2023-05-12T10:23:30-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 460224598 Avera St Luke's AVER 6056225272 305 South State Street Aberdeen SD 57401 Julie Lautt CFO Avera Health 6056225272 2023-05-09 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-05-04 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Daniel Bjerknes 305 South State Street Aberdeen SD 57401 251902496 0 0928 X See Schedule O X 1901 SD Promotion of Health 15 11 1328 23 1369957 0 6884016 6648881 201077251 203538638 1185526 365203 -375199 -336009 208771594 210216713 178976 193606 0 0 109533166 111534406 0 0 19632 90131340 98402531 199843482 210130543 8928112 86170 180080420 172474557 90950665 84504541 89129755 87970016 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 189434761 193606 202257348 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 16 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, radiation, radiology, oncology, therapy, neurology, urology, hematology, psychiatry, neonatology, gastroenterology, and cardiology. Avera St. Luke's provides acute care and long-term healthcare services. Avera St. Luke's Hospital3,336 Acute patient discharges360 Newborn patient discharges43 Swing bed patient discharges123,579 Outpatient visits561 Swing-bed patient days603 Newborn patient days150,529 Clinic visits43,939 Nursing home resident days104 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 $3,758,750.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. 189434761 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 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 124 0 1 1328 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 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 Garrett Wobst MDDirector Surgery/Podiatry 41.00 0.00 X 529593 0 39524 Adam LeFebvre MD Director/Anesthesiology 40.00 0.00 X 503789 0 45414 Tom Seyer Chair 1.00 0.00 X X 0 0 0 Marshall Lovrien Vice Chair 1.00 0.00 X X 0 0 0 Sr Mary Kay Panowicz Director 1.00 5.00 X 0 0 0 Sr Kathleen Bierne Director 1.00 2.00 X 0 0 0 Sr Marietta Kerkvliet Director 1.00 0.00 X 0 0 0 Sr Patricia Prunty Director 1.00 2.00 X 0 0 0 Sandra Kleinknecht Director 1.00 0.00 X 0 0 0 Dick Inman Director 1.00 0.00 X 0 0 0 Michael Herman Director 1.00 0.00 X 0 0 0 John Fritz MD Director 1.00 0.00 X 0 0 0 Diana Reynen Director 1.00 0.00 X 0 0 0 Heidi Golz Director 1.00 0.00 X 0 0 0 Kristen Fauth Director 1.00 0.00 X 0 0 0 Todd Forkel - Left 22022 President/CEO 25.00 17.00 X 0 721953 40612 Julie Lautt CFO Avera Health; Sec/Treas 0.10 46.30 X 0 1051228 16194 Tom Snyder VP Long Term Care 40.00 0.00 X 228723 0 25718 Brandon Fites MD Orthopedic Surgery/Sports Medicine 40.00 0.00 X 2752594 0 47904 Sushell Gundewar MD Cardiology 40.00 0.00 X 1889680 0 52390 Daniel Fritz MD Radiology 40.00 0.00 X 1126777 0 52370 Christopher Larson MD General Surgery 40.00 0.00 X 1259229 0 51691 Roger Werth MD General Surgery 40.00 0.00 X 1222695 0 46914 9513080 1773181 418731 130 0 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 571085721 Shared services 22509739 Avera McKennan PO Box 5045 Sioux Falls SD 57117 Shared services 2966502 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Contract labor 1212606 Restorix Health Inc 445 Hamilton Ave Ste 800 White Plains NY 10601 Medical services 844346 Concord Physician Solutions Inc 2304 Thornton Rd Unit A Austin TX 78704 Locum Fees 481926 20 45294 6603587 6648881 Net Patient Revenue 621110 198766714 198766714 Supporting Revenue 624100 4038243 2668286 1369957 Investment in Partnership 900099 733681 733681 203538638 69457 69457 415347 840023 -424676 -424676 -424676 41132356 9150 40779998 65762 352358 -56612 295746 295746 A/R Interest Income 900099 88667 88667 88667 210216713 202257348 1369957 -59473 X 193606 193606 1387805 1144479 243326 1073597 1073597 88673921 86994821 1679100 4322017 4232204 89813 10877623 10518734 358889 5199443 5074280 125163 24578 24578 8257 8257 37136655 21984849 15151382 424 46146 35218 10928 1602102 1307437 277452 17213 1114770 690804 423966 2288530 2105884 182646 440611 412140 28471 245102 238165 6937 2188439 1807161 381278 6621370 6094814 525858 698 1459265 572634 886631 Medical Supplies 43995543 43866149 128097 1297 Equipment Lease/Rental 263533 261622 1911 967630 826163 141467 210130543 189434761 20676150 19632 3923005 2385247 25270098 25273395 3988488 5145631 1220570 1716489 187550056 119365157 70722748 68184899 34314970 24976587 1313273 2956922 38880642 41593317 446626 242070 180080420 172474557 15758567 16792861 1250111 378277 64977853 62780127 64335 63114 8899799 4490162 90950665 84504541 X 86131393 85094605 2998362 2875411 89129755 87970016 180080420 172474557 X 86170 -3060672 1814763 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 8257 8257 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 1368473 21018 190 13 1389288 1304159 64327 13 1368473 1284673 30649 10626 537 1304159 1248105 45961 9386 7 1284673 2983726 65876 1801473 24 1248105 0.40789 0.59211 0.00000 0 1 1 1302022 4913892 6215914 134312340 84700854 49611486 44518398 33055335 11463063 2503404 1608968 894436 68184899 Avera Pooled Investments 21094703 F Investment in Avera Health Foundation 3881884 F 24976587 Interest Rate Swap Agreement 664160 Interest Payable 183515 Estimated Third Party Payor Settlements 2068725 Right of Use Operating Lease Obligations 246785 Deferred Payroll Taxes 1313240 Due to Related Party 13737 4490162 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. 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 0 923597 923597 0.00440 11407110 7303363 4103747 0.01950 929626 818951 110675 0.00050 13260333 8122314 5138019 0.02440 6164 6164 0.00000 207299 207299 0.00100 7899826 5675194 2224632 0.01060 612411 612411 0.00290 8725700 5675194 3050506 0.01450 21986033 13797508 8188525 0.03890 4470 4470 0.00000 2777 2777 0.00000 948 948 0.00000 215612 57729 157883 0.00080 10000 10000 0.00000 233807 57729 176078 0.00080 1 8650850 57867185 63903010 -6035825 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 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: 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. 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. 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. Patients will have access to emergency mental health care with the opening of a new stand-alone behavioral health facility, projected to open in 2024. A donation to Avera Health will help revitalize and update our emergency department within the next few years. It remains important that current and prospective patients know how to access care and which level of care to access. Avera St. Luke's continued to address the three prioritized needs resulting from the 2018 Community Health Needs Assessment: Preventative Care and Removing Barriers to Health Needs, Health Care Affordability, and Transportation Needs.Preventive Care and Removing Barriers to Health Needs:FY2022 Update:The COVID-19 pandemic often led us to focus on other community health needs like staying healthy, masking, and getting vaccinated. But with this, we helped to remove barriers to ensure our community had access to COVID-19 resources and materials by providing masks to area schools and nonprofits, providing otherwise hard to find thermometers to local schools, and hosting several vaccination clinics, sometimes even meeting people where they already were (i.e. Arts in the Park, Northern State University and Presentation College, area business partners, etc.). Avera St. Luke's administered tens of thousands of vaccines and had great success with educating the community on the importance of being vaccinated. COVID-19 also led to a huge increase in patients for Avera at Home, a true way to keep patients in their home and meet them where they were. We also began our Home to Hotel program, partnering with MyPlace Hotels. With this, surgical patients were discharged to MyPlace for an overnight stay. It allowed them the comfort of being close the hospital without being an inpatient. We update our 211 helpline information annually (and as needed) to ensure the community has access to all areas of life assistance and quality health programs.Health Care Affordability:FY2022 Update: Social workers continue to assist patients on navigation through Medicare, Medicaid, Disability and insurance exchange programs. Access and navigation assistance to medication programs and medical equipment needs are also available. Since navigating surges in positivity rates and hospitalization throughout the COVID-19 pandemic, we have been able to once again focus on preventative care, offering a series of screenings, encouraging annual wellness checks, and prioritizing other preventative care measures. Preventative care can help reduce the cost of emergency care or the care of chronic or serious diseases and conditions through early diagnosis. ACO's continue to reduce in-patient hospital stays and prevent a lower incident of further developing chronic disease. In January 2021, the Centers for Medicare and Medicaid Services (CMS) began to require hospitals to provide a price estimator tool. Thus, Avera is proud to be a leader in providing consumers with easily accessible, understandable and reliable information about health care costs. We offer an online tool to let consumers compare price estimates for a wide range of health care services. We've also worked to develop a brochure and communication that helps patients understand where to receive care depending on their health concern/issue/levels of crisis. The goal remains to decrease unnecessary costs for health care needs that can be handled when individuals go to the proper location.Transportation Needs:FY2022 Update:With the help of the Avera Foundation, the Avera Cancer Institute Aberdeen, and our Wound Care department, we provided gas cards and Ride Line punch cards to those needing transportation assistance. We also paid some transportation bills. As mentioned above, our Home to Hotel program also kept surgical patients close to the hospital without the cost of a night's stay, and without needing to drive home and back for a next day appointment. 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 - Avera Clinic of Ellendale 240 Main St Ellendale ND 58436 Clinic 5 - 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 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. We are a health ministry co-sponsored by the Benedictine Sisters of Yankton, South Dakota and the Presentation Sisters of Aberdeen, South Dakota. Our health ministry is rooted in the Gospel and requires us to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. Avera St. Luke's vision is tobe an exceptional health care organization for patients to receive care, physicians to practice and employees to work. The Organization's values are Compassion, Hospitality and Stewardship. Our governing body consists of 15 members who are physicians, community and regional residents and Sister representatives from the Presentation and Benedictine Orders. In addition, the CEO serves on the board as a non-voting member. In addition to the governing body, we have one advisory board. This includes Northern State University Business School. Medical Staff privileges can be extended to qualified physicians based on receiving approval of their application and credentials by the Medical Staff and the Hospital governing body. The Hospital's governing body takes into account other factors related to overall community need and how a physician would impact the Hospital's overall ability to fulfill the mission. Avera St. Luke's mission and values ensure our focus is on the patient, family, employees, physicians, those in need, visitors and our region as a whole. The value of Stewardship requires the organization to use all resources in a way that fulfills the mission and values. 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 milesb. 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 theirarea's patients in the local community when possible.j. Recruitment of specialists in nephrology, neurology, cardiology and psychiatry to meet the region's need 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 150-200miles. 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. 1 Aberdeen Library Foundation 215 SE 4th Avenue Aberdeen SD 57401 460428183 501(c)(3) 20000 0 New Library Building Funding Presentation College 1500 N Main St Aberdeen SD 57401 522424588 501(c)(3) 163800 0 Nursing Education Scholarship 2 0 Part I, Line 2: The organization provides grants/contributions to other organizations which are tax-exempt under IRC 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. 0 0 0 0 0 0 0 0 0 Brandon Fites MD Orthopedic Surgery/Sports Medicine 1498951 0 1249546 0 4097 0 14500 0 33404 0 2800498 0 0 0 Sushell Gundewar MD Cardiology 1523618 0 362294 0 3768 0 14500 0 37890 0 1942070 0 0 0 Christopher Larson MD General Surgery 1183483 0 71650 0 4096 0 14500 0 37191 0 1310920 0 0 0 Roger Werth MD General Surgery 1118302 0 82850 0 21543 0 14500 0 32414 0 1269609 0 0 0 Daniel Fritz MD Radiology 861569 0 261890 0 3318 0 14500 0 37870 0 1179147 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0 1032072 0 10440 0 8716 0 14500 0 1694 0 1067422 0 0 Todd Forkel - Left 22022 President/CEO 0 713453 0 0 0 8500 0 6948 0 33664 0 762565 0 0 Garrett Wobst MDDirector Surgery/Podiatry 433466 0 93391 0 2736 0 14500 0 25024 0 569117 0 0 0 Adam LeFebvre MD Director/Anesthesiology 480564 0 20225 0 3000 0 14500 0 30915 0 549204 0 0 0 Tom Snyder VP Long Term Care 210889 0 10100 0 7734 0 11439 0 14278 0 254440 0 0 0 Schedule J, Part I Line 3: The President/CEO serves Avera St. Luke's, Avera St. Mary's, and Avera Gettysburg and 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 460789 Compensation and benefits as an employee 0 Daniel Fritz Family member of board member John Fritz 514912 Compensation and benefits as an employee 0 Bari Fritz Family member of board member John Fritz 97896 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, Todd Forkel, and Sister Mary Kay Panowicz 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 reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. 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 Repairs and Maintenance: Program service expenses 3,266,971. Management and general expenses 12,098. Fundraising expenses 391. Total expenses 3,279,460. Purchased Services: Program service expenses 10,487,077. Management and general expenses 418,694. Fundraising expenses 33. Total expenses 10,905,804. Centralized Services: Program service expenses 5,889,096. Management and general expenses 14,546,256. Fundraising expenses 0. Total expenses 20,435,352. Medical Prof Fees: Program service expenses 2,341,705. Management and general expenses 174,334. Fundraising expenses 0. Total expenses 2,516,039. Form 990, Part XI, line 9: Change in Interest in Avera Foundation -156,259. Change in Fair Value of Interest Rate Swap 599,406. Transfers 389,787. Change in Interest in Endoscopy 981,829. 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 Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 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 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 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 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 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 Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 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 at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 10 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 Sacred Heart Health Services 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 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 Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Surgical Associates Endoscopy Center LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates/Endoscopy services SD Avera St Luke's Related 724434 293408 0 0 0.51000 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 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 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare services 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 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 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 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 Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency 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 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 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 Alucent Australia Pty Ltd Level 10 30 Collings Street Melbourne VIC 3000 AS Biotech Research AS N/A 0 1 0 1 0 0 0 0 1 0 0 1 1 1 0 1 0 1 0 1 Surgical Associates Endoscopy Clinic LLC L 556234 General Ledger Surgical Associates Endoscopy Clinic LLC S 693000 K-1 distribution Surgical Associates Endoscopy Clinic LLC A 85548 General Ledger