AVERA MCKENNAN: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: AVERA MCKENNAN (EIN 46-0224743)
Tax period: 2018-07-01 to 2019-06-30
Filed: 2020-07-10
IRS object ID: 202011929349302461
Schema version: 2018v3.2
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-07-10T15:45:32-05:00	ReturnTs
Tax Period End	2019-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	450250958	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Eide Bailly LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	800 Nicollet Mall Ste 1300	AddressLine1Txt
City	Minneapolis	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	554027033	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2018-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460224743	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera McKennan	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	6053228000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1325 South Cliff Ave	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	571175045	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Julie Norton	PersonNm
Person Title	CFO - Avera Health	PersonTitleTxt
Phone	6053228000	PhoneNum
Signature	2020-07-07	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen CPA	PreparerPersonNm
PTIN	P00484560	PTIN
Phone	6122536500	PhoneNum
Preparation	2020-07-07	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	216.147.181.49	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2020-07-07	IPDt
IP Tm	14:54:04	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC	AtSubmissionCreationDeviceId
At Submission Filing Device Id	F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	David Flicek	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1325 South Cliff Ave	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	571175045	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$1,231,907,649	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.averamckennan.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1911	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of Health	ActivityOrMissionDesc
Voting Members Governing Body	20	VotingMembersGoverningBodyCnt
Voting Members Independent	15	VotingMembersIndependentCnt
Total Employee	8460	TotalEmployeeCnt
Total Volunteers	1953	TotalVolunteersCnt
Total Gross UBI	$10,259,322	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$3,841,573	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$7,484,768	PYContributionsGrantsAmt
CY Contributions Grants	$8,270,026	CYContributionsGrantsAmt
PY Program Service Revenue	$995,826,100	PYProgramServiceRevenueAmt
CY Program Service Revenue	$1,049,156,777	CYProgramServiceRevenueAmt
PY Investment Income	$8,510,483	PYInvestmentIncomeAmt
CY Investment Income	$10,632,739	CYInvestmentIncomeAmt
PY Other Revenue	$51,157,256	PYOtherRevenueAmt
CY Other Revenue	$60,872,804	CYOtherRevenueAmt
PY Total Revenue	$1,062,978,607	PYTotalRevenueAmt
CY Total Revenue	$1,128,932,346	CYTotalRevenueAmt
PY Grants And Similar Paid	$746,359	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$1,004,588	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$520,069,419	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$564,139,370	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$81,670	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$19,260	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$1,447,936	CYTotalFundraisingExpenseAmt
PY Other Expenses	$493,537,324	PYOtherExpensesAmt
CY Other Expenses	$537,998,124	CYOtherExpensesAmt
PY Total Expenses	$1,014,434,772	PYTotalExpensesAmt
CY Total Expenses	$1,103,161,342	CYTotalExpensesAmt
PY Revenues Less Expenses	$48,543,835	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$25,771,004	CYRevenuesLessExpensesAmt
Total Assets BOY	$1,159,178,030	TotalAssetsBOYAmt
Total Assets EOY	$1,220,148,914	TotalAssetsEOYAmt
Total Liabilities BOY	$511,785,453	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$555,607,348	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$647,392,577	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$664,541,566	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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 and guided by Christian values.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$927,597,481	ExpenseAmt
Grant	$1,004,588	GrantAmt
Revenue	$1,100,080,246	RevenueAmt
Desc	Avera McKennan's mission is to provide healthcare services to Sioux Falls, South Dakota residents and residents of the surrounding area. Avera McKennan is a 501(c)(3) organization affiliated with Avera Health. Avera McKennan consists of a 511-bed hospital, a 53-bed heart hospital and a 138-bed nursing home in Sioux Falls, SD. Major service lines include oncology, surgery, obstetrics, pediatrics, neonatology, emergency and trauma, critical care including EICU, radiology and diagnostic imaging, psychiatry, pulmonary, orthopedics, neurology, cardiology and gastroenterology. Transplant services include solid organ (kidney, liver, and pancreas) and bone marrow transplant.(Continued on Schedule O)Avera McKennan owns or leases rural critical hospitals and a nursing home in South Dakota including a 25-bed critical access hospital and a 55-bed nursing home in Gregory, SD, a 25-bed critical access hospital in Milbank, SD, a 21-bed critical access hospital in Dell Rapids, SD, an 18-bed critical access hospital in Flandreau, SD and a 25-bed critical access hospital in Miller (Hand County), SD, and a 14-bed critical access hospital in Rock Rapids, IA. Services offered by the rural critical access hospitals include radiology and imaging, colonoscopy and endoscopy, therapy and rehabilitation, 24-hour emergency care, chemotherapy, orthopedics, cardiovascular testing, surgery, dialysis and obstetrics.In addition Avera McKennan provides clinical care, secondary and primary, in 98 physician clinics in South Dakota, Northwest Iowa, Southwest Minnesota and Northeastern Nebraska. The physician clinics provide primary care and urgent care, and specialties such as cardiology, dermatology, endocrinology, gastroenterology, hematology, hepatology, infection disease, internal medicine, neonatology, nephrology, neurology, ob/gyn, oncology, ophthalmology, pediatrics, orthopedics, pain management, psychiatry, pulmonology, general surgery, and vascular services. Following is a breakdown of these statistics by facility:Avera McKennan Hospital23,682 Acute patient discharges344,425 Outpatient visits1,845 Newborn patient discharges3,658 Newborn patient days1,029,400 Clinic visitsAvera Heart Hospital2,246 Acute patient discharges9,332 Outpatient visits60,143 Clinic visitsAvera Prince of Peace45,899 Long-term care resident days405 Long-term care patient dischargesAvera Gregory Hospital (CAH)420 Acute patient discharges13,930 Outpatient visits162 Swing-bed patient discharges1,084 Swing-bed patient days18,429 Clinic visitsAvera Rosebud Country Care Center13,099 Long-term care resident days36 Long-term care patient dischargesAvera Milbank Hospital (CAH)401 Acute patient discharges90 Swing-bed patient discharges26,689 Outpatient visits95 Newborn patient days383 Swing-bed patient days24,812 Clinic visitsAvera Dell Rapids Hospital (CAH)117 Acute patient discharges41 Swing bed patient discharges9,728 Outpatient visits413 Swing-bed patient days13,854 Clinic visitsAvera Flandreau Hospital (CAH)125 Acute patient discharges15 Swing-bed patient discharges16,643 Outpatient visits144 Swing-bed patient days10,047 Clinic visitsAvera Hand County Hospital (CAH)209 Acute patient discharges50 Swing-bed patient discharges11,801 Outpatient visits440 Swing-bed patient days8,663 Clinic visitsAvera Merrill Pioneer Hospital(CAH)(May 1, 2019 - June 30, 2019)8 Acute patient discharges1,101 Outpatient visits6 Swing-bed patient days676 Clinic visitsAvera McKennan 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 $66,646,224.Avera McKennan 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 McKennan 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 McKennan 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	$927,597,481	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	Yes (1)	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	497	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	8460	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	20	GoverningBodyVotingMembersCnt
Independent Voting Member	15	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	Jamie Schaefer	PersonNm
Phone	6053223992	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 W Avera Dr Ste 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Hugh Venrick
Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Mary Dally
Vice Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Rick Kooima MD
Chief of Staff	40.00	0.00	Yes (X)		$281,283	$0	$41,947
Cindy Walsh
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Tom Biegler
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Sister Carmella Luke
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Sister Joan Reichelt
Board Trustee	2.00	2.50	Yes (X)		$0	$0	$0
Sister Mary Carole Curran
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Van Fishback
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
J Pat Costello
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Laurie Knutson
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Jim Woster
Foundation Chair	2.00	0.00	Yes (X)		$0	$0	$0
Alejandro Ramirez
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Raed Sulaiman MD
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Carol Twedt
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Sister Lucille Welbig
Board Trustee	2.00	2.50	Yes (X)		$0	$0	$0
Cristina Hill Jensen MD
Board Trustee/Gastroenterologist	40.00	0.00	Yes (X)		$876,515	$0	$40,260
Randy Knecht
Board Trustee	2.00	0.00	Yes (X)		$0	$0	$0
Katherine Wang MD
Board Trustee/Neonatology	40.00	0.00	Yes (X)		$426,944	$0	$13,750
David Flicek
President	40.00	0.00	Yes (X)	Yes (X)	$0	$1,000,651	$46,357
Jim Breckenridge
CFO Avera Health; Sec/Treas	0.10	41.20		Yes (X)	$0	$918,859	$34,586
Lori Popkes
Sr Vice President	40.00	0.00			$345,401	$0	$37,064	Yes (X)
Mary Leedom
AVP of Surgical Services	40.00	0.00			$195,315	$0	$32,229	Yes (X)
Curtis Hohman
Sr Vice President until 4/6/19	40.00	0.50			$373,142	$0	$26,164	Yes (X)
Michael Elliott - Sr Vice
President Medical Affairs & CMO	40.00	0.00			$491,039	$0	$41,437	Yes (X)
Todd Zimprich MD
Neurology	40.00	0.00			$1,602,228	$0	$42,097		Yes (X)
Arvin Santos MD
Nephrology	40.00	0.00			$1,223,434	$0	$45,120		Yes (X)
Brian Knutson MD
Dermatology	40.00	0.00			$1,249,671	$0	$40,860		Yes (X)
Michael Wolak MD
Neurosurgery	40.00	0.00			$1,215,968	$0	$41,097		Yes (X)
Wissam Asfahani MD
Neurology Surgery	40.00	0.00			$1,242,843	$0	$43,857		Yes (X)
Steve Petersen - Former
AVP-Pharmacy	0.00	40.00			$0	$256,972	$26,400			Yes (X)
Julie Norton - Former
Sec/Treas & SrVP Finance	0.00	40.00			$0	$503,223	$35,880			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$9,523,783	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,679,705	TotReportableCompRltdOrgAmt
Total Other Compensation	$589,105	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	871	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Avera Health
3900 West Avera Drive	Sioux Falls	SD	57108	Shared & eCare services	$104,161,155
Grapetree Medical Staffing Inc
2501 Boji Bend Dr Ste 100	Milford	IA	51351	Medical Staffing	$2,910,776
CHG Companies Inc dba CompHealth
7259 S Bingham Junction Blvd	Midvale	UT	84047	Medical Staffing	$2,536,062
Physicians Laboratory Ltd
1301 S Cliff Ave Suite 700	Sioux Falls	SD	57105	Pathology	$2,042,178
Surgical Institute of South Dakota PC
911 E 20th St 700	Sioux Falls	SD	57105	Medical Dir & Prof Fees	$1,920,822

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	69	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$40,594	FederatedCampaignsAmt
Related Organizations	$2,519,968	RelatedOrganizationsAmt
Government Grants	$3,852,162	GovernmentGrantsAmt
All Other Contributions	$1,857,302	AllOtherContributionsAmt
Total Contributions	$8,270,026	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Patient service revenue	622110	$937,786,209	$937,786,209
Patient and clinic	621500	$93,004,671	$88,302,425	$4,702,246
Inc from subsidiaries	423000	$3,592,573	$3,592,573
Meaningful use revenue	900099	$82,167	$82,167

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$14,691,157	TotalRevenueColumnAmt
Related Or Exempt Func Income	$14,691,157	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$1,049,156,777	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,826,631	TotalRevenueColumnAmt
Exclusion	$1,826,631	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,661,002	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,970,989	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$309,987	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$309,987	TotalRevenueColumnAmt
Exclusion	-$309,987	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$57,456,824	SecuritiesAmt
Other	$2,272,170	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$49,454,632	SecuritiesAmt
Other	$1,468,254	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$8,002,192	SecuritiesAmt
Other	$803,916	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$8,806,108	TotalRevenueColumnAmt
Exclusion	$8,806,108	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$108,468,365	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$50,081,428	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$58,386,937	TotalRevenueColumnAmt
Related Or Exempt Func Income	$55,579,587	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$2,807,350	UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Commercial testing	621500	$1,469,091	$1,469,091
Sports program	900099	$1,280,635	$1,280,635
A/R Interest Income	900099	$46,128		$46,128

Field	Value	IRS element (for citing)
Other Revenue Total	$2,795,854	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,128,932,346	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,100,080,246	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$10,259,322	UnrelatedBusinessRevenueAmt
Exclusion	$10,322,752	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$600,776	TotalAmt
Program Services	$600,776	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$403,812	TotalAmt
Program Services	$403,812	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$3,206,406	TotalAmt
Program Services	$1,721,963	ProgramServicesAmt
Management And General	$1,484,443	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$933,881	TotalAmt
Program Services	$933,881	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$449,983,915	TotalAmt
Program Services	$427,477,240	ProgramServicesAmt
Management And General	$21,963,549	ManagementAndGeneralAmt
Fundraising	$543,126	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$29,924,904	TotalAmt
Program Services	$28,426,306	ProgramServicesAmt
Management And General	$1,478,313	ManagementAndGeneralAmt
Fundraising	$20,285	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$49,951,051	TotalAmt
Program Services	$45,290,962	ProgramServicesAmt
Management And General	$4,590,961	ManagementAndGeneralAmt
Fundraising	$69,128	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$30,139,213	TotalAmt
Program Services	$28,170,493	ProgramServicesAmt
Management And General	$1,929,259	ManagementAndGeneralAmt
Fundraising	$39,461	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$289,393	TotalAmt
Program Services	$11,486	ProgramServicesAmt
Management And General	$277,907	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$20,051	TotalAmt
Management And General	$20,051	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$54,739	TotalAmt
Management And General	$54,739	ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$19,260	TotalAmt
Fundraising	$19,260	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$195,524,225	TotalAmt
Program Services	$77,411,720	ProgramServicesAmt
Management And General	$118,062,523	ManagementAndGeneralAmt
Fundraising	$49,982	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$912,560	TotalAmt
Program Services	$558,866	ProgramServicesAmt
Management And General	$150,471	ManagementAndGeneralAmt
Fundraising	$203,223	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$13,960,898	TotalAmt
Program Services	$10,101,466	ProgramServicesAmt
Management And General	$3,686,946	ManagementAndGeneralAmt
Fundraising	$172,486	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$7,217,628	TotalAmt
Program Services	$4,009,750	ProgramServicesAmt
Management And General	$3,163,483	ManagementAndGeneralAmt
Fundraising	$44,395	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$17,698,137	TotalAmt
Program Services	$12,951,263	ProgramServicesAmt
Management And General	$4,702,171	ManagementAndGeneralAmt
Fundraising	$44,703	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$3,195,248	TotalAmt
Program Services	$2,743,074	ProgramServicesAmt
Management And General	$446,056	ManagementAndGeneralAmt
Fundraising	$6,118	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$2,796,900	TotalAmt
Program Services	$2,597,960	ProgramServicesAmt
Management And General	$198,573	ManagementAndGeneralAmt
Fundraising	$367	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$12,295,219	TotalAmt
Program Services	$12,093,638	ProgramServicesAmt
Management And General	$201,581	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$39,566,422	TotalAmt
Program Services	$34,733,544	ProgramServicesAmt
Management And General	$4,832,096	ManagementAndGeneralAmt
Fundraising	$782	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$4,206,968	TotalAmt
Program Services	$2,696,937	ProgramServicesAmt
Management And General	$1,510,031	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical supplies	$201,046,505	$201,046,505
Bad Debt expense	$29,707,822	$29,707,822
Equipment lease and ren	$1,927,109	$1,466,749	$458,818	$1,542
UBI tax	$1,457,603	$1,457,603

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$6,120,697	TotalAmt
Program Services	$983,665	ProgramServicesAmt
Management And General	$4,903,954	ManagementAndGeneralAmt
Fundraising	$233,078	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,103,161,342	TotalAmt
Program Services	$927,597,481	ProgramServicesAmt
Management And General	$174,115,925	ManagementAndGeneralAmt
Fundraising	$1,447,936	FundraisingAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part X	Yes (X)	InfoInScheduleOPartXInd

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$37,247,763	BOYAmt
EOY	$24,017,416	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,592,734	BOYAmt
EOY	$4,345,957	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$142,036,525	BOYAmt
EOY	$143,160,916	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$230,844	BOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$2,307,416	BOYAmt
EOY	$2,101,718	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$25,110,366	BOYAmt
EOY	$28,669,360	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$11,925,421	BOYAmt
EOY	$12,122,761	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$1,011,056,715	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$462,998,676	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$445,269,624	BOYAmt
EOY	$548,058,039	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$8,647,439	BOYAmt
EOY	$22,977,878	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$261,759,142	BOYAmt
EOY	$286,881,315	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$13,266,394	BOYAmt
EOY	$14,698,921	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$40,533,688	BOYAmt
EOY	$39,333,669	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$166,250,674	BOYAmt
EOY	$93,780,964	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,159,178,030	BOYAmt
EOY	$1,220,148,914	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$90,014,179	BOYAmt
EOY	$96,027,112	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$576,178	BOYAmt
EOY	$1,046,529	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$387,185,200	BOYAmt
EOY	$386,890,744	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$9,811,973	BOYAmt
EOY	$42,327,369	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$24,197,923	BOYAmt
EOY	$29,315,594	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$511,785,453	BOYAmt
EOY	$555,607,348	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$629,549,776	BOYAmt
EOY	$646,280,961	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$13,586,236	BOYAmt
EOY	$13,462,830	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,256,565	BOYAmt
EOY	$4,797,775	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$647,392,577	BOYAmt
EOY	$664,541,566	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,159,178,030	BOYAmt
EOY	$1,220,148,914	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$25,771,004	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$488,669	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$8,133,346	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$54,739	OtherActivitiesAmt
Total Lobbying Expenditures	$54,739	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Avera McKennan participates through various hospital organizations to promote legislation that would result in strengthening health care delivery systems on a national, regional, and local level. Dues were paid to the following organizations and a portion is attributable to lobbying. South Dakota Association of Healthcare Organizations $33,468 American Hospital Association 15,434 Catholic Health Association 5,758 LeadingAge 79	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	Yes (1)	AgentTrusteeEtcInd
Beginning Balance	$12,934	BeginningBalanceAmt
Additions During Year	$76,857	AdditionsDuringYearAmt
Distributions During Year	$79,310	DistributionsDuringYearAmt
Ending Balance	$10,481	EndingBalanceAmt
Incl Escrow Custodial Acct Liab	0	InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,256,565	BeginningYearBalanceAmt
Investment Earnings Or Losses	$540,675	InvestmentEarningsOrLossesAmt
End Year Balance	$4,797,240	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$3,764,520	BeginningYearBalanceAmt
Investment Earnings Or Losses	$492,045	InvestmentEarningsOrLossesAmt
End Year Balance	$4,256,565	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$3,174,562	BeginningYearBalanceAmt
Investment Earnings Or Losses	$589,958	InvestmentEarningsOrLossesAmt
End Year Balance	$3,764,520	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,828,539	BeginningYearBalanceAmt
Investment Earnings Or Losses	$346,023	InvestmentEarningsOrLossesAmt
End Year Balance	$3,174,562	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,692,789	BeginningYearBalanceAmt
Investment Earnings Or Losses	$135,750	InvestmentEarningsOrLossesAmt
End Year Balance	$2,828,539	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.00000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$25,255,096	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$27,126,590	OtherCostOrOtherBasisAmt
Book Value	$52,381,686	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$4,413,222	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$508,711,365	OtherCostOrOtherBasisAmt
Depreciation	$236,993,145	DepreciationAmt
Book Value	$276,131,442	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,950,592	OtherCostOrOtherBasisAmt
Depreciation	$1,839,853	DepreciationAmt
Book Value	$2,110,739	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$310,160,374	OtherCostOrOtherBasisAmt
Depreciation	$218,599,266	DepreciationAmt
Book Value	$91,561,108	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$131,439,476	OtherCostOrOtherBasisAmt
Depreciation	$5,566,412	DepreciationAmt
Book Value	$125,873,064	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$548,058,039	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (5 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Assets Limited as to Use - Avera Pooled Investments	$244,479,313	F
Interest in Avera Health Foundation	$14,648,653	F
Investment in Avera HME	$3,426,752	F
Investment in Heart Hospital of South Dakota, LLC	$18,921,809	F
Investments in affiliated companies	$5,404,788	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$286,881,315	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
Other Assets	$371,291
Other Receivables	$43,662,017
Due from Related party	$1,250,000
Custodial funds held by related party	$48,497,656

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$93,780,964	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
Other Liabilities	$8,967,363
Due to other Organizations	$1,205,998
Market value of interest swap	$7,050,919
Estimated third-party payor settlements	$7,924,854
Minority interest	$4,166,460

Field	Value	IRS element (for citing)
Total Liability	$29,315,594	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 1b:	The Organization holds funds in trust on behalf of its long-term care residents. Many small dollar transactions flow in and out of this account. The account is managed by the nursing home staff. The state has strict guidelines on how these accounts are managed.
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.

Schedule G IRS990ScheduleG

Field	Value	IRS element (for citing)
Mail Solicitations	Yes (X)	MailSolicitationsInd
Email Solicitations	Yes (X)	EmailSolicitationsInd
In Person Solicitations	Yes (X)	InPersonSolicitationsInd
Solicitation Of Non Govt Grants	Yes (X)	SolicitationOfNonGovtGrantsInd
Special Fundraising Events	Yes (X)	SpecialFundraisingEventsInd
Agrmt Prof Fundraising Acty	Yes (1)	AgrmtProfFundraisingActyInd

Fundraiser Activity Info FundraiserActivityInfoGrp

Field	Value	IRS element (for citing)
Person	Jon Oien	PersonNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	600 E Sunnybrook Dr	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57105	ZIPCd

Field	Value	IRS element (for citing)
Activity	Major and planned gift solicitations	ActivityTxt
Fundraiser Control Of Funds	0	FundraiserControlOfFundsInd
Gross Receipts	$0	GrossReceiptsAmt
Retained By Contractor	$18,120	RetainedByContractorAmt
Net To Organization	$0	NetToOrganizationAmt

Field	Value	IRS element (for citing)
Total Retained By Contractors	$18,120	TotalRetainedByContractorsAmt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Schedule G, part I, Line 2b:	John Oien was paid for services related to the major and planned gift solicitations. The organization does not record contributions in column (iv) as all contributions from the solicitations are received through Avera Health Foundation which is part of Avera Health, a related organization.
Form 990, Schedule G, part I, Line 3:	Avera McKennan is not required to be registered or licensed in any states. The solicitation and receipts of contributions from the donors occurs at the Avera Health Foundation. The contributions on Schedule B from Avera Health reflect payments to McKennan from the Foundation's temporarily restricted funds to cover certain program expenses.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
Most Hospitals Policy	Yes (X)	MostHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	0	AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,857,396	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$16,857,396	NetCommunityBenefitExpnsAmt
Total Expense	0.01570	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$84,316,502	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$62,532,017	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$21,784,485	NetCommunityBenefitExpnsAmt
Total Expense	0.02030	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,847,386	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,797,825	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,049,561	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$104,021,284	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$64,329,842	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$39,691,442	NetCommunityBenefitExpnsAmt
Total Expense	0.03700	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,129,512	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$479,047	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,650,465	NetCommunityBenefitExpnsAmt
Total Expense	0.00340	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,470,381	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,626,427	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,843,954	NetCommunityBenefitExpnsAmt
Total Expense	0.00730	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$24,705,103	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$16,564,066	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,141,037	NetCommunityBenefitExpnsAmt
Total Expense	0.00760	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,817,045	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,469,065	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$11,347,980	NetCommunityBenefitExpnsAmt
Total Expense	0.01060	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,571,082	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,571,082	NetCommunityBenefitExpnsAmt
Total Expense	0.00150	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$52,693,123	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$20,138,605	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$32,554,518	NetCommunityBenefitExpnsAmt
Total Expense	0.03040	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$156,714,407	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$84,468,447	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$72,245,960	NetCommunityBenefitExpnsAmt
Total Expense	0.06740	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,838	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,838	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$164,756	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$164,756	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,500	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$2,500	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$153	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$153	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$18,153	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$18,153	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,982	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,982	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$13,943	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$13,943	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,126	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,126	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$211,451	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$211,451	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$29,707,822	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$238,403,429	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$282,855,206	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$44,451,777	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	8	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (8 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Childrens HospitalChildrensHospitalInd	Teaching HospitalTeachingHospitalInd	Research FacilityResearchFacilityInd	Emergency Room24 HrsEmergencyRoom24HrsInd	OtherOtherDesc	Critical Access HospitalCriticalAccessHospitalInd
Avera McKennan
1	1325 S Cliff Ave	Sioux Falls	SD	57117	www.avera.org/mckennan	10563	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	36 Provider Based Clinics
Heart Hospital of South Dakota LLC
2	4500 W 69th Street	Sioux Falls	SD	57108	www.avera.org/heart-hospital	41953	Yes (X)	Yes (X)				Yes (X)	2/3 Owner in Joint Venture
Avera Milbank Area Hospital
3	901 Virgil Ave	Milbank	SD	57252	www.avera.org/milbank	48451	Yes (X)	Yes (X)				Yes (X)	2 Provider Based Clinics & 2 Rural Health PB Clinics	Yes (X)
Avera Gregory Healthcare Center
4	400 Park Ave	Gregory	SD	57533	www.avera.org/gregory-hospital	54875	Yes (X)	Yes (X)				Yes (X)	2 Provider Based Clinics & 2 Rural Health PB Clinics	Yes (X)
Avera Dells Area Health Center
5	909 N Iowa Avenue	Dell Rapids	SD	57022	www.avera.org/dell-rapids	50754	Yes (X)	Yes (X)				Yes (X)	3 Provider Based Clinics	Yes (X)
Avera Flandreau Medical Center
6	214 N Prairie	Flandreau	SD	57028	www.avera.org/flandreau-medical	10540	Yes (X)	Yes (X)				Yes (X)	1 Rural Health Provider Based Clinic	Yes (X)
Avera Hand County Memorial Hospital
7	300 W 5th St	Miller	SD	57362	www.avera.org/miller	53862	Yes (X)	Yes (X)				Yes (X)	1 Provider Based Clinic	Yes (X)
Avera Merrill Pioneer Hospital
8	1100 S 10th Ave	Rock Rapids	IA	51246	www.avera.org/locations/profile/avera-	600118H	Yes (X)	Yes (X)				Yes (X)	2 rural health provider based clinics	Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (8 entries)

FacilityFacilityNum	First Licensed CY Or PYFirstLicensedCYOrPYInd	Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd	CHNA ConductedCHNAConductedInd	Community DefinitionCommunityDefinitionInd	Community DemographicsCommunityDemographicsInd	Existing ResourcesExistingResourcesInd	How Data ObtainedHowDataObtainedInd	Community Health NeedsCommunityHealthNeedsInd	Other Health IssuesOtherHealthIssuesInd	Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd	Consulting ProcessConsultingProcessInd	Prior CHNA ImpactPriorCHNAImpactInd	CHNA ConductedCHNAConductedYr	Take Into Account Others InputTakeIntoAccountOthersInputInd	CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd	CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd	CHNA Report Widely AvailableCHNAReportWidelyAvailableInd	Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd	Own Website URLOwnWebsiteURLTxt	Paper Copy Public InspectionPaperCopyPublicInspectionInd	Implementation Strategy AdoptImplementationStrategyAdoptInd	Implementation Strategy AdptImplementationStrategyAdptYr	Strategy Posted WebsiteStrategyPostedWebsiteInd	Strategy Website URLStrategyWebsiteURLTxt	Organization Incur Excise TaxOrganizationIncurExciseTaxInd	Elig Criteria ExplainedEligCriteriaExplainedInd	FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd	FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct	FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct	Asset Level CriteriaAssetLevelCriteriaInd	Medical Indigency CriteriaMedicalIndigencyCriteriaInd	Insurance Status CriteriaInsuranceStatusCriteriaInd	Other CriteriaOtherCriteriaInd	Explained BasisExplainedBasisInd	App Financial Asst ExplnAppFinancialAsstExplnInd	Described InfoDescribedInfoInd	Described Suprt DocDescribedSuprtDocInd	Provided Hospital ContactProvidedHospitalContactInd	Includes Publicity MeasuresIncludesPublicityMeasuresInd	FAP Available On WebsiteFAPAvailableOnWebsiteInd	FAP Available On Website URLFAPAvailableOnWebsiteURLTxt	FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd	FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt	FAP Summary On WebsiteFAPSummaryOnWebsiteInd	FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt	FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd	FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd	FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd	Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd	Communtity Notified FAPCommuntityNotifiedFAPInd	FAP TranslatedFAPTranslatedInd	Other PublicityOtherPublicityInd	FAP Actions On NonpaymentFAPActionsOnNonpaymentInd	Permit No ActionsPermitNoActionsInd	Collection ActivitiesCollectionActivitiesInd	Provided Written NoticeProvidedWrittenNoticeInd	Made Effort Orally NotifyMadeEffortOrallyNotifyInd	Processed FAP ApplicationProcessedFAPApplicationInd	Made Presumptive Elig DetermMadePresumptiveEligDetermInd	Other Actions TakenOtherActionsTakenInd	Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd	Look Back Medicare PrivateLookBackMedicarePrivateInd	Amounts Generally BilledAmountsGenerallyBilledInd	Gross ChargesGrossChargesInd
Avera McKennan
1	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	Yes (1)	Yes (1)	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Heart Hospital of South Dakota LLC
2	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	Yes (1)	Yes (1)	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Gregory Healthcare Center
4	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	0	0	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Milbank Area Hospital
3	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	0	0	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Dells Area Health Center
5	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	0	0	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Flandreau Medical Center
6	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	0	0	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Hand County Memorial Hospital
7	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	0	0	Yes (1)	Yes (X)	see Part V, Page 8	Yes (X)	Yes (1)	18	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Merrill Pioneer Hospital
8	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	17	Yes (1)	0	0	Yes (1)	Yes (X)	See Part V, Page 8	Yes (X)	Yes (1)	17	Yes (1)	See Part V, Page 8	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	www.avera.org/patients-visitors/charity-patient-assistance-programs/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0

Supplemental Information SupplementalInformationGrp (54 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Avera McKennan	Part V, Section B, Line 5: Avera McKennan solicited community input in a variety of methods. A survey of residents in the Sioux Falls Metropolitan Statistical area was conducted. Three focus groups were conducted in March 2018. Key informant individual interviews were conducted in May and June 2018. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input represented the medically underserved, low-income and minority populations as they serve these populations through their activities.
Heart Hospital of South Dakota, LLC	Part V, Section B, Line 5: Heart Hospital of South Dakota, LLC solicited community input in a variety of methods. A survey of residents in the Sioux Falls Metropolitan Statistical area was conducted. Three focus groups were conducted in March 2018. Key informant individual interviews were conducted in May and June 2018. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input represented the medically underserved, low-income and minority populations as they serve these populations through their activities.
Avera Gregory Healthcare Center	Part V, Section B, Line 5: The assessment began with the gathering of primary data for Avera Gregory Hospital's service area. To ensure accurate input and representation from the service area, primary data collection included engagement of local community members of which represented a broad range of interests. Representatives from various community groups were invited to participate in the survey process. Avera Medical group Gregory Medical Staff, Avera Medical Group Clinic Manager, Avera Gregory Hospital Administrator and Director of Nursing as well as Gregory County Community Health Services Manager represented the Medical background. The Avera Gregory Hospital Advisory Board approved the Community Health Needs Assessment.
Avera Milbank Area Hospital	Part V, Section B, Line 5: Community input was solicited through surveys and personal interviews. The facility surveyed community members using printed surveys. Personal interviews were conducted with the community health nurse and the Director of Inter-Lakes Community Action Partnership.
Avera Dells Area Health Center	Part V, Section B, Line 5: Community input was solicited using a variety of methods. In November of 2018, three focus groups representing a variety of community residents were held. An individual interview was held with the Moody County Community Services Manager. Data was also gathered from Avera Medical Group Dell Rapids Medical Staff and Clinic Manager, and Avera Dells Area Hospital Administrator and Director of Nursing.
Avera Flandreau Medical Center	Part V, Section B, Line 5: Community input was solicited using a variety of methods. In November of 2018, three focus groups representing a variety of community residents were held. An individual interview was held with the Moody County Community Services Manager.
Avera Hand County Memorial Hospital	Part V, Section B, Line 5: The CHNA process began by defining the community and collecting secondary data and resources. The hospital used a survey tool to begin the process of qualitative data collection. Surveys were distributed to Hand County Memorial Hospital Auxiliary and patients at Avera Medical Group-Miller. Interviews were conducted with three groups: Community Health Nurse, Coordinated Care Team, and Miller High School Counselor. The Avera Hand County Memorial Hospital Board of Directors approved the Community Health Needs Assessment.
Avera Merrill Pioneer Hospital	Part V, Section B, Line 5: Community input was solicited using a variety of methods. An online survey was developed by public health experts and reviewed by the Minnesota Health Department. The survey was posted on Facebook and a survey link was emailed to members of the community. Asset mapping was conducted to find the community resources available to address the assessed needs. The Community Health Needs Assessment was conducted in FY2018 by Sanford Health Network operating a hospital in Rock Rapids, Iowa as Sanford Medical Center Rock Rapids. As of May 1, 2019 the Rock Rapids Hospital became a member of the Avera Health System. The facility began operating under the name Avera Merrill Pioneer Hospital. The transition of operations occurred during the three year community health needs assessment cycle, thus, Avera Merrill Pioneer Hospital adopted the Community Health Needs Assessment developed for the Rock Rapids Hospital.
Avera McKennan	Part V, Section B, Line 6a: The CHNA was conducted with Heart Hospital of South Dakota, LLC and Sanford USD Medical Center.
Heart Hospital of South Dakota, LLC	Part V, Section B, Line 6a: The CHNA was conducted with Avera McKennan Hospital and University Health Center and Sanford USD Medical Center.
Avera McKennan	Part V, Section B, Line 6b: City of Sioux Falls Health Department
Heart Hospital of South Dakota, LLC	Part V, Section B, Line 6b: City of Sioux Falls Health Department
Avera McKennan	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. Avera McKennan Hospital & University Health Center, including the Avera Heart Hospital of South Dakota, will address aspects of all top needs identified in the 2019 Community Health Needs Assessment.The following community health priority areas were identified and the following actions will be taken by the hospital during future years.ACCESS TO CARE1. Expand patient transportation program. Review current partnerships and explore new opportunities with transportation providers.2. Workforce transportation pilot program. Conduct a pilot program to assist qualified staff with transportation on a case-by-case basis.BEHAVIORAL HEALTH AND SUBSTANCE ABUSE1. Investigate adding a 4th wing at Avera Behavioral Health.2. Expand navigation and case management services. Create one call number as entry point for services.3. Partner with Community-Based Triage Center. Support the development of a community-based triage center to assist residents in accessing resources for addiction treatment, behavioral health, and other needs.4. Partner with Mental Health Awareness Campaign. Develop a community-wide awareness campaign to reduce behavioral health stigma and increase earlier access to care.CHRONIC DISEASE PREVENTION1. One Sioux Falls Project. Address social determinants of health, seek opportunities to actively support the One Sioux Falls framework that includes accessible housing, engaging people, health and safety, and workforce development.2. Starfish Housing Pilot. Explore utilizing Avera-owned housing to pilot a new health program that addresses chronic health conditions for qualified individuals in Avera's Coordinated Care Program.3. Workforce Housing Pilot. Explore utilizing Avera-owned housing to encourage/attract potential employees who previously experienced affordable housing as a barrier to employment in the community.4. Healthy Food Program. Pursue program designed to prevent and limit weight gain and improve overall physical health for qualified individuals in Avera's Coordinated Care Program.5. Food Education Program. Create education programming focused on selecting, storing and utilizing healthier food options.6. Partner with Healthy Weight Project. Pursue policy, system and environmental changes to maintain or increase the percentage of people living at a healthy body weight.
Heart Hospital of South Dakota, LLC	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. Avera McKennan Hospital & University Health Center, including the Avera Heart Hospital of South Dakota, is addressing aspects of all top needs identified in the 2019 Community Health Needs Assessment. The following community health priority areas were identified and the following actions will be taken by the hospital during future years.ACCESS TO CARE1. Expand patient transportation program. Review current partnerships and explore new opportunities with transportation providers.2. Workforce transportation pilot program. Conduct a pilot program to assist qualified staff with transportation on a case-by-case basis.BEHAVIORAL HEALTH AND SUBSTANCE ABUSE1. Investigate adding a 4th wing at Avera Behavioral Health2. Expand navigation and case management services. Create one call number as entry point for services.3. Partner with Community-Based Triage Center. Support the development of a community-based triage center to assist residents in accessing resources for addiction treatment, behavioral health, and other needs.4. Partner with Mental Health Awareness Campaign. Develop a community-wide awareness campaign to reduce behavioral health stigma and increase earlier access to care.CHRONIC DISEASE PREVENTION1. One Sioux Falls Project. Address social determinants of health, seek opportunities to actively support the One Sioux Falls framework that includes accessible housing, engaging people, health and safety, and workforce development.2. Starfish Housing Pilot. Explore utilizing Avera-owned housing to pilot a new health program that addresses chronic health conditions for qualified individuals in Avera's Coordinated Care Program.3. Workforce Housing Pilot. Explore utilizing Avera-owned housing to encourage/attract potential employees who previously experienced affordable housing as a barrier to employment in the community.4. Healthy Food Program. Pursue program designed to prevent and limit weight gain and improve overall physical health for qualified individuals in Avera's Coordinated Care Program.5. Food Education Program. Create education programming focused on selecting, storing and utilizing healthier food options.6. Partner with Healthy Weight Project. Pursue policy, system and environmental changes to maintain or increase the percentage of people living at a healthy body weight.
Avera Gregory Healthcare Center	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. Two needs were identified in the CHNA: public awareness of hospital/clinic services and nutrition education. The facility will work to implement a process to expand media presence to include social media, and partner with the school to promote awareness. The facility will increase the presence with monthly healthcare related articles to inform the service area of changes in delivery and implementation of healthcare in the community. In addition, social media will be expanded as a source for more information and interaction with the local community. The focus will be on health and wellness to promote a healthy lifestyle. The facility will work with partners to conduct monthly community fellowship meals to promote nutrition education. Dietary education programs will be expanded by participating in community meals to offer nutrition education. The facility will work with local grocery stores to promote healthy eating and good food choices. The facility will offer nutritional education on products to allow consumers to make health choices when shopping.The following health needs/priorities emerged but will not be directly addressed by Avera Gregory as they are beyond the scope of the facility or are addressed by other community organizations:Convenience to careTobacco education/cessationMental HealthPhysical activityOutreach servicesTransportation
Avera Milbank Area Hospital	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. Three needs were identified in the CHNA: continued recruitment of primary care physicians, mental health, and outreach to ethnic minority patients. Avera Milbank will address recruitment of primary care physicians by utilizing services of a recruitment firm. The Hospital will serve as a rural experience rotation for residency programs and the local high school. Mental health will be addressed by adding mental health services. Milbank Area Hospital Avera will continue working with the National Alliance on Mental Illness and local citizens to form a local group called "Moving to Wellness". Group leaders will be trained and certified for group leadership. Outreach to ethnic minority patients will be addressed by distributing an information packet to corporations with a large number of ethnic background employees. The information packet will create an awareness of what resources are available at Avera Milbank.The following health needs/priorities emerged but will not be directly addressed by Avera Milbank as they are beyond the scope of the facility or are addressed by other community organizations:Healthcare affordability
Avera Dells Area Health Center	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. Two needs were identified in the CHNA: Public awareness of health care services and nutrition education for community members. The facility will support or participate in local community activities and functions, utilize social media, and organize online tools and resources for consistent messaging and education to promote health care services awareness. Nutrition education will be addressed by partnering with the local grocery store to offer free dietary cooling/food preparation classes to the public. Classes will be offered in the evening at the grocery store with each class being led by an Avera Dietitian. In addition to the free classes, the Avera Dietitian offers free dietary consultations to the community members upon request or referral. Six identified needs are not being addressed: convenience to care, tobacco education, mental health, physical activity, outreach services, and transportation. Those needs were presented to community leaders during the prioritization process and it was felt that the two identified needs that are being addressed will be more impactful.
Avera Flandreau Medical Center	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. Two needs were identified in the CHNA: mental health and chemical dependency. Avera Flandreau will look to partner with local community members to establish a non-profit organization that focuses on awareness and education of mental health issues. Avera Flandreau will support the non-profit through employee time, resources, and educational materials. The facility will also look for ways to partner with local businesses to add additional program resources. Avera Flandreau will work with Avera Behavioral Health to establish a chemical dependency counseling program. Patients will be able to see a counselor on a regular basis. Avera Flandreau will promote and educate community members on the new service. Eight other significant needs were identified and will not be addressed. These needs are public awareness and use, nutrition education, health care education in Spanish, insurance education, tobacco education/cessation, transportation, physical activity, and outreach services. Each of the non-addressed needs were presented to community leaders who felt the two identified needs that will be addressed will have a greater level of impact.
Avera Hand County Memorial Hospital	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. Avera Hand County Memorial Hospital adopted an implementation plan in FY19 to address disease prevention & maintenance, and access to specialty care. Avera Hand County Memorial Hospital is addressing aspects of all top needs identified in the 2019 Community Health Needs Assessment. The facility will promote programs and resources available to the community to provide awareness. The focus will be on immunizations, substance abuse and wellness. Social media and local newspaper healthcare related articles will be used as a source of education. The facility will participate in community events as a way to reach the community for educational healthcare topics. The facility will continue to expand access to specialty care by increasing outreach providers to provide clinics locally. The focus will be on dialysis, endocrinology, dermatology and mental health. The local clinic will expand mental health services by offering Avera eCare technology and increasing public awareness. The facility will continue to expand Avera eConsult services to connect patients locally to specialist in larger facilities.
Avera Merrill Pioneer Hospital	Part V, Section B, Line 11: As part of Avera Health System beginning May 1, 2019, Avera Merrill Pioneer will continue to address the two needs, obesity and chronic disease, identified in the FY2018 Implementation Strategy. The facility set up the Diabetic Education Program. The facility also set up the Coordinated Care Program which has a focus on chronic disease, including obesity.The following health needs/priorities emerged but will not be directly addressed by Avera Merrill Pioneer as they are beyond the scope or there is capability to address by other community organizations:1. Seatbelt and car seat safety2. Health care access3. Mental health and substance abuse
Avera McKennan	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.
Heart Hospital of South Dakota, LLC	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 Gregory Healthcare Center	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 Milbank Area Hospital	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 Dells Area Health Center	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 Flandreau Medical Center	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 Hand County Memorial Hospital	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 Merrill Pioneer Hospital	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 McKennan	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Heart Hospital of South Dakota, LLC	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 on the billing statement.
Avera Gregory Healthcare Center	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Milbank Area Hospital	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Dells Area Health Center	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Flandreau Medical Center	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Hand County Memorial Hospital	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Merrill Pioneer Hospital	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 on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera McKennan	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.
Heart Hospital of South Dakota, LLC	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 Gregory Healthcare Center	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 Milbank Area Hospital	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 Dells Area Health Center	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 Flandreau Medical Center	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 Hand County Memorial Hospital	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 Merrill Pioneer Hospital	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 McKennan	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.
Heart Hospital of South Dakota, LLC	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.
Avera Gregory Healthcare Center	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.
Avera Milbank Area Hospital	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.
Avera Dells Area Health Center	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.
Avera Flandreau Medical Center	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.
Avera Hand County Memorial Hospital	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.
Avera Merrill Pioneer Hospital	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.
Part V, Section B, line 7a:	Hospital facility's website for CHNA:www.avera.org/about/community-health-needs-assessments/The CHNA for Avera Merrill Pioneer Hospital was/is available on the predecessor's website.
Part V, Section B, line 10a:	Hospital facility's website for Implementation Strategy:www.avera.org/about/community-health-needs-assessments/The Implementation Strategy for Avera Merrill Pioneer Hospital was/is available on the predecessor's website.

Field	Value	IRS element (for citing)
Facility	40	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (40 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Avera McKennan Behavioral Health Center
4400 W 69th St	Sioux Falls	SD	57108	Inpatient & Outpatient behavioral health services
2 - Avera Plaza 2 Pharmacy
1301 S Cliff Avenue	Sioux Falls	SD	57105	Retail pharmacy
3 - Avera Prince of Peace
4500 S Prince of Peace Place	Sioux Falls	SD	57103	Skilled nursing facility
4 - Avera McKennan Home Infusion
1020 S Cliff Avenue	Sioux Falls	SD	57105	Comprehensive home infusion therapies & supplies
5 - McKennan Regional Laboratory
1325 S Cliff Avenue	Sioux Falls	SD	57105	Laboratory services
6 - Avera Medical Group Maternal Fetal Med
1417 South Cliff Avenue Suite 100	Sioux Falls	SD	57105	High-risk pregnancy care clinic
7 - Avera Medical Group Worthington
508 Tenth Street	Worthington	MN	56187	Primary care clinic
8 - Avera Medical Group Pediatric Specialist
1417 S Cliff Avenue Suite 010	Sioux Falls	SD	57105	Pediatric specialties clinic
9 - Avera Rosebud Country Care Center
300 Park Avenue	Gregory	SD	57533	Skilled nursing facility
10 - Avera McKennan Fitness Center
3400 S Southeastern Drive	Sioux Falls	SD	57105	Fitness center
11 - Avera 69th Street Pharmacy - Behavioral
4400 W 69th St Suite 300	Sioux Falls	SD	57108	Retail pharmacy
12 - Avera Medical Group Windom
820 - 2nd Avenue	Windom	MN	56101	Primary care clinic
13 - Avera McKennan Hosp & Univ Campus Pharm
1325 S Cliff Avenue	Sioux Falls	SD	57105	Retail pharmacy
14 - Avera Institute for Human Genetics
4400 W 69th St Suite 200	Sioux Falls	SD	57108	Genetic research program
15 - Laurel Oaks Apartments
4510 S Prince of Peace Place	Sioux Falls	SD	57103	Independent living apartments
16 - Avera Medical Group Sibley
600-9th Avenue North	Sibley	IA	51249	Primary care clinic
17 - Avera Medical Group Comprehensive Breast
1000 East 23rd Street Suite 360	Sioux Falls	SD	57105	Specialty clinic
18 - Avera Research Institute
3720 W 69th St	Sioux Falls	SD	57108	Clinical research studies
19 - Avera Medical Group Optometry
702 Tenth Street	Worthington	MN	56187	Ophthalmology and optometry clinic
20 - Avera Dermatology Pharmacy
6701 South Minnesota Avenue	Sioux Falls	SD	57108	Retail pharmacy
21 - Avera Medical Group Occupational Med
2100 S Marion Rd	Sioux Falls	SD	57106	Business and corporate health care clinic
22 - Avera Medical Group Women's Midlife Care
911 East 20th Street - Suite 200	Sioux Falls	SD	57105	Women's services clinic
23 - Avera Medical Group Optometry
1006 4th Avenue	Windom	MN	56101	Ophthalmology and optometry clinic
24 - Curaquick Avera Clinic
3000 S Minnesota Ave	Sioux Falls	SD	57105	Primary care clinic
25 - Avera Medical Group Big Stone City
451 Main Street	Big Stone City	SD	57216	Primary care clinic
26 - Hegg Medical Clinic Avera
2121 Hegg Drive	Rock Valley	IA	51247	Primary care clinic
27 - Health Care Clinic
300 North Dakota Avenue Suite 117	Sioux Falls	SD	57104	Free healthcare clinic
28 - Community Blood Bank
1301 South Cliff Avenue Suite 3	Sioux Falls	SD	57105	Community blood services
29 - Yorkshire Eye Clinic
2311 Yorkshire Drive	Brookings	SD	57006	Ophthalmology and optometry clinic
30 - Avera Medical Group Estherville
926 North 8th Street	Estherville	IA	51334	Primary care clinic
31 - Rural Medical Clinics
301 South Walnut Street	Freeman	SD	57029	Primary care clinic
32 - Dakota Family Medical Center
101 South Front PO Box 27	Chamberlain	SD	57325	Primary care clinic
33 - Pipestone Medical Group Avera
920 - 4th Avenue SW	Pipestone	MN	56164	Primary care clinic
34 - Avera Medical Group McGreevy Salem
740 South Hill	Salem	SD	57058	Primary care clinic
35 - Avera Medical Group Larchwood
916 Holder Street PO Box 8	Larchwood	IA	51241	Primary care clinic
36 - Avera Medical Group Butte
730 Wilson Street	Butte	NE	68722	Satellite primary care clinic
37 - Avera Medical Group Elkton
203 Elk Street	Elkton	SD	57026	Satellite primary care clinic
38 - Avera Medical Group Fulda
201 N St Paul Avenue	Fulda	MN	56131	Satellite primary care clinic
39 - Avera Medical Group Lakefield
221 - 3rd Avenue	Lakefield	MN	56150	Satellite primary care clinic
40 - Avera Medical Group Volga
210 Kasan Avenue	Volga	SD	57071	Satellite primary care clinic

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 methodology was used to calculate the amounts reported in the table. A cost accounting system was used to calculate Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for our tertiary medical center. A cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate charity care at cost for all entities and Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for any operations outside of the tertiary medical center. For all other amounts, costs and revenues as reflected by the general ledger system were used.
Part I, Line 7g:	Physician clinic costs for transplant services are included in subsidized health services. Revenues of $755,359 and costs of $2,458,617 were included for a net community benefit of $1,703,258. Our facility is the principal provider of bone marrow and pancreas transplant services throughout our service area, in addition to developing a liver transplant program, with the clinics as a crucial component of successful pre and post-transplant care.
Part I, Ln 7 Col(f):	Bad debt expense of $29,707,822 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage.
Part II, Community Building Activities:	The community building activities include monetary assistance to organizations that focus their efforts on providing furniture for low income families, neighborhood improvement projects in high needs areas, children and youth development programs, local economic development, and job creation and training programs.
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:	Avera McKennan has several procedures in place to determine which patients would qualify for financial assistance, therefore the hospital feels confident that no amount of bad debt expense is attributable to patients eligible under the Organization's financial assistance policy.
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:	The Medicare revenues received (line 5), allowable costs (line 6), and the resulting loss (line 7) does not include a significant portion of the Organization's expenses. These lines require use of the Medicare cost report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Avera McKennan. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removes the costs from the hospital's cost report entirely. Examples of a portion of these overhead costs would be finance, business office, information technology, human resources and administration. Examples of non-cost report entities operated by Avera McKennan include clinics, mobile imaging services, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, hospitalists care, CRNA's, and interest expense. Avera McKennan also receives a Medicare Disproportionate Share Hospital (DSH) adjustment as part of the cost report due to its significant number of low-income patients served. Part III, line 5 requires inclusion of this revenue though expenses included are much lower. Schedule H instructions also require the exclusion of $2,245,226 of Medicare losses because they are included in Schedule H, Part 1, Line 7f or 7g. Including the Medicare percentage of disallowed costs, entities which don't file a cost report but nevertheless care for Medicare patients, and the impact of the home office cost report, the Medicare shortfall is $84,311,873 as opposed to a shortfall of $44,451,777.Avera McKennan follows the Catholic Health Association 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.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 & 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 assessment occurs at various points in the system. Through annual strategic planning sessions, community leaders are brought in to update and educate Avera McKennan board members and administrative council on the successes, challenges, and service gaps in the community. Examples include school district officials, state health department, and community health organizations. Leaders also serve on boards of various community organizations which seek to address the health and well-being of area citizens. Local governing boards at outlying facilities, who are members of the community, discuss and help direct resources to areas of targeted needs as well.
Part VI, Line 3:	Notices are posted in English and Spanish in a visible manner in locations where there is a high volume of inpatient or outpatient admitting/registration, such as emergency departments, billing offices, admitting offices, and outpatient service settings as well as the Organization website. Posted notices state that the Organization has a financial assistance policy for low-income uninsured patients who may not be able to pay their bill and that this policy provides for charity care and reduced-payment for healthcare services. There is also identification of a contact phone number that a patient can call to obtain more information about the financial assistance policy and about how to apply for such assistance. Additionally, admitting staff makes available a brochure designed to help patients understand how we bill patients and provides summary information on financial assistance if you are unable to pay. Patient Advocates work with uninsured patients in our main tertiary facility to enroll them in applicable social programs and identify charity eligibility, eligibility and enrollment for county, state or federal risk pools, and eligibility for modified Medicare or Medicaid programs.
Part VI, Line 4:	Avera McKennan's service area is a largely rural population. Services are provided through a health care network of clinics, critical access hospitals and tertiary facilities covering communities in four states. The main tertiary facility is located in a population center of over 181,000 served by another non-profit hospital of similar size, Veterans Administration Hospital, a hospital dedicated to diagnosis and treatment of heart disease, and a hospital for children with special health care needs. Outside of this population center, most of the communities served have less than 4,000 residents. The primary service area includes four counties covering approximately 2,600 square miles and contains seven federally designated medically underserved communities. The 2018 U.S. Census Bureau data estimates 8.25% of residents in the primary service area are at or below the poverty level. Our secondary service area covers an additional 17 counties in South Dakota, Iowa, and Minnesota.
Part VI, Line 5:	Surplus funds are reinvested in facilities to improve patient care.Medical staff privileges are extended to all qualified physicians in the community. The Avera McKennan Board of Trustees is principally comprised of community members from the primary service area. Members come from a variety of backgrounds ranging from private industry and banking to healthcare.Avera McKennan is a verified Level II trauma center and was the first such Center in the State of South Dakota. Avera McKennan's Emergency Department is staffed 24 hours a day with board-certified emergency specialists and provides emergency care regardless of ability to pay. Avera McKennan had 35,956 Emergency Department visits in FY 2019. Operating both Fixed Wing and Helicopter medical air transports, Avera McKennan's flight teams cover a large geographic area providing state-of-the-art air transport services and access to critical care, with 1,876 flights in the past year.Health Care Clinic: In 1992, Avera McKennan established a Health Care Clinic to provide free care for people who are uninsured or underinsured in the community. The clinic is managed by a Registered Nurse and staffed by Registered Nurses, two midlevel providers, medical residents and volunteer health care providers. The goal of the clinic is to prevent or treat patients' medical conditions before they become catastrophic. The clinic averages 420 visits per month, providing preventative care, diagnosis and treatment of illnesses and injuries, medication assistance and assistance in obtaining specialist care for patients with complex cases. The clinic also serves to train physicians, nurses and other health care students. It provides a free evening clinic one evening per month, staffed by medical students under supervision of physicians. Avera McKennan is the only health care organization to provide free services such as this in the state of South Dakota. The clinic had 5,018 visits in 2019, and was operated at an annual cost of $1,360,909. Partnership in Live Well Sioux Falls: The City of Sioux Falls received a Community Health Transformation Grant from the South Dakota Department of Health, sparking a project to improve the health and well-being of the citizens of Sioux Falls. Guided by the City of Sioux Falls Health Department, this ongoing project is known as Live Well Sioux Falls. It involves more than 24 community partner organizations. Among these partners are Avera McKennan and the other major health care system in Sioux Falls, Sanford Health. Avera plans to work in partnership with the City of Sioux Falls and Sanford Health to address the priorities of Live Well Sioux Falls, and arrive at solutions which are collaborative in nature.Avera McKennan collaborates with Live Well Sioux Falls to promote the Big Squeeze, a hypertension initiative in April to promote blood pressure screening and education, with the goal of diagnosing high blood pressure. One in three American adults have high blood pressure, but only half of them have it under control, adding to the risk of stroke, heart attack and vascular disease.Residency/Health Professions Training and Internships: In 2019, Avera McKennan had 53 medical residents in training at Avera McKennan in Internal Medicine, Family Practice, Psychiatry, Geriatrics and Transitional Residency Programs offered in partnership with the University of South Dakota School of Medicine. Over 1,000 students in medicine, nursing, pharmacy, physician assistant programs, medical assisting, radiology and respiratory therapy also completed clinical rotations at Avera McKennan. In non-clinical areas, Avera McKennan offers paid and nonpaid internships in the areas of research, finance, administration, therapies, exercise science and social work. Avera McKennan is currently legally affiliated with approximately 158 institutions of higher education.Patient and Community Education: Avera McKennan is a regional leader in offering educational programs for a variety of learners, leaders and employees. Utilizing advanced technology, many of these programs are provided electronically throughout the tri-state area. Educational sessions are offered to medical staff, employees, health care professionals, students at all levels and the general public. Utilizing Avera McKennan's Education Center, a broad cross-section of classes involving diverse audiences are provided as a community service each year.1. Online resources: Avera McKennan offers vast free patient educational online resources on its public website on numerous health topics, with suggestions for lifestyle change, behavior modification and management for improved health.2. To Be Well free education events were held on topics including orthopedics, cancer, diabetes, weight loss/healthy eating, multiple sclerosis, anxiety and acupuncture. 3. Forums: The Avera Behavioral Health Center offers free Friday Forums, in which school counselors and therapists are invited to presentations on children's mental health topics such as conflict cycles, reactive attachment disorder, depression and bipolar disorder in children, and teen substance use, abuse and addiction. 4. The Avera Behavioral Health Center offers free monthly educational sessions on various topics followed by discussion for adults who have been impacted by a loved one's mental illness. Topics have included grief and loss, anxiety, and parenting strategies for managing challenging behaviors.5. Women's & Children's Services: Avera McKennan's Women's & Children's Services offers a number of parenting and community education opportunities, for free or at a minimal cost. In fiscal year 2019, 81 childbirth education classes were held with 394 attendees. A total of 11 parent and family education classes were held with 161 attendees. A total of 41 car seats were issued through the South Dakota Child Safety Seat Distribution Program. Free burn education was provided to 2,988 students during presentations in schools.6. Daycare training: Free of charge, Avera McKennan offers two in-service training sessions per month to daycare providers through EmBe, with a total of 16 scheduled annually, and additional sessions for requested topics. Support groups: Avera McKennan offers approximately 10 free support groups. They range in topic from cancer to liver disease, diabetes, bone marrow transplant, stroke and grief and loss. The organization provides free meeting space as well as speakers and leaders. Information and Assistance: Avera McKennan operates a 24-hour Medical Call Center, through which patients have access to the Ask-A-Nurse program. Patients can call a toll-free number and talk personally with a Registered Nurse to ask health questions or receive general health information. Avera McKennan's web site also provides an extensive health library that consumers can access free of charge.Interpreter service: Avera McKennan employs two full-time Spanish interpreters in-house, and their services are offered to patients free of charge. In addition, in cooperation with external agencies, Avera McKennan is able to handle 210 different languages and dialects through phone, video remote interpreting and other means. Interpretation services are available for patients when they are at Avera McKennan in person, or when they call by phone. All the above services are provided at no cost to the patient.
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.
Part VI, Line 5, continued:	Transport to Transplant: Avera McKennan developed the Transport to Transplant project, which removes transportation barriers for patients from rural areas which may prevent them from completing the evaluation and testing needed for kidney and/or pancreas transplant. A van funded through a grant from the Avera McKennan Foundation is used to transport patients who demonstrate a financial need. Patients are brought to the Avera Transplant Institute for a condensed multi-day evaluation with all testing and visits completed in less than one week. Ultimately, the project results in improved morbidity and mortality, as kidney transplant doubles patient survival as compared to remaining on dialysis.Avera Family Wellness: This program combines positive activities like violin lessons and family wellness coordination at no charge for children beginning in early childhood programs in the Sioux Falls School District. The families have direct access to mental health services when needed. The goal is to lessen the number of adverse childhood experiences to improve the chances for children living in poverty to be successful in school and in life. Families with the most difficult situations are being referred by the school district. Currently, over 300 students and their families are being served by the program.The Walsh Family Village: This hospitality house complex adjacent to the Avera McKennan campus provides a home away from home for patients and their families who come for care at Avera McKennan from outside of Sioux Falls. The project was funded by donations and is operated by Avera McKennan. Eleven guest rooms are available. Avera McKennan also donates use of a building in the complex for a Ronald McDonald House for families of pediatric patients. If they can afford it, guests are charged a low fee per night. Guests are not turned away due to inability to pay the fee. Employees regularly donate non-perishable food items to stock a food pantry for guests. In fiscal year 2019, the Walsh Family Village served 6,530 guests, staying in 3,468 nightly rooms, an 86 percent occupancy. Avera McKennan provides a subsidy of approximately $239,858 per year to operate the hospitality complex. Prevention and support of substance use disorder: Avera McKennan is a partner with Face It TOGETHER, Inc., a nonprofit organization which serves as the local face and voice for recovery from addiction through its recovery support services, advocacy and awareness programs. Avera has been a partner with Face It TOGETHER since its inception, and in a recent awareness campaign. Community Connections: Avera McKennan reaches out to people and communities throughout eastern South Dakota, southwestern Minnesota and northwest Iowa through Home Town Connections. Providing a critical feedback link to local referring doctors, this program completes the communications links necessary to keep local health care providers current on the treatment of their patients at Avera McKennan.Support of the arts and cultural life: Avera McKennan hosts Sioux Falls' only indoor SculptureWalk, an extension of the community's downtown SculptureWalk. Artists donate sculptures for one year, which are placed at locations throughout Avera McKennan's campus, in buildings connected by skywalks. Brochures contain a map, and visitors who follow the route suggested walk approximately 1 mile, making this a healthy as well as a cultural journey.Community Benefits: Avera McKennan provides additional community benefits including: support of youth programs; homeless programs; community arts programming; health prevention; awareness and education about cancer, heart disease and other conditions; and support of the Sioux Empire United Way and other services in the region. Preschool vision and hearing screening: Avera McKennan provided free screening for 1,165 preschool and grade school children in fiscal year 2019.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc
South Dakota Department of Health - All Women Count
615 E 4th Street	Pierre	SD	57501	466000364	State of SD	$15,000	Donation
Darwin Foundation
4600 East-West Hwy Suite 525	Bethesda	MD	20814	371473821	501(c)(3)	$112,000	Donation
East Africa Medical Assistance Foundation
400 South 4th Street Suite 401-225	Minneapolis	MN	55415	363412789	501(c)(3)	$10,000	Donation
City of Sioux Falls
224 West Ninth Street	Sioux Falls	SD	57104	466000425	State of SD		Donation	$98,000	Book	Land

Field	Value	IRS element (for citing)
Total501c3 Org	4	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt
Scholarships	6	$67,500
Assistance with medical expenses	3400	$313,962
Employee Flood Recovery Assistance	45	$22,350

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	The governing board and management develop programs which enhance the charitable mission of the Organization. Disbursement for grants or assistance for these programs are made in accordance with prescribed procedures and are subject to conditions established by the Organization's governing board and management, which are designed to ensure that individuals and organizations receiving grants or assistance are adequately investigated to ensure that they are qualified recipients.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Rick Kooima MD
Chief of Staff	$268,783	$0	$7,855	$0	$4,645	$0	$13,750	$0	$28,197	$0	$323,230	$0	$0	$0
Cristina Hill Jensen MD
Board Trustee/Gastroenterologist	$735,189	$0	$138,179	$0	$3,147	$0	$13,750	$0	$26,510	$0	$916,775	$0	$0	$0
Katherine Wang MD
Board Trustee/Neonatology	$315,898	$0	$109,435	$0	$1,611	$0	$13,750	$0	$0	$0	$440,694	$0	$0	$0
David Flicek
President	$0	$762,321	$0	$2,960	$0	$235,370	$0	$13,750	$0	$32,607	$0	$1,047,008	$0	$0
Jim Breckenridge
CFO Avera Health; Sec/Treas	$0	$693,359	$0	$1,720	$0	$223,780	$0	$13,750	$0	$20,836	$0	$953,445	$0	$0
Lori Popkes
Sr Vice President	$289,743	$0	$240	$0	$55,418	$0	$8,377	$0	$28,687	$0	$382,465	$0	$0	$0
Mary Leedom
AVP of Surgical Services	$191,893	$0	$700	$0	$2,722	$0	$9,980	$0	$22,249	$0	$227,544	$0	$0	$0
Curtis Hohman
Sr Vice President until 4/6/19	$295,230	$0	$420	$0	$77,492	$0	$13,750	$0	$12,414	$0	$399,306	$0	$0	$0
Michael Elliott - Sr Vice
President Medical Affairs & CMO	$414,852	$0	$240	$0	$75,947	$0	$13,750	$0	$27,687	$0	$532,476	$0	$0	$0
Todd Zimprich MD
Neurology	$903,323	$0	$674,543	$0	$24,362	$0	$13,750	$0	$28,347	$0	$1,644,325	$0	$0	$0
Arvin Santos MD
Nephrology	$752,816	$0	$467,955	$0	$2,663	$0	$13,750	$0	$31,370	$0	$1,268,554	$0	$0	$0
Brian Knutson MD
Dermatology	$1,070,533	$0	$172,962	$0	$6,176	$0	$13,750	$0	$27,110	$0	$1,290,531	$0	$0	$0
Michael Wolak MD
Neurosurgery	$1,000,497	$0	$15,000	$0	$200,471	$0	$13,750	$0	$27,347	$0	$1,257,065	$0	$0	$0
Wissam Asfahani MD
Neurology Surgery	$1,130,699	$0	$83,000	$0	$29,144	$0	$13,750	$0	$30,107	$0	$1,286,700	$0	$0	$0
Steve Petersen - Former
AVP-Pharmacy	$0	$247,498	$0	$400	$0	$9,074	$0	$12,905	$0	$13,495	$0	$283,372	$0	$0
Julie Norton - Former
Sec/Treas & SrVP Finance	$0	$501,193	$0	$285	$0	$1,745	$0	$13,750	$0	$22,130	$0	$539,103	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule J, Part I, Line 3:	FormAndLineReferenceDesc
Explanation	The President is compensated by Avera Health. Avera McKennan relied on the related organization for determining the compensation for the President using the methods described in Part I, Line 3.	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (11 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Matthew Leedom
Family of Key Employee	$93,113	Employee Compensation	0
Sarah Kappel
Family of Key Employee	$140,558	Employee Compensation	0
Allison Leedom-Christensen
Family of Key Employee	$75,212	Employee Compensation	0
Victoria Petersen
Family of Key Employee	$47,147	Employee compensation	0
Deann Matthiesen
Family of Key Employee	$129,481	Employee compensation	0
Nick Christensen
Family of Key Employee	$79,438	Employee compensation	0
Kathy Kooima
Family of Board Member	$10,080	Employee compensation	0
Kristy Mickelson
Family of Key Employee	$54,509	Employee compensation	0
Grant Flicek
Family of Officer and board member	$64,943	Employee Compensation	0
Christine Maroun MD
Family of Board Member	$141,798	Employee compensation	0
Ashley Steffen
Family of Key Employee	$97,602	Employee compensation	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Section A, line 2	Jim Breckenridge, David Flicek, Steve Petersen, and Julie Norton 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 section 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, all 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	Avera McKennan 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 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 McKennan.
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 VI, Section B, Line 16b:	There is no written policy or procedure requiring the Organization to evaluate its participation in joint venture arrangements. 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 must be approved by the board and the member.
Form 990, Part IX, line 11g	FFS Other: Program service expenses 74,754,952. Management and general expenses 118,062,523. Fundraising expenses 49,982. Total expenses 192,867,457. Research expenses: Program service expenses 2,550,534. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,550,534. Management fees: Program service expenses 106,234. Management and general expenses 0. Fundraising expenses 0. Total expenses 106,234.
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).
Form 990, Part XI, line 9:	Equity Transfers, net -8,714,427. Other changes in unrestricted net assets 114,548. Change in interest of Avera Health Foundation 466,533.
Form 990, Part XII, Line 2c:	The Audit Committee of Avera Health, parent organization of Avera McKennan, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which inclues Avera McKennan.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Sioux Falls Hospital Management LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	562141521	Management company of Heart Hospital	NC	$5,972,805	$20,276,162	West 69th Street LLC
West 69th Street LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	460224743	Holding company	SD	$5,972,805	$20,276,162	Avera McKennan
Alumend LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	460224743	Research and development	SD	-$2,550,534	$24,309,436	Avera McKennan
MRIS LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	470874983	Healthcare Services	SD	$0	$0	Avera McKennan

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
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
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 Health
3900 West Avera Drive STE 300	Sioux Falls	SD	57108	460422673	Promotion of Health	SD	501(c)(3)	Line 10		0	N/A
Avera Queen of Peace
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 Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare Services	SD	501(c)(3)	Line 3	Avera St Mary's	0
Avera at Home
5116 S Solberg Ave	Sioux Falls	SD	57108	460399291	Home Services	SD	501(c)(3)	Line 10	Avera Health	0
Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9	Yankton	SD	57078	460337013	Healthcare Education	SD	501(c)(3)	Line 10	Sacred Heart Health Services	0
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare Services	SD	501(c)(3)	Line 3	Avera Health	0
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare Services	SD	501(c)(3)	Line 3	Avera Health	0
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	Healthcare Services	MN	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 STE 300	Sioux Falls	SD	57108	460451539	Health financing and health plan admin	SD	501(c)(4)		Avera Health	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct	Share Of Total IncomeShareOfTotalIncomeAmt
Avera Home Medical Equipment of Floyd 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
Q&M Properties LLC
525 North Foster	Mitchell	SD	57301	731652049	Medical Clinic Building	SD		Avera Queen of Peace	Excluded	$311,668	0	0	0.50000
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	Surgical Associates	SD	N/A
Avera HME of Spencer Hospital LLC
2400 S Minnesota Avenue 102	Sioux Falls	SD	57117	800619999	Medical Services - Home Medical Equipment	SD	N/A
Heart Hospital of South Dakota LLC
4500 W 69th Street	Sioux Falls	SD	57108	562143771	Healthcare Services	SD		Avera McKennan	Related	$40,552,324	0	0	0.66670	$11,945,609
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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct
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 Biomedical Inc
675 S Arapeen Dr Ste 102	Salt Lake City	UT	84108	471818349	Biotechnology	SD		C	Yes (1)	Alumend LLC	-$7,216,841	$4,824,539	1.00000
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

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	Yes (1)	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Avera Heart Hospital of South Dakota LLC
R	$3,267,242	Intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
S	$11,416,154	Intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
L	$2,301,196	Intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
Q	$952,296	Intercompany detail from GL

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Form 990, Schedule R, Part V, Line 2, Column c	FormAndLineReferenceDesc
Explanation	The amounts reported in column c are reported based on a review of general ledger activity in intercompany accounts, and review of equity accounts for contributions and distributions.	ExplanationTxt