SACRED HEART HEALTH SERVICES: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: SACRED HEART HEALTH SERVICES (EIN 46-0225483)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2019-05-14
IRS object ID: 201921349349308222
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 G
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-05-14T15:28:29-05:00	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	460225483	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sacred Heart Health Services	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	SACR	BusinessNameControlTxt
Phone	6056688000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	501 Summit Street	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Jim Breckenridge	PersonNm
Person Title	CFO Avera Health	PersonTitleTxt
Phone	6056688000	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 CPA	PreparerPersonNm
PTIN	P00484560	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	16:34:19	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

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Sacred Heart Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	Douglas R Ekeren	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	501 Summit Street	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$141,398,475	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.averasacredheart.com	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1911	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of Health	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	13	VotingMembersIndependentCnt
Total Employee	1363	TotalEmployeeCnt
Total Volunteers	261	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$943,887	PYContributionsGrantsAmt
CY Contributions Grants	$966,366	CYContributionsGrantsAmt
PY Program Service Revenue	$125,620,739	PYProgramServiceRevenueAmt
CY Program Service Revenue	$129,437,883	CYProgramServiceRevenueAmt
PY Investment Income	$16,159,759	PYInvestmentIncomeAmt
CY Investment Income	$10,647,727	CYInvestmentIncomeAmt
PY Other Revenue	-$333,615	PYOtherRevenueAmt
CY Other Revenue	-$370,984	CYOtherRevenueAmt
PY Total Revenue	$142,390,770	PYTotalRevenueAmt
CY Total Revenue	$140,680,992	CYTotalRevenueAmt
PY Grants And Similar Paid	$261,829	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$60,000	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$60,973,246	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$62,159,460	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$293,157	CYTotalFundraisingExpenseAmt
PY Other Expenses	$61,285,915	PYOtherExpensesAmt
CY Other Expenses	$66,087,656	CYOtherExpensesAmt
PY Total Expenses	$122,520,990	PYTotalExpensesAmt
CY Total Expenses	$128,307,116	CYTotalExpensesAmt
PY Revenues Less Expenses	$19,869,780	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$12,373,876	CYRevenuesLessExpensesAmt
Total Assets BOY	$325,213,601	TotalAssetsBOYAmt
Total Assets EOY	$336,401,545	TotalAssetsEOYAmt
Total Liabilities BOY	$61,341,554	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$57,651,198	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$263,872,047	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$278,750,347	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$107,829,669	ExpenseAmt
Grant	$60,000	GrantAmt
Revenue	$129,441,714	RevenueAmt
Desc	Avera Sacred Heart's mission is to provide healthcare services to Yankton, South Dakota residents and residents of the surrounding area. Avera Sacred Heart is a 501(c)(3) organization affiliated with Avera Health. Avera Sacred Heart consists of a 100-bed hospital and a 187-bed nursing home, congregate housing facility and a hospice house in Yankton, SD, a 23-bed critical access hospital and a 47-bed nursing home in Creighton, NE, and 15 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, internal medicine, radiation, radiology, oncology, podiatry, therapy, dialysis, behavioral health, and palliative care. Avera Sacred Heart provides acute care and long-term healthcare services, of which there were 3,462 patient discharges, 91,169 outpatient visits, 1,477 swing-bed patient days, 1,693 nursery patient days, 82,535 nursing home resident days, and 44,516 clinic visits. Following is a breakdown of these statistics by facility:Avera Sacred Heart Hospital3,343 Acute patient discharges79,731 Outpatient visits732 Swing-bed patient days1,693 Newborn patient days24,453 Clinic visitsAvera Sacred Heart Majestic Bluffs66,824 Long-term care resident daysAvera Creighton Hospital (CAH)119 Acute patient discharges11,438 Outpatient visits745 Swing-bed patient days20,063 Clinic visitsAvera Creighton Care Centre15,711 Long-term care resident daysAvera Sacred Heart maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $4,521,620.Avera Sacred Heart also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera Sacred Heart upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera Sacred Heart engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed.	Desc
Total Program Service Expenses	$107,829,669	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	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	Yes (1)	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	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	146	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1363	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
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	15	GoverningBodyVotingMembersCnt
Independent Voting Member	13	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Jamie A Schaefer	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6053223992	PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (23 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
Wayne A Kindle
Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Ryan Loecker
Vice Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Sr Jeanne Annette Weber
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Richard Strom MD
Board Member/Chief of Staff	10.00	0.00	Yes (X)		$0	$0	$0
Carolyn Becker
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Kathy Greeneway
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Patrick Leonard Murphy PBVM
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Lucille Welbig
Board Member	2.00	2.00	Yes (X)		$0	$0	$0
Kevin Bray
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Russ Deidrichsen
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Tim Irwin
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Debra Kolecka OSB
Board Member	2.00	5.00	Yes (X)		$0	$0	$0
Michael Peterson MD
Board Member & Physician	40.00	0.00	Yes (X)		$597,054	$0	$39,647
Michael Pietila MD
Board Member & Physician	2.00	0.00	Yes (X)		$0	$0	$0
Douglas Ekeren
President & CEO	2.50	40.00	Yes (X)	Yes (X)	$0	$502,279	$38,156
Jim Breckenridge
CFO Avera Health	0.10	39.90		Yes (X)	$0	$887,406	$34,116
Anthony Erickson
Exec Director-Senior Services	40.00	0.00			$182,975	$0	$35,706	Yes (X)
Gregory Taylor MD
Diagnostic Radiology	40.00	0.00			$666,978	$0	$43,109		Yes (X)
Steve Gutnik MD FACP
Gastroenterology	40.00	0.00			$774,773	$0	$25,269		Yes (X)
Matthew G Winkelbauer MD
Family Medicine/OB	40.00	0.00			$546,832	$0	$38,410		Yes (X)
Naila Qazi
Physician	40.00	0.00			$614,713	$0	$41,971		Yes (X)
Wayne Schneidermann MD
Orthopedic Surgeon	40.00	0.00			$576,269	$0	$24,713		Yes (X)
Jamie SchaeferFormer
Sec/Treas & VP Finance	0.00	40.00			$0	$166,618	$25,586			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,959,594	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,556,303	TotReportableCompRltdOrgAmt
Total Other Compensation	$346,683	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	69	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Avera Health
3900 W Avera Dr	Sioux Falls	SD	57108	Administrative Services	$21,409,143
Avera McKennan
1325 S Cliff Ave	Sioux Falls	SD	57105	Physician Services	$1,930,863
Yankton Anesthesiology PC
1000 W 4th St Suite 13	Yankton	SD	57078	Anesthesiologists	$1,070,902
Yankton Medical Clinic PC
PO Box 706	Yankton	SD	57078	Physician Services	$937,586
Jalal U Akbar
2405 Brisbane Ln	Plano	TX	75075	Physician Services	$500,986

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	30	CntrctRcvdGreaterThan100KCnt
Fundraising	$50,718	FundraisingAmt
Related Organizations	$246,629	RelatedOrganizationsAmt
Government Grants	$244,547	GovernmentGrantsAmt
All Other Contributions	$424,472	AllOtherContributionsAmt
Total Contributions	$966,366	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net patient service revenue	622110	$125,934,874	$125,934,874
Pharmacy revenue	900099	$536,744	$536,744

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,966,265	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,966,265	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$129,437,883	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$784,801	TotalRevenueColumnAmt
Exclusion	$784,801	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$284,519	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$696,848	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$412,329	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$412,329	TotalRevenueColumnAmt
Exclusion	-$412,329	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$9,862,926	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

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

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$9,862,926	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$9,862,926	TotalRevenueColumnAmt
Exclusion	$9,862,926	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$58,149	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$50,718	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$20,635	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$37,514	TotalRevenueColumnAmt
Exclusion	$37,514	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	A/R Interest Income	Desc
Business	900099	BusinessCd
Total Revenue Column	$3,831	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,831	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$3,831	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$140,680,992	TotalRevenueColumnAmt
Related Or Exempt Func Income	$129,441,714	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$10,272,912	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	$40,000	TotalAmt
Program Services	$40,000	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$20,000	TotalAmt
Program Services	$20,000	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$864,837	TotalAmt
Program Services	$642,495	ProgramServicesAmt
Management And General	$222,342	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$129,105	TotalAmt
Program Services	$129,105	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$47,769,800	TotalAmt
Program Services	$45,153,296	ProgramServicesAmt
Management And General	$2,505,107	ManagementAndGeneralAmt
Fundraising	$111,397	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,962,273	TotalAmt
Program Services	$1,818,284	ProgramServicesAmt
Management And General	$138,045	ManagementAndGeneralAmt
Fundraising	$5,944	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$8,020,543	TotalAmt
Program Services	$7,226,030	ProgramServicesAmt
Management And General	$775,367	ManagementAndGeneralAmt
Fundraising	$19,146	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,412,902	TotalAmt
Program Services	$3,184,957	ProgramServicesAmt
Management And General	$219,300	ManagementAndGeneralAmt
Fundraising	$8,645	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$2,739	TotalAmt
Management And General	$2,739	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$25,595	TotalAmt
Management And General	$25,595	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$15,968	TotalAmt
Management And General	$15,968	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$24,505,955	TotalAmt
Program Services	$10,212,750	ProgramServicesAmt
Management And General	$14,292,993	ManagementAndGeneralAmt
Fundraising	$212	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$55,816	TotalAmt
Program Services	$31,548	ProgramServicesAmt
Management And General	$6,389	ManagementAndGeneralAmt
Fundraising	$17,879	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,172,898	TotalAmt
Program Services	$1,558,657	ProgramServicesAmt
Management And General	$608,861	ManagementAndGeneralAmt
Fundraising	$5,380	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$991,292	TotalAmt
Program Services	$270,252	ProgramServicesAmt
Management And General	$721,040	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,357,806	TotalAmt
Program Services	$2,279,067	ProgramServicesAmt
Management And General	$78,739	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$357,589	TotalAmt
Program Services	$304,608	ProgramServicesAmt
Management And General	$51,748	ManagementAndGeneralAmt
Fundraising	$1,233	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$398,582	TotalAmt
Program Services	$276,283	ProgramServicesAmt
Management And General	$117,985	ManagementAndGeneralAmt
Fundraising	$4,314	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,857,646	TotalAmt
Program Services	$1,857,646	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$8,245,477	TotalAmt
Program Services	$8,245,477	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$362,358	TotalAmt
Program Services	$275,374	ProgramServicesAmt
Management And General	$86,984	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical Supplies	$18,308,860	$18,308,860
Bad Debt Expense	$5,189,912	$5,189,912
Equipment Lease and Ren	$281,909	$187,140	$94,769
Licenses and Permits	$48,777	$23,827	$24,950

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$908,477	TotalAmt
Program Services	$594,101	ProgramServicesAmt
Management And General	$195,369	ManagementAndGeneralAmt
Fundraising	$119,007	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$128,307,116	TotalAmt
Program Services	$107,829,669	ProgramServicesAmt
Management And General	$20,184,290	ManagementAndGeneralAmt
Fundraising	$293,157	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$5,847,797	BOYAmt
EOY	$3,023,627	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$18,434,942	BOYAmt
EOY	$25,169,274	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$845,245	BOYAmt
EOY	$1,168,280	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$2,642,560	BOYAmt
EOY	$2,483,341	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,840,916	BOYAmt
EOY	$1,319,871	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$191,517,564	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$111,889,852	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$85,601,148	BOYAmt
EOY	$79,627,712	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$7,239,447	BOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$195,665,057	BOYAmt
EOY	$216,508,428	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$6,537,503	BOYAmt
EOY	$6,537,503	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$558,986	BOYAmt
EOY	$563,509	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$325,213,601	BOYAmt
EOY	$336,401,545	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$10,677,175	BOYAmt
EOY	$8,528,710	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$153,681	BOYAmt
EOY	$120,971	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$49,016,362	BOYAmt
EOY	$47,520,620	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$23,903	BOYAmt
EOY	$116,613	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,470,433	BOYAmt
EOY	$1,364,284	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$61,341,554	BOYAmt
EOY	$57,651,198	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$251,556,306	BOYAmt
EOY	$265,663,805	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$11,637,441	BOYAmt
EOY	$12,373,467	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$678,300	BOYAmt
EOY	$713,075	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$263,872,047	BOYAmt
EOY	$278,750,347	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$325,213,601	BOYAmt
EOY	$336,401,545	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$12,373,876	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$3,210,890	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$706,466	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$15,968	OtherActivitiesAmt
Total Lobbying Expenditures	$15,968	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Avera Sacred Heart Hospital and Avera Creighton paid dues to organizations which have a portion of the dues attributed to lobbying activities.	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	$1,071,080	BeginningYearBalanceAmt
Contributions	$28,881	ContributionsAmt
Investment Earnings Or Losses	$188,014	InvestmentEarningsOrLossesAmt
Other Expenditures	$5,491	OtherExpendituresAmt
End Year Balance	$1,282,484	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,071,080	BeginningYearBalanceAmt
Contributions	$38,729	ContributionsAmt
Investment Earnings Or Losses	-$24,812	InvestmentEarningsOrLossesAmt
Other Expenditures	$13,917	OtherExpendituresAmt
End Year Balance	$1,071,080	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,045,751	BeginningYearBalanceAmt
Contributions	$77,699	ContributionsAmt
Investment Earnings Or Losses	-$35,356	InvestmentEarningsOrLossesAmt
Other Expenditures	$17,014	OtherExpendituresAmt
End Year Balance	$1,071,080	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,013,689	BeginningYearBalanceAmt
Contributions	$52,266	ContributionsAmt
Investment Earnings Or Losses	-$2,578	InvestmentEarningsOrLossesAmt
Other Expenditures	$17,626	OtherExpendituresAmt
End Year Balance	$1,045,751	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$839,365	BeginningYearBalanceAmt
Contributions	$51,690	ContributionsAmt
Investment Earnings Or Losses	$133,464	InvestmentEarningsOrLossesAmt
Other Expenditures	$10,830	OtherExpendituresAmt
End Year Balance	$1,013,689	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	0.44850	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.55150	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	0	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,546,594	OtherCostOrOtherBasisAmt
Book Value	$4,546,594	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$130,129,502	OtherCostOrOtherBasisAmt
Depreciation	$73,027,463	DepreciationAmt
Book Value	$57,102,039	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$48,927,866	OtherCostOrOtherBasisAmt
Depreciation	$34,015,419	DepreciationAmt
Book Value	$14,912,447	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$7,913,602	OtherCostOrOtherBasisAmt
Depreciation	$4,846,970	DepreciationAmt
Book Value	$3,066,632	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$79,627,712	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	Assets limited to use - Avera Pooled Investments	Desc
Book Value	$216,508,428	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$216,508,428	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
Estimated third-party payor settlements	$1,009,706
Derivative liability	$354,578

Field	Value	IRS element (for citing)
Total Liability	$1,364,284	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Resident trust funds are held on behalf of the residents.
Part V, Line 4:	The Organization's endowment consists of various individual funds established for a variety of purposes. Its endowment represents donor-restricted endowment funds. As required by generally accepted accounting principles, net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions.
Part X, Line 2:	Avera Health and most of its sponsored organizations are considered nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the 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 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 subisidiary returns for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2015.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Simply d'Vine	Event1Nm
Gross Receipts Event1	$95,992	GrossReceiptsEvent1Amt
Charitable Contri Event1	$50,718	CharitableContriEvent1Amt
Gross Revenue Event1	$45,274	GrossRevenueEvent1Amt
Non Cash Prizes Event1	$3,150	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$4,572	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$2,051	FoodAndBeverageEvent1Amt
Entertainment Event1	$5,040	EntertainmentEvent1Amt
Other Direct Expenses Event1	$2,000	OtherDirectExpensesEvent1Amt
Event2	Roses Just Because	Event2Nm
Gross Receipts Event2	$12,875	GrossReceiptsEvent2Amt
Gross Revenue Event2	$12,875	GrossRevenueEvent2Amt
Other Direct Expenses Event2	$3,822	OtherDirectExpensesEvent2Amt
Gross Receipts Total	$108,867	GrossReceiptsTotalAmt
Charitable Contributions Tot	$50,718	CharitableContributionsTotAmt
Gross Revenue Total Events	$58,149	GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events	$3,150	NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$4,572	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$2,051	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$5,040	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$5,822	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$20,635	DirectExpenseSummaryEventsAmt
Net Income Summary	$37,514	NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

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

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	2500	PersonsServedCnt
Total Community Benefit Expns	$2,629,719	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$107,639	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,522,080	NetCommunityBenefitExpnsAmt
Total Expense	0.02050	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$15,365,692	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,725,900	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,639,792	NetCommunityBenefitExpnsAmt
Total Expense	0.04580	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	2500	PersonsServedCnt
Total Community Benefit Expns	$17,995,411	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,833,539	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,161,872	NetCommunityBenefitExpnsAmt
Total Expense	0.06630	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	16	ActivitiesOrProgramsCnt
Persons Served	424	PersonsServedCnt
Total Community Benefit Expns	$10,020,190	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,420,746	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,599,444	NetCommunityBenefitExpnsAmt
Total Expense	0.02110	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$76,124	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$19,560	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$56,564	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	6	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$13,384,800	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,778,756	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,606,044	NetCommunityBenefitExpnsAmt
Total Expense	0.01300	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$118,774	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$118,774	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	28	ActivitiesOrProgramsCnt
Persons Served	424	PersonsServedCnt
Total Community Benefit Expns	$23,599,888	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$19,219,062	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,380,826	NetCommunityBenefitExpnsAmt
Total Expense	0.03560	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	28	ActivitiesOrProgramsCnt
Persons Served	2924	PersonsServedCnt
Total Community Benefit Expns	$41,595,299	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$29,052,601	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$12,542,698	NetCommunityBenefitExpnsAmt
Total Expense	0.10190	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$1,320	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,320	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$1,320	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,320	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$5,189,912	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$29,993,169	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$30,184,878	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$191,709	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	2	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (2 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Emergency Room24 HrsEmergencyRoom24HrsInd	OtherOtherDesc	Critical Access HospitalCriticalAccessHospitalInd
Avera Sacred Heart Hospital
1	501 Summit Street	Yankton	SD	57078	www.avera.org/sacred-heart/	10576	Yes (X)	Yes (X)	Yes (X)	7 provider based clinics
Avera Creighton Hospital
2	1503 Main Street	Creighton	NE	68729	www.avera.org/creighton/	490001	Yes (X)	Yes (X)	Yes (X)	1 provider based clinic and 6 RHC's	Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)

FacilityFacilityNum	First Licensed CY Or PYFirstLicensedCYOrPYInd	Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd	CHNA ConductedCHNAConductedInd	Community DefinitionCommunityDefinitionInd	Community DemographicsCommunityDemographicsInd	Existing ResourcesExistingResourcesInd	How Data ObtainedHowDataObtainedInd	Community Health NeedsCommunityHealthNeedsInd	Other Health IssuesOtherHealthIssuesInd	Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd	Consulting ProcessConsultingProcessInd	Prior CHNA ImpactPriorCHNAImpactInd	CHNA ConductedCHNAConductedYr	Take Into Account Others InputTakeIntoAccountOthersInputInd	CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd	CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd	CHNA Report Widely AvailableCHNAReportWidelyAvailableInd	Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd	Own Website URLOwnWebsiteURLTxt	Other WebsiteOtherWebsiteInd	Other Website URLOtherWebsiteURLTxt	Paper Copy Public InspectionPaperCopyPublicInspectionInd	Implementation Strategy AdoptImplementationStrategyAdoptInd	Implementation Strategy AdptImplementationStrategyAdptYr	Strategy Posted WebsiteStrategyPostedWebsiteInd	Strategy Website URLStrategyWebsiteURLTxt	Organization Incur Excise TaxOrganizationIncurExciseTaxInd	Elig Criteria ExplainedEligCriteriaExplainedInd	FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd	FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct	FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct	Asset Level CriteriaAssetLevelCriteriaInd	Medical Indigency CriteriaMedicalIndigencyCriteriaInd	Insurance Status CriteriaInsuranceStatusCriteriaInd	Other CriteriaOtherCriteriaInd	Explained BasisExplainedBasisInd	App Financial Asst ExplnAppFinancialAsstExplnInd	Described InfoDescribedInfoInd	Described Suprt DocDescribedSuprtDocInd	Provided Hospital ContactProvidedHospitalContactInd	Includes Publicity MeasuresIncludesPublicityMeasuresInd	FAP Available On WebsiteFAPAvailableOnWebsiteInd	FAP Available On Website URLFAPAvailableOnWebsiteURLTxt	FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd	FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt	FAP Summary On WebsiteFAPSummaryOnWebsiteInd	FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt	FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd	FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd	FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd	Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd	Communtity Notified FAPCommuntityNotifiedFAPInd	FAP TranslatedFAPTranslatedInd	Other PublicityOtherPublicityInd	FAP Actions On NonpaymentFAPActionsOnNonpaymentInd	Permit No ActionsPermitNoActionsInd	Collection ActivitiesCollectionActivitiesInd	Provided Written NoticeProvidedWrittenNoticeInd	Made Effort Orally NotifyMadeEffortOrallyNotifyInd	Processed FAP ApplicationProcessedFAPApplicationInd	Made Presumptive Elig DetermMadePresumptiveEligDetermInd	Other Actions TakenOtherActionsTakenInd	Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd	Look Back Medicare PrivateLookBackMedicarePrivateInd	Amounts Generally BilledAmountsGenerallyBilledInd	Gross ChargesGrossChargesInd
Avera Sacred Heart Hospital
1	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	15	Yes (1)	0	0	Yes (1)	Yes (X)	See part V Section C	Yes (X)	See Part V Section C	Yes (X)	Yes (1)	15	Yes (1)	See Part V Section C	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	See Section C	Yes (X)	See Section C	Yes (X)	See Section C	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
Avera Creighton Hospital
2	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	15	Yes (1)	Yes (1)	0	Yes (1)	Yes (X)	See Part V Section C	Yes (X)	See Part V Section C	Yes (X)	Yes (1)	15	Yes (1)	See Part V Section C	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	See Section C	Yes (X)	See Section C	Yes (X)	See Section C	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0

Supplemental Information SupplementalInformationGrp (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Avera Sacred Heart Hospital	Part V, Section B, Line 5: Avera Sacred Heart Hospital worked closely with the SD Department of Health and also utilized Maximizing Excellence LLC to conduct focus groups. Careful consideration was taken to be sure that representatives from the community at large, the medically underserved, low-income and minority populations were included.
Avera Creighton Hospital	Part V, Section B, Line 5: Avera Creighton Hospital in conjunction with the North Central District Health Department used community stakeholder meetings, county focus groups and surveys targeted to specific population groups to determine potential areas to focus health improvement efforts on. Dr. Joseph Nitzke, a partner in Ionia Research, was contracted for data collection, compilation, analysis and presentation for the project.
Avera Creighton Hospital	Part V, Section B, Line 6a: Avera Creighton Hospital partnered with nine other hospitals in the North Central District Health Department including: Antelope Memorial Hospital, Avera St. Anthony's Hospital, Brown County Hospital, Cherry County Hospital, CHI Plainview, Niobrara Valley Hospital, Osmond General Hospital, Rock County Hospital and West Holt Memorial Hospital.
Avera Sacred Heart Hospital	Part V, Section B, Line 11: The 2015 Implementation Plan has addressed nutrition education, healthy choices, and awareness in the community and to continues to increase care coordination between the hospital and clinical providers in service of our mutual patients and colleagues.Nutrition:The first need identified is to increase nutrition education, healthy choices and community awareness of the issue. Avera Sacred Heart Hospital will implement quarterly nutrition education opportunities at various community events. Avera Sacred Heart Hospital will also provide nutrition tips such as portion control, healthy recipes and basic cooking tips quarterly on their Facebook page. Avera Sacred Heart Hospital will introduce and encourage updated vending options and snack bars to reflect the Good & Healthy SD vending criteria.Avera Sacred Heart Hospital was instrumental in establishing the Yankton Food Council which provides monthly education and recipes. The Yankton Food Council hosted a Conversation on Hunger at Avera Sacred Heart Hospital Pavilion in July 2017. Twenty-seven individuals representing twenty-three different agencies, non-profits,South Dakota Social Services, health care, and local business leaders gathered to discuss food insecurities specifically in Yankton and in the surrounding communities as well. Much of the discussion focused on lack of access to health food choices.Avera Sacred Heart Hospital continues its commitment to provide quality nutrition education in its service area.Increase Care Coordination:Avera Sacred Heart has established a Chief Medical Officer position that has the primary responsibility of developing and strengthening physician and clinic relationships.In April 2017, Avera Sacred Heart Hospital purchased the 10-bed Lewis and Clark Specialty Hospital and Medical Office Building in Yankton, South Dakota. Avera Sacred Heart Hospital now has a primary care clinic in Yankton staffed by one physician and two advanced care providers.Avera Sacred Heart Hospital requested from and granted access to electronic medical records within the hospital and various local clinics to facilitate a better flow of information for patient care where applicable and when appropriate.
Avera Creighton Hospital	Part V, Section B, Line 11: The most significant need identified was weight management, including increased nutrition education, healthy choices and awareness in the community and increased physical activity in the community. Creighton has continued to offer a community Wellness Center that is the only one in our service area. We also offer reduced rates for Senior Citizens, employees and subscribers paying an annual fee. Avera offers through our marketing an education departments news and educational articles on healthy eating and wellness choices. We also offer the "Know Your Numbers" every weekday. Our vending and dietary services offer healthy meals and meal choices. We have also redone our vending machines to make snack choices "healthier" offerings. Aging Population and Related illnesses - We continue to operate our 47-bed nursing home/skilled nursing facility, the Avera Creighton Care Centre. There we offer Adult Day Care, respite care and other services as appropriate.Housing/Environmental - The Creighton Chamber and Knox County Economic Development are groups we consider partners. We involve ourselves with those groups for economic development, recruitment, retention, and housing efforts. We also continue to lead or participate in emergency preparadeness including common farm accidents and weather events. Mental Health and substance abuse continue to be a challenge and we continue to offer on-site and telemedicine services. We also participate in Avera wide opioid and mental health initiates.
Avera Sacred Heart Hospital	Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide.
Avera Creighton Hospital	Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide.
Avera Sacred Heart Hospital	Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Creighton Hospital	Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Sacred Heart Hospital	Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility.
Avera Creighton Hospital	Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility.
Avera Sacred Heart Hospital	Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.
Avera Creighton Hospital	Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.
Schedule H, Part V, Line 7a, 7b, and 10a:	www.avera.org/about/community-health-needs-assessments/
Schedule H, Part V, Line 16a, 16b, and 16c:	https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Avera Sister James Care Center
2111 W 11th Street	Yankton	SD	57078	Skilled nursing facility
2 - Avera Sacred Heart Majestic Bluffs
2111 W 11th Street	Yankton	SD	57078	Assisted living
3 - Avera Sacred Heart Hospital-Swing Bed
501 Summit Street	Yankton	SD	57078	Swing Bed
4 - Avera Creighton Care Centre
1603 Main Street	Creighton	NE	687292999	Long Term Care
5 - Avera Sacred Heart Hospital-Dialysis
501 Summit Street	Yankton	SD	57078	Dialysis Unit
6 - AMG Gastroenterology
1104 West 8th Street	Yankton	SD	57078	Gastroenterology clinic

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted.
Part I, Line 7:	Charity care was converted to cost using the cost-to-charge ratio based on the Medicare Cost Report from the prior year. The amounts on lines 7e-i represent expenses reported in the general ledger and compiled using CBISA software.
Part I, Ln 7 Col(f):	Bad debt expense of $5,189,912 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage.
Part II, Community Building Activities:	Sacred Heart Health Services provided a public school athletic trainer. This helps with the prevention of injuries, recognition of an injury requiring additonal medical attention, post-injury rehabilitation and education.
Part III, Line 2:	Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Bad debt expense on line 2 is reported at charges as presented on the financial statements.
Part III, Line 3:	Avera Sacred Heart has several procedures in place to determine which patients would qualify for financial assistance, therefore the hospital feels confident that no amount of bad debt expense is attributable to patients eligible under the Organization's financial assistance policy.
Part III, Line 4:	The footnote to the Organization's financial statements that describes bad debt expenses can be found on page 10 of the attached financial statements.
Part III, Line 8:	Part III, Lines 5, 6, and 7: The Medicare revenues received (line 5), allowable costs (line 6), and the resulting shortfall (line 7) does not include a significant portion of the organization's expenses. These lines require use of the Medicare Cost Report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Sacred Heart Health Services. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removing the costs from the hospital's cost report entirely. Examples of non-cost report entities operated by Sacred Heart Health Services include clinics, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, marketing, CRNA's, and interest expense. In addition to these disallowed costs within the Hospital, Sacred Heart Health Services operates clinics, long-term care facilities, and other health care related businesses which do not file a cost report.Medicare allowable costs of care are based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Sacred Heart Health Services follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. However, Medicare is the organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community.
Part III, Line 9b:	If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven.
Part VI, Line 2:	Avera Sacred Heart Hospital includes community members on committees, boards and advisory groups to allow community reaction and input in the actions we take. We also review all data provided by the health departments regarding disease rates, mortality, morbidity, population changes, etc. The hospital also conducts focus groups, consumer perception studies, and patient satisfaction surveys to identify primary needs of the community and responds with preventative/educational information or activities for the community.
Part VI, Line 3:	The brochure "Understanding Your Health Care Bill" is provided in visible locations experiencing high volumes of inpatient or outpatient registrations such as the admitting office, the billing/business office, and emergency department as well as the organization website. Patients are also made aware of possible eligibility when given the "Patient Rights and Responsibilities" brochure upon admission. The Patient Advocate works with uninsured/underinsured patients to enroll them in applicable social service programs and/or identify charity, county or risk pool eligibility.
Part VI, Line 4:	Avera Sacred Heart Hospital primarily serves the city and county of Yankton, SD and the surrounding South Dakota counties of Bon Homme, Charles Mix, Clay and Hutchinson, and Cedar County and Knox in Nebraska. U.S Census statistics indicate that 17.4% of the City of Yankton's individual residents fall below the federal poverty guidelines. For fiscal year 2017, 46.1% of our revenue came from Medicare and Medicare Advantage plans, and 11.5% came from Medicaid and Medicaid Replacement plans.
Part VI, Line 5:	The Hospital board is comprised of individuals who represent the interests of the community served by the organization. The Hospital offers staff privileges to all qualified physicians in the community. Selected services such as Radiation Oncology and Swingbed Services would not be available in our service area unless provided by the organization. The Hospital serves all individuals regardless of their ability to pay, providing 24 hour a day emergency services. The facility participates in the education of medical students from The University of South Dakota through their Yankton location. The Hospital also offers a 2-year Radiology Technologist program that graduates approximately 6 students per year. Sacred Heart Hospital also provides clinical education for Mount Marty College students. The Hospital is also proud of the fact that 261 individuals chose to volunteer at the facility during fiscal year 2018.
Part VI, Line 6:	Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera Health operates all have unique health and community benefits needs. In keeping with Catholic Health Association guidelines, each Hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Mount Marty College	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1105 W 8th Street	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	460283336	RecipientEIN
IRC Section	501(c)(3)	IRCSectionDesc
Cash Grant	$40,000	CashGrantAmt
Purpose Of Grant	Healthcare education	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	Educational scholarships	GrantTypeTxt
Recipient	4	RecipientCnt
Cash Grant	$20,000	CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	The Organization only makes grants to other organizations which are also tax-exempt. Individual scholarship recipients are selected by the University School of Medicine according to its criteria. In fiscal year 2018, 4 medical school students were chosen for $5,000 scholarships.	ExplanationTxt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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
Michael Peterson MD
Board Member & Physician	$541,430	$0	$50,201	$0	$5,423	$0	$13,500	$0	$26,147	$0	$636,701	$0	$0	$0
Douglas Ekeren
President & CEO	$0	$376,003	$0	$1,500	$0	$124,776	$0	$13,500	$0	$24,656	$0	$540,435	$0	$0
Jim Breckenridge
CFO Avera Health	$0	$815,781	$0	$0	$0	$71,625	$0	$13,500	$0	$20,616	$0	$921,522	$0	$0
Anthony Erickson
Exec Director-Senior Services	$171,954	$0	$0	$0	$11,021	$0	$9,301	$0	$26,405	$0	$218,681	$0	$0	$0
Gregory Taylor MD
Diagnostic Radiology	$506,171	$0	$153,061	$0	$7,746	$0	$13,500	$0	$29,609	$0	$710,087	$0	$0	$0
Steve Gutnik MD FACP
Gastroenterology	$659,834	$0	$96,007	$0	$18,932	$0	$13,500	$0	$11,769	$0	$800,042	$0	$0	$0
Matthew G Winkelbauer MD
Family Medicine/OB	$530,086	$0	$15,000	$0	$1,746	$0	$13,500	$0	$24,910	$0	$585,242	$0	$0	$0
Naila Qazi
Physician	$386,435	$0	$226,803	$0	$1,475	$0	$13,500	$0	$28,471	$0	$656,684	$0	$0	$0
Wayne Schneidermann MD
Orthopedic Surgeon	$516,461	$0	$18,600	$0	$41,208	$0	$13,500	$0	$11,213	$0	$600,982	$0	$0	$0
Jamie SchaeferFormer
Sec/Treas & VP Finance	$0	$151,372	$0	$0	$0	$15,246	$0	$8,088	$0	$17,498	$0	$192,204	$0	$0

Supplemental Information Detail SupplementalInformationDetail

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

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Allison Diedrichsen
Spouse of board member	$30,806	Employee compensation	0
Mary Loecker
Parent of board member	$10,291	Employee compensation	0
Laura Alexander
Child of officer	$38,163	Employee compensation	0
Katherine Schild
Child of officer	$49,845	Employee compensation	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Section A, line 2	Sr. Lucille Welbig, Jim Breckenridge, and Douglas Ekeren have a business relationship.
Form 990, Part VI, Section A, line 6	The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended.
Form 990, Part VI, Section A, line 7a	Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors.
Form 990, Part VI, Section A, line 7b	Avera Health, as the sole member, has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member.
Form 990, Part VI, Section B, line 11b	The Form 990 is reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders.
Form 990, Part VI, Section B, line 12c	The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all Board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and board members. The information is maintained in a database and a report is provided to the Board.
Form 990, Part VI, Section B, line 15b	The CEO was compensated by Avera Health System. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Depending on the individuals's role with the organization, some officers and key employees are compensated by Avera Sacred Heart.
Form 990, Part VI, Section C, line 19	The organization's governing documents and conflict of interest policy are not made available to the general public. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public.
Form 990, Part IX, line 11g	Repairs and Maintenance: Program service expenses 2,617,116. Management and general expenses 32,512. Fundraising expenses 0. Total expenses 2,649,628. Consulting: Program service expenses 616,029. Management and general expenses 7,700. Fundraising expenses 0. Total expenses 623,729. ACS Fees: Program service expenses 0. Management and general expenses 10,089,073. Fundraising expenses 0. Total expenses 10,089,073. Other Fees: Program service expenses 6,979,605. Management and general expenses 4,163,708. Fundraising expenses 212. Total expenses 11,143,525.
Form 990, Part XI, line 9:	Capital transfers, net -859,809. Change in fair value of interest rate swap 96,882. Net assets released from donor restrictions -172,417. Other change in net assets held by Avera Health Foundation 228,878.
Form 990, Part XII, Line 2c:	The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Health, which includes Sacred Heart Health Services.
Form 990, Part VI, Line 16:	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 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 Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Gettysburg, Avera at Home,and Sacred Heart Health Services. 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).

Schedule R IRS990ScheduleR

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	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Avera Health
3900 West Avera Drive Suite 300	Sioux Falls	SD	57108	460422673	Healthcare services	SD	501(c)(3)	Line 10	N/A	0
Avera at Home
5116 S Solberg Ave	Sioux Falls	SD	57108	460399291	Home Services	SD	501(c)(3)	Line 10		0	Avera Health
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		Yes (1)	Sacred Heart Health Services
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare services	NE	501(c)(3)	Line 3		0	Avera Health
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare services	IA	501(c)(3)	Line 3		0	Avera Health
Avera Holy Family Foundation
826 North 8th Street	Estherville	IA	51334	421317452	Support health related services	IA	501(c)(3)	Line 10		0	Avera Holy Family
Avera Marshall
300 S Bruce St	Marshall	MN	56258	410919153	Healthcare services	MN	501(c)(3)	Line 3		0	Avera Health
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
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		0	St Benedict Health Center
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Queen of Peace Hospital
525 N Foster Street	Mitchell	SD	57301	460224604	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare services	SD	501(c)(3)	Line 3		0	Avera St Mary's
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare services	MN	501(c)(3)	Line 3		0	Avera Marshall
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health financing and health plans admin	SD	501(c)(4)			0	Avera Health

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
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	Surgical associates	SD	N/A
Avera Home Medical Equipment of Floyd Valley Hospital LLC
714 Lincoln St NE	Lemars	IA	51031	820582350	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Sioux Center LLC
38 19th ST SW	Sioux Center	IA	51250	753203100	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Spencer Hospital LLC
2400 S MN Ave 102	Sioux Falls	SD	57117	800619999	Medical services - home medical equipment	SD	N/A
Q&M Properties
525 North Foster	Mitchell	SD	57301	731652049	Medical clinic building	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	Medical Services - Home Medical Equipment	SD	N/A
National Rural ACO 4 LLC dba Prairie Hills Care Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	371780735	Accountable care organization	KS	N/A
National Rural ACO 5 LLC dba Great Plains Care Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	383958290	Accountable care organization	KS	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
Valley Health Services Inc
501 Summit Street	Yankton	SD	57078	460357149	Rental real estate	SD	N/A	C	0
Accounts Management Inc
5132 S Cliff Ave Suite 101	Sioux Falls	SD	57108	460373021	Collection agency	SD	N/A	C	0
Avera Property Insurance Inc
610 W 23rd St Ste 1 PO Box 38	Yankton	SD	57078	460463155	Insurance	SD	N/A	C	0
Alucent Medical Inc
1325 S Cliff Avenue PO Box 5045	Sioux Falls	SD	571175045	471818349	Biotech Research	SD	N/A	C	0
South Dakota State Medical Holding Company Inc
2600 W 49th Street	Sioux Falls	SD	57105	460401087	Insurance	SD	N/A	C	0
DakotaCare Administrative Services Inc
2600 W 49th Street	Sioux Falls	SD	57105	460424322	Insurance	SD	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	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	Yes (1)	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	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Lewis and Clark Health Education and Service Agency
L	$98,874	Recorded in General Ledger
Lewis and Clark Health Education and Service Agency
M	$219,074	Recorded in General Ledger