2021-05-17T13:17:02-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 460224598 Avera St Luke's AVER 6056225272 305 South State Street Aberdeen SD 57401 Julie Lautt CFO Avera Health 6056225272 2021-05-12 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-12 2019 2022-09-23 18:48:47Z Todd Forkel 305 South State Street Aberdeen SD 57401 193843919 0 0928 X www.averastlukes.org X 1901 SD Promotion of Health 15 12 1414 51 866947 -74455 400626 9169507 199869615 182283325 420120 107544 -351101 -418376 200339260 191142000 193616 174020 0 0 112994113 111299687 0 0 181447 92919365 83048148 206107094 194521855 -5767834 -3379855 162705089 188282898 85400534 113318180 77304555 74964718 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 162900710 174020 181481913 Avera St. Luke's mission is to provide healthcare services to Aberdeen, South Dakota residents and residents of the surrounding area. Avera St. Luke's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Luke's consists of 50 hospital beds, 10 inpatient psych beds, an 81 bed nursing home in Aberdeen, SD and a 56 bed nursing home in Eureka, SD, a 10-bed surgical center in Aberdeen, SD, and 20 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, radiation, radiology, oncology, therapy, neurology, urology, hematology, psychiatry, neonatology, gastroenterology, and cardiology. Avera St. Luke's provides acute care and long-term healthcare services. Avera St. Luke's Hospital3,252 Acute patient discharges397 Newborn patient discharges186 Swing bed patient discharges122,668 Outpatient visits1,983 Swing-bed patient days702 Newborn patient days152,040 Clinic visits47,671 Nursing home resident days92 Long Term Care patient dischargesAvera St. Luke'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 $5,452,289.Avera St. Luke's also provides community benefit health activities at less than or at no cost to support those in the area served, see Schedule H.As a member of the Avera Health Network, Avera St. Luke'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. Luke'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. 162900710 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 168 0 1 1414 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Brandon Fites Orthopedic Surgeon 40.00 0.00 X 1596582 0 44526 Sushell Gundewar Cardiology 40.00 0.00 X 1455404 0 44022 Richard Conklin Oncologist 40.00 0.00 X 1322078 0 50034 Christopher Larson General Surgeon 40.00 0.00 X 1270977 0 48495 Roger Werth General Surgeon 40.00 0.00 X 1200746 0 43432 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0.10 41.30 X 0 1018166 36856 Todd Forkel President & CEO 40.00 4.00 X 0 690400 40607 Garret Wobst MDDirector Surgery/Podiatry 40.00 0.00 X 541940 0 42563 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0.10 40.70 X 0 518454 35583 Adam LeFebvre MD Director/Anesthesiology 40.00 0.00 X 456958 0 43955 Lyle Biegler MD Director/Family Medicine 40.00 0.00 X 384300 0 42802 Will FlettFormer Secretary/Treasurer 0.00 40.00 X 0 195844 40656 Tom Snyder VP Long Term Care 40.00 1.00 X 209300 0 25678 Robert Fouberg Chair 1.00 5.00 X X 0 0 0 Tom Seyer Vice Chair 1.00 0.00 X X 0 0 0 Sr Mary Kay Panowicz Director 1.00 5.00 X 0 0 0 Sr Kathleen Ann Bierne Director 1.00 2.50 X 0 0 0 Sr Marietta Kerkvliet Director 1.00 0.00 X 0 0 0 Sr Patricia Prunty PBVM Director 1.00 2.00 X 0 0 0 Sandra Kleinknecht Director 1.00 0.00 X 0 0 0 Dick Inman Director 1.00 0.00 X 0 0 0 Marshall Lovrien Director 1.00 0.00 X 0 0 0 Carmen Meyer Director 1.00 0.00 X 0 0 0 Diana Reynen Director 1.00 0.00 X 0 0 0 Heidi Golz Director 1.00 0.00 X 0 0 0 8438285 2422864 539209 137 1 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 571085721 Shared services 20335866 Restorix Health Inc 445 Hamilton Ave Ste 800 White Plains NY 10601 Medical services 1444538 Huff Construction Inc 11 N Dakota St Aberdeen SD 57401 Construction 1077012 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Contract labor 706352 Dahme Construction Co Inc PO Box 407 Aberdeen SD 57401 Construction 391294 19 84700 8947430 137377 48541 9169507 Net patient services 621110 177447553 177447553 Supporting revenue 624100 4286326 3419379 866947 Investment in Partnership 900099 549446 549446 182283325 133170 133170 344839 828750 -483911 -483911 -483911 1838393 9150 1845194 27975 -6801 -18825 -25626 -25626 A/R Interest Income 900099 65535 65535 65535 191142000 181481913 866947 -376367 X 174020 174020 1797453 1536769 260684 66757 66757 86210490 81537934 4572438 100118 5545385 5276918 266805 1662 12587803 11382070 1175821 29912 5091799 4765712 318914 7173 20076 20076 30 30 20421 20421 31784657 10884394 20899212 1051 45891 20947 23138 1806 1911889 1026317 871806 13766 981534 658875 322659 2474511 2005820 468691 423486 370831 52655 328152 318581 9571 2592086 2285455 306631 6556963 5859490 696775 698 1315865 565870 749995 Medical Supplies 33110664 32971143 116936 22585 Equipment Lease/Rental 341071 254533 86538 1140852 938274 199902 2676 194521855 162900710 31439698 181447 5994262 4157846 26199683 23108022 3437742 4103778 1338582 1026581 195348297 121554838 77571534 73793459 6903053 41255638 1264669 1260323 38993959 38935207 1001605 642044 162705089 188282898 14166527 14394020 0 3208298 69638058 67141345 56200 70534 1539749 28503983 85400534 113318180 X 74802434 72536209 2502121 2428509 77304555 74964718 162705089 188282898 X -3379855 1220561 -180543 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 20421 20421 0 Part II-B, Line 1: Avera St. Luke's paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1284673 30649 10626 537 1304159 1248105 45961 9386 7 1284673 2983726 65876 1801473 24 1248105 3036970 469170 351817 857309 16922 2983726 4364943 462040 65820 1837645 18188 3036970 0.40790 0.59210 0.00000 0 1 1 1428952 4918054 6347006 134394941 78306593 56088348 52408002 41729976 10678026 2198348 1518269 680079 73793459 Assets limited to use - Avera pooled investments 37940993 F Investment in Avera Health Foundation 3314645 F 41255638 Interest Rate Swap Agreement 1684784 Interest Payable 198659 Estimated Third Party Payor Settlements 494433 Right of Use Operating Lease Obligations 643842 Deferred Payroll Taxes 1070846 Contract Liability - Medicare Advanced Payments 24400784 Due to Related Party 10635 28503983 X Part IV, Line 2b: The organization holds funds in trust on behalf of its residents. 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. The Organization's permanently restricted endowment funds are donor restricted. 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 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 2037000 2037000 0.01050 8360662 4034803 4325859 0.02220 342605 342605 0.00180 10740267 4034803 6705464 0.03450 25452 25452 0.00010 89160 89160 0.00050 6635755 6635755 0.03410 538093 538093 0.00280 7288460 7288460 0.03750 18028727 4034803 13993924 0.07200 20550 20550 0.00010 3150 3150 0.00000 2800 2800 0.00000 500 500 0.00000 2350 2350 0.00000 1000 1000 0.00000 30350 30350 0.00010 1 9912624 0 52658626 56806018 -4147392 X 1 1 1 Surgical Associates Endoscopy Clinic LLC Endoscopy Procedures 0.51000 0.49000 1 1 Avera St Luke's 305 South State Street Aberdeen SD 57401 www.averastlukes.org 10525 X X X 16 provider based clinics Avera St Luke's 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V X 1 18 1 See Part V 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V X See Part V X See Part V X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera St. Luke's Part V, Section B, Line 5: The St. Luke's Hospital Foundation invited individuals from all facets of the community to participate in an on-line survey, over a period of three months. After review of the results, the Avera St. Luke's Foundation then hosted eight focus groups representing community leaders and members, health care providers, dentists, uninsured/underinsured persons and policy makers to discuss the survey results and address health care needs in Brown County. Avera St. Luke's collaborated with the City of Aberdeen to review existing programs and find new ways to support and improve existing programs as well as implement new programs. In collecting data, Avera St. Luke's contacted a wide range of respondents from several different ages, economic classes, organizations, and cultures. The groups involved included:* The Brown County 211 Helpline Board* United Way Board Members* Presentation Sisters* Salvation Army* Local Universities* Aberdeen Diversity Coalition* City Emergency Responders* Aberdeen Area Chamber of Commerce Business and Health committees* Aberdeen Area Human Resource Association* Aberdeen Military Committee* Social Workers* Cancer Center Patients and Families Avera St. Luke's Part V, Section B, Line 11: Three prioritized needs resulted for the 2018 Community Health Needs Assessment, Preventative Care and Removing Barriers to Health Needs, Health Care Affordability, and Transportation Needs. Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. The hospital will take steps to address the identified needs.Preventive Care and Removing Barriers to Health Needs- Support of better nutrition through Food Bank. - Avera Human Performance team and dietitians will create an educational handout that is delivered and updated quarterly to the area food banks that list best choices and wellness options, and money-saving strategies for patients that are trying to make healthy and cost-effective choices.- Avera St. Luke's will collaborate with area service organizations and food banks to provide the resources and educational pieces to assist individuals with health issues to make better choices.- Coordinated Care is a program that can help individuals overcome barriers to better health. Providers and members of the coordinated care teams will work to track trends and patterns that predict risk and then will work to redirect care or need.- Collaboration with community programs and philanthropic offices to provide additional devices/items or support outside of medical facilities to decrease the need for medical care. - The Lifetime Resiliency program is a wellness continuum designed to assist individuals/patients on their path to healthier living. This program helps patients who are recovering from a medical condition or who need to prepare for an upcoming procedure. - Physicians and the Avera Human Performance Center team will work together to determine the best steps and needs on an individual basis based on the medical condition.FY2020 Update:Coordinated Care Teams assist individuals with the items needed to manage medical conditions as a means to decrease medical costs and reduce the number of and length of hospital stays.Collaboration with other community groups and food banks to provide education and resource materials on healthy food choices. Lifetime Resiliency wellness program has been implemented and is active.Health Care Affordability- Avera St. Luke's plans to host an educational event that brings together health insurance and financial experts to present about best use of health insurance, HSAs/FSAs, and high deductible plans. Avera St. Luke's Quality Care and Innovation Strategy Officer, Financial and Billing will develop the presentation; Marketing and Communications will work to promote and provide the materials necessary for the program.- Avera St. Luke's will work with the Aberdeen Area Human Resource Association, business health partners, financial and insurance connections and Brown County offices. - We will partner with the community programs and locations to provide the marketing pieces and education on locations of Avera facilities in Brown County.FY2020 Update: Due to Covid protocols, many educational events and programs were temporarily put on hold. Avera St. Luke's was able to work with Public Relations and Marketing teams to update handouts explaining when to go to the doctor/clinic versus going to the emergency room. A full-time social worker is available to assist patients on navigating through Medicare, Medicaid, Disability and insurance exchange programs.Transportation Needs- Aberdeen has created a community coordination committee, of which Avera St. Luke's will serve as a leader. A key area of focus will be how to improve transportation gaps.- Avera St. Luke's will collaborate with city transportation groups to improve access to transportation to patients and families in the Aberdeen region. The first step will be to have our patient scheduling and patient care coordinators meet with city transit to establish windows of time that would best coordinate with medical appointments, as well as partnering with area churches, schools and organizations that provide transportation.- Through volunteers, Road to Recovery provides transportation to and from treatment for people with cancer who do not have a ride or are unable to drive themselves.- The Avera St. Luke's Foundation and Avera Cancer Institute will work closely with our American Cancer Society representative and provide the support needed to recruit, train and support the "Road to Recovery" for Aberdeen.FY2020 Update:The community coordination committee, led by Avera St. Luke's, is focusing on ways to improve transportation gaps in and around Aberdeen.Avera St. Luke's is working and collaborating with transportation groups in and around Aberbeen to identify options for expanded access to transportation for patients and their families. Many other region/community themes emerged that were beyond the scope or control of Avera St. Luke's. The following health needs/priorities will be deferred to the appropriate organizations and programs in place that are working on the specific issue: - Adult dental care- Housing- Suicide prevention- Diversity and education Avera St. Luke'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. Luke'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 is included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Luke'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. Luke'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. Schedule H, Part V, Section B, Line 7a and 10a: www.avera.org/about/community-health-needs-assessments/ Schedule H, Part V, Line 16a, 16b, and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 6 1 - Avera Mother Joseph Manor 1002 N Jay Street Aberdeen SD 57401 Nursing Home, Assisted and Congregate Living 2 - Avera Eureka Health Care Center E Hwy 10 Eureka SD 57437 Skilled Nursing Facility 3 - Avera Clinic of Ellendale 240 Main St Ellendale ND 58436 Clinic 4 - Avera Medical Group AveraQuick Kesslers 615 6th Ave SE Aberdeen SD 57401 Clinic 5 - Avera Medical Group Selby 4401 Main St Selby SD 57472 Clinic 6 - Pain Management Center 815 1st Ave SE Aberdeen SD 57401 Clinic 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: A combination of costing methodologies were used to calculate the amounts reported in the table. A cost-to-charge ratio derived from Worksheet 2, ratio of patient care cost-to-charges was used to calculate charity care at cost, unreimbursed Medicaid and Means-Tested Government Program expenses. Subsidized health was calculated based on actual cost/loss. For all other amounts, costs and revenues as reflected by the general ledger system were used. Part II, Community Building Activities: NATIONAL NIGHT OUT - National Night Out is an annual community-building campaign that promotes police-community partnerships and neighborhood camaraderie to make our neighborhoods safer, more caring places to live. National Night Out enhances the relationship between neighbors and law enforcement. Our local sponsor, the Aberdeen Police Department, invites local organizations to participate each year in this event held on the first Tuesday of August at Melgaard Park. A free meal is served by volunteers from many organizations and entertainment is offered all free of charge. Avera St. Luke's has participated by offering a booth with games and prizes with our focus on child safety - recent focuses have been on back to school safety with walking, bike riding and outdoor play. The event brings out around 1,500 to 2,000 children and families for a fun evening. Due to COVID, the National Night Out event was canceled for August 2020. The 2021 event has not yet been approved by the city. If approved, Avera intends to participate in the event.ASPIRE/SD DEPT OF VOC REHAB - Project SEARCH provides internships for high school students in their last year of high school and assists in helping students attain work skills and prepare them for a job. Students are chosen for the program who are ready to join the workforce and do not have plans to go to college but have skills that would enable them to be gainfully employed. We want to assist in meeting the community workforce needs as well as help these students obtain employment vs. being on federal assistance. Due to COVID, the interactions with ASPIRE were minimal in FY2020. Quarterly partner meetings for Project SEARCH were still held. The plan is to resume Project SEARCH and brings students back into Avera next school year. 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: 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. Avera St. Luke's follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall (as calculated including our non-cost report entities) is excluded from community benefit. However, Medicare is the organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community. 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. Given Aberdeen is a regional center/hub and the third largest city in South Dakota, Avera St. Luke's is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. Although another smaller hospital opened in Aberdeen during FY 2013, the next largest hospital is 100 miles from Aberdeen and most of the towns within our region have a population of less than 2,000. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. Our third community health needs assessment (CHNA) was completed and posted to our website by June 30, 2019. The identified areas of need highlighted for further research and comparison are dental care, removal of barriers to community health needs, health care affordability and travel and accessibility to health care. The overall goal is to focus on removing all barriers to health. Part VI, Line 3: The Organization utilizes various methods to inform patients about our financial assistance policy. Admitting areas have signs/posters noting charity care and financial assistance. Avera St. Luke's and Avera Health utilize the internet to address financial assistance. Social workers are in direct contact with patients and make referrals to the Business Office for financial assistance and in many cases, work directly with the patient on various government programs which may be available and help with applications. For those who receive bills for services and have concerns about their ability to pay, financial counselors work directly with them on financial assistance. We have brochures available to all and treat all without regard to their ability to pay. Part VI, Line 4: Avera St Luke's includes a 50-bed hospital and a 10-bed mental health unit in Aberdeen, South Dakota. The primary service area is defined as Brown County, South Dakota, including the communities of Aberdeen, Frederick, Groton, Hecla, and Leola. Aberdeen is the county seat. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Brown County as of July 1, 2019 is 38,839 and is predominately white at 89.0%. It is estimated that 17.9% of the population is 65 years and over. The median household income is $58,216 with a 9.4% poverty rate. Uninsured individuals under age 65 is estimated at 10.5%. Part VI, Line 5: Avera St. Luke's is a regional facility within Avera Health System. We are a health ministry cosponsored by the Benedictine Sisters of Yankton, South Dakota and the Presentation Sisters of Aberdeen, South Dakota. Ourhealth ministry is rooted in the Gospel and requires us to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. Avera St. Luke's vision is tobe an exceptional health care organization for patients to receive care, physicians to practice and employees to work. The Organization's values are Compassion, Hospitality and Stewardship. Our governing body consists of 15 members who are physicians, community and regional residents and Sister representatives from the Presentation and Benedictine Orders. In addition, the CEO serves on the board. In addition to the governing body, we have one advisory board. This includes Northern State University Business School. Medical Staff privileges can be extended to qualified physicians based on receiving approval of their application and credentials by the Medical Staff and the Hospital governing body. The Hospital's governing body takes into account other factors related to overall community need and how a physician would impact the Hospital's overall ability to fulfill the mission. Avera St. Luke's mission and values ensure our focus is on the patient, family, employees, physician, those in need, visitors and our region as a whole. The value of Stewardship requires the organization to use all resources in a way that fulfills the mission and values. Each year, our operating and capital budgets are based on various assumptions that in the end provide the needed resources and take into account charity care, patient care, technology, education, community services, employee benefit and compensation plans and programs for meeting the region's needs. All surplus funds are used and maintained to provide for both current and future needs.Specific examples of how we further our exempt purpose include but are not limited to the following:a. The only inpatient psychiatric unit within 200 milesb. Interventional Cardiology and Radiology services. These services allow us to meet patient needs when care is critical to their survival and must be delivered on a very timely basis.c. Air Ambulance to transport patients to our facility or 200 miles to tertiary facilities.d. End Stage Renal Disease program which serves our broad region with the next closest facility being 100 miles away. Additionally, we employ a full-time Nephrologist to care for the patients along with others who require intensive physician care.e. A 24 hour Emergency Room which treats all patients without regard to the ability to pay. The ER is staffed by physicians 24 hours per day.f. Provision of a multitude of educational and training programs for healthcare professionals and regional residents. The region was awarded an Area Health Education Center by the South Dakota School of Medicine and will be located in Aberdeen. The award was based on applications and interviews within the State and was a collaborative effort of many healthcare and non-healthcare organizations within the region with two being 100 miles from Aberdeen.g. Avera St. Luke's is currently a Rural Referral Center. The nearest hospitals are tertiary facilities 200 miles away by ground and approximately 140 miles by air.h. Avera St. Luke's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (Chamber of Commerce, United Way, AberdeenDevelopment Corporation, College/University Advisory Boards, Kiwanis Club Board, Lake Area Technical Institute Alumni Board).i. Provide assistance to small rural hospitals (Critical Access Hospitals) within the region through various programs, management agreements, computer systems, education and other services to assist in keeping theirarea's patients in the local community when possible.j. Recruitment of specialists in nephrology, neurosurgery, neurology, cardiology and psychiatry to meet the region's need in order to eliminate travel of 200 miles to obtain these services.k. Development and subsidy of various rural clinics to meet needs in those communities.l. Chemical Addiction services on an outpatient basis are provided to the region and State. Our Worthmore program is well known and respected within the region and state and is the closest program within 150-200miles. We contract with the State for patients who meet their qualification guidelines and work with governmental agencies within the region and State.m. Provide drug and alcohol prevention programs to the local schools through various contracts. Our involvement started when the previous provider discontinued their contract. 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 Presentation College 1500 N Main Aberdeen SD 57401 522424588 501(c)(3) 163800 Nursing Education Scholarship Eureka Community Health Services PO Box 517 Eureka SD 57437 460246437 501(c)(3) 10000 Capital Campaign 2 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRC 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 Brandon Fites Orthopedic Surgeon 1116502 0 472283 0 7797 0 14000 0 30526 0 1641108 0 0 0 Sushell Gundewar Cardiology 1001724 0 451481 0 2199 0 14000 0 30023 0 1499427 0 0 0 Richard Conklin Oncologist 1303376 0 7500 0 11202 0 14000 0 36035 0 1372113 0 0 0 Christopher Larson General Surgeon 1190437 0 46000 0 34540 0 14000 0 34495 0 1319472 0 0 0 Roger Werth General Surgeon 1107084 0 50000 0 43662 0 14000 0 29432 0 1244178 0 0 0 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0 945274 0 1760 0 71132 0 14000 0 22856 0 1055022 0 0 Todd Forkel President & CEO 0 673697 0 0 0 16703 0 7952 0 32655 0 731007 0 0 Garret Wobst MDDirector Surgery/Podiatry 418189 0 122376 0 1375 0 14000 0 28562 0 584502 0 0 0 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0 516081 0 400 0 1973 0 14000 0 21583 0 554037 0 0 Adam LeFebvre MD Director/Anesthesiology 447961 0 7500 0 1497 0 14000 0 29955 0 500913 0 0 0 Lyle Biegler MD Director/Family Medicine 225713 0 157710 0 877 0 13964 0 28838 0 427102 0 0 0 Will FlettFormer Secretary/Treasurer 0 195065 0 0 0 779 0 9593 0 31062 0 236499 0 0 Tom Snyder VP Long Term Care 193244 0 650 0 15406 0 10594 0 15084 0 234978 0 0 0 Schedule J, Part I Line 3: The President/CEO is compensated by Avera Health. Avera St. Luke's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Megan Biegler Wife of board member Lyle Biegler 16039 Compensation and benefits as an employee 0 Shelby Forkel Daughter of Todd Forkel 50717 Compensation and benefits as an employee 0 X 4 48541 FMV 0 0 0 0 Part I, Column (b): The amount in column B represents the number of items contributed. Form 990, Part VI, Section A, line 2 Jim Breckenridge, Julie Lautt, Will Flett, Todd Forkel, Tom Snyder, and Sister Kathleen Ann Bierne 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 15b 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. Depending on the individual's role with the organization, some officers and key employees are compensated by Avera St. Luke's. 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 are available to the general public. Form 990, Part IX, line 11g Repairs and Maintenance: Program service expenses 2,818,064. Management and general expenses 49,037. Fundraising expenses 1,051. Total expenses 2,868,152. Purchased Services: Program service expenses 6,209,988. Management and general expenses 860,409. Fundraising expenses 0. Total expenses 7,070,397. Centralized Services: Program service expenses 0. Management and general expenses 19,881,566. Fundraising expenses 0. Total expenses 19,881,566. Medical Prof Fees: Program service expenses 1,856,342. Management and general expenses 108,200. Fundraising expenses 0. Total expenses 1,964,542. Form 990, Part XI, line 9: Equity Transfer 193,845. Change in Net Assets held by Avera Health Foundation -68,530. Other changes in net assets -146,999. Change in Fair Value of Interest Rate Swap -376,035. Transfers 389,787. Change in interest in Endoscopy -172,611. 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. Luke's. 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). 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 0 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 Avera Queen of Peace Hospital 525 North Foster 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 St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 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 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 Surgical Associates Endoscopy Center LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates/Endoscopy services SD Avera St Luke's Related 640008 364974 0 0 0.51000 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 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 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical services - home medical equipment SD N/A Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 Medical clinic building SD N/A Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare services SD N/A Brookings Health System - Avera Home Medical Equipment LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD N/A 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 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 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 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 Medical 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 1 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 1 Surgical Associates Endoscopy Clinic LLC L 420775 General Ledger Surgical Associates Endoscopy Clinic LLC S 606000 K-1 distribution Surgical Associates Endoscopy Clinic LLC A 85542 General Ledger