SACRED HEART HEALTH SERVICES: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: SACRED HEART HEALTH SERVICES (EIN 46-0225483)
Tax period: 2014-07-01 to 2015-06-30
Filed: 2016-05-11
IRS object ID: 201631329349303648
Schema version: 2014v6.0
Source: Download XML · Original 990 at ProPublica

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

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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-05-11T16:19:08-05:00	ReturnTs
Tax Period End	2015-06-30	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	2014-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460225483	EIN

Business Name BusinessName

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

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

US Address USAddress

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

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Douglas R Ekeren	PersonNm
Person Title	President & CEO	PersonTitleTxt
Phone	6056688000	PhoneNum
Signature	2016-05-09	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	2016-05-09	PreparationDt

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-08-17 19:52:53Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

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

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

US Address USAddress

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

Field	Value	IRS element (for citing)
Gross Receipts	$123,675,611	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.averasacredheart.com	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1911	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of Health	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	1233	TotalEmployeeCnt
Total Volunteers	326	TotalVolunteersCnt
Total Gross UBI	-$8,488	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$8,488	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$667,563	PYContributionsGrantsAmt
CY Contributions Grants	$1,011,886	CYContributionsGrantsAmt
PY Program Service Revenue	$109,377,521	PYProgramServiceRevenueAmt
CY Program Service Revenue	$116,843,533	CYProgramServiceRevenueAmt
PY Investment Income	$8,040,496	PYInvestmentIncomeAmt
CY Investment Income	$5,339,698	CYInvestmentIncomeAmt
PY Other Revenue	-$790,951	PYOtherRevenueAmt
CY Other Revenue	-$716,313	CYOtherRevenueAmt
PY Total Revenue	$117,294,629	PYTotalRevenueAmt
CY Total Revenue	$122,478,804	CYTotalRevenueAmt
PY Grants And Similar Paid	$195,581	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$461,232	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$54,376,511	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$54,704,969	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$19,195	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$77,019	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$362,345	CYTotalFundraisingExpenseAmt
PY Other Expenses	$52,034,393	PYOtherExpensesAmt
CY Other Expenses	$54,696,827	CYOtherExpensesAmt
PY Total Expenses	$106,625,680	PYTotalExpensesAmt
CY Total Expenses	$109,940,047	CYTotalExpensesAmt
PY Revenues Less Expenses	$10,668,949	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$12,538,757	CYRevenuesLessExpensesAmt
Total Assets BOY	$287,231,478	TotalAssetsBOYAmt
Total Assets EOY	$291,814,370	TotalAssetsEOYAmt
Total Liabilities BOY	$44,761,449	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$45,144,202	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$242,470,029	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$246,670,168	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$89,616,884	ExpenseAmt
Grant	$461,232	GrantAmt
Revenue	$116,843,534	RevenueAmt
Desc	Avera Sacred Heart Hospital (Sacred Heart Health Services) leads delivery of healthcare to its region through over 1,200 employees (as well as more than 60 physicians on its active medical staff) who coordinate care to deliver patient care as an integrated unit. Avera Sacred Heart and its affiliates (referred to collectively as Sacred Heart Health Services) also work seamlessly to meet the needs of the communities they serve in southeast South Dakota and northeast Nebraska. In addition to the 144-bed hospital, Avera Sacred Heart includes one nursing home and a congregate housing facility, a 23-bed critical access hospital, long-term care facility, and 2 clinics in Creighton, NE. It also manages three hospitals and two nursing homes. Avera Sacred Heart operates under the tenets of the Roman Catholic Church and in accordance with the philosophy and values established for Avera Health, a sponsored health ministry of the Benedictine and Presentation Sisters. Avera Sacred Heart engages in activities designed to improve the health of the individuals and communities that it serves in response to a calling to heal the sick, the elderly and the oppressed.Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Avera Sacred Heart Hospital's larger charitable mission of improving health and quality of life. Specifically, Avera Sacred heart is governed by an independent board including community leaders, business and clinical healthcare experts. The board has a history of commitment to act with the highest integrity and has been proactively evaluating opportunities to voluntarily adopt governance best practices for the benefit of the community. * Sacred Heart Health Services makes medical care accessible to the communities it serves regardless of ability to pay, of which there were 13,398 hospital patient days and 82,855 nursing home resident days in fiscal year 2015. Avera Sacred Heart Hospital was named by HealthGrades as one of the top 2% hospitals in the nation for providing an outstanding patient experience, seven years in a row, and patient safety excellence. The Hospital received a three-year accreditation from the Joint Commission with "Top Performer for Key Quality Measures." The Avera Sacred Heart Hospital Dialysis Unit was recognized as a 5-Diamond Patient Safety Facility. Avera Sister James Care Center and Avera Yankton Care Center were recognized as five-year recipients of the Excellence in Action award by My Innerview. Avera Cancer Institute Yankton also received a full accreditation from the American College of Surgeons with a Commendation Silver Level award (5 commendations out of a possible 7). Sacred Heart Health Services operates 2 full-time emergency departments, one in Yankton and one in Creighton, Nebraska, which provide emergency care regardless of ability to pay. Sacred Heart provides clinical services needed to operate the emergency center and provides on-site emergency medical, rescue and medical transportation services. In addition, Avera Sacred Heart, through its integrated network of providers, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare and Medicaid, regardless of ability to pay. Avera's charity care policy provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The charity care policy is designed to ensure the communities served by Avera facilities have access to needed healthcare services. The Avera Sacred Heart Board of Directors oversees services delivered under the charity care policy including assessing community needs, approving eligibility criteria and monitoring the effectiveness of the program in providing community access to medical care.Eligibility for discounted or free services under the charity care policy is based on income and asset levels and family size. Applications for coverage under the program may be obtained at any Avera Sacred Heart patient registration area or by calling the Avera Sacred Heart or Avera Creighton business office. Sacred Heart Health Services maintains records to identify and monitor the level of care provided under the charity care policy. Sacred Heart Health Services had charges forgone for charity for the year ended June 30, 2015 of approximately $3,140,000.Sacred Heart Health Services takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the community. It strives to identify community needs beyond basic health care, respond to them, aiming to make a positive, life-enhancing difference in the community. Sacred Heart Health Services takes a strategic, community needs-based approach to delivering benefits to the community. Avera Sacred Heart Hospital demonstrates its commitment to providing community benefit through specific accomplishments:E-technology: Avera Sacred Heart started with its EICU program six years ago. EICU is a telemedicine-based system that aids in the care of ICU patients at Avera Sacred Heart and across the Avera system. Patients receive constant, around-the-clock monitoring and interventions from a remote care team in addition to the care they receive from their bedside team. Avera has also implemented an E-pharmacy program where facilities without 24 hour a day pharmacist coverage can access pharmacist services remotely.Teaching hospital: Avera Sacred Heart is a teaching hospital, which reflects a strong commitment to education, research and a high level of care. In the summer of 2007, the Hospital opened the new Avera Professional Office Pavilion & Education Center to enhance their commitment to medical education. The Avera Pavilion is the new home of the unique Yankton Ambulatory Program for the third-year medical students of the Sanford School of Medicine of the University of South Dakota. The program challenges medical students to solve clinical problems and experience the doctor-patient relationship through the year. Yankton is only one of three communities in the state where a campus is provided for the Sanford School of Medicine. The Office for the Dean of the Yankton Ambulatory Program of the Avera Sacred Heart Yankton Campus is now located on the first floor of the Pavilion. A unique component to the Pavilion is the expansion and enhancement of educational facilities. Along with a 116-seat auditorium, there are also three conference rooms, all equipped with the latest in audiovisual technology.(Continued on Page 8 of Schedule O)	Desc
Total Program Service Expenses	$89,616,884	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	Yes (1)	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	Yes (1)	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	Yes (1)	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	178	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1233	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (1)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (1)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	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	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

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

Field	Value	IRS element (for citing)
Phone	6056688776	PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (21 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
Michael Pietila
Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Wayne A Kindle
Vice Chair	2.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Ryan Loecker
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Jeanne Annette Weber
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Rosemary Weber
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Brad Dykes
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Marty Jans
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Sr Lucille Welbig
Board Member	2.00	2.00	Yes (X)		$0	$0	$0
Sr Lynn Marie Welbig
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Kevin Bray
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Russ Deidrichsen
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Tim Irwin
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Dan Specht
Board Member	2.00	0.00	Yes (X)		$0	$0	$0
Michael Peterson MD
Board Member & Physician	40.00	0.00	Yes (X)		$577,669	$0	$34,328
Douglas Ekeren
President & CEO	60.00	2.50	Yes (X)	Yes (X)	$197,980	$66,069	$19,384
Jamie A Schaefer
Sec/Treas & VP Finance	52.00	0.00		Yes (X)	$205,237	$0	$30,751
Gregory Taylor MD
Diagnostic Radiology	40.00	0.00			$540,033	$0	$35,777	Yes (X)
Steve Gutnik MD FACP
Gastroenterology	40.00	0.00			$746,509	$0	$35,503	Yes (X)
Matthew G Winkelbauer MD
Family Medicine	40.00	0.00			$556,762	$0	$33,189	Yes (X)
Ralph Tullo MD
Physician	40.00	0.00			$467,827	$0	$26,602	Yes (X)
Ryan Banks MD
Physician	40.00	0.00			$385,970	$0	$19,929	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,677,987	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$66,069	TotReportableCompRltdOrgAmt
Total Other Compensation	$235,463	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	48	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Fiegan Construction
3712 S Western Ave Ste 200	Sioux Falls	SD	57078	Construction	$5,113,463
Yankton Anesthesiology PC
1000 W 4th St Suite 13	Yankton	SD	57078	Anesthesiologists	$1,582,938
Aegis Therapies Inc
7160 Dallas Parkway	Plano	TX	75024	Rehab & Therapy Services	$981,997
Welfl Construction Company
800 West 23rd Street	Yankton	SD	57078	Construction	$881,781
Yankton Medical Clinic PC
PO Box 706	Yankton	SD	57078	Physician Services	$871,830

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	7	CntrctRcvdGreaterThan100KCnt
Fundraising	$46,921	FundraisingAmt
Government Grants	$335,833	GovernmentGrantsAmt
All Other Contributions	$629,132	AllOtherContributionsAmt
Noncash Contributions	$27,266	NoncashContributionsAmt
Total Contributions	$1,011,886	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net patient service revenue	622110	$112,500,690	$112,500,690
Other revenue	900099	$2,071,022	$2,071,022
EHR Revenue	900099	$1,132,794	$1,132,794
Nonmedical outreach	900099	$1,119,684	$1,119,684
Interest in Home Medical Equipmen	900099	$28,347	$28,347

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$9,004	TotalRevenueColumnAmt
Related Or Exempt Func Income	-$516	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$8,488	UnrelatedBusinessRevenueAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$116,843,533	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$12,592	TotalRevenueColumnAmt
Exclusion	$12,592	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$327,414	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$1,140,218	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$812,804	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$812,804	TotalRevenueColumnAmt
Exclusion	-$812,804	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$5,361,963	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$34,857	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$5,361,963	SecuritiesAmt
Other	-$34,857	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$5,327,106	TotalRevenueColumnAmt
Exclusion	$5,327,106	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$53,698	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$46,921	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$21,732	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$31,966	TotalRevenueColumnAmt
Exclusion	$31,966	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	Operating interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$64,525	TotalRevenueColumnAmt
Exclusion	$64,525	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$64,525	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$122,478,804	TotalRevenueColumnAmt
Related Or Exempt Func Income	$116,852,021	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$8,488	UnrelatedBusinessRevenueAmt
Exclusion	$4,623,385	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	$441,232	TotalAmt
Program Services	$441,232	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

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

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$944,883	TotalAmt
Program Services	$607,054	ProgramServicesAmt
Management And General	$337,829	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$108,389	TotalAmt
Program Services	$108,389	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$42,878,922	TotalAmt
Program Services	$38,049,281	ProgramServicesAmt
Management And General	$4,735,277	ManagementAndGeneralAmt
Fundraising	$94,364	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,478,547	TotalAmt
Program Services	$1,282,125	ProgramServicesAmt
Management And General	$195,206	ManagementAndGeneralAmt
Fundraising	$1,216	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$6,501,407	TotalAmt
Program Services	$5,695,443	ProgramServicesAmt
Management And General	$797,016	ManagementAndGeneralAmt
Fundraising	$8,948	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,792,821	TotalAmt
Program Services	$2,441,227	ProgramServicesAmt
Management And General	$344,584	ManagementAndGeneralAmt
Fundraising	$7,010	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$134,103	TotalAmt
Management And General	$134,103	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,325	TotalAmt
Management And General	$1,325	ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$77,019	TotalAmt
Fundraising	$77,019	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$17,687,649	TotalAmt
Program Services	$6,260,104	ProgramServicesAmt
Management And General	$11,422,195	ManagementAndGeneralAmt
Fundraising	$5,350	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$44,191	TotalAmt
Program Services	$36,711	ProgramServicesAmt
Management And General	$5,797	ManagementAndGeneralAmt
Fundraising	$1,683	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$6,167,180	TotalAmt
Program Services	$5,383,082	ProgramServicesAmt
Management And General	$782,504	ManagementAndGeneralAmt
Fundraising	$1,594	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$462,940	TotalAmt
Program Services	$173,890	ProgramServicesAmt
Management And General	$288,901	ManagementAndGeneralAmt
Fundraising	$149	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,158,267	TotalAmt
Program Services	$2,158,267	ProgramServicesAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$334,704	TotalAmt
Program Services	$247,424	ProgramServicesAmt
Management And General	$85,777	ManagementAndGeneralAmt
Fundraising	$1,503	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$519,934	TotalAmt
Program Services	$181,027	ProgramServicesAmt
Management And General	$336,092	ManagementAndGeneralAmt
Fundraising	$2,815	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$718,138	TotalAmt
Program Services	$718,138	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$7,391,422	TotalAmt
Program Services	$7,391,422	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$778,760	TotalAmt
Program Services	$778,465	ProgramServicesAmt
Management And General	$295	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical Supplies	$12,744,296	$12,743,081	$1,215
Bad Debt Expense	$4,140,342	$4,140,342
Equipment Lease and Ren	$295,851	$166,144	$129,707
Licenses and Permits	$129,694	$106,236	$23,458

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$988,031	TotalAmt
Program Services	$487,800	ProgramServicesAmt
Management And General	$339,537	ManagementAndGeneralAmt
Fundraising	$160,694	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$109,940,047	TotalAmt
Program Services	$89,616,884	ProgramServicesAmt
Management And General	$19,960,818	ManagementAndGeneralAmt
Fundraising	$362,345	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$6,344,415	BOYAmt
EOY	$7,734,545	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$16,104,452	BOYAmt
EOY	$17,671,823	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$10,416	BOYAmt
EOY	$30,000	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$8,000,000	BOYAmt
EOY	$2,654,252	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,976,313	BOYAmt
EOY	$1,955,868	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$2,173,199	BOYAmt
EOY	$1,267,813	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$165,937,172	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$96,373,141	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$66,242,474	BOYAmt
EOY	$69,564,031	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$7,047,745	BOYAmt
EOY	$7,192,772	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$177,315,904	BOYAmt
EOY	$181,678,719	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$840,348	BOYAmt
EOY	$893,793	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$632,156	BOYAmt
EOY	$632,157	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$544,056	BOYAmt
EOY	$538,597	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$287,231,478	BOYAmt
EOY	$291,814,370	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$10,556,444	BOYAmt
EOY	$12,081,745	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$597,330	BOYAmt
EOY	$82,416	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$32,243,561	BOYAmt
EOY	$31,392,383	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$21,309	BOYAmt
EOY	$21,902	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,342,805	BOYAmt
EOY	$1,565,756	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$44,761,449	BOYAmt
EOY	$45,144,202	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$226,856,166	BOYAmt
EOY	$231,126,146	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$15,104,257	BOYAmt
EOY	$14,982,150	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$509,606	BOYAmt
EOY	$561,872	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$242,470,029	BOYAmt
EOY	$246,670,168	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$287,231,478	BOYAmt
EOY	$291,814,370	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$12,538,757	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$6,832,417	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$1,506,201	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

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

Contributor US Address ContributorUSAddress

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

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

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$18,178	OtherActivitiesAmt
Total Lobbying Expenditures	$18,178	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Avera Sacred Heart Health Services paid dues to Health Organizations that have a portion of the dues attributed to lobbying activities. The amount attributed to lobbying activities was $18,178.	ExplanationTxt

Schedule D IRS990ScheduleD

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

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

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

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$716,457	BeginningYearBalanceAmt
Contributions	$1,120	ContributionsAmt
Investment Earnings Or Losses	$87,570	InvestmentEarningsOrLossesAmt
Other Expenditures	$4,083	OtherExpendituresAmt
End Year Balance	$801,064	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	0.54000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.46000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,538,850	OtherCostOrOtherBasisAmt
Book Value	$3,538,850	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$102,919,867	OtherCostOrOtherBasisAmt
Depreciation	$60,986,495	DepreciationAmt
Book Value	$41,933,372	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$44,484,131	OtherCostOrOtherBasisAmt
Depreciation	$31,480,218	DepreciationAmt
Book Value	$13,003,913	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$14,994,324	OtherCostOrOtherBasisAmt
Depreciation	$3,906,428	DepreciationAmt
Book Value	$11,087,896	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$69,564,031	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Assets limited to use - Avera Pooled Investments	$180,648,781	F
Investment in Affiliated Organization	$1,029,938	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$181,678,719	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
Estimated third-party payor settlements	$1,076,483
Market Value of Interest Rate Swap	$489,273

Field	Value	IRS element (for citing)
Total Liability	$1,565,756	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Resident trust funds are held on behalf of the residents.
Part V, Line 4:	The Organization's endowment consists of various individual funds established for a variety of purposes. Its endowment represents donor-restricted endowment funds. As required by generally accepted accounting principles, net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions.
Part X, Line 2:	The Organization is organized as a South Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Certain consolidated subsidiaries, including Valley Health Services, are not tax-exempt entities and are considered partnerships or disregarded entities for tax purposes. The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2012.

Schedule G IRS990ScheduleG

Field	Value	IRS element (for citing)
Mail Solicitations	Yes (X)	MailSolicitationsInd
Email Solicitations	Yes (X)	EmailSolicitationsInd
Phone Solicitations	Yes (X)	PhoneSolicitationsInd
In Person Solicitations	Yes (X)	InPersonSolicitationsInd
Special Fundraising Events	Yes (X)	SpecialFundraisingEventsInd
Agrmt Prof Fundraising Acty	Yes (1)	AgrmtProfFundraisingActyInd

Fundraiser Activity Info FundraiserActivityInfoGrp

Organization Business Name OrganizationBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Paul J Strawhecker Inc	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	4913 Dodge Street	AddressLine1Txt
City	Omaha	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	68132	ZIPCd

Field	Value	IRS element (for citing)
Activity	Fundraising consulting	ActivityTxt
Fundraiser Control Of Funds	0	FundraiserControlOfFundsInd
Gross Receipts	$0	GrossReceiptsAmt
Retained By Contractor	$77,019	RetainedByContractorAmt
Net To Organization	$0	NetToOrganizationAmt

Field	Value	IRS element (for citing)
Total Retained By Contractors	$77,019	TotalRetainedByContractorsAmt
Licensed States	SD	LicensedStatesCd
Licensed States	IA	LicensedStatesCd
Licensed States	NE	LicensedStatesCd

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Simply D'Vine	Event1Nm
Gross Receipts Event1	$76,211	GrossReceiptsEvent1Amt
Charitable Contri Event1	$46,921	CharitableContriEvent1Amt
Gross Revenue Event1	$29,290	GrossRevenueEvent1Amt
Food And Beverage Event1	$585	FoodAndBeverageEvent1Amt
Entertainment Event1	$700	EntertainmentEvent1Amt
Other Direct Expenses Event1	$9,494	OtherDirectExpensesEvent1Amt
Event2	Roses Just Because	Event2Nm
Gross Receipts Event2	$24,408	GrossReceiptsEvent2Amt
Gross Revenue Event2	$24,408	GrossRevenueEvent2Amt
Other Direct Expenses Event2	$10,953	OtherDirectExpensesEvent2Amt
Gross Receipts Total	$100,619	GrossReceiptsTotalAmt
Charitable Contributions Tot	$46,921	CharitableContributionsTotAmt
Gross Revenue Total Events	$53,698	GrossRevenueTotalEventsAmt
Food And Beverage Total Events	$585	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$700	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$20,447	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$21,732	DirectExpenseSummaryEventsAmt
Net Income Summary	$31,966	NetIncomeSummaryAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule G, Part I, Line 2b, Column (v)	FormAndLineReferenceDesc
Explanation	Payments to fundraiser for consulting services to assist in fundraising for the new Hospice Unit.	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)
Persons Served	1265	PersonsServedCnt
Total Community Benefit Expns	$1,203,938	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,203,938	NetCommunityBenefitExpnsAmt
Total Expense	0.01140	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	3827	PersonsServedCnt
Total Community Benefit Expns	$15,770,566	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,406,760	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,363,806	NetCommunityBenefitExpnsAmt
Total Expense	0.04120	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	5092	PersonsServedCnt
Total Community Benefit Expns	$16,974,504	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,406,760	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,567,744	NetCommunityBenefitExpnsAmt
Total Expense	0.05260	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	10	ActivitiesOrProgramsCnt
Persons Served	3670	PersonsServedCnt
Total Community Benefit Expns	$3,197,982	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,161,866	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,036,116	NetCommunityBenefitExpnsAmt
Total Expense	0.00980	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	250	PersonsServedCnt
Total Community Benefit Expns	$150,341	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$150,341	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	197	PersonsServedCnt
Total Community Benefit Expns	$2,150,493	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,346,945	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$803,548	NetCommunityBenefitExpnsAmt
Total Expense	0.00760	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	294	PersonsServedCnt
Total Community Benefit Expns	$113,168	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$113,168	NetCommunityBenefitExpnsAmt
Total Expense	0.00110	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$572,774	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$572,774	NetCommunityBenefitExpnsAmt
Total Expense	0.00540	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	20	ActivitiesOrProgramsCnt
Persons Served	4411	PersonsServedCnt
Total Community Benefit Expns	$6,184,758	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,508,811	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,675,947	NetCommunityBenefitExpnsAmt
Total Expense	0.02530	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	20	ActivitiesOrProgramsCnt
Persons Served	9503	PersonsServedCnt
Total Community Benefit Expns	$23,159,262	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,915,571	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,243,691	NetCommunityBenefitExpnsAmt
Total Expense	0.07790	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,140,342	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$27,961,936	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$28,553,880	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$591,944	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

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

Hospital Facilities HospitalFacilitiesGrp (2 entries)

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

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)

FacilityFacilityNum	First Licensed CY Or PYFirstLicensedCYOrPYInd	Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd	CHNA ConductedCHNAConductedInd	Community DefinitionCommunityDefinitionInd	Community DemographicsCommunityDemographicsInd	Existing ResourcesExistingResourcesInd	How Data ObtainedHowDataObtainedInd	Community Health NeedsCommunityHealthNeedsInd	Other Health IssuesOtherHealthIssuesInd	Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd	Consulting ProcessConsultingProcessInd	Information GapsInformationGapsInd	CHNA ConductedCHNAConductedYr	Take Into Account Others InputTakeIntoAccountOthersInputInd	CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd	CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd	CHNA Report Widely AvailableCHNAReportWidelyAvailableInd	Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd	Own Website URLOwnWebsiteURLTxt	Paper Copy Public InspectionPaperCopyPublicInspectionInd	Implementation Strategy AdoptImplementationStrategyAdoptInd	Implementation Strategy AdptImplementationStrategyAdptYr	Strategy Posted WebsiteStrategyPostedWebsiteInd	Strategy Website URLStrategyWebsiteURLTxt	Strategy AttachedStrategyAttachedInd	Organization Incur Excise TaxOrganizationIncurExciseTaxInd	Elig Criteria ExplainedEligCriteriaExplainedInd	FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd	FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct	FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct	Asset Level CriteriaAssetLevelCriteriaInd	Medical Indigency CriteriaMedicalIndigencyCriteriaInd	Insurance Status CriteriaInsuranceStatusCriteriaInd	Underinsurance Stat CriteriaUnderinsuranceStatCriteriaInd	Explained BasisExplainedBasisInd	App Financial Asst ExplnAppFinancialAsstExplnInd	Described InfoDescribedInfoInd	Described Suprt DocDescribedSuprtDocInd	Provided Hospital ContactProvidedHospitalContactInd	Provided Nonprofit ContactProvidedNonprofitContactInd	Includes Publicity MeasuresIncludesPublicityMeasuresInd	FAP Available On WebsiteFAPAvailableOnWebsiteInd	FAP Available On Website URLFAPAvailableOnWebsiteURLTxt	FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd	FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt	FAP Summary On WebsiteFAPSummaryOnWebsiteInd	FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt	FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd	FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd	FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd	FAP Notice DisplayedFAPNoticeDisplayedInd	Communtity Notified FAPCommuntityNotifiedFAPInd	Other PublicityOtherPublicityInd	FAP Actions On NonpaymentFAPActionsOnNonpaymentInd	Permit No ActionsPermitNoActionsInd	Collection ActivitiesCollectionActivitiesInd	FAP Notified Upon AdmissionFAPNotifiedUponAdmissionInd	FAP Notified Before DischargeFAPNotifiedBeforeDischargeInd	FAP Notified All PatientsFAPNotifiedAllPatientsInd	Documented Elig DeterminationDocumentedEligDeterminationInd	Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd	Average Negotiated RatesAverageNegotiatedRatesInd	Amounts Generally BilledAmountsGenerallyBilledInd	Gross ChargesGrossChargesInd
Avera Sacred Heart Hospital
1	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	12	Yes (1)	0	0	Yes (1)	Yes (X)	www.avera.org/sacred-heart	Yes (X)	Yes (1)	12	Yes (1)	www.avera.org/experience/shared/community-needs-health-assessments/	0	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	www.avera.org/sacred-heart	Yes (X)	www.avera.org/sacred-heart	Yes (X)	www.avera.org/sacred-heart	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (1)
Avera Creighton Hospital
2	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	12	Yes (1)	Yes (1)	0	Yes (1)	Yes (X)	www.avera.org/creighton/	Yes (X)	Yes (1)	12	Yes (1)	http://www.avera.org/experience/shared/community-needs-health-assessments/	0	0	Yes (1)	Yes (X)	150.000000000000	400.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	http://www.avera.org/creighton					Yes (X)					Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (1)

Supplemental Information SupplementalInformationGrp (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Avera Sacred Heart Hospital	Part V, Section B, Line 5: Avera Sacred Heart Hospital utilized a consultant to assist with the process of conducting focus groups to ensure participants felt at ease to share their opinions. Additional focus groups and interviews were conducted by hospital personnel in counties outside the immediate service area. Personal invitations were sent to organizations and individuals representing the broad interest of the communities, including areas most impacted by health disparities.
Avera Creighton Hospital	Part V, Section B, Line 5: Avera Creighton Hospital used interviews, surveys, and focus groups ensuring they reached individuals with specific knowledge regarding insurance issues, health reform, medical specialists, rural health issues, population isolation, job loss, water issues, skin cancer, affordable housing, and elderly. Specific targeted participants included representatives of North Central District Health Department, North Central Community Care Partnership, Region 4 Behavioral Health System, and Heartland Counseling.
Avera Creighton Hospital	Part V, Section B, Line 6a: Avera Creighton Hospital partnered with the ten other hospitals in the North Central District Health Department including Antelope Memorial Hospital, Avera St. Anthony's Hospital, Osmond General Hospital, Plainview Community Hospital, Tilden Community Hospital, Niobrara Valley Hospital, West Holt Memorial Hospital, Brown County Hospital, Cherry County Hospital, and Rock County Hospital in conducting the community health needs assessment.
Avera Sacred Heart Hospital	Part V, Section B, Line 11: Based on the Avera Sacred Heart Hospital Board of Directors' recommendation, the 2012 community health needs assessment and implementation plan focused on diabetes prevention, education, and screening. Avera Sacred Heart Hospital utilized the Centers for Disease Control and Prevention (CDC) approved program Lifestyle Coaching which is part of the CDC National Diabetes Prevention Program to address the need. Registered nurses and registered dieticians from the hospital were trained to offer this year-long program. There are currently two cohorts of the Lifestyle Coaching program meeting; one has transitioned to monthly meetings per the program guidelines, and the other is meeting weekly. A participant in the hospital's diabetic programs shared that he has lost 100 pounds, decreased his A1C from 12.7 to 5.0, averages 20,000 steps daily, and has learned to monitor portion sizes and choose healthy options. He has even begun growing his own vegetables since enrolling in the program. Avera Sacred Heart Hospital held programs on diabetes risks, prevention, and education. Screenings were conducted and distributed for use in the community. Over 150 community members participated in the Diabetes Recognition breakfast event hosted by the hospital. Avera Sacred Heart Hospital will continue to create awareness around diabetes focusing on prevention, education, and screenings.
Avera Creighton Hospital	Part V, Section B, Line 11: The focus of the Avera Creighton Hospital Community Benefit Program will be Disease Prevention through Screening and Education Programs in one of the high priority areas of diabetes, heart disease or cancer. An implementation team will be established and be responsible for the following:* Choose one or two priorities from those diseases delineated by the Medical Staff;* Research what other community organizations are doing regarding the selected priority(ies);* Organize a team which will include both field professionals and representative community members;* Guide the work of the team, including development of a work plan which would include choosing the right partners, right locations, right procedures, and right value;* Establish measurable outcomes and metrics for same indicators;* Communicate appropriately with the ACH Advisory COuncil and the community at large.
Avera Sacred Heart Hospital	Part V, Section B, Line 16i: A summary of the financial assistance policy is provided on the billing invoices, in the emergency room, waiting rooms, in the admissions office, and to patients upon admission.
Avera Creighton Hospital	Part V, Section B, Line 16i: A summary of the financial assistance policy is provided on the billing invoices, in the emergency room, waiting rooms, in the admissions office, and to patients upon admission.
Avera Sacred Heart Hospital	Part V, Section B, Line 24: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care.
Avera Creighton Hospital	Part V, Section B, Line 24: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care.
Part V, Section B, Line 16	Financial Assistance Policy Website Availability
Avera Sacred Heart Hospital Part V, Section B, line 16a website:	www.avera.org/sacred-heart
Avera Sacred Heart Hospital Part V, Section B, line 16b website:	www.avera.org/sacred-heart
Avera Sacred Heart Hospital Part V, Section B, line 16c website:	www.avera.org/sacred-heart
Avera Creighton Hospital Part V, Section B, line 16a website:	http://www.avera.org/creighton

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

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

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	A combination of income and assets test is utilized to determine eligibility for free or discounted care. Points are assigned based on income as a percentage of FPG and net assets owned with points deducted for ongoing medical expenses such as drugs. Patients with the fewest points receive the largest discount. 0-1 points receive 100% discount on bills while remaining discounts range from 10-90% depending on point totals and dollar amount of charges.
Part I, Line 6a:	Our community benefit report is contained in a report prepared by Avera Health, a related organization. It is available through the website and requested mailing, and is filed with the Catholic Health Association.
Part I, Line 7:	Charity care, unreimbursed Medicaid, and other means-tested government programs were converted to cost using the cost-to-charge ratio based on the Medicare Cost Report from the prior year. Unreimbursed Medicaid uses a cost-to-charge ratio that includes other activities beyond hospital inpatient. The amounts on lines 7e-i represent expenses reported in the general ledger and compiled using CBISA software.
Part I, Ln 7 Col(f):	Bad debt expense of $4,140,342 is included on Form 990, Part IX, Line 25, Column (A) but excluded for purposes of calculating this percentage.
Part II, Community Building Activities:	The participation in the Yankton Area Progressive Growth YES campaign strengthens the community's capacity to promote health and well-being of its residents by offering the resources and expertise of the hospital.
Part III, Line 4:	Note 1 on page 8 of the financial statements describes bad debt expense.
Part III, Line 8:	Part III, Lines 5, 6, and 7: The Medicare revenues received (line 5), allowable costs (line 6), and the resulting shortfall (line 7) does not include a significant portion of the organization's expenses. These lines require use of the Medicare Cost Report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Sacred Heart Health Services. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removing the costs from the hospital's cost report entirely. Examples of non-cost report entities operated by Sacred Heart Health Services include clinics, a home medical equipment store, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, marketing, CRNA's, and interest expense. In addition to these disallowed costs within the Hospital, Sacred Heart Health Services operates clinics, a home medical equipment store, long-term care facilities, and other health care related businesses which do not file a cost report.Medicare allowable costs of care are based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Sacred Heart Health Services follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. However, Medicare is the organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community.
Part III, Line 9b:	If the patient qualifies for the Organization's financial assistance policy for low-income, uninsured patients and is cooperating with the Organization with regard to efforts to settle an outstanding bill within a reasonable time period, the Organization or its agent shall not send, nor indicate that it will send, the unpaid bill to any outside collection agency. At such time as the Organization sends the uncollected account to an outside collection agency, the amount referred to the agency shall reflect the reduced-payment level for which the patient was eligible under the Organization's financial assistance policy for low-income uninsured patients. Sacred Heart Health Services does not report any data to any of the credit agencies, however, the collection agencies Sacred Heart Health Services utilizes may report to the credit agencies. Any extended payment plans offered by the Hospital, or the Hospital's representative, in settling the outstanding bills of patients who qualify for financial assistance shall be interest-free so long as the repayment schedule is met.
Part VI, Line 2:	Avera Sacred Heart Hospital includes community members on committees, boards and advisory groups to allow community reaction and input in the actions we take. We also review all data provided by the health departments regarding disease rates, mortality, morbidity, population changes, etc. The hospital also conducts focus groups, consumer perception studies, and patient satisfaction surveys to identify primary needs of the community and responds with preventative/educational information or activities for the community.
Part VI, Line 3:	The brochure "Understanding Your Health Care Bills" is provided in visible locations experiencing high volumes of inpatient or outpatient registrations such as the admitting office, the billing/business office, and emergency department as well as the organization website. Patients are also made aware of possible eligibility when given the "Patient Rights and Responsibilities" brochure upon admission. The Patient Advocate works with uninsured/underinsured patients to enroll them in applicable social service programs and/or identify charity, county or risk pool eligibility.
Part VI, Line 4:	Avera Sacred Heart Hospital primarily serves the city and county of Yankton, SD and the surrounding South Dakota counties of Bon Homme, Charles Mix, Clay and Hutchinson, and Cedar County and Knox in Nebraska. U.S Census statistics indicate that 15.4% of the City of Yankton's individual residents fall below the federal poverty guidelines. For fiscal year 2015, 48% of our revenue came from Medicare and Medicare Advantage plans, and 12% came from Medicaid and Medicaid Replacement plans.
Part VI, Line 5:	The Hospital board is comprised of individuals who represent the interests of the community served by the organization. The Hospital offers staff privileges to all qualified physicians in the community. Selected services such as Radiation Oncology and Swingbed Services would not be available in our service area unless provided by the organization. The Hospital serves all individuals regardless of their ability to pay, providing 24 hour a day emergency services. The facility participates in the education of medical students from The University of South Dakota through their Yankton location. The Hospital also offers a 2 -year Radiation Technologist program that graduates approximately 6 students per year. Sacred Heart Hospital also provides clinical education for Mount Marty College students. The Hospital is also proud of the fact that 326 individuals chose to volunteer at the facility during fiscal year 2015.
Part VI, Line 6:	Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera Health operates all have unique health and community benefits needs. In keeping with Catholic Health Association guidelines, each Hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Yankton YES Campaign YAPG
803 East 4th Street	Yankton	SD	57078	460348636	501(c)(3)	$60,000	economic development
University of South Dakota
PO Box 5555	Vermillion	SD	57069	466000364	State of SD	$50,000	outcomes research
United Way of Yankton
610 W 23rd	Yankton	SD	57078	460252854	501(c)(3)	$12,000	community support

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

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

Supplemental Information Detail SupplementalInformationDetail

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

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Michael Peterson MD
Board Member & Physician	$575,044	$0	$0	$0	$2,625	$0	$13,000	$0	$21,328	$0	$611,997	$0	$0	$0
Douglas Ekeren
President & CEO	$196,955	$61,528	$0	$0	$1,025	$4,541	$9,889	$0	$5,876	$3,621	$213,745	$69,690	$0	$0
Jamie A Schaefer
Sec/Treas & VP Finance	$204,828	$0	$0	$0	$409	$0	$10,423	$0	$20,328	$0	$235,988	$0	$0	$0
Gregory Taylor MD
Diagnostic Radiology	$533,383	$0	$0	$0	$6,650	$0	$12,949	$0	$22,828	$0	$575,810	$0	$0	$0
Steve Gutnik MD FACP
Gastroenterology	$736,749	$0	$0	$0	$9,760	$0	$12,675	$0	$22,828	$0	$782,012	$0	$0	$0
Matthew G Winkelbauer MD
Family Medicine	$555,779	$0	$0	$0	$983	$0	$12,861	$0	$20,328	$0	$589,951	$0	$0	$0
Ralph Tullo MD
Physician	$461,177	$0	$0	$0	$6,650	$0	$13,260	$0	$13,342	$0	$494,429	$0	$0	$0
Ryan Banks MD
Physician	$385,970	$0	$0	$0	$0	$0	$0	$0	$19,929	$0	$405,899	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

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

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

Field	Value	IRS element (for citing)
Person	Timothy Irwin	PersonNm
Relationship With Org	Board member	RelationshipWithOrgTxt
Loan Purpose	Physician Community Needs	LoanPurposeTxt
Loan From Organization	Yes (X)	LoanFromOrganizationInd
Original Principal	$90,000	OriginalPrincipalAmt
Balance Due	$30,000	BalanceDueAmt
Default	0	DefaultInd
Board Or Committee Approval	0	BoardOrCommitteeApprovalInd
Written Agreement	Yes (1)	WrittenAgreementInd

Field	Value	IRS element (for citing)
Total Balance Due	$30,000	TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Janet Jans
Spouse of board member	$62,887	Employee compensation	0
Allison Diedrichsen
Spouse of board member	$28,275	Employee compensation	0
Yankton Medical Clinic
Partner of Yankton Medical Clinic is board member of organization	$733,937	Professional services	0
Mary Loecker
Parent of board member	$17,227	Employee compensation	0

Schedule M IRS990ScheduleM

Clothing And Household Goods ClothingAndHouseholdGoodsGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Noncash Contributions Rpt F990	$25,706	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Food Inventory FoodInventoryGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	6	ContributionCnt
Noncash Contributions Rpt F990	$1,560	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

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

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part III, line 2	* Maybe a Baby (prospective parent education program), Feb. 2015 * Purchase of four Olympus 190-Series scopes to improve diagnostics in the GI lab, March 2015
Form 990, Part VI, Section A, line 2	Sr. Lucille Welbig and Douglas Ekeren have a business relationship.
Form 990, Part VI, Section A, line 6	The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended.
Form 990, Part VI, Section A, line 7a	Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors.
Form 990, Part VI, Section A, line 7b	Avera Health has the following rights as the Member. 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member.
Form 990, Part VI, Section B, line 11	The Form 990 is reviewed initially by the CEO and CFO. The return is made available to the Board of Directors for review prior to filing.
Form 990, Part VI, Section B, line 12c	The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all Board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and board members. The information is maintained in a database and a report is provided to the Board.
Form 990, Part VI, Section B, line 15b	The CEO was compensated by Avera Health System beginning November 2014. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. The compensation of the CEO, other officers, directors, and key employees is reviewed annually. The organization utilizes the resources of an outside independent agency for market comparability. The compensation is approved within the annual budget approved by the Board.
Form 990, Part VI, Section C, line 19	The organization's governing documents and conflict of interest policy are not made available to the general public. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public.
Form 990, Part IX, line 11g	Repairs and Maintenance: Program service expenses 1,672,408. Management and general expenses 381,094. Fundraising expenses 0. Total expenses 2,053,502. Consulting: Program service expenses 840,844. Management and general expenses 151,459. Fundraising expenses 0. Total expenses 992,303. Professional Medical Services: Program service expenses 3,746,852. Management and general expenses 3,182,838. Fundraising expenses 5,350. Total expenses 6,935,040. ACS Fees: Program service expenses 0. Management and general expenses 7,706,804. Fundraising expenses 0. Total expenses 7,706,804.
Form 990, Part XI, line 9:	Capital transfers, net -1,262,753. Net Assets Released from Donor Restriction -233,567. Change in fair value of interest rate swap -9,881.
Form 990, Part XII, Line 2c:	The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Sacred Heart Health Services.
Part III, Line 4a:	(Continued from Page 4 of Schedule O) Residency/health professions training: At any one time, 10 to 15 Sanford School of Medicine of the University of South Dakota medical students are in training at Avera Sacred Heart Hospital. In addition, students in nursing, pharmacy, physician assistant programs, radiology and respiratory therapy also affiliate here. Avera Sacred Heart also has a radiology technologist school, which graduates 6 to 8 new radiology technologists each year. Preventive care a priority: Avera Sacred Heart has taken steps to enhance preventive care for people of all ages through the many educational programs, health screenings and fairs that are held throughout the year. Avera Sacred Heart holds screenings throughout the region at their rural health clinics as well as in Yankton. The Hospital is now connected to the Ask-A-Nurse program that provides general information concerning health-related topics. Our web site incorporates the "Adam" software that provides a unique level of health-related information to the consumer. In 2009, Avera Sacred Heart Hospital introduced Planet Heart (in conjunction with the Avera Heart Hospital) and an in-house cardiovascular screening package to keep the people we served better informed about their health. Based on community needs, we are continually striving to provide more preventative tools and risk assessments to our population. Community education: Avera Sacred Heart reaches out to people and communities throughout southeastern South Dakota and northeastern Nebraska in a variety of ways. Community flu shot clinics are generally held throughout the region. Through well coordinated efforts statewide with other hospitals and state entities, Avera Sacred Heart was able to effectively distribute the vaccine doses it received in a timely and efficient manner. Educational sessions are offered to medical staff, students, employees, health care professionals, students of all levels and the general public. Utilizing the Avera Professional Office Pavilion and Education Center, hundreds of classes involving thousands of people are provided as a community service each year. Other examples of community education include our student/youth mentoring programs and parish nursing. Partnerships with schools, churches, businesses and other organizations make many of these programs possible. As an integrated organization, Avera and Avera Sacred Heart are leaders in the implementation of the electronic patient record (EMR). Commitment to quality: Avera Sacred Heart is accredited by the Joint Commission and received another three-year accreditation in 2014.
Form 990, Part VI, Line 16:	There is no written policy or procedure. In the event of any such proposed transaction, the board or a committee with delegated authority reviews all materials, valuations and operational aspects for any proposed transaction. Such transaction would be evaluated in accordance with the exempt status of the organization and its applicable purposes. Any transaction also would be approved by the board and the member.
Form 990, Part X, Line 20:	The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Marshall, Avera St. Mary's, and Sacred Heart Health Services. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673).

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Avera Health
3900 West Avera Drive Suite 300	Sioux Falls	SD	57108	460422673	Healthcare services	SD	501(c)(3)	Line 9	N/A	0
Avera at Home
5116 S Solberg Ave	Sioux Falls	SD	57108	460399291	Home Services	SD	501(c)(3)	Line 9		0	Avera Health
Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9	Yankton	SD	57078	460337013	Healthcare education	SD	501(c)(3)	Line 9		Yes (1)	Sacred Heart Health Services
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare services	NE	501(c)(3)	Line 3		0	Avera Health
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare services	IA	501(c)(3)	Line 3		0	Avera Health
Avera Holy Family Foundation
826 North 8th Street	Estherville	IA	51334	421317452	Fundraising	IA	501(c)(3)	Line 9		0	Avera Holy Family
Avera Marshall
300 S Bruce St	Marshall	MN	56258	410919153	Healthcare services	MN	501(c)(3)	Line 3		0	Avera Health
Avera Marshall Foundation
300 S Bruce St	Marshall	MN	56258	411784801	Fundraising	MN	501(c)(3)	Line 7		0	Avera Marshall
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
St Benedict Health Center Foundation
West Glynn Drive PO Box B	Parkston	SD	57366	460458725	Support health related services	SD	501(c)(3)	Line 11a, I		0	St Benedict Health Center
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Queen of Peace Hospital
525 N Foster Street	Mitchell	SD	57301	460224604	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare services	SD	501(c)(3)	Line 3		0	Avera St Mary's
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare services	SD	501(c)(3)	Line 3		0	Avera Health

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (11 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	Surgical associates	SD	N/A
Avera Home Medical Equipment LLC
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460488198	Medical services - home medical equipment	SD		Avera McKennan	Related	-$22,337	0	0	0.23000
Home Medical Equipment of Pierre LLC
329 E Dakota	Pierre	SD	57501	460444002	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Floyd Valley Hospital LLC
714 Lincoln St NE	Lemars	IA	51031	820582350	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Estherville LLC
PO Box 5045	Sioux Falls	SD	57117	201686097	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Sioux Center LLC
38 19th ST SW	Sioux Center	IA	51250	753203100	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Marshall LLC
1104 East College Drive	Marshall	MN	56258	205271924	Medical services - home medical equipment	SD	N/A
Avera Home Medical Equipment of Spencer Hospital LLC
2400 S MN Ave 102	Sioux Falls	SD	57117	800619999	Medical services - home medical equipment	SD	N/A
Q&M Properties
525 North Foster	Mitchell	SD	57301	731652049	Medical clinic building	SD	N/A
Heart Hospital of South Dakota LLC
4500 W 69th Street	Sioux Falls	SD	57108	562143771	Healthcare services	SD	N/A
Brookings Health System - Avera HME LLC
101 22nd Ave Suite 101	Brookings	SD	57006	453204123	Medical Services - Home Medical Equipment	SD	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
Valley Health Services Inc
501 Summit Street	Yankton	SD	57078	460357149	Rental real estate	SD	Sacred Heart Health Services	C	$50,442	$1,519,946	1.00000	0
Accounts Management Inc
5132 S Cliff Ave Suite 101	Sioux Falls	SD	57108	460373021	Collection agency	SD		C				0	N/A
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health financing and health plan administration	SD		C				0	N/A
Avera Property Insurance Inc
610 W 23rd St Ste 1 PO Box 38	Yankton	SD	57078	460463155	Insurance	SD		C				0	N/A
Alucent Medical Inc
1325 S Cliff Avenue PO Box 5045	Sioux Falls	SD	571175045	471818349	Biotech Research	SD		C				0	N/A

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

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Lewis and Clark Health Education and Service Agency
L	$100,264	Recorded in General Ledger
Lewis and Clark Health Education and Service Agency
M	$209,574	Recorded in General Ledger
Avera McKennan
L		Recorded in General Ledger
Avera McKennan
M	$731,009	recorded in General Ledger