2024-05-14T15:12:44-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 460224598 Avera St Luke's AVER 6056225272 305 South State Street Aberdeen SD 57401 Julie Lautt CFO Avera Health 6056225272 2024-05-08 1 Julie Lautt XXX-XX-XXXX 1 Kim Hunwardsen CPA P00484560 6122536500 2024-04-30 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Daniel Bjerknes 305 South State Street Aberdeen SD 57401 211511125 0 0928 X See Schedule O X 1901 SD Promotion of health 14 11 1313 23 1899140 0 6648881 720538 203538638 196613050 365203 191456 -336009 2603735 210216713 200128779 193606 13020 0 0 111534406 111776241 0 0 21220 98402531 97383165 210130543 209172426 86170 -9043647 172474557 155386406 84504541 76429350 87970016 78957056 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 191736662 13020 197826051 Avera St. Luke's mission is to provide healthcare services to Aberdeen, South Dakota residents and residents of the surrounding area. Avera St. Luke's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Luke's consists of 50 acute beds, 10 inpatient behavioral health beds, an 81 bed nursing home in Aberdeen, SD, a 56 bed nursing home in Eureka, SD, a 2-bed surgical center in Aberdeen, SD, and 17 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, radiation, radiology, oncology, therapy, urology, hematology, psychiatry, pulmonology, nephrology, podiatry, ear nose and throat, pain management, and cardiology. Avera St. Luke's provides acute care and long-term healthcare services. Avera St. Luke's Hospital 3,354 Acute patient discharges 354 Newborn patient discharges 29 Swing bed patient discharges 154,782 Outpatient visits 285 Swing-bed patient days 569 Newborn patient days 142,201 Clinic visits 44,546 Nursing home resident days 124 Long Term Care patient dischargesAvera St. Luke's maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $5,152,117.Avera St. Luke's also provides community benefit health activities at less than or at no cost to support those in the area served, see Schedule H. As a member of the Avera Health Network, Avera St. Luke's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Luke's engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 191736662 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 129 0 1 1313 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 11 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Thomas Seyer Chair 1.00 0.00 X X 0 0 0 Heidi Golz Vice Chair 1.00 0.00 X X 0 0 0 Marshall Lovrien Board Member (until 12/2022) 1.00 0.00 X X 0 0 0 Sr Kathleen Bierne Board Member 1.00 2.00 X 0 0 0 Kristen Fauth Board Member 1.00 0.00 X 0 0 0 Shane Franks Board Member 1.00 0.00 X 0 0 0 John Fritz MD Board Member 1.00 0.00 X 0 0 0 Michael Herman Board Member 1.00 0.00 X 0 0 0 Richard Inman Board Member 1.00 0.00 X 0 0 0 Sr Marietta Kerkvliet Board Member 1.00 0.00 X 0 0 0 Adam LeFebvre MD Board Member/Anesthesiology 41.00 0.00 X 533168 0 46560 Sr Mary Kay Panowicz Board Member 1.00 5.00 X 0 0 0 Sr Patricia Prunty Board Member 1.00 0.00 X 0 0 0 Diana Reynen Board Member 1.00 0.00 X 0 0 0 Garrett Wobst MD Board Member/Orthopedic Surgery 41.00 0.00 X 544407 0 41564 Julie Lautt CFO Avera Health;Secretary/Treasurer 0.10 46.30 X 0 1086452 17088 Daniel Bjerknes President/CEO (Beg 08/2022) 41.00 0.00 X 0 211303 8894 Tom J Snyder VP - Strategy Network Ops and LTC 40.00 0.00 X 220869 0 26711 Brandon Fites MD Sports Medicine, Surgery and Ortho 40.00 0.00 X 2034733 0 49050 Daniel Fritz MD Radiology 40.00 0.00 X 1083485 0 53065 Sushell Gundewar MD Cardiology 40.00 0.00 X 1720029 0 54164 Christopher Larson MD General Surgery 40.00 0.00 X 1326777 0 53164 Roger Werth MD General Surgery 40.00 0.00 X 1206329 0 43417 Todd Forkel Former President/CEO 0.00 0.00 X 0 113998 11419 8669797 1411753 405096 153 1 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 571085721 Shared services 21789483 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Contract labor 4731963 Avera McKennan PO Box 5045 Sioux Falls SD 57117 Shared services 2032115 Restorix Health Inc 445 Hamilton Ave Ste 800 White Plains NY 10601 Medical services 1046992 Avel eCare Medical Group 4500 N Lewis Ave Sioux Falls SD 57104 eCare services 748274 28 185295 532109 3134 720538 Net Patient Revenue 621110 190760313 190309162 451151 Patient and Clinic Revenue 621110 1579879 1579879 Investment in Partnership 900099 840330 840330 3432528 3432528 196613050 93929 93929 254023 762430 -508407 -508407 -508407 84977 12550 0 0 84977 12550 97527 97527 13532425 10619916 2912509 1464520 1447989 A/R Interest Income 900099 199633 199633 199633 200128779 197826052 1899140 -316951 X 13020 13020 1483947 1225456 258491 2162381 2162381 88387519 86692863 1694656 3027599 2959130 68469 11629505 11345169 284336 5085290 4962537 122753 173814 112200 61614 7481 7481 38045887 25413795 12626961 5131 25058 18118 6440 500 1319669 1096287 215397 7985 734931 726064 8867 2248439 2058435 190004 370892 351112 19780 400855 398418 2437 2330256 1922795 407461 6673633 6166700 506235 698 1348433 607523 740910 Medical Supplies 42359336 42292953 59483 6900 Equipment Lease/Rental 230399 230339 60 1114082 981367 132709 6 209172426 191736662 17414544 21220 2385247 41670 25273395 28031852 5145631 5028788 1716489 1034330 188240045 124325270 68184899 63914775 24976587 12871473 2956922 1367227 41593317 41350782 242070 1745509 172474557 155386406 16792861 14608812 378277 111876 62780127 60470223 63114 16964 4490162 1221475 84504541 76429350 X 85094605 75841229 2875411 3115827 87970016 78957056 172474557 155386406 X -9043647 827418 -1416097 619366 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7481 7481 0 Part II-B, Line 1: Avera St. Luke's paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1465145 100544 20511 1545178 1635977 -170630 202 1465145 1391327 244663 13 1635977 1407609 -5119 11163 1391327 1321544 95458 9393 1407609 0.40389 0.36251 0.23360 0 1 1 1122022 4913892 6035914 132999042 86697423 46301619 45668207 35965168 9703039 3536882 1662679 1874203 63914775 Avera Pooled Investments 8245795 F Investment in Avera Health Foundation 4215692 F Investment in Subsidiaries 409986 F 12871473 Deferred Payroll Taxes 8319 Estimated Third Party Payor Settlements 643443 Derivative Liability 378778 Right of Use Operating Lease Obligations 140185 Security Deposits 50750 1221475 X Part IV, Line 2b: The organization holds funds in trust on behalf of its residents. Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any,) are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization's permanently restricted endowment funds are donor restricted. The endowment fund calculation was changed in current year and all amounts for prior years have been updated to properly reflect the new calculation. Part X, Line 2: Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 1694000 1694000 0.00810 13279774 8936618 4343156 0.02080 397351 197546 199805 0.00100 15371125 9134164 6236961 0.02990 6824 6824 0.00000 233108 233108 0.00110 6526433 4745987 1780446 0.00850 795785 22661 773124 0.00370 7562150 4768648 2793502 0.01330 22933275 13902812 9030463 0.04320 1365 1365 0.00000 172653 172653 0.00080 5082 5082 0.00000 455 455 0.00000 10000 10000 0.00000 189555 189555 0.00080 1 6337489 58404672 68189435 -9784763 X 1 1 1 Surgical Associates Endoscopy Clinic LLC Endoscopy Procedures 0.51000 0.49000 1 1 Avera St Luke's 305 South State Street Aberdeen SD 57401 See Part V Section C 10525 X X X 14 provider based clinics, 1 rural health clinic Avera St Luke's 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V Section C X See Part V Section C X 1 21 1 See Part V Section C 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V Section C X See Part V Section C X See Part V Section C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera St. Luke's Part V, Section B, Line 5: Avera St. Luke's CHNA data was obtained by way of an online survey that launched on April 7, 2022. This was followed by personal meetings with our Public Health providers, as well as emails and communications to regional and community organizations and the general public inviting their participation in the survey. The survey was also posted to and available through Avera St. Luke's Facebook page. The survey closed April 15, 2022. The hospital invited a vast array of groups and approximately 80 businesses in Aberdeen and the surrounding area to participate, which included: *Aberdeen Chamber of Commerce, which included the survey in their Monday morning Chamber email *Aberdeen Chamber committees *Aberdeen Area Fire and Rescue *Social Work Department, which sent the survey to all the organizations and food banks they work with such as the Salvation Army and Journey Home*Mission and Chaplaincy, which forwarded on to all area priests in our region *Boys and Girls Club families *United Way, which sent it to organizations and board members *Aberdeen City Council *City of Aberdeen via its Human Resource Department *Brown County Health*ASL employees *ASL Facebook page, which is open to the public *ASL Patient and Family Advisory Committee *Presentation Sisters*Aberdeen Area Diversity Coalition Avera St. Luke's Part V, Section B, Line 11: The Community Health Needs Assessment survey was completed in FY2022. An internal team at Avera St. Luke's reviewed survey results and identified the top three health needs from the survey. This decision was based on the severity of the issue, our current involvement in these areas, and our professional outlook. Our overall focus is to review these opportunities and identify current programs already in place that will address the following health needs: Mental Health issues, Hospice and End of Life Care, and Access to Care/Urgent Care. 1. Mental Health: Avera St. Luke's has announced a significant investment in our region, which includes a stand-alone behavioral health facility and access to emergency mental health care. With the onboarding of our new CEO, Dan Bjerknes, we had the opportunity to re-evaluate the building project. After much discernment, the new plan will be to utilize existing space and remodel to accommodate the Behavioral Health Department while still providing the improvements sited in our original plan. We have also received a State Grant that will support the programmatic needs for our staff and residents and assist with an adolescent area. This will also be a safer location as it will be secured and have direct access from our Emergency Department. We have an approved design and layout for the remodel and look to begin this project soon.2. Hospice Care: A multi-disciplinary team has been created to take a deeper look into hospice needs in our region. That team will report their findings to our Administration and Board of Directors. The Team has worked to find space that will be transformed into 2 Hospice suites, space for family, and a conference room for our Avera@Home staff to meet with family members. We are currently working with philanthropy to support the needs for this space. 3. Access to Care/Urgent Care: It's likely that the results of this survey were affected by the limited access to care and urgent care during the COVID-19 pandemic. At times, our Urgent Care was not available. Patients also stopped seeking routine care, and many of our resources were reallocated to serve an influx of COVID-19 patients. However, with a decrease in COVID-19, we have been able to reestablish set hours for our Urgent Care and Primary Care Providers. It remains important that current and prospective patients know how to access care and which level of care to access. We have updated our brochure and communications by working with our marketing director.There are needs identified in the Community Health Needs Assessment which Avera St. Luke's has not included in its priority implementation plan. These needs were not included in the priority needs implementation plan in order to focus resources on the three most urgent health care needs. We continue to address these needs throughout the Avera St. Luke's Region using the appopriate standards of care. Avera St. Luke's Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera St. Luke's Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, waiting rooms, and admissions office and is included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera St. Luke's Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera St. Luke's Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section A organization's website: avera.org/locations/st-lukes-hospital/ Part V, Section B, Line 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/#st-lukes Part V, Section B, Line 16a, 16b, and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 4 1 - Avera Mother Joseph Manor 1002 N Jay Street Aberdeen SD 57401 Nursing Home, Assisted and Congregate Living 2 - Avera Eureka Health Care Center E Hwy 10 Eureka SD 57437 Skilled Nursing Facility 3 - AMG Radiation Oncology 310 S Penn St Ste 105 Aberdeen SD 57401 Clinic 4 - Pain Management Center 701 8th Ave NW Ste C Aberdeen SD 57401 Clinic Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 6a: The community benefit report is prepared by a related organization, Avera Health, and is available to the public at https://www.avera.org/about/annual-report/. Part I, Line 7: A combination of costing methodologies were used to calculate the amounts reported in the table. A cost-to-charge ratio derived from Worksheet 2, ratio of patient care cost-to-charges was used to calculate charity care at cost, unreimbursed Medicaid and Means-Tested Government Program expenses. Subsidized health was calculated based on actual cost/loss. For all other amounts, costs and revenues as reflected by the general ledger system were used. Part II, Community Building Activities: NATIONAL NIGHT OUT - National Night Out is an annual community-building campaign that promotes police/community partnerships and neighborhood comaraderie to make our neighborhoods safer, more caring places to live. National Night Out enhances the relationship between neighbors and law enforcement. Our local sponsor, the Aberdeen Police Department, invites local organizations to participate each year in this event held on the first Tuesday of August at Melgaard Park. A free meal is served by volunteers from many organizations and entertainment is offered to all free of charge. Avera St. Luke's participated in the event on August 3, 2021 by offering a booth with games and prizes with our focus on child safety. The event brings out around 1,500 to 2,000 children and families for a fun evening.ASPIRE/SD DEPT OF VOC REHAB - Project SEARCH provides internships for high school students with disabilities in their last year of high school and assists in helping students attain work skills and prepare them for a job. Students chosen for the program are ready to join the workforce and do not have plans to go to college but have skills that would enable them to be gainfully employed. We want to assist in meeting the community workforce needs as well as help these students obtain employment vs. being on federal assistance. Avera St. Luke's donated to the Aberdeen Park and Recreation Board. The donation was used to build an all-inclusive, handicap-accessible playground inside Storybook Land. The new playground was named after Nano Nagle, the founder of the Presentation Sisters. The playground will give all children a place to play together.Through the Avera Human Performance Center, athletic trainers offer high quality sports medicine care to regional school districts by assisting student athletes with acute injuries or rehabilitating chronic sprains and strains. Athletic trainers are provided to the school district as an extension of the athletic department through a sports medicine partnership with Avera St. Luke's.Because solid community partnerships are important, Avera has committed $80,000 over four years to the Boys and Girls Club of Aberdeen Area. Many of Avera St. Luke's employees utilize the services the club offers which means this gift will not only greatly benefit the community but also our own workforce. In fact, Avera is the largest employer in the Aberdeen area using the club's after school program services. The donation will assist the Boys and Girls Club to help grow its membership and programming capability to its pre-COVID numbers through scholarships. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 19 and 20. Part III, Line 8: Avera St. Luke's provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare program are not completely covered, the Medicare shortfall is considered a community benefit. 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 Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: Health Care needs are assessed through various methods. Given Aberdeen is a regional center/hub and the third largest city in South Dakota, Avera St. Luke's is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. Although another smaller hospital opened in Aberdeen during FY 2013, the next largest hospital is 100 miles from Aberdeen, and most of the towns within our region have a population of less than 2,000. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. Our fourth community health needs assessment (CHNA) was completed and posted to our website by June 30, 2022. The identified areas of need highlighted for further research and comparison are Mental Health issues, Hospice and End of Life Care and lastly Access to Care/Urgent Care. The overall goal is to focus on removing all barriers to health. Part VI, Line 3: Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs. Part VI, Line 4: Avera St Luke's includes a 50-bed hospital and a 10-bed mental health unit in Aberdeen, South Dakota. The primary service area is defined as Brown County, South Dakota, including the communities of Aberdeen, Frederick, Groton, Hecla, and Leola. Brown County is the focus of the Avera St. Luke's Community Health Needs Assessment. The total population as of 2022 is 39,780, which places it as the fourth largest county in South Dakota. Brown County is also the most populated county in the Avera St. Luke's service area. 57% of residents served are between the ages of 18 and 64. 87% of Brown County's population consists of people who are of White Ethnicity. Brown County has seen an increase of people from other ethnic backgrounds. Because we are all created in God's image and belong to the same human family, Avera has worked hard to meet the growing need to address complex issues within our footprint. Through our system initiatives, Avera St. Luke's is committed to evaluating the health needs and priorities of all members of our community without regard to race or ethnicity. Programs and support are added to address the identified needs as appropriate. The unemployment rate in South Dakota is at 2.55% while the rate in Brown County is at 2.8%, both of which are better than the national average of 3.6%. According to the U.S. Census Bureau as of July 1, the income per capita for the county is $33,535 and the median household income is $61,816. However, the rate of persons below the poverty level in Brown County is 9.1%. Approximately 12.2% of the county's population is uninsured, while the State average is 15%. Although Brown County's numbers are slightly better than the state and national statistics in these categories, Avera has identified opportunities. Part VI, Line 5: Avera St. Luke's is a regional facility within Avera Health System. Each year, our operating and capital budgets are based on various assumptions that in the end provide the needed resources and take into account charity care, patient care, technology, education, community services, employee benefit, and compensation plans and programs for meeting the region's needs. All surplus funds are used and maintained to provide for both current and future needs.Specific examples of how we further our exempt purpose include but are not limited to the following: a. The only inpatient psychiatric unit within 200 miles. b. Interventional Cardiology and Radiology services. These services allow us to meet patient needs when care is critical to their survival and must be delivered on a very timely basis. c. Air Ambulance to transport patients to our facility or 200 miles to tertiary facilities. d. End Stage Renal Disease program which serves our broad region with the next closest facility being 100 miles away. Additionally, we employ a full-time Nephrologist to care for the patients along with others who require intensive physician care. e. A 24-hour Emergency Room which treats all patients without regard to the ability to pay. The ER is staffed by physicians 24 hours per day. f. Provision of a multitude of educational and training programs for healthcare professionals and regional residents. The region was awarded an Area Health Education Center by the South Dakota School of Medicine and will be located in Aberdeen. The award was based on applications and interviews within the State and was a collaborative effort of many healthcare and non-healthcare organizations within the region with two being 100 miles from Aberdeen. g. Avera St. Luke's is currently a Rural Referral Center. The nearest hospitals are tertiary facilities 200 miles away by ground and approximately 140 miles by air. h. Avera St. Luke's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (College/University Advisory Boards, Marshall County Health Center, Chamber of Commerce, Area Health Education Center (AHEC), United Way and the YMCA). Other community involvement includes the Sertoma Club, Junior Achievement, Northern Brown County Community Foundation, Diversity Committee, Aberdeen Hockey Association, American Foundation for Suicide Prevention and CoJourner for the Presentation Sisters (Lay Associate). i. Provide assistance to small rural hospitals (Critical Access Hospitals) within the region through various programs, management agreements, computer systems, education and other services to assist in keeping their area's patients in the local community when possible. j. Recruitment of specialists in nephrology, neurology, cardiology, family medicine, orthopedic, pulmonology, radiation, oncology, pediatrics, general surgery, urology, rheumatology, internal medicine, and psychiatry to meet the region's needs in order to eliminate travel of 200 miles to obtain these services. k. Development and subsidy of various rural clinics to meet needs in those communities. l. Chemical Addiction services on an outpatient basis are provided to the region and State. Our Addiction Care program is well known and respected within the region and state and is the closest program within 150-200 miles. We contract with the State for patients who meet their qualification guidelines and work with governmental agencies within the region and State. m. Provide drug and alcohol prevention programs to the local schools through various contracts. Our involvement started when the previous provider discontinued their contract. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 0 0 0 0 0 0 0 0 0 Brandon Fites MD Sports Medicine, Surgery and Ortho 2010962 0 20882 0 2889 0 15250 0 33800 0 2083783 0 0 0 Sushell Gundewar MD Cardiology 1520748 0 197122 0 2159 0 15250 0 38914 0 1774193 0 0 0 Christopher Larson MD General Surgery 1290199 0 33689 0 2889 0 15250 0 37914 0 1379941 0 0 0 Roger Werth MD General Surgery 1167096 0 18200 0 21033 0 15250 0 28167 0 1249746 0 0 0 Daniel Fritz MD Radiology 868133 0 213273 0 2079 0 15250 0 37815 0 1136550 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0 1075517 0 460 0 10475 0 15250 0 1838 0 1103540 0 0 Garrett Wobst MD Board Member/Orthopedic Surgery 430905 0 112048 0 1454 0 15250 0 26314 0 585971 0 0 0 Adam LeFebvre MD Board Member/Anesthesiology 494191 0 37400 0 1577 0 15250 0 31310 0 579728 0 0 0 Tom J Snyder VP - Strategy Network Ops and LTC 216884 0 725 0 3260 0 11078 0 15632 0 247579 0 0 0 Daniel Bjerknes President/CEO (Beg 08/2022) 0 177939 0 10000 0 23364 0 1011 0 7883 0 220197 0 0 Todd Forkel Former President/CEO 0 112827 0 0 0 1171 0 5725 0 5693 0 125416 0 0 Schedule J, Part I Line 3: The President/CEO was compensated by a related organization, Avera Health. Avera St. Luke's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Dr Matthew Reynen Husband of board member Diana Reynen 501759 Compensation and benefits as an employee 0 Daniel Fritz Family member of board member John Fritz 1430895 Compensation and benefits as an employee 0 Bari Fritz Family member of board member John Fritz 229726 Compensation and benefits as an employee 0 Form 990, Item J The organization's website is: avera.org/locations/st-lukes-hospital/ Form 990, Part VI, Section A, line 2 Julie Lautt, Sister Mary Kay Panowicz, Daniel Bjerknes, and Todd Forkel have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and reviewed by an independent accounting firm. The Form 990 is then reviewed by the Avera Health VP of Financial Reporting and Tax Manager. After initial internal review, the Form 990 is made available to various members of Avera Health Executive Management, including the Avera Health CFO, President/CEO and COO. In addition, the Form 990 is made available to the Facility CEO, other Operation Finance Leaders and the Facility Board members. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. Form 990, Part VI, Section B, line 15b The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Depending on the individual's role with the organization, some officers and key employees are compensated by Avera St. Luke's. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not available to the general public. The organization's financial statements are attached to the Form 990 per IRS instructions and therefore are available to the general public. Form 990, Part IX, line 11g Purchased Services: Program service expenses 12,743,297. Management and general expenses 566,663. Fundraising expenses 4,826. Total expenses 13,314,786. Medical Professional Fees: Program service expenses 2,505,922. Management and general expenses 9,100. Fundraising expenses 0. Total expenses 2,515,022. Repairs & Maintenance: Program service expenses 3,641,783. Management and general expenses 11,088. Fundraising expenses 305. Total expenses 3,653,176. Centralized Services: Program service expenses 6,522,793. Management and general expenses 12,040,110. Fundraising expenses 0. Total expenses 18,562,903. Form 990, Part XI, line 9: Change in Fair Value of Interest Rate Swap 285,382. Change in Interest in Avera Foundation 333,984. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Luke's. Form 990, Part VI, Section B, Line 16b: There is no written policy or procedure since in the event of any such proposed transaction the board or a committee with delegated authority reviews all materials, valuations and operational aspects for any proposed transaction. Such transaction would be evaluated in accordance with the exempt status of the organization and its applicable purposes. Any transaction also would be approved by the board and the member. Form 990, Part X, Line 20: The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg and Avera at Home. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN: 46-0422673.) Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of health SD 501(c)(3) Line 10 N/A 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5300 S Broadband Lane Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 10 Avera Health 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan admin SD 501(c)(4) Avera Health 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 Avera Health 0 Avera Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 Holy Family Hospital Foundation 826 North 8th Street Estherville IA 51334 421317452 Support health related services IA 501(c)(3) Line 10 Avera Holy Family 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare services SD 501(c)(3) Line 10 Avera Health 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 2301 Hwy 71 South Ste D Spirit Lake IA 51360 862949748 Medical services - home medical equipment IA N/A 0 0 Avera Home Medical Equipment of Sioux Center LLC 38 19th St Sw Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical services - home medical equipment SD N/A 0 0 Brookings Health System - Avera Home Medical Equipment LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 7509 NW Tiffany Springs Parkway Ste Kansas City MO 64153 611843657 Accountable care organization MO N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 821447782 Accountable care organization MO N/A 0 0 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare services SD N/A 0 0 Surgical Associates Endoscopy Center LLC 310 S Pennsylvania Street Suite 201 Aberdeen SD 57401 460461429 Surgical Associates/ Endoscopy Services SD Avera St Luke's Related 305444 96852 1 0 0.51000 Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency SD N/A C 0 Alucent Australia Pty Ltd Level 10 30 Collings Street Melbourne VIC 3000 AS Biotech Research AS N/A 0 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 5300 South Broadband Lane Sioux Falls SD 57108 460424322 Insurance SD N/A C 0 Kore Cares In Home Services LLC 5300 South Broadband Lane Sioux Falls SD 57108 882778902 In-home care services SD N/A S 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 1 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 Surgical Associates Endoscopy Clinic LLC L 149580 General Ledger Surgical Associates Endoscopy Clinic LLC S 502000 K-1 Distribution Surgical Associates Endoscopy Clinic LLC A 119669 General Ledger Surgical Associates Endoscopy Clinic LLC O 516092 General Ledger Surgical Associates Endoscopy Clinic LLC P 55407 General Ledger Form 990, Schedule R, Part II St. Benedict Health Center Foundation dissolved as of December 31, 2022.