AVERA HEALTH: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: AVERA HEALTH (EIN 46-0422673)
Tax period: 2020-07-01 to 2021-06-30
Filed: 2022-05-16
IRS object ID: 202231369349312508
Schema version: 2020v4.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule G
Schedule I
Schedule J
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-05-16T15:18:08-05:00	ReturnTs
Tax Period End	2021-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	450250958	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Eide Bailly LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	800 Nicollet Mall Ste 1300	AddressLine1Txt
City	Minneapolis	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	554027033	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460422673	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Health	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	6053227300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 West Avera Drive No 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Julie Lautt	PersonNm
Person Title	Secretary/CFO	PersonTitleTxt
Phone	6053224700	PhoneNum
Signature	2022-05-13	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Julie	PersonFirstNm
Person Last	Lautt	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen	PreparerPersonNm
PTIN	P00484560	PTIN
Phone	6122536500	PhoneNum
Preparation	2022-05-13	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Bob Sutton	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 West Avera Drive No 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$325,452,539	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.avera.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1998	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of Health	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	1976	TotalEmployeeCnt
Total Volunteers	11	TotalVolunteersCnt
Total Gross UBI	$6,639,442	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$3,179,172	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$23,574,843	PYContributionsGrantsAmt
CY Contributions Grants	$21,836,149	CYContributionsGrantsAmt
PY Program Service Revenue	$257,966,861	PYProgramServiceRevenueAmt
CY Program Service Revenue	$275,697,373	CYProgramServiceRevenueAmt
PY Investment Income	$1,602,327	PYInvestmentIncomeAmt
CY Investment Income	$17,107,893	CYInvestmentIncomeAmt
PY Other Revenue	$12,456,161	PYOtherRevenueAmt
CY Other Revenue	$8,927,575	CYOtherRevenueAmt
PY Total Revenue	$295,600,192	PYTotalRevenueAmt
CY Total Revenue	$323,568,990	CYTotalRevenueAmt
PY Grants And Similar Paid	$15,871,633	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$30,646,490	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$143,987,528	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$194,034,408	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$2,316,734	CYTotalFundraisingExpenseAmt
PY Other Expenses	$106,869,460	PYOtherExpensesAmt
CY Other Expenses	$108,462,349	CYOtherExpensesAmt
PY Total Expenses	$266,728,621	PYTotalExpensesAmt
CY Total Expenses	$333,143,247	CYTotalExpensesAmt
PY Revenues Less Expenses	$28,871,571	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$9,574,257	CYRevenuesLessExpensesAmt
Total Assets BOY	$1,513,047,085	TotalAssetsBOYAmt
Total Assets EOY	$1,761,941,902	TotalAssetsEOYAmt
Total Liabilities BOY	$1,166,092,281	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$1,374,402,196	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$346,954,804	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$387,539,706	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Avera Health 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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$292,572,064	ExpenseAmt
Grant	$30,646,490	GrantAmt
Revenue	$278,210,607	RevenueAmt
Desc	Avera Health is a nonprofit corporation jointly sponsored by the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota and the Benedictine Convent of the Sacred Heart of Yankton, South Dakota, together referenced as the "Sisters." Avera Health acts as the leader of the Avera health ministry, serving as an overall parent to support its affiliated tax-exempt health care organizations. These organizations provide services principally in eastern South Dakota and surrounding states. Avera Health provides management consulting, fund raising and other administrative services to the hospitals, long-term health care facilities, clinics, services and programs that are sponsored or otherwise affiliated with the Sisters.Avel eCARE is a visionary care delivery model that provides rural health care professionals around-the-clock access to specialty care physicians, nurses and pharmacists. Using advanced communication technology, eCARE supports rural facilities in the provision of evidence-based, high-quality care and offsets workforce shortages in rural communities. eCARE is a natural extension of Avera's Health mission and its century-long commitment to its rural communities to maintain access to quality care close to home. Avel eCARE works with some of the most underserved populations in the United States. This includes frontier populations, long term care residents, Native American Reservations, disabled veterans, and inmates. By bringing high quality, on demand access to specialty care, these unique populations are able to receive care within their home community and in a familiar, culturally appropriate setting. They are treated in coordination with the local practitioners that best understand their ongoing care needs.During the COVID pandemic over the last two years, Avera Health and its affiliated entities have stewarded significant funding toward community benefit, from our own resources and from state and federal assistance and relief funds. When the first cases were identified in 2020, we created a 24/7 hotline people could call to inquire about testing, treatment, and later vaccination. This hotline minimized the burden of clinics and helped protect patients and the public by keeping patients from presenting to healthcare facilities in person. Along with the hotline, Avera launched an innovative and specialized program for caring for COVID patients at home, including daily check-ins, virtual visits (if needed) and at-home oxygen therapy. Throughout the pandemic this program has supported patients and kept hospitals from becoming overwhelmed.Additionally, we launched public awareness campaigns for masking and vaccination that included earned media, paid advertising, and digital presence. We set up testing sites and events, including a mass testing event for workers at the local protein plant. The state delegated vaccination efforts to South Dakota's health systems, and our state was recognized nationally for our "shots in arms" efficiency. Avera led efforts to prioritize those at highest risk, including not only elderly and infirm but homeless, congregate living residents and protein plant workers which included a high percentage of immigrants. We participated in national research for COVID therapies including convalescent plasma, monoclonal antibodies and antiviral medications. We worked with local and state officials to inform the public at regular press conferences and expanded bed capacity by reallocating resources across all hospitals in our system. Avera partnered with other health facilities and systems to ensure capacity for the sickest patients, and those in need of ICU care and ventilators. Avera also launched efforts to support and retain health care workforce, including such things as paying health insurance premiums, providing support payments, $2 across-the-board pay increases, increased on-call pay and shift differentials, and more.	Desc
Total Program Service Expenses	$292,572,064	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	Yes (1)	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	Yes (1)	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	261	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1976	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (1)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (1)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	Yes (1)	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	10	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	0	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	AL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	AR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	FL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	GA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	HI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	KS	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	KY	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MD	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MS	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NH	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NJ	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NM	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	PA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	RI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	SC	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	TN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	UT	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	VA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WV	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	Jamie Schaefer	PersonNm
Phone	6053223992	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 W Avera Dr Ste 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Bob Sutton
President/CEO	40.00	4.50	Yes (X)	Yes (X)	$1,749,379	$0	$51,920
Dr Luis Rojas-Espaillat
Director	5.00	40.00	Yes (X)		$0	$759,905	$48,824
Dr Jason Wickersham
Director	5.00	40.00	Yes (X)		$0	$406,922	$45,525
Dr Merritt Gregg Warren
Chair	5.00	40.00	Yes (X)	Yes (X)	$0	$56,466	$11,040
Sister Janet Horstman
Vice Chair	5.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Sister Mary Jaeger PVBM
Director	5.00	0.00	Yes (X)		$0	$0	$0
Sister Debra Kolecka OSB
Director	5.00	3.00	Yes (X)		$0	$0	$0
Sister Mary Kay Panowicz
Director	5.00	1.00	Yes (X)		$0	$0	$0
Sister Penny Bingham
Director	5.00	4.00	Yes (X)		$0	$0	$0
Sister Pam Donelan
Director	5.00	0.00	Yes (X)		$0	$0	$0
Lori Essig
Director	5.00	0.00	Yes (X)		$0	$0	$0
Robert Fouberg
Director	5.00	1.00	Yes (X)		$0	$0	$0
Clark Sinclair
Director	5.00	0.00	Yes (X)		$0	$0	$0
Doneen Hollingsworth
Director	5.00	0.00	Yes (X)		$0	$0	$0
Gary Gaspar
Director	5.00	0.00	Yes (X)		$0	$0	$0
Julie Lautt
CFO Avera Health; Sec/Treas	40.00	1.40		Yes (X)	$903,545	$0	$36,378
David Flicek
Pres/CEO - Avera McKennan	0.00	42.00			$1,275,864	$0	$45,092	Yes (X)
Todd Forkel
Pres/CEO - Avera St. Luke's	0.00	42.00			$728,359	$0	$42,148	Yes (X)
Deanna Larson
CEO - eCare	40.00	0.00			$444,674	$0	$40,176	Yes (X)
Tom Clark
Chief Strategy & Growth Officer	40.00	0.00			$587,865	$0	$45,092	Yes (X)
Doug Ekeren
President/CEO -Sacred Heart	0.00	47.00			$626,756	$0	$40,677	Yes (X)
David Erickson
Chief Medical/Innovation Officer	40.00	4.00			$905,630	$0	$44,796		Yes (X)
Richard Korman
Senior VP - General Counsel	40.00	0.00			$732,582	$0	$52,055		Yes (X)
James Veline - Senior Vice
Pres - Chief Information Officer	40.00	0.00			$1,086,624	$0	$20,376		Yes (X)
Robin Bates - Executive VP
Insurance Svcs & Population	40.00	0.00			$880,985	$0	$26,946		Yes (X)
Richard Molseed
Exec VP - Governance & Strategy	40.00	0.00			$1,771,632	$0	$24,321		Yes (X)
Jim Breckenridge
Former CFO Avera Health; Sec/Treas	0.00	0.00			$329,248	$0	$15,667			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$12,023,143	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,223,293	TotReportableCompRltdOrgAmt
Total Other Compensation	$591,033	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	235	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Avera McKennan
1325 S Cliff Avenue	Sioux Falls	SD	57117	Services	$13,975,588
CDW Government
230 N Milwaukee Ave	Vernon Hills	IL	60061	Computer Hardware; Consulting	$13,430,887
Medical Information Technology Inc
1 Meditech Circle	Westwood	MA	02090	Hardware/Software; Consulting	$5,192,193
Medspeed
655 West Grand Avenue	Elmhurst	IL	60126	Courier Services	$3,848,113
Cisco Systems Capital Corporation
170 W Tasman Dr	San Jose	CA	95134	Hardware/Software; Consulting	$3,390,629

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	137	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$199,382	FederatedCampaignsAmt
Fundraising	$451,874	FundraisingAmt
Related Organizations	$16,372	RelatedOrganizationsAmt
Government Grants	$1,815,012	GovernmentGrantsAmt
All Other Contributions	$19,353,509	AllOtherContributionsAmt
Noncash Contributions	$1,735,275	NoncashContributionsAmt
Total Contributions	$21,836,149	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
ACS revenue	900099	$202,053,582	$202,053,582
Other revenue	900099	$40,572,927	$38,503,589	$2,069,338
eCare revenue	900099	$24,425,603	$24,425,603
PACE revenue	561000	$5,596,621	$1,614,425	$3,982,196
Premier expense credits	900099	$2,864,269	$2,864,269

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$184,371	TotalRevenueColumnAmt
Related Or Exempt Func Income	$184,371	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$275,697,373	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$199,301	TotalRevenueColumnAmt
Exclusion	$199,301	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,972,913	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,807,270	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$165,643	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$165,643	TotalRevenueColumnAmt
Unrelated Business Revenue	$165,643	UnrelatedBusinessRevenueAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$16,908,592	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$16,908,592	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$16,908,592	TotalRevenueColumnAmt
Unrelated Business Revenue	$422,265	UnrelatedBusinessRevenueAmt
Exclusion	$16,486,327	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$273,443	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$451,874	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$76,279	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$197,164	TotalRevenueColumnAmt
Exclusion	$197,164	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	A/R Interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$8,564,768	TotalRevenueColumnAmt
Related Or Exempt Func Income	$8,564,768	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$8,564,768	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$323,568,990	TotalRevenueColumnAmt
Related Or Exempt Func Income	$278,210,607	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$6,639,442	UnrelatedBusinessRevenueAmt
Exclusion	$16,882,792	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$30,587,047	TotalAmt
Program Services	$30,587,047	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$59,443	TotalAmt
Program Services	$59,443	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$7,015,041	TotalAmt
Management And General	$7,015,041	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$129,740	TotalAmt
Program Services	$129,740	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$128,547,239	TotalAmt
Program Services	$108,205,966	ProgramServicesAmt
Management And General	$18,892,633	ManagementAndGeneralAmt
Fundraising	$1,448,640	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$32,328,306	TotalAmt
Program Services	$31,194,896	ProgramServicesAmt
Management And General	$1,037,478	ManagementAndGeneralAmt
Fundraising	$95,932	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$17,183,227	TotalAmt
Program Services	$14,012,853	ProgramServicesAmt
Management And General	$2,936,641	ManagementAndGeneralAmt
Fundraising	$233,733	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$8,830,855	TotalAmt
Program Services	$8,286,838	ProgramServicesAmt
Management And General	$446,135	ManagementAndGeneralAmt
Fundraising	$97,882	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$771,413	TotalAmt
Program Services	$714,581	ProgramServicesAmt
Management And General	$56,832	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,531,254	TotalAmt
Program Services	$1,531,254	ProgramServicesAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$249,325	TotalAmt
Program Services	$249,325	ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$34,283,919	TotalAmt
Program Services	$30,515,769	ProgramServicesAmt
Management And General	$3,682,616	ManagementAndGeneralAmt
Fundraising	$85,534	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$8,093,310	TotalAmt
Program Services	$8,039,091	ProgramServicesAmt
Management And General	$4,103	ManagementAndGeneralAmt
Fundraising	$50,116	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$7,504,621	TotalAmt
Program Services	$6,676,308	ProgramServicesAmt
Management And General	$724,229	ManagementAndGeneralAmt
Fundraising	$104,084	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$22,041,333	TotalAmt
Program Services	$21,827,351	ProgramServicesAmt
Management And General	$66,637	ManagementAndGeneralAmt
Fundraising	$147,345	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$6,133,997	TotalAmt
Program Services	$3,974,599	ProgramServicesAmt
Management And General	$2,123,670	ManagementAndGeneralAmt
Fundraising	$35,728	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$699,083	TotalAmt
Program Services	$618,465	ProgramServicesAmt
Management And General	$71,618	ManagementAndGeneralAmt
Fundraising	$9,000	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$553,557	TotalAmt
Program Services	$540,080	ProgramServicesAmt
Management And General	$13,616	ManagementAndGeneralAmt
Fundraising	-$139	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$850,183	TotalAmt
Program Services	$711,914	ProgramServicesAmt
Management And General	$138,269	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$19,659,605	TotalAmt
Program Services	$18,871,580	ProgramServicesAmt
Management And General	$782,743	ManagementAndGeneralAmt
Fundraising	$5,282	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	-$482,008	TotalAmt
Program Services	-$542,330	ProgramServicesAmt
Management And General	$60,322	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Repairs and maintenance	$4,518,654	$4,378,647	$139,995	$12
UBI tax	$885,964	$885,964
Lease and rental	$34,927	$7,253	$27,197	$477

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,133,212	TotalAmt
Program Services	$1,095,430	ProgramServicesAmt
Management And General	$34,674	ManagementAndGeneralAmt
Fundraising	$3,108	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$333,143,247	TotalAmt
Program Services	$292,572,064	ProgramServicesAmt
Management And General	$38,254,449	ManagementAndGeneralAmt
Fundraising	$2,316,734	FundraisingAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part X	Yes (X)	InfoInScheduleOPartXInd

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$25,050,804	BOYAmt
EOY	$28,905,697	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$524,649	BOYAmt
EOY	$1,742,261	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$30,791,487	BOYAmt
EOY	$29,283,558	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$584,602	BOYAmt
EOY	$396,483	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$8,136,519	BOYAmt
EOY	$15,988,570	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$233,627,462	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$131,932,154	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$98,966,598	BOYAmt
EOY	$101,695,308	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$1,070,788,545	BOYAmt
EOY	$1,294,673,040	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$165,755,052	BOYAmt
EOY	$148,615,736	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$12,588	BOYAmt
EOY	$32,516	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,139,552	BOYAmt
EOY	$16,139,552	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$96,296,689	BOYAmt
EOY	$124,469,181	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,513,047,085	BOYAmt
EOY	$1,761,941,902	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$25,278,499	BOYAmt
EOY	$34,826,307	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$7,439,578	BOYAmt
EOY	$6,753,531	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$23,209,808	BOYAmt
EOY	$20,936,012	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$951,318,025	BOYAmt
EOY	$1,108,976,303	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$34,732,688	BOYAmt
EOY	$33,371,297	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$124,113,683	BOYAmt
EOY	$169,538,746	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,166,092,281	BOYAmt
EOY	$1,374,402,196	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$340,335,399	BOYAmt
EOY	$379,904,627	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$6,619,405	BOYAmt
EOY	$7,635,079	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$346,954,804	BOYAmt
EOY	$387,539,706	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,513,047,085	BOYAmt
EOY	$1,761,941,902	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$9,574,257	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$44,963,019	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$5,196,140	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	Yes (X)	PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$15,789,136	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$14,467,701	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$17,411,813	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$23,574,843	CurrentTaxYearMinus1YearAmt
Current Tax Year	$21,836,149	CurrentTaxYearAmt
Total	$93,079,642	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$186,830,145	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$207,086,072	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$254,799,501	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$266,987,769	CurrentTaxYearMinus1YearAmt
Current Tax Year	$278,210,607	CurrentTaxYearAmt
Total	$1,193,914,094	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$202,619,281	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$221,553,773	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$272,211,314	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$290,562,612	CurrentTaxYearMinus1YearAmt
Current Tax Year	$300,046,756	CurrentTaxYearAmt
Total	$1,286,993,736	TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$33,177	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$101,472	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$63,613	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$368,889	CurrentTaxYearMinus1YearAmt
Current Tax Year	$446,030	CurrentTaxYearAmt
Total	$1,013,181	TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$122,171,044	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$130,522,462	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$166,560,168	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$178,295,346	CurrentTaxYearMinus1YearAmt
Current Tax Year	$177,531,681	CurrentTaxYearAmt
Total	$775,080,701	TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$122,204,221	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$130,623,934	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$166,623,781	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$178,664,235	CurrentTaxYearMinus1YearAmt
Current Tax Year	$177,977,711	CurrentTaxYearAmt
Total	$776,093,882	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total509	$510,899,854	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$2,768,304	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$1,317,953	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$157,217	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$22,385	CurrentTaxYearMinus1YearAmt
Current Tax Year	$199,301	CurrentTaxYearAmt
Total	$4,465,160	TotalAmt

Post1975 UBTI Post1975UBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$249,441	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$509,369	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,094,391	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,515,692	CurrentTaxYearAmt
Total	$4,368,893	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$2,768,304	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$1,567,394	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$666,586	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,116,776	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,714,993	CurrentTaxYearAmt
Total	$8,834,053	TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$343,127	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$309,458	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$260,272	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$369,995	CurrentTaxYearMinus1YearAmt
Current Tax Year	$197,164	CurrentTaxYearAmt
Total	$1,480,016	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$205,730,712	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$223,430,625	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$273,138,172	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$292,049,383	CurrentTaxYearMinus1YearAmt
Current Tax Year	$302,958,913	CurrentTaxYearAmt
Total	$1,297,307,805	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.39380	PublicSupportCY509Pct
Public Support PY509	0.39150	PublicSupportPY509Pct
Investment Income CY	0.00680	InvestmentIncomeCYPct
Investment Income PY	0.00560	InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509	Yes (X)	ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	Yes (1)	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	Yes (1)	DirectContactLegislatorsInd
Direct Contact Legislators	$5,752	DirectContactLegislatorsAmt
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$243,573	OtherActivitiesAmt
Total Lobbying Expenditures	$249,325	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Through paid staff and paid consultants Avera Health meets with legislators. Avera Health provides grants to other organizations for lobbying and pays dues of which a small portion is attributable to lobbying.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$6,403,165	BeginningYearBalanceAmt
Contributions	$1,694,590	ContributionsAmt
Investment Earnings Or Losses	$432,897	InvestmentEarningsOrLossesAmt
Other Expenditures	$696,359	OtherExpendituresAmt
Administrative Expenses	$36,245	AdministrativeExpensesAmt
End Year Balance	$7,798,048	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,765,277	BeginningYearBalanceAmt
Contributions	$820,309	ContributionsAmt
Investment Earnings Or Losses	$128,114	InvestmentEarningsOrLossesAmt
Other Expenditures	$273,739	OtherExpendituresAmt
Administrative Expenses	$36,796	AdministrativeExpensesAmt
End Year Balance	$6,403,165	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,295,563	BeginningYearBalanceAmt
Contributions	$392,984	ContributionsAmt
Investment Earnings Or Losses	$629,457	InvestmentEarningsOrLossesAmt
Other Expenditures	$527,554	OtherExpendituresAmt
Administrative Expenses	$25,173	AdministrativeExpensesAmt
End Year Balance	$5,765,277	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$5,004,011	BeginningYearBalanceAmt
Contributions	$421,937	ContributionsAmt
Investment Earnings Or Losses	$280,361	InvestmentEarningsOrLossesAmt
Other Expenditures	$386,932	OtherExpendituresAmt
Administrative Expenses	$23,814	AdministrativeExpensesAmt
End Year Balance	$5,295,563	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$4,854,052	BeginningYearBalanceAmt
Contributions	$583,639	ContributionsAmt
Investment Earnings Or Losses	$147,566	InvestmentEarningsOrLossesAmt
Other Expenditures	$548,377	OtherExpendituresAmt
Administrative Expenses	$32,869	AdministrativeExpensesAmt
End Year Balance	$5,004,011	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.43770	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.13400	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.42830	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$948,600	OtherCostOrOtherBasisAmt
Book Value	$948,600	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$33,647,748	OtherCostOrOtherBasisAmt
Depreciation	$12,035,818	DepreciationAmt
Book Value	$21,611,930	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,215,169	OtherCostOrOtherBasisAmt
Depreciation	$2,402,582	DepreciationAmt
Book Value	$812,587	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$161,363,856	OtherCostOrOtherBasisAmt
Depreciation	$117,493,754	DepreciationAmt
Book Value	$43,870,102	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$34,452,089	OtherCostOrOtherBasisAmt
Book Value	$34,452,089	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$101,695,308	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (4 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Interest in Innovation Institute	$13,047,131	F
Non-publicly traded hedge, private equity, debt, and multi-strategy funds	$120,178,322	F
Non-publicly traded real estate	$15,290,283	F
NPPC, LLC	$100,000	C

Field	Value	IRS element (for citing)
Total Book Value Securities	$148,615,736	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDesc	Book ValueBookValueAmt
Deferred financing costs	$14,145,515
Interest in South Dakota Community Foundation	$1,113,321
Deferred compensation	$95,303,456
Swap account	$111,332
Right of use operating lease	$9,684,303
Line of credit - Avel	$1,200,000
Tax Receivable Agreement	$2,911,254

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$124,469,181	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
Estimated insurance claims payable	$41,441,914
Bond interest payable	$9,266,846
Due to affiliated entities	$6,438,747
Deferred compensation	$95,303,456
Deferred payroll tax	$5,168,909
Long-term commitments	$9,950,000
Right of use lease obligations	$1,968,874

Field	Value	IRS element (for citing)
Total Liability	$169,538,746	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Avera Health administers the Avera Health Pooled Investment Fund, a fund that is maintained for the benefit of facilities that are sponsored, operated, or managed by Avera Health. Investments are made in conformity with the objectives and guidelines of the Avera Health Pooled Investment Committee. Within the fund, participating facilities share in a pool of investments that are managed by various fund managers. Investments that are held for participating facilities are recorded as Avera Health Pooled Investments with a corresponding liability account of Custodial Funds - Avera Health Pooled Investments on the balance sheet. Avera Health also holds its own investments within the pooled fund and records their allocated share of income and losses from these investments as investment income in the financial statements.
Part V, Line 4:	The Organization's endowment consists of funds established for a variety of purposes related to health and wellness programs in Avera affiliated organizations.
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.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

Field	Value	IRS element (for citing)
Region	Central America and the Caribbean -	RegionTxt
Offices	0	OfficesCnt
Employee	0	EmployeeCnt
Type Of Activities Conducted	Investments	TypeOfActivitiesConductedTxt
Region Total Expenditures	$120,178,322	RegionTotalExpendituresAmt

Field	Value	IRS element (for citing)
Subtotal Offices	0	SubtotalOfficesCnt
Subtotal Employees	0	SubtotalEmployeesCnt
Continuation Total Office	0	ContinuationTotalOfficeCnt
Continuation Total Employee	0	ContinuationTotalEmployeeCnt
Total Office	0	TotalOfficeCnt
Total Employee	0	TotalEmployeeCnt
Subtotal Spent	$120,178,322	SubtotalSpentAmt
Continuation Spent	$0	ContinuationSpentAmt
Total Spent	$120,178,322	TotalSpentAmt
Transfer To Foreign Corp	0	TransferToForeignCorpInd
Interest In Foreign Trust	0	InterestInForeignTrustInd
Foreign Corp Ownership	Yes (1)	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	Yes (1)	PassiveForeignInvestmestCoInd
Foreign Partnership	0	ForeignPartnershipInd
Boycott Countries	0	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Part III Accounting Method:

Form 990, Schedule F, Part IV:

Avera Health reviews its direct and indirect investments during the tax period for determining required foreign filings. The Organization's ownership interests in foreign corporations do not require a Form 5471 to be filed. The Organization invests in partnerships that hold direct or indirect interest in passive foreign investment companies. The investment partnerships have properly filed Form 8621, or the underlying investments did not generate any unrelated business income. Under these facts, Avera Health is not required to file an additional Form 8621.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Race Against Breast Cancer	Event1Nm
Gross Receipts Event1	$299,277	GrossReceiptsEvent1Amt
Charitable Contri Event1	$209,892	CharitableContriEvent1Amt
Gross Revenue Event1	$89,385	GrossRevenueEvent1Amt
Cash Prizes Event1	$0	CashPrizesEvent1Amt
Non Cash Prizes Event1	$0	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$0	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$0	FoodAndBeverageEvent1Amt
Entertainment Event1	$0	EntertainmentEvent1Amt
Other Direct Expenses Event1	$56,363	OtherDirectExpensesEvent1Amt
Event2	Deck the Halls	Event2Nm
Gross Receipts Event2	$89,491	GrossReceiptsEvent2Amt
Charitable Contri Event2	$71,853	CharitableContriEvent2Amt
Gross Revenue Event2	$17,638	GrossRevenueEvent2Amt
Cash Prizes Event2	$0	CashPrizesEvent2Amt
Non Cash Prizes Event2	$0	NonCashPrizesEvent2Amt
Rent Facility Costs Event2	$0	RentFacilityCostsEvent2Amt
Food And Beverage Event2	$0	FoodAndBeverageEvent2Amt
Entertainment Event2	$0	EntertainmentEvent2Amt
Other Direct Expenses Event2	$0	OtherDirectExpensesEvent2Amt
Other Events Total	12	OtherEventsTotalCnt
Gross Receipts Other Events	$314,803	GrossReceiptsOtherEventsAmt
Charitable Contri Other Events	$161,460	CharitableContriOtherEventsAmt
Gross Revenue Other Events	$153,343	GrossRevenueOtherEventsAmt
Cash Prizes Other Events	$0	CashPrizesOtherEventsAmt
Non Cash Prizes Other Events	$0	NonCashPrizesOtherEventsAmt
Rent Fclty Costs Other Events	$1,473	RentFcltyCostsOtherEventsAmt
Food And Beverage Other Events	$1,405	FoodAndBeverageOtherEventsAmt
Entertainment Other Events	$0	EntertainmentOtherEventsAmt
Oth Direct Expnss Other Events	$16,546	OthDirectExpnssOtherEventsAmt
Gross Receipts Total	$703,571	GrossReceiptsTotalAmt
Charitable Contributions Tot	$443,205	CharitableContributionsTotAmt
Gross Revenue Total Events	$260,366	GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events	$1,473	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$1,405	FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events	$72,909	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$75,787	DirectExpenseSummaryEventsAmt
Net Income Summary	$184,579	NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (115 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Abbott House Foundation
909 Court Merrill St	Mitchell	SD	57301	460379896	501c3	$22,500	Sponsorship
Aberdeen Catholic School System
1400 N Dakota St	Aberdeen	SD	57401	460336005	501c3	$85,971	Sponsorship
Aberdeen Christian School
1500 Hwy 281 N	Aberdeen	SD	57401	911806433	501c3	$10,000	Sponsorship
Aberdeen Development Corporation
506 S Main St Ste 2	Aberdeen	SD	57401	466011831	501c6	$10,000	Sponsorship
Aberdeen Ride Line
205 N 4th St	Aberdeen	SD	57401	466000010	501c3	$20,000	Sponsorship
Alexander Mitchell Library Foundation Inc
215 SE 4th Ave	Aberdeen	SD	57401	460428183	501c3	$30,000	Sponsorship
ALS Association - MNNDSD Chapter
1919 University Ave W Ste 175	Saint Paul	MN	55104	411756085	501c3	$10,000	Sponsorship
American Cancer Society
250 Williams St	Atlanta	GA	30303	131788491	501c3	$52,500	Sponsorship
American Telemedicine Association
1100 Connecticut Ave NW Ste 540	Washington	DC	20036	742676503	501c3	$10,000	Sponsorship
Banquet
900 E 8th St	Sioux Falls	SD	571031604	460387495	501c3	$56,500	Sponsorship
Beresford School District #61-2
301 W Maple	Beresford	SD	57004	476002216	City of Beresford	$19,552	Sponsorship
Bishop Dudley Hospitality House
101 N Indiana Ave	Sioux Falls	SD	57103	911836528	501c3	$16,000	Sponsorship
Bishop O'Gorman Catholic Schools
3100 W 41st St	Sioux Falls	SD	57105	460413591	501c3	$1,700,000	Sponsorship
Boy Scouts of America - Sioux Council
800 N West Ave	Sioux Falls	SD	57104	460224599	501c3	$6,000	Sponsorship
Boys & Girls Club of Aberdeen Area
1121 1st Ave SE	Aberdeen	SD	57401	237062273	501c3	$9,000	Sponsorship
Boys & Girls Club of Brookings SD Inc
1126 Southland Lane	Brookings	SD	57006	731630215	501c3	$50,250	Sponsorship
Boys & Girls Club of the Sioux Empire
824 E 14th St	Sioux Falls	SD	57104	460399482	501c3	$20,000	Sponsorship
Brookings School District
2130 8th St S	Brookings	SD	57006	466000834	City of Brookings	$38,162	Sponsorship
Capital Area Counseling Service Inc
800 E Dakota PO Box 148	Pierre	SD	57501	460305571	501c3	$110,000	Sponsorship
Capital Area United Way
PO Box 1111	Pierre	SD	575011111	460403398	501c3	$10,506	Sponsorship
Catholic Community Foundation for Eastern SD
523 N Duluth Ave	Sioux Falls	SD	571042714	466000424	501c3	$110,000	Sponsorship
Central Lyon Community School
1010 S Greene St	Rock Rapids	IA	51246	426037624	City of Rock Rapids	$15,000	Sponsorship
Charis Ministry Partners
1300 E 10th St	Sioux Falls	SD	57103	383775128	501c3	$7,000	Sponsorship
Children's Home Society of South Dakota Foundation
PO Box 1749	Sioux Falls	SD	571011749	460224542	501c3	$18,000	Sponsorship
Citizens Involvement Council
110 W Missouri Ave	Pierre	SD	57501	460317107	501c3	$15,000	Sponsorship
City of Aberdeen
123 S Lincoln St	Aberdeen	SD	574014215	466000010	City of Aberdeen	$200,000	Sponsorship
City of Pierre
2301 Patron Pkwy Ste 1	Pierre	SD	57501	466000356	City of Pierre	$75,000	Sponsorship
City of Yankton
PO Box 176	Yankton	SD	57078	466000567	City of Yankton	$200,000	Sponsorship
Compass Center
1704 S Cleveland Ave Ste 3	Sioux Falls	SD	57103	460350199	501c3	$7,500	Sponsorship
Dakota Resources
25795 475th Ave Ste 1	Renner	SD	57055	460442430	501c3	$25,000	Sponsorship
Dakota Weslyan University
1200 W University Ave	Mitchell	SD	57301	460224589	501c3	$34,500	Scholarship; Sponsorship
DakotAbilities
1116 S 4th Ave	Sioux Falls	SD	57105	460306216	501c3	$16,000	Sponsorship
Delta Dental of South Dakota Foundation
804 N Euclid Ave Ste 101	Pierre	SD	57501	911776857	501c3	$20,000	Sponsorship
Destiny Healthcare International
PO Box 90648	Sioux Falls	SD	57109	510529480	501c3	$30,000	Sponsorship
Downtown Sioux Falls Inc
230 S Phillips Ave Ste 306	Sioux Falls	SD	571046708	363627217	501c4	$22,000	Sponsorship
EmBe
300 W 11th St	Sioux Falls	SD	571046306	460234998	501c3	$46,778	Sponsorship
Face It Together
5020 S Tennis Ln Ste 4	Sioux Falls	SD	57108	272501220	501c3	$20,000	Sponsorship
Fellowship of Christian Athletes
1208 Horizon Dr	Marshall	MN	56258	440610626	501c3	$16,000	Sponsorship
Friends of Levitt Shell Sioux Falls
524 N Main Ave 106	Sioux Falls	SD	57104	611699910	501c3	$20,000	Sponsorship
Furniture Mission of South Dakota
209 N Nesmith Ave	Sioux Falls	SD	57103	810584450	501c3	$15,000	Sponsorship
Greater Sioux Falls Chamber of Commerce
200 N Phillips Ave Ste 200	Sioux Falls	SD	571046058	460189300	501c6	$12,800	Sponsorship
Greatlife Cares Foundation
3800 W 53rd St	Sioux Falls	SD	57106	472447820	501c3	$19,500	Sponsorship
GroundWorks
102 N Krohns Pl Ste 113	Sioux Falls	SD	57103	475498537	501c3	$7,500	Sponsorship
Habitat for Humanity
721 E Amidon St	Sioux Falls	SD	57104	460407140	501c3	$6,500	Sponsorship
Harrisburg Baseball Association Inc
PO Box 434	Harrisburg	SD	57032	270606157	501c3	$8,000	Sponsorship
Helpline Center Inc
1000 N West Ave Ste 310	Sioux Falls	SD	571041314	237424387	501c3	$15,000	Sponsorship
Junior Achievement of South Dakota
1000 N West Ave Ste 110	Sioux Falls	SD	57104	460306352	501c3	$25,650	Sponsorship
Leadership South Dakota
PO Box 675	Platte	SD	57369	462384525	501c3	$11,000	Sponsorship
Leukemia & Lymphoma Society
1711 Broadway St NE	Minneapolis	MN	55413	135644916	501c3	$20,500	Sponsorship
LifeScape Foundation
2011 W 26th St Ste 201	Sioux Falls	SD	57105	465151247	501c3	$15,000	Sponsorship
Lost and Foundation Association
5015 S Crossing Pl 110	Sioux Falls	SD	57108	454306370	501c3	$10,000	Sponsorship
Make-A-Wish Foundation of SD
1400 W 17th St	Sioux Falls	SD	57104	460375953	501c3	$10,000	Sponsorship
McCrossan Boys Ranch
47135 260th St	Sioux Falls	SD	571079905	460311913	501c3	$15,000	Sponsorship
Mitchell Area Safehouse Inc
1809 N Wisconsin St	Mitchell	SD	57301	460389086	501c3	$10,000	Sponsorship
Mitchell School District 17-2
821 N Capital St	Mitchell	SD	57301	466001338	City of Mitchell	$10,000	Sponsorship
Mitchell Technical College Foundation
1800 E Spruce St	Mitchell	SD	57301	460452950	501c3	$92,000	Sponsorship
Mitchell United Way
417 N Main St Ste 103	Mitchell	SD	57301	461250302	501c3	$7,354	Sponsorship
Mount Marty College
1105 W 8th St	Yankton	SD	57078	460283336	501c3	$286,000	Scholarship; Sponsorship
Multi-Cultural Center of Sioux Falls
515 N Main Ave	Sioux Falls	SD	57104	460445034	501c3	$10,000	Sponsorship
NAMI South Dakota
PO Box 88808	Sioux Falls	SD	571098808	363593027	501c3	$35,000	Sponsorship
National Kidney Foundation
2601 S Minnesota Ave Ste 105	Sioux Falls	SD	57105	131673104	501c3	$15,500	Sponsorship
National Multiple Sclerosis Society
733 Third Ave	New York	NY	10017	410790658	501c3	$16,000	Sponsorship
No Way on Amendment A (SD Chamber of Commerce & Industry)
PO Box 190	Pierre	SD	57501	460141180	501c6	$25,000	Sponsorship
NSU Foundation
620 15th Ave SE	Aberdeen	SD	57401	237002314	501c3	$151,000	Scholarship; Sponsorship
Office of Attorney General
1302 E Hwy 14 Ste 2	Pierre	SD	575018502	466000364	State of SD	$50,000	Sponsorship
Pierre School District
211 S Poplar	Pierre	SD	57501	466001892	City of Pierre	$10,000	Sponsorship
Prairie Family Business Association
4801 N Career Ave	Sioux Falls	SD	57107	466000364	City of Sioux Falls	$5,650	Sponsorship
Presentation College
1500 N Main St	Aberdeen	SD	57401	460280847	501c3	$100,000	Scholarship; Sponsorship
Presentation Sisters of the Blessed Virgin Mary
1500 N 2nd St	Aberdeen	SD	57401	460253283	501c3	$22,500	Sponsorship
President's Bowl
PO Box 1443	Sioux Falls	SD	571011443	911776303	501c3	$20,000	Sponsorship
Pride in the Tiger Foundation
400 Tiger Dr	Marshall	MN	56258	411948007	501c3	$10,000	Sponsorship
REACH Literacy
2101 W 41st St Ste 23	Sioux Falls	SD	57105	460396579	501c3	$5,500	Sponsorship
River Cities Public Transit
1600 E Dakota Ave	Pierre	SD	57501	460449059	City of Pierre	$8,000	Sponsorship
Ronald McDonald House Charities of SD
825 S Lake Ave	Sioux Falls	SD	57104	460371152	501c3	$27,000	Sponsorship
Safe Harbor
PO Box 41	Aberdeen	SD	574020041	460344310	501c3	$10,000	Sponsorship
SculptureWalk Inc
300 S Phillips Ave Ste L104	Sioux Falls	SD	57104	208535871	501c3	$17,000	Sponsorship
Sioux Empire Baseball Association
1601 W 44th Pl Ste 3	Sioux Falls	SD	571056377	411903475	501c3	$24,000	Sponsorship
Sioux Empire United Way
1000 N West Ave Ste 120	Sioux Falls	SD	571041314	460233701	501c3	$89,800	Sponsorship
Sioux Falls Area CASA Program
PO Box 1901	Sioux Falls	SD	571011901	460430647	501c3	$10,000	Sponsorship
Sioux Falls Area Community Foundation
200 N Cherapa Pl	Sioux Falls	SD	57103	311748533	501c3	$29,500	Sponsorship
Sioux Falls Family YMCA
220 S Minnesota	Sioux Falls	SD	57104	460225021	501c3	$7,000	Sponsorship
Sioux Falls Public Schools Education Foundation
PO Box 560	Sioux Falls	SD	57101	263537657	501c3	$11,000	Sponsorship
Sioux Falls School District 49-5
201 E 38th St	Sioux Falls	SD	571055898	466002586	City of Sioux Falls	$115,100	Sponsorship
SMSU Foundation
FH 229	Marshall	MN	56258	237108470	501c3	$60,000	Sponsorship
South Dakota Agricultural and Rural Leadership Foundation
Box 2170 Animal Science Ctr 132	Brookings	SD	57007	364293293	501c3	$10,000	Sponsorship
South Dakota Chamber of Commerce and Industry
PO Box 190	Pierre	SD	575010190	460141180	501c6	$10,500	Sponsorship
South Dakota Community Foundation
Po Box 296	Pierre	SD	57501	460398115	501c3	$11,270,000	Sponsorship
South Dakota Hall of Fame
1480 S Main	Chamberlain	SD	57325	460324210	501c3	$31,000	Sponsorship
South Dakota Parks and Wildlife Foundation
523 E Capitol Ave	Pierre	SD	57501	460387968	501c3	$52,500	Sponsorship
South Dakota State University Foundation
815 Medary Ave Lohr Build	Brookings	SD	57007	460273801	501c3	$87,000	Sponsorship
South Dakota Symphony Orchestra
301 S Main Ave	Sioux Falls	SD	57104	466017026	501c3	$40,000	Sponsorship
South Dakota Youth Foundation Inc
1310 Main Ave S Ste 109	Brookings	SD	57006	474832848	501c3	$10,000	Sponsorship
South Dakotans Decide Healthcare
3708 W Brooks Pl	Sioux Falls	SD	57106	862041240	501c4	$250,000	Sponsorship
Southeast Technical Institute
2320 N Career Ave	Sioux Falls	SD	57107	466002586	City of Sioux Falls	$27,185	Sponsorship
Special Olympics South Dakota
800 East I-90 Lane	Sioux Falls	SD	57104	460359776	501c3	$10,000	Sponsorship
St Francis House
1301 E Austin St	Sioux Falls	SD	57103	460423202	501c3	$60,000	Sponsorship
Teach for America-South Dakota
132 Main Street	Mission	SD	57555	133541913	501c3	$10,000	Sponsorship
Teddy Bear Den
500 S Main Ave	Sioux Falls	SD	57104	311802800	501c3	$8,000	Sponsorship
United Way & Volunteer Services of Greater Yankton
610 W 23rd St Ste 11	Yankton	SD	57078	460252854	501c3	$12,240	Sponsorship
United Way of Northeastern SD Inc
PO Box 1065	Aberdeen	SD	57401	237086355	501c3	$15,759	Sponsorship
United Way of Southwest MN
PO Box 41	Marshall	MN	56258	416023143	501c3	$5,253	Sponsorship
University of Sioux Falls
1101 W 22nd St	Sioux Falls	SD	57105	460224600	501c3	$400,000	Scholarship; Sponsorship
USD Foundation
1110 N Dakota St	Vermillion	SD	57069	466018891	501c3	$354,100	Sponsorship
Vision Brookings Foundation
2301 Research Park Way Ste 113	Brookings	SD	57006	460440746	501c6	$20,000	Sponsorship
Volunteers of America Dakotas
PO Box 89306	Sioux Falls	SD	571099306	237353508	501c3	$15,000	Sponsorship
Washington Pavilion
301 S Main Ave	Sioux Falls	SD	57104	460435791	501c3	$75,763	Sponsorship
WGB Management LLC (SF Skedaddle)
124 S Phillips Ave	Sioux Falls	SD	57104	844114013		$15,000	Sponsorship
Yankton Area Arts Association
508 Douglas	Yankton	SD	57078	510172432	501c3	$5,500	Sponsorship
Yankton Area Progressive Growth
803 E 4th St	Yankton	SD	57078	460348636	501c6	$60,000	Sponsorship
Yankton School District 63-3
2410 W City Limits Rd	Yankton	SD	57078	466003280	City of Yankton	$10,000	Sponsorship
Yankton Thrive Inc
803 E 4th St	Yankton	SD	57078	460348636	501c6	$60,000	Sponsorship
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	501c3	$100,001	Sponsorship
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	501c3	$14,310	Sponsorship
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	501c3	$18,600	Sponsorship
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	501c3	$15,900	Sponsorship

Field	Value	IRS element (for citing)
Total501c3 Org	105	Total501c3OrgCnt
Total Other Org	11	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt
Medical assistance to employees	18	$43,443
Medical educational scholarships	10	$16,000

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	The Organization makes grants to other organizations exempt under 501(c)(3) to ensure the funds will be used for charitable purposes. During the year ending June 30, 2021, the Organization made contributions to other non-public charities in furtherance of community development. The contributions are approved by the Board for this purpose. Scholarship funds have different sets of criteria for determining eligibility and winners. Assistance to individuals is determined with assistance from each hospital's social services department or within a committee at the hospital.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Bob Sutton
President/CEO	$1,647,459	$0	$91,108	$0	$10,812	$0	$14,250	$0	$37,670	$0	$1,801,299	$0	$0	$0
Richard Molseed
Exec VP - Governance & Strategy	$334,204	$0	$0	$0	$1,437,428	$0	$14,250	$0	$10,071	$0	$1,795,953	$0	$0	$0
David Flicek
Pres/CEO - Avera McKennan	$1,191,662	$0	$62,652	$0	$21,550	$0	$14,250	$0	$30,842	$0	$1,320,956	$0	$0	$0
James Veline - Senior Vice
Pres - Chief Information Officer	$394,644	$0	$0	$0	$691,980	$0	$14,250	$0	$6,126	$0	$1,107,000	$0	$0	$0
David Erickson
Chief Medical/Innovation Officer	$824,656	$0	$46,065	$0	$34,909	$0	$14,250	$0	$30,546	$0	$950,426	$0	$0	$0
Julie Lautt
CFO Avera Health; Sec/Treas	$842,009	$0	$55,127	$0	$6,409	$0	$14,250	$0	$22,128	$0	$939,923	$0	$0	$0
Robin Bates - Executive VP
Insurance Svcs & Population	$347,690	$0	$2,500	$0	$530,795	$0	$14,250	$0	$12,696	$0	$907,931	$0	$0	$0
Dr Luis Rojas-Espaillat
Director	$0	$685,273	$0	$25,500	$0	$49,132	$0	$14,250	$0	$34,574	$0	$808,729	$0	$0
Richard Korman
Senior VP - General Counsel	$683,510	$0	$37,839	$0	$11,233	$0	$14,250	$0	$37,805	$0	$784,637	$0	$0	$0
Todd Forkel
Pres/CEO - Avera St. Luke's	$685,402	$0	$35,420	$0	$7,537	$0	$8,174	$0	$33,975	$0	$770,508	$0	$0	$0
Doug Ekeren
President/CEO -Sacred Heart	$587,258	$0	$28,842	$0	$10,656	$0	$14,250	$0	$26,426	$0	$667,432	$0	$0	$0
Tom Clark
Chief Strategy & Growth Officer	$547,808	$0	$26,164	$0	$13,893	$0	$14,250	$0	$30,842	$0	$632,957	$0	$0	$0
Deanna Larson
CEO - eCare	$403,627	$0	$21,450	$0	$19,597	$0	$14,250	$0	$25,926	$0	$484,850	$0	$0	$0
Dr Jason Wickersham
Director	$0	$297,119	$0	$108,278	$0	$1,525	$0	$14,250	$0	$31,274	$0	$452,446	$0	$0
Jim Breckenridge
Former CFO Avera Health; Sec/Treas	$299,918	$0	$0	$0	$29,330	$0	$7,703	$0	$7,964	$0	$344,915	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 4a	Richard Molseed received a severance payment of $1,413,802.80, James Veline received a severance payment of $673,519.20, and Robin Bates received a severance payment of $515,595.60.
Part I, Line 7	During the current year, the organization paid certain executives incentive payments related to COVID and also paid some physician retention payments to certain physicians.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
South Dakota Health and Educational Facilities Authority
A	460315509	83755VUS1	2012-05-01	$206,383,927	Series 2012B refunded 2002 and 2008A bonds issued 4/11/02 and 6/18/08	0	0	0
South Dakota Health and Educational Facilities Authority
B	460315509	83755VVY7	2014-06-26	$61,821,688	Series 2014A Various capital projects	0	0	0
South Dakota Health and Educational Facilities Authority
C	460315509	83755VG99	2017-10-11	$242,848,916	Series 2017 refunded bond issued 6/18/08;const/equip healthcare facilities	0	0	0
South Dakota Health and Educational Facilities Authority
D	460315509	83755VJ54	2019-11-13	$50,276,218	Series 2019A refunded bond issued 4/3/2017	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	Substantial CompletionSubstantialCompletionYr	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Refunding Taxable BondsRefundingTaxableBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$97,153,927	$206,383,927	$1,032,422	$38,100,000	$167,251,505	2013	Yes (1)	0	Yes (1)	Yes (1)
B		$61,821,688	$821,688	$61,000,000		2015	0	0	Yes (1)	Yes (1)
C	$20,433,916	$242,848,916	$1,786,422	$190,000,000	$51,062,494		0	Yes (1)	Yes (1)	Yes (1)
D		$50,276,218			$50,276,218		0	Yes (1)	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	Yes (1)	Yes (1)	0	Yes (1)
B	0	0		Yes (1)
C	0	0		Yes (1)
D	0	0		Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A	Yes (1)	Yes (1)	Yes (1)
B	Yes (1)	0	Yes (1)
C	0	0	Yes (1)
D	0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Date Rebate Computation Performed	Issuer Name: South Dakota Health and Educational Facilities Authority Date the Rebate Computation was Performed: 06/30/2021 Issuer Name: South Dakota Health and Educational Facilities Authority Date the Rebate Computation was Performed: 06/30/2021
Schedule K, Part IV, Line 2C:	The arbitrage analysis is performed annually, therefore the analysis was completed as of June 30, 2021 for Bonds A and B.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Interstates Office Products Inc
Owned by board member, Gary Gaspar	$254,833	Office product purchases	0
Katherine Schild
Family member of Key Employee, Doug Ekeren	$87,000	Compensation and benefits as an employee	0
Laura Alexander
Family member of Key Employee, Doug Ekeren	$42,740	Compensation and benefits as an employee	0

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTradedGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	3	ContributionCnt
Noncash Contributions Rpt F990	$1,142,309	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Avg of high/low	MethodOfDeterminingRevenuesTxt

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	6	ContributionCnt
Noncash Contributions Rpt F990	$128,210	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp (7 entries)

Non Cash CheckboxNonCashCheckboxInd	DescDesc	ContributionContributionCnt	Noncash Contributions Rpt F990NoncashContributionsRptF990Amt	Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)	Windows, millwork, siding, shingles, lumber	1	$200,000	Cost
Yes (X)	Furniture and flooring	1	$116,028	Cost
Yes (X)	Fireplace; Patio furniture; privacy fence	1	$58,593	Cost
Yes (X)	Mowers	6	$56,232	Cost
Yes (X)	Auction items	2	$16,000	FMV
Yes (X)	Items for patients and residents	8	$14,903	Cost
Yes (X)	Fountain	1	$3,000	Cost

Field	Value	IRS element (for citing)
Form8283 Received	0	Form8283ReceivedCnt
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (1)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	0	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Column (b):	The organization is reporting in Part I, column (b) the number of contributions.
Part I, Line 33:	Amounts included in revenue for the financial statement reporting are included on Schedule M. Additional non-cash contributions not included on Schedule M and the financial statements include items for the benefit of the Avera facilities which include special event donations.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI	Jim Breckenridge, Julie Lautt, Dr. Luis Rojas-Espaillat, Dr. Jason Wickersham, and Dr. Merritt Gregg Warren had a business relationship.
Form 990, Part VI, Section A, line 6	Avera Health has two classes of members: Sponsorship Members and System Members. Sponsorship Members shall consist collectively of (i) those persons serving from time to time as the President and Council of the Presentation Sisters of the Blessed Virgin Mary of Aberdeen, South Dakota and (ii) those persons serving from time to time as the Prioress and Council of the Benedictine Convent of the Sacred Heart (Yankton, S.D.). System Members shall consist of six Sisters- three Presentation Sisters appointed by the Presentation Sponsorship Members and three Benedictine Sisters appointed by the Benedictine Sponsorship Members.
Form 990, Part VI, Section A, line 7a	The System Members have the power to appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause. They also have the power to appoint a Benedictine Sister, Presentation Sister, or a Ministerial Juridic Person to the Boards of Directors of any sponsored work or ministry of Avera Health.
Form 990, Part VI, Section A, line 7b	The following powers shall be reserved to and exercised exclusively by the Sponsorship Members and none of the following actions shall be taken by Avera Health without action of the Sponsorship Members: (a) To approve the adoption, amendment or repeal of the statements of philosophy, mission, Guiding Principles and values of Avera Health; (b) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Avera Health, and to give final approval of any such action with respect thereto; (c) To establish policies regarding the alienation of real property and precious artifacts associated with the healthcare ministry which are under the canonical stewardship of the Presentation Sisters or the Benedictine Sisters; (d) To approve any plan of merger, consolidation or dissolution of Avera Health, or the divestiture of any sponsored work or ministry associated with Avera Health; (e) To change the composition of the Sponsorship Members, including the addition of other individuals, parties or entities to be Sponsorship Members; and (f) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of Avera Health. The following powers shall be reserved to and exercised exclusively by the System Members and none of the following actions shall be taken by Avera Health without action of the System Members: (a) To appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause; (b) To appoint a Presentation Sister, a Benedictine Sister, or a Ministerial Juridic Person to the Boards of Directors of any sponsored work or ministry of Avera Health; (c) To appoint the Chair and Vice Chair of the Board of Directors; (d) To appoint, evaluate, suspend or remove the Avera Health President; (e) To review and approve expenditures outside of the annual operating and capital budgets, for Avera Health in accordance with established Avera Health fiscal policies; (f) To review and approve the Avera Health Strategic Plan; (g) To review and approve any and all Rescript Applications on behalf of Avera Health; (h) To adopt procedures for assuring that corporate actions are consistent with the philosophy, mission, Guiding Principles and values of Avera Health; (i) To provide recommendations to the Sponsorship Members on matters requiring Sponsorship Members' approval or action; (j) To adopt policies designed to effectuate the powers reserved to the System Members; and (k) To exercise oversight of the Guiding Principles and such authorities which may be assigned or delegated by the Sponsorship Members.
Form 990, Part VI, Section A, line 8b	Avera Health does not have any committees with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11b	The Form 990 is reviewed by the VP of Financial Reporting, Tax Manager, and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. In FY2021, the board was provided a copy of the return with the name of a donor who wished to remain anonymous removed from Schedule B. All other aspects of the return as provided to the board mirrored the return as filed with the IRS.
Form 990, Part VI, Section B, line 12c	The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board.
Form 990, Part VI, Section B, line 15	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 for compensation 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.
Form 990, Part VI, Section C, line 19	The Organization's governing documents, conflict of interest policy, and financial statements are not made available to the general public.
Form 990, Part VI, Section B, Line 16b:	There is no written policy or procedure. 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 IX, line 11g	Purchased services: Program service expenses 15,283,846. Management and general expenses 976,658. Fundraising expenses 74,133. Total expenses 16,334,637. Contract labor: Program service expenses 11,677,008. Management and general expenses 385,516. Fundraising expenses 0. Total expenses 12,062,524. Recruitment: Program service expenses 292,749. Management and general expenses 88,647. Fundraising expenses 0. Total expenses 381,396. Consulting fees: Program service expenses 2,227,132. Management and general expenses 2,231,795. Fundraising expenses 11,401. Total expenses 4,470,328. Medical Director fees: Program service expenses 144,799. Management and general expenses 0. Fundraising expenses 0. Total expenses 144,799. Management fees: Program service expenses 890,235. Management and general expenses 0. Fundraising expenses 0. Total expenses 890,235.
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).
Form 990, Part XI, line 9:	Net equity transfers 9,370,574. Other changes in net assets -1,730,234. Contributions received by Avera Health Foundation not reflected in financial statements -15,944,168. Net assets released from restrictions 844,144. Grants to organizations distributed by Avera Health Foundation not reflected in financial statements 12,655,824.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Avel eCare LLC
3900 West Avera Drive	Sioux Falls	SD	571085721	Telehealth	SD	$26,129,177	$14,906,477	Avera Health
Avel Research and Education LLC
3900 West Avera Drive	Sioux Falls	SD	571085721	Telehealth education	SD	$0	$495,182	Avera Health

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare services	NE	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare services	IA	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Holy Family Foundation
826 North 8th Street	Estherville	IA	51334	421317452	Support health related services	IA	501(c)(3)	Line 10	Avera Holy Family	Yes (1)
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
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	Yes (1)
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Queen of Peace Hospital
525 North Foster	Mitchell	SD	57301	460224604	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Sacred Heart Health Services
501 Summit Street	Yankton	SD	57078	460225483	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare services	SD	501(c)(3)	Line 3	Avera St Mary's	Yes (1)
Avera at Home
5116 S Solberg Ave	Sioux Falls	SD	57108	460399291	Home services	SD	501(c)(3)	Line 10	Avera Health	Yes (1)
Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9	Yankton	SD	57078	460337013	Healthcare education	SD	501(c)(3)	Line 10	Sacred Heart Health Services	Yes (1)
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	Healthcare services	MN	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare services	MN	501(c)(3)	Line 3	Avera Marshall	Yes (1)
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health financing & health plan admin	SD	501(c)(4)		Avera Health	Yes (1)
Avera Granite Falls
345 10th Ave	Granite Falls	MN	56241	843156881	Healthcare services	MN	501(c)(3)	Line 3	Avera Marshall	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (10 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
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
Q&M Properties LLC
525 North Foster	Mitchell	SD	57301	731652049	Medical clinic building	SD	N/A	0	0
Surgical Associates Endoscopy Clinic LLC
310 S Penn	Aberdeen	SD	57401	460461429	Surgical associates	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 HME LLC
101 22nd Ave Suite 101	Brookings	SD	57006	453204123	Healthcare Services	SD	N/A	0	0
National Rural ACO 4 LLC dba Prairie Hills Care Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	371780735	Accountable Care Organization	KS	N/A	0	0
National Rural ACO 5 LLC dba Great Plains Care Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	383958290	Accountable Care Organization	KS	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	KS	N/A	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd
Accounts Management Inc
5132 S Cliff Ave Suite 101	Sioux Falls	SD	57108	460373021	Collection agency	SD	Avera Health	C	$3,184,615	$3,041,663	0.75000	Yes (1)
Avera Property Insurance Inc
1000 West 4th Street Suite 1	Yankton	SD	57078	460463155	Insurance	SD	Avera Health	C	$964,061	$1,346,422	1.00000	Yes (1)
Valley Health Services
501 Summit Street	Yankton	SD	57078	460357149	Rental real estate	SD	Sacred Heart Health Services	C	$205,477	$1,419,106	1.00000	Yes (1)
Alucent Biomedical Inc
1325 S Cliff Avenue PO Box 5045	Sioux Falls	SD	571175045	471818349	Biotech Research	SD	Alumend LLC	C	$22,990	$35,115,239	1.00000	Yes (1)
South Dakota State Medical Holding Company Inc
5300 South Broadband Lane	Sioux Falls	SD	57108	460401087	Insurance	SD	Avera Health	C	$35,046,731	$24,734,794	1.00000	Yes (1)
DakotaCare Administrative Services Inc
5300 South Broadband Lane	Sioux Falls	SD	57108	460424322	Insurance	SD	Avera Health	C	$8,553,679	$13,044,420	1.00000	Yes (1)

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (1)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	Yes (1)	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (40 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Accounts Management Inc
L	$435,780	General Ledger
Avera At Home
L	$3,746,244	General Ledger
Avera Health Plans Inc
L	$624,564	General Ledger
Avera Marshall
L	$11,290,860	General Ledger
Avera McKennan
L	$124,034,028	General Ledger
Avera Queen Of Peace Hospital
L	$13,546,344	General Ledger
Avera Sacred Heart Health Services
L	$17,068,596	General Ledger
Avera St Luke's
L	$19,881,540	General Ledger
Avera St Mary's
L	$9,621,516	General Ledger
Avera McKennan
K	$1,165,813	Vendor Payment Listing
Avera Sacred Heart Health Services
K	$87,775	Vendor Payment Listing
Avera Health Plans Inc
P	$16,634,735	Vendor Payment Listing
Avera Marshall
P	$525,424	Vendor Payment Listing
Avera McKennan
P	$13,758,085	Vendor Payment Listing
Avera Queen Of Peace Hospital
P	$280,185	Vendor Payment Listing
Avera Sacred Heart Health Services
P	$393,125	Vendor Payment Listing
Avera St Luke's
P	$232,379	Vendor Payment Listing
Avera St Mary's
P	$88,856	Vendor Payment Listing
Accounts Management Inc
Q	$64,401	Customer Invoice Listing
Avera At Home
Q	$743,363	Customer Invoice Listing
Avera Health Plans Inc
Q	$835,122	Customer Invoice Listing
Avera Holy Family
Q	$767,224	Customer Invoice Listing
Avera Marshall
Q	$2,659,493	Customer Invoice Listing
Avera McKennan
Q	$39,754,417	Customer Invoice Listing
Avera Queen Of Peace Hospital
Q	$4,254,554	Customer Invoice Listing
Avera Sacred Heart Health Services
Q	$4,361,667	Customer Invoice Listing
Avera St Anthony's Hospital
Q	$934,524	Customer Invoice Listing
Avera St Luke's
Q	$6,579,390	Customer Invoice Listing
Avera St Mary's
Q	$2,784,163	Customer Invoice Listing
St Benedict Health Center
Q	$632,681	Customer Invoice Listing
Avera At Home
R	$323,217	General Ledger
Avera Holy Family
R	$67,332	General Ledger
Avera Marshall
R	$180,867	General Ledger
Avera McKennan
R	$1,575,567	General Ledger
Avera Queen Of Peace Hospital
R	$168,878	General Ledger
Avera Sacred Heart Health Services
R	$322,091	General Ledger
Avera St Luke's
R	$99,205	General Ledger
Avera St Mary's
R	$5,526,801	General Ledger
St Benedict Health Center
R	$60,270	General Ledger
Avera McKennan
B	$100,001	General Ledger

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule R, Part III:	Q&M Properties, LLC dissolved effective June 30, 2021. National Rural ACO 4 LLC liquidated effective December 31, 2020.
Schedule R, Part I:	The name Avera eCare, LLC changed to Avel eCare, LLC effective November 17, 2020.