Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Saint Anthony's Health Center
Employer identification number
37-0661234
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Saint Anthony's Health Center
Employer identification number
37-0661234
Return Reference
Explanation
ORGANIZATION'S MISSION
PART I, LINE I SPONSORED BY THE SISTERS OF ST. FRANCIS OF THE MARTYR ST. GEORGE, SAINT ANTHONYS HEALTH CENTER IS A TWO-CAMPUS SYSTEM WITH A MISSION OF MAKING CHRISTS MERCIFUL LOVE VISIBLE BY PROVIDING QUALITY HEALTH CARE DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS PART VI, LINE 6 SAINT ANTHONY'S HEALTH CENTER HAS ONE MEMBER, DESIGNATED AS THE CORPORATE MEMBER, WHICH SHALL BE SAINT ANTHONY'S HEALTH SYSTEM, AN ILLINOIS NOT-FOR-PROFIT CORPORATION. SAINT ANTHONY'S HEALTH SYSTEM SHALL ACT IN STEWARDSHIP CAPACITY AND ENSURE THAT ALL ACTIONS OF SAINT ANTHONY'S HEALTH CENTER ARE CONSISTENT WITH THE PURPOSES, AND ETHICAL AND RELIGIOUS PRINCIPLES IN FURTHERANCE OF THEIR CHARITABLE APOSTOLATE OF QUALITY HEALTH CARE.
APPROVAL AND VOTING RIGHTS OF MEMBERS OR STOCKHOLDERS
PART VI, LINE 7A & 7B SAINT ANTHONY'S HEALTH SYSTEM HAS THE EXCLUSIVE POWER TO APPOINT AND REMOVE THE DIRECTORS AND THE PRESIDENT/CEO, ADOPT, AMEND, RESTATE AND REPEAL THE ARTICLES OF INCORPORATION AND THE BYLAWS, ADOPT ANY PLAN OF MERGER, CONSOLIDATION, OR DISSOLUTION, ADOPT STATEMENT OF PHILOSOPHY, MISSION, AND APOSTOLATE, ESTABLISH A CORPORATE LIMIT FOR EXPENDITURES, AND APPROVE THE MISSION STATEMENT, STRATEGIC PLAN, AND ANNUAL OPERATING BUDGET. SAINT ANTHONY'S HEALTH SYSTEM MUST APPROVE PURCHASES, SALES, TRANSFERS, LEASES OR ENCUMBRANCES OF REAL PROPERTY OR OF SUBSTANTIALLY ALL OF THE PERSONAL PROPERTY, BORROWING WHICH IS IN EXCESS OF THE CORPORATE LIMIT AS DETERMINED FROM TIME TO TIME BY SAINT ANTHONY'S HEALTH SYSTEM, THE EXECUTION OF ANY DEEDS, MORTGAGES, OR BONDS, ANY TRANSACTION WHICH INVOLVES AN ALIENATION OF PROPERTY OR OTHER ACT OF EXTRAORDINARY ADMINISTRATION, AND EXTRAORDINARY MEDICAL/MORAL ISSUES AND ANY MATTER CHALLENGING THE CATHOLICITY OF SAINT ANTHONY'S HEALTH CENTER.
PROCESS TO REVIEW FORM 990
PART VI, LINE 11B SAINT ANTHONY'S HEALTH CENTER USES AN OUTSIDE PREPARER TO PREPARE ITS FORM 990 AND 990-T. ONCE COMPLETED, THE RETURNS ARE REVIEWED INTERNALLY BY THE PRESIDENT/CEO, EVP/CFO AND THE CONTROLLER BEFORE FILING. ANNUALLY, THE RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FORM 990, AND THE EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN, FORM 990-T, WILL BE PROVIDED TO THE SAINT ANTHONY'S HEALTH SYSTEM GOVERNING BOARD AND SAINT ANTHONY'S HEALTH SYSTEM FINANCE COMMITTEE FOR REVIEW PRIOR TO FILING SUCH RETURNS WITH THE INTERNAL REVENUE SERVICE FOR SAINT ANTHONY'S HEALTH CENTER, SAINT ANTHONY'S PHYSICIAN GROUP, AND SAINT ANTHONY'S FOUNDATION. WRITTEN NOTIFICATION WILL BE SENT TO EACH OF THE GOVERNING BOARDS' MEMBERS OF SAINT ANTHONY'S HEALTH CENTER, SAINT ANTHONY'S PHYSICIAN GROUP, AND SAINT ANTHONY'S FOUNDATION ADVISING THEM THAT THE RETURNS HAVE BEEN FILED AND TO CONTACT MICHAEL NELSON AT (618) 463-5616 IF THEY WOULD LIKE TO REVIEW THEIR RESPECTIVE RETURN.
COMPLIANCE WITH CONFLICT OF INTEREST POLICY
PART VI, LINE 12C A CONFLICT OF INTEREST DISCLOSURE STATEMENT MUST BE COMPLETED ANNUALLY BY: ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, DIRECTORS, MANAGERS, EMPLOYED PHYSICIANS, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICAL AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST; AND NON-EMPLOYED MEMBERS OF THE MEDICAL STAFF WHO ALSO EITHER: HOLDS PAID OR UNPAID MEDICAL ADMINISTRATIVE POSITIONS OR HAVE PROCUREMENT RESPONSIBILITY OR THE AUTHORITY EFFECTIVELY TO RECOMMEND SUCH PROCUREMENT. THE STATEMENTS ARE REVIEWED ANNUALLY BY THE PRESIDENT/CEO AND THE BOARD SECRETARY. ANY MEMBER OF A BOARD INCLUDING PHYSICIANS SHALL REFRAIN FROM VOTING ON ANY POTENTIAL CONFLICTS.
PROCESS FOR DETERMINING COMPENSATION
PART VI, LINE 15A IN 2010, HEWITT ASSOCIATES WAS ENGAGED TO PERFORM A REVIEW OF EXECUTIVE COMPENSATION, INCLUDING ALL DISQUALIFIED PERSONS. HEWITT ASSOCIATES ISSUED AN OPINION LETTER SHOWING REBUTTABLE PRESUMPTION OF REASONABLENESS OF EXECUTIVE COMPENSATION FOR SAINT ANTHONY'S. THIS ANALYSIS INVOLVED COMPARABLE DATA. SAINT ANTHONY'S CONTINUES TO USE HEWITT'S DATA BY ADJUSTING FOR AN AGING FACTOR AND LOOKING AT ANY MARKET DYNAMICS SINCE 2010 WHEN MAKING CHANGES TO EXECUTIVE COMPENSATION. THE COMPENSATION COMMITTEE OF THE HEALTH SYSTEM BOARD OVERSEES MATTERS OF EXECUTIVE COMPENSATION AND UTILIZES OUTSIDE CONSULTING SERVICES WHEN APPROPRIATE. THE PROCESS IS DOCUMENTED IN COMPENSATION COMMITTEE MEETING MINUTES. THERE HAVE BEEN NO CHANGES TO THIS PROCESS IN THE PAST YEAR. PART VI, LINE 15B THE COMPENSATION COMMITTEE OF SAINT ANTHONY'S HEALTH SYSTEM, PARENT CORPORATION, RELIED ON MARKET SURVEYS AND COMPENSATION ANALYSIS COMPLETED BY HEWITT ASSOCIATES DURING 2010 TO ASSIST IN CALCULATING COMPENSATION IN 2013. THE 2010 DATA WAS ADJUSTED BY AN AGING FACTOR AND CHANGES IN THE MARKET TO CREATE THE 2013 COMPENSATION FOR SENIOR TEAM MEMBERS IN 2013. ALL OF THIS ACTIVITY IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE.
AVAILABILITY TO THE PUBLIC
PART VI, LINE 19 FINANCIAL INFORMATION IS PROVIDED IN ACCORDANCE WITH THE FREEDOM OF INFORMATION ACT.
OTHER COMPENSATION
PART VII, SECTION A, COLUMN F CERTAIN RETIREMENT AND OTHER DEFERRED COMPENSATION AMOUNTS IN COLUMN F ARE NEGATIVE DUE TO THE DECREASE IN ACTUARIAL VALUE OF DEFINED BENEFIT PLAN ACCRUALS.
OTHER FEES FOR SERVICES
PART IX, LINE 11G CONTRACT SERVICES $4,005,424 PURCHASED SERVICES 2,929,635 PHYSICIAN FEES 1,043,709 PHYSICIAN SUPPORT SERVICES 557,780 REFERENCE LAB SERVICES 322,019 PURCHASED LAUNDRY SERVICES 288,825 OTHER FEES FOR SERVICES 817,465 ---------- $9,964,857
OTHER CHANGES TO NET ASSETS
PART XI, LINE 9 CHANGE IN TEMPORARILY RESTRICTED ASSETS 79,037 FAS 158 ADJUSTMENT 9,432,380 CHANGE IN INVESTMENT IN UNCONSOLIDATED ORGANIZATIONS (34) TRANSFER TO ST. ANTHONY HEALTH SYSTEM (4,223,000) ROUNDING (13) ----------- 5,288,370
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.