Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
SAINT ANTHONY HOSPITAL |
510217097 | 3 | Yes | Yes | Yes | 0 | |||
| Total | 0 | ||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11b | A THOROUGH REVIEW OF THE FORM 990 IS PERFORMED BY MANAGEMENT. THE FORM 990 IS THEN DISTRIBUTED TO MEMBERS OF THE FINANCE COMMITTEE FOR REVIEW AND WITH A REQUEST FOR RECOMMENDATIONS OR CHANGES. A PRESENTATION IS MADE BY THE PAID TAX PREPARERS AND A COPY OF THE RETURN IS SHARED WITH THE BOARD OF DIRECTORS PRIOR TO FILING THE FORM 990 WITH THE IRS. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | ANNUALLY THE CORPORATE RESPONSIBILITY OFFICER HAS THE BOARD, AS WELL AS OFFICERS AND VICE PRESIDENTS, REVIEW, FILL OUT AND SIGN THE CONFLICT OF INTEREST QUESTIONNAIRE. IF A CONFLICT OF INTEREST ARISES, THE AFFECTED BOARD MEMBER OR OFFICER ABSTAINS FROM VOTING ON THE RESPECTIVE ISSUE. THE CORPORATE RESPONSIBILITY OFFICER MAINTAINS ALL SIGNED CONFLICT OF INTEREST STATEMENTS ON FILE. |
| Process used to establish compensation of top management official | Form 990, Part VI, Section B, Line 15a | THE ORGANIZATION RELIES ON SAINT ANTHONY HOSPITAL, A RELATED ORGANIZATION, TO DETERMINE COMPENSATION OF ITS OFFICERS. ALL ANNUAL SALARY INCREASES FOR THE VICE PRESIDENTS AND ABOVE ARE REVIEWED AND APPROVED BY THE BOARD OF SAINT ANTHONY HOSPITAL AND DOCUMENTED IN MINUTES PREPARED FOR EACH MEETING. ALSO AN INDEPENDENT MARKET SURVEY WAS CONDUCTED IN FY09 TO ENSURE THAT THE SALARIES OF VICE PRESIDENTS AND ABOVE WERE WITHIN MARKET. |
| Process used to establish compensation of other officers/key employees | Form 990, Part VI, Section B, Line 15b | THE ORGANIZATION RELIES ON SAINT ANTHONY HOSPITAL, A RELATED ORGANIZATION, TO DETERMINE COMPENSATION OF ITS OFFICERS. ALL ANNUAL SALARY INCREASES FOR THE VICE PRESIDENTS AND ABOVE ARE REVIEWED AND APPROVED BY THE BOARD OF SAINT ANTHONY HOSPITAL AND DOCUMENTED IN MINUTES PREPARED FOR EACH MEETING. ALSO AN INDEPENDENT MARKET SURVEY WAS CONDUCTED IN FY09 TO ENSURE THAT THE SALARIES OF VICE PRESIDENTS AND ABOVE WERE WITHIN MARKET. |
| Public Disclosure | Form 990, Part VI, Section C, Line 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| PROCESS USED TO ESTABLISH COMPENSATION FOR TOP MANAGEMENT | FORM 990, PART VI, SECTION B, LINES 15A AND 15B | THE FILING ORGANIZATION DOES NOT COMPENSATE ITS OFFICERS, DIRECTORS, OR TRUSTEES; THEREFORE, THESE QUESTIONS HAVE BEEN ANSWERED AS "NO" PER THE FORM INSTRUCTIONS. SAINT ANTHONY HOSPITAL, A RELATED TAX EXEMPT ORGANIZATION, COMPENSATES ITS OFFICERS, DIRECTORS, AND TRUSTEES. |
| COMPENSATION OF OFFICERS, DIRECTORS, ETC. | FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) | VARIOUS BOARD MEMBERS REPORTED ON PART VII DEVOTE APPROXIMATELY 1-5 HRS TO VARIOUS RELATED ORGANIZATIONS REPORTED ON SCHEDULE R. |
| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |