AVERA MCKENNAN: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: AVERA MCKENNAN (EIN 46-0224743)
Tax period: 2009-07-01 to 2010-06-30
Filed: 2011-05-16
IRS object ID: 201101369349300900
Schema version: 2009v1.7
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 G
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-05-16T06:45:03-05:00	Timestamp
Tax Period End Date	2010-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

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	5601 Green Valley Drive Ste 700	AddressLine1
City	Minneapolis	City
State	MN	State
ZIP Code	554371145	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2009-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	460224743	EIN

Name Name

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

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

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	Dr David Kapaska	Name
Title	Regional President	Title
Phone	6053228000	Phone
Date Signed	2011-05-12	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Kim Hunwardsen CPA	Name
Phone	9529446166	Phone

Field	Value	IRS element (for citing)
Tax Year	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

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

Field	Value	IRS element (for citing)
Gross Receipts	603717161	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c	X	Organization501c
Web Site	www.averamckennan.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1911	YearFormation
State Legal Domicile	SD	StateLegalDomicile
Activity Or Mission Description	Promotion of Health	ActivityOrMissionDescription
Nbr Voting Members Governing Body	19	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	12	NbrIndependentVotingMembers
Total Nbr Employees	5868	TotalNbrEmployees
Total Nbr Volunteers	1068	TotalNbrVolunteers
Total Gross UBI	6403753	TotalGrossUBI
Net Unrelated Business Txbl Income	1006160	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	2453417	ContributionsGrantsPriorYear
Contributions Grants Current Year	3451139	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	555191084	ProgramServiceRevenuePriorYear
Program Service Revenue CY	596067216	ProgramServiceRevenueCY
Investment Income Prior Year	1957267	InvestmentIncomePriorYear
Investment Income Current Year	553875	InvestmentIncomeCurrentYear
Other Revenue Prior Year	2462019	OtherRevenuePriorYear
Other Revenue Current Year	2763167	OtherRevenueCurrentYear
Total Revenue Prior Year	562063787	TotalRevenuePriorYear
Total Revenue Current Year	602835397	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	3041319	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	3322297	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	304921829	SalariesEtcPriorYear
Salaries Etc Current Year	311726810	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	113548	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	54527	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	756846	TotalFundrsngExpCurrentYear
Other Expense Prior Year	238441318	OtherExpensePriorYear
Other Expenses Current Year	256769316	OtherExpensesCurrentYear
Total Expenses Prior Year	546518014	TotalExpensesPriorYear
Total Expenses Current Year	571872950	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	15545773	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	30962447	RevenuesLessExpensesCY
Total Assets BOY	655503598	TotalAssetsBOY
Total Assets EOY	696072011	TotalAssetsEOY
Total Liabilities BOY	323845827	TotalLiabilitiesBOY
Total Liabilities EOY	333428534	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	331657771	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	362643477	NetAssetsOrFundBalancesEOY
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	1	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	264679831	Expense
Grants	3253880	Grants
Revenue	390519455	Revenue
Description	Avera McKennan Hospital & University Health CenterAvera McKennan promotes the health of the community by providing a variety of charitable health care services. Avera McKennan operates under the tenets of the Roman Catholic Church and in accordance with the philosophy and values established for Avera Health, a sponsored ministry of the Benedictine and Presentation Sisters.(continued on page 1 of Schedule O)Major service lines include oncology, surgery, orthopedics, obstetrics, pediatrics, neonatology, emergency and trauma, critical care including eICU, radiology and diagnostic imaging, psychiatry, pulmonary, neurology, cardiology and gastroenterology. Transplant services include solid organ (kidney and pancreas) and bone marrow transplant.The following are specific exempt purpose achievements for Avera McKennan Hospital:Charity and uncompensated care: Avera McKennan provides necessary medical services (diagnostic and treatment) for whomever comes to us for care, regardless of their ability to pay. In fiscal year 2010, services provided to those who are unable to pay totaled $25,618,000 based on charges foregone. Eligibility for discounted or free services under the charity care policy is based on income levels. Generally, individuals earning income of up to 400% of the Federal Policy Income Guidelines are eligible for varying levels of discounts, including full discounts for certain income levels. Application for coverage under the program may be obtained at any Avera McKennan patient registration area or by calling Avera McKennan Patient Financial Services.Accessibility to health care: Avera McKennan makes medical care accessible to the entire community it serves. In 2010 Avera McKennan had 19,567 hospital discharges, 103,551 patient days and 194,947 outpatient visits. Avera McKennan is a verified Level II trauma center and was the first such Center in the State of South Dakota. Avera McKennan's Emergency Department is staffed 24 hours a day with board-certified emergency specialists and provides emergency care regardless of ability to pay. Avera McKennan had 24,528 Emergency Department visits in FY 2010. Operating both Fixed Wing and Helicopter medical air transports, Avera McKennan's flight teams cover a large geographic area providing state-of-the-art air transport services and access to critical care, with 1,247 flights in the past year.Health Care Clinic: In 1992, Avera McKennan established a Health Care Clinic to provide free care for people who are uninsured or underinsured in the community. The clinic is managed by a Registered Nurse and staffed by Registered Nurses, two midlevel providers, medical residents and volunteer health care providers. The goal of the clinic is to prevent or treat patients' medical conditions before they become catastrophic. The clinic averages 620 visits per month, providing preventative care, diagnosis and treatment of illnesses and injuries, medication assistance and assistance in obtaining specialist care for patients with complex cases. The clinic also serves to train physicians, nurses and other health care students. It provides a free evening clinic one evening per month, staffed by medical students under supervision of physicians. Avera McKennan is the only health care organization to provide free services such as this in the state of South Dakota. The clinic had 7,465 visits in fiscal year 2010.Residency/Health Professions Training and Internships: In 2010, Avera McKennan had 80 medical school residents in training in Internal Medicine, Family Practice, Psychiatry and Transitional Residency Programs offered in partnership with the University of South Dakota School of Medicine. Over 1,200 students in nursing, pharmacy, physician assistant programs, radiology and respiratory therapy also completed rotations at Avera McKennan. Avera McKennan has many joint agreements with institutions of higher education for both clinical and educational programming. In non-clinical areas, Avera McKennan offered 40 unpaid internships in 2010 in the areas of marketing, human resources, foundation, network operations and process excellence, working with approximately 18 institutions of higher education.Community Education: Avera McKennan is a regional leader in offering educational programs for a variety of learners, leaders and employees. Utilizing advanced technology, many of these programs are provided electronically throughout the tri-state area. Educational sessions are offered to medical staff, employees, health care professionals, students at all levels and the general public. Utilizing Avera McKennan's Education Center, a broad cross-section of classes involving diverse audiences are provided as a community service each year.-To Be Well free education events were held on topics including orthopedics, cancer, diabetes, weight loss/healthy eating, multiple sclerosis, anxiety and acupuncture. A total of 55 seminars enrolled 382 participants.-Forums: The Avera Behavioral Health Center offers free Friday Forums, in which school counselors and therapists are invited to presentations on children's mental health topics such as anxiety disorder, disruptive behavior, medication, coping with grief and bullying. These sessions, held nine times each year, are attended in person by approximately 50. Throughout 2010, videos of these presentations were viewed 656 times online.-Women's & Children's Services: Avera McKennan's Women's & Children's Services offers a number of parenting and community education opportunities, for free or at a minimal cost. In fiscal year 2010, 209 childbirth education classes were held with 1,152 attendees. A total of 48 parent and family education classes were held with 408 attendees. A total of 189 car seats were issued through Project 8, South Dakota Governor's child seat program with training on their correct use. Free burn education was provided to 525 students during presentations in schools.-Daycare training: Free of charge, Avera McKennan offers four in-service training sessions per month to daycare providers through the YWCA, with a total of 38 scheduled annually, and additional sessions for requested topics. Medical Research: As a research institution, Avera McKennan draws physicians who are committed to seeking new treatments and preventive measures. The Avera Research Institute is currently conducting basic research to add to the body of medical knowledge in the areas of kidney disease linked to obesity, kidney filtration and growth, and neuroscience research in regard to stress and addiction. The Avera Research Institute also continues ongoing applied research in the area of developing a novel photochemical tissue bonding technology that has ophthalmologic and dermatological applications. In the state of South Dakota's only genetics lab, Avera McKennan is studying genetic precursors of mental health conditions, which has wide application in both the clinical and research arenas. The Avera Research Institute in 2010 participated in 79 clinical trials, involving cancer, Alzheimer's disease, ulcerative colitis, rheumatoid arthritis, and more. In fiscal year 2010, Avera McKennan operated the Avera Research Institute at a loss of $1,996,000.Support groups: Avera McKennan offers approximately 10 free support groups. They range in topic from cancer to liver disease, diabetes, bone marrow transplant, stroke and grief and loss. The organization provides free meeting space as well as speakers and leaders. Information and Assistance: Avera McKennan operates a 24-hour Medical Call Center, through which patients have access to the Ask-A-Nurse program. Patients can call a toll-free number and talk personally with a Registered Nurse to ask health questions or receive general health information. In 2010, the Medical Call Center handled 67,196 calls. Avera McKennan's web site also provides an extensive health library that consumers can access free of charge.Interpreter service: Avera McKennan employs two full-time Spanish interpreters in-house, and their services are offered to patients free of charge. In addition, in cooperation with external agencies, Avera McKennan is able to handle over 150 different languages and dialects. Avera McKennan contracts for an inbound call-in service for Spanish speaking individuals. This is available at the main hospital switchboard, as well as Avera McGreevy Clinic and Avera Women's Clinic. All the above services are provided at no cost to the patient.(continued on page 14 of Schedule O)	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	31683887	Expense
Grants	7306	Grants
Revenue	42586521	Revenue
Description	Rural Critical Access HospitalsAvera McKennan owns or leases rural Critical Access Hospitals in Flandreau, Gregory, Dell Rapids, Milbank and Miller (Hand County), S.D. As such, they operate as a department of Avera McKennan. The hospitals in Flandreau, Gregory and Hand County serve medically underserved counties. In addition to the following exempt purpose achievements, rural hospitals participate in many of the above as part of Avera McKennan.Among services offered by rural hospitals are radiology and imaging, colonoscopy and endoscopy, therapy and rehabilitation, 24-hour emergency care, chemotherapy, orthopedics, cardiovascular testing and care, obstetrics, surgery, and dialysis.Charity and uncompensated care: As part of Avera McKennan, these facilities provide necessary medical services (diagnostic and treatment) for whomever comes to us for care, regardless of their ability to pay. In fiscal year 2010, charity and uncompensated care provided by rural hospitals based on charges foregone totaled $440,000.Accessibility to health care: Avera McKennan regional hospitals make medical care accessible to the entire community they serve regardless of a patient's ability to pay. In 2010 rural hospitals had 2,050 discharges, 8,361 patient days and 59,868 outpatient visits. Each of the hospitals provides 24-hour emergency care with eEmergency services through Avera McKennan. eICU services are also available at these hospitals, providing access to critical care medicine near home and lessening the need for transport. There is no additional billing to patients. Telemedicine consults are also offered at rural locations in a number of medical specialties.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	157235080	Expense
Grants	60133	Grants
Revenue	132980577	Revenue
Description	ClinicsAvera McKennan provides clinical care, secondary and primary, in 67 owned/joint venture clinics in South Dakota, northwest Iowa, southwest Minnesota and northeastern Nebraska. In addition to the following exempt purpose achievements, clinics participate in many of the above as part of Avera McKennan. Clinic visits in 2010 totaled 895,906.Clinics provide primary care and urgent care, and among specialties are cardiology; dermatology; endocrinology; gastroenterology; hematology; hepatology; infectious disease; internal medicine; neonatology; nephrology; neurology and neurosurgery; OB/GYN; oncology; ophthalmology; orthopedics; pain management; pediatrics; psychiatry; pulmonology; sports medicine; surgery; and vascular services.Charity and uncompensated care: As part of Avera McKennan, clinics provide necessary medical services (diagnostic and treatment) for whoever comes to us for care, regardless of their ability to pay. In fiscal year 2010, charity and uncompensated care provided by clinics based on charges foregone totaled $1,282,000.Accessibility to health care: In addition to regular clinic hours, Avera McGreevy Clinic provides Urgent Care, seeing patients on a walk-in basis at two locations during the evening hours on weekdays, and throughout the daytime hours on Saturdays and Sundays. This provides greater accessibility without having to rely on emergency room care. In addition, through our Curaquick clinics, Avera offers convenient, affordable clinic care in local HyVee pharmacies. In 2010, Avera donated approximately 100 Curaquick Avera cards, good for one free visit, to students of Sioux Falls Catholic Schools and YWCA daycare, each valued at $59.Health Screenings: Avera McKennan clinics offered two free health screenings in 2010 including a skin cancer screening in cooperation with the another local hospital and pharmacy, serving 139 persons; and a men's health screening, providing free cholesterol, blood sugar, blood pressure and body-mass index scoring, serving 103 men.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	26803654	Expense
Grants	978	Grants
Revenue	24712103	Revenue
Description	Avera McKennan also provides Long-term care, Home Medical Equipment & Other Retail, Home Infusion, Research, Fitness Center, Regional Lab, and Mobile Services.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	26803654	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	978	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	24712103	TotalOfOtherProgramServiceRev
Total Program Service Expense	480402452	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	1	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Balance Sheet Amounts Reported	1	BalanceSheetAmountsReported
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	1	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	1	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	1	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	408	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	5868	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Nbr Voting Governing Body Members	19	NbrVotingGoverningBodyMembers
Number Independent Voting Members	12	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	0	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	0	WrittenPolicyOrProcedure
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

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

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

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Rob Everist
Chairman	2.00	X	X	0	0	0
Tom Dempster
Vice Chair	2.00	X	X	0	0	0
James Wiederrich
Board Trustee	2.00	X		0	0	0
Sister Candyce Chrystal
Board Trustee	2.00	X		0	0	0
Cathy Clark
Board Trustee	2.00	X		0	0	0
Michael Bender
Board Trustee	2.00	X		0	0	0
Sister Janice Klein
Board Trustee	2.00	X		0	0	0
Gene Jones Jr
Board Trustee	2.00	X		0	0	0
Mitchell Johnson DO
Board Trustee	2.00	X		0	0	0
John Griffin MD
Board Trustee	2.00	X		0	0	0
Sister Kathryn Easley
Board Trustee	2.00	X		0	0	0
Kim Pederson MD
Board Trustee	40.00	X		306360	0	33003
Sister Joan Reichelt
Board Trustee	2.00	X		0	0	0
Dave Rozenboom
Board Trustee	2.00	X		0	0	0
Dave Strand MD
Board Trustee	2.00	X		0	0	0
Brad Thaemert MD
Board Trustee	2.00	X		0	0	0
Fred Thurman
Board Trustee	2.00	X		0	0	0
David Fleck
Board Trustee	2.00	X		0	0	0
Fredrick W Slunecka
President & CEO	40.00	X	X	0	608919	26966
Julie N Norton
Sec/Treas & SrVP Finance	40.00		X	348892	0	39639
Judy Blauwet
Sr Vice President	40.00			478016	0	31220	X
David Flicek
Sr Vice President	40.00			420486	0	34798	X
Steve Petersen
Director-Pharmacy	40.00			166229	0	30050	X
Patricia Jagoe
AVP-Surgery	40.00			173648	0	28068	X
Michael Puumala MD
Physician	40.00			1109146	0	34698		X
Kelly McCaul MD
Physician	40.00			1136264	0	24990		X
Brian Knutson MD
Physician	40.00			1301709	0	37698		X
Daniel Tynan MD
Physician	40.00			1326914	0	35449		X
Leonard Gutnik MD
Physician	40.00			1073487	0	30471		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	7841151	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	608919	TotalReportableCompFrmRltdOrgs
Total Other Compensation	387050	TotalOtherCompensation
Number Individuals GT100 K	431	NumberIndividualsGT100K
Formers Listed	0	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
Sioux Falls Construction
PO Box 2728	Sioux Falls	SD	571012728	Construction	36090785
Avera Health
3900 West Avera Drive	Sioux Falls	SD	57108	Shared Services	17222315
Sanford School of Medicine
1400 W 22nd St 120	Sioux Falls	SD	571051505	Physician Services	2557334
Medical X-Ray Center
1417 S Minnesota Ave	Sioux Falls	SD	571051505	Radiology Services	2141129
Associated Regional & University Patholo
PO Box 27964	Salt Lake City	UT	84127	Lab Testing	1896516

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	84	NumberOfContractorsGT100K
Related Organizations	641599	RelatedOrganizations
Government Grants	2343203	GovernmentGrants
All Other Contributions	466337	AllOtherContributions
Total Contributions	3451139	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
Net Patient Service Re	622110	558747862	558747862
Other patient and clin	621500	28980560	23853369	5127191
Interest in Foundation	900099	1873936	1873936
Program rent	900099	1549099	1549099
Income from subsidiari	423000	1241562	1120387	121175

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	3674197	TotalRevenueColumn
Related Or Exempt Function Income	3654003	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	20194	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	596067216	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	573561	TotalRevenueColumn
Exclusion	$573,561	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	1052182	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	715033	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	337149	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	337149	TotalRevenueColumn
Exclusion	$337,149	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	137738	Securities
Other	9307	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	166731	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	137738	Securities
Other	-157424	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-19686	TotalRevenueColumn
Exclusion	-$19,686	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount	Unrelated Business RevenueUnrelatedBusinessRevenue
Interest income	900099	1290825	$1,290,825
Commercial testing	621500	1095676		1095676
Management Services	541610	39517		39517

Field	Value	IRS element (for citing)
Total Other Revenue	2426018	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	602835397	TotalRevenueColumn
Related Or Exempt Function Income	590798656	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	6403753	UnrelatedBusinessRevenue
Exclusion	$2,181,849	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	3238347	Total
Program Services	3238347	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	83950	Total
Program Services	83950	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1682810	Total
Program Services	696413	ProgramServices
Management And General	986397	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	184130	Total
Program Services	184130	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	248366340	Total
Program Services	225346952	ProgramServices
Management And General	22681661	ManagementAndGeneral
Fundraising	337727	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	15766608	Total
Program Services	13924655	ProgramServices
Management And General	1816805	ManagementAndGeneral
Fundraising	25148	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	29742225	Total
Program Services	26129684	ProgramServices
Management And General	3564116	ManagementAndGeneral
Fundraising	48425	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	15984697	Total
Program Services	13779657	ProgramServices
Management And General	2182558	ManagementAndGeneral
Fundraising	22482	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	174637	Total
Program Services	174637	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	48239	Total
Management And General	48239	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	25404	Total
Program Services	3991	ProgramServices
Management And General	21413	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	54527	Total
Fundraising	54527	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	69143330	Total
Program Services	38864414	ProgramServices
Management And General	30271588	ManagementAndGeneral
Fundraising	7328	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	3061364	Total
Program Services	350355	ProgramServices
Management And General	2699433	ManagementAndGeneral
Fundraising	11576	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	9112563	Total
Program Services	4248413	ProgramServices
Management And General	4690811	ManagementAndGeneral
Fundraising	173339	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	6249954	Total
Program Services	609052	ProgramServices
Management And General	5640902	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	17125515	Total
Program Services	11571035	ProgramServices
Management And General	5502344	ManagementAndGeneral
Fundraising	52136	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	2270886	Total
Program Services	1859804	ProgramServices
Management And General	401956	ManagementAndGeneral
Fundraising	9126	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	1567795	Total
Program Services	1382823	ProgramServices
Management And General	184356	ManagementAndGeneral
Fundraising	616	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	5372450	Total
Program Services	5132401	ProgramServices
Management And General	240049	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	23851706	Total
Program Services	17889198	ProgramServices
Management And General	5958428	ManagementAndGeneral
Fundraising	4080	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	998238	Total
Program Services	998238	ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
Medical supplies	88793343	88330613	457040	5690
Bad debt	19440529	19423813	16716
Equipment lease and ren	4898360	4275346	623014
Licenses and permits	1176909	1078297	98612
UBI tax	142663	142663

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	3315431	Total
Program Services	683571	ProgramServices
Management And General	2627214	ManagementAndGeneral
Fundraising	4646	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	571872950	Total
Program Services	480402452	ProgramServices
Management And General	90713652	ManagementAndGeneral
Fundraising	756846	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	22000015	BOY
EOY	24167419	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	3842192	BOY
EOY	3781641	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	81274812	BOY
EOY	80278346	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	108333	BOY
EOY	58333	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	3557714	BOY
EOY	3496249	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	9029375	BOY
EOY	11076812	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	4068834	BOY
EOY	5172280	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	573524584	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	257617882	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	275226435	BOY
EOY	315906702	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	73769899	BOY
EOY	55378107	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	121725789	BOY
EOY	152452866	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	5839322	BOY
EOY	5104920	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	28171593	BOY
EOY	26488947	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	26889285	BOY
EOY	12709389	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	655503598	BOY
EOY	696072011	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	54627636	BOY
EOY	65243074	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	330502	BOY
EOY	2156365	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	218633178	BOY
EOY	215394148	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	13962739	BOY
EOY	9188968	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	9759990	BOY
EOY	9305204	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	26531782	BOY
EOY	32140775	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	323845827	BOY
EOY	333428534	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	323069202	BOY
EOY	353311977	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	6691235	BOY
EOY	7350458	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1897334	BOY
EOY	1981042	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	331657771	BOY
EOY	362643477	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	655503598	BOY
EOY	696072011	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	1	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	1	GrantsOtherOrganizations
Grants Other Organizations	$51,741	GrantsOtherOrganizationsAmount
Direct Contact Legislators	1	DirectContactLegislators
Direct Contact Legislators	$23,281	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	0	OtherActivities
Total Lobbying Expenditures IIB	75022	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Part II-B, Line 1i:	Identifier
Return Reference	Explanation of Other Lobbying Activities:	ReturnReference
Explanation	Part II-B Line 1f and 1g: Avera McKennan participates through various hospital organizations to promote legislation that would result in strengthening health care delivery systems on a national, regional, and local level. In addition, Avera McKennan representatives have provided information to the legislators regarding the purpose of the Medicare Chronic Care Practice Research Network (MCCPRN) and promoted their support for financing of MCCPRN. In addition, MCCPRN requested authorization by the legislators to request the network be initiated and run through CMS within the Innovation Center. Avera McKennan also provided information to legislators for legislative processes such as development of the above directed bill through legislative council. Another employee of McKennan testified twice, both via phone, regarding a change in the licensing law for social workers.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	1	AgentTrusteeEtc
Beginning Balance	9612	BeginningBalance
Additions During Year	101456	AdditionsDuringYear
Distributions During Year	99434	DistributionsDuringYear
Ending Balance	11634	EndingBalance
Included On FS	1	IncludedOnFS

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

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

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	5856199	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	17995249	OtherCostOrOtherBasis
Book Value	23851448	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	1542926	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	283931783	OtherCostOrOtherBasis
Depreciation	122923015	Depreciation
Book Value	162551694	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	178559497	OtherCostOrOtherBasis
Depreciation	130061097	Depreciation
Book Value	48498400	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	85638930	OtherCostOrOtherBasis
Depreciation	4633770	Depreciation
Book Value	81005160	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	315906702	TotalOfBookValueLandBuildings

Other Securities OtherSecurities (5 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
Assets Limited as to Use - Avera Pooled Investments	125103164	F
Avera Home Medical Equipment	3802287	C
Interest in Avera Health Foundation	7264057	F
Investments in affiliated companies	11721787	C
Midwest Regional Imaging	4561571	C

Field	Value	IRS element (for citing)
Total Of Book Value Securities	152452866	TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescription	AmountAmount
Other Liabilities	$1,781,569
Due to other Organizations	$1,925,398
Amounts held in trust	$788,535
Market value of interest swap	$8,679,458
Capital lease obligation	$133,605
Estimated third-party payor settlements	$13,033,700
Due to affilate	$5,798,510

Field	Value	IRS element (for citing)
Total Of Amounts	32140775	TotalOfAmounts
Total Revenue	602835397	TotalRevenue
Total Expenses	571872950	TotalExpenses
Excess Or Deficit For Year	30962447	ExcessOrDeficitForYear
Net Unrealized GL On Investments	3340042	NetUnrealizedGLOnInvestments
Other	-$3,316,783	OtherAmount
Total Adjustments	23259	TotalAdjustments
Excess Or Deficit Per FS	30985706	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	612675488	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	3340042	NetUnrealizedGainsInvestments
Other Revenues	9050947	OtherRevenues
Revenue Not Rptd F990	12390989	RevenueNotRptdF990
Revenue Subtotal	600284499	RevenueSubtotal
Other Revenues Not Included	2550898	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	2550898	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	602835397	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	581661597	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	11155814	OtherExpensesIncluded
Expenses Not Rptd F990	11155814	ExpensesNotRptdF990
Expenses Subtotal	570505783	ExpensesSubtotal
Other Expenses Not Included	1367167	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	1367167	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	571872950	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (9 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Part IV, Line 1b:	The organization holds funds in trust on behalf of its residents. Many small dollar transactions flow in and out of this account. The account is managed by the nursing home staff. The state has strict guidelines on how these accounts are managed.
Part IV, Line 2b:	Through July 1, 2009, Avera McKennan sponsored a nonqualified retirement deferred compensation plan ("Plan") under which physicians and key management executives could elect deferred vesting dates. Due to the changes made by Congress affecting nonqualified deferred compensation benefit plans under Section 409A of the Internal Revenue Code, significant regulatory changes and requirements were imposed by IRS rules. However, the Internal Revenue Service granted a transition rule to assist in adjusting to the new rules. Under this rule, one option was that employers could discontinue the Plan, but the individual participants would be required to receive all the benefit plan balances. This option was adopted by Avera McKennan and consequently in July 2009 the Plan deferral was discontinued and all accrued benefits were distributed in August 2010 to the individual participants. Participants however were required to pay income tax on the distribution in 2009. This deferred compensation plan was established in 1996. The distribution from the plan therefore represents contributions up to 14 years plus any investment gains that have accrued on those balances over the years represented.
Part V, Line 4:	The organization's endowment consists of a portion of their interest in the net assets of Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization's permanently restricted endowment funds are donor restricted. The Organization currently does not have any board designated endowment funds.	Description of Intended Use of Endowment Funds:
Part X:	Avera McKennan has implemented FASB ASC 740-10 (formerly Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes). Avera McKennan 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. Avera McKennan is subject to income taxes on income from certain unrelated business activities.	Description of Uncertain Tax Positions Under FIN 48:
Part XI, Line 8 - Other Adjustments:	Book/Tax adjustments on partnerships: -489139. Equity Transfers, net: -2136931. Change in fair value of interest rate swap: -2111045. Income from grantor trust not included on financial statements: 1420332.
Part XII, Line 2d - Other Adjustments:	Revenues of consolidated subsidiaries consolidated for financial statements: 12909899. Occupancy expenses included in nonoperating income on financial statements: -1367167. Change in fair value of interest rate swap: -2111045. Reclass of accumulated losses on interest rate swaps on financial statements: -380740.
Part XII, Line 4b - Other Adjustments:	Change in investment in Avera Health Fdtn recorded in fund balance on f/s: 1728006. Minority interest share of gains from subsidiaries: 924071. Net income from subsidiaries eliminated on financial statements: 1298459. Management fees included in expenses on financial statements: 246588. Book/tax adjustments on partnerships: 489139. Rental expense included in revenues on financial statements: -715033. Income from grantor trust not included on financial statements: -1420332.
Part XIII, Line 2d - Other Adjustments:	Expenses of consolidated subsidiaries consolidated for financial statements: 10687369. Management fees included in revenue for tax return: -246588. Rental expense included in expenses for tax return: 715033.
Part XIII, Line 4b - Other Adjustments:	Occupancy expenses included in nonoperating income on financial statements: 1367167.

Schedule G IRS990ScheduleG

Field	Value	IRS element (for citing)
Solicitation Of Non Govt Grants	X	SolicitationOfNonGovtGrants
Solicitation Of Govt Grants	X	SolicitationOfGovtGrants
Agreement Ref Fundraising	1	AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation (2 entries)

ActivityActivity	Fundraiser Control Of FundsFundraiserControlOfFunds	Gross ReceiptsGrossReceipts	Amount Retained By ContractorAmountRetainedByContractor	Net To OrganizationNetToOrganization
Bentz Whaley Flessner
Consulting services	0	0	9027	-9027
Theodore R Muenster
Consulting services	0	0	45500	-45500

Field	Value	IRS element (for citing)
Total Retained By Contractors	54527	TotalRetainedByContractors
Total Net To Organization	-54527	TotalNetToOrganization

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)
Total Community Benefit Expense	9312929	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	9312929	NetCommunityBenefitExpense
Percent Of Total Expense	0.01690	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	48165432	TotalCommunityBenefitExpense
Direct Offsetting Revenue	37931236	DirectOffsettingRevenue
Net Community Benefit Expense	10234196	NetCommunityBenefitExpense
Percent Of Total Expense	0.01850	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1589132	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1237078	DirectOffsettingRevenue
Net Community Benefit Expense	352054	NetCommunityBenefitExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	59067493	TotalCommunityBenefitExpense
Direct Offsetting Revenue	39168314	DirectOffsettingRevenue
Net Community Benefit Expense	19899179	NetCommunityBenefitExpense
Percent Of Total Expense	0.03600	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2495811	TotalCommunityBenefitExpense
Direct Offsetting Revenue	248754	DirectOffsettingRevenue
Net Community Benefit Expense	2247057	NetCommunityBenefitExpense
Percent Of Total Expense	0.00410	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	6568325	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1555668	DirectOffsettingRevenue
Net Community Benefit Expense	5012657	NetCommunityBenefitExpense
Percent Of Total Expense	0.00910	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	50997236	TotalCommunityBenefitExpense
Direct Offsetting Revenue	42547204	DirectOffsettingRevenue
Net Community Benefit Expense	8450032	NetCommunityBenefitExpense
Percent Of Total Expense	0.01530	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3725978	TotalCommunityBenefitExpense
Direct Offsetting Revenue	192000	DirectOffsettingRevenue
Net Community Benefit Expense	3533978	NetCommunityBenefitExpense
Percent Of Total Expense	0.00640	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1363984	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1363984	NetCommunityBenefitExpense
Percent Of Total Expense	0.00250	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	65151334	TotalCommunityBenefitExpense
Direct Offsetting Revenue	44543626	DirectOffsettingRevenue
Net Community Benefit Expense	20607708	NetCommunityBenefitExpense
Percent Of Total Expense	0.03740	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	124218827	TotalCommunityBenefitExpense
Direct Offsetting Revenue	83711940	DirectOffsettingRevenue
Net Community Benefit Expense	40506887	NetCommunityBenefitExpense
Percent Of Total Expense	0.07340	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	97226	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	97226	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	248630	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	248630	NetCommunityBuildingExpense
Percent Of Total Expense	0.00050	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	345856	TotalCommunityBuildingExpense
Net Community Building Expense	345856	NetCommunityBuildingExpense
Percent Of Total Expense	0.00070	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$10,066,360	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	113967063	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	100940188	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	13026875	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

Form990 Schedule H Part V Form990ScheduleHPartV (10 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	Childrens HospitalChildrensHospital	Teaching HospitalTeachingHospital	Research FacilityResearchFacility	Er24 HoursEr24Hours	Critical Access HospitalCriticalAccessHospital	OtherOther
Avera McKennan
1325 S Cliff Ave	Sioux Falls	SD	57117	X	X	X	X	X	X
Avera Dells Area Health Center
909 N Iowa Avenue	Dell Rapids	SD	57022	X	X				X	X
Avera Flandreau Medical Center
214 N Prairie	Flandreau	SD	57028	X	X				X	X
Avera Hand County Memorial Hospital
300 W 5th St	Miller	SD	57362	X	X				X	X
Avera Milbank Area Hospital
901 Virgil Ave	Milbank	SD	57252	X	X				X	X
Avera Gregory Healthcare Center
400 Park Ave	Gregory	SD	57533	X	X				X	X
Avera Prince of Peace
4500 Prince of Peace Pl	Sioux Falls	SD	57103								Nursing Home
Avera Prince of Peace Retirement Center
4500 Prince of Peace Pl	Sioux Falls	SD	57103								Assisted Living
Avera Rosebud Country Care Center
400 Park Ave	Gregory	SD	57533								Nursing Home
Heart Hospital of South Dakota LLC
10720 Sikes Place Suite 300	Charlotte	NC	28277	X	X				X		1/3 owner in joint venture

Form990 Schedule H Part VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Income Based Criteria	Part I, Line 3c: A combination of income and assets test is utilized to determine eligibility for free or discounted care. Points are assigned based on income as a percentage of FPG and net assets owned with points deducted for ongoing medical expenses such as drugs. Patients with the fewest points receive the largest discount. 0-1 points receive 100% discount on bills while remaining discounts range from 10-90% depending on point totals and dollar amount of charges.	IncomeBasedCriteria
Annual Community Benefit Expln	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.	AnnualCommunityBenefitExpln
Costing Method Used	Part I, Line 7: A combination of costing methodology was used to calculate the amounts reported in the table. A cost accounting system was used to calculate Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for our tertiary medical center. A cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate charity care at cost for all entities and Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for any operations outside of the tertiary medical center. For all other amounts, costs and revenues as reflected by the general ledger system were used.	CostingMethodUsed
Subsidized Health Services Expln	Part I, Line 7g: Physician clinic costs for behavioral health services and transplant services are included in subsidized health services. Revenues of $8,348,425 and costs of $11,666,779 were included for a net community benefit of $3,318,354. Outside of the Veterans Administration hospital, we are the sole provider of hospital behavioral health services to the community, of which the clinics are an integral part of these services. Our facility is also the principal provider of transplant services throughout our service area and the clinics are a crucial component of successful pre and post transplant care.	SubsidizedHealthServicesExpln
Percent Of Total Expense Expln	Part I, Line 7f: Bad debt expense of $19,440,529 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage.	PercentOfTotalExpenseExpln
Bad Debt Footnote	Part III, Line 4: Costing methodology used to report bad debt expense (at cost) was a cost to charge ratio as outlined in Worksheet 2 Ratio of Patient Care Costs to Charges.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. Unpaid patient and resident receivables, excluding amounts due from third-party payors, with invoice dates over 90 days old have interest assessed at 1 percent per month. These interest charges are recognized as income when charged. 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, Lines 5, 6, and 7: The Medicare revenues received (line 5), allowable costs (line 6), and the resulting surplus (line 7) does not include a significant portion of the organization's expenses. These lines require use of the Medicare Cost Report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Avera McKennan. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removing the costs from the hospital's cost report entirely. Examples of a portion of these overhead costs would be finance, business office, information technology, human resources and administration. Examples of non-cost report entities operated by Avera McKennan include clinics, home medical equipment stores, mobile imaging services, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, Hospitalists care, marketing, CRNA's, and interest expense. Schedule H instructions also require the exclusion of $1,430,252 of Medicare losses because they are included in Schedule H, Part 1, Line 7g. Including the Medicare percentage of disallowed costs, entities which don't file a cost report but nevertheless care for Medicare patients, and the impact of the home office cost report, the Medicare shortfall is $22,649,208 as opposed to a surplus of $13,026,875.	BadDebtFootnote
Shortfall As Community Benefit	Part III, Line 8: Avera McKennan 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.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.	ShortfallAsCommunityBenefit
Debt Collection Policy	Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within a reasonable time period, the organization or it's agent shall not send, nor suggest that it will send, the unpaid bill to any outside agency 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.	DebtCollectionPolicy
General Explanation	Part V: The organization also has the following types of facilities other than those required to be licensed as healthcare facilities in the state of South Dakota:1 Behavioral Health Center1 Fitness Center1 Occupational Health Clinic33 Specialty Care clinics1 Senior apartments14 Home Medical Equipment facilities45 Primary care clinics1 Outpatient Diagnostic Imaging Center1 Free Clinic	GeneralExplanation
Needs Assessment	Part VI, Line 2: Community needs assessment occurs at various points in the system. Through annual strategic planning sessions, community leaders are brought in to update and educate Avera McKennan board members and administrative council on the successes, challenges, and service gaps in the community. Examples include school district officials, state health department, and community health organizations. Leaders also serve on boards of various community organizations which seek to address the health and well-being of area citizens. Local governing boards at outlying facilities, who are members of the community, discuss and help direct resources to areas of targeted needs as well.	NeedsAssessment
Patient Education Assistance	Part VI, Line 3: Notices are posted in English and Spanish in a visible manner in locations where there is a high volume of inpatient or outpatient admitting/registration, such as emergency departments, billing offices, admitting offices, and outpatient service settings as well as the organization website. Posted notices state that the organization has a financial assistance policy for low-income uninsured patients who may not be able to pay their bill and that this policy provides for charity care and reduced-payment for healthcare services. There is also identification of a contact phone number that a patient can call to obtain more information about the financial assistance policy and about how to apply for such assistance. Additionally, admitting staff distributes a brochure designed to help patients understand how we bill patients and provides summary information on financial assistance if you are unable to pay. Patient Advocates work with uninsured patients in our main tertiary facility to enroll them in applicable social programs and identify charity eligibility, eligibility and enrollment for county, state or federal risk pools, and eligibility for modified Medicare or Medicaid programs.	PatientEducationAssistance
Community Information	Part VI, Line 4: Avera McKennan's service area is a largely rural population. Services are provided through a health care network of 115 locations covering 54 communities in four states. The main tertiary facility is located in a population center of over 155,000 served by another non-profit hospital of similar size, Veterans Administration hospital, a hospital dedicated to diagnosis and treatment of heart disease, and a hospital for children with special health care needs. Outside of this population center, most of the communities served have less than 4,000 residents. The primary service area includes four counties covering approximately 2,600 square miles and contains seven federally designated medically underserved areas. The 2007 U.S. Census Bureau data estimates 8% of residents in the primary service area are at or below the poverty level. Our secondary setvice area covers an additional 17 counties in South Dakota, Iowa and Minnesota with an estimated total population of 226,000 based on U.S. Census Bureau projections for 2009.	CommunityInformation
Community Building Activities	Part VI, Line 5: The organization actively works to promote community building endeavors. There are numerous leaders serving on community boards throughout our service area. The organization supports several economic development organizations in its service area through donations. Additionally, the organization's workforce development program works with universities, technical schools, and local high schools to address healthcare worker shortfalls in the community. Through partnering with these organizations, Avera McKennan provides speakers, work experience for students, shadowing, career fairs and informational literature to encourage students to consider a career in healthcare and stay in the community.	CommunityBuildingActivities
Other Information	Part VI, Line 6: Avera McKennan is a verified Level II trauma center and operates an Emergency Center staffed 24 hours a day with board-certified emergency specialists and provides emergency care regardless of ability to pay. In addition, the facility operates both Fixed Wing and Helicopter medical air transports covering a large geographic area providing access to critical care.Through an integrated network of clinic providers the organization provides nonemergency services to the communities it serves. It makes these services accessible to the community through participation in government programs such as Medicare and Medicaid.Avera McKennan owns or leases five rural Critical Access Hospitals which provide a broad variety of inpatient and outpatient services and 24-hour emergency rooms. Telemedicine consults are also offered at rural locations in a number of medical specialties.Both in the tertiary medical center and in rural facilities, eICU technology offers constant, around-the-clock monitoring and interventions in the intensive care units from a remote care team in addition to the care they receive from their bedside team. The service is provided on a contract basis to hospitals so there is no additional charge to the patient. This enables critically ill patients to receive the highest quality care, close to home, with the support of family and friends.Avera McKennan has medical school residents in training in Internal Medicine, Family Practice, Psychiatry and Transitional Residency Programs offered in partnership with the University of South Dakota Sanford School of Medicine. Over 1,200 students in nursing, pharmacy, physician assistant programs, radiology and respiratory therapy also complete rotations at Avera McKennan. Avera McKennan has many joint agreements with institutions of higher education for both clinical and educational programming. In non-clinical areas, Avera McKennan offers unpaid internships in the areas of marketing, human resources, foundation, network operations and process excellence, working with approximately 18 institutions of higher education.Through the Avera Research Institute, physicians conduct basic research to add to the body of medical knowledge in the areas such as kidney disease and neuroscience research in regard to stress and addiction; participates in clinical trials for a variety of diseases; studies genetic precursors of mental health conditions; and also continues ongoing applied research in the area of developing a novel photochemical tissue bonding technology that has ophthalmologic and dermatological applications. Avera McKennan is also studying genetic precursors of mental health conditions which has applications in both clinical and research areas.Avera McKennan is a regional leader in offering educational programs for a variety of learners, leaders and employees. Utilizing advanced technology, many of these programs are provided electronically throughout the tri-state area. Educational sessions are offered to medical staff, employees, health care professionals, students at all levels and the general public.Avera McKennan operates a 24-hour Medical Call Center, through which patients have access to the Ask-A-Nurse program. Patients can call a toll-free number and talk personally with a Registered Nurse to ask health questions or receive general health information. Avera McKennan's web site also provides an extensive health library that consumers can access free of charge. Avera McKennan operates a health care clinic to provide free care to uninsured or underinsured people in the community. The clinic provides preventative care, diagnosis and treatment of illness and injuries, medication assistance and assistance in obtaining specialist care. The clinic also serves to train physicians, nurses and healthcare students.Surplus funds are reinvested in facilities to improve patient care.Medical staff privileges are extended to all qualified physicians in the community. The Avera McKennan Board of Trustees is principally comprised of community members from the primary service area. Members come from a variety of backgrounds ranging from private industry and banking to healthcare.	OtherInformation
Affiliated Health Care System	Part VI, Line 7: The communities in which the Avera system operates all have unique health and community benefit needs and in keeping with the Catholic Healthcare Association guidelines each Hospital strives to meet its community's identified needs. The Avera Central Office advocates for all on community benefit-related matters of state, regional, and national importance.	AffiliatedHealthCareSystem

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (41 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Address Line2AddressUS/AddressLine2
SIOUX FALLS CATHOLIC SCHOOLS
3100 W 41st Street	Sioux Falls	SD	57105	510145184	501(c)(3)	602850	Donation
RONALD MCDONALD HOUSE
2001 S Norton	Sioux Falls	SD	57105	460371152	501(c)(3)	197395	Donation
USD FOUNDATION
1100 N Dakota	Vermillion	SD	57069	466018891	501(c)(3)	196000	Donation
FORWARD SIOUX FALLS
PO Box 907	Sioux Falls	SD	57101	460396647		74000	Donation
SIOUX EMPIRE UNITED WAY
1000 N West Ave 120	Sioux Falls	SD	57104	460233701	501(c)(3)	73500	Donation
SOUTH DAKOTA STATE UNIVERSITY
PO Box 2218	Brookings	SD	57007	460273801	501(c)(3)	1076712	Donation
CATHOLIC DIOCESE
523 N Duluth Ave	Sioux Falls	SD	57104	466000424	501(c)(3)	60334	Donation
YWCA
300 W 11th Street	Sioux Falls	SD	57104	460234998	501(c)(3)	50000	Donation
FACE IT SIOUX FALLS
PO Box 5127	Sioux Falls	SD	57117	943472044	501(c)(3)	50000	Donation
RIVER OF HOPE
PO Box 1597	Sioux Falls	SD	57101	263130719	501(c)(3)	50000	Donation
WASHINGTON PAVILION
PO Box 984	Sioux Falls	SD	57101	460435791	501(c)(3)	44505	Donation
HARRISBURG ACTIVITIES FOUNDATION
PO Box 479	Harrisburg	SD	57032	061749081	501(c)(3)	40000	Donation
AMERICAN CANCER SOCIETY
4904 S Technopolis Drive	Sioux Falls	SD	57106	131788491	501(c)(3)	32350	Donation
TWELVE STEP LIVING CORPORATION
2601 S Minnesota Ave Ste 105-378	Sioux Falls	SD	57105	200293050	501(c)(3)	30000	Donation
SOUTH DAKOTA SYMPHONY
315 N Main Ave Suite 204	Sioux Falls	SD	571046078	466017026	501(c)(3)	21000	Donation
NATIONAL KIDNEY FOUNDATION
1100 E 21st Street Avera Doctors	Sioux Falls	SD	57105	460448030	501(c)(3)	20550	Donation	Plaza 2 Ste 210
SIOUX EMPIRE ARTS COUNCIL
309 E Falls Parks Drive	Sioux Falls	SD	57104	460354287	501(c)(3)	20000	Donation
SIOUX FALLS JAZZ & BLUES SOCIETY
123 S Main Ave Suite 204	Sioux Falls	SD	571046430	460418356	501(c)(3)	15000	Donation
DAKOTA STATE UNIVERSITY
800 N Washington Avenue	Madison	SD	570421799	237299995	501(c)(3)	13261	Donation
JUNIOR ACHIEVEMENT OF SOUTH DAKOTA
1000 N West Ave Suite 110	Sioux Falls	SD	57104	460306352	501(c)(3)	11225	Donation
NORTHWEST IOWA COMMUNITY COLLEGE
603 W Park Street	Sheldon	IA	51201	421275893	501(c)(3)	10500	Donation
DAKOTABILITIES
3600 S Duluth Ave	Sioux Falls	SD	57105	460306216	501(c)(3)	10000	Donation
THERAPEUTIC HEALING INSTITUTE
122 W 19th Street	Sioux Falls	SD	57105	043807841	501(c)(3)	10000	Donation
WORTHINGTON YMCA
211 11th St	Worthington	MN	56187	416007596	501(c)(3)	9600	Donation
SOUTH DAKOTA HUMANITIES COUNCIL
1215 Trail Ridge Rd	Brookings	SD	57006	460316222	501(c)(3)	9000	Donation
NAMI OF SOUTH DAKOTA
PO Box 88808	Sioux Falls	SD	57109	363593027	501(c)(3)	7600	Donation
SOUTH DAKOTA ACHIEVE
4100 S Western Ave	Sioux Falls	SD	57105	237072116	501(c)(3)	7500	Donation
DOWNTOWN SIOUX FALLS INC
230 S Phillips Ave Suite 102	Sioux Falls	SD	571046708	363627217	501(c)(4)	7500	Donation
PRESENTATION SISTERS
1500 N 2nd St	Aberdeen	SD	57401	460253283	501(c)(3)	7500	Donation
HELPLINE CENTER
1000 N West Ave Ste 310	Sioux Falls	SD	57104	237424387	501(c)(3)	6400	Donation
SOUTH DAKOTA CHAMBER OF COMMERCE
PO Box 190	Pierre	SD	57501	460141180	501(c)(6)	14076	Donation
FURNITURE MISSION OF SOUTH DAKOTA
209 N Nesmith	Sioux Falls	SD	57104	810584500	501(c)(3)	6000	Donation
SALES & MARKETING EXECUTIVES
PO Box 90310	Sioux Falls	SD	57109	466012934	501(c)(6)	5800	Donation
SIOUX FALLS AREA CASA
PO Box 1901	Sioux Falls	SD	57101	460430647	501(c)(3)	5400	Donation
AMERICAN DIABETES ASSOCIATION
1701 N Beauregard Street	Alexandria	VA	22311	131623888	501(c)(3)	5000	Donation
CHILDRENS CARE FOUNDATION
2501 W 26th Street	Sioux Falls	SD	57105	460233030	501(c)(3)	5000	Donation
SOUTHEASTERN BEHAVIORAL HEALTH
2000 S Summit Ave	Sioux Falls	SD	57105	460232306	501(c)(3)	5000	Donation
FAMILY VISITATION CENTER
311 E 14th St	Sioux Falls	SD	57104	263654937	501(c)(3)	5000	Donation
SIOUX EMPIRE HOMELESS COALITION
521 N Main Ave Suite 201	Sioux Falls	SD	571045965	460448734	501(c)(3)	5000	Donation
ST MARY CHURCH
812 N State Ave	Dell Rapids	SD	57022	466003662	501(c)(3)	5000	Donation
South Dakota Chorale
300 S Minnesota Ave	Sioux Falls	SD	57104	460225435	501(c)(3)	5000	Donation

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	37	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	4	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	Scholarships	TypeOfGrant
Number Of Recipients	18	NumberOfRecipients
Amount Of Cash Grant	83950	AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

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

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	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 (12 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
Kim Pederson MD
304723	0	0	0	1637	0	19091	0	13912	0	339363	0	0	0
Fredrick W Slunecka
0	595304	0	0	0	13615	0	12187	0	16092	0	637198	0	0
Julie N Norton
245497	0	0	0	103395	0	19091	0	20548	0	388531	0	26571	0
Judy Blauwet
240138	0	0	0	237878	0	14191	0	17029	0	509236	0	36221	0
David Flicek
362660	0	0	0	57826	0	14191	0	20607	0	455284	0	41691	0
Steve Petersen
164829	0	0	0	1400	0	10441	0	19608	0	196278	0	0	0
Patricia Jagoe
172862	0	0	0	786	0	12462	0	15607	0	201717	0	0	0
Michael Puumala MD
1039240	0	0	0	69906	0	19091	0	15607	0	1143844	0	43500	0
Kelly McCaul MD
913319	0	0	0	222945	0	19091	0	5899	0	1161254	0	72500	0
Brian Knutson MD
935538	0	0	0	366171	0	19091	0	18607	0	1339407	0	65842	0
Daniel Tynan MD
1255615	0	0	0	71299	0	19091	0	16358	0	1362363	0	43500	0
Leonard Gutnik MD
698799	0	0	0	374688	0	14191	0	16280	0	1103958	0	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 McKennan relied on the related organization for determining the compensation for the President & CEO using the methods described in Part I, Line 3. Schedule J, Part I Line 4b: Julie Norton - $102,510 Judy Blauwet - $233,542 David Flicek - $55,777 Michael Puumala, MD - $64,997 Brian Knutson, MD - $363,391 Leonard Gutnik, MD - $366,945 Daniel Tynan, MD - $66,063 Kelly McCaul, MD - $219,784 Through July 1, 2009, Avera McKennan sponsored a nonqualified retirement deferred compensation plan ("Plan") under which physicians and key management executives could elect deferred vesting dates. Due to the changes made by Congress affecting nonqualified deferred compensation benefit plans under Section 409A of the Internal Revenue Code, significant regulatory changes and requirements were imposed by IRS rules. However, the Internal Revenue Service granted a transition rule to assist in adjusting to the new rules. Under this rule, one option was that employers could discontinue the Plan, but the individual participants would be required to receive all the benefit plan balances. This option was adopted by Avera McKennan and consequently in July 2009 the Plan deferral was discontinued and all accrued benefits were distributed in August 2010 to the individual participants. Participants however were required to pay income tax on the distribution in 2009. This deferred compensation plan was established in 1996. The distribution from the plan therefore represents contributions up to 14 years plus any investment gains that have accrued on those balances over the years represented.	Explanation

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoan	Loan From OrganizationLoanFromOrganization	Original PrincipalOriginalPrincipalAmount	Balance DueBalanceDue	DefaultDefault	Approved By BoardApprovedByBoard	Written AgreementWrittenAgreement
Michael Puumala
physician recruitment	X	$100,000	31250	0	1	1
Daniel Tynan
physician recruitment	X	$100,000	27083	0	1	1

Field	Value	IRS element (for citing)
Total Balance Due	58333	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
Michael Bender
Board Member	208716	property lease	0
Surgical Institute of SD
Entity controlled by two Board Members	879154	trauma contract and acute surgical services contract	0
Victoria Petersen
Family of Key Employee	34817	employee compensation	0
Agnes Klein
Family of Board Member	35843	employee compensation	0
Alexander Petersen
Family of Key Employee	21003	employee compensation	0
James Hartung
Family of Key Employee	80310	employee compensation	0
Sioux Falls Construction Co
Board member is an officer of the entity	34991289	Construction	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Form 990, Part III, line 2	New Program Services	In August of 2009 a surgicalist program was added. In July of 2009 Avera McKennan added urogynecology. In July of 2009 Avera Health, a related organization, received funds from the Helmsley Grant to provide eCARE. Avera harnesses the latest interactive video and computer technology to extend specialty care to rural locations through eServices, also known as telemedicine. This includes Avera eICU CARE, eConsult, eEmergency, ePharmacy and eStroke. The start-up of these services were funded by grants and support from Avera Health, as these programs are not revenue producing at this time. With the exception of eConsult in which patients can have a physician consult via telemedicine, participating hospitals pay a contract fee, and patients are not billed additionally for these services. Patients benefit from having additional specialty care for their case. eServices also allow patients to remain in their home community rather than travel to a larger city for care.
Form 990, Part VI, Section A, line 2		Gene Jones, Jr. and Fred Thurman - business relationship Dave Strand, MD and Brad Thaemert, MD - business relationship Tom Dempster, Fred Slunecka, and Fred Thurman - business relationship
Form 990, Part VI, Section A, line 6		The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 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		Form 990 is reviewed by the CEO, CFO and Director of Financial Reporting. After the initial review, a draft is provided to the finance committee for their review. The return is provided to the full board prior to filing.
Form 990, Part VI, Section B, line 12c		The Conflict of Interest Policy covers Board members, officers, and key employees. At each board meeting, a request is made for all Board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The Declaration of Conflict of Interest is recorded in the meeting minutes. The Board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the Board.
Form 990, Part VI, Section B, line 15b		The CEO is compensated by Avera Health System. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. The CFO and key employees are compensated by Avera McKennan. Annually, the Compensation Committee of Avera McKennan, which is comprised of board members, meets to review compensation of executives and physicians. Avera McKennan compares its compensation plan to other healthcare organizations similar in size and complexity to Avera McKennan on a national basis to ensure compensation is comparable. Avera McKennan utilizes multiple salary surveys and an independent compensation consultant to provide a market analysis for each executive's suggested pay or pay range. Individual salaries reflect related education and experience, as well as the scope of the duties to assure amounts paid are reasonable.
Form 990, Part VI, Section C, line 19		The organization's governing documents, conflict of interest policy, and financial statements are not made available to the general public.
Schedule G, Part I, Line 2b, Column (v)	Explanation of Fundraising Payments	Bentz Whaley Flessner assisted with a feasibility study, consulted for the cancer capital campaign and other foundation functions. Theodore Muenster assisted in reorganizing the foundation department, developed job descriptions, policies and procedures and was involved in some specific in-person solicitations.
Form 990, Part III		Continuation of Statement of Exempt Purpose Achievements - Line 4a Prenatal and delivery care: Because early and regular prenatal care is important to prevent premature birth, Avera McKennan collaborates in a community effort to provide obstetrics care for women who do not qualify for Medicaid, but cannot afford health insurance. The program offers prenatal care, and hospital labor and delivery for a low fee of $950. Women receive care whether they can cover any or all of the fee. Care is provided primarily by first-year family practice residents, supervised by experienced physicians. Through this program in 2010, Avera McKennan assisted with 79 births and provided 759 prenatal and post-partum visits. Avera Family Wellness: This program combines positive activities like violin lessons with family coaching at no charge for children in early childhood programs in the Sioux Falls School District. The goal is to prevent or lessen the effects of behavioral health conditions on children and families by fostering a positive environment. In the 2009-10 school year, 141 students were served, and 183 are being served in the 2010-11 school year. The Walsh Family Village: This hospitality house complex adjacent to the Avera McKennan campus provides a home away from home for patients and their families who come for care at Avera McKennan from outside of Sioux Falls. The project was funded by donations and is operated by Avera McKennan. Ten guest rooms are available. Avera McKennan also donates use of a building in the complex for a Ronald McDonald House for families of pediatric patients. If they can afford it, guests are charged a low fee of $46.50 per night. If they cannot afford the expense, the cost of the room is waived. Employees regularly donate non-perishable food items to stock a food pantry for guests. In 2010, the Walsh Family Village served 7,378 guests, staying in 3,669 nightly rooms. Support of Indian Reservations: In 2010, Avera McKennan delivered three truckloads of excess medical equipment, furniture, clothing and supplies to Indian reservations in South Dakota. With truck rental and fuel expense, each trip cost approximately $1,000 in addition to the donations. Community Connections: Avera McKennan reaches out to people and communities throughout eastern South Dakota, southwestern Minnesota and northwest Iowa through Home Town Connections. Providing a critical feedback link to local referring doctors, this program completes the communications links necessary to keep local health care providers current on the treatment of their patients at Avera McKennan. Community Benefits: Avera McKennan provides additional community benefits including: support of youth programs; homeless programs; community arts programming; health prevention; awareness and education about cancer, heart disease and other conditions; and support of the Sioux Empire United Way and other services in the region. Donations toward these efforts totaled $1,766,000 in 2010. Preschool vision and hearing screening: Avera McKennan provided free screening for 341 preschool children in fiscal year 2010.
Form 990, Part VI, Question 16		There is no written policy or procedure since in the event of any such proposed transaction the board or a committee with delegated authority reviews all materials, valuations and operational aspects for any proposed transaction. Such transaction would be evaluated in accordance with the exempt status of the organization and its applicable purposes. Any transaction also would be approved by the board and the member.
Form 990, Schedule R, Part V, Line 2, Column c		The amounts reported in column c are reported based on a review of general ledger activity in intercompany accounts, and review of equity accounts for contributions and distributions.
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 McKennan, Avera St. Luke's, Avera Queen of Peace, 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 (17 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
Avera Health Foundation
3900 West Avera Drive STE 300	Sioux Falls	SD	57108	460367530	grant making	SD	501(c)(3)	7	N/A
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	healthcare services	NE	501(c)(3)	3	N/A
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	healthcare services	IA	501(c)(3)	3	N/A
Avera Holy Family Foundation
826 North 8th Street	Estherville	IA	51334	421317452	fundraising	IA	501(c)(3)	9	N/A
St Benedict Hospital Inc
401 West Glynn Drive	Parkston	SD	57366	460226738	healthcare services	SD	501(c)(3)	3	N/A
St Benedict Health Center Foundation
West Glynn Drive PO Box B	Parkston	SD	57366	460458725	support health related services	SD	501(c)(3)	11a	N/A
Avera Health
3900 West Avera Drive STE 300	Sioux Falls	SD	57108	460422673	promotion of health	SD	501(c)(3)	9	N/A
Avera Queen of Peace
Fifth and Foster	Mitchell	SD	57301	460224604	healthcare services	SD	501(c)(3)	3	N/A
Sacred Heart Health Services
501 Summit Street	Yankton	SD	57078	460225483	healthcare services	SD	501(c)(3)	3	N/A
Sacred Heart Rural Health Clinics
501 Summit Street	Yankton	SD	57078	460423930	clinic services	SD	501(c)(3)	3	N/A
Health Management Services
501 Summit Street	Yankton	SD	57078	460399291	adult daycare and homemaking services	SD	501(c)(3)	9	N/A
Avera Education and Staffing Solutions
1000 W 4th Street Suite 9	Yankton	SD	57078	460337013	healthcare education	SD	501(c)(3)	9	N/A
Benedictine Health Foundation
1017 West Fifth Street	Yankton	SD	57078	460370373	support for organizations providing health care services	SD	501(c)(3)	11b	N/A
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	healthcare services	SD	501(c)(3)	3	N/A
Avera Workers' Compensation Trust
3900 West Avera Drive	Sioux Falls	SD	57108	460407148	economical coverage of workers' compensation claims	SD	501(c)(3)	11b	N/A
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	healthcare services	MN	501(c)(3)	3	N/A
Avera Marshall Foundation
300 South Bruce Street	Marshall	MN	56258	411784801	fundraising	MN	501(c)(3)	7	N/A

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	Code VCodeVAmount	General Or Managing PartnerGeneralOrManagingPartner	Business Name Line1DirectControllingEntityName/BusinessNameLine1
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	related	378675	4613420	0	$78,164	1
Midwest Regional Imaging Services LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	470874983	health care - medical imaging	SD	N/A	related	863778	5324816	0		1
Mersco Medical of Pierre LLC
329 E Dakota	Pierre	SD	57501	460444002	medical services - home medical equipment	SD	N/A	related	71414	242582	0	$20,194	1
Avera Home Medical Equipment of Floyd Valley Hospital LLC
714 Lincoln St NE	Lemars	IA	51031	820582350	medical services - home medical equipment	IA		related	11529	87962	0	$3,239	1	Avera Home Medical Equipment LLC
Avera Home Medical Equipment of Estherville LLC
PO Box 5045	Sioux Falls	SD	57117	201686097	medical services - home medical equipment	SD		related	17481	145696	0	$5,155	1	Avera Home Medical Equipment LLC
Avera Home Medical Equipment of Sioux Center LLC
38 19th St SW	Sioux Center	IA	51250	753203100	medical services - home medical equipment	IA		related	30262	103239	0	$9,821	1	Avera Home Medical Equipment LLC
Avera Home Medical Equipment of Marshall LLC
1104 East College Drive	Marshall	MN	56258	205271924	medical services - home medical equipment	MN		related	81204	293619	0	$24,796	1	Avera Home Medical Equipment LLC
Q&M Properties LLC
525 North Foster	Mitchell	SD	57301	731652049	medical clinic building	SD	N/A
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	surgical associates	SD	N/A
Avera Home Medical Equipment of Spencer Hospital LLC
2400 S Minnesota Avenue 102	Sioux Falls	SD	57117	800619999	medical services - home medical equipment	SD		related		30502	0		1	Avera Home Medical Equipment LLC
Marshall Medical Services LLC
300 S Bruce St	Marshall	MN	56258	208874448	Medical Services	MN	N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Type Of EntityTypeOfEntity
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
Avera Pace Inc
3900 West Avera Drive	Sioux Falls	SD	57108	460341869	healthcare services	SD	N/A	C
Valley Health Services
501 Summit Street	Yankton	SD	57078	460357149	Medical Equipment	SD	N/A	C
Northern Dakota Health Company
305 S State Street	Aberdeen	SD	57401	460385179	Clinics	SD	N/A	C

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

Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved
Avera Home Medical Equipment LLC
A	290746
Midwest Regional Imaging Services LLC
K	115324
Avera Home Medical Equipment LLC
K	131301
Midwest Regional Imaging Services LLC
Q	262677
Avera Home Medical Equipment LLC
Q	4237214
Midwest Regional Imaging Services LLC
R	497286
Avera Home Medical Equipment LLC
R	4395473
Midwest Regional Imaging Services LLC
B	3039942
Midwest Regional Imaging Services LLC
C	385560
Avera Home Medical Equipment LLC
C	1305285