AVERA ST MARYS: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- AVERA ST MARYS (EIN 46-0230199)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201711359349304436
- 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 H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T13:45:29-05:00 | 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 | 460230199 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HEALTHCARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STMA | BusinessNameControlTxt |
| Phone | 6052243130 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 EAST SIOUX AVENUE | AddressLine1Txt |
| City | PIERRE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57501 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD FORKEL | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6052243130 | PhoneNum |
| Signature | 2017-05-10 | 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 | 2017-05-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TODD FORKEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 EAST SIOUX AVENUE | AddressLine1Txt |
| City | PIERRE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $81,776,317 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.AVERA.ORG/ST-MARYS-PIERRE | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1951 | FormationYr |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Activity Or Mission | PROMOTION OF HEALTH | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 591 | TotalEmployeeCnt |
| Total Volunteers | 256 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $201,871 | PYContributionsGrantsAmt |
| CY Contributions Grants | $839,724 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $78,760,800 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $80,627,548 | CYProgramServiceRevenueAmt |
| PY Investment Income | $374,817 | PYInvestmentIncomeAmt |
| CY Investment Income | $84,001 | CYInvestmentIncomeAmt |
| PY Other Revenue | $152,292 | PYOtherRevenueAmt |
| CY Other Revenue | $225,044 | CYOtherRevenueAmt |
| PY Total Revenue | $79,489,780 | PYTotalRevenueAmt |
| CY Total Revenue | $81,776,317 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,028 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $324 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $43,730,180 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $45,353,874 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,234,175 | PYOtherExpensesAmt |
| CY Other Expenses | $38,501,320 | CYOtherExpensesAmt |
| PY Total Expenses | $81,972,383 | PYTotalExpensesAmt |
| CY Total Expenses | $83,855,518 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,482,603 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,079,201 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $75,312,722 | TotalAssetsBOYAmt |
| Total Assets EOY | $61,277,349 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $39,148,640 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,728,264 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $36,164,082 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $29,549,085 | 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 | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $74,371,016 | ExpenseAmt |
| Grant | $324 | GrantAmt |
| Revenue | $80,627,548 | RevenueAmt |
| Desc | AVERA ST. MARY'S IS LISTED IN THE OFFICIAL CATHOLIC DIRECTORY. IT IS A TAX EXEMPT 501(C)(3) ORGANIZATION OPERATED AS A MINISTRY OF THE CATHOLIC CHURCH. AVERA ST. MARY'S IS AFFILIATED WITH AVERA HEALTH.THE HOSPITAL SERVES ALL PERSONS IN THE COMMUNITY ON A NON-DISCRIMINATORY BASIS. AVERA ST. MARY'S OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. AVERA ST. MARY'S HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE GOVERNING BODY IS COMPRISED OF PRIMARILY INDEPENDENT INDIVIDUALS, REPRESENTATIVE OF THE COMMUNITY AS A WHOLE. AVERA ST. MARY'S PROVIDES EDUCATION AND TRAINING OPPORTUNITIES TO HEALTHCARE STUDENTS ENROLLED IN THE LOCAL COLLEGE CAPITAL UNIVERSITY CENTER. AVERA ST. MARY'S PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE AND/OR OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. | Desc |
| Total Program Service Expenses | $74,371,016 | 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 | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | 0 | 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 | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 74 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 591 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | 0 | 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 | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GEOFF DURST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6052243127 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 EAST SIOUX AVENUE | AddressLine1Txt |
| City | PIERRE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57501 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TERRY FITZKE | ||||||||
| CHAIR | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR JOSEPH VILLA | ||||||||
| VICE CHAIR/SEC/TREAS | 2.00 | 40.00 | Yes (X) | Yes (X) | $0 | $507,529 | $28,729 | |
| DAN LUSK | ||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JUSTIN CRONIN | ||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SCOTT ISBURG | ||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MIKE WEISGRAM | ||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JOSEPH WYATT | ||||||||
| BOARD MEMBER | 2.00 | 40.00 | Yes (X) | $0 | $565,860 | $5,773 | ||
| DR JESSICA RASMUSSEN | ||||||||
| BOARD MEMBER | 2.00 | 40.00 | Yes (X) | $0 | $321,000 | $5,300 | ||
| PEGGY WILLIAMS | ||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SISTER MARY JAEGER | ||||||||
| BOARD MEMBER | 2.00 | 9.00 | Yes (X) | $0 | $0 | $0 | ||
| SISTER KATHLEEN CROWLEY | ||||||||
| BOARD MEMBER | 2.00 | 4.50 | Yes (X) | $0 | $0 | $0 | ||
| TODD FORKEL | ||||||||
| PRESIDENT & CEO (AS OF DEC 2015) | 2.00 | 40.00 | Yes (X) | $0 | $518,707 | $40,404 | ||
| BOB SUTTON | ||||||||
| PRESIDENT & CEO (THRU DEC 2015) | 2.00 | 40.00 | Yes (X) | $0 | $371,428 | $40,732 | ||
| GEOFF DURST | ||||||||
| CFO (AS OF OCT 2015) | 5.00 | 37.00 | Yes (X) | $0 | $218,970 | $22,005 | ||
| TOM WAGNER | ||||||||
| CFO (THRU OCT 2015) | 40.00 | 0.00 | Yes (X) | $125,861 | $0 | $19,352 | ||
| CHRISTOPHER OLSON | ||||||||
| CRNA | 40.00 | 0.00 | $196,125 | $0 | $22,892 | Yes (X) | ||
| THERESA SIMMONS | ||||||||
| CRNA | 40.00 | 0.00 | $199,345 | $0 | $20,657 | Yes (X) | ||
| KEVIN ROARK | ||||||||
| CRNA | 40.00 | 0.00 | $171,533 | $0 | $23,925 | Yes (X) | ||
| BRAD SAATHOFF | ||||||||
| STAFF PHARMACIST | 40.00 | 0.00 | $158,563 | $0 | $10,822 | Yes (X) | ||
| TRAE TURNER | ||||||||
| STAFF PHARMACIST | 40.00 | 0.00 | $144,324 | $0 | $8,863 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $995,751 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,503,494 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $249,454 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | 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 |
|---|---|---|---|---|---|
| AVERA MCKENNAN | |||||
| 1325 S CLIFF AVE PO BOX 5045 | SIOUX FALLS | SD | 57117 | STAFFING AND OTHER SERVICES | $24,736,413 |
| JOURNEY GROUP COMPANIES | |||||
| 4500 W 58TH ST | SIOUX FALLS | SD | 57108 | CONSTRUCTION | $1,019,575 |
| C&A INDUSTRIES INC | |||||
| 13609 CALIFORNIA ST | OMAHA | NE | 681545233 | CONTRACT LABOR | $726,511 |
| NXC IMAGING | |||||
| 2118 4TH AVE S | MINNEAPOLIS | MN | 554042642 | HOSPITAL SERVICES | $635,268 |
| READY TECH GO | |||||
| 1005 E 23RD ST STE 200 | FREEMONT | NE | 68025 | PURCHASED SERVICES | $551,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $10,000 | RelatedOrganizationsAmt |
| Government Grants | $461,774 | GovernmentGrantsAmt |
| All Other Contributions | $367,950 | AllOtherContributionsAmt |
| Total Contributions | $839,724 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $77,668,584 | $77,668,584 |
| PHARMACY 340B | 900099 | $974,236 | $974,236 |
| ASSISTED LIVING LTC | 623312 | $928,889 | $928,889 |
| MEANINGFUL USE PAYMENTS | 900099 | $493,536 | $493,536 |
| CHANGE IN INTEREST IN FOUNDATION | 900099 | -$28,129 | -$28,129 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $590,432 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $590,432 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $80,627,548 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,677 | TotalRevenueColumnAmt |
| Exclusion | $18,677 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $225,044 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $225,044 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $225,044 | TotalRevenueColumnAmt |
| Exclusion | $225,044 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $65,324 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $65,324 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,324 | TotalRevenueColumnAmt |
| Exclusion | $65,324 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $81,776,317 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $80,627,548 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $309,045 | 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 | $324 | TotalAmt |
| Program Services | $324 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,091 | TotalAmt |
| Management And General | $58,091 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,089 | TotalAmt |
| Program Services | $36,089 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,381,102 | TotalAmt |
| Program Services | $32,822,662 | ProgramServicesAmt |
| Management And General | $3,558,440 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,994,200 | TotalAmt |
| Program Services | $1,797,680 | ProgramServicesAmt |
| Management And General | $196,520 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,690,945 | TotalAmt |
| Program Services | $4,231,114 | ProgramServicesAmt |
| Management And General | $459,831 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,193,447 | TotalAmt |
| Program Services | $1,976,296 | ProgramServicesAmt |
| Management And General | $217,151 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,400 | TotalAmt |
| Management And General | $2,400 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,120 | TotalAmt |
| Management And General | $13,120 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,204,592 | TotalAmt |
| Program Services | $8,726,284 | ProgramServicesAmt |
| Management And General | $3,478,308 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,128 | TotalAmt |
| Management And General | $17,128 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,735,610 | TotalAmt |
| Program Services | $2,585,151 | ProgramServicesAmt |
| Management And General | $150,459 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,644 | TotalAmt |
| Program Services | $48,644 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,254,688 | TotalAmt |
| Program Services | $1,175,643 | ProgramServicesAmt |
| Management And General | $79,045 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,090 | TotalAmt |
| Program Services | $130,733 | ProgramServicesAmt |
| Management And General | $89,357 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,385 | TotalAmt |
| Management And General | $227,385 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $789,597 | TotalAmt |
| Program Services | $789,597 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,524,546 | TotalAmt |
| Program Services | $3,464,629 | ProgramServicesAmt |
| Management And General | $59,917 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $523,936 | TotalAmt |
| Program Services | $515,029 | ProgramServicesAmt |
| Management And General | $8,907 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $10,208,488 | $10,208,488 | |
| BAD DEBT EXPENSE | $4,536,615 | $4,536,615 | |
| REPAIRS AND MAINTENANCE | $1,528,074 | $664,711 | $863,363 |
| UNRELATED BUSINESS INCO | $5,080 | $5,080 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $661,327 | TotalAmt |
| Program Services | $661,327 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,855,518 | TotalAmt |
| Program Services | $74,371,016 | ProgramServicesAmt |
| Management And General | $9,484,502 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,587,595 | BOYAmt |
| EOY | $1,251,882 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,086,785 | BOYAmt |
| EOY | $10,722,952 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $386,756 | BOYAmt |
| EOY | $217,215 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,088,268 | BOYAmt |
| EOY | $2,169,632 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $426,583 | BOYAmt |
| EOY | $396,599 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $91,159,027 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $61,042,099 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,022,579 | BOYAmt |
| EOY | $30,116,928 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,885,112 | BOYAmt |
| EOY | $15,864,613 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,846 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $609,198 | BOYAmt |
| EOY | $537,528 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,312,722 | BOYAmt |
| EOY | $61,277,349 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,228,657 | BOYAmt |
| EOY | $4,784,729 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,243 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,040,251 | BOYAmt |
| EOY | $8,726,982 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,287,311 | BOYAmt |
| EOY | $11,724,978 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,574,178 | BOYAmt |
| EOY | $6,491,575 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,148,640 | BOYAmt |
| EOY | $31,728,264 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,059,192 | BOYAmt |
| EOY | $27,800,099 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,791,890 | BOYAmt |
| EOY | $1,435,986 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $313,000 | BOYAmt |
| EOY | $313,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,164,082 | BOYAmt |
| EOY | $29,549,085 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,312,722 | BOYAmt |
| EOY | $61,277,349 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,079,201 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,058,307 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,477,489 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 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 | $2,603 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,603 | 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 ST. MARY'S PAID DUES TO ORGANIZATIONS WHICH HAVE A PORTION OF THE DUES ATTRIBUTED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,391,428 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $3,086,916 | OtherCostOrOtherBasisAmt |
| Book Value | $4,478,344 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,323,251 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,554,500 | DepreciationAmt |
| Book Value | $15,768,751 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,755,536 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,229,505 | DepreciationAmt |
| Book Value | $9,526,031 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,601,896 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,258,094 | DepreciationAmt |
| Book Value | $343,802 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $30,116,928 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENT FUND | $6,201,101 | F |
| INTEREST IN AVERA HEALTH FOUNDATION | $9,663,512 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $15,864,613 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTY | $6,261,825 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $229,750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,491,575 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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 FOR CONSOLIDATED SUBSIDIARIES ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2013. | ExplanationTxt |
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) |
|---|---|---|
| Total Community Benefit Expns | $308,972 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $308,972 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,272,273 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,401,164 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $871,109 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01100 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,581,245 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,401,164 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,180,081 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01490 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,109,964 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,858,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,251,700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.24270 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $97,071 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $97,071 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $34,207,035 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,858,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,348,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.24390 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $41,788,280 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,259,428 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,528,852 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.25880 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,536,615 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,159,787 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,130,733 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,970,946 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA ST MARY'S | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 EAST SIOUX AVENUE | AddressLine1Txt |
| City | PIERRE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.AVERA.ORG/ST-MARYS-PIERRE/ | WebsiteAddressTxt |
| State License | 10566 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PROVIDER BASED CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA ST MARY'S | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.AVERA.ORG/ST-MARYS-PIERRE/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.AVERA.ORG/EXPERIENCE/AH/FINANCIAL-ASSISTANCE-CHARITY-CARE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.AVERA.ORG/EXPERIENCE/AH/FINANCIAL-ASSISTANCE-CHARITY-CARE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.AVERA.ORG/EXPERIENCE/AH/FINANCIAL-ASSISTANCE-CHARITY-CARE/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| AVERA ST. MARY'S | PART V, SECTION B, LINE 5: AVERA ST. MARY'S GATHERED INFORMATION REGARDING THE NEEDS OF THE COMMUNITY THROUGH A THREE-PRONGED PROCESS GATHERING STAKEHOLDER INFORMATION ON COMMUNITY PERCEPTIONS OF THE HEALTH OF CENTRAL SOUTH DAKOTA INCLUDING A SURVEY OF THREE CIVIC SOCIAL CLUBS, INTERVIEWS WITH IDENTIFIED COMMUNITY LEADERS, AND SEVERAL FOCUS GROUPS. ALL MEMBERS OF THE CHNA TEAM WERE SELECTED FOR ROLES THEY HAVE IN THE COMMUNITY BY A MATRIX DEVELOPED BY THE AVERA ST. MARY'S HOSPITAL ADMINISTRATIVE COUNCIL AND INCLUDED ATTRIBUTES SUCH AS: UNINSURED/UNDERINSURED, PARENTS OF YOUNG CHILDREN, CLOSE CONTACT WITH UNDERPRIVILEGED PEOPLE TO ASSURE A "VOICE" IN THE PROCESS, HEALTH LEADERS WITH IN-DEPTH KNOWLEDGE OF THE LOCAL HEALTH CARE ENVIRONMENT, GOVERNMENT, BUSINESS, RETIRED, SOUTH DAKOTA STATE DEPARTMENTS OF HEALTH AND SOCIAL SERVICES, URBAN INDIAN HEALTH, AND RURAL HEALTH CLINICS. |
| AVERA ST. MARY'S | PART V, SECTION B, LINE 6B: SOUTH DAKOTA DEPARTMENT OF HEALTHURBAN INDIAN HEALTHDELTA DENTAL OF SOUTH DAKOTAPIERRE AREA CHAMBER OF COMMERCEPIERRE AREA REFERRAL SERVICE |
| AVERA ST. MARY'S | PART V, SECTION B, LINE 11: THE PRIORITIZED COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED MAY 2016 INCLUDE A CANCER TREATMENT CENTER, RECRUITMENT OF PHYSICIANS INCLUDING ONCOLOGIST, PSYCHIATRIST, ADOLESCENT PSYCHIATRIST AND OTHER SPECIALISTS. OVER THE NEXT THREE YEARS, AN IMPLEMENTATION STRATEGY FOR EACH OF THE THREE SELECTED PRIORITIES WILL BE ADDRESSED.GOAL 1: INCREASE CANCER TREATMENT OPTIONS AND SERVICES IN CENTRAL SOUTH DAKOTA BY RECRUITING A RADIATION ONCOLOGIST, BUILDING A CANCER CENTER, PROVIDING EDUCATION SCREENINGS AND SUPPORT GROUPS AND PROMOTING AVERA CANCER NAVIGATOR PROGRAM.GOAL 2: REDUCE CHRONIC DISEASE IMPACTS BY DECREASING CANCER, HEART DISEASE, AND OBESITY RATES AND INCREASING MANAGEMENT, SUPPORT AND EDUCATION FOR PERSONS WITH CHRONIC DISEASE BY INCREASING CANCER PREVENTION EFFORTS, COMPLETING THE CIRCLE PROJECT, A COLLABORATION WITH AVERA ST. MARY'S HOSPITAL, URBAN INDIAN HEALTH AND VILAS PHARMACY HELPING PEOPLE WITH DIABETES OVERCOME BARRIERS AND MANAGE THEIR DISEASE, AND DIABETES PROGRAMS AT THE CLINIC BECOMING AMERICAN DIABETES ASSOCIATION CERTIFIED. OTHER OBJECTIVES ARE TO INCREASE HEART DISEASE PREVENTION EFFORTS AND DECEASE THE RATE OF HEART DISEASE, CONTINUE TO REDUCE THE PROPORTION OF CHILDREN AND ADOLESCENTS WHO ARE CONSIDERED OBESE TO THE HEALTHY PEOPLE 2020 INITIATIVE TARGETS, AND TEACH HEALTHY LIVING CLASSES BY TRAINED PHYSICIANS AND COMMUNITY MEMBERS.GOAL 3: INCREASE MENTAL HEALTH SERVICES IN CENTRAL SOUTH DAKOTA BY INCREASING PSYCHIATRIC SERVICES IN CENTRAL SOUTH DAKOTA, ESTABLISHING A TELEPSYCH PROGRAM, IF FEASIBLE, WORKING WITH AVERA BEHAVIORAL HEALTH TO RECRUIT OR PLACE A PSYCHIATRIST AND ADOLESCENT PSYCHIATRIST TO SERVE CENTRAL SOUTH DAKOTA BY 6/30/2019, DEVELOPING AN ACTION PLAN FOR A REGIONAL CENTER IN CENTRAL SOUTH DAKOTA FOR MENTAL HEALTH TREATMENT AND SERVICES, AND CONTINUING TO DEVELOP MENTAL HEALTH EMERGENCY/CRISIS PROGRAM WITHIN THE COMMUNITY TO BEST SERVE PERSONS IN CRISIS IN THE MOST COMPASSIONATE AND COST EFFECT MANOR.COMMUNITY HEALTH NEEDS NOT BEING ADDRESSEDSHORT-TERM SHELTER FACILITY FOR THOSE OF LIMITED MEANS, DIVERSE CULTURAL NEEDS (NATIVE AMERICAN), DETOX FACILITIES AND PROGRAMS, BARRIERS (HOURS, AFFORDABILITY, AND AVAILABILITY) WILL NOT BE ADDRESSED.THE SHELTER AND DETOX FACILITIES HAVE BEEN STUDIED BY VARIOUS GROUPS IN THE PAST AND THE END RESULT IS A LACK OF SUSTAINABLE FINANCING. UNTIL THERE IS A WORKABLE PLAN, WE ARE UNABLE TO ADDRESS THESE NEEDS IN THE NEXT FEW YEARS. HOWEVER, BY FURTHER DEVELOPING MENTAL HEALTH SUPPORT SERVICES, WE BELIEVE THAT BOTH NEEDS WILL BE CONSTRUCTIVELY IMPACTED AND WILL BE FURTHER DEVELOPED DURING THE ACTION PROCESS.NATIVE AMERICAN "CULTURAL NEEDS" IS MUCH MORE THAN JUST ONE NEED AND SIMPLE SOLUTIONS. AS WE ADDRESS THE KEY NEEDS DURING PLANNING, WE WILL INCLUDE INPUT AND PARTICIPATION BY AND WITH THE NATIVE AMERICAN COMMUNITY. THE BARRIERS MENTIONED WILL BE INCLUDED IN ANY WORK DONE REGARDING HOURS, AFFORDABILITY AND AVAILABILITY FOR COMMUNITY HEALTH NEEDS AND BENEFITS OF AVERA ST. MARY'S HOSPITAL. |
| AVERA ST. MARY'S | PART V, SECTION B, LINE 13H: PRESUMPTIVE CHARITY CARE MAY BE APPLIED IN SITUATIONS WHERE ALL OTHER AVENUES OF FINANCIAL ASSISTANCE HAVE BEEN EXHAUSTED. THE FACILITY HAS THE DISCRETION TO WEIGH EXTENUATING CIRCUMSTANCES WHEN DETERMINING ELIGIBILITY FOR AND THE AMOUNT OF CHARITY CARE TO PROVIDE. |
| AVERA ST. MARY'S | 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 ST. MARY'S | PART V, SECTION B, LINE 20E: IF A PATIENT IS SELF-PAY AND HAS A LARGE BALANCE, AN AVERA PATIENT ADVOCATE WILL HELP THEM APPLY FOR OTHER FORMS OF ASSISTANCE. IF THEY ARE NOT ELIGIBLE FOR ANY OTHER COVERAGE, THE PATIENT IS GIVEN A FINANCIAL ASSISTANCE APPLICATION TO COMPLETE AND RETURN TO THE FACILITY. |
| AVERA ST. MARY'S | 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 ST. MARY'S | 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. |
| SCHEDULE H, PART V, SECTION B, LINE 7B: | WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AVERA PARKWOOD INDEPENDENT LIVING FACILI | ||||
| 400 PARKWOOD DRIVE | PIERRE | SD | 57501 | INDEPENDENT LIVING |
| 2 - MARYHOUSE | ||||
| 400 PARKWOOD DRIVE | PIERRE | SD | 57501 | LONG TERM CARE |
Supplemental Information Detail SupplementalInformationDetail (14 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: | THE COMMUNITY BENEFIT REPORT IS POSTED ON OUR WEB SITE AT WWW.AVERA.ORG/ST-MARYS/. |
| PART I, LINE 7: | CHARITY CARE ON LINE 7A WAS CONVERTED TO COST USING IRS WORKSHEET 2. LINES 7B AND 7G ARE FROM THE COST REPORTS. LINE 7I IS FROM THE GENERAL LEDGER. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $4,536,615. |
| 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: | AVERA ST. MARY'S 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 AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | IF THE PATIENT QUALIFIES FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME, UNINSURED PATIENTS AND IS COOPERATING WITH THE ORGANIZATION WITH REGARD TO EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN CURRENT SELF-PAY COLLECTION POLICY GUIDELINES AND TIMEFRAMES, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. AVERA ORGANIZATIONS WILL ALLOW ALL INDIVIDUALS 120 DAYS FROM THE FIRST POST DISCHARGE STATEMENT TO APPLY FOR FINANCIAL ASSISTANCE BEFORE SENDING THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY. AVERA WILL PROVIDE THE PATIENT WITH A STATEMENT OR FINAL NOTICE THAT CONTAINS A LISTING OF THE SPECIFIC COLLECTION ACTION(S) IT INTENDS TO INITIATE, AND A DEADLINE AFTER WHICH THEY MAY BE INITIATED NO EARLIER THAN 30 DAYS BEFORE ACTION IS INITIATED. IF THE PATIENT QUALIFIES FOR 100% CHARITY CARE, NO FURTHER BILLS WILL BE SENT. A LETTER WILL BE SENT INSTEAD INDICATING THAT THE PATIENT'S BILL HAS BEEN COMPLETELY FORGIVEN. |
| PART VI, LINE 2: | EVERY THREE YEARS, AVERA ST. MARY'S HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA)AND DEVELOPS AN IMPLEMENTATION PLAN. THE CURRENT PLAN WAS ACCEPTED BY AVERA ST. MARY'S HOSPITAL BOARD OF DIRECTORS IN MAY, 2016. PARTICIPANTS IN THE ASSESSMENT INCLUDED MUNICIPAL DEPARTMENTS, SCHOOL DISTRICTS, URBAN INDIAN HEALTH, RURAL HEALTH CLINICS, AND MENTAL HEALTH. TO ENSURE INPUT FROM PERSONS WITH BROAD KNOWLEDGE OF THE COMMUNITIES, WE INCLUDED PEOPLE WITH A WIDE SPECTRUM OF AGE, MEMBERS OF UNDERSERVED POPULATIONS, UNINSURED/UNDERINSURED, CONSUMERS OF HEALTH CARE, PARENTS OF SCHOOL AGED CHILDREN, UNITED WAY AND OTHER SOCIAL SERVICE STAFF AND ORGANIZATION, LOCAL CLERGY, STAFF FROM STATE AGENCIES ON AGING, SOCIAL SERVICES, AND HEALTH, GOVERNMENT EMPLOYEES, EMERGENCY ROOM PHYSICIAN, HOSPITALISTS, HOSPITAL LEADERSHIP AND PERSONS RESIDING IN EACH OF THE THREE COUNTIES SURVIVED (HUGHES, STANLEY, SULLY).THE WORK OF THE CHNA TEAM BEGAN WITH A PRESENTATION TO THE ENTIRE TEAM OF "FOCUS ON SOUTH DAKOTA, A PICTURE OF HEALTH", A SURVEY COMMISSIONED BY THE LEONA M. AND HARRY B. HELMSLEY CHARITABLE TRUST. THIS STATEWIDE SURVEY DATA COVERED BEHAVIORAL HEALTH, ACCESS TO CARE, AND INTRODUCED MANY ISSUES SUCH AS WORK FORCE NEEDS.COMMUNITY SURVEYS WERE COMPLETED BY PIERRE/FORT PIERRE ROTARY, PIERRE LIONS CLUB, PIERRE KIWANIS, HEAD START AND PARENTS MATTER AND DATE WAS GATHERED FROM SOURCES SUCH AS PIERRE AREA REFERRAL, SOUTH DAKOTA DEPARTMENT OF HEALTH AND EDUCATION, COUNTY HEALTH RANKINGS AND AVERA ST. MARY'S HOSPITAL. INTERVIEWS WERE CONDUCTED WITH KEY COMMUNITY MEMBERS AND FOCUS GROUPS WERE CONDUCTED FOR SPECIAL POPULATIONS.IDENTIFIED HEALTH NEEDS INCLUDED: MENTAL HEALTH SERVICES, CHRONIC HEALTH ISSUES, SUCH AS CANCER, DIABETES, AND OBESITY. AN IMPLEMENTATION PLAN HAS BEEN DEVELOPED AND IS MONITORED BY THE AVERA ST. MARY'S BOARD OF DIRECTORS. |
| PART VI, LINE 3: | AVERA ST. MARY'S POSTS ITS CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT; (2) PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS; (3) PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS WITH DISCHARGE MATERIALS; (4) INCLUDES THE POLICY, OR A SUMMARY THEREOF, ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION, IN PATIENT BILLS; AND/OR (5) DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. |
| PART VI, LINE 4: | AVERA ST. MARY'S IS AN ACUTE CARE HOSPITAL SERVING A RURAL COMMUNITY AREA OF CENTRAL SOUTH DAKOTA WHICH CONSISTS OF THE FOLLOWING PRIMARY COUNTIES: HUGHES, STANLEY AND SULLY COUNTY.USING SOUTH DAKOTA ESTIMATED DATA FROM JULY 2016, CENSUS REFLECTED THE FOLLOWING ESTIMATED POPULATIONS FOR THE THREE AFOREMENTIONED COUNTIES: FACTFINDER.CENSUS.GOVHUGHES: 17,600STANLEY: 2,993SULLY: 1,421MEDIAN AGE AND PERCENTAGE OF THE POPULATION OVER THE AGE OF 65 FOR THE THREE COUNTIES ARE SHOWN RESPECTIVELY BELOW.2010 CENSUS DATAHUGHES: 39.8 AND 13.4%STANLEY: 41.9 AND 15.8%SULLY: 46.6 AND 19.2%RACIAL/ETHNIC COMPOSITIONACCORDING TO THE U.S. CENSUS BUREAU, AVERA ST. MARY'S PRIMARY SERVICE AREA IS COMPRISED OF 90.8% WHITE, WITH 9.2% AMERICAN INDIAN. HUGHES COUNTY: 88.7% WHITE 10% AMERICAN INDIAN 0.8% AFRICAN AMERICAN 0.8% AMERICAN ASIANSTANLEY COUNTY: 90.2% WHITE 9.8% AMERICAN INDIANSULLY COUNTY: 99.7% WHITE 0.3% AMERICAN INDIAN MEDIAN HOUSEHOLD INCOME: FACTFINDER.CENSUS.GOVSTATE OF SD $50,957HUGHES COUNTY $59,177STANLEY COUNTY $56,829 SULLY COUNTY $60,417UNEMPLOYMENT RATE: FROM COUNTY HEALTH RANKINGSHUGHES COUNTY 3.0%STANLEY COUNTY 2.7% SULLY COUNTY 2.5%PERCENTAGE OF THE POPULATION WITHOUT HEALTH INSURANCE: FROM COUNTY HEALTH RANKINGSHUGHES COUNTY 12%STANLEY COUNTY 16% SULLY COUNTY 14% |
| PART VI, LINE 5: | THE HOSPITAL SERVES ALL PERSONS IN THE COMMUNITY ON A NON-DISCRIMINATORY BASIS. AVERA ST. MARY'S OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. AVERA ST. MARY'S HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE GOVERNING BODY IS COMPRISED OF PRIMARILY INDEPENDENT INDIVIDUALS, REPRESENTATIVE OF THE COMMUNITY AS A WHOLE. AVERA ST. MARY'S PROVIDES EDUCATION AND TRAINING OPPORTUNITIES TO HEALTHCARE STUDENTS ENROLLED IN THE LOCAL COLLEGE CAPITAL UNIVERSITY CENTER. AVERA ST. MARY'S PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE AND/OR OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS.AVERA ST. MARY'S PARTICIPATES IN MANY COMMUNITY ORGANIZATIONS AND EFFORTS TO BETTER THE REGION. LEADERSHIP OF THE ORGANIZATION IS ON BOARDS OF MANY EXEMPT ORGANIZATIONS (CAPITAL AREA UNITED WAY, PIERRE/FORT PIERRE ROTARY, PIERRE AREA CHAMBER OF COMMERCE, YMCA BOARD, PIERRE BOOSTER CLUB AND MANY MORE). |
| PART VI, LINE 6: | THE COMMUNITIES IN WHICH AVERA OPERATES ALL HAVE UNIQUE HEALTH AND COMMUNITY BENEFIT NEEDS AND IN KEEPING WITH THE CATHOLIC HEALTHCARE ASSOCIATION GUIDELINES EACH HOSPITAL STRIVES TO MEET ITS COMMUNITY'S IDENTIFIED NEEDS. THE AVERA CENTRAL OFFICE ADVOCATES FOR ALL ON COMMUNITY BENEFIT RELATED MATTERS OF STATE, REGIONAL AND NATIONAL IMPORTANCE. |
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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR JOSEPH VILLA | ||||||||||||||
| VICE CHAIR/SEC/TREAS | $0 | $496,775 | $0 | $0 | $0 | $10,754 | $0 | $5,300 | $0 | $24,204 | $0 | $537,033 | $0 | $0 |
| DR JOSEPH WYATT | ||||||||||||||
| BOARD MEMBER | $0 | $564,234 | $0 | $0 | $0 | $1,626 | $0 | $5,300 | $0 | $1,248 | $0 | $572,408 | $0 | $0 |
| DR JESSICA RASMUSSEN | ||||||||||||||
| BOARD MEMBER | $0 | $320,025 | $0 | $0 | $0 | $975 | $0 | $5,300 | $0 | $0 | $0 | $326,300 | $0 | $0 |
| TODD FORKEL | ||||||||||||||
| PRESIDENT & CEO (AS OF DEC 2015) | $0 | $412,140 | $0 | $0 | $0 | $106,567 | $0 | $18,750 | $0 | $22,586 | $0 | $560,043 | $0 | $0 |
| BOB SUTTON | ||||||||||||||
| PRESIDENT & CEO (THRU DEC 2015) | $0 | $298,482 | $0 | $0 | $0 | $72,946 | $0 | $19,300 | $0 | $22,112 | $0 | $412,840 | $0 | $0 |
| GEOFF DURST | ||||||||||||||
| CFO (AS OF OCT 2015) | $0 | $215,821 | $0 | $0 | $0 | $3,149 | $0 | $0 | $0 | $22,780 | $0 | $241,750 | $0 | $0 |
| CHRISTOPHER OLSON | ||||||||||||||
| CRNA | $195,509 | $0 | $0 | $0 | $616 | $0 | $2,013 | $0 | $21,654 | $0 | $219,792 | $0 | $0 | $0 |
| THERESA SIMMONS | ||||||||||||||
| CRNA | $198,401 | $0 | $0 | $0 | $944 | $0 | $0 | $0 | $21,432 | $0 | $220,777 | $0 | $0 | $0 |
| KEVIN ROARK | ||||||||||||||
| CRNA | $171,244 | $0 | $0 | $0 | $289 | $0 | $3,268 | $0 | $21,432 | $0 | $196,233 | $0 | $0 | $0 |
| BRAD SAATHOFF | ||||||||||||||
| STAFF PHARMACIST | $158,349 | $0 | $0 | $0 | $214 | $0 | $2,870 | $0 | $8,265 | $0 | $169,698 | $0 | $0 | $0 |
| TRAE TURNER | ||||||||||||||
| STAFF PHARMACIST | $144,126 | $0 | $0 | $0 | $198 | $0 | $971 | $0 | $8,205 | $0 | $153,500 | $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 IS PAID BY A RELATED ORGANIZATION, AVERA HEALTH. AVERA ST. MARY'S 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 (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| CAITIE GRAVES | |||
| DAUGHTER OF OFFICER | $20,234 | EMPLOYEE COMPENSATION | 0 |
| BROOKE LUSK | |||
| FAMILY MEMBER OF BOARD MEMBER | $15,855 | EMPLOYEE COMPENSATION | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART V, LINE 1A: | INDEPENDENT CONTRACTORS REPORTED RELATE TO SERVICES RECEIVED BY AVERA ST. MARY'S, HOWEVER A RELATED ORGANIZATION FILES APPLICABLE FORM 1099S ON BEHALF OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 2 | SISTER KATHLEEN CROWLEY, SISTER MARY JAEGER, JOE VILLA, AND BOB SUTTON HAVE BUSINESS RELATIONSHIPS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS AVERA HEALTH, A NONPROFIT CORPORATION ORGANIZED AND EXISTING UNDER THE LAWS OF THE STATE OF SOUTH DAKOTA AND EXEMPT UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. |
| FORM 990, PART VI, SECTION A, LINE 7A | AVERA HEALTH, AS THE SOLE MEMBER HAS THE POWER TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | AVERA HEALTH, AS THE SOLE MEMBER, HAS THE FOLLOWING RIGHTS AS THE MEMBER: 1) TO APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE STATEMENTS OF PHILOSOPHY, MISSION AND VALUES OF CORPORATION; 2) TO INITIATE THE ADOPTION, AMENDMENT OR REPEAL OF ANY PROVISION OF THE ARTICLES OF INCORPORATION OR BYLAWS OF CORPORATION, AND TO GIVE FINAL APPROVAL OF ANY SUCH ACTION WITH RESPECT THERETO; 3) TO APPROVE AND ACT UPON THE ALIENATION OF REAL PROPERTY AND PRECIOUS ARTIFACTS UNDER THE CANONICAL STEWARDSHIP OF THE SISTERS OF THE PRESENTATION OF THE BLESSED VIRGIN MARY OF ABERDEEN, SOUTH DAKOTA ("PRESENTATION SISTERS") OR THE BENEDICTINE SISTERS OF SACRED HEART MONASTERY ("BENEDICTINE SISTERS"), PURSUANT TO THE POLICIES ESTABLISHED BY THE MEMBER; 4) TO APPROVE ANY PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION, OR THE DIVESTITURE OF A SPONSORED WORK OR MINISTRY ASSOCIATED WITH THE CORPORATION; 5) TO APPROVE THE CREATION OF NEW SPONSORED WORKS OR MINISTRIES TO BE CONDUCTED BY OR UNDER THE AUTHORITY OF THE CORPORATION; 6) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE BOARD OF DIRECTORS OF THE CORPORATION. 7) TO APPOINT AND/OR REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION. 8) TO APPROVE OPERATING/CAPITAL BUDGETS AND STRATEGIC PLANS OF THE CORPORATION. 9) TO APPROVE EXPENDITURES OUTSIDE OF OPERATING AND CAPITAL BUDGETS EXCEEDING DEFINED THRESHOLDS ACCORDING TO POLICY WHICH MAY BE ADOPTED FROM TIME TO TIME BY THE MEMBER. 10) TO APPROVE ACQUISITIONS, SALES AND LEASES, ACCORDING TO POLICY WHICH MAY BE ADOPTED FROM TIME TO TIME BY THE MEMBER. 11) TO ESTABLISH AND MAINTAIN EMPLOYEE BENEFIT PROGRAMS. 12) TO ESTABLISH AND MAINTAIN INSURANCE PROGRAMS. 13) TO APPROVE MAJOR COMMUNITY FUND DRIVES. 14) TO APPROVE THE APPOINTMENT OF AUDITORS. 15) TO ADOPT POLICIES DESIGNED TO EFFECTUATE THE RESERVED POWERS OF THE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN IS REVIEWED BY THE CFO. THE CFO PRESENTS THE RETURN TO THE BOARD AT A BOARD MEETING OR AN ELECTRONIC COPY OF THE RETURN IS SENT TO EACH BOARD MEMBER BY EMAIL FOR THEIR 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 DIRECTORS. THE INFORMATION IS MAINTAINED IN A DATABASE AND A REPORT IS PROVIDED TO THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15B | THE CEO IS COMPENSATED BY AVERA HEALTH. ANNUALLY THE COMPENSATION COMMITTEE OF AVERA HEALTH, WHICH IS COMPRISED OF SIX (6) SYSTEM MEMBERS APPOINTED BY THE RELIGIOUS ORDERS, MEETS WITH AN INDEPENDENT CONSULTANT REGARDING FAIR MARKET VALUE OF OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE APPROVES ALL SALARIES BASED ON COMPARABLE DATA AND DOCUMENTS THE BASIS FOR THEIR DECISION IN MEETING MINUTES. THE ORGANIZATION HAS A PHYSICIAN RELATIONS/EXECUTIVE COMPENSATION COMMITTEE TO REVIEW PHYSICIAN RELATED TRANSACTIONS AND COMPENSATION RELATED TO PHYSICIANS, OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMMITTEE MEETS AS NEEDED WITH RESPECT TO PHYSICIAN COMPENSATION. WITH RESPECT TO LEADERSHIP POSITIONS WE CONTRACT WITH AN OUTSIDE CONSULTANT TO GATHER WAGE AND MARKET DATA. INFORMATION IS PROVIDED TO THE CONSULTANT FOR LEADERSHIP POSITIONS THAT REFLECTS THE LEADER'S AREA OF RESPONSIBILITIES INCLUDING THE POSITION TITLE AND EDUCATION REQUIREMENTS, REPORTING STRUCTURE, NUMBER OF FTE'S, TOTAL REVENUE AND EXPENSES AND YEARS OF EXPERIENCE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLICLY AVAILABLE. FINANCIAL STATEMENTS ARE CONSOLIDATED IN THE AVERA HEALTH CONSOLIDATED FINANCIALS. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,261,494. MANAGEMENT AND GENERAL EXPENSES 502,833. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,764,327. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,652,182. MANAGEMENT AND GENERAL EXPENSES 1,057,163. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,709,345. OTHER FEES: PROGRAM SERVICE EXPENSES 4,812,608. MANAGEMENT AND GENERAL EXPENSES 1,918,312. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,730,920. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFERS -2,856,811. NET ASSETS RELEASED FROM RESTRICTIONS -620,678. |
| 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 AVERA SACRED HEART. IN ACCORDANCE WITH IRS INSTRUCTIONS, INFORMATION RELATED TO THE TAX EXEMPT BOND REPORTING IS BEING REPORTED ON AVERA HEALTH'S TAX RETURN (EIN 46-0422673). |
| FORM 990, PART XII, LINE 2C: | THE AUDIT COMMITTEE OF AVERA HEALTH, PARENT ORGANIZATION, SELECTS THE AUDITOR AND REVIEWS THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR AVERA HEALTH, WHICH INCLUDES AVERA ST. MARY'S. |
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 | PROMOTION OF HEALTH | SD | 501(C)(3) | LINE 9 | N/A | 0 | |
| AVERA GETTYSBURG | |||||||||||
| 606 EAST GARFIELD | GETTYSBURG | SD | 57442 | 460234354 | HEALTHCARE SERVICES | SD | 501(C)(3) | LINE 3 | Yes (1) | AVERA ST MARY'S HEALTHCARE CENTER | |
| AVERA ST ANTHONY'S HOSPITAL | |||||||||||
| 300 N 2ND STREET | ONEILL | NE | 68763 | 470463911 | HEALTHCARE EDUCATION | 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 STREET | MARSHALL | MN | 56258 | 410919153 | HEALTHCARE SERVICES | MN | 501(C)(3) | LINE 3 | 0 | AVERA HEALTH | |
| AVERA MARSHALL FOUNDATION | |||||||||||
| 300 S BRUCE STREET | 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 | |
| SACRED HEART HEALTH SERVICES | |||||||||||
| 501 SUMMIT STREET | YANKTON | SD | 57078 | 460225483 | HEALTHCARE SERVICES | SD | 501(C)(3) | LINE 3 | 0 | AVERA HEALTH | |
| AVERA QUEEN OF PEACE HOSPITAL | |||||||||||
| 525 NORTH FOSTER | MITCHELL | SD | 57301 | 460224604 | HEALTHCARE SERVICES | SD | 501(C)(3) | LINE 3 | 0 | AVERA HEALTH | |
| 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 | 0 | SACRED HEART HEALTH SERVICES | |
| AVERA ST LUKE'S | |||||||||||
| 305 SOUTH STATE STREET | ABERDEEN | SD | 57401 | 460224598 | 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 PLAN 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 |
|---|---|---|---|---|---|---|---|
| Q&M PROPERTIES LLC | |||||||
| 525 NORTH FOSTER | MITCHELL | SD | 57301 | 731652049 | MEDICAL CLINIC BUILDING | 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 MINNESOTA AVE 102 | SIOUX FALLS | SD | 57117 | 800619999 | MEDICAL SERVICES - HOME MEDICAL EQUIPMENT | SD | N/A |
| SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC | |||||||
| 310 S PENNSYLVANIA ST | ABERDEEN | SD | 57401 | 460461429 | SURGICAL ASSOCIATES | SD | N/A |
| HEART HOSPITAL OF SOUTH DAKOTA LLC | |||||||
| 4500 W 69TH STREET | SIOUX FALLS | SD | 57108 | 562143771 | HEALTHCARE SERVICES | SD | N/A |
| BROOKINGS HEALTH SYSTEM - AVERA HME LLC | |||||||
| 101 22ND AVE SUITE 101 | BROOKINGS | SD | 57006 | 453204123 | HEALTHCARE SERVICES | 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 |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| VALLEY HEALTH SERVICES | |||||||||
| 501 SUMMIT STREET | YANKTON | SD | 57078 | 460357149 | RENTAL REAL ESTATE | 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 | Yes (1) | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | 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 |
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. |