2017-05-15T13:45:29-05:00 2016-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2015-07-01 460230199 ST MARY'S HEALTHCARE CENTER STMA 6052243130 801 EAST SIOUX AVENUE PIERRE SD 57501 TODD FORKEL CEO 6052243130 2017-05-10 1 KIM HUNWARDSEN CPA P00484560 6122536500 2017-05-10 2015 2021-01-29 14:40:06Z TODD FORKEL 801 EAST SIOUX AVENUE PIERRE SD 57501 81776317 0 0928 X WWW.AVERA.ORG/ST-MARYS-PIERRE X 1951 SD PROMOTION OF HEALTH 11 8 591 256 0 0 201871 839724 78760800 80627548 374817 84001 152292 225044 79489780 81776317 8028 324 0 0 43730180 45353874 0 0 0 38234175 38501320 81972383 83855518 -2482603 -2079201 75312722 61277349 39148640 31728264 36164082 29549085 X AVERA IS A HEALTH MINISTRY ROOTED IN THE GOSPEL. OUR MISSION IS TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES BY PROVIDING QUALITY SERVICES GUIDED BY CHRISTIAN VALUES. 0 0 74371016 324 80627548 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. 74371016 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 X 74 0 1 591 1 0 0 0 0 0 1 1 0 0 0 0 X 11 8 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 X GEOFF DURST 6052243127 801 EAST SIOUX AVENUE PIERRE SD 57501 TERRY FITZKE CHAIR 2.00 2.00 X X 0 0 0 DR JOSEPH VILLA VICE CHAIR/SEC/TREAS 2.00 40.00 X X 0 507529 28729 DAN LUSK BOARD MEMBER 2.00 2.00 X 0 0 0 JUSTIN CRONIN BOARD MEMBER 2.00 2.00 X 0 0 0 SCOTT ISBURG BOARD MEMBER 2.00 2.00 X 0 0 0 MIKE WEISGRAM BOARD MEMBER 2.00 2.00 X 0 0 0 DR JOSEPH WYATT BOARD MEMBER 2.00 40.00 X 0 565860 5773 DR JESSICA RASMUSSEN BOARD MEMBER 2.00 40.00 X 0 321000 5300 PEGGY WILLIAMS BOARD MEMBER 2.00 2.00 X 0 0 0 SISTER MARY JAEGER BOARD MEMBER 2.00 9.00 X 0 0 0 SISTER KATHLEEN CROWLEY BOARD MEMBER 2.00 4.50 X 0 0 0 TODD FORKEL PRESIDENT & CEO (AS OF DEC 2015) 2.00 40.00 X 0 518707 40404 BOB SUTTON PRESIDENT & CEO (THRU DEC 2015) 2.00 40.00 X 0 371428 40732 GEOFF DURST CFO (AS OF OCT 2015) 5.00 37.00 X 0 218970 22005 TOM WAGNER CFO (THRU OCT 2015) 40.00 0.00 X 125861 0 19352 CHRISTOPHER OLSON CRNA 40.00 0.00 X 196125 0 22892 THERESA SIMMONS CRNA 40.00 0.00 X 199345 0 20657 KEVIN ROARK CRNA 40.00 0.00 X 171533 0 23925 BRAD SAATHOFF STAFF PHARMACIST 40.00 0.00 X 158563 0 10822 TRAE TURNER STAFF PHARMACIST 40.00 0.00 X 144324 0 8863 995751 2503494 249454 12 0 1 0 AVERA MCKENNAN 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS SD 57117 STAFFING AND OTHER SERVICES 24736413 JOURNEY GROUP COMPANIES 4500 W 58TH ST SIOUX FALLS SD 57108 CONSTRUCTION 1019575 C&A INDUSTRIES INC 13609 CALIFORNIA ST OMAHA NE 681545233 CONTRACT LABOR 726511 NXC IMAGING 2118 4TH AVE S MINNEAPOLIS MN 554042642 HOSPITAL SERVICES 635268 READY TECH GO 1005 E 23RD ST STE 200 FREEMONT NE 68025 PURCHASED SERVICES 551627 12 10000 461774 367950 839724 PATIENT SERVICE REVENUE 621110 77668584 77668584 PHARMACY 340B 900099 974236 974236 ASSISTED LIVING LTC 623312 928889 928889 MEANINGFUL USE PAYMENTS 900099 493536 493536 CHANGE IN INTEREST IN FOUNDATION 900099 -28129 -28129 590432 590432 80627548 18677 18677 225044 0 225044 225044 225044 65324 0 65324 65324 65324 81776317 80627548 0 309045 X 324 324 58091 58091 36089 36089 36381102 32822662 3558440 1994200 1797680 196520 4690945 4231114 459831 2193447 1976296 217151 2400 2400 13120 13120 12204592 8726284 3478308 17128 17128 2735610 2585151 150459 48644 48644 1254688 1175643 79045 220090 130733 89357 227385 227385 789597 789597 3524546 3464629 59917 523936 515029 8907 MEDICAL SUPPLIES 10208488 10208488 BAD DEBT EXPENSE 4536615 4536615 REPAIRS AND MAINTENANCE 1528074 664711 863363 UNRELATED BUSINESS INCO 5080 5080 661327 661327 83855518 74371016 9484502 0 5587595 1251882 11086785 10722952 386756 217215 2088268 2169632 426583 396599 91159027 61042099 29022579 30116928 25885112 15864613 219846 0 609198 537528 75312722 61277349 12228657 4784729 18243 9040251 8726982 12287311 11724978 5574178 6491575 39148640 31728264 X 34059192 27800099 1791890 1435986 313000 313000 36164082 29549085 75312722 61277349 X -2079201 -1058307 -3477489 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2603 2603 0 PART II-B, LINE 1: AVERA ST. MARY'S PAID DUES TO ORGANIZATIONS WHICH HAVE A PORTION OF THE DUES ATTRIBUTED TO LOBBYING ACTIVITIES. 1391428 3086916 4478344 39323251 23554500 15768751 45755536 36229505 9526031 1601896 1258094 343802 30116928 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENT FUND 6201101 F INTEREST IN AVERA HEALTH FOUNDATION 9663512 F 15864613 DUE TO RELATED PARTY 6261825 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 229750 6491575 X 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 FOR CONSOLIDATED SUBSIDIARIES ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2013. 1 1 X 1 X 1 X 1 1 1 0 1 1 308972 308972 0.00390 7272273 6401164 871109 0.01100 7581245 6401164 1180081 0.01490 34109964 14858264 19251700 0.24270 1 97071 97071 0.00120 1 34207035 14858264 19348771 0.24390 1 41788280 21259428 20528852 0.25880 1 4536615 0 11159787 13130733 -1970946 X 1 1 1 1 AVERA ST MARY'S 801 EAST SIOUX AVENUE PIERRE SD 57501 WWW.AVERA.ORG/ST-MARYS-PIERRE/ 10566 X X X PROVIDER BASED CLINIC AVERA ST MARY'S 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X WWW.AVERA.ORG/ST-MARYS-PIERRE/ X SEE PART V X 1 15 1 SEE PART V 0 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.AVERA.ORG/EXPERIENCE/AH/FINANCIAL-ASSISTANCE-CHARITY-CARE/ X HTTP://WWW.AVERA.ORG/EXPERIENCE/AH/FINANCIAL-ASSISTANCE-CHARITY-CARE/ X HTTP://WWW.AVERA.ORG/EXPERIENCE/AH/FINANCIAL-ASSISTANCE-CHARITY-CARE/ X X X X X X 1 X 0 X X X X X 1 X 0 1 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/ 2 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 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. 0 0 0 0 0 0 0 0 0 DR JOSEPH VILLA VICE CHAIR/SEC/TREAS 0 496775 0 0 0 10754 0 5300 0 24204 0 537033 0 0 DR JOSEPH WYATT BOARD MEMBER 0 564234 0 0 0 1626 0 5300 0 1248 0 572408 0 0 DR JESSICA RASMUSSEN BOARD MEMBER 0 320025 0 0 0 975 0 5300 0 0 0 326300 0 0 TODD FORKEL PRESIDENT & CEO (AS OF DEC 2015) 0 412140 0 0 0 106567 0 18750 0 22586 0 560043 0 0 BOB SUTTON PRESIDENT & CEO (THRU DEC 2015) 0 298482 0 0 0 72946 0 19300 0 22112 0 412840 0 0 GEOFF DURST CFO (AS OF OCT 2015) 0 215821 0 0 0 3149 0 0 0 22780 0 241750 0 0 CHRISTOPHER OLSON CRNA 195509 0 0 0 616 0 2013 0 21654 0 219792 0 0 0 THERESA SIMMONS CRNA 198401 0 0 0 944 0 0 0 21432 0 220777 0 0 0 KEVIN ROARK CRNA 171244 0 0 0 289 0 3268 0 21432 0 196233 0 0 0 BRAD SAATHOFF STAFF PHARMACIST 158349 0 0 0 214 0 2870 0 8265 0 169698 0 0 0 TRAE TURNER STAFF PHARMACIST 144126 0 0 0 198 0 971 0 8205 0 153500 0 0 0 SCHEDULE J, PART I, LINE 3: 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. CAITIE GRAVES DAUGHTER OF OFFICER 20234 EMPLOYEE COMPENSATION 0 BROOKE LUSK FAMILY MEMBER OF BOARD MEMBER 15855 EMPLOYEE COMPENSATION 0 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. 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 AVERA ST MARY'S HEALTHCARE CENTER 1 AVERA ST ANTHONY'S HOSPITAL 300 N 2ND STREET ONEILL NE 68763 470463911 HEALTHCARE EDUCATION NE 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA HOLY FAMILY 826 NORTH 8TH STREET ESTHERVILLE IA 51334 420680370 HEALTHCARE SERVICES IA 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA HOLY FAMILY FOUNDATION 826 NORTH 8TH STREET ESTHERVILLE IA 51334 421317452 FUNDRAISING IA 501(C)(3) LINE 9 AVERA HOLY FAMILY 0 AVERA MARSHALL 300 S BRUCE STREET MARSHALL MN 56258 410919153 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA MARSHALL FOUNDATION 300 S BRUCE STREET MARSHALL MN 56258 411784801 FUNDRAISING MN 501(C)(3) LINE 7 AVERA MARSHALL 0 ST BENEDICT HEALTH CENTER 401 WEST GLYNN DRIVE PARKSTON SD 57366 460226738 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 ST BENEDICT HEALTH CENTER FOUNDATION WEST GLYNN DRIVE PO BOX B PARKSTON SD 57366 460458725 SUPPORT HEALTH RELATED SERVICES SD 501(C)(3) LINE 11A, I ST BENEDICT HEALTH CENTER 0 AVERA MCKENNAN 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS SD 57117 460224743 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 SACRED HEART HEALTH SERVICES 501 SUMMIT STREET YANKTON SD 57078 460225483 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA QUEEN OF PEACE HOSPITAL 525 NORTH FOSTER MITCHELL SD 57301 460224604 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA AT HOME 5116 S SOLBERG AVE SIOUX FALLS SD 57108 460399291 HOME SERVICES SD 501(C)(3) LINE 9 AVERA HEALTH 0 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 SACRED HEART HEALTH SERVICES 0 AVERA ST LUKE'S 305 SOUTH STATE STREET ABERDEEN SD 57401 460224598 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA TYLER 240 WILLOW STREET TYLER MN 56178 410853163 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 AVERA MARSHALL 0 AVERA HEALTH PLANS INC 3900 WEST AVERA DRIVE SUITE 101 SIOUX FALLS SD 57108 460451539 HEALTH FINANCING AND HEALTH PLAN ADMIN SD 501(C)(4) AVERA HEALTH 0 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 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 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 0 0 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.