AVERA ST ANTHONYS HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- AVERA ST ANTHONYS HOSPITAL (EIN 47-0463911)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-13
- IRS object ID
- 201131339349302298
- 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 D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-13T11:18:19-05:00 | 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 Suite 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 | 470463911 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera St Anthony's Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STAN | NameControl |
| Phone | 4023365132 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1 |
| City | ONeill | City |
| State | NE | State |
| ZIP Code | 687631569 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Ronald Cork | Name |
| Title | CEO | Title |
| Phone | 4023365132 | Phone |
| Date Signed | 2011-05-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kim Hunwardsen | Name |
| Phone | 9529446166 | Phone |
| Date Prepared | 2011-05-11 | DatePrepared |
| 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) |
|---|---|---|
| Name Of Principal Officer Person | Ronald Cork | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1 |
| City | ONeill | City |
| State | NE | State |
| ZIP Code | 687631569 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 29052211 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c | X | Organization501c |
| Web Site | www.avera-sta.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | Promotion of health | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 255 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 222087 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 676123 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 25147289 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 28192582 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 140825 | InvestmentIncomePriorYear |
| Investment Income Current Year | 169378 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5565 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4750 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25515766 | TotalRevenuePriorYear |
| Total Revenue Current Year | 29042833 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 35000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 35000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11817651 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13276849 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12526375 | OtherExpensePriorYear |
| Other Expenses Current Year | 13286003 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 24379026 | TotalExpensesPriorYear |
| Total Expenses Current Year | 26597852 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1136740 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2444981 | RevenuesLessExpensesCY |
| Total Assets BOY | 20784081 | TotalAssetsBOY |
| Total Assets EOY | 25909611 | TotalAssetsEOY |
| Total Liabilities BOY | 2725518 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5229383 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18058563 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 20680228 | 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 | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23270384 | Expense |
| Grants | 35000 | Grants |
| Revenue | 28192582 | Revenue |
| Description | To provide acute patient visits and outpatient visits of health care services. For the year ended June 30, 2010, a total of 3,459 patient days were recorded and 275 newborn patient days were recorded. Charity care is also provided by the facility. For the year ended June 30, 2010, the facility provided $802,279 in charity care, based on charges foregone.The Hospital also provides community benefit health activities at less than or at no cost to support those in the area served. These activities include community education programs; special programs for the elderly, handicapped, and medically underserved; and a variety of broad community support activities. During the years ended June 30, 2010 and 2009, specific activities included senior resource programs for billing assistance; meeting facilities; programs for patients and families suffering from cancer, diabetes, breathing disorders, mental illness, and others; assistance to health educators; emergency healthcare providers; wellness programs; reduced priced sports medicine services; and overnight housing for families of hospitalized patients. | Description |
| Total Program Service Expense | 23270384 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 10 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 255 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Garman | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4023365132 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1 |
| City | ONeill | City |
| State | NE | State |
| ZIP Code | 687631569 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Dian Edwards | |||||||
| Chairperson | 1.00 | X | X | 0 | 0 | 0 | |
| Jim Rabe | |||||||
| Vice-Chairperson | 1.00 | X | X | 0 | 0 | 0 | |
| Lisa Lind | |||||||
| Secretary/Treasurer | 1.00 | X | X | 0 | 0 | 0 | |
| Dr Richard Fitch | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Rod Schellpeper | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Jack Hurley | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Ed North | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Deb Kelly | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Sister Sharon Ann Haas OSB | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Sister Janet Schumacher PBVM | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Sister Joan Reichelt PBVM | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Matthew Winkelbauer MD | |||||||
| Pres of Med Staff/Physician | 1.00 | X | 0 | 0 | 0 | ||
| Ronald Cork | |||||||
| President & CEO | 50.00 | X | X | 0 | 167534 | 10109 | |
| Michael Garman | |||||||
| Sec/Treas & SrVP Finance | 40.00 | X | 122761 | 0 | 25483 | ||
| Edwin N Cook | |||||||
| Radiologist | 40.00 | 324418 | 0 | 8404 | X | ||
| Dean Benson | |||||||
| Surgical PA | 40.00 | 119792 | 0 | 22392 | X | ||
| Bart Eastwood | |||||||
| Orthopedic Surgeon | 40.00 | 487730 | 0 | 56787 | X | ||
| Cameron Everitt | |||||||
| Director of PT/OT | 40.00 | 146307 | 0 | 26784 | X | ||
| Anthony Akainda | |||||||
| General Surgeon | 40.00 | 329675 | 0 | 61949 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1530683 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 167534 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 211908 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| North Central Anesthesia Services | |||||
| PO Box 741 | ONeill | NE | 68763 | Anesthesia Service | 1529962 |
| Sacred Heart Health Services | |||||
| 501 Summit St | Yankton | SD | 57078 | Management Fee/IT | 1153091 |
| Doc's Who Care | |||||
| 1309 S Fountain Drive | Olathe | KS | 66061 | Weekend Physician Coverage | 329462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Related Organizations | 660897 | RelatedOrganizations |
| Government Grants | 8904 | GovernmentGrants |
| All Other Contributions | 6322 | AllOtherContributions |
| Total Contributions | 676123 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenu | 622110 | 27099746 | 27099746 |
| Clinic Revenue | 621110 | 567850 | 567850 |
| Other Revenue | 900099 | 305393 | 305393 |
| Change in Fdtn Interes | 900099 | 219593 | 219593 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 28192582 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 69957 | TotalRevenueColumn |
| Exclusion | $69,957 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4750 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4750 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4750 | TotalRevenueColumn |
| Exclusion | $4,750 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 59088 | Securities |
| Other | 49711 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9378 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 59088 | Securities |
| Other | 40333 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 99421 | TotalRevenueColumn |
| Exclusion | $99,421 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29042833 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28192582 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $174,128 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35000 | Total |
| Program Services | 35000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158416 | Total |
| Management And General | 158416 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10464463 | Total |
| Program Services | 9596631 | ProgramServices |
| Management And General | 867832 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 312808 | Total |
| Program Services | 256451 | ProgramServices |
| Management And General | 56357 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1624781 | Total |
| Program Services | 1423365 | ProgramServices |
| Management And General | 201416 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 716381 | Total |
| Program Services | 622347 | ProgramServices |
| Management And General | 94034 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 708848 | Total |
| Management And General | 708848 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 450 | Total |
| Management And General | 450 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49813 | Total |
| Management And General | 49813 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1341978 | Total |
| Program Services | 1176959 | ProgramServices |
| Management And General | 165019 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42005 | Total |
| Management And General | 42005 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 736806 | Total |
| Program Services | 87823 | ProgramServices |
| Management And General | 648983 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37082 | Total |
| Management And General | 37082 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 329164 | Total |
| Program Services | 329164 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65709 | Total |
| Program Services | 48027 | ProgramServices |
| Management And General | 17682 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 206799 | Total |
| Program Services | 121597 | ProgramServices |
| Management And General | 85202 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24444 | Total |
| Program Services | 24444 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1142162 | Total |
| Program Services | 1142162 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 186427 | Total |
| Program Services | 186427 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 6221536 | 6221536 | |
| Bad Debts | 1181794 | 1181794 | |
| Equipment Lease and Ren | 799502 | 739811 | 59691 |
| Miscellaneous | 128544 | 33953 | 94591 |
| Dues and Subscriptions | 82940 | 42893 | 40047 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26597852 | Total |
| Program Services | 23270384 | ProgramServices |
| Management And General | 3327468 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3649130 | BOY |
| EOY | 3960791 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3611698 | BOY |
| EOY | 3541890 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 11500 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129500 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 930712 | BOY |
| EOY | 964032 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54735 | BOY |
| EOY | 155144 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 23661965 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14014371 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7068428 | BOY |
| EOY | 9647594 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1178706 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5128059 | BOY |
| EOY | 6087415 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 50000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 211819 | BOY |
| EOY | 312539 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20784081 | BOY |
| EOY | 25909611 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1411400 | BOY |
| EOY | 1889906 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1314118 | BOY |
| EOY | 1689477 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1650000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2725518 | BOY |
| EOY | 5229383 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17901012 | BOY |
| EOY | 20529728 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7051 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 150500 | BOY |
| EOY | 150500 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18058563 | BOY |
| EOY | 20680228 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20784081 | BOY |
| EOY | 25909611 | 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 Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 150500 | BeginningOfYearBalance |
| End Of Year Balance | 150500 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 150500 | BeginningOfYearBalance |
| End Of Year Balance | 150500 | 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 | 59191 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 665832 | OtherCostOrOtherBasis |
| Book Value | 725023 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 220512 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 10334975 | OtherCostOrOtherBasis |
| Depreciation | 6554105 | Depreciation |
| Book Value | 4001382 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9171193 | OtherCostOrOtherBasis |
| Depreciation | 7181985 | Depreciation |
| Book Value | 1989208 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3210262 | OtherCostOrOtherBasis |
| Depreciation | 278281 | Depreciation |
| Book Value | 2931981 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9647594 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| Assets Limited to Use - Avera Pooled Investments | 3963072 | F |
| Investment in Foundation | 1861294 | F |
| Investment in Collaborative Arrangement | 263049 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 6087415 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated Third-Party Payor Settlements | Description |
| Amount | $1,650,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1650000 | TotalOfAmounts |
| Total Revenue | 29042833 | TotalRevenue |
| Total Expenses | 26597852 | TotalExpenses |
| Excess Or Deficit For Year | 2444981 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 176684 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 176684 | TotalAdjustments |
| Excess Or Deficit Per FS | 2621665 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 28565421 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 176684 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 176684 | RevenueNotRptdF990 |
| Revenue Subtotal | 28388737 | RevenueSubtotal |
| Other Revenues Not Included | 654096 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 654096 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 29042833 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 26597852 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 26597852 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 26597852 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | The Hospital's endowment consists of a portion of their interest in the net assets of Avera St. Anthony's Hospital Foundation. The Avera St. Anthony's Hospital Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | The Hospital has implemented the provision of FASB Accounting Standards Codification Topic ASC 740-10 (formerly Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes). The Hospital undergoes an annual analysis of its various tax positions, assessing the likelihood of those positions being upheld upon examination with relevant tax authorities, as defined by ASC 740-10. The implementation of this standard has had no impact on the financial statements. For the years ended June 30, 2010 and 2009, the unrecognized tax benefit accrual was zero. |
| Part XII, Line 4b - Other Adjustments: | Contributions Recorded in Fund Balance on Financial Statements: 654096. |
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 |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| 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 | 525493 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 525493 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01980 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2071546 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1547341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 524205 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01970 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2597039 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1547341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1049698 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03950 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1861 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1861 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 988 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 988 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2849 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2849 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2599888 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1547341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1052547 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03960 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $774,075 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11952000 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11828985 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 123015 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 0 | WrittenDebtCollectionPolicy |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera St Anthony's Hospital (ASAH) | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N 2nd Street | AddressLine1 |
| City | ONeill | City |
| State | NE | State |
| ZIP Code | 68763 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: Charity care and discounted care utilizes a combination of income, assets, and expenses to determine what percentage of charity care they would qualify for. | IncomeBasedCriteria |
| Annual Community Benefit Expln | Part I, Line 6a: Our community benefit report is contained in a report prepared by Avera Health, a related organization. It is available through the website and requested mailing, and is filed with the Catholic Health Association. | AnnualCommunityBenefitExpln |
| Costing Method Used | Part I, Line 7: Charity care and unreimbursed Medicaid was converted to cost using an overall cost to charge ratio. Other benefits are actual expenses recorded in the general ledger. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: The amount of bad debt expense removed from the denominator of the calculation was $1,181,794. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Bad debt expense was converted to cost using an overall cost to charge ratio.The organization did not estimate the amount of bad debt expense attributable to patients eligible under the organization's charity care policy as the organization works hard at encouraging people to apply and makes adjustments to bad debt expense based on recommendations of the collection agency or reviews bad debt for those who qualify under charity care. Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Notes from Financial Statement: The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amount that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. | ShortfallAsCommunityBenefit |
| Number Of Facility Type Expln | 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 Nebraska:1 home health1 sleep lab1 family practice clinic - Joint Venture | NumberOfFacilityTypeExpln |
| Needs Assessment | Part VI, Line 2: Avera St. Anthony's Hospital conducts an annual strategic planning meeting that includes a cross section of community members. Our Hospital Board of Directors, Hospital Finance Committee, Foundation Board of Directors, COmmunity Medical Staff, and Hospital Department Directors meet to assess community input from the local nursing facility, assisted living, local public health office. Our Hospital and Foundation Boards and Finance Committee are made up of a majority of community members. This group drafts an annual strategic plan of goals, objectives, and strategies that are continuously updated to address the needs of the community. Additionally, input from the local ministerial association, law enforcement, chamber of commerce, elementary and secondary public and parochial schools, and the local community college are assessed and incorporated into the plan. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Patients are informed of the financial assistance/charity care policy through brochures and posted policies at the registration desks of the hospital and emergency department. Avera St. Anthony's has staff in central registration that identify if a patient has the financial means to pay for services or insurance to cover these services. Public assistance is also pursued if deemed appropriate. If patients are identified as candidates for charity care they are directed to our financial services representative and the application process is inititated for charity care. Patient financial services can assist with determining what benefits the patient may qualify for and assists with helping them apply for any benefits. If there is no option for an outside assistance program, the patient is informed and encouraged to complete the application that utilizes a combination of income, assets, and expenses to determine what percentage of charity care they would qualify for. Additionally patients are advised of our financial assistance package when they receive our statements and if they are telephoned for payment arrangements. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Avera St. Anthony's Hospital is located in O'Neill, NE the county seat of Holt County. We serve a large radius to include patients from Brown, Rock, Boyd, Keya Paha, Wheeler, Knox, Garfield, and Antelope counties. In 2009, the population for Holt County was estimated to be 10,011. Approximately 21% of the population is age 65 or older. The average per capita income is 20,914 and approximately 10.3% of the population is below the federal poverty level. The nearest hospital in the area is approximately 18 miles from Avera St. Anthony. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: N/A | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: The communities in which Avera operates all have unique health and community benefit needs and in keeping with the Catholic Healthcare Association Guidelines each hospital strives to meet its community's identified needs. The Avera Central Office advocates for all on community benefit related matters of state, regional, and national importance. | AffiliatedHealthCareSystem |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| Northeast Community College Foundation | |||||||
| 801 E Benjamin Avenue | Norfolk | NE | 68702 | 510145185 | 501(c)(3) | 25000 | The $25,000 grant is to be used for the future Nursing College in Norfolk. |
| O'Neill Community Foundation - Community Center Capital Campaign | |||||||
| PO Box 543 | ONeill | NE | 68763 | 470769903 | 501(c)(3) | 10000 | The $10,000 grant is for the future O'Neill Community Center. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
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: Grant fund compliance is monitored by the Chief Financial Officer annually at fiscal year end or sooner if dictated by the grantor. The recipient department director or administrator provides progress documentation through capital and operation budget requests and utilization. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ronald Cork | |||||||||||||
| 0 | 165182 | 0 | 287 | 0 | 2065 | 0 | 7947 | 0 | 2162 | 0 | 177643 | 0 | 0 |
| Edwin N Cook | |||||||||||||
| 324418 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 10358 | 0 | 334776 | 0 | 0 | 0 |
| Bart Eastwood | |||||||||||||
| 487730 | 0 | 0 | 0 | 0 | 0 | 11000 | 0 | 48498 | 0 | 547228 | 0 | 0 | 0 |
| Cameron Everitt | |||||||||||||
| 146307 | 0 | 0 | 0 | 0 | 0 | 6028 | 0 | 22022 | 0 | 174357 | 0 | 0 | 0 |
| Anthony Akainda | |||||||||||||
| 329675 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 55388 | 0 | 394863 | 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, Sacred Heart Health Services. Avera St. Anthony's Hospital relied on the related organization for determining the compensation for the President & CEO using the methods described in Part I, Line 3. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Edwin N Cook DO | NamePerson |
| Purpose Of Loan | Pre-employment Advance | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $50,000 | OriginalPrincipalAmount |
| Balance Due | 11500 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 11500 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 3 | The organization utilizes the management services of Avera Sacred Heart Hospital for day-to-day operations of the facility. The CEO of the facility is an employee of Avera Sacred Heart Hospital. |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. |
| Form 990, Part VI, Section A, line 7a | Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors. |
| Form 990, Part VI, Section A, line 7b | Avera Health has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. |
| Form 990, Part VI, Section B, line 11 | The return is reviewed by the CEO and CFO prior to filing. The return is made available to the Board of Directors subsequent 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 15 | Compensation of the CEO is determined by the management company Avera Sacred Heart Hospital. The board of directors reviews the management agreement with Avera Sacred Heart Hospital and discusses and approves the agreement. Negotiations are done as needed. For the CFO, a salary review is done by a committee based off hospital association surveys, including hospital size. There is also a relationship between the CEO's salary and the CFO's salary, in that a percentage of the increase for the CFO is based on CEO's salary base. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest policy, and financial statements are not available to the general public. |
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 | |||||||||
| 3900 W Avera Drive Suite 300 | Sioux Falls | SD | 57108 | 460422673 | Promotion of health | SD | 501(c)(3) | 9 | N/A |
| Avera Health Foundation | |||||||||
| 3900 W Avera Drive Suite 300 | Sioux Falls | SD | 57108 | 460367530 | Grant making | SD | 501(c)(3) | 7 | 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 | Support of Holy Family Hospital and Home Health Agency | 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 | |||||||||
| 401 West Glynn Drive PO Box B | Parkston | SD | 57366 | 460458725 | Support health related services | SD | 501(c)(3) | 11a | N/A |
| Avera McKennan | |||||||||
| 1325 S Cliff Ave PO Box 5045 | Sioux Falls | SD | 57117 | 460224743 | Healthcare services | SD | 501(c)(3) | 3 | N/A |
| St Anthony's Hospital Foundation | |||||||||
| 2nd Adams Street | ONeill | NE | 68763 | 470728707 | Support to Hospital | NE | 501(c)(3) | 11a | N/A |
| Avera Queen of Peace Hospital | |||||||||
| 525 North Foster | Mitchell | SD | 57301 | 420224604 | 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 Inc | |||||||||
| 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 |
| Lewis and Clark Health Ed and Serv Agency | |||||||||
| 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 | 410370373 | 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 Marshall | |||||||||
| 300 S Bruce St | Marshall | MN | 56258 | 410919153 | Healthcare Services | MN | 501(c)(3) | 3 | N/A |
| Avera Marshall Foundation | |||||||||
| 300 S Bruce St | Marshall | MN | 56258 | 411784801 | Fundraising | MN | 501(c)(3) | 9 | 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 |
|---|---|---|---|---|---|---|---|
| Avera Home Medical Equipment LLC | |||||||
| 1325 S Cliff Ave PO Box 5045 | Sioux Falls | SD | 57117 | 460488198 | Medical services - home medical equipment | SD | N/A |
| Midwest Regional Imaging | |||||||
| 1325 S Cliff Ave PO Box 5045 | Sioux Falls | SD | 57117 | 470874983 | Health care - medical imaging | SD | N/A |
| Mersco Medical of Pierre LLC | |||||||
| 329 E Dakota | Pierre | SD | 57501 | 460444002 | Medical services - home medical equipment | SD | N/A |
| Avera Home Medical Equipment of Floyd Valley Hospital LLC | |||||||
| 714 E Lincoln St NE | Lemars | IA | 51031 | 820582350 | Medical services - home medical equipment | IA | N/A |
| Avera Home Medical Equipment of Estherville LLC | |||||||
| PO Box 5045 | Sioux Falls | SD | 57117 | 201686097 | Medical services - home medical equipment | IA | N/A |
| Avera Home Medical Equipment of Sioux Center LLC | |||||||
| 38 19th St SW | Sioux Center | IA | 51250 | 753203100 | Medical services - home medical equipment | IA | N/A |
| Avera Home Medical Equipment of Marshall LLC | |||||||
| 1104 East College Drive | Marshall | MN | 56258 | 205271924 | Medical services - home medical equipment | MN | 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 | N/A |
| Q&M Properties LLC | |||||||
| 525 North Foster | Mitchell | SD | 57301 | 730652049 | Medical clinic building | SD | N/A |
| Surgical Associates Endoscopy Clinic LLC | |||||||
| 310 S Pennsylvania St | Aberdeen | SD | 57401 | 460461429 | Surgical associates | SD | N/A |
| 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 Avenue Suite 101 | Sioux Falls | SD | 57108 | 460373021 | Collection Services | SD | N/A | C |
| Avera Health Plans Inc | ||||||||
| 3900 West Avera Drive Suite 101 | Sioux Falls | SD | 57105 | 460451539 | HealthCare Benefits | SD | N/A | C |
| Avera Property Insurance Inc | ||||||||
| 610 W 23rd Street | Yankton | SD | 57078 | 460463155 | Property Insurance | SD | N/A | C |
| Avera Pace | ||||||||
| 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 | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | 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 | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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