2013-02-11T13:10:51-06:00 2011-06-30 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2010-07-01 470463911 AVERA ST ANTHONY'S HOSPITAL AVER 4023365132 300 N 2ND STREET ONEILL NE 687631569 RONALD CORK 4023365132 2013-02-01 1 KIM HUNWARDSEN 6122536500 2013-01-08 2010 2016-02-25 16:41:14Z X ST ANTHONY'S HOSPITAL RONALD CORK 300 N 2ND STREET ONEILL NE 687631569 27637587 0 0928 X WWW.AVERA-STA.ORG X 1955 NE PROMOTION OF HEALTH 13 12 258 30 0 0 676123 25352 28192582 27370120 169378 226030 4750 4785 29042833 27626287 35000 500 0 0 13276849 13256864 0 0 0 13286003 12639660 26597852 25897024 2444981 1729263 25909611 38907872 5229383 16057624 20680228 22850248 X AVERA IS A HEALTH MINISTRY ROOTED IN THE GOSPEL. OUR MISSION IS TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES BY PROVIDING QUALITY SERVICES GUIDED BY CHRISTIAN VALUES. 1 0 21985755 500 27370120 TO PROVIDE ACUTE PATIENT VISITS AND OUTPATIENT VISITS OF HEALTH CARE SERVICES. FOR THE YEAR ENDED JUNE 30, 2011, A TOTAL OF 2,850 PATIENT DAYS WERE RECORDED AND 308 NEWBORN PATIENT DAYS WERE RECORDED. CHARITY CARE IS ALSO PROVIDED BY THE FACILITY. FOR THE YEAR ENDED JUNE 30, 2011, THE FACILITY PROVIDED $856,227 IN CHARITY CARE, BASED ON CHARGES FOREGONE.THE HOSPITAL ALSO PROVIDES COMMUNITY BENEFIT HEALTH ACTIVITIES AT LESS THAN OR AT NO COST TO SUPPORT THOSE IN THE AREA SERVED. 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 YEARS ENDED JUNE 30, 2011 AND 2010, SPECIFIC ACTIVITIES INCLUDED SENIOR RESOURCE PROGRAMS FOR BILLING ASSISTANCE; MEETING FACILITIES; PROGRAMS FOR PATIENTS AND FAMILIES SUFFERING FROM CANCER, DIABETES, BREATHING DISORDERS, MENTAL ILLNESS, AND OTHERS; ASSISTANCE TO HEALTH EDUCATORS; EMERGENCY HEALTHCARE PROVIDERS; WELLNESS PROGRAMS; REDUCED PRICED SPORTS MEDICINE SERVICES; AND OVERNIGHT HOUSING FOR FAMILIES OF HOSPITALIZED PATIENTS. 21985755 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 12 0 1 258 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 1 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 0 0 0 X MICHAEL GARMAN 4023365132 300 N 2ND STREET ONEILL NE 687631569 X JIM RABE 1.00 X X 0 0 0 ED NORTH 1.00 X X 0 0 0 LISA LIND 1.00 X X 0 0 0 DR RICHARD FITCH 1.00 X 0 0 0 ROD SCHELLPEPER 1.00 X 0 0 0 JACK HURLEY 1.00 X 0 0 0 DIAN EDWARDS 1.00 X 0 0 0 DEB KELLY 1.00 X 0 0 0 SISTER SHARON ANN HAAS OSB 1.00 X 0 0 0 SISTER JANET SCHUMACHER PBVM 1.00 X 0 0 0 SISTER MARY JAEGER PBVM 1.00 X 0 0 0 PETER LUENINGHOENER MD 1.00 X 0 0 0 RONALD CORK 50.00 X X 0 225409 13804 MICHAEL GARMAN 40.00 X 128517 0 25479 EDWIN N COOK 40.00 X 501663 0 25863 AVINASH L JADHAV 40.00 X 229936 0 0 BART EASTWOOD 40.00 X 332824 0 15794 CAMERON EVERITT 40.00 X 152937 0 22484 ANTHONY AKAINDA 40.00 X 337970 0 27863 1683847 225409 131287 7 0 1 0 SACRED HEART HEALTH SERVICES 501 SUMMIT ST YANKTON SD 57078 SHARED SERVICES 1473303 1 25352 25352 PATIENT SERVICE REVENU 622110 26104911 26104911 CLINIC REVENUE 621110 699969 699969 CHANGE IN FDTN INTERES 900099 313465 313465 OTHER REVENUE 900099 251775 251775 27370120 62259 62259 4785 4785 4785 4785 147176 27895 11300 147176 16595 163771 163771 27626287 27370120 0 230815 500 500 153996 153996 10332407 9352912 979495 292102 251905 40197 1768251 1521098 247153 710108 612023 98085 788372 788372 1320 1320 48000 48000 1497690 1312058 185632 59331 59331 894572 212994 681578 222607 222607 336367 336367 86926 61308 25618 214010 113171 100839 45215 45215 1214074 1214074 207670 207670 MEDICAL SUPPLIES 5115020 5115020 EQUIPMENT LEASE AND REN 844070 787444 56626 BAD DEBTS 717175 717175 DUES AND SUBSCRIPTIONS 139444 98442 41002 REPAIRS AND MAINTENANCE 18716 18716 189081 26379 162702 25897024 21985755 3911269 0 3960791 4762441 3541890 4150720 11500 964032 1007942 155144 53252 36674312 15185258 9647594 21489054 1178706 1191719 6087415 5525765 50000 149996 280332 312539 296651 25909611 38907872 1889906 2933748 11372343 1689477 1650000 1751533 5229383 16057624 X 20529728 22699748 150500 150500 20680228 22850248 25909611 38907872 X 1729263 440757 X 0 1 1 X 0 X 150500 150500 150500 150500 150500 150500 1.00000 0 1 1 725022 725022 220512 22938656 7100978 16058190 11304088 7770221 3533867 1486034 314059 1171975 21489054 ASSETS LIMITED TO USE - AVERA POOLED INVESTMENTS 4551006 F INVESTMENT IN FOUNDATION 974759 F 5525765 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1000000 CONSTRUCTION ACCOUNTS PAYABLE 751533 1751533 27626287 25897024 1729263 440757 440757 2170020 28067044 440757 440757 27626287 0 27626287 25897024 0 25897024 0 25897024 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HOSPITAL'S ENDOWMENT CONSISTS OF A PORTION OF THEIR INTEREST IN THE NET ASSETS OF AVERA ST. ANTHONY'S HOSPITAL FOUNDATION. THE AVERA ST. ANTHONY'S HOSPITAL 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL HAS IMPLEMENTED THE PROVISIONS OF FASB ACCOUNTING STANDARDS CODIFICATION TOPIC ASC 740-10. THE HOSPITAL UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THOSE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ASC 740-10. FOR THE YEARS ENDED JUNE 30, 2011 AND 2010, THE UNRECOGNIZED TAX BENEFIT ACCRUAL WAS ZERO. 1 1 X 1 X 1 X 1 1 0 1 1 1174 605000 605000 0.02400 4526 2351507 1660109 691398 0.02750 5700 2956507 1660109 1296398 0.05150 4 1875 1875 1875 0.00010 1 197 583 583 0.00000 5 2072 2458 2458 0.00010 5 7772 2958965 1660109 1298856 0.05160 2 15713 8904 8904 0.00040 2 15713 8904 8904 0.00040 0 517800 0 12762959 12982016 -219057 X 1 1 1 1 AVERA ST ANTHONY'S HOSPITAL

300 N 2ND STREET ONEILL NE 68763

X X X X NOT REQUIRED 1 5 AVERA MEDICAL GROUP O'NEILL

300 N 2ND STREET SUITE 100 ONEILL NE 687631519

RURAL HEALTH CLINIC AVERA MEDICAL GROUP SPENCER

103 THAYER ST SPENCER NE 687779784

FAMILY PRACTICE CLINIC AVERA MEDICAL GROUP CHAMBERS

110 PARK AVENUE CHAMBERS NE 687253858

FAMILY PRACTICE CLINIC AVERA MEDICAL GROUP EWING

202 NEBRASKA STREET EWING NE 687359513

FAMILY PRACTICE CLINIC AVERA MEDICAL GROUP PAGE

103 N 4TH STREET PAGE NE 687665018

FAMILY PRACTICE CLINIC PART I, LINE 3C: CHARITY CARE AND DISCOUNTED CARE UTILIZES A COMBINATION OF INCOME, ASSETS, AND EXPENSES TO DETERMINE WHAT PERCENTAGE OF CHARITY CARE THEY WOULD QUALIFY FOR. PART I, LINE 6A: OUR COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY AVERA HEALTH, A RELATED ORGANIZATION. IT IS AVAILABLE THROUGH THE WEBSITE AND REQUESTED MAILING, AND IS FILED WITH THE CATHOLIC HEALTH ASSOCIATION. PART I, LINE 7: CHARITY CARE WAS CONVERTED TO COST BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. OTHER BENEFITS ARE ACTUAL EXPENSES RECORDED IN THE GENERAL LEDGER. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION WAS $717,175. PART II: LIFELINE IS A SECURE PERSONAL MEDICAL ALERT EMERGENCY RESPONSE SERVICE FOR THE ELDERLY AND DISABLED. THIS SERVICE ASSISTS THESE INDIVIDUALS TO LIVE WITH GREATER INDEPENDENCE BY LIVING ALONE BUT STILL HAVING ACCESS TO MEDICAL HELP. VAN TRANSPORTATION IS PROVIDED TO INDIVIDUALS THAT ARE UNABLE TO DRIVE. WITH NO PUBLIC TRANSPORTATION IN OUR AREA THE VAN TRANSPORTATION HELPS BUS CHILDREN TO SCHOOL AND TAKES THE ELDERLY SHOPPING AND TO HEALTH CARE APPOINTMENTS. THE VAN EVEN OFFERS TRANSPORTATION TO LARGER CITIES ABOUT 200 MILES AWAY WITH ADVANCE NOTICE FOR SPECIALTY MEDICAL SERVICES. PART III, LINE 4: BAD DEBT EXPENSE WAS CONVERTED TO COST USING AN OVERALL COST TO CHARGE RATIO.THE ORGANIZATION DID NOT ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY AS THE ORGANIZATION WORKS HARD AT ENCOURAGING PEOPLE TO APPLY AND MAKES ADJUSTMENTS TO BAD DEBT EXPENSE BASED ON RECOMMENDATIONS OF THE COLLECTION AGENCY OR REVIEWS BAD DEBT FOR THOSE WHO QUALIFY UNDER CHARITY CARE. 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.NOTES FROM FINANCIAL STATEMENT: THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNT THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT 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 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. ST. ANTHONY'S FOLLOWS THE CHA GUIDELINES IN REPORTING COMMUNITY BENEFITS AND THEREFORE ANY MEDICARE SHORTFALL IS EXCLUDED FROM OUR COMMUNITY BENEFIT REPORT. HOWEVER, MEDICARE IS THE ORGANIZATION'S LARGEST PAYER AND PATIENTS WITH MEDICARE COVERAGE ARE ACCEPTED REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED FROM PROVIDING THE SERVICES. THIS BASIS THEREFORE MEANS PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A KEY ADVANTAGE FOR OUR COMMUNITY. PART III, LINE 9B: IF THE PATIENT QUALIFIES FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME, UNINSURED PATIENTS AND IS COOPERATING WITH THE ORGANIZATION WITH REGARD TO EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. AT SUCH TIME AS THE ORGANIZATION SENDS THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY SHALL REFLECT THE REDUCED-PAYMENT LEVEL FOR WHICH THE PATIENT WAS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS. AVERA ST. ANTHONY'S HOSPITAL DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES AVERA ST. ANTHONY'S HOSPITAL UTILIZES MAY REPORT TO THE CREDIT AGENCIES. ANY EXTENDED PAYMENT PLANS OFFERED BY THE HOSPITAL, OR THE HOSPITAL'S REPRESENTATIVE, IN SETTLING THE OUTSTANDING BILLS OF PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SHALL BE INTEREST-FREE SO LONG AS THE REPAYMENT SCHEDULE IS MET. PART VI, LINE 2: AVERA ST. ANTHONY'S HOSPITAL CONDUCTS AN ANNUAL STRATEGIC PLANNING MEETING THAT INCLUDES A CROSS SECTION OF COMMUNITY MEMBERS. OUR HOSPITAL BOARD OF DIRECTORS, HOSPITAL FINANCE COMMITTEE, FOUNDATION BOARD OF DIRECTORS, COMMUNITY MEDICAL STAFF, AND HOSPITAL DEPARTMENT DIRECTORS MEET TO ASSESS COMMUNITY INPUT FROM THE LOCAL NURSING FACILITY, ASSISTED LIVING, AND LOCAL PUBLIC HEALTH OFFICE. OUR HOSPITAL AND FOUNDATION BOARDS AND FINANCE COMMITTEE ARE MADE UP OF A MAJORITY OF COMMUNITY MEMBERS. THIS GROUP DRAFTS AN ANNUAL STRATEGIC PLAN OF GOALS, OBJECTIVES, AND STRATEGIES THAT ARE CONTINUOUSLY UPDATED TO ADDRESS THE NEEDS OF THE COMMUNITY. ADDITIONALLY, INPUT FROM THE LOCAL MINISTERIAL ASSOCIATION, LAW ENFORCEMENT, CHAMBER OF COMMERCE, ELEMENTARY AND SECONDARY PUBLIC AND PAROCHIAL SCHOOLS, AND THE LOCAL COMMUNITY COLLEGE ARE ASSESSED AND INCORPORATED INTO THE PLAN. PART VI, LINE 3: PATIENTS ARE INFORMED OF THE FINANCIAL ASSISTANCE/CHARITY CARE POLICY THROUGH BROCHURES AND POSTED POLICIES AT THE REGISTRATION DESKS OF THE HOSPITAL AND EMERGENCY DEPARTMENT. AVERA ST. ANTHONY'S HAS STAFF IN CENTRAL REGISTRATION THAT IDENTIFY IF A PATIENT HAS THE FINANCIAL MEANS TO PAY FOR SERVICES OR INSURANCE TO COVER THESE SERVICES. PUBLIC ASSISTANCE IS ALSO PURSUED IF DEEMED APPROPRIATE. IF PATIENTS ARE IDENTIFIED AS CANDIDATES FOR CHARITY CARE THEY ARE DIRECTED TO OUR FINANCIAL SERVICES REPRESENTATIVE AND THE APPLICATION PROCESS IS INITITATED FOR CHARITY CARE. PATIENT FINANCIAL SERVICES CAN ASSIST WITH DETERMINING WHAT BENEFITS THE PATIENT MAY QUALIFY FOR AND ASSISTS WITH HELPING THEM APPLY FOR ANY BENEFITS. IF THERE IS NO OPTION FOR AN OUTSIDE ASSISTANCE PROGRAM, THE PATIENT IS INFORMED AND ENCOURAGED TO COMPLETE THE APPLICATION THAT UTILIZES A COMBINATION OF INCOME, ASSETS, AND EXPENSES TO DETERMINE WHAT PERCENTAGE OF CHARITY CARE THEY WOULD QUALIFY FOR. ADDITIONALLY PATIENTS ARE ADVISED OF OUR FINANCIAL ASSISTANCE PACKAGE WHEN THEY RECEIVE OUR STATEMENTS AND IF THEY ARE TELEPHONED FOR PAYMENT ARRANGEMENTS. PART VI, LINE 4: AVERA ST. ANTHONY'S HOSPITAL IS LOCATED IN O'NEILL, NEBRASKA, THE COUNTY SEAT OF HOLT COUNTY. WE SERVE A LARGE RADIUS TO INCLUDE PATIENTS FROM BROWN, ROCK, BOYD, KEYA PAHA, WHEELER, KNOX, GARFIELD, AND ANTELOPE COUNTIES. IN 2010, THE POPULATION FOR HOLT COUNTY WAS ESTIMATED TO BE 10,435. APPROXIMATELY 20.5% OF THE POPULATION IS AGE 65 OR OLDER. THE AVERAGE PER CAPITA INCOME IS $22,498 AND APPROXIMATELY 7.8% OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. THE NEAREST HOSPITAL IN THE AREA IS APPROXIMATELY 18 MILES FROM AVERA ST. ANTHONY. PART VI, LINE 6: THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF VOLUNTEER MEMBERS WHO RESIDE IN THE COMMUNITY. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SURPLUS FUNDS ARE REINVESTED IN FACILITIES TO IMPROVE PATIENT CARE. THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL, REGARDLESS OF ABILITY TO PAY. PART VI, LINE 7: THE COMMUNITIES IN WHICH AVERA OPERATES ALL HAVE UNIQUE HEALTH AND COMMUNITY BENEFIT NEEDS AND IN KEEPING WITH THE CATHOLIC HEALTHCARE ASSOCIATION GUIDELINES EACH HOSPITAL STRIVES TO MEET ITS COMMUNITY'S IDENTIFIED NEEDS. THE AVERA CENTRAL OFFICE ADVOCATES FOR ALL ON COMMUNITY BENEFIT RELATED MATTERS OF STATE, REGIONAL, AND NATIONAL IMPORTANCE. 0 0 0 0 0 0 0 0 0 RONALD CORK 0 221278 0 0 0 4131 0 11304 0 2500 0 239213 0 0 MICHAEL GARMAN 123741 0 0 0 4776 0 5426 0 20053 0 153996 0 0 0 EDWIN N COOK 496792 0 0 0 4871 0 9800 0 16063 0 527526 0 0 0 AVINASH L JADHAV 229670 0 0 0 266 0 0 0 0 0 229936 0 0 0 BART EASTWOOD 201398 0 131032 0 394 0 9800 0 5994 0 348618 0 0 0 CAMERON EVERITT 137664 0 14990 0 283 0 6308 0 16176 0 175421 0 0 0 ANTHONY AKAINDA 336240 0 0 0 1730 0 9800 0 18063 0 365833 0 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: THE PRESIDENT & CEO'S COMPENSATION IS PAID BY A RELATED ORGANIZATION, SACRED HEART HEALTH SERVICES. AVERA ST. ANTHONY'S HOSPITAL RELIED ON THE RELATED ORGANIZATION FOR DETERMINING THE COMPENSATION FOR THE PRESIDENT & CEO USING THE METHODS DESCRIBED IN PART I, LINE 3. THE CITY OF O'NEILL NEBRASKA 476006305 2010-03-18 14665000 ADDITION TO AND REMODELING OF HOSPITAL 0 0 0 14665000 10692343 3972657 2012 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 ADDED FAMILY PRACTICE RURAL HEALTH CLINIC (AVERA MEDICAL GROUP O'NEILL) JUNE 27, 2011. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION UTILIZES THE MANAGEMENT SERVICES OF SACRED HEART HEALTH SERVICES FOR DAY-TO-DAY OPERATIONS OF THE FACILITY. THE CEO OF THE FACILITY IS AN EMPLOYEE OF SACRED HEART HEALTH SERVICES. 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 A, LINE 8B AVERA ST. ANTHONY'S HOSPITAL DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE CEO AND CFO. AFTER INITIAL REVIEWS, A DRAFT IS PROVIDED TO THE FINANCE COMMITTEE FOR FINAL REVIEW. THE RETURN IS PROVIDED TO THE BOARD AFTER 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, LINE 15: COMPENSATION OF THE CEO IS DETERMINED BY THE MANAGEMENT COMPANY AVERA SACRED HEART HOSPITAL. THE BOARD OF DIRECTORS REVIEWS THE MANAGEMENT AGREEMENT WITH AVERA SACRED HEART HOSPITAL AND DISCUSSES AND APPROVES THE AGREEMENT. NEGOTIATIONS ARE DONE AS NEEDED. FOR THE CFO, A SALARY REVIEW IS DONE BY A COMMITTEE BASED OFF HOSPITAL ASSOCIATION SURVEYS, INCLUDING HOSPITAL SIZE. THERE IS ALSO A RELATIONSHIP BETWEEN THE CEO'S SALARY AND THE CFO'S SALARY, IN THAT A PERCENTAGE OF THE INCREASE FOR THE CFO IS BASED ON CEO'S SALARY BASE. 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 VII, SECTION A: THE SR. MARY JAEGER DEVOTED TIME PROVIDING SERVICES TO THE FOLLOWING RELATED ORGANIZATIONS. ST. BENEDICT HEALTH CENTER 2 HOURS PER WEEK AVERA WORKERS' COMPENSATION TRUST 1 HOUR PER WEEK AVERA HEALTH 5 HOURS PER WEEK CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 440,757. 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 ST. ANTHONY'S HOSPITAL. AMENDED RETURN SCHEDULE K WAS NOT INCLUDED ON THE ORIGINAL FILING. THE 2010 FORM 990 IS BEING AMENDED TO INCLUDE SCHEDULE K. LONG TERM DEBT ORGINALLY REPORTED ON PART X LINE 23(B) IS REPORTED ON PART X LINE 20(B) OF THE AMENDED 2010 RETURN. 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