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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | |||||
| 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...... | 3,372,369 | 4,663,562 | 2,667,709 | 3,760,207 | 5,856,205 | 20,320,052 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 3,372,369 | 4,663,562 | 2,667,709 | 3,760,207 | 5,856,205 | 20,320,052 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public Support (Subtract line 7c from line 6.) | 20,320,052 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 3,372,369 | 4,663,562 | 2,667,709 | 3,760,207 | 5,856,205 | 20,320,052 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 4,347 | 42 | 4,390 | 9,726 | 0 | 18,505 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 3,376,716 | 4,663,604 | 2,672,099 | 3,769,933 | 5,856,205 | 20,338,557 |




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - MISCELLANEOUS INCOME, COLUMN A - 4347, COLUMN B - 42, COLUMN C - 4390, COLUMN D - 9726, COLUMN E - , COLUMN F - 18505;, |
| Software ID: | 11000230 |
| Software Version: | v2011.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Classes of members or stockholders | Form 990, Part VI, Section A, Line 6 | THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE CORPORATE MEMBER OF THE SAINT ANTHONY HEALTH AFFILIATES (SAHA) IS SAINT ANTHONY HOSPITAL. THE SOLE MEMBER OF SAINT ANTHONY HOSPITAL IS SAINT ANTHONY HEALTH MINISTRIES, WHICH HAS CERTAIN RESERVED POWERS OVER THE SAHA. |
| Members or stockholders electing members of governing body | Form 990, Part VI, Section A, Line 7a | THE SOLE CORPORATE MEMBER OF THE SAINT ANTHONY HEALTH AFFILIATES IS SAINT ANTHONY HOSPITAL. THE SOLE MEMBER OF SAINT ANTHONY HOSPITAL IS SAINT ANTHONY HEALTH MINISTRIES. SAINT ANTHONY HEALTH MINISTRIES HAS THE RIGHT TO APPOINT OR REMOVE MEMBERS OF THE GOVERNING BODY. |
| Decisions requiring approval by members or stockholders | Form 990, Part VI, Section A, Line 7b | THE SOLE CORPORATE MEMBER OF THE SAINT ANTHONY HEALTH AFFILIATES IS SAINT ANTHONY HOSPITAL. THE SOLE MEMBER OF SAINT ANTHONY HOSPITAL IS SAINT ANTHONY HEALTH MINISTRIES. SAINT ANTHONY HEALTH MINISTRIES HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS MADE BY THE GOVERNING BODY. SUCH RIGHTS INCLUDE: 1) APPROVING THE MISSION AND VISION STATEMENTS OF THE ORGANIZATION; 2) APPROVING CHANGES TO THE GOVERNING DOCUMENTS; 3) APPOINTMENT OR REMOVAL OF MEMBERS OF THE GOVERNING BOARD; 4) APPROVING OR RECOMMENDING THE FORMATION OF LEGAL ENTITIES, THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS, DIVESTITURES, DISSOLUTIONS, CLOSURES, MERGERS, CONSOLIDATIONS OR CHANGES IN CORPORATE MEMBERSHIP; 5) APPROVING THE OPERATING BUDGET AND CAPITAL PLAN; 6) APPROVING THE TRANSFER OR ENCUMBRANCE OF THE ASSETS; 7) APPROVING THE INCURRENCE OF DEBT OF THE ORGANIZATION. |
| 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. 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, 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. |
| COMPENSATION OF THE CEO AND OTHER OFFICERS | FORM 990, PART VI, LINE 15 | 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. |
| Governing documents, conflict of interest policy and financial statements available to the public | 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. |
| FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) | FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B) | ALL BOARD MEMBERS LISTED IN PART VII DEVOTE APPROXIMATELY 1 HR A WEEK TO VARIOUS RELATED ORGANIZATIONS REPORTED ON SCHEDULE R. ALL OFFICERS LISTED IN PART VII DEVOTE APPROXIMATELY 15-30HRS A WEEK TO SAINT ANTHONY HOSPITAL, A RELATED TAX EXEMPT ORGANIZATION. |
| Other changes in net assets or fund balances | Form 990, Part XI, Line 5 | PRIOR PERIOD ADJUSTMENTS - 140267; INCOME REPORTED ON HOSPITAL'S RETURN - -2626447; |
| Software ID: | 11000230 |
| Software Version: | v2011.1.0 |