2016-05-13T07:06:59-05:00 2015-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-07-01 460224598 Avera St Luke's AVER 6056225272 305 South State Street Aberdeen SD 57401 Geoff Durst Sec/Treas & VP of Finance 6056225127 2016-05-12 1 Kim Hunwardsen CPA P00484560 6122536500 2016-05-12 2014 2016-08-17 19:52:53Z Todd Forkel 305 South State Street Aberdeen SD 57401 178661183 0 0928 X www.averastlukes.org X 1901 SD Promotion of Health 17 11 1645 186 485712 -188729 281232 2620304 161836612 173912031 2557954 1080669 -1565872 -569733 163109926 177043271 461361 472158 0 0 97621169 107375006 0 0 265774 76314136 73471173 174396666 181318337 -11286740 -4275066 183011769 202990393 65534031 94997573 117477738 107992820 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 156977976 472158 172937327 Avera St. Luke's mission is to provide acute care and long-term healthcare services including skilled nursing, congregate living and assisted living (Medicaid certified), of which there were 15,073 acute patient days, 964 nursery patient days, 46,999 nursing home resident days, 188,456 clinic visits and 130,484 outpatient visits. Avera St. Luke's provides health care services to patients who meet certain criteria under its Charity Care Policy without charge or at amounts less than established rates. Since the Organization does not pursue collection of these amounts, they are not reported as patient service revenue. The amount of charges foregone for services provided under the Organization's charity care policy was approximately $6,967,750 for the year ended June 30, 2015. The estimated cost of providing these services was $2,509,176 for the year ended June 30, 2015, calculated by multiplying the ratio of cost to gross charges for the Organization by the gross uncompensated charges associated with providing charity care to its patients.Avera St. Luke's also provides community benefit health activities at less than or at no cost to support those in the area served. These activities include: donations/grants/educational scholarships, community education programs; special programs for the elderly, handicapped, and medically underserved; support for rural clinics; nursing staff for health centers serving minority populations; and a variety of broad community support activities. During the year ended June 30, 2015, specific activities included meals delivered to residential homes; senior resource programs for billing assistance; meeting facilities and programs for patients and families; assistance to health educators; emergency healthcare providers; wellness programs; and housing families of hospitalized patients.As a member of the Avera Health System, Avera St. Luke's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide a quality, effective health ministry and to improve the health care of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Luke's engages in activities (including a Community Health Needs Assessment) designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 156977976 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 171 0 1 1645 1 1 1 0 0 0 0 0 0 0 0 0 X 17 11 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 0 X Geoff Durst 6056225272 305 South State Street Aberdeen SD 57401 Bob Olson Chair 1.00 0.00 X X 0 0 0 Josh Kraft Vice Chair 1.00 0.00 X X 0 0 0 Sr Mary Kay Panowicz Director 1.00 7.00 X 0 0 0 Jean Gerber MD Director 1.00 0.00 X 0 0 0 Lyle Biegler MD Director 1.00 0.00 X 382712 0 46728 Thomas Luzier MD Director 1.00 0.00 X 0 0 0 Michael Evans Director 1.00 0.00 X 0 0 0 Tage Born MD Director 1.00 0.00 X 799223 0 43128 Carmen Meyer Director 1.00 0.00 X 0 0 0 Robert Fouberg Director 1.00 0.00 X 0 0 0 Judith Bledsoe Director 1.00 0.00 X 0 0 0 Sr Denette Leifeld OSB Director 1.00 0.00 X 0 0 0 Stephen Peters MD Director 1.00 0.00 X 472818 0 47021 Sr Mary Thomas Director 1.00 0.00 X 0 0 0 Sr Pam Donelan Director 1.00 0.00 X 0 0 0 Larry Sidaway Physician/Chief of Staff 1.00 0.00 X 484973 0 39448 Todd Forkel President & CEO 40.00 0.00 X X 0 493403 29779 Geoffrey Durst Sec/Treas & SrVP Finance 40.00 0.00 X 216907 0 35076 Shahid Chaudhary CMO 40.00 0.00 X 1214179 0 46128 Christine Stehly MD Obstetrics/gynecology 40.00 0.00 X 745483 0 43728 James Macdougall Orthopedic 40.00 0.00 X 741427 0 30340 Patrick Miller Orthopedic 40.00 0.00 X 752097 0 41936 Leslie Lenter MD Radiologist 40.00 0.00 X 787364 0 41128 Richard Conklin Oncologist 40.00 0.00 X 1327153 0 43628 7924336 493403 488068 125 0 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 571085721 Shared services 15896242 JDH Construction Inc 507 N Hyman Dr Aberdeen SD 57401 Construction 6498625 Med-Trans Corporation 209 State Hwy 121 Bypass Lewisville TX 75067 Helicopter Transportation Services 1313776 Cardiosolution LLC 4270 Glendale Milford Rd Cincinnati OH 45242 Physician Services 825481 Aegis Therapies Inc 1000 Fianna Way Fort Smith AR 72919 Physical therapy 341613 21 34809 124358 2461137 2620304 Net patient services 621110 170122256 170122256 Supporting revenue 624100 2295108 1809396 485712 EHR revenue 900099 1051893 1051893 Invest AH Foundation 900099 442774 442774 173912031 184101 184101 536479 1205672 -669193 -669193 -669193 1255582 5000 0 364014 1255582 -359014 896568 896568 70497 48226 22271 22271 Interest Income 900099 77189 77189 77189 177043271 173503508 485712 433747 X 468658 468658 3500 3500 2631128 2369048 262080 24146 24146 84571479 77778772 6635074 157633 4916641 4522119 385357 9165 10539097 9690628 828835 19634 4692515 4304357 379437 8721 3040 3040 18899267 6940690 11948126 10451 108615 85852 22718 45 11631928 9450001 2178595 3332 127243 126267 976 2224692 2181438 43254 257914 181622 75773 519 206439 196284 10155 1262463 1262463 7469093 6682680 786413 1469642 1455986 13656 Medical supplies 18651251 18650752 499 Bad debt 6130956 6130956 Licenses and permits 2791758 2405054 386704 Equipment lease/rental 1841784 1800728 41056 395088 265975 72839 56274 181318337 156977976 24074587 265774 850858 10864818 23260242 20713988 16007 190231 1522812 1559124 2986614 3545632 2725658 1473897 180879917 96494020 75940750 84385897 56786411 35008289 1660814 1298097 8261603 39928130 9000000 4022290 183011769 202990393 13038334 14862082 49924161 76504467 75905 70118 2495631 3560906 65534031 94997573 X 113425659 102181918 3524073 5282837 528006 528065 117477738 107992820 183011769 202990393 X -4275066 -4514249 -695603 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14859 14859 0 Part II-B, Line 1: Avera St. Luke's paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 3963040 676958 153521 414764 13812 4364943 756018 3133989 168152 73620 21499 3963040 1159121 4051 407154 756018 526177 641131 -8187 1159121 525050 1127 526177 0.13000 0.13000 0.74000 0 1 1 1608403 4589137 6197540 117375786 59210203 58165583 47598453 35701821 11896632 9708138 1581996 8126142 84385897 Investment in Surgical Associates Endoscopy Center LLC 634156 F Assets limited to use - Avera pooled investments 29515511 F Investment in Avera Health Foundation 4858622 F 35008289 Estimated third-party payor settlements 1999744 Interest rate swap agreement 1561162 3560906 X Part IV, Line 2b: The organization holds funds in trust on behalf of its residents. Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization's permanently restricted endowment funds are donor restricted. Part X, Line 2: The Organization is organized as a South Dakota 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). Certain consolidated subsidiaries, including Valley Health Services, are not tax-exempt entities and are considered partnerships or disregarded entities for tax purposes. The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization 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 consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2012. 1 1 X 1 X 1 X 1 1 1 0 1 1 4092 2509176 2509176 0.01430 36046 7821235 4459237 3361998 0.01920 770 1015157 1015157 0.00580 40908 11345568 4459237 6886331 0.03930 10 4139 392054 130116 261938 0.00150 4 41 7705 4479 3226 0.00000 8 1421 6779456 4841157 1938299 0.01110 5 14744 1095343 1095343 0.00630 27 20345 8274558 4975752 3298806 0.01890 27 61253 19620126 9434989 10185137 0.05820 1 3000 2000 2000 0.00000 1 3 3798 3798 0.00000 2 3003 5798 5798 1 6130956 0 45966925 55997795 -10030870 X 1 1 1 Surgical Associates Endoscopy Clinic LLC Endoscopy Procedures 0.51000 0.49000 1 1 Avera St Luke's 305 South State Street Aberdeen SD 57401 www.averastlukes.org 10525 X X X 18 provider based clinics Avera St Luke's 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X www.averastlukes.org X 1 12 1 http://www.avera.org/experience/shared/community-needs-health-assessments/ 0 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X X 1 X 0 X X X X 1 X 0 1 Avera St. Luke's Part V, Section B, Line 5: Avera St. Luke's conducted five focus groups representing community leaders and members, health care providers, uninsured/underinsured persons and policy makers in order to discuss health care needs and concerns in Brown County. The hospital invited a vast array of individuals from all facets of the community to participate in the focus groups. Those individuals who were able to attend one of the focus groups included representatives from local schools, including colleges and universities; health care related organizations; Brown County; churches; city officials; and other government officials. Avera St. Luke's Part V, Section B, Line 11: The following key themes were identified by the Focus Groups as community needs. The Hospital reviewed and assessed its current involvement in each to determine future steps to take. The Hospital has involvement in the following five identified areas. Health Care AffordabilityAvera St. Luke's does many things in order to help with health care affordability. The Social Services Department provides assistance to those unable to pay for services and the Business Office assists patients as needed in setting up payment plans. Access to Health Care SpecialistsAvera St. Luke's currently offers 27 physician specialties locally. The Avera St. Luke's physician recruiter works on an ongoing basis to recruit additional specialists as needed.Avera St. Luke's also has access to eConsult services. eConsult is a program facilitated by the Avera Health system that uses cutting edge technology to provide access to specialty services in rural facilities through two-way video technology.Preventive Care and EducationAvera St. Luke's currently has numerous programs that provide preventive care and health education opportunities to the community such as screening, health fairs, fitness programs, education, classes, health forums and safety.Chronic Disease CareAvera St. Luke's currently provides both support and care facilities for the chronically ill through our Kidney Dialysis Unit, Behavioral Health Services, Home Health, Palliative Care and Hospice Services. Travel and Accessibility to CareAvera St. Luke's monetarily supports the Aberdeen Ride Line service as well as the Groton Community Transit service for patients who have no transportation to doctor appointments. Two FastCare clinics provide after hours and weekend care, the ER is staffed 24-hours a day, helicopter services are available 24-hours a day, St. Luke's manages two critical access hospitals and five primary clinics, specialists travel to eight communities within the region on a monthly basis to provide clinic services, eConsult services are available, and the Auxiliary Guest House is available at a low price for patients and families who need overnight stays and can't afford a hotel.Dental CareThe Community Assessment focus was on Dental Care given number of patients who come to the ER for care, some of which is basic. In our City, dental care for Medicaid and low income families is not readily available. We reached out to the Dental Association and tried other avenues to create access. We have not been completely successful. We do host the Delta Dental van when it comes to Aberdeen and the response in the past and currently, has been very high. Lots of children receive care when the van comes to our campus. Additionally our Social Work department has worked with individuals and families to gain access and in some cases, have asked their personal dentist to care for the person and have had success. Avera St. Luke's Part V, Section B, Line 16i: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, waiting rooms, and admissions office and is included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Luke's 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. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Avera St. Luke's Part V, Section B, line 16a website: http://www.avera.org/experience/ah/financial-assistance-charity-care/ 9 Avera Mother Joseph Manor 1002 N Jay Street Aberdeen SD 57401 Nursing Home, Assisted and Congregate Living Avera Eureka Health Care Center E Hwy 10 Eureka SD 57437 Skilled Nursing Facility Aberdeen Plastic Surgery Associates 201 S Lloyd St Suite W230 Aberdeen SD 57401 Clinic Marshall County Medical ClinicAvera 413 9th St Britton SD 574302274 Clinic Avera Medical Group Pediatrics 201 S Lloyd St Suite E205 Aberdeen SD 57401 Clinic Avera Clinic of Ellendale 240 Main St Ellendale ND 58436 Clinic Avera Medical Group Fastcare Shopko 500 N Hwy 281 Aberdeen SD 57401 Clinic Avera Medical Group Fastcare Kesslers 615 6th Ave SE Aberdeen SD 57401 Clinic Avera Medical Group Selby 4401 Main St Selby SD 57472 Clinic Part I, Line 3c: A combination of income and assets test is utilized to determine eligibility for free or discounted care. Points are assigned based on income as a percentage of FPG and net assets owned with points deducted for ongoing medical expenses such as drugs. Patients with the fewest points receive the largest discount. 0-1 points receive 100% discount on bills while remaining discounts range from 10-90% depending on point totals and dollar amount of charges. Part I, Line 6a: Our community benefit report is 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: A combination of costing methodologies were used to calculate the amounts reported in the table. A cost-to-charge ratio derived from Worksheet 2, ratio of patient care cost-to-charges was used to calculate charity care at cost, unreimbursed Medicaid and Means-Tested Government Program expenses. Subsidized health was calculated based on actual cost/loss. For all other amounts, costs and revenues as reflected by the general ledger system were used. Part I, Ln 7 Col(f): Bad debt expense of $6,130,956 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. 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 is reported at charges as recorded by the organization. Part III, Line 3: Avera St. Luke's does not believe that any portion of bad debt expense could reasonably be attributed to patients who may qualify for financial assistance since evaluations are completed to determine those amounts due and will be reclassified from bad debt expense to charity care within 30 days following the evaluation of the amount. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses is located in Footnote 1 on pages 10 of the attached financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Avera St. Luke's follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall (as calculated including our non-cost report entities) 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 a reasonable time period, the Organization or its agent shall not send, nor indicate that it will send, the unpaid bill to any outside collection agency. At such time as the Organization sends the uncollected account to an outside collection agency, the amount referred to the agency shall reflect the reduced-payment level for which the patient was eligible under the Organization's financial assistance policy for low-income uninsured patients. Avera St. Luke's does not report any data to any of the credit agencies, however, the collection agencies Avera St. Luke's utilizes may report to the credit agencies. Any extended payment plans offered by the Hospital, or the Hospital's representative, in settling the outstanding bills of patients who qualify for financial assistance shall be interest-free so long as the repayment schedule is met. Part VI, Line 2: Health care needs are assessed through various methods. Given Aberdeen is a regional center/hub and the third largest city in South Dakota, Avera St. Luke's is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. Although another smaller hospital opened in Aberdeen during FY 2013, the next largest hospital is 100 miles from Aberdeen and most of the towns within our region have a population of less than 2,000. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. Our community health needs assessment (CHNA) was completed and posted to our website by June 30, 2013. We are currently performing a new (CHNA) and will have that completed by June 30, 2016. Part VI, Line 3: The Organization utilizes various methods to inform patients about our financial assistance policy. Admitting areas have signs/posters noting charity care and financial assistance. Avera St. Luke's and Avera Health utilize the internet to address financial assistance. Social workers are in direct contact with patients and make referrals to the Business Office for financial assistance and in many cases, work directly with the patient on various government programs which may be available and help with applications. For those who receive bills for services and have concerns about their ability to pay, financial counselors work directly with them on financial assistance. We have brochures available to all and treat all without regard to their ability to pay. Part VI, Line 4: Aberdeen is the third largest city in South Dakota. Using South Dakota estimated data for 2013 and 2014, census reflected a population of approximately 27,800. Our primary service area consists of the following counties: Brown, Marshall, Day, Faulk, Edmunds, McPherson, and Spink in South Dakota and Dickey County in North Dakota. The population of this area is approximately 69,000. Our secondary service area includes other close by counties. This large service area is due to outreach and the scope of specialty services offered by Avera St. Luke's for which if not offered, a patient would travel up to 200 miles for the same service. Given we are a rural community in the truest sense; we have a very aged population. Many of the patients within this region are Medicare age. Other than the hospital that opened in Aberdeen during FY 2013, the next closest hospitals are 40 to 100 miles away and have limited services and are Critical Access Hospitals served by limited physicians. Patient demographics within the region would indicate that after you consider those patients admitted to the smaller hospitals, the majority of the rest seek services at Avera St. Luke's and the other hospital in Aberdeen. The population in the primary service counties range from 2,429 to 38,408. South Dakota Census data estimates for 2013 and 2014 contains many data elements, therefore, will comment on Brown County (location of Avera St. Luke's), Spink County (second largest in primary service area with growth) and McPherson County (due to aged population). % change in Pop. % over 65 Non-White Pop. % State of SD 4.8% 15.3% 14.30%Brown County 5.1% 16.0% 8.80% Spink County 2.9% 19.6% 3.8%McPherson County -1.2% 28.2% 1.8%Median Household IncomeState of SD 49,495Brown County 51,398Spink County 48,911McPherson County 37,240As the above indicate, our region has experienced essentially little growth with the exception of Brown County and the percent over 65 years old is high compared to the State average. The high average age correlates with Medicare admissions being 48.63% of total admissions. Medicaid admissions totaled 8.70%, and newborn admissions totaled 10.59% of all admissions. In addition to Medicare and Medicaid, there is a County Indigent Program which resulted in approximately $5,289,000 of assistance at charge and was for 248 patients.From an unemployment standpoint, South Dakota (3.1%) and our region has faired much better than the US. Within the primary service area, current unemployment rates range from a low of 2.7% in Brown County to a high of 5.5% in Day County. Part VI, Line 5: Avera St. Luke's is a regional facility within Avera Health System. We are a health ministry cosponsored by the Benedictine Sisters of Yankton, South Dakota and the Presentation Sisters of Aberdeen, South Dakota. Our health ministry is rooted in the Gospel and requires us to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. Avera St. Luke's vision is to be an exceptional health care organization for patients to receive care, physicians to practice and employees to work. The Organization's values are Compassion, Hospitality and Stewardship.Our governing body consists of 17 members who are physicians, community and regional residents and Sister representatives from the Presentation and Benedictine Orders. In addition, four employees (three physicians and the CEO) serve on the board. The governing body included one Sister who represents both orders and is a System Representative. In addition to the governing body, we have two advisory boards. These include: Northern State University Business School and Salvation Army Advisory Board. Medical Staff privileges can be extended to qualified physicians based on receiving approval of their application and credentials by the Medical Dental Staff and then the Hospital governing body. The Hospital's governing body then takes into account other factors related to overall community need and how a physician would impact the Hospital's overall ability to fulfill the mission.Avera St. Luke's mission and values ensure our focus is on the patient, family, employees, physician, those in need, visitors and our region as a whole. The value of Stewardship requires the organization to use all resources in a way that fulfills the mission and values. Each year, our operating and capital budgets are based on various assumptions that in the end provide the needed resources and take into account Charity Care, patient care, technology, education, community services, employee benefit and compensation plans and programs for meeting the region's needs. All surplus funds are used and maintained to provide for both current and future needs.Specific examples of how we further our exempt purpose include but are not limited to the following:a. The only inpatient psychiatric unit within 200 milesb. Interventional Cardiology and Radiology services. These services allow us to meet patient needs when care is critical to their survival and must be delivered on a very timely basis.c. Air Ambulance to transport patients to our facility or 200 miles to tertiary facilities.d. End Stage Renal Disease program which serves our broad region with the next closest facility being 100 miles away. Additionally, we employ a full-time Nephrologist to care for the patients along with others who require intensive physician care.e. A 24 hour Emergency Room which treats all patients without regard to the ability to pay. The ER is staffed by physicians 24 hours per day.f. Provision of a multitude of educational and training programs for healthcare professionals and regional residents. The region was awarded an Area Health Education Center by the South Dakota School of Medicine and will be located in Aberdeen. The award was based on applications and interviews within the State and was a collaborative effort of many healthcare and non-healthcare organizations within the region with two being 100 miles from Aberdeen.g. Avera St. Luke's is currently a Rural Referral Center. The nearest hospitals are tertiary facilities 200 miles away by ground and approximately 140 miles by air.h. Avera St. Luke's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (Salvation Army, Foundations, College/University Advisory Boards, Youth Adult Partnership of Aberdeen).i. Our Auxiliary and Volunteers provide opportunities for over 400 individuals. The Auxiliary provides annual scholarships of $500 for students entering higher education in health related fields. In fiscal year 2015, 15,200 hours of service were provided to Avera St. Luke's by volunteers which reduces costs.j. Provide assistance to small rural hospitals (Critical Access Hospitals) within the region through various programs, management agreements, computer systems, educations and other services to assist in keeping their area's patients in the local community when possible.k. Recruitment of specialists in nephrology, neurosurgery, neurology, cardiology and psychiatry to meet the region's need in order to eliminate travel of 200 miles to obtain these services.l. Development and subsidy of various rural clinics to meet needs in those communities.m. Development of a local clinic to provide primary health care (not urgent or emergency care) to individuals regardless of their ability to pay in a setting that is conducive to walk-in for a very minimal cost (about $65 - $90). This clinic is staffed by mid-level providers (PA/Nurse Practioners) and is open on weekends and certain holidays to all and insurance billing is provided.n. Chemical Addiction services on an outpatient basis are provided to the region and State. Our Worthmore program is well known and respected within the region and state and is the closest program within 150-200 miles. We contract with the State for patients who meet their qualification guidelines and work with governmental agencies within the region and State. o. Provide drug and alcohol prevention programs to the local schools through various contracts. Our involvement started when the previous provider discontinued their contract. 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 Avera Central Office advocates for all on community benefit related matters of state, regional, and national importance. 1 Northern State University Foundation 620 15th Ave SE Aberdeen SD 57401 237002314 501(c)(3) 171000 General support Aberdeen Ride Line 205 N 4th Street Aberdeen SD 57401 466000010 City of Aberdeen 13620 General support Aberdeen Public Schools Foundation 1224 S 3rd St Aberdeen SD 57401 460423109 Government 10000 General support Presentation College 1500 N Main Aberdeen SD 57401 522424588 501(c)(3) 163800 General support Aberdeen Swim Club PO Box 1874 Aberdeen SD 57401 450338253 501(c)(3) 10000 General support Bethesda Home of Aberdeen 1224 S High St Aberdeen SD 57401 460367117 501(c)(3) 10000 General support Aberdeen Catholic School System 1400 N Dakota St Aberdeen SD 57401 460336005 501(c)(3) 10650 General support Glacial Lakes Area Development 909 S Main St PO Box 231 Britton SD 57069 870787080 501(c)(3) 10000 General support 8 0 Part I, Line 2: Avera St. Luke's policy is to provide grants/contributions to not-for-profit entities and governmental divisions that benefit the community and region through programs and activities. The organization also provides scholarships to medical students and other students in the community. Scholarships are given to schools to help monitor the use of the funds. 0 0 0 0 0 0 0 0 0 Lyle Biegler MD Director 228118 0 154193 0 401 0 20800 0 26348 0 429860 0 0 0 Tage Born MD Director 720831 0 74666 0 3726 0 20800 0 22468 0 842491 0 0 0 Stephen Peters MD Director 463594 0 0 0 9224 0 20800 0 26221 0 519839 0 0 0 Larry Sidaway Physician/Chief of Staff 471213 0 0 0 13760 0 20800 0 18648 0 524421 0 0 0 Todd Forkel President & CEO 0 399161 0 0 0 94242 0 9451 0 20328 0 523182 0 0 Geoffrey Durst Sec/Treas & SrVP Finance 213795 0 0 0 3112 0 13340 0 22576 0 252823 0 0 0 Shahid Chaudhary CMO 1162559 0 50000 0 1620 0 20800 0 26168 0 1261147 0 0 0 Christine Stehly MD Obstetrics/gynecology 685564 0 56268 0 3651 0 20800 0 22928 0 789211 0 0 0 James Macdougall Orthopedic 690029 0 0 0 51398 0 20800 0 10240 0 772467 0 0 0 Patrick Miller Orthopedic 703565 0 0 0 48532 0 20800 0 21836 0 794733 0 0 0 Leslie Lenter MD Radiologist 743154 0 0 0 44210 0 20800 0 20328 0 828492 0 0 0 Richard Conklin Oncologist 1295987 0 0 0 31166 0 20800 0 23668 0 1371621 0 0 0 Schedule J, Part I Line 3: The President/CEO's compensation is paid by a related organization, Avera Health. Avera St. Luke's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Richard Conklin Employee Client Billing X 140231 140231 0 0 0 Richard Conklin Employee Community Needs Loan X 100000 50000 0 1 1 190231 Bernard Gerber Father to board member Jean Gerber 204000 Avera St. Luke's purchased an ASL suite from Jean Gerber's father. 0 Megan Biegler Wife of board member Lyle Biegler 24146 Compensation and benefits as an employee 0 Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the CEO and CFO. 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 15b The CEO is compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) system members appointed by the religious orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. The organization has a Physician Relations/Executive Compensation Committee to review physician related transactions and compensation related to physicians, other officers and key employees of the Organization. The Committee meets as needed with respect to physician compensation. With respect to leadership positions we contract with an outside consultant to gather wage and market data. Information is provided to the consultant for leadership positions that reflects the leader's area of responsibilities including the position title and education requirements, reporting structure, number of FTE's, total revenue and expenses and years of experience. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not available to the general public. The organization's financial statements are attached to the Form 990 per IRS instructions and therefore are available to the general public. Form 990, Part IX, line 11g Repairs and maintenance: Program service expenses 2,385,589. Management and general expenses 57,630. Fundraising expenses 0. Total expenses 2,443,219. Other fees: Program service expenses 4,364,053. Management and general expenses 1,544,212. Fundraising expenses 10,451. Total expenses 5,918,716. ACS fees: Program service expenses 191,048. Management and general expenses 10,346,284. Fundraising expenses 0. Total expenses 10,537,332. Form 990, Part XI, line 9: Capital Transfer -1,925,896. Change in fair value of interest rate swap -107,543. Book/Tax adjustment on investment in Endoscopy LLC 1,337,836. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Luke's. Form 990, Part VI, Line 16b: There is no written policy or procedure since 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 St. Mary's, Avera Sacred Heart, and Avera Marshall. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return. Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of health SD 501(c)(3) Line 9 N/A 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 Avera Holy Family Foundation 826 North 8th Street Estherville IA 51334 421317452 Fundraising IA 501(c)(3) Line 9 Avera Holy Family 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 Avera Health 0 Avera Marshall Foundation 300 S Bruce Street Marshall MN 56258 411784801 Fundraising MN 501(c)(3) Line 7 Avera Marshall 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 11a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 9 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare education SD 501(c)(3) Line 9 Sacred Heart Health Services 0 Surgical Associates Endoscopy Center LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates/Endoscopy services SD Avera St Luke's Related 2501378 693280 0 1 0.51000 Avera Home Medical Equipment LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460488198 Medical services - home medical equipment SD N/A Home Medical Equipment of Pierre LLC 329 E Dakota Pierre SD 57501 460444002 Medical services - home medical equipment 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 Estherville LLC 602 Central Ave Estherville IA 51334 201686097 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 Marshall LLC 1104 East College Drive Marshall MN 56258 205271924 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical services - home medical equipment SD N/A Q&M Properties LLC 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 Home Medical Equipment LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD N/A Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency SD N/A C 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan administration SD N/A C 0 Avera Property Insurance Inc 610 W 23rd St Ste 1 PO Box 38 Yankton SD 57078 460463155 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 Alucent Medical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 1 0 1 0 0 0 0 1 0 0 0 1 0 0 0 1 0 0 1 Surgical Associates Endoscopy Clinic LLC L 475521 General Ledger Surgical Associates Endoscopy Clinic LLC S 770000 Financial Statements Surgical Associates Endoscopy Clinic LLC A 86443 General Ledger Avera McKennan L 398212 General Ledger Avera McKennan H 464011 General Ledger Avera St Mary's L 107984 General Ledger Avera Sacred Heart L 90135 General Ledger Avera at Home L 320921 General Ledger Avera St Mary's P 54577 General Ledger Avera McKennan S 95296 General Ledger Avera at Home S 283966 General Ledger