AVERA ST ANTHONYS HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- AVERA ST ANTHONYS HOSPITAL (EIN 47-0463911)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-10
- IRS object ID
- 201841309349301524
- Schema version
- 2016v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-10T10:45:42-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | 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 | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470463911 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Anthony's Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STAN | BusinessNameControlTxt |
| Phone | 4023365132 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1Txt |
| City | ONeill | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 687631569 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Todd Consbruck | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 4023365132 | PhoneNum |
| Signature | 2018-05-08 | 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 | 2018-04-30 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Todd Consbruck | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1Txt |
| City | ONeill | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 687631569 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $43,819,366 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.avera-sta.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | Promotion of health | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 311 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $33,517 | PYContributionsGrantsAmt |
| CY Contributions Grants | $79,458 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $40,037,898 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $41,911,829 | CYProgramServiceRevenueAmt |
| PY Investment Income | $319,090 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,823,360 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,570 | PYOtherRevenueAmt |
| CY Other Revenue | $4,719 | CYOtherRevenueAmt |
| PY Total Revenue | $40,396,075 | PYTotalRevenueAmt |
| CY Total Revenue | $43,819,366 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $407 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,331,524 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,448,298 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,676,255 | PYOtherExpensesAmt |
| CY Other Expenses | $18,346,720 | CYOtherExpensesAmt |
| PY Total Expenses | $36,009,279 | PYTotalExpensesAmt |
| CY Total Expenses | $35,795,425 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,386,796 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,023,941 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $46,811,666 | TotalAssetsBOYAmt |
| Total Assets EOY | $54,786,075 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,527,369 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,900,641 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $34,284,297 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $42,885,434 | 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 | $31,033,135 | ExpenseAmt |
| Grant | $407 | GrantAmt |
| Revenue | $41,911,829 | RevenueAmt |
| Desc | Avera St. Anthony's Hospital operates a 25-bed critical access hospital in O'Neill, Nebraska.For the year ended June 30, 2017, a total of 2,866 acute patient days were recorded, 920 swing bed patient days were recorded and 283 newborn patient days were recorded. Charity care is also provided by the facility. For the year ended June 30, 2017, the facility provided $486,082 in charity care, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients.The Hospital also provides community benefit health activities at less than or at no cost to support those in the area served. These activities include community education programs; special programs for the elderly, handicapped, and medically underserved; and a variety of broad community support activities. During the years ended June 30, 2017 and 2016, specific activities included health fair; meeting facilities; programs for patients and families suffering from cancer, diabetes, breathing disorders, mental illness, and others; transportation services; emergency healthcare providers; wellness programs; and overnight housing for families of hospitalized patients. | Desc |
| Total Program Service Expenses | $31,033,135 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | 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 | Yes (1) | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | 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 | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 54 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 311 | 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 | 0 | QuidProQuoContributionsInd |
| 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 | 13 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Shannon Miller | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4023365179 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1Txt |
| City | ONeill | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 687631569 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Jack Hurley | ||||||||
| Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dian Edwards | ||||||||
| Vice-Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Joe Krotter | ||||||||
| Secretary/Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Richard Fitch MD | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ed North | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MaLaine Strope | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kirk Cisler | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Paul Carlson | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sister Kathryn Burt OSB | ||||||||
| Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sister Lynn Marie Welbig PBVM | ||||||||
| Member | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Sister Mary Jaeger PBVM | ||||||||
| Member | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | ||
| Ryan Banks MDPres of Med | ||||||||
| Staff/Physician | 40.00 | 0.00 | Yes (X) | $0 | $438,561 | $22,782 | ||
| Todd Consbruck | ||||||||
| President & CEO | 50.00 | 0.00 | Yes (X) | Yes (X) | $0 | $83,540 | $9,958 | |
| Michael Garman | ||||||||
| Sec/Treas & SrVP Finance | 40.00 | 0.00 | Yes (X) | $165,310 | $0 | $30,470 | ||
| Edwin N Cook DO | ||||||||
| Radiologist | 40.00 | 0.00 | $576,971 | $0 | $36,122 | Yes (X) | ||
| Josh Becker | ||||||||
| CRNA | 40.00 | 0.00 | $254,163 | $0 | $35,437 | Yes (X) | ||
| Kevin Loecker | ||||||||
| CRNA | 40.00 | 0.00 | $242,109 | $0 | $26,385 | Yes (X) | ||
| Wendell Spencer | ||||||||
| Director of Anesthesia | 40.00 | 0.00 | $338,199 | $0 | $34,684 | Yes (X) | ||
| Cameron Everitt | ||||||||
| Director of PT | 40.00 | 0.00 | $157,892 | $0 | $15,192 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,734,644 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $522,101 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $211,030 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| Sacred Heart Health Services | |||||
| 501 Summit St | Yankton | SD | 57078 | Management, Support & Lab Services | $6,639,090 |
| Cardinal Health 110 LLC | |||||
| 5303 Collection Center Drive | Chicago | IL | 60693 | Pharmaceuticals | $2,286,204 |
| Avera Health | |||||
| 3900 W Avera Drive Suite 300 | Sioux Falls | SD | 57108 | Shared Services | $391,220 |
| Beckenhauer Construction Inc | |||||
| 1901 Riverside Blvd | Norfolk | NE | 68701 | Building/Construction | $328,214 |
| ENT Specialists PC | |||||
| 366 Regency Parkway Dr | Omaha | NE | 68114 | ENT Services | $147,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $28,974 | RelatedOrganizationsAmt |
| All Other Contributions | $50,484 | AllOtherContributionsAmt |
| Total Contributions | $79,458 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 622110 | $33,701,969 | $33,701,969 |
| Clinic Revenue | 621110 | $6,918,745 | $6,918,745 |
| Other Revenue | 900099 | $667,318 | $667,318 |
| Pharmacy Revenue | 900099 | $541,063 | $541,063 |
| Change in Foundation | 900099 | $82,734 | $82,734 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $41,911,829 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,548 | TotalRevenueColumnAmt |
| Exclusion | $44,548 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,610 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,610 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,610 | TotalRevenueColumnAmt |
| Exclusion | $4,610 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,778,812 | 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 | $1,778,812 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,778,812 | TotalRevenueColumnAmt |
| Exclusion | $1,778,812 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AR Interest Income | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $109 | TotalRevenueColumnAmt |
| Exclusion | $109 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $109 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,819,366 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $41,911,829 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,828,079 | 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 | $407 | TotalAmt |
| Program Services | $407 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,216 | TotalAmt |
| Management And General | $206,216 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,367,131 | TotalAmt |
| Program Services | $12,234,145 | ProgramServicesAmt |
| Management And General | $1,132,986 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,501 | TotalAmt |
| Program Services | $333,466 | ProgramServicesAmt |
| Management And General | $38,035 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,644,266 | TotalAmt |
| Program Services | $2,227,666 | ProgramServicesAmt |
| Management And General | $416,600 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $859,184 | TotalAmt |
| Program Services | $754,230 | ProgramServicesAmt |
| Management And General | $104,954 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,705 | TotalAmt |
| Management And General | $130,705 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,215 | TotalAmt |
| Management And General | $12,215 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,133 | TotalAmt |
| Management And General | $41,133 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,886,226 | TotalAmt |
| Program Services | $6,677,723 | ProgramServicesAmt |
| Management And General | $2,208,503 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,179 | TotalAmt |
| Management And General | $2,179 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $969,952 | TotalAmt |
| Program Services | $747,194 | ProgramServicesAmt |
| Management And General | $222,758 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,468 | TotalAmt |
| Management And General | $37,468 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,941 | TotalAmt |
| Program Services | $412,941 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,714 | TotalAmt |
| Program Services | $253,657 | ProgramServicesAmt |
| Management And General | $15,057 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,361 | TotalAmt |
| Program Services | $34,723 | ProgramServicesAmt |
| Management And General | $32,638 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,333 | TotalAmt |
| Program Services | $314,333 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,168,400 | TotalAmt |
| Program Services | $2,168,400 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $219,072 | TotalAmt |
| Program Services | $219,072 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $4,164,162 | $4,164,162 | |
| Bad Debts | $353,895 | $353,895 | |
| Equipment Lease and Ren | $125,074 | $55,629 | $69,445 |
| Dues and Subscriptions | $86,949 | $37,236 | $49,713 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,941 | TotalAmt |
| Program Services | $44,256 | ProgramServicesAmt |
| Management And General | $41,685 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,795,425 | TotalAmt |
| Program Services | $31,033,135 | ProgramServicesAmt |
| Management And General | $4,762,290 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,032,163 | BOYAmt |
| EOY | $6,560,306 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,954,873 | BOYAmt |
| EOY | $4,977,632 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $958,894 | BOYAmt |
| EOY | $1,153,119 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,765 | BOYAmt |
| EOY | $52,830 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,292,980 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,078,392 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,100,356 | BOYAmt |
| EOY | $16,214,588 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,520,504 | BOYAmt |
| EOY | $1,782,667 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,900,587 | BOYAmt |
| EOY | $24,044,933 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,524 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,811,666 | BOYAmt |
| EOY | $54,786,075 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,344,565 | BOYAmt |
| EOY | $2,219,671 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,142,804 | BOYAmt |
| EOY | $8,480,101 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,040,000 | BOYAmt |
| EOY | $1,200,869 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,527,369 | BOYAmt |
| EOY | $11,900,641 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,133,797 | BOYAmt |
| EOY | $42,734,934 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,500 | BOYAmt |
| EOY | $150,500 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,284,297 | BOYAmt |
| EOY | $42,885,434 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,811,666 | BOYAmt |
| EOY | $54,786,075 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,023,941 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $577,196 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,500 | BeginningYearBalanceAmt |
| End Year Balance | $150,500 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,500 | BeginningYearBalanceAmt |
| End Year Balance | $150,500 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,500 | BeginningYearBalanceAmt |
| End Year Balance | $150,500 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,500 | BeginningYearBalanceAmt |
| End Year Balance | $150,500 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $150,500 | BeginningYearBalanceAmt |
| End Year Balance | $150,500 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $745,022 | OtherCostOrOtherBasisAmt |
| Book Value | $745,022 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,509,430 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,731,114 | DepreciationAmt |
| Book Value | $11,778,316 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,866,665 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,649,068 | DepreciationAmt |
| Book Value | $3,217,597 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,171,863 | OtherCostOrOtherBasisAmt |
| Depreciation | $698,210 | DepreciationAmt |
| Book Value | $473,653 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,214,588 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Assets Limited to Use - Avera Pooled Investments | $23,269,424 | F |
| Investment in Foundation | $775,509 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $24,044,933 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated Third Party Payor Settlements | Desc |
| Amt | $1,200,869 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,200,869 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $44,042,667 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $577,196 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$353,895 | OtherRevenueAmt |
| Revenue Not Reported | $223,301 | RevenueNotReportedAmt |
| Revenue Subtotal | $43,819,366 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $43,819,366 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $35,441,530 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $35,441,530 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $353,895 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $353,895 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $35,795,425 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The Foundation's endowment consists of a portion of their interest in the net assets of St. Anthony's Hospital Foundation. The St. Anthony's Hospital Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. |
| Part X, Line 2: | The Hospital is organized as a Nebraska nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes that it has 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 Hospital would recognize future and accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for Bad Debts Included in Revenue on Financial Statements -353,895. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts Included in Revenue on Financial Statements 353,895. |
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 | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 460 | PersonsServedCnt |
| Total Community Benefit Expns | $486,082 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $486,082 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01370 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5321 | PersonsServedCnt |
| Total Community Benefit Expns | $2,139,615 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,663,499 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $476,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01340 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5781 | PersonsServedCnt |
| Total Community Benefit Expns | $2,625,697 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,663,499 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $962,198 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02710 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 4420 | PersonsServedCnt |
| Total Community Benefit Expns | $234,498 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $94,980 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $139,518 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $116,721 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $116,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 1028 | PersonsServedCnt |
| Total Community Benefit Expns | $334,035 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $59,389 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $274,646 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $462 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $462 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 5448 | PersonsServedCnt |
| Total Community Benefit Expns | $685,716 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $154,369 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $531,347 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01490 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 11229 | PersonsServedCnt |
| Total Community Benefit Expns | $3,311,413 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,817,868 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,493,545 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04200 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 13759 | PersonsServedCnt |
| Total Community Benefit Expns | $229,441 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $194,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $34,902 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $87,392 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $87,392 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 13759 | PersonsServedCnt |
| Total Community Benefit Expns | $316,833 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $194,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $122,294 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $353,895 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $16,544,685 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,781,519 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$236,834 | 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 | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera St Anthony's Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1Txt |
| City | ONeill | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68763 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.avera-sta.org | WebsiteAddressTxt |
| State License | 410002 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Provider based clinics - 1 RHC & 3 physician clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Anthony's Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See website address on 7d narrative | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See website address on 7d narrative | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See website address on Part V narrative. | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.avera.org/experience/ah/financial-assistance-charity-care/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.avera.org/experience/ah/financial-assistance-charity-care/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.avera.org/experience/ah/financial-assistance-charity-care/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| St. Anthony's Hospital | Part V, Section B, Line 5: Our Hospital worked with the North Central District Health Department and nine other hospitals in the health department's district. This collaborative approach allowed for additional resources and the support and expertise of a state public health agency. |
| St. Anthony's Hospital | Part V, Section B, Line 6a: CNCS, Osmond General HospitalAntelope Memorial HospitalBrown County HospitalNiobrara Valley HospitalTilden Community HospitalWest Holt Memorial HospitalCherry County HospitalAvera Creighton HospitalRock County Hospital |
| St. Anthony's Hospital | Part V, Section B, Line 6b: North Central District Health Department |
| St. Anthony's Hospital | Part V, Section B, Line 7d: Other website: www.avera.org/about/community-health-needs-assessments/ |
| St. Anthony's Hospital | Part V, Section B, Line 11: Prioritized List of Significant Health Needs Identified in CHNAThrough the discussion and consensus voting, the following community health priority areas were finalized:Priority area 1: Physical wellnessPriority area 2: Mental wellnessPriority area 3: Aging population and related issuesPriority area 4: Substance abuseSignificant Health Needs to be AddressedIn general the hospital's core group determined that two broad focus areas would be adequate to cover the major health problems and high-risk behaviors. The identified community health needs led to the creation of the following focus areas specific to Avera St. Anthony's Hospital:* Physical Wellness* Mental WellnessThe following is an update of what activities took place during the fiscal year to address these focus areas.Goals:1. Enhance population health through promotion of community assistance initiatives.Avera St. Anthony's continues to support programs previously established with known positive impact while promoting alternative volunteer groups to identify the recognized needs of compromised individuals or families.It is our intent to work with Ministerial Associations, School Extracurricular/ Governmental/Civic groups and Senior Living organizations to address a demonstrated community need of home assistance.Status Report - 2017* Partnership with NCDHD - Avera St. Anthony's Hospital participates in bi-monthly meetings of focus groups to enhance progression through strategic plan of the north central district. * Tend My Flock Mentoring Program: Feb. 15, 2017 - Joint meeting with Kay Mudloff (OPS Psychologist & Tend My Flock President), Dr. Mark Stordvedt, Heather Rohde (Director and Coordinator of the Befriend Mentoring program with OASIS Counseling) and Karen Larson (Presbyterian Minister) to discuss testimonials, liability insurance concerns and program sponsorship within the Holt County community. Progress in this local endeavor was discussed as a United Way Venture Grant had been submitted with interest of support from the O'Neill Ministerial Assoc., O'Neill Public Schools, West Holt Ministries and Avera St. Anthony's Hospital. The United Way Venture Grant application was denied. Members of the Tend My Flock group continue to meet to research grants and access/solicit financial support to initiate the program.* WE CARE Food Pantry - Offered information regarding this local community resource.* O'Neill Ministerial Association (OMA) - Provide guidance and documentation of assistance program that offers aid to community members or transient persons in an emergent situation. From June - December there were more than 25 individuals/families that were assisted with housing, utility, food through the management of the OMA support program.* Medicare D Program - Medicare D Services are provided throughout the year. 464 contacts were had with beneficiaries: 137 Phone contacts, 321 face to face contacts, and 6 through mail/fax. There were a total of 158 enrollments completed. * Public Health Screens - During the month of April and October, ASAH provided the public with the opportunity of reduced cost blood profile testing. There were 1105 screenings done in April and 474 in October assisting a total of 1500+ persons with an awareness of their health status.2. Improve access to physical/mental wellness activities through partnership with community organizations to maintain and populate programs already in existence.Through collaboration with local entities Avera St. Anthony's will explore known programs and offer increased input and health-related expertise to encourage and improve participation.Status Report - 2017* Participation in Mental Health First Aid training provided locally by Region IV Behavioral Health. Program was held on March 14, 2017. Attendees from O'Neill Valley Hope and ASAH. * Partnership with NCDHD - Avera St. Anthony Hospital participates in bi-monthly meetings of focus groups to enhance the progression through strategic plan of the north central district. 3. Advance generalizable knowledge by publicizing known activities/resources on local multi-media outlets.Guided by desire for improved accessibility Avera St. Anthony's will work to streamline community events into a recognizable technological format for public viewing. Status Report - 2017* April - Publicized Public Health screening events through radio and newspaper outlets. * Partnership with NCDHD Community Health Improvement Plan (CHIP) Meeting - with a hospital staff member chairing 2 of 3 workgroups for Mental Health. * KBRX Mental Health Forum - August 21-25: Utilize the radio media outlet to address mental health issues, CHIP efforts and resources for community listeners. Message provided through on-air broadcasts with contributions from local Mental Health counselor and Directors of Mission Services and Social Services. * Mental Health Awareness Video - completed and released to Social Media and websites on Aug. 22. Video entitled "O'Neill Talks About Mental Health" featured community leaders promoting awareness and the importance of seeking help. * Mental Health Screening Tool - Workgroup developed tool with distribution in September to various organizations.Goal of screening tool:* Keep it short and simple (10 questions or less)* Intended for those without a screening process in place (schools/clinics)* Address components of science and evidence-based practice* Bring awareness to potential concern/need* Offer resources for referral* Emphasis of non-diagnostic intent.Significant Health Needs Not AddressedThe following health needs/priorities will not be addressed due to either, a relative low priority or, because other facilities or educational entities are addressing the issues:* Aging Population and Related Issues* Substance AbuseA housing and environmental category was eliminated due to the issue being outside the scope of control; this issue is being addressed by other organizations in the community. The access to care, safety, aging population and chronic disease categories were eliminated as stand-alone categories, as they can be addressed through the final priority areas that were chosen. |
| St. Anthony's 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. |
| St. Anthony's 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. |
| St. Anthony's 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. |
| St. Anthony's Hospital | Part V, Section B, Line 24: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care. |
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 6a: | We have a community benefit report specific to our Hospital available on our website or on request as well as contained in a report prepared by Avera Health, a related organization. It is available through the website and requested mailing, and is filed with the Catholic Health Association. |
| Part I, Line 7: | Charity care, unreimbursed Medicaid and subsidized health services were converted to cost using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, health professions education and research are actual expenses recorded in the general ledger. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculation was $353,895. |
| Part II, Community Building Activities: | We provide transportation at a reduced rate to the community. Many children use our transportation to get to school keeping them out of the elements. The elderly and disabled use our transportation to get to appointments, shopping, and loved ones. Workforce development keeps and recruits health care professionals to this small community. |
| 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. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on pages 5 and 6 of the attached audited financial statements. |
| Part III, Line 8: | St. Anthony's Hospital 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.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. |
| Part VI, Line 2: | Avera St. Anthony's Hospital conducts an annual strategic planning meeting that includes a cross section of community members. Our Hospital Board of Directors, Hospital Finance Committee, Foundation Board of Directors, Community Medical Staff, and Hospital Department Directors meet to assess community input from the local nursing facility, assisted living, and local public health office. Our Hospital and Foundation Boards and Finance Committee are made up of a majority of community members. This group drafts an annual strategic plan of goals, objectives, and strategies that are continuously updated to address the needs of the community. Additionally, input from the local ministerial association, law enforcement, Chamber of Commerce, elementary and secondary public and parochial schools, and the local community college are assessed and incorporated into the plan. We are also currently working with our local health department to assess additional community needs through surveys and additional input from community leaders and community health care professionals. |
| Part VI, Line 3: | Patients are informed of the financial assistance/charity care policy through brochures and posted policies at the registration desks of the Hospital and Emergency Department. Avera St. Anthony's has staff in central registration that identify if a patient has the financial means to pay for services or insurance to cover these services. Public assistance is also pursued if deemed appropriate. If patients are identified as candidates for charity care they are directed to our financial services representative and the application process is initiated for charity care. Patient financial services can assist with determining what benefits the patient may qualify for and assists with helping them apply for any benefits. If there is no option for an outside assistance program, the patient is informed and encouraged to complete the application that utilizes a combination of income, assets, and expenses to determine what percentage of charity care they would qualify for. |
| Part VI, Line 4: | Avera St. Anthony's Hospital is located in O'Neill, Nebraska, the county seat of Holt County. We serve a large radius to include patients from Brown, Rock, Boyd, Keya Paha, Wheeler, Knox, Garfield, and Antelope counties. In 2016, the population estimate for Holt County was estimated to be 10,250. Approximately 20.5% of the population is age 65 or older. The average per capita income is $26,267 and approximately 10.6% of the population is below the federal poverty level. The nearest hospital in the area is approximately 18 miles from Avera St. Anthony. |
| Part VI, Line 5: | The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay. |
| Part VI, Line 6: | The communities in which Avera operates all have unique health and community benefit needs and in keeping with the Catholic Healthcare Association Guidelines each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional, and national importance. |
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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ryan Banks MDPres of Med | ||||||||||||||
| Staff/Physician | $0 | $437,360 | $0 | $0 | $0 | $1,201 | $0 | $0 | $0 | $23,588 | $0 | $462,149 | $0 | $0 |
| Michael Garman | ||||||||||||||
| Sec/Treas & SrVP Finance | $161,035 | $0 | $0 | $0 | $4,275 | $0 | $6,788 | $0 | $24,771 | $0 | $196,869 | $0 | $0 | $0 |
| Edwin N Cook DO | ||||||||||||||
| Radiologist | $568,746 | $0 | $0 | $0 | $8,225 | $0 | $16,000 | $0 | $20,760 | $0 | $613,731 | $0 | $0 | $0 |
| Josh Becker | ||||||||||||||
| CRNA | $253,844 | $0 | $0 | $0 | $319 | $0 | $10,507 | $0 | $26,062 | $0 | $290,732 | $0 | $0 | $0 |
| Kevin Loecker | ||||||||||||||
| CRNA | $241,406 | $0 | $0 | $0 | $703 | $0 | $9,750 | $0 | $17,785 | $0 | $269,644 | $0 | $0 | $0 |
| Wendell Spencer | ||||||||||||||
| Director of Anesthesia | $336,080 | $0 | $0 | $0 | $2,119 | $0 | $9,754 | $0 | $26,080 | $0 | $374,033 | $0 | $0 | $0 |
| Cameron Everitt | ||||||||||||||
| Director of PT | $157,409 | $0 | $0 | $0 | $483 | $0 | $6,360 | $0 | $9,911 | $0 | $174,163 | $0 | $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's compensation is paid by a related organization, Sacred Heart Health Services. Avera St. Anthony's Hospital relied on the related organization for determining the compensation for the President & CEO using the methods described in Part I, Line 3. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. |
| Form 990, Part VI, Section A, line 8b | Avera St. Anthony's Hospital does not have a committee 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 CEO and Sec/Treas & SrVP. After initial reviews, a draft is provided to the Finance Committee for final review. The return is provided to the Board prior to filing. |
| 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 | Compensation of the CEO is determined by Avera Sacred Heart Hospital, a related exempt organization. The Board of Directors reviews the management agreement with Avera Sacred Heart Hospital and discusses and approves the agreement. Negotiations are done as needed. For the Sec/Treas & SrVP, a salary review is done by a committee based on hospital association surveys, including hospital size. |
| 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 737,585. Management and general expenses 92,791. Fundraising expenses 0. Total expenses 830,376. Professional Fees: Program service expenses 3,310,279. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,310,279. Miscellaneous Fees: Program service expenses 2,629,859. Management and general expenses 280,883. Fundraising expenses 0. Total expenses 2,910,742. ACS Fees: Program service expenses 0. Management and general expenses 1,834,829. Fundraising expenses 0. Total expenses 1,834,829. |
| 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 St. Anthony's Hospital. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 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 W Avera Drive Suite 300 | Sioux Falls | SD | 57108 | 460422673 | Promotion of health | SD | 501(c)(3) | Line 10 | N/A | 0 | |
| Avera Holy Family | |||||||||||
| 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 of Holy Family Hospital and Home Health Agency | IA | 501(c)(3) | Line 10 | 0 | Avera Holy Family | |
| 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 | |||||||||||
| 401 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 Gettysburg | |||||||||||
| 606 East Garfield | Gettysburg | SD | 57442 | 460234354 | Healthcare services | SD | 501(c)(3) | Line 3 | 0 | Avera St Mary's | |
| Avera Queen of Peace Hospital | |||||||||||
| 525 North Foster | Mitchell | SD | 57301 | 420224604 | Healthcare services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Sacred Heart Health Services | |||||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460225483 | Healthcare services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| 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 Ed and Serv Agency | |||||||||||
| 1000 W 4th Street Suite 9 | Yankton | SD | 57078 | 460337013 | Healthcare education | SD | 501(c)(3) | Line 10 | 0 | Sacred Heart Health Services | |
| Avera St Luke's | |||||||||||
| 305 South State Street | Aberdeen | SD | 57401 | 460224598 | Healthcare services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera Marshall | |||||||||||
| 300 S Bruce St | Marshall | MN | 56258 | 410919153 | Healthcare Services | MN | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera St Mary's | |||||||||||
| 801 East Sioux Avenue | Pierre | SD | 57501 | 460230199 | Healthcare services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| St Anthony's Hospital Foundation | |||||||||||
| 300 North 2nd Street | ONeill | NE | 68763 | 470728707 | Support to Avera St. Anthony's Hospital | NE | 501(c)(3) | Line 12a, I | Yes (1) | Avera St Anthony's Hospital | |
| 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 W Avera Drive Suite 101 | Sioux Falls | SD | 57108 | 460451539 | Health financing and health plan admin | SD | 501(c)(4) | 0 | Avera Health | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 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 E Lincoln St NE | Lemars | IA | 51031 | 820582350 | Medical services - home medical equipment | SD | N/A |
| Avera Home Medical Equipment of Sioux Center LLC | |||||||
| 38 19th St SW | Sioux Center | IA | 51250 | 753203100 | Medical services - home medical equipment | SD | N/A |
| Avera Home Medical Equipment of Spencer Hospital LLC | |||||||
| 2400 S Minnesota Avenue 102 | Sioux Falls | SD | 57117 | 800619999 | Medical Services - home medical equipment | SD | N/A |
| Q&M Properties LLC | |||||||
| 525 North Foster | Mitchell | SD | 57301 | 730652049 | Medical clinic building | SD | N/A |
| Surgical Associates Endoscopy Clinic LLC | |||||||
| 310 S Pennsylvania St | Aberdeen | SD | 57401 | 460461429 | Surgical associates | SD | N/A |
| Heart Hospital of South Dakota LLC | |||||||
| 4500 W 69th Street | Sioux Falls | SD | 57108 | 562143771 | Healthcare Services | SD | N/A |
| Brookings Health System - Avera HME LLC | |||||||
| 101 22nd Ave Suite 101 | Brookings | SD | 57006 | 453204123 | Medical Services - Home Medical Equipment | SD | 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 |
|---|---|---|---|---|---|---|---|---|---|
| Accounts Management Inc | |||||||||
| 5132 S Cliff Avenue Suite 101 | Sioux Falls | SD | 57108 | 460373021 | Collection Services | SD | N/A | C | 0 |
| Avera Property Insurance Inc | |||||||||
| 610 W 23rd Street | Yankton | SD | 57078 | 460463155 | Property Insurance | SD | N/A | C | 0 |
| Valley Health Services | |||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460357149 | Rental Real Estate | SD | N/A | C | 0 |
| Alucent Medical Inc | |||||||||
| 31325 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 | Yes (1) | 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 | Yes (1) | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | Yes (1) | 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 | 0 | 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 | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |