AVERA HEALTH: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization: AVERA HEALTH (EIN 46-0422673)
Tax period: 2024-07-01 to 2025-06-30
Filed: 2026-05-15
IRS object ID: 202621359349303687
Schema version: 2024v5.5
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 C
Schedule D
Schedule F
Schedule G
Schedule I
Schedule J
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2026-05-15T09:56:31-05:00	ReturnTs
Tax Period End	2025-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	450250958	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Eide Bailly LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	800 Nicollet Mall Ste 1300	AddressLine1Txt
City	Minneapolis	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	554027033	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2024-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	460422673	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Health	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	6053227300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 West Avera Drive 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Julie Lautt	PersonNm
Person Title	CFO/Secretary	PersonTitleTxt
Phone	6053224700	PhoneNum
Signature	2026-05-15	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Field	Value	IRS element (for citing)
IRS Responsible Prty Info Curr	Yes (1)	IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen CPA	PreparerPersonNm
PTIN	P00484560	PTIN
Phone	6122536500	PhoneNum
Preparation	2026-05-11	PreparationDt

Field	Value	IRS element (for citing)
Tax	2024	TaxYr
Build TS	2025-03-06 01:10:19Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	James Dover FACHE	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 West Avera Drive 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$360,603,487	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.avera.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1998	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of health	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	2167	TotalEmployeeCnt
Total Volunteers	11	TotalVolunteersCnt
Total Gross UBI	$8,164,267	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$5,052,538	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$13,740,538	PYContributionsGrantsAmt
CY Contributions Grants	$21,987,213	CYContributionsGrantsAmt
PY Program Service Revenue	$249,827,079	PYProgramServiceRevenueAmt
CY Program Service Revenue	$313,700,061	CYProgramServiceRevenueAmt
PY Investment Income	$13,888,133	PYInvestmentIncomeAmt
CY Investment Income	$23,200,058	CYInvestmentIncomeAmt
PY Other Revenue	$968,330	PYOtherRevenueAmt
CY Other Revenue	$244,051	CYOtherRevenueAmt
PY Total Revenue	$278,424,080	PYTotalRevenueAmt
CY Total Revenue	$359,131,383	CYTotalRevenueAmt
PY Grants And Similar Paid	$16,682,844	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$24,860,573	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$159,054,954	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$188,626,111	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$2,729,346	CYTotalFundraisingExpenseAmt
PY Other Expenses	$104,648,744	PYOtherExpensesAmt
CY Other Expenses	$148,917,886	CYOtherExpensesAmt
PY Total Expenses	$280,386,542	PYTotalExpensesAmt
CY Total Expenses	$362,404,570	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,962,462	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$3,273,187	CYRevenuesLessExpensesAmt
Total Assets BOY	$2,306,128,147	TotalAssetsBOYAmt
Total Assets EOY	$2,578,930,497	TotalAssetsEOYAmt
Total Liabilities BOY	$1,968,523,287	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$2,188,023,598	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$337,604,860	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$390,906,899	NetAssetsOrFundBalancesEOYAmt
Mission	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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$326,114,099	ExpenseAmt
Grant	$24,860,573	GrantAmt
Revenue	$313,700,061	RevenueAmt
Desc	Avera Health is a nonprofit corporation sponsored by Caring for Life Catholic Health Ministries under the guidance of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota and the Benedictine Sisters of the Convent of the Sacred Heart. 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. These organizations provide services principally in eastern South Dakota and surrounding states. Avera Health provides management consulting, fund raising and other administrative services to the hospitals, long-term health care facilities, clinics, services and programs that are sponsored or otherwise affiliated with the Sisters.	Desc
Total Program Service Expenses	$326,114,099	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	Yes (1)	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	Yes (1)	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	177	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	2167	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (1)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (1)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	Yes (1)	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (1)	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	AK	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	AL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	AR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	CA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	CO	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	CT	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	DC	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	FL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	GA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	HI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	IL	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	KS	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	ME	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MD	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MS	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	MO	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NV	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NH	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NJ	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NM	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NY	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	NC	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	ND	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OH	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OK	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	OR	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	PA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	RI	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	SC	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	TN	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	VA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WA	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WV	StatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	Jamie Schaefer	PersonNm
Phone	6053223992	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3900 W Avera Dr Ste 300	AddressLine1Txt
City	Sioux Falls	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57108	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
James Dover
President/CEO	45.00	0.00	Yes (X)	Yes (X)	$2,453,843	$0	$50,892
Lori Essig
Chair	5.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Doneen Hollingsworth
Vice Chair	5.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
Sister Debra Kolecka
Board Member	5.00	6.00	Yes (X)		$0	$0	$0
Sister Candyce Chrystal
Board Member	5.00	3.00	Yes (X)		$0	$0	$0
Sister Roxanne Seifert
Board Member	5.00	2.00	Yes (X)		$0	$0	$0
Sister Lucille Welbig
Board Member	5.00	7.00	Yes (X)		$0	$0	$0
Sister Mary Kay Panowicz
Board Member	5.00	1.00	Yes (X)		$0	$0	$0
Dr Luis Rojas-Espaillat
Board Member, Gynecologic Oncology	5.00	40.00	Yes (X)		$0	$749,692	$55,838
Jacquelyn Johnson
Board Member	5.00	0.00	Yes (X)		$0	$0	$0
Sister Mary Jaeger
Board Member	5.00	0.00	Yes (X)		$0	$0	$0
Clark Sinclair
Board Member	5.00	0.00	Yes (X)		$0	$0	$0
Dr Jason Wickersham
Board Member, Family Practice/OB Phys	5.00	40.00	Yes (X)		$0	$527,321	$39,391
Robert Fouberg
Board Member	5.00	0.00	Yes (X)		$0	$0	$0
Dr Katherine Wang
Board Member, Neonatology	5.00	40.00	Yes (X)		$0	$589,998	$18,180
Julie Lautt
CFO, Treasurer	45.00	1.40		Yes (X)	$1,274,363	$0	$20,218
Richard Korman
Chief Legal Officer, Secretary	45.00	0.00		Yes (X)	$910,447	$0	$55,428
David Flicek
Chief Operating Officer, Vice Pres	40.00	0.00		Yes (X)	$1,450,140	$0	$47,062
Shantel Krebs
President/CEO, St. Mary's	0.00	44.00			$447,249	$0	$21,380	Yes (X)
Doug EkerenRetired May 2025
President/CEO, Sacred Heart	0.00	43.00			$639,691	$0	$50,728	Yes (X)
Debbie Streier
President/CEO, Marshall	0.00	46.00			$578,021	$0	$18,180	Yes (X)
Dr Ronald Place
President/CEO, McKennan	0.00	42.00			$1,093,970	$0	$28,917	Yes (X)
Dr Hillary Rockwell
President/CEO, Queen of Peace	0.00	42.00			$501,643	$0	$55,634	Yes (X)
Daniel Bjerknes
President/CEO, St. Luke's	0.00	41.00			$543,341	$0	$52,408	Yes (X)
Yassine Kanaan MD
Radiology	40.00	0.00			$1,086,199	$0	$48,193		Yes (X)
Kevin Post DO
Chief Medical Officer	40.00	0.00			$1,002,860	$0	$62,634		Yes (X)
Shandon Hatch MD
Radiology	40.00	0.00			$867,408	$0	$59,160		Yes (X)
Casey Swenson MD
Radiology	40.00	0.00			$861,131	$0	$59,040		Yes (X)
Bruk Kammerman
Sr. VP - Chief Information	40.00	0.00			$855,085	$0	$18,684		Yes (X)
Bob Sutton
Former President/CEO	0.00	0.00			$247,745	$0	$7,987			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$14,813,136	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,867,011	TotReportableCompRltdOrgAmt
Total Other Compensation	$769,954	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	316	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
CDW LLC
230 N Milwaukee Ave	Vernon Hills	IL	60061	Software, hardware, services	$35,227,349
KPMG LLP
3 Chestnut Ridge Rd	Montvale	NJ	07645	Services	$8,768,435
Epic Systems Corporation
1979 Milky Way	Verona	WI	53593	Software, services	$7,423,351
Microsoft Corporation
1950 N Stemmons Fwy Ste 5010	Dallas	TX	75207	Software, services	$6,607,724
Medical Information Technology Inc
7 Blue Hill River Rd	Canton	MA	02021	Software, services	$6,508,768

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	115	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$280,882	FederatedCampaignsAmt
Fundraising	$1,466,716	FundraisingAmt
Related Organizations	$27,283	RelatedOrganizationsAmt
Government Grants	$2,736,535	GovernmentGrantsAmt
All Other Contributions	$17,475,797	AllOtherContributionsAmt
Noncash Contributions	$240,203	NoncashContributionsAmt
Total Contributions	$21,987,213	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
ACS revenue	900099	$268,678,830	$268,678,830
Other revenue	900099	$31,813,341	$30,809,217	$1,004,124
PACE revenue	561000	$7,300,219	$112,204	$7,188,015
Premier expense credits	900099	$5,907,671	$5,907,671

Field	Value	IRS element (for citing)
Total Program Service Revenue	$313,700,061	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$7,382,908	TotalRevenueColumnAmt
Exclusion	$7,382,908	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$103,981	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$131,853	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$27,872	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$27,872	TotalRevenueColumnAmt
Unrelated Business Revenue	-$27,872	UnrelatedBusinessRevenueAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$15,990,419	SecuritiesAmt
Other	$1,048,780	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$1,222,049	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$15,990,419	SecuritiesAmt
Other	-$173,269	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$15,817,150	TotalRevenueColumnAmt
Exclusion	$15,817,150	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$390,125	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$1,466,716	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$118,202	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$271,923	TotalRevenueColumnAmt
Exclusion	$271,923	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$359,131,383	TotalRevenueColumnAmt
Related Or Exempt Func Income	$305,507,922	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$8,164,267	UnrelatedBusinessRevenueAmt
Exclusion	$23,471,981	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$24,776,558	TotalAmt
Program Services	$24,776,558	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$84,015	TotalAmt
Program Services	$84,015	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$10,498,940	TotalAmt
Management And General	$10,498,940	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$305,917	TotalAmt
Program Services	$305,917	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$138,024,212	TotalAmt
Program Services	$122,631,302	ProgramServicesAmt
Management And General	$13,865,831	ManagementAndGeneralAmt
Fundraising	$1,527,079	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$6,212,097	TotalAmt
Program Services	$5,734,828	ProgramServicesAmt
Management And General	$407,335	ManagementAndGeneralAmt
Fundraising	$69,934	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$23,054,212	TotalAmt
Program Services	$21,263,266	ProgramServicesAmt
Management And General	$1,527,041	ManagementAndGeneralAmt
Fundraising	$263,905	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$10,530,733	TotalAmt
Program Services	$9,597,792	ProgramServicesAmt
Management And General	$824,533	ManagementAndGeneralAmt
Fundraising	$108,408	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$162,545	TotalAmt
Program Services	$77,461	ProgramServicesAmt
Management And General	$85,076	ManagementAndGeneralAmt
Fundraising	$8	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$1,528,798	TotalAmt
Program Services	$1,496,917	ProgramServicesAmt
Management And General	$31,881	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$312,902	TotalAmt
Management And General	$312,902	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$21,877,292	TotalAmt
Program Services	$19,946,898	ProgramServicesAmt
Management And General	$1,732,687	ManagementAndGeneralAmt
Fundraising	$197,707	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$7,502,971	TotalAmt
Program Services	$7,506,729	ProgramServicesAmt
Management And General	-$130,208	ManagementAndGeneralAmt
Fundraising	$126,450	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$10,276,619	TotalAmt
Program Services	$10,050,822	ProgramServicesAmt
Management And General	$146,580	ManagementAndGeneralAmt
Fundraising	$79,217	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$50,198,639	TotalAmt
Program Services	$49,240,946	ProgramServicesAmt
Management And General	$646,646	ManagementAndGeneralAmt
Fundraising	$311,047	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,788,972	TotalAmt
Program Services	$1,434,363	ProgramServicesAmt
Management And General	$1,354,503	ManagementAndGeneralAmt
Fundraising	$106	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,253,948	TotalAmt
Program Services	$915,988	ProgramServicesAmt
Management And General	$308,559	ManagementAndGeneralAmt
Fundraising	$29,401	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$1,688,263	TotalAmt
Program Services	$1,464,079	ProgramServicesAmt
Management And General	$218,670	ManagementAndGeneralAmt
Fundraising	$5,514	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$821,546	TotalAmt
Program Services	$745,077	ProgramServicesAmt
Management And General	$76,469	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$22,622,635	TotalAmt
Program Services	$21,466,387	ProgramServicesAmt
Management And General	$1,153,855	ManagementAndGeneralAmt
Fundraising	$2,393	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$9,792,140	TotalAmt
Program Services	$9,406,585	ProgramServicesAmt
Management And General	$385,555	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical supplies	$2,651,506	$2,589,369	$58,403	$3,734
UBI tax	$1,628,525	$1,628,525
Equip Lease/Rental	$159,009	$118,931	$40,078
Bad debt expense	$121,904	$121,800	$104

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$13,529,672	TotalAmt
Program Services	$13,509,544	ProgramServicesAmt
Management And General	$15,685	ManagementAndGeneralAmt
Fundraising	$4,443	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$362,404,570	TotalAmt
Program Services	$326,114,099	ProgramServicesAmt
Management And General	$33,561,125	ManagementAndGeneralAmt
Fundraising	$2,729,346	FundraisingAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part X	Yes (X)	InfoInScheduleOPartXInd

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$185,193,801	BOYAmt
EOY	$61,128,400	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$1,414,472	BOYAmt
EOY	$1,235,426	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$28,855,505	BOYAmt
EOY	$28,474,650	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$2,288	BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$7,943,618	BOYAmt
EOY	$4,418,421	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$27,068,144	BOYAmt
EOY	$28,196,841	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$336,060,537	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$185,550,915	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$97,768,402	BOYAmt
EOY	$150,509,622	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$1,667,210,051	BOYAmt
EOY	$1,998,226,659	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$136,750,549	BOYAmt
EOY	$81,361,645	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$41,565	BOYAmt
EOY	$1,002,545	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,197,241	BOYAmt
EOY	$16,197,241	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$137,682,511	BOYAmt
EOY	$208,179,047	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,306,128,147	BOYAmt
EOY	$2,578,930,497	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$36,735,756	BOYAmt
EOY	$58,200,625	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$5,077,859	BOYAmt
EOY	$5,974,224	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$36,331,786	BOYAmt
EOY	$34,093,955	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$1,433,900,514	BOYAmt
EOY	$1,735,015,104	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$18,589,482	BOYAmt
EOY	$17,713,404	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$437,887,890	BOYAmt
EOY	$337,026,286	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,968,523,287	BOYAmt
EOY	$2,188,023,598	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$320,611,813	BOYAmt
EOY	$373,936,087	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,993,047	BOYAmt
EOY	$16,970,812	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$337,604,860	BOYAmt
EOY	$390,906,899	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,306,128,147	BOYAmt
EOY	$2,578,930,497	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$3,273,187	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$23,865,713	NetUnrlzdGainsLossesInvstAmt
Prior Period Adjustments	$395,334	PriorPeriodAdjustmentsAmt
Other Changes In Net Assets	$32,314,179	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	Yes (X)	PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$21,836,149	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$40,871,703	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$22,270,065	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$13,740,538	CurrentTaxYearMinus1YearAmt
Current Tax Year	$21,987,213	CurrentTaxYearAmt
Total	$120,705,668	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$278,210,607	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$277,318,143	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$249,787,142	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$252,265,042	CurrentTaxYearMinus1YearAmt
Current Tax Year	$305,507,922	CurrentTaxYearAmt
Total	$1,363,088,856	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$300,046,756	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$318,189,846	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$272,057,207	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$266,005,580	CurrentTaxYearMinus1YearAmt
Current Tax Year	$327,495,135	CurrentTaxYearAmt
Total	$1,483,794,524	TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$446,030	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$157,537	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$58,522	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$158,013	CurrentTaxYearMinus1YearAmt
Current Tax Year	$772,869	CurrentTaxYearAmt
Total	$1,592,971	TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$177,531,681	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$212,485,978	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$194,153,214	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$177,815,503	CurrentTaxYearMinus1YearAmt
Current Tax Year	$223,232,749	CurrentTaxYearAmt
Total	$985,219,125	TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$177,977,711	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$212,643,515	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$194,211,736	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$177,973,516	CurrentTaxYearMinus1YearAmt
Current Tax Year	$224,005,618	CurrentTaxYearAmt
Total	$986,812,096	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total509	$496,982,428	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$199,301	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$1,830,463	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$2,609,325	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,863,854	CurrentTaxYearMinus1YearAmt
Current Tax Year	$7,486,889	CurrentTaxYearAmt
Total	$13,989,832	TotalAmt

Post1975 UBTI Post1975UBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$2,515,692	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$2,884,876	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$5,736,624	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,138,863	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,991,505	CurrentTaxYearAmt
Total	$19,267,560	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$2,714,993	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$4,715,339	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$8,345,949	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$6,002,717	CurrentTaxYearMinus1YearAmt
Current Tax Year	$11,478,394	CurrentTaxYearAmt
Total	$33,257,392	TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$197,164	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$243,606	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$540,124	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$950,471	CurrentTaxYearMinus1YearAmt
Current Tax Year	$271,923	CurrentTaxYearAmt
Total	$2,203,288	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$302,958,913	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$323,148,791	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$280,943,280	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$272,958,768	CurrentTaxYearMinus1YearAmt
Current Tax Year	$339,245,452	CurrentTaxYearAmt
Total	$1,519,255,204	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.32710	PublicSupportCY509Pct
Public Support PY509	0.34330	PublicSupportPY509Pct
Investment Income CY	0.02190	InvestmentIncomeCYPct
Investment Income PY	0.01560	InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests PY509	Yes (X)	ThirtyThrPctSuprtTestsPY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	Yes (1)	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	Yes (1)	DirectContactLegislatorsInd
Direct Contact Legislators	$2,154	DirectContactLegislatorsAmt
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$310,748	OtherActivitiesAmt
Total Lobbying Expenditures	$312,902	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Through paid staff and paid consultants Avera Health meets with legislators. Avera Health provides grants to other organizations for lobbying and pays dues of which a small portion is attributable to lobbying.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$18,056,175	BeginningYearBalanceAmt
Contributions	$836,923	ContributionsAmt
Investment Earnings Or Losses	-$576,286	InvestmentEarningsOrLossesAmt
Other Expenditures	$2,888,532	OtherExpendituresAmt
Administrative Expenses	$55,620	AdministrativeExpensesAmt
End Year Balance	$15,372,660	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$19,295,442	BeginningYearBalanceAmt
Contributions	$1,301,057	ContributionsAmt
Investment Earnings Or Losses	-$1,419,368	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,062,186	OtherExpendituresAmt
Administrative Expenses	$58,770	AdministrativeExpensesAmt
End Year Balance	$18,056,175	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$20,349,540	BeginningYearBalanceAmt
Contributions	$829,430	ContributionsAmt
Investment Earnings Or Losses	$141,193	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,977,165	OtherExpendituresAmt
Administrative Expenses	$47,556	AdministrativeExpensesAmt
End Year Balance	$19,295,442	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$7,798,048	BeginningYearBalanceAmt
Contributions	$12,909,313	ContributionsAmt
Investment Earnings Or Losses	$136,229	InvestmentEarningsOrLossesAmt
Other Expenditures	$450,181	OtherExpendituresAmt
Administrative Expenses	$43,869	AdministrativeExpensesAmt
End Year Balance	$20,349,540	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$6,403,165	BeginningYearBalanceAmt
Contributions	$1,694,590	ContributionsAmt
Investment Earnings Or Losses	$432,897	InvestmentEarningsOrLossesAmt
Other Expenditures	$696,359	OtherExpendituresAmt
Administrative Expenses	$36,245	AdministrativeExpensesAmt
End Year Balance	$7,798,048	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.06610	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.07580	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.85810	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$948,600	OtherCostOrOtherBasisAmt
Book Value	$948,600	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$32,005,994	OtherCostOrOtherBasisAmt
Depreciation	$14,657,296	DepreciationAmt
Book Value	$17,348,698	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,297,610	OtherCostOrOtherBasisAmt
Depreciation	$2,762,425	DepreciationAmt
Book Value	$13,535,185	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$249,091,006	OtherCostOrOtherBasisAmt
Depreciation	$167,500,725	DepreciationAmt
Book Value	$81,590,281	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$37,717,327	OtherCostOrOtherBasisAmt
Depreciation	$630,469	DepreciationAmt
Book Value	$37,086,858	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$150,509,622	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDesc	Book ValueBookValueAmt
Interest in South Dakota Community Foundation	$1,407,859
Deferred compensation	$135,753,629
Right of use operating lease	$25,982,064
Cash surrender value of life insurance policies	$2,948,313
Due from affiliated entities	$42,087,182

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$208,179,047	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
Estimated insurance claims payable	$30,509,838
Due to affiliated entities	$72,113,354
Deferred compensation	$135,753,629
Long-term commitments	$7,343,871
Right of use lease obligations	$38,009,218
Other liabilities	$1,367,630
Pension liability	$51,928,746

Field	Value	IRS element (for citing)
Total Liability	$337,026,286	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	Avera Health administers the Avera Health Pooled Investment Fund, a fund that is maintained for the benefit of facilities that are sponsored, operated, or managed by Avera Health. Investments are made in conformity with the objectives and guidelines of the Avera Health Pooled Investment Committee. Within the fund, participating facilities share in a pool of investments that are managed by various fund managers. Investments that are held for participating facilities are recorded as Avera Health Pooled Investments with a corresponding liability account of Custodial Funds - Avera Health Pooled Investments on the balance sheet. Avera Health also holds its own investments within the pooled fund and records their allocated share of income and losses from these investments as investment income in the financial statements.
Part V, Line 4:	The Organization's endowment consists of funds established for a variety of purposes related to health and wellness programs in Avera affiliated organizations.
Part X, Line 2:	Avera Health and its sponsored organizations believe that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated 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.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

Field	Value	IRS element (for citing)
Region	Central America and the Caribbean -	RegionTxt
Offices	0	OfficesCnt
Employee	0	EmployeeCnt
Type Of Activities Conducted	Investments	TypeOfActivitiesConductedTxt
Region Total Expenditures	$61,520,000	RegionTotalExpendituresAmt

Field	Value	IRS element (for citing)
Subtotal Offices	0	SubtotalOfficesCnt
Subtotal Employees	0	SubtotalEmployeesCnt
Continuation Total Office	0	ContinuationTotalOfficeCnt
Continuation Total Employee	0	ContinuationTotalEmployeeCnt
Total Office	0	TotalOfficeCnt
Total Employee	0	TotalEmployeeCnt
Subtotal Spent	$61,520,000	SubtotalSpentAmt
Continuation Spent	$0	ContinuationSpentAmt
Total Spent	$61,520,000	TotalSpentAmt
Transfer To Foreign Corp	0	TransferToForeignCorpInd
Interest In Foreign Trust	0	InterestInForeignTrustInd
Foreign Corp Ownership	Yes (1)	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	Yes (1)	PassiveForeignInvestmestCoInd
Foreign Partnership	0	ForeignPartnershipInd
Boycott Countries	0	BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Form 990, Schedule F, Part IV:	FormAndLineReferenceDesc
Explanation	Avera Health reviews its direct and indirect investments during the tax period for determining required foreign filings. The Organization's ownership interests in foreign corporations required a Form 5471 to be filed. The Organization invests in partnerships that hold direct or indirect interest in passive foreign investment companies. The investment partnerships have properly filed Form 8621, or the underlying investments did not generate any unrelated business income. Under these facts, Avera Health is not required to file an additional Form 8621.	ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	RACE	Event1Nm
Gross Receipts Event1	$840,929	GrossReceiptsEvent1Amt
Charitable Contri Event1	$557,656	CharitableContriEvent1Amt
Gross Revenue Event1	$283,273	GrossRevenueEvent1Amt
Rent Facility Costs Event1	$35,806	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$2,947	FoodAndBeverageEvent1Amt
Entertainment Event1	$20,240	EntertainmentEvent1Amt
Other Direct Expenses Event1	$7,386	OtherDirectExpensesEvent1Amt
Event2	Hearts in Healing	Event2Nm
Gross Receipts Event2	$273,304	GrossReceiptsEvent2Amt
Charitable Contri Event2	$259,644	CharitableContriEvent2Amt
Gross Revenue Event2	$13,660	GrossRevenueEvent2Amt
Rent Facility Costs Event2	$6,443	RentFacilityCostsEvent2Amt
Food And Beverage Event2	$7,400	FoodAndBeverageEvent2Amt
Entertainment Event2	$5,895	EntertainmentEvent2Amt
Other Events Total	18	OtherEventsTotalCnt
Gross Receipts Other Events	$733,696	GrossReceiptsOtherEventsAmt
Charitable Contri Other Events	$646,849	CharitableContriOtherEventsAmt
Gross Revenue Other Events	$86,847	GrossRevenueOtherEventsAmt
Food And Beverage Other Events	$10,637	FoodAndBeverageOtherEventsAmt
Entertainment Other Events	$18,584	EntertainmentOtherEventsAmt
Oth Direct Expnss Other Events	$2,864	OthDirectExpnssOtherEventsAmt
Gross Receipts Total	$1,847,929	GrossReceiptsTotalAmt
Charitable Contributions Tot	$1,464,149	CharitableContributionsTotAmt
Gross Revenue Total Events	$383,780	GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events	$42,249	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$20,984	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$44,719	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$10,250	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$118,202	DirectExpenseSummaryEventsAmt
Net Income Summary	$265,578	NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (109 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt	Purpose Of GrantPurposeOfGrantTxt
Aberdeen Catholic School System Inc
1400 N Dakota St	Aberdeen	SD	57401	460336005	501c3	$11,700	$0	Donation
Aberdeen Christian School
1500 N Hwy 281	Aberdeen	SD	57401	911806433	501c3	$8,000	$0	Scholarship
Aberdeen Development Corporation
506 S Main St Ste 2	Aberdeen	SD	57401	466011831	501c6	$10,000	$0	Community Development
Aberdeen Ride Line
204 N 4th St	Aberdeen	SD	57401	466000010	501c3	$20,000	$0	Donation
Active Generations
2300 W 46th St	Sioux Falls	SD	57105	460305500	501c3	$40,500	$0	Donation
ALS Assoc MN ND SD Chapter
1919 University Ave West Ste 175	St Paul	MN	55104	411756085	501c3	$7,500	$0	Donation
Alzheimers Association South Dakota
4304 S Technology Dr	Sioux Falls	SD	57106	320151779	501c3	$10,000	$0	Donation
American Cancer Society
250 Williams St NW Ste 200	Atlanta	GA	30303	131788491	501c3	$16,875	$0	Donation
American Heart Association
7272 Greenville Ave	Dallas	TX	75231	135613797	501c3	$8,500	$0	Donation
Beresford School District 61-2
301 W Maple	Beresford	SD	57004	476002216	School District	$30,000	$0	Donation
Bishop Dudley Hospitality House
101 N Indiana Ave	Sioux Falls	SD	57103	911836528	501c3	$30,000	$0	Donation
Boy Scouts of America Sioux Council
800 NW Avenue Service Rd	Sioux Falls	SD	57104	460224599	501c3	$6,000	$0	Donation
Boys & Girls Club of Aberdeen Area
1121 1st Ave SE	Aberdeen	SD	57401	237062273	501c3	$49,000	$0	Donation
Boys & Girls Club of Brookings
1126 Southland Ln	Brookings	SD	57006	731630215	501c3	$8,300	$0	Donation
Boys & Girls Club of the Sioux Empire
100 S Spring Ave Ste 280	Sioux Falls	SD	57104	460399482	501c3	$15,500	$0	Donation
Brookings School District 5-1
2130 8th St S	Brookings	SD	57006	466000834	School District	$60,000	$0	Donation
Capital Area Counseling Service Inc
2001 Eastgate Ave	Pierre	SD	57501	460305571	501c3	$12,000	$0	Donation
Capitol Area United Way
925 E Sioux Ave Pierre	Sioux Falls	SD	57501	460403398	501c3	$5,912	$0	Donation
Career & Technical Education Academy
201 E 38th St	Sioux Falls	SD	57105	466002586	School District	$10,000	$0	Donation
Catholic Chancery Office
523 N Duluth Ave	Sioux Falls	SD	57104	466000424	501c3	$50,000	$0	Donation
Central Lyon Community School
1010 S Greene St	Rock Rapids	IA	51246	426037624	School District	$15,100	$0	Donation
Children's Home Society
801 N Sycamore Ave	Sioux Falls	SD	57103	460224542	501c3	$12,000	$0	Donation
City of Pierre Innaugural Committee
PO Box 277	Pierre	SD	57501	466000364	501c3	$15,000	$0	Donation
Coalition to Strengthen America's Healthcare
PO Box 30211	Bethesda	MD	208240211	522253225	501c4	$189,100	$0	Donation
Compass Center
1704 S Cleveland Ave Ste 3	Sioux Falls	SD	57103	460350199	501c3	$31,000	$0	Donation
Crofton Community School
PO Box 429	Crofton	NE	68730	476003902	School District	$5,100	$0	Donation
Dakota Resources
25795 475th Ave Ste 1	Renner	SD	57055	460442430	501c3	$30,000	$0	Donation
Dakotabilities
1116 S 4th Ave	Sioux Falls	SD	57105	460306216	501c3	$25,000	$0	Scholarship
Delta Dental of SD Foundation
804 N Euclid Ste 101	Pierre	SD	57501	911776857	501c3	$24,000	$0	Donation
Downtown Sioux Falls Inc
315 N Phillips Ave Ste 200	Sioux Falls	SD	57104	363627217	501c4	$25,000	$0	Donation
Embe
300 W 11th St	Sioux Falls	SD	57104	460234998	501c3	$57,500	$0	Donation
Emily's Hope
221 S Phillips Ave Ste 203	Sioux Falls	SD	57104	833324332	501c3	$10,950	$0	Community Development
Face It Together Inc
5020 S Tennis Ln Ste 4	Sioux Falls	SD	57108	272501220	501c3	$15,000	$0	Donation
Feeding South Dakota
4701 N Westport Ave	Sioux Falls	SD	57107	363293534	501c3	$163,250	$0	Donation
Fellowship of Christian Athletes
1601 E 69th St Ste 210	Sioux Falls	SD	57108	440610626	501c3	$20,500	$0	Donation
Flandreau School District 50-3
600 W Community Dr	Flandreau	SD	57028	466002593	School District	$15,000	$0	Donation
Forward Sioux Falls
200 N Phillips Ave Ste 200	Sioux Falls	SD	57104	460189300		$12,645	$0	Donation
Friends of Levitt Shell Sioux Falls
400 N Main Ave Ste 202	Sioux Falls	SD	57104	611699910	501c3	$15,000	$0	Community Development
Furniture Mission of South Dakota
209 N Nesmith Ave	Sioux Falls	SD	57103	810584500	501c3	$37,250	$0	Donation
Girl Scouts-Dakota Horizons
1101 S Marion Rd	Sioux Falls	SD	57106	460250744	501c3	$6,000	$0	Donation
Governor's Office of Economic Development
711 E Wells Ave	Pierre	SD	57501	466000364	State of SD	$51,500	$0	Community Development
Great Life Cares Foundation
3800 W 53rd St	Sioux Falls	SD	57106	472447820	501c3	$32,000	$0	Community Development
Greater Sioux Falls Chamber of Commerce
200 N Phillips Ave Ste 200	Sioux Falls	SD	57104	460189300	501c6	$39,550	$0	Community Development
Ground Works
102 N Krohns Pl Ste 113	Sioux Falls	SD	57103	475498537	501c3	$9,000	$0	Donation
Helpline Center Inc
3817 S Elmwood Ave	Sioux Falls	SD	57105	237424387	501c3	$54,500	$0	Donation
Junior Achievement of South Dakota
300 S Phillips Ave Ste L102	Sioux Falls	SD	57104	460306352	501c3	$25,000	$0	Donation
Leadership South Dakota
PO Box 887	Sioux Falls	SD	57101	820880122	501c3	$15,000	$0	Scholarship
Leukemia & Lymphoma Society Inc
3 International Dr Ste 200	Rye Brook	NY	10573	135644916	501c3	$15,000	$0	Donation
Lewis & Clark Behavioral Health Services Inc
1028 Walnut St	Yankton	SD	57078	460309601	501c3	$100,876	$0	Donation
Lost & Found Association
319 N Main Ave Ste 1	Sioux Falls	SD	57104	454306370	501c3	$12,500	$0	Donation
Make-A-Wish Foundation of SD
1400 W 17th St	Sioux Falls	SD	57104	460375953	501c3	$15,000	$0	Donation
Marshall Area YMCA
200 S A St	Marshall	MN	56258	411984589	501c3	$33,000	$0	Donation
Marshall Food4Kids
PO Box 771	Marshall	MN	56258	830865066	501c3	$7,000	$0	Donation
McCrossan Boys Ranch
47135 260th St	Sioux Falls	SD	57107	460311913	501c3	$15,000	$0	Donation
Mitchell Area Safehouse Inc
1809 N Wisconsin St	Mitchell	SD	57301	460389086	501c3	$13,000	$0	Donation
Mitchell School District 17-2
821 N Capital St	Mitchell	SD	57301	466001338	School District	$102,500	$0	Donation
Mitchell Technical Institute Foundation
1800 E Spruce St	Mitchell	SD	57301	460452950	501c3	$67,000	$0	Donation
Mitchell United Way
417 N Main St Ste 103	Mitchell	SD	57301	461250302	501c3	$8,277	$0	Donation
Mount Marty University
1105 W 8th St Yankton	Yankton	SD	57078	460283336	501c3	$229,000	$0	Donation
NAMI of South Dakota
1601 E 69th St Ste 210	Sioux Falls	SD	57108	363593027	501c3	$30,000	$0	Scholarship
National Kidney Foundation Inc
30 E 33rd St Ste 100	New York	NY	10016	131673104	501c3	$15,500	$0	Donation
National Multiple Sclerosis Society
733 Third Ave Fir 3	New York	NY	10017	135661935	501c3	$12,000	$0	Donation
Northern State University
620 15th Ave SE	Aberdeen	SD	57401	237002314	State of SD	$500,000	$0	Donation
Pathways Shelter for Homeless Inc
412 E 4th St	Yankton	SD	57078	473974624	501c3	$40,000	$0	Donation
Pierre Area Referral Service
100 W Missouri Ave	Pierre	SD	57501	460317107	501c3	$20,000	$0	Donation
Presentation Sisters
1500 N 2nd St	Aberdeen	SD	57401	460253283	501c3	$25,000	$0	Donation
President's Bowl
PO Box 1443	Sioux Falls	SD	57101	911776303	501c3	$10,000	$0	Donation
Pride in the Tiger Foundation
400 Tiger Dr	Marshall	MN	56258	411948007	501c3	$10,000	$0	Donation
River Cities Public Transit
1600 E Dakota Ave	Pierre	SD	57501	460449059	501c3	$25,000	$0	Donation
Ronald McDonald House Charities of South Dakota
825 S Lake Ave	Sioux Falls	SD	57104	460371152	501c3	$25,000	$0	Donation
Safe Harbor
PO Box 41	Aberdeen	SD	57401	460344310	501c3	$14,000	$0	Donation
Sales & Marketing Executives Inc of Sioux Falls
200 N Phillips Ave Ste 101	Sioux Falls	SD	57104	466012934	501c6	$15,164	$0	Donation
Sculpture Walk Inc
300 S Phillips Ave Ste 104	Sioux Falls	SD	57104	208535871	501c3	$47,250	$0	Donation
SD Youth Foundation Inc
10 Main Ave S Ste 109	Brookings	SD	57006	474832848	501c3	$10,000	$0	Donation
Sioux Empire Baseball Assoc Inc
1321 N Cleveland Ave	Sioux Falls	SD	57103	411903475	501c3	$19,200	$0	Donation
Sioux Empire United Way
1000 N West Ave 120	Sioux Falls	SD	57104	460233701	501c3	$113,000	$0	Donation
Sioux Falls Area CASA Program
100 S Spring Ave Ste 140	Sioux Falls	SD	57104	460430647	501c3	$10,000	$0	Donation
Sioux Falls Catholic School Corporation
3100 W 41st St	Sioux Falls	SD	57105	460413591	501c3	$850,000	$0	Donation
Sioux Falls Public Schools
PO Box 560	Sioux Falls	SD	57101	263537657	School District	$14,000	$0	Donation
Sioux Falls School District
201 E 38th St	Sioux Falls	SD	57105	466002586	School District	$124,000	$0	Donation
YMCA of Sioux Falls
220 S Minnesota Ave	Sioux Falls	SD	57104	460225021	501c3	$10,000	$0	Community Development
South Dakota Agricultural and Rural Leadership Foundation
Box 2170 Animal Science Ctr 132	Brookings	SD	57007	364293293	501c3	$10,000	$0	Donation
South Dakota Community Foundation
1714 N Lincoln Ave	Pierre	SD	57501	460398115	501c3	$189,541	$0	Community Development
South Dakota Discovery Center
805 W Sioux Ave	Sioux Falls	SD	57105	363599183	501c3	$7,500	$0	Donation
South Dakota State Medical Assoc
2600 W 49th St	Sioux Falls	SD	57105	460213945	501c6	$20,000	$0	Donation
South Dakota State University
Multiple Locations	Brookings	SD	57006	466000364	State of SD	$395,005	$0	Donation
South Dakota Symphony
301 S Main Ave 4th Fl	Sioux Falls	SD	57104	466017026	501c3	$54,500	$0	Scholarship
South Dakota Voters First
250 S Main Ave Apt 501	Sioux Falls	SD	57104	471494685	501c3	$25,000	$0	Donation
Southeast Technical College
2320 N Career Ave	Sioux Falls	SD	57107	460214496	School District	$525,018	$0	Donation
Southwest Minnesota State University
1501 State St	Marshall	MN	56258	411687554	State of MN	$113,000	$0	Donation
Special Olympics South Dakota
800 E I90 Ln	Sioux Falls	SD	57104	460359776	501c3	$12,000	$0	Donation
St Francis House
210 N Sherman Ave	Sioux Falls	SD	57103	460423202	501c3	$15,000	$0	Donation
St Mary's Catholic Schools
300 N 4th St	ONeill	NE	68763	470413713	501c3	$10,000	$0	Donation
Teddy Bear Den
500 S Main Ave	Sioux Falls	SD	57104	311802800	501c3	$15,000	$0	Scholarship
The Banquet
900 E 8th St	Sioux Falls	SD	57103	460387495	501c3	$17,590	$0	Donation
United Way of Northeastern SD Inc
PO Box 1065	Aberdeen	SD	57402	421568636	501c3	$17,737	$0	Scholarship
United Way of Southwest Minnesota
800 E Main St	Marshall	MN	56258	416023143	501c3	$5,912	$0	Scholarship
United Way & Volunteer Services of Greater Yankton
610 W 3rd St Ste 11	Yankton	SD	57078	460252854	501c3	$14,607	$0	Donation
University of Minnesota
505 Essex St SE	Minneapolis	MN	55455	416007513	State of MN	$24,000	$0	Donation
University of Sioux Falls
1101 W 22nd St	Sioux Falls	SD	57105	460224600	501c3	$200,000	$0	Donation
University of South Dakota
414 E Clark St	Vermillion	SD	57069	466000364	State of SD	$163,214	$0	Donation
Volunteers of America Dakotas
PO Box 89306	Sioux Falls	SD	57109	237353508	501c3	$16,000	$0	Donation
Washington High School
201 E 38th St	Sioux Falls	SD	57105	466002586	School District	$100,100	$0	Donation
Washington Pavilion Management Inc
PO Box 984	Sioux Falls	SD	571010984	460435791	501c3	$90,467	$0	Donation
Women Religious Archives Collaborative
2475 E 22nd St	Cleveland	OH	44115	882485236	501c3	$75,000	$0	Donation
Yankton School District 63-3
2410 W City Limits Rd	Yankton	SD	57078	466003280	School District	$10,000	$0	Donation
Zoological Society of Sioux Falls
805 S Kiwanis Ave	Sioux Falls	SD	57104	466015015	501c3	$55,000	$0	Donation
Project CAR
2425 S Western Ave	Sioux Falls	SD	57105	460358227	501c3	$16,000	$0	Donation
LifeScape Foundation
2501 W 26th St	Sioux Falls	SD	57105	460353254	501c3	$45,000	$0	Donation

Field	Value	IRS element (for citing)
Total501c3 Org	102	Total501c3OrgCnt
Total Other Org	7	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt
Medical assistance to employees	26	$49,715
Medical educational scholarships	10	$10,000
Pastoral educational scholarships	9	$24,300

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	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, 2025, the Organization made contributions to other non-public charities and other organizations 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.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
James Dover
President/CEO	$2,312,616	$0	$76,501	$0	$64,726	$0	$17,250	$0	$33,642	$0	$2,504,735	$0	$0	$0
David Flicek
Chief Operating Officer, Vice Pres	$1,382,300	$0	$47,730	$0	$20,110	$0	$17,250	$0	$29,812	$0	$1,497,202	$0	$0	$0
Julie Lautt
CFO, Treasurer	$1,226,098	$0	$41,964	$0	$6,301	$0	$17,250	$0	$2,968	$0	$1,294,581	$0	$0	$0
Yassine Kanaan MD
Radiology	$842,988	$0	$220,712	$0	$22,499	$0	$17,250	$0	$30,943	$0	$1,134,392	$0	$0	$0
Dr Ronald Place
President/CEO, McKennan	$1,045,760	$0	$35,190	$0	$13,020	$0	$17,250	$0	$11,667	$0	$1,122,887	$0	$0	$0
Kevin Post DO
Chief Medical Officer	$966,345	$0	$33,188	$0	$3,327	$0	$17,250	$0	$45,384	$0	$1,065,494	$0	$0	$0
Richard Korman
Chief Legal Officer, Secretary	$868,971	$0	$29,862	$0	$11,614	$0	$17,250	$0	$38,178	$0	$965,875	$0	$0	$0
Shandon Hatch MD
Radiology	$638,360	$0	$195,463	$0	$33,585	$0	$17,250	$0	$41,910	$0	$926,568	$0	$0	$0
Casey Swenson MD
Radiology	$610,273	$0	$220,457	$0	$30,401	$0	$16,626	$0	$42,414	$0	$920,171	$0	$0	$0
Bruk Kammerman
Sr. VP - Chief Information	$823,978	$0	$27,840	$0	$3,267	$0	$17,250	$0	$1,434	$0	$873,769	$0	$0	$0
Dr Luis Rojas-Espaillat
Board Member, Gynecologic Oncology	$0	$688,451	$0	$24,000	$0	$37,241	$0	$17,250	$0	$38,588	$0	$805,530	$0	$0
Doug EkerenRetired May 2025
President/CEO, Sacred Heart	$607,102	$0	$21,842	$0	$10,747	$0	$17,250	$0	$33,478	$0	$690,419	$0	$0	$0
Dr Katherine Wang
Board Member, Neonatology	$0	$490,065	$0	$80,980	$0	$18,953	$0	$17,250	$0	$930	$0	$608,178	$0	$0
Debbie Streier
President/CEO, Marshall	$550,926	$0	$18,936	$0	$8,159	$0	$17,250	$0	$930	$0	$596,201	$0	$0	$0
Daniel Bjerknes
President/CEO, St. Luke's	$523,336	$0	$17,945	$0	$2,060	$0	$17,250	$0	$35,158	$0	$595,749	$0	$0	$0
Dr Jason Wickersham
Board Member, Family Practice/OB Phy	$0	$413,246	$0	$112,212	$0	$1,863	$0	$17,250	$0	$22,141	$0	$566,712	$0	$0
Dr Hillary Rockwell
President/CEO, Queen of Peace	$483,647	$0	$16,579	$0	$1,417	$0	$17,250	$0	$38,384	$0	$557,277	$0	$0	$0
Shantel Krebs
President/CEO, St. Mary's	$417,072	$0	$14,110	$0	$16,067	$0	$17,250	$0	$4,130	$0	$468,629	$0	$0	$0
Bob Sutton
Former President/CEO	$246,847	$0	$0	$0	$898	$0	$3,519	$0	$4,467	$0	$255,731	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 1a	Some executives received payment for a "dining club" benefit.
Part I, Line 7	During the current year, the organization paid bonuses for longevity, Great Expectation incentive program, and employee referral program bonus. Some individuals received incentives related to retention and loan forgiveness. Physicians receive incentives based on production.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
South Dakota Health and Educational Facilities Authority
A	460315509	83755VUS1	2012-05-01	$206,383,927	Series 2012B refunded 2002 and 2008A bonds issued 4/11/02 and 6/18/08	0	0	0
South Dakota Health and Educational Facilities Authority
B	460315509	83755VG99	2017-10-11	$242,848,916	Series 2017 refunded bond issued 6/18/08;const/equip healthcare facilities	0	0	0
South Dakota Health and Educational Facilities Authority
C	460315509	83755VU44	2024-04-24	$114,418,553	See Supplemental Detail	0	0	0
South Dakota Health and Educational Facilities Authority
D	460315509	83755VU44	2024-04-24	$251,862,322	Construction/equipment healthcare facilities	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Other Spent ProceedsOtherSpentProceedsAmt	Substantial CompletionSubstantialCompletionYr	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Refunding Taxable BondsRefundingTaxableBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	UnspentUnspentAmt
A	$113,093,927	$206,383,927	$1,032,422	$38,100,000	$167,251,505	2013	Yes (1)	0	Yes (1)	Yes (1)
B	$24,883,916	$242,848,916	$1,786,422	$190,000,000	$51,062,494		0	Yes (1)	Yes (1)	Yes (1)
C		$114,418,553	$742,310		$113,676,243		Yes (1)	Yes (1)	Yes (1)	Yes (1)
D		$251,862,322	$1,633,842	$114,389,045	$11,398,072		0	0	0	Yes (1)	$124,441,363

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	Yes (1)	Yes (1)	0	Yes (1)
B	0	0		Yes (1)
C	0	0		Yes (1)
D	0	0		Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Exception To RebateExceptionToRebateInd	Variable Rate IssueVariableRateIssueInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A	Yes (1)	Yes (1)	Yes (1)
B	Yes (1)	0	Yes (1)
C	0	0	Yes (1)
D	0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line (f) Description of purpose, Bond C:	FormAndLineReferenceDesc
Explanation	Refund Series 2014 Bonds issued 6/26/2014, Series 2019A Bonds issued 11/13/2019, and 2017 taxable loan obtained 6/28/2017.	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
Katherine Schild
Family member of Key Employee, Doug Ekeren	$107,404	Compensation and benefits as an employee	0
Grant Flicek
Family member of Key Employee, David Flicek	$163,264	Compensation and benefits as an employee	0
Laura Alexander
Family member of Key Employee, Doug Ekeren	$35,249	Compensation and benefits as an employee	0

Schedule M IRS990ScheduleM

Books And Publications BooksAndPublicationsGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Noncash Contributions Rpt F990	$5,392	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Clothing And Household Goods ClothingAndHouseholdGoodsGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Noncash Contributions Rpt F990	$80,000	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Cost	MethodOfDeterminingRevenuesTxt

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	1	ContributionCnt
Noncash Contributions Rpt F990	$5,707	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FMV	MethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)

Non Cash CheckboxNonCashCheckboxInd	DescDesc	ContributionContributionCnt	Noncash Contributions Rpt F990NoncashContributionsRptF990Amt	Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)	Items for Patients	7	$120,301	FMV
Yes (X)	Auction Items	24	$16,206	FMV
Yes (X)	Miscelleanous	3	$12,597	FMV

Field	Value	IRS element (for citing)
Form8283 Received	0	Form8283ReceivedCnt
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	Yes (1)	ReviewProcessUnusualNCGiftsInd
Third Parties Used	0	ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Column (b):	The organization is reporting in Part I, column (b) the number of contributions.
Part I, Line 33:	Amounts included in revenue for the financial statement reporting are included on Schedule M. Additional non-cash contributions not included on Schedule M and the financial statements include items for the benefit of the Avera facilities which include special event donations.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Section A, line 2	Julie Lautt and Dr. Jason Wickersham have a business relationship. Sister Candyce Chrystal, Sister Roxanne Seifert, Sister Lucille Welbig, Dr. Ronald Place, and Julie Lautt have a business relationship with Dr. Luis Rojas-Espaillat and Dr. Katherine Wang.
Form 990, Part VI, Section A, line 4	Avera Health has revised the governance document to create a second category of Membership, Caring for Life Catholic Health Ministries, a Public Juridic Person, Members (CLCHM Members). The CLCHM Members shall consist of no less than five nor more than seven persons to be jointly appointed by the Presentation Sponsorship Members and Benedictine Sponsorship Members. The CLCHM Members shall serve for a three-year term with no limitation upon terms served. The initial appointments of CLCHM Members may be for a period longer or shorter than a three-year term such that one-third of the CLCHM Members shall be subject to reappointment each year. The Presentation Sponsorship Members and the Benedictine Sponsorship Members may remove and replace their appointees at any time, with or without cause, in which case the new appointee shall assume the term held by the individual being replaced. The revision removed the category of System Members.
Form 990, Part VI, Section A, line 6	Avera Health has two classes of members: Sponsorship Members and Caring for Life Catholic Health Ministries, a Public Juridic Person, Members (CLCHM Members). Sponsorship Members shall consist collectively of (i) those persons serving from time to time as the Presentation Sponsorship Members, and (ii) those persons serving from time to time as the Benedictine Sponsorship Members. The CLCHM Members shall consist of no less than five (5) nor more than seven (7) persons to be jointly appointed by the Presentation Sponsorship Members and the Benedictine Sponsorship Members. The CLCHM Members shall serve for a three-year term with no limitation upon terms served. The initial appointments of CLCHM Members may be for a period longer or shorter than a three-year term such that one-third of the CLCHM Members shall be subject to reappointment each year. The Presentation Sponsorship Members and the Benedictine Sponsorship Members may remove and replace their appointees at any time, with or without cause, in which case the new appointee shall assume the term held by the individual being replaced.
Form 990, Part VI, Section A, line 7a	The CLCHM 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 CLCHM Members, Benedictine Sisters 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 CLCHM Members. None of the following actions shall be taken by Avera Health without action of the CLCHM 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 CLCHM Members, Benedictine Sisters 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 Avera Health President/CEO; (e) To review and approve expenditures outside of the annual operating and capital budgets for Avera Health in accordance with established Avera Health fiscal policies; (f) To review and approve the Avera Health Strategic Plan; (g) To review and approve any and all Rescript Applications on behalf of Avera Health; (h) To adopt procedures for assuring that corporate actions are consistent with the philosophy, mission, Guiding Principles and values of Avera Health; (i) To provide recommendations to the Sponsorship Members on matters requiring Sponsorship Member's approval or action; (j) To adopt policies designed to effectuate the powers reserved to the CLCHM Members; and (k) To exercise oversight of the Guiding Principles and such authorities which may be assigned or delegated by the Sponsorship Members.
Form 990, Part VI, Section A, line 8b	Avera Health does not have any committees with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11b	The Form 990 is prepared and reviewed by an independent accounting firm. The Form 990 is then reviewed by the Avera Health VP of Financial Reporting and Tax Manager. After initial internal review, the Form 990 is made available to various members of Avera Health Executive Management, including the Avera Health CFO, President/CEO and COO. A copy is made available to the Board members.
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 the Caring for Life Catholic Health Ministries Members, 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 and conflict of interest policy are not made available to the general public.
Form 990, Part VI, Section B, Line 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:	The issue price includes the filing Organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg, and Avera at Home. In accordance with IRS instructions, information related to the tax-exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673).
Form 990, Part XI, line 9:	Net equity transfers -250,000. Net assets released from restriction -2,262,583. Adjustments to the funded status of pension plans 35,779,477. Contributions received by Avera Health Foundation not reflected in -17,218,963. financial statements Grants to organizations distributed by Avera Health 18,336,774. Foundation not reflected in financial statements Other changes in net assets -2,074,092. Change in Assets with Donor Restrictions 3,566.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera at Home
5300 S Broadband Lane	Sioux Falls	SD	57108	460399291	Home services	SD	501(c)(3)	Line 10	Avera Health	Yes (1)
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health financing & health plan admin	SD	501(c)(4)		Avera Health	Yes (1)
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	Healthcare services	MN	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Granite Falls
345 10th Ave	Granite Falls	MN	56241	843156881	Healthcare services	MN	501(c)(3)	Line 3	Avera Marshall	Yes (1)
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare services	MN	501(c)(3)	Line 3	Avera Marshall	Yes (1)
Avera Queen of Peace Hospital
525 North Foster	Mitchell	SD	57301	460224604	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare services	NE	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera St Mary's
801 East Sioux Avenue	Pierre	SD	57501	460230199	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare services	SD	501(c)(3)	Line 3	Avera St Mary's	Yes (1)
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare services	IA	501(c)(3)	Line 3	Avera Health	Yes (1)
Holy Family Hospital Foundation
826 North 8th Street	Estherville	IA	51334	421317452	Support health related services	IA	501(c)(3)	Line 10	Avera Holy Family	Yes (1)
Sacred Heart Health Services
501 Summit Street	Yankton	SD	57078	460225483	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)
Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9	Yankton	SD	57078	460337013	Healthcare services	SD	501(c)(3)	Line 10	Avera Health	Yes (1)
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	Healthcare services	SD	501(c)(3)	Line 3	Avera Health	Yes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	Predominant Income TypePredominantIncomeTypeTxt	OwnershipOwnershipPct
Avera Home Medical Equipment of Floyd Valley Hospital LLC
5300 S Broadband Lane	Sioux Falls	SD	57108	820582350	Medical services - home medical equipment	SD	N/A	0	0
Avera Home Medical Equipment of Lakes Regional Healthcare LLC
5300 S Broadband Lane	Sioux Falls	SD	57108	862949748	Medical services - home medical equipment	SD	N/A	0	0
Avera Home Medical Equipment of Sioux Center LLC
5300 S Broadband Lane	Sioux Falls	SD	57108	753203100	Medical services - home medical equipment	SD	N/A	0	0
Avera Home Medical Equipment of Spencer Hospital LLC
5300 S Broadband Lane	Sioux Falls	SD	57108	800619999	Medical services - home medical equipment	SD	N/A	0	0
Brookings Health System - Avera HME LLC
100 22nd Ave Suite 101	Brookings	SD	57006	453204123	Healthcare Services	SD	N/A	0	0
Caravan Health ACO 15 LLC dba Prairie Vista Care Organization
20 Burton Hills Blvd Ste 100	Nashville	TN	37215	611843657	Accountable Care Organization	MO	N/A	0	0
Caravan Health ACO 41 LLC dba Prairie View Care Organization
20 Burton Hills Blvd Ste 100	Nashville	TN	37215	821447782	Accountable Care Organization	MO	N/A	0	0	Related	0.63630
Heart Hospital of South Dakota LLC
4500 W 69th Street	Sioux Falls	SD	57108	562143771	Healthcare Services	NC	N/A	0	0
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania St	Aberdeen	SD	57401	460461429	Surgical associates	SD	N/A	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	Province Or StateForeignAddress/ProvinceOrStateNm	CountryForeignAddress/CountryCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
Accounts Management Inc
5132 S Cliff Ave Suite 101	Sioux Falls	SD	57108	460373021	Collection Agency	SD	Avera Health	C	$4,395,824	$4,464,393	1.00000	Yes (1)
Avera Property Insurance Inc
1000 West 4th Street Suite 1	Yankton	SD	57078	460463155	Insurance	SD	Avera Health	C	-$797,491	$1,948,671	1.00000	Yes (1)
DakotaCare Administrative Services Inc
5300 South Broadband Lane	Sioux Falls	SD	57108	460424322	Insurance	SD	Avera Health	C	$629,718	$2,924,243	1.00000	Yes (1)
South Dakota State Medical Holding Company Inc
5300 South Broadband Lane	Sioux Falls	SD	57108	460401087	Insurance	SD	Avera Health	C	$3,974	$399,272	1.00000	Yes (1)
Valley Health Services
501 Summit Street	Yankton	SD	57078	460357149	Rental Real Estate	SD	Sacred Heart Health Services	C	$130,251		1.00000	Yes (1)
Kore Cares In Home Services LLC
5300 South Broadband Lane	Sioux Falls	SD	57108	882778902	In-Home Care Services	SD	Avera at Home	S	$368,262	$976,126	0.80000	Yes (1)
Alucent Australia Pty Ltd
					Biotech Research		Alucent Biomedical Inc		$569,662		0.70200	Yes (1)	Level 10 30 Collings Street	Melbourne	VIC 3000	AS	AS
Alucent Biomedical Inc
1325 S Cliff Avenue PO Box 5045	Sioux Falls	SD	571175045	471818349	Biotechnology	SD	Alumend LLC	C	-$4,930,272	$514,825	0.70200	Yes (1)

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (1)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (52 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
AVERA HEALTH PLANS INC
K	$195,602	VENDOR PAYMENT LISTING
AVERA MCKENNAN
K	$149,327	VENDOR PAYMENT LISTING
ACCOUNTS MANAGEMENT INC
L	$510,149	GENERAL LEDGER
AVERA AT HOME
L	$3,850,687	GENERAL LEDGER
AVERA HEALTH PLANS INC
L	$3,917,600	GENERAL LEDGER
AVERA HOLY FAMILY
L	$3,155,587	GENERAL LEDGER
AVERA MARSHALL
L	$15,187,420	GENERAL LEDGER
AVERA MCKENNAN
L	$165,323,015	GENERAL LEDGER
AVERA QUEEN OF PEACE HOSPITAL
L	$13,539,332	GENERAL LEDGER
AVERA SACRED HEART HEALTH SERVICES
L	$14,546,965	GENERAL LEDGER
AVERA ST ANTHONY'S HOSPITAL
L	$4,501,886	GENERAL LEDGER
AVERA ST LUKE'S
L	$20,269,130	GENERAL LEDGER
AVERA ST MARY'S
L	$12,211,183	GENERAL LEDGER
ST BENEDICT HEALTH CENTER
L	$2,564,174	GENERAL LEDGER
AVERA HEALTH PLANS INC
O	$1,430,648	GENERAL LEDGER
AVERA MARSHALL
O	$137,023	GENERAL LEDGER
AVERA MCKENNAN
O	$10,271,220	GENERAL LEDGER
AVERA QUEEN OF PEACE HOSPITAL
O	$1,227,921	GENERAL LEDGER
AVERA SACRED HEART HEALTH SERVICES
O	$2,127,894	GENERAL LEDGER
AVERA ST ANTHONY'S HOSPITAL
O	$129,578	GENERAL LEDGER
AVERA ST LUKE'S
O	$3,860,403	GENERAL LEDGER
AVERA ST MARY'S
O	$1,596,771	GENERAL LEDGER
ACCOUNTS MANAGEMENT INC
P	$134,289	VENDOR PAYMENT LISTING
AVERA HEALTH PLANS INC
P	$30,037,598	VENDOR PAYMENT LISTING
AVERA MARSHALL
P	$172,501	VENDOR PAYMENT LISTING
AVERA MCKENNAN
P	$8,811,011	VENDOR PAYMENT LISTING
AVERA QUEEN OF PEACE HOSPITAL
P	$418,721	VENDOR PAYMENT LISTING
AVERA SACRED HEART HEALTH SERVICES
P	$132,816	VENDOR PAYMENT LISTING
AVERA ST ANTHONY'S HOSPITAL
P	$59,256	VENDOR PAYMENT LISTING
AVERA ST LUKE'S
P	$814,077	VENDOR PAYMENT LISTING
AVERA ST MARY'S
P	$238,225	VENDOR PAYMENT LISTING
ACCOUNTS MANAGEMENT INC
Q	$102,975	VENDOR PAYMENT LISTING
AVERA AT HOME
Q	$601,898	VENDOR PAYMENT LISTING
AVERA HEALTH PLANS INC
Q	$127,952	VENDOR PAYMENT LISTING
AVERA HOLY FAMILY
Q	$714,589	VENDOR PAYMENT LISTING
AVERA MARSHALL
Q	$4,183,862	VENDOR PAYMENT LISTING
AVERA MCKENNAN
Q	$102,494,307	VENDOR PAYMENT LISTING
AVERA QUEEN OF PEACE HOSPITAL
Q	$4,993,033	VENDOR PAYMENT LISTING
AVERA SACRED HEART HEALTH SERVICES
Q	$6,320,881	VENDOR PAYMENT LISTING
AVERA ST ANTHONY'S HOSPITAL
Q	$1,343,428	VENDOR PAYMENT LISTING
AVERA ST LUKE'S
Q	$8,267,435	VENDOR PAYMENT LISTING
AVERA ST MARY'S
Q	$4,482,117	VENDOR PAYMENT LISTING
ST BENEDICT HEALTH CENTER
Q	$426,735	VENDOR PAYMENT LISTING
AVERA AT HOME
R	$273,311	GENERAL LEDGER
AVERA MARSHALL
R	$273,619	GENERAL LEDGER
AVERA MCKENNAN
R	$6,394,587	GENERAL LEDGER
AVERA QUEEN OF PEACE HOSPITAL
R	$580,126	GENERAL LEDGER
AVERA SACRED HEART HEALTH SERVICES
R	$1,216,490	GENERAL LEDGER
AVERA ST ANTHONY'S HOSPITAL
R	$58,002	GENERAL LEDGER
AVERA ST LUKE'S
R	$570,633	GENERAL LEDGER
AVERA ST MARY'S
R	$1,134,927	GENERAL LEDGER
ST BENEDICT HEALTH CENTER
R	$50,469	GENERAL LEDGER

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Schedule R, Part II, Tax Exempt Organizations:	Holy Family Hospital Foundation dissolved November 2024.
Form 990, Schedule R, Part IV, Corporation or Trust:	Valley Health Services dissolved June 2025. Alucent Biomedical, Inc. dissolved May 2025. Alucent Australia Pty Ltd dissolved May 2025.