2026-05-04T14:09:17-05:00 2025-06-30 450250958 Eide Bailly LLP 18081 Burt St Ste 200 Omaha NE 680224722 990 2024-07-01 420733472 St Anthony Regional Hospital and Nursing Home STAN 7127945246 311 South Clark Street PO Box 628 Carroll IA 51401 Eric Salmonson CFO/Vice President 7127945246 2026-05-01 1 1 Wendy R Cooley CPA P01523804 4023302660 2026-05-01 2024 2025-03-06 01:10:19Z Allen Anderson 311 South Clark Street PO Box 628 Carroll IA 51401 201739140 0 0928 X www.stanthonyhospital.org X 1905 IA Consistently providing high quality healthcare services to meet patient and community needs. 11 10 878 198 0 0 5035967 1411406 102774653 123797099 6170406 5363167 -273175 339372 113707851 130911044 229430 303205 0 0 49763404 51400912 0 0 0 58470994 66208296 108463828 117912413 5244023 12998631 212933809 221335527 49780254 40525563 163153555 180809964 X St. Anthony Regional Hospital is inspired by faith and committed to excellence. We are dedicated to improving the health of the people we serve. We will lead in providing high quality, high value healthcare services responsive to the needs of our patients and the region. We are committed to the health ministry of our sponsors, St. Anthony Ministries. 0 0 112119888 303205 123826915 St. Anthony Regional Hospital and Nursing Home, located in Carroll, Iowa, operates an acute care hospital, a nursing care center, several medical clinics, retirement housing called Orchard View, and assisted living called Garden View. The Hospital is a 49-bed Critical Access Hospital. St. Anthony Nursing Home has 79 beds. In the year ended June 30, 2025, St. Anthony Regional Hospital and Nursing Home provided health care services to approximately 1,591 inpatients, 74,795 outpatients, and 39,961 clinic visits. The Hospital provided services for 1,334 acute care inpatients, and provided psychiatric, swing bed, and nursing home services for the remainder of inpatients. Outpatient services were provided to patients through ancillary departments, emergency room, and clinics. (Continued on Schedule O)St. Anthony Hospital provides services of cardiac rehabilitation, dialysis, hospice care, laboratory, observation, chemotherapy, pathology, radiology, respiratory therapy, physical therapy, occupational therapy, speech therapy, diabetes, medical oncology, radiation therapy, and surgical services. St. Anthony's largest patient service area is physical therapy. In the year ended June 30, 2025, St. Anthony services 10,335 patients in physical therapy, 7,121 in emergency room, and 7,287 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.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.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of amounts, they are not reported as revenue. The estimated cost of providing these services was $1,437,000 for the year ended June 30, 2025, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. For classification of accounts as charity care, the Hospital uses the "exhaust all possible sources" of payment standard, as referenced in the Hill Burton program. Although the Hospital no longer has a HillBurton obligation, they continue to use this standard when determining if an account is eligible for charity care. The Hospital exercises sound business practices and makes reasonable efforts to collect accounts; therefore, any unpaid balance that the Hospital has exhausted their collection efforts on is subsequently classified as charity care. 112119888 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 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 170 0 1 878 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Eric Salmonson 7127945246 311 South Clark Street PO Box 628 Carroll IA 51401 Jeff Scharfenkamp Chairperson 0.30 0.00 X X 0 0 0 Matt Greteman Treasurer 0.30 0.30 X X 0 0 0 Sr Rose Elsbernd Secretary 0.30 0.00 X X 0 0 0 Deb Auen Board Member 0.30 0.30 X 0 0 0 Nick Badding Board Member 0.30 0.00 X 0 0 0 Karl Eischeid DDS Board Member 0.30 0.00 X 0 0 0 Sr Theresa Keller Board Member 0.30 0.30 X 0 0 0 Jeff Koster Board Member 0.30 0.00 X 0 0 0 Sr Joanne Moeller Board Member 0.30 0.00 X 0 0 0 Sr Michelle Pettit Board Member 0.30 0.00 X 0 0 0 Carly Quam DO Chief of Staff 0.30 0.00 X 0 0 0 Allen Anderson CEO/President 40.00 0.30 X 321184 0 45884 Eric Salmonson CFO/Vice President 40.00 0.30 X 37403 0 27918 Lindsey Pogge DO Family Medicine 40.00 0.00 X 391402 0 22979 Danielle Coffey DO Family Medicine 40.00 0.00 X 431572 0 37482 Brian Boes MD Neurology 40.00 0.00 X 465107 0 44395 Richard Goding MD Orthopedics 40.00 0.00 X 627456 0 53933 Amy Canuso DO Mental Health 40.00 0.00 X 389866 0 41959 2663990 0 274550 67 0 1 0 Medical Oncology and Hematology 1221 Pleasant St Suite 100 Des Moines IA 50309 Oncology Physician Services 1383838 Fusion Medical PO Box 30131 Omaha NE 68103 Contract Labor 1047391 Michael John Dirkx DO 2343 Skyline Dr Carroll IA 51401 Contract Labor 344718 Park Place International LLC DBA Cloudwa Dept CH 19800 Palatine IL 600559800 Software IT support 336739 Prime Time Healthcare LLC 15380 Weir Street Omaha NE 68137 Contract Labor 320311 11 29500 865513 402368 114025 1411406 Patient Service Revenue 621110 119775290 119775290 Assisted Living 623000 2073900 2073900 Retirement Housing 623000 591664 591664 Cafeteria Revenue 722514 390152 390152 966093 966093 123797099 2273499 2273499 729556 420000 309556 309556 309556 70798155 2699609 67920658 2487438 2877497 212171 3089668 3089668 Insurance Proceeds 900099 29816 29816 29816 130911044 123826915 0 5672723 X 303205 303205 281953 281953 41748607 40155143 1593464 1151003 1123300 27703 5394768 5190435 204333 2824581 2702048 122533 183425 183425 45970 45970 10182 10182 16384881 15446252 938629 198236 1141 197095 1464522 1425675 38847 1529374 1523020 6354 365407 295402 70005 922705 729150 193555 8235504 6485409 1750095 845970 845970 Medical Supplies 26111681 26111583 98 Repairs and Maintenance 4005070 3937391 67679 Tax Assessment 3612232 3612232 Dues and Subscriptions 1433542 1372937 60605 859595 859595 117912413 112119888 5792525 0 3247273 1107670 180086 127131 26090098 17874183 97500 484480 1000 0 2790459 3036144 843518 1087272 180392302 114035607 72110601 66356695 79632470 101801357 27940804 29460595 212933809 221335527 8887686 8880538 1296221 990624 5400000 2816197 26718938 25432057 7477409 2406147 49780254 40525563 X 138508930 154220313 24644625 26589651 163153555 180809964 212933809 221335527 X 12998631 2712752 1945026 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10182 10182 0 Part II-B, Line 1: St. Anthony Regional Hospital and Nursing Home paid dues to the Iowa Hospital Association and the Catholic Health Association. A portion of the dues were used for lobbying activities. 25464734 68808 3007420 766304 27774658 23467384 260568 3695066 20800 1937484 25464734 21094463 362476 2538624 43550 484629 23467384 23500033 255947 -2620802 43550 -2835 21094463 19046674 868052 6253780 15900 2652573 23500033 0.00000 0.03600 0.96400 0 1 1 989471 989471 123652714 72586790 51065924 48466429 38267669 10198760 7283688 3181148 4102540 66356695 Beneficial Interest in net asset of St. Anthony Foundation 26589651 Deferred compensation investments 990624 Right to use assets 49936 Estimated third-party payor settlements 448245 Investment in Burtik Dialysis, LLC 1121878 Split dollar life insurance receivable 260261 29460595 Finance lease liability 1716189 Operating lease liability 49936 Estimated third-party payor settlements 640022 2406147 X 134043796 2712752 420000 3132752 130911044 0 130911044 118332413 420000 420000 117912413 0 117912413 Part V, Line 4: All restricted endowed funds held at the St. Anthony Foundation are used for the benefit of St. Anthony Regional Hospital and Nursing Home and for scholarships. Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Rental expenses 420,000. Part XII, Line 2d - Other Adjustments: Rental expenses 420,000. 1 1 X 1 X 1 X 1 1 1 0 1 1 1437000 1437000 0.01220 1437000 1437000 0.01220 193009 193009 0.00160 785509 785509 0.00670 13644706 10884581 2760125 0.02340 148222 46960 101262 0.00090 14771446 10931541 3839905 0.03260 16208446 10931541 5276905 0.04480 1 2975466 248154 34963879 34902759 61120 X 1 1 1 1 St Anthony Regional Hospital and Nursing Home 311 South Clark St Carroll IA 51401 www.stanthonyhospital.org 14009OH X X X X 5 provider based clinics St Anthony Regional Hospital and Nursin 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X See supplemental info. X 1 24 1 See supplemental info. 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See supplemental info. X See supplemental info. X See supplemental info. X X X X X X 1 X 0 X X X X 1 X 0 0 St. Anthony Regional Hospital and Nursing Home Part V, Section B, Line 5: The CHNA process began in the Spring of 2025 with the collection of quantitative and qualitative data. A significant number of community leaders representing educators, health care professionals, and health and human services leaders in the St. Anthony service area participated in the study. Data was collected from a variety of sources as part of the assessment. Demographics, health outcomes, and chronic disease prevalence were gathered from local, state, and Federal databases and were analyzed as part of a robust secondary data compilation. High-risk behaviors, behavioral outcomes, and societal matters were key themes that resonated within the collection process. The comprehensive community health needs assessment resulted in the identification of the St. Anthony community health needs for 2025. St. Anthony Regional Hospital and Nursing Home Part V, Section B, Line 11: The most recent Community Health Needs Assessment was conducted in fiscal year 2025. The following needs were identified and will be addressed over the next 3 years. Due to timing of the completion of this needs assessment no needs were addressed during fiscal year 2025 except needs that overlapped with the prior community health needs assessment.1. Behavoral Health2. Chronic Disease Management and Prevention3. Live HealthyThe following significant health needs were identified in the 2021 Community Health Needs Assessment. All needs were addressed. Fiscal year 2025 updates are below.Mental Health Goal 1. Decrease depression among children, youth, and adults.Strategy 1.1: Provided depression screening in primary care settings, with systems in place to ensure accurate diagnoses, effective treatment and appropriate follow up.Strategy 1.2 Implemented Collaborative Care for the Management of Depressive Disorders.Strategy 1.3 Integrated behavioral health and primary care services.Goal 2. Reduce Suicide RiskStrategy 2.1 Train healthcare providers, educators, and community volunteers in Mental Health First Aid.Strategy 2.2 Implemented the "Zero Suicide in Healthcare" framework (organizational assessment, training, consultation).Goal 3. Promote mental health and social cohesion in community settings.Strategy 3.1 Iowa "Connections Matter" Initiative (Connections Matter in Health Care component).Strategy 3.2 Supported group-based parent education and support.CancerGoal 1. Increase Cancer Screenings Strategy 1.1 Implemented Prostate Specific Antigen (PSA) Screening Campaign.Strategy 1.2 Implemented Multicomponent Interventions to Increase Cancer Screening: Increased community demand (education, incentives, reminders, media): Increased community access. Increased Provider Delivery (reminders, incentives, feedback).Goal 2. Reduce Cancer MortalitiesStrategy 2.1 Provided anticoagulation therapy (aspirin) to prostate cancer patients.Strategy 2.2 Vaccinated cancer patients against infectious diseases, including influenza and pneumonia.Strategy 2.3 Implemented risk assessment for breast cancer in primary care settings and provide tailored recommendations based on individual risk (including use of chemoprevention).Strategy 2.4 Educated patients (and the families of adolescent patients) about the importance of the HPV vaccine.Goal 3: Increase patient access and retention through support services.Strategy 3.1 Incorporated Patient Navigators into Cancer Center care team.Strategy 3.2 Provided psychosocial care for patients with cancer and their families.Obesity/Live Healthy Goal 1. Increase daily physical activity among children, youth and adults.Strategy 1.1 Used Point of Decision Prompts for Physical Activity in healthcare and community settings.Strategy 1.2 Provided Exercise "Prescriptions" in primary care and other healthcare settings.Strategy 1.3 Promoted community-based Social Support for Physical ActivityGoal 2. Increase consumption of fruits and vegetables.Strategy 2.1 Developed school-based fruit and vegetable gardens and garden based nutrition education.Strategy 2.2 Provided fruit and vegetable incentives for low-income patients (vouchers, coupons, etc.). Goal 3. Increase diabetes prevention and management.Strategy 3.1 Used Text Message Based Health Interventions.Strategy 3.2 Promoted use Type2 Diabetes Self-Management Mobile App.Substance UseGoal 1. Reduce Risky and underage alcohol use.Strategy 1.1 Implemented CDC Risky Alcohol Use Screening and Brief Interventions in Primary Care Settings (for youth and adults).Strategy 1.2 Supported universal school-based alcohol prevention programs (lesson plans, prevention education, alcohol free fundraising policies, peer support, life skills training,etc.).Strategy 1.3 Promoted enhanced enforcement to prevent underage access to alcohol (responsible beverage sales training, decoys/shoulder taps, social host ordinances, etc.).Goal 2. Reduce Alcohol Impaired Driving Strategy 2.1 Implemented media campaign against alcohol impaired driving.Strategy 2.2 Implemented "Every 15 Minutes" program in local high schools.Goal 3. Reduce of tobacco products Strategy 3.1 Implemented cell phone-based tobacco cessation program.Strategy 3.2 Implemented social media and media campaigns against use of tobacco products.Strategy 3.3 Expanded promotion of Quit Line to reach at risk populations.Strategy 3.4 Promoted smokefree workplaces, shared public spaces and multiunit housing.Strategy 3.5 Reduced or eliminated copayments for tobacco cessation services.Women's HealthGoal 1: Improved access to quality health services that enhance the overall maternal health for childbearing families in the service region.Strategy 1.1 Increased knowledge of services available to child-bearing families within the service area. Strategy 1.2 Increased facilitation of childbearing families into support services within the St. Anthony service area. Goal 2: Facilitated return to health services with local providers following medical care within St. Anthony for childbearing family.Strategy 2.1 Identify points of contact with local hospitals, providers, and public health entities within the local community of childbearing families.Strategy 2.2 Developed formal process of care coordination activities to facilitate communication between Birth Place medical staff and local providers.Goal 3: Decreased the number of child abuse and unintentional injury rates within the St. Anthony service area.Strategy 3.1 Maintained efforts aimed at prevention of child abuse. Strategy 3.2 Increased access to services for women experiencing post-partum depression.Goal 4: Provide access to high quality obstetrical care to child-bearing families.Strategy 4.1 Reduced primary C-section rates.Strategy 4.2 Increased additional physician providers to provide obstetrical and gynecological care with the St. Anthony service area.Strategy 4.3 Increased training and advanced certifications for nursing staff providing care to mothers and babies within the St. Anthony service area.Strategy 4.4 Completed infrastructure improvements to the Birth Place at St. Anthony. St. Anthony Regional Hospital and Nursing Home Part V, Section B, Line 13h: In addition to FPG, the Hospital will consider the extent to which the patient's household has assets that could be used to meet his or her financial obligation. Assets may include, but are not limited to, cash, savings and checking account, certificates of deposit, stocks and bonds, individual retirement accounts (IRAs), trust funds, real estate (excluding the patient's home) and motor vehicles. The hospital will take into account any liabilities that are the responsibility of the patient's household. To relieve stress related to financial burdens, families with a medical catastrophe with self-pay balances greater than 20 percent of their annual household income in one calendar year may be eligible for substantial discounts. St. Anthony's Regional Hospital and Nursing Home also uses asset level, medical indigency, insurance status, Medicaid/Medicare coverage, and state regulations as factors in determining eligibility for free and discounted care. Schedule H, Part V, Schedule B, Line 16a-c: FAP, FAP Application, and Plain Language Summary:https://www.stanthonyhospital.org/patients-visitors/patients/financial-assistance/ Schedule H, Part V, Section B, Line 7 and 10: CHNA and Implementation Strategy:https://www.stanthonyhospital.org/webres/File/legal/CHNA%202025.pdf 4 1 - St Anthony Nursing Home 311 South Clark St Carroll IA 51401 Nursing Home 2 - St Anthony Regional Home Health Agency 311 South Clark St Carroll IA 51401 Home Health Services 3 - St Anthony Regional Hospice 311 South Clark St Carroll IA 51401 Hospice Services 4 - St Anthony Clinic - Denison 1820 4th Ave South Denison IA 51442 Family Practice Clinic Part I, Line 3c: In addition to FPG, the Hospital will consider the extent to which the patient's household has assets that could be used to meet his or her financial obligation. Assets may include, but are not limited to, cash, savings and checking account, certificates of deposit, stocks and bonds, individual retirement accounts (IRAs), trust funds, real estate (excluding the patient's home) and motor vehicles. The hospital will take into account any liabilities that are the responsibility of the patient's household. To relieve stress related to financial burdens, families with a medical catastrophe with self-pay balances greater than 20 percent of their annual household income in one calendar year may be eligible for substantial discounts. St. Anthony's Regional Hospital and Nursing Home also uses asset level, medical indigency, insurance status, Medicaid/Medicare coverage, and state regulations as factors in determining eligibility for free and discounted care. Part I, Line 6a: The annual community benefit report is available upon request. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. Cost of community health improvement services on line 7e, health professions education on line 7f, and cash and in-kind contributions for community benefit on line 7i are based on actual costs recorded in the general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part II, Community Building Activities: The Hospital CEO participates in the Carroll Area Development board that is active in economic development. 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: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated based on an approximate 8.34% of individuals living below the poverty level in the service area. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concessions is located in Note 1 on pages 13 and 14 of the attached financial statements. Part III, Line 8: St. Anthony Regional Hospital did not have a Medicare shortfall. Whether a shortfall or surplus providing services to Medicare patients is essential to these patients and the community and increases their access to healthcare services, which is a community benefit.Medicare allowable costs of care are based on the Medicare Cost Report. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: St. Anthony Regional Hospital accepts and processes financial assistance applications beginning on the date care is provided and ends on the 240th day after the first post-discharge billing statement or can also be the deadline indicated by the Hospital for the application deadline or the deadline for providing additional information. If there is an incomplete application within 240 days of the first post-discharge billing statement, St. Anthony Regional Hospital will suspend any extraordinary collection activities (ECAs) and notify the individual in writing with contact information for resources of how to complete the application and give a reasonable time to respond. If there is a complete application within 240 days of the first post-discharge billing statement, St. Anthony Regional Hospital will suspend any ECAs and notify the individual of eligibility and updated billing statements. If a financial assistance application is filed with the Hospital on or close to the deadline, the application will be processed on an expedited basis. Notification is sent to patients 30 days prior to initiating any ECAs. Part VI, Line 2: An internal working group was charged, along with Tripp Umbach, to help identify the needs of those living in the hospital's service area. The information presented in the community health needs assessment represents a comprehensive community-wide process where St. Anthony Regional Hospital continued to connect with public and private organizations, such as health-related professionals, human service organizations, non-profits, civic organizations, and childcare facilities, to evaluate the community's health and social needs. The needs assessment took a deep dive into existing resources integrating helpful information to achieve health equality in the community. An independent review of existing data, including in-depth interviews with local stakeholders, resulted in the identification and confirmation of crucial community health needs. We coordinate with local county organizations including law enforcement, ambulance service, and other providers of healthcare. We participate and host forums, feedback surveys, the Patient and Family Advisory Council, multiple support groups, and community grants. All of these things, along with our CHNA, help St. Anthony Regional Hospital to assess and ascertain the needs of the communities we serve. 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 policies. The charity care policy is made available to patients in the admissions office and provided in the admission packets. If patients have questions, they can stop in the business office and discuss them with the financial counselor. Part VI, Line 4: St. Anthony Regional Hospital and Nursing Home is located in Carroll, Iowa, St. Anthony serves a predominantly rural population over a large geographic area comprising six counties in West Central Iowa. These counties include Audubon, Calhoun, Carroll, Crawford, Greene, and Sac. Carroll, IA had a population of 20,677 people with a median household income of $68,528. In 2023, the median household income of the 8,075 households in Carroll, IA grew to $68,528 from the previous year's value of $68,041.From 2022 to 2023, employment in Carroll, IA declined at a rate of 1.5%, from 10,800 employees to 10,600 employees. The largest industries in Carroll, IA are Manufacturing, Health Care & Social Assistance, and Retail Trade. Part VI, Line 5: St. Anthony Regional Hospital and Nursing Home operates an acute care hospital, a nursing care center, several medical clinics, retirement housing called Orchard View, and assisted living called Garden View. The Hospital is a 99-bed acute care facility. St. Anthony Nursing Home has 79 beds. The Hospital has a 10 member independent board of directors. The Hospital extends medical staff privileges to all qualified physicians in the community. St. Anthony Regional Hospital and Nursing Home invests surplus funds in infrastructure and equipment improvements.St. Anthony Regional Hospital has demonstrated a commitment to promoting health care to further its exempt purpose of providing quality health care in the community and surrounding counties for more than one hundred and fifteen years. St. Anthony Regional Hospital is a regional provider and is committed to providing quality care to the community. The majority of the Hospital's board members are from local businesses and reside in the community.Community benefit projects include community health education, health care support services, behavioral health services, community health improvement advocacy, and other traditional charity care. Part VI, Line 7, Reports Filed With States IA 1 St Anthony Foundation 311 South Clark St PO Box 628 Carroll IA 51401 421419695 501(c)(3) 303205 0 Development Office Expenses 1 0 Part I, Line 2: St. Anthony Hospital and Nursing Home made a payment to a related organization, St. Anthony Foundation. The Foundation and Hospital have a close working relationship and monitor the use of the funds. X X X X 0 1 0 0 0 0 0 1 0 Richard Goding MD Orthopedics 491170 0 136286 0 0 0 21387 0 32870 0 681713 0 0 0 Brian Boes MD Neurology 323041 0 142066 0 0 0 13221 0 31498 0 509826 0 0 0 Danielle Coffey DO Family Medicine 274100 0 157472 0 0 0 14328 0 23463 0 469363 0 0 0 Amy Canuso DO Mental Health 389866 0 0 0 0 0 9413 0 32780 0 432059 0 0 0 Lindsey Pogge DO Family Medicine 202865 0 188537 0 0 0 13192 0 10074 0 414668 0 0 0 Allen Anderson CEO/President 300481 0 20703 0 0 0 13838 0 33360 0 368382 0 0 0 Part I, Line 4b St. Anthony Regional Hospital and Nursing Home has a non-qualified loan regime split dollar life insurance arrangement. The arrangement is subject to the rules for non-qualified deferred compensation, including IRC 409A. Allen Anderson, CEO/President, and Eric Salmonson, CFO/Vice President, participated in a loan regime split dollar life insurance arrangement. Part I, Line 7 In their roles as executives employed by St. Anthony Regional Hospital and Nursing Home, the executives are eligible for incentive payouts. The incentive award will be a percentage of the base pay compensation for the CEO and CFO. 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 000000000 2022-10-27 6000000 See Part VI 0 0 0 A 3183803 6000000 47500 5952500 2023 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 Schedule K, Part I, (f), Description of Purpose: Finance a portion of the costs of constructing, renovating, equipping and furnishing the Hospital's dialysis and obstetrical departments and other improvements at the Hospital facilities. Eric Salmonson VP/CFO Split-dollar life insurance X 299865 299865 0 1 1 Allen Anderson CEO Split-dollar life insurance X 184615 184615 0 1 1 484480 Badding Construction Entity owned more than 35% by Nick Badding, Board Member, and family 933270 Construction Services 0 Form 990, Part VI, Section A, line 6 The former members of the St. Anthony Regional Hospital and Nursing Home are the sisters of the religious community known as the Congregation of the Sisters of the Third Order of the St. Francis of Perpetual Adoration (FSPA). The FSPA formed St. Anthony Ministries to assume canonical sponsorship and membership of St. Anthony Regional Hospital and Nursing Home, performed previously by the FSPA. Form 990, Part VI, Section A, line 7a St. Anthony Ministries, as the sole member of St. Anthony Regional Hospital and Nursing Home has the power to appoint the Board of Directors. 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 and Nursing Home are subject to the approval of St. Anthony Ministries. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The final version of the form 990 is given to each member of the Board of Directors prior to filing the return. The Form 990 was reviewed by the CFO and the Audit committee. Form 990, Part VI, Section B, line 12c The Officers and Board Members annually disclose in writing, "any interest which would be inconsistent with the expeditious, proper, and impartial performance of duties." Defining disclosable conflict or duality of interest as any matter in which the corporations are "interested which affects the financial interest or employment of such member, a member of his/her family by blood or marriage, or any business enterprise in which he/she or such family member is employed or has a financial interest." Officers and Board members are required to disclose the facts surrounding any possible conflict of interest throughout the year. If a conflict of interest is disclosed by an Officer or Board Member, during a board meeting the Officer or Board Member will not participate in any discussions or deliberations regarding the matter and would abstain from any voting decisions on this matter during the meeting. All conflict of interests that are disclosed will be reported in the minutes of the board meetings. Form 990, Part VI, Section B, line 15 At the direction of the Board of Directors the CEO gathers compensation information (salary and benefits) from various sources including Iowa Hospital Association and benefit consultants for like-sized organizations. The Executive Committee then determines the annual compensation for the CEO and CFO for the total board approval. The compensation process for the CEO is completed in August annually. The compensation process for the CFO is completed in March annually. The process and determination is documented in the meeting minutes and personnel files. Form 990, Part VI, Section C, line 19 St. Anthony Regional Hospital and Nursing Home's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, line 11g Other Fees: Program service expenses 3,436,222. Management and general expenses 729,517. Fundraising expenses 0. Total expenses 4,165,739. Consulting Services: Program service expenses 148,379. Management and general expenses 149,623. Fundraising expenses 0. Total expenses 298,002. Contract Labor: Program service expenses 3,639,548. Management and general expenses 59,489. Fundraising expenses 0. Total expenses 3,699,037. Physician Fees: Program service expenses 8,222,103. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,222,103. Form 990, Part XI, line 9: Change in beneficial interest in net assets of St. Anthony Foundation 1,945,026. St Anthony Foundation 311 South Clark St PO Box 628 Carroll IA 51401 421419695 Support St. Anthony Regional Hospital and Nursing Home IA 501(c)(3) Line 7 St Anthony Ministries 0 St Anthony Ministries 311 South Clark St PO Box 628 Carroll IA 51401 Religious Order IA 501(c)(3) Canonical entity N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0