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 460226738 St Benedict Health Center STBE 6059283311 401 West Glynn Drive Parkston SD 57366 Julie Norton CFO Avera Health 6059283311 2020-05-12 1 Kim Hunwardsen CPA P00484560 6122536500 2020-05-15 216.147.181.49 2020-05-12 08:32:53 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2020-09-22 18:59:49Z Avera St Benedict Health Center Rita Blasius 401 West Glynn Drive Parkston SD 57366 29559834 0 0928 X www.avera.org/st-benedict X 1965 SD Promotion of health 10 8 260 170 0 0 74311 145932 25047117 26821885 1000186 917116 43486 34426 26165100 27919359 58615 111699 0 0 13911189 13639804 0 0 0 8132825 8774499 22102629 22526002 4062471 5393357 45051661 51176712 1999430 2178254 43052231 48998458 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 20077483 111699 26832009 Avera St. Benedict Health Center's (Avera St. Benedict) mission is to provide healthcare services to Parkston, Tripp and Lake Andes, South Dakota residents and residents of the surrounding area. Avera St. Benedict is a 501(c)(3) organization affiliated with Avera Health. Avera St. Benedict consists of a 25-bed critical access hospital, a 49-bed nursing home, a 26-bed assisted living center and three rural health clinics. Services offered by Avera St. Benedict include primary care, general surgery, cardiac rehab, behavioral health, laboratory, imaging, telemedicine, wellness center, speech therapy, physical therapy and occupational therapy. Avera St. Benedict provides acute care and long-term healthcare services.Following is a breakdown of these statistics by facility:Avera St. Benedict Hospital422 Acute patient discharges57 Newborn patient discharges157 Swing bed patient discharges19,228 Outpatient visits1,277 Swing-bed patient days97 Newborn patient days21,686 Clinic visitsAvera Bormann Manor25,565 Nursing home resident days25 Long Term Care patient dischargesAvera St. Benedict 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 $136,452.Avera St. Benedict 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 St. Benedict 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. Benedict 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. 20077483 1 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 43 0 1 260 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Dan Neugebauer Chair 2.00 0.00 X X 0 0 0 Patricia Leischner Vice Chair 2.00 0.00 X X 0 0 0 Dave Neugebauer Secretary 2.00 0.00 X X 0 0 0 Barb Weidenbach Board Member 2.00 0.00 X 0 0 0 Pat Reiner Board Member 2.00 0.00 X 0 0 0 Dorothy Marie Fink Board Member 2.00 0.00 X 0 0 0 Antoinette VanderPol MD Board Member/Chief of Staff 40.00 0.00 X 359282 0 25391 Sr Patricia Prunty PBVM Board Member 2.00 0.00 X 0 0 0 Sr Patricia Ann Toscano Board Member 2.00 0.00 X 0 0 0 Shayne McIntosh Board Member 2.00 0.00 X 0 0 0 Rita Blasius President/CEO 40.00 0.50 X X 172931 0 21006 Jim Breckenridge CFO Avera Health; Sec/Treas 0.10 39.90 X 0 918859 34586 Jason Wickersham MD Family Medicine/OB 40.00 5.00 X 390578 0 39297 Denise Muntefering VP Patient Care Services 40.00 0.00 X 143883 0 28384 Richard W Honke II MD Family Medicine Physician 40.00 0.00 X 425333 0 37236 Larissa Sanger MD Family Medicine Physician 40.00 0.00 X 350936 0 40656 Beth Schroeder PA-C Clinic Manager 40.00 0.00 X 237561 0 38341 2080504 918859 264897 11 0 1 0 Avera Queen of Peace 525 North Foster Street Mitchell SD 57301 ITS, administrative & management fees 2276090 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Shared Services & eCare Services 1165453 Avera McKennan PO Box 5045 Sioux Falls SD 57117 Medical Services 244431 South Dakota Anesthesia PC 1907 Walnut Yankton SD 57078 Medical Professional Services 236596 Cassling Diagnostic Imaging Inc 13808 F St Omaha NE 681371102 Maintenance Contract and Repairs 108294 5 101047 42497 2388 145932 Net Patient & Resident Service Re 622110 25288527 25288527 Pharmacy Revenue 900099 762092 762092 Daycare Revenue 624410 117013 117013 654253 654253 26821885 48099 48099 24302 0 24302 24302 24302 2509492 1640475 869017 869017 869017 AR Interest Income 900099 10124 10124 10124 27919359 26832009 0 941418 X 111699 111699 568743 379363 189380 100435 100435 10249626 9902246 347380 420778 409524 11254 1588067 1515782 72285 712155 688784 23371 4647 4647 35489 35489 3545472 1920956 1624516 1059 1059 361201 338276 22925 116549 115776 773 461760 460260 1500 60688 47269 13419 27062 22638 4424 1294828 1294828 137701 137701 Medical Supplies 2141318 2141318 Bad Debt Provision 395496 395496 Sales Tax and Licenses 52285 50940 1345 138944 44192 94752 22526002 20077483 2448519 0 4259520 1030893 2715697 5853676 288198 299148 74400 96779 25682541 12972174 13685129 12710367 23688550 31007588 340167 178261 45051661 51176712 1999430 1812963 4003 0 361288 1999430 2178254 X 42404483 48109367 591681 833024 56067 56067 43052231 48998458 45051661 51176712 X 5393357 353806 199064 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 68235 108 6735 75078 65370 124 2741 68235 52199 9508 3663 65370 52694 -495 52199 54947 -2253 52694 0.82130 0.17870 0 1 1 97483 97483 16786201 7335296 9450905 8236395 5430873 2805522 562462 206005 356457 12710367 Assets Limited to Use - Avera Pooled Investments 29618367 F Interest in Avera Health Foundation 1389221 F 31007588 Estimated Third-Party Payors Settlements 361288 361288 X Part IV, Line 2b: Funds are held on behalf of the residents. Part V, Line 4: The Organization's endowment consists of a portion of their interest in the net assets of 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. 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. 1 1 X 1 X 1 X 1 1 0 0 81628 81628 0.00370 1005079 887340 117739 0.00530 96419 55133 41286 0.00190 1183126 942473 240653 0.01090 69663 69663 0.00310 7309 7309 0.00030 5102938 3718196 1384742 0.06260 9900 9900 0.00040 5189810 3718196 1471614 0.06640 6372936 4660669 1712267 0.07730 261246 117013 144233 0.00650 261246 117013 144233 0.00650 1 395496 0 6629538 6655821 -26283 X 1 1 1 1 Avera St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 www.avera.org/st-benedict 50749 X X X X 3 provider based clinics St Benedict Hospital Inc 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Section C X 1 18 1 See Part V, Section C 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X X 1 X 0 X X X X X 1 X 0 0 St. Benedict Hospital Inc. Part V, Section B, Line 5: A variety of individuals and groups of people were involved in the CHNA process from November 2018 through February 2019. Qualitative data was obtained from focus groups with the Parkston Commercial Club and Ministerial Association. The Parkston Commercial Club is a group of businesses in the Parkston area that meet monthly to support the community in a variety of ways, including fundraising for local events and family centered entertainment. Commercial club members are generally involved in many different activities in the community of Parkston, the local school district, and the surrounding area. The Ministerial Association members are clergy from many different congregations, some of which run food and clothing banks for individuals in need. The Ministerial Association meets monthly to work together to address many community and individual needs that are also social determinants of health. Formal individual interviews were conducted with two county health nurses, Andes Central School District Principal; Tripp School District Principal; Parkston School District superintendent; one Hutterite Colony boss; and manager of the only medical clinic in Lake Andes, SD. County health nurses are the only form of public health in Hutchinson County. A survey (electronic and paper) was completed by 103 community members. St. Benedict Hospital Inc. 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.Obesity* Create a "Shop with the Dietician" program. * Incorporate nutritional education for young athletes at Coaches' Clinics.* Provide educational opportunities to the community for weight loss. * Provide scheduled free access to Avera St. Benedict's Wellness Center. * Promote "Fitness on Demand" virtual classes available at Avera St. Benedict's Wellness Center. * Train elementary school teachers on the value of physical activity through incorporating it into daily classroom activities. Substance Use Prevention* Have vaping education materials available at school registration day and other school events. * Make a video for distribution on dangers of vaping and tobacco use. * Provide vaping education in conjunction with influenza injections. * Teach the Tar Wars program for grade 4. * Collaborate with law enforcement to provide alcohol prevention education to at risk youth. Transportation* Thoroughly assess gaps in transportation to create a volunteer based transportation network. * Create guidelines for facility based transportation.* Promote telehealth services to reduce transportation needs. * Continue in-home medical care when possible, specifically with the homebound, Hutterite populations, and Amish populations. Deterioration of Homes* Collaborate with Commercial Club and Economic Development to launch a "Paint a House" program. After School Activities for Kids* Host a Safe at Home program to elementary/middle school children. * Host a Safe Baby-Sitting program to elementary/middle school children. * Support the Public Library in their efforts to have after school programs for children. * Make a video for distribution on ways kids can stay safe at home and in the community. * Teach agricultural safety to local rural kids. Access to Care* Collaborate with local dentists to implement free or reduced cost dental screening program in the community for kids.* Collaborate with local optometrists and the Lions Club to implement free or reduced cost vision screening program in the community for kids.* Provide worksite wellness screenings at a minimum of 3 worksites.* Work towards expanding clinic hours for urgent care needs.The following health need will not be addressed due to resource constraints for the hospital at this time: * Walking/bike paths.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. St. Benedict Hospital Inc. 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. St. Benedict Hospital Inc. Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. St. Benedict Hospital Inc. 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. St. Benedict Hospital Inc. 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 C, Lines 7a and 10a: Community Health Needs Assessment and Implementation Strategy websitehttps://www.avera.org/about/community-health-needs-assessments/ Schedule H Part V, Section C, Lines 16a, 16b and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 2 1 - Avera Bormann Manor 501 North 4th Street Parkston SD 57366 Nursing Home 2 - Avera St Benedict Assisted Living 400 W Fir Parkston SD 57366 Assisted Living 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 using an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost report. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Other means tested government programs, community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded in the general ledger. Part I, Ln 7 Col(f): Bad debt expense of $395,496 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. Part II, Community Building Activities: Avera St. Benedict Health Center (ASBHC) operates a community daycare providing a safe environment for the children. Lower income families are provided a safe and affordable place for their children. While not all the families are lower income, the orgainzation sees this as a community need as there is no other facility in the area and the ocmmunity as a whole would struggle to find daycare for their children. Despite operating at a loss, the Board of Directors is committed to providing the service to the community.The organization supported a mission during the fiscal year. 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 expense can be found on page 11 of the attached audited financial statements. Part III, Line 8: Any Medicare shortfall for St. Benedict Hospital is excluded from the community benefit report. Patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This means providing Medicare services promotes access to healthcare services which is a key advantage for our community and therefore any shortfall is considered a community benefit.Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the Organization's financial assistance policy for low-income, uninsured patients and is cooperating with the Organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: Community needs are evaluated and assessed on an on-going basis in several ways. ASBHC has completed formal "needs assessments" several times over the course of the past several years. This has been accomplished with input from focus groups, surveys, short and long range planning by the Health Center Board, demographic and health care data analysis, regular meetings with the provider staff, and collaboration with the local school and churches, as well as local law enforcement. Part VI, Line 3: Patients are informed of the financial assistance/charity care policy through brochures at the registration desks of the Hospital and Clinics. ASBHC has staff in Central Registration that identify if a patient is able to pay for services through insurance or otherwise. If they identify on the front end that the patient needs assistance, the patient is connected to a representative in Patient Financial Services who can assist with determining what benefits the patient may qualify for and help them apply for any benefits. If there is no option for an outside assistance program, the patient is informed and encouraged to complete the application that utilizes a combination of income, assets, and expenses to determine what percentage of charity care they would qualify for. Part VI, Line 4: Avera St. Benedict Health Center (ASB) is located in Parkston, S.D and also has health services available in the surrounding communities of Tripp, and Lake Andes, SD. Tripp is about 12 miles south of Parkston, in Hutchinson County, SD and Lake Andes is about 45 miles southwest of Parkston in Charles Mix County, SD. Also included in the community is an adolescent psychiatric residential treatment facility that has an ongoing census of up to 40 adolescents who have been either emotionally or physically abused or have been ordered by the courts to reside at this residential treatment center.Parkston is located in Hutchinson County, S.D., in the south central part of the state. Agriculture is the primary economic driver in the county. Avera St. Benedict's primary service area is defined as Hutchinson County. About 60 percent of inpatient discharges and 65 percent of Emergency Room visits were from Hutchinson County. According to the U.S. Census Bureau QuickFacts 2018 data, the population of Hutchinson County was estimated at 7,380 people and is predominately White/Caucasian (96.2%). About 23.0% of the population is over the age of 65. County Health Rankings statistics assesses the unemployment rate of 2.4 percent compared with the state of South Dakota's 2.8 percent unemployment (2018.) U.S. Census Bureau QuickFacts estimates that the median household income of Hutchinson County is $54,868, which is about $1,630 less than the state's average. Uninsured individuals under age 65 is estimated at 12.3%. The U.S. Census Bureau QuickFacts estimates 11.5% of Hutchinson County residents living in poverty. High school graduation rates in the county are at 87.7% and adults over 25 years of age with a Bachelor's degree or higher are at 25.5% (2014-2018). The secondary service area, including portions of Douglas, Davison, Bon Homme and Hanson counties are demographically similar to Hutchinson County with rural, agricultural lifestyles. These four counties made up about 40 percent of inpatient discharges and 30 percent of Emergency Room visits. Charles Mix County is demographically different from the rest of the service area in that there is a 32% Native American population, lower rates of individuals 16 and older in the civilian labor force (60.5%), and higher rates of poverty (20.9%). Avera St. Benedict is the primary medical provider for 8 Hutterian Brethren Colonies in the primary and secondary service area, which includes about 550 individuals. Avera St. Benedict Health Center sees about 8,000 people a year for one or more services at the health center. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. The Board of Directors meets monthly and has community representation that brings forward issues relative to challenges, needs and services within the community. The local ministerial group meets monthly at the Hospital and also identifies needs and gaps within the parishioners they serve. Medical staff privileges are extended to all qualified physicians in the community. The medical staff, including the physicians/mid-levels/department directors, has the opportunity to meet monthly and also discuss ways to meet the needs of the community they serve. Surplus funds are reinvested in facilities to improve patient care. The Hospital operates an emergency room that is available to all, regardless of ability to pay.ASBHC has a fitness center on campus that is available to help the community focus on wellness and prevention. This endeavor is subsidized by the facility to improve the health and well-being of the community as a whole. The chaplaincy mission services participate and spearhead many community projects including an angel tree at Christmas to address the needs of children in our service area. ASBHC also donates to the local food pantry and purchases, prepares, and serves a meal to the Love Feast in Mitchell, SD annually. The meal serves 300 plus people in need of nutrition. At that event, bags of groceries are provided to the families in need that are in attendance to take home. There are several other projects of this nature on a smaller scale at the local school system. ASBHC donates to community events such as American Cancer Society projects and sponsors health related educational programs to the community at large. Avera St. Benedict also provides medical, nursing, and other ancillary health professions the opportunity for hands on learning experiences through residencies, internships, clinical rotations and other shadowing and profession mentoring programs to help with students health care training needs. 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 Mount Marty College 1105 W 8th Street Yankton SD 57078 460283336 501(c)(3) 15000 Donation Mitchell Heart & Sole PO Box 1412 Mitchell SD 57301 460449620 501(c)(3) 6500 Donation Dakota Heartland Development Association 601 N Main St Mitchell SD 57301 352397643 501(c)(3) 7500 Sponsorship Parkston Rural Ambulance District 711 W Maple St Parkston SD 57366 460397613 501(c)(3) 3000 25259 FMV LifePak 15 (Monitor/Defibulator) Sponsorship and Equipment for Rural Ambulance 4 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRS Section 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. X X 0 0 0 0 0 0 0 0 0 Antoinette VanderPol MD Board Member/Chief of Staff 291159 0 63109 0 5014 0 13750 0 11641 0 384673 0 0 0 Rita Blasius President/CEO 168707 0 700 0 3524 0 8658 0 12348 0 193937 0 0 0 Jim Breckenridge CFO Avera Health; Sec/Treas 0 693359 0 1720 0 223780 0 13750 0 20836 0 953445 0 0 Jason Wickersham MD Family Medicine/OB 296811 0 88709 0 5058 0 13750 0 25547 0 429875 0 0 0 Denise Muntefering VP Patient Care Services 139720 0 1225 0 2938 0 7301 0 21082 0 172266 0 0 0 Richard W Honke II MD Family Medicine Physician 340269 0 71147 0 13917 0 13750 0 23486 0 462569 0 0 0 Larissa Sanger MD Family Medicine Physician 258325 0 42109 0 50502 0 13750 0 26906 0 391592 0 0 0 Beth Schroeder PA-C Clinic Manager 156908 0 70272 0 10381 0 11949 0 26392 0 275902 0 0 0 Denise Leischner Family member of Pat Leischner, Board Member 100435 Compensation and benefits as an employee 0 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) Define the purpose, philosophy and mission of this Corporation. 2) Receive and approve budgets of this Corporation. 3) Review and approve audited financial reports of this Corporation. 4) Dissolve, merge or consolidate this Corporation. 5) Approve the selection and retention of the independent auditing firm. 6) Approve any action which would change the character of this Corporation. 7) Initiate and/or approve all amendments to the Articles of Incorporation and Bylaws of this Corporation. 8) Appoint and remove, with or without cause, the Directors, sanction vacancies and determine the number of Directors of this 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 St. Benedict Hospital does not have any committees with 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 15a The President and CEO of Avera Queen of Peace, a related organization, initiates the annual review for the CEO. He sends out evaluation forms to the board of St. Benedict's. Comparative data from Avera Health System is used to develop a recommended compensation structure. The compensation for the CEO is approved by Avera St. Benedict's board. This is done on an annual basis, usually in January. The CFO-Avera Health is compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not made available to the general public. The organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public. Form 990, Part IX, line 11g Purchased Services: Program service expenses 787,157. Management and general expenses 73,868. Fundraising expenses 0. Total expenses 861,025. Repairs and Maintenance: Program service expenses 480,233. Management and general expenses 2,476. Fundraising expenses 0. Total expenses 482,709. ACS Fees: Program service expenses 653,566. Management and general expenses 1,548,172. Fundraising expenses 0. Total expenses 2,201,738. Form 990, Part XI, line 9: Change in Interest in Avera Foundation 199,064. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Health, which includes St. Benedict Health Center. Form 990, Part X, Line 20: St. Benedict Health Center is part of the Avera Obligated Group which consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Gettysburg and Avera at Home. St. Benedict Health Center was not allocated any share of the bond issue, and thus does not have an amount on line 20. 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 St Benedict Health Center Foundation 401 West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 0 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 McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Street Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home Services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th ST Suite 9 Yankton SD 57078 460337013 Healthcare education SD 501(c)(3) Line 10 Sacred Heart Health Services 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Marshall 300 S Bruce ST Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan admin SD 501(c)(4) Avera Health 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln ST NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Sioux Center LLC 38 19th ST SW Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota 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 Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 Surgical Associates 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 HME 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 Avenue Suite 101 Sioux Falls SD 57108 460373021 Collection Agency SD N/A C 0 Avera Property Insurance Inc 510 W 23rd Street 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 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 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0