2019-05-14T15:28:52-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 420680370 Avera Holy Family AVER 7123626519 826 North 8th Street Estherville IA 51334 Jim Breckenridge CFO Avera Health 7123626519 2019-05-10 1 Kim Hunwardsen CPA P00484560 6122536500 2019-05-12 8.39.233.75 2019-05-10 14:20:09 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2017 2019-02-21 02:37:17Z Deb Herzberg 826 North 8th Street Estherville IA 51334 30388470 0 0928 X www.avera-holyfamily.org X 1996 IA Promotion of Health 8 7 265 15 0 0 39769 194303 27809874 29120185 1386767 1045364 32827 28618 29269237 30388470 22275 22955 0 0 13904437 14154664 0 0 0 12366895 13146471 26293607 27324090 2975630 3064380 41561915 45730184 7031225 6361496 34530690 39368688 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 24885014 22955 29120185 Avera Holy Family's mission is to provide healthcare services to Estherville, Iowa residents and residents of the surrounding area. Avera Holy Family is a 501(c)(3) organization affiliated with Avera Health. Avera Holy Family consists of a 25-bed critical access hospital and a clinic in Estherville, Iowa. The program services offered include primary care, general surgery, cardiac rehab, nuclear medicine, ICU, emergency, ultrasound, speech therapy, physical therapy and occupational therapy. Avera Holy Family provides acute care and long-term healthcare services, of which there were 618 patient discharges, 36,006 outpatient visits, 747 swing-bed days, 144 newborn patient days, and 22,380 clinic visits. Following is a breakdown of these statistics by facility:Avera Holy Family Hospital618 Acute patient discharges36,006 Outpatient visits747 Swing-bed patient days144 Newborn patient days22,380 Clinic visitsAvera Holy Family 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 $372,293.Avera Holy Family 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 Holy Family 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 Holy Family 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. 24885014 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 43 0 1 265 1 0 0 0 0 0 0 0 0 0 0 X 8 7 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Kathy Preston Chair 1.00 0.00 X X 0 0 0 Joe Greig Vice Chair 1.00 0.00 X X 0 0 0 Dr Anthony Cook Board Member (thru Oct 2017) 1.00 0.00 X 0 392525 31967 Sr Mary Jaeger Board Member 1.00 1.00 X 0 0 0 Chris Schlitz Board Member 1.00 0.00 X 0 0 0 Joe Fitzgibbons Board Member 1.00 0.00 X 0 0 0 Sr Sharon Haas Board Member 1.00 0.00 X 0 0 0 Roslyn Gunderson Board Member 1.00 0.00 X 0 0 0 Scott Stokes Board Member (thru Jan 2018) 1.00 1.00 X 0 0 0 Dr Randy Asman Board Member 40.00 0.00 X 0 273358 37056 Dr Adrianne Westmoreland Board Member (thru Jun 2018) 40.00 0.00 X 0 229648 38483 Dale Hustedt President & CEO 40.00 1.00 X 0 183927 34434 Jim Breckenridge CFO Avera Health 0.10 39.90 X 0 887406 34116 Kristi Hough Pharmacy Manager 40.00 0.00 X 148334 0 8288 April Krull Pharmacist 40.00 0.00 X 117903 0 35578 Shannon Adams Former Sec/Treas & SrVP Finance 40.00 1.00 X 0 112705 27537 266237 2079569 247459 2 1 1 0 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Medical services 3695378 Estherville Medical Center 926 N 8th St Estherville IA 51334 Medical Locum Services 823992 Acute Care Inc 1609 N Ankeny Blvd Ste 200 Ankeny IA 50023 Medical Locum Services 469915 Woodward Anesthesia Services PC 203 N 8th St Estherville IA 51334 Medical Professional fee 310231 Fit For Life Physical Therapy LLC 4125 145th St Estherville IA 51334 Physical Therapy Services 254078 10 183303 11000 194303 Patient Service Revenue 622110 26784822 26784822 Pharmacy Revenue 900099 1585788 1585788 Collaborative Agreement 900099 470613 470613 Cafeteria 900099 46813 46813 232149 232149 29120185 18671 18671 28618 0 28618 28618 28618 1016027 10666 0 0 1016027 10666 1026693 1026693 30388470 29120185 0 1073982 22955 22955 10805063 9896748 908315 841543 770800 70743 1772805 1651873 120932 735253 688956 46297 12 12 52700 52700 2687014 2277053 409961 56371 749 55622 338708 240968 97740 110955 62418 48537 413002 413002 13975 5472 8503 74848 65997 8851 90843 90843 1551550 1551550 319420 73457 245963 Medical Supplies 3977620 3977620 Locum Fees 2017849 2017849 Bad Debt Expense 725848 725848 715756 350856 364900 27324090 24885014 2439076 0 2788478 2667304 3004144 3224675 794867 704094 322260 150979 29871501 16933162 13055280 12938339 295163 298852 21117582 24675244 184141 176037 0 894660 41561915 45730184 2101122 2553991 2768824 2527657 2161279 1279848 7031225 6361496 X 34199641 37865315 308507 1480831 22542 22542 34530690 39368688 41561915 45730184 X 3064380 354720 1418898 X X 0 1 X 1 0 X 1490407 3412 1493819 1055754 442798 8145 1490407 908995 146759 1055754 823825 85170 908995 721217 102608 823825 0.96800 0.01510 0.01690 0 1 1 475540 475540 17524347 10063016 7461331 10063666 6503710 3559956 1807948 366436 1441512 12938339 Assets Limited as to Use - Avera Pooled Investments 21290156 F Investment in Foundation 3385088 F 24675244 Due to Related Party 1279848 1279848 X Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. Part X, Line 2: Avera Health and most of its sponsored organizations are considered nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. These organizations are required to file a Return of Organization Exempt from Income Tax (Form 990) with the Internal Revenue Service (IRS). Avera Health and certain sponsored organizations also file an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report their unrelated business taxable income. 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. The federal Form 990T filings and taxable subsidiary returns for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2015. Certain consolidated entities are subject to federal income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. Deferred tax assets and liabilities are not material as of June 30, 2018 and 2017. The Organization paid an immaterial amount of federal and state income taxes for the years ended June 30, 2018 and 2017. 1 1 X 1 X 1 X 1 1 1 0 0 335313 335313 0.01260 449070 266918 182152 0.00680 784383 266918 517465 0.01940 9 44435 44435 0.00170 2 27496 27496 0.00100 3483086 2108655 1374431 0.05170 1 596 596 0.00000 5 10609 10609 0.00040 17 3566222 2108655 1457567 0.05480 17 4350605 2375573 1975032 0.07420 1 3840 3840 0.00010 2 433 25589 25589 0.00100 1 159285 159285 0.00600 1 1373 1373 0.00010 5 433 190087 190087 0.00720 1 725848 0 11590996 11658822 -67826 X 1 1 1 1 Avera Holy Family Health 826 N 8th Street Estherville IA 51334 www.avera-holyfamily.org 320014H X X X X Provider Based Clinic Avera Holy Family 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Part V statement X See Part V statement X 1 15 1 See Part V statement 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V X See Part V X See Part V X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Holy Family Part V, Section B, Line 5: Avera Holy Family utilized data gathered through input from community partners and services groups, survey responses, community leader interviews, and results from focus groups. Avera Holy Family and Emmet County Public Health collaborated with a number of community partners in the completion of the community health needs assessment. Multiple sources of data were analyzed in the needs assessment including public health reports, U.S. Census data related to population, housing and economics, and other labor force data. A community health needs assessment survey was conducted using Survey Monkey. Community input was gathered through community partners and service groups who represent the broad interests of the community. The following groups were involved in the community health needs assessment: Emmet County Public Health; Avera Holy Family Medical Staff; Emmet County Wellness Coalition; the Free Clinic Board; Nursing Home Leaders; Fire, Law Enforcement, Ambulance and Support Services (FLEAS); Compass Pointe Alcohol, Drug & Gambling Behavioral Health Services; and Emmet County Mental Health. Members from these community groups participated in meetings and/or completed a community health needs survey. Avera Holy Family Part V, Section B, Line 11: The Emmet County Iowa 2016 Community Health Needs Assessment priorities include: obesity, diabetes, cardiovascular disease and falls in older adults. Health needs identified but not being addressed include transportation, mental health services and alcohol consumption. These needs are not being addressed due to competing priorities/projects, lack of professional resources and/or the need is being addressed by another community partner.The annual Lifestyle Challenge was conducted January 5 through March 23 2018. Two hundred and fifty four individuals participated in the event. There were 61 teams competing for the greatest weight loss and the most exercise minutes logged. Total weight loss was 2013 pounds and 585,863 exercise minutes were reported. Health education was provided to participants each week throughout the challenge. Planet Heart is a screening program for cardiovascular disease. Planet Heart participants benefit from a cardiovascular risk assessment and health education including tobacco cessation, nutrition counseling and cardiovascular disease prevention. During fiscal year 2018, 106 individuals were screened for cardiovascular disease. Seven individuals were found to be at significant risk and fifteen were found to be at moderate risk of cardiovascular disease. These individuals were encouraged to seek further care and treatment. Participates at low risk of cardiovascular disease were encouraged to continue healthy lifestyle choices that reduce the risk of cardiovascular disease.A prediabetes program was conducted during fiscal year 2018. Eight individuals participated in the program. The group lost 25 pounds and reported an average of 150 minutes of exercise per week per participant. The Pre-Diabetes Education Program provides information on lifestyle choices that impact the risk of diabetes such as being physically active, cooking and eating healthy foods, dealing with stress and the importance of adequate sleep.The hospital supported the following community wellness events during fiscal year 2018: * a ServeSafe class for restaurants and schools with 8 individuals participating * a bike safety event with over 200 individuals in attendance * a farm safety day with approximately 100 4th grade students in attendance* the Healthiest State Annual Walk with over 925 individuals participating in the walk* the Back to School Bash attended by many students and their parents The hospital disseminates health information through the local media. The CEO writes a monthly newsletter for the paper which provides health awareness information as well as information about hospital services. In addition, during 2018, the hospital staff provided health information to the community through the media. Some of the topics included reducing the risk of cardiovascular disease, the 5-2-1-0 youth nutrition program and diabetes prevention. The hospital participated in MOCSY, a community partnership to address underage and binge drinking. The Matter of Balance Program designed to reduce the fear of falling and increase activity levels of older adults was offered to the community. However, there was not enough interest to conduct the program. The hospital and Emmet County Public health collaborated on development of a referral process for this program to encourage more interest and participation in the program. A refresher course for Matter of Balance volunteers was held and the classes will continue to be offered to the community. Previous participants of the class reported how helpful the education was in helping to overcome their fear of falling. Avera Holy Family 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 Holy Family Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Holy Family 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 Holy Family Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Schedule H, Part V, Section B, Line 7b: www.avera.org/about/community-health-needs-assessments/ Schedule H, Part V, Section B, Line 7a: https://www.avera.org/locations/profile/avera-holy-family-hospital/ Schedule H, Part V, Section C, Lines 16a, 16b, and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 2 1 - Avera Parkwood Independent Living Facili 400 Parkwood Drive Pierre SD 57501 Independent living 2 - Maryhouse 400 Parkwood Drive Pierre SD 57501 Long term care Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: Charity care was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Medicaid was calculated based on the Medicaid cost report. Subsidized health services were calculated based on the Medicare cost report. Community health improvement services, health professions education, research and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. Costs attributable to a physician clinic included in the subsidized health services were $3,483,086. Part I, Ln 7 Col(f): Bad debt expense of $725,848 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 Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. Part III, Line 2: Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses can be found on page 10 of the attached financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules set forth by Centers for Medicare and Medicaid Services. Avera Holy Family follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. However, Medicare is the Organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: The hospital utilizes the Health Stream Patient Experience Survey to gather information about patients' perceptions of their care experiences. The survey helps us know how to improve care and services to better meet the needs of our community. The Professional Activities Committee of the Medical Staff meets eight times a year to discuss patient needs, evaluate care & services and identify opportunities to enhance care and services. The Medical Staff meets quarterly to discuss these same topics. The Critical Access CAH Committee meets quarterly to review and approve care and service policies and procedures and to evaluate care and services. Part VI, Line 3: Information regarding charity care is made available to patients via their billing statements. The Finance Department also informs patients of the policy through their contact with patients. Brochures regarding financial assistance are located in the lobby of the Hospital and the Clinic. Part VI, Line 4: Avera Holy Family Health operates a 25-bed critical access hospital and provider-based clinic located in Estherville, Iowa. Avera Holy Family's service area includes Emmet County and surrounding counties in Iowa. In 2014, the population for Emmet County was 9,990. Approximately 19.2% of the population is age 65 or older. The average per capita income is $28,293 and approximately 11.3% of the population is below the federal poverty level. The nearest hospital in the area is approximately 15 miles from Avera Holy Family's main campus. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 1 Regional Transit Authority ART PO Box 1240 Spencer IA 51301 421133312 501(c)(3) 6500 Support Estherville community transportation 1 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRS Section 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. 0 0 0 0 0 0 0 0 0 Dr Anthony Cook Board Member (thru Oct 2017) 0 335747 0 55184 0 1594 0 13500 0 18467 0 424492 0 0 Dr Randy Asman Board Member 0 221916 0 45686 0 5756 0 13500 0 23556 0 310414 0 0 Dr Adrianne Westmoreland Board Member (thru Jun 2018) 0 182063 0 17213 0 30372 0 7980 0 30503 0 268131 0 0 Dale Hustedt President & CEO 0 155443 0 13067 0 15417 0 9007 0 25426 0 218360 0 0 Jim Breckenridge CFO Avera Health 0 815781 0 0 0 71625 0 13500 0 20616 0 921522 0 0 Kristi Hough Pharmacy Manager 139943 0 25 0 8366 0 6717 0 1570 0 156621 0 0 0 April Krull Pharmacist 114079 0 25 0 3799 0 6452 0 29127 0 153482 0 0 0 Shannon Adams Former Sec/Treas & SrVP Finance 0 112380 0 25 0 300 0 4724 0 22813 0 140242 0 0 Schedule J, Part I, Line 3: The President/CEO's compensation is paid by a related organization, Avera McKennan. Avera Holy Family relied on the related organizations for determining the compensation for the President/CEO using the methods described in Part I, Line 3. A The City of Estherville Iowa 426004647 297542BG6 2012-06-21 3840000 Refund the Series 2000 Bonds issued 12/14/2000 0 0 0 A 1225000 3840000 76800 3763200 2000 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Form 990, Part VI, Section A, line 2 Jim Breckenridge and Sister Mary Jaeger have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the Board of Directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the Member: 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of the 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, SD ("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 CEO of the Corporation; 8) To approve the operating/capital budgets and strategic plans of the Corporation; 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member; 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member; 11) To establish and maintain employee benefit programs; 12) To establish and maintain insurance programs; 13) To approve major community fund drives; 14) To approve the appointment of auditors; 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There is no committee with authority to act on behalf of the Board. 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 15 The President and CEO and certain board members are compensated by Avera McKennan, a related exempt organization. Avera McKennan has a process in place for determining compensation. The CFO-Avera Health is compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not 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 XI, line 9: Change in Interest in Avera Foundation 1,418,898. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera Holy Family. Form 990, Part X, Line 20: Avera Holy Family is part of the Avera Obligated Group which consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Gettysburg and Avera at Home. Avera Holy Family was not allocated any share of the bond issue, and thus does not have an amount on line 20 related to the Obligated group bond issuance. The amount shown on line 20 and detailed in Schedule K relates to a separate bond issue of Avera Holy Family. Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of Health SD 501(c)(3) Line 10 N/A 0 Avera Holy Family Foundation 826 N 8th Street Estherville IA 51334 421317452 Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare Services NE 501(c)(3) Line 3 Avera Health 0 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 401 West Glynn Drive PO Box B Parkston SD 57366 460458725 Support Health Related Services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO BOX 5045 Sioux Falls SD 57117 460224743 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Street Mitchell SD 57301 460224604 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home Services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th 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 Marshall 300 S Bruce St Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 W Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health Financing and Health Plan Admin SD 501(c)(4) Avera Health 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Sioux Center LLC 38 19th ST SW Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Av 102 Sioux Falls SD 57117 800619999 Medical Services - home medical equipment SD N/A Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 Medical clinic building SD N/A Surgical Associates Endoscopy Clinic LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates SD N/A Heart Hospital of South Dakota LLC 4500 W 69th St Sioux Falls SD 57108 562143771 Healthcare Services NC N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - Home Medical Equipment SD N/A National Rural ACO 5 LLC dba Great Plains Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 383958290 Accountable Care Organization KS 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 Accounts Management Inc 5132 S Cliff Avenue Suite 101 Sioux Falls SD 57108 460373021 Collection Agency SD N/A C 0 Avera Property Insurance Inc 510 W 23rd Street PO Box 38 Yankton SD 57078 460463155 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental real estate SD N/A C 0 Alucent Medical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech research SD N/A C 0 South Dakota State Medical Holding 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 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 Avera Holy Family Foundation C 183303 General Ledger