2020-07-10T15:45:32-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 460224743 Avera McKennan AVER 6053228000 1325 South Cliff Ave Sioux Falls SD 571175045 Julie Norton CFO - Avera Health 6053228000 2020-07-07 1 Kim Hunwardsen CPA P00484560 6122536500 2020-07-07 216.147.181.49 2020-07-07 14:54:04 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2018 2021-01-29 14:40:06Z David Flicek 1325 South Cliff Ave Sioux Falls SD 571175045 1231907649 0 0928 X www.averamckennan.org X 1911 SD Promotion of Health 20 15 8460 1953 10259322 3841573 7484768 8270026 995826100 1049156777 8510483 10632739 51157256 60872804 1062978607 1128932346 746359 1004588 0 0 520069419 564139370 81670 19260 1447936 493537324 537998124 1014434772 1103161342 48543835 25771004 1159178030 1220148914 511785453 555607348 647392577 664541566 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services and guided by Christian values. 0 0 927597481 1004588 1100080246 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. 927597481 1 1 0 1 0 0 0 0 1 1 1 1 0 1 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 497 0 1 8460 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 15 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Hugh Venrick Chair 2.00 0.00 X X 0 0 0 Mary Dally Vice Chair 2.00 0.00 X X 0 0 0 Rick Kooima MD Chief of Staff 40.00 0.00 X 281283 0 41947 Cindy Walsh Board Trustee 2.00 0.00 X 0 0 0 Tom Biegler Board Trustee 2.00 0.00 X 0 0 0 Sister Carmella Luke Board Trustee 2.00 0.00 X 0 0 0 Sister Joan Reichelt Board Trustee 2.00 2.50 X 0 0 0 Sister Mary Carole Curran Board Trustee 2.00 0.00 X 0 0 0 Van Fishback Board Trustee 2.00 0.00 X 0 0 0 J Pat Costello Board Trustee 2.00 0.00 X 0 0 0 Laurie Knutson Board Trustee 2.00 0.00 X 0 0 0 Jim Woster Foundation Chair 2.00 0.00 X 0 0 0 Alejandro Ramirez Board Trustee 2.00 0.00 X 0 0 0 Raed Sulaiman MD Board Trustee 2.00 0.00 X 0 0 0 Carol Twedt Board Trustee 2.00 0.00 X 0 0 0 Sister Lucille Welbig Board Trustee 2.00 2.50 X 0 0 0 Cristina Hill Jensen MD Board Trustee/Gastroenterologist 40.00 0.00 X 876515 0 40260 Randy Knecht Board Trustee 2.00 0.00 X 0 0 0 Katherine Wang MD Board Trustee/Neonatology 40.00 0.00 X 426944 0 13750 David Flicek President 40.00 0.00 X X 0 1000651 46357 Jim Breckenridge CFO Avera Health; Sec/Treas 0.10 41.20 X 0 918859 34586 Lori Popkes Sr Vice President 40.00 0.00 X 345401 0 37064 Mary Leedom AVP of Surgical Services 40.00 0.00 X 195315 0 32229 Curtis Hohman Sr Vice President until 4/6/19 40.00 0.50 X 373142 0 26164 Michael Elliott - Sr Vice President Medical Affairs & CMO 40.00 0.00 X 491039 0 41437 Todd Zimprich MD Neurology 40.00 0.00 X 1602228 0 42097 Arvin Santos MD Nephrology 40.00 0.00 X 1223434 0 45120 Brian Knutson MD Dermatology 40.00 0.00 X 1249671 0 40860 Michael Wolak MD Neurosurgery 40.00 0.00 X 1215968 0 41097 Wissam Asfahani MD Neurology Surgery 40.00 0.00 X 1242843 0 43857 Steve Petersen - Former AVP-Pharmacy 0.00 40.00 X 0 256972 26400 Julie Norton - Former Sec/Treas & SrVP Finance 0.00 40.00 X 0 503223 35880 9523783 2679705 589105 871 1 1 0 Avera Health 3900 West Avera Drive Sioux Falls SD 57108 Shared & eCare services 104161155 Grapetree Medical Staffing Inc 2501 Boji Bend Dr Ste 100 Milford IA 51351 Medical Staffing 2910776 CHG Companies Inc dba CompHealth 7259 S Bingham Junction Blvd Midvale UT 84047 Medical Staffing 2536062 Physicians Laboratory Ltd 1301 S Cliff Ave Suite 700 Sioux Falls SD 57105 Pathology 2042178 Surgical Institute of South Dakota PC 911 E 20th St 700 Sioux Falls SD 57105 Medical Dir & Prof Fees 1920822 69 40594 2519968 3852162 1857302 8270026 Patient service revenue 622110 937786209 937786209 Patient and clinic 621500 93004671 88302425 4702246 Inc from subsidiaries 423000 3592573 3592573 Meaningful use revenue 900099 82167 82167 14691157 14691157 1049156777 1826631 1826631 1661002 1970989 -309987 -309987 -309987 57456824 2272170 49454632 1468254 8002192 803916 8806108 8806108 108468365 50081428 58386937 55579587 2807350 Commercial testing 621500 1469091 1469091 Sports program 900099 1280635 1280635 A/R Interest Income 900099 46128 46128 2795854 1128932346 1100080246 10259322 10322752 X 600776 600776 403812 403812 3206406 1721963 1484443 933881 933881 449983915 427477240 21963549 543126 29924904 28426306 1478313 20285 49951051 45290962 4590961 69128 30139213 28170493 1929259 39461 289393 11486 277907 20051 20051 54739 54739 19260 19260 195524225 77411720 118062523 49982 912560 558866 150471 203223 13960898 10101466 3686946 172486 7217628 4009750 3163483 44395 17698137 12951263 4702171 44703 3195248 2743074 446056 6118 2796900 2597960 198573 367 12295219 12093638 201581 39566422 34733544 4832096 782 4206968 2696937 1510031 Medical supplies 201046505 201046505 Bad Debt expense 29707822 29707822 Equipment lease and ren 1927109 1466749 458818 1542 UBI tax 1457603 1457603 6120697 983665 4903954 233078 1103161342 927597481 174115925 1447936 X 37247763 24017416 4592734 4345957 142036525 143160916 230844 2307416 2101718 25110366 28669360 11925421 12122761 1011056715 462998676 445269624 548058039 8647439 22977878 261759142 286881315 13266394 14698921 40533688 39333669 166250674 93780964 1159178030 1220148914 90014179 96027112 576178 1046529 387185200 386890744 9811973 42327369 24197923 29315594 511785453 555607348 X 629549776 646280961 13586236 13462830 4256565 4797775 647392577 664541566 1159178030 1220148914 X 25771004 -488669 -8133346 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 54739 54739 0 Part II-B, Line 1: 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 1 12934 76857 79310 10481 0 4256565 540675 4797240 3764520 492045 4256565 3174562 589958 3764520 2828539 346023 3174562 2692789 135750 2828539 0.00000 1.00000 0.00000 0 1 1 25255096 27126590 52381686 4413222 508711365 236993145 276131442 3950592 1839853 2110739 310160374 218599266 91561108 131439476 5566412 125873064 548058039 Assets Limited as to Use - Avera Pooled Investments 244479313 F Interest in Avera Health Foundation 14648653 F Investment in Avera HME 3426752 F Investment in Heart Hospital of South Dakota, LLC 18921809 F Investments in affiliated companies 5404788 F 286881315 Other Assets 371291 Other Receivables 43662017 Due from Related party 1250000 Custodial funds held by related party 48497656 93780964 Other Liabilities 8967363 Due to other Organizations 1205998 Market value of interest swap 7050919 Estimated third-party payor settlements 7924854 Minority interest 4166460 29315594 X 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. X X X X X 1 Jon Oien 600 E Sunnybrook Dr Sioux Falls SD 57105 Major and planned gift solicitations 0 0 18120 0 18120 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. 1 1 X 1 X 1 X 1 1 1 0 0 16857396 16857396 0.01570 84316502 62532017 21784485 0.02030 2847386 1797825 1049561 0.00100 104021284 64329842 39691442 0.03700 4129512 479047 3650465 0.00340 9470381 1626427 7843954 0.00730 24705103 16564066 8141037 0.00760 12817045 1469065 11347980 0.01060 1571082 1571082 0.00150 52693123 20138605 32554518 0.03040 156714407 84468447 72245960 0.06740 1838 1838 0.00000 164756 164756 0.00020 2500 2500 0.00000 153 153 0.00000 18153 18153 0.00000 3982 3982 0.00000 13943 13943 0.00000 6126 6126 0.00000 211451 211451 0.00020 1 29707822 0 238403429 282855206 -44451777 X 1 1 8 1 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 www.avera.org/mckennan 10563 X X X X X X 36 Provider Based Clinics 2 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 www.avera.org/heart-hospital 41953 X X X 2/3 Owner in Joint Venture 3 Avera Milbank Area Hospital 901 Virgil Ave Milbank SD 57252 www.avera.org/milbank 48451 X X X X 2 Provider Based Clinics & 2 Rural Health PB Clinics 4 Avera Gregory Healthcare Center 400 Park Ave Gregory SD 57533 www.avera.org/gregory-hospital 54875 X X X X 2 Provider Based Clinics & 2 Rural Health PB Clinics 5 Avera Dells Area Health Center 909 N Iowa Avenue Dell Rapids SD 57022 www.avera.org/dell-rapids 50754 X X X X 3 Provider Based Clinics 6 Avera Flandreau Medical Center 214 N Prairie Flandreau SD 57028 www.avera.org/flandreau-medical 10540 X X X X 1 Rural Health Provider Based Clinic 7 Avera Hand County Memorial Hospital 300 W 5th St Miller SD 57362 www.avera.org/miller 53862 X X X X 1 Provider Based Clinic 8 Avera Merrill Pioneer Hospital 1100 S 10th Ave Rock Rapids IA 51246 www.avera.org/locations/profile/avera- 600118H X X X X 2 rural health provider based clinics Avera McKennan 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Heart Hospital of South Dakota LLC 2 0 0 1 X X X X X X X X X 18 1 1 1 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Gregory Healthcare Center 4 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Milbank Area Hospital 3 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Dells Area Health Center 5 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Flandreau Medical Center 6 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Hand County Memorial Hospital 7 0 0 1 X X X X X X X X X 18 1 0 0 1 X see Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Merrill Pioneer Hospital 8 0 0 1 X X X X X X X X X 17 1 0 0 1 X See Part V, Page 8 X 1 17 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X www.avera.org/patients-visitors/charity-patient-assistance-programs/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 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. 40 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 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. 1 South Dakota Department of Health - All Women Count 615 E 4th Street Pierre SD 57501 466000364 State of SD 15000 Donation Darwin Foundation 4600 East-West Hwy Suite 525 Bethesda MD 20814 371473821 501(c)(3) 112000 Donation East Africa Medical Assistance Foundation 400 South 4th Street Suite 401-225 Minneapolis MN 55415 363412789 501(c)(3) 10000 Donation City of Sioux Falls 224 West Ninth Street Sioux Falls SD 57104 466000425 State of SD 98000 Book Land Donation 4 0 Scholarships 6 67500 Assistance with medical expenses 3400 313962 Employee Flood Recovery Assistance 45 22350 Part I, Line 2: 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. 0 0 0 0 0 0 0 0 0 Rick Kooima MD Chief of Staff 268783 0 7855 0 4645 0 13750 0 28197 0 323230 0 0 0 Cristina Hill Jensen MD Board Trustee/Gastroenterologist 735189 0 138179 0 3147 0 13750 0 26510 0 916775 0 0 0 Katherine Wang MD Board Trustee/Neonatology 315898 0 109435 0 1611 0 13750 0 0 0 440694 0 0 0 David Flicek President 0 762321 0 2960 0 235370 0 13750 0 32607 0 1047008 0 0 Jim Breckenridge CFO Avera Health; Sec/Treas 0 693359 0 1720 0 223780 0 13750 0 20836 0 953445 0 0 Lori Popkes Sr Vice President 289743 0 240 0 55418 0 8377 0 28687 0 382465 0 0 0 Mary Leedom AVP of Surgical Services 191893 0 700 0 2722 0 9980 0 22249 0 227544 0 0 0 Curtis Hohman Sr Vice President until 4/6/19 295230 0 420 0 77492 0 13750 0 12414 0 399306 0 0 0 Michael Elliott - Sr Vice President Medical Affairs & CMO 414852 0 240 0 75947 0 13750 0 27687 0 532476 0 0 0 Todd Zimprich MD Neurology 903323 0 674543 0 24362 0 13750 0 28347 0 1644325 0 0 0 Arvin Santos MD Nephrology 752816 0 467955 0 2663 0 13750 0 31370 0 1268554 0 0 0 Brian Knutson MD Dermatology 1070533 0 172962 0 6176 0 13750 0 27110 0 1290531 0 0 0 Michael Wolak MD Neurosurgery 1000497 0 15000 0 200471 0 13750 0 27347 0 1257065 0 0 0 Wissam Asfahani MD Neurology Surgery 1130699 0 83000 0 29144 0 13750 0 30107 0 1286700 0 0 0 Steve Petersen - Former AVP-Pharmacy 0 247498 0 400 0 9074 0 12905 0 13495 0 283372 0 0 Julie Norton - Former Sec/Treas & SrVP Finance 0 501193 0 285 0 1745 0 13750 0 22130 0 539103 0 0 Schedule J, Part I, Line 3: 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. Matthew Leedom Family of Key Employee 93113 Employee Compensation 0 Sarah Kappel Family of Key Employee 140558 Employee Compensation 0 Allison Leedom-Christensen Family of Key Employee 75212 Employee Compensation 0 Victoria Petersen Family of Key Employee 47147 Employee compensation 0 Deann Matthiesen Family of Key Employee 129481 Employee compensation 0 Nick Christensen Family of Key Employee 79438 Employee compensation 0 Kathy Kooima Family of Board Member 10080 Employee compensation 0 Kristy Mickelson Family of Key Employee 54509 Employee compensation 0 Grant Flicek Family of Officer and board member 64943 Employee Compensation 0 Christine Maroun MD Family of Board Member 141798 Employee compensation 0 Ashley Steffen Family of Key Employee 97602 Employee compensation 0 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. Sioux Falls Hospital Management LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 562141521 Management company of Heart Hospital NC 5972805 20276162 West 69th Street LLC West 69th Street LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 460224743 Holding company SD 5972805 20276162 Avera McKennan Alumend LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 460224743 Research and development SD -2550534 24309436 Avera McKennan MRIS LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 470874983 Healthcare Services SD 0 0 Avera McKennan 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 N/A 0 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 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 311668 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 11945609 40552324 0 0 0.66670 Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical Services - Home Medical Equipment SD N/A National Rural ACO 4 LLC dba Prairie Hills Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 371780735 Accountable Care Organization KS N/A National Rural ACO 5 LLC dba Great Plains Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 383958290 Accountable Care Organization KS N/A Accounts Management Inc 5132 S Cliff 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 Alumend LLC C -7216841 4824539 1.00000 1 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 0 0 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 1 Avera Heart Hospital of South Dakota LLC R 3267242 Intercompany detail from GL Avera Heart Hospital of South Dakota LLC S 11416154 Intercompany detail from GL Avera Heart Hospital of South Dakota LLC L 2301196 Intercompany detail from GL Avera Heart Hospital of South Dakota LLC Q 952296 Intercompany detail from GL Form 990, Schedule R, Part V, Line 2, Column c 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.