2021-05-17T13:19:44-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 470463911 Avera St Anthony's Hospital AVER 4023365132 300 N 2nd Street ONeill NE 687631569 Julie Lautt CFO Avera Health 4023365132 2021-05-10 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-10 2019 2022-09-23 18:48:47Z Todd Consbruck 300 N 2nd Street ONeill NE 687631569 43599316 0 0928 X See Schedule O X 1955 NE Promotion of health 12 10 284 14 0 0 149580 3055291 41518798 39509607 1480021 976343 -14952 -634 43133447 43540607 3621 4500 0 0 17002687 17698154 0 0 0 20323732 19921313 37330040 37623967 5803407 5916640 68496816 81208125 10758150 18949177 57738666 62258948 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 31501716 4500 39510828 Avera St. Anthony's mission is to provide healthcare services to O'Neill, Nebraska residents and residents of the surrounding area. Avera St. Anthony is a 501(c)(3) organization affiliated with Avera Health. Avera St. Anthony consists of a 25-bed critical access hospital in O'Neill, Nebraska and 7 clinics. The program services offered include primary care, emergency, telemedicine, general surgery, orthopedic surgery, podiatry surgery, cardiac rehab, pain management, OB, chemotherapy, radiology, sleep lab, dialysis, speech therapy, physical therapy, occupational therapy and pharmacy. Avera St. Anthony provides acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera St. Anthony Hospital630 Acute patient discharges146 Newborn patient discharges88 Swing bed patient discharges28,630 Outpatient visits647 Swing-bed patient days242 Newborn patient days25,774 Clinic visitsAvera St. Anthony maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $647,095.Avera St. Anthony also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera St. Anthony upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Anthony engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 31501716 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 57 0 1 284 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0.10 41.30 X 0 1018166 36856 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0.10 40.70 X 0 518454 35583 Wendell Spencer CRNA 40.00 0.00 X 352299 0 46995 Josh Becker CRNA 40.00 0.00 X 338048 0 46995 Wayne ScheidemannMemberMed Staff Pres/Ortho Surg-Left 9/2019 1.00 40.00 X 0 355555 22894 Kevin Loecker CRNA 40.00 0.00 X 248702 0 41894 Todd Consbruck President & CEO 24.00 16.00 X X 0 208207 31400 Cameron Everitt Director of PT 40.00 0.00 X 163915 0 22169 Dean Benson Physician Assistant 40.00 0.00 X 165188 0 19651 Joe Krotter Chair 1.00 0.00 X X 0 0 0 Deb Kelly Vice-Chair 1.00 0.00 X X 0 0 0 Sister Kathryn Burt OSB Member 1.00 0.00 X 0 0 0 Sister Lynn Marie Welbig PBVM Member 1.00 4.00 X 0 0 0 Merri Schneider Member 1.00 0.00 X 0 0 0 Dick Grosch Member 1.00 0.00 X 0 0 0 Paul Carlson Member 1.00 0.00 X 0 0 0 Russ McIntosh Member 1.00 0.00 X 0 0 0 Jack Hurley Member 1.00 0.00 X 0 0 0 Kirk Cisler Member 1.00 0.00 X 0 0 0 1268152 2100382 304437 12 0 1 0 Avera Sacred Heart 501 Summit St Yankton SD 57078 Management, Support, & Lab Services 7950142 Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 Shared Services 4153658 Docs Who Care 800 West Frontier Ln Olathe KS 66061 ER Coverage Services 494903 Avera McKennan Hospital 1325 S Cliff Ave Sioux Falls SD 57105 Physician Services 323613 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Contract Labor 241732 8 19095 3018746 17450 12135 3055291 Patient Service Revenue 622110 37323841 37323841 Pharmacy Revenue 900099 1857090 1857090 Clinic Revenue 621110 186864 186864 141812 141812 39509607 42160 42160 17700 19555 -1855 -1855 -1855 972825 512 0 39154 972825 -38642 934183 934183 AR Interest Income 900099 1221 1221 1221 43540607 39510828 0 974488 X 4500 4500 13104630 12254341 850289 505866 467870 37996 3193255 2847371 345884 894403 835844 58559 2058 2058 10683825 6635892 4047933 1947 937 1010 371174 185464 185710 220565 67109 153456 511539 413830 97709 319294 310508 8786 24973 23056 1917 290893 238620 52273 2090463 1864210 226253 29321 29321 Medical Supplies 5317284 5310843 6441 Equipment Lease/Rental 12725 7896 4829 45252 33425 11827 37623967 31501716 6122251 0 856950 2079779 5306346 3291897 1260806 1200875 95829 85621 39110179 26250497 14525231 12859682 1824942 621475 44626712 60817732 0 251064 68496816 81208125 2684664 2654193 0 2086565 0 0 7082771 7370319 990715 6838100 10758150 18949177 X 57628766 62133098 109900 125850 57738666 62258948 68496816 81208125 X 5916640 -926190 -470168 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 2058 2058 0 Part II-B, Line 1: Avera St. Anthony's Hospital paid dues to organizations which have a portion of the dues attributed to lobbying activities. 150500 150500 150500 150500 150500 150500 150500 150500 150500 150500 0.00000 1.00000 0.00000 0 1 1 745022 745022 25169518 16592215 8577303 11788193 8835403 2952790 1407446 822879 584567 12859682 Assets Limited to Use - Avera Pooled Investments 59674496 F Investment in Foundation 1143236 F 60817732 Right of Use Operating Lease Obligation 17315 Contract Liability - Medicare Advance Payments 6611671 Deferred Payroll Taxes 209114 6838100 X Part V, Line 4: The Foundation's endowment consists of a portion of their interest in the net assets of St. Anthony's Hospital Foundation. The St. Anthony's Hospital Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. Part X, Line 2: Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 1 0 0 320436 320436 0.00850 2538504 1364862 1173642 0.03120 2858940 1364862 1494078 0.03970 347620 43277 304343 0.00810 7284 7284 0.00020 1178527 451042 727485 0.01930 64 64 0.00000 1533495 494319 1039176 0.02760 4392435 1859181 2533254 0.06730 1 1149400 0 16353747 16615427 -261680 X 1 1 1 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 See Part V, Page 10 410002 X X X X Provider based clinics - 1 RHC & 6 physician clinics St Anthony's Hospital 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X See website address on 7d narrative X See website address on 7d narrative X X 1 18 1 See website address on Part V narrative. 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 St. Anthony's Hospital Part V, Section B, Line 5: Avera St. Anthony's Hospital initiated a community focus group meeting and also conducted personal interviews with electronic communication responses. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input represented the medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: * O'Neill Police Department (OPD)* O'Neill Public Schools (OPS)* North Central District Health Department (NCDHD)* Avera St. Anthony's Hospital Social Service Department* University of Nebraska Lincoln Extension* Central Nebraska Community Action Partnership* O'Neill Ministerial Association* United Methodist Church Food Pantry* Holt County Economic Development St. Anthony's Hospital Part V, Section B, Line 6a: Antelope Memorial HospitalAvera Creighton HospitalBrown County HospitalCHI Health Plainview HospitalOsmond General Hospital St. Anthony's Hospital Part V, Section B, Line 6b: North Central District Health Department Region 4 Behavioral Health SystemO'Neill Public School Rural Region One Medical Response System St. Anthony's Hospital Part V, Section B, Line 7d: Other website: www.avera.org/about/community-health-needs-assessments/ St. Anthony's Hospital Part V, Section B, Line 11: The community health needs assessment was completed in 2018. The following community health priority areas were identified. CHRONIC DISEASE DETECTION & MANAGEMENT-Explore feasibility of expanding Social Work support to incorporate a Cancer case management system, child abuse prevention strategies, domestic violence, and Hospice care.FY2020 Update: October 2019 - A PA-C transitioned to the Oncology service area, received training and provides case management to acute and ambulatory care services.FY2020 Update: Social Worker integrates services with Avera Coordinated Care, Dialysis and Home Health/Hospice. Referrals were initiated from the providers in January 2019 for short term counseling resulting in 47 referrals with current consultations of 18 people, some weekly, some every other week.In 2020 there were 30 referrals for short term counseling with integrated virtual options for counseling services.-Continue to promote health maintenance through health screenings and additional options of detection/care management (Blood Pressure checks, bone density, skin cancer screening).Health Fair April & OctoberFY2020 Update: October 2019 - The Fair was held on Oct 8th and 22nd. 581 lab panels, 145 PSA tests and 286 Hgb. A1Cs were completed.FY2020 Update: April 2020 With considerations given to COVID-19 restraints the 2020 Health Fairs were cancelled.Farm & Home Show February FY2020 Update: February 5 & 6 2020- Educational awareness of services in public transportation and Health Fair event utilizing brochures and radio broadcast interview.Community Food Pantry monthly/quarterlyFY2020 Update: No public interaction provided due to COVID-19 restraints.-Provide support to the community food pantry through financial contribution and physical presence to offer blood pressure screening, mental wellness screening tools, nutrition education.FY2020 Update: November 2019 - Financial support provided to United Methodist Church Community Food Pantry with intent to assist in the expense of food transport.-Promote dietary education internally and externally of the hospital through provision of calorie counts of food items and nutritional information tools. FY2020 Update: Met with Dietician discussed the following:-Childhood Obesity Prevention Program "Food, Fitness, Fun" for grades 1-6 1hr/day for 8 weeks.-Developing eagles-Summerfest-Food Pantry-KBRX Radio-NCCCP Grants-Food Pyramid purchaseFY2020 Update: Considerations given to COVID-19 restraints. This action step was not completed due to COVID 19 restraints of public interaction and compromised staffing issues. MENTAL WELLNESS-Provide support to the Befriend Family mentoring program through financial contribution to maintain coordination and viability of program. Provide program brochure to Medical Staff and clinic waiting areas.FY2020 Update: November 2019 Program promoted in Medical Staff and Ministerial Association meetings. Brochures made available in community churches and clinic waiting rooms. Hospital room space provided for organizational meetings. Support for viability and coordination continues.FY2020: May 2020 Program Coordinator hired for management of Befriend program. Financial donation submitted to organization to support expenses.-Partner with North Central District Health Department in suicide prevention initiative through sponsorship of public viewing of Suicide Prevention video "The Ripple Effect".FY2020 Update: November 25, 2019 40 people attended the event hosted at a community church and sponsored by the following: NCDHD, Region 4 Behavioral Health System, O'Neill Public Schools, Avera St. Anthony's Hospital, Faith Community Church, Norfolk Area Loss Team, and North Central Community Care Partnership. Behavioral Health professionals were available following viewing but no interest taken.-Implement Avera suicide staff education, precautions and screening policies in the ED and promote use of Avera Farmer's Stress Hotline resources.FY2020 Update: Brochures of Farmer Stress hotline were made available throughout hospital waiting area and promoted periodically on social media/radio stations. FY2020 Update: Interventions to predict the presence and severity of depression were completed within the Emergency Department. A screening policy performs the Suicide Risk Primary Screen that additionally addresses abuse and violence/trafficking. This screening then potentially leads to the Columbia Suicide Severity Rating Scale which allows for continued support and/or intervention.The following health needs/priorities will not be addressed due to either a relative low priority, resource constraints or, because other facilities or educational entities are addressing the issues:-Resources Across the Lifespan-Substance AbuseMany of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. St. Anthony's Hospital Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. St. Anthony's Hospital Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. St. Anthony's Hospital Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. St. Anthony's Hospital Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Lines 16a, 16b, and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: Charity care and unreimbursed Medicaid were converted to cost using the cost-to-charge ratio derived from Worksheet 2. Subsidized health services were calculated using a combination of cost-to-charge ratio derived from Worksheet 2 and the Medicare cost report. Community health improvement services, health professions education and cash and inkind donations are actual expenses recorded in the general ledger. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 17 and 18. Part III, Line 8: St. Anthony's Hospital follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. However, Medicare is the Organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Schedule H, Part V, Section A, Line 1 https://www.avera.org/locations/profile/avera-st-anthonys-hospital/ Part VI, Line 2: Avera St. Anthony's Hospital conducts an annual strategic planning meeting that includes a cross section of community members. Our Hospital Board of Directors, Hospital Finance Committee, Foundation Board of Directors, Community Medical Staff, and Hospital Department Directors meet to assess community input from the local nursing facility, assisted living, and local public health office. Our Hospital and Foundation Boards and Finance Committee are made up of a majority of community members. This group drafts an annual strategic plan of goals, objectives, and strategies that are continuously updated to address the needs of the community. Additionally, input from the local ministerial association, law enforcement, Chamber of Commerce, elementary and secondary public and parochial schools, and the local community college are assessed and incorporated into the plan. Our CHNA report was completed during fiscal year ended June 30, 2019. Part VI, Line 3: Patients are informed of the financial assistance/charity care policy through brochures and posted policies at the registration desks of the Hospital and Emergency Department. Avera St. Anthony's has staff in central registration that identify if a patient has the financial means to pay for services or insurance to cover these services. Public assistance is also pursued if deemed appropriate. If patients are identified as candidates for charity care they are directed to our financial services representative and the application process is initiated for charity care. Patient financial services can assist with determining what benefits the patient may qualify for and assists with helping them apply for any benefits. If there is no option for an outside assistance program, the patient is informed and encouraged to complete the application that utilizes a combination of income, assets, and expenses to determine what percentage of charity care they would qualify for. Part VI, Line 4: Avera St Anthony's is a 25-bed hospital in O'Neill, Nebraska. The primary service area is defined as Holt County, Nebraska. O'Neill is the county seat. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Holt County as of July 1, 2019 is 10,067 and is predominately white at 97.2%. It is estimated that 22.0% of the population is 65 years and over. The median household income is $60,387 with an 11.1% poverty rate. Uninsured individuals under age 65 is estimated at 10.7%. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 0 0 0 0 0 0 0 0 0 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0 945274 0 1760 0 71132 0 14000 0 22856 0 1055022 0 0 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0 516081 0 400 0 1973 0 14000 0 21583 0 554037 0 0 Wendell Spencer CRNA 234331 0 114475 0 3493 0 14000 0 32995 0 399294 0 0 0 Josh Becker CRNA 211338 0 125850 0 860 0 14000 0 32995 0 385043 0 0 0 Wayne ScheidemannMemberMed Staff Pres/Ortho Surg-Left 9/2019 0 328510 0 17400 0 9645 0 14000 0 8894 0 378449 0 0 Kevin Loecker CRNA 227782 0 19725 0 1195 0 12732 0 29162 0 290596 0 0 0 Todd Consbruck President & CEO 0 207174 0 0 0 1033 0 10717 0 20683 0 239607 0 0 Cameron Everitt Director of PT 162941 0 440 0 534 0 8385 0 13785 0 186085 0 0 0 Dean Benson Physician Assistant 164455 0 0 0 733 0 8349 0 11301 0 184838 0 0 0 Schedule J, Part I, Line 3: The President/CEO's compensation is paid by a related organization, Avera Sacred Heart. Avera St. Anthony's Hospital relied on the related organizations for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Form 990, Part VI, Section A, line 6 The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the Board of Directors. Form 990, Part VI, Section A, line 7b Avera Health, as the sole member, has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member. Form 990, Part VI, Section A, line 8b Avera St. Anthony's Hospital does not have a committee 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 Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all Board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. Form 990, Part VI, Section B, line 15 Compensation of the President and CEO is determined by Avera Sacred Heart Hospital, a related exempt organization. The Board of Directors reviews the management agreement with Avera Sacred Heart Hospital and discusses and approves the agreement. The CFO-Avera Health is compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Negotiations are done as needed. For other staff members, some of whom may serve on the board of directors, as officers, or as key employees, a salary review is done by a committee based on hospital association surveys, including hospital size. Form 990, Part VI, Section C, line 19 The Organization's governing documents and conflict of interest policy are not made available to the general public. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public. Form 990, Part IX, line 11g Repairs and Maintenance: Program service expenses 822,430. Management and general expenses 17,830. Fundraising expenses 0. Total expenses 840,260. Medical Prof Fees: Program service expenses 669,268. Management and general expenses 0. Fundraising expenses 0. Total expenses 669,268. Purchased Services: Program service expenses 5,144,194. Management and general expenses 178,103. Fundraising expenses 0. Total expenses 5,322,297. Centralized Services: Program service expenses 0. Management and general expenses 3,852,000. Fundraising expenses 0. Total expenses 3,852,000. Form 990, Part XI, line 9: Equity Transfers -477,118. Change in Interest in Avera Foundation 6,950. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Health, which includes Avera St. Anthony's Hospital. Form 990, Part X, Line 20: Avera St. Anthony's Hospital is part of the Avera Obligated Group which 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. Avera St. Anthony's Hospital was not allocated any share of the bond issue, and thus does not have an amount on line 20. Form 990, Page 1, Item J Website: avera.org/locations/profile/avera-st-anthonys-hospital/ Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Promotion of health SD 501(c)(3) Line 10 N/A 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 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 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation 401 West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 420224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home Services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Ed and Serv Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare education SD 501(c)(3) Line 10 Sacred Heart Health Services 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Marshall 300 S Bruce St Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 W Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan admin SD 501(c)(4) Avera Health 0 Avera Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 E Lincoln St NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A 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 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Avenue 102 Sioux Falls SD 57117 800619999 Medical Services - home medical equipment SD N/A Q&M Properties LLC 525 North Foster Mitchell SD 57301 730652049 Medical clinic building SD N/A Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 Surgical associates SD N/A Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare Services SD N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical Services - Home Medical Equipment SD N/A 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 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 Caravan Health ACO 41 LLC dba Prairie View Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 821447782 Accountable Care Organization KS N/A Accounts Management Inc 5132 S Cliff Avenue Suite 101 Sioux Falls SD 57108 460373021 Collection Services SD N/A C 0 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Property Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental Real Estate SD N/A C 0 Alucent Medical Inc 31325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 5300 South Broadband Lane Sioux Falls SD 57108 460424322 Insurance SD N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0