2014-05-14T10:01:25-05:00 2013-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2012-07-01 460230199 AVERA ST MARY'S AVER 6052243130 801 EAST SIOUX AVENUE PIERRE SD 57501 PAUL EBMEIER 6052243130 2014-05-13 1 KIM HUNWARDSEN CPA P00484560 6122536500 2014-05-13 2012 2015-11-30 17:44:51Z PAUL EBMEIER 801 EAST SIOUX AVENUE PIERRE SD 57501 53138490 0 0928 X WWW.AVERA.ORG/ST-MARYS-PIERRE X 1951 SD AVERA ST. MARY'S SERVES THE COMMUNITY ON A NON-DISCRIMINATORY BASIS THROUGH ITS GENERAL HOSPITAL, LONG-TERM CARE FACILITIES AND 24-HOUR EMERGENCY CARE SERVICES. 13 10 661 111 17254 16254 129050 0 44851370 51887350 1260643 1113330 347110 137810 46588173 53138490 47683 2468 0 0 20240984 22132338 0 0 0 21731728 27559580 42020395 49694386 4567778 3444104 80703661 60526872 7613867 20078675 73089794 40448197 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. 1 0 45381096 2468 51887350 AVERA ST. MARY'S IS LISTED IN THE OFFICIAL CATHOLIC DIRECTORY. IT IS A TAX EXEMPT 501(C)(3) ORGANIZATION OPERATED AS A MINISTRY OF THE CATHOLIC CHURCH. EFFECTIVE JANUARY 1, 2013, AVERA ST. MARY'S BECAME AFFILIATED WITH AVERA HEALTH.THE HOSPITAL SERVES ALL PERSONS IN THE COMMUNITY ON A NON-DISCRIMINATORY BASIS. AVERA ST. MARY'S OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. AVERA ST. MARY'S HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE GOVERNING BODY IS COMPRISED OF PRIMARILY INDEPENDENT INDIVIDUALS, REPRESENTATIVE OF THE COMMUNITY AS A WHOLE. AVERA ST. MARY'S PROVIDES EDUCATION AND TRAINING OPPORTUNITIES TO HEALTHCARE STUDENTS ENROLLED IN THE LOCAL COLLEGE CAPITAL UNIVERSITY CENTER. AVERA ST. MARY'S PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE AND/OR OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. 45381096 1 0 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 X 2 0 1 661 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 X TOM WAGNER 6052243127 801 EAST SIOUX AVENUE PIERRE SD 57501 WILLIAM VAN CAMP 2.00 1.00 X X 0 0 0 COLLEEN LAMB 2.00 1.00 X X 0 0 0 JANET CRONIN 2.00 1.00 X X 0 0 0 RONALD TEDROW 2.00 1.00 X X 0 0 0 TERRY FITZKE 4.00 1.00 X X 0 0 0 SISTER MARY JAEGER 2.00 8.00 X 0 0 0 JEFFREY DROP 2.00 40.00 X 0 606105 98149 JOE VILLA 2.00 1.00 X 0 0 0 MIKEL HOLLAND 2.00 40.00 X 0 291943 5000 OWEN GARNOS 2.00 1.00 X 0 0 0 PEGGY WILLIAMS 2.00 1.00 X 0 0 0 SISTER SANDRA MEEK 2.00 1.00 X 0 0 0 SISTER KATHLEEN CROWLEY 2.00 9.50 X 0 0 0 DICK MOLSEED 2.00 40.00 X 0 351883 31541 BOB SUTTON 2.00 1.00 X 0 0 0 JOSEPH MESSMER 40.00 40.00 X 0 300163 33096 TOM WAGNER 50.00 0.00 X 129574 0 16010 DEBBIE BRAKKE 50.00 0.00 X 128542 0 27674 ELLEN LEE 50.00 0.00 X 139874 0 28679 PAUL MARSO 50.00 0.00 X 123387 0 33846 ROBIN CRIST 50.00 0.00 X 143071 0 18270 KARL RICHARDS 0.00 50.00 X 0 34642 5418 KAREN GALLAGHER 50.00 0.00 X 130580 0 29440 MARK SCHMIDT 20.00 30.00 X 142207 0 34969 CHRISTOPHER OLSON 40.00 0.00 X 217167 0 26807 DAWN ZASTOUPIL 40.00 0.00 X 203771 0 35210 KEVIN ROARK 40.00 0.00 X 193784 0 25026 SANDRA JACOBSON 40.00 0.00 X 137028 0 29649 STEVEN CASE 40.00 0.00 X 140739 0 33676 1829724 1584736 512460 14 0 1 0 CAPITAL CITY PHYSICIANS 800 E DAKOTA PIERRE SD 57501 PHYSICIAN COVERAGE 1286550 AVERA MCKENNAN PO BOX 5045 SIOUX FALLS SD 571175045 PHYSICIAN COVERAGE 548982 AVERA HEALTH 3900 WEST AVERA DRIVE SIOUX FALLS SD 57108 SHARED SERVICES 473751 ALL ABOUT STAFFING 1000 SAWGRASS CORPORATE PARKWAY 6T SUNRISE FL 33323 CONTRACT STAFF 457636 THERESA SIMMONS 4102 HACKAMORE COURT GILLETTE WY 82718 CRNA 309921 11 PATIENT SERVICE REVENUE 621110 51138561 51138561 MISCELLANEOUS REVENUE 900099 676073 658819 17254 CAFETERIA REVENUE 900099 72716 72716 51887350 417487 417487 137810 0 137810 137810 137810 695343 500 0 0 695343 500 695843 695843 53138490 51870096 17254 1251140 X 2468 2468 1126122 1126122 49130 49130 15061615 13944018 1117597 1114243 1098551 15692 3222591 2979125 243466 1558637 1397738 160899 62107 62107 8990964 8320070 670894 142934 4413 138521 2241640 2117083 124557 1104554 1033643 70911 123517 72713 50804 80225 80225 185817 185817 2642245 2597039 45206 149074 146540 2534 MEDICAL SUPPLIES 5572798 5572798 BAD DEBT EXPENSE 3327940 3327940 REPAIRS AND MAINTENANCE 686749 291494 395255 UNRELATED BUSINESS TAXE 8500 8500 2240516 2240516 49694386 45381096 4313290 0 1100 3497763 13656128 7113335 12502781 160074 210608 152651 216861 1174288 1334490 41980 233253 64340602 46930560 19333161 17410042 46448226 14962709 2781083 80703661 60526872 4979043 6348536 9953635 2634824 3776504 7613867 20078675 X 73148543 40448197 -58749 0 73089794 40448197 80703661 60526872 X 3444104 2068035 -9322402 -28831334 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2434 2434 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: AVERA ST. MARY'S PAID DUES TO ORGANIZATIONS WHICH HAVE A PORTION OF THE DUES ATTRIBUTED TO LOBBYING ACTIVITIES. 1765571 1765571 26263869 17869987 8393882 34775117 27919246 6855871 1536045 1141327 394718 17410042 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENT FUND 14764176 F INVESTMENTS IN AFFILIATED ORGANIZATIONS 198533 F 14962709 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1660113 RELATED PARTY PAYABLES 2116391 3776504 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AVERA HEALTH AND MOST OF ITS SPONSORED ORGANIZATIONS ARE CONSIDERED NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE INTERNAL REVENUE SERVICE (IRS). AVERA HEALTH AND CERTAIN SPONSORED ORGANIZATIONS ALSO FILE AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT THEIR UNRELATED BUSINESS TAXABLE INCOME. AVERA HEALTH AND ITS SPONSORED ORGANIZATIONS BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE FEDERAL FORM 990T FILINGS FOR CONSOLIDATED SUBSIDIARIES ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2010. 1 1 X 1 X 1 X 1 1 1 0 1 1 221241 221241 0.00480 3852211 1732147 2120064 0.04570 4073452 1732147 2341305 0.05050 16340 16340 0.00040 2379293 2379293 0.05130 165759 165759 0.00360 2561392 2561392 0.05530 6634844 1732147 4902697 0.10580 1 3327940 0 11991187 14666728 -2675541 X 1 1 1 1 AVERA ST MARY'S

801 EAST SIOUX AVENUE PIERRE SD 57501

WWW.AVERA.ORG/ST-MARYS-PIERRE/ X X X PROVIDER BASED CLINIC AVERA ST MARY'S 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X 0 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 1 2 AVERA PARKWOOD INDEPENDENT LIVING FACILI

400 PARKWOOD DRIVE PIERRE SD 57501

INDEPENDENT LIVING MARYHOUSE

400 PARKWOOD DRIVE PIERRE SD 57501

LONG TERM CARE PART I, LINE 3C: AVERA ST. MARY'S USED HUD LOW INCOME GUIDELINES FOR DETERMINING FREE AND DISCOUNTED CARE FOR JULY THRU DECEMBER 2012 WHILE THEY WERE A PART OF CHI. AVERA ST. MARY'S ADOPTED AVERA'S FINANCIAL ASSISTANCE POLICY AFTER BECOMING A MEMBER OF AVERA HEALTH ON JANUARY 1, 2013. AVERA USES FPG TO DETERMINE FREE AND DISCOUNTED CARE. PATIENTS WITH INCOME LESS THAN 400% OF THE POVERTY GUIDELINES ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE ORGANIZATION HAS A GRID THAT LOOKS AT INCOME, ASSETS AND BALANCE OF CURRENT MEDICAL CLAIMS TO DETERMINE ELIGIBILITY BASED UPON A SLIDING SCALE. IT IS POSSIBLE TO RECEIVE ASSISTANCE FROM ZERO TO 100%. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS POSTED ON OUR WEB SITE AT WWW.AVERA.ORG/ST-MARYS-PIERRE. PART I, LINE 7: CHARITY CARE AND UNREIMBURSED MEDICAID WAS CONVERTED TO COST USING THE OVERALL COST TO CHARGE RATIO IN IRS WORKSHEET 2. THE AMOUNTS ON LINES 7E AND 7I REPRESENT EXPENSES REPORTED IN THE GENERAL LEDGER. LINE 7G IS FROM THE COST REPORT. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $3,327,940. PART III, LINE 4: BAD DEBT IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION. 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. AVERA ST. MARY'S DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO 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. NOTE 1 ON PAGE 9 OF THE FINANCIAL STATEMENTS DESCRIBES BAD DEBT EXPENSE. 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. MARY'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. MARY'S DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES AVERA ST. MARY'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. AVERA ST. MARY'S PART V, SECTION B, LINE 3: AVERA ST. MARY'S GATHERED INFORMATION REGARDING THE NEEDS OF THE COMMUNITY THROUGH A THREE-PRONGED PROCESS, INCLUDING SURVEYING THE COMMUNITY AS A WHOLE AT A LARGE COMMINITY EVENT, INTERVIEWING COMMUNITY LEADERS, AND HOLDING FOCUS GROUPS. AVERA ST. MARY'S ENSURED TO INCLUDE THE FOLLOWING GROUPS IN THEIR INFORMATION GATHERING: HEALTH LEADERS WITH IN-DEPTH KNOWLEDGE OF THE LOCAL HEALTH CARE ENVIRONMENT, GOVERNMENT, BUSINESS, RETIRED, SOUTH DAKOTA STATE DEPARTMENTS OF HEALTH AND SOCIAL SERVICES, URBAN INDIAN HEALTH, AND RURAL HEALTH CLINICS. AVERA ST. MARY'S PART V, SECTION B, LINE 5C: THE CHNA IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/ AVERA ST. MARY'S PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/ AVERA ST. MARY'S PART V, SECTION B, LINE 7: ISSUES THAT WERE MENTIONED IN THE ASSESSMENT AND NO ACTION TAKEN ARE: SHORT TERM SHELTER FACILITY FOR THOSE OF LIMITED MEANS, DIVERSE CULTURAL NEEDS, DETOX FACILITIES AND PROGRAMS, BARRIERS (HOURS, AFFORDABILITY, AND AVAILABILITY). THE SHELTER AND DETOX HAVE BEEN STUDIED BY VARIOUS GROUPS IN THE PAST AND THE END RESULT HAS BEEN LACK OF SUSTAINABLE FINANCING. UNTIL THERE IS A SUSTAINABLE PLAN, WE ARE UNABLE TO ADDRESS THIS IN THE NEXT FEW YEARS. HOWEVER, BY FURTHER DEVELOPING MENTAL HEATH, WE BELIEVE THAT BOTH OF THESE NEEDS WILL BE FURTHER DEVELOPED IN THE PLANNING AND ACTION PROCESSES. CULTURAL NEEDS IS MUCH MORE THAN JUST ONE NEED AND SIMPLE SOLUTION. WE ARE PLANNING THAT THE KEY NEEDS WE ARE ADDRESSING WILL INCLUDE INPUT AND PARTICIPATION BY AND WITH THE NATIVE AMERICAN COMMUNITY. AVERA ST. MARY'S PART V, SECTION B, LINE 11: AVERA ST. MARY'S USED HUD LOW INCOME GUIDELINES FOR DETERMINING FREE AND DISCOUNTED CARE FOR JULY THRU DECEMBER 2012 WHILE THEY WERE A PART OF CHI. AVERA ST. MARY'S ADOPTED AVERA'S FINANCIAL ASSISTANCE POLICY AFTER BECOMING A MEMBER OF AVERA HEALTH ON JANUARY 1, 2013. AVERA USES FPG TO DETERMINE FREE AND DISCOUNTED CARE. PATIENTS WITH INCOME LESS THAN 400% OF THE POVERTY GUIDELINES ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE ORGANIZATION HAS A GRID THAT LOOKS AT INCOME, ASSETS AND BALANCE OF CURRENT MEDICAL CLAIMS TO DETERMINE ELIGIBILITY BASED UPON A SLIDING SCALE. IT IS POSSIBLE TO RECEIVE ASSISTANCE FROM ZERO TO 100%. AVERA ST. MARY'S PART V, SECTION B, LINE 14G: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE AND INCLUDED IN THE BILLING STATEMENT. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY IS DISCUSSED WITH THE PATIENT UPON ADMISSION TO THE FACILITY. AVERA ST. MARY'S PART V, SECTION B, LINE 22: 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 VI, LINE 2: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS A THREE-PRONGED PROCESS TO GATHER STAKEHOLDER INFORMATION ON COMMUNITY PERCEPTIONS OF THE HEALTH OF CENTRAL SOUTH DAKOTA WHICH INCLUDED A SURVEY AT A LARGE FARM/HOME SHOW IN FEBRUARY, 2013, INTERVIEWS WITH IDENTIFIED COMMUNITY LEADERS, AND SEVERAL FOCUS GROUPS.THE COMMUNITY HEALTH NEEDS ASSESSEMENT FOR AVERA ST. MARY'S WAS COMPLETED AND POSTED TO THEIR WEBSITE BY JUNE 30, 2013. PART VI, LINE 3: AVERA ST. MARY'S POSTS ITS CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT; (2) PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS; (3) PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS WITH DISCHARGE MATERIALS; (4) INCLUDES THE POLICY, OR A SUMMARY THEREOF, ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION, IN PATIENT BILLS; AND/OR (5) DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. PART VI, LINE 4: AVERA ST. MARY'S IS AN ACUTE CARE HOSPITAL SERVING A RURAL COMMUNITY AREA OF CENTRAL SOUTH DAKOTA. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2011 WAS $56,525. THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN 2011 WAS 9.5%. PART VI, LINE 5: THE HOSPITAL SERVES ALL PERSONS IN THE COMMUNITY ON A NON-DISCRIMINATORY BASIS. AVERA ST. MARY'S OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. AVERA ST. MARY'S HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE GOVERNING BODY IS COMPRISED OF PRIMARILY INDEPENDENT INVIDIVUALS, REPRESENTATIVE OF THE COMMUNITY AS A WHOLE. AVERA ST. MARY'S PROVIDES EDUCATION AND TRAINING OPPORTUNITIES TO HEALTHCARE STUDENTS ENROLLED IN THE LOCAL COLLEGE CAPITAL UNIVERSITY CENTER. AVERA ST. MARY'S PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE AND/OR OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. 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 NATION IMPORTANCE. 0 0 0 0 0 0 0 0 0 JEFFREY DROP 0 400149 0 146277 0 59679 0 76703 0 21446 0 704254 0 0 MIKEL HOLLAND 0 290783 0 0 0 1160 0 5000 0 0 0 296943 0 0 DICK MOLSEED 0 282651 0 0 0 69232 0 13475 0 18695 0 384053 0 0 JOSEPH MESSMER 0 300000 0 0 0 163 0 33096 0 0 0 333259 0 0 DEBBIE BRAKKE 108274 0 20001 0 267 0 15465 0 12209 0 156216 0 0 0 ELLEN LEE 117885 0 21524 0 465 0 15842 0 12837 0 168553 0 0 0 PAUL MARSO 102250 0 20725 0 412 0 14404 0 19442 0 157233 0 0 0 ROBIN CRIST 120970 0 21992 0 109 0 11518 0 6752 0 161341 0 0 0 KAREN GALLAGHER 109492 0 20987 0 101 0 16444 0 12996 0 160020 0 0 0 MARK SCHMIDT 119068 0 23021 0 118 0 15331 0 19638 0 177176 0 0 0 CHRISTOPHER OLSON 216925 0 0 0 242 0 20024 0 6783 0 243974 0 0 0 DAWN ZASTOUPIL 203662 0 0 0 109 0 16405 0 18805 0 238981 0 0 0 KEVIN ROARK 193528 0 0 0 256 0 15790 0 9236 0 218810 0 0 0 SANDRA JACOBSON 136371 0 0 0 657 0 16664 0 12985 0 166677 0 0 0 STEVEN CASE 140647 0 0 0 92 0 14708 0 18968 0 174415 0 0 0 SUPPLEMENTAL INFORMATION PART III COMPENSATION REPORTED ON THE TAX RETURN FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION AS IT REFLECTS COMPENSATION PAID IN CALENDAR YEAR 2012 WHEN THE ENTITY WAS AFFILIATED WITH CHI. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. DR RILEY LAMB FAMILY RELATIONSHIP WITH BOARD MEMBER RELOCATION X 210608 210608 0 1 1 210608 CAPITAL CITY PHYSICIANS LLC OWNED BY BOARD MEMBER 1286550 PHYSICIAN SERVICES 0 DEBORAH HOLLAND FAMILY MEMBER OF BOARD MEMBER 49130 COMPENSATION 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 A PROVIDER BASED CLINIC WAS ADDED MARCH 1, 2013. FORM 990, PART V, LINE 1A: INDEPENDENT CONTRACTORS REPORTED RELATE TO SERVICES RECEIVED BY AVERA ST. MARY'S, HOWEVER A RELATED ORGANIZATION FILES APPLICABLE FORM 1099S ON BEHALF OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE, WHILE AFFILIATED WITH CHI, CONSISTED ONLY OF DIRECTORS OF THE CORPORATION AND WAS COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, AND THE PRESIDENT. THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER, EACH OF WHOM SERVED AS EX OFFICIO VOTING MEMBERS OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE HAD THE POWER TO TRANSACT THE ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIODS BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT THEIR ACTIONS ARE CONSISTENT WITH ANY ACTIONS OR POLICIES OF THE BOARD OR THE CORPORATE MEMBER. ALL ACTIONS TAKEN WERE CONTEMPORANEOUSLY DOCUMENTED AND REPORTED TO THE BOARD AT THE EARLIEST MEETING. AFTER AFFILIATING WITH AVERA HEALTH, THERE NO LONGER IS AN EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 2 SISTER MARY JAEGER, SISTER KATHLEEN CROWLEY, JEFFREY DROP, DICK MOLSEED, AND BOB SUTTON HAVE BUSINESS RELATIONSHIPS. FORM 990, PART VI, SECTION A, LINE 4 A CHANGE OF SPONSORSHIP OCCURRED ON JANUARY 1, 2013. THE ORGANIZATION'S DOCUMENTS WERE AMENDED TO REFLECT AVERA HEALTH AS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 6 AS OF JANUARY 1, 2013, 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. PRIOR TO JANUARY 1, 2013, THE SOLE MEMBER WAS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A 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 OF JANUARY 1, 2013: 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. PRIOR TO JANUARY 1, 2013, CHI AS SOLE MEMBER HAD COMPARABLE RIGHTS. FORM 990, PART VI, SECTION B, LINE 11 ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CFO. THE CFO PRESENTS THE RETURN TO THE BOARD AT A BOARD MEETING OR AN ELECTRONIC COPY OF THE RETURN IS SENT TO EACH BOARD MEMBER BY EMAIL FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C AS OF JANUARY 1, 2013, 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. PRIOR TO JANUARY 1, 2013, THE CONFLICT OF INTEREST POLICY COVERED ALL EMPLOYEES UNDER THE CHI STANDARDS OF CONDUCT. 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 DURING THE ENTIRE FISCAL YEAR, THE ORGANIZATION'S CEO'S COMPENSATION WAS PAID BY CHI. CHI HAD A DEFINED COMPENSATION PHILOSOPHY. BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. CHI USED THE HAY GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES WAS REVIEWED ANNUALLY. THE HAY GROUP REVIEWED BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO CHI'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW WAS DELIVERED BY HAY GROUP TO THE HR COMMITTEE OF THE CHI BOARD OF STEWARDSHIP TRUSTEES ANNUALLY AT THEIR SEPTEMBER MEETING AND MINUTES WERE SHARED WITH THE FULL BOARD AT THE DECEMBER MEETING. THE LAST REVIEW WAS SEPTEMBER 2012. IN ADDITION, IN DECEMBER 2009, HAY GROUP COMPLETED A COMPREHENSIVE REVIEW OF ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE TO DETERMINE AND VALIDATE APPROPRIATE COMPENSATION LEVELS. THESE LEVELS HAVE BEEN REVIEWED ANNUALLY SINCE AND REVISED BASED ON MARKET DATA, WHERE APPLICABLE. THE COMPENSATION OF KARL RICHARDS AND DICK MOLSEED WAS DETERMINED BY THE AVERA HEALTH HUMAN RESOURCES BASED ON A MARKET ANALYSIS OF COMPARABLE POSITIONS. THE COMPENSATION WAS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE CONSOLIDATED IN THE AVERA HEALTH CONSOLIDATED FINANCIALS. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 5,657,493. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,657,493. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 979,456. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 979,456. OTHER FEES: PROGRAM SERVICE EXPENSES 1,683,121. MANAGEMENT AND GENERAL EXPENSES 670,894. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,354,015. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AVERA HEALTH RELATED TO ACQUISITION -50,000,000. TRANSFER FROM ST. MARY'S FOUNDATION 11,168,666. TRANSFER FROM RELATED ENTITY 10,000,000. FORM 990, PART X, LINE 20: THE ISSUE PRICE INCLUDES THE FILING ORGANIZATION'S SHARE OF THE ENTIRE BOND ISSUE, WHICH WAS ISSUED TO AVERA HEALTH ON BEHALF OF THE AVERA OBLIGATED GROUP. THE AVERA OBLIGATED GROUP CONSISTS OF AVERA HEALTH, AVERA MCKENNAN, AVERA ST. LUKE'S, AVERA QUEEN OF PEACE, AVERA MARSHALL, AVERA ST. MARY'S, AND AVERA SACRED HEART. IN ACCORDANCE WITH IRS INSTRUCTIONS, INFORMATION RELATED TO THE TAX EXEMPT BOND REPORTING IS BEING REPORTED ON AVERA HEALTH'S TAX RETURN (EIN 46-0422673). FORM 990, PART XII, LINE 2C: DURING THE TAX YEAR, AVERA ST. MARY'S WAS AFFILIATED WITH CHI FROM JULY 1, 2012 THROUGH DECEMBER 31, 2012 AND AFFILIATED WITH AVERA HEALTH FROM JANUARY 1, 2013 THROUGH JUNE 30, 2013. THE FINANCIAL INFORMATION WAS INCLUDED IN THE CONSOLIDATED FINANIAL STATEMENTS FOR BOTH CHI AND AVERA HEALTH FOR THE RESPECTIVE PORTION OF THE YEAR. FOR THE PERIOD JANUARY 1 THROUGH JUNE 30, THE AUDIT COMMITTEE OF AVERA HEALTH, PARENT ORGANIZATION, SELECTED THE AUDITOR AND REVIEWED THE AUDITED FINANCIAL STATEMENTS FOR AVERA ST. MARY'S. FORM 990, PART XI, LINE 8: THE PRIOR PERIOD ADJUSTMENT IS DUE TO TRANSACTIONS RELATED TO THE UNFUNDED PENSION LIABILITY. 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 HEALTHCARE CENTER 0 AVERA ST ANTHONY'S HOSPITAL 300 N 2ND STREET ONEILL NE 68763 470463911 HEALTHCARE EDUCATION 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 SACRED HEART HEALTH SERVICES 501 SUMMIT STREET YANKTON SD 57078 460225483 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA QUEEN OF PEACE HOSPITAL 525 NORTH FOSTER MITCHELL SD 57301 460224604 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 HEALTH MANAGEMENT SERVICES 501 SUMMIT STREET YANKTON SD 57078 460399291 ADULT DAYCARE AND HOMEMAKING SERVICES SD 501(C)(3) LINE 9 SACRED HEART HEALTH SERVICES 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 AVERA ST LUKE'S 305 SOUTH STATE STREET ABERDEEN SD 57401 460224598 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 ALEGENT CREIGHTON CLINIC 12809 WEST DODGE ROAD OMAHA NE 68154 470765154 HEALTHCARE NE 501(C)(3) LINE 3 ACH 0 ALEGENT CREIGHTON HEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 470757164 HEALTHCARE NE 501(C)(3) LINE 3 N/A 0 ALEGENT HEALTH - BERGAN MERCY HEALTH SYS 7500 MERCY ROAD OMAHA NE 68124 470484764 HEALTHCARE NE 501(C)(3) LINE 3 ACH 0 ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH STREET MISSOURI VALLEY IA 51555 420776568 HEALTHCARE IA 501(C)(3) LINE 3 AHIMC 0 ALEGENT HEALTH FOUNDATION 12809 WEST DODGE ROAD OMAHA NE 68154 470648586 FUNDRAISING NE 501(C)(3) LINE 7 ACH 0 ALEGENT HEALTH IMMANUEL MEDICAL CENTER 6901 NORTH 72ND STREET OMAHA NE 68122 470376615 HEALTHCARE NE 501(C)(3) LINE 3 ACH 0 ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE 104 W 17TH STREET SCHUYLER NE 68661 470399853 HEALTHCARE NE 501(C)(3) LINE 3 AHIMC 0 ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HEALTHCARE IA 501(C)(3) LINE 3 AHBMHS 0 ALVERNA APARTMENTS 300 SE 8TH AVENUE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) LINE 9 CHI 0 APPLETREE COURT 601 OAK STREET BRECKENRIDGE MN 56520 411850500 SENIOR HOMES MN 501(C)(3) LINE 9 SFH 0 BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVENUE DES MOINES IA 50314 420725196 LTERM CARE IA 501(C)(3) LINE 9 CHI-IA CORP 0 BORNEMANN HEALTH CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232187242 HEALTHCARE PA 501(C)(3) LINE 11A, I CHI 0 CARRINGTON HEALTH CENTER 800 NORTH 4TH STREET CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(C)(3) LINE 3 CHI 0 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(C)(3) LINE 9 N/A 0 CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 840902211 FUNDRAISING CO 501(C)(3) LINE 7 CHIC 0 CATHOLIC HEALTH INITIATIVES INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(C)(3) LINE 11A, I CHI 0 CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 270930004 FUNDRAISING CO 501(C)(3) LINE 9 CHI 0 CATHOLIC HEALTH INITIATIVES-COLORADO 188 INVERNESS DRIVE WEST SUITE 500 ENGLEWOOD CO 80112 840405257 HEALTHCARE CO 501(C)(3) LINE 3 CHI 0 CATHOLIC HEALTH INITIATIVES-IOWA CORP DBA MERCY MEDICAL CENTER-DES MOINES 1111 6TH AVENUE DES MOINES IA 50314 420680448 HEALTHCARE IA 501(C)(3) LINE 3 CHI 0 CENTENNIAL MEDICAL GROUP INC 2700 STEWART PARKWAY ROSEBURG OR 97470 263946191 PHYSICIANS OR 501(C)(3) LINE 9 MMC 0 CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 SURGERY CNTR KS 501(C)(3) LINE 3 CHI 0 CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PARKWAY SOUTH FARGO ND 58104 271966847 HEALTHCARE ND 501(C)(3) LINE 9 CHI 0 CHI KENTUCKY INC 3900 OLYMPIC BLVD SUITE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(C)(3) LINE 11A, I CHI 0 CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(C)(3) LINE 9 CHI NHC 0 CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(C)(3) LINE 11A, I CHI 0 CHI NEBRASKA 6940 O STREET LINCOLN NE 68510 363233121 HEALTHCARE NE 501(C)(3) LINE 11A, I CHI 0 COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 237419853 DIALYSIS OH 501(C)(3) LINE 11A, I GSH 0 COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION MISSOURI VALLEY IA 631 N 8TH STREET MISSOURI VALLEY IA 51555 421294399 FUNDRAISING IA 501(C)(3) LINE 11A, I AHCMH 0 CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DRIVE LEXINGTON KY 40509 611400619 LTACH KY 501(C)(3) LINE 3 SJHS 0 COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232018429 HOME HEALTH PA 501(C)(3) LINE 11A, I N/A 0 ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVENUE ENUMCLAW WA 98022 910715805 HEALTHCARE WA 501(C)(3) LINE 3 FHS 0 FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 611345363 HEALTHCARE KY 501(C)(3) LINE 3 KOH 0 FLAGET MEMORIAL HOSPITAL FOUNDATION 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 562351341 FUNDRAISING KY 501(C)(3) LINE 11A, I FH 0 FRANCISCAN FOUNDATION 1717 SOUTH J STREET TACOMA WA 98405 911145592 FUNDRAISING WA 501(C)(3) LINE 9 FHS 0 FRANCISCAN HEALTH SYSTEM 1717 SOUTH J STREET TACOMA WA 98405 910564491 HEALTHCARE WA 501(C)(3) LINE 3 CHI 0 FRANCISCAN MEDICAL GROUP 1708 SOUTH YAKIMA AVENUE TACOMA WA 98405 911939739 HEALTHCARE WA 501(C)(3) LINE 9 FHS 0 FRANCISCAN VILLA OF SOUTH MILWAUKEE 3601 SOUTH CHICAGO AVENUE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(C)(3) LINE 9 CHI 0 GETTYSBURG MEDICAL CENTER 606 EAST GARFIELD AVENUE GETTYSBURG SD 57442 460234354 HEALTHCARE SD 501(C)(3) LINE 3 SMHC 0 GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(C)(3) LINE 11A, I CHI 0 GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 311778403 EDUCATION OH 501(C)(3) LINE 2 GSH 0 GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 311206047 FUNDRAISING OH 501(C)(3) LINE 11A, I GSH 0 GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HEALTHCARE NE 501(C)(3) LINE 3 CHI NEBRASKA 0 GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST STREET KEARNEY NE 68847 470659443 FUNDRAISING NE 501(C)(3) LINE 7 GSH 0 HEALTH SET 4200 WEST CONEJOS PLACE 436 DENVER CO 80204 841102943 LOW INC.CARE CO 501(C)(3) LINE 7 CHIC 0 HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 760761782 FUNDRAISING MN 501(C)(3) LINE 11A, I SFMC 0 HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL 7601 OSLER DRIVE TOWSON MD 21204 526050777 HEALTHCARE MD 501(C)(3) LINE 9 SJMC 0 HOUSE OF MERCY 1111 6TH AVENUE DES MOINES IA 50314 421323808 SHELTER IA 501(C)(3) LINE 7 CHI-IA CORP 0 JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 539 S 4TH STREET LOUISVILLE KY 40202 611029768 HEALTHCARE KY 501(C)(3) LINE 3 KOH 0 JEWISH PHYSICIAN GROUP INC 539 S 4TH STREET LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(C)(3) LINE 9 JHSMH 0 KENTUCKYONE HEALTH INC FKA JH PROPERTIES INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(C)(3) LINE 9 CHI 0 LAKEWOOD HEALTH CENTER 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 410758434 HEALTHCARE MN 501(C)(3) LINE 3 CHI 0 LINUS OAKES INC 2700 STEWART PARKWAY ROSEBURG OR 97470 930821381 SENIOR LIVING OR 501(C)(3) LINE 9 MMC 0 LISBON AREA HEALTH SERVICES 905 MAIN STREET LISBON ND 58054 820558836 HEALTHCARE ND 501(C)(3) LINE 3 CHI 0 MEMORIAL HEALTH CARE SYSTEM FOUNDATION 2525 DE SALES AVENUE CHATTANOOGA TN 37404 621839548 FUNDRAISING TN 501(C)(3) LINE 7 MHCS 0 MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVENUE CHATTANOOGA TN 37404 620532345 HEALTHCARE TN 501(C)(3) LINE 3 CHI 0 MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVENUE DES MOINES IA 50314 426076069 AUXILIARY IA 501(C)(3) LINE 11A, I CHI-IA CORP 0 MERCY CLINICS INC 1111 6TH AVENUE DES MOINES IA 50314 421193699 PHYSICIAN IA 501(C)(3) LINE 9 CHI-IA CORP 0 MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVENUE DES MOINES IA 50314 421511682 EDUCATION IA 501(C)(3) LINE 2 CHI-IA CORP 0 MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVENUE DES MOINES IA 50314 237358794 FUNDRAISING IA 501(C)(3) LINE 7 CHI-IA CORP 0 MERCY FOUNDATION INC 2700 STEWART PARKWAY ROSEBURG OR 97470 936088946 FUNDRAISING OR 501(C)(3) LINE 7 MMC 0 MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING NE 501(C)(3) LINE 11A, I AHMH 0 MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 450435338 FUNDRAISING ND 501(C)(3) LINE 11A, I MHVC 0 MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DRIVE COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING IA 501(C)(3) LINE 11A, I AHBMHS 0 MERCY HOSPITAL OF DEVILS LAKE 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 450227012 HEALTHCARE ND 501(C)(3) LINE 3 CHI 0 MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 352367360 FUNDRAISING ND 501(C)(3) LINE 7 CHI 0 MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 450226553 HEALTHCARE ND 501(C)(3) LINE 3 CHI 0 MERCY MEDICAL CENTER 1301 15TH AVENUE WEST WILLISTON ND 58801 450231183 HEALTHCARE ND 501(C)(3) LINE 3 CHI 0 MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HEALTHCARE IA 501(C)(3) LINE 3 CHI-IA CORP 0 MERCY MEDICAL CENTER INC 2700 STEWART PARKWAY ROSEBURG OR 97470 930386868 HEALTHCARE OR 501(C)(3) LINE 3 CHI 0 MERCY MEDICAL FOUNDATION 1301 15TH AVENUE WEST WILLISTON ND 58801 450381803 FUNDRAISING ND 501(C)(3) LINE 11A, I MMC 0 MERCY PROFESSIONAL PRACTICE ASSOCIATES INC 1111 6TH AVENUE DES MOINES IA 50314 421470935 PHYSICIAN IA 501(C)(3) LINE 9 CHI-IA CORP 0 MLIFECARES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 431305163 PROPERTY MGMT MO 501(C)(3) LINE 11A, I SJRMC 0 MNMCH INC 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 481216238 HEALTHCARE 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