AVERA WORKERS' COMPENSATION TRUST: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- AVERA WORKERS' COMPENSATION TRUST (EIN 46-0407148)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201141329349303514
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T15:31:52-05:00 | 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 Dr 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 | 460407148 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Workers' Compensation Trust | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AVER | NameControl |
| Phone | 6053227050 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3900 W Avera Dr | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 57108 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | John Porter | Name |
| Title | President | Title |
| Phone | 6053227050 | Phone |
| Date Signed | 2011-05-09 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kim Hunwardsen | Name |
| Phone | 9529446166 | Phone |
| Date Prepared | 2011-05-09 | 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 | John Porter | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3900 W Avera Dr | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 57108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4031196 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | Provide an economical coverage of workers' compensation claims. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 12 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 3177828 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3599235 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 222080 | InvestmentIncomePriorYear |
| Investment Income Current Year | 187259 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3399908 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3786494 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23118 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 30682 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4296039 | OtherExpensePriorYear |
| Other Expenses Current Year | 4134506 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4319157 | TotalExpensesPriorYear |
| Total Expenses Current Year | 4165188 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -919249 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -378694 | RevenuesLessExpensesCY |
| Total Assets BOY | 13548304 | TotalAssetsBOY |
| Total Assets EOY | 15246876 | TotalAssetsEOY |
| Total Liabilities BOY | 6788879 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7829889 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6759425 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7416987 | NetAssetsOrFundBalancesEOY |
| Mission Description | None | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4049435 | Expense |
| Revenue | 3599235 | Revenue |
| Description | The Avera Workers' Compensation Trust ("Trust") was established to provide an economical coverage of workers' compensation exposure to exempt organizations associated with Avera Health of Sioux Falls in furtherance of their promotion of health care. Stop loss type insurance coverage is purchased by the trust. The participants are required to contribute to the reserves of the trust in accordance with the independent actuarial's valuation. The valuation is made annually to determine the funding level necessary to provide reserves for workers' compensation claims and is reviewed by the Trust's Employer's Advisor. | Description |
| Total Program Service Expense | 4049435 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | 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 | 0 | 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 | 0 | Hospital |
| Grants To Organizations | 0 | 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 | 0 | 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 | 34 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Nbr Voting Governing Body Members | 16 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jim Breckenridge | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6053224700 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3900 W Avera Dr | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 57108 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Institutional TrusteeInstitutionalTrustee |
|---|---|---|---|---|---|---|---|
| Rodney W Fouberg | |||||||
| Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Sister Lucille Welbig | |||||||
| Vice Chair | 1.00 | X | X | 0 | 0 | 0 | |
| John Porter | |||||||
| Pres/CEO Avera Health | 1.00 | X | X | 0 | 1015449 | 43466 | |
| Sister Aidan Bourke | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Mark Buche | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Sister Kathleen Crowley | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Sister Mary Jaeger | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Daniel P Murphy | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Sister Debra Kolecka | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr James Reynolds | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Kevin Conlin | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr Herbert A Saloum | |||||||
| Director | 1.00 | X | 0 | 6461 | 0 | ||
| Dr Stephan Schroeder | |||||||
| Director | 1.00 | X | 0 | 165955 | 18350 | ||
| Bob Sutton | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Sister Mary M Thomas | |||||||
| Director | 1.00 | X | 0 | 119907 | 403 | ||
| Mark Schalanta | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| US Bank | |||||||
| Trustee | 5.00 | 30682 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 30682 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1307772 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 62219 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Health | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3900 W Avera Drive | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 57108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | Shared Services | DescriptionOfServices |
| Compensation | 650000 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Assessments | Description |
| Business Code | 524298 | BusinessCode |
| Total Revenue Column | 3599235 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3599235 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3599235 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 431961 | TotalRevenueColumn |
| Exclusion | $431,961 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 244702 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -244702 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -244702 | TotalRevenueColumn |
| Exclusion | -$244,702 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3786494 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3599235 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $187,259 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30682 | Total |
| Management And General | 30682 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 640000 | Total |
| Program Services | 640000 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9000 | Total |
| Management And General | 9000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10900 | Total |
| Program Services | 10900 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1789 | Total |
| Program Services | 1789 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 155 | Total |
| Management And General | 155 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Insurance Claims | 3163653 | 3163653 | |
| Reinsurance Fees | 225348 | 225348 | |
| State Fees - SD and IA | 75916 | 75916 | |
| Claims Processing Fee | 7745 | 7745 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4165188 | Total |
| Program Services | 4049435 | ProgramServices |
| Management And General | 115753 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1251165 | BOY |
| EOY | 1671334 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64006 | BOY |
| EOY | 43779 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12218698 | BOY |
| EOY | 13518004 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14280 | BOY |
| EOY | 13759 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13548304 | BOY |
| EOY | 15246876 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69206 | BOY |
| EOY | 55580 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6719673 | BOY |
| EOY | 7774309 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6788879 | BOY |
| EOY | 7829889 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6759425 | BOY |
| EOY | 7416987 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6759425 | BOY |
| EOY | 7416987 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13548304 | BOY |
| EOY | 15246876 | 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 | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (9 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| Avera McKennan | |||||
| 460224743 | 3 | 0 | 0 | 1 | $1,254,012 |
| Avera St Luke's | |||||
| 460224598 | 3 | 0 | 0 | 1 | $357,593 |
| Sacred Heart Health Services | |||||
| 460225483 | 3 | 0 | 0 | 1 | $107,366 |
| Avera Queen of Peace | |||||
| 460224604 | 3 | 0 | 0 | 1 | $65,350 |
| St Benedict Health Center | |||||
| 460226738 | 3 | 0 | 0 | 1 | $19,363 |
| Avera Holy Family | |||||
| 420680370 | 3 | 0 | 0 | 1 | $166,132 |
| Presentation College | |||||
| 460280847 | 2 | 0 | 0 | 1 | $37,971 |
| Sisters of the Presentation of the Blessed Virgin Mary | |||||
| 460253283 | 1 | 0 | 0 | 1 | $17,348 |
| Avera Health | |||||
| 460422673 | 9 | 0 | 0 | 1 | $83,879 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 9 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 2109014 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated Claims Payable | Description |
| Amount | $7,774,309 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 7774309 | TotalOfAmounts |
| Total Revenue | 3786494 | TotalRevenue |
| Total Expenses | 4165188 | TotalExpenses |
| Excess Or Deficit For Year | -378694 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1036256 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 1036256 | TotalAdjustments |
| Excess Or Deficit Per FS | 657562 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 4822750 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1036256 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 1036256 | RevenueNotRptdF990 |
| Revenue Subtotal | 3786494 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 3786494 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 4165188 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 4165188 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 4165188 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X: | Identifier |
| Return Reference | Description of Uncertain Tax Positions Under FIN 48: | ReturnReference |
| Explanation | Avera Workers' Compensation Trust is organized as a nonprofit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization has implemented Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes, (FIN No. 48) subsequently codified within FASB ASC 740, Income Taxes. The Organization 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 the standard. As of June 30, 2010 and 2009 there were no liabilities recorded as a result of this guidance. | 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John Porter | |||||||||||||
| 0 | 999189 | 0 | 0 | 0 | 16260 | 0 | 28687 | 0 | 16459 | 0 | 1060595 | 0 | 0 |
| Dr Stephan Schroeder | |||||||||||||
| 0 | 163891 | 0 | 0 | 0 | 2064 | 0 | 2742 | 0 | 15607 | 0 | 184304 | 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: John Porter, President and CEO of Avera Health (related organization), is compensated by Avera Health for his services provided to the related organization. The related organization uses methods identified in question 3 to determine compensation. Schedule J Part II - Compensation from Avera McKennan The compensation of the board member is paid by Avera Health. None of the gross wages and benefits are related to his position on the governing body of Avera Workers' Compensation Trust. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | Avera Health Office of General Counsel serves as the Administrator of the Trust. The Administrator delegates administrative responsibilities to a trust administrator who acts under the direction of the Avera Health General Counsel. The Trust Administrator is an employee of Avera Health, a related organization. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is reviewed by the CEO and CFO of Avera Health. The return is provided to the 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. | |
| Part VI, Section B, Line 15: Compensation is determined by Avera Health. 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 trustee fee is negotiated by the Board. | ||
| Form 990, Part VI, Section C, line 19 | The organization does not make its governing documents, conflict of interest policy or financial statements available to the public. | |
| Form 990 Part XI, Line 2c | The independent auditors are selected and approved by the Avera Health Audit Committee and the independent actuary is selected by Avera Health Management. | |
| Schedule A, Part I, Line 11f(iv) | Avera Workers Compensation Trust was organized by those facilities of Avera Health or its sponsoring religious orders which are identified in the trust document exhibit. The Trust serves as a repository for the employer's funds to meet its obligations to provide workers' compensation benefits to the employer's employees. No organizations are specifically named in the trust document. Instead, the trust agreement defines employer as 'those healthcare facilities and other institutions which are owned or which membership or control of its Board of Directors is controlled by Avera Health'. The facilities and institutions which comprise the employer are identified in Exhibit A to the trust agreement. There is evidence of a historic and continuing relationship with the supported organizations. The amount of support provided on Schedule A, Part IV is related to claims paid on behalf of the employer. | Organizations as identified in Trust Agreement |
| Form 990 Part VII Line 1A Column B | John Porter devotes an average of 40 hours per week to Avera Health. Dr. Stephen Schroeder and Sister Mary M. Thomas serve Avera McKennan 40 hours per week. All other board members serve Avera Health 5 hours per week. | Average hours devoted to related organizations |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (18 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 |
| Presentation College | |||||||||
| 1500 North Main Street | Aberdeen | SD | 57401 | 460280847 | College | SD | 501(c)(3) | 2 | N/A |
| Avera McKennan | |||||||||
| 1325 S Cliff Avenue PO Box 5045 | Sioux Falls | SD | 57117 | 460224743 | Healthcare Services | SD | 501(c)(3) | 3 | N/A |
| Avera Queen of Peace | |||||||||
| Fifth and Foster | Mitchell | SD | 57301 | 460224604 | Healthcare Services | SD | 501(c)(3) | 3 | N/A |
| Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen SD | |||||||||
| 15th Avenue and 2nd Street NW | Aberdeen | SD | 57401 | 460253283 | Monastery | SD | 501(c)(3) | 1 | N/A |
| Avera St Luke's | |||||||||
| 305 South State Street | Aberdeen | SD | 57401 | 460224598 | Healthcare Services | SD | 501(c)(3) | 3 | N/A |
| St Benedict Hospital Inc | |||||||||
| 401 West Glynn Drive | Parkston | SD | 57366 | 460226738 | 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 |
| Avera Holy Family | |||||||||
| 826 North 8th Street | Estherville | IA | 51334 | 420680370 | Healthcare Services | IA | 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 | Yankton | SD | 57078 | 460399291 | Adult Daycare and Homemaking Services | SD | 501(c)(3) | 9 | N/A |
| Avera Education and Staffing Solutions | |||||||||
| 1000 W 4th ST Suite 9 | Yankton | SD | 57078 | 460337013 | Healthcare Education | SD | 501(c)(3) | 9 | N/A |
| Benedictine Health Foundation | |||||||||
| 1017 West Fifth Street Suite 14 | Yankton | SD | 57078 | 460370373 | Support for Organizations Providing Healthcare Services | SD | 501(c)(3) | 11b | 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 Holy Family Foundation | |||||||||
| 826 North 8th Street | Estherville | IA | 51334 | 421317452 | Support of Holy Family Hospital an Home Health Agency | IA | 501(c)(3) | 9 | N/A |
| Avera St Anthony's Hospital | |||||||||
| 300 N 2nd Street | ONeill | NE | 687631569 | 470463911 | Healthcare Services | NE | 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) | 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 |
|---|---|---|---|---|---|---|---|
| Avera Home Medical Equipment LLC | |||||||
| 1325 S Cliff Avenue PO Box 5045 | Sioux Falls | SD | 57117 | 460488198 | Medical Services - Home Medical Equipment | SD | N/A |
| Midwest Regional Imaging Services LLC | |||||||
| 1325 S Cliff Avenue 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 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 Av 102 | Sioux Falls | SD | 57117 | 800619999 | Medical Services - Home Medical Equipment | SD | N/A |
| 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 Street | 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 |
|---|---|---|---|---|---|---|---|---|
| Avera Pace Inc | ||||||||
| 3900 West Avera Drive | Sioux Falls | SD | 57108 | 460341869 | Healthcare Services | SD | N/A | C |
| Accounts Management Inc | ||||||||
| 5132 S Cliff Avenue Suite 101 | Sioux Falls | SD | 57108 | 460373021 | Collection Agency | SD | N/A | C |
| Avera Health Plans Inc | ||||||||
| 3816 S Elmwood Avenue Suite 101 | Sioux Falls | SD | 57108 | 460451539 | Health Financing and Health Plan Admin | SD | N/A | C |
| Avera Property Insurance Inc | ||||||||
| 610 W 23rd Street Ste 1 PO Box 38 | Yankton | SD | 57078 | 460463155 | Insurance | SD | N/A | C |
| Northern Dakota Health Company | ||||||||
| 305 S State Street | Yankton | SD | 57401 | 460385179 | Clinics | SD | N/A | C |
| Valley Health Services | ||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460357149 | Medical Equipment | SD | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | 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 |