2013-05-15T14:46:26-05:00 2012-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2011-07-01 460422673 AVERA HEALTH AVER 6053224700 3900 WEST AVERA DRIVE NO 300 SIOUX FALLS SD 57108 JIM BRECKENRIDGE 6053224700 2013-05-13 1 KIM HUNWARDSEN CPA P00484560 6122536500 2013-05-13 2011 2016-02-24 21:20:13Z JOHN PORTER 3900 WEST AVERA DRIVE NO 300 SIOUX FALLS SD 57108 84730102 0 X WWW.AVERA.ORG X 1998 SD PROMOTION OF HEALTH 16 14 460 20 1860852 550548 13930641 8237289 56880853 75219976 3097724 315722 384343 607295 74293561 84380282 5903271 2459808 0 0 37127214 50029701 0 0 0 20261316 21641856 63291801 74131365 11001760 10248917 700195823 1060451267 523220103 894626647 176975720 165824620 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 64895143 2367946 75219976 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, SERVED 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 ACCORD 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 $16,592,276 CHARITY CARE/PATIENT 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 $ 33,585,417 *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 ACCORD 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, 2012, WAS $35,978,177.ADDITIONAL COMMUNITY BENEFITS $34,300,416COMMUNITY 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 $84,478,109AVERA 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 FIVE REGIONAL CENTERS: AVERA ST. LUKE'S IN ABERDEEN, S.D.; AVERA MARSHALL REGIONAL MEDICAL CENTER IN MARSHALL, MINN.; AVERA QUEEN OF PEACE IN MITCHELL, S.D.; AVERA MCKENNAN IN SIOUX FALLS, S.D.; AND AVERA SACRED HEART IN YANKTON, S.D. 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, 2012 ARE:* PROVIDING SUPPORT SERVICES TO NEARLY 330 AFFILIATED HEALTH CARE FACILITIES* PROVIDING MORE THAN $1,935,394 (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. 64895143 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 1 188 0 1 460 1 1 1 1 CJ VI 0 0 0 1 1 0 0 0 0 X 16 14 0 0 0 0 1 1 1 1 1 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 X DR HERBERT A SALOUM 5.20 X X 0 0 0 SISTER KATHLEEN CROWLEY 5.00 X X 0 0 0 SISTER LUCILLE WELBIG 5.00 X 0 0 0 DANIEL P MURPHY 5.00 X 0 0 0 BOB SUTTON 5.00 X 0 0 0 SISTER BARBARA MCTAGUE 5.00 X 0 0 0 SISTER MARY M THOMAS 5.00 X 0 0 0 SISTER MARY JAEGER 5.00 X 0 0 0 DAN EISENBRAUN 5.00 X 0 0 0 MARK SHLANTA 5.00 X 0 0 0 SISTER DEBRA KOLECKA 5.00 X 0 0 0 DR KIM W JUNDT 5.00 X 0 447476 30292 MARK BUCHE 5.00 X 0 0 0 DR J MICHAEL BACHARACH 5.00 X 0 0 0 KEN KARELS 5.00 X 0 0 0 JOHN PORTER 40.00 X X 1149458 0 49310 JAMES BRECKENRIDGE 40.00 X 593176 0 37767 FREDRICK SLUNECKA 40.00 X 999474 0 47257 DAVID ERICKSON 40.00 X 522857 0 31447 RON JACOBSON 1.00 X 717478 0 46986 PAM REZAC 1.00 X 442362 0 51187 DAVID KAPASKA 1.00 X 656504 0 42862 MARY MAERTENS 1.00 X 283750 0 48882 JEAN REED 40.00 X 438392 0 24738 5803451 447476 410728 61 1 1 0 MEDICAL INFORMATION TECHNOLOGY 1 MEDITECH CIRCLE WESTWOOD MA 02090 HARDWARE/SOFTWARE CONSULTING 4690534 CDW GOVERNMENT 230 N MILWAUKEE AVE VERNON HILLS IL 60061 COMPUTER HARDWARE 3774427 FIRST NATIONAL BANK 100 S PHILLIPS AVE SIOUX FALLS SD 57117 FINANCIAL MANAGEMENT 2237833 SDN COMMUNICATION 2900 WEST 10TH SIOUX FALLS SD 57104 COMMUNICATIONS 2088959 LSS DATA 6423 CITY WEST PARK EDEN PRAIRIE MN 55344 SOFTWARE CONSULTING 2024616 96 759671 959742 6517876 411143 8237289 SUPPORT SERVICES 561000 71414472 69577135 1837337 INCOME FROM AFFILIATES 561000 2832672 2809157 23515 MISCELLANEOUS REVENUE 900099 932845 932845 EDUCATION & CONFERENCE 900099 39987 39987 75219976 362221 362221 46499 -46499 -46499 -46499 892719 759671 303321 589398 589398 GAIN ON 2012 BOND 900099 17897 17897 17897 84380282 73359124 1860852 923017 2027256 2027256 432552 432552 2916716 2916716 36136888 36136888 10976097 10976097 22171 22171 732692 732692 5100350 4258401 841949 616119 616119 3609943 3212603 397340 1000017 813284 186733 1314738 1109233 205505 947979 696747 251232 468594 468594 3669827 443016 3226811 181137 68731 112406 MARKETING 2307907 2307907 GRANT PROGRAM EXPENDITU 1166448 1166448 UBI TAX 227494 227494 FOOD 58227 41658 16569 218213 119609 98604 74131365 64895143 9236222 0 15343895 12500896 648629 11000954 10726494 10765618 5820292 762874 930863 39577462 17424147 23559100 22153315 534791104 605891309 100442658 84606057 2880991 317822041 700195823 1060451267 6703263 7198014 3125829 5688709 285614307 488139251 529354739 25251760 66770878 523220103 894626647 X 154394102 164409064 16685296 949113 5896322 466443 176975720 165824620 700195823 1060451267 X 10248917 -21400017 X 0 1 1 X 1 1 X 895894 1400471 5772674 13930641 8237289 30236969 26077880 34777947 40864118 56880853 75219976 233820774 26973774 36178418 46636792 70811494 83457265 264057743 0 17820549 18814556 17719931 18116948 37279233 109751217 17820549 18814556 17719931 18116948 37279233 109751217 154306526 2357097 2775837 3905961 1831569 1214380 12084844 2357097 2775837 3905961 1831569 1214380 12084844 448152 392132 537241 435237 550548 2363310 29779023 39346387 51079994 73078300 85222193 278505897 0.55410 0.52040 0.04340 0.05790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 75000 1 33240 0 1 13442 121682 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: AVERA DAY AT THE SD LEGISLATURE 0 1 10228130 328691 -4335972 174528 6046321 8535863 2080865 388598 10228130 0.28890 0.57390 0.13720 0 0 100000 948600 1048600 7908376 3039634 4868742 29636087 14071682 15564405 984399 312831 671568 22153315 NON-PUBLICLY TRADED HEDGE FUNDS 71784753 F NON-PUBLICLY TRADED REAL ESTATE 11349222 F NPPC, LLC 100000 C PREMIER PURCHASING PARTNERS, L.P. 1372082 C 84606057 CASH SURRENDER VALUE OF LIFE INSURANCE 1965140 RELATED PARTY RECEIVABLES 281732351 DEFERRED FINANCING COSTS 1515020 BOND PROJECT FUND 32609530 317822041 ESTIMATED INSURANCE CLAIMS PAYABLE 34709999 DUE TO AFFILIATES 32060879 66770878 84380282 74131365 10248917 -217576 -21182441 -21400017 -11151100 94171987 -217576 15591586 15374010 78797977 5582305 5582305 84380282 74093842 303321 303321 73790521 340844 340844 74131365 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. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION 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 FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: BOOK/TAX DIFFERENCE ON PARTNERSHIPS -458,656. TRANSFERS FROM AFFILIATES, NET 8,186,918. INSURANCE PROGRAM ADMIN INCOME NOT RECOGNIZED FOR TAX REPORTING 16,391,086. ELIMINATION OF INVESTMENT IN SUBSIDIARIES -9,819,071. FOUNDATION CHANGES IN FUND BALANCE -5,415,421. ELIMINATION OF EXPENSES PAID TO AVERA HEALTH BY AVERA HEALTH FOUNDATION -208,187. OTHER CHANGES IN UNRESTRICTED NET ASSETS 242,415. PRIOR PERIOD ADJUSTMENT ON AVERA HEALTH FOUNDATION MERGER -30,101,525. TOTAL TO SCHEDULE D, PART XI, LINE 8: -21,182,441. PART XII, LINE 2D - OTHER ADJUSTMENTS: INSURANCE PROGRAM ADMIN INCOME NOT RECOGNIZED FOR TAX REPORTING 16,391,086. FOUNDATION EXPENSES REPORTED IN REVENUE ON FINANCIAL STATEMENTS -340,820. BOOK/TAX DIFFERENCE IN PARTNERSHIPS -458,680. PART XII, LINE 4B - OTHER ADJUSTMENTS: FOUNDATION NET ASSETS RELEASED FROM RESTRICTION 1,019,257. CONTRIBUTIONS REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS 4,470,616. SPECIAL EVENTS EXPENSES REPORTED IN REVENUE ON FORM 990 -303,321. FOUNDATION EXPENSES REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS -244,737. FOUNDATION NET TRANSFERS FROM AFFILIATES 599,930. FOUNDATION INVESTMENT INCOME REPORTED IN FUND BALANCE ON FINANCIAL STATEMENT 40,560. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES REPORTED IN REVENUE ON FORM 990 303,321. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BOOK/TAX DIFFERENCE ON PARTNERSHIP EXPENSES 24. FOUNDATION EXPENSES REPORTED IN REVENUE ON FINANCIAL STATEMENTS 340,820. CENTRAL AMERICA AND THE CARIBBEAN - INVESTMENTS 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 RACE AGAINST BREAST CANCER 473710 265733 207977 10207 11957 250 81691 THE BIG GRAPE RESERVE 197194 157403 39791 3267 5598 3226 887 52 981486 336535 644951 175 2833 22906 117527 3395 39402 1652390 759671 892719 175 2833 36380 135082 6871 121980 303321 589398 1 SOUTH DAKOTA STATE UNIVERSITY 815 MEDARY AVE BROOKINGS SD 57007 460273801 STATE OF SD 1521000 CHARITABLE ASSISTANCE SDREI PO BOX 2282 SIOUX FALLS SD 571051505 460442430 501(C)(3) 25000 BOOK NOTE FORGIVENESS NOTE FORGIVENESS CATHOLIC FOUNDATION OF EASTERN SD 523 NORTH DULUTH SIOUX FALLS SD 57104 466068924 501(C)(3) 216477 CHARITABLE ASSISTANCE SD COMMUNITY FOUNDATION PO BOX 296 PIERRE SD 57501 460398115 501(C)(3) 10000 CHARITABLE ASSISTANCE MOUNTY MARTY COLLEGE 1105 W 8TH STREET YANKTON SD 57078 460283336 501(C)(3) 51000 CHARITABLE ASSISTANCE LOS CABOS CHILDRENS FOUNDATION 3800 W 53RD ST SIOUX FALS SD 57106 202882711 501(C)(3) 14000 CHARITABLE ASSISTANCE CATHOLIC HEALTH ASSOCIATION 4455 WOODSON RD ST LOUIS MO 63134 430653271 501(C)(3) 16667 CHARITABLE ASSISTANCE AVERA ST LUKE'S 305 S STATE ST ABERDEEN SD 57401 460224598 501(C)(3) 91862 EQUIPMENT AND PROGRAMS 8 0 HAITI SCHOLARSHIPS 24 26700 OUT OF POCKET MEDICAL ASSISTANCE 60 122247 HEALTH INSURANCE PREMIUM ASSISTANCE 453 283605 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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, 2012, THE ORGANIZATION MADE CONTRIBUTIONS TO OTHER NON-PUBLIC CHARITIES AND GOVERNMENTAL TYPE ENTITIES 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 1 0 0 0 0 0 0 0 0 DR KIM W JUNDT 0 316770 0 73176 0 57530 0 12250 0 18042 0 477768 0 0 JOHN PORTER 901311 0 500 0 247647 0 31098 0 19361 0 1199917 0 0 0 JAMES BRECKENRIDGE 469467 0 500 0 123209 0 29975 0 8428 0 631579 0 0 0 FREDRICK SLUNECKA 768660 0 500 0 230314 0 30245 0 17972 0 1047691 0 0 0 DAVID ERICKSON 420686 0 500 0 101671 0 13475 0 18559 0 554891 0 0 0 RON JACOBSON 631189 0 500 0 85789 0 29975 0 17538 0 764991 0 0 0 PAM REZAC 356092 0 500 0 85770 0 29975 0 21212 0 493549 0 0 0 DAVID KAPASKA 504214 0 500 0 151790 0 25849 0 17709 0 700062 0 0 0 MARY MAERTENS 250872 0 500 0 32378 0 29975 0 19304 0 333029 0 0 0 JEAN REED 385170 0 500 0 52722 0 4226 0 20807 0 463425 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. PART I, LINE 4A JEAN REED CEASED EMPLOYMENT PRIOR TO FY2012. AS A RESULT, SEVERANCE PAYMENTS EQUAL TO $463,425 WERE PAID. SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VUS6 2012-05-01 206383927 2012 FUNDED A PROJECT AND REFUNDED SERIES 2008A AND SERIES 2002 0 0 0 SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VNH3 2008-07-01 61495000 2008C REFUNDED 2006 SERIES 0 0 0 SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VNB6 2008-06-18 189222932 2008A REFUNDED SERIES 1994, 2000, AND BRIDGE LOAN 1 0 0 206387545 47759316 1032422 6011168 134111382 17469639 1 0 0 1 61495000 388831 31169 61075000 2008 1 0 1 1 131265000 189222932 1272562 282213 91009361 96658796 2010 1 0 0 1 0 1 1 0 0 0.00000 0.00000 0.00000 1 0 0 1 0 0 0.00000 0.00000 0.00000 1 0 1 1 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 0 1 1 BANK OF AMERICA/MERRILL 25.000000000000 0 1 0 0 0 0 1 1 BANK OF AMERICA/MERRILL 24.100000000000 0 0 0 0 0 LINDA BRECKENRIDGE SPOUSE OF OFFICER 122359 EMPLOYEE COMPENSATION 0 SDN COMMUNICATIONS DIRECTOR OF THE BOARD IS CEO OF SDN COMMUNICATIONS 2088959 VOICE DATA AND VIDEO SERVICES 0 X 14 221640 AVG OF HIGH/LOW X 1 114892 FMV X LAWN TRACTOR 1 1700 FMV X GRAIN 6 72911 SELLING PRICE 0 0 0 0 NON REPORTING OF REVENUE: PART I, LINE 33: THE ONLY AMOUNTS INCLUDED IN REVENUE FOR THE FINANCIAL STATEMENT REPORTING ARE NON-CASH CONTRIBUTIONS OF STOCK SECURITIES, DONATED LAND, AND GRAIN. 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 BENEDCITINE 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 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 VII, SECTION A: THE FOLLOWING INDIVIDUALS DEDICATED A MINIMUM OF 40 HOURS PER WEEK TO RELATED ORGANIZATIONS. DR. KIM JUNDT - AVERA ST. LUKE'S RON JACOBSON - AVERA ST. LUKE'S PAM REZAC - SACRED HEART HEALTH SERVICES MARY MAERTENS - AVERA MARSHALL THE FOLLOWING INDIVIDUALS PROVIDE THE INDICATED HOURS PER WEEK TO VARIOUS RELATED ORGANIZATIONS: SISTER BARBARA MCTAGUE - AVERA WORKERS' COMPENSATION TRUST (1) SISTER KATHLEEN CROWLEY - AVERA HOLY FAMILY (1), AVERA QUEEN OF PEACE HOSPITAL (2.5), AVERA WORKERS' COMPENSATION TRUST (1) SISTER LUCILLE WELBIG - AVERA WORKERS' COMPENSATION TRUST (1), SACRED HEART HEALTH SERVICES (2) SISTER MARY JAEGER - AVERA ST. ANTHONY'S HOSPITAL (1), ST. BENEDICT HEALTH CENTER (2), AVERA WORKERS' COMPENSATION TRUST (1) SISTER DEBRA KOLECKA - AVERA WORKERS' COMPENSATION TRUST (1) SISTER MARY THOMAS - AVERA WORKERS' COMPENSATION TRUST (1) CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -217,576. BOOK/TAX DIFFERENCE ON PARTNERSHIPS -458,656. TRANSFERS FROM AFFILIATES, NET 8,186,918. INSURANCE PROGRAM ADMIN INCOME NOT RECOGNIZED FOR TAX REPORTING 16,391,086. ELIMINATION OF INVESTMENT IN SUBSIDIARIES -9,819,071. FOUNDATION CHANGES IN FUND BALANCE -5,415,421. ELIMINATION OF EXPENSES PAID TO AVERA HEALTH BY AVERA HEALTH FOUNDATION -208,187. OTHER CHANGES IN UNRESTRICTED NET ASSETS 242,415. PRIOR PERIOD ADJUSTMENT ON AVERA HEALTH FOUNDATION MERGER -30,101,525. TOTAL TO FORM 990, PART XI, LINE 5: -21,400,017. 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 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. FORM 990, PART X, LINES 28 AND 29 AS OF JUNE 30, 2011, AVERA HEALTH FOUNDATION MERGED WITH AVERA HEALTH. A PRIOR PERIOD ADJUSTMENT WAS POSTED IN THE CURRENT YEAR TO ELIMINATE FUNDS HELD FOR RELATED ENTITIES. FORM 8621, PART IV AVERA HEALTH IS FILING FORM 8621 AS A SHAREHOLDER IN VARIOUS FOREIGN FUNDS AS THEY ARE CONSIDERED TO BE PASSIVE FOREIGN INVESTMENT COMPANIES. THE DISTRIBUTIONS FROM THESE FUNDS TO AVERA HEALTH ARE NOT TAXABLE AND THEREFORE NOT INCLUDED ON PART IV OF FORM 8621. THE FUNDS ARE IDENTIFIED BELOW: SHEPHERD INVESTMENTS INTERNATIONAL, LTD. THE CANYON VALUE REALIZATION FUND SCP OCEAN FUND, LTD. 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