2026-05-15T09:25:54-05:00 2025-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2024-07-01 420680370 Avera Holy Family AVER 7123626519 826 North 8th Street Estherville IA 51334 Julie Lautt CFO Avera Health 7123626519 2026-05-11 1 1 Kim Hunwardsen CPA P00484560 6122536500 2026-05-14 2024 2025-03-06 01:10:19Z Michelle Majerus 826 North 8th Street Estherville IA 51334 38249103 0 0928 X See Schedule O X 1996 IA Promotion of health 8 7 189 20 0 0 25968 16617 35123681 35840669 722151 2343040 31928 48777 35903728 38249103 11937 9936 0 0 13207965 13683298 0 0 521 16634864 17493867 29854766 31187101 6048962 7062002 68362497 79193311 2203623 2760834 66158874 76432477 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 26865782 9936 35867385 Avera Holy Family's mission is to provide healthcare services to Estherville, Iowa residents and residents of the surrounding area. Avera Holy Family is a 501(c)(3) organization affiliated with Avera Health. Avera Holy Family consists of a 25-bed critical access hospital and a clinic in Estherville, Iowa. The program services offered include primary care, general surgery, ENT, orthopedic and ophthalmology surgical services, wound care, pain management, emergency, imaging services, laboratory, behavioral health, speech therapy, physical therapy, and occupational therapy. Avera Holy Family provides acute healthcare services. Following is a breakdown of these statistics by facility:Avera Holy Family Hospital 275 Acute inpatient discharges 94 Swing-bed patient discharges 29,393 Outpatient visits 790 Swing-bed patient days 14,734 Clinic visitsAvera Holy Family 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 $395,176.Avera Holy Family 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 Holy Family 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 Holy Family 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. 26865782 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 48 0 1 189 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Julie Lautt CFO Avera Health;Secretary/Treasurer 0.10 46.30 X 0 1274363 20218 Kristi Hough Manager - Pharmacy 40.00 0.00 X 174609 0 50293 Deb Herzberg President/CEO (Until Oct.) 42.00 0.00 X X 0 166757 24082 April Sue Krull Pharmacist 40.00 0.00 X 134622 0 46201 Martin Bergstrom Chief Nursing Officer 40.00 0.00 X 115870 0 41043 Gemaima Marie Mumar Flor Medical Laboratory Scient 40.00 0.00 X 109292 0 21060 Kari Ann Sorenson Director - Clinical Services 40.00 0.00 X 107744 0 47848 Michelle Majerus President/CEO (Beg. Oct.) 41.00 0.00 X X 22840 32924 3515 Yas Mata Chair 1.00 0.00 X X 0 0 0 Mike Cornwall Vice Chair 1.00 0.00 X X 0 0 0 Trudy Ahrens Board Member 1.00 0.00 X 0 0 0 Sr Candyce Chrystal Board Member 1.00 7.00 X 0 0 0 Cody Newgard Board Member 1.00 0.00 X 0 0 0 Jim Rosendahl Board Member 1.00 0.00 X 0 0 0 Penny Clayton Board Member 1.00 0.00 X 0 0 0 664977 1474044 254260 9 0 1 0 Avera Health 3900 W Avera Drive Sioux Falls SD 57108 Shared Services 2861898 Docs Who Care Inc 800 W Frontier Lane Olathe KS 66061 Medical and Locum Services 1804042 Journey Group Companies 4500 W 58th St Sioux Falls SD 57108 Construction 535544 Psychiatric Medical Care LLC 8 Cadillac Dr Ste 230 Brentwood TN 37027 Medical Services 484263 Woodward Anesthesia Services PC 203 N 8th St Estherville IA 51334 Medical Professional Services 297726 7 12678 3939 16617 Patient Service Revenue 621110 32395228 32395228 Pharmacy Revenue 456110 3278884 3278884 Patient and Clinic 621110 57979 57979 108578 108578 35840669 477 477 22061 0 22061 22061 22061 2341263 1300 0 0 2341263 1300 2342563 2342563 AR Interest Income 900099 26716 26716 26716 38249103 35867385 0 2365101 X 9936 9936 139407 139407 10599870 10429471 170399 439776 432432 7344 1745160 1704837 40323 759085 736476 22609 3765 3765 2200 2200 2043 2043 8739112 6061636 2677476 5636 5636 274927 220732 54195 148556 147766 790 509762 425982 83780 40436 36032 4404 37178 33426 3752 1531481 1450909 80572 48736 48736 Medical Supplies 4877160 4861314 15846 Equipment Lease/Rental 35979 18716 17263 1236896 292352 944023 521 31187101 26865782 4320798 521 -38351 123725 3590555 3123024 606429 617934 85220 123454 37769882 25370079 12495262 12399803 50538253 58191582 152336 120229 932793 4493560 68362497 79193311 1368946 1903851 834677 856983 2203623 2760834 X 65080193 75204799 1078681 1227678 66158874 76432477 68362497 79193311 X 7062002 2723757 487844 X 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 2043 2043 0 Part II-B, Line 1: Avera Holy Family paid dues to organizations which have a portion of the dues attributed to lobbying activities. 2652793 52015 287255 11743 2980320 2362025 52271 249102 10605 2652793 2161342 21024 198406 18747 2362025 2219508 207261 -252374 13053 2161342 1859198 369234 8925 2219507 0.84897 0.13763 0.01340 0 1 1 510540 510540 23539427 15450749 8088678 12507545 9207364 3300181 1212370 711966 500404 12399803 Avera Pooled Investments 53752755 F Investment in Foundation 4438827 F 58191582 Intercompany Assets 4493560 4493560 Estimated Third-Party Settlements 819566 Intercompany Liabilities 37417 856983 X 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 160947 160947 0.00520 2721271 2255728 465543 0.01490 2882218 2255728 626490 0.02010 66367 4544 61823 0.00200 46220 46220 0.00150 8382736 3482930 4899806 0.15710 79032 43125 35907 0.00120 8574355 3530599 5043756 0.16180 11456573 5786327 5670246 0.18190 13228 13228 0.00040 2103 2103 0.00010 15331 15331 0.00050 1 1011770 0 9377084 9407295 -30211 X 1 1 1 1 Avera Holy Family Health 826 N 8th Street Estherville IA 51334 See Part V Section C 320014H X X X X Provider Based Clinic Avera Holy Family 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X See Part V Section C X See Part V Section C X 1 24 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 Holy Family Part V, Section B, Line 5: Collaboration between Avera Holy Family, Emmet County Iowa Public Health and various community partners resulted in the CHNA. A survey was conducted November 18, 2024 to December 30, 2024. The survey was provided to community members via a variety of methods. 140 individuals completed the survey. Community input was gathered through community partners and service groups that represented the broad interests of the community. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources, and improvements. Those providing community input represent the interests of medically underserved populations and provided helpful information related to the needs of the community. Avera Holy Family Part V, Section B, Line 6b: Emmet County Iowa Public Health Avera Holy Family Part V, Section B, Line 11: The community health needs assessment was completed during FY2025. The hospital has not taken specific actions with respect to the FY2025 implementation strategy. The following community health priority areas were identified and the following actions will be taken by the hospital during future years. - Limited or no access to mental health care - Education and wellness related to aging - Drug/alcohol addictionPRIORITY 1: Limited or No Access to Mental Health Care - Develop a community guide listing available service providers - Identify barriers to services, including but not limited to transportation, cost, and communication options with respect to HIPAA - Navigate the statewide realignment of services - Identify and mitigate gaps in service created by statewide realignment - Promote mental health awareness to reduce stigmaPRIORITY 2: Education and Wellness Related to Aging - Promote aging services - Promote active aging to reduce stigmaPRIORITY 3: Drug and Alcohol Addiction - Encourage genetic screening and early intervention, routine mental health screenings, therapeutic intervention, and integrated treatment - Promote support services - Facilitate action to reduce access to drugs and alcohol, neighborhood improvement, school-based preventions programs, after-school programs, parental involvement, safe housing and employment, and anti-stigma campaigns.Other health related needs and services identified but will not be addressed, include:- Transportation barriers- Affordable Housing- Resources for life skills- Healthy cooking/cooking on a budgetAvera Holy Family does not currently have the resources to directly address all the identified needs. However, the leadership team recognizes that the needs exist and will continue to actively participate in numerous community organizations focused on community needs and improvement.Avera Holy Family continued to address the community health needs identified in the community health needs assessment completed in FY2022. Avera Holy Family maintained its implementation plan for each of the priorities of Covid Mitigation, Access to mental health care, Access to urgent/convenient healthcare, Cardiovascular disease/hypertension, Early detection of cancer, and Obesity. The following actions were taken during FY2025 to address the needs identified in the FY2022 community health needs assessment:COVID-19 MITIGATIONAvera Holy Family continued to follow CDC recommendations pertaining to vaccines and patient monitoring and testing. Appropriate employee health measures were implemented based on exposure and symptom management as well as length of days of work.ACCESS TO MENTAL HEALTH CARE*Promote awareness of mental health issuesAvera Holy Family continued to work with Senior Life Solutions to promote mental health in elderly people. Senior Life Solutions also worked with promoting suicide awareness in the community and among hospital employees.*Identify resources to address mental health concernsAvera Holy Family continued to work with Flowstate and the Sioux Rivers Regional Mental Health agency to provide needed support for patients with mental health issues. Flowstate works to help with assessment and placement of the patients and Sioux Rivers works with the patient post discharge to try and keep them from needing placement again in the future. Avera Holy Family also continued to use Avel eBehavioral Health to work with the patients who have been admitted to inpatient or observation care and will do reassessments and start medications on patients before they are sent for inpatient treatment. ACCESS TO URGENT/CONVENIENT HEALTH CARE SERVICES*Collaborate with medical staff to identify options for expanding services to allow more flexible and convenient hours of service to the communityAvera Sleep Lab has made more appointments available and currently has no wait list to obtain an in-house or at-home sleep study. Avera Holy Family Therapy department has hired 2 new PT's and is now able to see all patients within a timely manner.Avera Medical Group-Estherville has been approved to give vaccines through the Vaccines for Children program making childhood vaccinations more readily available.CARDIOVASCULAR DISEASE/HYPERTENSION*Raise awareness of the factors that contribute to heart disease and measures to prevent disease*Ensure people at risk have access to diagnosis and appropriate treatment*Promote healthy eating and physical activity *Encourage smoking cessationAvera Holy Family continues to address cardiovascular disease and hypertension through Planet Heart screenings. Employees have also reached out to provide education to the community regarding the signs of heart attack and stroke and the importance of seeking prompt treatment. Avera Holy Family has continued to expand the practice of pharmacists seeing more patients in clinic as well as doing discharge teaching of medications for patients who are being discharged.EARLY DETECTION OF CANCER*Promote awareness of contributing factors and signs and symptoms of cancer*Encourage screening for early detectionAvera Holy Family continues to provide education to the public concerning cancer risks and screening options by means of social media, community outreach like the educational booths mentioned above and encouragement to continue yearly screening. Avera Holy Family has increased their reach to include text messaging to encourage patients to schedule their annual mammogram screenings. The clinic continues to offer low dose CT for lung cancer screening for eligible patients.Avera Holy Family worked with the hospital foundation to make funds available for breast cancer screening for individuals that cannot afford it. We had our first breast cancer screening for an individual that could not afford it and have gotten the process simplified and ready for future patients. Patients who are uninsured or underinsured can receive financial assistance with mammography and annual Pap screening costs through the Care for Yourself program.OBESITY*Raise awareness of the impact obesity has on quality of life, incidence of disease and medical complications, and healthcare costs*Collaborate with Emmet County Public Health, Emmet County Wellness Coalition, and other community partners to promote physical activity and wellness*Raise awareness on the impact that poor eating habits have on health and wellness*Collaborate with Emmet County Public Health, Emmet County Wellness Coalition, and other community partners to promote healthier eating habitsAvera Holy Family provides education to the community through the Better Choices Better Health Program which helps adults and their caregivers manage symptoms of chronic diseases such as heart disease, diabetes, depression, asthma, bronchitis, emphysema, and others. Avera Holy Family also supports community programs including the bike safely event and the Emmet County Wellness Coalition. Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. Avera Holy Family 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 Holy Family 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 in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Holy Family 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 Holy Family 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. Schedule H, Part V, Section B, Line 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/ Schedule H, Part V, Section A organization's website: avera.org/locations/profile/avera-holy-family-hospital/ Schedule H, Part V, Section B, Lines 16a, 16b, and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/ 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 was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost report. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. Part II, Community Building Activities: The organization supports and donates to various community organizations focusing on issues impacting the community's health and safety. 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. 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 18 and 19. Part III, Line 8: Avera Holy Family 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 program are not completely covered, the Medicare shortfall is considered a community benefit. Medicare allowable costs of care are based on the Medicare cost report. The 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: The hospital utilizes the Press Ganey patient Experience Survey to gather information about patients' perceptions of their care experiences. The survey helps us know how to improve care and services to better meet the needs of our community.The Professional Activities Committee of the Medical Staff meets eight times a year to discuss patient needs, evaluate care and services, and identify opportunities to enhance care and services. The Medical Staff meets quarterly to discuss these same topics. The other duty of both parties is to ensure all providers who are considered for the Medical Staff have the proper credentials and training that are needed before voting to accept them as part of the organizations Medical Staff.The Critical Access CAH Committee meets quarterly to provide bi-annual policy review of all patient care policies. The CAH committee also approves new patient care and service policies and procedures while also evaluating care and services of patients. After the CAH committee approves these policies and procedures, they are then sent to the Hospital Board for final approval. 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 Holy Family is a 25-bed critical access hospital in Estherville, Iowa. The primary service area is defined as Emmet County, Iowa, including the communities of Armstrong, Dolliver, Estherville, Gruver, Ringsted, and Wallingford. Estherville is the county seat. According to the U.S. Census Bureau Quick Facts 2025 data, the estimated population of Emmet County as of July 1, 2024 is 9,162 and is predominately white at 93.6%. It is estimated that 24.6% of the population is 65 years and over. The median household income is $63,730 with an 11.9% poverty rate. Uninsured individuals under age 65 is estimated at 8.1%. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community and are given final approval by the governing body. Surplus funds are reinvested in facilities to improve patient care. The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; provides preceptorships for students; and provides Meals on Wheels. 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. 1 Regional Transit Authority ART PO Box 1240 Spencer IA 51301 421133312 501(c)(3) 7500 0 Support Estherville community transportation 1 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRC Section 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. X X 0 0 0 0 0 0 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0 1226098 0 41964 0 6301 0 17250 0 2968 0 1294581 0 0 Kristi Hough Manager - Pharmacy 168166 0 460 0 5983 0 9283 0 41010 0 224902 0 0 0 Deb Herzberg President/CEO (Until Oct.) 0 163662 0 0 0 3095 0 8460 0 15622 0 190839 0 0 April Sue Krull Pharmacist 134140 0 270 0 212 0 7202 0 38999 0 180823 0 0 0 Martin Bergstrom Chief Nursing Officer 115664 0 0 0 206 0 6201 0 34842 0 156913 0 0 0 Kari Ann Sorenson Director - Clinical Services 106950 0 675 0 119 0 6006 0 41842 0 155592 0 0 0 Schedule J, Part I, Line 3: The President/CEO's compensation was paid by a related organization, Avera McKennan, until October 2024 at which time there was a change in leadership. Avera Holy Family relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Form 990, Item J: The organization's website is: avera.org/locations/profile/avera-holy-family-hospital/ Form 990, Part VI, Section A, line 2 Julie Lautt has a business relationship with Michelle Majerus and Deb Herzberg. Julie Lautt and Sr. Candyce Chrystal 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 the 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, SD ("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 CEO of the Corporation; 8) To approve the 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 is no committee with authority to act on behalf of the Board. 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 The compensation amount and structure for the Avera Holy Family's CEO is derived from Avera Health's comparative data in cooperation with a compensation consultant who utilized multiple salary survey results with predominant factors of FTE, revenue, and operating expenses to benchmark the CEO position to similar healthcare organization data. The compensation for the CEO is then approved by Avera McKennan President and CEO. The CFO of Avera Health is compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of the Caring for Life Catholic Health Ministries Members of Avera Health, meet 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 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 2,148,883. Management and general expenses 51,439. Fundraising expenses 0. Total expenses 2,200,322. Medical Professional Fees: Program service expenses 2,696,068. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,696,068. Repairs & Maintenance: Program service expenses 700,443. Management and general expenses 27,216. Fundraising expenses 0. Total expenses 727,659. Centralized Services: Program service expenses 516,242. Management and general expenses 2,598,821. Fundraising expenses 0. Total expenses 3,115,063. Form 990, Part XI, line 9: Change in Interest in Avera Foundation 338,847. Change in Assets with Donor Restrictions 148,997. 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 Holy Family. Form 990, Part X, Line 20: Avera Holy Family is part of the Avera Obligated Group which 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. Avera Holy Family was not allocated any share of the bond issue, and thus does not have an amount on line 20 related to the Obligated group bond issuance. Avera Health 3900 W 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 W 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 St 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 Street 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 St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 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 0 Holy Family Hospital Foundation 826 N 8th Street Estherville IA 51334 421317452 Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 1 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 100 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 20 Burton Hills Blvd Ste 100 Nashville TN 37215 611843657 Accountable Care Organization MO N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 20 Burton Hills Blvd Ste 100 Nashville TN 37215 821447782 Accountable Care Organization MO N/A 0 0 Heart Hospital of South Dakota LLC 4500 W 69th St Sioux Falls SD 57108 562143771 Healthcare Services NC N/A 0 0 Surgical Associates Endoscopy Clinic LLC 310 S Penn St Aberdeen SD 57401 460461429 Surgical associates SD N/A 0 0 Accounts Management Inc 5132 S Cliff Avenue 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 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 0 0 0 0 0 1 1 1 1 1 0 0 Form 990, Schedule R, Part II, Tax Exempt Organizations: Holy Family Hospital Foundation dissolved November 2024. Form 990, Schedule R, Part IV, Corporation or Trust: Valley Health Services dissolved June 2025. Alucent Biomedical, Inc. dissolved May 2025. Alucent Australia Pty Ltd dissolved May 2025.