2015-05-15T07:30:55-05:00 2014-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2013-07-01 460224604 AVERA QUEEN OF PEACE AVER 6059952251 525 NORTH FOSTER STREET MITCHELL SD 57301 WILLIAM E FLETT SEC/TREAS & VP OF FINANCE 6059952251 2015-05-12 0 KIM HUNWARDSEN CPA P00484560 6122536500 2015-05-12 2013 2016-03-07 17:11:31Z AVERA QUEEN OF PEACE HEALTH SERVICE THOMAS A CLARK 525 NORTH FOSTER STREET MITCHELL SD 57301 103104884 0 0928 X WWW.AVERAQUEENOFPEACE.ORG X 1905 SD PROMOTION OF HEALTH 18 15 979 110 0 0 1738160 865066 94804644 99738113 1906582 1920627 -289504 63191 98159882 102586997 540476 163753 0 0 54118975 54264575 0 35130 217948 37618998 42814333 92278449 97277791 5881433 5309206 115213085 136395220 33371299 45965069 81841786 90430151 X AVERA IS A HEALTH MINISTRY ROOTED IN THE GOSPEL. OUR MISSION IS TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES BY PROVIDING QUALITY SERVICES GUIDED BY CHRISTIAN VALUES. 1 0 80803837 163753 99738113 AVERA QUEEN OF PEACE'S MISSION IS TO PROVIDE HEALTHCARE SERVICES TO MITCHELL, SD RESIDENTS AND THE SURROUNDING AREA. THEY PROVIDE ACUTE CARE AND LONG-TERM HEALTHCARE SERVICES, OF WHICH THERE WERE 7,603 ACUTE PATIENT DAYS, 2,958 SWING-BED PATIENT DAYS, 1,148 NURSERY PATIENT DAYS, 29,209 NURSING HOME RESIDENT DAYS, 8,826 ASSISTED LIVING RESIDENT DAYS, AND 2,142 INDEPENDENT LIVING DAYS. THE BREAKOUT OF THESE STATISTICS PER FACILITY IS AS FOLLOWS.AVERA QUEEN OF PEACE HOSPITAL7,228 ACUTE PATIENT DAYS2,174 SWING-BED PATIENT DAYS1,148 NEWBORN PATIENT DAYSAVERA BRADY HEALTH AND REHABILITATION29,209 LONG-TERM CARE RESIDENT DAYS8,826 ASSISTED LIVING DAYS2,142 INDEPENDENT LIVING DAYSAVERA WESKOTA MEMORIAL MEDICAL CENTER (CAH)263 ACUTE PATIENT DAYS425 SWING-BED PATIENT DAYSAVERA DE SMET MEMORIAL HOSPITAL (CAH)112 ACUTE PATIENT DAYS359 SWING-BED PATIENT DAYS AVERA QUEEN OF PEACE 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 $2,539,469.AVERA QUEEN OF PEACE ALSO PROVIDES COMMUNITY BENEFIT HEALTH ACTIVITIES AT LESS THAN OR AT NO COST TO SUPPORT THOSE IN THE AREA SERVICED. THESE ACTIVITIES INCLUDE COMMUNITY EDUCATION PROGRAMS; SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, AND MEDICALLY UNDERSERVED; AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING THE YEAR ENDED JUNE 30, 2014, SPECIFIC ACTIVITIES INCLUDE MEALS DELIVERED TO RESIDENTIAL HOMES; MEETING FACILITIES; PROGRAMS FOR PATIENTS AND FAMILIES SUFFERING FROM CANCER, DIABETES, BREATHING DISORDERS, AND OTHERS; ASSISTANCE TO HEALTH EDUCATORS; EMERGENCY HEALTHCARE PROVIDERS; WELLNESS PROGRAMS; AND OVERNIGHT HOUSING FOR FAMILIES OF HOSPITALIZED PATIENTS.AS A MEMBER OF THE AVERA HEALTH NETWORK, AVERA QUEEN OF PEACE UPHOLDS THE VISION OF THE PRESENTATION AND BENEDICTINE SISTERS TO WORK THROUGH COLLABORATION TO PROVIDE A QUALITY, EFFECTIVE HEALTH MINISTRY AND TO IMPROVE THE HEALTH CARE OF INDIVIDUALS AND OUR COMMUNITIES THROUGH A REGIONALLY INTEGRATED NETWORK OF PERSONS AND INSTITUTIONS. AVERA QUEEN OF PEACE ENGAGES IN ACTIVITIES DESIGNED TO IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES IN RESPONSE TO A CALLING TO HEAL THE SICK, THE ELDERLY, AND THE OPPRESSED. 80803837 1 1 0 1 0 0 0 0 1 1 1 1 0 1 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 156 0 1 979 1 0 0 0 0 0 0 0 0 0 0 X 18 15 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 0 X WILLIAM E FLETT 6059952251 525 NORTH FOSTER MITCHELL SD 57301 LORI ESSIG CHAIRPERSON 2.50 0.00 X X 0 0 0 TERRY TORGERSON VICE CHAIR 2.50 0.00 X X 0 0 0 LOREN NOESS BOARD MEMBER 2.50 0.00 X 0 0 0 CHARLES BERGELEEN BOARD MEMBER 2.50 0.00 X 0 0 0 SISTER KATHLEEN CROWLEY BOARD MEMBER 2.50 8.00 X 0 0 0 DENNIS KRUSE BOARD MEMBER 2.50 0.00 X 0 0 0 SISTER BONITA GACNIK BOARD MEMBER 2.50 0.00 X 0 0 0 DAVID OLSON BOARD MEMBER 2.50 0.00 X 0 0 0 JACQUELYN JOHNSON BOARD MEMBER 2.50 0.00 X 0 0 0 KELLY SMITH MD THRU 13114 BOARD MEMBER/PHYSICIAN 42.50 0.00 X 61092 0 0 DIANE SANDHOFF BOARD MEMBER 2.50 0.00 X 0 0 0 JERRY THOMSEN BOARD MEMBER 2.50 0.00 X 0 0 0 ROGER MUSICK BOARD MEMBER 2.50 0.00 X 0 0 0 MICHAEL KRAUSE DO BOARD MEMBER/PHYSICIAN 7.50 0.00 X 15664 0 0 PATRICIA MALTERS MD BOARD MEMBER/PHYSICIAN 42.50 0.00 X 254715 0 25761 GREG VAN WALD BOARD MEMBER 2.50 0.00 X 0 0 0 SISTER JOAN REICHELT BOARD MEMBER 2.50 43.30 X 0 0 0 WILLIAM GRAHAM DO AS OF 2114 BOARD MEMBER/PHYSICIAN 2.50 0.00 X 0 0 0 THOMAS CLARK PRESIDENT & CEO 40.00 0.00 X X 0 375700 35643 WILLIAM E FLETT SEC/TREAS & VP OF FINANCE 40.00 0.00 X 169052 0 36312 BRIAN KAMPMANN MD ORTHOPEDICS, SPORTS MEDICINE 40.00 0.00 X 748953 0 39962 STEPHEN DICK MD MPH RADIATION ONCOLOGY 40.00 0.00 X 425257 0 39962 CHRIS KROUSE OD ORTHOPEDICS, SPORTS MEDICINE 40.00 0.00 X 995123 0 39962 MICHAEL HALEY MD FACS BARIATRICS, GENERAL SURGERY 40.00 0.00 X 435441 0 42462 DENNIS LELAND MD FACS GENERAL SURGERY 40.00 0.00 X 513027 0 42462 3618324 375700 302526 56 0 1 0 AVERA HEALTH 3900 W AVERA DRIVE SUITE 300 SIOUX FALLS SD 57108 SHARED SERVICES 5677350 PUETZ CORPORATION 800 N KIMBALL MITCHELL SD 57301 CONSTRUCTION SERVICES 2659356 AEGIS THERAPIES INC 1000 FIANNA WAY FORT SMITH AR 72919 PT, OT & SPEECH THERAPY SERVICES 420601 HORIZON HEALTH CARE INC PO BOX 99 HOWARD SD 57349 MEDICAL LOCUM SERVICES 266792 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LABORATORY TESTING SERVICES 256038 8 38500 271840 554726 865066 NET PATIENT & RESIDENT SERVICES 622110 96296673 96296673 OTHER REVENUE 900099 1205217 1205217 MEANINGFUL USE REVENUE 900099 1065513 1065513 INTEREST IN AVERA HEALTH FND 900099 584885 584885 CAFETERIA 900099 461411 461411 124414 124414 99738113 13310 13310 299488 517476 -217988 -217988 -217988 1892365 14952 0 0 1892365 14952 1907317 1907317 3843 411 3432 3432 OPERATING INTEREST 900099 277747 277747 277747 102586997 99738113 0 1983818 X 163753 163753 578396 372762 205634 230365 230365 41891203 36176410 5583526 131267 2490913 2153760 329279 7874 6503751 5612332 871092 20327 2569947 2214523 347457 7967 288584 288584 35130 35130 11353010 5763409 5589601 424449 37519 386930 7997258 6297805 1686379 13074 224748 137611 87137 2082667 1487217 595450 218383 163770 52907 1706 116484 67209 48672 603 663129 663129 4123937 4123937 839765 839765 MEDICAL SUPPLIES 9643879 9643879 BAD DEBT EXPENSE 4297912 4297912 EQUIPMENT LEASE AND REN 184750 90548 94202 355378 266222 89156 97277791 80803837 16256006 217948 4401190 4243794 1813 13089118 18708790 5180 1320954 1402519 1461874 2342808 101943789 59659789 41145828 42284000 938557 959046 49838610 49788645 1055564 1356132 200000 1142822 1754397 14166664 115213085 136395220 8094367 7533002 46409 105274 22845170 35799553 2385353 2527240 33371299 45965069 X 78648850 87085253 2392230 2543121 800706 801777 81841786 90430151 115213085 136395220 X 5309206 3235746 43413 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8392 8392 0 PART II-B, LINE 1: AVERA QUEEN OF PEACE HOSPITAL PAID DUES TO ORGANIZATIONS WHICH HAVE A PORTION OF THE DUES ATTRIBUTED TO LOBBYING ACTIVITIES. 0 1 X 1065019 1990675 117527 473098 19025 2681098 1040814 24205 1065019 1034190 6624 1040814 793583 109334 131273 1034190 1032880 -239297 793583 0.20960 0.09520 0.69520 0 1 1 448670 2918464 3367134 1853386 57491862 30463538 28881710 37438800 27958869 9479931 1792607 1237382 555225 42284000 INVESTMENT IN AFFILIATED ORGANIZATIONS 253929 C INTEREST IN AVERA HEALTH FOUNDATION 3113198 F INTEREST IN NET ASSETS OF MABEE TRUST 864630 F ASSETS LIMITED TO USE - AVERA POOLED INVESTMENTS 45556888 F 49788645 DUE FROM RELATED PARTIES 166664 CUSTODIAL FUNDS HELD BY RELATED PARTY 14000000 14166664 DERIVATIVE LIABILITY 2010840 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 516400 2527240 X PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS IN TRUST ON BEHALF OF ITS RESIDENTS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENTS CONSIST OF A PORTION OF THEIR INTEREST IN THE NET ASSETS OF AVERA HEALTH FOUNDATION AND THEIR BENEFICIAL INTEREST IN THE MABEE TRUST. AVERA HEALTH FOUNDATION INCLUDES ENDOWMENT FUNDS WHICH HAVE BEEN ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENT FUND ASSETS INCLUDED IN THE ORGANIZATION'S BENEFICIAL INTEREST IN THE MABEE TRUST HAVE BEEN ESTABLISHED TO PURCHASE EQUIPMENT AND FURNISHINGS FOR THE ORGANIZATION. 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. THE ORGANIZATION'S PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE DONOR RESTRICTED. THE ORGANIZATION CURRENTLY DOES NOT HAVE ANY BOARD-DESIGNATED ENDOWMENT FUNDS. PART X, LINE 2: AVERA HEALTH AND MOST OF ITS SPONSORED ORGANIZATIONS ARE CONSIDERED NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE INTERNAL REVENUE SERVICE (IRS). AVERA HEALTH AND CERTAIN SPONSORED ORGANIZATIONS ALSO FILE AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT THEIR UNRELATED BUSINESS TAXABLE INCOME. AVERA HEALTH AND ITS SPONSORED ORGANIZATIONS BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE FEDERAL FORM 990T FILINGS FOR CONSOLIDATED SUBSIDIARIES ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. 0 SHERWOOD CONSULTING SERVICE INC 4529 SHORELINE DRIVE 5 FORT COLLINS CO 80526 FEASIBILITY STUDY/CAMPAIGN CONSULTATION 0 0 35130 -35130 35130 -35130 1 1 X 1 X 1 X 1 1 1 0 1 1 2949 959470 959470 0.01030 7333 7656076 5593566 2062510 0.02220 10282 8615546 5593566 3021980 0.03250 21 1628 34571 695 33876 0.00040 5 1 63458 63458 0.00070 3 5766 1047106 672482 374624 0.00400 40 4 332255 332255 0.00360 69 7399 1477390 673177 804213 0.00870 69 17681 10092936 6266743 3826193 0.04120 1 250 200 200 0.00000 1 79626 55386 24240 0.00030 2 250 79826 55386 24440 0.00030 1 4297912 0 29397213 39232245 -9835032 X 1 1 3 1 AVERA QUEEN OF PEACE HOSPITAL 525 NORTH FOSTER STREET MITCHELL SD 57301 WWW.AVERAQUEENOFPEACE.ORG 10552 X X X 5 PROVIDER BASED CLINICS 2 AVERA WESKOTA MEMORIAL MEDICAL CENTER 609 1ST STREET NE WESSINGTON SPRINGS SD 57382 WWW.AVERA.ORG/WESKOTA 48209 X X X 3 AVERA DE SMET MEMORIAL HOSPITAL 306 PRAIRIE AVENUE SW DE SMET SD 57231 WWW.AVERA.ORG/DE-SMET 50726 X X X AVERA QUEEN OF PEACE HOSPITAL 1 1 X X X X X X X 12 1 0 1 X WWW.AVERA.ORG/QUEEN-OF-PEACE X WWW.AVERA.ORG X X X X X X 0 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 1 AVERA WESKOTA MEMORIAL MEDICAL CENTER 2 1 X X X X X X X X 12 1 0 1 X WWW.AVERA.ORG/WESKOTA/ X WWW.AVERA.ORG X X X X X X X 0 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 1 AVERA DE SMET MEMORIAL HOSPITAL 3 1 X X X X X X X X 12 1 0 1 X WWW.AVERA.ORG/DE-SMET/ X WWW.AVERA.ORG X X X X X X X X X X 0 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 1 AVERA QUEEN OF PEACE HOSPITAL PART V, SECTION B, LINE 3: SIX FOCUS GROUPS WERE HELD TO COLLECT PRIMARY DATA FROM COMMUNITY LEADERS, SENIOR CITIZENS, SINGLE PARENTS, SMALL BUSINESS REPRESENTATIVES, LARGE BUSINESS REPRESENTATIVES, AND POST-SECONDARY STUDENTS. IN ADDITION, THE FOLLOWING INDIVIDUALS WERE CONSULTED IN CONDUCTING THE NEEDS ASSESSMENT: PRINCIPAL, LONGFELLOW ELEMENTARY SCHOOL; DIRECTOR OF ADULT SERVICES AND AGING, DAVISON COUNTY; PUBLIC HEALTH NURSE, DAVISON COUNTY; DIRECTOR OF FAMILY PLANNING, DAVISON COUNTY; AND PARISH HEALTH NURSE, FIRST LUTHERAN CHURCH. AVERA WESKOTA MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 3: AVERA WESKOTA MEMORIAL HOSPITAL GATHERED BOTH SECONDARY AND PRIMARY DATA FOR THE ASSESSMENT. A COMMUNITY DEVELOPMENT SPECIALIST WITH THE PLANNING AND DEVELOPMENT DISTRICT GATHERED PRIMARY DATA BY CONDUCTING FOCUS GROUPS AND A NUMBER OF KEY INFORMANT INTERVIEWS. AVERA WESKOTA ALSO COLLECTED PRIMARY DATA THROUGH A SURVEY TOOL. THE SURVEY WAS UTILIZED TO REACH THE BROADER COMMUNITY AND WAS DISTRIBUTED TO THE FOLLOWING FOUR GROUPS OF PEOPLE THROUGHOUT THE WESSINGTON SPRINGS AREA: 1) COMMUNITY & COUNTY MEMBERS 2) HEALTH CARE PROVIDERS, STAFF & BOARD MEMBERS 3) UNINSURED/UNDERINSURED POPULATIONS & 4) COMMUNITY LEADERS. AVERA DE SMET MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: INPUT WAS GATHERED FROM INDIVIDUALS REPRESENTING THE FOLLOWING GROUPS: PUBLIC SAFETY, HEALTHCARE, LOW INCOME, CONTRACTORS/SELF EMPLOYED, SCHOOLS, SD DEPT OF HEALTH OFFICE OF RURAL HEALTH AVERA QUEEN OF PEACE HOSPITAL PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/ AVERA WESKOTA MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/ AVERA DE SMET MEMORIAL HOSPITAL PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/ AVERA QUEEN OF PEACE HOSPITAL PART V, SECTION B, LINE 7: DUE TO LIMITED FINANCIAL, PHYSICAL SPACE AND TIME LIMITATIONS, THE INTERDISCIPLINARY CHNA TEAM DID NOT PRIORITIZE/ASSIGN FOR IMPLEMENTATION AT THIS TIME: ADEQUATE AND AFFORDABLE HOUSING: AVERA QUEEN OF PEACE CURRENTLY HAS REPRESENTATION ON THE MITCHELL DEVELOPMENT CORPORATION. THE MITCHELL DEVELOPMENT CORPORATION IS ACTIVE IN ATTRACTING INVESTMENT IN AFFORDABLE HOUSING.AFFORDABLE DENTAL CARE: A MOBILE DENTAL CARE CLINIC CURRENTLY ASSISTS LOCAL DENTIST IN PROVIDING FREE DENTAL SERVICES TO NEEDY CHILDREN. OUR FINDINGS OF PATIENTS ARE UNABLE TO FIND A DENTIST WITH AVAILABLE APPOINTMENTS OR WILLING TO ACCEPT UNINSURED PATIENTS WILL BE COMMUNICATED WITH DENTISTS. AFFORDABLE AND RELIABLE PUBLIC TRANSPORTATION: THE CITY OF MITCHELL CURRENTLY OPERATES A PUBLIC TRANSIT SYSTEM, IN ADDITION, A LOCAL COMPANY ALSO PROVIDES TRANSPORTATION SERVICES. OUR FINDINGS OF WAIT TIMES FOR TRANSPORTATION HAVE BEEN COMMUNICATED WITH TRANSPORTATION PROVIDERS. AVERA WESKOTA MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 7: DUE TO LIMITED FINANCIAL, PHYSICAL SPACE AND TIME LIMITATIONS, THE INTERDISCIPLINARY CHNA TEAM DID NOT PRIORITIZE/ASSIGN FOR IMPLEMENTATION AT THIS TIME: LACK OF ASSISTED LIVING HOUSING: THIS FINDING WAS REPORTED TO THE LOCAL NURSING HOME BOARD OF DIRECTORS TO ADDRESS IN THEIR STRATEGIC PLANNING AS THEY CURRENTLY PROVIDE INDEPENDENT SENIOR HOUSING AND MAY BE ABLE TO ADD OR CONVERT SPACE FOR ASSISTED LIVING.ALL OTHER NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE ADDRESSED AND WILL CONTINUE TO BE ADDRESSED IN FUTURE YEARS. AVERA DE SMET MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: DUE TO LIMITED FINANCIAL, PHYSICAL SPACE AND TIME LIMITATIONS, THE INTERDISCIPLINARY CHNA TEAM DID NOT PRIORITIZE/ASSIGN FOR IMPLEMENTATION AT THIS TIME: WATER QUALITY: ALL COMMENTS AND CONCERNS WILL BE ADDRESSED BY THE CITY OF DE SMET.PHYSICAL ACTIVITY: THE CITY OF DE SMET IS ADDRESSING THE WELLNESS NEEDS OF THE COMMUNITY WITH PLANS FOR CONSTRUCTION OF A COMMUNITY CENTER AND WELLNESS CENTER.DOMESTIC ABUSE: THIS NEED WILL BE ADDRESSED BY THE BROOKINGS ABUSE SHELTER RURAL OUTREACH PROGRAM AS THIS PROGRAM IS BEST QUALIFIED TO ADDRESS THIS NEED.ALL OTHER NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE ADDRESSED AND WILL CONTINUE TO BE ADDRESSED IN FUTURE YEARS. AVERA QUEEN OF PEACE HOSPITAL PART V, SECTION B, LINE 14G: 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 WESKOTA MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 14G: 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 DE SMET MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: 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 QUEEN OF PEACE HOSPITAL PART V, SECTION B, LINE 22: 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 WESKOTA MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 22: 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 DE SMET MEMORIAL HOSPITAL PART V, SECTION B, LINE 22: 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. 2 AVERA BRADY HEALTH AND REHAB 500 S OHMAN ST MITCHELL SD 57301 NURSING HOME AVERA BRADY ASSISTED LIVING 1414 W CEDAR AVE MITCHELL SD 57301 ASSISTED LIVING 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 EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND DONATIONS, LINE 7I WERE COMPILED USING ACTUAL COSTS RECORDED IN THE CBISA SOFTWARE. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART I, LN 7 COL(F): AVERA QUEEN OF PEACE BAD DEBT EXPENSE OF $4,297,912 IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT EXCLUDED FOR PURPOSES OF CALCULATING THIS PERCENTAGE. PART II, COMMUNITY BUILDING ACTIVITIES: AVERA QUEEN OF PEACE SUPPORTS NUMEROUS ECONOMIC DEVELOPMENT ORGANIZATIONS WITH PARTICIPATION AT MEETINGS AND DONATIONS THROUGHOUT ITS SERVICE AREA. ADDITIONALLY, AVERA QUEEN OF PEACE WORKS WITH DAKOTA WESLEYAN UNIVERSITY, THE MITCHELL TECHNICAL INSTITUTE, AND LOCAL HIGH SCHOOLS TO ADDRESS HEALTHCARE WORKER SHORTAGES IN THE COMMUNITIES OF ITS SERVICE AREA. AVERA QUEEN OF PEACE ALSO PARTNERS WITH THE MITCHELL SENIOR MEALS PROGRAM TO ENSURE ACCESS TO NUTRITIOUS MEALS FOR THE ELDERLY. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR. BAD DEBT IS RECORDED AT CHARGES AS RECORDED BY THE ORGANIZATION. PART III, LINE 3: AVERA QUEEN OF PEACE DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE SINCE EVALUATIONS ARE COMPLETED TO DETERMINE THOSE AMOUNTS DUE AND WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE EVALUATION OF THE AMOUNT. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. AVERA QUEEN OF PEACE FOLLOWS THE CHA GUIDELINES IN REPORTING COMMUNITY BENEFITS AND THEREFORE ANY MEDICARE SHORTFALL (AS CALCULATED INCLUDING OUR NON-COST REPORT ENTITIES) 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 AGENCY IF DOING SO MAY NEGATIVELY IMPACT A PATIENT'S CREDIT. 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. ANY EXTENDED PAYMENT PLANS OFFERED BY A HOSPITAL IN SETTLING THE OUTSTANDING BILLS OF LOW INCOME, UNINSURED PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SHALL BE INTEREST-FREE SO LONG AS THE REPAYMENT SCHEDULE IS MET. PART VI, LINE 2: AVERA QUEEN OF PEACE CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR EACH FACILITY DURING 2012 AND 2013. THE CHNA IMPLEMENTATION PLANS FOR AVERA WESKOTA MEMORIAL MEDICAL CENTER AND AVERA DE SMET MEMORIAL HOSPITAL WERE ADOPTED BY THE AVERA QUEEN OF PEACE GOVERNING BOARD ON MAY 28, 2013. THE CHNA IMPLEMENTATION PLAN FOR AVERA QUEEN OF PEACE HOSPITAL WAS ADOPTED BY THE AVERA QUEEN OF PEACE GOVERNING BOARD ON JUNE 25, 2013. PART VI, LINE 3: ANYONE WHO IS UNINSURED RECEIVES A LETTER WITH THEIR ITEMIZED BILL WHICH DESCRIBES BOTH THE UNINSURED PROGRAM AND THE CHARITY CARE PROGRAM. ANY UNINSURED PATIENT IS CONTACTED BY PHONE OR LETTER BY OUR COLLECTIONS DEPARTMENT AT WHICH TIME OUR PROGRAMS ARE DESCRIBED. ALSO, INPATIENT AND SAME DAY SURGERY PATIENTS RECEIVE A BROCHURE IN THEIR ADMISSIONS PACKET. PRE-COLLECTION LETTERS ALSO INCLUDE INFORMATION REGARDING OUR CHARITY CARE AND UNINSURED PROGRAMS. PART VI, LINE 4: AVERA QUEEN OF PEACE'S SERVICE AREA INCLUDES DAVISON COUNTY AND SURROUNDING COUNTIES IN SOUTH DAKOTA. IN 2013, THE POPULATION FOR DAVISON COUNTY WAS ESTIMATED TO BE 19,823. APPROXIMATELY 17.2% OF THE POPULATION IS AGE 65 OR OLDER. THE AVERAGE PER CAPITA INCOME IS $24,597 AND APPROXIMATELY 12.2% OF INDIVIDUALS ARE BELOW THE FEDERAL POVERTY LEVEL. THE NEAREST LIKE HOSPITAL IN THE AREA IS APPROXIMATELY 72 MILES FROM AVERA QUEEN OF PEACE. PART VI, LINE 5: AVERA QUEEN OF PEACE IS A VERIFIED LEVEL II TRAUMA CENTER AND OPERATES AN EMERGENCY DEPARTMENT STAFFED 24 HOURS PER DAY WITH BOARD CERTIFIED PHYSICIANS. EMERGENCY CARE IS PROVIDED ON AN OPEN DOOR BASIS REGARDLESS OF ABILITY TO PAY. AVERA QUEEN OF PEACE LEASES TWO CRITICAL ACCESS HOSPITALS WHICH PROVIDE A BROAD RANGE OF INPATIENT, OUTPATIENT SERVICES AND 24 HOUR EMERGENCY ROOMS IN TWO VERY RURAL COMMUNITIES.AVERA QUEEN OF PEACE OWNS THREE RURAL HEALTH CLINICS WHICH PROVIDE PRIMARY CARE SERVICES IN THREE RURAL COMMUNITIES.SIMILAR TO THE HOSPITALS IN THE AVERA QUEEN OF PEACE REGION, THE CLINICS ARE OPERATED ON AN OPEN DOOR BASIS AND CARE IS PROVIDED REGARDLESS OF ABILITY TO PAY.MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL LICENSED AND QUALIFIED APPLICANTS. THE AVERA QUEEN OF PEACE BOARD OF DIRECTORS IS PRINCIPALLY COMPRISED OF COMMUNITY MEMBERS FROM THE PRIMARY AND SECONDARY SERVICES AREAS. MEMBERS COME FROM A VARIETY OF BACKGROUNDS INCLUDING BANKING, EDUCATION, AGRICULTURE, HEALTHCARE AND PRIVATE INDUSTRY. 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 NATION IMPORTANCE. 1 MITCHELL TECH INSTITUTE FOUNDATION 1800 E SPRUCE ST MITCHELL SD 57301 460452950 501(C)(3) 45000 DONATION DE SMET COMMUNITY FOUNDATION PO BOX 42 DE SMET SD 57231 461401425 501(C)(3) 25000 DONATION DAKOTA WESLEYAN UNIVERSITY 1200 W UNIVERSITY AVE MITCHELL SD 57301 460224589 501(C)(3) 28500 DONATION 3 0 PART I, LINE 2: THE ORGANIZATION ONLY MAKES GRANTS TO OTHER ORGANIZATIONS WHICH ARE TAX-EXEMPT UNDER SECTION 501(C)(3). 0 0 0 0 0 0 0 0 0 PATRICIA MALTERS MD BOARD MEMBER/PHYSICIAN 223752 0 16940 0 14023 0 20283 0 5954 0 280952 0 0 0 THOMAS CLARK PRESIDENT & CEO 0 315704 0 0 0 59996 0 13475 0 22845 0 412020 0 0 WILLIAM E FLETT SEC/TREAS & VP OF FINANCE 168192 0 360 0 500 0 14150 0 22535 0 205737 0 0 0 BRIAN KAMPMANN MD ORTHOPEDICS, SPORTS MEDICINE 746303 0 360 0 2290 0 20300 0 21145 0 790398 0 0 0 STEPHEN DICK MD MPH RADIATION ONCOLOGY 343702 0 72713 0 8842 0 20300 0 20418 0 465975 0 0 0 CHRIS KROUSE OD ORTHOPEDICS, SPORTS MEDICINE 895214 0 96600 0 3309 0 20300 0 21174 0 1036597 0 0 0 MICHAEL HALEY MD FACS BARIATRICS, GENERAL SURGERY 378159 0 40577 0 16705 0 20300 0 23019 0 478760 0 0 0 DENNIS LELAND MD FACS GENERAL SURGERY 478116 0 30360 0 4551 0 20300 0 23213 0 556540 0 0 0 SCHEDULE J, PART I LINE 3: THE PRESIDENT/CEO'S COMPENSATION IS PAID BY A RELATED ORGANIZATION, AVERA HEALTH. AVERA QUEEN OF PEACE RELIED ON THE RELATED ORGANIZATION FOR DETERMINING THE COMPENSATION FOR THE PRESIDENT/CEO USING THE METHODS DESCRIBED IN PART I, LINE 3. DAVID MALTERS MD FAMILY MEMBER OF BOARD MEMBER 200378 COMPENSATION 0 ANDREA MALTERS FAMILY MEMBER OF BOARD MEMBER 29987 COMPENSATION 0 FORM 990, PART III, LINE 2 AVERA QUEEN OF PEACE ADDED A MEDICAL ONCOLOGY PRACTICE IN DECEMBER 2013 AND UROLOGY PRACTICE IN JANUARY 2014. FORM 990, PART VI, SECTION A, LINE 2 SISTER KATHLEEN CROWLEY HAS A BUSINESS RELATIONSHIP WITH THOMAS CLARK. 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 A, LINE 8B AVERA QUEEN OF PEACE HOSPITAL DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED INITIALLY BY THE 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 DIRECTORS. THE INFORMATION IS MAINTAINED IN A DATABASE AND A REPORT IS PROVIDED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 15B THE CEO IS COMPENSATED BY AVERA HEALTH. ANNUALLY THE COMPENSATION COMMITTEE OF AVERA HEALTH, WHICH IS COMPRISED OF SIX (6) SYSTEM MEMBERS APPOINTED BY THE RELIGIOUS ORDERS, MEETS WITH AN INDEPENDENT CONSULTANT REGARDING FAIR MARKET VALUE OF OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE APPROVES ALL SALARIES BASED ON COMPARABLE DATA AND DOCUMENTS THE BASIS FOR THEIR DECISION IN MEETING MINUTES. THE COMPENSATION OF THE VP OF FINANCE IS DETERMINED BY HUMAN RESOURCES BASED ON A MARKET ANALYSIS OF COMPARABLE POSITIONS. THE COMPENSATION IS APPROVED BY THE CEO. 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 ARE AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G RECRUITMENT: PROGRAM SERVICE EXPENSES 93,607. MANAGEMENT AND GENERAL EXPENSES 55,644. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 149,251. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 1,296,705. MANAGEMENT AND GENERAL EXPENSES 48,806. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,345,511. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,373,097. MANAGEMENT AND GENERAL EXPENSES 5,485,151. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,858,248. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 43,413. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE OF AVERA HEALTH, PARENT ORGANIZATION, SELECTS THE AUDITOR AND REVIEWS THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF AVERA HEALTH, WHICH INCLUDES AVERA QUEEN OF PEACE. 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. FORM 990, PART X, LINE 20: THE ISSUE PRICE INCLUDES THE FILING ORGANIZATION'S SHARE OF THE ENTIRE BOND ISSUE, WHICH WAS ISSUED TO AVERA HEALTH ON BEHALF OF THE AVERA OBLIGATED GROUP. THE AVERA OBLIGATED GROUP CONSISTS OF AVERA HEALTH, AVERA MCKENNAN, AVERA ST. LUKE'S, AVERA QUEEN OF PEACE, AVERA MARSHALL, AVERA ST. MARY'S, AND AVERA SACRED HEART. IN ACCORDANCE WITH IRS INSTRUCTIONS, INFORMATION RELATED TO THE TAX EXEMPT BOND REPORTING IS BEING REPORTED ON AVERA HEALTH'S TAX RETURN (EIN 46-0422673). 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