2025-05-14T14:16:24-05:00 2024-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-07-01 460230199 Avera St Mary's AVER 6052243130 801 East Sioux Avenue Pierre SD 57501 Julie Lautt CFO Avera Health 6052243130 2025-05-09 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-04-22 2023 2025-03-06 01:10:19Z Avera St Mary's Hospital Shantel Krebs 801 East Sioux Avenue Pierre SD 57501 124219885 0 0928 X See Schedule O X 1951 SD Promotion of health 12 9 655 61 475483 277200 210022 993638 106036186 118474317 258432 423128 2168712 2217524 108673352 122108607 23205 24893 0 0 60330367 60961967 0 0 18307 53784728 60195646 114138300 121182506 -5464948 926101 94524377 98108691 35239544 35176486 59284833 62932205 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 113399249 24893 120128180 Avera St. Mary's mission is to provide healthcare services to Pierre, South Dakota residents and residents of the surrounding area. Avera St. Mary's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Mary's consists of a 50-bed hospital, an 80-bed nursing home, senior living apartments, and one physician clinic in Pierre, South Dakota. The program services offered include primary care, ob/gyn, pediatrics, orthopedics, general surgery, emergency, internal medicine, oncology, podiatry, urology, dermatology, pain management, ENT, speech therapy, occupational therapy, respiratory therapy, and wound care. Avera St. Mary's provides acute care and long-term healthcare services.Following is a breakdown of these statistics by facility:Avera St. Mary's Hospital 1,634 Acute patient discharges 455 Newborn patient discharges 117 Swing bed patient discharges 59,429 Outpatient visits 754 Swing-bed patient days 744 Newborn patient days 90,744 Clinic visitsAvera Maryhouse 20,870 Long-term resident days 104 Long Term Care patient dischargesAvera St. Mary's maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $12,392,847.Avera St. Mary's also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera St. Mary's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Mary's engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 113399249 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 70 0 1 655 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 9 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Shantel Krebs President/CEO 2.00 42.00 X X 0 269654 18256 Mike Weisgram Chair 2.00 2.00 X X 0 0 0 Robert Wylie Vice Chair 2.00 2.00 X X 0 0 0 Kristin Brost Board Member 2.00 2.00 X 0 0 0 Jamie Cronin Board Member 2.00 2.00 X 0 0 0 Dr Mark Hagy Board Member/Orthopedics 2.00 42.00 X 0 881207 23027 Sr Debra Kolecka Board Member 2.00 7.00 X 0 0 0 Michael Larson Board Member 2.00 2.00 X 0 0 0 Meredith Lee Board Member 2.00 2.00 X 0 0 0 Kim Olson Board Member 2.00 2.00 X 0 0 0 Rena Robbennolt Board Member/Nurse Practicioner 2.00 42.00 X 0 100805 45118 Sr Lynn Marie Welbig Board Member 2.00 2.00 X 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0.01 46.30 X 0 1203675 19401 Karna Pfeffer Director - Clinical Excellence & Education 40.00 0.00 X 152678 0 47968 Matthew Deichert CRNA 40.00 0.00 X 304101 0 55304 Nick Jung CRNA 40.00 0.00 X 291615 0 29147 Michael Murphy CRNA 40.00 0.00 X 294998 0 41944 Scott Oswald CRNA 40.00 0.00 X 321756 0 45402 Kevin Roark CRNA 40.00 0.00 X 297376 0 43706 Dr Mikel Holland Former Regional President/CEO 42.00 2.00 X 0 137258 20766 1662524 2592599 390039 31 1 1 0 Avera Health 3900 W Avera Drive Sioux Falls SD 57108 Shared Services 9720470 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Contract Labor 5795277 Health Carousel LLC PO Box 714216 Cincinnati OH 45271 Contract Labor 726686 Avel eCare Medical Group PC 4500 N Lewis Ave Sioux Falls SD 57104 Clinical Services 581376 ProLink Healthcare LLC 4600 Montgomery Rd Ste 300 Cincinnati OH 45212 Contract Labor 442212 27 37000 25232 902862 28544 993638 Patient Service Revenue 621110 111475324 111475324 Pharmacy Revenue 456110 5832963 5832963 Patient and Clinic Revenue 621110 72286 72286 1093744 1093744 118474317 9965 9965 88178 0 88178 88178 88178 377912 35251 0 0 377912 35251 413163 413163 4176798 2111278 2065520 1590037 475483 A/R Interest 900099 63826 63826 63826 122108607 120128180 475483 511306 X 24893 24893 178756 178756 80974 80974 50175668 49449581 726087 1707256 1676122 31134 5781254 5707965 73289 3038059 2967124 70935 149826 1099 148727 2952 2952 25040142 19788296 5247200 4646 14589 7952 4513 2124 818821 663370 152952 2499 417426 416821 605 1378259 1297038 81221 174677 160744 13271 662 203426 199990 3436 1111561 922455 189106 5441530 5005184 436346 577674 260703 316971 Medical Supplies 23445021 23411420 32629 972 Equipment Lease/Rental 182027 170562 4061 7404 Provision for income ta 60000 60000 Bad Debt 20717 20717 1156998 1106239 50759 121182506 113399249 7764950 18307 -356923 8540 12548144 13678696 3553979 4654161 779039 419021 116983500 72934460 47479294 44049040 26869530 16871859 325567 358301 687521 651686 2638226 17417387 94524377 98108691 6112054 6865726 63206 0 20960425 20545755 4932 3297 6920387 6591248 1178540 1170460 35239544 35176486 X 55885664 58887351 3399169 4044854 59284833 62932205 94524377 98108691 X 926101 1785354 935917 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2952 2952 0 Part II-B, Line 1: Avera St. Mary's paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1539208 500 127912 5990 1661630 1518879 73966 9363 63000 1539208 1486599 1877 30403 1518879 1203694 119546 164484 1125 1486599 900367 303547 -220 1203694 0.00000 0.83327 0.16673 0 1 1 1391428 4260981 5652409 66715476 37164747 29550729 43239265 35020475 8218790 1376350 749238 627112 44049040 Interest in Avera Health Foundation 5858615 F Avera Pooled Investments 11013244 F 16871859 Intercompany Assets 17417387 17417387 Estimated Third Party Payor Settlements 563189 Other Liabilities 607271 1170460 X Part IV, Line 2b: The Organization holds funds on behalf of its residents. Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. Part X, Line 2: Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 3060283 3060283 0.02530 16297 9217 7080 0.00010 3076580 9217 3067363 0.02540 29284 29284 0.00020 44027073 21443551 22583522 0.18640 82173 82173 0.00070 44138530 21443551 22694979 0.18730 47215110 21452768 25762342 0.21270 725 725 0.00000 36 36 0.00000 761 761 0.00000 1 0 19639573 21803595 -2164022 X 1 1 1 1 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 See Part V Section C 10566 X X X Provider based clinic Avera St Mary's 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X See Part V Section C X See Part V Section C X 1 21 1 See Part V Section C 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V Section C X See Part V Section C X See Part V Section C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera St. Mary's Part V, Section B, Line 5: Avera St. Mary's gathered information regarding the needs of the community through an established process gathering stakeholder information on community perceptions of the health of Central South Dakota including a survey of the public, and interviews with identified community leaders. All members of the CHNA team were selected for roles they have in the community by a matrix developed by the Avera St. Mary's Hospital Administrative Council and included attributes such as: uninsured/underinsured, parents of young children, close contact with underprivileged people to assure a "voice" in the process, health leaders with in-depth knowledge of the local health care environment, government, business, retired, South Dakota State Departments of Health and Social Services, Urban Indian Health, and Rural Health Clinics. Avera St. Mary's Part V, Section B, Line 6b: South Dakota Department of HealthSouth Dakota Department of Social ServicesMunicipal Government stakeholdersRural Health ClinicUrban Indian HealthYMCARiver Cities Public TransitPierre Area Referral Services Avera St. Mary's Part V, Section B, Line 11: The Community Health Needs Assessment was completed during the 2021 tax year with approval by the Governing Board in May 2022 and the implementation strategy for the following community health priority areas are underway.*Mental Health Concerns*Support for Healthy Lifestyle Choices, including - Eating Healthy/Healthy Food Choices - Physical Activities Available and AffordableFY2024 Update:Regarding the first priority of Mental Health Concerns: The task force continues to meet every other month with sub-groups meeting more frequently to accomplish goals and report back to the full group. Promotion of 988 as the nationwide crisis number and 211 as a resource number has been undertaken by each agency represented on the task force. In conjunction with the State of South Dakota Division of Behavioral Health, a consulting firm has been engaged to assist in the assessment and planning for an Appropriate Regional Facility. A timeline has been developed and the sub-group is actively working toward this goal. The Mobile Crisis Response remains an integral aspect of care for those in crisis in our community. The Communities That Care project was completed with elements incorporated into the work of the local community mental health center and has helped inform ongoing work.Regarding the Physical Inactivity Concern: The stakeholders including the Cities of Pierre and Ft. Pierre, YMCA, and Avera, have collaborated to develop a map of free assets and resources in the community to be physically active. The content has been created and the group is now moving to the development of the online and printed versions. Once created, we will work with local groups to promote the utilization of the variety of free options to be physically active in the area. Regarding Support for Healthy Eating: A series of community education on affordable healthy eating has started in collaboration with the culinary arts class at the local high school, Urban Indian Health, a local community center where the Community Banquet is held each week, a pediatrician, along with local individuals with an interest in improving healthy eating options/awareness. There will be four sessions held (October and November 2023 and February and April 2024). After this initial pilot school year, the hope is to make this an ongoing opportunity. Work with local restaurants is the next phase of the plan as our initial focus has been on the classes.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. During the community health needs assessment process, Covid-related concerns such as lack of vaccinated people and poor mitigation efforts were raised. In addition, the following health needs/priorities emerged but are beyond the scope or control of Avera St. Mary's. The issues will be referred to the appropriate community organizations: *Assistance for uninsured, beyond Avera St. Mary's financial assistance program *Affordable housing *Workforce shortage Avera St. Mary's Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera St. Mary's Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Mary's Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera St. Mary's Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section B, Lines 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/ Part V Section A website address: avera.org/locations/st-marys/ Part V, Section B, Line 16a, 16b, and 16c: avera.org/patients-visitors/pay-my-bill-online/financial-assistance-forms/ 3 1 - Avera Parkwood Independent Living 400 Parkwood Drive Pierre SD 57501 Independent living 2 - MaryHouse 717 E Dakota Ave Pierre SD 57501 Long term care 3 - Avera St Mary's Campus Pharmacy 100 Mac Lane Suite 101 Pierre SD 57501 Retail pharmacy Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 6a: The community benefit report is prepared by a related organization, Avera Health, and is available to the public at https://www.avera.org/about/annual-report/. Part I, Line 7: Charity care expense was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Subsidized health services were calculated based on a combination of the FY2023 Medicare cost report and an overall cost-to-charge ratio for certain expenses. Health professions education and cash and in-kind contributions are reported based on actual expenses recorded in the general ledger. Part II, Community Building Activities: Avera St. Mary's provided donations to various organizations to support activities as listed on Part II. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. During the year ended June 30, 2024, the Organization adjusted the qualifying criteria under the charity care policy, which resulted in a reclassification of accounts considered bad debt in previous years that now qualified as presumptive charity care under the adjusted policy. Implicit price concession for the year of $4,414,538 was reduced for prior year reclassifications of $9,070,757 resulting in a net negative implicit price concession of $4,656,219. Due to the negative implicit price concession per the general ledger, an amount of $0 has been reported on Line 2. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 19 and 20. Part III, Line 8: Avera St. Mary's provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare programs are not completely covered, the Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the FY2023 Medicare cost report. The FY2023 Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: Health care needs are assessed through various methods. Avera St. Mary's strives to deliver comprehensive care and extensive medical specialty services to community members located in central South Dakota. Avera St. Mary's is integrally involved with community organizations, the university center, schools, and state and local governments. The closest hospitals offering the same level of care and services are located 154 miles away in Mitchell, SD and 160 miles away in Aberdeen, SD. Within our regional footprint, the majority of the communities have populations of less than 2,500 people. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. In addition to activities reported in the Community Health Needs Assessment and implementation plan, Avera St. Mary's and Avera Gettysburg collaborate with a number of agencies including the YMCA, Feeding South Dakota, The Pierre/Ft. Pierre Mental Health Task Force, the United Way, Pierre Area Referral, Pierre-Ft. Pierre Ministerial Association, City of Pierre and Ft. Pierre and River City Public Transit to assess and promote health related matters. Part VI, Line 3: Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs. Part VI, Line 4: Avera St Mary's is a 50-bed hospital in Pierre, South Dakota. The primary service area includes Hughes, Stanley, and Sully Counties. Pierre is the county seat of Hughes County as well as the capital of South Dakota. According to the U.S. Census Bureau Quick Facts 2023 data, the estimated population of Hughes County as of July 1, 2023, is 17,624. The population is predominately white at 82.3% and Native American 12.8%. It is estimated that 18.9% of the population is 65 years and over. The median household income is $83,750 with a 9.6% poverty rate. Uninsured individuals under age 65 is estimated at 7.6%.According to the U.S. Census Bureau Quick Facts 2023 data, the estimated population of Stanley County as of July 1, 2023 is 3,043. The population is predominately white at 89.2% and Native American 6.5%. It is estimated that 23.1% of the population is 65 years and over. The median household income is $82,298 with an 8.4% poverty rate. Uninsured individuals under age 65 is estimated at 10.3%.According to the U.S. Census Bureau Quick Facts 2023 data, the estimated population of Sully County as of July 1, 2023, is 1,494 and is predominately white at 91.6%. It is estimated that 28.0% of the population is 65 years and over. The median household income is $66,875 with a 7.6% poverty rate. Uninsured individuals under age 65 is estimated at 6.5%. Part VI, Line 5: The hospital serves all persons in the community on a non-discriminatory basis. Avera St. Mary's operates an emergency room that is open to all persons regardless of ability to pay. Avera St. Mary's has an open medical staff with privileges available to all qualified physicians in the area. The governing body is comprised of primarily independent individuals, representative of the community. Avera St. Mary's provides education and training opportunities to healthcare students enrolled in the local college, Capital City Campus. Avera St. Mary's participates in Medicaid, Medicare, Indian Health, Champus, Tricare and/or Other Government sponsored Health Care Programs.Avera St. Mary's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (Capital Area United Way, Pierre/Fort Pierre Rotary, Pierre Area Chamber of Commerce, River City Public Transit, YMCA Board, Pierre Booster Club and many more.)Staff volunteer in the community throughout the year at Avera St. Mary's promoted events including the monthly "Avera Night" at Feeding South Dakota, serving twice a year at the community banquet, assisting with the bed build with Sleep in Heavenly Peace, and the community clean up efforts each spring with the Go Green and Clean city-wide campaign. Several drives, including food, clothing, scrubs, school supplies, Christmas gift drives are held throughout the year as well to support community members in need. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 0 0 0 0 0 0 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0 1197590 0 480 0 5605 0 16500 0 2901 0 1223076 0 0 Dr Mark Hagy Board Member/Orthopedics 0 760942 0 31400 0 88865 0 16500 0 6527 0 904234 0 0 Scott Oswald CRNA 259662 0 45500 0 16594 0 11473 0 33929 0 367158 0 0 0 Matthew Deichert CRNA 253801 0 33750 0 16550 0 14938 0 40366 0 359405 0 0 0 Kevin Roark CRNA 255912 0 30250 0 11214 0 10277 0 33429 0 341082 0 0 0 Michael Murphy CRNA 257474 0 26250 0 11274 0 9295 0 32649 0 336942 0 0 0 Nick Jung CRNA 252651 0 27750 0 11214 0 6636 0 22511 0 320762 0 0 0 Shantel Krebs President/CEO 0 253181 0 4000 0 12473 0 17737 0 519 0 287910 0 0 Karna Pfeffer Director - Clinical Excellence & Edu 141958 0 6265 0 4455 0 7965 0 40004 0 200647 0 0 0 Dr Mikel Holland Former Regional President/CEO 0 135783 0 0 0 1475 0 6992 0 13775 0 158025 0 0 Schedule J, Part I, Line 3: President/CEO serves Avera St. Mary's and Avera Gettysburg and was compensated by related organizations, Avera McKennan and Avera Health. Avera St. Mary's relied on the related organizations for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Deborah Holland Family member of board member 80974 Employee Compensation & Benefits 0 Form 990, Item J The organization's website is: www.avera.org/st-marys-pierre Form 990, Part VI, Section A, line 2 Julie Lautt, Mikel Holland, Sr. Debra Kolecka, and Shantel Krebs have a business relationship. Julie Lautt, Dr. Mike Hagy, and Shantel Krebs have a business relationship. Julie Lautt, Kristin Brost, Jamie Cronin, Sr. Debra Kolecka, Michael Larson, Meredith Lee, Kim Olson, Rena Robbennolt, Mike Weisgram, Sr. Lynn Marie Welbig, and Robert Wylie have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the member: 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters,") pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and reviewed by an independent accounting firm. The Form 990 is then reviewed by the Avera Health VP of Financial Reporting and Tax Manager. After initial internal review, the Form 990 is made available to various members of Avera Health Executive Management, including the Avera Health CFO, President/CEO and COO. In addition, the Form 990 is made available to the Facility CEO, other Operation Finance Leaders and the Facility Board members. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers, and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. Form 990, Part VI, Section B, line 15 From July 1 to October 15, the organization had an interim President and CEO. The Interim President and CEO was paid an interim stipend that was added to base salary and paid by Avera McKennan, a related organization. Upon full time hire, compensation was transitioned from Avera McKennan to Avera Health, a related organization. The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not made available to the general public. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public. Form 990, Part IX, line 11g Purchased Services: Program service expenses 11,182,894. Management and general expenses 349,750. Fundraising expenses 4,151. Total expenses 11,536,795. Medical Professional Fees: Program service expenses 1,484,221. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,484,221. Repairs & Maintenance: Program service expenses 2,436,865. Management and general expenses 11,155. Fundraising expenses 495. Total expenses 2,448,515. Centralized Services: Program service expenses 4,684,316. Management and general expenses 4,886,295. Fundraising expenses 0. Total expenses 9,570,611. Form 990, Part XI, line 9: Change in Interest in Avera Foundation 935,917. Form 990, Part X, Line 20: The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg and Avera at Home. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673). Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Mary's. Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of Health SD 501(c)(3) Line 10 N/A 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5300 S Broadband Lane Sioux Falls SD 57108 460399291 Home Services SD 501(c)(3) Line 10 Avera Health 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health Financing and Health Plan Admin SD 501(c)(4) Avera Health 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare Services NE 501(c)(3) Line 3 Avera Health 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's Healthcare Center 1 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare Services IA 501(c)(3) Line 3 Avera Health 0 Holy Family Hospital Foundation 826 North 8th Street Estherville IA 51334 421317452 Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare Services SD 501(c)(3) Line 10 Avera Health 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 5300 S Broadband Lane Sioux Falls SD 57108 820582350 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 5300 S Broadband Lane Sioux Falls SD 57108 862949748 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Sioux Center LLC 5300 S Broadband Lane Sioux Falls SD 57108 753203100 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 5300 S Broadband Lane Sioux Falls SD 57108 800619999 Medical services - home medical equipment SD N/A 0 0 Brookings Health System - Avera HME LLC 300 22nd Ave Brookings SD 57006 453204123 Healthcare services SD N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 4055 Valley View Lane Ste 700 Dallas TX 75244 611843657 Accountable care organization TX N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 4055 Valley View Lane Ste 700 Dallas TX 75244 821447782 Accountable care organization TX N/A 0 0 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare services SD N/A 0 0 Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 Surgical associates SD N/A 0 0 Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency SD N/A C 0 Alucent Australia Pty Ltd Level 10 30 Collings Street Melbourne VIC 3000 AS Biotech Research AS N/A 0 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 5300 South Broadband Lane Sioux Falls SD 57108 460424322 Insurance SD N/A C 0 Kore Cares In Home Services LLC 5300 South Broadband Lane Sioux Falls SD 57108 882778902 In-home care services SD N/A S 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 0 0 1 0 0 0 0 1 0 1 0 1 1 1 1 1 1 1 1 Avera Gettysburg M 77244 General Ledger Avera Gettysburg O 3077045 General Ledger Avera Gettysburg Q 5958923 General Ledger Avera Gettysburg S 713721 General Ledger