2022-05-16T15:19:22-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 460226738 St Benedict Health Center STBE 6059283311 401 West Glynn Drive Parkston SD 57366 Julie Lautt CFO Avera Health 6059283311 2022-04-25 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-04-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Avera St Benedict Health Center Rita Blasius 401 West Glynn Drive Parkston SD 57366 30600718 0 0928 X See Schedule O X 1965 SD Promotion of health 11 8 243 150 0 0 2001623 1257297 25126526 26782326 753352 2114671 26233 44041 27907734 30198335 86775 61418 0 0 14204072 13825983 0 0 0 8664416 9164287 22955263 23051688 4952471 7146647 61214683 69775695 7951813 3088830 53262870 66686865 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 19434246 61418 26811048 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 Hospital426 Acute patient discharges40 Newborn patient discharges163 Swing bed patient discharges17,482 Outpatient visits1,422 Swing-bed patient days57 Newborn patient days19,917 Clinic visitsAvera Bormann Manor16,559 Nursing home resident days41 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 $151,534.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.During the COVID pandemic over the last two years, Avera Health and its affiliated entities have stewarded significant funding toward community benefit, from our own resources and from state and federal assistance and relief funds. When the first cases were identified in 2020, we created a 24/7 hotline people could call to inquire about testing, treatment, and later vaccination. This hotline minimized the burden of clinics and helped protect patients and the public by keeping patients from presenting to healthcare facilities in person. Along with the hotline, Avera launched an innovative and specialized program for caring for COVID patients at home, including daily checkins, virtual visits (if needed) and at-home oxygen therapy. Throughout the pandemic this program has supported patients and kept hospitals from becoming overwhelmed.Additionally we launched public awareness campaigns for masking and vaccination that included earned media, paid advertising and digital presence. We set up testing sites and events, including a mass testing event for workers at the local protein plant. The state delegated vaccination efforts to South Dakota's health systems, and our state was recognized nationally for our "shots in arms" efficiency. Avera led efforts to prioritize those at highest risk, including not only elderly and infirm but homeless, congregate living residents and protein plant workers which included a high percentage of immigrants. We participated in national research for COVID therapies including convalescent plasma, monoclonal antibodies and antiviral medications. We worked with local and state officials to inform the public at regular press conferences and expanded bed capacity by reallocating resources across all hospitals in our system. Avera partnered with other health facilities and systems to ensure capacity for the sickest patients, and those in need of ICU care and ventilators. Avera also launched efforts to support and retain health care workforce, including such things as paying health insurance premiums, providing support payments, $2 across-the-board pay increases, increased on-call pay and shift differentials, and more. 19434246 1 1 0 0 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 32 0 1 243 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 Board Member/Chief of Staff 42.00 0.00 X 366732 0 26325 Rita Blasius President/CEO 41.50 0.50 X X 187821 0 21529 Patricia Leischner Chair 2.00 0.00 X X 0 0 0 Dave Neugebauer Vice Chair 2.00 0.00 X X 0 0 0 Barb Weidenbach Secretary 2.00 0.00 X 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 Shayne McIntosh Board Member 2.00 0.00 X 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0.10 41.30 X 0 903545 36378 Cody Freudenthal CRNA 40.00 0.00 X 205905 0 43390 Jason Wickersham MD Family Medicine/OB Physician 40.00 5.00 X 406922 0 45524 Larissa Sanger MD Family Medicine/OB Physician 40.00 0.00 X 295439 0 44985 Beth Schroeder PA-C Clinic Manager 40.00 0.00 X 187116 0 38581 Jedd Bialas CRNA 40.00 0.00 X 214962 0 43440 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0.00 0.00 X 0 329248 15667 1864897 1232793 315819 17 1 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Shared Services 2605590 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Medical Services 425154 Puetz Corporation 800 N Kimball Mitchell SD 57301 Construction 345866 Avera Queen of Peace 525 North Foster Street Mitchell SD 57301 ITS, administrative & management fees 142756 Cassling Diagnostic Imaging Inc 13808 F St Omaha NE 681371102 Maintenance Contract & Repairs 126080 6 60270 1197027 1257297 Net Patient & Resident Service Re 622110 25417426 25417426 Pharmacy Revenue 900099 697734 697734 Daycare Revenue 624410 29310 29310 637856 637856 26782326 7562 7562 15319 0 15319 15319 15319 2509492 398802 3581 2110690 -3581 2107109 2107109 AR Interest Income 900099 16722 16722 12000 12000 28722 30198335 26811048 0 2129990 X 61418 61418 553151 344431 208720 112202 112202 10326274 10125238 201036 408805 400127 8678 1708184 1635574 72610 717367 693969 23398 3450 3450 4213747 1723603 2490144 1683 236 1447 262701 108684 154017 219148 72448 146700 445222 358726 86496 30409 29265 1144 25764 23614 2150 1279938 1136107 143831 79297 49468 29829 Medical Supplies 2391440 2378102 13338 Equipment Lease/Rental 35245 35245 176243 145789 30454 23051688 19434246 3617442 0 656432 564705 943766 2401534 328361 271240 82874 87025 26393463 15234742 11996103 11158721 46912997 55015778 294150 276692 61214683 69775695 1862311 1906277 2828725 447044 7998 6542 3252779 728967 7951813 3088830 X 52314020 65512949 948850 1173916 53262870 66686865 61214683 69775695 X 7146647 5896317 381031 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 74568 10453 85021 75078 -510 74568 68235 108 6735 75078 65370 124 2741 68235 52199 9508 3663 65370 0.00000 0.81712 0.18288 0 1 1 97483 97483 17171746 8690018 8481728 8583756 6279541 2304215 540478 265183 275295 11158721 Avera Pooled Investments 53158539 F Interest in Avera Health Foundation 1857239 F 55015778 Estimated Third-Party Payors Settlements 190412 Right of Use Operating Lease Obligations 85705 Deferred Payroll Taxes 452850 728967 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 1 X 1 1 0 0 48271 48271 0.00210 791310 745703 45607 0.00200 51325 41008 10317 0.00040 890906 786711 104195 0.00450 90523 90523 0.00390 16750 16750 0.00070 4597263 4004743 592520 0.02570 22364 22364 0.00100 4726900 4004743 722157 0.03130 5617806 4791454 826352 0.03580 39500 39500 0.00170 67161 29310 37851 0.00160 106661 29310 77351 0.00330 1 614396 6882823 6814668 68155 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 18 1 0 0 1 X See Part V Section C X See Part V Section C X 1 18 1 See Part V Section C 0 1 X 150.000000000000 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 2018 through February 2019. Qualitative data was obtained from focus groups with the Parkston Commercial Club and Ministerial Association. The Parkston Commercial Club is a group of businesses in the Parkston area that meet monthly to support the community in a variety of ways, including fundraising for local events and family centered entertainment. Commercial club members are generally involved in many different activities in the community of Parkston, the local school district, and the surrounding area. The Ministerial Association members are clergy from many different congregations, some of which run food and clothing banks for individuals in need. The Ministerial Association meets monthly to work together to address many community and individual needs that are also social determinants of health. Formal individual interviews were conducted with two county health nurses, Andes Central School District Principal; Tripp School District Principal; Parkston School District superintendent; one Hutterite Colony boss; and manager of the only medical clinic in Lake Andes, SD. County health nurses are the only form of public health in Hutchinson County. A survey (electronic and paper) was completed by 103 community members. St. Benedict Hospital Inc. Part V, Section B, Line 11: Action on the implementation plan has started or was completed in most areas. COVID 19 impacted some of the activities by delaying or canceling them completely. The activities in the implementation plan that were not started secondary to COVID 19 are not listed. The following community health priorities were identified and the following actions have been taken during the tax year.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.TransportationFacility has promoted telehealth services to reduce transportation needs and to keep residents safe during pandemic. In-home medical care has happened when able secondary to COVID, specifically in high risk populations.Deterioration of Homes*Collaboration with the Commercial Club and Economic Development started in hopes of launching a "paint a house" program. Due to COVID 19, further progress has been delayed.After School Activities for KidsSupported the public library in their efforts to have a safe after school program for kids. Due to COVID 19 there was minimal movement on this. Access to CareWorksite wellness screenings took place at three worksites with a social distancing method.The following health need needs were not addressed due to resource constraints for the hospital at this time: Walking/Bike pathsMany areas of our implementation plan were not able to be completed due to COVID 19 and the continued surges and disease spread that we saw throughout the year. In order to keep the public health risk minimized, activities that would have potentially caused spread by putting people together in small places and putting staff at risk for contracting COVID 19 were not completed. The activities and priorities identified in the implementation plan will be addressed and implemented as able, secondary to COVID 19. Since many of our implementation plan efforts were collaborative, some of the other organizations either canceled programs or did not have the resources for some of the collaborative models because of the impact of COVID 19. 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/ 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 $4,004,743 and costs of $4,351,760 were included for a net community benefit of $347,017. Part II, Community Building Activities: Avera St. Benedict Health Center (ASBHC) operated a community daycare until September, 2020, providing a safe environment for the children. Lower income families are provided a safe and affordable place for their children. While not all the families are lower income, the organization sees this as a community need as there is no other facility in the area and the community as a whole would struggle to find daycare for their children. After ASBHC ceased operating the daycare, the space was made available to a community run daycare in March, 2021.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 17 and 18. 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. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Hutchinson County as of July 1, 2019 is 7,291 and is predominately white at 96.2%. It is estimated that 22.9% of the population is 65 years and over. The median household income is $57,089 with a 10.5% poverty rate. Uninsured individuals under age 65 is estimated at 12.3%.The secondary service area includes the coverage of 8 Hutterian Brethern Colonies and Charles Mix County. Charles Mix County is demographically different from the rest of the service area. The population is 32.7% Native American. The median household income is $50,481 with a 21.2% poverty rate. Uninsured individuals under age 65 is estimated at 17.0%. 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 Rural Economic Development Parkston Area Foundation PO Box 823 Parkston SD 57366 460444442 501(c)(3) 7500 Community Development American Legion PO Box 392 Parkston SD 57366 466014551 501(c)(19) 20000 Community Building Remodel 2 1 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 842009 0 55127 0 6409 0 14250 0 22128 0 939923 0 0 Jason Wickersham MD Family Medicine/OB Physician 297119 0 108278 0 1525 0 14250 0 31274 0 452446 0 0 0 Antoinette VanderPol MD Board Member/Chief of Staff 299905 0 65279 0 1548 0 14250 0 12076 0 393058 0 0 0 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0 299918 0 0 0 29330 0 7704 0 7964 0 344916 0 0 Larissa Sanger MD Family Medicine/OB Physician 237060 0 57465 0 914 0 14250 0 30735 0 340424 0 0 0 Jedd Bialas CRNA 213343 0 0 0 1619 0 10732 0 32708 0 258402 0 0 0 Cody Freudenthal CRNA 194725 0 0 0 11180 0 10632 0 32757 0 249294 0 0 0 Beth Schroeder PA-C Clinic Manager 163345 0 20305 0 3466 0 9423 0 29158 0 225697 0 0 0 Rita Blasius President/CEO 183595 0 900 0 3326 0 9384 0 12144 0 209349 0 0 0 Denise Leischner Family member of Pat Leischner, Board Member 112202 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 1,118,773. Management and general expenses 215,045. Fundraising expenses 0. Total expenses 1,333,818. Repairs and Maintenance: Program service expenses 529,730. Management and general expenses 34,099. Fundraising expenses 0. Total expenses 563,829. Medical Prof Fees: Program service expenses 75,100. Management and general expenses 0. Fundraising expenses 0. Total expenses 75,100. Centralized Services: Program service expenses 0. Management and general expenses 2,241,000. Fundraising expenses 0. Total expenses 2,241,000. Form 990, Part XI, line 9: Other change in net assets held by Avera Health Foundation 381,031. 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 Avera Holy Family 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 education 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 Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 Medical Clinic Building 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 National Rural ACO 4 LLC dba Prairie Hills Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 371780735 Accountable Care Organization KS N/A 0 0 National Rural ACO 5 LLC dba Great Plains Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 383958290 Accountable Care Organization KS 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 KS 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 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 Schedule R, Part III: Q&M Properties, LLC dissolved effective June 30, 2021. National Rural ACO 4 LLC liquidated effective December 31, 2020.