2022-05-16T15:18:09-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 470463911 Avera St Anthony's Hospital AVER 4023365132 300 N 2nd Street ONeill NE 687631569 Julie Lautt CFO Avera Health 4023365132 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 Todd Consbruck 300 N 2nd Street ONeill NE 687631569 45361116 0 0928 X See Schedule O X 1955 NE Promotion of health 12 10 274 10 0 0 3055291 1507164 39509607 41081260 976343 2751169 -634 6111 43540607 45345704 4500 1934 0 0 17698154 21234335 0 0 0 19921313 16290388 37623967 37526657 5916640 7819047 81208125 90346342 18949177 12331762 62258948 78014580 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 31492006 1934 41081629 Avera St. Anthony's mission is to provide healthcare services to O'Neill, Nebraska residents and residents of the surrounding area. Avera St. Anthony is a 501(c)(3) organization affiliated with Avera Health. Avera St. Anthony consists of a 25-bed critical access hospital in O'Neill, Nebraska and 6 clinics. The program services offered include primary care, emergency, telemedicine, general surgery, orthopedic surgery, podiatry surgery, cardiac rehab, pain management, OB, chemotherapy, radiology, sleep lab, dialysis, speech therapy, physical therapy, occupational therapy and pharmacy. Avera St. Anthony provides acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera St. Anthony Hospital624 Acute patient discharges140 Newborn patient discharges84 Swing bed patient discharges34,154 Outpatient visits676 Swing-bed patient days211 Newborn patient days27,113 Clinic visitsAvera St. Anthony 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 $349,552.Avera St. Anthony 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. Anthony 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. Anthony 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 check-ins, 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. 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. 31492006 1 0 0 0 0 0 0 0 0 1 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 0 0 0 0 0 0 0 1 1 0 0 0 1 49 0 1 274 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Brian Jundt MD Medical Staff Pres/Family Medicine 1.00 40.00 X 0 263825 9987 Todd Consbruck President/CEO 24.00 16.00 X X 0 219552 33841 Joe Krotter Chair 1.00 0.00 X X 0 0 0 Deb Kelly Member 1.00 0.00 X 0 0 0 Sister Kathryn Burt OSB Member 1.00 0.00 X 0 0 0 Sister Lynn Marie Welbig PBVM Member 1.00 4.00 X 0 0 0 Merri Schneider Member 1.00 0.00 X 0 0 0 Dick Grosch Member 1.00 0.00 X 0 0 0 Richard Fitch Member 1.00 0.00 X 0 0 0 Russ McIntosh Member 1.00 0.00 X 0 0 0 Amy Shane Member 1.00 0.00 X 0 0 0 Kirk Cisler Member 1.00 0.00 X 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0.10 41.30 X 0 903544 36378 Logan Kopf CRNA 40.00 0.00 X 165709 0 32013 Josh Becker CRNA Coordinator 40.00 0.00 X 415548 0 53040 Kevin Loecker CRNA Coordinator 40.00 0.00 X 261162 0 47666 Cameron Everitt Director of PT 40.00 0.00 X 162048 0 22694 Dean Benson Physician Assistant 40.00 0.00 X 167248 0 21097 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0.00 0.00 X 0 329248 15667 1171715 1716169 272383 12 1 1 0 Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 Shared Services 4367965 Avera Sacred Heart 501 Summit St Yankton SD 57078 Management, Support, & Lab Services 3103294 Docs Who Care 800 West Frontier Ln Olathe KS 66061 Physician Services 526070 Avera McKennan Hospital 1325 S Cliff Ave Sioux Falls SD 57105 Physician Services 360139 ENT Specialists PC 720 N 129th St Omaha NE 68154 Physician Services 284523 8 4604 1502450 110 1507164 Patient Service Revenue 622110 39335852 39335852 Pharmacy Revenue 900099 1464354 1464354 Clinic Revenue 621110 174936 174936 106118 106118 41081260 10559 10559 18240 12498 5742 5742 5742 2743524 0 2914 2743524 -2914 2740610 2740610 AR Interest Income 900099 369 369 369 45345704 41081629 0 2756911 X 1934 1934 16472235 15569706 902529 646369 604970 41399 3065485 2763502 301983 1050246 990662 59584 2056 2056 7412026 3410226 4001800 2058 1141 917 330500 157589 172911 245018 87903 157115 531635 427314 104321 81009 80994 15 38007 37917 90 242117 200926 41191 1904442 1710028 194414 125124 100376 24748 Medical Supplies 5247671 5241378 6293 Equipment Lease/Rental 11456 7504 3952 117269 97936 19333 37526657 31492006 6034651 0 2079779 903529 3291897 6912122 1200875 1491826 85621 73176 38411321 26946298 12859682 11465023 621475 628206 60817732 68860763 251064 11697 81208125 90346342 2654193 2689122 2086565 366125 7370319 7018086 6838100 2258429 18949177 12331762 X 62133098 77863959 125850 150621 62258948 78014580 81208125 90346342 X 7819047 7704178 232407 X 0 1 X 1 0 X 1 2056 2056 0 Part II-B, Line 1: Avera St. Anthony's Hospital paid dues to organizations which have a portion of the dues attributed to lobbying activities. 150500 150500 150500 150500 150500 150500 150500 150500 150500 150500 0.00000 1.00000 0.00000 0 1 1 745022 745022 25026642 17464832 7561810 11208524 8610848 2597676 1431133 870618 560515 11465023 Avera Pooled Investments 67498110 F Investment in Foundation 1362653 F 68860763 Right of Use Operating Lease Obligation 11697 Deferred Payroll Taxes 607065 Estimated Third Party Payor Settlements 1639667 2258429 X Part V, Line 4: The Foundation's endowment consists of a portion of their interest in the net assets of St. Anthony's Hospital Foundation. The St. Anthony's Hospital Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. Part X, Line 2: Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 1 0 0 166000 166000 0.00440 2897922 2278223 619699 0.01650 3063922 2278223 785699 0.02090 408546 60218 348328 0.00930 37292 37292 0.00100 11433219 4553192 6880027 0.18330 401 401 0.00000 11879458 4613410 7266048 0.19360 14943380 6891633 8051747 0.21450 8553 8553 0.00020 8553 8553 0.00020 1 1109171 12407490 12284644 122846 X 1 1 1 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 See Part V Section C 410002 X X X X 1 Provider based clinic, 1 RHC, 4 physician clinics St Anthony's Hospital 1 0 0 1 X X X X X X X X X 18 1 1 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, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X X 1 X 0 X X X X X 1 X 0 0 St. Anthony's Hospital Part V, Section B, Line 5: Avera St. Anthony's Hospital initiated a community focus group meeting and also conducted personal interviews with electronic communication responses. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input represented the medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: * O'Neill Police Department (OPD)* O'Neill Public Schools (OPS)* North Central District Health Department (NCDHD)* Avera St. Anthony's Hospital Social Service Department* University of Nebraska Lincoln Extension* Central Nebraska Community Action Partnership* O'Neill Ministerial Association* United Methodist Church Food Pantry* Holt County Economic Development St. Anthony's Hospital Part V, Section B, Line 6a: Antelope Memorial HospitalAvera Creighton HospitalBrown County HospitalCHI Health Plainview HospitalOsmond General Hospital St. Anthony's Hospital Part V, Section B, Line 6b: North Central District Health Department Region 4 Behavioral Health SystemO'Neill Public School Rural Region One Medical Response System St. Anthony's Hospital Part V, Section B, Line 11: The community health needs assessment was completed in 2018. The following community health priority areas were identified. CHRONIC DISEASE DETECTION & MANAGEMENT-Explore feasibility of expanding Social Work support to incorporate a Cancer case management system, child abuse prevention strategies, domestic violence, and Hospice care.-Continue to promote health maintenance through health screenings and additional options of detection/care management (Blood Pressure checks, bone density, skin cancer screening).Health Fair FY2021 Update: October 2020 - With considerations given to COVID-19 restraints the October 2020 Health Fair was cancelled. Farm & Home Show FY2021 Update: February 2021 - Avera COVID restrictions did not allow for personal contact with the public. With no physical presence available, limited information on ER/Radiology Project was provided at hospital booth.Women's Health ConferenceFY2021 Update: August 2020 - Conference proceeded with Pandemic Directed Health Measures in place but vendor representation was eliminated. FY2021 Update: June 2021 - Conference proceeded. The hospital was allowed to host a booth at the conference.Community Food Pantry monthly/quarterlyFY2021 Update: No public interaction provided due to COVID-19 restrictions.-Provide support to the community food pantry through financial contribution and physical presence to offer blood pressure screening, mental wellness screening tools, nutrition education.FY2021 Update: November 2020 Pamphlets of educational awareness for mental wellness addressing depression and the elderly were provided as handouts in the individualized packaging at the Community Food Pantry throughout September and October 2020.-Promote dietary education internally and externally through provision of calorie counts of food items and nutritional information tools. FY2021 Update: Members of Administrative Council/Director of Mission Services will collaborate with NCDHD, KBRX Radio Station, Northeast Community College, United Methodist Church and applicable Avera Service Lines.MENTAL WELLNESS-Provide support to the Befriend Family mentoring program through financial contribution to maintain coordination and viability of program. Provide program brochure to Medical Staff and clinic waiting areas.Befriend is an advocacy program that was adopted from Oasis Counseling International. It seeks to match mentee families with caring mentor families to local faith communities. Befriend's purpose is to restore at-risk families and individuals to their full God-designed potential through positive and caring relationships.FY2021 Update: In February 2021, there was a change in the Befriend program coordinator/management. The program is still financially viable. The number of families involved is disappointedly low. Barriers of "form phobia and confidentiality compromise are issues that the program hopes to overcome.-Partner with North Central District Health Department in suicide prevention initiative through sponsorship of public viewing of Suicide Prevention video "The Ripple Effect".-Implement Avera suicide staff education, precautions and screening policies in the ED and promote use of Avera Farmer's Stress Hotline resources.FY2021 Update: Handout of educational awareness for mental wellness addressing suicide prevention was provided within individualized packages distributed at Food Pantry during September and October 2020.FY2021 Update: Continued interventions to predict the presence and severity of depression were completed within the Emergency Department. A screening policy performs the Suicide Risk Primary Screen that additionally addresses abuse and violence/trafficking. This screening then potentially leads to the Columbia Suicide Severity Rating Scale which allows for continued support and/or intervention.-Members of Administrative Council/Director of Mission Services will collaborate with OASIS Counseling, Befriend Family Mentoring, NCDHD and Region 4 Behavioral Health System.The following health needs/priorities will not be addressed due to either a relative low priority, resource constraints or, because other facilities or educational entities are addressing the issues:-Resources Across the Lifespan-Substance AbuseMany of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. St. Anthony's Hospital 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. Anthony's Hospital 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. St. Anthony's Hospital 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. Anthony's Hospital 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 A, Line 1 https://www.avera.org/locations/profile/avera-st-anthonys-hospital/ Part V, Section B, Lines 7a, 7b and 10a: The CHNA and Implementation Strategy reports are available at avera.org/about/community-health-needs-assessments/#anthony Part V, Section B, Lines 16a, 16b, and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 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 and unreimbursed Medicaid were converted to cost using the cost-to-charge ratio derived from Worksheet 2. Subsidized health services were calculated using a combination of cost-to-charge ratio derived from Worksheet 2 and the Medicare cost report. Community health improvement services, health professions education and cash and inkind donations are actual expenses recorded in the general ledger. Part I, Line 7g: Provider based clinic costs are included in subsidized health services. Revenues of $4,050,864 and costs of $10,328,442 were included for a net community benefit of $6,277,578. 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. Anthony'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 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: Avera St. Anthony's Hospital conducts an annual strategic planning meeting that includes a cross section of community members. Our Hospital Board of Directors, Hospital Finance Committee, Foundation Board of Directors, Community Medical Staff, and Hospital Department Directors meet to assess community input from the local nursing facility, assisted living, and local public health office. Our Hospital and Foundation Boards and Finance Committee are made up of a majority of community members. This group drafts an annual strategic plan of goals, objectives, and strategies that are continuously updated to address the needs of the community. Additionally, input from the local ministerial association, law enforcement, Chamber of Commerce, elementary and secondary public and parochial schools, and the local community college are assessed and incorporated into the plan. Our CHNA report was completed during fiscal year ended June 30, 2019. 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 Anthony's is a 25-bed hospital in O'Neill, Nebraska. The primary service area is defined as Holt County, Nebraska. O'Neill is the county seat. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Holt County as of July 1, 2019 is 10,067 and is predominately white at 97.2%. It is estimated that 22.0% of the population is 65 years and over. The median household income is $60,387 with an 11.1% poverty rate. Uninsured individuals under age 65 is estimated at 10.7%. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. 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.Avera St. Anthony's has expanded Social Work support to integrate mental health services with Avera Coordinated Care, Dialysis and Home Health/Hospice. The organization also promotes health maintenance through screenings and additional options of detection and care management through blood pressure checks, bone density checks and skin cancer screening. Avera St. Anthony's had a hospital booth at the Women's Health Conference. Avera St. Anthony's supports the Community Food Pantry. They also provide support to the Befriend Family mentoring program through financial contributions to maintain coordination and viability of the program. Program brochures are available in clinic waiting areas. 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 55126 0 6409 0 14250 0 22128 0 939922 0 0 Josh Becker CRNA Coordinator 237102 0 177230 0 1216 0 14250 0 38790 0 468588 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 Kevin Loecker CRNA Coordinator 239007 0 20220 0 1935 0 13452 0 34214 0 308828 0 0 0 Brian Jundt MD Medical Staff Pres/Family Medicine 0 231905 0 31217 0 703 0 9987 0 0 0 273812 0 0 Todd Consbruck President/CEO 0 217743 0 0 0 1809 0 11251 0 22590 0 253393 0 0 Logan Kopf CRNA 133249 0 26521 0 5939 0 7072 0 24940 0 197721 0 0 0 Dean Benson Physician Assistant 161944 0 3812 0 1492 0 8448 0 12648 0 188344 0 0 0 Cameron Everitt Director of PT 156420 0 3645 0 1983 0 8206 0 14489 0 184743 0 0 0 Schedule J, Part I, Line 3: The President/CEO's compensation is paid by a related organization, Avera Sacred Heart. Avera St. Anthony's Hospital relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Form 990, Part VI, Section A, line 2 Julie Luatt, Jim Breckenridge, Brian Jundt, MD and Todd Consbruck 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 Avera St. Anthony's Hospital does not have a committee 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 15 Compensation of the President and CEO is determined by Avera Sacred Heart Hospital, a related exempt organization. The Board of Directors reviews the management agreement with Avera Sacred Heart Hospital and discusses and approves the agreement. 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 Repairs and Maintenance: Program service expenses 860,263. Management and general expenses 15,746. Fundraising expenses 0. Total expenses 876,009. Medical Prof Fees: Program service expenses 1,007,068. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,007,068. Purchased Services: Program service expenses 1,542,895. Management and general expenses 134,054. Fundraising expenses 0. Total expenses 1,676,949. Centralized Services: Program service expenses 0. Management and general expenses 3,852,000. Fundraising expenses 0. Total expenses 3,852,000. Form 990, Part XI, line 9: Other change in net assets held by Avera Health Foundation 232,407. 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 Avera St. Anthony's Hospital. Form 990, Part X, Line 20: Avera St. Anthony's Hospital is part of the Avera Obligated Group which consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg and Avera at Home. Avera St. Anthony's Hospital was not allocated any share of the bond issue, and thus does not have an amount on line 20. Form 990, Page 1, Item J Website: avera.org/locations/profile/avera-st-anthonys-hospital/ Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of health SD 501(c)(3) Line 10 N/A 0 Avera 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 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 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 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 Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 420224604 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 Ed and Serv 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 Marshall 300 S Bruce St Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 W Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan admin SD 501(c)(4) Avera Health 0 Avera 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 E 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 Avenue 102 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 730652049 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 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 Services SD N/A C 0 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Property 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 31325 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 0 0 0 0 0 1 0 1 1 1 0 0 Schedule R, Part III: Q&M Properties, LLC dissolved effective June 30, 2021. National Rural ACO 5 LLC dba Great Plains Care Organization liquidated effective December 31, 2020.