AVERA HEALTH: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: AVERA HEALTH (EIN 46-0422673)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2019-05-14
IRS object ID: 201921349349308172
Schema version: 2017v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule G
Schedule I
Schedule J
Schedule K
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-05-14T15:28:08-05:00	ReturnTs
Tax Period End	2018-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

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

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

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

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460422673	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	AVERA HEALTH	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	6053227300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 WEST AVERA DRIVE No 300	AddressLine1Txt
City	SIOUX FALLS	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Jim Breckenridge	PersonNm
Person Title	Secretary and CFO	PersonTitleTxt
Phone	6053224700	PhoneNum
Signature	2019-05-13	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen	PreparerPersonNm
PTIN	P00078516	PTIN
Phone	6122536500	PhoneNum
Preparation	2019-05-13	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	8.39.233.107	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-05-13	IPDt
IP Tm	14:34:11	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC	AtSubmissionCreationDeviceId
At Submission Filing Device Id	EFC25E59FA7409AE560978A003AFB9E955B778C6	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Bob Sutton	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 WEST AVERA DRIVE No 300	AddressLine1Txt
City	SIOUX FALLS	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$227,619,779	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.avera.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1998	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of Health	ActivityOrMissionDesc
Voting Members Governing Body	14	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	1381	TotalEmployeeCnt
Total Volunteers	39	TotalVolunteersCnt
Total Gross UBI	$1,289,487	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$357,326	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$15,789,136	PYContributionsGrantsAmt
CY Contributions Grants	$14,467,701	CYContributionsGrantsAmt
PY Program Service Revenue	$187,050,828	PYProgramServiceRevenueAmt
CY Program Service Revenue	$199,967,555	CYProgramServiceRevenueAmt
PY Investment Income	$15,603,501	PYInvestmentIncomeAmt
CY Investment Income	$2,304,385	CYInvestmentIncomeAmt
PY Other Revenue	$450,275	PYOtherRevenueAmt
CY Other Revenue	$8,717,462	CYOtherRevenueAmt
PY Total Revenue	$218,893,740	PYTotalRevenueAmt
CY Total Revenue	$225,457,103	CYTotalRevenueAmt
PY Grants And Similar Paid	$5,790,679	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$15,582,714	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$110,023,045	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$121,091,438	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$79,902,077	PYOtherExpensesAmt
CY Other Expenses	$98,223,646	CYOtherExpensesAmt
PY Total Expenses	$195,715,801	PYTotalExpensesAmt
CY Total Expenses	$234,897,798	CYTotalExpensesAmt
PY Revenues Less Expenses	$23,177,939	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$9,440,695	CYRevenuesLessExpensesAmt
Total Assets BOY	$1,067,436,720	TotalAssetsBOYAmt
Total Assets EOY	$1,282,022,027	TotalAssetsEOYAmt
Total Liabilities BOY	$755,278,638	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$978,667,960	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$312,158,082	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$303,354,067	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Avera Health 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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$209,907,828	ExpenseAmt
Grant	$15,582,714	GrantAmt
Revenue	$207,086,072	RevenueAmt
Desc	Avera Health is a nonprofit corporation jointly sponsored by the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota and the Benedictine Convent of the Sacred Heart, together referenced as the "Sisters." Avera Health acts as the leader of the Avera health ministry, serving as an overall parent to support its affiliated tax-exempt health care organizations. These organizations provide services principally in eastern South Dakota and surrounding states. Avera Health provides management consulting, fund raising and other administrative services to the hospitals, long-term health care facilities, clinics, services and programs that are sponsored or otherwise affiliated with the Sisters.Avera eCARE is a visionary care delivery model that provides rural health care professionals around-the-clock access to specialty care physicians, nurses and pharmacists. Using advanced communication technology, eCARE supports rural facilities in the provision of evidence-based, high-quality care and offsets workforce shortages in rural communities. eCARE is a natural extension of Avera's Health mission and its century-long commitment to its rural communities to maintain access to quality care close to home. Avera eCARE works with some of the most underserved populations in the United States. This includes frontier populations, long term care residents, Native American Reservations, disabled veterans, and inmates. By bringing high quality, on demand access to specialty care, these unique populations are able to receive care within their home community and in a familiar, culturally appropriate setting. They are treated in coordination with the local practitioners that best understand their ongoing care needs.	Desc
Total Program Service Expenses	$209,907,828	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	Yes (1)	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (1)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	303	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1381	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (1)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (1)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	14	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	AL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	AR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	CA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	FL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	GA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	HI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	IL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	KS	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	KY	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MD	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NV	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NH	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NJ	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NM	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NY	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NC	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	PA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	RI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	SC	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	TN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	UT	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	VA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WV	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	AK	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OK	StatesWhereCopyOfReturnIsFldCd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

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

US Address USAddress

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

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

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Dan Eisenbraun
Chair	5.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Sister Debra Kolecka OSB
Vice Chair	5.00	2.50	Yes (X)	Yes (X)	$0	$0	$0
Ken Karels
Director	5.00	0.00	Yes (X)		$0	$0	$0
Sister Mary Jaeger
Director	5.00	1.00	Yes (X)		$0	$0	$0
Sister Barbara McTague
Director	5.00	0.00	Yes (X)		$0	$0	$0
Sister Janet Horstman
Director	5.00	0.00	Yes (X)		$0	$0	$0
Clark Sinclair
Director	5.00	0.00	Yes (X)		$0	$0	$0
Dr Merritt Gregg Warren
Director	5.00	40.00	Yes (X)		$0	$203,313	$33,123
Sister Mary Kay Panowicz
Director	5.00	1.00	Yes (X)		$0	$0	$0
Gary Gaspar
Director	5.00	0.00	Yes (X)		$0	$0	$0
Cathy Clark
Director	5.00	0.00	Yes (X)		$0	$0	$0
Dr J Michael Bacharach
Director	5.00	0.00	Yes (X)		$0	$0	$0
Dr Dale Vizcarra
Director	5.00	1.00	Yes (X)		$0	$0	$0
Sister Pam Donelan
Director	5.00	0.00	Yes (X)		$0	$0	$0
John Porter
President and CEO thru May 2018	40.00	0.00	Yes (X)	Yes (X)	$1,768,380	$0	$38,156
Bob Sutton
President and CEO began June 2018	40.00	0.00	Yes (X)	Yes (X)	$522,924	$0	$42,493
James Breckenridge
Secretary and CFO	38.70	1.30		Yes (X)	$887,406	$0	$34,116
Fredrick Slunecka
Chief Operating Officer	40.00	0.00			$1,167,988	$0	$35,556	Yes (X)
David Flicek
Pres/CEO - Avera McKennan	40.00	40.00			$742,425	$0	$43,493	Yes (X)
David Erickson
Chief Medical Officer	40.00	0.00			$761,544	$0	$42,599		Yes (X)
Todd Forkel
Pres/CEO - Avera St. Luke's	0.00	40.00			$683,117	$0	$32,568		Yes (X)
Richard Korman
Senior VP - General Counsel	40.00	0.00			$625,619	$0	$42,493		Yes (X)
Robin Bates
Exec VP - Ins Serv and Pop Health	40.00	0.00			$552,489	$0	$38,156		Yes (X)
Douglas Ekeren
Pres/CEO - Avera Sacred Heart	0.00	40.00			$502,279	$0	$38,156		Yes (X)
David Kapaska - Former HCE
Pres/CEO - Avera McKennan	0.00	0.00			$983,620	$0	$23,808			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$9,197,791	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$203,313	TotReportableCompRltdOrgAmt
Total Other Compensation	$444,717	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	154	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
CDW Government
230 N Milwaukee Ave	Vernon Hills	IL	60061	Computer Hardware Consulting	$16,776,538
Avera McKennan
1325 S Cliff Avenue	Sioux Falls	SD	57117	Services, computer hardware & software	$9,684,315
Elekta
400 Perimeter Center Terrace Suite	Atlanta	GA	30346	Computer Hardware/Software/Consulting/Ca	$4,057,292
Medspeed
655 West Grand Avenue	Elmhurst	IL	60126	Courier Services	$3,529,604
Medical Information Technology
1 Meditech Circle	Westwood	MA	02090	Hardware/Software Consulting	$3,313,011

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	113	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$642,325	FederatedCampaignsAmt
Fundraising	$1,079,377	FundraisingAmt
Related Organizations	$68,711	RelatedOrganizationsAmt
Government Grants	$1,888,591	GovernmentGrantsAmt
All Other Contributions	$10,788,697	AllOtherContributionsAmt
Noncash Contributions	$251,665	NoncashContributionsAmt
Total Contributions	$14,467,701	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
ACS revenue	900099	$154,420,664	$154,420,664
eCare revenue	900099	$29,994,806	$29,994,806
PACE revenue	561000	$6,997,773	$6,140,163	$857,610
Premier expense credit	900099	$6,465,972	$6,465,972
Inc from affiliates	561000	$70,838	-$271,908	$342,746

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,017,502	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,017,502	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$199,967,555	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,317,953	TotalRevenueColumnAmt
Exclusion	$1,317,953	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,877,516	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,788,385	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$89,131	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$89,131	TotalRevenueColumnAmt
Unrelated Business Revenue	$89,131	UnrelatedBusinessRevenueAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$967,564	SecuritiesAmt
Other	$18,868	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$967,564	SecuritiesAmt
Other	$18,868	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$986,432	TotalRevenueColumnAmt
Exclusion	$986,432	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$683,749	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$1,079,377	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$374,291	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$309,458	TotalRevenueColumnAmt
Exclusion	$309,458	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	A/R Interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$8,318,873	TotalRevenueColumnAmt
Related Or Exempt Func Income	$8,318,873	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$8,318,873	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$225,457,103	TotalRevenueColumnAmt
Related Or Exempt Func Income	$207,086,072	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$1,289,487	UnrelatedBusinessRevenueAmt
Exclusion	$2,613,843	ExclusionAmt

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

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$15,422,839	TotalAmt
Program Services	$15,422,839	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$159,875	TotalAmt
Program Services	$159,875	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$3,880,365	TotalAmt
Management And General	$3,880,365	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$59,526	TotalAmt
Program Services	$59,526	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$87,748,173	TotalAmt
Program Services	$77,316,335	ProgramServicesAmt
Management And General	$10,431,838	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$7,662,990	TotalAmt
Program Services	$6,791,268	ProgramServicesAmt
Management And General	$871,722	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$15,269,339	TotalAmt
Program Services	$12,960,815	ProgramServicesAmt
Management And General	$2,308,524	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$6,471,045	TotalAmt
Program Services	$6,005,256	ProgramServicesAmt
Management And General	$465,789	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$106,657	TotalAmt
Management And General	$106,657	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,179,018	TotalAmt
Program Services	$763,699	ProgramServicesAmt
Management And General	$415,319	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$40,956	TotalAmt
Program Services	$40,956	ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$42,162,359	TotalAmt
Program Services	$37,023,388	ProgramServicesAmt
Management And General	$5,138,971	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$9,314,758	TotalAmt
Program Services	$9,238,883	ProgramServicesAmt
Management And General	$75,875	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$7,774,385	TotalAmt
Program Services	$7,350,691	ProgramServicesAmt
Management And General	$423,694	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$9,497,033	TotalAmt
Program Services	$9,398,966	ProgramServicesAmt
Management And General	$98,067	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$3,874,873	TotalAmt
Program Services	$3,259,112	ProgramServicesAmt
Management And General	$615,761	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,932,969	TotalAmt
Program Services	$1,756,295	ProgramServicesAmt
Management And General	$176,674	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$1,203,941	TotalAmt
Program Services	$1,053,376	ProgramServicesAmt
Management And General	$150,565	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$255,078	TotalAmt
Management And General	$255,078	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$19,718,585	TotalAmt
Program Services	$19,030,129	ProgramServicesAmt
Management And General	$688,456	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$353,236	TotalAmt
Program Services	$232,869	ProgramServicesAmt
Management And General	$120,367	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Grant Prog Expenditures	$583,899	$583,899
License & publications	$519,747	$512,733	$7,014
UBI tax	$486,511		$486,511
Foundation expenses	$340,126	$340,126

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	-$1,120,485	TotalAmt
Program Services	$606,792	ProgramServicesAmt
Management And General	-$1,727,277	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$234,897,798	TotalAmt
Program Services	$209,907,828	ProgramServicesAmt
Management And General	$24,989,970	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

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

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$2,587,101	BOYAmt
EOY	$22,583,709	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$819,321	BOYAmt
EOY	$230,615	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$11,520,461	BOYAmt
EOY	$15,166,840	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$4,750,610	BOYAmt
EOY	$4,652,651	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$962,367	BOYAmt
EOY	$511,303	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$7,678,449	BOYAmt
EOY	$10,269,822	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$178,432,095	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$79,910,975	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$102,696,792	BOYAmt
EOY	$98,521,120	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$755,017,402	BOYAmt
EOY	$796,174,085	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$156,100,597	BOYAmt
EOY	$180,652,447	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$33,615	BOYAmt
EOY	$21,208	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,139,552	BOYAmt
EOY	$16,139,552	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$9,130,453	BOYAmt
EOY	$137,098,675	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,067,436,720	BOYAmt
EOY	$1,282,022,027	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$20,592,416	BOYAmt
EOY	$31,744,090	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$6,078,613	BOYAmt
EOY	$3,745,366	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$10,473,243	BOYAmt
EOY	$28,066,451	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$645,715,791	BOYAmt
EOY	$708,539,428	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$30,823,538	BOYAmt
EOY	$29,145,378	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$41,595,037	BOYAmt
EOY	$177,427,247	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$755,278,638	BOYAmt
EOY	$978,667,960	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$308,992,474	BOYAmt
EOY	$300,038,875	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,720,423	BOYAmt
EOY	$2,824,509	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$445,185	BOYAmt
EOY	$490,683	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$312,158,082	BOYAmt
EOY	$303,354,067	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,067,436,720	BOYAmt
EOY	$1,282,022,027	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$9,440,695	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$4,718,111	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$4,081,431	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	Yes (X)	PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$8,015,201	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$12,575,041	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$17,527,901	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$15,789,136	CurrentTaxYearMinus1YearAmt
Current Tax Year	$14,467,701	CurrentTaxYearAmt
Total	$68,374,980	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$125,942,998	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$150,269,980	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$170,255,307	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$186,832,895	CurrentTaxYearMinus1YearAmt
Current Tax Year	$207,086,072	CurrentTaxYearAmt
Total	$840,387,252	TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$578,521	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$612,510	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$691,652	CurrentTaxYearMinus1YearAmt
Current Tax Year	$683,749	CurrentTaxYearAmt
Total	$2,566,432	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$133,958,199	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$163,423,542	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$188,395,718	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$203,313,683	CurrentTaxYearMinus1YearAmt
Current Tax Year	$222,237,522	CurrentTaxYearAmt
Total	$911,328,664	TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$5,755	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$78,763	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$33,177	CurrentTaxYearMinus1YearAmt
Current Tax Year	$101,472	CurrentTaxYearAmt
Total	$219,167	TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$67,619,274	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$93,124,170	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$113,505,331	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$122,171,044	CurrentTaxYearMinus1YearAmt
Current Tax Year	$130,522,462	CurrentTaxYearAmt
Total	$526,942,281	TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$67,619,274	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$93,129,925	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$113,584,094	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$122,204,221	CurrentTaxYearMinus1YearAmt
Current Tax Year	$130,623,934	CurrentTaxYearAmt
Total	$527,161,448	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total509	$384,167,216	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$761,213	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$626,811	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$456,596	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,875,452	CurrentTaxYearMinus1YearAmt
Current Tax Year	$1,317,953	CurrentTaxYearAmt
Total	$6,038,025	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$761,213	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$626,811	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$456,596	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,875,452	CurrentTaxYearMinus1YearAmt
Current Tax Year	$1,317,953	CurrentTaxYearAmt
Total	$6,038,025	TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$105,051	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$129,714	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$92,791	CurrentTaxYearMinus2YearsAmt
Current Tax Year	$344,310	CurrentTaxYearAmt
Total	$671,866	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$134,824,463	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$164,180,067	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$188,945,105	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$206,189,135	CurrentTaxYearMinus1YearAmt
Current Tax Year	$223,899,785	CurrentTaxYearAmt
Total	$918,038,555	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.41850	PublicSupportCY509Pct
Public Support PY509	0.43170	PublicSupportPY509Pct
Investment Income CY	0.00660	InvestmentIncomeCYPct
Investment Income PY	0.00720	InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509	Yes (X)	ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	Yes (1)	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	Yes (1)	DirectContactLegislatorsInd
Direct Contact Legislators	$21,837	DirectContactLegislatorsAmt
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$19,119	OtherActivitiesAmt
Total Lobbying Expenditures	$40,956	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Through paid staff and paid consultants Avera Health meets with legislatures. Avera Health provides grants to other organizations for lobbying and pays dues of which a small portion is attributable to lobbying.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,004,011	BeginningYearBalanceAmt
Contributions	$421,937	ContributionsAmt
Investment Earnings Or Losses	$280,361	InvestmentEarningsOrLossesAmt
Other Expenditures	$386,932	OtherExpendituresAmt
Administrative Expenses	$23,814	AdministrativeExpensesAmt
End Year Balance	$5,295,563	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,854,052	BeginningYearBalanceAmt
Contributions	$583,639	ContributionsAmt
Investment Earnings Or Losses	$147,566	InvestmentEarningsOrLossesAmt
Other Expenditures	$548,377	OtherExpendituresAmt
Administrative Expenses	$32,869	AdministrativeExpensesAmt
End Year Balance	$5,004,011	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,361,194	BeginningYearBalanceAmt
Contributions	$413,851	ContributionsAmt
Investment Earnings Or Losses	$391,376	InvestmentEarningsOrLossesAmt
Other Expenditures	$277,515	OtherExpendituresAmt
Administrative Expenses	$34,854	AdministrativeExpensesAmt
End Year Balance	$4,854,052	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$3,542,771	BeginningYearBalanceAmt
Contributions	$367,555	ContributionsAmt
Investment Earnings Or Losses	$782,973	InvestmentEarningsOrLossesAmt
Other Expenditures	$296,350	OtherExpendituresAmt
Administrative Expenses	$35,755	AdministrativeExpensesAmt
End Year Balance	$4,361,194	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$3,302,432	BeginningYearBalanceAmt
Contributions	$477,896	ContributionsAmt
Investment Earnings Or Losses	$155,637	InvestmentEarningsOrLossesAmt
Other Expenditures	$370,880	OtherExpendituresAmt
Administrative Expenses	$22,314	AdministrativeExpensesAmt
End Year Balance	$3,542,771	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.55570	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.23780	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.20650	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$948,600	OtherCostOrOtherBasisAmt
Book Value	$948,600	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$29,744,865	OtherCostOrOtherBasisAmt
Depreciation	$8,510,237	DepreciationAmt
Book Value	$21,234,628	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,554,336	OtherCostOrOtherBasisAmt
Depreciation	$2,467,172	DepreciationAmt
Book Value	$2,087,164	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$122,983,198	OtherCostOrOtherBasisAmt
Depreciation	$68,933,566	DepreciationAmt
Book Value	$54,049,632	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$20,201,096	OtherCostOrOtherBasisAmt
Book Value	$20,201,096	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$98,521,120	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (5 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Interest in Innovation Institute	$12,519,867	F
Non-publicly traded hedge, private equity, debt, and multi-strategy funds	$155,199,527	F
Non-publicly traded real estate	$12,232,767	F
NPPC, LLC	$100,000	C
Premier Purchasing Partners, L.P.	$600,286	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$180,652,447	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
Deferred financing costs	$7,988,854
Bond project fund	$128,041,099
Interest in South Dakota Community Foundation	$1,068,222
Due from related entity	$500

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$137,098,675	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
Estimated insurance claims payable	$37,157,888
Bond interest payable	$8,544,579
Due to affiliated entities	$131,724,780

Field	Value	IRS element (for citing)
Total Liability	$177,427,247	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Avera Health administers the Avera Health Pooled Investment Fund, a fund that is maintained for the benefit of facilities that are sponsored, operated, or managed by Avera Health. Investments are made in conformity with the objectives and guidelines of the Avera Health Pooled Investment Committee. Within the fund, participating facilities share in a pool of investments that are managed by various fund managers. Investments that are held for participating facilities are recorded as Avera Health Pooled Investments with a corresponding liability account of Custodial Funds - Avera Health Pooled Investments on the balance sheet. Avera Health also holds its own investments within the pooled fund and records their allocated share of income and losses from these investments as investment income in the financial statements.
Part V, Line 4:	The Organization's endowment consists of approximately 98 individual funds established for a variety of purposes related to health and wellness programs in Avera affiliated organizations.
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.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

Field	Value	IRS element (for citing)
Region	Central America and the Caribbean -	RegionTxt
Offices	0	OfficesCnt
Employee	0	EmployeeCnt
Type Of Activities Conducted	Investments reported on cost basis	TypeOfActivitiesConductedTxt
Region Total Expenditures	$106,809,297	RegionTotalExpendituresAmt

Field	Value	IRS element (for citing)
Subtotal Offices	0	SubtotalOfficesCnt
Subtotal Employees	0	SubtotalEmployeesCnt
Continuation Total Office	0	ContinuationTotalOfficeCnt
Continuation Total Employee	0	ContinuationTotalEmployeeCnt
Total Office	0	TotalOfficeCnt
Total Employee	0	TotalEmployeeCnt
Subtotal Spent	$106,809,297	SubtotalSpentAmt
Continuation Spent	$0	ContinuationSpentAmt
Total Spent	$106,809,297	TotalSpentAmt
Transfer To Foreign Corp	Yes (1)	TransferToForeignCorpInd
Interest In Foreign Trust	0	InterestInForeignTrustInd
Foreign Corp Ownership	0	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	0	PassiveForeignInvestmestCoInd
Foreign Partnership	0	ForeignPartnershipInd
Boycott Countries	0	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Form 990, Schedule F, Part IV:	FormAndLineReferenceDesc
Explanation	Avera Health reviews its direct and indirect investments during the tax period for determining required foreign filings. The Organization's ownership interests in foreign corporations do not require a Form 5471 to be filed. The Organization invests in partnerships that hold direct or indirect interest in passive foreign investment companies. The investment partnerships have properly filed Form 8621, or the underlying investments did not generate any unrelated business income. Under these facts, Avera Health is not required to file an additional Form 8621.	ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Race Against Breast Cancer	Event1Nm
Gross Receipts Event1	$500,173	GrossReceiptsEvent1Amt
Charitable Contri Event1	$328,301	CharitableContriEvent1Amt
Gross Revenue Event1	$171,872	GrossRevenueEvent1Amt
Non Cash Prizes Event1	$11,500	NonCashPrizesEvent1Amt
Other Direct Expenses Event1	$139,638	OtherDirectExpensesEvent1Amt
Event2	The Big Grape Reserve	Event2Nm
Gross Receipts Event2	$215,836	GrossReceiptsEvent2Amt
Charitable Contri Event2	$173,950	CharitableContriEvent2Amt
Gross Revenue Event2	$41,886	GrossRevenueEvent2Amt
Other Direct Expenses Event2	$43,840	OtherDirectExpensesEvent2Amt
Other Events Total	29	OtherEventsTotalCnt
Gross Receipts Other Events	$1,047,117	GrossReceiptsOtherEventsAmt
Charitable Contri Other Events	$577,126	CharitableContriOtherEventsAmt
Gross Revenue Other Events	$469,991	GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events	$179,313	OthDirectExpnssOtherEventsAmt
Gross Receipts Total	$1,763,126	GrossReceiptsTotalAmt
Charitable Contributions Tot	$1,079,377	CharitableContributionsTotAmt
Gross Revenue Total Events	$683,749	GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events	$11,500	NonCashPrizesTotalEventsAmt
Oth Direct Expnss Total Events	$362,791	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$374,291	DirectExpenseSummaryEventsAmt
Net Income Summary	$309,458	NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (125 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Aberdeen Catholic School System
1400 N Dakota St	Aberdeen	SD	57401	460336005	501c3	$89,500	Sponsorship
Aberdeen Christian School
1500 Hwy 281 N	Aberdeen	SD	57401	911806433	501c3	$10,500	Sponsorship
Aberdeen Ride Line
205 N 4th St	Aberdeen	SD	57401	466000010	501c3	$15,000	Sponsorship
ALS Association - MNNDSD Chapter
333 N Washington Ave Ste 105	Minneapolis	MN	55401	411756085	501c3	$15,000	Sponsorship
American Cancer Society
250 Williams St	Atlanta	GA	30303	131788491	501c3	$37,900	Sponsorship
American Cancer Society Cancer Action Network
555 11th St NW Ste 300	Washington	DC	20004	522340031	501c4	$8,500	Sponsorship
American Heart Association - Midwest Affiliate
PO Box 50035	Prescott	AZ	86304	135613797	501c3	$25,000	Sponsorship
American Red Cross of Eastern SD
808 West Ave North	Sioux Falls	SD	57104	530196605	501c3	$10,000	Sponsorship
Boys & Girls Club of Aberdeen Area
1121 1st Ave SE	Aberdeen	SD	57401	237062273	501c3	$60,000	Sponsorship
Boys & Girls Club of the Sioux Empire
824 E 14th St	Sioux Falls	SD	57104	460399482	501c3	$10,000	Sponsorship
Brandon Valley Baseball Association
PO Box 605	Brandon	SD	57005	460401362	501c3	$10,000	Sponsorship
Brandon Valley Booster Club
PO Box 572	Brandon	SD	57005	460393971	501c3	$6,500	Sponsorship
Brookings Health System
300 22nd Ave	Brookings	SD	57006	466000069	City of Brookings	$30,500	Sponsorship
Brookings School District
2130 8th St S	Brookings	SD	57006	466000834	City of Brookings	$36,050	Sponsorship
Canton School District 41-1
800 N Main St	Canton	SD	57013	466002143	City of Canton	$10,000	Sponsorship
Sioux Falls School District 49-5 (CTE Academy)
4700 W Career Cir	Sioux Falls	SD	57107	466002586	City of Sioux Falls	$12,500	Sponsorship
Catholic Community Foundation for Eastern SD
523 N Duluth Ave	Sioux Falls	SD	57104	466000424	501c3	$100,000	Sponsorship
Charis Ministry Partners
1300 E 10th St	Sioux Falls	SD	57103	383775128	501c3	$7,000	Sponsorship
Children's Home Society of South Dakota Foundation
PO Box 1749	Sioux Falls	SD	57101	460224542	501c3	$12,000	Sponsorship
Citizens Involvement Council
2520 E Franklin	Pierre	SD	57501	460317107	501c3	$10,000	Sponsorship
City of Mitchell
612 N Main St	Mitchell	SD	57301	466000305	City of Mitchell	$15,000	Sponsorship
Compass Center
1704 S Cleveland Ave Ste 3	Sioux Falls	SD	57103	460350199	501c3	$5,500	Sponsorship
Dakota Resources
25795 475th Ave Ste 1	Renner	SD	57055	460442430	501c3	$35,000	Sponsorship
Dakota Wesleyan University
1200 W University Ave	Mitchell	SD	57301	460224589	501c3	$34,500	Sponsorship
DakotAbilities
1116 S 4th Ave	Sioux Falls	SD	57105	460306216	501c3	$13,000	Sponsorship
Daktronics Inc
PO Box 86	Minneapolis	MN	55486	460306862		$11,250	Community Development
Delta Dental of South Dakota Foundation
804 N Euclid Ave Ste 101	Pierre	SD	57501	911776857	501c3	$20,000	Sponsorship
Destiny Healthcare International
1417 S Minnesota Ave	Sioux Falls	SD	57105	510529480	501c3	$15,000	Sponsorship
Dow Rummel Village
1321 W Dow Rummel St	Sioux Falls	SD	57104	460271277	501c3	$25,000	Sponsorship
Downtown Sioux Falls Inc
230 S Phillips Ave Ste 102	Sioux Falls	SD	57104	363627217	501c4	$21,000	Sponsorship
EmBe
300 W 11th St	Sioux Falls	SD	57104	460234998	501c3	$31,500	Sponsorship
Etc for Her
1112 S Holly Dr	Sioux Falls	SD	57105	263803061		$19,000	Sponsorship
Family Visitation Center
311 E 14th St	Sioux Falls	SD	57104	263654937	501c3	$18,500	Sponsorship
Feeding South Dakota
4701 N Westport Ave	Sioux Falls	SD	57107	363293534	501c3	$25,100	Sponsorship
Fellowship of Christian Athletes
8701 Leeds Road	Kansas City	MO	64129	440610626	501c3	$20,000	Sponsorship
Forward Sioux Falls
PO Box 907	Sioux Falls	SD	57101	460396647		$150,000	Sponsorship
Furniture Mission of South Dakota
209 N Nesmith Ave	Sioux Falls	SD	57103	810584450	501c3	$9,000	Sponsorship
Glacial Lakes Area Development
PO Box 231	Britton	SD	57430	870787080	501c3	$10,000	Sponsorship
Governor's Office of Economic Development
711 E Wells Ave	Pierre	SD	57501	466000364	State of SD	$16,000	Sponsorship
Ground Works
201 N Weber Ave Ste 201	Sioux Falls	SD	57103	475498537	501c3	$6,000	Sponsorship
Habitat for Humanity of the Brookings Area
PO Box 412	Brookings	SD	57006	460437158	501c3	$15,000	Sponsorship
Harrisburg Baseball Association
PO Box 434	Harrisburg	SD	57032	270606157	501c3	$18,000	Sponsorship
Harrisburg School District
PO Box 187	Harrisburg	SD	57032	466002218	City of Harrisburg	$27,000	Sponsorship
Helpline Center Inc
1000 N West Ave Ste 310	Sioux Falls	SD	57104	237424387	501c3	$15,000	Sponsorship
Holy Redeemer Catholic Church
503 W Lyon St	Marshall	MN	56258	410718327	501c3	$50,000	Sponsorship
Junior Achievement of South Dakota
1000 N West Ave Ste 110	Sioux Falls	SD	57104	460306352	501c3	$17,025	Sponsorship
LifeLight Communications Inc
2601 S Western Ave	Sioux Falls	SD	57105	460460742	501c3	$10,000	Sponsorship
Make-A-Wish Foundation of SD
1400 W 17th St	Sioux Falls	SD	57104	460375953	501c3	$10,000	Sponsorship
Marshall Fire Department Relief Assn
201 E Saratoga St	Marshall	MN	56258	410978542	501c4	$7,500	Sponsorship
McCrossan Boys Ranch
47135 260th St	Sioux Falls	SD	57107	460311913	501c3	$11,000	Sponsorship
Mitchell Aquatic Club
PO Box 1371	Mitchell	SD	57301	460461058	501c3	$25,000	Sponsorship
Mitchell Technical Institute Foundation
1800 E Spruce St	Mitchell	SD	57301	460452950	501c3	$80,250	Sponsorship
Mitchell United Way
417 N Main St Suite 103	Mitchell	SD	57301	461250302	501c3	$6,000	Sponsorship
Mount Marty College
1105 W 8th St	Yankton	SD	57078	460283336	501c3	$258,081	Sponsorship
NAMI South Dakota
PO Box 88808	Sioux Falls	SD	57109	363593027	501c3	$27,500	Sponsorship
National Field Archery Association Foundation
800 Archery Ln	Yankton	SD	57078	330430066	501c3	$25,000	Sponsorship
National Kidney Foundation
30 East 33rd St 3rd fl	New York	NY	10016	131673104	501c3	$15,500	Sponsorship
The National MS Society Upper Midwest Chapter
200 12th Ave S	Minneapolis	MN	55415	410790658	501c3	$16,000	Sponsorship
NSU Foundation
620 15th Ave SE	Aberdeen	SD	57401	237002314	501c3	$150,000	Sponsorship
OLLI at University Center
4801 N Career Ave	Sioux Falls	SD	57107	466000364	State of SD	$7,500	Sponsorship
Philanthropy Promotions Inc
2601 W 60th St N	Sioux Falls	SD	57107	870695596	501c3	$20,000	Sponsorship
Pierre Area Chamber of Commerce
800 W Dakota Ave	Pierre	SD	57501	460177425	501c6	$6,700	Sponsorship
Pierre School District
211 S Poplar St	Pierre	SD	57501	466001892	City of Pierre	$10,000	Sponsorship
Post 8 Baseball
PO Box 431	Pierre	SD	57501	466008690	501c3	$10,000	Sponsorship
Prairie Family Business Association
4801 N Career Ave Ste 140	Sioux Falls	SD	57107	466000364	State of SD	$5,500	Sponsorship
Presentation College
1500 N Main St	Aberdeen	SD	57401	460280847	501c3	$250,600	Sponsorship
Presentation Sisters of the Blessed Virgin Mary
1500 N 2nd St	Aberdeen	SD	57401	460253283	501c3	$22,500	Sponsorship
Pride in the Tiger Foundation
400 Tiger Dr	Marshall	MN	56258	411948007	501c3	$10,000	Sponsorship
Ronald McDonald House Charities of SD
825 S Lake Ave	Sioux Falls	SD	57104	460371152	501c3	$20,000	Sponsorship
Safe Harbor
PO Box 41	Aberdeen	SD	57402	460344310	501c3	$11,000	Sponsorship
SculptureWalk Inc
300 S Phillips Ave Ste L104	Sioux Falls	SD	57104	208535871	501c3	$19,500	Sponsorship
SD Youth Foundation Inc
1310 Main Ave S Ste 109	Brookings	SD	57006	474832848	501c3	$10,000	Sponsorship
South Dakot Agriculatural & Rural Leadership Inc
1905 N Plaza Blvd	Rapid City	SD	57702	364293293	501c3	$10,000	Sponsorship
South Dakota State University
Box 2201	Brookings	SD	57007	466000364	501c3	$8,010	Sponsorship
SDSU Foundation
815 Medary Ave	Brookings	SD	57006	460273801	501c3	$165,000	Scholarship
Sioux Empire Baseball Association
1601 W 44th Pl Ste 3	Sioux Falls	SD	57105	411903475	501c3	$16,000	Sponsorship
Sioux Empire United Way
1000 N West Ave Ste 120	Sioux Falls	SD	57104	460233701	501c3	$84,240	Sponsorship
Sioux Falls Catholic Schools
3100 W 41st St	Sioux Falls	SD	57105	460413591	501c3	$1,000,000	Sponsorship
Sioux Falls Jazz & Blues Society
PO Box 1285	Sioux Falls	SD	57101	460418356	501c3	$20,000	Sponsorship
Sioux Falls Youth Hockey Association
4235 W Mesa Pass	Sioux Falls	SD	57106	460427805	501c3	$17,500	Sponsorship
South Dakota Chamber of Commerce and Industry
PO Box 190	Pierre	SD	57501	460141180	501c6	$7,500	Sponsorship
South Dakota Hall of Fame
1480 S Main	Chamberlain	SD	57325	460324210	501c3	$25,000	Sponsorship
South Dakota Community Foundation
1714 North Lincoln Ave	Pierre	SD	57501	460398115	501c3	$50,000	Sponsorship
South Dakota Symphony Orchestra
301 S Main Ave	Sioux Falls	SD	57104	466017026	501c3	$57,250	Sponsorship
Southeast Technical Institute Foundation
2320 N Career Ave	Sioux Falls	SD	57107	364112897	501c3	$20,000	Scholarship
Special Olympics South Dakota
800 East I-90 Lane	Sioux Falls	SD	57104	460359776	501c3	$17,500	Sponsorship
Stockyards Plaza Inc
PO Box 2042	Sioux Falls	SD	57101	465391991	501c3	$50,000	Sponsorship
Teach for America-South Dakota
25 Broadway 12th fl	New York	NY	10004	133541913	501c3	$12,500	Sponsorship
Tempo Soccer Club
PO Box 776	Tea	SD	57064	475029561	501c3	$7,000	Sponsorship
United Way of Northeastern SD Inc
PO Box 1065	Aberdeen	SD	57401	237086355	501c3	$10,000	Sponsorship
United Way of Yankton
610 W 23rd St Ste 11	Yankton	SD	57078	460252854	501c3	$12,500	Sponsorship
University of Sioux Falls
1101 W 22nd St	Sioux Falls	SD	57105	460224600	501c3	$400,000	Sponsorship
USD Foundation
PO Box 5555	Vermillion	SD	57069	466018891	501c3	$75,000	Scholarship
USD Sanford School of Medicine
414 E Clark St	Vermillion	SD	57069	466000364	State of SD	$25,250	Sponsorship
Vision Brookings Foundation
2301 Research Park Way Ste 113	Brookings	SD	57006	460440746	501c3	$20,000	Sponsorship
Volunteers of America Dakotas
PO Box 89306	Sioux Falls	SD	57109	237353508	501c3	$15,000	Sponsorship
Yankton Area Progressive Growth
803 E 4th St	Yankton	SD	57078	460348636	501c6	$60,000	Sponsorship
Yankton School District 63-3
2410 W City Limits Rd	Yankton	SD	57078	466003280	City of Yankton	$15,000	Sponsorship
Bishop Dudley Hospitality House
101 N Indiana Ave	Sioux Falls	SD	57103	911836528	501c3	$10,000	Sponsorship
Avera McKennan Hospital
1325 S Cliff Ave	Sioux Falls	SD	57105	460224743	501c3	$4,180,006	Sponsorship
Avera St Mary's
801 E Sioux Avenue	Pierre	SD	57501	460230199	501c3	$129,164	Sponsorship
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	501c3	$23,000	Sponsorship
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	501c3	$238,253	Sponsorship
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	501c3	$11,458	Sponsorship
Avera Queen of Peace Hospital
525 North Foster	Mitchell	SD	57301	460224604	501c3	$528,928	Sponsorship
Sacred Heart Health Services
501 Summit Street	Yankton	SD	57078	460225483	501c3	$42,131	Sponsorship
Avera at Home
5116 S Solberg Avenue	Sioux Falls	SD	57108	460399291	501c3	$166,525	Sponsorship
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	501c3	$51,449	Sponsorship
Avera Marshall
300 South Bruce Street	Marshall	MN	56258	410919153	501c3	$80,720	Sponsorship
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	501c3	$9,981	Sponsorship
American Red Cross
431 18th Street NW	Washington	DC	20006	530196605	501c3	$28,088	Sponsorship
Weskota Foundation
604 1st Street NE	Wessington Springs	SD	57382	460415751	501c3	$7,569	Sponsorship
Catholic Charities USA
2050 Ballenger Avenue	Alexandria	VA	22314	530196620	501c3	$35,588	Sponsorship
Children's Museum of South Dakota
521 4th Street	Brookings	SD	57006	263493723	501c3	$38,657	Sponsorship
Eureka Community Health Services
PO Box 517	Eureka	SD	57437	460246437	501c3	$833,813	Sponsorship
Floyd Valley Healthcare
714 Lincoln Street NE	Lemars	IA	51031	420928451	501c3	$255,289	Sponsorship
Friends for Health in Haiti
PO Box 122	Pewaukee	WI	53072	204832316	501c3	$9,450	Sponsorship
Hegg Memorial Health Center
1202 21st Avenue	Rock Valley	IA	51247	420932564	501c3	$34,620	Sponsorship
King of Glory Church
1001 East 17th Street	Sioux Falls	SD	57104	452247326	501c3	$7,500	Sponsorship
Lakes Regional Healthcare
2301 Hwy 71	Spirit Lake	IA	51360	426037582	501c3	$24,782	Sponsorship
Landmann-Jungman Memorial Hospital
600 Billars Street	Scotland	SD	57059	466015787	501c3	$78,964	Sponsorship
Marshall County Healthcare Center
413 9th Street	Britton	SD	57430	460380552	501c3	$33,495	Sponsorship
Pipestone County Medical Center
916 4th Avenue SW	Pipestone	MN	56164	411392082	501c3	$14,625	Sponsorship
Platte Health Center
601 East 7th Street	Platte	SD	57369	460239781	501c3	$39,865	Sponsorship
Weskota Manor Inc
609 1st Street NE	Wessington Springs	SD	57382	460273307	501c3	$68,787	Sponsorship

Field	Value	IRS element (for citing)
Total501c3 Org	116	Total501c3OrgCnt
Total Other Org	9	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt
Haiti scholarships	27	$34,597
Medical assistance to employees	67	$125,278

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	The Organization makes grants to other organizations exempt under 501(c)(3) to ensure the funds will be used for charitable purposes. During the year ending June 30, 2018, the Organization made contributions to other non-public charities in furtherance of community development. The contributions are approved by the Board for this purpose. Scholarship funds have different sets of criteria for determining eligibility and winners. Assistance to individuals is determined with assistance from each hospital's social services department or within a committee at the hospital.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Dr Merritt Gregg Warren
Director	$0	$176,171	$0	$21,940	$0	$5,202	$0	$10,266	$0	$22,856	$0	$236,435	$0	$0
John Porter
President and CEO thru May 2018	$1,282,547	$0	$0	$0	$485,833	$0	$13,500	$0	$24,656	$0	$1,806,536	$0	$0	$0
Bob Sutton
President and CEO began June 2018	$392,340	$0	$520	$0	$130,064	$0	$13,500	$0	$28,993	$0	$565,417	$0	$0	$0
James Breckenridge
Secretary and CFO	$815,781	$0	$0	$0	$71,625	$0	$13,500	$0	$20,616	$0	$921,522	$0	$0	$0
Fredrick Slunecka
Chief Operating Officer	$1,097,138	$0	$0	$0	$70,850	$0	$13,500	$0	$22,056	$0	$1,203,544	$0	$0	$0
David Flicek
Pres/CEO - Avera McKennan	$689,489	$0	$0	$0	$52,936	$0	$13,500	$0	$29,993	$0	$785,918	$0	$0	$0
David Erickson
Chief Medical Officer	$557,540	$0	$0	$0	$204,004	$0	$13,500	$0	$29,099	$0	$804,143	$0	$0	$0
Todd Forkel
Pres/CEO - Avera St. Luke's	$512,786	$0	$50	$0	$170,281	$0	$7,865	$0	$24,703	$0	$715,685	$0	$0	$0
Richard Korman
Senior VP - General Counsel	$570,831	$0	$0	$0	$54,788	$0	$13,500	$0	$28,993	$0	$668,112	$0	$0	$0
Robin Bates
Exec VP - Ins Serv and Pop Health	$506,105	$0	$0	$0	$46,384	$0	$13,500	$0	$24,656	$0	$590,645	$0	$0	$0
Douglas Ekeren
Pres/CEO - Avera Sacred Heart	$376,003	$0	$1,500	$0	$124,776	$0	$13,500	$0	$24,656	$0	$540,435	$0	$0	$0
David Kapaska - Former HCE
Pres/CEO - Avera McKennan	$374,121	$0	$0	$0	$609,499	$0	$13,500	$0	$10,308	$0	$1,007,428	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 4a	FormAndLineReferenceDesc
Explanation	David Kapaska received $454,243 in severance payments. The amount is reported on Part VII, column (D).	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
South Dakota Health and Educational Facilities Authority
A	460315509	83755VUS1	2012-05-01	$206,383,927	2012A funded a project and refunded Series 2008A and Series 2002	0	0	0
South Dakota Health and Educational Facilities Authority
B	460315509	83755VNH3	2008-07-01	$61,495,000	2008C refunded 2006 Series	0	0	0
South Dakota Health and Educational Facilities Authority
C	460315509	83755VNB6	2008-06-18	$189,222,932	2012B refunded Series 1994, 2000, and bridge loan	0	0	0
South Dakota Health and Educational Facilities Authority
D	460315509	83755VVY7	2014-06-26	$61,821,688	2014A Various capital projects	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Advance RefundingAdvanceRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Credit EnhancementCreditEnhancementAmt
A	$144,093,927	$206,383,927	$1,032,422	$38,100,000	$167,251,505	2014	Yes (1)	Yes (1)	Yes (1)	Yes (1)
B	$7,520,000	$61,495,000	$388,831		$61,075,000	2010	Yes (1)	0	Yes (1)	Yes (1)	$31,169
C	$71,102,932	$189,222,932	$1,272,562	$91,009,361	$96,658,796	2010	Yes (1)	0	Yes (1)	Yes (1)	$282,213
D	$3,071,688	$61,821,688	$821,688	$61,000,000		2015	0	0	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	Yes (1)	Yes (1)	0	Yes (1)
B	0	Yes (1)	0	Yes (1)
C	Yes (1)	Yes (1)	0	Yes (1)
D	0	0		Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Business Name Line2HedgeProviderName/BusinessNameLine2Txt	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd
(no name)
A	0	0	0	Yes (1)	Yes (1)	0	0	0	Yes (1)
Bank of
B	0	0	0	Yes (1)	Yes (1)	Yes (1)	0	0	Yes (1)	America/Merrill	25.000000000000	0	Yes (1)
Bank of
C	0	0	0	Yes (1)	Yes (1)	Yes (1)	0	0	Yes (1)	America/Merrill	24.100000000000	0	0
(no name)
D	0	Yes (1)	0	0	0	0	0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule K, Part IV, Line 2C:	FormAndLineReferenceDesc
Explanation	The arbitrage analysis is performed annually, therefore the analysis was completed as of June 30, 2018 for Bonds A, B, and C.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	South Dakota Health and Educational Facilities Authority	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	460315509	BondIssuerEIN
CUSIP	83755VG99	CUSIPNum
Bond Issued	2017-10-11	BondIssuedDt
Issue Price	$242,848,916	IssuePriceAmt
Purpose	Series 2017 refund bond issued 6/18/08;construct/equip healthcare facilities	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$242,848,916	TotalProceedsAmt
Issuance Costs From Proceeds	$1,786,422	IssuanceCostsFromProceedsAmt
Capital Expenditures	$190,000,000	CapitalExpendituresAmt
Other Spent Proceeds	$51,062,494	OtherSpentProceedsAmt
Current Refunding	0	CurrentRefundingInd
Advance Refunding	Yes (1)	AdvanceRefundingInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.00000	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00000	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Grant Flicek
Family member of David Flicek, key employee	$59,526	Compensation as an employee	0
Interstates Office Products Inc
Owned by board member	$3,397,145	Office product purchases	0

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTradedGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	8	ContributionCnt
Noncash Contributions Rpt F990	$119,655	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Avg of high/low	MethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxInd	DescDesc	ContributionContributionCnt	Noncash Contributions Rpt F990NoncashContributionsRptF990Amt	Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)	Cryotherapy Chamber	1	$75,000	cost
Yes (X)	Items for patients and auction	21	$31,666	cost
Yes (X)	Audio Lighting	1	$20,515	cost
Yes (X)	Food for 2018 Gala	1	$4,829	cost

Field	Value	IRS element (for citing)
Form8283 Received	0	Form8283ReceivedCnt
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (1)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	Yes (1)	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Column (b):	Number of contributions are included in column (b).
Part I, Line 32b:	Avera Health uses third parties to process and sell the stocks received.
Part I, Line 33:	The only amounts included in revenue for the financial statement reporting are non-cash contributions of stock securities. Non-cash contributions not included for financial statements include items for the benefit of the Avera facilities which include special event donations.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Section A, line 6	The organization has two classes of members: Sponsorship Members and System Members. Sponsorship Members shall consist collectively of (i) those persons serving from time to time as the President and Council of the Presentation Sisters of the Blessed Virgin Mary of Aberdeen, South Dakota and (ii) those persons serving from time to time as the Prioress and Council of the Benedictine Convent of the Sacred Heart (Yankton, S.D.). System Members shall consist of six Sisters- three Presentation Sisters appointed by the Presentation Sponsorship Members and three Benedictine Sisters appointed by the Benedictine Sponsorship Members.
Form 990, Part VI, Section A, line 7a	The System Members have the power to appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause. They also have the power to appoint Benedictine or Presentation Sisters to the Boards of Directors of any sponsored work or ministry of Avera Health.
Form 990, Part VI, Section A, line 7b	The following powers shall be reserved to and exercised exclusively by the Sponsorship Members and none of the following actions shall be taken by Avera Health without action of the Sponsorship Members: (a) To approve the adoption, amendment or repeal of the statements of philosophy, mission, Guiding Principles and values of Avera Health; (b) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Avera Health, and to give final approval of any such action with respect thereto; (c) To establish policies regarding the alienation of real property and precious artifacts associated with the healthcare ministry which are under the canonical stewardship of the Presentation Sisters or the Benedictine Sisters; (d) To approve any plan of merger, consolidation or dissolution of Avera Health, or the divestiture of any sponsored work or ministry associated with Avera Health; (e) To change the composition of the Sponsorship Members, including the addition of other individuals, parties or entities to be Sponsorship Members; and (f) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of Avera Health. The following powers shall be reserved to and exercised exclusively by the System Members and none of the following actions shall be taken by Avera Health without action of the System Members: (a) To appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause; (b) To appoint Benedictine or Presentation Sisters to the Boards of Directors of any sponsored work or ministry of Avera Health; (c) To appoint the Chair and Vice Chair of the Board of Directors; (d) To appoint, evaluate, suspend or remove the President and Chief Executive Officer; (e) To review and approve the operating and capital budgets, including expenditures outside of budget, and the strategic plan, of Avera Health; (f) To adopt procedures for assuring that corporate actions are consistent with the philosophy, mission, Guiding Principles and values of Avera Health; (g) To provide recommendations to the Sponsorship Members on matters requiring Sponsorship Members' approval or action; (h) To adopt policies designed to effectuate the powers reserved to the System Members; and (i) To exercise oversight of the Guiding Principles and such authorities which may be assigned or delegated by the Sponsorship Members.
Form 990, Part VI, Section A, line 8b	Avera Health 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 VP of Financial Reporting, Tax Manager, 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	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 for compensation 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, conflict of interest policy, and financial statements are not made available to the general public.
Form 990, Part VI, Section B, Line 16b:	There is no written policy or procedure. 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 would be approved by the board and the member.
Form 990, Part VII:	David Flicek served as Chief Administration Officer for Avera Health through calendar year 2017. Starting in calendar year 2018 he served as President/CEO for Avera McKennan, a related organization. Part VII shows 40 hours served for Avera Health, the reporting organization, and 40 hours served for Avera McKennan, a related organization.
Form 990, Part IX, line 11g	Purchased services: Program service expenses 585,713. Management and general expenses 9,317. Fundraising expenses 0. Total expenses 595,030. Contracted services: Program service expenses 34,710,645. Management and general expenses 5,097,505. Fundraising expenses 0. Total expenses 39,808,150. Repairs and maintenance: Program service expenses 1,216,231. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,216,231. Professional fees: Program service expenses 170,435. Management and general expenses 15,251. Fundraising expenses 0. Total expenses 185,686. Recruitment: Program service expenses 340,364. Management and general expenses 16,898. Fundraising expenses 0. Total expenses 357,262.
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:	Net equity transfers -2,065,416. Insurance program admin income not recognized for tax reporting -826,050. Change in interest in net assets of foundations and trusts 47,507. Contributions received by Avera Health Foundation not reflected in financial statements -11,836,392. Net assets released from restrictions -528,894. Grants to organizations distributed by Avera Health Foundation not reflected in financial statements 11,127,814.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

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

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 West Avera Drive	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	571085721	ZIPCd

Field	Value	IRS element (for citing)
Primary Activities	Telehealth	PrimaryActivitiesTxt
Legal Domicile State	SD	LegalDomicileStateCd
Total Income	$0	TotalIncomeAmt
End Of Year Assets	$0	EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

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

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare services	NE	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare services	IA	501(c)(3)	Line 3	Avera Health	Yes (1)
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	Yes (1)
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	Yes (1)
Avera Queen of Peace Hospital
525 North Foster	Mitchell	SD	57301	460224604	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Sacred Heart Health Services
501 Summit Street	Yankton	SD	57078	460225483	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
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	Yes (1)
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	Yes (1)
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	Healthcare services	MN	501(c)(3)	Line 3	Avera Health	Yes (1)
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 & health plan admin	SD	501(c)(4)		Avera Health	Yes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd
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
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
Avera Home Medical Equipment of Spencer Hospital LLC
2400 S Minnesota Ave	Sioux Falls	SD	57117	800619999	Medical Services - home medical equipment	SD	N/A
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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
Accounts Management Inc
5132 S Cliff Ave Suite 101	Sioux Falls	SD	57108	460373021	Collection agency	SD	Avera Health	C	$2,898,977	$2,179,088	0.75000	Yes (1)
Avera Property Insurance Inc
610 W 23rd St PO Box 38	Yankton	SD	57078	460463155	Insurance	SD	Avera Health	C	$487,404	$1,090,635	1.00000	Yes (1)
Valley Health Services
501 Summit Street	Yankton	SD	57078	460357149	Rental real estate	SD		C				0	N/A
Alucent Medical Inc
1325 S Cliff Avenue PO Box 5045	Sioux Falls	SD	571175045	471818349	Biotech Research	SD		C				0	N/A
South Dakota State Medical Holding Company Inc
2600 W 49th Street	Sioux Falls	SD	57105	460401087	Insurance	SD	Avera Health	C	$57,513,230	$26,530,916	1.00000	Yes (1)
DakotaCare Administrative Services Inc
2600 W 49th Street	Sioux Falls	SD	57105	460424322	Insurance	SD	Avera Health	C	$5,865,922	$13,195,270	1.00000	Yes (1)

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

Transactions Related Org TransactionsRelatedOrgGrp (38 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Avera St Mary's
D	$176,831	Change in note receivable
Accounts Management Inc
L	$400,980	General ledger
Avera at Home
L	$2,307,756	General ledger
Avera Health Plans Inc
L	$441,996	General ledger
Avera Marshall
L	$5,883,612	General ledger
Avera McKennan
L	$87,687,096	General ledger
Avera Queen of Peace Hospital
L	$11,499,528	General ledger
Avera Sacred Heart Health Services
L	$14,500,104	General ledger
Avera St Luke's
L	$16,947,516	General ledger
Avera St Mary's
L	$7,369,836	General ledger
South Dakota State Medical Holding Company
L	$99,996	General ledger
Avera Health Plans Inc
P	$1,863,759	Vendor payment listing
Avera Marshall
P	$566,922	Vendor payment listing
Avera McKennan
P	$12,115,564	Vendor payment listing
Avera Queen of Peace Hospital
P	$464,551	Vendor payment listing
Avera Sacred Heart Health Services
P	$431,977	Vendor payment listing
Avera St Luke's
P	$309,764	Vendor payment listing
Avera St Mary's
P	$59,806	Vendor payment listing
Accounts Management Inc
Q	$114,943	Customer invoice listing
Avera at Home
Q	$687,800	Customer invoice listing
Avera Health Plans Inc
Q	$130,118	Customer invoice listing
Avera Holy Family
Q	$376,451	Customer invoice listing
Avera Marshall
Q	$1,683,351	Customer invoice listing
Avera McKennan
Q	$37,324,093	Customer invoice listing
Avera Queen of Peace Hospital
Q	$4,474,154	Customer invoice listing
Avera Sacred Heart Health Services
Q	$4,720,010	Customer invoice listing
Avera St Anthony's Hospital
Q	$626,183	Customer invoice listing
Avera St Luke's
Q	$7,764,684	Customer invoice listing
Avera St Mary's
Q	$2,648,092	Customer invoice listing
St Benedict Health Center
Q	$341,401	Customer invoice listing
South Dakota State Medical Holding Company
Q	$505,420	Customer invoice listing
Avera at Home
R	$166,525	General ledger
Avera Holy Family
R	$238,253	General ledger
Avera Marshall
R	$80,720	General ledger
Avera McKennan
R	$17,716,536	General ledger
Avera Queen of Peace Hospital
R	$528,928	General ledger
Avera St Luke's
R	$51,449	General ledger
Avera St Mary's
R	$119,164	General ledger