2025-05-14T14:18:06-05:00 2024-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-07-01 460224604 Avera Queen of Peace AVER 6059966531 525 N Foster Mitchell SD 57301 Julie Lautt CFO Avera Health 6059952251 2025-05-09 0 1 Kim Hunwardsen CPA P00484560 6122536500 2025-05-06 2023 2025-03-06 01:10:19Z Avera Queen of Peace Health Service Hilary Rockwell 525 N Foster Mitchell SD 57301 144187525 0 0928 X See Schedule O X 1905 SD Promotion of health 15 12 860 60 76677 0 389291 1079869 130773538 138016143 682898 1835209 1665129 1649945 133510856 142581166 44405 774062 0 0 69325678 74773489 0 0 36751 59669824 61439476 129039907 136987027 4470949 5594139 169784455 180639963 41104298 39120261 128680157 141519702 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 127668971 774062 138480581 Avera Queen of Peace's mission is to provide healthcare services to Mitchell, South Dakota residents and residents of the surrounding area. Avera Queen of Peace is a 501(c)(3) organization affiliated with Avera Health. Avera Queen of Peace consists of a 25-bed critical access hospital and an 84-bed nursing home in Mitchell, SD, a 16-bed critical access hospital in Wessington Springs, SD, a 6-bed critical access hospital in De Smet, SD and 10 physician clinics. The program services offered include orthopedics, general surgery, internal medicine, radiation, laboratory, radiology, sleep lab, wound care, emergency, EKG, EEG, IP surgery, OP surgery, oncology, dermatology, physical therapy, occupational therapy, speech therapy, pharmacy, ophthalmology, and optometry. They provide acute care & long-term healthcare services. Following is a breakdown of these statistics by facility:Avera Queen of Peace Hospital 1,746 Acute patient discharges 406 Newborn patient discharges 18 Swing Bed patient discharges95,792 Outpatient visits 164 Swing-bed patient days 799 Newborn patient days48,995 Clinic visitsAvera Brady Health and Rehabilitation 75 Long Term Care patient discharges26,673 Long-term care resident daysAvera Weskota Memorial Medical Center (CAH) 84 Acute patient discharges 21 Swing Bed discharges 5,664 Outpatient visits 216 Swing-bed patient daysAvera De Smet Memorial Hospital (CAH) 64 Acute patient discharges 17 Swing Bed patient discharges11,090 Outpatient visits 90 Swing-bed patient days 4,406 Clinic visitsAvera Queen of Peace 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 $29,577,103.Avera Queen of Peace also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera Queen of Peace 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 Queen of Peace 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. 127668971 1 1 0 1 0 0 0 0 1 1 1 1 0 1 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 0 0 0 1 110 0 1 860 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 X X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Hilary Rockwell MD Regional President & CEO 40.00 0.00 X 221675 245314 57403 Jay Tolsma Chair 2.00 0.00 X X 0 0 0 Ryan Thompson Vice Chair 2.00 0.00 X X 0 0 0 Darlene Bergeleen Board Member 2.00 0.00 X 0 0 0 Julie Brookbank Board Member 2.00 0.00 X 0 0 0 Jessica Claussen MD Board Member/Opthalmology 42.00 0.00 X 583380 0 58017 Trevor Dierks Board Member 2.00 0.00 X 0 0 0 Mark Hunhoff Board Member 2.00 1.00 X 0 0 0 Jean Koehler Board Member 2.00 0.00 X 0 0 0 Tracey Larson Board Member 2.00 0.00 X 0 0 0 Mark Puetz Board Member 2.00 0.00 X 0 0 0 Diane Sandhoff Board Member 2.00 0.00 X 0 0 0 Nicole Stahle Board Member 2.00 0.00 X 0 0 0 Jennifer Tegethoff MD Board Member/Pediatrics 42.00 0.00 X 502618 0 53291 Brad Zomer Board Member 2.00 0.00 X 0 0 0 Sister Erin Colgan Board Member until 01/2024 2.00 0.00 X 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0.10 46.30 X 0 1203675 19401 Mandi Greenway Bietz MD Dermatology 40.00 0.00 X 620124 0 50139 Michael Gedwill DO Radiology 40.00 0.00 X 772700 0 49410 Brian Kampmann MD Orthopedics & Sports Medicine 40.00 0.00 X 1244155 0 57902 Chris Krouse DO Orthopedics & Sports Medicine 40.00 0.00 X 1280854 0 53291 Kelly Smith MD Diagnostic Radiology & Radiology 40.00 0.00 X 693147 0 48668 Thomas Clark Former Regional President/CEO 0.00 0.00 X 0 1666396 25250 Douglas Ekeren Former Regional President & CEO 0.00 40.00 X 0 652618 50377 5918653 3768003 523149 94 1 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Shared Services 10076508 AMN Healthcare Inc 2735 Collection Center Dr Chicago IL 60693 Contract Labor 2597574 ProLink Healthcare LLC 4600 Montgomery Rd Ste 300 Cincinnati OH 45212 Contract Labor 1358457 Avel eCare Medical Group PC 4500 N Lewis Ave N Sioux Falls SD 57104 eCare Purchased Services 885980 Restorix Health Inc PO Box 71849 Chicago IL 60694 Purchased Services 505164 21 144842 935027 1079869 Net Patient & Resident Services 621110 125921996 125921996 Patient and Clinic Revenue 621110 1500938 1500938 Pharmacy Revenue 456110 1122311 1122311 9470898 9470898 138016143 250939 250939 1499175 390345 1108830 1108830 1108830 1277000 307270 0 0 1277000 307270 1584270 1584270 1556952 1216014 340938 264261 76677 A/R Interest 900099 185817 185817 Sports Programs 900099 14360 14360 200177 142581166 138480581 76677 2944039 X 774062 774062 1155129 1155129 202628 202628 59124576 58352540 772036 2153338 2122913 30425 8399895 8280153 119742 3737923 3689558 48365 5680 5680 3772 3772 23950559 17812616 6133264 4679 13010 3493 9200 317 1097572 866976 211070 19526 768179 752857 15322 1741914 1627670 113554 690 279684 270107 9373 204 205015 194425 10590 1250159 1083815 166344 5111932 4172582 939160 190 559085 216535 342550 Medical Supplies 25413716 25384285 26963 2468 Equipment Lease/Rental 30890 30490 400 1008309 676137 323495 8677 136987027 127668971 9281305 36751 -354423 -1536438 34866063 16323509 2182656 2502788 526741 423849 122555344 79634752 46818499 42920592 75753666 107332149 1262964 1559382 1270104 1241707 7458185 9872425 169784455 180639963 8143344 7759764 59996 0 31359174 30564696 9334 9350 1532450 786451 41104298 39120261 X 126619192 139305167 2060965 2214535 128680157 141519702 169784455 180639963 X 5594139 6410632 834774 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 3772 3772 0 Part II-B, Line 1: Avera Queen of Peace paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 3796349 5679 327065 14795 4114298 3677745 183 171141 52720 3796349 1593589 2232370 -93733 54481 3677745 1458737 125 139074 4347 1593589 1463190 3630 -2991 5092 1458737 0.63366 0.19964 0.16670 0 1 1 433670 2417684 2851354 1463373 79410651 48583458 32290566 35484872 29304479 6180393 3345094 1746815 1598279 42920592 Interest in Avera Health Foundation 4841211 F Interest in net assets of Mabee Trust 802570 F Avera Pooled Investments 101688368 F 107332149 Due from Related Parties 9230110 Other Assets 931 Right of Use Assets 641384 9872425 Derivative Liability 74577 Estimated Third-Party Payor Settlements 36719 Right of Use Operating Lease Obligation 645555 Security Deposit 29600 786451 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 Avera Health Foundation and their beneficial interest in the Mabee Trust. Avera Health Foundation includes endowment funds which have been established for a variety of purposes. The endowment fund assets included in the Organization's beneficial interest in the Mabee Trust have been established to purchase equipment and furnishings for the Organization. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization's permanently restricted endowment funds are donor restricted. The Organization currently does not have any board-designated endowment funds. 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 consolidated 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 7747283 7747283 0.05660 1069113 448792 620321 0.00450 8816396 448792 8367604 0.06110 1101 1101 0.00000 35405 35405 0.00030 793687 793687 0.00580 987196 987196 0.00720 1817389 1817389 0.01330 10633785 448792 10184993 0.07440 182679 182679 0.00130 498 498 0.00000 39 39 0.00000 3276 3276 0.00000 780 780 0.00000 187272 187272 0.00130 1 0 33452317 48891232 -15438915 X 1 1 3 1 Avera Queen of Peace Hospital 525 North Foster Street Mitchell SD 57301 See Part V Section C 10552 X X X X 6 Provider Based Clinics 2 Avera Weskota Memorial Medical Center 609 1st Street NE Wessington Springs SD 57382 See Part V Section C 48209 X X X 3 Avera De Smet Memorial Hospital 306 Prairie Avenue SW De Smet SD 57231 See Part V Section C 50726 X X X 1 Provider Based Clinic Avera Queen of Peace Hospital 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 Section V Part C X See Section V Part C X See Section V Part C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Weskota Memorial Medical Center 2 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 Section V Part C X See Section V Part C X See Section V Part C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera De Smet Memorial Hospital 3 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 Section V Part C X See Section V Part C X See Section V Part C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Queen of Peace Hospital Part V, Section B, Line 5: The assessment process, initiated by Avera Queen of Peace, is an effort to identify significant unmet health needs in the community. The process is an opportunity to review, identify and analyze strengths and barriers to the health of the community. Mission leaders at Avera Queen of Peace collected primary data through stakeholder interviews and community surveys. Avera Queen of Peace contracted with inHealth Strategies to analyze primary data, provide technical assistance, and prepare the CHNA and implementation strategy. inHealth Strategies collected and analyzed secondary data. Throughout the data collection process, steps were taken to ensure the hospital's community health needs assessment took into account input from persons who represent the broad interests of the community, including the medically underserved, minority, senior citizens, children and low-income populations. The following organizations were represented in the process: - Mitchell Area Development Corporation - Mitchell Department of Public Safety - Mitchell Fire & Emergency Management Services (EMS) - Hanson County Sheriff's Office - Dakota Wesleyan University - Episcopal Church - Mitchell School District - Mitchell Safe House - Palace Transit, Senior Nutrition - Salvation Army - The Caring Closet - SDDOH County Health Nurse - Davison County Avera Weskota Memorial Medical Center Part V, Section B, Line 5: The assessment process, initiated by Avera Weskota, is an effort to identify significant unmet health needs in the community. Mission leaders at Avera Queen of Peace collected primary data through stakeholder interviews and community surveys. Avera Weskota Hospital contracted with inHealth Strategies to analyze primary data, provide technical assistance, and prepare the CHNA and implementation strategy. inHealth Strategies collected and analyzed secondary data. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Throughout the data collection process, steps were taken to ensure the hospital's community health needs assessment took into account input from persons who represent the broad interests of the community, including the medically underserved, minority, senior citizens, children and low-income populations. The following organizations were represented in the process: - City of Wessington Springs - Mayor's Office/Business Owner - Jerauld County Auditor - Ministerial Association - Jerauld County Commissioner/Business Owner - South Dakota Department of Health and Human Services - Wessington Springs School District Avera De Smet Memorial Hospital Part V, Section B, Line 5: Avera De Smet Hospital hired inHealth Strategies to conduct the focus group and analyze the results. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources, and improvements. Those providing community input were chosen for their familiarity with the needs of medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: - Inter-Lakes Community Action Partnership (ICAP) - Kingsbury County - Eastern South Dakota SHINE (seniors over 60 services) - Kingsbury County Sheriff's Department - City of De Smet - Kingsbury Court House - South Dakota Department of Social Services - De Smet United Methodist Church - American Lutheran Church, De Smet - Community Health Nurse - De Smet School District Avera Queen of Peace Hospital Part V, Section B, Line 11: Avera Queen of Peace conducted a community health needs assessment during FY2022. After review of the primary and secondary data, the Avera Queen of Peace leadership team weighed the findings against available hospital and community resources and the likelihood that reasonable interventions would yield positive, sustainable health improvement. These criteria were used as they prioritized the significant health needs of the community.Based on the results of this assessment, Avera Queen of Peace is committed to addressing the following identified significant community health needs: *Continue to explore creative solutions that remove barriers to community health needs posed by Behavioral Health and Substance Abuse issues; and *Support healthy lifestyle choices to help individuals manage their weight and associated chronic diseases.BEHAVIORAL HEALTH AND SUBSTANCE ABUSE ISSUESFY2024 Update:Avera Queen of Peace is in the process of recruiting behavioral health providers at Access Health Mitchell.Avera Queen of Peace is taking steps to increase utilization of eBehavioral Health consults in the Emergency Department.Avera Queen of Peace implemented "Ask the Question: Are you thinking about suicide" campaign into its care delivery model.Avera Queen of Peace has implemented SBIRT (Screening, Brief Intervention, and Referral to Treatment) into the care delivery model in its emergency department. SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.Avera Queen of Peace implemented the Edinburgh Scale for depression and suicide screening into the care delivery model for OB patients at Avera Queen of Peace Hospital and follow-up visits at Access Health for OB and pediatric patients.Avera Queen of Peace leadership provided advisory support for the creation of a 24-hour emergency mental health crisis center in the city of Mitchell, SD. This facility is scheduled to open in January 2025.HEALTHY LIFESTYLE CHOICESFY2024 Update:Implemented education on healthy eating as a component for wellness for those who experience chronic diseases. A registered dietitian nutritionist coordinated quarterly events in FY2024.Primary Care Providers at Access Health in Mitchell have committed to referring patients, as appropriate, to the registered dieticians from Avera Queen of Peace Hospital for healthy choices counseling.Avera Medical Group has a clinic in Sioux Falls with a specialized focus on weight management. Primary Care Providers at Access Health in Mitchell refer patients, as appropriate, to the Avera Medical Group Comprehensive Weight Management clinic.Avera Queen of Peace analyzed the feasibility of developing community or employee gardening plots at the Avera Queen of Peace Hospital campus. This was determined to not be feasible at this time, due to limited access to a water source and limited volunteer availability.The following health needs were identified but will not be addressed: - Transportation - Affordable HousingAvera Queen of Peace does not currently have the resources to directly address the identified issues of transportation and affordable housing. However, the leadership team recognizes that the needs exist and will continue to actively participate in numerous community organizations focused on community needs and improvement. Avera Weskota Memorial Medical Center Part V, Section B, Line 11: Avera Weskota conducted a community health needs assessment during FY2022. After review of the primary and secondary data, the Weskota leadership team weighed the findings against available resources and potential sustainability. These criteria were used as they prioritized the identified needs.Based on the results of this assessment, Avera Weskota is committed to addressing the following identified significant community health need: *Supporting healthy lifestyle choices through education with a focus on food choices, physical activity, and stress reduction.HEALTHY LIFESTYLE CHOICESFY2024 Update: Financial support was provided for healthy snacks for students in the local school district. Weskota organized and conducted the annual fun run/walk 5K. However, there was a decrease in participation over the prior year from the local community. The following health need was identified but will not be addressed: *Economic stressAvera Weskota will not be directly addressing the identified issue of economic stress. While the leadership team recognizes that economic stressors exist, the hospital does not have the resources to address the issue at this time. Avera De Smet Memorial Hospital Part V, Section B, Line 11: Avera De Smet conducted a community health needs assessment during FY2022. The prioritization process was done by the hospital administration and other healthcare professionals, along with community members serving on the new healthcare facility's fundraising committee, all of whom are highly engaged with the community and general community health needs. The process took into consideration the size of the problem (i.e., how many people does it impact,) urgency of the health need, the potential impact for the community, the feasibility of being able to address the concern and the value it would bring to the community.Based on the results of this assessment, Avera De Smet will work to address the following identified significant community health need: *Supporting healthy lifestyle choices through education with a focus on food choices, physical activity, and stress reduction.HEALTHY LIFESTYLE CHOICESFY2024 Update: We partnered with a community group that provides public education to the community. This group offered topics that fell into the nutrition and activity categories in 2024. We are annual participants in a community wide effort to bring education topics to the 65+ age group through education events in the winter months. The following health needs were identified but will not be addressed: *Behavioral Health *Substance AbuseAlthough the above needs were not selected for focus, Avera De Smet will continue to advocate for behavioral health resources and substance abuse resources in the communtiy. Avera Queen of Peace Hospital 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 Weskota Memorial Medical Center 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 De Smet Memorial Hospital 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 Queen of Peace Hospital 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 included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Weskota Memorial Medical Center 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 included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera De Smet Memorial Hospital 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 included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Queen of Peace Hospital 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. A plain language summary is offered to all uninsured patients at the time of registration. Avera Weskota Memorial Medical Center 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. A plain language summary is offered to all uninsured patients at the time of registration. Avera De Smet Memorial Hospital 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. A plain language summary is offered to all uninsured patients at the time of registration. Avera Queen of Peace Hospital 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. Avera Weskota Memorial Medical Center 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. Avera De Smet Memorial Hospital 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. Avera Queen of Peace Hospital Part V, Section B, Line 7a, 7b and 10c: avera.org/about/community-health-needs-assessments/ Avera Weskota Memorial Medical Center Part V, Section B, Ln 7a, 7b, and 10a: avera.org/about/community-health-needs-assessments/ Avera De Smet Memorial Hospital Part V, Section B, Line 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/ Part V, Section B, Lines 16a-16c The FAP, FAP Application, and plain language summary are available for all facilities at:avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ Schedule H Part V, Section A organization's website: The website for Avera Queen of Peace Hospital is:avera.org/locations/queen-of-peace/The website for Avera Weskota Memorial Medical Center is:avera.org/locations/profile/avera-weskota-memorial-hospital/The website for Avera De Smet Memorial Hospital is:avera.org/locations/profile/avera-de-smet-memorial-hospital/ 5 1 - Avera Brady Health and Rehab 500 S Ohman St Mitchell SD 57301 Nursing Home 2 - Avera Brady Assisted Living 1414 W Cedar Ave Mitchell SD 57301 Assisted Living 3 - AMG Radiation Oncology 605 N Foster St Mitchell SD 57301 Clinic 4 - AMG Oncology & Hematology 605 N Foster St Mitchell SD 57301 Clinic 5 - AMG Optometry 1200 East 6th Ave Mitchell SD 57301 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: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Costs of other means-tested government programs, line 7c, and subsidized health services, line 7g, were obtained from EPSi analytical reports. Community health improvement services, line 7e, Health professions education, line 7f, and cash and in-kind donations, line 7i were compiled using actual costs recorded in the CBISA software. Part II, Community Building Activities: Avera Queen of Peace Hospital provided donations to various organizations to support activities as listed on Part II. 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. During the year ended June 30, 2024, the Organization adjusted the qualifying criteria under the charity care policy, which resulted in a reclassification of accounts considered bad debt in previous years that now qualified as presumptive charity care under the adjusted policy. Implicit price concession for the year of $2,756,472 was reduced for prior year reclassifications of $21,781,806 resulting in a net negative implicit price concession of $19,025,334. Due to the negative implicit price concession per the general ledger, an amount of $0 has been reported on Line 2. 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 Queen of Peace 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 Mitchell is a regional center/hub and the sixth largest city in South Dakota, Avera Queen of Peace is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. The next largest hospital offering the same level of services is 72 miles from Mitchell 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. In addition to activities reported in the Community Health Needs Assessment, Avera Queen of Peace, Avera Weskota, and Avera De Smet collaborate with community health committees within their respective community to assess and promote health related matters. 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 Queen of Peace is a 25-bed critical access hospital in Mitchell, South Dakota. The primary service area is defined as Davison County, South Dakota. Mitchell is the county seat of Davison County. According to the U.S. Census Bureau Quick Facts 2023 data, the estimated population of Davison County as of July 1, 2023, is 19,922 and is predominately white at 91.5%. It is estimated that 21.2% of the population is 65 years and over. The median household income is $55,606 with a 13.7% poverty rate. Uninsured individuals under age 65 is estimated at 11.0%. Part VI, Line 5: Avera Queen of Peace is a State Certified Level #4 Community Trauma Center and operates an emergency department staffed 24 hours per day with board certified physicians. Emergency care is provided on an open-door basis regardless of ability to pay. Avera Queen of Peace leases two critical access hospitals which provide a broad range of inpatient, outpatient services and 24-hour emergency rooms in two very rural communities.Similar to the hospitals in the Avera Queen of Peace region, the clinics are operated on an open-door basis and care is provided regardless of ability to pay.Medical staff privileges are extended to all licensed and qualified applicants. The Avera Queen of Peace Board of Directors is principally comprised of community members from the primary and secondary services areas. Members come from a variety of backgrounds including banking, education, agriculture, healthcare, and private industry.Recognizing a need for affordable housing in Mitchell, Avera Queen of Peace donated 22 acres of land near the hospital for the Ridgeview on Foster project. The Ridgeview on Foster project is a unique collaboration between the City of Mitchell, Mitchell Area Development Corporation and Avera to build an affordable housing development with the goal of attracting and retaining a workforce in Mitchell. 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 Mitchell Area Development Corporation 601 North Main Street Mitchell SD 57301 460394983 Government 0 750000 Appraisal Land Affordable Housing Project 1 0 1 0 0 0 0 0 0 0 0 Thomas Clark Former Regional President/CEO 0 6334 0 0 0 1660062 0 16500 0 8750 0 1691646 0 0 Chris Krouse DO Orthopedics & Sports Medicine 1206724 0 68039 0 6091 0 16500 0 36791 0 1334145 0 0 0 Brian Kampmann MD Orthopedics & Sports Medicine 1083098 0 157405 0 3652 0 16500 0 41402 0 1302057 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0 1197590 0 480 0 5605 0 16500 0 2901 0 1223076 0 0 Michael Gedwill DO Radiology 495095 0 216546 0 61059 0 16500 0 32910 0 822110 0 0 0 Kelly Smith MD Diagnostic Radiology & Radiology 500275 0 178431 0 14441 0 15399 0 33269 0 741815 0 0 0 Douglas Ekeren Former Regional President & CEO 0 641698 0 900 0 10020 0 16500 0 33877 0 702995 0 0 Mandi Greenway Bietz MD Dermatology 467266 0 103504 0 49354 0 16500 0 33639 0 670263 0 0 0 Jessica Claussen MD Board Member/Opthalmology 534372 0 16000 0 33008 0 16500 0 41517 0 641397 0 0 0 Jennifer Tegethoff MD Board Member/Pediatrics 394851 0 106079 0 1688 0 16500 0 36791 0 555909 0 0 0 Hilary Rockwell MD Regional President & CEO 213545 237154 7500 7500 630 660 10993 5507 20454 20449 253122 271270 0 0 Part I, Line 4a Thomas Clark received a severance payment of $1,660,062. Schedule J, Part I, Line 3: The President/CEO is compensated by Avera Health. Avera Queen of Peace relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Rhonda Zomer Family member of board member 81554 Compensation and benefits as an employee 0 Julie Dierks Family member of board member 34096 Compensation and benefits as an employee 0 Laurie Young Family member of board member 86979 Compensation and benefits as an employee 0 Form 990, Item J The organization's website is: avera.org/locations/queen-of-peace/ Form 990, Part VI, Section A, line 2 Julie Lautt, Thomas Clark, Douglas Ekeren, and Hilary Rockwell 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 Avera Queen of Peace Hospital does not have committees with 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 Queen of Peace. 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 10,380,284. Management and general expenses 378,790. Fundraising expenses 4,679. Total expenses 10,763,753. Medical Professional Fees: Program service expenses 947,330. Management and general expenses 0. Fundraising expenses 0. Total expenses 947,330. Repairs & Maintenance: Program service expenses 2,073,854. Management and general expenses 21,641. Fundraising expenses 0. Total expenses 2,095,495. Centralized Services: Program service expenses 4,411,148. Management and general expenses 5,732,833. Fundraising expenses 0. Total expenses 10,143,981. Form 990, Part XI, line 9: Change in Beneficial Interest in Mabee Trust 54,942. Change in Interest in Avera Foundation 628,305. Equity Transfers 151,527. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements of Avera Health, which includes Avera Queen of Peace. 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 Marshall, Avera St. Mary's, Avera St. Anthony, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg, Avera at Home, and Avera Sacred Heart. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673). 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 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 Luke's 305 South State Street Aberdeen SD 57401 460224598 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 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 Avera Home Medical Equipment of Floyd Valley Hospital LLC 5300 S Broadband Lane Sioux Falls SD 57108 820582350 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 5300 S Broadband Lane Sioux Falls SD 57108 862949748 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Sioux Center LLC 5300 S Broadband Lane Sioux Falls SD 57108 753203100 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 5300 S Broadband Lane Sioux Falls SD 57108 800619999 Medical services - home medical equipment SD N/A 0 0 Brookings Health System - Avera HME LLC 300 22nd Ave Brookings SD 57006 453204123 Medical Services - Home Medical Equipment SD N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 4055 Valley View Lane Ste 700 Dallas TX 75224 611843657 Accountable Care Organization TX N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 4055 Valley View Lane Ste 700 Dallas TX 75224 821447782 Accountable Care Organization TX 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 Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 Surgical associates SD 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 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 Dr Donald & Marguerite Mabee Trust c/o First National Bank of South Da Mitchell SD 57301 466056202 Investing SD Avera Queen of Peace Hospital T 54942 802570 1.00000 1 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 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 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0