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
St Anthony's Physician Organization
Employer identification number
43-1784536
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
St Anthony's Physician Organization
Employer identification number
43-1784536
Return Reference
Explanation
FORM 990, PART I, LINE 1
ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES: ST. ANTHONY'S PHYSICIAN ORGANIZATION, IN CONJUNCTION WITH ST. ANTHONY'S MEDICAL CENTER, CARRIES OUT ITS HEALING MISSION BY RESPONDING TO THE DIVERSE NEEDS OF THE PEOPLE OF OUR COMMUNITY WITH CONCERN FOR THE POOR.
PART VI, LINE 6
MEMBERS AND STOCKHOLDERS: THE CORPORATE MEMBER IS ST. ANTHONY'S MEDICAL CENTER, A MISSOURI NONPROFIT CORPORATION.
PART VI, LINE 7A
MEMBERS AND STOCKHOLDERS: THE MEMBER HAS THE POWER TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE MEMBERS OF THE BOARD THROUGH THE ACTION OF THE PRESIDENT / CEO OF THE MEMBER.
PART VI, LINE 7B
MEMBERS AND STOCKHOLDERS: THE MEMBER HAS THE FOLLOWING POWERS: - AMENDMENT OF THE MISSION, VISION AND OPERATING VALUES PURSUANT TO WHICH THE CORPORATION WILL OPERATE, AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS AND ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF ANY AFFILIATE OF THE CORPORATION - APPOINTMENT AND REMOVAL, WITH OR WITHOUT CAUSE, OF MEMBERS OF THE BOARD THROUGH THE ACTION OF THE PRESIDENT/CEO OF THE CORPORATE MEMBER - ADOPTION OR AMENDMENT OF THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION AND OF ANY AFFILIATE OF THE CORPORATION - ADOPTION OR AMENDMENT OF THE OPERATING, CAPITAL, CONSTRUCTION AND ALL OTHER BUDGETS FOR THE CORPORATION - ASSIGNMENT, TRANSFER, SALE OR LEASE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY AFFILIATE OF THE CORPORATION IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000) IN ANY ONE OR SERIES OF RELATED TRANSACTIONS OCCURRING WITHIN ANY TWELVE (12) MONTH PERIOD - AUTHORIZATION AND APPROVAL OF THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY AFFILIATE OF THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT - APPROVAL OF A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION - APPROVAL OF THE LEASE, MANAGEMENT OR PURCHASE OF, OR AFFILIATION WITH, ANOTHER HOSPITAL OR HOSPITAL SYSTEM, OR HEALTH CARE FACILITY OR HEALTH CARE SYSTEM BY THE CORPORATION - APPROVAL OF THE CREATION OR DISSOLUTION OF ANY AFFILIATE OF THE CORPORATION - APPROVAL OF THE CREATION OF OR WITHDRAWAL FROM ANY JOINT VENTURE INVOLVING THE CORPORATION - APPROVAL OF ANY CONTRACTS TO BE ENTERED INTO BY THE CORPORATION REQUIRING A FINANCIAL COMMITMENT IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000), UNLESS SUCH CONTRACT OR EXPENDITURE WAS CONTAINED IN A PREVIOUSLY AUTHORIZED BUDGET OF THE CORPORATION, AND APPROVAL OF ANY ACTIONS OF ANY AFFILIATE OF THE CORPORATION WHICH, IF SUCH ACTION WAS TAKEN BY THE CORPORATION, WOULD BE SUBJECT TO THE APPROVAL OF THE CORPORATE MEMBER.
PART VI, LINE 11B
REVIEW OF FORM 990: RETURNS ARE PREPARED AND INITIALLY REVIEWED BY ST ANTHONY'S MEDICAL CENTER'S FINANCE STAFF AND PREPARER BKD. AFTER THESE REVIEWS ARE COMPLETED, THE RETURNS ARE THEN REVIEWED WITH THE CHIEF FINANCIAL OFFICER (CFO) BY FINANCE STAFF. ONCE THIS REVIEW OCCURS, RETURNS ARE MAILED TO ST ANTHONY'S MEDICAL CENTER'S BOARD / FINANCE COMMITTEE MEMBERS ALONG WITH THE BOARD / FINANCE COMMITTEE PACKET. REVIEW OF THE 990 IS AN AGENDA ITEM AT THE ST ANTHONY'S MEDICAL CENTER'S FINANCE COMMITTEE MEETING WHERE EACH OF THE RETURNS ARE REVIEWED AND DISCUSSED WITH MEMBERS, TO INCLUDE THE CEO. ONCE THIS REVIEW OCCURS, RETURNS ARE DISTRIBUTED TO THE FULL ST ANTHONY'S MEDICAL CENTER BOARD FOR REVIEW AND DISCUSSION AS PART OF THE ST ANTHONY'S MEDICAL CENTER'S FINANCE COMMITTEE REPORT. ONCE ALL REVIEWS HAVE TAKEN PLACE, THE RETURNS ARE FILED WITH THE INTERNAL REVENUE SERVICE. IN THE EVENT THAT THE FORM 990 CANNOT BE REVIEWED IN A FINANCE COMMITTEE OR BOARD MEETING, THE FORM 990 WILL BE DISTRIBUTED TO THE ST ANTHONY'S MEDICAL CENTER'S GOVERNING BODY VIA OTHER MEANS PRIOR TO FILING WITH THE IRS.
PART VI, LINE 12C
CONFLICT OF INTEREST: TO ENSURE THAT ST. ANTHONY'S OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT ENGAGES ONLY IN TRANSACTIONS THAT ARE REASONABLE AND ARE THE RESULT OF ARM'S LENGTH BARGAINING, THE BOARD HAS ADOPTED AND ENFORCES COMPLIANCE WITH A CONFLICT OF INTEREST POLICY, WHICH REQUIRES DISCLOSURE OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IF THE BOARD OR COMMITTEE OR ADMINISTRATOR HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE INDIVIDUAL OF THE BASIS FOR SUCH BELIEF AND AFFORD THE INDIVIDUAL AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INDIVIDUAL AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE OR ADMINISTRATOR DETERMINES THAT THE INDIVIDUAL HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
PART VI, LINE 15A & B
PROCESS FOR DETERMINING COMPENSATION: COMPENSATION FOR THE CEO AND ALL SENIOR MANAGEMENT STAFF MEMBERS IS BASED UPON COMPARABLE MARKET RATES FOR SIMILAR POSITIONS WITHIN THE NATION. PERIODICALLY, AN OUTSIDE COMPENSATION CONSULTANT IS HIRED TO REVIEW COMPENSATION AND COMPARE IT TO APPROPRIATE PEER GROUPS. THESE EXTERNAL REPORTS ARE PRESENTED TO THE BOARD OF DIRECTORS' COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL ALONG WITH THE ANNUAL EVALUATIONS OF THE SENIOR STAFF MEMBERS. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN APRIL OF 2013. PHYSICIAN COMPENSATION IS VALIDATED BY AN INDEPENDENT VALUATION CONSULTANT TO ENSURE COMMERCIAL REASONABLENESS AND CONSISTENCY WITH FAIR MARKET VALUE.
PART VI, LINE 19
AVAILABILITY OF DOCUMENTS TO THE PUBLIC: THE ORGANIZATION CONSIDERS ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO BE PROPRIETARY. ACCORDINGLY THEY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC.
FORM 990, PART VI, LINE 3
DELEGATION OF CONTROL TO A MANAGEMENT COMPANY OR OTHER PERSON: DAN MCCORMICK WAS A CONTRACTED COO OF ST. ANTHONY'S PHYSICIAN ORGANIZATION. HE WORKED FOR THE ADVISORY BOARD COMPANY, WHICH WAS PAID BY ST. ANTHONY'S MEDICAL CENTER, A RELATED ENTITY. ST ANTHONY'S MEDICAL CENTER PAID THE ADVISORY BOARD COMPANY $1,059,923 WHICH INCLUDES THE SERVICES OF THE ST. ANTHONY'S PHYSICIAN ORGANIZATION'S COO AND OTHER CONTRACTED SERVICES FOR ST. ANTHONY'S MEDICAL CENTER AND ST. ANTHONY'S PHYSICIAN ORGANIZATION.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.