AVERA MCKENNAN: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: AVERA MCKENNAN (EIN 46-0224743)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-05-15
IRS object ID: 201411359349308326
Schema version: 2012v2.1
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-05-15T15:44:33-05:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	450250958	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Eide Bailly LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	800 Nicollet Mall Ste 1300	AddressLine1
City	Minneapolis	City
State	MN	State
ZIP Code	554027033	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	460224743	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Avera McKennan	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	AVER	NameControl
Phone	6053228000	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1325 S Cliff Ave PO Box 5045	AddressLine1
City	Sioux Falls	City
State	SD	State
ZIP Code	571175045	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Julie Norton	Name
Title	Sec/Treas & Sr VP Finance	Title
Phone	6053228000	Phone
Date Signed	2014-05-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Kim Hunwardsen CPA	Name
PTIN	P00484560	PTIN
Phone	6122536500	Phone
Date Prepared	2014-05-14	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Dr David Kapaska	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1325 S Cliff Ave PO Box 5045	AddressLine1
City	Sioux Falls	City
State	SD	State
ZIP Code	571175045	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	759202729	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c3	X	Organization501c3
Web Site	www.averamckennan.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1911	YearFormation
State Legal Domicile	SD	StateLegalDomicile
Activity Or Mission Description	Promotion of Health	ActivityOrMissionDescription
Nbr Voting Members Governing Body	20	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	10	NbrIndependentVotingMembers
Total Nbr Employees	6976	TotalNbrEmployees
Total Nbr Volunteers	1248	TotalNbrVolunteers
Total Gross UBI	5825791	TotalGrossUBI
Net Unrelated Business Txbl Income	1344777	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	2006604	ContributionsGrantsPriorYear
Contributions Grants Current Year	3708700	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	710238566	ProgramServiceRevenuePriorYear
Program Service Revenue CY	747902697	ProgramServiceRevenueCY
Investment Income Prior Year	5478842	InvestmentIncomePriorYear
Investment Income Current Year	4006242	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1681944	OtherRevenuePriorYear
Other Revenue Current Year	1900322	OtherRevenueCurrentYear
Total Revenue Prior Year	719405956	TotalRevenuePriorYear
Total Revenue Current Year	757517961	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	3588944	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	3822676	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	371268910	SalariesEtcPriorYear
Salaries Etc Current Year	402340146	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	67066	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	730517	TotalFundrsngExpCurrentYear
Other Expense Prior Year	307380219	OtherExpensePriorYear
Other Expenses Current Year	326008484	OtherExpensesCurrentYear
Total Expenses Prior Year	682305139	TotalExpensesPriorYear
Total Expenses Current Year	732171306	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	37100817	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	25346655	RevenuesLessExpensesCY
Total Assets BOY	800980977	TotalAssetsBOY
Total Assets EOY	827983677	TotalAssetsEOY
Total Liabilities BOY	348719013	TotalLiabilitiesBOY
Total Liabilities EOY	342106191	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	452261964	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	485877486	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	Avera McKennan, as part of 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.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	356418601	Expense
Grants	3666920	Grants
Revenue	495520730	Revenue
Description	Avera McKennan Hospital & University Health CenterAvera McKennan promotes the health of the community by providing a variety of charitable health care services. Avera McKennan operates under the tenets of the Roman Catholic Church and in accordance with the philosophy and values established for Avera Health, a sponsored ministry of the Benedictine and Presentation Sisters.Major service lines include oncology, surgery, obstetrics, pediatrics, neonatology, emergency and trauma, critical care including eICU, radiology and diagnostic imaging, psychiatry, pulmonary, orthopedics, neurology, cardiology and gastroenterology. Transplant services include solid organ (kidney and pancreas) and bone marrow transplant.The following are specific exempt purpose achievements for Avera McKennan Hospital:Charity and uncompensated care: Avera McKennan provides necessary medical services (diagnostic and treatment) for whomever comes to us for care, regardless of their ability to pay. In fiscal year 2013, services provided to those who are unable to pay totaled $33,879,000.Eligibility for discounted or free services under the charity care policy is based on income levels. Generally, individuals earning income of up to 400% of the Federal Policy Income Guidelines are eligible for varying levels of discounts, including full discounts for certain income levels. Application for coverage under the program may be obtained at any Avera McKennan patient registration area or by calling Avera McKennan Patient Financial Services.Avera McKennan helps patients apply for any applicable government insurance programs, and offers health care services on a discounted or charitable basis to those who are uninsured or underinsured. Charity care is not capped by a budget figure unreimbursed expenses are covered by the organization as needed, not until a budget figure is met.In addition to charity care, in the past fiscal year Avera McKennan provided $186,876 in lodging, transportation and prescriptions to those in need.Accessibility to health care: Avera McKennan makes medical care accessible to the entire community it serves. In 2013 Avera McKennan had 20,390 hospital discharges, 105,801 patient days and 230,224 outpatient visits. Avera McKennan is a verified Level II trauma center and was the first such Center in the State of South Dakota. Avera McKennan's Emergency Department is staffed 24 hours a day with board-certified emergency specialists and provides emergency care regardless of ability to pay. Avera McKennan had 26,861 Emergency Department visits in FY 2013. Operating both Fixed Wing and Helicopter medical air transports, Avera McKennan's flight teams cover a large geographic area providing state-of-the-art air transport services and access to critical care, with 1,293 flights in the past year.Health Care Clinic: In 1992, Avera McKennan established a Health Care Clinic to provide free care for people who are uninsured or underinsured in the community. The clinic is managed by a Registered Nurse and staffed by Registered Nurses, two midlevel providers, medical residents and volunteer health care providers. The goal of the clinic is to prevent or treat patients' medical conditions before they become catastrophic. The clinic averages 560 visits per month, providing preventative care, diagnosis and treatment of illnesses and injuries, medication assistance and assistance in obtaining specialist care for patients with complex cases. The clinic also serves to train physicians, nurses and other health care students. It provides a free evening clinic one evening per month, staffed by medical students under supervision of physicians. Avera McKennan is the only health care organization to provide free services such as this in the state of South Dakota. The clinic had 6,724 visits in 2013, and was operated at an annual cost of $733,620. Avera McKennan partners with the not-for-profit Destiny Clinic by providing funding of $13,000 per year to provide free evening clinic services.Partnership in Live Well Sioux Falls: The City of Sioux Falls received a Community Health Transformation Grant from the South Dakota Department of Health, sparking a project to improve the health and well-being of the citizens of Sioux Falls. Guided by the City of Sioux Falls Health Department, this ongoing project is known as Live Well Sioux Falls. It involves more than 24 community partner organizations. Among these partners are Avera McKennan and the other major health care system in Sioux Falls, Sanford Health. Avera plans to work in partnership with the City of Sioux Falls and Sanford Health to address the priorities of Live Well Sioux Falls, and arrive at solutions which are collaborative in nature.Avera McKennan collaborates with Live Well Sioux Falls to promote the Big Squeeze, a hypertension initiative in April to promote blood pressure screening and education, with the goal of diagnosing high blood pressure. One in three American adults have high blood pressure, but only half of them have it under control, adding to the risk of stroke, heart attack and vascular disease.Residency/Health Professions Training and Internships: In 2013, Avera McKennan had 84 medical school residents in training at Avera McKennan in Internal Medicine, Family Practice, Psychiatry, Geriatrics and Transitional Residency Programs offered in partnership with the University of South Dakota School of Medicine. Over 800 students in nursing, pharmacy, physician assistant programs, radiology and respiratory therapy also completed rotations at Avera McKennan. Avera McKennan has many joint agreements with institutions of higher education for both clinical and educational programming. In non-clinical areas, Avera McKennan offered 29 internships in 2013 in the areas of marketing, human resources, finance, foundation, and network operations, working with approximately 16 institutions of higher education.Patient and Community Education: Avera McKennan is a regional leader in offering educational programs for a variety of learners, leaders and employees. Utilizing advanced technology, many of these programs are provided electronically throughout the tri-state area. Educational sessions are offered to medical staff, employees, health care professionals, students at all levels and the general public. Utilizing Avera McKennan's Education Center, a broad cross-section of classes involving diverse audiences are provided as a community service each year.* Online resources: Avera McKennan offers vast free patient educational online resources on its public website on numerous health topics, with suggestions for lifestyle change, behavior modification and management for improved health.* To Be Well free education events were held on topics including orthopedics, cancer, diabetes, weight loss/healthy eating, multiple sclerosis, anxiety and acupuncture. * Forums: The Avera Behavioral Health Center offers free Friday Forums, in which school counselors and therapists are invited to presentations on children's mental health topics such as conflict cycles, reactive attachment disorder, depression and bipolar disorder in children, and teen substance use, abuse and addiction. These sessions, held nine times each year, are attended in person by approximately 85. Throughout 2013, videos of these presentations were viewed 398 times online.* The Avera Behavioral Health Center offers free monthly educational sessions on various topics followed by discussion for adults who have been impacted by a loved one's mental illness. Topics have included grief and loss, anxiety, and parenting strategies for managing challenging behaviors.* Women's & Children's Services: Avera McKennan's Women's & Children's Services offers a number of parenting and community education opportunities, for free or at a minimal cost. In fiscal year 2013, 171 childbirth education classes were held with 891 attendees. A total of 23 parent and family education classes were held with 230 attendees. A total of 137 car seats were issued through the South Dakota Child Safety Seat Distribution Program. Free burn education was provided to 2,936 students during presentations in schools.* Daycare training: Free of charge, Avera McKennan offers four in-service training sessions per month to daycare providers through the YWCA, with a total of 36 scheduled annually, and additional sessions for requested topics. Support groups: Avera McKennan offers approximately 10 free support groups. They range in topic from cancer to liver disease, diabetes, bone marrow transplant, stroke and grief and loss. The organization provides free meeting space as well as speakers and leaders.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	42003608	Expense
Grants	7200	Grants
Revenue	50699863	Revenue
Description	Rural Critical Access HospitalsAvera McKennan owns or leases rural Critical Access Hospitals in Flandreau, Gregory, Dell Rapids, Milbank and Miller (Hand County), S.D. As such, they operate as a department of Avera McKennan. The hospitals in Flandreau, Gregory and Hand County serve medically underserved counties. In addition to the exempt purpose achievements described below, the rural hospitals participate in many of the activies described in Part III, Line 4a as part of Avera McKennan.Among services offered by rural hospitals are radiology and imaging, colonoscopy and endoscopy, therapy and rehabilitation, 24-hour emergency care, chemotherapy, orthopedics, cardiovascular testing and care, obstetrics, surgery, and dialysis.Charity and uncompensated care: As part of Avera McKennan, these facilities provide necessary medical services (diagnostic and treatment) for whomever comes to us for care, regardless of their ability to pay. In fiscal year 2013, charity and uncompensated care provided by rural hospitals totaled $640,000.Accessibility to health care: Avera McKennan regional hospitals make medical care accessible to the entire community they serve regardless of a patient's ability to pay. In 2013 rural hospitals had 1,761 discharges, 7,227 patient days and 60,655 outpatient visits. Each of the hospitals provides 24-hour emergency care with eEmergency services through Avera McKennan. eICU services are also available at these hospitals, providing access to critical care medicine near home and lessening the need for transport. There is no additional billing to patients. Telemedicine consults are also offered at rural locations in a number of medical specialties.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	190104465	Expense
Grants	148230	Grants
Revenue	156778087	Revenue
Description	ClinicsAvera McKennan provides clinical care, secondary and primary, in 87 owned/joint venture clinics in South Dakota, northwest Iowa, southwest Minnesota and northeastern Nebraska. In addition to the following exempt purpose achievements, clinics participate in many of the above as part of Avera McKennan. Clinic visits in 2013 totaled 1,040,163.Clinics provide primary care and urgent care, and among specialties are cardiology; dermatology; endocrinology; gastroenterology; hematology; hepatology; infectious disease; internal medicine; neonatology; nephrology; neurology and neurosurgery; OB/GYN; oncology; ophthalmology; orthopedics; pain management; pediatrics; psychiatry; pulmonology; sports medicine; surgery; and vascular services.Charity and uncompensated care: As part of Avera McKennan, clinics provide necessary medical services (diagnostic and treatment) for whoever comes to us for care, regardless of their ability to pay. In fiscal year 2013, charity and uncompensated care provided by clinics totaled $989,000.Accessibility to health care: In addition to regular clinic hours, Avera McGreevy Clinic provides Urgent Care, seeing patients on a walk-in basis at two locations during the evening hours on weekdays, and throughout the daytime hours on Saturdays and Sundays. This provides greater accessibility without having to rely on emergency room care. In addition, through our Curaquick clinic, Avera offers convenient, affordable clinic care in a local HyVee pharmacy.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	29963792	Expense
Grants	326	Grants
Revenue	45741441	Revenue
Description	Avera McKennan also provides long-term care, home medical equipment & other retail, home infusion, research, fitness center, regional lab and mobile services.Medical Research: As a research institution, Avera McKennan draws physicians who are committed to seeking new treatments and preventive measures. The Avera Research Institute in 2013 participated in over 90 clinical trials, involving cancer, Alzheimer's disease, behavioral health, gastroenterology and more. The Avera Research Institute also continues ongoing applied research in the area of developing a novel photochemical tissue bonding technology that has vascular, ophthalmologic and dermatological applications. Through its genetics lab, Avera McKennan is studying clinical applications of personalized medicine through pharmacogenomics in areas of pain management, behavioral health, cardiovascular health and internal medicine. In fiscal year 2013, Avera McKennan operated the Avera Research Institute at a loss of $4,266,000.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	29963792	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	326	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	45741441	TotalOfOtherProgramServiceRev
Total Program Service Expense	618490466	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	1	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	1	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	1	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	1	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	419	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	6976	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	20	NbrVotingGoverningBodyMembers
Number Independent Voting Members	10	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	0	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	0	WrittenPolicyOrProcedure
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Julie Norton	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6053228000	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1325 S Cliff Ave	AddressLine1
City	Sioux Falls	City
State	SD	State
ZIP Code	571175045	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
Dave Rozenboom
Chair	2.00	0.00	X	X	0	0	0
Michael Bender
Vice Chair	2.00	0.00	X	X	0	0	0
Dave Kapaska DO
President & CEO	40.00	0.00	X	X	0	723774	48865
Sister Janice Klein
Board Trustee	2.00	0.00	X		0	0	0
Gene Jones Jr
Board Trustee	2.00	0.00	X		0	0	0
Amy Krie MD
Board Trustee	40.00	0.00	X		533149	0	39188
Sister Kathryn Easley
Board Trustee	2.00	0.00	X		0	0	0
Kim Pederson MD
Board Trustee	40.00	0.00	X		300264	0	36659
Sister Joan Reichelt
Board Trustee	2.00	3.80	X		0	0	0
Greg Schroeder MD
Board Trustee	2.00	0.00	X		0	0	0
Fred Thurman
Board Trustee	2.00	0.00	X		0	0	0
David Fleck
Board Trustee	2.00	0.00	X		0	0	0
James Wiederrich
Board Trustee	2.00	0.00	X		0	0	0
Bill Rossing MD
Board Trustee	2.00	0.00	X		0	0	0
Cindy Walsh
Board Trustee	2.00	0.00	X		0	0	0
David Chicoine
Board Trustee	2.00	0.00	X		0	0	0
Sister Candyce Chrystal
Board Trustee	2.00	0.00	X		0	0	0
Hugh Venrick
Board Trustee	2.00	0.00	X		0	0	0
Raed Sulaiman MD
Board Trustee	2.00	0.00	X		0	0	0
Carol Twedt
Board Trustee	2.00	0.00	X		0	0	0
Julie N Norton
Sec/Treas & SrVP Finance	40.00	0.00		X	384400	0	45508
Judy Blauwet
Sr Vice President	40.00	0.00			338369	0	35463	X
David Flicek
Sr Vice President	1.00	40.00			0	419347	34909	X
Steve Petersen
AVP-Pharmacy	40.00	0.00			195190	0	35167	X
Mary Leedom
AVP-Surgery	40.00	0.00			170883	0	12582	X
Curt Hohman
Sr Vice President	40.00	0.00			281740	0	27354	X
Kelly McCaul MD
Physician	40.00	0.00			1326856	0	27854		X
Steven Condron MD
Physician	40.00	0.00			1140497	0	44007		X
Brian Knutson MD
Physician	40.00	0.00			1120835	0	41187		X
Michael Puumala MD
Physician	40.00	0.00			1062046	0	39008		X
Daniel Tynan MD
Physician	40.00	0.00			1060503	0	41507		X
Patricia Jagoe
Former Key Employee	0.00	0.00			139051	0	27042			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	8053783	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1143121	TotalReportableCompFrmRltdOrgs
Total Other Compensation	536300	TotalOtherCompensation
Number Individuals GT100 K	548	NumberIndividualsGT100K
Formers Listed	1	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Avera Central Services
3900 West Avera Drive	Sioux Falls	SD	57108	Shared Services	25548796
Sioux Falls Construction
PO Box 2728	Sioux Falls	SD	571072728	Construction	14758600
Sanford School of Medicine
1400 W 22nd St 120	Sioux Falls	SD	571051505	Physician Services	2960791
Henkin Schultz Inc
6201 S Pinnacle Pl	Sioux Falls	SD	57104	Advertising	1871193
Associated Regional & University Patholo
PO Box 27964	Salt Lake City	UT	84127	Lab Testing	1862304

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	95	NumberOfContractorsGT100K
Federated Campaigns	67450	FederatedCampaigns
Related Organizations	1440914	RelatedOrganizations
Government Grants	189124	GovernmentGrants
All Other Contributions	2011212	AllOtherContributions
Total Contributions	3708700	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
Net Patient Service Re	622110	684906990	684906990
Other patient and clin	621500	41334307	36133786	5200521
Income from subsidiari	423000	9404758	9500245	-95487
Meaningful use revenue	900099	6445799	6445799
Interest in Foundation	900099	2148839	2148839

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	3662004	TotalRevenueColumn
Related Or Exempt Function Income	3644750	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	17254	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	747902697	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	81575	TotalRevenueColumn
Exclusion	$81,575	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	1457459	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	1098064	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	359395	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	359395	TotalRevenueColumn
Exclusion	$359,395	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	4511371	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	586704	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	4511371	Securities
Other	-586704	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	3924667	TotalRevenueColumn
Exclusion	$3,924,667	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
Interest income	900099	837424	837424
Commercial testing	621500	527097		527097
Sports program	900099	176406		176406

Field	Value	IRS element (for citing)
Total Other Revenue	1540927	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	757517961	TotalRevenueColumn
Related Or Exempt Function Income	743617833	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	5825791	UnrelatedBusinessRevenue
Exclusion	$4,365,637	ExclusionAmount

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

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	3708926	Total
Program Services	3708926	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	113750	Total
Program Services	113750	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	2368719	Total
Program Services	1291234	ProgramServices
Management And General	1077485	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	349463	Total
Program Services	349463	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	322242742	Total
Program Services	294651325	ProgramServices
Management And General	27194289	ManagementAndGeneral
Fundraising	397128	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	19626875	Total
Program Services	17388072	ProgramServices
Management And General	2209554	ManagementAndGeneral
Fundraising	29249	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	37400337	Total
Program Services	33261143	ProgramServices
Management And General	4081034	ManagementAndGeneral
Fundraising	58160	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	20352010	Total
Program Services	18164770	ProgramServices
Management And General	2158664	ManagementAndGeneral
Fundraising	28576	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	316561	Total
Program Services	316561	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	497125	Total
Management And General	497125	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	106130	Total
Management And General	106130	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	37848	Total
Management And General	37848	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	97856155	Total
Program Services	57677852	ProgramServices
Management And General	40177515	ManagementAndGeneral
Fundraising	788	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	3545710	Total
Program Services	589859	ProgramServices
Management And General	2947561	ManagementAndGeneral
Fundraising	8290	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	11949845	Total
Program Services	6366798	ProgramServices
Management And General	5391151	ManagementAndGeneral
Fundraising	191896	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	8403615	Total
Program Services	615387	ProgramServices
Management And General	7788228	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	21150569	Total
Program Services	14650698	ProgramServices
Management And General	6499764	ManagementAndGeneral
Fundraising	107	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	3235504	Total
Program Services	2728243	ProgramServices
Management And General	501410	ManagementAndGeneral
Fundraising	5851	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	2100832	Total
Program Services	1832689	ProgramServices
Management And General	267621	ManagementAndGeneral
Fundraising	522	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	7987206	Total
Program Services	7746033	ProgramServices
Management And General	241173	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	36030899	Total
Program Services	30053309	ProgramServices
Management And General	5971639	ManagementAndGeneral
Fundraising	5951	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1307714	Total
Program Services	1305262	ProgramServices
Management And General	2452	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Medical supplies	105489715	105489715
Bad Debt expense	16988522	16988522
Equipment lease and ren	4108329	2703965	1404364
UBI tax	662915		662915

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4233290	Total
Program Services	496890	ProgramServices
Management And General	3732401	ManagementAndGeneral
Fundraising	3999	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	732171306	Total
Program Services	618490466	ProgramServices
Management And General	112950323	ManagementAndGeneral
Fundraising	730517	Fundraising

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

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	28110750	BOY
EOY	25389142	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	2439599	BOY
EOY	2382202	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	92528140	BOY
EOY	93735966	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	20833	BOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	3360181	BOY
EOY	3220401	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	14389349	BOY
EOY	14929302	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	8098767	BOY
EOY	10595030	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	708615671	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	350002821	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	343607662	BOY
EOY	358612850	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	8322781	BOY
EOY	8554927	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	207116305	BOY
EOY	229497375	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	12187088	BOY
EOY	11817238	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	44273450	BOY
EOY	45416755	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	36526072	BOY
EOY	23832489	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	800980977	BOY
EOY	827983677	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	65431052	BOY
EOY	69147875	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	791440	BOY
EOY	1464257	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	224989669	BOY
EOY	221217723	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	818999	BOY
EOY	823621	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	22024359	BOY
EOY	17706579	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	34663494	BOY
EOY	31746136	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	348719013	BOY
EOY	342106191	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	440185934	BOY
EOY	471655159	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	9934388	BOY
EOY	11590650	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2141642	BOY
EOY	2631677	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	452261964	BOY
EOY	485877486	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	800980977	BOY
EOY	827983677	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	25346655	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	7440887	ReconciliationUnrealizedInvest
Reconcilation Other Changes	827980	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	1	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	1	DirectContactLegislators
Direct Contact Legislators	$1,268	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$36,580	OtherActivitiesAmount
Total Lobbying Expenditures IIB	37848	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1:	ReturnReference
Explanation	Part II-B Line 1g and 1i: Avera McKennan participates through various hospital organizations to promote legislation that would result in strengthening health care delivery systems on a national, regional, and local level. An employee of McKennan met with Congressional members to discuss and promote the pharmacy compounding legislation.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	1	AgentTrusteeEtc
Beginning Balance	11845	BeginningBalance
Additions During Year	156773	AdditionsDuringYear
Distributions During Year	148601	DistributionsDuringYear
Ending Balance	20017	EndingBalance
Included On FS	1	IncludedOnFS
Explanation In Part XIII	X	ExplanationInPartXIII

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2141642	BeginningOfYearBalance
Investment Earnings Or Losses	490035	InvestmentEarningsOrLosses
End Of Year Balance	2631677	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2021909	BeginningOfYearBalance
Investment Earnings Or Losses	119733	InvestmentEarningsOrLosses
End Of Year Balance	2141642	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1981042	BeginningOfYearBalance
Investment Earnings Or Losses	40867	InvestmentEarningsOrLosses
End Of Year Balance	2021909	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1897334	BeginningOfYearBalance
Investment Earnings Or Losses	83708	InvestmentEarningsOrLosses
End Of Year Balance	1981042	EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2160515	BeginningOfYearBalance
Investment Earnings Or Losses	-263181	InvestmentEarningsOrLosses
End Of Year Balance	1897334	EndOfYearBalance

Field	Value	IRS element (for citing)
Permanent Endowment EOY Balance	1.00000	PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	1	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	1	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	7665722	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	21123158	OtherCostOrOtherBasis
Book Value	28788880	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	2279713	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	403537844	OtherCostOrOtherBasis
Depreciation	157641909	Depreciation
Book Value	248175648	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	257701727	OtherCostOrOtherBasis
Depreciation	186781642	Depreciation
Book Value	70920085	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	16307507	OtherCostOrOtherBasis
Depreciation	5579270	Depreciation
Book Value	10728237	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	358612850	TotalOfBookValueLandBuildings

Other Securities OtherSecurities (5 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
Assets Limited as to Use - Avera Pooled Investments	193575151	F
Avera Home Medical Equipment, LLC	3633078	C
Heart Hospital of South Dakota, LLC	14198011	C
Interest in Avera Health Foundation	13377003	F
Investments in affiliated companies	4714132	C

Field	Value	IRS element (for citing)
Total Of Book Value Securities	229497375	TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescription	AmountAmount
Other Liabilities	$2,741,802
Due to other Organizations	$1,174,897
Market value of interest swap	$8,644,872
Estimated third-party payor settlements	$9,350,011
Due to affilate	$5,156,584
Minority interest	$4,677,970

Field	Value	IRS element (for citing)
Total Of Amounts	31746136	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	824010890	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	7440887	NetUnrealizedGainsInvestments
Other Revenues	72573083	OtherRevenues
Revenue Not Rptd F990	80013970	RevenueNotRptdF990
Revenue Subtotal	743996920	RevenueSubtotal
Other Revenues Not Included	13521041	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	13521041	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	757517961	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	786743861	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	73520962	OtherExpensesIncluded
Expenses Not Rptd F990	73520962	ExpensesNotRptdF990
Expenses Subtotal	713222899	ExpensesSubtotal
Other Expenses Not Included	18948407	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	18948407	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	732171306	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (8 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part IV, Line 1b:	The organization holds funds in trust on behalf of its long-term care residents. Many small dollar transactions flow in and out of this account. The account is managed by the nursing home staff. The state has strict guidelines on how these accounts are managed.
Part IV, Line 2b:	The organization holds an amount in trust related to a non-compete as part of an employment agreement for an employed physician. The amount will be held and then paid out when the physician reaches age 65 or earlier according to the written trust agreement.
Part V, Line 4:	The Organization's endowment consists of a portion of their interest in the net assets of 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. The Organization currently does not have any board designated endowment funds.	Description of Intended Use of Endowment Funds:
Part X, Line 2:	The Organization is organized as a 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 Avera Home Medical Equipment LLC, MRIS, LLC, Heart Hospital of South Dakota LLC, and Alumend LLC, are not tax exempt entities and are considered partnerships or disregarded entities for tax purposes. Avera McKennan is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, Avera McKennan is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. Avera McKennan files an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS to report its unrelated business taxable income. For the years ended June 30, 2013 and 2012, cash paid for income taxes was $852,192 and $270,406, respectively. 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 990-T and other tax return filings are generally no longer subject to federal tax examinations by tax authorities for years before 2010.	Description of Uncertain Tax Positions Under FIN 48:
	Revenues of consolidated subsidiaries consolidated for financial statements 87,954,874. Occupancy expenses included in nonoperating income on financial statements -1,959,885. Change in fair value of interest rate swap recorded in n/a for tax return 3,947,356. Reclass of losses on interest rate swaps recorded in n/a for tax return -380,740. Bad Debt expense reported in revenue for financial statements -16,988,522.	Part XI, Line 2d - Other Adjustments:
	Investment chg in Avera Health Fdtn recorded in fd balance on financial stmt 339,043. Gain from investment in subsidiaries recorded in revenue for tax return 9,257,454. Management fees included in expenses on financial statements 1,600,993. Rental expense included in revenues on financial statements -1,098,064. Contribution of long-lived asset recorded in net assets for financial stmt 1,128,014. Temp & Perm Changes in investment of Avera Foundation 2,146,297. Change in noncontrolling interest in Heart Hospital of South Dakota 147,304.	Part XI, Line 4b - Other Adjustments:
	Expenses of consolidated subsidiaries consolidated for financial statements 74,023,891. Management fees included in revenue for tax return -1,600,993. Rental expense included in expenses for tax return 1,098,064.	Part XII, Line 2d - Other Adjustments:
	Occupancy expenses included in the nonoperating income for financial stmts 1,959,885. Bad Debt expense reported in revenue for financial statements 16,988,522.	Part XII, Line 4b - Other Adjustments:

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To Most Hospitals	X	PolicyAppliedToMostHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent150	X	Pcent150
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	12211198	TotalCommunityBenefitExpense
Net Community Benefit Expense	12211198	NetCommunityBenefitExpense
Percent Of Total Expense	0.01710	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	63368457	TotalCommunityBenefitExpense
Direct Offsetting Revenue	44572470	DirectOffsettingRevenue
Net Community Benefit Expense	18795987	NetCommunityBenefitExpense
Percent Of Total Expense	0.02630	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1247665	TotalCommunityBenefitExpense
Direct Offsetting Revenue	786501	DirectOffsettingRevenue
Net Community Benefit Expense	461164	NetCommunityBenefitExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	76827320	TotalCommunityBenefitExpense
Direct Offsetting Revenue	45358971	DirectOffsettingRevenue
Net Community Benefit Expense	31468349	NetCommunityBenefitExpense
Percent Of Total Expense	0.04400	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2872839	TotalCommunityBenefitExpense
Direct Offsetting Revenue	267068	DirectOffsettingRevenue
Net Community Benefit Expense	2605771	NetCommunityBenefitExpense
Percent Of Total Expense	0.00360	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	7525537	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1609899	DirectOffsettingRevenue
Net Community Benefit Expense	5915638	NetCommunityBenefitExpense
Percent Of Total Expense	0.00830	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	22490592	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11905979	DirectOffsettingRevenue
Net Community Benefit Expense	10584613	NetCommunityBenefitExpense
Percent Of Total Expense	0.01480	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4155961	TotalCommunityBenefitExpense
Direct Offsetting Revenue	662070	DirectOffsettingRevenue
Net Community Benefit Expense	3493891	NetCommunityBenefitExpense
Percent Of Total Expense	0.00490	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3061510	TotalCommunityBenefitExpense
Net Community Benefit Expense	3061510	NetCommunityBenefitExpense
Percent Of Total Expense	0.00430	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	40106439	TotalCommunityBenefitExpense
Direct Offsetting Revenue	14445016	DirectOffsettingRevenue
Net Community Benefit Expense	25661423	NetCommunityBenefitExpense
Percent Of Total Expense	0.03590	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	116933759	TotalCommunityBenefitExpense
Direct Offsetting Revenue	59803987	DirectOffsettingRevenue
Net Community Benefit Expense	57129772	NetCommunityBenefitExpense
Percent Of Total Expense	0.07990	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	69952	TotalCommunityBuildingExpense
Net Community Building Expense	69952	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Total Community Building Expense	15000	TotalCommunityBuildingExpense
Net Community Building Expense	15000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	5000	TotalCommunityBuildingExpense
Net Community Building Expense	5000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	191382	TotalCommunityBuildingExpense
Net Community Building Expense	191382	NetCommunityBuildingExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	281334	TotalCommunityBuildingExpense
Net Community Building Expense	281334	NetCommunityBuildingExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$16,988,522	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	170804190	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	148520178	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	22284012	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	7	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (7 entries)

Facility NumberFacilityNumber	Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	Childrens HospitalChildrensHospital	Teaching HospitalTeachingHospital	Research FacilityResearchFacility	Er24 HoursEr24Hours	OtherOther	Critical Access HospitalCriticalAccessHospital
Avera McKennan
1	1325 S Cliff Ave	Sioux Falls	SD	57117	X	X	X	X	X	X	34 Provider Based Clinics
Heart Hospital of South Dakota LLC
2	10720 Sikes Place Suite 300	Charlotte	NC	28277	X	X				X	2/3 Owner in Joint Venture
Avera Gregory Healthcare Center
3	400 Park Ave	Gregory	SD	57533	X	X				X	Four Provider Based Clinics	X
Avera Milbank Area Hospital
4	901 Virgil Ave	Milbank	SD	57252	X	X				X	Three Rural Provider Based Clinics	X
Avera Dells Area Health Center
5	909 N Iowa Avenue	Dell Rapids	SD	57022	X	X				X	Three Provider Based Clinics	X
Avera Flandreau Medical Center
6	214 N Prairie	Flandreau	SD	57028	X	X				X	One Provider Based Clinic	X
Avera Hand County Memorial Hospital
7	300 W 5th St	Miller	SD	57362	X	X				X	One Provider Based Clinic	X

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (7 entries)

Hospital Facility NumberHospitalFacilityNumber	CHNA ConductedCHNAConducted	Community DefinitionCommunityDefinition	Community DemographicsCommunityDemographics	Existing ResourcesExistingResources	How Data ObtainedHowDataObtained	Community Health NeedsCommunityHealthNeeds	Other Health IssuesOtherHealthIssues	Identifying ProcessIdentifyingProcess	Consulting ProcessConsultingProcess	Needs Assessment ConductedNeedsAssessmentConducted	Take Into AccountTakeIntoAccount	Other FacilitiesOtherFacilities	CHNA Widely AvailableCHNAWidelyAvailable	Own WebsiteOwnWebsite	On RequestOnRequest	Other MethodOtherMethod	Adopt Implement StrategyAdoptImplementStrategy	Prioritize Health NeedsPrioritizeHealthNeeds	Prioritize ServicesPrioritizeServices	Other Needs AddressedOtherNeedsAddressed	All Needs AddressedAllNeedsAddressed	Organization Incur Excise TaxOrganizationIncurExciseTax	Eligibility Criteria ExplainedEligibilityCriteriaExplained	Uses FPG FreeUsesFPGFree	FPG Free PercentFPGFreePercent	Uses FPG DiscountedUsesFPGDiscounted	FPG Discount PercentFPGDiscountPercent	Explains BasisExplainsBasis	Income LevelIncomeLevel	Asset LevelAssetLevel	Medical IndigencyMedicalIndigency	Insurance StatusInsuranceStatus	Uninsured DiscountUninsuredDiscount	Medicaid MedicareMedicaidMedicare	State RegulationStateRegulation	Explains Application MethodExplainsApplicationMethod	Includes Publicity MeasuresIncludesPublicityMeasures	Posted On WebsitePostedOnWebsite	Available On RequestAvailableOnRequest	Other PublicityOtherPublicity	Actions On NonpaymentActionsOnNonpayment	Collection ActivitiesCollectionActivities	Notify Upon AdmissionNotifyUponAdmission	Notify Before DischargeNotifyBeforeDischarge	Notified All PatientsNotifiedAllPatients	Documented DeterminationDocumentedDetermination	Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy	Average Negotiated RatesAverageNegotiatedRates	Amounts Generally BilledAmountsGenerallyBilled	Gross ChargesGrossCharges	Used Other MethodUsedOtherMethod
Avera McKennan
1	1	X	X	X	X	X	X	X	X	12	1	1	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
Heart Hospital of South Dakota LLC
2	1	X	X	X	X	X	X	X	X	12	1	1	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	1		1	0	X
Avera Gregory Healthcare Center
3	1	X	X	X	X	X			X	12	1	0	1	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
Avera Milbank Area Hospital
4	1	X	X	X	X	X			X	12	1	0	1	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
Avera Dells Area Health Center
5	1	X	X	X	X	X		X	X	12	1	0	1	X	X	X	X			X	1	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
Avera Flandreau Medical Center
6	1	X	X	X	X	X			X	12	1	0	1	X	X	X	X			X	1	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
Avera Hand County Memorial Hospital
7	1	X	X	X	X	X			X	12	1	0	1	X	X	X	X			X	1	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

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	62	NumberOfOtherFacilities

Other Facilities OtherFacilities (62 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
Avera McKennan Behavioral Health Center
4400 W 69th St	Sioux Falls	SD	57108	Inpatient & Outpatient behavioral health services
CORE Orthopedics Avera Medical Group
2908 East 26th Street	Sioux Falls	SD	57103	Orthopedic clinic
Avera Medical Group Pierre
100 MAC Lane	Pierre	SD	57501	Primary and specialty clinic; outpatient surgery center
Avera Medical Group Brookings
400 - 22nd Avenue	Brookings	SD	57006	Primary care clinic
Avera Plaza 2 Pharmacy
1301 S Cliff Avenue	Sioux Falls	SD	57105	Retail pharmacy
Avera Medical Group Worthington
508 Tenth Street	Worthington	MN	56187	Primary care clinic
Avera Medical Group Spencer
116 East 11th Suite 101	Spencer	IA	51301	Primary care clinic
Avera McKennan Home Infusion
1020 S Cliff Avenue	Sioux Falls	SD	57105	Comprehensive home infusion therapies & supplies
Avera Prince of Peace
4500 S Prince of Peace Place	Sioux Falls	SD	57103	Skilled nursing facility
McKennan Regional Laboratory
1325 S Cliff Avenue	Sioux Falls	SD	57105	Laboratory services
Avera Home Medical Equipment
2400 S Minnesota Ave	Sioux Falls	SD	57105	Rental & sale of home medical equipment
Avera Medical Group Maternal Fetal Medic
1417 South Cliff Avenue Suite 100	Sioux Falls	SD	57105	High-risk pregnancy care clinic
Avera Medical Group Pediatric Specialist
1417 S Cliff Avenue Suite 010	Sioux Falls	SD	57105	Pediatric specialties clinic
Avera McKennan Hosp & Univ Campus Pharm
1325 S Cliff Avenue	Sioux Falls	SD	57105	Retail pharmacy
Dougherty Hospice House
4509 Prince of Peace Place	Sioux Falls	SD	57103	Hospice care
Avera McKennan Fitness Center
3400 S Southeastern Drive	Sioux Falls	SD	57105	Fitness center
Avera Rosebud Country Care Center
300 Park Avenue	Gregory	SD	57533	Skilled nursing facility
Avera Medical Group Windom
820 - 2nd Avenue	Windom	MN	56101	Primary care clinic
Avera Home Medical Equipment
418 S 2nd Street	Aberdeen	SD	57401	Rental & sale of home medical equipment
Avera Medical Group Sibley
600-9th Avenue North	Sibley	IA	51249	Primary care clinic
Avera Home Medical Equipment
1104 East College Dr	Marshall	SD	56258	Rental & sale of home medical equipment
Laurel Oaks Apartments
4510 S Prince of Peace Place	Sioux Falls	SD	57103	Independent living apartments
Avera Home Medical Equipment
1001 W 9th Street	Yankton	SD	57078	Rental & sale of home medical equipment
Avera Home Medical Equipment
1307 N Main	Mitchell	SD	57301	Rental & sale of home medical equipment
Avera Medical Group Occupational Medicin
4928 North Cliff Avenue	Sioux Falls	SD	57104	Business and corporate health care clinic
Avera Medical Group Comprehensive Breast
1000 East 23rd Street Suite 360	Sioux Falls	SD	57105	Specialty clinic
Avera Home Medical Equipment
1411 Wells Ave	Pierre	SD	57501	Rental & sale of home medical equipment
Avera Home Medical Equipment
1508 4th Street NE	Watertown	SD	57201	Rental & sale of home medical equipment
Avera Medical Group Spirit Lake Medical
2700 - 23rd Street Suite A	Spirit Lake	IA	51360	Primary care clinic
Avera Medical Group McGreevy Salem
740 South Hill	Salem	SD	57058	Primary care clinic
Avera 69th Street Pharmacy - Behavioral
4400 W 69th St Suite 300	Sioux Falls	SD	57108	Retail pharmacy
Avera Home Medical Equipment Floyd Valle
190 6th Ave NE	LeMars	IA	51031	Rental & sale of home medical equipment
Avera Research Institute
2020 S Norton Ave	Sioux Falls	SD	57105	Clinical research studies
Avera Home Medical Equipment
100 22nd Avenue Suite 101	Brookings	SD	57006	Rental & sale of home medical equipment
Avera Dermatology Pharmacy
6701 South Minnesota Avenue	Sioux Falls	SD	57108	Retail pharmacy
Avera Medical Group Women's Midlife Care
911 East 20th Street - Suite 200	Sioux Falls	SD	57105	Women's services clinic
Avera Home Medical Equipment
38 19th Street SW	Sioux Center	IA	51250	Rental & sale of home medical equipment
Avera Home Medical Equipment
602 Central Ave	Estherville	IA	51334	Rental & sale of home medical equipment
Avera Home Medical Equipment
903 N Washington	Madison	SD	57042	Rental & sale of home medical equipment
Avera Home Medical Equipment
1325 South Cliff Avenue	Sioux Falls	SD	57117	Rental & sale of home medical equipment
Avera Institute for Human Genetics
4400 W 69th St Suite 200	Sioux Falls	SD	57108	Genetic research program
Avera Medical Group Lakes Family Practic
2700 - 23rd Street Suite C	Spirit Lake	IA	51360	Primary care clinic
Avera Home Medical Equipment of Spencer
716 Grand Ave	Spencer	IA	51301	Rental & sale of home medical equipment
Avera Lee Mabee OBGYN
1910 West 69th Suite 100	Sioux Falls	SD	57108	Obstetric and gynecology clinic
Avera Home Medical Equipment
102 West Main Suite A	Parkston	SD	57366	Rental & sale of home medical equipment
Avera Medical Group Larchwood
916 Holder Street PO Box 8	Larchwood	IA	51241	Primary care clinic
Avera Home Medical Equipment
1565 Dakota Ave S	Huron	SD	57350	Rental & sale of home medical equipment
Curaquick Avera Clinic
3000 S Minnesota Ave	Sioux Falls	SD	57105	Primary care clinic
Avera Medical Group Big Stone City
451 Main Street	Big Stone City	SD	57216	Primary care clinic
Community Blood Bank
1301 South Cliff Avenue Suite 3	Sioux Falls	SD	57105	Community blood services
Health Care Clinic
300 North Dakota Avenue Suite 117	Sioux Falls	SD	57104	Free healthcare clinic
Pipestone Medical Group Avera
920 - 4th Avenue SW	Pipestone	MN	56164	Primary care clinic
Avera Medical Group Chamberlain
101 South Front PO Box 27	Chamberlain	SD	57325	Primary care clinic
Rural Medical Clinics
301 South Walnut Street	Freeman	SD	57029	Primary care clinic
Avera Medical Group Estherville
926 North 8th Street	Estherville	IA	51334	Primary care clinic
Hegg Medical Clinic Avera
2121 Hegg Drive	Rock Valley	IA	51247	Primary care clinic
Yorkshire Eye Clinic
2311 Yorkshire Drive	Brookings	SD	57006	Ophthalmology and optometry clinic
Avera Medical Group Butte
730 Wilson Street	Butte	NE	68722	Satellite primary care clinic
Avera Medical Group Elkton
203 Elk Street	Elkton	SD	57026	Satellite primary care clinic
Avera Medical Group Fulda
201 N St Paul Avenue	Fulda	MN	56131	Satellite primary care clinic
Avera Medical Group Lakefield
221 - 3rd Avenue	Lakefield	MN	56150	Satellite primary care clinic
Avera Medical Group Volga
210 Kasan Avenue	Volga	SD	57071	Satellite primary care clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (59 entries)

ExplanationExplanation	Return ReferenceReturnReference	IdentifierIdentifier
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: Avera McKennan's 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 methodology was used to calculate the amounts reported in the table. A cost accounting system was used to calculate Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for our tertiary medical center. A cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate charity care at cost for all entities and Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for any operations outside of the tertiary medical center. For all other amounts, costs and revenues as reflected by the general ledger system were used.
Part I, Line 7g: Physician clinic costs for transplant services are included in subsidized health services. Revenues of $763,300 and costs of $2,263,193 were included for a net community benefit of $1,499,893. Our facility is the principal provider of transplant services through our service area with the clinics a crucial componenet of successful pre and post transplant care.
Part I, L7 Col(f): Bad debt expense of $16,988,522 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage.
Part II: Economic development, environmental improvement, and coalition building are supported mainly through monetary donations in addition to service preparedness committees. The Organization's workforce development program works with universities, technical schools, and local high schools to address healthcare worker shortfalls in the community. Through partnering with these organizations, Avera McKennan provides speakers, work experience for students, shadowing, career fairs and informational literature to encourage students to consider a career in healthcare and stay in the community.
Part III, Line 4: Bad debt expense 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.The footnote to the Organization's financial statements can be found on page eight of the attached audited financial statements.
Part III, Line 8: Avera McKennan follows the Catholic Health Association 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.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 & 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 a reasonable time period, the Organization or it's agent shall not send, nor suggest that it will send, the unpaid bill to any outside 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 does not report any data to any of the credit agencies; however, the collection agencies Avera utilizes may report to the credit agencies. Any extended payment plans offered by a hospital in settling the outstanding bills of low income, uninsured patients who qualify for financial assistance shall be interest-free so long as the repayment schedule is met.
The Medicare revenues received (line 5), allowable costs (line 6), and the resulting surplus (line 7) does not include a significant portion of the organization's expenses. These lines require use of the Medicare cost report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Avera McKennan. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removing the costs from the hospital's cost report entirely. Examples of a portion of these overhead costs would be finance, business office, information technology, human resources and administration. Examples of non-cost report entities operated by Avera McKennan include clinics, home medical equipment stores, mobile imaging services, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, hospitalists care, marketing, CRNA's, and interest expense. Avera McKennan also receives a Medicare Disproportionate Share Hospital (DSH) adjustment as part of the cost report due to its significant number of low-income patients served. Part III, line 5 requires inclusion of this revenue though expenses included are much lower. Schedule H instructions also require the exclusion of $11,936,462 of Medicare losses because they are included in Schedule H, part 1, line 7f or 7g. Including the Medicare percentage of disallowed costs, entities which don't file a cost report but nevertheless care for Medicare patients, and the impact of the home office cost report, the Medicare shortfall is $23,315,153 as opposed to a surplus of $22,284,012.	Part III, Line 5, 6, and 7:
Part V, Section B, Line 3: Avera McKennan collected data from a community survey sponsored by the City of Sioux Falls and completed in August 2012 was also utilized. The facility sponsored a survey distributed at two public events in 2011. As background information, a community needs assessment survey conducted in 2010 supplemented the 2011 and 2012 activities. This assessment included surveys, phone interviews and focus groups. Personal interviews were conducted with the Executive Director of South Dakota Urban Indian Health, Inc.; the Assistant Director of the Sioux Falls Department of Health; Sioux Falls Community Health Dental Director; and Manager of the Avera Medical Group Health Care Clinic.		Avera McKennan
Part V, Section B, Line 3: The health needs assessment included data from a community survey sponsored by the City of Sioux Falls and completed in August 2012. Avera Mckennan sponsored a survey distributed at two public events in 2011. As background information, a community needs assessment survey conducted in 2010 supplemented the 2011 and 2012 activities. This assessment included surveys, phone interviews and focus groups. Personal interviews were conducted with the Executive Director of South Dakota Urban Indian Health, Inc.; the Assistant Director of the Sioux Falls Department of Health; Sioux Falls Community Health Dental Director; and Manager of the Avera Medical Group Health Care Clinic.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 3: Avera Gregory Hospital began the community health needs assessment with primary data collection consisting of one-on-one interviews and focus groups with representatives from within the service area. These individuals showed representation from civic and business organizations such as the Gregory Public School systems, the Gregory Chamber of Commerce, the Department of Social Services, the Gregory Ministerial Association, the Gregory Rotary and Gregory/Winner business owners. One focus group included the Avera Gregory Hospital Advisory Board, made up of community leaders who had been appointed based on their knowledge and involvement in the community and with the following backgrounds: mortuary services, banking, law and local business owners. The second focus group was conducted as a town hall style meeting in which 42 community members attended. The third focus group was conducted with the local school board, the principal of the high school and elementary school and the superintendent of schools for Gregory County.		Avera Gregory Healthcare Center
Part V, Section B, Line 3: Milbank Area Hospital Avera held five focus groups to seek the input of community and health leaders. The focus groups were conducted involving the general public, all aspects of health care, a service organization, key community leaders, city and county government including law enforcement, school nursing and administration, and church officials in addition to individuals with special knowledge in public health including programs for the elderly and the local recreational facility. Personal interviews were held with the county's public health nurses and the Grant County social worker.		Avera Milbank Area Hospital
Part V, Section B, Line 3: The assessment began by gathering primary data about the Avera Dells Area Hospital's service area. Key informant interviews were completed, which included asking a number of key questions regarding the health needs of the community. The interviews lasted approximately one hour each. Participants represented in the interview process included: the Avera Medical Group Dell Rapids physicians, Avera Medical Group Dell Rapids clinic manager, Avera Dells Area Hospital administrator, Avera Dells Area Hospital director of patient care, Dell Rapids mayor, Dell Rapids city administrator, Minnehaha County public health assistant director, area school nurses, and Avera Dells Area Hospital Advisory Board members. More specifically, the Avera Dells Area Hospital Advisory Board Members consisted of representation from the following fields/professions: 1) dental hygiene, 2) school administration, 3) banking, 4) College of Nursing professor, 5) licensed practical nurse, 6) small business, and 7) medicine.		Avera Dells Area Health Center
Part V, Section B, Line 3: Avera Flandreau Medical Center began its assessment with primary data collection consisting of one-on-one interviews and written questionnaires with representatives from within the service area. These individuals represented civic and business organizations such as Flandreau and Colman-Egan public school systems, Flandreau Indian Boarding School (a federal school for Native American children grades 9 - 12), Food Pantry (The Breadbasket), Public Health Office, Domestic Violence Shelter, and Moody County Pastoral Association. Focus groups were also utilized for primary data collection using the above questions. One focus group included AFH Advisory Board, made up of community leaders who had been appointed based on their involvement in the community and with the organization. The Advisory Board consists of individuals with the following professional backgrounds: agriculture, insurance, real estate, education, medicine, and business ownership. A second focus group was the Medical Staff Committee, consisting of AFH senior leaders and primary care providers. A third focus group was AFH nursing staff.		Avera Flandreau Medical Center
Part V, Section B, Line 3: Avera Hand County Memorial Hospital used a survey tool to begin the process of qualitative data collection. The survey was available to a patients and visitors from March to April 2012. The surveys were compiled and printed for presentation to various groups. At each group setting, representatives of the facility reviewed the satisfaction ratings of the survey to begin the dialogue, asking various questions to identify themes or trends. The small groups meetings consisted of the hospital's advisory board, department managers, auxiliary, foundation, the Miller School Guidance Counselor, On Hand Development leadership, and the Hand County Public Health Nurse.		Avera Hand County Memorial Hospital
Part V, Section B, Line 4: The CHNA was conducted with Heart Hospital of South Dakota, LLC.		Avera McKennan
Part V, Section B, Line 4: The CHNA was conducted with Avera McKennan.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera McKennan
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Gregory Healthcare Center
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Milbank Area Hospital
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Dells Area Health Center
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Flandreau Medical Center
Part V, Section B, Line 5c: The community health needs assessment can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Hand County Memorial Hospital
Part V, Section B, Line 6i: Avera McKennan adopted an implementation strategy to address four of the most commonly and highly identified needs. Those four needs are obseity/poor diet/lack of exercise, health care access for uninsured/underinsured people including specialty care and mental health services, management of chronic conditions and smoking/alcohol use. The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera McKennan
Part V, Section B, Line 6i: Heart Hospital of South Dakota, LLC (Heart Hospital) will adopt an implementation strategy that addresses four of the most commonly and highly identified needs. Those four needs are obesity/poor diet/lack of exercise, health care access for uninsured/underinsured people, management of chronic conditions and smoking/alcohol use. The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.Heart Hospital is operated as a joint venture in which Avera McKennan has 66.67% ownership. Avera McKennan provides management services and ensures the hospital operates with a charitable intent. Based on Proposed Regulation 1.501(r)-1(c)(2), Avera McKennan is treating the Heart Hospital as a facility subject to the rules under 501(r). Avera McKennan performed a Community Health Needs Assessment with consideration of all the services they provide, including the services and operations of the Heart Hospital. During the preparation of the June 30, 2013 tax return, it was determined Heart Hospital should have conducted a Community Health Needs Assessment. Avera McKennan determined the process used to conduct their assessment was the same process that would have been used for Heart Hospital as they both serve the same community and health needs. As such, the report was updated to include specific Heart Hospital information and an Implementation Strategy was formalized. These documents will be approved by the Heart Hospital Board of Directors at their normal meeting at the end of May 2014. The failure to formally include the Heart Hospital in the initial process and for the board to approve the reports during the tax year has not had a negative impact on patients or the community. Heart Hospital addresses the needs identified which were relevant to the services they provide on an on-going basis. The failure to approve the report and implementation strategy was an oversight in the process and was not intentional. Correction has occurred and both the Heart Hospital and Avera McKennan will continue to address the needs identified.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 6i: The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Gregory Healthcare Center
Part V, Section B, Line 6i: The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Milbank Area Hospital
Part V, Section B, Line 6i: The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Dells Area Health Center
Part V, Section B, Line 6i: The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Flandreau Medical Center
Part V, Section B, Line 6i: The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/.		Avera Hand County Memorial Hospital
Part V, Section B, Line 7: Dental care was a need identified but not directly addressed as it was not one of the highest priorities. In addition, it is outside the facilitys competencies and is already addressed by City of Sioux Falls Health Department, Falls Community Health. Avera Medical Group Health Care Clinic does facilitate distribution of vouchers for dental care which are provided through donations.		Avera McKennan
Part V, Section B, Line 7: Heart Hospital will address community concerns of health care access for uninsured/underinsured, obesity/poor diet, management of chronic conditions, and smoking use through current service offerings in addition to partnering with the City and other community health care entities. Other needs identified such as dental care, behavioral health services and access to exercise facilities were a lower priority and are not within the hospital's core competencies.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 7: Three needs were identified and not addressed. Reducing tobacco use was identified but not included in the implementation plan due to lack of financial resources, competing priorities and projects, and a downward use trend under current interventions. Providing dermatology and Ophthalmology services were not addressed due to difficulty in recruiting specialists due to population density, lack of financial resources, and complexity of the services.		Avera Gregory Healthcare Center
Part V, Section B, Line 7: One need was identified and not addressed: lack of kidney dialysis available in the community. There is a provider at a facility 12 miles to the east of Milbank Area Hospital (MAH) Avera. MAH Avera does not currently have the equipment and dedicated space needed to provide the service. The facility continues researching the service and will decide at a later date if it will be able to address the need.		Avera Milbank Area Hospital
Part V, Section B, Line 14g: Avera McKennan's summary of the policy is posted in the hospital facility's emergency room or waiting rooms, admissions offices, and is provided, in writting, to patients on admission to the hospital facility.		Avera McKennan
Part V, Section B, Line 14g: Heart Hospital of South Dakota's policy is made available upon request and is provided and discussed with patient as the need is identified. It is also available via the website.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 14g: Avera Gregory Healthcare Center's summary of the policy is posted in the hospital facility's emergency room or waiting rooms, admissions offices, and is provided, in writting, to patients on admission to the hospital facility.		Avera Gregory Healthcare Center
Part V, Section B, Line 14g: Avera Milbank Area Hospital's summary of the policy is posted in the hospital facility's emergency room or waiting rooms, admissions offices, and is provided, in writting, to patients on admission to the hospital facility.		Avera Milbank Area Hospital
Part V, Section B, Line 14g: Avera Dells Area Health Center's summary of the policy is posted in the hospital facility's emergency room or waiting rooms, admissions offices, and is provided, in writting, to patients on admission to the hospital facility.		Avera Dells Area Health Center
Part V, Section B, Line 14g: Avera Flandreau Medical Center's summary of the policy is posted in the hospital facility's emergency room or waiting rooms, admissions offices, and is provided, in writting, to patients on admission to the hospital facility.		Avera Flandreau Medical Center
Part V, Section B, Line 14g: Avera Hand County Memorial Hospital's summary of the policy is posted in the hospital facility's emergency room or waiting rooms, admissions offices, and is provided, in writting, to patients on admission to the hospital facility.		Avera Hand County Memorial Hospital
Part V, Section B, Line 20d: All self-pay patients are provided a 20% discount in an effort reflect discounts provided under commercial insurance. In addition, the maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 80% of the gross charges or the discouned rate if they are self pay. This is based on the lowest discount under the financial assistance policy.		Heart Hospital of South Dakota, LLC
Part V, Section B, Line 21: The hospital provides a reduction to gross charges under their financial assistance policy and their self pay discount. The hospital has not determined the amount generally billed under the various proposed methods of calculation. Therefore, it is possible a patient under the financial assistance policy could have paid more than the amount generally billed (as defined). The hospital will review the various methods to ensure appropriate discounts are provided to equal or exceed the amounts generally billed to those with insurance.		Heart Hospital of South Dakota, LLC
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.		Avera McKennan
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.		Avera Gregory Healthcare Center
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.		Avera Milbank Area Hospital
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.		Avera Dells Area Health Center
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.		Avera Flandreau Medical Center
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.		Avera Hand County Memorial Hospital
Part VI, Line 2: Community needs assessment occurs at various points in the system. Through annual strategic planning sessions, community leaders are brought in to update and educate Avera McKennan board members and administrative council on the successes, challenges, and service gaps in the community. Examples include school district officials, state health department, and community health organizations. Leaders also serve on boards of various community organizations which seek to address the health and well-being of area citizens. Local governing boards at outlying facilities, who are members of the community, discuss and help direct resources to areas of targeted needs as well.
Part VI, Line 3: Notices are posted in English and Spanish in a visible manner in locations where there is a high volume of inpatient or outpatient admitting/registration, such as emergency departments, billing offices, admitting offices, and outpatient service settings as well as the Organization website. Posted notices state that the Organization has a financial assistance policy for low-income uninsured patients who may not be able to pay their bill and that this policy provides for charity care and reduced-payment for healthcare services. There is also identification of a contact phone number that a patient can call to obtain more information about the financial assistance policy and about how to apply for such assistance. Additionally, admitting staff makes available a brochure designed to help patients understand how we bill patients and provides summary information on financial assistance if you are unable to pay. Patient Advocates work with uninsured patients in our main tertiary facility to enroll them in applicable social programs and identify charity eligibility, eligibility and enrollment for county, state or federal risk pools, and eligibility for modified Medicare or Medicaid programs.
Part VI, Line 4: Avera McKennan's service area is a largely rural population. Services are provided through a health care network of 115 locations covering 54 communities in four states. The main tertiary facility is located in a population center of over 155,000 served by another non-profit hospital of similar size, Veterans Administration Hospital, a Hospital dedicated to diagnosis and treatment of heart disease, and a hospital for children with special health care needs. Outside of this population center, most of the communities served have less than 4,000 residents. The primary service area includes four counties covering approximately 2,600 square miles and contains seven federally designated medically underserved areas. The U.S. Census Bureau data estimates just under 10% of residents in the primary service area are at or below the poverty level. Our secondary service area covers an additional 19 counties in South Dakota, Iowa and Minnesota with an estimated total population of 235,000 based on U.S. Census Bureau projections for 2011.
Part VI, Line 5: Surplus funds are reinvested in facilities to improve patient care.Medical staff privileges are extended to all qualified physicians in the community. The Avera Mckennan board of trustees is principally comprised of community members from the primary service area. Members come from a variety of backgrounds ranging from private industry and banking to healthcare.Avera McKennan is a verified Level II trauma center and was the first such Center in the State of South Dakota. Avera McKennan's Emergency Department is staffed 24 hours a day with board-certified emergency specialists and provides emergency care regardless of ability to pay. Operating both Fixed Wing and Helicopter medical air transports, Avera McKennan's flight teams cover a large geographic area providing state-of-the-art air transport services and access to critical care, with 1,293 flights in the past year. Avera McKennan owns or leases rural Critical Access Hospitals in Flandreau, Gregory, Dell Rapids, Milbank and Miller (Hand County), S.D. As such, they operate as a department of Avera McKennan. The hospitals in Flandreau, Gregory and Hand County serve medically underserved counties. In addition to the following exempt purpose achievements, rural hospitals participate in many of the above as part of Avera McKennan. Among services offered by rural hospitals are radiology and imaging, colonoscopy and endoscopy, therapy and rehabilitation, 24-hour emergency care, chemotherapy, orthopedics, cardiovascular testing and care, obstetrics, surgery, and dialysis.Health Care Clinic: In 1992, Avera McKennan established a Health Care Clinic to provide free care for people who are uninsured or underinsured in the community. The clinic is managed by a Registered Nurse and staffed by Registered Nurses, two midlevel providers, medical residents and volunteer health care providers. The goal of the clinic is to prevent or treat patients' medical conditions before they become catastrophic. The clinic averages 560 visits per month, providing preventative care, diagnosis and treatment of illnesses and injuries, medication assistance and assistance in obtaining specialist care for patients with complex cases. The clinic also serves to train physicians, nurses and other health care students. It provides a free evening clinic one evening per month, staffed by medical students under supervision of physicians. Avera McKennan is the only health care organization to provide free services such as this in the state of South Dakota. The clinic had 6,724 visits in 2013, and was operated at an annual cost of $733,620. Avera McKennan partners with the not-for-profit Destiny Clinic by providing funding of $13,000 per year to provide free evening clinic services.Partnership in Live Well Sioux Falls: The City of Sioux Falls received a Community Health Transformation Grant from the South Dakota Department of Health, sparking a project to improve the health and well-being of the citizens of Sioux Falls. Guided by the City of Sioux Falls Health Department, this ongoing project is known as Live Well Sioux Falls. It involves more than 24 community partner organizations. Among these partners are Avera McKennan and the other major health care system in Sioux Falls, Sanford Health. Avera plans to work in partnership with the City of Sioux Falls and Sanford Health to address the priorities of Live Well Sioux Falls, and arrive at solutions which are collaborative in nature.Avera McKennan collaborates with Live Well Sioux Falls to promote the Big Squeeze, a hypertension initiative in April to promote blood pressure screening and education, with the goal of diagnosing high blood pressure. One in three American adults have high blood pressure, but only half of them have it under control, adding to the risk of stroke, heart attack and vascular disease.Residency/Health Professions Training and Internships: In 2013, Avera McKennan had 84 medical school residents in training at Avera McKennan in Internal Medicine, Family Practice, Psychiatry, Geriatrics and Transitional Residency Programs offered in partnership with the University of South Dakota School of Medicine. Over 800 students in nursing, pharmacy, physician assistant programs, radiology and respiratory therapy also completed rotations at Avera McKennan. Avera McKennan has many joint agreements with institutions of higher education for both clinical and educational programming. In non-clinical areas, Avera McKennan offered 29 internships in 2013 in the areas of marketing, human resources, finance, foundation, and network operations, working with approximately 16 institutions of higher education.Patient and Community Education: Avera McKennan is a regional leader in offering educational programs for a variety of learners, leaders and employees. Utilizing advanced technology, many of these programs are provided electronically throughout the tri-state area. Educational sessions are offered to medical staff, employees, health care professionals, students at all levels and the general public. Utilizing Avera McKennan's Education Center, a broad cross-section of classes involving diverse audiences are provided as a community service each year.* Online resources: Avera McKennan offers vast free patient educational online resources on its public website on numerous health topics, with suggestions for lifestyle change, behavior modification and management for improved health.* To Be Well free education events were held on topics including orthopedics, cancer, diabetes, weight loss/healthy eating, multiple sclerosis, anxiety and acupuncture. * Forums: The Avera Behavioral Health Center offers free Friday Forums, in which school counselors and therapists are invited to presentations on children's mental health topics such as conflict cycles, reactive attachment disorder, depression and bipolar disorder in children, and teen substance use, abuse and addiction. These sessions, held nine times each year, are attended in person by approximately 85. Throughout 2013, videos of these presentations were viewed 398 times online.* The Avera Behavioral Health Center offers free monthly educational sessions on various topics followed by discussion for adults who have been impacted by a loved one's mental illness. Topics have included grief and loss, anxiety, and parenting strategies for managing challenging behaviors.* Women's & Children's Services: Avera McKennan's Women's & Children's Services offers a number of parenting and community education opportunities, for free or at a minimal cost. In fiscal year 2013, 171 childbirth education classes were held with 891 attendees. A total of 23 parent and family education classes were held with 230 attendees. A total of 137 car seats were issued through the South Dakota Child Safety Seat Distribution Program. Free burn education was provided to 2,936 students during presentations in schools.* Daycare training: Free of charge, Avera McKennan offers four in-service training sessions per month to daycare providers through the YWCA, with a total of 36 scheduled annually, and additional sessions for requested topics. Support groups: Avera McKennan offers approximately 10 free support groups. They range in topic from cancer to liver disease, diabetes, bone marrow transplant, stroke and grief and loss. The organization provides free meeting space as well as speakers and leaders. Information and Assistance: Avera McKennan operates a 24-hour Medical Call Center, through which patients have access to the Ask-A-Nurse program. Patients can call a toll-free number and talk personally with a Registered Nurse to ask health questions or receive general health information. In 2013, the Medical Call Center handled 107,214 calls. Avera McKennan's web site also provides an extensive health library that consumers can access free of charge.Interpreter service: Avera McKennan employs two full-time Spanish interpreters in-house, and their services are offered to patients free of charge. In addition, in cooperation with external agencies, Avera McKennan is able to handle 200 different languages and dialects through phone, video remote interpreting and other means. Interpretation services are available for patients when they are at Avera McKennan in person, or when they call by phone. All the above services are provided at no cost to the patient.
Part VI, Line 6: The communities in which the Avera system 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.
Prenatal and delivery care: Because early and regular prenatal care is important to prevent premature birth, Avera McKennan collaborates in a community effort to provide obstetrics care for women who do not qualify for Medicaid, but cannot afford health insurance. The program offers prenatal care, and hospital labor and delivery serves for a low fee of $1,000. Women receive care whether they can cover any or all of the fee. Care is provided primarily by first-year family practice residents, supervised by experienced physicians. Through this program in 2013, Avera McKennan assisted with 46 births and provided 644 prenatal and post-partum visits.Transport to Transplant: Avera McKennan developed the Transport to Transplant project, which removes transportation barriers for patients from rural areas which may prevent them from completing the evaluation and testing needed for kidney and/or pancreas transplant. A van funded through a grant from the Avera McKennan Foundation is used to transport patients who demonstrate a financial need. Patients are brought to the Avera Transplant Institute for a condensed multi-day evaluation with all testing and visits completed in less than one week. Ultimately, the project results in improved morbidity and mortality, as kidney transplant doubles patient survival as compared to remaining on dialysis.Avera Family Wellness: This program combines positive activities like violin lessons with family coaching at no charge for children in early childhood programs in the Sioux Falls School District. The goal is to prevent or lessen the effects of behavioral health conditions on children and families by fostering a positive environment. Over 300 students and their families are enrolled.The Walsh Family Village: This hospitality house complex adjacent to the Avera McKennan campus provides a home away from home for patients and their families who come for care at Avera McKennan from outside of Sioux Falls. The project was funded by donations and is operated by Avera McKennan. Eleven guest rooms are available. Avera McKennan also donates use of a building in the complex for a Ronald McDonald House for families of pediatric patients. If they can afford it, guests are charged a low fee of $50 per night. Guests are not turned away due to inability to pay the fee. Employees regularly donate non-perishable food items to stock a food pantry for guests. In FY2013, the Walsh Family Village served 6,780 guests, staying in 4,015 nightly rooms a 90 percent occupancy. Avera McKennan provides a subsidy of approximately $226,000 per year to operate the hospitality complex. Prevention and support of substance use disorder: Avera McKennan is a partner with Face It TOGETHER Sioux Falls, a nonprofit organization which serves as the local face and voice for recovery from addiction through its recovery support services, advocacy and awareness programs. Avera has been a partner with Face It TOGETHER since its inception, and in a recent awareness campaign. In 2013, Avera McKennan provided $30,000 in funding toward this effort.Community Connections: Avera McKennan reaches out to people and communities throughout eastern South Dakota, southwestern Minnesota and northwest Iowa through Home Town Connections. Providing a critical feedback link to local referring doctors, this program completes the communications links necessary to keep local health care providers current on the treatment of their patients at Avera McKennan.Support of the arts and cultural life: Avera McKennan hosts Sioux Falls' only indoor SculptureWalk, an extension of the community's downtown SculptureWalk. Artists donate sculptures for one year, which are placed at locations throughout Avera McKennan's campus, in buildings connected by skywalks. Brochures contain a map, and visitors who follow the route suggested walk approximately 1 mile, making this a healthy as well as a cultural journey.Diabetes programming: Avera participates in a collaborative project with Sioux Falls Public Schools and the South Dakota Board of Nursing to implement eConsult services with diabetic education specialists monitoring medications and the health of children with diabetes in the school setting. Avera McKennan diabetes educators provided classes and one-on-one consultations at a loss of $195,000 in the past fiscal year.Community Benefits: Avera McKennan provides additional community benefits including: support of youth programs; homeless programs; community arts programming; health prevention; awareness and education about cancer, heart disease and other conditions; and support of the Sioux Empire United Way and other services in the region. Donations toward these efforts totaled $2,098,035 in 2013.Preschool vision and hearing screening: Avera McKennan provided free screening for 378 preschool children in fiscal year 2013.
The communities in which the Avera system 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.	Part VI, Line 6

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (48 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance	Address Line2AddressUS/AddressLine2
SIOUX FALLS CATHOLIC SCHOOLS
3100 W 41st Street	Sioux Falls	SD	57105	510145184	501(c)(3)	700200	Donation
FORWARD SIOUX FALLS
PO Box 907	Sioux Falls	SD	57101	460396647	501(c)(6)	18439	Donation
RONALD MCDONALD HOUSE
2001 S Norton	Sioux Falls	SD	57105	460371152	501(c)(3)	70500	Donation	160516	FMV	rented space
YWCA
300 W 11th Street	Sioux Falls	SD	57104	460234998	501(c)(3)	52500	Donation
SOUTH DAKOTA STATE UNIVERSITY
PO BOX 2218	Brookings	SD	57007	460273801	STATE OF SD	1009246	Donation
AMYOTROPHIC LATERAL SCLEROSIS ASSOCIATION MINNESOTA CHAPTER
333 Washington Ave N Ste 105	Minneapolis	MN	554011352	411756085	501(c)(3)	50000	Donation
WASHINGTON PAVILION
PO Box 984	Sioux Falls	SD	57101	460435791	501(c)(3)	46000	Donation
SIOUX EMPIRE UNITED WAY
1000 N West Ave 120	Sioux Falls	SD	57104	460233701	501(c)(3)	43500	Donation
SOUTHEAST TECHNICAL INSTITUTE FOUNDATION
2320 North Career Avenue	Sioux Falls	SD	57107	364112897	501(c)(3)	96980	Donation
CATHOLIC DIOCESE
523 N DULUTH AVE	Sioux Falls	SD	57104	466000424	501(c)(3)	130009	Donation
SERTOMA BUTTERFLY HOUSE INC
4320 South Oxbow Ave	Sioux Falls	SD	57106	522370420	501(c)(3)	27500	Donation
SOUTH DAKOTA SYMPHONY
315 N MAIN AVE SUITE 204	Sioux Falls	SD	571046078	466017026	501(c)(3)	25820	Donation
AMERICAN CANCER SOCIETY
4904 S Technopolis Drive	Sioux Falls	SD	57106	131788491	501(c)(3)	23675	Donation
NATIONAL KIDNEY FOUNDATION
1100 E 21st Street Avera Doctors	Sioux Falls	SD	57105	460448030	501(c)(3)	23500	Donation				Plaza 2 Ste 210
MCCROSSAN BOYS RANCH
47135 260th Street	Sioux Falls	SD	57107	460311913	501(c)(3)	20332	Donation
HARRISBURG ACTIVITIES FOUNDATION
PO Box 479	Harrisburg	SD	57032	061749081	501(c)(3)	20000	Donation
USD FOUNDATION
1100 N DAKOTA	Vermillion	SD	57069	466018891	501(c)(3)	96000	Donation
SOUTH DAKOTA ACHIEVE
4100 S Western Ave	Sioux Falls	SD	57105	237072116	501(c)(3)	20000	Donation
UNIVERISITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE
1400 W 22nd St	Sioux Falls	SD	57105	466000364	STATE OF SD	20000	Donation
HARRISBURG DAYS FOUNDATION
PO Box 343	Harrisburg	SD	57032	841709233	501(c)(3)	16667	Donation
HELPLINE CENTER
1000 N West Ave Ste 310	Sioux Falls	SD	57104	237424387	501(c)(3)	16500	Donation
BOYS AND GIRLS CLUB OF THE SIOUX EMPIRE
824 E 14th Street	Sioux Falls	SD	57104	460399482	501(c)(3)	16000	Donation
SIOUX FALLS GREEN PROJECT
431 N Phillips Ave 200	Sioux Falls	SD	57104	263820362	501(c)(3)	15000	Donation
SOUTH DAKOTA PARKS AND WILDLIFE FOUNDATION
523 E Capitol Ave	Pierre	SD	57501	460387968	501(c)(3)	15000	Donation
TEACH FOR AMERICA INC
315 West 36th Street 8th Floor	New York	NY	10018	133541913	501(c)(3)	15000	Donation
DAKOTABILITIES INC
3600 S Duluth Ave	Sioux Falls	SD	57105	460306216	501(c)(3)	13583	Donation
SIOUX FALLS SCHOOL DISTRICT
201 E 38th St	Sioux Falls	SD	57105	466002586	CITY OF SIOUX FALLS	13500	Donation
DESTINY HEALTHCARE INTERNATIONAL
2701 S Minnesota Ave 3	Sioux Falls	SD	57105	510529480	501(c)(3)	13000	Donation
FAMILY VISITATION CENTER
311 E 14th St	Sioux Falls	SD	57104	263654937	501(c)(3)	12000	Donation
NAMI OF SOUTH DAKOTA
PO Box 88808	Sioux Falls	SD	57109	363593027	501(c)(3)	10000	Donation
SIOUX FALLS JAZZ & BLUES SOCIETY
123 S Main Ave Suite 204	Sioux Falls	SD	571046430	460418356	501(c)(3)	10000	Donation
TRANSITIONAL LIVING CORPORATION
2601 S Minnesota Ave	Sioux Falls	SD	571054742	200293050	501(c)(3)	10000	Donation
ICE SPORTS ASSOCIATION
PO Box 90504	Sioux Falls	SD	57109	271234271	501(c)(3)	10000	Donation
SIOUX CENTER COMMUNITY HOSPITAL AND HEALTH CENTER
605 South Main Street	Sioux Center	IA	51250	420796764	501(c)(3)	10000	Donation
VOLUNTEERS OF AMERICA DAKOTAS
1401 W 51st	Sioux Falls	SD	57105	237353508	501(c)(3)	27730	Donation
JUNIOR ACHIEVEMENT OF SOUTH DAKOTA
100 N West Avenue No 110	Sioux Falls	SD	57104	460306352	501(c)(3)	8700	Donation
SIOUX EMPIRE BASEBALL ASSOCIATION
1601 W 44th Pl Suite 3	Sioux Falls	SD	57105	411903475	501(c)(3)	8667	Donation
FURNITURE MISSION OF SOUTH DAKOTA INC
209 N Nesmith Ave	Sioux Falls	SD	57103	810584500	501(c)(3)	6000	Donation
PRESENTATION SISTERS
1500 N 2nd St	Aberdeen	SD	57401	460253283	501(c)(3)	7500	Donation
NATIONAL MULTIPLE SCLEROSIS SOCIETY UPPER MIDWEST CHAPTER
200 12th Ave S	Minneapolis	MN	55415	410790658	501(c)(3)	7500	Donation
SIOUX EMPIRE FAIR ASSOCIATION INC
WH Lyons Fairgrounds	Sioux Falls	SD	57107	460209185	501(c)(5)	7500	Donation
ARTHRITIS FOUNDATION INC
1876 N Minnehaha Ave W	St Paul	MN	55104	390860526	501(c)(3)	6000	Donation
CHILDRENS HOME FOUNDATION
PO Box 1749	Sioux Falls	SD	571011749	460366277	501(c)(3)	6000	Donation
ST MARY CATHOLIC SCHOOLS
812 N State Ave	Dell Rapids	SD	57022	466003662	501(c)(3)	5500	Donation
BOYS AND GIRLS CLUB OF BROOKINGS
307 6th St	Brookings	SD	57006	731630215	501(c)(3)	5300	Donation
KILIAN COMMUNITY COLLEGE
300 East 6th Strret	Sioux Falls	SD	57103	460385443	501(c)(3)	10000	Donation
COMMUNITY INDOOR TENNIS CENTER CHAMBER APPEAL
300 N Phillips Ave Ste 102	Sioux Falls	SD	57104	452784394	501(c)(3)	27233	Donation
Avera Health
3900 West Avera Dr Ste 300	Sioux Falls	SD	57108	460422673	501(c)(3)	13051	Donation

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	46	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	2	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	Scholarships	TypeOfGrant
Number Of Recipients	48	NumberOfRecipients
Amount Of Cash Grant	113750	AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedure for Monitoring Grants in the U.S.:	Identifier
Return Reference	Part I, Line 2:	ReturnReference
Explanation	Schedule I, Part I, Line 2: The governing board and management develop programs which enhance the charitable mission of the Organization. Disbursement for grants or assistance for these programs are made in accordance with prescribed procedures and are subject to conditions established by the Organization's governing board and management, which are designed to ensure that individuals and organizations receiving grants or assistance are adequately investigated to ensure that they are qualified recipients.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	1	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dave Kapaska DO
President & CEO	0	578511	0	0	0	145263	0	30475	0	19702	0	773951	0	0
Amy Krie MD
Board Trustee	531952	0	0	0	1197	0	20300	0	19614	0	573063	0	0	0
Kim Pederson MD
Board Trustee	295728	0	0	0	4536	0	20300	0	17086	0	337650	0	0	0
Julie N Norton
Sec/Treas & SrVP Finance	383180	0	0	0	1220	0	20300	0	25934	0	430634	0	0	0
Judy Blauwet
Sr Vice President	331429	0	0	0	6940	0	15300	0	20890	0	374559	0	0	0
David Flicek
Sr Vice President	0	378960	0	0	0	40387	0	13475	0	22303	0	455125	0	0
Steve Petersen
AVP-Pharmacy	193448	0	0	0	1742	0	11960	0	23935	0	231085	0	0	0
Mary Leedom
AVP-Surgery	170068	0	0	0	815	0	10339	0	2970	0	184192	0	0	0
Curt Hohman
Sr Vice President	280479	0	0	0	1261	0	20300	0	7349	0	309389	0	0	0
Kelly McCaul MD
Physician	1322328	0	0	0	4528	0	20300	0	7849	0	1355005	0	0	0
Steven Condron MD
Physician	1137617	0	0	0	2880	0	20300	0	24434	0	1185231	0	0	0
Brian Knutson MD
Physician	1117827	0	0	0	3008	0	20300	0	21614	0	1162749	0	0	0
Michael Puumala MD
Physician	1056615	0	0	0	5431	0	20300	0	19434	0	1101780	0	0	0
Daniel Tynan MD
Physician	1052116	0	0	0	8387	0	20300	0	21934	0	1102737	0	0	0
Patricia Jagoe
Former Key Employee	138364	0	0	0	687	0	11452	0	16195	0	166698	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 4a	Patricia Jagoe, former key employee, received severance payments through October 10, 2012 that totaled $59,580.
Part III	Schedule J, Part I Line 3: The President & CEO's compensation is paid by a related Organization, Avera Health. Avera McKennan relied on the related Organization for determining the compensation for the President & CEO using the methods described in Part I, Line 3.	Supplemental Information

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (12 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
Michael Bender
Board Member	217488	Property Lease	0
Physicians Laboratory Ltd
Board Member is greater than 5% owner	1703846	Lab Services - Histology	0
Victoria Petersen
Family of Key Employee	36295	Employee Compensation	0
Anesthesiology Associates Inc
Board Member is greater than 5% owner	750528	Pain Mangement Services	0
Sioux Falls Construction Co
Board member is an Officer of the Entity	17032211	Construction	0
Steven Reichelt
Family of Board Member	26197	Employee Compensation	0
Neurology Associates
Board Member is a greater than 5% Partner in the Entity	405747	ER call coverage, rented space, and rented equipment from McKennan	0
Vincenta Rossing
Family of Board Member	11604	Employee Compensation	0
Woods Fuller Schultz & Smith PC
Board Member is an officer of the entity	241505	Legal Services	0
Marlene Schroeder
Family of Board Member	29766	Employee Compensation	0
Jess Carlson
Family of Board Member	100035	Employee Compensation	0
Christiane Maroun
Family of Board Member	145566	Employee Compensation	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Program Service Statement	Form 990, Part III, Line 4a	Information and Assistance: Avera McKennan operates a 24-hour Medical Call Center, through which patients have access to the Ask-A-Nurse program. Patients can call a toll-free number and talk personally with a Registered Nurse to ask health questions or receive general health information. In 2013, the Medical Call Center handled 107,214 calls. Avera McKennan's web site also provides an extensive health library that consumers can access free of charge. Interpreter service: Avera McKennan employs two full-time Spanish interpreters in-house, and their services are offered to patients free of charge. In addition, in cooperation with external agencies, Avera McKennan is able to handle 200 different languages and dialects through phone, video remote interpreting and other means. Interpretation services are available for patients when they are at Avera McKennan in person, or when they call by phone. All the above services are provided at no cost to the patient. Prenatal and delivery care: Because early and regular prenatal care is important to prevent premature birth, Avera McKennan collaborates in a community effort to provide obstetrics care for women who do not qualify for Medicaid, but cannot afford health insurance. The program offers prenatal care, and hospital labor and delivery serves for a low fee of $1,000. Women receive care whether they can cover any or all of the fee. Care is provided primarily by first-year family practice residents, supervised by experienced physicians. Through this program in 2013, Avera McKennan assisted with 46 births and provided 644 prenatal and post-partum visits. Transport to Transplant: Avera McKennan developed the Transport to Transplant project, which removes transportation barriers for patients from rural areas which may prevent them from completing the evaluation and testing needed for kidney and/or pancreas transplant. A van funded through a grant from the Avera McKennan Foundation is used to transport patients who demonstrate a financial need. Patients are brought to the Avera Transplant Institute for a condensed multi-day evaluation with all testing and visits completed in less than one week. Ultimately, the project results in improved morbidity and mortality, as kidney transplant doubles patient survival as compared to remaining on dialysis. Avera Family Wellness: This program combines positive activities like violin lessons with family coaching at no charge for children in early childhood programs in the Sioux Falls School District. The goal is to prevent or lessen the effects of behavioral health conditions on children and families by fostering a positive environment. Over 300 students and their families are enrolled. The Walsh Family Village: This hospitality house complex adjacent to the Avera McKennan campus provides a home away from home for patients and their families who come for care at Avera McKennan from outside of Sioux Falls. The project was funded by donations and is operated by Avera McKennan. Eleven guest rooms are available. Avera McKennan also donates use of a building in the complex for a Ronald McDonald House for families of pediatric patients. If they can afford it, guests are charged a low fee of $50 per night. Guests are not turned away due to inability to pay the fee. Employees regularly donate non-perishable food items to stock a food pantry for guests. In FY2013, the Walsh Family Village served 6,780 guests, staying in 4,015 nightly rooms a 90 percent occupancy. Avera McKennan provides a subsidy of approximately $226,000 per year to operate the hospitality complex. Prevention and support of substance use disorder: Avera McKennan is a partner with Face It TOGETHER Sioux Falls, a nonprofit organization which serves as the local face and voice for recovery from addiction through its recovery support services, advocacy and awareness programs. Avera has been a partner with Face It TOGETHER since its inception, and in a recent awareness campaign. In 2013, Avera McKennan provided $30,000 in funding toward this effort. Community Connections: Avera McKennan reaches out to people and communities throughout eastern South Dakota, southwestern Minnesota and northwest Iowa through Home Town Connections. Providing a critical feedback link to local referring doctors, this program completes the communications links necessary to keep local health care providers current on the treatment of their patients at Avera McKennan. Support of the arts and cultural life: Avera McKennan hosts Sioux Falls' only indoor SculptureWalk, an extension of the community's downtown SculptureWalk. Artists donate sculptures for one year, which are placed at locations throughout Avera McKennan's campus, in buildings connected by skywalks. Brochures contain a map, and visitors who follow the route suggested walk approximately 1 mile, making this a healthy as well as a cultural journey. Diabetes programming: Avera participates in a collaborative project with Sioux Falls Public Schools and the South Dakota Board of Nursing to implement eConsult services with diabetic education specialists monitoring medications and the health of children with diabetes in the school setting. Avera McKennan diabetes educators provided classes and one-on-one consultations at a loss of $195,000 in the past fiscal year. Community Benefits: Avera McKennan provides additional community benefits including: support of youth programs; homeless programs; community arts programming; health prevention; awareness and education about cancer, heart disease and other conditions; and support of the Sioux Empire United Way and other services in the region. Donations toward these efforts totaled $2,098,035 in 2013. Preschool vision and hearing screening: Avera McKennan provided free screening for 378 preschool children in fiscal year 2013.
	Form 990, Part VI, Section A, line 2	Gene Jones Jr., Cindy Walsh, and Fred Thurman - business relationship
	Form 990, Part VI, Section A, line 6	The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under section 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, all 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 B, line 11	The Form 990 is reviewed by the CEO, CFO, and Assistant VP of Financial Reporting. After the initial review, a draft is provided to the Finance Committee for their review. The approved return is provided to the full 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 System. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value for compensation of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. The CFO and key employees are compensated by Avera McKennan. Annually, the Compensation Committee of Avera McKennan, which is comprised of board members, meets to review the compensation of executives and physicians. Avera McKennan compares its compensation plan to other healthcare organizations similar in size and complexity to Avera McKennan on a national basis to ensure compensation is comparable. Avera McKennan utilizes multiple salary surveys and an independent compensation consultant to provide a market analysis for each executive's suggested pay or pay range. Individual salaries reflect related education and experience, as well as the scope of the duties to assure amounts paid are reasonable.
	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 VI, Section B, Line 16b:	There is no written policy or procedure requiring the Organization to evaluate its participation in joint venture arrangements. 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 must be approved by the board and the member.
Other Fees	Form 990, Part IX, line 11g	Contract labor and purchased services: Program service expenses 32,172,442. Management and general expenses 9,887,426. Fundraising expenses 61. Total expenses 42,059,929. Medical fees: Program service expenses 9,174,772. Management and general expenses 297,734. Fundraising expenses 0. Total expenses 9,472,506. FFS Other: Program service expenses 16,330,638. Management and general expenses 29,992,355. Fundraising expenses 727. Total expenses 46,323,720.
	Form 990, Part X, Line 20:	The issue price includes the filing Organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, 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 (EIN 46-0422673).
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 9:	Equity Transfers, net -3,467,243. Change in fair value of interest rate swap 3,947,357. Other changes in net assets 347,866.
	Form 990, Part XII, Line 2c:	The Audit Committee of Avera Health, the parent organization of Avera McKennan, selects the auditor and reviews the audited financial statements for Avera McKennan. Also, the Finance Committee at Avera McKennan takes responsibility for reviewing the audited financial statements.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Total IncomeTotalIncome	EOY AssetsEOYAssets	Business Name Line1DirectControllingEntityName/BusinessNameLine1
Sioux Falls Hospital Managment LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	562141521	Management company of Heart Hospital	NC	4799439	19665591	West 69th Street LLC
West 69th Street LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	460224743	Holding company	SD	4799439	19665591	Avera McKennan
Alumend LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	571175045	460224743	Research and development	SD	-35481	1589424	Avera McKennan

Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg	Direct Controlling Entity NADirectControllingEntityNA
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
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 Health
3900 West Avera Drive STE 300	Sioux Falls	SD	57108	460422673	Promotion of Health	SD	501(c)(3)	Line 9		0	N/A
Avera Queen of Peace
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 Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare Services	SD	501(c)(3)	Line 3	Avera St Mary's	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
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare Services	SD	501(c)(3)	Line 3	Avera Health	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 South Bruce Street	Marshall	MN	56258	411784801	Fundraising	MN	501(c)(3)	Line 7	Avera Marshall	0

Form990 Schedule R Part III Form990ScheduleRPartIII (12 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	Code VCodeVAmount	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership	Direct Controlling Entity NADirectControllingEntityNA
Avera Home Medical Equipment LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460488198	Medical Services - Home Medical Equipment	SD	Avera McKennan	Related	-246836	5057858	1	-$107,017	1	0.78630
MRIS LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	470874983	Health care services including aircraft	SD	Avera McKennan	Related			1		1	1.00000
Home Medical Equipment of Pierre LLC
329 E Dakota	Pierre	SD	57501	460444002	Medical Services - Home Medical Equipment	SD	Avera McKennan	Related	61320	222675	0	$17,254	1	0.50000
Avera Home Medical Equipment of Floyd Valley Hospital LLC
714 Lincoln St NE	Lemars	IA	51031	820582350	Medical Services - Home Medical Equipment	SD	Avera Home Medical Equipment LLC	Related	31277	103511	1	$7,873	1	0.39330
Avera Home Medical Equipment of Estherville LLC
PO Box 5045	Sioux Falls	SD	57117	201686097	Medical Services - Home Medical Equipment	SD	Avera Home Medical Equipment LLC	Related	-4992	143403	1	-$1,548	1	0.39330
Avera Home Medical Equipment of Sioux Center LLC
38 19th St SW	Sioux Center	IA	51250	753203100	Medical Services - Home Medical Equipment	SD	Avera Home Medical Equipment LLC	Related	16958	119974	1	$5,430	1	0.39330
Avera Home Medical Equipment of Marshall LLC
1104 East College Drive	Marshall	MN	56258	205271924	Medical Services - Home Medical Equipment	SD	Avera Home Medical Equipment LLC	Related	52422	304633	1	$15,427	1	0.39330
Q&M Properties LLC
525 North Foster	Mitchell	SD	57301	731652049	Medical Clinic Building	SD	Avera Queen of Peace	Related	-513	395782	0		0	0.50000
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	Surgical Associates	SD									N/A
Avera HME of Spencer Hospital LLC
2400 S Minnesota Avenue 102	Sioux Falls	SD	57117	800619999	Medical Services - Home Medical Equipment	SD	Avera Home Medical Equipment LLC	Related	-24660	122541	1	-$11,830	1	0.39330
Heart Hospital of South Dakota LLC
4500 W 69th Street	Sioux Falls	SD	57108	562143771	Healthcare Services	SD	Avera McKennan	Related	9598877	39331182	0		0	0.66670
Brookings Health System - Avera HME LLC
101 22nd Ave Suite 101	Brookings	SD	57006	453204123	Medical Services - Home Medical Equipment	SD	Avera Home Medical Equipment LLC	Related	-12061	185139	1	-$3,822	1	0.39330

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Type Of EntityTypeOfEntity	Controlled OrgControlledOrg
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

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	1	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	1	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	0	DividendsRelatedOrganization
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
Avera Home Medical Equipment LLC
A	268324	Intercompany detail from GL
Avera Home Medical Equipment LLC
K	121844	Intercompany detail from GL
Avera Home Medical Equipment LLC
Q	5195534	Intercompany detail from GL
Avera Home Medical Equipment LLC
R	5277541	intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
R	1283785	Intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
C	7862554	Intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
K	1564897	Intercompany detail from GL
Avera Heart Hospital of South Dakota LLC
Q	588403	Intercompany detail from GL

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Return Reference	Form 990, Schedule R, Part V, Line 2, Column c	ReturnReference
Explanation	The amounts reported in column c are reported based on a review of general ledger activity in intercompany accounts, and review of equity accounts for contributions and distributions.	Explanation