2014-05-15T15:44:33-05:00 2013-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2012-07-01 460224743 Avera McKennan AVER 6053228000 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 Julie Norton 6053228000 2014-05-14 1 Kim Hunwardsen CPA P00484560 6122536500 2014-05-14 2012 2015-11-30 17:44:51Z Dr David Kapaska 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 571175045 759202729 0 0928 X www.averamckennan.org X 1911 SD Promotion of Health 20 10 6976 1248 5825791 1344777 2006604 3708700 710238566 747902697 5478842 4006242 1681944 1900322 719405956 757517961 3588944 3822676 0 0 371268910 402340146 67066 0 730517 307380219 326008484 682305139 732171306 37100817 25346655 800980977 827983677 348719013 342106191 452261964 485877486 X 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. 0 0 356418601 3666920 495520730 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. 42003608 7200 50699863 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. 190104465 148230 156778087 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. 29963792 326 45741441 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. 29963792 326 45741441 618490466 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 419 0 1 6976 1 1 1 0 0 0 0 0 0 0 0 0 X 20 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 X Julie Norton 6053228000 1325 S Cliff Ave Sioux Falls SD 571175045 Dave Rozenboom 2.00 0.00 X X 0 0 0 Michael Bender 2.00 0.00 X X 0 0 0 Dave Kapaska DO 40.00 0.00 X X 0 723774 48865 Sister Janice Klein 2.00 0.00 X 0 0 0 Gene Jones Jr 2.00 0.00 X 0 0 0 Amy Krie MD 40.00 0.00 X 533149 0 39188 Sister Kathryn Easley 2.00 0.00 X 0 0 0 Kim Pederson MD 40.00 0.00 X 300264 0 36659 Sister Joan Reichelt 2.00 3.80 X 0 0 0 Greg Schroeder MD 2.00 0.00 X 0 0 0 Fred Thurman 2.00 0.00 X 0 0 0 David Fleck 2.00 0.00 X 0 0 0 James Wiederrich 2.00 0.00 X 0 0 0 Bill Rossing MD 2.00 0.00 X 0 0 0 Cindy Walsh 2.00 0.00 X 0 0 0 David Chicoine 2.00 0.00 X 0 0 0 Sister Candyce Chrystal 2.00 0.00 X 0 0 0 Hugh Venrick 2.00 0.00 X 0 0 0 Raed Sulaiman MD 2.00 0.00 X 0 0 0 Carol Twedt 2.00 0.00 X 0 0 0 Julie N Norton 40.00 0.00 X 384400 0 45508 Judy Blauwet 40.00 0.00 X 338369 0 35463 David Flicek 1.00 40.00 X 0 419347 34909 Steve Petersen 40.00 0.00 X 195190 0 35167 Mary Leedom 40.00 0.00 X 170883 0 12582 Curt Hohman 40.00 0.00 X 281740 0 27354 Kelly McCaul MD 40.00 0.00 X 1326856 0 27854 Steven Condron MD 40.00 0.00 X 1140497 0 44007 Brian Knutson MD 40.00 0.00 X 1120835 0 41187 Michael Puumala MD 40.00 0.00 X 1062046 0 39008 Daniel Tynan MD 40.00 0.00 X 1060503 0 41507 Patricia Jagoe 0.00 0.00 X 139051 0 27042 8053783 1143121 536300 548 1 1 0 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 95 67450 1440914 189124 2011212 3708700 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 3662004 3644750 17254 747902697 81575 81575 1457459 1098064 359395 359395 359395 4511371 0 586704 4511371 -586704 3924667 3924667 Interest income 900099 837424 837424 Commercial testing 621500 527097 527097 Sports program 900099 176406 176406 1540927 757517961 743617833 5825791 4365637 X 3708926 3708926 113750 113750 2368719 1291234 1077485 349463 349463 322242742 294651325 27194289 397128 19626875 17388072 2209554 29249 37400337 33261143 4081034 58160 20352010 18164770 2158664 28576 316561 316561 497125 497125 106130 106130 37848 37848 97856155 57677852 40177515 788 3545710 589859 2947561 8290 11949845 6366798 5391151 191896 8403615 615387 7788228 21150569 14650698 6499764 107 3235504 2728243 501410 5851 2100832 1832689 267621 522 7987206 7746033 241173 36030899 30053309 5971639 5951 1307714 1305262 2452 Medical supplies 105489715 105489715 Bad Debt expense 16988522 16988522 Equipment lease and ren 4108329 2703965 1404364 UBI tax 662915 662915 4233290 496890 3732401 3999 732171306 618490466 112950323 730517 X 28110750 25389142 2439599 2382202 92528140 93735966 20833 3360181 3220401 14389349 14929302 8098767 10595030 708615671 350002821 343607662 358612850 8322781 8554927 207116305 229497375 12187088 11817238 44273450 45416755 36526072 23832489 800980977 827983677 65431052 69147875 791440 1464257 224989669 221217723 818999 823621 22024359 17706579 34663494 31746136 348719013 342106191 X 440185934 471655159 9934388 11590650 2141642 2631677 452261964 485877486 800980977 827983677 X 25346655 7440887 827980 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 1268 0 1 36580 37848 0 Explanation of Lobbying Activities: Part II-B, Line 1: 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. 1 11845 156773 148601 20017 1 X 2141642 490035 2631677 2021909 119733 2141642 1981042 40867 2021909 1897334 83708 1981042 2160515 -263181 1897334 1.00000 0 1 1 7665722 21123158 28788880 2279713 403537844 157641909 248175648 257701727 186781642 70920085 16307507 5579270 10728237 358612850 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 229497375 Other Liabilities 2741802 Due to other Organizations 1174897 Market value of interest swap 8644872 Estimated third-party payor settlements 9350011 Due to affilate 5156584 Minority interest 4677970 31746136 X 824010890 7440887 72573083 80013970 743996920 13521041 13521041 757517961 786743861 73520962 73520962 713222899 18948407 18948407 732171306 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. Description of Intended Use of Endowment Funds: 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 Uncertain Tax Positions Under FIN 48: 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. Part XI, Line 2d - Other Adjustments: 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 4b - 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 XII, Line 2d - 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 4b - 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 12211198 12211198 0.01710 63368457 44572470 18795987 0.02630 1247665 786501 461164 0.00060 76827320 45358971 31468349 0.04400 2872839 267068 2605771 0.00360 7525537 1609899 5915638 0.00830 22490592 11905979 10584613 0.01480 4155961 662070 3493891 0.00490 3061510 3061510 0.00430 40106439 14445016 25661423 0.03590 116933759 59803987 57129772 0.07990 69952 69952 0.00010 15000 15000 0.00000 5000 5000 0.00000 191382 191382 0.00030 281334 281334 0.00040 1 16988522 0 170804190 148520178 22284012 X 1 1 7 1 Avera McKennan

1325 S Cliff Ave Sioux Falls SD 57117

X X X X X X 34 Provider Based Clinics 2 Heart Hospital of South Dakota LLC

10720 Sikes Place Suite 300 Charlotte NC 28277

X X X 2/3 Owner in Joint Venture 3 Avera Gregory Healthcare Center

400 Park Ave Gregory SD 57533

X X X X Four Provider Based Clinics 4 Avera Milbank Area Hospital

901 Virgil Ave Milbank SD 57252

X X X X Three Rural Provider Based Clinics 5 Avera Dells Area Health Center

909 N Iowa Avenue Dell Rapids SD 57022

X X X X Three Provider Based Clinics 6 Avera Flandreau Medical Center

214 N Prairie Flandreau SD 57028

X X X X One Provider Based Clinic 7 Avera Hand County Memorial Hospital

300 W 5th St Miller SD 57362

X X X X One Provider Based Clinic 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 X 1 0 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 62 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 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. Part III, Line 5, 6, and 7: 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. Avera McKennan 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. Heart Hospital of South Dakota, LLC 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. Avera Gregory Healthcare Center 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 Milbank Area Hospital 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 Dells Area Health Center 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 Flandreau Medical 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 Hand County Memorial Hospital 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 McKennan Part V, Section B, Line 4: The CHNA was conducted with Heart Hospital of South Dakota, LLC. Heart Hospital of South Dakota, LLC Part V, Section B, Line 4: The CHNA was conducted with Avera McKennan. 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 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 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/. Heart Hospital of South Dakota, LLC 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. 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 6i: The implementation strategy can be found at: http://www.avera.org/experience/shared/community-needs-health-assessments/. Avera McKennan 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. Heart Hospital of South Dakota, LLC 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. Avera Gregory Healthcare Center 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 Milbank Area Hospital 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 McKennan 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. Heart Hospital of South Dakota, LLC 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. Avera Gregory Healthcare Center 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 Milbank Area Hospital 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 Dells Area Health Center 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 Flandreau Medical 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 Hand County Memorial Hospital 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. Heart Hospital of South Dakota, LLC 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. 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 V, Section B, Line 22: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care. Part VI, Line 2: 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. 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. 1 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 160516 FMV rented space Donation 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 Plaza 2 Ste 210 Sioux Falls SD 57105 460448030 501(c)(3) 23500 Donation 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 46 2 Scholarships 48 113750 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: 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. 1 0 0 0 0 0 0 0 0 Dave Kapaska DO 0 578511 0 0 0 145263 0 30475 0 19702 0 773951 0 0 Amy Krie MD 531952 0 0 0 1197 0 20300 0 19614 0 573063 0 0 0 Kim Pederson MD 295728 0 0 0 4536 0 20300 0 17086 0 337650 0 0 0 Julie N Norton 383180 0 0 0 1220 0 20300 0 25934 0 430634 0 0 0 Judy Blauwet 331429 0 0 0 6940 0 15300 0 20890 0 374559 0 0 0 David Flicek 0 378960 0 0 0 40387 0 13475 0 22303 0 455125 0 0 Steve Petersen 193448 0 0 0 1742 0 11960 0 23935 0 231085 0 0 0 Mary Leedom 170068 0 0 0 815 0 10339 0 2970 0 184192 0 0 0 Curt Hohman 280479 0 0 0 1261 0 20300 0 7349 0 309389 0 0 0 Kelly McCaul MD 1322328 0 0 0 4528 0 20300 0 7849 0 1355005 0 0 0 Steven Condron MD 1137617 0 0 0 2880 0 20300 0 24434 0 1185231 0 0 0 Brian Knutson MD 1117827 0 0 0 3008 0 20300 0 21614 0 1162749 0 0 0 Michael Puumala MD 1056615 0 0 0 5431 0 20300 0 19434 0 1101780 0 0 0 Daniel Tynan MD 1052116 0 0 0 8387 0 20300 0 21934 0 1102737 0 0 0 Patricia Jagoe 138364 0 0 0 687 0 11452 0 16195 0 166698 0 0 0 Part I, Line 4a Patricia Jagoe, former key employee, received severance payments through October 10, 2012 that totaled $59,580. Supplemental Information 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. 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 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. 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 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 N/A 0 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 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 -107017 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 17254 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 7873 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 -1548 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 5430 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 15427 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 -11830 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 -3822 1 0.39330 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 1 1 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 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 Form 990, Schedule R, Part V, Line 2, Column c 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.