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 420680370 Avera Holy Family AVER 7123626519 826 North 8th Street Estherville IA 51334 Julie Lautt CFO Avera Health 7123626519 2022-05-12 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-05-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Deb Herzberg 826 North 8th Street Estherville IA 51334 30600480 0 0928 X See Schedule O X 1996 IA Promotion of Health 8 8 234 8 0 0 2521830 171100 26152069 28706956 497762 1703031 26123 19393 29197784 30600480 29420 46336 0 0 13781226 13081109 0 0 52282 11957252 12836523 25767898 25963968 3429886 4636512 58037598 61816340 13240891 7148901 44796707 54667439 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 23118873 46336 28707067 Avera Holy Family's mission is to provide healthcare services to Estherville, Iowa residents and residents of the surrounding area. Avera Holy Family is a 501(c)(3) organization affiliated with Avera Health. Avera Holy Family consists of a 22-bed critical access hospital and a clinic in Estherville, Iowa. The program services offered include primary care, general surgery, cardiac rehab, nuclear medicine, ICU, emergency, ultrasound, speech therapy, physical therapy and occupational therapy. Avera Holy Family provides acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera Holy Family Hospital345 Acute inpatient discharges124 Swing-bed patient discharges32,636 Outpatient visits936 Swing-bed patient days18,093 Clinic visitsAvera Holy Family maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $500,815.Avera Holy Family also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera Holy Family upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera Holy Family engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed.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. 23118873 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 51 0 1 234 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 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 Joe Greig Chair 1.00 0.00 X X 0 0 0 Roslyn Gunderson Vice Chair 1.00 0.00 X X 0 0 0 Sr Janet Schumacher Board Member 1.00 0.00 X 0 0 0 Sr Sharon Haas Board Member 1.00 0.00 X 0 0 0 Mike Cornwall Board Member 1.00 1.00 X 0 0 0 Chris Schiltz Board Member 1.00 0.00 X 0 0 0 Joe Fitzgibbons Board Member 1.00 0.00 X 0 0 0 Kathy Preston Board Member 1.00 0.00 X 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0.10 41.30 X 0 903545 36378 Deb Herzberg President/CEO 40.00 1.00 X 0 192180 47969 Kristi Hough Pharmacy Manager 40.00 0.00 X 163479 0 42490 April Krull Pharmacist 40.00 0.00 X 128055 0 44440 Molly Anderson Physical Therapist 40.00 0.00 X 103195 0 23845 Carey Fehr Radiology Diagnostic Imaging Supervisor 40.00 0.00 X 103516 0 23673 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0.00 0.00 X 0 329248 15667 498245 1424973 234462 4 1 1 0 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Medical services 3583550 Docs Emergency Medicine Inc 800 W Frontier Lane Olathe KS 66061 Medical/Locum Services 884042 Acute Care Inc 1609 N Ankeny Blvd Ste 200 Ankeny IA 50023 Medical Healthcare Services 670617 Avera Health 3900 W Avera Drive Sioux Falls SD 57108 Shared Services 483266 Psychiatric Medical Care LLC 4322 Harding Pike 417 Nashville TN 37205 Medical Services 362340 8 67999 86520 16581 171100 Patient Service Revenue 622110 25965611 25965611 Pharmacy Revenue 900099 2269184 2269184 Collaborative Agreement 900099 381405 381405 Cafeteria 900099 56051 56051 34705 34705 28706956 15222 15222 19282 0 19282 19282 19282 1678799 9010 0 0 1678799 9010 1687809 1687809 AR Interest Income 900099 111 111 111 30600480 28707067 0 1722313 X 46336 46336 9822938 9160253 643163 19522 780454 734790 44837 827 1794804 1632031 162122 651 682913 638015 43515 1383 2913 2913 5744334 5137113 603243 3978 6242 259 5983 395581 234393 147642 13546 582865 502533 80332 515524 428937 82072 4515 7855 7721 134 27819 23392 4427 73770 61220 12550 1587502 1409756 177746 183273 118978 64295 Medical Supplies 3378637 2838311 532672 7654 Equipment Lease/Rental 75328 28891 46437 254880 115944 138864 72 25963968 23118873 2792813 52282 1201847 1395446 3091306 3638570 719938 697564 145554 130475 34096149 20453391 14315574 13642758 306011 311605 38117638 41898753 139730 101169 58037598 61816340 1962052 2464775 1996483 145651 2027993 1768161 7254363 2770314 13240891 7148901 X 44144876 53886310 651831 781129 44796707 54667439 58037598 61816340 X 4636512 4645207 589013 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2913 2913 0 Part II-B, Line 1: Avera Holy Family paid dues to organizations which have a portion of the dues attributed to lobbying activities. 1859198 360310 2219508 1807087 52111 1859198 1493819 80000 233268 1807087 1490407 3412 1493819 1055754 442798 8145 1490407 0.93070 0.06930 0.00000 0 1 1 475540 475540 22398297 12312538 10085759 10154069 7637238 2516831 1068243 503615 564628 13642758 Avera Pooled Investments 38492302 F Investment in Foundation 3406451 F 41898753 Due to Related Party -275995 Estimated Third Party Settlements 2563678 Deferred Payroll Taxes 379989 Right of Use Operating Lease Obligation 102642 2770314 X Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. Part X, Line 2: Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 1 0 0 284361 284361 0.01100 2434610 2028342 406268 0.01560 2718971 2028342 690629 0.02660 27439 27439 0.00110 22383 22383 0.00090 3370260 1103506 2266754 0.08730 123853 123853 0.00480 3543935 1103506 2440429 0.09410 6262906 3131848 3131058 0.12070 4013 4013 0.00020 4013 4013 0.00020 1 220683 11182859 11072137 110722 X 1 1 1 1 Avera Holy Family Health 826 N 8th Street Estherville IA 51334 See Part V Section C 320014H X X X X Provider Based Clinic Avera Holy Family 1 0 0 1 X X X X X X X X X 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 Avera Holy Family Part V, Section B, Line 5: Avera Holy Family Hospital initiated community discussion groups and community health needs survey. Community input was gathered through community partners and service groups that represented the broad interests of the community. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. All of those providing community input represent the interests of medically underserved populations and provided helpful information related to the needs of the community. The following organizations were represented in the process: * Emmet County Public Health* Avera Holy Family Medical Staff* Emmet County Wellness Coalition* Nursing Home Leaders* Fire, Law Enforcement, Ambulance and Support Services (FLEAS)* Compass Pointe Alcohol, Drug & Gambling Behavioral Health Services Avera Holy Family Part V, Section B, Line 11: The community health needs assessment was completed in 2018. The following community health priority areas were identified and the following actions will be taken by the hospital during future years.ACCESS TO MENTAL HEALTH CARE* Promote public awareness of mental health issues FY2021 Update: Senior Life Solutions continued to reach out to community organizations to promote their program and provide information on mental health issues in the elderly especially those impacted by restrictions and having to stay home.* Identify resources to address mental health concerns FY2021 Update: Welcomed Beth Will as MHDS Coordinator in Emmet County and she has started to work with Emmet County Sheriff's Office and other organizations to find faster and more appropriate mental health placement. AHFH became a partner with eBehavioral Health in order to be able to help with the initial treatment of patients that need mental health placement but do not have bed availability.* Determine gaps in programs/services that address mental illnessFY 2021 Update: Continued with Virtual Training Videos for the community, parents, and students. ACCESS TO URGENT/CONVENIENT HEALTHCARE* Collaborate with medical staff to determine options for expanding services to allow more flexible and convenient hours of service to the communityFY2021 Update: Promoted Virtual Clinic visits for patients that had COVID-like symptoms and also offered COVID testing by drive-up and also by accommodating patients with COVID-like symptoms to have an alternate entrance for lab and radiologic procedures.CARDIOVASCULAR DISEASE/HYPERTENSION* Raise awareness of the factors that contribute to heart disease and measures to prevent diseaseFY2021 Update: Extended days that Planet Heart screenings could be done in order to allow for quicker appointment times especially since a lot of people put off health activities during COVID. * Ensure people at risk have access to diagnosis and appropriate treatment* Promote healthy eating and physical activity * Encourage smoking cessation FY2021 Update: Still not able to participate in local health fairs with the COVID restrictions that are in place. AHFH did start to provide Diabetic Education via webex technology.EARLY DETECTION OF CANCER* Promote awareness of contributing factors and signs and symptoms of cancerFY2021 Update: Focused on catching up on all mammograms that were put off during the pandemic. Continued with social media posts focusing on cancer. * Encourage screening for early detection of cancer. OBESITY* Raise awareness regarding the impact obesity has on quality of life, incidence of disease and medical complications, and healthcare costs* Collaborate with Emmet County Public Health, Emmet County Wellness Coalition and other community partners to promote physical activity and wellness * Raise awareness regarding the impact that poor eating habits have on health and wellness. FY2021 Update: Continued promoting lifestyle changes and healthy habits through social media platforms in collaboration with other community groups and organizations.* Collaborate with Emmet County Public Health, Emmett County Wellness Coalition and other community partners to promote healthier eating habits.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 will not be addressed due to either a relative low priority, resource constraints or, because other facilities or educational entities are addressing the issues:* Low immunization ratesFY2021 Update: AHFH, Emmet County Public Health, and Estherville Pharmacy all participated in COVID vaccination clinics in order to get the vaccine out and promote the vaccine.* Lack of access to dental care* Lack of parenting skills* Alcohol and drug abuse Avera Holy Family Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera Holy Family Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Holy Family Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera Holy Family Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Schedule H, Part V, Section B, Line 7a, 7b and 10a: https://www.avera.org/locations/profile/avera-holy-family-hospital/ Schedule H, Part V, Section A organization's website: avera.org/locations/profile/avera-holy-family-hospital/ Schedule H, Part V, Section B, Lines 16a, 16b, and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/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 was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost report. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. Part II, Community Building Activities: The organization supports and donates to various community organizations focusing on issues impacting the community's health and safety. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 17 and 18. Part III, Line 8: Avera Holy Family provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare program are not completely covered, the Medicare shortfall is considered a community benefit. Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: The hospital utilizes the Health Stream Patient Experience Survey to gather information about patients' perceptions of their care experiences. The survey helps us know how to improve care and services to better meet the needs of our community. The Professional Activities Committee of the Medical Staff meets eight times a year to discuss patient needs, evaluate care & services and identify opportunities to enhance care and services. The Medical Staff meets quarterly to discuss these same topics. The Critical Access CAH Committee meets quarterly to review and approve care and service policies and procedures and to evaluate care and services. Part VI, Line 3: Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs. Part VI, Line 4: Avera Holy Family is a 22-bed critical access hospital in Estherville, Iowa. The primary service area is defined as Emmet County, Iowa, including the communities of Armstrong, Dolliver, Estherville, Gruver, Ringsted and Wallingford. Estherville is the county seat. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Emmet County as of July 1, 2019 is 9,208 and is predominately white at 94.1%. It is estimated that 21.6% of the population is 65 years and over. The median household income is $51,563 with a 11.4% poverty rate. Uninsured individuals under age 65 is estimated at 7.1%. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 1 Regional Transit Authority ART PO Box 1240 Spencer IA 51301 421133312 501(c)(3) 7500 Support Estherville community transportation City of Estherville 2 N 7th St PO Box 417 Estherville IA 51334 426004647 Governmental 5500 Community/Athletic support Estherville Lincoln Central Community School District 1814 7th Ave S Estherville IA 51334 391886795 Governmental 12873 School General & Wellness support 3 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRC Section 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. 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 Jim Breckenridge Former CFO Avera Health; Sec/Treas 0 299918 0 0 0 29330 0 7704 0 7964 0 344916 0 0 Deb Herzberg President/CEO 0 188233 0 0 0 3947 0 10045 0 37924 0 240149 0 0 Kristi Hough Pharmacy Manager 154797 0 285 0 8397 0 8491 0 33999 0 205969 0 0 0 April Krull Pharmacist 123619 0 0 0 4436 0 6887 0 37554 0 172496 0 0 0 Schedule J, Part I, Line 3: The President/CEO's compensation is paid by a related organization, Avera McKennan. Avera Holy Family relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. A The City of Estherville Iowa 426004647 297542BG6 2012-06-21 3840000 Refund the Series 2000 Bonds issued 12/14/2000 0 0 0 A 2015000 3840000 76800 3763200 2000 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Form 990, Item J The organization's website is: avera.org/locations/profile/avera-holy-family-hospital/ Form 990, Part VI, Section A, line 2 Jim Breckenridge, Julie Lautt, Dr. James Creech, Deb Herzberg and Dr. Meshia Waleh have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the Board of Directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the Member: 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of the Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, SD ("Presentation Sisters"), or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation; 7) To appoint and/or remove, with or without cause, the President and CEO of the Corporation; 8) To approve the operating/capital budgets and strategic plans of the Corporation; 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member; 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member; 11) To establish and maintain employee benefit programs; 12) To establish and maintain insurance programs; 13) To approve major community fund drives; 14) To approve the appointment of auditors; 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There is no committee with authority to act on behalf of the Board. Form 990, Part VI, Section B, line 11b The Form 990 is 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 President and CEO and certain board members are compensated by Avera McKennan, a related exempt organization. Avera McKennan has a process in place for determining compensation. 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 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 639,879. Management and general expenses 18,657. Fundraising expenses 19. Total expenses 658,555. Medical Prof Fees: Program service expenses 2,638,507. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,638,507. Purchased Services: Program service expenses 1,858,727. Management and general expenses 584,586. Fundraising expenses 3,959. Total expenses 2,447,272. Form 990, Part XI, line 9: Other change in net assets held by Avera Health Foundation 589,013. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera Holy Family. Form 990, Part X, Line 20: Avera Holy Family is part of the Avera Obligated Group which consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg and Avera at Home. Avera Holy Family was not allocated any share of the bond issue, and thus does not have an amount on line 20 related to the Obligated group bond issuance. The amount shown on line 20 and detailed in Schedule K relates to a separate bond issue of Avera Holy Family. 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 Foundation 826 N 8th Street Estherville IA 51334 421317452 Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 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 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 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 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 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 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 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 Av 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 731652049 Medical clinic building SD N/A 0 0 Surgical Associates Endoscopy Clinic LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates SD N/A 0 0 Heart Hospital of South Dakota LLC 4500 W 69th St Sioux Falls SD 57108 562143771 Healthcare Services NC N/A 0 0 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 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 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 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 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 Avera Holy Family Foundation C 67999 Cash Schedule R, Part III: Q&M Properties, LLC dissolved effective June 30, 2021. National Rural ACO 4 LLC liquidated effective December 31, 2020.