000001
00000.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied
(no name)
000000
Citi Group
0001001.9000000000001
Citi Group
0001001.9000000000001

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
ExplanationThe 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.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Mid Iowa InsuranceBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipFred Dolezal - VPRelationship
Amount Of Transaction299369AmountOfTransaction
Description Of TransactionInsuranceDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
ExplanationMid Iowa Insurance: Fred Dolezal Vice President, Insurance services for St. Anthony Regional Hospital and Nursing Home.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The 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 7aThe 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 7bAll 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 11St. 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 12cThe 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 15At 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 19St. 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 VII:Gary P. Reidmann, CEO, John Munson, CFO, and Edward H. Smith Jr., Vice President, 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 5:Net unrealized losses on investments: -998,311. Transfer to St. Anthony Foundation for Op. cash requirements -206,745. Change in beneficial interest of net assets of Foundation 1,515,165. Income from Partnerships -217. Total to Form 990, Part XI, Line 5: 309,892.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
St Anthony Foundation
311 South Clark Street PO Box 628CarrollIA51401421419695FundraisingIA501(c)(3)Line 11, Type I: 509St Anthony Regional Hospital1
Franciscan Sisters of Perpetual Adoration
912 Market StreetLa CrosseWI546014782390806386Religious OrderWI501(c)(3)Line 1: 170(b)(1)(a)0N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
St Anthony Foundation
C149934FMV
St Anthony Foundation
O206745FMV
St Anthony Foundation
Q2500000FMV