2023-05-12T10:34:15-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 460226738 St Benedict Health Center STBE 6059283311 401 West Glynn Drive Parkston SD 57366 Julie Lautt CFO Avera Health 6059283311 2023-05-09 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-05-05 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Avera St Benedict Health Center Lindsay Weber 401 West Glynn Drive Parkston SD 57366 30986862 0 0928 X See Schedule O X 1965 SD Promotion of health 11 8 215 70 0 0 1257297 716811 26782326 27662119 2114671 738545 44041 48697 30198335 29166172 61418 81741 0 0 13825983 14007242 0 0 0 9164287 9050153 23051688 23139136 7146647 6027036 69775695 68707930 3088830 2878867 66686865 65829063 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 20458683 81741 27690537 Avera St. Benedict Health Center's (Avera St. Benedict) mission is to provide healthcare services to Parkston, Tripp and Lake Andes, South Dakota residents and residents of the surrounding area. Avera St. Benedict is a 501(c)(3) organization affiliated with Avera Health. Avera St. Benedict consists of a 25-bed critical access hospital, a 49-bed nursing home, a 25-bed assisted living center and three provider based clinics. Services offered by Avera St. Benedict include primary care, emergency, general surgery, orthopedic surgery, podiatry surgery, cardiac rehab, pain management, pharmacy, behavioral health, laboratory, imaging, telemedicine, wellness center, speech therapy, physical therapy and occupational therapy. Avera St. Benedict provides acute care and long-term healthcare services.Following is a breakdown of these statistics by facility:Avera St. Benedict Hospital416 Acute patient discharges58 Newborn patient discharges147 Swing bed patient discharges16,574 Outpatient visits1,092 Swing-bed patient days88 Newborn patient days21,829 Clinic visitsAvera Bormann Manor16,725 Nursing home resident days25 Long Term Care patient dischargesAvera St. Benedict 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 $60,175.Avera St. Benedict 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. Benedict 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 or persons and institutions. Avera St. Benedict 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. 20458683 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 29 0 1 215 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Antoinette VanderPol MD Vice Chair/Family Medicine, OB 42.00 0.00 X X 298592 0 26956 Rita Blasius President/CEO 41.50 0.50 X X 187443 0 23597 Patricia Leischner Chair 2.00 0.00 X X 0 0 0 Barb Weidenbach Secretary 2.00 0.00 X X 0 0 0 Dave Neugebauer Board Member 2.00 0.00 X 0 0 0 Sr Patricia Prunty PBVM Board Member 2.00 1.00 X 0 0 0 Sr Denette Leifeld OSB Board Member 2.00 0.00 X 0 0 0 Richard Boettcher Board Member 2.00 0.00 X 0 0 0 Pat Reiner Board Member 2.00 0.00 X 0 0 0 Bob Just Board Member 2.00 0.00 X 0 0 0 Patrick McCann Board Member 2.00 0.00 X 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0.10 46.30 X 0 1051228 16194 Cody Freudenthal CRNA 40.00 0.00 X 190751 0 48015 Jason Wickersham MD Family Medicine/OB Physician 40.00 5.00 X 396630 0 45414 Larissa Sanger MD Family Medicine/OB Physician 40.00 0.00 X 307594 0 38295 Paul Berndt Physician 40.00 0.00 X 258480 0 48972 Jedd Bialas CRNA 40.00 0.00 X 207006 0 43726 1846496 1051228 291169 17 0 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Shared Services 2679648 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Medical Services 414182 Avera Queen of Peace 525 North Foster Street Mitchell SD 57301 ITS, Administrative & Management fees 188596 Cassling Diagnostic Imaging Inc 13808 F St Omaha NE 681371102 Maintenance Contract & Repairs 142624 4 69383 645167 2261 716811 Net Patient & Resident Service Re 622110 26561383 26561383 Pharmacy Revenue 900099 635988 635988 464748 464748 27662119 533 533 20279 0 20279 20279 20279 2509492 49210 1820690 0 688802 49210 738012 738012 AR Interest Income 900099 28418 28418 28418 29166172 27690537 0 758824 X 81741 81741 542306 330252 212054 89974 89974 10559035 10503910 55125 427656 424957 2699 1647933 1620238 27695 740338 724287 16051 17957 17957 1070 1070 4081352 2239912 1841440 736 736 265804 186578 79226 219950 78226 141724 413559 374912 38647 33931 31128 2803 20190 19197 993 1345732 1206731 139001 133605 42417 91188 Medical Supplies 2394795 2377864 16931 Equipment Lease/Rental 35182 35182 86290 72484 13806 23139136 20458683 2680453 0 564705 380868 2401534 3034509 271240 388337 87025 104021 27318497 16436377 11158721 10882120 55015778 53802131 276692 115944 69775695 68707930 1906277 1958902 447044 585965 6542 3599 728967 330401 3088830 2878867 X 65512949 64731982 1173916 1097081 66686865 65829063 69775695 68707930 X 6027036 -6732792 -152046 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 1070 1070 0 Part II-B, Line 1: St. Benedict Health Center paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 85021 -10506 74515 74568 10453 85021 75078 -510 74568 68235 108 6735 75078 65370 124 2741 68235 0.18607 0.81393 0.00000 0 1 1 97483 97483 17377152 9374079 8003073 9286101 6766881 2519220 557761 295417 262344 10882120 Avera Pooled Investments 52102552 F Interest in Avera Health Foundation 1699579 F 53802131 Estimated Third-Party Payor Settlements 42077 Right of Use Operating Lease Obligations 61901 Deferred Payroll Taxes 226423 330401 X Part IV, Line 2b: Funds are held on behalf of the residents. Part V, Line 4: The Organization's endowment consists of a portion of their interest in the net assets of 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. The organization's permanently restricted endowment funds are donor restricted. The organization currently does not have any board designated endowment funds. 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 0 0 102316 102316 0.00440 994933 965420 29513 0.00130 45890 33955 11935 0.00050 1143139 999375 143764 0.00620 87971 87971 0.00380 18000 18000 0.00080 3912518 3844783 67735 0.00290 39964 39964 0.00170 4058453 3844783 213670 0.00920 5201592 4844158 357434 0.01540 47030 47030 0.00200 9295 9295 0.00040 56325 56325 0.00240 1 718816 6887213 6825723 61490 X 1 1 1 1 Avera St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 See Part V Section C 50749 X X X X 3 provider based clinics St Benedict Hospital Inc 1 0 0 1 X X X X X X X X X 21 1 0 0 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 St. Benedict Hospital Inc. Part V, Section B, Line 5: A variety of individuals and groups of people were involved in the CHNA process from November 2021 through February 2022. Qualitative data was obtained from questionnaires and interviews with the Hutchinson County Community Health Nurse, Ministerial Association member, Trojen Den organizer, Parkston School District teacher and superintendent, local daycare provider, low income patient, local business representative, American Legion Post 194 representative, and a Hutterite Colony boss. Each of these were chosen to represent a cross section of the community and to adequately assess the needs of underserved populations. A survey (electronic and paper) was completed by 98 community members. St. Benedict Hospital Inc. Part V, Section B, Line 11: Identified health needs through the data gathering process were stratified into five broad categories to help prioritize areas and realistically choose options for the health center to address. The CHNA committee discussed the health needs identified during the community health needs assessment and prioritized the needs based on the following criteria:1. Estimated feasibility for the health care center to address the issue with current resources2. Importance the community placed on the need 3. Burden, scope, severity, or urgency of the health need4. Health disparities associated with the needThrough the assessment process, the following needs were determined to be of highest priority:*Cancer prevention screening*Improving access to care through better dissemination of resource materials*Accident prevention*Substance abuse/alcohol use preventionCancer prevention screening. The community feels there are some great resources in the service area, but there are gaps. Cancer prevention screening rates are below the state average and gaps were identified in meeting the needs of the community with cancer prevention screenings, especially with mammograms. Cancer prevention is an issue that potentially effects everyone in our service area. Lack of cancer prevention screening leads to health disparities and increased rates of mortality.Improving access to care through better dissemination of resource materials. Access to care includes being a resource for current community members and being able to reach new people that come to the service area. Providing resource packets to community members that help people navigate access to healthcare can help increase access to those in need by raising awareness. This was prioritized based on importance the community placed on the need and feasibility for the health center to address with current resources.Accident prevention. This was prioritized based on importance the community placed on the need and the health disparities associated with the need. Preventable accidents lead to higher costs of care and increased strain on emergency medical services. There are other organizations within the service area that can be partnered with to help address this need. Substance Abuse/Alcohol Use prevention. There were many concerns identified during the process regarding alcohol use and drug use in the community across the lifespan. Avera St. Benedict has the current infrastructure to integrate some elements of substance use prevention at no cost as a community benefit. Evaluation of impact of the community going without these services was discussed and how this would potentially leave a void in the community where feedback and data indicate substance use prevention is valued. Activities To Address significant needs:CANCER PREVENTION SCREENING*Implement better identification of, and opportunities to, screen for cancer prevention. *Implement and execute better patient identification and personalized contact to improve cancer screening rates in the service area.*Improve staff and community education on cancer screening opportunities through multiple different avenues.*Promote and utilize the All Women Count program to improve screening in women who qualify for the program.*Implement a cancer prevention health fair in conjunction with the annual cancer walk that takes place in Parkston, SD.*Work towards establishing a foundation account for cancer prevention.IMPROVING ACCESS TO CARE THROUGH BETTER DISSEMINATION OF RESOUCE MATERIALS*Increase community knowledge of how to access healthcare locally.*Create an ASB guide of healthcare services to be disseminated at City Hall so new community residents understand healthcare access locally.*Have an information booth at school registration on healthcare access.*Have healthcare access guides within the facility, including outreach sites.*Integrate community health into the care of newborns before and after OB deliveries, including before new parent(s) are discharged.*Utilize print media and social media to educate the service area on access to care issues.ACCIDENT PREVENTION*Avera St. Benedict will lead community partnerships to facilitate accident prevention in the service area.*Host a baby sitters clinic with safety elements such as how to access poison control.*Promote ways to have a safer community in areas such as agricultural safety, gun safety, water safety, bike safety, equine safety, grain bin safety, motor vehicle safety.SUBSTANCE ABUSE/ALCOHOL USE PREVENTION*Educate the community on substance use and alcohol use prevention.*Assist in a substance use prevention curriculum at school.*Educate parents on substance and alcohol prevention.*Promote local recovery access to groups such as Alcoholics Anonymous.*Create a resource on how to reach out for help with behavioral health needs such as, mental health, substance use or alcohol use.Significant Health Needs Not Addressed:When the Community Health Needs Assessment Committee met on June 29, 2022 to discuss goals and action plans for the significant health needs, there was also discussion on what needs identified would not be addressed. Lifestyle choices, poverty, and socioeconomic issues were all items of interest and assessed as a community need. As a health care organization, there are limits to what can be addressed regarding lifestyle choices, poverty, and socioeconomic issues. Due to feasibility, these issues will not be directly addressed. The previous community health needs assessment was completed in 2018. Action on the implementation plan has started or completed in most areas. COVID 19 impacted some of the activities by delaying or canceling them completely. Following are the community health priorities identified and actions taken.ObesityProvided scheduled free access to Avera St. Benedict's Wellness Center and provided Fitness on Demand classes. The facility also continues to provide Meals on Wheel to the community.Transportation and Access to CareFacility has promoted telehealth services to reduce transportation needs and to keep residents safe during pandemic. Continued to provide in-home medical care for those that do not have transportation, specifically in high risk populations.After School Activities for KidsDue to COVID 19 there was minimal movement on this. St. Benedict Hospital Inc. 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. St. Benedict Hospital Inc. 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. St. Benedict Hospital Inc. 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. St. Benedict Hospital Inc. 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, Lines 7a, 7b and 10a: Community Health Needs Assessment and Implementation Strategy websiteavera.org/about/community-health-needs-assessments/#benedict Schedule H Part V, Section B, Lines 16a, 16b and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ Schedule H Part V, Section A organization's website: avera.org/locations/profile/avera-st-benedict-health-center/ 2 1 - Avera Bormann Manor 501 North 4th Street Parkston SD 57366 Nursing Home 2 - Avera St Benedict Assisted Living 400 W Fir Parkston SD 57366 Assisted Living 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 7: Charity care expense 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. Other means tested government programs, community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded in the general ledger. Part I, Line 7g: Rural health clinic costs are included in subsidized health services. Revenues of $3,844,783 and costs of $3,849,344 were included for a net community benefit of $4,561. Part II, Community Building Activities: Avera St. Benedict Health Center 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. 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. Benedict 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: Community needs are evaluated and assessed on an on-going basis in several ways. ASBHC has completed formal "needs assessments" several times over the course of the past several years. This has been accomplished with input from focus groups, surveys, short and long range planning by the Health Center Board, demographic and health care data analysis, regular meetings with the provider staff, and collaboration with the local school and churches, as well as local law enforcement. 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 Benedict is a 25-bed critical access hospital in Parkston, South Dakota. The primary service area is defined as Hutchinson County, South Dakota, including the communities of Freeman, Menno, Olivet and Tripp. Olivet is the county seat. Agriculture is the primary economic driver in the county. In calendar year 2020, Avera St. Benedict had 422 inpatient discharges, 59.48% of inpatient discharges were from Hutchinson County (2020 South Dakota Association of Healthcare Organization Inpatient Origin and Destination Study). In fiscal year 2021, Hutchinson County produced 66% of total emergency department visits to Avera St. Benedict. According to the U.S. Census Bureau's 2020 data, the population of Hutchinson County was just over 7,400 people and is predominately White/Caucasian (95%). About 23% of the population is over the age of 65. County Health Rankings statistics assesses the unemployment rate of 3.1% compared with the state of South Dakota's 3.3% unemployment (2021.) County Health Rankings states that the median household income of Hutchinson County is $59,300, which is about $1,100 less than the state's average. The percentage of children in poverty in the county was projected at 17%, while about 9% of households being single parent households (2021). County Health Rankings rates high school graduation rates in the county at 88% and adults with some post-secondary education at 73% (2021). The secondary service area, including portions of Douglas, Davison, Bon Homme, Hanson and Charles Mix Counties are demographically similar to Hutchinson County with rural, agricultural lifestyles. In calendar year 2020, 38.87% of inpatient discharges were from one of these five counties (2020 South Dakota Association of Healthcare Organization Inpatient Origin and Destination Study). In fiscal year 2021, Douglas, Davison, Bon Homme, Hanson, and Charles Mix counties produced 25% of total emergency department visits to Avera St. Benedict. According to County Health Rankings and the US Census, Charles Mix County is different from the rest of the service area in that there is a 31.3% Native American population, median household income of $50,481, more children in poverty (30%) and children in single parent households (32%). Avera St. Benedict is the primary medical provider for 8 Hutterian Brethren Colonies in the primary and secondary service area, which includes about 550 individuals. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. The Board of Directors meets monthly and has community representation that brings forward issues relative to challenges, needs and services within the community. The local ministerial group meets monthly at the Hospital and also identifies needs and gaps within the parishioners they serve. Medical staff privileges are extended to all qualified physicians in the community. The medical staff, including the physicians/mid-levels/department directors, has the opportunity to meet monthly and also discuss ways to meet the needs of the community they serve. Surplus funds are reinvested in facilities to improve patient care. The Hospital operates an emergency room that is available to all, regardless of ability to pay.ASBHC has a fitness center on campus that is available to help the community focus on wellness and prevention. This endeavor is subsidized by the facility to improve the health and well-being of the community as a whole. The chaplaincy mission services participate and spearhead many community projects including an angel tree at Christmas to address the needs of children in our service area. ASBHC also donates to the local food pantry and purchases, prepares, and serves a meal to the Love Feast in Mitchell, SD annually. The meal serves 300 plus people in need of nutrition. At that event, bags of groceries are provided to the families in need that are in attendance to take home. There are several other projects of this nature on a smaller scale at the local school system. ASBHC donates to community events such as American Cancer Society projects and sponsors health related educational programs to the community at large. Avera St. Benedict also provides medical, nursing, and other ancillary health professions the opportunity for hands on learning experiences through residencies, internships, clinical rotations and other shadowing and profession mentoring programs to help with students health care training needs. 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 Dakota Heartland Development Association 601 N Main St Mitchell SD 57301 352397643 501(c)(3) 7500 0 Rural Economic Development City of Parkston 207 W Main St PO Box 490 Parkston SD 57366 466000348 501(c)(3) 37500 0 Community Donation for Baseball and PAPA's Parks 2 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRS 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; Sec/Treas 0 1032072 0 10440 0 8716 0 14500 0 1694 0 1067422 0 0 Jason Wickersham MD Family Medicine/OB Physician 295099 0 26000 0 75531 0 14500 0 30914 0 442044 0 0 0 Larissa Sanger MD Family Medicine/OB Physician 241740 0 24700 0 41154 0 14500 0 23795 0 345889 0 0 0 Antoinette VanderPol MD Vice Chair/Family Medicine, OB 230044 0 18850 0 49698 0 14500 0 12456 0 325548 0 0 0 Paul Berndt Physician 216538 0 13125 0 28817 0 11563 0 37410 0 307453 0 0 0 Jedd Bialas CRNA 191465 0 0 0 15541 0 9972 0 33755 0 250733 0 0 0 Cody Freudenthal CRNA 186215 0 0 0 4536 0 9010 0 39004 0 238765 0 0 0 Rita Blasius President/CEO 182712 0 930 0 3801 0 8862 0 14734 0 211039 0 0 0 Denise Leischner Family member of Pat Leischner, Board Member 89974 Compensation and benefits as an employee 0 Form 990, Item J: The organization's website is: avera.org/locations/profile/avera-st-benedict-health-center/ 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) Define the purpose, philosophy and mission of this Corporation. 2) Receive and approve budgets of this Corporation. 3) Review and approve audited financial reports of this Corporation. 4) Dissolve, merge or consolidate this Corporation. 5) Approve the selection and retention of the independent auditing firm. 6) Approve any action which would change the character of this Corporation. 7) Initiate and/or approve all amendments to the Articles of Incorporation and Bylaws of this Corporation. 8) Appoint and remove, with or without cause, the Directors, sanction vacancies and determine the number of Directors of this 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 St. Benedict Hospital does not have any committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. 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 15a The President and CEO of Avera Queen of Peace, a related organization, initiates the annual review for the CEO. He sends out evaluation forms to the board of St. Benedict's. Comparative data from Avera Health System is used to develop a recommended compensation structure. The compensation for the CEO is approved by Avera St. Benedict's board. This is done on an annual basis, usually in January. The CFO-Avera Health is 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 942,729. Management and general expenses 162,701. Fundraising expenses 0. Total expenses 1,105,430. Repairs and Maintenance: Program service expenses 505,001. Management and general expenses 30,935. Fundraising expenses 0. Total expenses 535,936. Medical Prof Fees: Program service expenses 43,994. Management and general expenses 0. Fundraising expenses 0. Total expenses 43,994. Centralized Services: Program service expenses 748,188. Management and general expenses 1,647,804. Fundraising expenses 0. Total expenses 2,395,992. Form 990, Part XI, line 9: Change in Interest in Avera Foundation -152,046. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Health, which includes St. Benedict Health Center. Form 990, Part X, Line 20: St. Benedict Health Center 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. St. Benedict Health Center was not allocated any share of the bond issue, and thus does not have an amount on line 20. 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 St Benedict Health Center Foundation 401 West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 1 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 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 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 Queen of Peace Hospital 525 North Foster Street Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th ST Suite 9 Yankton SD 57078 460337013 Healthcare services SD 501(c)(3) Line 10 Sacred Heart Health Services 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 Marshall 300 S Bruce ST Marshall MN 56258 410919153 Healthcare services MN 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 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 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 Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln ST NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Sioux Center LLC 38 19th ST SW Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical services - home medical equipment 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 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare Services SD N/A 0 0 Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 821447782 Accountable Care Organization MO N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 7509 NW Tiffany Springs Parkway Ste Kansas City MO 64153 611843657 Accountable Care Organization MO N/A 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 2301 Hwy 71 South Ste D Spirit Lake IA 51360 862949748 Medical services - home medical equipment IA 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 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company 5300 South Broadband Lane Sioux Falls SD 57108 460401087 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 Alucent Australia Pty Ltd Level 10 30 Collings Street Melbourne VIC 3000 AS Biotech Research AS N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0