2019-05-14T15:30:23-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 460230199 St Mary's Healthcare Center STMA 6052243130 801 East Sioux Avenue Pierre SD 57501 Jim Breckenridge CFO Avera Health 6052243130 2019-05-13 1 Kim Hunwardsen CPA P00484560 6122536500 2019-05-13 8.39.233.107 2019-05-13 13:58:56 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2017 2019-02-21 02:37:17Z Todd Forkel 801 East Sioux Avenue Pierre SD 57501 94784204 0 0928 X www.avera.org/st-marys-pierre X 1951 SD Promotion of health 11 6 693 279 564960 102724 5644177 5770689 85351805 88558350 367433 332321 245030 122844 91608445 94784204 0 148918 0 0 47689106 47415957 0 0 0 39083010 42286143 86772116 89851018 4836329 4933186 68916757 102711782 35698568 62296874 33218189 40414908 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 78113337 148918 88559599 Avera St. Mary's mission is to provide healthcare services to Pierre, South Dakota residents and residents of the surrounding area. Avera St. Mary's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Mary's consists of a 60-bed hospital and a 80-bed nursing home, and one physician clinic in Pierre, South Dakota. The physician clinic includes primary care, ob/gyn, pediatrics, orthopedics, general surgery, internal medicine, oncology, podiatry, urology, dermatology, and ENT. Avera St. Mary's provides acute care and long-term healthcare services, of which there were 1,529 patient discharges, 49,296 outpatient visits, 772 nursery patient days, 22,554 nursing home resident days, and 94,326 clinic visits. Following is a breakdown of these statistics by facility:Avera St. Mary's Hospital1,529 Acute patient discharges49,296 Outpatient visits772 Newborn patient days94,326 Clinic visitsAvera Maryhouse22,554 Long-term resident daysAvera St. Mary's maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $2,849,006.Avera St. Mary's also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera St. Mary's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Mary's engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 78113337 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 X 76 0 1 693 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 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 Terry Fitzke Chair 2.00 2.00 X X 0 0 0 Dr Joseph Villa Vice Chair/Treasurer 2.00 40.00 X X 0 491769 39603 Dan Lusk Board Member 2.00 2.00 X 0 0 0 Justin Cronin Board Member 2.00 2.00 X 0 0 0 Scott Isburg Board Member 2.00 2.00 X 0 0 0 Mike Weisgram Board Member 2.00 2.00 X 0 0 0 Dr Joseph Wyatt Board Member 2.00 40.00 X 0 540172 14830 Dr Jessica Rasmussen Board Member 2.00 40.00 X 0 341527 13500 Karen Brown Board Member (thru May 2018) 2.00 2.00 X 0 0 0 Sr Lynn Marie Welbig Board Member 2.00 3.00 X 0 0 0 Todd Forkel President & CEO 2.00 40.00 X X 0 683117 32568 Will Flett Secretary 1.00 40.00 X X 0 194049 36536 Dr Mikel Holland President & CMO 2.00 40.00 X 0 274808 41743 Jim Breckenridge CFO Avera Health 0.10 39.90 X 0 887406 34116 Christopher Olson CRNA 40.00 0.00 X 200121 0 3903 Barbara Hespen VP 40.00 0.00 X 206307 0 28599 Kevin Roark CRNA 40.00 0.00 X 189318 0 33545 Christopher Miller CRNA 40.00 0.00 X 202247 0 31751 Brad Saathoff Director-Pharmacy 40.00 0.00 X 171751 0 19273 Geoff Durst Former CFO 0.00 0.00 X 0 317773 25280 969744 3730621 355247 19 1 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Shared Services 9998837 Journey Group Companies PO Box 2728 Sioux Falls SD 571012728 Construction 4846311 BWBR Architects Inc 380 St Peter St Ste 600 St Paul MN 551021996 Architectual Services 1100898 Matthew H Swartz DO PLLC 5208 Boulware CT Charlotte NC 28277 Locum Services 475964 Rural Health Care Inc 202 Island Dr Ste 1 Ft Pierre SD 57532 Locum Services 450000 23 46500 129164 267233 5327792 5770689 Patient Service Revenue 621110 83198052 83198052 Pharmacy Revenue 900099 3121105 2556145 564960 Assisted Living LTC 623312 891464 891464 1347729 1347729 88558350 48198 48198 121595 0 121595 121595 121595 284123 0 284123 284123 284123 A/R Interest 900099 1249 1249 1249 94784204 87994639 564960 453916 X 148918 148918 53614 53614 38320396 37143962 1176434 2021227 1958395 62832 4702093 4305763 396330 2318627 2193055 125572 2470 2470 67885 67885 10735 10735 13251547 5195818 8055729 41319 26993 14326 2728297 2188568 539729 269326 218356 50970 1285763 1284785 978 260603 185215 75388 243323 2904 240419 863629 863629 3786940 3160261 626679 549361 548374 987 Medical Supplies 13772640 13772640 Bad Debt Expense 3201873 3201873 Repairs and Maintenance 1440637 1430883 9754 Lease and Rental 10211 10211 499584 219120 280464 89851018 78113337 11737681 0 7165656 10738989 10055165 16614331 116635 24060 2668069 2763324 361289 239601 118266762 68325755 32099437 49941007 15392963 21404597 1057543 985873 68916757 102711782 15836637 18423173 8414430 24039353 11247501 10783160 200000 9051188 35698568 62296874 X 27739912 31494452 5165277 8607456 313000 313000 33218189 40414908 68916757 102711782 X 4933186 -13836 2277369 X 0 1 X 1 0 X 0 0 0 0 0 0 0 1 2987 1 7748 10735 0 Part II-B, Line 1: Avera St. Mary's paid dues to organizations which have a portion of the dues attributed to lobbying activities. Staff members attended a 340b Summit in Washington, DC. 1391428 3838852 5230280 40310008 26067606 14242402 48441718 40914904 7526814 24284756 1343245 22941511 49941007 Assets Limited as to Use - Avera Pooled Investment Fund 10054472 F Interest in Avera Health Foundation 11350125 F 21404597 Estimated Third Party Payor Settlements 364703 Due to Related Party 8686485 9051188 X 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 1067743 1067743 0.01230 1067743 1067743 0.01230 1 75000 75000 0.00090 39293867 18703943 20589924 0.23760 5 33910 33910 0.00040 6 39402777 18703943 20698834 0.23890 6 40470520 18703943 21766577 0.25120 1 36000 36000 0.00040 1 1000 1000 0.00000 2 37000 37000 0.00040 1 3201873 0 14944477 14292068 652409 X 1 1 1 1 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 www.avera.org/st-marys-pierre/ 10566 X X X provider based clinic Avera St Mary's 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X See Part V X 1 15 1 See Part V 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera St. Mary's Part V, Section B, Line 5: Avera St. Mary's gathered information regarding the needs of the community through a three-pronged process gathering stakeholder information on community perceptions of the health of Central South Dakota including a survey of three civic social clubs, interviews with identified community leaders, and several focus groups. All members of the CHNA team were selected for roles they have in the community by a matrix developed by the Avera St. Mary's Hospital Administrative Council and included attributes such as: uninsured/underinsured, parents of young children, close contact with underprivileged people to assure a "voice" in the process, health leaders with in-depth knowledge of the local health care environment, government, business, retired, South Dakota State Departments of health and social services, Urban Indian Health, and Rural Health Clinics. Avera St. Mary's Part V, Section B, Line 6b: South Dakota Department of HealthSouth Dakota Department of Social ServicesMunicipal Government stakeholdersCapital Area Counseling ServicesRural Health ClinicUrban Indian Health Avera St. Mary's Part V, Section B, Line 11: The prioritized community health needs identified in the community health needs assessment completed May 2016 include a cancer treatment center, recruitment of physicians including oncologist, psychiatrist, adolescent psychiatrist and other specialists. Over the next three years, an implementation strategy for each of the three selected priorities will be addressed.Goal 1The first goal from the 2016 CHNA was to increase cancer treatment services in Central South Dakota. Avera St. Mary's was awarded a grant from the Leona Helmsley Charitable Trust to assist in building a Cancer Center that would bring Radiation Oncology to the city of Pierre and to central South Dakota. The grant included $7.5M in funding for a linear accelerator, a vault to house the linear and funding for infrastructure and engineering. On top of the $7.5M, the Helmsley Trust will also match community donations up to $2.5M. Avera St. Mary's broke ground on the Helmsley Center in April 2017. As of June 30th, 2018, $2,316,436 in cash donations have been raised within the community of Pierre. With less than $200,000 of donations needed to meet the goal, the region has scheduled the grand opening of the Helmsley Cancer Center to be held on September 28th, 2018.Avera St. Mary's continues to experience growth within the Oncology field. During this reporting period, Medical Oncology clinic visits have increased by 59% and chemo therapy infusions have increased by 25%. These statistics mean that more cancer patients in central South Dakota are able to receive their care closer to home. The Region has also signed a Radiation Oncologist, whose employment will begin on October 15th, 2018.Goal 2In regards to Goal 2, Avera Medical Group Pierre (AMGP) continues to operate the Avera Coordinated Care program. This extension of care program is offered at no additional cost to patients and compliments the care that they would receive in a clinic setting. The patient is able to work with a personalized team that consists of their Primary Care Physician, a RN case manager and a social worker. This team identifies barriers to successful clinical outcomes and establishes a treatment plan. Follow up is done weekly to track personal and clinical outcomes. During FY2017, AMGP saw an average 151 patients a month in this program. That monthly average increased to 190 a month in FY2018.The region also staffs a Diabetic Education team that consists of 2 part time RNs. Staff meet in a 1:1 setting with patients and educate them on monitoring of blood sugar, self-administering insulin and establishing a healthy diet and exercise plan. During 2017, this program served 330 patients with 94% of these patients experiencing a decrease in A1c levels. During 2018, 200 patients were served, with 85% of patients experiencing a decrease in A1c levels. In April 2017, Avera St. Mary's implemented Planet Heart. Planet Heart screenings are offered to males age 40 and over and females age 45 and older. Two screenings are offered; a heart screening and a vascular screening. The heart screening includes a calcium score CT, blood pressure, cholesterol and tobacco cessation as needed. The vascular screening includes carotid artery screening, abdominal aortic aneurysm screening and peripheral artery disease screening. 42 patients were seen during FY2017 and 151 patients were seen during FY2018. These screenings are not billed to insurance. Another Avera St. Mary's program that benefits Goal 2 is the Rural Health Care Coordination grant through HRSA. The purpose of this grant is to develop health networks in rural locations that address chronic conditions. Avera St. Mary's chose to focus on diabetic outreach. Since the grant was received in September 2015, outreach has been done in the following South Dakota communities; Pierre, Chamberlain, Gregory, Winner, and Miller. The goal of the grant was to enroll 35 patients in the program; currently 40 patients are enrolled. Since inception, these 40 patients have experienced: a 50% reduction in hospital inpatient admissions, a 46% decrease in emergency room visits, a 2 point reduction in their HbA1C levels, a 34% improvement in dilated eye exams and a 65% improvement in diabetic foot exams. Goal 3Avera St. Mary's is continually attempting to recruit a Psychiatrist to join the team, but as of the end of the tax year, no leads have been identified. Avera St. Mary's employed a visiting physician from Avera St. Luke's who would see patients in a clinic setting once a month; unfortunately his services ended in November 2016. Avera St. Mary's continues to employ a Certified Nurse Practitioner that specializes in behavioral health. For the fiscal years ending June 30th, 2017 and June 30th 2018, this provider saw 965 patients and 832 patients respectively. Avera St. Mary's continues to collaborate with Capital Area Counseling. Capital Area Counseling is a local 501(c)(3) that provides counseling services to adults and children. They also specialize in addiction services, therapeutic foster care and suicide safe care. Capital Area Counseling rents space on the campus of Avera St. Mary's. Avera St. Mary's Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera St. Mary's Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Mary's Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera St. Mary's Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. 3 1 - Avera Parkwood Independent Living 400 Parkwood Drive Pierre SD 57501 Independent living 2 - MaryHouse 717 E Dakota Ave Pierre SD 57501 Long term care 3 - Avera St Mary's Campus Pharmacy 100 Mac Lane Suite 101 Pierre SD 57501 Retail pharmacy Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. Line 7g is from the cost reports. Lines 7e and 7i are from the general ledger. Part I, Line 7g: The amount on line 7g includes $13,477,768 related to physician clinics. Part I, Ln 7 Col(f): Bad debt expense of $3,201,873 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. Part II, Community Building Activities: Avera St. Mary's provided a donation to Capital Area Counseling, specializing in treatment of substance abuse, and participated in the health community initiative. 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 audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: Health care needs are assessed through various methods. Avera St. Mary's strives to deliver comprehensive care and extensive medical specialty services to community members located in central South Dakota. Avera St. Mary's is integrally involved with community organizations, the university center, schools, and state and local governments. The closest hospitals offering the same level of care and services are located 154 miles away in Mitchell, SD and 160 miles away in Aberdeen, SD. Within our regional footprint, the majority of the communities have populations of less than 2,500 people. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. In addition to activities reported in the Community Health Needs Assessment, Avera St. Mary's and Avera Gettysburg collaborate with the YMCA, Feeding South Dakota, the PierreFt. Pierre Mental Health Task Force, the United Way, RSVP, the Senior Services Committee and the Transit Community Grant group to assess and promote health related matters. Part VI, Line 3: Avera St. Mary's posts its charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials; (4) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: Avera St. Mary's is an acute care hospital serving a rural community area of central South Dakota which consists of the following primary counties: Hughes, Stanley, Sully and Potter County.Using South Dakota estimated data from 2017 population estimates, census reflected the following estimated populations for the four aforementioned counties: factfinder.census.govHughes: 17,666Stanley: 3,011Sully: 1,407Potter: 2,299Median Age and percentage of the population over the age of 65 for the four counties are shown respectively below.2016 Fact Finder Census dataHughes: 38.4 and 16.3%Stanley: 41.1 and 18.8%Sully: 42.8 and 20.5%Potter: 50.5 and 30.0%Racial/Ethnic CompositionHughes County: 84.6% White 11.1% American Indian 0.8% African AmericanStanley County: 89.4% White 6.8% American Indian 0.9% African AmericanSully County: 94.9% White 2.5% American Indian 0.4% African AmericanPotter County: 95.4% White 2.1% American Indian 0.4% African American Median Household Income: factfinder.census.govState of SD $52,078Hughes County $58,934Stanley County $60,046 Sully County $59,800Potter County $47,991Percentage of the population without health insurance (under age 65): from County Health RankingsHughes County 9.6%Stanley County 9.1% Sully County 10.9%Potter County 9.9% Part VI, Line 5: The hospital serves all persons in the community on a non-discriminatory basis. Avera St. Mary's operates an emergency room that is open to all persons regardless of ability to pay. Avera St. Mary's has an open medical staff with privileges available to all qualified physicians in the area. The governing body is comprised of primarily independent individuals, representative of the community as a whole. Avera St. Mary's provides education and training opportunities to healthcare students enrolled in the local college - Capital University Center. Avera St. Mary's participates in Medicaid, Medicare, Indian Health, Champus, Tricare and/or Other Government sponsored Health Care Programs.Avera St. Mary's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (Capital Area United Way, Pierre/Fort Pierre Rotary, Pierre Area Chamber of Commerce, YMCA Board, Pierre Booster Club and many more). 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 South Dakota Community Foundation PO Box 823 Parkston SD 57366 460398115 501(c)(3) 36000 CACS Behavioral Health and Addiction Treatment 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. 1 0 0 0 0 0 0 0 0 Dr Joseph Villa Vice Chair/Treasurer 0 462114 0 16811 0 12844 0 13500 0 26103 0 531372 0 0 Dr Joseph Wyatt Board Member 0 513713 0 24000 0 2459 0 13500 0 1330 0 555002 0 0 Dr Jessica Rasmussen Board Member 0 300019 0 40000 0 1508 0 13500 0 0 0 355027 0 0 Todd Forkel President & CEO 0 512786 0 50 0 170281 0 7865 0 24703 0 715685 0 0 Will Flett Secretary 0 181282 0 0 0 12767 0 10107 0 26429 0 230585 0 0 Dr Mikel Holland President & CMO 0 271363 0 592 0 2853 0 13500 0 28243 0 316551 0 0 Jim Breckenridge CFO Avera Health 0 815781 0 0 0 71625 0 13500 0 20616 0 921522 0 0 Christopher Olson CRNA 199177 0 0 0 944 0 1999 0 1904 0 204024 0 0 0 Barbara Hespen VP 185366 0 8000 0 12941 0 9547 0 19052 0 234906 0 0 0 Kevin Roark CRNA 188951 0 0 0 367 0 8307 0 25238 0 222863 0 0 0 Christopher Miller CRNA 193748 0 0 0 8499 0 6266 0 25485 0 233998 0 0 0 Brad Saathoff Director-Pharmacy 145560 0 0 0 26191 0 7503 0 11769 0 191023 0 0 0 Geoff Durst Former CFO 0 128440 0 431 0 188902 0 13500 0 11780 0 343053 0 0 Part I, Line 4a Geoffrey Durst received a severance payment of $166,247 during the fiscal year. Schedule J, Part I, Line 3: The President/CEO and is compensated by a related organization, Avera Health. Avera Gettysburg relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Deborah Holland Family member of board member 53613 employee compensation 0 Form 990, Part V, Line 1a: Independent contractors reported relate to services received by Avera St. Mary's, however a related organization files applicable Form 1099s on behalf of the organization. Form 990, Part VI, Section A, line 2 Jim Breckenridge and Todd Forkel have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the member: 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers, and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. Form 990, Part VI, Section B, line 15 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. Form 990, Part VI, Section C, line 19 The organization's conflict of interest policy and governing documents are not publicly available. Financial statements are consolidated in the Avera Health consolidated financials. Form 990, Part IX, line 11g Contract Labor: Program service expenses 552,779. Management and general expenses 0. Fundraising expenses 0. Total expenses 552,779. Purchased Services: Program service expenses 4,430,628. Management and general expenses 441,377. Fundraising expenses 0. Total expenses 4,872,005. Other Fees: Program service expenses 212,411. Management and general expenses 244,516. Fundraising expenses 0. Total expenses 456,927. ACS Fees: Program service expenses 0. Management and general expenses 7,369,836. Fundraising expenses 0. Total expenses 7,369,836. Form 990, Part XI, line 9: Equity Transfers 379,302. Change in Interest in Avera Foundation 1,898,067. 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 XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Mary's. Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of Health SD 501(c)(3) Line 10 N/A 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's Healthcare Center 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare Services NE 501(c)(3) Line 3 Avera Health 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare Services IA 501(c)(3) Line 3 Avera Health 0 Avera Holy Family Foundation 826 North 8th Street Estherville IA 51334 421317452 Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support Health Related Services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 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 Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health Financing and Health Plan Admin SD 501(c)(4) Avera Health 0 Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 medical clinic building SD N/A Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 medical services - home medical equipment SD N/A Avera Home Medical Equipment of Sioux Center LLC 38 19th ST SW Sioux Center IA 51250 753203100 medical services - home medical equipment SD N/A Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave 102 Sioux Falls SD 57117 800619999 medical services - home medical equipment SD N/A Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 surgical associates SD N/A Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 healthcare services SD N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Healthcare services SD N/A National Rural ACO 4 LLC dba Prairie Hills Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 371780735 Accountable care organization KS N/A National Rural ACO 5 LLC dba Great Plains Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 383958290 Accountable care organization KS N/A Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 collection agency SD N/A C 0 Avera Property Insurance Inc 610 W 23rd St Ste 1 PO Box 38 Yankton SD 57078 460463155 insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 Alucent Medical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company Inc 2600 W 49th Street Sioux Falls SD 57105 460401087 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 2600 W 49th Street Sioux Falls SD 57105 460424322 Insurance SD N/A C 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 1 1 0 0 0 Avera Gettysburg M 84822 General Ledger