AVERA QUEEN OF PEACE: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- AVERA QUEEN OF PEACE (EIN 46-0224604)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-15
- IRS object ID
- 201301359349300720
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-15T07:26:05-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460224604 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Queen of Peace Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AVER | NameControl |
| Phone | 6059952251 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 North Foster Street | AddressLine1 |
| City | Mitchell | City |
| State | SD | State |
| ZIP Code | 57301 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | William E Flett | Name |
| Title | Sec/Treas & VP of Finance | Title |
| Phone | 6059952251 | Phone |
| Date Signed | 2013-05-10 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kim Hunwardsen CPA | Name |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | Phone |
| Date Prepared | 2013-05-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Queen of Peace Health Service | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Thomas A Clark | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 North Foster Street | AddressLine1 |
| City | Mitchell | City |
| State | SD | State |
| ZIP Code | 57301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 93753224 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.averaqueenofpeace.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1905 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | Promotion of Health | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 959 | TotalNbrEmployees |
| Total Nbr Volunteers | 120 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1259988 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 299594 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 82985131 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 91771776 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1329553 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1356570 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -82807 | OtherRevenuePriorYear |
| Other Revenue Current Year | -185416 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 85491865 | TotalRevenuePriorYear |
| Total Revenue Current Year | 93242524 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 163174 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 205016 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 47230003 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 52453229 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 139704 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 32188106 | OtherExpensePriorYear |
| Other Expenses Current Year | 35084825 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 79581283 | TotalExpensesPriorYear |
| Total Expenses Current Year | 87743070 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 5910582 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5499454 | RevenuesLessExpensesCY |
| Total Assets BOY | 105824301 | TotalAssetsBOY |
| Total Assets EOY | 111663788 | TotalAssetsEOY |
| Total Liabilities BOY | 32789972 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 35720424 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 73034329 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 75943364 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 71069712 | Expense |
| Grants | 205016 | Grants |
| Revenue | 91771776 | Revenue |
| Description | Avera Queen of Peace's mission is to provide healthcare services to Mitchell, SD residents and surrounding area. They provide acute care and long-term healthcare services, of which there were 8,381 acute patient days, 2,503 swing-bed patient days, 1,190 nursery patient days, and 39,970 nursing home resident days. The breakout of these statistics per facility is as follows.Avera Queen of Peace Hospital7,861 Acute patient days1,657 Swing-bed patient days1,190 Newborn patient daysAvera Brady Health and Rehabilitation29,123 Long-term care resident days8,913 Assisted living days1,934 Independent living daysAvera Weskota Memorial Medical Center (CAH)382 Acute patient days537 Swing-bed patient daysAvera De Smet Memorial Hospital (CAH)138 Acute patient days309 Swing-bed patient days Avera Queen of Peace maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $2,102,462.Avera Queen of Peace also provides community benefit health activities at less than or at no cost to support those in the area serviced. These activities include community education programs; special programs for the elderly, handicapped, and medically underserved; and a variety of broad community support activities. During the year ended June 30, 2012, specific activities include meals delivered to residential homes; meeting facilities; programs for patients and families suffering from cancer, diabetes, breathing disorders, and others; assistance to health educators; emergency healthcare providers; wellness programs; and overnight housing for families of hospitalized patients.As a member of the Avera Health network, Avera Queen of Peace upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide a quality, effective health ministry and to improve the health care of individuals and our communities through a regionally integrated network of persons and institutions. Avera Queen of Peace engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. | Description |
| Total Program Service Expense | 71069712 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 165 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 959 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Will Flett | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6059952251 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 North Foster | AddressLine1 |
| City | Mitchell | City |
| State | SD | State |
| ZIP Code | 57301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (27 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Roger Musick | ||||||||
| Chairperson | 2.50 | X | X | 0 | 0 | 0 | ||
| Lori Essig | ||||||||
| Vice Chair | 2.50 | X | X | 0 | 0 | 0 | ||
| Loren Noess | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Charles Bergeleen | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Sister Kathleen Crowley | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Dennis Kruse | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Sister Bonita Gacnik | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| David Olson | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Jacquelyn Johnson | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Jennifer Tegethoff MD | ||||||||
| Board Member (1-12 - 6-12) | 40.00 | X | 211069 | 0 | 11584 | |||
| Diane Sandhoff | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Robert Snortum MD | ||||||||
| Board Member (thru 1-12) | 40.00 | X | 344454 | 0 | 22343 | |||
| Jerry Thomsen | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Terry Torgerson | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Michael Krause DO | ||||||||
| Board Member | 2.50 | X | 40000 | 0 | 0 | |||
| Patricia Malters MD | ||||||||
| Board Member | 40.00 | X | 76075 | 0 | 3745 | |||
| Greg Van Wald | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Sister Joan Reichelt | ||||||||
| Board Member | 2.50 | X | 0 | 0 | 0 | |||
| Thomas Clark | ||||||||
| President & CEO | 40.00 | X | X | 0 | 161842 | 14011 | ||
| William E Flett | ||||||||
| Sec/Treas & VP of Finance | 40.00 | X | 59746 | 0 | 13242 | |||
| Patrick J Clark | ||||||||
| Sec/Treas & SrVP Finance (thru 1/12) | 40.00 | X | 206629 | 0 | 22916 | |||
| Stephen Dick MD | ||||||||
| Physician | 40.00 | 421749 | 0 | 29474 | X | |||
| Christopher Krouse MD | ||||||||
| Physician | 40.00 | 1035566 | 0 | 29474 | X | |||
| Michael Haley MD | ||||||||
| Physician | 40.00 | 447185 | 0 | 29474 | X | |||
| Dennis Leland MD | ||||||||
| Physician | 40.00 | 566195 | 0 | 32473 | X | |||
| Brian Kampmann MD | ||||||||
| Physician | 40.00 | 646502 | 0 | 29474 | X | |||
| Tom Rasmusson | ||||||||
| Former President & CEO | 40.00 | 0 | 253336 | 18798 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4055170 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 415178 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 257008 | TotalOtherCompensation |
| Number Individuals GT100 K | 43 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Avera Health | |||||
| 3900 W Avera Drive Suite 300 | Sioux Falls | SD | 57108 | Shared Services | 3709284 |
| Aegis Therapies Inc | |||||
| PO Box 8103 | Fort Smith | AR | 72902 | Physical and Occupational Therapy | 283916 |
| Custom Touch Homes LLC | |||||
| 411 SE 12th St | Madison | SD | 57042 | Construction | 205262 |
| Quality Homes LLC | |||||
| 1525 W Elm Ave | Mitchell | SD | 57301 | Construction | 188960 |
| Integrated Therapy Services | |||||
| PO Box 1284 | Sioux Falls | SD | 57105 | PT, OT, Speech Therapy Services | 150052 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| All Other Contributions | 299594 | AllOtherContributions |
| Total Contributions | 299594 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient & Resident | 623000 | 89738446 | 89738446 |
| Other Revenue | 900099 | 1181634 | 1181634 |
| Cafeteria | 900099 | 453662 | 453662 |
| Interest in Avera Heal | 900099 | 285600 | 285600 |
| Community wellness | 900099 | 112434 | 112434 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 91771776 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34701 | TotalRevenueColumn |
| Exclusion | $34,701 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 319103 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 504519 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -185416 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -185416 | TotalRevenueColumn |
| Exclusion | -$185,416 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1328050 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 6181 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1328050 | Securities |
| Other | -6181 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1321869 | TotalRevenueColumn |
| Exclusion | $1,321,869 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 93242524 | TotalRevenueColumn |
| Related Or Exempt Function Income | 91771776 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,171,154 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 205016 | Total |
| Program Services | 205016 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1203971 | Total |
| Program Services | 918036 | ProgramServices |
| Management And General | 285935 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40774055 | Total |
| Program Services | 33331453 | ProgramServices |
| Management And General | 7342356 | ManagementAndGeneral |
| Fundraising | 100246 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2010783 | Total |
| Program Services | 1643447 | ProgramServices |
| Management And General | 362396 | ManagementAndGeneral |
| Fundraising | 4940 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5939628 | Total |
| Program Services | 4818780 | ProgramServices |
| Management And General | 1106079 | ManagementAndGeneral |
| Fundraising | 14769 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2524792 | Total |
| Program Services | 2058715 | ProgramServices |
| Management And General | 460017 | ManagementAndGeneral |
| Fundraising | 6060 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6685803 | Total |
| Program Services | 2831873 | ProgramServices |
| Management And General | 3853930 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 453636 | Total |
| Program Services | 86019 | ProgramServices |
| Management And General | 367617 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8887521 | Total |
| Program Services | 7047818 | ProgramServices |
| Management And General | 1828813 | ManagementAndGeneral |
| Fundraising | 10890 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 244041 | Total |
| Program Services | 147123 | ProgramServices |
| Management And General | 96918 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1920951 | Total |
| Program Services | 1270741 | ProgramServices |
| Management And General | 650210 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 272029 | Total |
| Program Services | 185303 | ProgramServices |
| Management And General | 85756 | ManagementAndGeneral |
| Fundraising | 970 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103321 | Total |
| Program Services | 39687 | ProgramServices |
| Management And General | 63425 | ManagementAndGeneral |
| Fundraising | 209 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 712175 | Total |
| Program Services | 712175 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4187685 | Total |
| Program Services | 4187685 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 816129 | Total |
| Program Services | 816129 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 6760724 | 6760724 | |
| Bad Debt Expense | 3026522 | 3026522 | |
| Equipment Lease and Ren | 128333 | 106704 | 21629 |
| Grant program expenditu | 124900 | 124900 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 761055 | Total |
| Program Services | 750862 | ProgramServices |
| Management And General | 8573 | ManagementAndGeneral |
| Fundraising | 1620 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87743070 | Total |
| Program Services | 71069712 | ProgramServices |
| Management And General | 16533654 | ManagementAndGeneral |
| Fundraising | 139704 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3286441 | BOY |
| EOY | 3368813 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 639 | BOY |
| EOY | 1292 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11706690 | BOY |
| EOY | 12573812 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108959 | BOY |
| EOY | 39762 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1222612 | BOY |
| EOY | 1234335 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 653214 | BOY |
| EOY | 957408 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 89438453 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 51435175 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38296504 | BOY |
| EOY | 38003278 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7237868 | BOY |
| EOY | 924180 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41750866 | BOY |
| EOY | 51789691 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 332077 | BOY |
| EOY | 292572 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1228431 | BOY |
| EOY | 2478645 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105824301 | BOY |
| EOY | 111663788 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6928998 | BOY |
| EOY | 7863100 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128877 | BOY |
| EOY | 33476 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22262117 | BOY |
| EOY | 23448866 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 544037 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2925943 | BOY |
| EOY | 4374982 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32789972 | BOY |
| EOY | 35720424 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70490116 | BOY |
| EOY | 73165461 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1748895 | BOY |
| EOY | 1981585 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 795318 | BOY |
| EOY | 796318 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73034329 | BOY |
| EOY | 75943364 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105824301 | BOY |
| EOY | 111663788 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 5499454 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2590419 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $14,322 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 14322 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1034190 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 6624 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1040814 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 793583 | BeginningOfYearBalance |
| Contributions | 109334 | Contributions |
| Investment Earnings Or Losses | 131273 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1034190 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1032880 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -239297 | InvestmentEarningsOrLosses |
| End Of Year Balance | 793583 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1028163 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 4717 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1032880 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.13080 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.76510 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.10410 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1149953 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1164024 | OtherCostOrOtherBasis |
| Book Value | 2313977 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 51729252 | OtherCostOrOtherBasis |
| Depreciation | 26220564 | Depreciation |
| Book Value | 25508688 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33788998 | OtherCostOrOtherBasis |
| Depreciation | 24050775 | Depreciation |
| Book Value | 9738223 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1606226 | OtherCostOrOtherBasis |
| Depreciation | 1163836 | Depreciation |
| Book Value | 442390 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38003278 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (4 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| Investment in affiliated organizations | 166125 | C |
| Interest in Avera Health Foundation | 2438855 | F |
| Interest in net assets of Mabee Trust | 754227 | F |
| Assets Limited to use - Avera Pooled Investments | 48430484 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 51789691 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Derivative liability | $3,039,225 |
| Estimated third-party payor settlements | $1,235,000 |
| Capital lease obligations | $100,757 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4374982 | TotalOfAmounts |
| Total Revenue | 93242524 | TotalRevenue |
| Total Expenses | 87743070 | TotalExpenses |
| Excess Or Deficit For Year | 5499454 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -1121879 | NetUnrealizedGLOnInvestments |
| Other | -$1,468,540 | OtherAmount |
| Total Adjustments | -2590419 | TotalAdjustments |
| Excess Or Deficit Per FS | 2909035 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 87391701 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -1121879 | NetUnrealizedGainsInvestments |
| Other Revenues | -4392766 | OtherRevenues |
| Revenue Not Rptd F990 | -5514645 | RevenueNotRptdF990 |
| Revenue Subtotal | 92906346 | RevenueSubtotal |
| Other Revenues Not Included | 336178 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 336178 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 93242524 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 84716548 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 84716548 | ExpensesSubtotal |
| Other Expenses Not Included | 3026522 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 3026522 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 87743070 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part IV, Line 2b: | The organization holds funds in trust on behalf of its residents. | |
| Part V, Line 4: | The organization's endowments consist of a portion of their interest in the net assets of Avera Health Foundation and their beneficial interest in the Mabee Trust. Avera Health Foundation includes endowment funds which have been established for a variety of purposes. The endowment fund assets included in the Organization's beneficial interest in the Mabee Trust have been established to purchase equipment and furnishings for the Organization. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization's permanently restricted endowment funds are donor restricted. The Organization currently does not have any board-designated endowment funds. | Description of Intended Use of Endowment Funds: |
| Part X: | The Organization is organized as a South Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2009. | Description of Uncertain Tax Positions Under FIN 48: |
| Capital Contributions, Net -162,805. Change in Fair Value of Interest Rate Swap -1,193,985. Loss on Refinancing -111,750. Total to Schedule D, Part XI, Line 8: -1,468,540. | Part XI, Line 8 - Other Adjustments: | |
| Change in Fair Value of Interest Rate Swap -1,193,985. Loss on Refinancing -111,750. Reclassification of Accumulated Losses on Interest Rate Swap -60,509. Provision for bad debts included in revenue on financial statements -3,026,522. | Part XII, Line 2d - Other Adjustments: | |
| Grants and contributions recorded in fund balance for financial statements 48,747. Change in interest in Avera Foundation recorded in fund balance for F/S 296,541. Change in interest in Mabee Trust recorded in fund balance for F/S -9,110. | Part XII, Line 4b - Other Adjustments: | |
| Provision for bad debts included in revenue on financial statements 3,026,522. | Part XIII, Line 4b - Other Adjustments: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2154 | PersonsServed |
| Total Community Benefit Expense | 854145 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 854145 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01010 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6631 | PersonsServed |
| Total Community Benefit Expense | 7149781 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4992731 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2157050 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02550 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8785 | PersonsServed |
| Total Community Benefit Expense | 8003926 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4992731 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3011195 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03560 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 29 | NumberOfActivitiesOrPrograms |
| Persons Served | 44642 | PersonsServed |
| Total Community Benefit Expense | 49789 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 625 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 49164 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 4 | PersonsServed |
| Total Community Benefit Expense | 12042 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12042 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 41 | NumberOfActivitiesOrPrograms |
| Persons Served | 42245 | PersonsServed |
| Total Community Benefit Expense | 166055 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 166055 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 71 | NumberOfActivitiesOrPrograms |
| Persons Served | 86891 | PersonsServed |
| Total Community Benefit Expense | 227886 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 625 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 227261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 71 | NumberOfActivitiesOrPrograms |
| Persons Served | 95676 | PersonsServed |
| Total Community Benefit Expense | 8231812 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4993356 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3238456 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03830 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 500 | PersonsServed |
| Total Community Building Expense | 2196 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2196 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 247 | PersonsServed |
| Total Community Building Expense | 1681 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1681 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 68679 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 46800 | DirectOffsettingRevenue |
| Net Community Building Expense | 21879 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 747 | PersonsServed |
| Total Community Building Expense | 72556 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 46800 | DirectOffsettingRevenue |
| Net Community Building Expense | 25756 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,026,522 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 28804465 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 34836000 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -6031535 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 3 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (3 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours | OtherOther | Critical Access HospitalCriticalAccessHospital |
|---|---|---|---|---|---|---|---|---|---|
| Avera Queen of Peace Hospital | |||||||||
| 1 | 525 North Foster Street | Mitchell | SD | 57301 | X | X | X | 3 Provider Based Clinics | |
| Avera Weskota Memorial Medical Center | |||||||||
| 2 | 609 1st Street NE | Wessington Springs | SD | 57382 | X | X | X | ||
| Avera De Smet Memorial Hospital | |||||||||
| 3 | 306 Prairie Avenue SW | De Smet | SD | 57231 | X | X | X | ||
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (3 entries)
| Hospital Facility NumberHospitalFacilityNumber | CHNA ConductedCHNAConducted | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | FPG Free PercentFPGFreePercent | Uses FPG DiscountedUsesFPGDiscounted | FPG Discount PercentFPGDiscountPercent | Explains BasisExplainsBasis | Income LevelIncomeLevel | Asset LevelAssetLevel | Medical IndigencyMedicalIndigency | Insurance StatusInsuranceStatus | Uninsured DiscountUninsuredDiscount | Medicaid MedicareMedicaidMedicare | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Posted On WebsitePostedOnWebsite | Available On RequestAvailableOnRequest | Other PublicityOtherPublicity | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | Used Other MethodUsedOtherMethod | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Avera Queen of Peace Hospital | ||||||||||||||||||||||||
| 1 | 0 | 1 | 1 | 150.000000000000 | 1 | 400.000000000000 | 1 | X | X | X | X | X | X | 1 | 1 | X | X | X | 1 | 0 | 1 | X | 1 | 1 |
| Avera Weskota Memorial Medical Center | ||||||||||||||||||||||||
| 2 | 0 | 1 | 1 | 150.000000000000 | 1 | 400.000000000000 | 1 | X | X | X | X | X | X | 1 | 1 | X | X | X | 1 | 0 | 1 | X | 1 | 1 |
| Avera De Smet Memorial Hospital | ||||||||||||||||||||||||
| 3 | 0 | 1 | 1 | 150.000000000000 | 1 | 400.000000000000 | 1 | X | X | X | X | X | X | 1 | 1 | X | X | X | 1 | 0 | 1 | X | 1 | 1 |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Avera Brady Assisted Living | ||||
| 1414 W Cedar Ave | Mitchell | SD | 57301 | Assisted Living |
| Avera Brady Health and Rehab | ||||
| 500 S Ohman St | Mitchell | SD | 57301 | Nursing Home |
Form990 Schedule H Part VI Form990ScheduleHPartVI (25 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: To determine eligibility for charity care, Avera Queen of Peace Hospital has developed a test which utilizes a combination of household income, household assets, and also considers unpaid past and ongoing medical expenses. Charity discount may range from 10 - 100% depending on score. | |
| Part I, Line 6a: Part 1, line 6A: Our community benefit report is contained in a report prepared by Avera Health, a related organization. It is available through the website and requested mailing, and is filed with the Catholic Health Association. | |
| Part I, Line 7: Charity care and unreimbursed medicaid was converted to cost using the cost to charge ratio in IRS worksheet 2. The amounts on lines 7e-i represent expenses reported in the general ledger. | |
| Part I, L7 Col(f): AQOP bad debt expense of $3,026,522 is included on Form 990, Part IX, Line 25, Column (A) but excluded for purposes of calculating this percentage. | |
| Part II: Avera Queen of Peace supports numerous economic development organizations with participation at meetings and donations throughout its service area. Additionally, Avera Queen of Peace works with Dakota Wesleyan University, the Mitchell Technical Institute, and local high schools to address healthcare worker shortages in the communities of its service area. | |
| Part III, Line 4: Bad debt is reported at charges as recorded by the organization. Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Note from Financial Statement:Patient and resident receivables are uncollateralized patient, resident and third-party payor obligations. Payments of patient and resident receivables are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim.The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate. | |
| Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by CMS. Avera Queen of Peace follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall (as calculated including our non-cost report entities) is excluded from our community benefit report. However, Medicare is the organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community. | |
| Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within a reasonable time period, the organization or it's agent shall not send, nor indicate that it will send, the unpaid bill to any outside agency if doing so may negatively impact a patient's credit. 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. 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 V, Section B, Line 13g: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. | Avera Queen of Peace Hospital |
| Part V, Section B, Line 13g: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. | Avera Weskota Memorial Medical Center |
| Part V, Section B, Line 13g: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. | Avera De Smet Memorial Hospital |
| Part V, Section B, Line 19d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 90% of the gross charges. This is based on the lowest discount under the charity care policy of 10%. | Avera Queen of Peace Hospital |
| Part V, Section B, Line 19d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 90% of the gross charges. This is based on the lowest discount under the charity care policy of 10%. | Avera Weskota Memorial Medical Center |
| Part V, Section B, Line 19d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 90% of the gross charges. This is based on the lowest discount under the charity care policy of 10%. | Avera De Smet Memorial Hospital |
| Part V, Section B, Line 20: The hospital provides a reduction to gross charges under their financial assistance policy. 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. 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 Queen of Peace Hospital |
| Part V, Section B, Line 20: The hospital provides a reduction to gross charges under their financial assistance policy. 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. 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 Weskota Memorial Medical Center |
| Part V, Section B, Line 20: The hospital provides a reduction to gross charges under their financial assistance policy. 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. 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 De Smet Memorial Hospital |
| Part V, Section B, Line 21: 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 Queen of Peace Hospital |
| Part V, Section B, Line 21: 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 Weskota Memorial Medical Center |
| Part V, Section B, Line 21: 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 De Smet Memorial Hospital |
| Part VI, Line 2: Avera Queen of Peace is currently conducting a Community Health Needs Assessment. Several groups/organizations have been contacted and interviews have been set up in order to cultivate their needs and input. A target date of January 2013 has been set to quantify information received from these meetings. | |
| Part VI, Line 3: Anyone who is uninsured receives a letter with their itemized bill which describes both the uninsured program and the charitycare program. Any uninsured patient is contacted by phone or letter by our collections department at which time our programs are described. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding our charity care and uninsured programs. | |
| Part VI, Line 4: Avera Queen of Peace's service area includes Davison County and surrounding counties in South Dakota. In 2010, the population for Davison County was estimated to be 19,504. Approximately 16.9% of the population is age 65 or older. The average per capita income is $23,510 and approximately 12% of individuals are below the federal poverty level. The nearest hospital in the area is approximately 22 miles from Avera Queen of Peace. | |
| Part VI, Line 5: AVERA QUEEN OF PEACE IS A VERIFIED LEVEL III TRAUMA CENTER AND OPERATES AN EMERGENCY DEPARTMENT STAFFED 24 HOURS PER DAY WITHBOARD CERTIFIED PHYSICIANS. EMERGENCY CARE IS PROVIDED ON AN OPEN DOOR BASIS REGARDLESS OF ABILITY TO PAY. AVERA QUEEN OF PEACE LEASES OR MANAGES THREE CRITICAL ACCESS HOSPITALS WHICH PROVIDE A BROAD RANGE OF INPATIENT, OUTPATIENT SERVICES AND 24 HOUR EMERGENCY ROOMS IN 3 VERY RURAL COMMUNITIES.AVERA QUEEN OF PEACE OWNS THREE RURAL HEALTH CLINICS WHICH PROVIDE PRIMARY CARE SERVICES IN THREE RURAL COMMUNITIES. SIMILAR TO THE HOSPITALS IN THE AQOP REGION, THESE CLINICS ARE OPERATED ON AN OPEN DOOR BASIS AND CARE IS PROVIDED REGARDLESS OF ABILITY TO PAY. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL LICENSED AND QUALIFIED APPLICANTS. THE AVERA QUEEN OF PEACE BOARD OF DIRECTORS IS PRINCIPALLY COMPRISED OF COMMUNITY MEMBERS FROM THE PRIMARY AND SECONDARY SERVICES AREAS. MEMBERS COME FROM A VARIETY OF BACKGROUNDS INCLUDING BANKING, EDUCATION, AGRICULTURE, HEALTHCARE, AND PRIVATE INDUSTRY. | |
| Part VI, Line 6: The communities in which Avera operates all have unique health and community benefit needs and in keeping with the Catholic Healthcare Association guidelines each hospital strives to meet its community's identified needs. The Avera central office advocates for all on community benefit related matters of state, regional and nation importance. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| Mitchell Tech Institute Foundation | |||||||
| 821 N Capital | Mitchell | SD | 57301 | 460452950 | 501(c)(3) | 58948 | donation |
| University of South Dakota | |||||||
| 414 E Clark St | Vermillion | SD | 57069 | 466018891 | 501(c)(3) | 24000 | donation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: The organization only makes grants to other organizations which are tax-exempt under Section 501(c)(3). | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jennifer Tegethoff MD | |||||||||||||
| 124871 | 0 | 85810 | 0 | 388 | 0 | 10584 | 0 | 1273 | 0 | 222926 | 0 | 0 | 0 |
| Robert Snortum MD | |||||||||||||
| 311679 | 0 | 28001 | 0 | 4774 | 0 | 12250 | 0 | 10608 | 0 | 367312 | 0 | 0 | 0 |
| Thomas Clark | |||||||||||||
| 0 | 122288 | 0 | 25000 | 0 | 14554 | 0 | 7995 | 0 | 6016 | 0 | 175853 | 0 | 0 |
| Patrick J Clark | |||||||||||||
| 184527 | 0 | 17186 | 0 | 4916 | 0 | 11832 | 0 | 11157 | 0 | 229618 | 0 | 0 | 0 |
| Stephen Dick MD | |||||||||||||
| 354913 | 0 | 45452 | 0 | 21384 | 0 | 12250 | 0 | 17972 | 0 | 451971 | 0 | 0 | 0 |
| Christopher Krouse MD | |||||||||||||
| 880157 | 0 | 92964 | 0 | 62445 | 0 | 12250 | 0 | 18736 | 0 | 1066552 | 0 | 0 | 0 |
| Michael Haley MD | |||||||||||||
| 195359 | 0 | 244849 | 0 | 6977 | 0 | 12250 | 0 | 18088 | 0 | 477523 | 0 | 0 | 0 |
| Dennis Leland MD | |||||||||||||
| 192359 | 0 | 371739 | 0 | 2097 | 0 | 12250 | 0 | 21311 | 0 | 599756 | 0 | 0 | 0 |
| Brian Kampmann MD | |||||||||||||
| 547149 | 0 | 45186 | 0 | 54167 | 0 | 12250 | 0 | 18713 | 0 | 677465 | 0 | 0 | 0 |
| Tom Rasmusson | |||||||||||||
| 0 | 213452 | 0 | 2000 | 0 | 37884 | 0 | 8645 | 0 | 10506 | 0 | 272487 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Schedule J, Part I Line 3: The President/CEO's compensation is paid by a related organization, Avera Health. Avera Queen of Peace relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable (3 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| Brian Kampmann | ||||||
| recruitment | X | $136,000 | 4028 | 0 | 1 | 1 |
| Patricia Malters | ||||||
| recruitment | X | $30,000 | 17867 | 0 | 1 | 1 |
| David Malters | ||||||
| recruitment | X | $30,000 | 17867 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 39762 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | David Malters MD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Family member of board member | Relationship |
| Amount Of Transaction | 159934 | AmountOfTransaction |
| Description Of Transaction | compensation | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | SISTER KATHLEEN CROWLEY HAS A BUSINESS RELATIONSHIP WITH THOMAS CLARK. | |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. | |
| Form 990, Part VI, Section A, line 7a | Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors. | |
| Form 990, Part VI, Section A, line 7b | Avera Health has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. | |
| Form 990, Part VI, Section B, line 11 | The return is reviewed initially by the CFO. The return is made available to the Board of Directors for review 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. | |
| The CEO is compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. The compensation of the Senior VP of Finance is determined by Human Resources based on a market analysis of comparable positions. The compensation is approved by the CEO. | ||
| Form 990, Part VI, Section C, line 19 | The organization's governing documents and conflict of interest policy are not available to the general public. The organization's financial statements are attached to the Form 990 per IRS instructions and therefore are available to the general public. | |
| Form 990, Part VII: | In addition to the hours served at Avera Queen of Peace Hospital, Sister Kathleen Crowley also serves 1 hour per week at both Avera Workers' Compensation Trust and Avera Holy Family and 5 hours per week at Avera Health and Sister Joan Reichelt also serve 1 and three-tenths hours per week at Avera Marshall and 2 hours per week at Avera McKennan. | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -1,121,879. Capital Contributions, Net -162,805. Change in Fair Value of Interest Rate Swap -1,193,985. Loss on Refinancing -111,750. Total to Form 990, Part XI, Line 5: -2,590,419. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2c: | The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Queen of Peace. | |
| Form 990, Part X, Line 20: | The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Marshall, and Avera Sacred Heart. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673). |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Avera Health | |||||||||||
| 3900 West Avera Drive Suite 300 | Sioux Falls | SD | 57108 | 460422673 | Promotion of Health | SD | 501(c)(3) | Line 9 | N/A | 0 | |
| Avera Workers' Compensation Trust | |||||||||||
| 3900 West Avera Drive | Sioux Falls | SD | 57108 | 460407148 | Economical Coverage of Workers' Compensation Claims | SD | 501(c)(3) | Line 11b, II | 0 | Avera Health | |
| Avera St Anthony's Hospital | |||||||||||
| 300 N 2nd Street | ONeill | NE | 68763 | 470463911 | Healthcare Education | NE | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera Holy Family | |||||||||||
| 826 North 8th Street | Estherville | IA | 51334 | 420680370 | Healthcare Services | IA | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera Holy Family Foundation | |||||||||||
| 826 North 8th Street | Estherville | IA | 51334 | 421317452 | Fundraising | IA | 501(c)(3) | Line 9 | 0 | Avera Holy Family | |
| Avera Marshall | |||||||||||
| 300 S Bruce Street | Marshall | MN | 56258 | 410919153 | Healthcare Services | MN | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera Marshall Foundation | |||||||||||
| 300 S Bruce Street | Marshall | MN | 56258 | 411784801 | Fundraising | MN | 501(c)(3) | Line 7 | 0 | Avera Marshall | |
| St Benedict Health Center | |||||||||||
| 401 West Glynn Drive | Parkston | SD | 57366 | 460226738 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| St Benedict Health Center Foundation | |||||||||||
| West Glynn Drive PO Box B | Parkston | SD | 57366 | 460458725 | Support Health Related Services | SD | 501(c)(3) | Line 11a, I | 0 | St Benedict Health Center | |
| Avera McKennan | |||||||||||
| 1325 S Cliff Ave PO Box 5045 | Sioux Falls | SD | 57117 | 460224743 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Sacred Heart Health Services | |||||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460225483 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Sacred Heart Rural Health Clinics Inc | |||||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460423930 | Clinic Services | SD | 501(c)(3) | Line 3 | 0 | Sacred Heart Health Services | |
| Health Management Services | |||||||||||
| 501 Summit | Yankton | SD | 57078 | 460399291 | Adult Daycare and Homemaking Services | SD | 501(c)(3) | Line 9 | 0 | Sacred Heart Health Services | |
| Lewis and Clark Health Education and Service Agency | |||||||||||
| 1000 W 4th Street Suite 9 | Yankton | SD | 57078 | 460337013 | Healthcare Services | SD | 501(c)(3) | Line 9 | 0 | Sacred Heart Health Services | |
| Avera St Luke's | |||||||||||
| 305 South State Street | Aberdeen | SD | 57401 | 460224598 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
Form990 Schedule R Part III Form990ScheduleRPartIII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Q&M Properties LLC | |||||||||||||
| 525 North Foster | Mitchell | SD | 57301 | 731652049 | medical clinic building | SD | N/A | excluded - Sec 512 | -477 | 412030 | 0 | 1 | 0.50000 |
| Avera Home Medical Equipment LLC | |||||||||||||
| 1325 S Cliff Ave PO Box 5045 | Sioux Falls | SD | 57117 | 460488198 | medical services - home medical equipment | SD | N/A | ||||||
| Midwest Regional Imaging Services LLC | |||||||||||||
| 1325 S Cliff Ave PO Box 5045 | Sioux Falls | SD | 57117 | 470874983 | health care - medical imaging | SD | N/A | ||||||
| Home Medical of Pierre LLC | |||||||||||||
| 329 E Dakota | Pierre | SD | 57501 | 460444002 | medical services - home medical equipment | SD | N/A | ||||||
| Avera Home Medical Equipment of Floyd Valley Hospital LLC | |||||||||||||
| 714 Lincoln St NE | Lemars | IA | 51031 | 820582350 | medical services - home medical equipment | SD | N/A | ||||||
| Avera Home Medical Equipment of Estherville LLC | |||||||||||||
| PO Box 5045 | Sioux Falls | SD | 57117 | 201686097 | medical services - home medical equipment | SD | N/A | ||||||
| Avera Home Medical Equipment of Sioux Center LLC | |||||||||||||
| 38 19th ST SW | Sioux Center | IA | 51250 | 753203100 | medical services - home medical equipment | SD | N/A | ||||||
| Avera Home Medical Equipment of Marshall LLC | |||||||||||||
| 1104 East College Drive | Marshall | MN | 56258 | 205271924 | medical services - home medical equipment | SD | N/A | ||||||
| Avera Home Medical Equipment of Spencer Hospital LLC | |||||||||||||
| 2400 S Minnesota Ave 102 | Sioux Falls | SD | 57117 | 800619999 | medical services - home medical equipment | SD | N/A | ||||||
| Surgical Associates Endoscopy Clinic LLC | |||||||||||||
| 310 S Pennsylvania St | Aberdeen | SD | 57401 | 460461429 | surgical associates | SD | N/A | ||||||
| Heart Hospital of South Dakota LLC | |||||||||||||
| 10720 Sikes Place Suite 300 | Charlotte | NC | 28277 | 562143771 | healthcare services | NC | N/A | ||||||
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Accounts Management Inc | |||||||||||
| 5132 S Cliff Ave Suite 101 | Sioux Falls | SD | 57108 | 460373021 | collection agency | SD | N/A | C | |||
| 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 | |||
| Avera Property Insurance Inc | |||||||||||
| 610 W 23rd St Ste 1 PO Box 38 | Yankton | SD | 57078 | 460463155 | insurance | SD | N/A | C | |||
| Dr Donald & Marguerite Mabee Trust | |||||||||||
| c/o First National Bank of South Da | Mitchell | SD | 57301 | 466056202 | investing | SD | N/A | T | -9110 | 754227 | 1.00000 |
| Valley Health Services | |||||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460357149 | medical equipment | SD | N/A | C | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dr Donald & Marquerite Mabee Trust | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Involved | 0 | AmountInvolved |