2015-05-14T15:10:17-05:00 2014-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-07-01 460422673 AVERA HEALTH AVER 6053227300 3900 WEST AVERA DRIVE No 300 SIOUX FALLS SD 57108 Jim Breckenridge Secretary/Treasurer 6053224700 2015-05-12 1 Kim Hunwardsen CPA P00484560 6122536500 2015-05-12 2013 2016-02-25 16:41:14Z John Porter 3900 WEST AVERA DRIVE No 300 SIOUX FALLS SD 57108 135049558 0 0928 X www.avera.org X 1998 SD Promotion of Health 15 12 837 20 1589065 104051 8049256 8015201 92494783 125942998 792695 572957 23710523 278813 125047257 134809969 2656331 3241116 0 0 54745019 74107652 0 0 0 30221636 42106832 87622986 119455600 37424271 15354369 1156273576 1372317642 944979987 1121323279 211293589 250994363 X Avera Health is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 104524341 3241116 125942998 Avera Health delivers health care to individuals and communities through a system of nearly 330 affiliated health care facilities, which are referred to collectively as "Avera." Avera, the health ministry of the Benedictine and Presentation Sisters, serves the people of eastern South Dakota and surrounding states with a wide spectrum of health services delivered through hospitals, long-term care facilities, clinics and other health programs.Avera Health VisionWorking with its partners, Avera Health shall provide a quality, cost-effective health ministry, which reflects Gospel values. We shall improve the health care of the people we serve through a regionally integrated network of persons and institutions.Avera ValuesIn caring for life, the Avera community is guided by the Gospel values of compassion, hospitality and stewardship.Avera is sponsored by the Benedictine Sisters of Yankton, S.D., and the Presentation Sisters of Aberdeen, S.D. In accordance with its Catholic mission, Avera adheres to "The Ethical and Religious Directives for Catholic Health Care Services".Avera facilities return any revenues over expenses that they receive to the people in their communities in three ways:We provide care of those who cannot afford to pay. Avera affiliates provide free or discounted health and health-related services to persons who cannot afford to pay all or part of a bill, including persons who are uninsured and low-income patients, using income-related discounts. As the number of uninsured persons grows, so does the need for charity care, or free or discounted health services provided to those who cannot afford to pay.Charity Care/Patient Assistance at cost $22,098,628Charity care/financial assistance is free or discounted health and health-related services provided to persons who cannot afford to pay all or part of a bill, including persons who are uninsured and low-income patients, using an income-related schedule. The dollar amount provided for charity care is based on the actual cost of providing that service, not the amount that would have been charged for that service. Charity care does not include bad debt.Unpaid Costs of Government and Other Programs $35,540,386 *Medicaid, State Children's Health Insurance Program (SCHIP), local and state government programs that reimburse health care providers for persons not eligible for Medicaid and other government programs provide health coverage for thousands of individuals in our region. However, they generally do not reimburse hospitals and doctors for the full costs of services. In many instances, payment is based on data from previous years that doesn't accurately reflect the rapidly changing nature of health services, such as new processes, new equipment, new technologies and rising costs for supplies.*In accordance with "A Guide for Planning and Reporting Community Benefit" (St. Louis: Catholic Health Association of the United States, 2008), unpaid costs of Medicare are not included in this amount. The amount of unpaid costs of Medicare for the fiscal year ending June 30, 2014, was $51,036,521.Additional Community Benefits $40,408,260Community benefits are programs or activities that provide treatment or promote health and healing as a response to identified community needs. These programs and services are not provided for marketing purposes. A community benefit must meet at least one of the following criteria: improve access to health care services; enhance health of the community; advance medical or health care knowledge; or relieve or reduce the burden of government or other community efforts. Included in this category are community health improvement services, health professions education, subsidized health services, research activities, financial and in-kind contributions, community-building and leadership activities and community-benefit-operations activities.Total $99,047,274Avera operates under the premise that social and institutional wellness are best promoted through joint efforts of various religious and community-sponsored institutions. Choosing collaboration and empowerment enables us to be better stewards of our human, financial, technical and environmental resources.Our caregivers are supported by the resources and expertise of the region's largest health system. Management and other support services are provided through the Avera Central Office, and Avera's six regional centers: Avera St. Luke's in Aberdeen, SD; Avera Marshall Regional Medical Center in Marshall, MN.; Avera Queen of Peace in Mitchell, SD; Avera St. Mary's in Pierre, SD; Avera McKennan in Sioux Falls, SD; and Avera Sacred Heart in Yankton, SD. As a leading health system in the region, Avera is committed to meeting the needs of communities it serves through the provision of quality health care services guided by Christian values and by making a positive impact on the community. Avera Health acts as the leader of the Avera health ministry, serving as an overall parent to support its affiliated tax-exempt health care organizations. Through Avera Health, affiliates collaborate to improve the lives and health of individuals and of the communities we serve. This collaboration allows affiliates to access leading edge strategies and expertise while keeping administrative costs as low as possible.Avera Health serves health care facilities that are owned by Avera Health as well as facilities that are owned by local communities. Through Avera Health, affiliates are able to share costs of management, legal and other support services among many facilities rather than each facility incurring those costs separately. Avera Health provides a variety of services for the benefit of affiliates including coordinating the delivery of health care service to the region, overall strategic planning, group purchasing of supplies and services at lowest possible cost and education. Avera Health also coordinates joint investments and risk-management programs for affiliates.Some of the specific ways Avera Health has improved the communities we serve include during the year ended June 30, 2014 are:* Providing support services to nearly 330 affiliated health care facilities* Providing $2,687,673 (shown on Form 990, Part IX, line 1) in financial support for various projects in local communities* Sponsoring education programs including a gerontological care conference, nursing conference, ethics conference, parish nursing conference and more. 104524341 1 1 0 1 0 0 0 0 1 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 388 0 1 837 1 1 1 1 CJ VI 0 0 0 1 1 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 0 CA X Jim Breckenridge 6053224700 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Mark Buche Chair 5.20 0.00 X X 0 0 0 Sister Mary Jaeger Vice Chair 5.00 5.00 X X 0 0 0 Cathy Clark Director 5.00 0.00 X 0 0 0 Sister Janet Horstman Director 5.00 0.00 X 0 0 0 Sister Barbara McTague Director 5.00 0.00 X 0 0 0 Sister Mary Kay Panowicz Director 5.00 3.00 X 0 0 0 Sister JoAnn Sturzl Director 5.00 2.30 X 0 0 0 Merrit Warren MD Director 5.00 6.50 X 0 0 0 Dan Eisenbraun Director 5.00 0.00 X 0 0 0 Mark Shlanta Director 5.00 0.00 X 0 0 0 Sister Debra Kolecka Director 5.00 1.00 X 0 0 0 Dr Dale Vizcarra Director 5.00 40.00 X 0 216218 33954 Dr J Michael Bacharach Director 5.00 0.00 X 0 0 0 Ken Karels Director 5.00 0.00 X 0 0 0 John Porter President & CEO 40.00 2.00 X X 1334108 0 34581 James Breckenridge Sec/Treas & SrVP Finance 40.00 0.00 X 701996 0 22231 Fredrick Slunecka Chief Operating Officer 40.00 0.00 X 1032419 0 32081 David Flicek Chief Administrative Officer 40.00 1.00 X 531634 0 35637 David Erickson Sr VP Medical Affair 40.00 0.00 X 645050 0 33137 Todd Forkel Pres/CEO-St. Lukes 1.00 40.00 X 445623 0 33137 Pamela Rezac Pres/CEO-Sacred Heart 1.00 40.00 X 471589 0 34081 David Kapaska Pres/CEO-McKennan 1.00 40.00 X 796316 0 32081 William McLean SrVP Human Resoures/McKennan 1.00 40.00 X 396265 0 25321 6355000 216218 316241 80 0 1 0 Avera McKennan 1325 S Cliff Avenue Sioux Falls SD 57117 Services 7134242 CDW Government 230 N Milwaukee Ave Vernon Hills IL 60061 Computer Hardware Consulting 5205840 Medical Information Technology 1 Meditech Circle Westwood MA 02090 Hardware/Software Consulting 3660887 The Advisory Board 2445 M Street NW Washington DC 20037 Healthcare Consulting 2141597 LSS Systems 6423 City West Park Eden Prairie MN 55344 Software Consulting 1889683 71 54200 482937 1111628 6366436 150136 8015201 Support services 561000 119899245 118259672 1639573 Income from affiliates 561000 5776003 5826511 -50508 Supporting revenue 900099 230497 230497 Education & conference 900099 37253 37253 125942998 594929 594929 166284 0 166284 166284 166284 21972 -21972 -21972 -21972 330146 482937 217617 112529 112529 134809969 124353933 1589065 851770 X 2687673 2687673 553443 553443 3723975 3723975 128898 128898 54612378 52318049 2294329 1103434 1041817 61617 10076221 9234214 842007 4462746 4010990 451756 20473 20473 653500 653500 22164338 18068429 4095909 1713486 1713486 4970732 3565900 1404832 340624 340624 1694553 917474 777079 1135221 955142 180079 1465170 1158028 307142 258946 258946 5424105 5345071 79034 227918 223679 4239 Grant Program Expenditu 1430698 1430698 Food 132781 105441 27340 License & publications 85278 85278 Project expenses 54833 54833 334176 326228 7948 119455600 104524341 14931259 0 19083600 15968518 385850 18407034 20602716 5615816 13299979 1815394 3359137 96241879 27347262 62176883 68894617 657520238 736782319 93959195 116166617 81858 72494 297613558 396785395 1156273576 1372317642 9870268 15828911 8993817 18999349 303801062 323567541 577774575 639694294 35127161 44540265 88106023 944979987 1121323279 X 209732497 249236026 1088551 1261151 472541 497186 211293589 250994363 1156273576 1372317642 X 15354369 20850064 3496341 X 0 1 X 1 0 X 5772674 13930641 8237289 8049256 8015201 44005061 40864118 56880853 75219976 92494783 125942998 391402728 46636792 70811494 83457265 100544039 133958199 435407789 0 17719931 18116948 37279233 49428377 67619274 190163763 17719931 18116948 37279233 49428377 67619274 190163763 245244026 3905961 1831569 1214380 980380 761213 8693503 3905961 1831569 1214380 980380 761213 8693503 537241 435237 550548 328468 105051 1956545 51079994 73078300 85222193 101852887 134824463 446057837 0.54980 0.56080 0.01950 0.03120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 685 0 1 33200 1 15564 0 0 49449 0 Part II-B, Line 1: Grants to other organizations: The Lehman Group $12,000 Dougherty & Dougherty, LLP $21,200 Other Activities: Avera Day at the SD Legislature = $15,563 0 1 X 3302432 477896 155637 370880 22314 3542771 6046321 328355 656901 3729145 3302432 10228130 328691 -4335972 174528 6046321 8535863 2080865 388598 10228130 0.59930 0.25940 0.14130 0 0 13544035 948600 14492635 29744865 4226851 25518014 2628793 1035647 1593146 39112592 22084764 17027828 10262994 10262994 68894617 Non-publicly traded hedge funds 95555214 F Non-publicly traded real estate 16810265 F NPPC, LLC 100000 C Premier Purchasing Partners, L.P. 1372082 C Premier Stock 2329056 F 116166617 Cash surrender value of life insurance 1536675 Related party receivables 337981861 Deferred financing costs 2053683 Bond project fund 55213176 396785395 Estimated insurance claims payable 35088625 Due to affiliates 51366553 Bond interest payable 1650845 88106023 X 154339416 20850064 10295237 31145301 123194115 11615854 11615854 134809969 112714228 217617 217617 112496611 6958989 6958989 119455600 Part IV, Line 2b: Avera Health administers the Avera Health Pooled Investment Fund, a fund that is maintained for the benefit of facilities that are sponsored, operated, or managed by Avera Health. Investments are made in conformity with the objectives and guidelines of the Avera Health Pooled Investment Committee. Within the fund, participating facilities share in a pool of investments that are managed by various fund managers. Investments that are held for participating facilities are recorded as Avera Health Pooled Investments with a corresponding liability account of Custodial Funds - Avera Health Pooled Investments on the balance sheet. Avera Health also holds its own investments within the pooled fund and records their allocated share of income and losses from these investments as investment income in the financial statements. Part V, Line 4: The Organization's endowment consists of approximately 65 individual funds established for a variety of purposes related to health and wellness programs in Avera affiliated organizations. 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. Part XI, Line 2d - Other Adjustments: Insurance program admin income not recognized for tax reporting 11,281,120. Foundation expenses reported in revenue on financial statements -75,347. Non-operating depreciation reported in revenue for financial statements -910,536. Part XI, Line 4b - Other Adjustments: Contributions reported in fund balance on financial statements 210,000. Fundraising events expenses reported in revenue on Form 990 -217,617. Investment income reported in fund balance on financial statement 166,499. Premier Program revenue included in expenses for financial statements 5,776,003. Transfer to affiliate included in Other Income for financial statements 17,849. Contributions received by Foundation - not reflected in financial statements 5,663,120. Part XII, Line 2d - Other Adjustments: Fundraising event expenses reported in revenue on Form 990 217,617. Part XII, Line 4b - Other Adjustments: Foundation expenses reported in revenue on financial statements 75,347. Premier Program revenue included in expenses for Form 990 5,776,003. Non-operating depreciation reported in expenses for Form 990 910,536. Project and operating expenses included in expense for Form 990 197,103. Central America and the Caribbean - Investments 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 Race Against Breast Cancer 495109 293172 201937 96055 14842 4818 5008 13667 The Big Grape Reserve 174691 130041 44650 914 21837 31258 1300 1692 4 143283 59724 83559 1387 1170 1772 21897 813083 482937 330146 98356 37849 36076 8080 37256 217617 112529 1 South Dakota State University Foundation 815 Medary Street Brookings SD 57007 460273801 501(c)(3) 1532600 Charitable Assistance Catholic Foundation of Eastern SD 523 N Duluth Ave Sioux Falls SD 57104 466000424 501(c)(3) 130000 Charitable Assistance Mounty Marty College 1105 W 8th Street Yankton SD 57078 460283336 501(c)(3) 52000 Charitable Assistance University of South Dakota Foundation 111 N Dakota Vermillion SD 57069 466018891 501(c)(3) 30000 Charitable Assistance Sisters of the Presentation of the Blessed Virgin Mary 1500 N Second St Aberdeen SD 57401 460253283 501(c)(3) 7500 Charitable Assistance Coalition to Protect America's Healthcare PO Box 30211 Bethesda MD 20824 522253225 501(c)(4) 30000 Charitable Assistance Sioux Empire United Way 1000 N West Ave Ste 120 Sioux Falls SD 57104 460233701 501(c)(3) 11000 Charitable Assistance South Dakota Humanities Council 1215 Trail Ridge Rd Ste A Brookings SD 57006 460316222 501(c)(3) 10000 Charitable Assistance Sacred Heart Monastery 1005 W 8th Street Yankton SD 57078 460224541 501(c)(3) 7500 Charitable Assistance Charitable Assistance South Dakota Golf Association Junior Golf Foundation 4809 W 41st Street Ste 201 Sioux Falls SD 57106 460449824 501(c)(3) 30500 Charitable Assistance Habitat for Humanity South Dakota PO Box 8116 Brookings SD 57006 460454907 501(c)(3) 6500 Charitable Assistance Hill City Area Chamber of Commerce PO Box 253 Hill City SD 57745 460386435 501(c)(6) 7500 Charitable Assistance Philanthropy Promotions Inc 2601 W 60th St N Sioux Falls SD 57107 870695596 501(c)(3) 7500 Charitable Assistance South Dakota Agricultural & Rural Leadership Foundation 1905 N Plaza Blvd Rapid City SD 57702 364293293 501(c)(3) 10000 Charitable Assistance Sioux Falls Jazz & Blues Society PO Box 1285 Sioux Falls SD 57101 460418356 501(c)(3) 20000 Charitable Assistance South Dakota High School Coaches Association 801 W Eagle Ridge Street Sioux Falls SD 57108 237297479 501(c)(3) 6500 Charitable Assistance Special Olympics of South Dakota 800 East I-90 Lane Sioux Falls SD 57104 460359776 501(c)(3) 53000 Charitable Assistance McCrossan Boys Ranch 47135 260th Street Sioux Falls SD 57107 460311913 501(c)(3) 8000 Charitable Assistance American Heart Association PO Box 4002902 Des Moines IA 50340 135613797 501(c)(3) 25000 Charitable Assistance Boys & Girls Club of the Sioux Empire 824 E 14th Street Sioux Falls SD 57104 460399482 501(c)(3) 6300 Charitable Assistance Catholic Relief Services 228 W Lexington Street Baltimore MD 21201 135563422 501(c)(3) 16667 Charitable Assistance Downtown Sioux Falls 230 S Phillips Ave Sioux Falls SD 57104 363627217 501(c)(3) 13000 Charitable Assistance Forward Sioux Falls PO Box 907 Sioux Falls SD 57101 460396647 501(c)(3) 15000 Charitable Assistance Governor's Office of Economic Development 711 E Wells Ave Pierre SD 57501 466000364 State of SD 15000 Charitable Assistance Healing Words Foundation PO Box 752 Brookings SD 57006 452513019 501(c)(3) 68750 Charitable Assistance Presentation College 1500 North Main Aberdeen SD 57401 460280847 501(c)(3) 200000 Charitable Assistance 24 2 Haiti scholarships 16 17700 Premium assistance to employees 629 456631 Out of pocket medical assistance 168 79112 Part I, Line 2: The Organization makes grants to other organizations exempt under 501(c)(3) to ensure the funds will be used for charitable purposes. During the year ending June 30, 2014, the Organization made contributions to other non-public charities in furtherance of community development. The contributions are approved by the Board for this purpose. Scholarship funds have different sets of criteria for determining eligibility and winners. Assistance to individuals is determined with assistance from each hospital's social services department or within a committee at the hospital. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Dr Dale Vizcarra Director 0 214565 0 0 0 1653 0 11152 0 23201 0 250571 0 0 John Porter President & CEO 1038280 0 0 0 295828 0 13475 0 23654 0 1371237 0 0 0 James Breckenridge Sec/Treas & SrVP Finance 549530 0 0 0 152466 0 13475 0 9939 0 725410 0 0 0 Fredrick Slunecka Chief Operating Officer 804860 0 0 0 227559 0 13475 0 20118 0 1066012 0 0 0 David Flicek Chief Administrative Officer 385091 0 0 0 146543 0 13475 0 23011 0 568120 0 0 0 David Erickson Sr VP Medical Affair 510134 0 0 0 134916 0 13475 0 20745 0 679270 0 0 0 Todd Forkel Pres/CEO-St. Lukes 363587 0 0 0 82036 0 13475 0 20483 0 479581 0 0 0 Pamela Rezac Pres/CEO-Sacred Heart 378174 0 0 0 93415 0 13475 0 21434 0 506498 0 0 0 David Kapaska Pres/CEO-McKennan 618552 0 0 0 177764 0 13475 0 19960 0 829751 0 0 0 William McLean SrVP Human Resoures/McKennan 311535 0 0 0 84730 0 13475 0 12508 0 422248 0 0 0 Part I, Line 1a All Senior Executives are eligible for $2,500 per year to pay for social club dues. If an employee chooses to take advantage of this benefit, the amount is included in their taxable income. Those paid: John Porter. A South Dakota Health and Educational Facilities Authority 460315509 83755VUS1 2012-05-01 206383927 2012A funded a project and refunded Series 2008A and Series 2002 0 0 0 B South Dakota Health and Educational Facilities Authority 460315509 83755VNH3 2008-07-01 61495000 2008C refunded 2006 Series 0 0 0 C South Dakota Health and Educational Facilities Authority 460315509 83755VNB6 2008-06-18 189222932 2012B refunded Series 1994, 2000, and bridge loan 0 0 0 D South Dakota Health and Educational Facilities Authority 460315509 83755VVY7 2014-06-26 61821688 Various capital projects 0 0 0 A 138152545 206387545 47759316 1032422 6011168 134111382 17326942 1 1 0 1 B 61495000 388831 31169 61075000 2008 1 0 1 1 C 62192932 131265000 189222932 1272562 282213 91009361 96658796 2010 1 0 1 1 D 61821688 821688 61000000 0 0 0 1 A 0 1 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 B 0 0 0 1 1 1 Bank of America/Merrill 25.000000000000 0 1 0 0 1 C 0 0 0 1 1 1 Bank of America/Merrill 24.100000000000 0 0 0 0 1 D 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K, Part IV, Line 2C: The arbitrage analysis is performed annually, therefore the analysis was completed as of June 30, 2014 for Bonds B and C. Linda Breckenridge Spouse of Sec/Treas & SrVP Finance 128898 Employee compensation and benefits 0 SDN Communications Director of the board is CEO of SDN Communications 820932 Voice data and video services 0 X 5 150136 Avg of high/low 0 0 1 0 Part I, Line 33: The only amounts included in revenue for the financial statement reporting are non-cash contributions of stock securities. Non-cash contributions not included for financial statements include items for the benefit of the Avera facilities which include such things as drugs, medical supplies, and special event donations. Form 990, Part VI, Section A, line 6 The organization has two classes of members: Sponsorship Members and System Members. Sponsorship Members shall consist collectively of (i) those persons serving from time to time as the President and Council of the Presentation Sisters of the Blessed Virgin Mary of Aberdeen, South Dakota and (ii) those persons serving from time to time as the Prioress and Council of the Benedictine Convent of the Sacred Heart (Yankton, S.D.). System Members shall consist of six Sisters- three Presentation Sisters appointed by the Presentation Sponsorship Members and three Benedictine Sisters appointed by the Benedictine Sponsorship Members. Form 990, Part VI, Section A, line 7a The System Members have the power to appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause. They also have the power to appoint Benedictine or Presentation Sisters to the Boards of Directors of any sponsored work or ministry of Avera Health. Form 990, Part VI, Section A, line 7b The following powers shall be reserved to and exercised exclusively by the Sponsorship Members and none of the following actions shall be taken by Avera Health without action of the Sponsorship Members: (a) To approve the adoption, amendment or repeal of the statements of philosophy, mission, Guiding Principles and values of Avera Health; (b) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Avera Health, and to give final approval of any such action with respect thereto; (c) To establish policies regarding the alienation of real property and precious artifacts associated with the healthcare ministry which are under the canonical stewardship of the Presentation Sisters or the Benedictine Sisters; (d) To approve any plan of merger, consolidation or dissolution of Avera Health, or the divestiture of any sponsored work or ministry associated with Avera Health; (e) To change the composition of the Sponsorship Members, including the addition of other individuals, parties or entities to be Sponsorship Members; and (f) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of Avera Health. The following powers shall be reserved to and exercised exclusively by the System Members and none of the following actions shall be taken by Avera Health without action of the System Members: (a) To appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause; (b) To appoint Benedictine or Presentation Sisters to the Boards of Directors of any sponsored work or ministry of Avera Health; (c) To appoint the Chair and Vice Chair of the Board of Directors; (d) To appoint, evaluate, suspend or remove the President and Chief Executive Officer; (e) To review and approve the operating and capital budgets, including expenditures outside of budget, and the strategic plan, of Avera Health; (f) To adopt procedures for assuring that corporate actions are consistent with the philosophy, mission, Guiding Principles and values of Avera Health; (g) To provide recommendations to the Sponsorship Members on matters requiring Sponsorship Members' approval or action; (h) To adopt policies designed to effectuate the powers reserved to the System Members; and (i) To exercise oversight of the Guiding Principles and such authorities which may be assigned or delegated by the Sponsorship Members. Form 990, Part VI, Section A, line 8b Avera Health does not have any committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the CEO and CFO. After initial reviews, the return is provided to the board 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 15 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 for compensation 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. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are not made available to the general public. Form 990, Part IX, line 11g Purchased & contracted services: Program service expenses 17,038,476. Management and general expenses 4,078,019. Fundraising expenses 0. Total expenses 21,116,495. Repairs and maintenance: Program service expenses 891,089. Management and general expenses 0. Fundraising expenses 0. Total expenses 891,089. Professional fees: Program service expenses 138,864. Management and general expenses 17,890. Fundraising expenses 0. Total expenses 156,754. Form 990, Part XI, line 9: Net equity transfers -2,250,000. Insurance program admin income not recognized for tax reporting 11,281,120. Other changes in unrestricted net assets 128,341. Contributions received by Foundation-not reflected in financial statements -5,663,120. Form 990, Part VI Question 16b: There is no written policy or procedure. In the event of any such proposed transaction, the board or a committee with delegated authority reviews all materials, valuations and operational aspects for any proposed transaction. Such transaction would be evaluated in accordance with the exempt status of the organization and its applicable purposes. Any transaction also would be approved by the board and the member. Form 990, Part X, Line 20: Avera Health is only disclosing a portion of the tax exempt bonds on Part X, Line 20. The bonds were issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of 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 entire tax exempt bond reporting is being reported on Avera Health's tax return on Schedule K. Avera Communication LLC 3900 West Avera Drive Suite 300 Sioux Falls SD 571085434 460453770 Telecommunications SD 630870 472098 Avera Health Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 1 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 1 Avera Holy Family Foundation 826 North 8th Street Estherville IA 51334 421317452 Support of Holy Family Hospital and Home Health Agency IA 501(c)(3) Line 9 Avera Holy Family 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 1 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 11a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 1 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 1 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 1 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 9 Avera Health 1 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare education SD 501(c)(3) Line 9 Sacred Heart Health Services 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare services SD 501(c)(3) Line 3 Avera Health 1 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 1 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 Avera Health 1 Avera Marshall Foundation 300 S Bruce Street Marshall MN 56258 411784801 Fundraising MN 501(c)(3) Line 7 Avera Marshall 0 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 of Pierre LLC 329 E Dakota Pierre SD 57501 460444002 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Estherville LLC PO Box 5045 Sioux Falls SD 57117 201686097 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Sioux Center LLC 38 19th St SW Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A Avera Home Medical Equipment of Marshall LLC 1104 East College Drive Marshall MN 56258 205271924 Medical services - home medical equipment SD N/A 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 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical Services - home medical equipment SD N/A Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare Services SD N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Healthcare Services SD N/A Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency SD Avera Health C 1815954 978752 0.75000 1 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plan admin SD Avera Health C 84345243 24159315 1.00000 1 Avera Property Insurance Inc 610 W 23rd St PO Box 38 Yankton SD 57078 460463155 Insurance SD Avera Health C 332617 1176197 1.00000 1 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Medical equipment SD N/A C 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 Avera Marshall D 208074 Change in note receivable Avera McKennan D 333298 Change in note receivable Avera McKennan L 43732188 General ledger Avera Queen of Peace Hospital L 6723420 General ledger Avera St Luke's L 94080876 General ledger Avera Sacred Heart Health Services L 8641524 General ledger Avera Marshall L 3440820 General ledger Avera Marshall Q 1905938 Customer invoice listing Avera McKennan Q 32942140 Customer invoice listing Avera Queen of Peace Hospital Q 5249982 Customer invoice listing Avera Sacred Heart Health Services Q 5485032 Customer invoice listing Avera St Luke's Q 7870967 Customer invoice listing Avera St Benedict Health Center Q 195532 Customer invoice listing Avera McKennan P 8502261 Vendor listing of payments Avera Queen of Peace Hospital P 193354 Vendor listing of payments Avera Sacred Heart Health Services P 935139 Vendor listing of payments Avera St Luke's P 221507 Vendor listing of payments Avera Holy Family Q 187189 Customer invoice listing Avera St Anthony's Q 296907 Customer invoice listing Avera Marshall P 377146 Vendor listing of payments Avera Property Insurance L 1611996 General ledger Avera Health Plans Inc L 149076 General ledger Accounts Management L 266244 General ledger Avera at Home L 591696 General ledger Avera St Mary's L 3689916 General ledger Avera at Home Q 99578 Customer invoice listing Avera St Mary's Q 2799277 Customer invoice listing