FURP.ORG / PUBLIC DATA EXPLORER

AVERA QUEEN OF PEACE: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
AVERA QUEEN OF PEACE (EIN 46-0224604)
Tax period
2019-07-01 to 2020-06-30
Filed
2021-05-17
IRS object ID
202131379349305453
Schema version
2019v5.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-05-17T13:17:02-05:00ReturnTs
Tax Period End2020-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1800 Nicollet Mall Ste 1300AddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP554027033ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN460224604EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Avera Queen of PeaceBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlAVERBusinessNameControlTxt
Phone6059952251PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1525 North Foster StreetAddressLine1Txt
CityMitchellCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57301ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJulie LauttPersonNm
Person TitleCFO Avera HealthPersonTitleTxt
Phone6059952251PhoneNum
Signature2021-05-10SignatureDt
Discuss With Paid Preparer0DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKim Hunwardsen CPAPreparerPersonNm
PTINP00484560PTIN
Phone6122536500PhoneNum
Preparation2021-05-10PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Avera Queen of Peace Health ServiceBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerThomas A ClarkPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1525 North Foster StreetAddressLine1Txt
CityMitchellCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57301ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$120,940,812GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.averaqueenofpeace.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1905FormationYr
Legal Domicile StateSDLegalDomicileStateCd
Activity Or MissionPromotion of healthActivityOrMissionDesc
Voting Members Governing Body18VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee880TotalEmployeeCnt
Total Volunteers84TotalVolunteersCnt
Total Gross UBI$239,799TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$1,338NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$532,887PYContributionsGrantsAmt
CY Contributions Grants$9,703,103CYContributionsGrantsAmt
PY Program Service Revenue$114,771,742PYProgramServiceRevenueAmt
CY Program Service Revenue$106,371,720CYProgramServiceRevenueAmt
PY Investment Income$2,312,286PYInvestmentIncomeAmt
CY Investment Income$1,409,273CYInvestmentIncomeAmt
PY Other Revenue-$114,393PYOtherRevenueAmt
CY Other Revenue$670,387CYOtherRevenueAmt
PY Total Revenue$117,502,522PYTotalRevenueAmt
CY Total Revenue$118,154,483CYTotalRevenueAmt
PY Grants And Similar Paid$38,267PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$26,125CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$63,508,948PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$64,450,306CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$114,366CYTotalFundraisingExpenseAmt
PY Other Expenses$54,488,401PYOtherExpensesAmt
CY Other Expenses$51,500,214CYOtherExpensesAmt
PY Total Expenses$118,035,616PYTotalExpensesAmt
CY Total Expenses$115,976,645CYTotalExpensesAmt
PY Revenues Less Expenses-$533,094PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,177,838CYRevenuesLessExpensesAmt
Total Assets BOY$139,254,238TotalAssetsBOYAmt
Total Assets EOY$166,237,397TotalAssetsEOYAmt
Total Liabilities BOY$43,111,410TotalLiabilitiesBOYAmt
Total Liabilities EOY$69,080,323TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$96,142,828NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$97,157,074NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionAvera 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$98,352,242ExpenseAmt
Grant$26,125GrantAmt
Revenue$106,149,008RevenueAmt
DescAvera Queen of Peace's mission is to provide healthcare services to Mitchell, South Dakota residents and residents of the surrounding area. Avera Queen of Peace is a 501(c)(3) organization affiliated with Avera Health. Avera Queen of Peace consists of 42 acute beds, 8 ICU beds and an 84-bed nursing home in Mitchell, SD, a 16-bed critical access hospital in Wessington Springs, SD, a 6-bed critical access hospital in De Smet, SD and 12 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, internal medicine, radiation, radiology, oncology, dermatology, therapy, ophthalmology and optometry. They provide acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera Queen of Peace Hospital1,505 Acute patient discharges468 Newborn patient discharges116 Swing Bed patient discharges100,963 Outpatient visits1,036 Swing-bed patient days991 Newborn patient days53,843 Clinic visitsAvera Brady Health and Rehabilitation137 Long Term Care patient discharges28,692 Long-term care resident days8,623 Assisted living patient daysAvera Westkota Memorial Medical Center (CAH)61 Acute patient discharges21 Swing Bed discharges3,869 Outpatient visits19 Swing-bed patient daysAvera De Smet Memorial Hospital (CAH)49 Acute patient discharges24 Swing Bed patient discharges10,694 Outpatient visits24 Swing-bed patient daysAvera Queen of Peace 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 $3,365,450. Avera Queen of Peace 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 Queen of Peace 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 Queen of Peace 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.Desc
Total Program Service Expenses$98,352,242TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document127IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee880EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members18GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or Procedure0WrittenPolicyOrProcedureInd
Own WebsiteYes (X)OwnWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Jamie SchaeferBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6053223992PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13900 W Avera Dr Ste 300AddressLine1Txt
CitySioux FallsCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57108ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndKey EmployeeKeyEmployeeInd
Brian Kampmann
Orthopedics, Sports Medicine40.000.00Yes (X)$1,292,342$0$48,735
Chris Krouse DO
Orthopedics, Sports Medicine40.000.00Yes (X)$1,250,979$0$42,023
Jim Breckenridge - Left 42020
CFO Avera Health; Sec/Treasurer0.1041.30$0$1,018,166$36,856Yes (X)
Kelly Smith
Diagnostic Radiology40.000.00Yes (X)$719,037$0$48,636
Aaron Baas
General Surgery40.000.00Yes (X)$681,051$0$48,735
Dennis Leland
General Surgery40.000.00Yes (X)$676,329$0$39,076
Thomas Clark
Regional President & CEO2.5041.00$0$512,041$42,504Yes (X)Yes (X)
Julie Lautt - Joined 42020
CFO Avera Health; Sec/Treasurer0.1040.70$0$518,454$35,583Yes (X)
Scott VanKeulen MD
Board Member/Pres. Medical Staff40.000.00$435,104$0$48,258Yes (X)
Hillary Rockwell MD
Board Member/Physician40.000.00$422,297$0$48,265Yes (X)
Will Flett
Former Secretary2.5040.00$0$195,844$40,656Yes (X)
Rochelle Reider
VP Patient Services40.000.00$189,144$0$33,380Yes (X)
Jean Koehler
Chairperson2.500.00$0$0$0Yes (X)Yes (X)
Ryan Huber
Vice Chair2.500.00$0$0$0Yes (X)Yes (X)
Sister Kathleen Bierne
Board Member2.501.00$0$0$0Yes (X)
Sister Erin Colgan OSB
Board Member2.500.00$0$0$0Yes (X)
Jason Bradley
Board Member2.500.00$0$0$0Yes (X)
Julie Brookbank
Board Member2.500.00$0$0$0Yes (X)
Quinten Burg
Board Member2.500.00$0$0$0Yes (X)
Brad Zomer
Board Member2.500.00$0$0$0Yes (X)
Michael Krause DO
Board Member2.500.00$0$0$0Yes (X)
Ryan Thompson
Board Member2.500.00$0$0$0Yes (X)
Jay Tolsma
Board Member2.500.00$0$0$0Yes (X)
Gopal Vyas
Board Member2.500.00$0$0$0Yes (X)
Mark Hunhoff
Board Member2.500.00$0$0$0Yes (X)
Tracey Larson
Board Member2.500.00$0$0$0Yes (X)
Amy Novak
Board Member2.500.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$5,666,283TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,244,505TotReportableCompRltdOrgAmt
Total Other Compensation$512,707TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K77IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Avera Health
3900 W Avera DrSioux FallsSD57108Shared Services and eCare Services$13,923,474
Avera McKennan
1325 S Cliff AveSioux FallsSD57117Medical Professionals, Interpreter, Prin$2,947,638
Medical Information Technology Inc
1 Meditech CirWestwoodMA02090Information Technology Services$855,024
Restorix Health Inc
445 Hamilton AveWhite PlainsNY10601Wound Care Services$602,766
Journey Group Companies
4500 W 58th StSioux FallsSD571186370Construction$374,009
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K17CntrctRcvdGreaterThan100KCnt
Related Organizations$167,510RelatedOrganizationsAmt
Government Grants$9,513,846GovernmentGrantsAmt
All Other Contributions$21,747AllOtherContributionsAmt
Noncash Contributions$24,270NoncashContributionsAmt
Total Contributions$9,703,103TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Net Patient & Resident Services622110$98,506,922$98,506,922
Retail Pharmacy900099$1,282,826$1,043,027$239,799
Cafeteria900099$298,182$298,182

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,283,790TotalRevenueColumnAmt
Related Or Exempt Func Income$6,283,790RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$106,371,720TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$97,409TotalRevenueColumnAmt
Exclusion$97,409ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,129,780RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$476,480RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$653,300RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$653,300TotalRevenueColumnAmt
Exclusion$653,300ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$3,621,713SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,309,849SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$1,311,864SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,311,864TotalRevenueColumnAmt
Exclusion$1,311,864ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOperating InterestDesc
Business900099BusinessCd
Total Revenue Column$17,087TotalRevenueColumnAmt
Related Or Exempt Func Income$17,087RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$17,087OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$118,154,483TotalRevenueColumnAmt
Related Or Exempt Func Income$106,149,008RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$239,799UnrelatedBusinessRevenueAmt
Exclusion$2,062,573ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$26,125TotalAmt
Program Services$26,125ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,242,019TotalAmt
Program Services$1,018,302ProgramServicesAmt
Management And General$223,717ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$67,408TotalAmt
Program Services$67,408ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$48,634,019TotalAmt
Program Services$47,195,149ProgramServicesAmt
Management And General$1,366,453ManagementAndGeneralAmt
Fundraising$72,417FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$3,376,375TotalAmt
Program Services$3,265,199ProgramServicesAmt
Management And General$106,365ManagementAndGeneralAmt
Fundraising$4,811FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,000,873TotalAmt
Program Services$7,733,554ProgramServicesAmt
Management And General$250,836ManagementAndGeneralAmt
Fundraising$16,483FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,129,612TotalAmt
Program Services$3,026,799ProgramServicesAmt
Management And General$97,759ManagementAndGeneralAmt
Fundraising$5,054FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$80TotalAmt
Management And General$80ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$10,875TotalAmt
Program Services$10,875ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$21,540,288TotalAmt
Program Services$9,538,617ProgramServicesAmt
Management And General$11,999,073ManagementAndGeneralAmt
Fundraising$2,598FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$9,424TotalAmt
Program Services$3,021ProgramServicesAmt
Management And General$6,058ManagementAndGeneralAmt
Fundraising$345FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,154,831TotalAmt
Program Services$651,597ProgramServicesAmt
Management And General$496,119ManagementAndGeneralAmt
Fundraising$7,115FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,316,337TotalAmt
Program Services$495,072ProgramServicesAmt
Management And General$821,265ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,736,269TotalAmt
Program Services$1,426,780ProgramServicesAmt
Management And General$309,489ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$315,342TotalAmt
Program Services$301,715ProgramServicesAmt
Management And General$10,346ManagementAndGeneralAmt
Fundraising$3,281FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$146,200TotalAmt
Program Services$138,369ProgramServicesAmt
Management And General$7,007ManagementAndGeneralAmt
Fundraising$824FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,278,665TotalAmt
Program Services$1,089,960ProgramServicesAmt
Management And General$188,705ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,332,490TotalAmt
Program Services$4,602,518ProgramServicesAmt
Management And General$729,782ManagementAndGeneralAmt
Fundraising$190FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$612,130TotalAmt
Program Services$236,102ProgramServicesAmt
Management And General$376,028ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Medical Supplies$16,799,749$16,779,719$19,524$506
Equipment Lease/Rental$38,346$37,167$1,179

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,209,188TotalAmt
Program Services$708,194ProgramServicesAmt
Management And General$500,252ManagementAndGeneralAmt
Fundraising$742FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$115,976,645TotalAmt
Program Services$98,352,242ProgramServicesAmt
Management And General$17,510,037ManagementAndGeneralAmt
Fundraising$114,366FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,090,367BOYAmt
EOY$147,462EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,912,217BOYAmt
EOY$17,278,694EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,715,229BOYAmt
EOY$1,599,259EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$702,529BOYAmt
EOY$441,828EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$122,833,410LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$70,625,043LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$54,104,827BOYAmt
EOY$52,208,367EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$73,348,847BOYAmt
EOY$88,745,882EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$380,347BOYAmt
EOY$226,522EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$1,406,837BOYAmt
EOY$1,473,683EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$593,038BOYAmt
EOY$4,115,700EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$139,254,238BOYAmt
EOY$166,237,397EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,964,918BOYAmt
EOY$8,442,743EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$8,540,944EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$33,900,473BOYAmt
EOY$33,008,277EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$44,462BOYAmt
EOY$43,869EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,201,557BOYAmt
EOY$19,044,490EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$43,111,410BOYAmt
EOY$69,080,323EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$92,664,596BOYAmt
EOY$93,943,696EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,478,232BOYAmt
EOY$3,213,378EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$96,142,828BOYAmt
EOY$97,157,074EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$139,254,238BOYAmt
EOY$166,237,397EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$2,177,838ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,256,256NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$92,664OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$10,875OtherActivitiesAmt
Total Lobbying Expenditures$10,875TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationAvera Queen of Peace Hospital paid dues to organizations which have a portion of the dues attributed to lobbying activities.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$726,701BeginningYearBalanceAmt
Contributions$3,630ContributionsAmt
Investment Earnings Or Losses$17,348InvestmentEarningsOrLossesAmt
Other Expenditures$5,093OtherExpendituresAmt
End Year Balance$742,586EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$708,556BeginningYearBalanceAmt
Contributions$356ContributionsAmt
Investment Earnings Or Losses$25,945InvestmentEarningsOrLossesAmt
Other Expenditures$8,156OtherExpendituresAmt
End Year Balance$726,701EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,748,708BeginningYearBalanceAmt
Contributions$424ContributionsAmt
Investment Earnings Or Losses$37,389InvestmentEarningsOrLossesAmt
Other Expenditures$2,077,965OtherExpendituresAmt
End Year Balance$708,556EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,715,895BeginningYearBalanceAmt
Contributions$256,959ContributionsAmt
Investment Earnings Or Losses$252,847InvestmentEarningsOrLossesAmt
Other Expenditures$463,879OtherExpendituresAmt
Administrative Expenses$13,114AdministrativeExpensesAmt
End Year Balance$2,748,708EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,859,724BeginningYearBalanceAmt
Contributions$304,703ContributionsAmt
Investment Earnings Or Losses$241,350InvestmentEarningsOrLossesAmt
Other Expenditures$676,074OtherExpendituresAmt
Administrative Expenses$13,808AdministrativeExpensesAmt
End Year Balance$2,715,895EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.01320BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.98680PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$473,670InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$2,875,511OtherCostOrOtherBasisAmt
Book Value$3,349,181BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$1,901,467InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$71,973,412OtherCostOrOtherBasisAmt
Depreciation$38,677,884DepreciationAmt
Book Value$35,196,995BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,483,721OtherCostOrOtherBasisAmt
Depreciation$1,154,248DepreciationAmt
Book Value$4,329,473BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$36,941,419OtherCostOrOtherBasisAmt
Depreciation$28,044,704DepreciationAmt
Book Value$8,896,715BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,184,210OtherCostOrOtherBasisAmt
Depreciation$2,748,207DepreciationAmt
Book Value$436,003BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$52,208,367TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
Interest in Avera Health Foundation$3,076,093F
Interest in net assets of Mabee Trust$778,690F
Assets Limited to use - Avera Pooled Investments$84,891,099F
FieldValueIRS element (for citing)
Total Book Value Securities$88,745,882TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDescAmtAmt
Derivative Liability$1,376,557
Deferred Payroll Taxes$689,884
Right of Use Operating Lease Obligation$1,730,567
Contract Liability - Medicare Advance Payments$14,123,225
Other Liabilities$204,168
Estimated Third-Party Payor Settlements$920,089
FieldValueIRS element (for citing)
Total Liability$19,044,490TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 Avera Health Foundation and their beneficial interest in the Mabee Trust. Avera Health Foundation includes endowment funds which have been established for a variety of purposes. The endowment fund assets included in the Organization's beneficial interest in the Mabee Trust have been established to purchase equipment and furnishings for the Organization. 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. The Organization currently does not have any board-designated endowment funds.
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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$957,063TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$957,063NetCommunityBenefitExpnsAmt
Total Expense0.00830TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,838,265TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,219,943DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,618,322NetCommunityBenefitExpnsAmt
Total Expense0.02260TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$92,915TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$72,596DirectOffsettingRevenueAmt
Net Community Benefit Expns$20,319NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$8,888,243TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,292,539DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,595,704NetCommunityBenefitExpnsAmt
Total Expense0.03110TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,632TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,632NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$27,440TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$27,440NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$244,474TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$244,474NetCommunityBenefitExpnsAmt
Total Expense0.00210TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$139,538TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$139,538NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$415,084TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$415,084NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,303,327TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,292,539DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,010,788NetCommunityBenefitExpnsAmt
Total Expense0.03460TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$374TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$374NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,142TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,142NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,904TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,904NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$340TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$340NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,598TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,598NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$680TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$680NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,038TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$7,038NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$5,631,901BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$25,898,357ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$37,279,317CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$11,380,960MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities3HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (3 entries)

FacilityFacilityNumAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdWebsite AddressWebsiteAddressTxtState LicenseStateLicenseNumLicensed HospitalLicensedHospitalIndGeneral Medical And SurgicalGeneralMedicalAndSurgicalIndEmergency Room24 HrsEmergencyRoom24HrsIndOtherOtherDescCritical Access HospitalCriticalAccessHospitalInd
Avera Queen of Peace Hospital
1525 North Foster StreetMitchellSD57301www.averaqueenofpeace.org10552Yes (X)Yes (X)Yes (X)9 Provider Based Clinics
Avera Weskota Memorial Medical Center
2609 1st Street NEWessington SpringsSD57382www.avera.org/weskota48209Yes (X)Yes (X)Yes (X)
Avera De Smet Memorial Hospital
3306 Prairie Avenue SWDe SmetSD57231www.avera.org/de-smet50726Yes (X)Yes (X)Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (3 entries)

FacilityFacilityNumFirst Licensed CY Or PYFirstLicensedCYOrPYIndTax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYIndCHNA ConductedCHNAConductedIndCommunity DefinitionCommunityDefinitionIndCommunity DemographicsCommunityDemographicsIndExisting ResourcesExistingResourcesIndHow Data ObtainedHowDataObtainedIndCommunity Health NeedsCommunityHealthNeedsIndOther Health IssuesOtherHealthIssuesIndCommunity Hlth Needs Id ProcessCommunityHlthNeedsIdProcessIndConsulting ProcessConsultingProcessIndPrior CHNA ImpactPriorCHNAImpactIndCHNA ConductedCHNAConductedYrTake Into Account Others InputTakeIntoAccountOthersInputIndCHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsIndCHNA Conducted With Non FcltsCHNAConductedWithNonFcltsIndCHNA Report Widely AvailableCHNAReportWidelyAvailableIndRpt Available On Own WebsiteRptAvailableOnOwnWebsiteIndOwn Website URLOwnWebsiteURLTxtPaper Copy Public InspectionPaperCopyPublicInspectionIndImplementation Strategy AdoptImplementationStrategyAdoptIndImplementation Strategy AdptImplementationStrategyAdptYrStrategy Posted WebsiteStrategyPostedWebsiteIndStrategy Website URLStrategyWebsiteURLTxtOrganization Incur Excise TaxOrganizationIncurExciseTaxIndElig Criteria ExplainedEligCriteriaExplainedIndFPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntIndFPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePctFPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePctAsset Level CriteriaAssetLevelCriteriaIndMedical Indigency CriteriaMedicalIndigencyCriteriaIndInsurance Status CriteriaInsuranceStatusCriteriaIndOther CriteriaOtherCriteriaIndExplained BasisExplainedBasisIndApp Financial Asst ExplnAppFinancialAsstExplnIndDescribed InfoDescribedInfoIndDescribed Suprt DocDescribedSuprtDocIndProvided Hospital ContactProvidedHospitalContactIndIncludes Publicity MeasuresIncludesPublicityMeasuresIndFAP Available On WebsiteFAPAvailableOnWebsiteIndFAP Available On Website URLFAPAvailableOnWebsiteURLTxtFAP App Available On WebsiteFAPAppAvailableOnWebsiteIndFAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxtFAP Summary On WebsiteFAPSummaryOnWebsiteIndFAP Summary On Website URLFAPSummaryOnWebsiteURLTxtFAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeIndFAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgIndFAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgIndNotified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayIndCommuntity Notified FAPCommuntityNotifiedFAPIndFAP TranslatedFAPTranslatedIndOther PublicityOtherPublicityIndFAP Actions On NonpaymentFAPActionsOnNonpaymentIndPermit No ActionsPermitNoActionsIndCollection ActivitiesCollectionActivitiesIndMade Effort Orally NotifyMadeEffortOrallyNotifyIndProcessed FAP ApplicationProcessedFAPApplicationIndMade Presumptive Elig DetermMadePresumptiveEligDetermIndOther Actions TakenOtherActionsTakenIndNondis Emergency Care PolicyNondisEmergencyCarePolicyIndLook Back Medicare PrivateLookBackMedicarePrivateIndAmounts Generally BilledAmountsGenerallyBilledIndGross ChargesGrossChargesIndProvided Written NoticeProvidedWrittenNoticeInd
Avera Queen of Peace Hospital
100Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)18Yes (1)00Yes (1)Yes (X)See Part V, Section CYes (X)Yes (1)18Yes (1)See Part V, Section C0Yes (1)Yes (X)150.000000000000400.000000000000Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (1)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)See Section VYes (X)See Section VYes (X)See Section VYes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)0Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)00
Avera Weskota Memorial Medical Center
200Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)18Yes (1)00Yes (1)Yes (X)See Part V, Section CYes (X)Yes (1)18Yes (1)See Part V, Section C0Yes (1)Yes (X)150.000000000000400.000000000000Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (1)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)See Section VYes (X)See Section VYes (X)See Section VYes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)0Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)00Yes (X)
Avera De Smet Memorial Hospital
300Yes (1)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)18Yes (1)00Yes (1)Yes (X)See Part V, Section CYes (X)Yes (1)18Yes (1)See Part V, Section C0Yes (1)Yes (X)150.000000000000400.000000000000Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (1)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)See Section VYes (X)See Section VYes (X)See Section VYes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)0Yes (X)Yes (X)Yes (X)Yes (X)Yes (1)Yes (X)00Yes (X)

Supplemental Information SupplementalInformationGrp (23 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Avera Queen of Peace HospitalPart V, Section B, Line 3j: Avera Queen of Peace Hospital hired inHealth Strategies to conduct the focus group and analyze the results. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input were chosen for their familiarity with the needs of medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: Mitchell Area Development Corporation Cornerstones Career Learning Center Mitchell Area Food Pantry Mitchell High School/Second Chance High School Mitchell Middle School Mitchell Ministerial Association Mitchell Department of Public Safety Mitchell Fire & Emergency Management Services (EMS) Hanson County Sheriff's Office Davison County Welfare Office Davison County Sheriff's Office SDDOH County Health Nurse - Davison County SDDOH County Health Nurse - Hanson County
Avera Weskota Memorial Medical CenterPart V, Section B, Line 5: Avera Weskota Hospital hired inHealth Strategies to conduct the focus group and analyze the results. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input were chosen for their familiarity with the needs of medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: Wessington Springs Senior Nutrition Program Wessington Springs Food Pantry City of Wessington Springs Jerauld County Auditor Jerauld County Sheriff Jerauld County Commissioner South Dakota Department of Health and Human Services - Jerauld County and Sanborn County Wessington Springs School District
Avera De Smet Memorial HospitalPart V, Section B, Line 5: Avera De Smet Hospital hired inHealth Strategies to conduct the focus group and analyze the results. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input were chosen for their familiarity with the needs of medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: Inter-Lakes Community Action Partnership (ICAP) - Kingsbury County Eastern South Dakota SHINE (seniors over 60 services) Kingsbury County Sheriff's Department City of De Smet Kingsbury Court House - South Dakota Department of Social Services De Smet United Methodist Church American Lutheran Church, De Smet - Community Health Nurse De Smet School District
Avera Queen of Peace HospitalPart V, Section B, Line 11: The community health needs assessment was completed in 2018. The community health priority areas identified were: Behavioral Health and Substance abuse, Transportation, and Affordable housing. The following actions and programs were included in the implementation strategy to address the community health priorities.BEHAVIORAL HEALTH AND SUBSTANCE ABUSEBehavioral health was identified as an area of need that Avera Queen of Peace is addressing. Access to services, early intervention, and education are critical to achieving positive outcomes for individuals and communities. The hospital has developed the following goals to address this need. -Increase psychology appointments; increase appointments with LCSW-Increase PHQ-9 screening follow-up appointments in ambulatory settings-Decrease average score on PHQ-9 screenings in in-patient settings-Decrease behavioral health crisis ED visits -Increase the number of Avera eBehavioral encountersFY 2020 Update: Avera Queen of Peace hired a new Psychologist in July 2019 increasing the available time for appointments. The average monthly appointments increased to 88%.FY 2020 Update: Avera Queen of Peace entered into an agreement for Avera eBehavioral Health in October 2019.TRANSPORTATIONAnother need continuing to rise to the top of the community health needs is the need for affordable and reliable on-demand transportation. The need exists within city limits and between towns and cities for all citizens as the need to get to and from school, work, and medical appointments. Avera Queen of Peace has developed the following goals to address this need.-Create resource list/algorithm on transportation options for all relevant staff-Evaluate number of rides paid for by the AQOP Foundation-Evaluate the number of conversations AMG-Care Coordination is having with patients about transportation needs-Increase the number of those enrolled in mail-order pharmacyFY 2020 Update: Due to Covid-19 transportation services in the Mitchell region were limited. Avera Queen of Peace was able to provide some rides using volunteers.AFFORDABLE HOUSINGGood health is dependent upon adequate housing, providing dwellers a sense of privacy, security, stability, and control. A minimum of 12 of every 100 households in the county is at risk for health issues such as infectious disease and poor childhood development due to the severe cost burden of housing. Avera Queen of Peace had started a project with the City of Mitchell for the construction of affordable housing on land that Avera Queen of Peace donated. With the price of land being removed from the housing costs, residential buildings were going to be built at an affordable price. FY 2020 Update: Due to Covid-19, this project was put on hold.
Avera Weskota Memorial Medical CenterPart V, Section B, Line 11: The community health needs assessment was completed in 2018. The community health priority areas identified were: Further Community Health Education and Remove barriers to primary care access. The following actions and programs were included in the implementation strategy to address the community health priorities.FURTHER COMMUNITY HEALTH EDUCATION-Increase awareness of the national "Stop the Bleed" campaignFY 2020 Update: Due to Covid-19, in-school program was suspended.-Increase collaboration with Horizon Healthcare on community health educationFY 2020 Update: Avera Weskota Memorial Medical Center worked closely with Horizon on our community Covid-19 vaccine efforts.-Increase educational posts on FacebookFY 2020 Update: There were 118 educational posts to the Avera Weskota Memorial Medical Center Facebook page.REMOVE BARRIERS TO PRIMARY CARE ACCESS-Increase access to primary care services through hiring of additional primary care providerFY 2020 Update: Horizon hired a full-time physician. The hospital is fully supportive of the hire and is actively working to help the physician feel welcomed and oriented into the hospital and community.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. Though the following health need/priority will not be addressed due to resource constraints, the hospital will continue to actively participate in numerous community organizations focused on community needs and improvements: -Economic stress
Avera De Smet Memorial HospitalPart V, Section B, Line 11: The community health needs assessment was completed in 2018. The following actions and programs were included in the implementation strategy to address the community health priorities. REMOVE BARRIERS TO SKILLED HOME HEALTH CARE ACCESS-Increase Avera@Home Home Health patientsFY 2020 Update: During Covid-19, Avera DeSmet Memorial Hospital was able to maintain a consistent number of Home Health patients.-Increase the number of Avera@Home Home Health patients using lab servicesFY 2020 Update: During Covid-19, Avera DeSmet Memorial Hospital was able to maintain a consistent number of patients as well as lab services for Home Health.-Provide education and marketing materials for patientsFY 2020 Update: Avera had an intense marketing response to the Covid-19 pandemic.-Provide Avera@Home access to community resource informationFY 2020 Update: All resources were provided to Avera @Home.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. Though the following health needs/priorities will not be addressed due to resource constraints, the hospital recognizes its shared responsibility with the community and is actively participating in at least two community groups that have been formed to address these issues. -Lack of public transportation-Lack of affordable housing
Avera De Smet Memorial HospitalPart V, Section B, Line 13b: 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 Queen of Peace HospitalPart 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 Weskota Memorial Medical CenterPart 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 Queen of Peace HospitalPart 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 Weskota Memorial Medical CenterPart 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 De Smet Memorial HospitalPart 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 Queen of Peace HospitalPart 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. A plain language summary is offered to all uninsured patients at the time of registration.
Avera Weskota Memorial Medical CenterPart 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. A plain language summary is offered to all uninsured patients at the time of registration.
Avera De Smet Memorial HospitalPart 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. A plain language summary is offered to all uninsured patients at the time of registration.
Avera Queen of Peace HospitalPart 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.
Avera Weskota Memorial Medical CenterPart 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.
Avera De Smet Memorial HospitalPart V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.
Part V, Section B, Line 10a: Implementation StrategyThe most recently adopted implementation strategy for each of the facilities has been posted to the following website:https://www.avera.org/app/files/public/75839/2019-chna-queen-of-peace-implementation-plan.pdf
Avera Queen of Peace Hospital Part V, Line 7a:https://www.avera.org/about/community-health-needs-assessments/#queen
Avera Weskota Memorial Medical Center Part V, Line 7a:https://www.avera.org/about/community-health-needs-assessments/#weskota
Avera De Smet Memorial Hospital Part V, Line 7a:https://www.avera.org/about/community-health-needs-assessments/#de-smet
Part V, Section B, Lines 16a-16cThe financial assistance policy, plain language summary, and application are available for all facilities at:https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/
FieldValueIRS element (for citing)
Facility5FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - Avera Brady Health and Rehab
500 S Ohman StMitchellSD57301Nursing Home
2 - Avera Brady Assisted Living
1414 W Cedar AveMitchellSD57301Assisted Living
3 - Avera Medical Group De Smet
801 3rd St SWDe SmetSD57231Clinic
4 - Avera Medical Group OBGYN Mitchell
625 N Foster St Suite 107MitchellSD57301Clinic
5 - Avera Medical Group Optometry
1200 East 6th AveMitchellSD57301Clinic

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3c:The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted.
Part I, Line 7:Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Costs of other means-tested government programs, line 7c, and subsidized health services, line 7g, were obtained from EPSi analytical reports. Community health improvement services, line 7e, Health professions education, line 7f, and cash and in-kind donations, line 7i were compiled using actual costs recorded in the CBISA software.
Part II, Community Building Activities:Avera Queen of Peace Hospital provided donations to various organizations to support activities as listed on Part II.
Part III, Line 2:The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents.
Part III, Line 4:The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 17 and 18.
Part III, Line 8: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 Queen of Peace follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall (as calculated including our non-cost report entities) 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:Health care needs are assessed through various methods. Given Mitchell is a regional center/hub and the sixth largest city in South Dakota, Avera Queen of Peace is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. The next largest hospital offering the same level of services is 72 miles from Mitchell 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. In addition to activities reported in the Community Health Needs Assessment, Avera Queen of Peace, Avera Weskota and Avera De Smet collaborate with a community health committees within their respective community to assess and promote health related matters.
Part VI, Line 3: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.
Part VI, Line 4:Avera Queen of Peace is a 50-bed hospital in Mitchell, South Dakota. The primary service area is defined as Davison County, South Dakota. Mitchell is the county seat of Davison County. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Davison County as of July 1, 2019 is 19,775 and is predominately white at 92.9%. It is estimated that 19.1% of the population is 65 years and over. The median household income is $50,570 with an 11.7% poverty rate. Uninsured individuals under age 65 is estimated at 9.8%.
Part VI, Line 5:Avera Queen of Peace is a State Certified Level #4 Community Trauma Center and operates an emergency department staffed 24 hours per day with board certified physicians. Emergency care is provided on an open door basis regardless of ability to pay. Avera Queen of Peace leases two critical access hospitals which provide a broad range of inpatient, outpatient services and 24 hour emergency rooms in two very rural communities.Similar to the hospitals in the Avera Queen of Peace region, the clinics are operated on an open door basis and care is provided regardless of ability to pay.Medical staff privileges are extended to all licensed and qualified applicants. The Avera Queen of Peace Board of Directors is principally comprised of community members from the primary and secondary services areas. Members come from a variety of backgrounds including banking, education, agriculture, healthcare and private industry.
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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Wessington Springs Area Chamber & Development CorporationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 132AddressLine1Txt
CityWessington SpringsCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57382ZIPCd
FieldValueIRS element (for citing)
Recipient EIN460336659RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$7,250CashGrantAmt
Purpose Of GrantEconomic and Community DevelopmentPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationThe 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Brian Kampmann
Orthopedics, Sports Medicine$1,122,643$0$165,431$0$4,268$0$14,000$0$34,735$0$1,341,077$0$0$0
Chris Krouse DO
Orthopedics, Sports Medicine$1,148,875$0$95,881$0$6,223$0$14,000$0$28,023$0$1,293,002$0$0$0
Jim Breckenridge - Left 42020
CFO Avera Health; Sec/Treasurer$0$945,274$0$1,760$0$71,132$0$14,000$0$22,856$0$1,055,022$0$0
Kelly Smith
Diagnostic Radiology$449,753$0$225,037$0$44,247$0$14,000$0$34,636$0$767,673$0$0$0
Aaron Baas
General Surgery$607,511$0$43,267$0$30,273$0$14,000$0$34,734$0$729,785$0$0$0
Dennis Leland
General Surgery$539,714$0$127,544$0$9,071$0$14,000$0$25,076$0$715,405$0$0$0
Thomas Clark
Regional President & CEO$0$494,905$0$0$0$17,136$0$14,000$0$28,504$0$554,545$0$0
Julie Lautt - Joined 42020
CFO Avera Health; Sec/Treasurer$0$516,081$0$400$0$1,973$0$14,000$0$21,583$0$554,037$0$0
Scott VanKeulen MD
Board Member/Pres. Medical Staff$377,859$0$54,132$0$3,113$0$14,000$0$34,258$0$483,362$0$0$0
Hillary Rockwell MD
Board Member/Physician$404,668$0$15,021$0$2,608$0$14,000$0$34,266$0$470,563$0$0$0
Will Flett
Former Secretary$0$195,065$0$0$0$779$0$9,593$0$31,062$0$236,499$0$0
Rochelle Reider
VP Patient Services$186,798$0$255$0$2,091$0$9,734$0$23,646$0$222,524$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule J, Part I, Line 3:FormAndLineReferenceDesc
ExplanationThe President/CEO is compensated by Avera Health. Avera Queen of Peace relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonRhonda ZomerPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionFamily member of board memberRelationshipDescriptionTxt
Transaction$67,408TransactionAmt
TransactionCompensationTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 2Jim Breckenridge, Julie Lautt, Thomas Clark, and Will Flett have a business relationship.
Form 990, Part VI, Section A, line 6The 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 7aAvera 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 7bAvera 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 8bAvera Queen of Peace Hospital does not have committees with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11bThe 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 12cThe 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 15bThe 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 Queen of Peace.
Form 990, Part VI, Section C, line 19The 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 11gPurchased Services: Program service expenses 6,156,804. Management and general expenses 662,259. Fundraising expenses 2,598. Total expenses 6,821,661. Repairs and Maintenance: Program service expenses 1,865,449. Management and general expenses 31,470. Fundraising expenses 0. Total expenses 1,896,919. Medical Prof Fees: Program service expenses 1,516,364. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,516,364. Centralized Services: Program service expenses 0. Management and general expenses 11,305,344. Fundraising expenses 0. Total expenses 11,305,344.
Form 990, Part XI, line 9:Change in Fair Value of Interest Rate Swap -175,000. Equity Transfers 321,002. Change in Beneficial Interest in Mabee Trust -20,902. Change in Interest in Avera Foundation -32,436.
Form 990, Part XII, Line 2c:The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements of Avera Health, which includes Avera Queen of Peace.
Form 990, Part VI, Section B, Line 16b:There is no written policy or procedure since in the event of any such proposed transaction the board or a committee with delegated authority reviews all materials, valuations and operational aspects for any proposed transaction. Such transaction would be evaluated in accordance with the exempt status of the organization and its applicable purposes. Any transaction also would be approved by the board and the member.
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 Marshall, Avera St. Mary's, Avera St. Anthony, Avera St.Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg, Avera at Home, and Avera Sacred Heart. 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).

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Avera Health
3900 West Avera Drive Suite 300Sioux FallsSD57108460422673Promotion of HealthSD501(c)(3)Line 10N/A0
Avera Gettysburg
606 East GarfieldGettysburgSD57442460234354Healthcare ServicesSD501(c)(3)Line 30Avera St Mary's
Avera St Anthony's Hospital
300 N 2nd StreetONeillNE68763470463911Healthcare ServicesNE501(c)(3)Line 30Avera Health
Avera Holy Family
826 North 8th StreetEsthervilleIA51334420680370Healthcare ServicesIA501(c)(3)Line 30Avera Health
Avera Holy Family Foundation
826 North 8th StreetEsthervilleIA51334421317452Support Health Related ServicesIA501(c)(3)Line 100Avera Holy Family
Avera Marshall
300 S Bruce StreetMarshallMN56258410919153Healthcare ServicesMN501(c)(3)Line 30Avera Health
St Benedict Health Center
401 West Glynn DriveParkstonSD57366460226738Healthcare ServicesSD501(c)(3)Line 30Avera Health
St Benedict Health Center Foundation
West Glynn Drive PO Box BParkstonSD57366460458725Support Health Related ServicesSD501(c)(3)Line 12a, I0St Benedict Health Center
Avera McKennan
1325 S Cliff Ave PO Box 5045Sioux FallsSD57117460224743Healthcare ServicesSD501(c)(3)Line 30Avera Health
Sacred Heart Health Services
501 Summit StreetYanktonSD57078460225483Healthcare ServicesSD501(c)(3)Line 30Avera Health
Avera St Mary's
801 East Sioux AvenuePierreSD57501460230199Healthcare ServicesSD501(c)(3)Line 30Avera Health
Avera at Home
5116 S Solberg AveSioux FallsSD57108460399291Home ServicesSD501(c)(3)Line 100Avera Health
Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9YanktonSD57078460337013Healthcare EducationSD501(c)(3)Line 100Sacred Heart Health Services
Avera St Luke's
305 South State StreetAberdeenSD57401460224598Healthcare ServicesSD501(c)(3)Line 30Avera Health
Avera Tyler
240 Willow StreetTylerMN56178410853163Healthcare ServicesMN501(c)(3)Line 30Avera Marshall
Avera Health Plans Inc
3900 West Avera Drive Suite 101Sioux FallsSD57108460451539Health Financing and Health Plan AdminSD501(c)(4)0Avera Health
Avera Granite Falls
345 10th AveGranite FallsMN56241843156881Healthcare ServicesMN501(c)(3)Line 30Avera Marshall

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
Q & M Properties LLC
525 North FosterMitchellSD57301731652049Medical clinic buildingSDN/A
Avera Home Medical Equipment of Floyd Valley Hospital LLC
714 Lincoln St NELemarsIA51031820582350Medical services - home medical equipmentSDN/A
Avera Home Medical Equipment of Sioux Center LLC
38 19th ST SWSioux CenterIA51250753203100medical services - home medical equipmentSDN/A
Avera Home Medical Equipment of Spencer Hospital LLC
2400 S Minnesota Ave 102Sioux FallsSD57117800619999medical services - home medical equipmentSDN/A
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania StAberdeenSD57401460461429surgical associatesSDN/A
Heart Hospital of South Dakota LLC
4500 W 69th StreetSioux FallsSD57108562143771healthcare servicesSDN/A
Brookings Health System - Avera HME LLC
101 22nd Ave Suite 101BrookingsSD57006453204123Medical Services - Home Medical EquipmentSDN/A
National Rural ACO 4 LLC dba Prairie Hills Care Organization
7509 NW Tiffany Springs ParkwayKansas CityMO64153371780735Accountable Care OrganizationKSN/A
National Rural ACO 5 LLC dba Great Plains Care Organization
7509 NW Tiffany Springs ParkwayKansas CityMO64153383958290Accountable Care OrganizationKSN/A
Caravan Health ACO 41 LLC dba Prairie View Care Organization
7509 NW Tiffany Springs ParkwayKansas CityMO64153821447782Accountable Care OrganizationKSN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPct
Accounts Management Inc
5132 S Cliff Ave Suite 101Sioux FallsSD57108460373021collection agencySDN/AC0
Avera Property Insurance Inc
1000 West 4th Street Suite 1YanktonSD57078460463155insuranceSDN/AC0
Dr Donald & Marguerite Mabee Trust
c/o First National Bank of South DaMitchellSD57301466056202investingSDTYes (1)Avera Queen of Peace Hospital-$20,902$778,6901.00000
Valley Health Services
501 Summit StreetYanktonSD57078460357149rental real estateSDN/AC0
Alucent Medical Inc
1325 S Cliff Avenue PO Box 5045Sioux FallsSD571175045471818349biotech researchSDN/AC0
South Dakota State Medical Holding Inc
5300 South Broadband LaneSioux FallsSD57108460401087insuranceSDN/AC0
DakotaCare Administrative Services Inc
5300 South Broadband LaneSioux FallsSD57108460424322insuranceSDN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other OrgYes (1)AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd