SACRED HEART HEALTH SERVICES: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: SACRED HEART HEALTH SERVICES (EIN 46-0225483)
Tax period: 2015-07-01 to 2016-06-30
Filed: 2017-05-09
IRS object ID: 201701299349302370
Schema version: 2015v3.0
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 G
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-05-09T14:44:14-05:00	ReturnTs
Tax Period End	2016-06-30	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	2015-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460225483	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sacred Heart Health Services	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	SACR	BusinessNameControlTxt
Phone	6056688000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	501 Summit Street	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Douglas R Ekeren	PersonNm
Person Title	President & CEO	PersonTitleTxt
Phone	6056688000	PhoneNum
Signature	2017-05-03	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen CPA	PreparerPersonNm
PTIN	P00484560	PTIN
Phone	6122536500	PhoneNum
Preparation	2017-05-03	PreparationDt

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Sacred Heart Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	Douglas R Ekeren	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	501 Summit Street	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$126,031,561	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.averasacredheart.com	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1911	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of Health	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	1278	TotalEmployeeCnt
Total Volunteers	305	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,011,886	PYContributionsGrantsAmt
CY Contributions Grants	$850,816	CYContributionsGrantsAmt
PY Program Service Revenue	$116,843,533	PYProgramServiceRevenueAmt
CY Program Service Revenue	$121,815,480	CYProgramServiceRevenueAmt
PY Investment Income	$5,339,698	PYInvestmentIncomeAmt
CY Investment Income	$2,449,104	CYInvestmentIncomeAmt
PY Other Revenue	-$716,313	PYOtherRevenueAmt
CY Other Revenue	-$602,544	CYOtherRevenueAmt
PY Total Revenue	$122,478,804	PYTotalRevenueAmt
CY Total Revenue	$124,512,856	CYTotalRevenueAmt
PY Grants And Similar Paid	$461,232	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$261,675	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$54,704,969	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$57,979,037	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$77,019	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$309,648	CYTotalFundraisingExpenseAmt
PY Other Expenses	$54,696,827	PYOtherExpensesAmt
CY Other Expenses	$58,707,369	CYOtherExpensesAmt
PY Total Expenses	$109,940,047	PYTotalExpensesAmt
CY Total Expenses	$116,948,081	CYTotalExpensesAmt
PY Revenues Less Expenses	$12,538,757	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$7,564,775	CYRevenuesLessExpensesAmt
Total Assets BOY	$291,814,370	TotalAssetsBOYAmt
Total Assets EOY	$288,972,533	TotalAssetsEOYAmt
Total Liabilities BOY	$45,144,202	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$43,567,671	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$246,670,168	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$245,404,862	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$95,311,231	ExpenseAmt
Grant	$261,675	GrantAmt
Revenue	$121,468,961	RevenueAmt
Desc	Avera Sacred Heart Hospital (Sacred Heart Health Services) leads delivery of healthcare to its region through over 1,200 employees (as well as approximately 80 physicians on its active medical staff) who coordinate care to deliver patient care as an integrated unit. Avera Sacred Heart and its affiliates (referred to collectively as Sacred Heart Health Services) also work seamlessly to meet the needs of the communities they serve in southeast South Dakota and northeast Nebraska. In addition to the 144-bed hospital, Avera Sacred Heart includes one nursing home and a congregate housing facility, a 23-bed critical access hospital, long-term care facility, and 2 clinics in Creighton, NE. It also manages three hospitals and two nursing homes. Continued on Schedule O.Avera Sacred Heart operates under the tenets of the Roman Catholic Church and in accordance with the philosophy and values established for Avera Health, a sponsored health ministry of the Benedictine and Presentation Sisters. Avera Sacred Heart engages in activities designed to improve the health of the individuals and communities that it serves in response to a calling to heal the sick, the elderly and the oppressed.Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Avera Sacred Heart Hospital's larger charitable mission of improving health and quality of life. Specifically, Avera Sacred heart is governed by an independent board including community leaders, business and clinical healthcare experts. The board has a history of commitment to act with the highest integrity and has been proactively evaluating opportunities to voluntarily adopt governance best practices for the benefit of the community. * Sacred Heart Health Services makes medical care accessible to the communities it serves regardless of ability to pay, of which there were 10,733 hospital patient days and 67,527 nursing home resident days in fiscal year 2016. The Hospital received a three-year accreditation from the Joint Commission with "Top Performer for Key Quality Measures." The Avera Sacred Heart Hospital Dialysis Unit was recognized as a 5-Diamond Patient Safety Facility. Avera Sister James Care Center and Avera Yankton Care Center were recognized as seven-year recipients of the Excellence in Action award by My Innerview. Avera Cancer Institute Yankton also received a full accreditation from the American College of Surgeons with a Commendation Silver Level award (5 commendations out of a possible 7). Sacred Heart Health Services operates 2 full-time emergency departments, one in Yankton and one in Creighton, Nebraska, which provide emergency care regardless of ability to pay. Sacred Heart provides clinical services needed to operate the emergency center and provides on-site emergency medical, rescue and medical transportation services. In addition, Avera Sacred Heart, through its integrated network of providers, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare and Medicaid, regardless of ability to pay. Avera's charity care policy provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The charity care policy is designed to ensure the communities served by Avera facilities have access to needed healthcare services. The Avera Sacred Heart Board of Directors oversees services delivered under the charity care policy including assessing community needs, approving eligibility criteria and monitoring the effectiveness of the program in providing community access to medical care.Eligibility for discounted or free services under the charity care policy is based on income and asset levels and family size. Applications for coverage under the program may be obtained at any Avera Sacred Heart patient registration area or by calling the Avera Sacred Heart or Avera Creighton business office. Sacred Heart Health Services maintains records to identify and monitor the level of care provided under the charity care policy. Sacred Heart Health Services had charges forgone for charity for the fiscal year ended June 30, 2016 of approximately $2,700,000.Sacred Heart Health Services takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the community. It strives to identify community needs beyond basic health care, respond to them, aiming to make a positive, life-enhancing difference in the community. Sacred Heart Health Services takes a strategic, community needs-based approach to delivering benefits to the community. Avera Sacred Heart Hospital demonstrates its commitment to providing community benefit through specific accomplishments:E-technology: Avera Sacred Heart utilizes an EICU program. EICU is a telemedicine-based system that aids in the care of ICU patients at Avera Sacred Heart and across the Avera system. Patients receive constant, around-the-clock monitoring and interventions from a remote care team in addition to the care they receive from their bedside team. Avera has also implemented an E-pharmacy program where facilities without 24 hour a day pharmacist coverage can access pharmacist services remotely.Teaching hospital: Avera Sacred Heart is a teaching hospital, which reflects a strong commitment to education, research and a high level of care. In the summer of 2007, the Hospital opened the Avera Professional Office Pavilion & Education Center to enhance their commitment to medical education. The Avera Pavilion is the new home of the unique Yankton Ambulatory Program for the third-year medical students of the Sanford School of Medicine of the University of South Dakota. The program challenges medical students to solve clinical problems and experience the doctor-patient relationship through the year. Yankton is only one of three communities in the state where a campus is provided for the Sanford School of Medicine. The Office for the Dean of the Yankton Ambulatory Program of the Avera Sacred Heart Yankton Campus is located on the first floor of the Pavilion. A unique component to the Pavilion is the expansion and enhancement of educational facilities. Along with a 116-seat auditorium, there are also three conference rooms, all equipped with the latest in audiovisual technology. Residency/health professions training: At any one time, 10 to 15 Sanford School of Medicine of the University of South Dakota medical students are in training at Avera Sacred Heart Hospital. In addition, students in nursing, pharmacy, physician assistant programs, radiology and respiratory therapy also affiliate here. Avera Sacred Heart also has a radiology technologist school, which graduates 6 to 8 new radiology technologists each year. Preventive care a priority: Avera Sacred Heart has taken steps to enhance preventive care for people of all ages through the many educational programs, health screenings and fairs that are held throughout the year. Avera Sacred Heart holds screenings throughout the region at their rural health clinics, as well as in Yankton. The Hospital is now connected to the Ask-A-Nurse program that provides general information concerning health-related topics. Our web site incorporates the "Adam" software that provides a unique level of health-related information to the consumer. In 2009, Avera Sacred Heart Hospital introduced Planet Heart (in conjunction with the Avera Heart Hospital) and an in-house cardiovascular screening package to keep the people we served better informed about their health. Based on community needs, we are continually striving to provide more preventative tools and risk assessments to our population. Community education: Avera Sacred Heart reaches out to people and communities throughout southeastern South Dakota and northeastern Nebraska in a variety of ways. Educational sessions are offered to medical staff, students, employees, health care professionals, students of all levels and the general public. Utilizing the Avera Professional Office Pavilion and Education Center, hundreds of classes involving thousands of people are provided as a community service each year. Other examples of community education include our student/youth mentoring programs and parish nursing. Partnerships with schools, churches, businesses and other organizations make many of these programs possible. Avera Sacred Heart Hospital also offers "Live Better, Live Balanced" events, which are occasional free events for the public during which our health care professionals share important health-related information. This year's events included the topics of colon cancer, allergy care, advance directives, cancer navigation services and how hospital status affects Medicare payments.(Continued on page 10 of Schedule O)	Desc
Total Program Service Expenses	$95,311,231	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
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	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	0	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	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
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	Yes (1)	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	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	178	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1278	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
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	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	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	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	0	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Jamie A Schaefer	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6056688776	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	501 Summit	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 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
Michael Pietila
Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Wayne A Kindle
Vice Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Ryan Loecker
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Jeanne Annette Weber
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Rosemary Weber
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Brad Dykes
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Marty Jans
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Lucille Welbig
Board Member	2.00	2.00	Yes (X)		$0	$0	$0
Sr Lynn Marie Welbig
Board Member	2.00	1.00	Yes (X)		$0	$0	$0
Kevin Bray
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Russ Deidrichsen
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Tim Irwin
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Dan Specht
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Michael Peterson MD
Board Member & Physician	40.00	0.00	Yes (X)		$597,613	$0	$19,513
Douglas Ekeren
President & CEO	2.50	60.00	Yes (X)	Yes (X)	$0	$463,510	$41,722
Jamie A Schaefer
Sec/Treas & VP Finance	52.00	0.00		Yes (X)	$222,150	$0	$17,161
Anthony Erickson
Exec Director-Senior Services	52.00	0.00			$165,354	$0	$16,229	Yes (X)
Gregory Taylor MD
Diagnostic Radiology	40.00	0.00			$524,467	$0	$21,942		Yes (X)
Steve Gutnik MD FACP
Gastroenterology	40.00	0.00			$772,947	$0	$21,558		Yes (X)
Matthew G Winkelbauer MD
Family Medicine/OB	40.00	0.00			$641,090	$0	$18,835		Yes (X)
Ralph Tullo MD
Diagnostic Radiology	40.00	0.00			$473,538	$0	$22,300		Yes (X)
Ryan Banks MD
Family Medicine/OB	40.00	0.00			$497,221	$0	$19,340		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,894,380	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$463,510	TotReportableCompRltdOrgAmt
Total Other Compensation	$198,600	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	67	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	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
Fiegan Construction
3712 S Western Ave Ste 200	Sioux Falls	SD	57078	Construction	$5,233,037
Welfl Construction Company
800 West 23rd Street	Yankton	SD	57078	Construction	$2,024,774
Yankton Anesthesiology PC
1000 W 4th St Suite 13	Yankton	SD	57078	Anesthesiologists	$1,579,078
Aegis Therapies Inc
7160 Dallas Parkway	Plano	TX	75024	Rehab & Therapy Services	$950,259
Yankton Medical Clinic PC
PO Box 706	Yankton	SD	57078	Physician Services	$702,350

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	22	CntrctRcvdGreaterThan100KCnt
Fundraising	$60,442	FundraisingAmt
Government Grants	$267,345	GovernmentGrantsAmt
All Other Contributions	$523,029	AllOtherContributionsAmt
Total Contributions	$850,816	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net patient service revenue	622110	$118,721,043	$118,721,043
Other revenue	900099	$1,388,015	$1,388,015
Nonmedical outreach	900099	$1,086,264	$1,086,264
EHR Revenue	900099	$643,195	$643,195
Income from affiliates	900099	-$23,037	-$23,037

Field	Value	IRS element (for citing)
Total Program Service Revenue	$121,815,480	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$248,369	TotalRevenueColumnAmt
Exclusion	$248,369	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$363,215	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,091,244	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$728,029	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$728,029	TotalRevenueColumnAmt
Exclusion	-$728,029	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$2,619,891	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$419,156	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$2,619,891	SecuritiesAmt
Other	-$419,156	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,200,735	TotalRevenueColumnAmt
Exclusion	$2,200,735	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$61,153	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$60,442	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$8,305	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$52,848	TotalRevenueColumnAmt
Exclusion	$52,848	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	Operating interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$72,637	TotalRevenueColumnAmt
Related Or Exempt Func Income	$72,637	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$72,637	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$124,512,856	TotalRevenueColumnAmt
Related Or Exempt Func Income	$121,888,117	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$1,773,923	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	$241,675	TotalAmt
Program Services	$241,675	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$20,000	TotalAmt
Program Services	$20,000	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,139,701	TotalAmt
Program Services	$662,842	ProgramServicesAmt
Management And General	$476,859	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$65,677	TotalAmt
Program Services	$65,677	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$45,134,887	TotalAmt
Program Services	$40,293,341	ProgramServicesAmt
Management And General	$4,736,884	ManagementAndGeneralAmt
Fundraising	$104,662	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,535,653	TotalAmt
Program Services	$1,336,788	ProgramServicesAmt
Management And General	$195,386	ManagementAndGeneralAmt
Fundraising	$3,479	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$7,083,322	TotalAmt
Program Services	$6,223,017	ProgramServicesAmt
Management And General	$847,463	ManagementAndGeneralAmt
Fundraising	$12,842	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,019,797	TotalAmt
Program Services	$2,661,044	ProgramServicesAmt
Management And General	$351,184	ManagementAndGeneralAmt
Fundraising	$7,569	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$27,012	TotalAmt
Management And General	$27,012	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$18,808	TotalAmt
Management And General	$18,808	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$19,440,763	TotalAmt
Program Services	$6,410,497	ProgramServicesAmt
Management And General	$13,030,096	ManagementAndGeneralAmt
Fundraising	$170	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$36,343	TotalAmt
Program Services	$31,172	ProgramServicesAmt
Management And General	$5,069	ManagementAndGeneralAmt
Fundraising	$102	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$6,792,960	TotalAmt
Program Services	$6,080,527	ProgramServicesAmt
Management And General	$709,439	ManagementAndGeneralAmt
Fundraising	$2,994	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$468,637	TotalAmt
Program Services	$200,227	ProgramServicesAmt
Management And General	$268,410	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,150,391	TotalAmt
Program Services	$2,150,362	ProgramServicesAmt
Management And General	$29	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$359,556	TotalAmt
Program Services	$282,336	ProgramServicesAmt
Management And General	$76,403	ManagementAndGeneralAmt
Fundraising	$817	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$320,422	TotalAmt
Program Services	$181,020	ProgramServicesAmt
Management And General	$137,213	ManagementAndGeneralAmt
Fundraising	$2,189	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$738,670	TotalAmt
Program Services	$738,670	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$7,538,697	TotalAmt
Program Services	$7,538,697	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$980,524	TotalAmt
Program Services	$979,662	ProgramServicesAmt
Management And General	$862	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical Supplies	$13,591,015	$13,590,176	$839
Bad Debt Expense	$4,880,073	$4,880,073
Equipment Lease and Ren	$316,756	$200,863	$115,893
Licenses and Permits	$123,994	$114,762	$9,232

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$922,748	TotalAmt
Program Services	$427,803	ProgramServicesAmt
Management And General	$320,121	ManagementAndGeneralAmt
Fundraising	$174,824	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$116,948,081	TotalAmt
Program Services	$95,311,231	ProgramServicesAmt
Management And General	$21,327,202	ManagementAndGeneralAmt
Fundraising	$309,648	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$7,734,545	BOYAmt
EOY	$7,064,577	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$17,671,823	BOYAmt
EOY	$17,016,065	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$30,000	BOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$2,654,252	BOYAmt
EOY	$839,085	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,955,868	BOYAmt
EOY	$2,295,133	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,267,813	BOYAmt
EOY	$1,047,053	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$173,658,479	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$101,143,162	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$69,564,031	BOYAmt
EOY	$72,515,317	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$7,192,772	BOYAmt
EOY	$6,914,205	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$181,678,719	BOYAmt
EOY	$180,113,931	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$893,793	BOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$632,157	BOYAmt
EOY	$632,157	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$538,597	BOYAmt
EOY	$535,010	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$291,814,370	BOYAmt
EOY	$288,972,533	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$12,081,745	BOYAmt
EOY	$10,474,347	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$82,416	BOYAmt
EOY	$137,450	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$31,392,383	BOYAmt
EOY	$30,582,858	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$21,902	BOYAmt
EOY	$35,558	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,565,756	BOYAmt
EOY	$2,337,458	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$45,144,202	BOYAmt
EOY	$43,567,671	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$231,126,146	BOYAmt
EOY	$233,896,065	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$14,982,150	BOYAmt
EOY	$10,869,226	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$561,872	BOYAmt
EOY	$639,571	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$246,670,168	BOYAmt
EOY	$245,404,862	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$291,814,370	BOYAmt
EOY	$288,972,533	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$7,564,775	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$3,721,293	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$5,108,788	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
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	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

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	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$13,962	OtherActivitiesAmt
Total Lobbying Expenditures	$13,962	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	Avera Sacred Heart Health Services paid dues to Health Organizations that have a portion of the dues attributed to lobbying activities. The amount attributed to lobbying activities was $13,962.	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	$1,045,751	BeginningYearBalanceAmt
Contributions	$77,699	ContributionsAmt
Investment Earnings Or Losses	-$35,356	InvestmentEarningsOrLossesAmt
Other Expenditures	$17,014	OtherExpendituresAmt
End Year Balance	$1,071,080	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,013,689	BeginningYearBalanceAmt
Contributions	$52,266	ContributionsAmt
Investment Earnings Or Losses	-$2,578	InvestmentEarningsOrLossesAmt
Other Expenditures	$17,626	OtherExpendituresAmt
End Year Balance	$1,045,751	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$839,365	BeginningYearBalanceAmt
Contributions	$51,690	ContributionsAmt
Investment Earnings Or Losses	$133,464	InvestmentEarningsOrLossesAmt
Other Expenditures	$10,830	OtherExpendituresAmt
End Year Balance	$1,013,689	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$793,011	BeginningYearBalanceAmt
Contributions	$6,400	ContributionsAmt
Investment Earnings Or Losses	$58,742	InvestmentEarningsOrLossesAmt
Other Expenditures	$18,788	OtherExpendituresAmt
End Year Balance	$839,365	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$801,064	BeginningYearBalanceAmt
Contributions	$5,310	ContributionsAmt
Investment Earnings Or Losses	-$480	InvestmentEarningsOrLossesAmt
Other Expenditures	$12,883	OtherExpendituresAmt
End Year Balance	$793,011	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.59710	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.40290	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	$3,506,594	OtherCostOrOtherBasisAmt
Book Value	$3,506,594	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$115,198,134	OtherCostOrOtherBasisAmt
Depreciation	$63,980,814	DepreciationAmt
Book Value	$51,217,320	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$45,854,060	OtherCostOrOtherBasisAmt
Depreciation	$33,002,104	DepreciationAmt
Book Value	$12,851,956	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$9,099,691	OtherCostOrOtherBasisAmt
Depreciation	$4,160,244	DepreciationAmt
Book Value	$4,939,447	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$72,515,317	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	Assets limited to use - Avera Pooled Investments	Desc
Book Value	$180,113,931	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$180,113,931	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
Estimated third-party payor settlements	$1,698,532
Market Value of Interest Rate Swap	$638,926

Field	Value	IRS element (for citing)
Total Liability	$2,337,458	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Resident trust funds are held on behalf of the residents.
Part V, Line 4:	The Organization's endowment consists of various individual funds established for a variety of purposes. Its endowment represents donor-restricted endowment funds. As required by generally accepted accounting principles, net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions.
Part X, Line 2:	Avera Health and most of its sponsored organizations are considered nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. These organizations are required to file a Return of Organization Exempt from Income Tax (Form 990) with the Internal Revenue Service (IRS). Avera Health and certain sponsored organizations also file an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report their unrelated business taxable income. Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The federal Form 990T filings and taxable subisidiary returns for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2013.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Simply D'Vine	Event1Nm
Gross Receipts Event1	$102,845	GrossReceiptsEvent1Amt
Charitable Contri Event1	$60,442	CharitableContriEvent1Amt
Gross Revenue Event1	$42,403	GrossRevenueEvent1Amt
Food And Beverage Event1	$331	FoodAndBeverageEvent1Amt
Entertainment Event1	$850	EntertainmentEvent1Amt
Event2	Roses Just Because	Event2Nm
Gross Receipts Event2	$18,750	GrossReceiptsEvent2Amt
Gross Revenue Event2	$18,750	GrossRevenueEvent2Amt
Other Direct Expenses Event2	$7,124	OtherDirectExpensesEvent2Amt
Gross Receipts Total	$121,595	GrossReceiptsTotalAmt
Charitable Contributions Tot	$60,442	CharitableContributionsTotAmt
Gross Revenue Total Events	$61,153	GrossRevenueTotalEventsAmt
Food And Beverage Total Events	$331	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$850	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$7,124	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$8,305	DirectExpenseSummaryEventsAmt
Net Income Summary	$52,848	NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	2219	PersonsServedCnt
Total Community Benefit Expns	$972,124	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$972,124	NetCommunityBenefitExpnsAmt
Total Expense	0.00870	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	7714	PersonsServedCnt
Total Community Benefit Expns	$15,203,021	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,329,258	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,873,763	NetCommunityBenefitExpnsAmt
Total Expense	0.04350	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Persons Served	4976	PersonsServedCnt
Total Community Benefit Expns	$3,042,053	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,689,211	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$352,842	NetCommunityBenefitExpnsAmt
Total Expense	0.00310	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	14909	PersonsServedCnt
Total Community Benefit Expns	$19,217,198	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,018,469	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,198,729	NetCommunityBenefitExpnsAmt
Total Expense	0.05530	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	10	ActivitiesOrProgramsCnt
Persons Served	2335	PersonsServedCnt
Total Community Benefit Expns	$3,093,709	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,029,942	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,063,767	NetCommunityBenefitExpnsAmt
Total Expense	0.00950	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	250	PersonsServedCnt
Total Community Benefit Expns	$159,604	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,578	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$149,026	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	24012	PersonsServedCnt
Total Community Benefit Expns	$7,714,479	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,492,642	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,221,837	NetCommunityBenefitExpnsAmt
Total Expense	0.01980	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	304	PersonsServedCnt
Total Community Benefit Expns	$11,969	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$11,969	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	5	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$662,711	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$662,711	NetCommunityBenefitExpnsAmt
Total Expense	0.00590	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	23	ActivitiesOrProgramsCnt
Persons Served	26901	PersonsServedCnt
Total Community Benefit Expns	$11,642,472	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,533,162	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,109,310	NetCommunityBenefitExpnsAmt
Total Expense	0.03660	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	23	ActivitiesOrProgramsCnt
Persons Served	41810	PersonsServedCnt
Total Community Benefit Expns	$30,859,670	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$20,551,631	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,308,039	NetCommunityBenefitExpnsAmt
Total Expense	0.09190	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$71,089	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$71,089	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$71,089	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$71,089	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,880,073	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$27,728,625	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$28,377,090	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$648,465	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	2	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (2 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Emergency Room24 HrsEmergencyRoom24HrsInd	OtherOtherDesc	Critical Access HospitalCriticalAccessHospitalInd
Avera Sacred Heart Hospital
1	501 Summit Street	Yankton	SD	57078	www.avera.org/sacred-heart/	10576	Yes (X)	Yes (X)	Yes (X)	6 provider based RHCs and 5 provider based clinics
Avera Creighton Hospital
2	1503 Main Street	Creighton	NE	68729	www.avera.org/creighton/	490001	Yes (X)	Yes (X)	Yes (X)	1 provider based clinic	Yes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)

FacilityFacilityNum	First Licensed CY Or PYFirstLicensedCYOrPYInd	Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd	CHNA ConductedCHNAConductedInd	Community DefinitionCommunityDefinitionInd	Community DemographicsCommunityDemographicsInd	Existing ResourcesExistingResourcesInd	How Data ObtainedHowDataObtainedInd	Community Health NeedsCommunityHealthNeedsInd	Other Health IssuesOtherHealthIssuesInd	Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd	Consulting ProcessConsultingProcessInd	Information GapsInformationGapsInd	CHNA ConductedCHNAConductedYr	Take Into Account Others InputTakeIntoAccountOthersInputInd	CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd	CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd	CHNA Report Widely AvailableCHNAReportWidelyAvailableInd	Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd	Own Website URLOwnWebsiteURLTxt	Other WebsiteOtherWebsiteInd	Other Website URLOtherWebsiteURLTxt	Paper Copy Public InspectionPaperCopyPublicInspectionInd	Implementation Strategy AdoptImplementationStrategyAdoptInd	Implementation Strategy AdptImplementationStrategyAdptYr	Strategy Posted WebsiteStrategyPostedWebsiteInd	Strategy Website URLStrategyWebsiteURLTxt	Strategy AttachedStrategyAttachedInd	Organization Incur Excise TaxOrganizationIncurExciseTaxInd	Elig Criteria ExplainedEligCriteriaExplainedInd	FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd	FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct	FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct	Asset Level CriteriaAssetLevelCriteriaInd	Medical Indigency CriteriaMedicalIndigencyCriteriaInd	Insurance Status CriteriaInsuranceStatusCriteriaInd	Other CriteriaOtherCriteriaInd	Explained BasisExplainedBasisInd	App Financial Asst ExplnAppFinancialAsstExplnInd	Described InfoDescribedInfoInd	Described Suprt DocDescribedSuprtDocInd	Provided Hospital ContactProvidedHospitalContactInd	Includes Publicity MeasuresIncludesPublicityMeasuresInd	FAP Available On WebsiteFAPAvailableOnWebsiteInd	FAP Available On Website URLFAPAvailableOnWebsiteURLTxt	FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd	FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt	FAP Summary On WebsiteFAPSummaryOnWebsiteInd	FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt	FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd	FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd	FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd	FAP Notice DisplayedFAPNoticeDisplayedInd	Communtity Notified FAPCommuntityNotifiedFAPInd	Other PublicityOtherPublicityInd	FAP Actions On NonpaymentFAPActionsOnNonpaymentInd	Permit No ActionsPermitNoActionsInd	Collection ActivitiesCollectionActivitiesInd	FAP Notified Upon AdmissionFAPNotifiedUponAdmissionInd	FAP Notified Before DischargeFAPNotifiedBeforeDischargeInd	FAP Notified All PatientsFAPNotifiedAllPatientsInd	Documented Elig DeterminationDocumentedEligDeterminationInd	Other Actions TakenOtherActionsTakenInd	Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd	Other Method UsedOtherMethodUsedInd	Amounts Generally BilledAmountsGenerallyBilledInd	Gross ChargesGrossChargesInd
Avera Sacred Heart Hospital
1	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	15	Yes (1)	0	0	Yes (1)	Yes (X)	See part V Section C	Yes (X)	See Par V Section C	Yes (X)	Yes (1)	15	Yes (1)	See Part V Section C	0	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	http://www.avera.org/experience/ah/financial-assistance-charity-care/	Yes (X)	http://www.avera.org/experience/ah/financial-assistance-charity-care/	Yes (X)	http://www.avera.org/experience/ah/financial-assistance-charity-care/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (1)
Avera Creighton Hospital
2	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	15	Yes (1)	Yes (1)	0	Yes (1)	Yes (X)	See Part V Section C	Yes (X)	See Par V Section C	Yes (X)	Yes (1)	15	Yes (1)	See Part V Section C	0	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	http://www.avera.org/experience/ah/financial-assistance-charity-care/	Yes (X)	http://www.avera.org/experience/ah/financial-assistance-charity-care/	Yes (X)	http://www.avera.org/experience/ah/financial-assistance-charity-care/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (1)

Supplemental Information SupplementalInformationGrp (19 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Avera Sacred Heart Hospital	Part V, Section B, Line 5: Avera Sacred Heart Hospital worked closely with the SD Department of Health and also utilized Maximizing Excellence LLC to conduct focus groups. Careful consideration was taken to be sure that representatives from the community at large, the medically underserved, low-income and minority populations were included.
Avera Creighton Hospital	Part V, Section B, Line 5: Avera Creighton Hospital in conjunction with the North Central District Health Department used community stakeholder meetings, county focus groups and surveys targeted to specific population groups to determine potential areas to focus health improvement efforts on. Dr. Joseph Nitzke, a partner in Ionia Research, was contracted for data collection, compilation, analysis and presentation for the project.
Avera Creighton Hospital	Part V, Section B, Line 6a: Avera Creighton Hospital partnered with nine other hospitals in the North Central District Health Department including: Antelope Memorial Hospital, Avera St. Anthony's Hospital, Brown County Hospital, Cherry County Hospital, CHI Plainview, Niobrara Valley Hospital, Osmond General Hospital, Rock County Hospital and West Holt Memorial Hospital.
Avera Sacred Heart Hospital	Part V, Section B, Line 11: The 2015 Implementation Plan will address nutrition education, healthy choices, and awareness in the community and to continue to increase care coordination between the hospital and clinical providers in service of our mutual patients and colleagues.Nutrition:The first need identified is to increase nutrition education, healthy choices and community awareness of the issue. Avera Sacred Heart Hospital will implement quarterly nutrition education opportunities at various community events including RibFest, Riverboat Days, YankTON Challenge and others. Avera Sacred Heart Hospital will also post healthy recipes and tips quarterly on their Facebook page as well as update vending machines and snack bars to reflect the Good & Healthy SD vending criteria.Increase Care Coordination:Avera Sacred Heart has established a Chief Medical Officer position that has the primary responsibility of developing and strengthening physician and clinic relationships.The Hospital also plans to increase the number of patients with advance directives from 19% to 25%.Avera Sacred Heart Hospital requested from and granted access to electronic medical records within the hospital and various local clinics to facilitate a better flow of information for patient care where applicable and when appropriate.
Avera Creighton Hospital	Part V, Section B, Line 11: The most significant need identified was weight management, to include increased nutrition education, healthy choices and awareness in the community and increased physical activity in the community. Avera Creighton Hospital is exploring options for nutrition education by partnering with grocery stores and local restaurants to promote healthy options. Vending machine choices at the hospital will also be evaluated. Avera Creighton Hospital will also promote physical activity and classes through their wellness center and continue to offer "Know Your Numbers" every weekday.As outlined in our CHNA, there were other significant health needs identified in the North Central District. Due to limited resources, these will not be focused on by Avera Creighton Hospital. We are already committed to several of the areas and will contribute where appropriate.a. Aging Population and Related Illnesses: Avera Creighton Hospital also operates Avera Creighton Care Centre, a 47 bed skilled nursing facility. Services include Adult Day Care, hospice support, respite and others. We work with Avera@Home and other agencies to coordinate home care for elderlyresidents.b. Housing/Environmental: Avera Creighton Hospital actively participates with the Chamber of Commerce and promotes economic development in Knox County. An Avera Creighton leader serves on the Steering Committee for the Leadership Knox County program, which promotes active community participation and economic development.c. Mental Health: Avera Creighton Hospital has worked to increase availability to mental health services. We recently added two mental health professionals to our outreach services and also offer telemedicine regularly in this area. Leaders from Avera Creighton participate on the Knox CountyCares committee, which focuses on community wellness including substance abuse, etc.
Avera Sacred Heart Hospital	Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide.
Avera Creighton Hospital	Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide.
Avera Sacred Heart Hospital	Part V, Section B, Line 16i: 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.
Avera Creighton Hospital	Part V, Section B, Line 16i: 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.
Avera Sacred Heart 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.
Avera Creighton 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.
Avera Sacred Heart Hospital	Part V, Section B, Line 22d: The hospital facility calculated the amount generally billed under the look-back method using the lowest inpatient and outpatient combined Medicare and commercial payment rate. This rate will be reviewed and updated on an annual basis each October.
Avera Creighton Hospital	Part V, Section B, Line 22d: The hospital facility calculated the amount generally billed under the look-back method using the lowest inpatient and outpatient combined Medicare and commercial payment rate. This rate will be reviewed and updated on an annual basis each October.
Avera Sacred Heart Hospital	Part V, Section B, Line 24: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care.
Avera Creighton Hospital	Part V, Section B, Line 24: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care.
Part V, Line 7a:	www.avera.org/sacred
Part V, Line 10a:	www.avera.org/about/community-health-needs-assessments/
Part V, Line 7a:	www.avera.org/creighton
Part V, Line 10a:	www.avera.org/about/community-health-needs-assessments/

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Avera Yankton Care Center
1212 W 8th Street	Yankton	SD	57078	Skilled nursing facility
2 - Avera Sister James Care Center
2111 W 11th Street	Yankton	SD	57078	Skilled nursing facility
3 - Avera Sacred Heart Majestic Bluffs
2111 W 11th Street	Yankton	SD	57078	Assisted living
4 - Avera Sacred Heart Hospital-Swing Bed
501 Summit Street	Yankton	SD	57078	Swing Bed
5 - Avera Creighton Care Centre
1603 Main Street	Creighton	NE	687292999	Long Term Care
6 - Avera Sacred Heart Hospital-Dialysis
501 Summit Street	Yankton	SD	57078	Dialysis Unit

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted.
Part I, Line 6a:	Our community benefit report is contained in a report prepared by Avera Health, a related organization. It is available through the website and requested mailing, and is filed with the Catholic Health Association.
Part I, Line 7:	Charity care, unreimbursed Medicaid, and other means-tested government programs were converted to cost using the cost-to-charge ratio based on the Medicare Cost Report from the prior year. Unreimbursed Medicaid uses a cost-to-charge ratio that includes other activities beyond hospital inpatient. The amounts on lines 7e-i represent expenses reported in the general ledger and compiled using CBISA software.
Part I, Ln 7 Col(f):	Bad debt expense of $4,880,073 is included on Form 990, Part IX, Line 25, Column (A) but excluded for purposes of calculating this percentage.
Part II, Community Building Activities:	Sacred Heart Health Services provided a public school athletic trainer. This helps with the prevention of injuries, recognition of an injury requiring additonal medical attention, post-injury rehabilitation and education.
Part III, Line 2:	Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Bad debt expense is reported at charges as recorded by the organization.
Part III, Line 3:	Sacred Heart Health Services does not believe that any portion of bad debt expense could reasonably be attributable to patients who may qualify for financial assistance since evaluations are completed to determine those amounts due and will be reclassified from bad debt expense to charity care within 30 days of the evaluation of the amount.
Part III, Line 4:	The footnote to the Organization's financial statements that describes bad debt expenses can be found on page 10 of the attached financial statements.
Part III, Line 8:	Part III, Lines 5, 6, and 7: The Medicare revenues received (line 5), allowable costs (line 6), and the resulting shortfall (line 7) does not include a significant portion of the organization's expenses. These lines require use of the Medicare Cost Report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Sacred Heart Health Services. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removing the costs from the hospital's cost report entirely. Examples of non-cost report entities operated by Sacred Heart Health Services include clinics, a home medical equipment store, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, marketing, CRNA's, and interest expense. In addition to these disallowed costs within the Hospital, Sacred Heart Health Services operates clinics, long-term care facilities, and other health care related businesses which do not file a cost report.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. Sacred Heart Health Services 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.
Part III, Line 9b:	If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven.
Part VI, Line 2:	Avera Sacred Heart Hospital includes community members on committees, boards and advisory groups to allow community reaction and input in the actions we take. We also review all data provided by the health departments regarding disease rates, mortality, morbidity, population changes, etc. The hospital also conducts focus groups, consumer perception studies, and patient satisfaction surveys to identify primary needs of the community and responds with preventative/educational information or activities for the community.
Part VI, Line 3:	The brochure "Understanding Your Health Care Bills" is provided in visible locations experiencing high volumes of inpatient or outpatient registrations such as the admitting office, the billing/business office, and emergency department as well as the organization website. Patients are also made aware of possible eligibility when given the "Patient Rights and Responsibilities" brochure upon admission. The Patient Advocate works with uninsured/underinsured patients to enroll them in applicable social service programs and/or identify charity, county or risk pool eligibility.
Part VI, Line 4:	Avera Sacred Heart Hospital primarily serves the city and county of Yankton, SD and the surrounding South Dakota counties of Bon Homme, Charles Mix, Clay and Hutchinson, and Cedar County and Knox in Nebraska. U.S Census statistics indicate that 16.9% of the City of Yankton's individual residents fall below the federal poverty guidelines. For fiscal year 2016, 47% of our revenue came from Medicare and Medicare Advantage plans, and 12% came from Medicaid and Medicaid Replacement plans.
Part VI, Line 5:	The Hospital board is comprised of individuals who represent the interests of the community served by the organization. The Hospital offers staff privileges to all qualified physicians in the community. Selected services such as Radiation Oncology and Swingbed Services would not be available in our service area unless provided by the organization. The Hospital serves all individuals regardless of their ability to pay, providing 24 hour a day emergency services. The facility participates in the education of medical students from The University of South Dakota through their Yankton location. The Hospital also offers a 2-year Radiology Technologist program that graduates approximately 6 students per year. Sacred Heart Hospital also provides clinical education for Mount Marty College students. The Hospital is also proud of the fact that 305 individuals chose to volunteer at the facility during fiscal year 2016.
Part VI, Line 6:	Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera Health operates all have unique health and community benefits needs. In keeping with Catholic Health 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.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Mount Marty College	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1105 W 8th Street	AddressLine1Txt
City	Yankton	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57078	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	460283336	RecipientEIN
IRC Section	501(c)(3)	IRCSectionDesc
Cash Grant	$240,000	CashGrantAmt
Purpose Of Grant	Healthcare education	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	Educational scholarships	GrantTypeTxt
Recipient	4	RecipientCnt
Cash Grant	$20,000	CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	The Organization only makes grants to other organizations which are also tax-exempt. Individual scholarship recipients are selected by the University school of medicine according to its criteria. In fiscal year 2015, 4 medical school students were chosen for $5,000 scholarships.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	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	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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
Michael Peterson MD
Board Member & Physician	$592,794	$0	$0	$0	$4,819	$0	$12,736	$0	$6,777	$0	$617,126	$0	$0	$0
Douglas Ekeren
President & CEO	$0	$339,634	$0	$0	$0	$123,876	$0	$18,791	$0	$23,691	$0	$505,992	$0	$0
Jamie A Schaefer
Sec/Treas & VP Finance	$221,729	$0	$0	$0	$421	$0	$11,384	$0	$5,777	$0	$239,311	$0	$0	$0
Anthony Erickson
Exec Director-Senior Services	$164,663	$0	$0	$0	$691	$0	$8,142	$0	$8,087	$0	$181,583	$0	$0	$0
Gregory Taylor MD
Diagnostic Radiology	$517,727	$0	$0	$0	$6,740	$0	$13,415	$0	$8,527	$0	$546,409	$0	$0	$0
Steve Gutnik MD FACP
Gastroenterology	$762,960	$0	$0	$0	$9,987	$0	$13,027	$0	$8,531	$0	$794,505	$0	$0	$0
Matthew G Winkelbauer MD
Family Medicine/OB	$640,042	$0	$0	$0	$1,048	$0	$13,098	$0	$5,737	$0	$659,925	$0	$0	$0
Ralph Tullo MD
Diagnostic Radiology	$466,798	$0	$0	$0	$6,740	$0	$13,339	$0	$8,961	$0	$495,838	$0	$0	$0
Ryan Banks MD
Family Medicine/OB	$496,659	$0	$0	$0	$562	$0	$13,323	$0	$6,017	$0	$516,561	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule J, Part I Line 3:	FormAndLineReferenceDesc
Explanation	The President & CEO's compensation was paid by a related organization, Avera Health. Avera Sacred Heart relied on the related organization for determining the compensation for the President & CEO using the methods described in Part I, Line 3.	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Janet Jans
Spouse of board member	$20,250	Employee compensation	0
Allison Diedrichsen
Spouse of board member	$27,923	Employee compensation	0
Yankton Medical Clinic
Partner of Yankton Medical Clinic is board member of organization	$718,350	Professional services	0
Mary Loecker
Parent of board member	$17,504	Employee compensation	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part III, line 2	Avera Yankton Care Center moved into an addition of the Avera Sister James Care Center in late December of 2015. This resulted in 73 skilled nursing beds being added to the Avera Sister James Care Center. However, the move did not result in a net increase in beds for our organization. Residential Hospice Care at the Avera Sacred Heart Majestic Bluffs Hospice House began April 5.
Form 990, Part VI, Section A, line 2	Sr. Lucille Welbig and Douglas Ekeren have a business relationship.
Form 990, Part VI, Section A, line 6	The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended.
Form 990, Part VI, Section A, line 7a	Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors.
Form 990, Part VI, Section A, line 7b	Avera Health 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 B, line 11	The Form 990 is reviewed initially by the CEO and CFO. The return is made available to the Board of Directors for review prior to filing.
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 board members. The information is maintained in a database and a report is provided to the Board.
Form 990, Part VI, Section B, line 15b	The CEO was compensated by Avera Health System. 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. The compensation of the CEO, other officers, directors, and key employees is reviewed annually. The organization utilizes the resources of an outside independent agency for market comparability. The compensation is approved within the annual budget approved by the Board.
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 1,748,828. Management and general expenses 461,328. Fundraising expenses 0. Total expenses 2,210,156. Consulting: Program service expenses 947,431. Management and general expenses 221,364. Fundraising expenses 0. Total expenses 1,168,795. Professional Medical Services: Program service expenses 3,714,238. Management and general expenses 3,469,219. Fundraising expenses 170. Total expenses 7,183,627. ACS Fees: Program service expenses 0. Management and general expenses 8,878,185. Fundraising expenses 0. Total expenses 8,878,185.
Form 990, Part XI, line 9:	Capital transfers, net -5,279,380. Net Assets Released from Donor Restriction 303,049. Change in fair value of interest rate swap -132,457.
Form 990, Part XII, Line 2c:	The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Sacred Heart Health Services.
Part III, Line 4a:	(Continued from Page 6 of Schedule O) The Avera Cancer Institute Navigation Center, an immediate and constant source of support and information to patients and their families across Avera's 72,000 mile footprint opened March 1. It can be accessed 24 hours a day, seven days a week, by calling 605-322-3211 or 888-422-1410. Reasons for calling the Navigation Center can range from managing symptoms, to finding resources for emotional support, to getting help for the whole family for issues created by the effects of cancer and treatment. Anyone can call the Navigation Center - they do not need to be an Avera patient. As an integrated organization, Avera and Avera Sacred Heart are leaders in the implementation of the electronic patient record (EMR). Commitment to quality: Avera Sacred Heart is accredited by the Joint Commission and received another three-year accreditation in 2014.
Form 990, Part VI, Line 16:	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 X, Line 20:	The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Marshall, Avera St. Mary's, and Sacred Heart Health Services. 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).

Schedule R IRS990ScheduleR

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	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Avera Health
3900 West Avera Drive Suite 300	Sioux Falls	SD	57108	460422673	Healthcare services	SD	501(c)(3)	Line 9	N/A	0
Avera at Home
5116 S Solberg Ave	Sioux Falls	SD	57108	460399291	Home Services	SD	501(c)(3)	Line 9		0	Avera Health
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 9		Yes (1)	Sacred Heart Health Services
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare services	NE	501(c)(3)	Line 3		0	Avera Health
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare services	IA	501(c)(3)	Line 3		0	Avera Health
Avera Holy Family Foundation
826 North 8th Street	Estherville	IA	51334	421317452	Fundraising	IA	501(c)(3)	Line 9		0	Avera Holy Family
Avera Marshall
300 S Bruce St	Marshall	MN	56258	410919153	Healthcare services	MN	501(c)(3)	Line 3		0	Avera Health
Avera Marshall Foundation
300 S Bruce St	Marshall	MN	56258	411784801	Fundraising	MN	501(c)(3)	Line 7		0	Avera Marshall
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
St Benedict Health Center Foundation
West Glynn Drive PO Box B	Parkston	SD	57366	460458725	Support health related services	SD	501(c)(3)	Line 11a, I		0	St Benedict Health Center
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Queen of Peace Hospital
525 N Foster Street	Mitchell	SD	57301	460224604	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare services	SD	501(c)(3)	Line 3		0	Avera St Mary's
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare services	MN	501(c)(3)	Line 3		0	Avera Marshall
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health financing and health plans admin	SD	501(c)(4)			0	Avera Health

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	Surgical associates	SD	N/A
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
Avera Home Medical Equipment of Estherville LLC
PO Box 5045	Sioux Falls	SD	57117	201686097	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 Marshall LLC
1104 East College Drive	Marshall	MN	56258	205271924	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Spencer Hospital LLC
2400 S MN Ave 102	Sioux Falls	SD	57117	800619999	Medical services - home medical equipment	SD	N/A
Q&M Properties
525 North Foster	Mitchell	SD	57301	731652049	Medical clinic building	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

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	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
Valley Health Services Inc
501 Summit Street	Yankton	SD	57078	460357149	Rental real estate	SD	N/A	C	0
Accounts Management Inc
5132 S Cliff Ave Suite 101	Sioux Falls	SD	57108	460373021	Collection agency	SD	N/A	C	0
Avera Property Insurance Inc
610 W 23rd St Ste 1 PO Box 38	Yankton	SD	57078	460463155	Insurance	SD	N/A	C	0
Alucent Medical Inc
1325 S Cliff Avenue PO Box 5045	Sioux Falls	SD	571175045	471818349	Biotech Research	SD	N/A	C	0
South Dakota State Medical Holding Company Inc
2600 W 49th Street	Sioux Falls	SD	57105	460401087	Insurance	SD	N/A	C	0
DakotaCare Administrative Services Inc
2600 W 49th Street	Sioux Falls	SD	57105	460424322	Insurance	SD	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	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	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	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	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Lewis and Clark Health Education and Service Agency
L	$114,387	Recorded in General Ledger
Lewis and Clark Health Education and Service Agency
M	$212,179	Recorded in General Ledger

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule R, Part II:	Effective October 1, 2015, Avera Health Plans Inc. obtained tax exempt status under IRC 501(c)(4). Avera Health Plans Inc. was previously taxed as a C-corporation. Effective March 1, 2016, Avera Tyler was acquired by Avera Health.
Schedule R, Part III:	Avera Home Medical Equipment of Estherville, LLC dissolved effective October 1, 2015. Avera Home Medical Equipment of Marshall, LLC dissolved effective January 1, 2016. Operations of both entities were transferred to Avera @ Home.