AVERA HOLY FAMILY: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- AVERA HOLY FAMILY (EIN 42-0680370)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-16
- IRS object ID
- 201641379349302199
- 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 D
- Schedule H
- Schedule I
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-16T09:55:41-05:00 | 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 | 420680370 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Holy Family | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AVER | BusinessNameControlTxt |
| Phone | 7123626519 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 North 8th Street | AddressLine1Txt |
| City | Estherville | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51334 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dale Hustedt | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 7123626519 | PhoneNum |
| Signature | 2016-05-12 | 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 | 2016-05-03 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Dale Hustedt | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 North 8th Street | AddressLine1Txt |
| City | Estherville | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51334 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,494,504 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.avera-holyfamily.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | Promotion of Health | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 249 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $2,447 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $55,243 | PYContributionsGrantsAmt |
| CY Contributions Grants | $41,213 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,603,719 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,936,162 | CYProgramServiceRevenueAmt |
| PY Investment Income | $428,394 | PYInvestmentIncomeAmt |
| CY Investment Income | $480,572 | CYInvestmentIncomeAmt |
| PY Other Revenue | $36,168 | PYOtherRevenueAmt |
| CY Other Revenue | $36,557 | CYOtherRevenueAmt |
| PY Total Revenue | $26,123,524 | PYTotalRevenueAmt |
| CY Total Revenue | $25,494,504 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $30,243 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $33,316 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,378,012 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,232,029 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,636,434 | PYOtherExpensesAmt |
| CY Other Expenses | $11,064,874 | CYOtherExpensesAmt |
| PY Total Expenses | $24,044,689 | PYTotalExpensesAmt |
| CY Total Expenses | $23,330,219 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,078,835 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,164,285 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,625,882 | TotalAssetsBOYAmt |
| Total Assets EOY | $37,324,543 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,370,026 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,535,705 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,255,856 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $29,788,838 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $20,448,423 | ExpenseAmt |
| Grant | $33,316 | GrantAmt |
| Revenue | $24,968,254 | RevenueAmt |
| Desc | Avera Holy Family Health operates a 25-bed critical access hospital and provider-based clinic located in Estherville, Iowa. Inpatient and outpatient medical services are provided. The hospital provided 2,856 inpatient bed days.Avera Holy Family maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $640,838 for the year ended June 30, 2015.The Hospital also provides community benefit health activities at less than or at no cost to support those in the area served. These activities include community education programs; special programs for the elderly, handicapped, and medically underserved; and a variety of broad community support activities. For the years ended June 30, 2015, specific activities included meals delivered to residential homes; meeting facilities; and programs for patients and families suffering from cancer, diabetes, breathing disorders, and others; assistance to health educators; emergency health care providers; and wellness programs. | Desc |
| Total Program Service Expenses | $20,448,423 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 249 | 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 | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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 | Shannon Adams | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7123626519 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 N 8th Street | AddressLine1Txt |
| City | Estherville | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51334 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 |
|---|---|---|---|---|---|---|---|---|
| Kathy Preston | ||||||||
| Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Joe Fitzgibbons | ||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dr Douglas Stangl | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Dr Anthony Cook | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Debra Kolecka | ||||||||
| Board Member | 1.00 | 5.50 | Yes (X) | $0 | $0 | $0 | ||
| Sr Mary Jaeger | ||||||||
| Board Member | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | ||
| Chris Schiltz | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Joe Greig | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Sharon Haas | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Roslyn Gunderson | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Scott Stokes | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Dale Hustedt | ||||||||
| President & CEO | 40.00 | 0.00 | Yes (X) | $0 | $112,958 | $20,011 | ||
| Shannon Adams | ||||||||
| Sec/Treas & SrVP Finance | 45.00 | 1.00 | Yes (X) | $0 | $86,483 | $26,950 | ||
| Kristi Hough | ||||||||
| Pharmacy Manager | 40.00 | 0.00 | $120,093 | $0 | $16,452 | Yes (X) | ||
| April Krull | ||||||||
| Pharmacist | 40.00 | 0.00 | $104,788 | $0 | $8,147 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $224,881 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $199,441 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $71,560 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | 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 |
|---|---|---|---|---|---|
| Estherville Medical Center ER | |||||
| 926 N 8th Street | Estherville | IA | 51334 | ER Coverage | $550,605 |
| Acute Care Inc | |||||
| PO Box 4130 | Des Moines | IA | 50333 | ER Coverage | $412,188 |
| Woodward Anesthesia Services PC | |||||
| 203 N 8th St | Estherville | IA | 51334 | Anesthesia Services | $263,638 |
| Fit for Life Physical Therapy LLC | |||||
| 826 N 8th | Estherville | IA | 51334 | Physical Therapy | $248,742 |
| Grapetree Medical Staffing | |||||
| 703 16th Street | Spirit Lake | IA | 51360 | Staffing | $204,392 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $32,092 | RelatedOrganizationsAmt |
| Government Grants | $7,416 | GovernmentGrantsAmt |
| All Other Contributions | $1,705 | AllOtherContributionsAmt |
| Total Contributions | $41,213 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient Service Revenu | 622110 | $23,854,161 | $23,854,161 | |
| Other Revenue | 900099 | $844,656 | $842,209 | $2,447 |
| Change in Foundation | 900099 | $70,549 | $70,549 | |
| Collaborative Agreement | 900099 | $58,708 | $58,708 | |
| EHR Incentive Income | 900099 | $56,000 | $56,000 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,088 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,088 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,936,162 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $452,520 | TotalRevenueColumnAmt |
| Exclusion | $452,520 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,557 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,557 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,557 | TotalRevenueColumnAmt |
| Exclusion | $36,557 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $28,052 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $28,052 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,052 | TotalRevenueColumnAmt |
| Exclusion | $28,052 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,494,504 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,933,715 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,447 | UnrelatedBusinessRevenueAmt |
| Exclusion | $517,129 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,316 | TotalAmt |
| Program Services | $33,316 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,606,808 | TotalAmt |
| Program Services | $8,459,798 | ProgramServicesAmt |
| Management And General | $1,147,010 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $479,425 | TotalAmt |
| Program Services | $92,668 | ProgramServicesAmt |
| Management And General | $386,757 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,491,653 | TotalAmt |
| Program Services | $1,286,804 | ProgramServicesAmt |
| Management And General | $204,849 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $654,143 | TotalAmt |
| Program Services | $577,052 | ProgramServicesAmt |
| Management And General | $77,091 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,416 | TotalAmt |
| Program Services | $30,000 | ProgramServicesAmt |
| Management And General | $322,416 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,051 | TotalAmt |
| Management And General | $3,051 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,550 | TotalAmt |
| Management And General | $37,550 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,623,778 | TotalAmt |
| Program Services | $1,586,201 | ProgramServicesAmt |
| Management And General | $37,577 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,696 | TotalAmt |
| Program Services | $1,002 | ProgramServicesAmt |
| Management And General | $17,694 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $265,388 | TotalAmt |
| Program Services | $120,701 | ProgramServicesAmt |
| Management And General | $144,687 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,106 | TotalAmt |
| Program Services | $42,478 | ProgramServicesAmt |
| Management And General | $37,628 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $397,607 | TotalAmt |
| Program Services | $397,607 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,030 | TotalAmt |
| Program Services | $8,232 | ProgramServicesAmt |
| Management And General | $8,798 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,137 | TotalAmt |
| Program Services | $83,402 | ProgramServicesAmt |
| Management And General | $11,735 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,871 | TotalAmt |
| Program Services | $113,871 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,464,825 | TotalAmt |
| Program Services | $1,464,825 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,423 | TotalAmt |
| Program Services | $70,202 | ProgramServicesAmt |
| Management And General | $198,221 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $4,153,311 | $4,153,311 | |
| Locum Fees | $1,045,947 | $1,045,947 | |
| Bad Debt Expense | $508,963 | $508,963 | |
| Equipment Lease and Ren | $156,870 | $151,652 | $5,218 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $461,905 | TotalAmt |
| Program Services | $220,391 | ProgramServicesAmt |
| Management And General | $241,514 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,330,219 | TotalAmt |
| Program Services | $20,448,423 | ProgramServicesAmt |
| Management And General | $2,881,796 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,837,581 | BOYAmt |
| EOY | $3,289,110 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,096,031 | BOYAmt |
| EOY | $3,545,567 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,625 | BOYAmt |
| EOY | $3,125 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $579,541 | BOYAmt |
| EOY | $749,685 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,209 | BOYAmt |
| EOY | $145,061 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,910,259 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,670,207 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,437,919 | BOYAmt |
| EOY | $13,240,052 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $289,974 | BOYAmt |
| EOY | $293,480 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,831,842 | BOYAmt |
| EOY | $15,680,663 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,171 | BOYAmt |
| EOY | $198,013 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $276,989 | BOYAmt |
| EOY | $179,787 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,625,882 | BOYAmt |
| EOY | $37,324,543 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,984,685 | BOYAmt |
| EOY | $1,886,891 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,600,000 | BOYAmt |
| EOY | $3,246,414 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,325 | BOYAmt |
| EOY | $55,049 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,625,016 | BOYAmt |
| EOY | $2,347,351 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,370,026 | BOYAmt |
| EOY | $7,535,705 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,992,289 | BOYAmt |
| EOY | $29,535,949 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $241,025 | BOYAmt |
| EOY | $230,347 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,542 | BOYAmt |
| EOY | $22,542 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,255,856 | BOYAmt |
| EOY | $29,788,838 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,625,882 | BOYAmt |
| EOY | $37,324,543 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,164,285 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$631,303 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $823,825 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $85,170 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $908,995 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $721,217 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $102,608 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $823,825 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $680,404 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $40,813 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $721,217 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $680,404 | BeginningYearBalanceAmt |
| End Year Balance | $680,404 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $680,404 | BeginningYearBalanceAmt |
| End Year Balance | $680,404 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.95000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.03000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.02000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $470,340 | OtherCostOrOtherBasisAmt |
| Book Value | $470,340 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,109,174 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,625,341 | DepreciationAmt |
| Book Value | $8,483,833 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,381,170 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,807,022 | DepreciationAmt |
| Book Value | $3,574,148 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $949,575 | OtherCostOrOtherBasisAmt |
| Depreciation | $237,844 | DepreciationAmt |
| Book Value | $711,731 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,240,052 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Assets Lmited as to Use - Avera Pooled Investments | $13,768,006 | F |
| Investment in Foundation | $1,912,657 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $15,680,663 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Related Party | $1,250,000 |
| Clinic Collaborative Arrangement | $619,206 |
| Compensated Absences | $44,652 |
| Estimated Third-Party Payor Settlements | $433,493 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,347,351 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $24,364,916 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$631,303 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$508,963 | OtherRevenueAmt |
| Revenue Not Reported | -$1,140,266 | RevenueNotReportedAmt |
| Revenue Subtotal | $25,505,182 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$10,678 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$10,678 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $25,494,504 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,821,256 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,821,256 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $508,963 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $508,963 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $23,330,219 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. |
| Part X, Line 2: | The Organization is an Iowa 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). 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 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. |
| Part XI, Line 2d - Other Adjustments: | Provision for Bad Debts Reported in Revenue on Financial Statements -508,963. |
| Part XI, Line 4b - Other Adjustments: | Change in Interest in Net Assets Avera Health Fdtn in Fund Balance for F/S -10,678. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts Reported in Revenue on Financial Statements 508,963. |
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 | 1603 | PersonsServedCnt |
| Total Community Benefit Expns | $384,502 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $384,502 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01680 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,435,677 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,200,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $234,862 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01030 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1603 | PersonsServedCnt |
| Total Community Benefit Expns | $2,820,179 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,200,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $619,364 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02710 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 624 | PersonsServedCnt |
| Total Community Benefit Expns | $33,726 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,726 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 108 | PersonsServedCnt |
| Total Community Benefit Expns | $109,708 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $109,708 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $380,017 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $380,017 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01670 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $680 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $680 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $48,748 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,748 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Persons Served | 732 | PersonsServedCnt |
| Total Community Benefit Expns | $572,879 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $572,879 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02510 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Persons Served | 2335 | PersonsServedCnt |
| Total Community Benefit Expns | $3,393,058 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,200,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,192,243 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05220 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $40,360 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $42,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $82,360 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $82,360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00360 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $508,963 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,486,421 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,566,311 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$79,890 | 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 | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Holy Family Health | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 N 8th Street | AddressLine1Txt |
| City | Estherville | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51334 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.avera-holyfamily.org | WebsiteAddressTxt |
| State License | 320014H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Provider Based Clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Holy Family | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.avera.org/holy-family-hospital | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V statement | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | see Part V | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Avera Holy Family | Part V, Section B, Line 5: Avera Holy Family utilized data gathered through input from community partners and services groups, survey responses, community leader interviews, and results from focus groups. The Emmet County Wellness Coalition, Emmet County Public Health, and other health groups in the community served were consulted throughout this process. |
| Avera Holy Family | Part V, Section B, Line 11: The Hospital did not address mental health services needs due to the lack of mental health providers in the area. Transportation and environmental issues were not addressed due to lack of financial resources, lack of technical know-how and skill, and other needs taking priority.All other needs from the Community Health Needs Assessment have been addressed and implemented. |
| Avera Holy Family | 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 in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. |
| Avera Holy Family | 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, Line 16a, FAP website: | www.avera.org/app/files/public/4735/avera-financial-assistance-corp |
| Schedule H, Part V, Line 11: | www.avera.org/experience/shared/community-needs-health-assessments/ |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Avera Holy Family Part V, Section B, line 16a website: | see Part V |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Avera Parkwood Independent Living Facili | ||||
| 400 Parkwood Drive | Pierre | SD | 57501 | Independent living |
| Maryhouse | ||||
| 400 Parkwood Drive | Pierre | SD | 57501 | Long term care |
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 within 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 and Medicaid were converted to cost using an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, health professions education, subsidized health services, research and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. |
| Part I, Ln 7 Col(f): | The amount of bad debt removed from the denominator of the calculation was $508,963. |
| Part II, Community Building Activities: | The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. |
| Part III, Line 4: | The footnote to the Organization's financial statements that describes bad debt expenses is located in Footnote 1 on pages 7 and 8 of the attached 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 set forth by Centers for Medicare and Medicaid Services. Avera Holy Family 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. Avera Holy Family does not report any data to any of the credit agencies, however, the collection agencies Avera Holy Family 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: | The Organization collaborated with the Department of Public Health on a needs assessment. The finalized Community Health Needs Assessment and Implementation Strategy is located on our website. |
| Part VI, Line 3: | Information regarding charity care is made available to patients via their billing statements. The Finance Department also informs patients of the policy through their contact with patients. Brochures regarding financial assistance are located in the lobby of the Hospital and the Clinic. |
| Part VI, Line 4: | Avera Holy Family Health operates a 25-bed critical access hospital and provider-based clinic located in Estherville, Iowa. Avera Holy Family's service area includes Emmet County and surrounding counties in Iowa. In 2014, the population for Emmet County was 9,990. Approximately 19.2% of the population is age 65 or older. The average per capita income is $28,293 and approximately 11.3% of the population is below the federal poverty level. The nearest hospital in the area is approximately 15 miles from Avera Holy Family's main campus. |
| Part VI, Line 5: | The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care.The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. |
| Part VI, Line 6: | The communities in which Avera operates all have unique health and community benefit needs and in keeping with the Catholic Healthcare Association guidelines each Hospital strives to meet its community's identified needs. The Avera Central Office advocates for all on community benefit related matters of state, regional, and national importance. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Iowa Lakes Community College | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19 South 7th St | AddressLine1Txt |
| City | Estherville | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51334 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 391872497 | RecipientEIN |
| IRC Section | 3 | IRCSectionDesc |
| Cash Grant | $5,850 | CashGrantAmt |
| Purpose Of Grant | Scholarships | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Avera Holy Family's policy is to provide grants/contributions to not-for-profit entities and governmental divisions that benefit the community and region through programs and activities. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The City of Estherville Iowa | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 426004647 | BondIssuerEIN |
| CUSIP | 297542BG6 | CUSIPNum |
| Bond Issued | 2012-06-21 | BondIssuedDt |
| Issue Price | $3,840,000 | IssuePriceAmt |
| Purpose | Refund the Series 2000 Bonds issued 12/14/2000 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $480,000 | RetiredAmt |
| Total Proceeds | $3,840,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $76,800 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $3,763,200 | OtherSpentProceedsAmt |
| Substantial Completion | 2000 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dr Anthony Cook | PersonNm |
| Relationship With Org | Board member | RelationshipWithOrgTxt |
| Loan Purpose | Recruitment | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $150,000 | OriginalPrincipalAmt |
| Balance Due | $3,125 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $3,125 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Estherville Medical Clinic PC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | 2 Board Members are more than 35% owners | RelationshipDescriptionTxt |
| Transaction | $550,605 | TransactionAmt |
| Transaction | Payment for physician services | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Doctors Stangl and Cook 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 the 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, SD ("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 CEO of the Corporation; 8) To approve the 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 is no committee with authority to act on behalf of the Board. |
| Form 990, Part VI, Section B, line 11 | The CEO reviews the 990 in detail. After the CEO's review, the 990 is provided to each Board Member. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. |
| Form 990, Part VI, Section B, line 15 | The CEO and officers are compensated by Avera McKennan. Avera McKennan has a process in place for determining compensation for these individuals. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents and conflict of interest policy are not 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 VI, Section B, Line 15: | Dale Hustedt is compensated by Avera McKennan, a related organization. Avera McKennan is a nonprofit 501(c)(3) corporation organized and operated in the State of South Dakota. Avera McKennan has a process in place for determining compensaton of these individuals using processes identified in Part I, Line 3. |
| Form 990, Part XII, Line 2c: | The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Holy Family. |
| Form 990, Part VI, Section B, Line 16b: | There is no written policy or procedure since 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. |
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 W Avera Drive Suite 300 | Sioux Falls | SD | 57108 | 460422673 | Promotion of Health | SD | 501(c)(3) | Line 9 | N/A | 0 | |
| Avera Holy Family Foundation | |||||||||||
| 826 N 8th Street | Estherville | IA | 51334 | 421317452 | Support of Holy Family Hospital and Home Health Agency | IA | 501(c)(3) | Line 9 | Yes (1) | Avera Holy Family | |
| Avera St Anthony's Hospital | |||||||||||
| 300 N 2nd Street | ONeill | NE | 68763 | 470463911 | Healthcare Services | NE | 501(c)(3) | Line 3 | 0 | Avera Health | |
| 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 | |||||||||||
| 401 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 North Foster Street | Mitchell | SD | 57301 | 460224604 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Sacred Heart Health Services | |||||||||||
| 501 Summit Street | Yankton | SD | 57078 | 460225483 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera at Home | |||||||||||
| 5116 S Solberg Ave | Sioux Falls | SD | 57108 | 460399291 | Home Services | SD | 501(c)(3) | Line 9 | 0 | Avera Health | |
| Lewis and Clark Health Education and Service Agency | |||||||||||
| 1000 W 4th Street Suite 9 | Yankton | SD | 57078 | 460337013 | Healthcare Education | SD | 501(c)(3) | Line 9 | 0 | Sacred Heart Health Services | |
| Avera St Luke's | |||||||||||
| 305 South State Street | Aberdeen | SD | 57401 | 460224598 | Healthcare Services | SD | 501(c)(3) | Line 3 | 0 | Avera Health | |
| Avera 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 | |
| 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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Avera Home Medical Equipment of Estherville LLC | ||||||||||||||
| PO Box 5045 | Sioux Falls | SD | 57117 | 201686097 | Medical services - home medical equipment | SD | Avera McKennan | related | $8,426 | $187,326 | 0 | Yes (1) | 0.50000 | |
| Avera Home Medical Equipment LLC | ||||||||||||||
| 1325 S Cliff Ave PO BOX 5045 | Sioux Falls | SD | 57117 | 460488198 | Medical services - home medical equipment | SD | N/A | |||||||
| 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 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 Av 102 | Sioux Falls | SD | 57117 | 800619999 | Medical Services - home medical equipment | SD | N/A | |||||||
| Q&M Properties LLC | ||||||||||||||
| 525 North Foster | Mitchell | SD | 57301 | 731652049 | Medical clinic building | SD | N/A | |||||||
| Surgical Associates Endoscopy Clinic LLC | ||||||||||||||
| 310 S Penn | Aberdeen | SD | 57401 | 460461429 | Surgical associates | SD | N/A | |||||||
| Heart Hospital of South Dakota LLC | ||||||||||||||
| 10720 Sikes Place Suite 300 | Charlotte | NC | 28277 | 562143771 | Healthcare Services | NC | 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 | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Accounts Management Inc | |||||||||
| 5132 S Cliff Avenue Suite 101 | Sioux Falls | SD | 57108 | 460373021 | Collection Agency | SD | N/A | C | 0 |
| Avera Health Plans Inc | |||||||||
| 3900 West Avera Drive Suite 101 | Sioux Falls | SD | 57108 | 460451539 | Health Financing and Health Plan Admin | SD | N/A | C | 0 |
| Avera Property Insurance Inc | |||||||||
| 510 W 23rd Street 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 |
| 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 | Yes (1) | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |