AVERA HOLY FAMILY: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- AVERA HOLY FAMILY (EIN 42-0680370)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201401349349303195
- Schema version
- 2012v2.1
- 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 J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-14T11:22:49-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 NICOLLET MALL STE 1300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420680370 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA HOLY FAMILY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AVER | NameControl |
| Phone | 7123622631 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 NORTH 8TH STREET | AddressLine1 |
| City | ESTHERVILLE | City |
| State | IA | State |
| ZIP Code | 51334 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DALE HUSTEDT | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 7123622631 | Phone |
| Date Signed | 2014-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KIM HUNWARDSEN CPA | Name |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | Phone |
| Date Prepared | 2014-05-09 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DALE HUSTEDT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 NORTH 8TH STREET | AddressLine1 |
| City | ESTHERVILLE | City |
| State | IA | State |
| ZIP Code | 51334 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 24430903 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AVERA-HOLYFAMILY.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | PROMOTION OF HEALTH | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 255 | TotalNbrEmployees |
| Total Nbr Volunteers | 9 | TotalNbrVolunteers |
| Total Gross UBI | -2011 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -2011 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 181634 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 144441 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22733879 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23792657 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 327821 | InvestmentIncomePriorYear |
| Investment Income Current Year | 260410 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 31403 | OtherRevenuePriorYear |
| Other Revenue Current Year | 31365 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23274737 | TotalRevenuePriorYear |
| Total Revenue Current Year | 24228873 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 21067 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 30030 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10208810 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11859792 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12104891 | OtherExpensePriorYear |
| Other Expenses Current Year | 10890446 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22334768 | TotalExpensesPriorYear |
| Total Expenses Current Year | 22780268 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 939969 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1448605 | RevenuesLessExpensesCY |
| Total Assets BOY | 35576786 | TotalAssetsBOY |
| Total Assets EOY | 34058209 | TotalAssetsEOY |
| Total Liabilities BOY | 12504548 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9004331 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 23072238 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 25053878 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 19969430 | Expense |
| Grants | 30030 | Grants |
| Revenue | 23792657 | Revenue |
| Description | PROVIDE INPATIENT AND OUTPATIENT MEDICAL SERVICES THROUGHOUT THE HOSPITAL AND HOME HEALTH AGENCY. THE HOSPITAL PROVIDED 2,806 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 $384,424 FOR THE YEAR ENDED JUNE 30, 2013.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, 2013, 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. | Description |
| Total Program Service Expense | 19969430 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 45 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 255 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHANNON ADAMS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7123626519 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 N 8TH STREET | AddressLine1 |
| City | ESTHERVILLE | City |
| State | IA | State |
| ZIP Code | 51334 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| NORMA BEAVER | ||||||||
| CHAIR | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| SR KATHLEEN CROWLEY | ||||||||
| BOARD MEMBER | 1.00 | 11.50 | X | 0 | 0 | 0 | ||
| DR DOUGLAS STANGL | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DR JAMES C CREECH | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DR ANTHONY COOK | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| DELAINE HINEY | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| MARK FRIESNER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| SR MARY JAEGER | ||||||||
| BOARD MEMBER | 1.00 | 10.00 | X | 0 | 0 | 0 | ||
| PASTOR GLENN BOHMER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| KATHY PRESTON | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| ISIDRO PENA | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| SR AIDAN BOURKE | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| MICHAEL HALL | ||||||||
| PRESIDENT & CEO | 45.00 | 1.00 | X | 0 | 150614 | 25340 | ||
| SHANNON ADAMS | ||||||||
| SEC/TREAS & SRVP FINANCE | 45.00 | 1.00 | X | 0 | 76329 | 20346 | ||
| CATHI SCHARNBERG | ||||||||
| VP PATIENT CARE | 40.00 | 0.00 | X | 0 | 105138 | 18663 | ||
| KRISTI HOUGH | ||||||||
| PHARMACY MANAGER | 40.00 | 0.00 | 108357 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 108357 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 332081 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 64349 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ESTHERVILLE MEDICAL CENTER PC | |||||
| 926 N 8TH STREET | ESTHERVILLE | IA | 51334 | CLINIC COVERAGE | 565223 |
| ACUTE CARE INC | |||||
| PO BOX 4130 | DES MOINES | IA | 50333 | ER COVERAGE | 483924 |
| GRAPETREE MEDICAL STAFFING | |||||
| 703 16TH STREET | SPIRIT LAKE | IA | 51360 | STAFFING | 452586 |
| ESTHERVILLE MEDICAL CENTER ER | |||||
| 926 N 8TH STREET | ESTHERVILLE | IA | 51334 | ER COVERAGE | 406974 |
| WOODWARD ANESTHESIA SERVICES PC | |||||
| 203 N 8TH ST | ESTHERVILLE | IA | 51334 | ANESTHESIA SERVICES | 267591 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 85117 | RelatedOrganizations |
| Government Grants | 18174 | GovernmentGrants |
| All Other Contributions | 41150 | AllOtherContributions |
| Total Contributions | 144441 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 622110 | 23065014 | 23065014 | |
| OTHER REVENUE | 900099 | 474914 | 476925 | -2011 |
| CHANGE IN FOUNDATION | 900099 | 248222 | 248222 | |
| CAFETERIA | 900099 | 48090 | 48090 | |
| COLLABORATIVE AGREEMENT | 900099 | -43583 | -43583 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23792657 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 460023 | TotalRevenueColumn |
| Exclusion | $460,023 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 31365 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 31365 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31365 | TotalRevenueColumn |
| Exclusion | $31,365 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2417 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 202030 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2417 | Securities |
| Other | -202030 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -199613 | TotalRevenueColumn |
| Exclusion | -$199,613 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24228873 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23794668 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -2011 | UnrelatedBusinessRevenue |
| Exclusion | $291,775 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30030 | Total |
| Program Services | 30030 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9377225 | Total |
| Program Services | 8260448 | ProgramServices |
| Management And General | 1116777 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 401310 | Total |
| Program Services | 81157 | ProgramServices |
| Management And General | 320153 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1527531 | Total |
| Program Services | 1293120 | ProgramServices |
| Management And General | 234411 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 553726 | Total |
| Program Services | 497032 | ProgramServices |
| Management And General | 56694 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 323131 | Total |
| Program Services | 30000 | ProgramServices |
| Management And General | 293131 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1308 | Total |
| Management And General | 1308 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38425 | Total |
| Management And General | 38425 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1802664 | Total |
| Program Services | 1773601 | ProgramServices |
| Management And General | 29063 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58833 | Total |
| Program Services | 3653 | ProgramServices |
| Management And General | 55180 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 255183 | Total |
| Program Services | 114801 | ProgramServices |
| Management And General | 140382 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54966 | Total |
| Program Services | 45836 | ProgramServices |
| Management And General | 9130 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 352561 | Total |
| Program Services | 352561 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53644 | Total |
| Program Services | 46110 | ProgramServices |
| Management And General | 7534 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69123 | Total |
| Program Services | 58458 | ProgramServices |
| Management And General | 10665 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145312 | Total |
| Program Services | 145312 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1199526 | Total |
| Program Services | 1199526 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 282952 | Total |
| Program Services | 24071 | ProgramServices |
| Management And General | 258881 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 4046490 | 4046490 | |
| LOCUM FEES | 1022812 | 1022812 | |
| BAD DEBT EXPENSE | 575236 | 575236 | |
| EQUIPMENT LEASE AND REN | 165894 | 161314 | 4580 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 442386 | Total |
| Program Services | 207862 | ProgramServices |
| Management And General | 234524 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22780268 | Total |
| Program Services | 19969430 | ProgramServices |
| Management And General | 2810838 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1667804 | BOY |
| EOY | 2494876 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2870484 | BOY |
| EOY | 3022451 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 78125 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 617853 | BOY |
| EOY | 622518 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 117761 | BOY |
| EOY | 88803 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25050035 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 12062744 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13051551 | BOY |
| EOY | 12987291 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4583873 | BOY |
| EOY | 297543 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11737064 | BOY |
| EOY | 13902886 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 322371 | BOY |
| EOY | 279066 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 608025 | BOY |
| EOY | 284650 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35576786 | BOY |
| EOY | 34058209 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2064298 | BOY |
| EOY | 1957059 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8245000 | BOY |
| EOY | 3840000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2195250 | BOY |
| EOY | 3207272 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12504548 | BOY |
| EOY | 9004331 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22856952 | BOY |
| EOY | 24811970 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 215286 | BOY |
| EOY | 241908 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23072238 | BOY |
| EOY | 25053878 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35576786 | BOY |
| EOY | 34058209 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1448605 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 533153 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -118 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 325223 | OtherCostOrOtherBasis |
| Book Value | 325223 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17036536 | OtherCostOrOtherBasis |
| Depreciation | 7481335 | Depreciation |
| Book Value | 9555201 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7282132 | OtherCostOrOtherBasis |
| Depreciation | 4415713 | Depreciation |
| Book Value | 2866419 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 406144 | OtherCostOrOtherBasis |
| Depreciation | 165696 | Depreciation |
| Book Value | 240448 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 12987291 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| ASSETS LMITED AS TO USE - AVERA POOLED INVESTMENTS | 12301177 | F |
| INVESTMENT IN FOUNDATION | 1601709 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 13902886 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO RELATED PARTY | $1,250,000 |
| CLINIC COLLABORATIVE ARRANGEMENT | $635,948 |
| CAPITALIZED LEASE OBLIGATIONS | $259,485 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $1,061,839 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3207272 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 24160168 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 533153 | NetUnrealizedGainsInvestments |
| Other Revenues | -575236 | OtherRevenues |
| Revenue Not Rptd F990 | -42083 | RevenueNotRptdF990 |
| Revenue Subtotal | 24202251 | RevenueSubtotal |
| Other Revenues Not Included | 26622 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 26622 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 24228873 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 22205032 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 22205032 | ExpensesSubtotal |
| Other Expenses Not Included | 575236 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 575236 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 22780268 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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 2010. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS REPORTED IN REVENUE ON FINANCIAL STATEMENTS -575,236. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN NET ASSETS AVERA HEALTH FDTN IN FUND BALANCE FOR F/S 26,622. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS REPORTED IN REVENUE ON FINANCIAL STATEMENTS 575,236. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 231196 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 231196 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01040 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1862493 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1308203 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 554290 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02500 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2093689 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1308203 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 785486 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03540 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 12 | NumberOfActivitiesOrPrograms |
| Persons Served | 52 | PersonsServed |
| Total Community Benefit Expense | 39963 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 39963 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 66220 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 66220 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 417821 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 146052 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 271769 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01220 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 454 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 454 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 74921 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 74921 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 23 | NumberOfActivitiesOrPrograms |
| Persons Served | 52 | PersonsServed |
| Total Community Benefit Expense | 599379 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 146052 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 453327 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 23 | NumberOfActivitiesOrPrograms |
| Persons Served | 52 | PersonsServed |
| Total Community Benefit Expense | 2693068 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1454255 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1238813 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05580 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 264 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 264 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 10282 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 10282 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 340 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 340 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 46365 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 46365 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 57251 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 57251 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $575,236 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11023693 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11055715 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -32022 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA HOLY FAMILY HEALTH | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 826 N 8TH STREET | AddressLine1 |
| City | ESTHERVILLE | City |
| State | IA | State |
| ZIP Code | 51334 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | PROVIDER BASED CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA HOLY FAMILY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: TO DETERMINE ELIGIBILITY FOR CHARITY CARE, AVERA HOLY FAMILY HAS DEVELOPED A TEST WHICH UTILIZES A COMBINATION OF HOUSEHOLD INCOME, HOUSEHOLD ASSETS, AND ALSO CONSIDERS UNPAID PAST AND ONGOING MEDICAL EXPENSES. CHARITY DISCOUNT MAY RANGE FROM 10 - 100% DEPENDING ON SCORE. | ||
| 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 REQUEST 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, L7 COL(F): THE AMOUNT OF BAD DEBT REMOVED FROM THE DENOMINATOR OF THE CALCULATION WAS $575,236. | ||
| PART II: 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: BAD DEBT EXPENSE IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.THE ORGANIZATION DID NOT ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY AS THE ORGANIZATION WORKS HARD AT ENCOURAGING PEOPLE TO APPLY AND MAKES ADJUSTMENTS TO BAD DEBT EXPENSE BASED ON RECOMMENDATIONS OF THE COLLECTION AGENCY OR REVIEWS OF BAD DEBT FOR THOSE WHO QUALIFY UNDER CHARITY CARE. 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. THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 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 V, SECTION B, LINE 3: 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 5C: THE CHNA REPORT IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/. | AVERA HOLY FAMILY | |
| 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 HOLY FAMILY | |
| PART V, SECTION B, LINE 7: THE HOSPITAL DID NOT ADDRESS MENTAL HEALTH SERVICES NEEDS DUE TO THE LACK OF MENTAL HEALTH PROVIDERS IN THE AREA. | AVERA HOLY FAMILY | |
| 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 HOLY FAMILY | |
| 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 HOLY FAMILY | |
| PART VI, LINE 2: THE ORGANIZATION COLLABORATED WITH THE DEPARTMENT OF PUBLIC HEALTH ON A NEEDS ASSESSMENT. THE ASSESSMENT STARTED IN FYE 2010. | ||
| 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 2012, THE POPULATION FOR EMMET COUNTY WAS 10,120. APPROXIMATELY 19% OF THE POPULATION IS AGE 65 OR OLDER. THE AVERAGE PER CAPITA INCOME IS $26,740 AND APPROXIMATELY 10.4% 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. | ||
| IA | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA HEALTH | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3900 WEST AVERA DR STE 300 | AddressLine1 |
| City | SIOUX FALLS | City |
| State | SD | State |
| ZIP Code | 57108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 460422673 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 5041 | AmountOfCashGrant |
| Purpose Of Grant | DONATION | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE BOARD DECIDES HOW MUCH WILL BE GIVEN TO ORGANIZATIONS EACH YEAR. THE FINANCIAL STATEMENTS OF RECIPIENTS ARE GIVEN TO THE BOARD OF DIRECTORS OF AVERA HOLY FAMILY FOR REVIEW AND TO ENSURE THE FUNDS ARE USED APPROPRIATELY. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MICHAEL HALL | NamePerson |
| Title | PRESIDENT & CEO | Title |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 147392 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 3222 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 3133 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 22935 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 176682 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | FORM 990, SCHEDULE J, PART I, LINE 3: MICHAEL HALL 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. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 426004647 | IssuerEIN |
| CUSIP Number | 297542BG6 | CUSIPNumber |
| Date Issued | 2012-06-21 | DateIssued |
| Issue Price | 3840000 | IssuePrice |
| Description Of Purpose | REFUND THE SERIES 2000 BONDS ISSUED 12/14/2000 | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 3840000 | TotalProceeds |
| Issuance Costs From Proceeds | 76800 | IssuanceCostsFromProceeds |
| Other Spent Proceeds | 3708457 | OtherSpentProceeds |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 0 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DR ANTHONY COOK | NamePerson |
| Relationship With Organization | BOARD MEMBER | RelationshipWithOrganization |
| Purpose Of Loan | RECRUITMENT | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $150,000 | OriginalPrincipalAmount |
| Balance Due | 78125 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 78125 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ESTHERVILLE MEDICAL CLINIC PC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | 2 BOARD MEMBERS ARE EACH MORE THAN 5% OWNER | Relationship |
| Amount Of Transaction | 972197 | AmountOfTransaction |
| Description Of Transaction | PAYMENT FOR PHYSICIAN SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DOCTORS STANGL, CREECH, 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. | |
| 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 DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE 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 XI, LINE 9: | CAPITAL TRANSFERS -118. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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
Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 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 | |
| HEALTH MANAGEMENT SERVICES | |||||||||||
| 501 SUMMIT STREET | YANKTON | SD | 57078 | 460399291 | ADULT DAYCARE AND HOMEMAKING SERVICES | SD | 501(C)(3) | LINE 9 | 0 | SACRED HEART HEALTH SERVICES | |
| 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 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AVERA HOME MEDICAL EQUIPMENT OF ESTHERVILLE LLC | ||||||||||||||
| PO BOX 5045 | SIOUX FALLS | SD | 57117 | 201686097 | MEDICAL SERVICES - HOME MEDICAL EQUIPMENT | SD | AVERA MCKENNAN | RELATED | 119026 | 186238 | 0 | 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 | |||||||
| MRIS LLC | ||||||||||||||
| 1325 S CLIFF AVE PO BOX 5045 | SIOUX FALLS | SD | 57117 | 470874983 | HEALTH CARE SERVICES INCLUDING AIRCRAFT | 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 | |||||||
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVERA HOLY FAMILY FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 85117 | AmountInvolved |
| Method Of Amt Determination | GENERAL LEDGER | MethodOfAmtDetermination |