Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 | 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 |
| FORM 990, PART VI, SECTION A, LINE 2 | MICHAEL NELSON IS THE SPOUSE OF ELIZABETH NELSON. |
| FORM 990, PART VI, SECTION A, 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. |
| FORM 990, PART VI, SECTION A, LINES 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. |
| FORM 990, PART VI, SECTION B, LINE 11B | SAINT ANTHONY'S HEALTH CENTER USES AN OUTSIDE PREPARER TO PREPARE ITS FORM 990. ONCE COMPLETED, THE RETURNS ARE REVIEWED INTERNALLY BY THE PRESIDENT, CFO AND THE CONTROLLER BEFORE FILING. |
| FORM 990, PART VI, SECTION B, 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. |
| FORM 990, PART VI, SECTION B, 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. DURING 2014, COMPENSATION THAT WOULD HAVE BEEN PAID DIRECTLY TO THE CEO WAS PAID TO THE SISTERS OF ST. FRANCIS OF THE MARTYR ST. GEORGE ON HER BEHALF. |
| FORM 990, PART VI, SECTION B, 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 2014. THE 2010 DATA WAS ADJUSTED BY AN AGING FACTOR AND CHANGES IN THE MARKET TO CREATE THE 2014 COMPENSATION FOR SENIOR TEAM MEMBERS IN 2014. ALL OF THIS ACTIVITY IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL INFORMATION IS PROVIDED IN ACCORDANCE WITH THE FREEDOM OF INFORMATION ACT. |
| FORM 990, PART IX, LINE 11G | CONTRACT SERVICES 3,638,885 PURCHASED SERVICES 2,079,236 PHYSICIAN FEES 1,002,080 PHYSICIAN SUPPORT SERVICES 522,932 REFERENCE LAB SERVICES 249,046 PURCHASED LAUNDRY SERVICES 246,431 OTHER FEES FOR SERVICES 662,759 ---------- 8,401,369 |
| FORM 990, PART XI, LINE 9 | CHANGE IN TEMPORARILY RESTRICTED ASSETS 8,657 FAS 158 ADJUSTMENT (11,334,247) CHANGE IN INVESTMENT IN UNCONSOLIDATED ORGANIZATIONS (27) TRANSFER TO ST. ANTHONY HEALTH SYSTEM (5,058,218) NET ASSET TRANSFER TO OSF 7,997,116 ------------ (8,386,719) |
| FORM 990, PART VI, SECTION A, LINE 4 | ARTICLES OF AMENDMENT WERE ADOPTED BY THE ORGANIZATION ON OCTOBER 31, 2014. COPY ATTACHED. |
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