AVERA ST MARYS: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization: AVERA ST MARYS (EIN 46-0230199)
Tax period: 2024-07-01 to 2025-06-30
Filed: 2026-05-15
IRS object ID: 202631359349304103
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 H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2026-05-15T09:25:54-05:00	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	460230199	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera St Mary's	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	6052243130	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 East Sioux Avenue	AddressLine1Txt
City	Pierre	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57501	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Julie Lautt	PersonNm
Person Title	CFO Avera Health	PersonTitleTxt
Phone	6052243130	PhoneNum
Signature	2026-05-11	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

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	Avera St Mary's Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	Shantel Krebs	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 East Sioux Avenue	AddressLine1Txt
City	Pierre	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57501	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$136,031,591	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	See Schedule O	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1951	FormationYr
Legal Domicile State	SD	LegalDomicileStateCd
Activity Or Mission	Promotion of health	ActivityOrMissionDesc
Voting Members Governing Body	10	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	695	TotalEmployeeCnt
Total Volunteers	60	TotalVolunteersCnt
Total Gross UBI	$814,550	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$610,838	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$993,638	PYContributionsGrantsAmt
CY Contributions Grants	$1,292,498	CYContributionsGrantsAmt
PY Program Service Revenue	$118,474,317	PYProgramServiceRevenueAmt
CY Program Service Revenue	$127,799,041	CYProgramServiceRevenueAmt
PY Investment Income	$423,128	PYInvestmentIncomeAmt
CY Investment Income	$598,027	CYInvestmentIncomeAmt
PY Other Revenue	$2,217,524	PYOtherRevenueAmt
CY Other Revenue	$4,174,520	CYOtherRevenueAmt
PY Total Revenue	$122,108,607	PYTotalRevenueAmt
CY Total Revenue	$133,864,086	CYTotalRevenueAmt
PY Grants And Similar Paid	$24,893	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$10,911	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$60,961,967	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$64,547,240	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$9,084	CYTotalFundraisingExpenseAmt
PY Other Expenses	$60,195,646	PYOtherExpensesAmt
CY Other Expenses	$67,454,022	CYOtherExpensesAmt
PY Total Expenses	$121,182,506	PYTotalExpensesAmt
CY Total Expenses	$132,012,173	CYTotalExpensesAmt
PY Revenues Less Expenses	$926,101	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,851,913	CYRevenuesLessExpensesAmt
Total Assets BOY	$98,108,691	TotalAssetsBOYAmt
Total Assets EOY	$101,112,444	TotalAssetsEOYAmt
Total Liabilities BOY	$35,176,486	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$36,186,367	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$62,932,205	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$64,926,077	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$122,835,490	ExpenseAmt
Grant	$10,911	GrantAmt
Revenue	$131,041,258	RevenueAmt
Desc	Avera St. Mary's mission is to provide healthcare services to Pierre, South Dakota residents and residents of the surrounding area. Avera St. Mary's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Mary's consists of a 50-bed hospital, an 80-bed nursing home, senior living apartments, and one physician clinic in Pierre, South Dakota. The program services offered include primary care, ob/gyn, pediatrics, orthopedics, general surgery, emergency, internal medicine, oncology, podiatry, urology, dermatology, pain management, ENT, laboratory, speech therapy, occupational therapy, respiratory therapy, and wound care. Avera St. Mary's provides acute care and long-term healthcare services.Following is a breakdown of these statistics by facility:Avera St. Mary's Hospital 1,542 Acute patient discharges 464 Newborn patient discharges 96 Swing bed patient discharges 62,334 Outpatient visits 614 Swing-bed patient days 771 Newborn patient days 96,599 Clinic visitsAvera Maryhouse 20,625 Long-term resident days 134 Long Term Care patient dischargesAvera St. Mary's maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $3,452,863.Avera St. Mary's also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera St. Mary's upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera St. Mary's engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed.	Desc
Total Program Service Expenses	$122,835,490	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	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	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	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
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	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	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	88	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	695	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	0	QuidProQuoContributionsInd
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	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	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	0	CompensationProcessCEOInd
Compensation Process Other	0	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Jamie Schaefer	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
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 (17 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
Julie Lautt
CFO Avera Health;Secretary/Treasurer	0.10	46.30	Yes (X)	$0	$1,274,363	$20,218
Dr Mark Hagy
Board Member/Orthopedics	42.00	2.00		$0	$893,268	$34,401	Yes (X)
Shantel Krebs
President/CEO	42.00	2.00	Yes (X)	$0	$447,249	$21,380	Yes (X)
Scott Oswald
CRNA	40.00	0.00		$314,396	$0	$46,518		Yes (X)
Matthew Deichert
CRNA	40.00	0.00		$291,066	$0	$54,466		Yes (X)
Kevin Roark
CRNA	40.00	0.00		$278,992	$0	$45,672		Yes (X)
Nick Jung
CRNA	40.00	0.00		$274,587	$0	$43,562		Yes (X)
Michael Murphy
CRNA	40.00	0.00		$273,664	$0	$42,268		Yes (X)
Rena Robbennolt Board Member
/Nurse Practitioner (Until Sept.)	2.00	40.00		$0	$127,050	$48,800	Yes (X)
Robert Wylie
Chair	2.00	2.00	Yes (X)	$0	$0	$0	Yes (X)
Kristin Brost
Vice Chair	2.00	2.00	Yes (X)	$0	$0	$0	Yes (X)
Jamie Cronin
Board Member	2.00	2.00		$0	$0	$0	Yes (X)
Sr Debra Kolecka
Board Member	2.00	9.00		$0	$0	$0	Yes (X)
Jeff Hallem
Board Member	2.00	2.00		$0	$0	$0	Yes (X)
Meredith Lee
Board Member	2.00	2.00		$0	$0	$0	Yes (X)
Kim Olson
Board Member	2.00	2.00		$0	$0	$0	Yes (X)
Sr Lynn Marie Welbig
Board Member	2.00	2.00		$0	$0	$0	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,432,705	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,741,930	TotReportableCompRltdOrgAmt
Total Other Compensation	$357,285	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	49	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	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
Avera Health
3900 W Avera Drive	Sioux Falls	SD	57108	Shared Services	$10,979,693
AMN Healthcare Inc
12400 High Bluff Dr	San Diego	CA	92130	Contract Labor	$5,783,999
Health Carousel LLC
PO Box 714216	Cincinnati	OH	45271	Contract Labor	$948,586
ProLink Healthcare LLC
4600 Montgomery Rd Ste 300	Cincinnati	OH	45212	Contract Labor	$508,967
Avel eCare Medical Group PC
4500 N Lewis Ave	Sioux Falls	SD	57104	Clinical Services	$505,071

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	21	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$17,000	FederatedCampaignsAmt
Related Organizations	$1,117,527	RelatedOrganizationsAmt
Government Grants	$88,103	GovernmentGrantsAmt
All Other Contributions	$69,868	AllOtherContributionsAmt
Total Contributions	$1,292,498	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Service Revenue	621110	$118,565,618	$118,565,618
Pharmacy Revenue	456110	$7,641,711	$7,641,711
Patient and Clinic Revenue	621110	$493,412	$493,412

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,098,300	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,098,300	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$127,799,041	TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$117,753	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$117,753	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$117,753	TotalRevenueColumnAmt
Exclusion	$117,753	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$596,767	SecuritiesAmt
Other	$1,260	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$596,767	SecuritiesAmt
Other	$1,260	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$598,027	TotalRevenueColumnAmt
Exclusion	$598,027	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$6,002,485	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$2,167,505	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,834,980	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,020,430	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$814,550	UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	A/R Interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$221,787	TotalRevenueColumnAmt
Related Or Exempt Func Income	$221,787	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$221,787	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$133,864,086	TotalRevenueColumnAmt
Related Or Exempt Func Income	$131,041,258	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$814,550	UnrelatedBusinessRevenueAmt
Exclusion	$715,780	ExclusionAmt

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

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$10,911	TotalAmt
Program Services	$10,911	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$53,706,700	TotalAmt
Program Services	$52,923,627	ProgramServicesAmt
Management And General	$783,073	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,953,937	TotalAmt
Program Services	$1,924,419	ProgramServicesAmt
Management And General	$29,518	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$5,582,688	TotalAmt
Program Services	$5,511,506	ProgramServicesAmt
Management And General	$71,182	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,303,915	TotalAmt
Program Services	$3,253,959	ProgramServicesAmt
Management And General	$49,956	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$36,304	TotalAmt
Program Services	$33,915	ProgramServicesAmt
Management And General	$2,389	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$2,395	TotalAmt
Management And General	$2,395	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$26,863,647	TotalAmt
Program Services	$19,735,274	ProgramServicesAmt
Management And General	$7,128,213	ManagementAndGeneralAmt
Fundraising	$160	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$6,505	TotalAmt
Program Services	$5,103	ProgramServicesAmt
Management And General	$1,110	ManagementAndGeneralAmt
Fundraising	$292	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$777,974	TotalAmt
Program Services	$608,344	ProgramServicesAmt
Management And General	$167,891	ManagementAndGeneralAmt
Fundraising	$1,739	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$532,072	TotalAmt
Program Services	$531,964	ProgramServicesAmt
Management And General	$108	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,701,866	TotalAmt
Program Services	$1,393,168	ProgramServicesAmt
Management And General	$308,698	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$327,341	TotalAmt
Program Services	$302,284	ProgramServicesAmt
Management And General	$23,878	ManagementAndGeneralAmt
Fundraising	$1,179	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$117,190	TotalAmt
Program Services	$113,159	ProgramServicesAmt
Management And General	$4,031	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,126,786	TotalAmt
Program Services	$1,021,906	ProgramServicesAmt
Management And General	$104,880	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$5,182,300	TotalAmt
Program Services	$4,920,884	ProgramServicesAmt
Management And General	$261,416	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$138,016	TotalAmt
Management And General	$138,016	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical Supplies	$28,785,239	$28,737,428	$42,700	$5,111
Equipment Lease/Rental	$128,180	$124,959	$2,721	$500
Provision for income ta	$53,950	$53,950

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,674,257	TotalAmt
Program Services	$1,628,730	ProgramServicesAmt
Management And General	$45,424	ManagementAndGeneralAmt
Fundraising	$103	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$132,012,173	TotalAmt
Program Services	$122,835,490	ProgramServicesAmt
Management And General	$9,167,599	ManagementAndGeneralAmt
Fundraising	$9,084	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$8,540	BOYAmt
EOY	-$233,596	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$13,678,696	BOYAmt
EOY	$15,415,569	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$4,654,161	BOYAmt
EOY	$4,524,220	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$419,021	BOYAmt
EOY	$423,481	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$120,113,387	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$78,077,108	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$44,049,040	BOYAmt
EOY	$42,036,279	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$16,871,859	BOYAmt
EOY	$12,818,072	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$358,301	BOYAmt
EOY	$496,225	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$651,686	BOYAmt
EOY	$651,686	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$17,417,387	BOYAmt
EOY	$24,980,508	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$98,108,691	BOYAmt
EOY	$101,112,444	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$6,865,726	BOYAmt
EOY	$7,731,785	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$15,728,440	BOYAmt
EOY	$15,614,536	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$3,297	BOYAmt
EOY	$5,436	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$11,408,563	BOYAmt
EOY	$10,754,886	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,170,460	BOYAmt
EOY	$2,079,724	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$35,176,486	BOYAmt
EOY	$36,186,367	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	$58,887,351	BOYAmt
EOY	$60,504,498	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,044,854	BOYAmt
EOY	$4,421,579	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$62,932,205	BOYAmt
EOY	$64,926,077	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$98,108,691	BOYAmt
EOY	$101,112,444	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,851,913	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$464,989	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$323,030	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)
Hospital	Yes (X)	HospitalInd

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	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$2,395	OtherActivitiesAmt
Total Lobbying Expenditures	$2,395	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	Avera St. Mary's paid dues to organizations which have a portion of the dues attributed to lobbying activities.	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	$1,661,630	BeginningYearBalanceAmt
Contributions	$11,000	ContributionsAmt
Investment Earnings Or Losses	$142,424	InvestmentEarningsOrLossesAmt
Administrative Expenses	$44,245	AdministrativeExpensesAmt
End Year Balance	$1,770,809	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,539,208	BeginningYearBalanceAmt
Contributions	$500	ContributionsAmt
Investment Earnings Or Losses	$127,912	InvestmentEarningsOrLossesAmt
Other Expenditures	$5,990	OtherExpendituresAmt
End Year Balance	$1,661,630	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,518,879	BeginningYearBalanceAmt
Contributions	$73,966	ContributionsAmt
Investment Earnings Or Losses	$9,363	InvestmentEarningsOrLossesAmt
Other Expenditures	$63,000	OtherExpendituresAmt
End Year Balance	$1,539,208	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,486,599	BeginningYearBalanceAmt
Contributions	$1,877	ContributionsAmt
Investment Earnings Or Losses	$30,403	InvestmentEarningsOrLossesAmt
End Year Balance	$1,518,879	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,203,694	BeginningYearBalanceAmt
Contributions	$119,546	ContributionsAmt
Investment Earnings Or Losses	$164,484	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,125	OtherExpendituresAmt
End Year Balance	$1,486,599	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.78783	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.21217	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$1,391,428	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$4,260,980	OtherCostOrOtherBasisAmt
Book Value	$5,652,408	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$67,902,492	OtherCostOrOtherBasisAmt
Depreciation	$39,649,421	DepreciationAmt
Book Value	$28,253,071	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$45,139,538	OtherCostOrOtherBasisAmt
Depreciation	$37,478,704	DepreciationAmt
Book Value	$7,660,834	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,418,949	OtherCostOrOtherBasisAmt
Depreciation	$948,983	DepreciationAmt
Book Value	$469,966	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$42,036,279	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Interest in Avera Health Foundation	$5,515,585	F
Avera Pooled Investments	$7,302,487	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$12,818,072	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp

Field	Value	IRS element (for citing)
Desc	Intercompany Assets	Desc
Book Value	$24,980,508	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$24,980,508	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
Estimated Third Party Payor Settlements	$661,509
Other Liabilities	$526,506
Intercompany Liabilities	$891,709

Field	Value	IRS element (for citing)
Total Liability	$2,079,724	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part IV, Line 2b:	The Organization holds funds on behalf of its residents.
Part V, Line 4:	The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions.
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 H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	250.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$903,783	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$903,783	NetCommunityBenefitExpnsAmt
Total Expense	0.00680	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$903,783	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$903,783	NetCommunityBenefitExpnsAmt
Total Expense	0.00680	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,146	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,146	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$52,010,711	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,501,217	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$19,509,494	NetCommunityBenefitExpnsAmt
Total Expense	0.14780	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$120,203	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$120,203	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$52,132,060	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,501,217	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$19,630,843	NetCommunityBenefitExpnsAmt
Total Expense	0.14870	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$53,035,843	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$32,501,217	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$20,534,626	NetCommunityBenefitExpnsAmt
Total Expense	0.15550	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,125,455	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$22,138,915	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$24,004,140	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$1,865,225	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera St Mary's	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	801 East Sioux Avenue	AddressLine1Txt
City	Pierre	CityNm
State Abbreviation	SD	StateAbbreviationCd
ZIP	57501	ZIPCd

Field	Value	IRS element (for citing)
Website Address	See Part V Section C	WebsiteAddressTxt
State License	10566	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	Provider based clinic	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Avera St Mary's	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	24	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	See Part V Section C	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	See Part V Section C	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	24	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	See Part V Section C	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	250.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	See Part V Section C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	See Part V Section C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	See Part V Section C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Avera St. Mary's	Part V, Section B, Line 5: Avera St. Mary's gathered information regarding the needs of the community through an established process gathering stakeholder information on community perceptions of the health of Central South Dakota including a survey of the public, and interviews with identified community leaders. All members of the CHNA team were selected for roles they have in the community by a matrix developed by the Avera St. Mary's Hospital Administrative Council and included attributes such as: uninsured/underinsured, parents of young children, close contact with underprivileged people to assure a "voice" in the process, health leaders with in-depth knowledge of the local health care environment, government, business, retired, South Dakota State Departments of Health and Social Services, Urban Indian Health, and Rural Health Clinics.
Avera St. Mary's	Part V, Section B, Line 6b: South Dakota Department of HealthSouth Dakota Department of Social ServicesMunicipal Government stakeholdersRural Health ClinicUrban Indian HealthYMCA
Avera St. Mary's	Part V, Section B, Line 11: The community health needs assessment was completed during FY2025. The hospital has not taken specific actions with respect to the FY2025 implementation strategy. The following community health priority areas were identified and the following actions will be taken by the hospital during future years. - Mental Health - Improved access to mental health services - Reduce the number of individuals in crisis requiring involuntary inpatient behavioral health hospitalizations and law enforcement transports. - Transportation - Continue to advocate for accessibility to transportation and expand awareness of River City Transit's (RTC) accessibility for patients' transportation needs. - Food Security - Improve access to food for those in our area who are food insecure.During the community health needs assessment process, the following health needs/priorities emerged but are beyond the scope, expertise, resources, or control of Avera St. Mary's. The issues will be referred to the appropriate community organizations: - Affordable housing - Affordable daycareAvera St. Mary's continued to address the community health needs identified in the community health needs assessment completed in FY2022. The following community health priority areas were identified: Mental Health, Healthy Eating/Healthy Food Choices, and Community Health Promotion - Education and Activities. Regarding the first priority of Mental Health Concerns:-Avera St. Mary's has representation on the area Mental Health Task Force. The task force continues to meet regularly with sub-groups also meeting to accomplish goals and report back to the full group.-Promotion of 988 as the nationwide crisis number and 211 as a resource number has been undertaken by each agency represented on the task force.-Avera's Project 437 "Ask the question" campaign for suicide prevention is utilized.-The Mobile Crisis Response continues to be an integral aspect of care for those in crisis in our community.-The Communities That Care project was completed with elements incorporated into the work of the local community mental health center and has helped inform ongoing work.Patients who come to the clinic are referred to local mental health providers when there is a mental health concern. A psychiatrist sees Pierre patients through telemed two days/week. A pediatric psychiatrist, or one of the residents, sees patients via telemed one-half day/week. A social worker with Coordinated Care is also a Qualified Mental Health Professional and available for urgent assessments of patients in the clinic. All patients who visit the clinic are asked if they have concerns about depression on each visit. Provider assesses further and provides the necessary education and resources.Regarding the Physical Inactivity Concern:-The stakeholders including the Cities of Pierre and Ft. Pierre, YMCA, and Avera, have collaborated to develop a map of free assets and resources in the community to be physically active. The map has been created, printed, and distributed throughout the hospital, clinic, and community. The map can also be found online on the City of Pierre website.-Avera St. Mary's works with local groups to promote the utilization of the variety of free options to be physically active in the area.-Avera St. Mary's promoted Walk/Bike to work week to coincide with Earth Day.Regarding Support for Healthy Eating:A series of community educational activities on affordable healthy eating has started in collaboration with the culinary arts class in the school, a pediatrician, and local individuals interested in health eating options/awareness. These educational programs and activities have taken place at the local high school, Urban Indian Health, and a local community center where the Community Banquet is held each week. Avera St. Mary's supports, and staff volunteer throughout the year to provide meals at the Community Banquet. Avera St. Mary's also supports the food backpack program at Pierre Area Referral Service (PARS).Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.
Avera St. Mary's	Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide.
Avera St. Mary's	Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera St. Mary's	Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility.
Avera St. Mary's	Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.
Part V, Section B, Lines 7a, 7b and 10a:	avera.org/about/community-health-needs-assessments/
Part V Section A website address:	avera.org/locations/st-marys/
Part V, Section B, Line 16a, 16b, and 16c:	avera.org/patients-visitors/pay-my-bill-online/financial-assistance-forms/

Field	Value	IRS element (for citing)
Facility	3	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Avera Parkwood Independent Living
400 Parkwood Drive	Pierre	SD	57501	Independent living
2 - MaryHouse
717 E Dakota Ave	Pierre	SD	57501	Long term care
3 - Avera St Mary's Campus Pharmacy
100 Mac Lane Suite 101	Pierre	SD	57501	Retail pharmacy

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted.
Part I, Line 6a:	The community benefit report is prepared by a related organization, Avera Health, and is available to the public at https://www.avera.org/about/annual-report/.
Part I, Line 7:	Charity care expense was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Health professions education and cash and in-kind contributions are reported based on actual expenses recorded in the general ledger.
Part III, Line 2:	The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents.
Part III, Line 4:	The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 18 and 19.
Part III, Line 8:	Avera St. Mary's provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare programs are not completely covered, the Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.
Part III, Line 9b:	If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven.
Part VI, Line 2:	Health care needs are assessed through various methods. Avera St. Mary's strives to deliver comprehensive care and extensive medical specialty services to community members located in central South Dakota. Avera St. Mary's is integrally involved with community organizations, the university center, schools, and state and local governments. The closest hospitals offering the same level of care and services are located 154 miles away in Mitchell, SD and 160 miles away in Aberdeen, SD. Within our regional footprint, the majority of the communities have populations of less than 2,500 people. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. In addition to activities reported in the Community Health Needs Assessment and implementation plan, Avera St. Mary's and Avera Gettysburg collaborate with a number of agencies including the YMCA, Feeding South Dakota, The Pierre/Ft. Pierre Mental Health Task Force, the United Way, Pierre Area Referral, Pierre-Ft. Pierre Ministerial Association, City of Pierre and Ft. Pierre and River City Public Transit to assess and promote health related matters.
Part VI, Line 3:	Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs.
Part VI, Line 4:	Avera St Mary's is a 50-bed hospital in Pierre, South Dakota. The primary service area includes Hughes, Stanley, and Sully Counties. Pierre is the county seat of Hughes County as well as the capital of South Dakota. According to the U.S. Census Bureau Quick Facts 2025 data, the estimated population of Hughes County as of July 1, 2024, is 17,526. The population is predominately white at 81.9% and Native American 12.9%. It is estimated that 19.2% of the population is 65 years and over. The median household income is $81,395 with an 8.7% poverty rate. Uninsured individuals under age 65 is estimated at 6.4%.According to the U.S. Census Bureau Quick Facts 2025 data, the estimated population of Stanley County as of July 1, 2024 is 3,015. The population is predominately white at 89.7% and Native American 5.9%. It is estimated that 23.7% of the population is 65 years and over. The median household income is $87,712 with a 7.4% poverty rate. Uninsured individuals under age 65 is estimated at 8.2%.
Part VI, Line 5:	The hospital serves all persons in the community on a non-discriminatory basis. Avera St. Mary's operates an emergency room that is open to all persons regardless of ability to pay. Avera St. Mary's has an open medical staff with privileges available to all qualified physicians in the area. The governing body is comprised of primarily independent individuals, representative of the community. Avera St. Mary's provides education and training opportunities to healthcare students enrolled in the local college, Capital City Campus. Avera St. Mary's participates in Medicaid, Medicare, Indian Health, Champus, Tricare and/or Other Government sponsored Health Care Programs.Avera St. Mary's participates in many community organizations and efforts to better the region. Leadership of the organization serve on boards of other exempt organizations in Pierre and the surrounding area. Staff volunteer in the community throughout the year at Avera St. Mary's promoted events including the monthly "Avera Night" at Feeding South Dakota, serving at the community banquet, filling backpacks at Pierre Area Referral Service (PARS), assisting with the bed build with Sleep in Heavenly Peace, and the community clean up efforts each spring with the Go Green and Clean city-wide campaign. Several drives, including food, clothing, scrubs, school supplies, and Christmas gift drives are held throughout the year as well to support community members in need.
Part VI, Line 6:	Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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
Julie Lautt
CFO Avera Health;Secretary/Treasurer	$0	$1,226,098	$0	$41,964	$0	$6,301	$0	$17,250	$0	$2,968	$0	$1,294,581	$0	$0
Dr Mark Hagy
Board Member/Orthopedics	$0	$761,185	$0	$31,647	$0	$100,436	$0	$17,250	$0	$17,151	$0	$927,669	$0	$0
Shantel Krebs
President/CEO	$0	$417,072	$0	$14,110	$0	$16,067	$0	$17,250	$0	$4,130	$0	$468,629	$0	$0
Scott Oswald
CRNA	$256,805	$0	$43,000	$0	$14,591	$0	$11,671	$0	$34,848	$0	$360,915	$0	$0	$0
Matthew Deichert
CRNA	$252,837	$0	$26,000	$0	$12,229	$0	$12,773	$0	$41,694	$0	$345,533	$0	$0	$0
Kevin Roark
CRNA	$256,505	$0	$14,500	$0	$7,987	$0	$10,524	$0	$35,148	$0	$324,664	$0	$0	$0
Nick Jung
CRNA	$254,974	$0	$11,500	$0	$8,113	$0	$6,884	$0	$36,678	$0	$318,149	$0	$0	$0
Michael Murphy
CRNA	$260,177	$0	$5,500	$0	$7,987	$0	$8,958	$0	$33,310	$0	$315,932	$0	$0	$0
Rena Robbennolt Board Member
/Nurse Practitioner (Until Sept.)	$0	$112,210	$0	$1,500	$0	$13,340	$0	$6,440	$0	$42,360	$0	$175,850	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule J, Part I, Line 3:	FormAndLineReferenceDesc
Explanation	President/CEO serves Avera St. Mary's and Avera Gettysburg and was compensated by a related organization, Avera Health. Avera St. Mary's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Item J	The organization's website is: www.avera.org/st-marys-pierre
Form 990, Part VI, Section A, line 2	Julie Lautt, Sr. Debra Kolecka, and Shantel Krebs have a business relationship. Julie Lautt, Kristin Brost, Jamie Cronin, Sr. Debra Kolecka, Meredith Lee, Kim Olson, Rena Robbennolt, Sr. Lynn Marie Welbig, Jeff Hallem, Mark Hagy MD, Shantel Krebs, and Robert Wylie have a business relationship. Julie Lautt and Mark Hagy MD have a business relationship.
Form 990, Part VI, Section A, line 6	The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended.
Form 990, Part VI, Section A, line 7a	Avera Health, as the sole member has the power to appoint and remove, with or without cause, members of the board of directors.
Form 990, Part VI, Section A, line 7b	Avera Health, as the sole member, has the following rights as the member: 1) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of Corporation; 2) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Corporation, and to give final approval of any such action with respect thereto; 3) To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters,") pursuant to the policies established by the Member; 4) To approve any plan of merger, consolidation or dissolution of the Corporation, or the divestiture of a sponsored work or ministry associated with the Corporation; 5) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; 6) To appoint and remove, with or without cause, the Board of Directors of the Corporation. 7) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. 8) To approve operating/capital budgets and strategic plans of the Corporation. 9) To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. 10) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member. 11) To establish and maintain employee benefit programs. 12) To establish and maintain insurance programs. 13) To approve major community fund drives. 14) To approve the appointment of auditors. 15) To adopt policies designed to effectuate the reserved powers of the Member.
Form 990, Part VI, Section A, line 8b	There are no committees with the 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. In addition, the Form 990 is made available to the Facility CEO, other Operation Finance Leaders and the Facility 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	The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of the Caring for Life Catholic Health Ministries Members of Avera Health, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes.
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. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public.
Form 990, Part IX, line 11g	Purchased Services: Program service expenses 11,460,433. Management and general expenses 113,050. Fundraising expenses 0. Total expenses 11,573,483. Medical Professional Fees: Program service expenses 725,212. Management and general expenses 0. Fundraising expenses 0. Total expenses 725,212. Repairs & Maintenance: Program service expenses 2,352,433. Management and general expenses 51,951. Fundraising expenses 160. Total expenses 2,404,544. Centralized Services: Program service expenses 5,197,196. Management and general expenses 6,963,212. Fundraising expenses 0. Total expenses 12,160,408.
Form 990, Part XI, line 9:	Change in Interest in Avera Foundation -719,754. Other changes in net assets 20,000. Change in Assets with Donor Restrictions 376,724.
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 XII, Line 2c:	The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera St. Mary's.

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	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Avera Health
3900 West Avera Drive Suite 300	Sioux Falls	SD	57108	460422673	Promotion of Health	SD	501(c)(3)	Line 10	N/A	0
Avera McKennan
1325 S Cliff Ave PO Box 5045	Sioux Falls	SD	57117	460224743	Healthcare Services	SD	501(c)(3)	Line 3		0	Avera Health
Avera at Home
5300 S Broadband Lane	Sioux Falls	SD	57108	460399291	Home Services	SD	501(c)(3)	Line 10		0	Avera Health
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health Financing and Health Plan Admin	SD	501(c)(4)			0	Avera Health
Avera Marshall
300 S Bruce Street	Marshall	MN	56258	410919153	Healthcare Services	MN	501(c)(3)	Line 3		0	Avera Health
Avera Granite Falls
345 10th Ave	Granite Falls	MN	56241	843156881	Healthcare Services	MN	501(c)(3)	Line 3		0	Avera Marshall
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare Services	MN	501(c)(3)	Line 3		0	Avera Marshall
Avera Queen of Peace Hospital
525 North Foster	Mitchell	SD	57301	460224604	Healthcare Services	SD	501(c)(3)	Line 3		0	Avera Health
Avera St Anthony's Hospital
300 N 2nd Street	ONeill	NE	68763	470463911	Healthcare Services	NE	501(c)(3)	Line 3		0	Avera Health
Avera St Luke's
305 South State Street	Aberdeen	SD	57401	460224598	Healthcare Services	SD	501(c)(3)	Line 3		0	Avera Health
Avera Gettysburg
606 East Garfield	Gettysburg	SD	57442	460234354	Healthcare Services	SD	501(c)(3)	Line 3		Yes (1)	Avera St Mary's Healthcare Center
Avera Holy Family
826 North 8th Street	Estherville	IA	51334	420680370	Healthcare Services	IA	501(c)(3)	Line 3		0	Avera Health
Holy Family Hospital Foundation
826 North 8th Street	Estherville	IA	51334	421317452	Support Health Related Services	IA	501(c)(3)	Line 10		0	Avera Holy Family
Sacred Heart Health Services
501 Summit Street	Yankton	SD	57078	460225483	Healthcare Services	SD	501(c)(3)	Line 3		0	Avera Health
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		0	Avera Health
St Benedict Health Center
401 West Glynn Drive	Parkston	SD	57366	460226738	Healthcare Services	SD	501(c)(3)	Line 3		0	Avera Health

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
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
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	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	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	N/A	C	0
Alucent Australia Pty Ltd
					Biotech Research		N/A		0	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	Biotech Research	SD	N/A	C	0
Avera Property Insurance Inc
1000 West 4th Street Suite 1	Yankton	SD	57078	460463155	Insurance	SD	N/A	C	0
DakotaCare Administrative Services Inc
5300 South Broadband Lane	Sioux Falls	SD	57108	460424322	Insurance	SD	N/A	C	0
Kore Cares In Home Services LLC
5300 South Broadband Lane	Sioux Falls	SD	57108	882778902	In-home care services	SD	N/A	S	0
South Dakota State Medical Holding Company Inc
5300 South Broadband Lane	Sioux Falls	SD	57108	460401087	Insurance	SD	N/A	C	0
Valley Health Services
501 Summit Street	Yankton	SD	57078	460357149	Rental Real Estate	SD	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	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	Yes (1)	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	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 (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Avera Gettysburg
M	$51,290	General Ledger
Avera Gettysburg
O	$1,500,047	General Ledger
Avera Gettysburg
Q	$4,248,820	General Ledger
Avera Gettysburg
S	$199,170	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.