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 420680370 Avera Holy Family AVER 7123626519 826 North 8th Street Estherville IA 51334 Julie Lautt CFO Avera Health 7123626519 2021-05-10 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-08 2019 2022-09-23 18:48:47Z Deb Herzberg 826 North 8th Street Estherville IA 51334 29197784 0 0928 X www.avera-holyfamily.org X 1996 IA Promotion of Health 9 8 237 13 0 0 1060805 2521830 25544896 26152069 770889 497762 27838 26123 27404428 29197784 26711 29420 0 0 13391281 13781226 0 0 46474 11281700 11957252 24699692 25767898 2704736 3429886 47595359 58037598 6403782 13240891 41191577 44796707 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 22666608 29420 26153018 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 Hospital501 Acute and swing-bed patient discharges30,204 Outpatient visits481 Swing-bed patient days17,613 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 $572,601.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. 22666608 1 1 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 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 55 0 1 237 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 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 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0.10 41.30 X 0 1018166 36856 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0.10 40.70 X 0 518454 35583 Dr James Creech Board Member/Chief of Staff 40.00 0.00 X 0 290445 40669 Deb Herzberg CEO 40.00 0.00 X 0 192826 43708 Kristi Hough Pharmacy Manager 40.00 0.00 X 158933 0 9609 April Krull Pharmacist 40.00 0.00 X 125303 0 41630 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 Mary Jaeger PBVM Board Member 1.00 5.00 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 Schlitz Board Member 1.00 0.00 X 0 0 0 Joe Fitzgibbons Board Member 1.00 0.00 X 0 0 0 Greg Deim Board Member 1.00 0.00 X 0 0 0 284236 2019891 208055 2 0 1 0 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Medical services 3859875 Journey Group Companies 4500 W 58th St Sioux Falls SD 57108 Construction 1779418 Acute Care Inc 1609 N Ankeny Blvd Ste 200 Ankeny IA 50023 Medical Healthcare Services 1263812 Avera Health 3900 W Avera Drive Sioux Falls SD 57108 Shared Services/eCare Services 357830 Woodward Anesthesia Services PC 203 N 8th St Estherville IA 51334 Medical Professional Fees 315140 8 77588 2410825 33417 12135 2521830 Patient Service Revenue 622110 23431278 23431278 Pharmacy Revenue 900099 2068473 2068473 Collaborative Agreement 900099 549175 549175 Cafeteria 900099 49700 49700 53443 53443 26152069 19617 19617 25174 0 25174 25174 25174 478145 0 478145 478145 478145 AR Interest Income 900099 949 949 949 29197784 26153018 0 522936 X 29420 29420 10381806 9632337 749469 721928 672433 49495 1925245 1770541 154704 752247 702463 49784 6900 6900 3475 3475 5334510 4636303 698207 8327 153 8174 434978 269938 121203 43837 636741 542276 94465 475986 383498 92488 63491 51537 11954 32873 25944 6929 91120 74746 16374 1719915 1430402 289513 230548 132569 97979 Medical Supplies 2768981 2252194 514150 2637 Equipment Lease/Rental 74335 28197 46138 Bad Debt 17606 17606 57466 14051 43415 25767898 22666608 3054816 46474 2026608 1201847 3287905 3091306 739437 719938 175747 145554 33591510 19275936 15863612 14315574 307003 306011 24936877 38117638 258170 0 139730 47595359 58037598 2085125 1962052 0 1996483 2282825 2027993 2035832 7254363 6403782 13240891 X 40452187 44144876 739390 651831 41191577 44796707 47595359 58037598 X 3429886 23137 152107 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1807087 52111 1859198 1493819 80000 233268 1807087 1490407 3412 1493819 1055754 442798 8145 1490407 908995 146759 1055754 0.92950 0.07050 0.00000 0 1 1 475540 475540 21975748 11531998 10443750 10082347 7288079 2794268 1057875 455859 602016 14315574 Assets Limited as to Use - Avera Pooled Investments 35295499 F Investment in Foundation 2822139 F 38117638 Due to Related Party 85031 Estimated Third Party Settlements 5647 Deferred Payroll Taxes 146024 Right of Use Operating Lease Obligation 140466 Contract Liability - Medicare Advanced Payments 6877195 7254363 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 229739 229739 0.00890 2832730 1874618 958112 0.03720 3062469 1874618 1187851 0.04610 18267 18267 0.00070 24530 24530 0.00100 3266618 1354998 1911620 0.07420 101318 101318 0.00390 3410733 1354998 2055735 0.07980 6473202 3229616 3243586 0.12590 8165 8165 0.00030 8165 8165 0.00030 1 397492 0 11698985 11733007 -34022 X 1 1 1 1 Avera Holy Family Health 826 N 8th Street Estherville IA 51334 www.avera-holyfamily.org 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 statement X See Part V statement X 1 18 1 See Part V statement 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 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: 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 FY2020 Update: Initiated pubic messages about mental health issues through Facebook posts and newspaper articles.* Identify resources to address mental health concerns FY2020 Update: Emmet County Mental Health Wellness Coalition (ECWC) with the following members, AHFH, Emmet County Public Health, Estherville Lincoln Central School and North Union School, local mental health providers, Estherville Police Department, and Emmet County Sheriff's Department, collaborate to address mental health concerns. * Determine gaps in programs/services that address mental illness FY2020 Update: Mental Health First Aid Training, Virtual Training Videos for the community, parents, students and support of Champions State of Mind.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 communityFY2020 Update: Increased the availability for Monday-Friday virtual visits through telemedicine with Avera eCare in Sioux Falls for patients that are struggling with their mental health but are not in need of emergency room care.CARDIOVASCULAR DISEASE/HYPERTENSION* Raise awareness of the factors that contribute to heart disease and measures to prevent disease FY 2020 Update: Resumed public messages about heart disease and measure to prevent heart disease through Facebook posts and social media posts. Also resumed Planet Heart screenings. * Ensure people at risk have access to diagnosis and appropriate treatment* Promote healthy eating and physical activity FY2020 Update: Physician encouragement for Lifestyle changes (AHFH physicians, Regional Wellness Center).* Encourage smoking cessation FY2020 Update: Due to COVID protocols we were unable to participate in local health fairs and other community events. We will resume participation as soon as it is deemed safe to hold these events again.EARLY DETECTION OF CANCER* Promote awareness of contributing factors and signs and symptoms of cancer FY2020 Update: Ran Social media posts and newspaper ads that include specific information for colorectal, breast, lung, and cervical cancer.* Encourage screening for early detection of cancer. FY2020 Update: Due to Covid protocols, mammogram services were suspended for a short period of time. Since resuming mammogram services we have made efforts to accommodate all those behind on their exams. Due to Covid protocols, we were not able to have the booths at the health fairs and Farm and Home show in FY2020 but look forward to participating in community events in future years.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 FY2020 Update: Partnered with the Emmet County Wellness Coalition (ECWC) to promote Lifestyle changes. Initiated Facebook posts promoting healthy habits and also promoting the area walking trails and parks. Worked with individuals with the Prediabetes Program, ECWC and Healthy Hometown to develop an action plan involving the following: edible orchard, fresh water access, walkability, and breastfeeding.* Raise awareness regarding the impact that poor eating habits have on health and wellness. FY2020 Update: Promoted lifestyle changes through social media posts in collaboration with the Regional Wellness Center.* Collaborate with Emmet County Public Health, Emmett County Wellness Coalition and other community partners to promote healthier eating habits.FY2020 Update: Compiled a list of available home delivery meals and nutrition program information, chronic disease self-management programs, Better Choices/Better Health, and Pre Diabetes self-management.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 rates* 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 7b: www.avera.org/about/community-health-needs-assessments/ Schedule H, Part V, Section B, Line 7a: https://www.avera.org/locations/profile/avera-holy-family-hospital/ Schedule H, Part V, Section C, 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 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 I, Ln 7 Col(f): Bad debt expense of $17,606 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. 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 and bad debts. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Bad debt reflects amounts that will not be paid by patients based on an adverse change in the patient's ability to pay. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession and bad debt 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 set forth by Centers for Medicare and Medicaid Services. Avera Holy Family follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. 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: 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: Information regarding charity care is made available to patients via their billing statements. The Finance Department also informs patients of the policy through their contact with patients. Brochures regarding financial assistance are located in the lobby of the Hospital and the Clinic. 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 an 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 1 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 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0 945274 0 1760 0 71132 0 14000 0 22856 0 1055022 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 Dr James Creech Board Member/Chief of Staff 0 236704 0 50968 0 2773 0 12647 0 28023 0 331115 0 0 Deb Herzberg CEO 0 166264 0 0 0 26562 0 9567 0 34141 0 236534 0 0 Kristi Hough Pharmacy Manager 148253 0 270 0 10410 0 7958 0 1650 0 168541 0 0 0 April Krull Pharmacist 119986 0 0 0 5317 0 6888 0 34742 0 166933 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 1745000 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, Part VI, Section A, line 2 Jim Breckenridge, Julie Lautt, Dr. James Creech, Deb Herzberg and Sister Mary Jaeger 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 625,236. Management and general expenses 9,789. Fundraising expenses 0. Total expenses 635,025. Medical Prof Fees: Program service expenses 2,522,999. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,522,999. Purchased Services: Program service expenses 1,488,068. Management and general expenses 688,418. Fundraising expenses 0. Total expenses 2,176,486. Form 990, Part XI, line 9: Change in Interest in Avera Foundation 132,525. Other Changes in Net Assets 19,582. 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 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 Av 102 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 Surgical Associates Endoscopy Clinic LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates SD N/A Heart Hospital of South Dakota LLC 4500 W 69th St Sioux Falls SD 57108 562143771 Healthcare Services NC N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - Home Medical Equipment SD 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 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 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 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 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 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 65453 Cash