2020-05-26T11:57:46-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 460224598 Avera St Luke's AVER 6056225272 305 South State Street Aberdeen SD 57401 Julie Norton CFO Avera Health 6056225272 2020-05-11 1 Kim Hunwardsen CPA P00484560 6122536500 2020-05-11 216.147.181.49 2020-05-11 15:47:00 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2021-01-29 14:40:06Z Todd Forkel 305 South State Street Aberdeen SD 57401 201035029 0 0928 X www.averastlukes.org X 1901 SD Promotion of Health 15 12 1465 73 488193 -519315 407121 400626 195316066 199869615 707451 420120 -460457 -351101 195970181 200339260 187455 193616 0 0 110737623 112994113 0 0 179626 87128899 92919365 198053977 206107094 -2083796 -5767834 171105213 162705089 85703890 85400534 85401323 77304555 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 179804284 193616 199927207 Avera St. Luke's mission is to provide healthcare services to Aberdeen, South Dakota residents and residents of the surrounding area. Avera St. Luke's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Luke's consists of 43 acute beds, 6 ICU beds, 10 inpatient psych beds, an 81 bed nursing home in Aberdeen, SD and a 56 bed nursing home in Eureka, SD, a 10-bed surgical center in Aberdeen, SD, and 20 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, radiation, radiology, oncology, therapy, neurology, urology, hematology, psychiatry, neonatology, gastroenterology, and cardiology. Avera St. Luke's provides acute care and long-term healthcare services. Avera St. Luke's Hospital4,073 Acute patient discharges461 Newborn patient discharges211 Swing bed patient discharges130,877 Outpatient visits1,936 Swing-bed patient days881 Newborn patient days163,124 Clinic visits47,304 Nursing home resident days106 Long Term Care patient dischargesAvera St. Luke's maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $6,905,029.Avera St. Luke's also provides community benefit health activities at less than or at no cost to support those in the area served, see Schedule H. As a member of the Avera Health Network, Avera St. Luke's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Luke's engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 179804284 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 184 0 1 1465 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Robert Fouberg Chair 1.00 0.00 X X 0 0 0 Tom Seyer Vice Chair 1.00 0.00 X X 0 0 0 Sr Mary Kay Panowicz Director 1.00 0.00 X 0 0 0 Sr Kathleen Ann Bierne Director 1.00 2.60 X 0 0 0 Lyle Biegler MD Director/Family Medicine 40.00 0.00 X 413173 0 41111 Sandra Kleinknecht Director 1.00 0.00 X 0 0 0 Dick Inman Director 1.00 0.00 X 0 0 0 Marshall Lovrien Director 1.00 0.00 X 0 0 0 Carmen Meyer Director 1.00 0.00 X 0 0 0 Diana Reynen Director 1.00 0.00 X 0 0 0 Heidi Golz Director 1.00 0.00 X 0 0 0 Sr Marietta Kerkvliet Director 1.00 0.00 X 0 0 0 Garret Wobst MDDirector Hyperbaric Treatment, Surgery, & Podiatry 40.00 0.00 X 463796 0 39297 Adam LeFebvre MD Director/Anesthesiology 40.00 0.00 X 461609 0 41097 Sr Pam Donelan Director 1.00 0.00 X 0 0 0 Todd Forkel President & CEO 40.00 5.00 X 0 666750 36229 Jim Breckenridge CFO Avera Health; Sec/Treas 0.10 39.90 X 0 918859 34586 Tom Snyder VP Long Term Care 40.00 0.50 X 190352 0 23460 Christopher Larson General Surgeon 40.00 0.00 X 1272967 0 45357 Sushell Gundewar Cardiology 40.00 0.00 X 1251978 0 40297 Brandon Fites Orthopedic Surgeon 40.00 0.00 X 1426606 0 40560 Roger Werth General Surgeon 40.00 0.00 X 1220398 0 41206 Richard Conklin Oncologist 40.00 0.00 X 1299294 0 46357 Will FlettFormer Secretary/Treasurer 0.00 40.00 X 0 191338 38137 8000173 1776947 467694 129 1 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 571085721 Shared services 21055690 Huff Construction Inc 11 N Dakota St Aberdeen SD 57401 Construction 1721854 Restorix Health Inc 445 Hamilton Ave Ste 800 White Plains NY 10601 Medical services 1330660 National Medical Resource 2792 E Broadway Ave Bismarck ND 58501 Physician Services 398594 Dahme Construction Co Inc PO Box 407 Aberdeen SD 57401 Construction 284305 17 44105 145378 211143 400626 Net patient services 621110 194659239 194659239 Supporting revenue 624100 4505942 4017749 488193 Invest in partnership 900099 704434 704434 199869615 193154 193154 268741 693143 -424402 -424402 -424402 149502 77464 0 0 149502 77464 226966 226966 18335 2626 15709 15709 Interest Income 900099 57592 57592 57592 200339260 199439014 488193 11427 X 193616 193616 1680093 1469324 210769 54900 54900 88877714 82171597 6608501 97616 5714219 5291474 416463 6282 11686220 10815671 857709 12840 4980967 4601327 374266 5374 20998 20998 540 540 11211 11211 30326380 15079259 15246821 300 50360 30669 19426 265 8389600 7067596 1289641 32363 213392 205792 7600 1929671 1896238 33011 422 422865 327337 94904 624 306708 290912 15796 2851958 2851958 7148155 6818447 329010 698 1431041 1420170 10871 Medical supplies 29162036 29152379 9657 Bad debt 8181646 8181646 Equipment lease/rental 411950 375316 36634 Licenses and permits 338575 39666 298909 1722279 1468990 230447 22842 206107094 179804284 26123184 179626 5577820 5994262 24360553 26199683 827647 0 3591276 3437742 1131503 1338582 196838491 119266957 80538832 77571534 14166554 6903053 848355 1264669 39095688 38993959 966985 1001605 171105213 162705089 14648829 14166527 69718058 69638058 57800 56200 1279203 1539749 85703890 85400534 X 82386068 74802434 2493304 1980170 521951 521951 85401323 77304555 171105213 162705089 X -5767834 -50995 -2277939 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11211 11211 0 Part II-B, Line 1: Avera St. Luke's paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1248105 45961 9386 7 1284673 2983726 65876 1801473 24 1248105 3036970 469170 351817 857309 16922 2983726 4364943 462040 65820 1837645 18188 3036970 3963040 676958 153521 414764 13812 4364943 0.40470 0.59530 0 1 1 1428952 4918054 6347006 134934148 75746575 59187573 53296594 42004441 11292153 2260743 1515941 744802 77571534 Interest rate swap agreement 1308749 Interest payable 231000 1539749 X Part IV, Line 2b: The organization holds funds in trust on behalf of its residents. Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization's permanently restricted endowment funds are donor restricted. Part X, Line 2: Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 1 0 0 1530697 1530697 0.00770 8567692 3865071 4702621 0.02380 393363 393363 0.00200 10491752 3865071 6626681 0.03350 361563 361563 0.00180 286528 286528 0.00140 6464343 3494250 2970093 0.01500 582370 20810 561560 0.00280 7694804 3515060 4179744 0.02100 18186556 7380131 10806425 0.05450 2836 2836 0.00000 3612 3612 0.00000 28 28 0.00000 3136 3136 0.00000 728 728 0.00000 2550 2550 0.00000 1120 1120 0.00000 14010 14010 0.00000 1 8181646 0 54332565 56482924 -2150359 X 1 1 1 Surgical Associates Endoscopy Clinic LLC Endoscopy Procedures 0.51000 0.49000 1 1 Avera St Luke's 305 South State Street Aberdeen SD 57401 www.averastlukes.org 10525 X X X 16 provider based clinics Avera St Luke's 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V X 1 18 1 See Part V 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V X See Part V X See Part V X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera St. Luke's Part V, Section B, Line 5: The St. Luke's Hospital Foundation invited individuals from all facets of the community to participate in an on-line survey, over a period of three months. After review of the results, the Avera St. Luke's Foundation then hosted eight focus groups representing community leaders and members, health care providers, dentists, uninsured/underinsured persons and policy makers to discuss the survey results and address health care needs in Brown County. Avera St. Luke's collaborated with the City of Aberdeen to review existing programs and find new ways to support and improve existing programs as well as implement new programs. In collecting data, Avera St. Luke's contacted a wide range of respondents from several different ages, economic classes, organizations, and cultures. The groups involved included:* The Brown County 211 Helpline Board* United Way Board Members* Presentation Sisters* Salvation Army* Local Universities* Aberdeen Diversity Coalition* City Emergency Responders* Aberdeen Area Chamber of Commerce Business and Health committees* Aberdeen Area Human Resource Association* Aberdeen Military Committee* Social Workers* Cancer Center Patients and Families Avera St. Luke's Part V, Section B, Line 11: The community health needs assessment was completed during the tax year and, as such, the hospital has not taken specific actions with respect to the current implementation strategy. The following community health priority areas were identified and the following actions will be taken by the hospital during future years:Preventive Care and Removing Barriers to Health Needs* Support of better nutrition through Food Bank. * Avera Human Performance team and dietitians will create an educational handout that is delivered and updated quarterly to the area food banks that list best choices and wellness options, and money-saving strategies for patients that are trying to make healthy and cost-effective choices.* Avera St. Luke's will collaborate with area service organizations and food banks to provide the resources and educational pieces to assist individuals with health issues to make better choices.* Coordinated Care is a program that can help individuals overcome barriers to better health. Providers and members of the coordinated care teams will work to track trends and patterns that predict risk and then will work to redirect care as needed.* Collaboration with community programs and philanthropic offices to provide additional devices/items or support outside of medical facilities to decrease the need for medical care. * The Lifetime Resiliency program is a wellness continuum designed to assist individuals/patients on their path to healthier living. This program helps patients who are recovering from a medical condition or who need to prepare for an upcoming procedure. * Physicians and the Avera Human Performance Center team will work together to determine the best steps and needs on an individual basis based on the medical condition.Health Care Affordability* Avera St. Luke's plans to host an educational event that brings together health insurance and financial experts to present about best use of health insurance, HSAs/FSAs, and high deductible plans. Avera St. Luke's Quality Care and Innovation Strategy Officer, Financial and Billing will develop the presentation; Marketing and Communications will work to promote and provide the materials necessary for the program.* Avera St. Luke's will work with the Aberdeen Area Human Resource Association, business health partners, financial and insurance connections and Brown County offices. * We will partner with the community programs and locations to provide the marketing pieces and education on locations of Avera facilities in Brown County.Transportation Needs* Aberdeen has created a community coordination committee, of which Avera St. Luke's will serve as a leader. A key area of focus will be how to improve transportation gaps.* Avera St. Luke's will collaborate with city transportation groups to improve access to transportation to patients and families in the Aberdeen region. The first step will be to have our patient scheduling and patient care coordinators meet with city transit to establish windows of time that would best coordinate with medical appointments, as well as partnering with area churches, schools and organizations that provide transportation.* Through volunteers, Road to Recovery provides transportation to and from treatment for people with cancer who do not have a ride or are unable to drive themselves.* The Avera St. Luke's Foundation and Avera Cancer Institute will work closely with our American Cancer Society representative and provide the support needed to recruit, train and support the "Road to Recovery" for Aberdeen.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.Many other region/community themes emerged that were beyond the scope or control of Avera St. Luke's. The following health needs/priorities will be deferred to the appropriate organizations and programs in place that are working on specific issues: * Adult dental care* Housing* Suicide prevention* Diversity and education Avera St. Luke's Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera St. Luke's Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, waiting rooms, and admissions office and is included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Luke's Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera St. Luke's Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Schedule H, Part V, Section B, Line 7a and 10a: www.avera.org/about/community-health-needs-assessments/ Schedule H, Part V, Line 16a, 16b, and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 6 1 - Avera Mother Joseph Manor 1002 N Jay Street Aberdeen SD 57401 Nursing Home, Assisted and Congregate Living 2 - Avera Eureka Health Care Center E Hwy 10 Eureka SD 57437 Skilled Nursing Facility 3 - Avera Clinic of Ellendale 240 Main St Ellendale ND 58436 Clinic 4 - Avera Medical Group AveraQuick Kesslers 615 6th Ave SE Aberdeen SD 57401 Clinic 5 - Avera Medical Group Selby 4401 Main St Selby SD 57472 Clinic 6 - Pain Management Center 815 1st Ave SE Aberdeen SD 57401 Clinic Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: A combination of costing methodologies were used to calculate the amounts reported in the table. A cost-to-charge ratio derived from Worksheet 2, ratio of patient care cost-to-charges was used to calculate charity care at cost, unreimbursed Medicaid and Means-Tested Government Program expenses. Subsidized health was calculated based on actual cost/loss. For all other amounts, costs and revenues as reflected by the general ledger system were used. Part I, Ln 7 Col(f): Bad debt expense of $8,181,646 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. Part II, Community Building Activities: NATIONAL NIGHT OUT - National Night Out is an annual community-building campaign that promotes police-community partnerships and neighborhood camaraderie to make our neighborhoods safer, more caring places to live. National Night Out enhances the relationship between neighbors and law enforcement. Our local sponsor, the Aberdeen Police Department, invites local organizations to participate each year in this event held on the first Tuesday of August at Melgaard Park. A free meal is served by volunteers from many organizations and entertainment is offered all free of charge. Avera St. Luke's has participated by offering a booth with games and prizes with our focus on child safety - recent focuses have been on back to school safety with walking, bike riding and outdoor play. The event brings out around 1,500 to 2,000 children and families for a fun evening. ASPIRE/SD DEPT OF VOC REHAB - Project SEARCH provides internships for high school students in their last year of high school and assists in helping students attain work skills and prepare them for a job. Students are chosen for the program who are ready to join the workforce and do not have plans to go to college but have skills that would enable them to be gainfully employed. We want to assist in meeting the community workforce needs as well as help these students obtain employment vs. being on federal assistance. Part III, Line 2: Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: 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 III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses can be found on page 11 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Avera St. Luke's follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall (as calculated including our non-cost report entities) is excluded from community benefit. However, Medicare is the organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: Health care needs are assessed through various methods. Given Aberdeen is a regional center/hub and the third largest city in South Dakota, Avera St. Luke's is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. Although another smaller hospital opened in Aberdeen during FY 2013, the next largest hospital is 100 miles from Aberdeen and most of the towns within our region have a population of less than 2,000. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. Our third community health needs assessment (CHNA) was completed and posted to our website by June 30, 2019. The identified areas of need highlighted for further research andcomparison are dental care, removal of barriers to community health needs, health care affordability and travel and accessibility to health care. The overall goal is to focus on removing all barriers to health. Part VI, Line 3: The Organization utilizes various methods to inform patients about our financial assistance policy. Admitting areas have signs/posters noting charity care and financial assistance. Avera St. Luke's and Avera Health utilize the internet to address financial assistance. Social workers are in direct contact with patients and make referrals to the Business Office for financial assistance and in many cases, work directly with the patient on various government programs which may be available and help with applications. For those who receive bills for services and have concerns about their ability to pay, financial counselors work directly with them on financial assistance. We have brochures available to all and treat all without regard to their ability to pay. Part VI, Line 4: Aberdeen is the third largest city in South Dakota. Using South Dakotaestimated data for July 2018, census reflected a population ofapproximately 28,562. Our primary service area consists of the followingcounties: Brown, Marshall, Day, Faulk, Edmunds, McPherson, and Spink inSouth Dakota and Dickey County in North Dakota. The population of thisarea is approximately 65,000. Our secondary service area includes othernearby counties. This large service area is due to outreach and the scopeof specialty services offered by Avera St. Luke's for which if notoffered, a patient would travel up to 200 miles for the same service.Given we are a rural community in the truest sense, we have a very agedpopulation. Many of the patients within this region are Medicare age.Other than the hospital that opened in Aberdeen during FY 2013, the nextclosest hospitals are 40 to 100 miles away. They are Critical Access Hospitals with limited services and served by limited physicians. Patientdemographics within the region would indicate that after you considerthose patients admitted to the smaller hospitals, the majority of the restseek services at Avera St. Luke's and the other hospital in Aberdeen. Thepopulation in the primary service counties range from 2,330 to 39,316.US Census QuickFacts data estimates for 2018 contains many dataelements, therefore, we will comment on Brown County (location of Avera St. Luke's), Spink County (second largest in primary service area with growth) and McPherson County (due to aged population). % change in Pop. % over 65 Non-White Pop. %State of SD 8.4% 16.6% 15.6%Brown County 7.6% 17.2% 11.5%Spink County 1.2% 20.8% 4.5%McPherson County -2.1% 28.1% 2.4%Median Household IncomeState of SD $56,499Brown County $56,455Spink County $52,729McPherson County $43,804From an unemployment standpoint, South Dakota (3.2%) and our region hasfared much better than the US. Within the primary service area, currentunemployment rates range from a low of 3.2% in Brown County to a high of5.4% in McPherson County. Part VI, Line 5: Avera St. Luke's is a regional facility within Avera Health System. Weare a health ministry cosponsored by the Benedictine Sisters of Yankton,South Dakota and the Presentation Sisters of Aberdeen, South Dakota. Ourhealth ministry is rooted in the Gospel and requires us to make a positiveimpact in the lives and health of persons and communities by providingquality services guided by Christian values. Avera St. Luke's vision is tobe an exceptional health care organization for patients to receive care,physicians to practice and employees to work. The Organization's valuesare Compassion, Hospitality and Stewardship. Our governing body consists of 15 members who are physicians, community and regional residents and Sister representatives from the Presentation and Benedictine Orders. In addition, the CEO serves on the board. In addition to the governing body, we have one advisory board. This includes Northern State University Business School. Medical Staff privileges can be extended to qualified physicians based on receiving approval of their application and credentials by the Medical Staff and the Hospital governing body. The Hospital's governing body takes into account other factors related to overall community need and how a physician would impact the Hospital's overall ability to fulfill the mission. Avera St. Luke's mission and values ensure our focus is on the patient, family, employees, physician, those in need, visitors and our region as a whole. The value of Stewardship requires the organization to use all resources in a way that fulfills the mission and values. Each year, our operating and capital budgets are based on various assumptions that in the end provide the needed resources and take into account charity care, patient care, technology, education, community services, employee benefit and compensation plans and programs for meeting the region's needs. Allsurplus funds are used and maintained to provide for both current andfuture needs.Specific examples of how we further our exempt purpose include but are notlimited to the following:a. The only inpatient psychiatric unit within 200 milesb. Interventional Cardiology and Radiology services. These services allowus to meet patient needs when care is critical to their survival and mustbe delivered on a very timely basis.c. Air Ambulance to transport patients to our facility or 200 miles totertiary facilities.d. End Stage Renal Disease program which serves our broad region with thenext closest facility being 100 miles away. Additionally, we employ afull-time Nephrologist to care for the patients along with others whorequire intensive physician care.e. A 24 hour Emergency Room which treats all patients without regard tothe ability to pay. The ER is staffed by physicians 24 hours per day.f. Provision of a multitude of educational and training programs forhealthcare professionals and regional residents. The region was awardedan Area Health Education Center by the South Dakota School of Medicine andwill be located in Aberdeen. The award was based on applications andinterviews within the State and was a collaborative effort of manyhealthcare and non-healthcare organizations within the region with twobeing 100 miles from Aberdeen.g. Avera St. Luke's is currently a Rural Referral Center. The nearesthospitals are tertiary facilities 200 miles away by ground andapproximately 140 miles by air.h. Avera St. Luke's participates in many community organizations andefforts to better the region. Leadership of the organization is on boardsof many exempt organizations (Chamber of Commerce, United Way, AberdeenDevelopment Corporation, College/University Advisory Boards, Kiwanis ClubBoard, Lake Area Technical Institute Alumni Board).i. Provide assistance to small rural hospitals (Critical Access Hospitals)within the region through various programs, management agreements,computer systems, education and other services to assist in keeping theirarea's patients in the local community when possible.j. Recruitment of specialists in nephrology, neurosurgery, neurology,cardiology and psychiatry to meet the region's need in order to eliminatetravel of 200 miles to obtain these services.k. Development and subsidy of various rural clinics to meet needs in thosecommunities.l. Chemical Addiction services on an outpatient basis are provided to theregion and State. Our Worthmore program is well known and respectedwithin the region and state and is the closest program within 150-200miles. We contract with the State for patients who meet theirqualification guidelines and work with governmental agencies within theregion and State.m. Provide drug and alcohol prevention programs to the local schoolsthrough various contracts. Our involvement started when the previousprovider discontinued their contract. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 1 Presentation College 1500 N Main Aberdeen SD 57401 522424588 501(c)(3) 163800 Nursing Education Scholarship Eureka Community Health Services PO Box 517 Eureka SD 57437 460246437 501(c)(3) 10000 Capital Campaign Lakes Area Tech Foundation 1201 Arrow Avenue PO Box 730 Watertown SD 57201 501(c)(3) 5500 Stretch the Millions 3 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRC 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. 0 0 0 0 0 0 0 0 0 Lyle Biegler MD Director/Family Medicine 221080 0 191291 0 802 0 13060 0 28051 0 454284 0 0 0 Garret Wobst MDDirector Hyperbaric Treatment, Surgery, & Pod 418644 0 43825 0 1327 0 13750 0 25547 0 503093 0 0 0 Adam LeFebvre MD Director/Anesthesiology 437756 0 22500 0 1353 0 13750 0 27347 0 502706 0 0 0 Todd Forkel President & CEO 0 529517 0 427 0 136806 0 8682 0 27547 0 702979 0 0 Jim Breckenridge CFO Avera Health; Sec/Treas 0 693359 0 1720 0 223780 0 13750 0 20836 0 953445 0 0 Tom Snyder VP Long Term Care 178086 0 625 0 11641 0 8993 0 14467 0 213812 0 0 0 Christopher Larson General Surgeon 1175097 0 41500 0 56370 0 13750 0 31607 0 1318324 0 0 0 Sushell Gundewar Cardiology 1027139 0 222871 0 1968 0 13750 0 26547 0 1292275 0 0 0 Brandon Fites Orthopedic Surgeon 1016888 0 364467 0 45251 0 13750 0 26810 0 1467166 0 0 0 Roger Werth General Surgeon 1104556 0 50400 0 65442 0 13750 0 27456 0 1261604 0 0 0 Richard Conklin Oncologist 1288092 0 0 0 11202 0 13750 0 32607 0 1345651 0 0 0 Will FlettFormer Secretary/Treasurer 0 187966 0 3000 0 372 0 9606 0 28531 0 229475 0 0 Schedule J, Part I Line 3: The President/CEO is compensated by Avera Health. Avera St. Luke's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Megan Biegler Wife of board member Lyle Biegler 16044 Compensation and benefits as an employee 0 Shelby Forkel Daughter of Todd Forkel 38856 Compensation and benefits as an employee 0 Form 990, Part VI, Section A, line 2 Jim Breckenridge, Will Flett, Todd Forkel, Tom Snyder, and Sister Kathleen Ann Bierne have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. Form 990, Part VI, Section B, line 15b The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Depending on the individual's role with the organization, some officers and key employees are compensated by Avera St. Luke's. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not available to the general public. The organization's financial statements are attached to the Form 990 per IRS instructions and therefore are available to the general public. Form 990, Part IX, line 11g Repairs and maintenance: Program service expenses 3,034,937. Management and general expenses 69,011. Fundraising expenses 0. Total expenses 3,103,948. Other fees: Program service expenses 6,017,814. Management and general expenses 414,162. Fundraising expenses 300. Total expenses 6,432,276. ACS fees: Program service expenses 6,026,508. Management and general expenses 14,763,648. Fundraising expenses 0. Total expenses 20,790,156. Form 990, Part XI, line 9: Capital Transfer -1,762,526. Change in fair value of interest rate swap -272,555. Distribution to controlled entity -697,000. Other change in net assets held by Avera Health Foundation -461,144. Net assets of auxiliary/gift shop -15,723. Other changes in net assets 118,000. Transfers/Eliminations 813,009. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Luke's. Form 990, Part X, Line 20: The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Gettysburg and Avera at Home. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673). Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of health SD 501(c)(3) Line 10 N/A 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 Avera Holy Family Foundation 826 North 8th Street Estherville IA 51334 421317452 Support health related services IA 501(c)(3) Line 10 Avera Holy Family 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare education SD 501(c)(3) Line 10 Sacred Heart Health Services 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan admin SD 501(c)(4) Avera Health 0 Surgical Associates Endoscopy Center LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates/Endoscopy services SD Avera St Luke's Related 841836 237193 0 0 0.51000 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Sioux Center LLC 38 19th St Sw Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical services - home medical equipment SD N/A Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 Medical clinic building SD N/A Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare services SD N/A Brookings Health System - Avera Home Medical Equipment LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD N/A National Rural ACO 4 LLC dba Prairie Hills Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 371780735 Accountable care organization KS N/A National Rural ACO 5 LLC dba Great Plains Care Organization 7509 NW Tiffany Springs Parkway kansas City MO 64153 383958290 Accountable care organization KS N/A Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency SD N/A C 0 Avera Property Insurance Inc 610 W 23rd St Ste 1 PO Box 38 Yankton SD 57078 460463155 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 Alucent Medical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company Inc 2600 W 49th Street Sioux Falls SD 57105 460401087 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 2600 W 49th Street Sioux Falls SD 57105 460424322 Insurance SD N/A C 0 1 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 1 Surgical Associates Endoscopy Clinic LLC L 497938 General Ledger Surgical Associates Endoscopy Clinic LLC S 697000 K-1 distribution Surgical Associates Endoscopy Clinic LLC A 84861 General Ledger