2022-05-16T15:18:08-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 460230199 Avera St Mary's AVER 6052243130 801 East Sioux Avenue Pierre SD 57501 Julie Lautt CFO Avera Health 6052243130 2022-05-12 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Avera St Mary's Hospital Todd Forkel 801 East Sioux Avenue Pierre SD 57501 120799783 0 0928 X See Schedule O X 1951 SD Promotion of health 10 7 661 120 515420 184465 9125748 4158857 97683351 109485690 19078 1826519 105047 54312 106933224 115525378 16113 19517 0 0 54077063 54531612 0 0 28794 45597053 50686052 99690229 105237181 7242995 10288197 117040382 117599795 61842379 44206934 55198003 73392861 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 92303295 19517 108974698 Avera St. Mary's mission is to provide healthcare services to Pierre, South Dakota residents and residents of the surrounding area. Avera St. Mary's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Mary's consists of a 50-bed hospital, an 80-bed nursing home, senior living apartments, and one physician clinic in Pierre, South Dakota. The program services offered include primary care, ob/gyn, pediatrics, orthopedics, general surgery, emergency, internal medicine, oncology, podiatry, urology, dermatology, pain management, ENT, speech therapy, occupational therapy, respiratory therapy, and wound care. Avera St. Mary's provides acute care and long-term healthcare services.Following is a breakdown of these statistics by facility:Avera St. Mary's Hospital1,601 Acute patient discharges386 Newborn patient discharges34 Swing bed patient discharges55,714 Outpatient visits191 Swing-bed patient days643 Newborn patient days81,216 Clinic visitsAvera Maryhouse20,567 Long-term resident days86 Long Term Care patient dischargesAvera St. Mary's maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $1,032,958.Avera St. Mary's also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera St. Mary's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Mary's engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed.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. 92303295 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 75 0 1 661 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 7 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Todd Forkel President/CEO 15.00 27.00 X X 0 728359 42148 Dr Joseph Wyatt Board Member/Urology 2.00 40.00 X 0 562548 15684 Dr Jessica Rasmussen Board Member/Obstetrics/Gynecology 2.00 40.00 X 0 314556 14250 Terry Fitzke Chair 2.00 2.00 X X 0 0 0 Sr Penny Bingham Board Member 2.00 7.00 X 0 0 0 Sr Lynn Marie Welbig PBVM Board Member 2.00 3.00 X 0 0 0 Michael Larson Board Member 2.00 2.00 X 0 0 0 Mike Weisgram Board Member 2.00 2.00 X 0 0 0 Scott Isburg Board Member 2.00 2.00 X 0 0 0 Dan Lusk Board Member 2.00 2.00 X 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0.10 41.30 X 0 903545 36378 Dr Mikel Holland Chief Medical Officer 2.00 40.00 X 0 337855 51761 Kevin Roark CRNA 40.00 0.00 X 217984 0 41846 Christopher Miller CRNA 40.00 0.00 X 231760 0 34398 Nick Jung CRNA 40.00 0.00 X 225024 0 16234 Erica Trebesch CRNA 40.00 0.00 X 231903 0 12351 Kevin Yackley CRNA 40.00 0.00 X 217990 0 20649 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0.00 0.00 X 0 329248 15667 1124661 3176111 301366 29 1 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Shared Services 11061346 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Medical Services 807110 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Contract Labor 786033 Health Carousel LLC 3805 Edwards Rd Ste 700 Cincinnati OH 45209 Contract Labor 523857 Restorix Health Inc 445 Hamilton Ave Ste 800 White Plains NY 10601 Wound Care Services 382140 15 39500 102939 3998506 17912 4158857 Patient Service Revenue 621110 101018495 101018495 Pharmacy Revenue 900099 6685417 6169997 515420 Assisted Living LTC 623312 750654 750654 1031124 1031124 109485690 49884 0 49884 49884 49884 6991248 109676 5183439 90966 1807809 18710 1826519 1826519 A/R Interest 900099 4428 4428 4428 115525378 108974698 515420 1876403 X 19517 19517 63378 63378 44598832 43221881 1376951 1906813 1559334 347479 5342663 4998206 344457 2619926 2548007 71919 1224 791 433 7066 7066 17738506 8594134 9131770 12602 10033 4869 40 5124 1107797 581754 517854 8189 591837 397251 194586 1558157 1331029 227128 151383 141811 9510 62 201478 193767 7594 117 1011934 839777 172157 5144009 4778646 365363 412636 383968 28668 Medical Supplies 22034418 22015960 17933 525 Equipment Lease/Rental 193389 188941 2875 1573 Income Taxes 32894 32894 489291 407380 81309 602 105237181 92303295 12905092 28794 3821140 6105366 13719625 15235777 3525081 3345275 263273 186931 116907204 67042316 51263107 49864888 43232388 41816721 902532 830862 313236 213975 117040382 117599795 6544032 1937042 2117094 585478 21951344 21647366 22221 7844086 7546753 23385823 12468074 61842379 44206934 X 49947573 69899084 5250430 3493777 55198003 73392861 117040382 117599795 X 10288197 4842187 3064474 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7066 7066 0 Part II-B, Line 1: Avera St. Mary's paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1391428 4260980 5652408 64954484 31236632 33717852 45036438 34824424 10212014 1263874 981260 282614 49864888 Avera Pooled Investment 33823860 F Interest in Avera Health Foundation 8120678 F Investments in Affiliated Organizations -127817 F 41816721 Estimated Third Party Payor Settlements 1122119 Due to Related Party 9643449 Right of Use Operating Lease Obligations 214815 Deferred Payroll Taxes 1487691 12468074 X Part IV, Line 2b: The Organization holds funds on behalf of its residents. 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 1 0 0 287112 287112 0.00270 62805 43354 19451 0.00020 349917 43354 306563 0.00290 10920 10920 0.00010 35893385 12375453 23517932 0.22350 123749 123749 0.00120 36028054 12375453 23652601 0.22480 36377971 12418807 23959164 0.22770 73784 73784 0.00070 1548 1548 0.00000 960 960 0.00000 240 240 0.00000 480 480 0.00000 77012 77012 0.00070 1 6414400 22214185 21240406 973779 X 1 1 1 1 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 See Part V Section C 10566 X X X provider based clinic Avera St Mary's 1 0 0 1 X X X X X X X X X 18 1 0 1 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 Avera St. Mary's Part V, Section B, Line 5: Avera St. Mary's gathered information regarding the needs of the community through a three-pronged process gathering stakeholder information on community perceptions of the health of Central South Dakota including a survey of three civic social clubs, interviews with identified community leaders, and several focus groups. All members of the CHNA team were selected for roles they have in the community by a matrix developed by the Avera St. Mary's Hospital Administrative Council and included attributes such as: uninsured/underinsured, parents of young children, close contact with underprivileged people to assure a "voice" in the process, health leaders with in-depth knowledge of the local health care environment, government, business, retired, South Dakota State Departments of health and social services, Urban Indian Health, and Rural Health Clinics. Avera St. Mary's Part V, Section B, Line 6b: South Dakota Department of HealthSouth Dakota Department of Social ServicesMunicipal Government stakeholdersRural Health ClinicUrban Indian Health Avera St. Mary's Part V, Section B, Line 11: The community health needs assessment was completed in 2018. The community health priority areas identified were: Mental Health Concerns, Physical Inactivity and Support for Healthy Eating. The following actions and programs included in the implementation strategy to address the community health priorities will be initiated in future years. FY2021 Update: Ongoing focus on community response to the pandemic has been the priority with vaccination clinics and engagement of a cross section of the community. Continue to lead the Pierre-Ft. Pierre Mental Health Task Force and engage with all stakeholders. The labor crisis in our community contributes to the various entities being unable to commit resources to these action steps. Refocusing and resuming the action steps below will be the goal in FY2022.MENTAL HEALTH CONCERNS-Conduct a survey to drill deeper into mental health concerns (access, family support, bullying, suicide/crisis, etc.)-Communicate back to the community on the specific needs identified in the survey and the plan to address-Request resources from all mental health providers, support groups, State of South Dakota, Counties, Cities Foundation of Hope, Schools, etc.-Share information with Helpline 211 to be a central resource-Support individuals in crisis with Mobile Crisis Response, phone, text, eCare optionsPHYSICAL INACTIVITY-Leverage Grants to develop incentive program in conjunction with Avera Grants office-Compile a list of activities available in the communitySUPPORT FOR HEALTHY EATING-Engage youth entities, schools, daycares, Cities of Pierre and Ft. Pierre and encourage initiating or expanding gardening. Collaborate with local Master Gardening group for education-Cooking classes for community and samples in local grocery store. Collaborate with Pierre Public School Culinary Arts 1 class and local chefs-Engage locally owned restaurants asking that they feature one or more low calorie option or add section to menu with healthier options. Provide support for making this change.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. The following health needs/priorities emerged but are beyond the scope or control of Avera St. Mary's. The issues will be referred to the appropriate community organizations:-Assistance for uninsured, beyond Avera St. Mary's financial assistance program-Affordable housing Avera St. Mary's Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera St. Mary's Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Mary's Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera St. Mary's Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section B, Lines 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/#mary Part V Section A website address: avera.org/locations/st-marys/ Part V, Section B, Line 16a, 16b, and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/ 3 1 - Avera Parkwood Independent Living 400 Parkwood Drive Pierre SD 57501 Independent living 2 - MaryHouse 717 E Dakota Ave Pierre SD 57501 Long term care 3 - Avera St Mary's Campus Pharmacy 100 Mac Lane Suite 101 Pierre SD 57501 Retail pharmacy Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: Charity care expense was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Health professions education and cash and in-kind contributions are reported based on actual expenses recorded in the general ledger. Part I, Line 7g: Physician clinic costs are included in subsidized health services. Revenues of $12,660,250 and costs of $27,672,073 were included for a net community benefit of $15,011,823. Part II, Community Building Activities: Avera St. Mary's provided donations to various organizations to support activities as listed on Part II. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. 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. Mary's provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare programs are not completely covered, the Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the 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: Health care needs are assessed through various methods. Avera St. Mary's strives to deliver comprehensive care and extensive medical specialty services to community members located in central South Dakota. Avera St. Mary's is integrally involved with community organizations, the university center, schools, and state and local governments. The closest hospitals offering the same level of care and services are located 154 miles away in Mitchell, SD and 160 miles away in Aberdeen, SD. Within our regional footprint, the majority of the communities have populations of less than 2,500 people. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. In addition to activities reported in the Community Health Needs Assessment, Avera St. Mary's and Avera Gettysburg collaborate with the YMCA, Feeding South Dakota, the Pierre\Ft. Pierre Mental Health Task Force, the United Way, RSVP, the Senior Services Committee and the Transit Community Grant group to assess and promote health related matters. Part VI, Line 3: Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs. Part VI, Line 4: Avera St Mary's is a 50-bed hospital in Pierre, South Dakota. The primary service area includes Hughes, Stanley and Sully Counties. Pierre is the county seat of Hughes County as well as the capital of South Dakota. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Hughes County as of July 1, 2019 is 17,526. The population is predominately white at 83.6% and Native American 12.1%. It is estimated that 18.0% of the population is 65 years and over. The median household income is $64,783 with a 8.9% poverty rate. Uninsured individuals under age 65 is estimated at 10.2%.According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Stanley County as of July 1, 2019 is 3,098. The population is predominately white at 88.3% and Native American 7.1%. It is estimated that 20.4% of the population is 65 years and over. The median household income is $71,382 with a 7.7% poverty rate. Uninsured individuals under age 65 is estimated at 10.0%.According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Sully County as of July 1, 2019 is 1,391 and is predominately white at 94.6%. It is estimated that 26.1% of the population is 65 years and over. The median household income is $62,153 with a 8.2% poverty rate. Uninsured individuals under age 65 is estimated at 11.2%. Part VI, Line 5: The hospital serves all persons in the community on a non-discriminatory basis. Avera St. Mary's operates an emergency room that is open to all persons regardless of ability to pay. Avera St. Mary's has an open medical staff with privileges available to all qualified physicians in the area. The governing body is comprised of primarily independent individuals, representative of the community as a whole. Avera St. Mary's provides education and training opportunities to healthcare students enrolled in the local college - Capital University Center. Avera St. Mary's participates in Medicaid, Medicare, Indian Health, Champus, Tricare and/or Other Government sponsored Health Care Programs.Avera St. Mary's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (Capital Area United Way, Pierre/Fort Pierre Rotary, Pierre Area Chamber of Commerce, YMCA Board, Pierre Booster Club and many more). Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 0 0 0 0 0 0 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0 842009 0 55127 0 6409 0 14250 0 22128 0 939923 0 0 Todd Forkel President/CEO 0 685402 0 35420 0 7537 0 8174 0 33974 0 770507 0 0 Dr Joseph Wyatt Board Member/Urology 0 534439 0 25500 0 2609 0 14250 0 1434 0 578232 0 0 Dr Mikel Holland Chief Medical Officer 0 334986 0 420 0 2449 0 14250 0 37510 0 389615 0 0 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0 299918 0 0 0 29330 0 7704 0 7964 0 344916 0 0 Dr Jessica Rasmussen Board Member/Obstetrics/Gynecology 0 296782 0 16242 0 1532 0 14250 0 0 0 328806 0 0 Christopher Miller CRNA 202177 0 225 0 29358 0 6867 0 27531 0 266158 0 0 0 Kevin Roark CRNA 215502 0 0 0 2482 0 9080 0 32766 0 259830 0 0 0 Erica Trebesch CRNA 223309 0 6113 0 2481 0 10577 0 1774 0 244254 0 0 0 Nick Jung CRNA 222397 0 0 0 2627 0 5789 0 10445 0 241258 0 0 0 Kevin Yackley CRNA 202775 0 0 0 15215 0 10212 0 10437 0 238639 0 0 0 Schedule J, Part I, Line 3: President/CEO serves Avera St. Luke's, Avera St. Mary's, and Avera Gettysburg and was compensated by a related organization, Avera Health. Avera St. Mary's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Deborah Holland Family member of board member 63378 Employee Compensation 0 Form 990, Item J The organization's website is: www.avera.org/st-marys-pierre Form 990, Part VI, Section A, line 2 Jim Breckenridge, Julie Lautt, Todd Forkel and Sister Penny Bignham have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the member: 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is 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 15 The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not made available to the general public. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public. Form 990, Part IX, line 11g Medical Prof Fees: Program service expenses 499,397. Management and general expenses 0. Fundraising expenses 0. Total expenses 499,397. Purchased Services: Program service expenses 6,128,110. Management and general expenses 230,966. Fundraising expenses 11,365. Total expenses 6,370,441. Repairs & Maintenance: Program service expenses 1,966,627. Management and general expenses 24,284. Fundraising expenses 1,237. Total expenses 1,992,148. Centralized Services: Program service expenses 0. Management and general expenses 8,876,520. Fundraising expenses 0. Total expenses 8,876,520. Form 990, Part XI, line 9: Equity Transfers -14,310. Other change in net assets held by in Avera Health Foundation 3,078,784. Form 990, Part X, Line 20: The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg and Avera at Home. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673). Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Mary's. Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of Health SD 501(c)(3) Line 10 N/A 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's Healthcare 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 Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 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 St Benedict Health Center Foundation 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 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 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera 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 Street 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 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 Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 medical clinic building SD N/A 0 1 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 102 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 Healthcare services 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 Ave 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 Inc 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 1 0 0 0 1 1 1 1 1 1 1 1 Avera Gettysburg M 109113 General Ledger Schedule R, Part III: Q&M Properties, LLC dissolved effective June 30, 2021. National Rural ACO 4 LLC liquidated effective December 31, 2020.